Showing papers in "American Journal of Occupational Therapy in 2012"
TL;DR: Head lag with other alterations in early development may be associated with autism risk and may serve as an early indicator of neurodevelopmental disruption in infants at risk for autism.
Abstract: OBJECTIVE.Poor postural control during pull-to-sit is a predictor of developmental disruption in cerebral palsy and preterm populations but has not been examined in infants at risk for autism. We examined the association between head lag during pull-to-sit at age 6 mo and autism risk status. METHOD.High-risk participants were siblings of children with autism. We studied one sample of 40 high-risk infants prospectively from 6-36 mo and obtained diagnostic classifications of autism or no autism. We conducted a subsequent between-group comparison with a new sample of 20 high-risk and 21 low-risk infants. RESULTS.Head lag was significantly associated with autism spectrum disorder at 36 mo (p = .020) and was more frequently observed in high-risk than in low-risk infants (p = .018). CONCLUSION.Head lag with other alterations in early development may be associated with autism risk and may serve as an early indicator of neurodevelopmental disruption. Results have clinical implications for occupational therapists in early intervention practice.
265 citations
TL;DR: The strongest results were found for multifactorial programs that included home evaluations and home modifications, physical activity or exercise, education, vision and medication checks, or assistive technology to prevent falls.
Abstract: This systematic review explored the impact of fall prevention programs and home modifications on falls and the performance of community-dwelling older adults. It was conducted as part of the American Occupational Therapy Association's Evidence-Based Practice Project. Thirty-three articles were analyzed and synthesized. The strongest results were found for multifactorial programs that included home evaluations and home modifications, physical activity or exercise, education, vision and medication checks, or assistive technology to prevent falls. Positive outcomes included a decreased rate of functional decline, a decrease in fear of falling, and an increase in physical factors such as balance and strength. The strength of the evidence for physical activity and home modification programs provided individually was moderate. Implications for practice, education, and research are also discussed.
171 citations
TL;DR: Results indicated that parents felt more competent and children significantly increased participation in everyday life, suggesting that this approach is an effective occupational therapy intervention.
Abstract: OBJECTIVE. We tested an occupational therapy contextual intervention for improving participation in children with autism spectrum disorders and for developing parental competence. METHOD. Using a repeated-measures pretest-posttest design, we evaluated the effectiveness of a contextually relevant reflective guidance occupational therapy intervention involving three components: authentic activity settings, family's daily routines, and the child's sensory processing patterns (Sensory Profile). We used these components to coach 20 parents in strategies to support their child's participation. Intervention sessions involved reflective discussion with parents to support them in identifying strategies to meet their goals and make joint plans for the coming week. We measured child participation (Canadian Occupational Performance Measure, Goal Attainment Scaling) and parent competence (Parenting Sense of Competence, Parenting Stress Index). RESULTS. Results indicated that parents felt more competent and children significantly increased participation in everyday life, suggesting that this approach is an effective occupational therapy intervention.
142 citations
TL;DR: Occupational therapy practitioners should consider screening their older adult clientele for fear of falling, anxiety, and depression because these states may lead to fall risk and activity restriction.
Abstract: OBJECTIVE. This study examined (1) the relationship of fear of falling to depression, anxiety, activity level, and activity restriction and (2) whether depression or anxiety predicted fear of falling, activity level, activity restriction, or changes in activity level. METHOD. We administered the Survey of Activities and Fear of Falling in the Elderly; the Geriatric Depression Scale-30; and the Hamilton Anxiety Scale, IVR Version, during a one-time visit to 99 community-dwelling adults ≥55 yr old. RESULTS. We found significant relationships between (1) fear of falling and depression, anxiety, and activity level; (2) depression and anxiety; and (3) activity restriction and depression. Activity level was negatively correlated with activity restriction, fear of falling, depression, and anxiety. Anxiety predicted both fear of falling and activity level. Both anxiety and depression predicted activity restriction because of fear of falling and for other reasons. CONCLUSION. Occupational therapy practitioners should consider screening their older adult clientele for fear of falling, anxiety, and depression because these states may lead to fall risk and activity restriction. Language: en
139 citations
TL;DR: A grounded theory approach to data analysis was used to discover what effect, if any, children's sensory experiences have on family occupations and the extent to which experiences, meaning, and feelings are shared.
