bluuebunny/crossref_metadata_2025 huggingface dataset:
A Short-Term Graphomotor Program for Improving Writing Readiness Skills of First-Grade Students
Authors: Ratzon Navah Z. , Efraim Daniela , Bart Orit
Published: October 2011

OBJECTIVE. Children with fine-motor problems and handwriting difficulties often are referred for occupational therapy. The objective of this study was to test the efficacy of a short-term treatment on the fine-motor and graphomotor skills of first-grade students.

METHOD. We recruited 52 first-grade students who had scored below the 21st percentile on the Visual–Motor Integration test from schools in a city with a low socioeconomic, mixed (Arab and Jewish) population. The children were randomly divided into an intervention group and a control group. Before and after the intervention, we administered two tests to both groups.

RESULTS. Students in the intervention group made significant gains both in the total score on the graphomotor test (Developmental Test of Visual Perception) and on the fine-motor test (Bruininks–Oseretsky Motor Development Scale).

CONCLUSION. This study provided preliminary evidence of the efficacy of a short-term graphomotor intervention. The results increased the feasibility of implementing occupational therapy intervention in the Israeli school system, allowing treatment of more children using the same resources.
Using Salivary Cortisol to Measure the Effects of a Wilbarger Protocol–Based Procedure on Sympathetic Arousal: A Pilot Study
Authors: Kimball Judith G. , Lynch Keara M. , Stewart Kelli C. , Williams Nicole E. , Thomas Meghan A. , Atwood Kam D.
Published: October 2011

OBJECTIVE. This study investigated changes in salivary cortisol, the stress hormone, after administration of a procedure based on the Wilbarger protocol to children diagnosed with sensory defensiveness (SD), a type of sensory modulation dysfunction.

METHOD. Using a single-subject design across participants, we studied 4 boys with SD ages 3 to 5 years. Each participant completed four sessions consisting of the collection of a saliva sample, administration of a procedure based on the Wilbarger protocol, 15 min of quiet neutral activities to allow time for any changes in cortisol level to manifest in the saliva, and the second collection of saliva. Saliva samples were analyzed using enzyme-linked immunosorbent assay (ELISA).

RESULTS. Salivary cortisol levels in all participants changed after each of four applications of a procedure based on the Wilbarger protocol. The cortisol levels of 2 children whose levels were relatively higher on pretest decreased at each posttest. The levels of 1 child whose cortisol was higher on pretest three times decreased those three times and increased the one time the pretest cortisol was lower. The levels of 1 child who had the lowest cortisol levels of any of the children increased each time. Therefore, in all participants, cortisol moved in the direction of modulation.

CONCLUSION. In these 4 boys, a procedure based on the Wilbarger protocol modulated cortisol levels toward a middle range. This pilot study indicates that there is an association between sympathetic nervous system response and the Wilbarger protocol–based procedure, as indicated by salivary cortisol levels.
Disposition Toward Critical Thinking Among Occupational Therapy Students
Authors: Lederer Jeffrey M.
Published: October 2011

The ability to think critically is an important outcome of education. The disposition, or internal motivation, to think critically strongly influences the development of critical thought. Students (N = 79) at three levels of education in one program were administered the California Critical Thinking Disposition Inventory (CCTDI). Results indicated no differences in the disposition to think critically related to length of time spent in the program. Differences in the dispositions of open-mindedness and maturity of judgment were found between undergraduate and graduate students. A difference also was found in the disposition to think critically between the two groups. The findings suggest that students, particularly undergraduates, can benefit from instruction designed to develop the disposition to think critically. The CCTDI appears to be a useful instrument for assessing the ability and disposition for critical thinking and could serve as a reliable baseline or outcome measure for use in programs.
Pediatric Constraint-Induced Movement Therapy in a Young Child With Minimal Active Arm Movement
Authors: Dickerson Anne E. , Brown LeeAnn Eagle
Published: October 2011

This study describes a single-subject design (ABA with follow-up evaluation) that demonstrated the possible effective use of constraint-induced movement therapy (CIMT) in producing gains in movement and function for a 24-month-old child with chronic hemiparesis. The noninvolved upper extremity was placed in a removable splint for 21 consecutive days. The child was involved in intensive occupational therapy in the home environment. Daily measurements were completed on the use and quality of motion of the involved upper extremity for eight specific fine and gross motor activities. Change in performance and quality of movement were measured and significant at the p < .05 level with the calculation of the C statistic for the motor activities with gains maintained after completion of the treatment and postsplinting phases. The results of the study contribute to the body of evidence finding CIMT to be effective for increasing movement and function in children with hemiparesis.
Immediate Effect of Ayres’s Sensory Integration–Based Occupational Therapy Intervention on Children With Autism Spectrum Disorders
Authors: Watling Renee L. , Dietz Jean
Published: October 2011

OBJECTIVE. This study examined the effects of Ayres’s sensory integration intervention on the behavior and task engagement of young children with autism spectrum disorders (ASD). Clinical observations and caregiver reports of behavior and engagement also were explored to help guide future investigations.

