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American Journal of Occupational Therapy
Journal Prestige (SJR): 0.821
Citation Impact (citeScore): 2
Number of Followers: 214  
 
  Partially Free Journal Partially Free Journal
ISSN (Print) 0272-9490 - ISSN (Online) 1943-7676
Published by AOTA Homepage  [1 journal]
  • Scoping Review of School-to-Work Transition for Youth With Intellectual
           Disabilities: A Practice Gap
    • Authors: Rosner T; Grasso A, Scott-Cole L, et al.
      Abstract: Importance: Youth with intellectual disabilities (ID) have persistently poor work outcomes. Occupational therapy can support school-to-work transition but is underrepresented in transition practice.Objective: To identify and describe interventions within the scope of occupational therapy for youth with ID who are transitioning from school to work.Data Sources: MEDLINE, ERIC, PsycINFO, and CINAHL were searched, and hand searching was performed in relevant peer-reviewed journals.Study Selection and Data Collection: Included were peer-reviewed, English-language articles published from 2004 to 2017 describing studies focused on youth with ID with no significant co-occurring physical diagnoses who were transitioning from U.S.-based school settings to paid employment. Data extraction was managed using Google Drive. Data were organized on extraction sheets by trained reviewers. The quality of each study was assessed using questions adapted from the Critical Appraisal Skills Program checklist.Findings: A total of 35 articles were included, 7 of which used randomized controlled designs. All articles described interventions aligned with the Occupational Therapy Practice Framework: Domain and Process (3rd ed.), but specific mention of occupational therapy was notably absent from the literature. Interventions had little and generally low-level evidence supporting their use.Conclusions and Relevance: Significant and concerning gaps exist in the literature on school-to-work transition for youth with ID, likely impeding evidence-based practice. No included article mentioned occupational therapy or had a contributor who was an occupational therapy practitioner. Practitioners should advocate for occupational therapy’s role in transition and contribute reports of occupational therapy transition services for youth with ID to the literature.What This Article Adds: This study demonstrates that occupational therapy is poorly represented in literature describing transition services for youth with ID. Although the articles described interventions within the occupational therapy domain, these interventions were not provided by occupational therapy practitioners and did not have a strong evidence base.
      PubDate: Fri, 20 Mar 2020 00:00:00 GMT
       
  • Occupation- and Activity-Based Interventions to Improve Performance of
           Instrumental Activities of Daily Living and Rest and Sleep for Children
           and Youth Ages 5–21: A Systematic Review
    • Authors: Beisbier S; Laverdure P.
      Abstract: Importance: Practitioners seek evidence from intervention effectiveness studies to provide best-practice services for children.Objective: To examine the effectiveness of occupation- and activity-based interventions to improve instrumental activities of daily living (IADLs) and sleep outcomes for children and youth ages 5–21 yr.Data Sources: MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane Database of Systematic Reviews.Study Selection and Data Collection: The American Occupational Therapy Association research methodologist conducted the first review of literature published from 2000 to 2017. The results were exported, and we completed the subsequent stages of review. Only peer-reviewed Level I, II, and III evidence was reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane risk-of-bias guidelines were used to compile evidence and risk-of-bias tables.Findings: We reviewed 96 articles; 28 studies met the inclusion criteria for IADL and rest–sleep outcomes. Analysis resulted in several themes: rest–sleep, health management (nutrition–dietary, physical activity–fitness, wellness), and the IADLs of driving, communication management, and safety. Strong evidence exists for interventions embedded in school programming to improve physical activity and fitness and for sleep preparation activities to maximize quality of rest and sleep. Moderate-strength evidence exists for interactive education and skills training interventions to improve health routines, dietary behaviors, and IADL participation and performance.Conclusions and Relevance: Use of skills-focused training in activity- and occupation-based interventions was supported. Service provision in the context of natural environments, including school settings and with parental or caregiver participation, is recommended for children and youth ages 5–21 yr with varied abilities and diagnoses.What This Article Adds: Occupational therapy practitioners can confidently examine their current practices and choose activity- and occupation-based interventions and methods of service delivery that are supported by evidence.
      PubDate: Fri, 20 Mar 2020 00:00:00 GMT
       
  • Becoming Critical Consumers of Evidence in Occupational Therapy for
           Children and Youth
    • Authors: Grajo LC; Laverdure P, Weaver LL, et al.
      Abstract: This special issue of the American Journal of Occupational Therapy on interventions for children and youth highlights the current developments in and evidence for the effectiveness of occupational therapy interventions and psychometric properties of assessments for children and youth. In this guest editorial, we identify various factors that challenge the implementation of evidence-based strategies in daily clinical practice. We assert that scholars, educators, and practitioners need to address several strategic steps. To facilitate critical consumption of evidence in practice, efforts need to be made to build capacity for evidence production and evidence use through implementation science and to ensure that evidence-based practice is not only taught but also reflectively applied across the educational curriculum and that clinicians are given more access to resources that are easy to translate to daily clinical practice.
      PubDate: Tue, 17 Mar 2020 00:00:00 GMT
       
  • Occupational Therapy Interventions for Older Adults With Low Vision
    • Authors: Smallfield S; Kaldenberg J.
      Abstract: Evidence Connection articles provide clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. Findings from the systematic review of occupational therapy for older adults with low vision were published in the January/February 2020 issue of the American Journal of Occupational Therapy (AJOT) and in AOTA’s Occupational Therapy Practice Guidelines for Older Adults With Low Vision, published in the March/April 2020 issue of AJOT. In this article, we describe a case report of an older adult with low vision who was referred to outpatient occupational therapy services because of a recent progression of her age-related macular degeneration that led to a decline in functional independence. Each article in the Evidence Connection series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.
      PubDate: Fri, 13 Mar 2020 00:00:00 GMT
       
