British Journal of Occupational Therapy

Upper limb post-stroke sensory impairments have an impact on a significant number of stroke survivors. There is limited research in this area and it is unclear how occupational therapists are addressing sensory impairments in clinical practice. This study aimed to investigate the clinical practice patterns of occupational therapists, perceived barriers to providing interventions and information sources used when addressing upper limb post-stroke sensory impairments.

A survey was sent to 500 randomly selected occupational therapists in the United States.

The majority of the 145 respondents reported frequently assessing sensation, and half reported providing interventions for sensory impairments. Interventions primarily focused on providing passive sensory stimulation followed by compensatory strategies. Most therapists provided patient/caregiver education about safety. Therapists cited lack of knowledge and skills, patients' short length of stay and lack of time as barriers to utilizing interventions. Most therapists reported not being up to date with current research and requested continuing education to support practice.

This survey established a profile of American occupational therapists' practice with people with upper limb post-stroke sensory impairments. Therapists have a need for information and training in all aspects of the management of upper limb post-stroke sensory impairment. Further research, evaluating the effectiveness of interventions and exploring therapists' clinical decision making when choosing interventions, is also needed.

No research-based guidelines for adaptation planning for shower chairs and other vehicles with four casters exist, despite the manual handling nature of the manoeuvring task and the occupational therapy responsibility to plan for such vehicles.

It was determined from theory that changes in direction for these vehicles, such as from a passageway through a door, could be represented by 13 manoeuvres. Participants (n = 17) carried out 11 (maximum) manoeuvres based on this theory, each with the maximum comfortable occupant weight of their choice (weights represented the occupant).

The maximum occupant weight selected as comfortable varied substantially between some of the 11 manoeuvres: there was a 100% difference between the lowest and highest weight selections. This indicated that four-caster vehicles (such as shower chairs) should not be treated as omni-directional for high occupant weights, or for floor materials with high motion resistance, because the manoeuvre direction substantially affects maximum comfortable weight selection.

The manoeuvre with the highest weight selection is proposed as a guideline when manual handling concerns exist for these vehicles. The guideline can be modified for individual vehicles sizes, occupant and carer anatomy.

Anti-TNFα treatment has revolutionised the disease pathway for some people with rheumatoid arthritis and ankylosing spondylitis, although physiological improvements do not always readily translate into re-engagement in occupational activities. This review explores the evidence base for the impact of anti-TNFα on occupational performance.

Literature was searched from 2000–11. A four-stage process resulted in the review of 19 articles. The Weight of Evidence framework was used to assess quality and relevance to the review question.

People on anti-TNFα treatment experience increased engagement in functional, psychological and social domains. Most studies focused on employment issues, with conflicting evidence about how well anti-TNFα protected against work disability and very limited evidence that anti-TNFα enabled return to paid work. The increase in productivity was to the detriment of other occupational domains, with resulting occupational imbalance.

The assumption that clinical improvement is relatively trouble free is incorrect, as some people on anti-TNFα treatment continue to experience difficulties in all occupational domains, particularly work. People on anti-TNFα treatment do not routinely have access to occupational therapy services. Further research needs to explore the nuanced experiences of treatment and the role of occupational therapy in maximising the treatment potential of anti-TNFα.