METHOD. This single-subject study used an ABAB design to compare the immediate effect of Ayres’s sensory integration and a play scenario on the undesired behavior and task engagement of 4 children with ASD.

RESULTS. No clear patterns of change in undesired behavior or task management emerged through objective measurement. Subjective data suggested that each child exhibited positive changes during and after intervention.

CONCLUSION. When effects are measured immediately after intervention, short-term Ayres’s sensory integration does not have a substantially different effect than a play scenario on undesired behavior or engagement of young children with ASD. However, subjective data suggest that Ayres’s sensory integration may produce an effect that is evident during treatment sessions and in home environments.
Extreme Sensory Modulation Behaviors in Toddlers With Autism Spectrum Disorders
Authors: Ben-Sasson Ayelet , Cermak Sharon A. , Orsmond Gael I. , Tager-Flusberg Helen , Carter Alice S. , Kadlec Mary Beth , Dunn Winnie
Published: October 2011

This study examined the incidence of extreme sensory modulation behaviors in toddlers with autism spectrum disorders (ASD) and investigated the consistency of sensory information across measures. Parent report of sensory behaviors in 101 toddlers with ASD was compared with 100 toddlers who were typically developing matched on chronological age and 99 additional infants or toddlers matched on mental age. Measures included the Infant/Toddler Sensory Profile, Infant–Toddler Social Emotional Assessment, Autism Diagnostic Interview–Revised, and Autism Diagnostic Observation Schedule–Generic. Toddlers with ASD were most distinct from typically developing groups in their high frequency of underresponsiveness and avoiding behaviors and their low frequency of seeking. Within the toddlers with ASD, there were significant associations across sensory parent report measures, but parent report was not correlated with clinical observation. Findings point to the early onset of an extreme sensory profile in ASD. Occupational therapists need to assess multiple domains of sensory behaviors to accurately identify the needs of toddlers with ASD.
Becoming Innovators in an Era of Hyperchange
Authors: Hinojosa Jim
Published: October 2011

We live in a time of hyperchange—rapid, dramatic, complex, and unpredictable change occurring in today’s society, which creates unprecedented challenges. High-speed advances in technology and knowledge and changes in society require that we shift our paradigms. We must become innovators of change. This lecture examines how occupational therapy is reacting to hyperchange as a profession. How is hyperchange influencing the roles and responsibilities of practitioners? How is hyperchange affecting education? And, in accepting hyperchange, what can we do as occupational therapy practitioners, educators, and scholars to shape our own future?
Effect of an Ergonomics Intervention on Workstations of Microscope Workers
Authors: Darragh Amy R. , Harrison Heather , Kenny Sabrina
Published: October 2011

OBJECTIVE. This study evaluated the effect of an occupational therapy ergonomics intervention on the workstation design and body positioning of microscope workers at a fiber optics facility.

METHOD. The study was quasi-experimental. Fifty-one microscope workers were assigned to one of three groups: control, education only, and education training. Their workstation design and body positioning were assessed before and after intervention.

RESULTS. Workers who participated in a client-centered, participatory, and onsite ergonomics program demonstrated improved workstation design and improved body positioning compared with both a control group (p = .000) and an education-only group (p = .001). These results were supported through analysis of covariance and effect size calculations. Workers who received only educational handouts also demonstrated improved body positioning and workstation design when compared with the control group (p = .001).

CONCLUSION. Researchers concluded that participation, client-centered training, context, and feedback represented critical components of ergonomics training.
Children With Fetal Alcohol Spectrum Disorders: Problem Behaviors and Sensory Processing
Authors: Franklin Laureen , Deitz Jean , Jirikowic Tracy , Astley Susan
Published: October 2011

OBJECTIVE. This study describes the sensory-processing and behavior profiles of a clinic-referred sample of children with fetal alcohol spectrum disorders (FASD) and examines the relationship between sensory processing and behavior.

METHODS. Outcomes on the Short Sensory Profile (SSP) and Child Behavior Checklist (CBCL) for 44 children, ages 5 to 10 years, were assessed and compared using retrospective data analysis.

RESULTS. A high proportion of the children demonstrated deficits in sensory processing and problem behaviors as measured by the SSP and the CBCL. Moreover, the correlation between the SSP and CBCL total scores (r = −.72) was significant.

CONCLUSION. Results provide evidence that children with FASD demonstrate problem behaviors and sensory-processing impairments as reported by parents and that sensory-processing deficits co-occur with problem behaviors at a high rate in this population. This finding suggests that deficits in sensory processing may affect the ability of children with FASD to respond adaptively to their environments.
Effectiveness of Disc ‘O’ Sit Cushions on Attention to Task in Second-Grade Students With Attention Difficulties
Authors: Pfeiffer Beth , Henry Amy , Miller Stephanie , Witherell Suzie
Published: October 2011