Abstract: We used a grounded theory approach to data analysis to discover what effect, if any, children's sensory experiences have on family occupations. We chose this approach because the existing literature does not provide a theory to account for the effect of children's sensory experiences on family occupations. Parents of six children who were typically developing and six children who had autism were interviewed. We analyzed the data using open, axial, and selective coding techniques. Children's sensory experiences affect family occupations in three ways: (1) what a family chooses to do and not to do; (2) how the family prepares; and (3) the extent to which experiences, meaning, and feelings are shared.
124 citations
TL;DR: It is demonstrated that use of daily classroomwide yoga interventions has a significant impact on key classroom behaviors among children with autism spectrum disorders.
Abstract: Occupational therapists use school-based yoga programs, but these interventions typically lack manualization and evidence from well-designed studies. Using an experimental pretest-posttest control group design, we examined the effectiveness of the Get Ready to Learn (GRTL) classroom yoga program among children with autism spectrum disorders (ASD). The intervention group received the manualized yoga program daily for 16 wk, and the control group engaged in their standard morning routine. We assessed challenging behaviors with standardized measures and behavior coding before and after intervention. We completed a between-groups analysis of variance to assess differences in gain scores on the dependent variables. Students in the GRTL program showed significant decreases (p < .05) in teacher ratings of maladaptive behavior, as measured with the Aberrant Behavior Checklist, compared with the control participants. This study demonstrates that use of daily classroomwide yoga interventions has a significant impact on key classroom behaviors among children with ASD.
122 citations
TL;DR: Most of the children with ASD had sensory processing challenges, and a significant relationship was found between SSP total scores and problem behavior scores; however, no significant relationships were foundbetween SSPtotal scores and adaptive behavior and cognitive functioning.
Abstract: OBJECTIVE. This retrospective study explored sensory processing characteristics in preschool-age children with autism spectrum disorders (ASD); the relationships between sensory processing and problem behavior, adaptive behavior, and cognitive function; and the differences in sensory processing between two subgroups (autism and pervasive developmental disorder-not otherwise specified). METHOD. Study measures included the Short Sensory Profile (SSP), Aberrant Behavior Checklist-Community, Vineland Adaptive Behavior Scales, and Mullen Scales of Early Learning. RESULTS. Most of the children with ASD had sensory processing challenges, and a significant relationship was found between SSP total scores and problem behavior scores; however, no significant relationships were found between SSP total scores and adaptive behavior and cognitive functioning. Although all the children had low Vineland scores, approximately one-quarter of the children had typical SSP scores. No significant differences in SSP scores were found between the subgroups. CONCLUSION. The findings highlight the importance of comprehensive evaluations for children with ASD.
120 citations
TL;DR: The results of this systematic review demonstrate the multidisciplinary appreciation for occupational engagement and associated well-being and elucidate the health effects of engagement in a wide variety of occupations and activities.
Abstract: We conducted this systematic review, one of four related to productive aging, to explore the existing evidence for the health benefits of engagement in occupations and activities among older adults. The review incorporates the breadth of areas of occupation in which older adults engage and the range of health benefits derived from that engagement. The results of this review demonstrate the multidisciplinary appreciation for occupational engagement and associated well-being and elucidate the health effects of engagement in a wide variety of occupations and activities. Additionally, the results of this systematic review support occupational therapy's historical ideologies and core philosophies linking occupational engagement to improved health and well-being. The findings suggest an increasing role for occupational therapy service delivery in community-based health promotion and prevention efforts to meet the everyday activity and health needs of the growing older adult population.
106 citations
TL;DR: The results support using sensory-enhanced hatha yoga for proactive combat stress management and any correlations between the State-Trait Anxiety Inventory scales and the Adolescent/Adult Sensory Profile quadrants are identified.
