Week 1

Question 1

What is neuroplasticity?

Answer 1

“the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function and connections” (Cramer et al., 2011)

Question 2

List three ways neuroplasticity involves change at a neuronal level

Answer 2

1. Function (increased excitability)
2. Chemical profile (amount of neurotransmitters)
3. Structure (dendritic branching)

Question 3

Three important mechanisms causing neuroplasticity

Answer 3

1. Habituation
2. Experience/use dependent plasticity
3. Recovery and maladaptation after injury

Question 4

What is habituation?

Answer 4

A mechanism of neuroplasticity which suggests that the repeated presentation of a stimulus causes a decrease in the reaction.

A result of changes in neurotransmitter release and postsynaptic receptor activity.

Not necessarily a permanent neuroplastic change.

Question 5

What is experience-dependent plasticity?

Answer 5

The process by which the brain changes its structure and function in response to new experiences (use it or lose/and improve it)

Involves the synthesis of new proteins, the growth of new synapses, and the modification of existing synapses

Neuroplastic change are persistent and long lasting

Can result in maladaptive consequences following injury (i.e., pain)

Question 6

What are the two important mechanisms within experience-dependent plasticity?

Answer 6

1. Long term potentiation (LTP)
2. Long term depression (LTD)

Question 7

What is long term potentiation?

Answer 7

A form of experience-dependent plasticity which results in a persistent enhancement of synaptic transmission.

Question 8

What is long term depression?

Answer 8

A form of experience-dependent plasticity which results in a persistent decrease of synaptic transmission.

Question 9

What are the 10 principles of experience-dependent plasticity?

Answer 9

1. Use it or Lose it
2. Use it and Improve it
3. Specificity
4. Repetition Matters
5. Intensity Matters
6. Time Matters
7. Salience Matters
8. Age Matters
9. Transference
10. Interference

Question 10

Structural neuroplastic changes during recovery/maladaptation after injury

Answer 10

1. Dendritic and axonal branching (i.e. arborization)
2. Spine density
3. Synapse number and size
4. Receptor density
5. Number of neurons (in some brain regions)

Question 11

What is assessment?

Answer 11

“Assessment is a considered a collaborative process of collecting, synthesising and interpreting information that provides occupational therapists with the knowledge necessary to take appropriate action to address people’s occupational needs” (Hocking & Hammell, 2017)

Question 12

Characteristics of standardised assessment

Answer 12

• Published
• Consistent rules and conditions for administration
• Reliability and stability
• Sometimes cost $
• Assesses and measures change
• Informs clinical reasoning and supports measurement

Question 13

Characteristics of non-standardised assessment

Answer 13

• Locally developed
• Screening assessment, interview questions
• Flexible, may lack accuracy
• Free
• Point in time
• Inform clinical reasoning

Question 14

Person factors influencing assessment process

Answer 14

• Communication
• Insight
• Culture
• Capacity / impairments
• Client age
• Technology
• Ethics
• Confidentiality
• Acceptable risk
• Progression & prognosis
• Values

Question 15

What is measurement?

Answer 15

“Measuring is undertaken by therapists to ascertain the dimensions (size), quantity (amount) or capacity of a trait, attribute or characteristic of a person that is required by a therapist to develop an accurate picture of the person’s strengths, needs and problems to form a baseline for therapeutic intervention and/or to provide a measure of outcome”

Question 16

List the 4 purposes of measurement

Answer 16

1. Descriptive
2. Discriminative
3. Predictive
4. Evaluative

Question 17

What is descriptive measurement?

Answer 17

Measurement that describes the person’s current functional status, problems, needs
E.g., ability to perform ADL, range of movement, ability to mobilise

Question 18

What is discriminative measurement?

Answer 18

Measurement that distinguishes between individuals or groups by comparison with one another
E.g., severity of UL/cognitive impairment

Question 19

What is predictive measurement?

Answer 19

Measurement that assesses individuals in terms of their likely future outcomes. Used to identify those at risk of a particular factor
E.g., hip fractures increasing falls risk, stroke influencing return to driving, risk of lung cancer as a smoker

Question 20

What is evaluative measurement?

Answer 20

Measurement that measures change over time. Used at the start to measure baseline from which measure change, and upon competition to evaluate the effect of the therapy intervention

Question 21

Types of psychometric properties of measurement

Answer 21

1. Validity
2. Reliability
3. Responsiveness

Question 22

What is validity of measurement?

Answer 22

The degree to which an outcome measure measures the construct it purports to measure, and contains the measurement properties: content validity, construct validity, criterion validity

The concept being measured is well defined and measured correctly and accurately

Question 23

What is content validity?

Answer 23

The degree to which content is an adequate reflection of the construct to be measured (items cover all aspects).

Involves development/design, content validity, face validity, structural validity, factorial validity

Question 24

What is construct validity?