This study investigated the effectiveness of a type of dynamic seating system, the Disc ‘O’ Sit cushion (Gymnic, Osoppo, Italy), for improving attention to task among second-grade students with attention difficulties. Sixty-three second-grade students participated in the study. Using a randomized controlled trial design, 31 students were assigned to a treatment group, and 32 were assigned to a control group. Treatment group participants used Disc ‘O’ Sit cushions throughout the school day for a 2-week period. The teachers completed the Behavior Rating Inventory of Executive Functioning (Gioia, Isquith, Guy, & Kenworthy, 1996) for each participant before and after the intervention. An analysis of variance identified a statistically significant difference in the attention to task before and after the intervention for the treatment group. The results of the study provide preliminary evidence for the use of the Disc ‘O’ Sit cushion as an occupational therapy intervention to improve attention in the school setting.
Case Report: ICF-Level Changes in a Preschooler After Constraint-Induced Movement Therapy
Authors: Martin Anna , Burtner Patricia A. , Poole Janet , Phillips John
Published: October 2011

The authors examined changes associated with constraint-induced movement therapy (CIMT) provided to a preschool-aged child with right spastic hemiplegia. This case study design used a 2-week pretest measure baseline period, 2 weeks of CIMT, and postmeasures at 1 week and 3 months. Measures were chosen to document changes at the different levels of International Classification of Functioning, Disability and Health (ICF), including the Canadian Occupational Performance Measure (COPM), Pediatric Evaluation of Disability Inventory (PEDI) Self-Care Section, Melbourne Assessment of Unilateral Upper Limb Function, and grip and pinch strength. Results showed increases on COPM-identified goals of increased independence with bilateral hand play and participation in gross motor play with friends. Changes were also documented in self-care, arm function, and grip strength. Another unexpected association reported by parents and professionals was increased speech intelligibility. Potential implications of implementing CIMT with young children are presented.
Development, Reliability, and Validity of the Handwriting Proficiency Screening Questionnaire (HPSQ)
Authors: Rosenblum Sara
Published: October 2011

OBJECTIVE. This study was used to (1) develop an occupational therapy screening questionnaire (the Handwriting Proficiency Screening Questionnaire [HPSQ]) to identify handwriting difficulties among school-aged children and (2) examine its reliability and validity.

METHOD. The questionnaire’s content validity was established. Internal consistency, interrater and test–retest reliability, and concurrent and construct validity were initiated. Participants included 7-to 14-year-old (N = 230) typically developing school-aged children.

RESULTS. The tool demonstrated good internal consistency (α = .90). Test–retest reliability for the score revealed an intraclass correlation coefficient (ICC) of .84 and interrater reliability of ICC =.92 for the total questionnaire score. Construct and concurrent validity were also confirmed.

CONCLUSION. The HPSQ is suitable for use by occupational therapists for identification of handwriting deficiency among school-aged children and is appropriate for varied academic and clinical uses. More studies with larger samples of varied age groups are required to further support the questionnaire’s reliability and validity.
Effects of Task Instructions and Target Location on Reaching Kinematics in People With and Without Cerebrovascular Accident: A Study of the Less-Affected Limb
Authors: Lin Keh-chung , Wu Ching-yi , Lin Kwan-hwa , Chang Chein-wei
Published: October 2011

OBJECTIVE. We investigated how verbal instructions and target location interacted to influence reaching movement of the less-affected limb in participants with and without unilateral cerebrovascular accidents (CVAs).

METHOD. Using a counterbalanced repeated-measures design, 26 people with CVA and 24 age-matched healthy people performed the reaching tasks under 4 conditions formed by the crossing of verbal instructions (speed and accuracy emphasis) and target locations (ipsilateral and contralateral to the performing hand).

RESULTS. In the control groups, speeded instructions and ipsilateral reaches elicited significantly more preprogrammed movements than did accuracy instruction and contralateral reaches, respectively. Similar patterns of performance in response to task constraints were found in the CVA groups except for movement initiation in the right CVA group.

CONCLUSION. Instruction and locations interacted to constrain reaching movements in both control and CVA groups. The combination of speeded instruction and ipsilateral reach may optimize movement performance of the less-affected limb in stroke patients.
Task-Specific, Patient-Driven Neuroprosthesis Training in Chronic Stroke: Results of a 3-Week Clinical Study
Authors: Hill-Hermann Valerie , Strasser Ashley , Albers Bethany , Schofield Kelly , Dunning Kari , Levine Peter , Page Stephen J.
Published: October 2011

OBJECTIVE. We examined the efficacy of a clinically based regimen in which a woman 16 months’ post-stroke participated in daily practice sessions of valued activities of daily living (ADLs). A unique aspect of this intervention was that it was largely patient driven, with the patient practicing ADLs while wearing an electrical stimulation neuroprosthesis.

METHOD. The Fugl-Meyer Assessment (FM), Action Research Arm Test (ARA), Arm Motor Activity Test (AMAT), and Canadian Occupational Performance Measure (COPM) were administered before intervention. Therapy consisted of 3-hr ADL training sessions every weekday during a 3-week period using a neuroprosthesis featuring functional electrical stimulation during treatment sessions. One week after the end of the treatment phase, the FM, ARA, AMAT, and COPM were again administered.

RESULTS. The patient exhibited reduced impairment (FM score change from 31 to 35), decreased time needed to complete AMAT tasks (from 998 s to 558 s), and increased ARA score (from 27 to 31).