Abstract: OBJECTIVE. We examined the effects of sensory-enhanced hatha yoga on symptoms of combat stress in deployed military personnel, compared their anxiety and sensory processing with that of stateside civilians, and identified any correlations between the State–Trait Anxiety Inventory scales and the Adolescent/Adult Sensory Profile quadrants. METHOD. Seventy military personnel who were deployed to Iraq participated in a randomized controlled trial. Thirty-five received 3 wk (³9 sessions) of sensory-enhanced hatha yoga, and 35 did not receive any form of yoga. RESULTS. Sensory-enhanced hatha yoga was effective in reducing state and trait anxiety, despite normal pretest scores. Treatment participants showed significantly greater improvement than control participants on 16 of 18 mental health and quality-of-life factors. We found positive correlations between all test measures except sensory seeking. Sensory seeking was negatively correlated with all measures except low registration, which was insignificant. CONCLUSION. The results support using sensory-enhanced hatha yoga for proactive combat stress management.
103 citations
TL;DR: Significant differences between the treatment and control groups were demonstrated on the BRIEF and the RATC, suggesting that the intervention improved executive functioning and emotional problem-solving skills.
Abstract: OBJECTIVE. This study evaluated the effectiveness of neurocognitive habilitation, a group therapy intervention for foster and adoptive caregivers and their children who were prenatally exposed to alcohol.
METHOD. Participants were recruited from clients seeking evaluation for fetal alcohol syndrome (FAS) and alcohol-related neurodevelopmental disorder (ARND) and were randomly assigned to treatment and no-treatment control groups. Forty children participated in the treatment program and were compared with 38 control participants using the Behavior Rating Inventory of Executive Function (BRIEF) and the Roberts Apperception Test for Children (RATC).
RESULTS. Significant differences between the treatment and control groups were demonstrated on the BRIEF and on the RATC, suggesting that the intervention improved executive functioning and emotional problem-solving skills.
CONCLUSION. These findings yield promising evidence of the effectiveness of the neurocognitive habilitation intervention in improving executive functioning and emotional problem solving in children with FAS or ARND.
99 citations
TL;DR: The intensity or magnitude of sensory responsivity mediates the relationship between baseline arousal and attention and outcome anxiety and physiologic recovery from sensory challenge.
Abstract: OBJECTIVE. To explore the relationship between sensory overresponsivity (SOR) and anxiety in children with autism, attention deficit hyperactivity disorder, and typical development. METHOD. Path analysis was used to examine the primary SOR model (Green & Ben-Sasson, 2010) using both physiological and behavioral data. RESULTS. The magnitude of physiological responses to sensory challenge was a mediator variable between predictors (baseline arousal and attention) and outcomes (anxiety and physiological recovery). Behavioral SOR was correlated with anxiety but not with physiological variables. CONCLUSION. The intensity or magnitude of sensory responsivity mediates the relationship between baseline arousal and attention and outcome anxiety and physiologic recovery from sensory challenge. Behavioral tools used to measure SOR do not reflect physiological responsiveness; this mismatch warrants further investigation. SOR can prevent children from participating in the occupations of childhood; the greater the understanding of SOR, the more successful occupational therapy practitioners will be in developing effective interventions.
TL;DR: Whether attending of 4 male students, ages 13-20, increased after the installation of sound-absorbing walls and halogen lighting was determined and results included increased frequency and stability of attending and engagement and improved classroom performance, comfort, and mood.
Abstract: Students with autism display sensory sensitivities to environmental stimuli that affect their attending and engagement in classroom learning activities. The purpose of the study was to determine whether attending of 4 male students, ages 13–20, increased after the installation of sound-absorbing walls and halogen lighting. The multiple single-subject, mixed-method design, AB(B+C), included a 2-wk baseline and two intervention phases: 2 wk after sound-absorbing wall installation using the Owens Corning Basement Finishing System™ (Owens Corning, Toledo, OH) and 2 wk after halogen light installation. We calculated nonattending frequencies from videotaped class sessions and used visual analysis to measure within-phase and between-phase characteristics. Results included increased frequency and stability of attending and engagement and improved classroom performance, comfort, and mood. Journaling provided students’ perspective on the modifications and reflected overall increased sensory comfort and themes of improved classroom environment, positive emotional response (mood), and improved classroom performance
TL;DR: Low fall-related efficacy may be an important barrier to occupational engagement for many older adults and warrants careful consideration by occupational therapists.