Answer 24

The degree to which scores are consistent which hypotheses assuming the measure validly captures the construct

Involves structural validity, hypothesis testing, discriminant validity, known groups validity, convergent/divergent validity, cross-cultural validity, ecological validity

Question 25

What is criterion validity?

Answer 25

The degree to which scores adequately reflect a gold standard - concurrent and predictive Involves predictive validity and convergent validity.

Question 26

What is reliability of measurement?

Answer 26

The degree to which the measurement is free from measurement error; the tool is dependable, stable and consistent when repeated under identical conditions. It contains the measurement properties: internal consistency, test-retest, inter-rater, intra-rater, parallel/alternate form.

Question 27

What is measurement error?

Answer 27

The systematic and random error of a patient’s score that is not attributed to true changes in the construct to be measured Can be calculated using: - Standard error of measurement (SEM) - Smallest/minimal detectable change (SDC/MDC) - Limits of Agreement

Question 28

What is Standard error of measurement (SEM)

Answer 28

The estimate of the amount of error in the measurement. Provides a range of scores in which the “true” score might lie – typically a 95% confidence interval.

Question 29

What is test-retest reliability?

Answer 29

Describes the extent to which a stable evaluation of the attribute or behaviour can be obtained on two different occasions when no change is expected. Timing is important: - Too soon - participant may remember performance - Too long - changed ability Statistical methods for test-retest reliability: - Intraclass correlation coefficient (ICC) > 0.7 - Kappa or weighted Kappa statistic > 0.7

Question 30

What is inter-rater reliability?

Answer 30

The consistency and agreement between or among different two or more therapists/raters to ensure objectivity. Statistical methods for inter-rater reliability: - Intraclass correlation coefficient (ICC) > 0.7 - Kappa or weighted Kappa statistic > 0.7

Question 31

What is Parallel/Alternate Forms Reliability?

Answer 31

The correlation between scores for the same person on two or more forms of test. Useful when client needs to be reassessed regularly. Statistical methods for parallel/alternate reliability: - Coefficient of equivalence (in form of ICC) > 0.8

Question 32

What is responsiveness of measurement?

Answer 32

The ability of an instrument to measure change following an intervention or over time. When the information changes, everyone gets a different answer Statistical methods for responsiveness: Effect size - Cohen's d - Small: 0.2 or less - Moderate: 0.2 - 0.5 - Large: 0.8 or more

Question 33

What is clinical utility?

Answer 33

The usefulness or value or ease of a measurement/strategy/instrument. E.g., Clarity of instructions, Format (i.e., OPA, observation, questionnaire), Time, Examiner Qualifications Required, Cost, Space/materials required

Question 34

What is interpretability?

Answer 34

All administers know how to interpret test results

Question 35

What is internal consistency?

Answer 35

The degree to which test items all measure the same behaviour or construct. It is an aspect of reliability, but is closely related to the concept of validity. Acceptable levels of internal consistency: - Cronbach's alpha over 0.6 - Rasch analysis showing uni-dimensionality

Question 36

Considerations when choosing a measure:

Answer 36

1. What level do you want/need to measure? (ICF / CMOP-E) 2. What attributes are being measured? Single or multiple? 3. Purpose/s: To describe / discriminate / predict / valuate 4. Whose perspective: Single or multiple perspectives Client / Caregiver/parent / Service provider / Other professional / Other 5. Population: age, diagnosis 6. Evaluation context – also considered in clinical utility

Question 37

Characteristics of 'good measurement'

Answer 37

1. The concept that is being measured is well defined and measured correctly / accurately (validity) 2. Everyone gets the same answer using the same information (reliability of data) 3. Everyone gets a different answer when the information (data) changes (responsiveness to change) 4. Everyone knows what the “answer” means (interpretability) 5. Error is reduced as much as possible 6. The measurement strategy/instrument can be easily used (clinical utility) 7. The measurement tool is available for use with published instructions

Question 38

What is a dynamic performance analysis?

Answer 38

A performance-based, top-down, task-oriented approach to occupational performance analysis - considering the person, occupation and environment - to identify performance breakdown. It is based on the PERSON's way of doing the task.

Question 39

What does 'localisation' mean in relation to brain-behaviour?

Answer 39

"Function is localised in the brain, which means that the brain comprises neural networks that are dedicated to specific functions"

Question 40

What does 'integration' mean in relation to brain-behaviour?

Answer 40

Normal function relies on communication between various parts of the brain, both brain areas and the neural pathways within and between them.

Question 41

What does 'Hemispheric integration and specialisation' mean in relation to brain-behaviour?

Answer 41

It refers to the coordinated communication and collaboration between the left and right hemispheres of the brain. As demonstrated by the extensive number of commissural fibres, hemispheric integration plays an important role in behaviour. There are some behaviours where one of the hemispheres plays a dominant role

Question 42

Why is neuroplasticity important to understand as an occupational therapist?

Answer 42

To establish the most appropriate time, content and intensity of rehabilitation, to optimise the functionality and durability of ensuing neuroplastic changes.