CONCLUSION. Clinically meaningful changes were realized with distant or minimal therapist supervision, making this regimen a practical and efficacious alternative.
Augmenting Occupational Therapy Treatment of Upper-Extremity Spasticity With Botulinum Toxin A: A Case Report of Progress at Discharge and 2 Years Later
Authors: Denham Susan P.
Published: October 2011

This case report summarizes occupational therapy services provided to a participant after botulinum toxin A (BTA) injections and her improvements 2 years later. The injections were performed to neutralize spasticity in the left upper extremity after a stroke. Along with BTA, the participant received occupational therapy for 12 weeks, using neurodevelopmental and biomechanical approaches and an activity-based home program. Spasticity decreased from a 4 to a 1 on the Modified Ashworth Scale (MAS) immediately after the injections. Two years after the injections, the MAS score ranged between 1 and 1+. Initially, the participant demonstrated functional limitations in areas of splint application, dressing, toileting, and bathing. Following BTA injections and occupational therapy, the participant demonstrated increased independence in all deficit areas. For this participant, BTA, combined with functional, activity-based occupational therapy interventions, was associated with neurological change and greater functional use of the spastic limb.
Factor Structure of the Four Motor-Free Scales of the Developmental Test of Visual Perception, 2nd Edition (DTVP–2)
Authors: Brown Ted , Rodger Sylvia , Davis Aileen
Published: October 2011

INTRODUCTION. Visual–perceptual skills of children are often assessed using the Developmental Test of Visual Perceptual Skills–2, 2nd Edition (DTVP–2).

PURPOSE. The factor structure of the four motor-free DTVP–2 subscales was examined.

METHOD. The scores from a sample of 356 healthy children (171 boys and 185 girls) ages 5 to 11 years were used to complete a principal components factor analysis of the 4 subscales.

RESULTS. The position-in-space subscale had items load on six factors. The figure ground subscale had items load on five factors. The visual closure scale and form constancy subscales both had four factors. When the four DTVP–2 subscales were combined to form one overall motor-free visual perceptual scale, the items loaded on 21 factors.

CONCLUSION. The DTVP–2 and its four motor-free subscales exhibited multidimensionality instead of the expected unidimensional visual–perceptual constructs.
Playful Interaction: Occupational Therapy for All Children on the School Playground
Authors: Bundy Anita C. , Luckett Tim , Naughton Geraldine A. , Tranter Paul J. , Wyver Shirley R. , Ragen Jo , Singleton Emma , Spies Greta
Published: October 2011

We examined the impact of an intervention on the playfulness of 5- to 7-year-old children who are developing typically. Materials that had no defined purpose were placed on a school playground for 11 weeks. The Test of Playfulness (ToP) was used to compare videotaped play segments pre- and postintervention. Teachers who did playground duty were interviewed regarding changes in play. ToP data were analyzed using a Wilcoxon signed- ranks test. Interview data were analyzed for themes. ToP scores were significantly higher after intervention (Z = −1.94; p = .025, one-tailed; Cohen's d = 0.55). Teachers reported that children were more social, creative, and resilient when the materials were on the playground. Children who were creative, rather than very physically capable, became leaders in activity. Our results revealed a potential role for occupational therapists with typically developing children in schools. This finding has clear implications for children with disability.
Development of a Performance Assessment of Executive Function: The Children’s Kitchen Task Assessment
Authors: Rocke Kristy , Hays Paige , Edwards Dorothy , Berg Christine
Published: October 2011

OBJECTIVE. This study developed and explored the validity of the Children's Kitchen Task Assessment (CKTA), a performance assessment of executive function.

METHOD. The development of the CKTA is described. Children were given the CKTA and neuropsychological assessments of executive functioning. Parents completed the Parent Behavior Rating Inventory of Executive Function (Parent BRIEF).

RESULTS. Forty-nine typically developing children ages 8 to 12 years participated in this study. Interrater reliability and internal consistency were established. Preliminary evidence of discriminant validity was reflected in significant differences on neuropsychological tests and the Parent BRIEF between high- and low-scoring CKTA groups. Age-related differences in CKTA performance further supported discriminant validity. Support for concurrent validity was observed in moderate correlations with established neuropsychological tests.

CONCLUSION. Preliminary results suggest the CKTA is a valid performance assessment that evaluates the level of cognitive assistance children require to complete a challenging functional activity.
Out-of-School Participation Patterns in Children With High-Functioning Autism Spectrum Disorders
Authors: Hilton Claudia List , Crouch Mary Catherine , Israel Heidi
Published: October 2011

PURPOSE. This study examined differences in out-of-school activity participation between typically developing children and those with high-functioning autism spectrum disorders (HFASD).

METHOD. Children with HFASD, ages 6 to 12 (N = 52), and a control group (N = 53) were assessed using the Children's Assessment of Participation and Enjoyment and the Social Responsiveness Scale.

RESULTS. Significant differences were seen in participation between typical and HFASD groups in number of activities in which children participate, the numbers of individuals with whom they participate, and the variety of environments in which they participate.