Abstract: OBJECTIVE. Fear of falling can lead to restricted activity, but little is known about how this fear affects different aspects of people's lives. This study examined the relationship between fall-related efficacy (i.e., confidence or belief in one's ability to perform activities without losing balance or falling) and activity and participation. METHOD. We conducted a meta-analysis of studies comparing community-dwelling older adults' fall-related efficacy to measures of activity or participation. RESULTS. An examination of 20 cross-sectional and prospective studies found a strong positive relationship between fall-related efficacy and activity (r = .53; 95% CI [.47, .58]). An insufficient number of studies examining fall-related efficacy and participation were available for analysis. CONCLUSION. Low fall-related efficacy may be an important barrier to occupational engagement for many older adults and warrants careful consideration by occupational therapists. Future research should explore interventions that target fall-related efficacy and examine their effects on activity performance and engagement. Language: en
TL;DR: The evidence that multicomponent interventions improve and maintain IADL performance in community-dwelling older adults is strong, and the results indicate that client-centered, occupation-based interventions can be effective in improving and maintaining I ADL performance.
Abstract: This systematic review examines the effectiveness of occupation- and activity-based interventions on community-dwelling older adults' performance of instrumental activities of daily living (IADLs). It was conducted as part of the American Occupational Therapy Association's Evidence-Based Practice Project. Forty studies met the inclusion criteria and were critically appraised and synthesized. Within occupation-based and client-centered interventions, the evidence that multicomponent interventions improve and maintain IADL performance in community-dwelling older adults is strong. The results also indicate that client-centered, occupation-based interventions can be effective in improving and maintaining IADL performance. The evidence is moderate for functional task exercise programs and limited for simulated IADL interventions to improve IADL performance. In the area of performance skills, the evidence related to physical activity and cognitive skills training is mixed, and the evidence that vision rehabilitation interventions improve IADL performance in older adults with low vision is moderate. Implications for practice, education, and research are also discussed.
TL;DR: The first multisite RCT of pediatric CIMT confirmed the maintenance of positive effects at 6 mo follow-up across multiple functional performance measures.
Abstract: OBJECTIVE. Pediatric constraint-induced movement therapy (CIMT) is a promising intervention for children with unilateral cerebral palsy (CP). This multisite randomized controlled trial (RCT) tested the hypothesis that 6 hr versus 3 hr per day for 21 days would produce larger maintenance of gains 6 mo posttreatment.
METHOD. Three sites recruited 18 children (6 per site) ages 3–6 yr with unilateral CP. Children were randomly assigned to 3 or 6 hr/day of CIMT for 21 days and wore a cast on the unaffected extremity the first 18 days. Occupational therapists applied a standardized pediatric CIMT protocol. Evaluators blinded to condition administered the Assisted Hand Assessment and the Quality of Upper Extremity Skills Test, and parents completed the Pediatric Motor Activity Log pre- and posttreatment (1 wk, 1 mo, and 6 mo).
RESULTS. Both CIMT dosage groups showed significant gains on all five assessments with no significant group differences at 6-mo follow-up. Effect sizes (n = 15) comparing preintervention to postintervention measures (partial η2) ranged from .33 to .80.
CONCLUSION. This first multisite RCT of pediatric CIMT confirmed the maintenance of positive effects at 6 mo follow-up across multiple functional performance measures. The hypothesis that maintenance of effects would differ for children who received 6 versus 3 hr/day of CIMT (126 vs. 63 total hr) was not supported.
TL;DR: The CO-OP group demonstrated larger performance improvements than the SOT group, and an investigation using a larger sample is warranted because of the promising results.
Abstract: OBJECTIVE. The authors compared changes in client performance on three goals poststroke after the Cognitive Orientation to daily Occupational Performance (CO–OP) intervention or standard occupational therapy (SOT) to determine the magnitude and direction of change.
METHOD. Eight people living in the community following a stroke were randomly assigned to receive CO–OP (n = 4) or SOT (n = 4). CO–OP is a 10-session, cognitive-oriented approach to improving performance that uses client-driven cognitive strategies. SOT was therapist driven and combined task-specific and component-based training. Goal performance was measured by the therapist-rated Performance Quality Rating Scale (PQRS) and the participant-rated Canadian Occupational Performance Measure (COPM).
RESULTS. Using Mann-Whitney U test, we found that CO–OP participants showed significantly greater improvement in performance (PQRS, p = .02; COPM Performance, p = .02) compared with SOT but no improvement in satisfaction (COPM Satisfaction, p = .38).
CONCLUSION. The CO–OP group demonstrated larger performance improvements than the SOT group. Because of the promising results, an investigation using a larger sample is warranted
TL;DR: Correlations between SC and SPM indicated that more severe auditory behavioral difficulties were associated with higher sympathetic activation at rest and stronger sympathetic reactivity to sound.
Abstract: OBJECTIVES. We examined whether children with and without autism spectrum disorder (ASD) differ in autonomic activity at rest and in response to auditory stimuli and whether behavioral problems related to sounds in everyday life are associated with autonomic responses to auditory stimuli. METHOD. We measured skin conductance (SC) at rest and in response to auditory stimuli as well as behavioral responses using the Sensory Processing Measure (SPM) Home Form. Participants were 25 children with ASD and 25 typically developing (TD) children, aged 5-12 yr. RESULTS. The ASD group had significantly higher resting SC and stronger SC reactivity to tones than the TD group. Correlations between SC and SPM indicated that more severe auditory behavioral difficulties were associated with higher sympathetic activation at rest and stronger sympathetic reactivity to sound. CONCLUSION. High sympathetic reactivity to sound may underlie the difficult behavioral responses to sound that children with ASD often demonstrate.
TL;DR: The results confirm the potential to validly measure subjective qualities of meaningful activity participation and the EMAS can be used to evaluate processes and outcomes central to occupational therapy practice and to aid in the design of therapeutic occupations.
Abstract: Objective This study evaluated the measurement characteristics of the Engagement in Meaningful Activities Survey (EMAS) in an age-diverse sample. Method The sample included 154 older adults and 122 college students (age range = 18-100 yr). A Rasch-Andrich rating scale model was used to evaluate the EMAS. Analyses addressed rating scale design, person and item fit, item hierarchy, model unidimensionality, and differential item functioning. Results Category functioning was improved by reducing the EMAS item responses to four categories. Adequate person response validity was established, and all but one EMAS item demonstrated an ideal fit to the Rasch measurement model. After establishing the item hierarchy, I found the EMAS to be a unidimensional measure. Differential item functioning was not detected using Bonferroni-adjusted statistical criteria. Conclusion The results confirm the potential to validly measure subjective qualities of meaningful activity participation. The EMAS can be used to evaluate processes and outcomes central to occupational therapy practice and to aid in the design of therapeutic occupations.
TL;DR: Improvement in sensory processing, as measured by the Sensory Integration and Praxis Tests, as well as enhanced participation in home, school, and family activities, as indicated on parent-rated goal attainment scales are found.
Abstract: In this case report, we describe the changes in adaptive behaviors and participation of 1 child with autism during a 10-wk program of intensive occupational therapy using a sensory integrative approach (OT-SI) following a manualized protocol. This case is part of a larger study examining the efficacy of the OT-SI approach. We found improvement in sensory processing, as measured by the Sensory Integration and Praxis Tests, as well as enhanced participation in home, school, and family activities, as indicated on parent-rated goal attainment scales.
TL;DR: Occupational therapy practitioners and their clients are poised to benefit from the use of emerging technologies to deliver health and wellness, habilitation, and rehabilitation services across multiple practice settings.