CONCLUSIONS. These findings indicate that out-of-school participation is significantly different for children with HFASD than for typically developing peers. Findings suggest that social impairment is related to some aspects of participation and that addressing social skills in intervention could contribute to increased participation in out-of-school activities by children with HFASD, which would contribute to their long-term mental and physical health.
Student Outcomes in a Postprofessional Online Master’s– Degree Program
Authors: Richardson Pamela K. , MacRae Anne , Schwartz Kathleen , Bankston Luriza , Kosten Carolyn
Published: October 2011

The outcomes of five cohorts of occupational therapists who completed an online postprofessional master's degree program were evaluated. Data on graduates’ satisfaction with professional skills and status, contribution of the program to their satisfaction, and engagement in professional activities since graduation were collected using an online survey. Forty-nine of 65 surveys distributed were returned (75% response rate). Respondents indicated high levels of satisfaction with professional skills and status and high levels of contribution of the program to their satisfaction. Respondents also reported participation in a variety of professional leadership activities. Results suggest that postprofessional graduate-level education is effective in developing advanced critical reasoning, reflection, and leadership skills in occupational therapists and in facilitating a variety of professional contributions. The online mode was effective in delivering the program content. The value of postprofessional education to individuals and the profession is discussed.
Meaning of Occupation-Based Groups for Low-Income Urban Youths Attending After-School Care
Authors: Bazyk Susan , Bazyk John
Published: October 2011

The purpose of this phenomenological study was to describe the meaning of occupational therapy groups focusing on occupational engagement, group process, and social–emotional learning for a purposeful sample of low-income urban youths attending after-school care. Interviews and participant observation were used to study how the children made sense of their experience. Qualitative data analysis resulted in two thematic descriptions of the experience. First, the groups were fun because of engagement in novel and challenging leisure occupations within a supportive group context. Participation in creative activities that allowed choice transformed mood—children experienced happiness and wanted more of these experiences. Second, the participants valued being able to talk about feelings and learn strategies for dealing with anger. Findings provide a glimpse into the possibilities of enhancing occupational balance by engaging children in occupations they find to be fun.
Integrating Occupational Therapy Services in a Kindergarten Curriculum: A Look at the Outcomes
Authors: Bazyk Susan , Michaud Paula , Goodman Glenn , Papp Paula , Hawkins Edwina , Welch Margery A.
Published: October 2011

PURPOSE. We measured fine motor and emergent literacy outcomes in kindergarteners enrolled in two integrated kindergarten classrooms. The students received fully integrated occupational therapy services. Most occupational therapy services focused on planning and teacher consultation versus direct intervention.

METHOD. A one-group pretest–posttest descriptive design was used to measure occupational therapy and emergent literacy outcomes in a convenience sample of 37 kindergarten-age children with and without disabilities. Four fine motor and two emergent literacy assessments were administered at the beginning and end of the school year. Data on the amount and type of occupational therapy services were documented over 7.months.

RESULTS. Children without disabilities made statistically significant changes in all areas. Children with disabilities made significant changes in two of the fine motor and three of the emergent literacy assessments.

CONCLUSION. Findings demonstrated that for this sample of children, significant improvements in fine motor and emergent literacy function were made.
Handwriting Performance, Self-Reports, and Perceived Self-Efficacy Among Children With Dysgraphia
Authors: Engel-Yeger Batya , Nagauker-Yanuv Limor , Rosenblum Sara
Published: October 2011

OBJECTIVE. This study examined the relationships between children's self-reports on their handwriting performance, their actual handwriting process and product, and wider motor-perceived self-efficacy.

METHOD. Twenty-one children with dysgraphia and 21 typically developing children copied a paragraph on an electronic tablet as part of a Computerized Penmanship Evaluation Tool. Handwriting product was evaluated by the Hebrew Handwriting Evaluation. Participants completed the Children's Questionnaire for Handwriting Proficiency (CHaP) and the Perceived Efficacy and Goal Setting System (PEGS).

RESULTS. The study group's CHaP scores significantly correlated with handwriting process, product measures (rs = .46–.59, ps = .034–.005), and PEGS scores, all of which were significantly poorer compared with those of the control participants.

CONCLUSIONS. Children are aware of their handwriting deficits and are able to report them. Children's reports may contribute to the identification of dysgraphia and facilitate their participation in occupational therapy intervention and in class.
Occupation of Motherhood: Challenges for Mothers With Scleroderma
Authors: Poole Janet L. , Willer Kelly , Mendelson Cindy
Published: October 2011

OBJECTIVE. We sought to identify which aspects of motherhood are difficult for mothers who have scleroderma along with variables associated with mothering.

METHOD. Participants were 75 mothers with scleroderma with a child between birth and 18 years old living with them. They completed the Parent Disability Index (PDI); a demographic questionnaire; and measures of pain, fatigue, and activity limitations.

RESULTS. Mothers with children ages 5 or younger reported that getting up and down from the floor to play with their children was the most difficult task, and mothers with children between 6 and 18 years old reported that playing with their children outdoors, doing household chores, and shopping were the most difficult tasks. Significant correlations were found between PDI and pain, fatigue, and activity limitations.

CONCLUSIONS. Mothers with scleroderma have difficulty with aspects of motherhood. The findings that pain, fatigue, and activity limitations were related to mothering suggest areas for occupational therapy intervention.
Participation of Students With Physical Disabilities in the School Environment
Authors: Egilson Snaefridur Thora , Traustadottir Rannveig
Published: October 2011

OBJECTIVE. We investigated the factors that facilitate or hinder school participation of students with physical disabilities and explored the interaction of those factors.

METHOD. The study used a mixed-methods design that used qualitative and quantitative data. Qualitative data were gathered on 49 participants: 14 students, 17 parents, and 18 teachers. Data analysis was based on grounded-theory procedures. Quantitative data were gathered on 32 students using the School Function Assessment.

RESULTS. The characteristics of each school setting influenced students’ participation. Some settings presented more challenges than others, particularly those with open spaces and limited structures such as the school playground and field trips. Possibilities of student participation decreased with increasing numbers of risk factors, but the interaction between factors was equally important.

CONCLUSION. To promote school participation of students with disabilities, occupational therapists should consider a confluence of child, environmental, and task factors rather than focusing on individual aspects.
Informing Early Intervention Through an Occupational Science Description of Infant–Toddler Interactions With Home Space
Authors: Pierce Doris , Munier Veronique , Myers Christine Teeters
Published: October 2011

OBJECTIVE. The study provides a substantive description of infant and toddler play with everyday objects and independent negotiation of home space.

METHOD. A grounded theory approach was used to study 18 typically developing children longitudinally from ages 1 to 18 months. Data from 133 home visits included videotaped self-directed play sessions with usual objects, maternal interviews, and observation records.

RESULTS. Infant Space Theory is a substantive theory of infant–toddler interactions with the spaces and objects of the home. This contextualized view of the infant–toddler describes progressions in gaze and visual play, in mapping and ranging home space, in stationary object play, and in the little-described development of mobile object play.

CONCLUSION. Therapists providing early intervention services within the home environment may benefit from the theory in their creation and modeling of naturalistic interventions with infants and families.
Response Factors Surrounding Progression of Pressure Ulcers in Community-Residing Adults With Spinal Cord Injury
Authors: Dunn Claudia A. , Carlson Mike , Jackson Jeanne M. , Clark Florence A.
Published: October 2011

OBJECTIVE. This study examined how community-dwelling adults with spinal cord injury (SCI) respond in real-life circumstances after detecting a low-grade (Stage 1 or Stage 2) pressure ulcer.

METHOD. We performed a secondary analysis of personal information profiles obtained in a previous qualitative research study. Profiles were examined to explore how individualized lifestyle considerations affected pressure ulcer risk in 19 adults with SCI who responded to an early ulcer that later progressed to a medically serious level.

RESULTS. On the basis of a total of 46 pressure ulcer events, we identified a typological framework that described eight primary response categories and seven subcategories.

CONCLUSION. The findings have significant practice implications for occupational therapists who provide services for adults with SCI living in the community. The importance of combining an initial individualized preventive intervention with structured follow-up within a person’s unique everyday life setting is further explored.
Long-Term Follow-Up After Constraint-Induced Therapy: A Case Report of a Chronic Stroke Survivor
Authors: Rowe Veronica T. , Blanton Sarah , Wolf Steven L.
Published: October 2011

OBJECTIVE. Upper-extremity functional improvements after constraint-induced movement therapy have not been documented beyond 2 years. This case report describes the long-term maintenance of the effects of change 4–5 years after an application of constraint-induced therapy.

METHOD. A 36-year-old female poststroke patient participated in constraint-induced therapy for 2 weeks. She was evaluated before and after treatment and again 4 and 5 years later. Primary outcome measures included the Wolf Motor Function Test, Stroke Impact Scale, and Motor Activity Log.

RESULTS. Improvements were maintained in reported use and ability of the arm and hand, time to complete functional tasks, and physical aspects of health-related quality of life. Fatigue may have had a moderating effect on the extent of these changes.

CONCLUSION. Improved upper-extremity function continued over a 5-year period after constraint-induced therapy; however, poststroke fatigue remained an influential limiting factor.
Adaptive Equipment to Assist With One-Handed Intermittent Self-Catheterization: A Case Study of a Patient With Multiple Brain Injuries
Authors: Carver Mandi Doolin
Published: October 2011

Intermittent self-catheterization is common for patients who have neurogenic bladder associated with traumatic brain injury (TBI). Intermittent self-catheterization is considered the gold standard for bladder drainage because of the significantly decreased incidence of urinary tract infection in comparison with other catheterization methods. Occupational therapists educate patients in how to complete intermittent self-catheterization and assist them with adaptive equipment so that they may catheterize themselves independently. This case study describes adaptive equipment fabricated to allow a male patient with TBI who was independent with intermittent self-catheterization to continue independent intermittent self-catheterization after a second injury resulting in hemiplegia. Without the use of his left hand, the patient could not complete self-catheterization; therefore, a trough-shaped prop was fabricated to maintain the penis in an upright, lengthened position.
Dying of Boredom: An Exploratory Case Study of Time Use, Apparent Affect, and Routine Activity Situations on Two Alzheimer’s Special Care Units
Authors: Wood Wendy , Womack Jennifer , Hooper Barbara
Published: October 2011