Abstract: Jana Cason, DHS, OTR/L, is Associate Professor, Auerbach School of Occupational Therapy, Spalding University, 845 South Third Street, Louisville, KY 40203; jcason@spalding.edu Occupational therapy practitioners and their clients are poised to benefit from the use of emerging technologies to deliver health and wellness, habilitation, and rehabilitation services across multiple practice settings. The Patient Protection and Affordable Care Act (ACA; 2010) defines a new direction for the U.S. health care system by transforming the current health care system to improve access, quality, efficiency, and transparency of health care services. These goals are addressed by employer incentives, expansion of public programs, premium and cost-sharing subsidies, health insurance exchanges, and coordinated care approaches such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). These aspects of the ACA may increase coverage and access to health care services for millions of Americans.
TL;DR: Pencil grasp patterns did not influence handwriting speed or legibility in this sample of typically developing children, adding to the mounting body of evidence that alternative grasps may be acceptable for fast and legible handwriting.
Abstract: OBJECTIVE. Pencil grasps other than the dynamic tripod may be functional for handwriting. This study examined the impact of grasp on handwriting speed and legibility. METHOD. We videotaped 120 typically developing fourth-grade students while they performed a writing task. We categorized the grasps they used and evaluated their writing for speed and legibility using a handwriting assessment. Using linear regression analysis, we examined the relationship between grasp and handwriting. RESULTS. We documented six categories of pencil grasp: four mature grasp patterns, one immature grasp pattern, and one alternating grasp pattern. Multiple linear regression results revealed no significant effect for mature grasp on either legibility or speed. CONCLUSION. Pencil grasp patterns did not influence handwriting speed or legibility in this sample of typically developing children. This finding adds to the mounting body of evidence that alternative grasps may be acceptable for fast and legible handwriting.
TL;DR: It is suggested that imagery perspective may not be an important variable in MP interventions, and MP combined with occupational therapy improves upper-extremity recovery after stroke.
Abstract: OBJECTIVE. This preliminary study sought to determine whether the imagery perspective used during mental practice (MP) differentially influenced performance outcomes after stroke.
METHOD. Nineteen participants with unilateral subacute stroke (9 men and 10 women, ages 28–77) were randomly allocated to one of three groups. All groups received 30-min occupational therapy sessions 2×/wk for 6 wk. Experimental groups received MP training in functional tasks using either an internal or an external perspective; the control group received relaxation imagery training. Participants were pre- and posttested using the Fugl-Meyer Motor Assessment (FMA), the Jebsen–Taylor Test of Hand Function (JTTHF), and the Canadian Occupational Performance Measure (COPM).
RESULTS. At posttest, the internal and external experimental groups showed statistically similar improvements on the FMA and JTTHF (p < .05). All groups improved on the COPM (p < .05).
CONCLUSION. MP combined with occupational therapy improves upper-extremity recovery after stroke. MP does not appear to enhance self-perception of performance. This preliminary study suggests that imagery perspective may not be an important variable in MP interventions
TL;DR: The results suggest that specificity of training exists only for performance of specific goals established by parents and that both CIMT and HABIT can be used to increase children's daily functioning.
Abstract: OBJECTIVE. We compared children’s self-care performance and caregivers’ perception of children’s performance on functional goals established for children with hemiplegic cerebral palsy (CP) after unimanual constraint-induced movement therapy (CIMT) or hand–arm bimanual intensive training (HABIT).
METHOD. Sixteen children with CP were randomized to the CIMT or HABIT group. Interventions lasted for 15 days, 6 hr/day, totaling 90 hr. We used the Pediatric Evaluation of Disability Inventory and the Canadian Occupational Performance Measure (COPM) to assess the children’s daily functioning and mixed analyses of variance to compare group means on functional test scores before and after intervention.
RESULTS. Both groups showed significant improvements on functional measures. Group × Assessment interaction in COPM performance revealed greater improvements for the HABIT group after intervention (p = .04).