The objective of this instrumental case study was to explore interrelationships among routine activity situations on 2 Alzheimer's special care units (SCUs) and 2 resident quality-of-life (QoL) indicators: daily time use and emotional well-being. Fourteen residents participated. We collected data across four 12-hr days using computer-assisted direct observations and computed associations of activity situations with QoL indicators and mean durations of QoL indicators in activity situations and daily by facility. We compared mean durations of QoL indicators across facilities and analyzed time-use profiles of 2 residents. We found that participants’ capacities for activity engagement and emotional vitality were infrequently expressed at both SCUs. Diminished QoL was attributable to participants’ dementia-related impairments coupled with insufficient attention to their occupational needs, initiatives, and capacities. Findings call for occupational therapists’ involvement as educators, mentors, and consultants to enhance the effectiveness of routine activity situations in promoting QoL through everyday occupations.
Conducting Systematic Reviews to Inform Occupational Therapy Practice
Authors: Murphy Susan L. , Robinson Jennifer C. , Lin Susan H.
Published: October 2011

Systematic reviews (SRs) are increasingly used in the health professions to evaluate research evidence to guide practice and justify reimbursement for services. Despite the importance of SRs in the health professions, there is no definitive guide for how to conduct a useful, high-quality review. In this article we will (1) provide an overview of the process of writing a traditional SR with particular emphasis on design and conduct, (2) discuss limitations of the traditional SR in occupational therapy, and (3) describe how information is synthesized and used for clinical practice.
Facilitating Family Occupations: Family Member Perceptions of a Specialized Environment for Children With Mental Retardation
Authors: Sachs Dalia , Nasser Kareem
Published: October 2011

OBJECTIVE. We studied the experience of family occupations in the Snoezelen context (i.e., a highly specialized therapeutic room for family gatherings) and analyzed how it facilitated occupations for parents of children with severe and profound mental retardation living in residential facilities.

METHOD. In-depth interviews and participatory observations were held with 10 families of children with mental retardation living in a long-term residential facility for children with mental retardation in Haifa, Israel.

RESULTS. Two main themes emerged: The Snoezelen environment was experienced as another world, where parents sensed detachment from external reality and a transition to relaxation and intimacy. The intimacy of the Snoezelen world fostered the experience of being together as a family, where all family members shared fun activities and strengthened their relationship.

CONCLUSIONS. A sense of intimacy and relaxation, provided by the Snoezelen environment, is important in facilitating family occupations for this population. Interventions in occupational therapy must be designed that take these requirements into consideration.
Effects of an Explicit Problem-Solving Skills Training Program Using a Metacomponential Approach for Outpatients With Acquired Brain Injury
Authors: Fong Kenneth N. K. , Howie Dorothy R.
Published: October 2011

OBJECTIVE. We investigated the effects of an explicit problem-solving skills training program using a meta componential approach with 33 outpatients with moderate acquired brain injury, in the Hong Kong context.

METHOD. We compared an experimental training intervention with this explicit problem-solving approach, which taught metacomponential strategies, with a conventional cognitive training approach that did not have this explicit metacognitive training.

RESULTS. We found significant advantages for the experimental group on the Metacomponential Interview measure in association with the explicit metacomponential training, but transfer to the real-life problem-solving measures was not evidenced in statistically significant findings. Small sample size, limited time of intervention, and some limitations with these tools may have been contributing factors to these results.

CONCLUSION. The training program was demonstrated to have a significantly greater effect than the conventional training approach on metacomponential functioning and the component of problem representation. However, these benefits were not transferable to real-life situations.
Executive Functioning, Awareness, and Participation in Daily Life After Mild Traumatic Brain Injury: A Preliminary Study
Authors: Bar-Haim Erez Asnat , Rothschild Ettie , Katz Noomi , Tuchner Maya , Hartman-Maeir Adina
Published: October 2011

OBJECTIVE. We investigated the relationship of executive functioning and self-awareness to participation in daily life of people after mild traumatic brain injury (mTBI) referred to occupational therapy in the postacute phase.

METHOD. Thirteen participants who sustained mTBI (average time since injury = 4.7 months, mean age = 43.4 years) were evaluated with the Behavioral Assessment of the Dysexecutive Syndrome, the Dysexecutive Questionnaire, the Self-Awareness of Deficits Interview, and the Participation Index (PI) of the Mayo–Portland Adaptability Inventory.

RESULTS. Analysis revealed high frequencies of deficits in executive functions such as planning and shifting. However, self-awareness of the executive deficits was intact. A significant percentage (62%–85%) of participants experienced restrictions in everyday life activities, and PI scores were significantly correlated with measures of executive functioning.