CONCLUSION. The results suggest that specificity of training exists only for performance of specific goals established by parents and that both CIMT and HABIT can be used to increase children’s daily functioning
TL;DR: Results suggest that the Comprehensive Observations of Proprioception has useful clinical research applications and further assessment of psychometric properties, clinical utility, and meaningful differences among diverse clinical populations are needed.
Abstract: OBJECTIVE. Sensory processing difficulties among children with autism spectrum disorders (ASD) have been extensively documented. However, less is known about this population's ability to process proprioceptive information. METHOD. We used the Comprehensive Observations of Proprioception (COP; Blanche, Bodison, Chang, & Reinoso, in press) to describe the proprioceptive difficulties experienced by children with ASD. A sample of 32 children with ASD, 26 children with developmental disabilities excluding ASD, and 28 typically developing control children were studied using the COP. RESULTS. Children with ASD present with proprioceptive processing difficulties that are different from those of children with developmental disabilities and their typically developing counterparts. Specific data, potential clinical applications, and directions for future research are described. CONCLUSION. Results suggest that the COP has useful clinical research applications. Further assessment of psychometric properties, clinical utility, and meaningful differences among diverse clinical populations are needed.
TL;DR: Students with initially low legibility improved most in legibility; progress on the other tests was similar across low-, average-, and high-performing groups.
Abstract: We examined the effects of a cotaught handwriting and writing program on first-grade students grouped by low, average, and high baseline legibility. The program's aim was to increase legibility, handwriting speed, writing fluency, and written expression in students with diverse learning needs. Thirty-six first-grade students in two classrooms participated in a 12-wk handwriting and writing program cotaught by teachers and an occupational therapist. Students were assessed at pretest, posttest, and 6-mo follow-up using the Evaluation Tool of Children's Handwriting-Manuscript (ETCH-M) and the Woodcock-Johnson Writing Fluency and Writing Samples tests. Students made large gains in ETCH-M legibility (η² = .74), speed (η²s = .52-.65), Writing Fluency (η² = .58), and Writing Samples (η² = .59). Students with initially low legibility improved most in legibility; progress on the other tests was similar across low-, average-, and high-performing groups. This program appeared to benefit first-grade students with diverse learning needs and to increase handwriting legibility and speed and writing fluency.
TL;DR: The sensory and motor differences found between typical and high-risk infants suggest that early screenings for ASD should include the examination of sensory andMotor behaviors.
Abstract: We compared the sensory and motor behaviors of typically developing infants with those of infant siblings of children with autism spectrum disorders (ASD), who are considered high risk for the disorder, to explore potential sensory and motor markers for use in early diagnosis of ASD. We compared frequencies of sensory and motor behaviors during 10-min, videotaped, infant–mother play sessions and during 5 min of spoon-feeding between groups of 12-mo-old infants. Data from standardized measures of development, sensory processing, and behaviors commonly associated with ASD were also analyzed descriptively for the high-risk group. The results indicated that high-risk infants demonstrated fewer movement transitions (t [23] = −2.4, p = .03) and less object manipulation (t [23] = −2.4, p = .03) than low-risk infants. The sensory and motor differences found between typical and high-risk infants suggest that early screenings for ASD should include the examination of sensory and motor behaviors.
TL;DR: An intent in this editorial is to discuss the five basic components of intervention fidelity, which are the extent to which the intervention is delivered as it was intended and how various factors may have influenced the outcome of their study.