CONCLUSIONS. After mTBI, people may be at significant risk for persistent executive deficits and restrictions in participation that warrant occupational therapy intervention.
Evaluation of Social Interaction During Occupational Engagement
Authors: Simmons C. Douglas , Griswold Lou Ann , Berg Brett
Published: October 2011

The Evaluation of Social Interaction (ESI; Fisher & Griswold, 2008) assesses a person's performance of social interaction skills in the natural context with typical social partners during any area of occupation. We used Rasch analysis of 175 observations of 128 people, ages 4–73, to examine internal scale validity, the items’ skill hierarchy and intended purpose, and the ESI's ability to differentiate between people with and without disabilities. The ESI demonstrated validity for 24 of 27 skills and six intended purposes, with a hierarchy of performance. Of the observations, 95.3% demonstrated goodness of fit to the Rasch model, indicating person response validity. People without a disability demonstrated significantly higher social skills performance than those with a known disability (t = 4.468, df = 83 p = .000). The ESI has the potential to provide a quantitative assessment of social interaction performance in the natural context of a person's desired occupation and may be useful for intervention planning and outcome measurement.
Establishing Criterion Validity of the Useful Field of View Assessment and Stroke Drivers’ Screening Assessment: Comparison to the Result of On-Road Assessment
Authors: George Stacey , Crotty Maria
Published: October 2011

OBJECTIVES. We sought to determine the criterion validity of the Useful Field of View (UFOV) assessment and Stroke Drivers’ Screening Assessment (SDSA) through comparison to the results of on-road assessment.

METHOD. This was a prospective study with people with stroke. Outcome measures used were UFOV, SDSA, and the results of on-road assessment.

RESULTS. Both the results on UFOV (Divided Attention subtest, p < .01; Selective Attention subtest, p < .05) and SDSA (p < .05) were significantly related to the recommendation from on-road assessment. The Divided Attention subtest of the UFOV had the highest sensitivity value (88.9%).

CONCLUSIONS. UFOV and SDSA are valid assessments of driving ability for stroke. The Divided Attention subtest of the UFOV can guide decision making of occupational therapists in stroke driver rehabilitation and in determining those who require further assessment on road because they pose a safety risk. Screening assists people with stroke to decide whether they are ready to have an on-road assessment.
Doing, Being, and Becoming: A Family’s Journey Through Perinatal Loss
Authors: Forhan Mary
Published: October 2011

Occupational therapists are encouraged to reflect on doing, being, and becoming not only as it relates to the development of their profession but also in their own lives (Wilcock 1999). This article is a description of that process for me and my family in our journey through perinatal loss. This autoethnography uses a personally situated account of perinatal death. This article is a form of self-narrative that places me and my family in social context through the lens of an occupational therapist. This article aims to convey the meanings attached to the experience of grief and loss in the context of participation in everyday occupations. By sharing a perspective on the lived experience and connecting it to the literature on grief and occupation, readers will be able to decide if the connection holds as valid from a theoretical and clinical perspective.
Randomized Controlled Trial of the Breast Cancer Recovery Program for Women With Breast Cancer–Related Lymphedema
Authors: McClure Marjorie K. , McClure Richard J. , Day Richard , Brufsky Adam M.
Published: October 2011

Evidence-based exercise and relaxation recommendations for people with breast cancer–related lymphedema (BCRL) are needed. We report a randomized controlled study of one program, designed to achieve synergistic improvements in physical and emotional BCRL symptoms. People in the treatment group received an exercise and relaxation program, The Breast Cancer Recovery Program (N = 16). The control participants (N = 16) continued with health professionals’ recommendations. Participants were tested at entry, 2.5 weeks, 5 weeks, and 3 months. Treatment group participants, compared with control participants, demonstrated significant treatment effects for improved bioimpedance z, arm flexibility, quality of life, mood at 3 months, and weight loss. Adherence was high for this safe and effective program, which improved lymphedema physical and emotional symptoms.
Telerehabilitation and Electrical Stimulation: An Occupation-Based, Client-Centered Stroke Intervention
Authors: Hermann Valerie Hill , Herzog Mandy , Jordan Rachel , Hofherr Maura , Levine Peter , Page Stephen J.
Published: October 2011

OBJECTIVE. We examined the efficacy of a remotely based arm rehabilitation regimen. A 62-year-old man participated in occupation-based, task-specific practice of activities of daily living (ADLs) >3 years after stroke. The entire regimen was administered over the Internet using personal computer–based cameras and free network meeting software.

METHOD. Fugl-Meyer Assessment (FM), Action Research Arm Test (ARA), and Canadian Occupational Performance Measure (COPM) were administered before intervention. One week after treatment, FM, ARA, and COPM were readministered.

RESULTS. The participant exhibited reduced impairment and reduced functional limitation. He also expressed enhanced satisfaction with his ability to perform ADLs and rated his ADL performance better after intervention. The participant could now drive using both hands, use eating utensils, and catch and throw a ball.

CONCLUSION. Data suggest feasibility and efficacy of a remotely based, inexpensive approach using functional electrical stimulation for affected arm rehabilitation after stroke.