Abstract: Sharon A. Gutman, PhD, OTR, FAOTA, is Editorin-Chief, American Journal of Occupational Therapy, and Associate Professor, Columbia University, Programs in Occupational Therapy, New York; ajoteditor@aota.org In a recent editorial, we highlighted information commonly absent from manuscripts that report intervention effectiveness (Gutman & Murphy, 2012). One critical element often missing from manuscripts is a discussion of intervention fidelity, which is the extent to which the intervention is delivered as it was intended (Gearing et al., 2011). To assess fidelity, researchers need to determine at the study design stage the methods they will use to assess and monitor the reliability and validity of the intervention (Bellg et al., 2004; Borrelli, 2011). Reporting of fidelity methods in the published product is crucial to allow readers to judge the quality of the study and replicate it and to assist the intervention developers in understanding how various factors may have influenced the outcome of their study. The Consolidated Standards of Reporting Trials (CONSORT) guidelines (Altman et al., 2001), the criteria now required by most medical journals for reporting clinical trials, have been expanded to include reporting of intervention fidelity in nonpharmacological trials (Boutron, Moher, Altman, Schulz, & Ravaud, 2008). The expanded criteria for reporting offer detailed guidance on how to report this additional information. Because fidelity methods are infrequently and inconsistently reported in journals, our intent in this editorial is to discuss the five basic components of intervention fidelity (Bellg et al., 2004; Borrelli, 2011; Gearing et al., 2011): 1. Intervention design 2. Training of providers 3. Intervention delivery 4. Receipt of intervention 5. Enactment of skills gained from the intervention.
TL;DR: There is moderate to strong evidence that client-centered occupational therapy improved physical functioning and occupational performance related to health management in community-dwelling older adults, as well as in adults with osteoarthritis and macular degeneration.
Abstract: We describe the results of a systematic review of the literature on occupation- and activity-based health management and maintenance interventions for productive aging. We found moderate to strong evidence that client-centered occupational therapy improved physical functioning and occupational performance related to health management in community-dwelling older adults, as well as in adults with osteoarthritis and macular degeneration. We found moderate evidence that health education programs reduce pain and increase physical activity and that individualized health action plans improve activities of daily living function and participation in physical activities. The evidence that self-management programs result in a decrease in pain and disability and that incorporating cognitive-behavioral principles into physical activity improves long-term participation in exercise was also moderate. Although the evidence for skill-specific training in isolation is limited, effectiveness increases when skill-specific training is combined with health management programs. The implications for practice, education, and research are discussed.
TL;DR: The WCPA may be useful to occupational therapists as a performance measure of EF and allows evaluation of complex task performance, strategy use, self-evaluation of performance, and error patterns, which can be used in developing intervention strategies.
Abstract: OBJECTIVE. We piloted the Weekly Calendar Planning Activity (WCPA), a performance-based measure of executive function (EF), to establish a baseline for at-risk adolescents.
METHOD. Participants were 113 youths ages 16–21 who were enrolled at a charter school for youth returning to high school after dropping out. We administered the WCPA and collected demographic information.
RESULTS. On average, participants spent 15.9 min on the WCPA, made 7.9 errors, and followed 4.0 of 5 possible rules. No ceiling effect was observed in overall accuracy. Participants used a mean of 3.1 strategies (standard deviation = 1.9) while completing the WCPA. Participants who used more strategies spent more time planning and completing the task and were more accurate.
CONCLUSION. The WCPA may be useful to occupational therapists as a performance measure of EF. This assessment allows evaluation of complex task performance, strategy use, self-evaluation of performance, and error patterns, which can be used in developing intervention strategies
TL;DR: Evidence for occupational therapy practitioner involvement in fall prevention in environmental modifications, exercise, and multifactorial and multicomponent interventions is identified.
Abstract: Falls are a serious public health concern among older adults in the United States. Although many fall prevention recommendations exist, such as those published by the American Geriatrics Society (AGS) and the British Geriatrics Society (BGS) in 2010, the specific role of occupational therapy in these efforts is unclear. This article presents a scoping review of current published research documenting the role of occupational therapy in fall prevention interventions among community-dwelling older adults, structured by the AGS and BGS guidelines. We identified evidence for occupational therapy practitioner involvement in fall prevention in environmental modifications, exercise, and multifactorial and multicomponent interventions. Although research documenting the efficacy of occupational therapy interventions is identified as part of the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; American Occupational Therapy Association, 2008), we identified little or no such research examining interventions to modify behaviors (e.g., fear of falling), manage postural hypotension, recommend appropriate footwear, and manage medications. Although occupational therapy is represented in the fall prevention research, the evidence for the profession's role in many areas is still lacking.