  • Interventions Within the Scope of Occupational Therapy Practice to Improve
           Motor Performance for Children Ages 0–5 Years: A Systematic Review
    • Authors: Tanner K; Schmidt E, Martin K, et al.
      Abstract: Importance: Occupational therapy practitioners need updated information about which interventions may improve motor skills for young children.Objective: To identify the effectiveness of occupational therapy interventions to promote motor development and prevent delay for children ages 0–5 yr.Data Sources: Six databases (CINAHL, MEDLINE, PsycINFO, ERIC, Cochrane, and OTseeker) were searched for articles published from January 2010 to March 2017.Study Selection and Data Collection: The search yielded 4,488 articles that were reviewed for inclusion. Fifty-six studies were entered into both evidence and risk-of-bias tables. Included studies used Level I–III designs, were within occupational therapy’s scope of practice, included participants with a mean age younger than 6 yr, and addressed motor skills.Findings: Three intervention themes emerged: early intervention for children younger than age 3 yr, interventions for preschool children ages 3–5 yr, and interventions for children with or at risk for cerebral palsy.Conclusions and Relevance: Occupational therapy practitioners should consider use of interventions with moderate or strong evidence as described in this review. Limitations include high risk of bias and limited evidence for several interventions.What This Article Adds: This article provides occupational therapy practitioners with updated information on evidence-based practices for children age 5 and younger who have motor delays.
      PubDate: Fri, 13 Mar 2020 00:00:00 GMT
       
  • Not Just Mortality and Morbidity but Also Function: Opportunities and
           Challenges for Occupational Therapy in the World Health Organization’s
           Rehabilitation 2030 Initiative
    • Authors: Richards L; Vallée C.
      Abstract: The World Health Organization’s (WHO’s) new focus on rehabilitation offers great opportunities for occupational therapy. Recognizing that the problems in daily function created by the aging of the world’s population and the increasing prevalence of chronic health conditions require rehabilitation to be a vital part of health systems, the World Health Organization brought a variety of stakeholders together in 2017 and 2019 to help them develop the Rehabilitation 2030 initiative. Occupational therapy was represented by the World Federation of Occupational Therapists, the American Journal of Occupational Therapy, the Canadian Journal of Occupational Therapy, editorial board members of several occupational therapy journals, and other occupational therapy researchers. A major challenge to meeting the goal of sufficient rehabilitation services to meet global need is the worldwide shortage of occupational therapists. This shortage can be attributed to a paucity of knowledge about occupational therapy as a health care profession, lack of understanding of the occupational therapy scope of practice, the cost of education required to become an occupational therapist, and the need for occupational therapy salaries to offset educational costs. Nonetheless, ongoing success in research and clinical outcomes will increase knowledge of the value of occupational therapy and increase the size of the profession. WHO’s focus on function is to be lauded. Yet, occupational therapists must not be content with an emphasis on function. They also need to advocate for contextual changes that eliminate barriers to participation and engagement experienced by people with disability.
      PubDate: Fri, 13 Mar 2020 00:00:00 GMT
       
  • Weighted Blanket Use: A Systematic Review
    • Authors: Eron K; Kohnert L, Watters A, et al.
      Abstract: Importance: Sensory integration modalities, such as weighted blankets, are used in occupational therapy practice to assist with emotional and physical regulation. However, the research related to the use and effectiveness of weighted blankets is sparse.Objective: To identify, evaluate, and synthesize the current literature to help develop the impetus needed to launch a research study into the effectiveness of using weighted blankets to decrease anxiety and insomnia.Data Sources: A literature search was conducted between January 23, 2018, and March 1, 2018. Databases and sites included the Cochrane Library, PubMed, PsycINFO, CINAHL, OTseeker, Web of Science, and Nursing Reference Center Plus. Search terms included weighted blanket, deep pressure, and occupational therapy as well as combinations of these terms.Study Selection and Data Collection: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were included if the study used weighted blankets as the modality of deep pressure stimulation. Data from presentations, conference proceedings, non–peer-reviewed literature, dissertations, and theses were excluded.Findings: Only 8 studies were included: 4 Level I, 2 Level III, and 2 Level IV studies. The outcomes of these studies suggest that weighted blankets have the potential to be beneficial in limited settings and populations.Conclusion and Relevance: Weighted blankets may be an appropriate therapeutic tool in reducing anxiety; however, there is not enough evidence to suggest they are helpful with insomnia.What This Article Adds: Evidence-based research on the effectiveness of weighted blankets in reducing anxiety and insomnia is sparse. More research is needed to define guidelines for the use of weighted blankets in clinical practice and to investigate the underlying mechanism of action. This systematic review can be used to begin an investigation of the use of weighted blankets for larger and more diverse populations.
      PubDate: Thu, 12 Mar 2020 00:00:00 GMT
       
  • Interventions Supporting Mental Health and Positive Behavior in Children
           Ages Birth–5 Yr: A Systematic Review
    • Authors: Kingsley K; Sagester G, Weaver LL.
      Abstract: Importance: It is critical for providers to use evidence-based interventions to address mental health and behavioral barriers to occupational performance during early childhood.Objective: To identify evidence-based interventions within the scope of occupational therapy practice to improve mental health and positive behavior for children ages 0–5 yr and their families.Data Sources: PsycINFO, Cochrane, ERIC, MEDLINE, and OTseeker databases were searched for publications from 2010 through March 2017.Study Selection and Data Collection: This review was completed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Risk of bias was assessed for each article using either A Measurement Tool to Assess Systematic Reviews (AMSTAR) or the Cochrane method. Articles meeting inclusion criteria were critically appraised.Findings: Forty-six articles met inclusion criteria and were organized into three themes: touch-based interventions (n = 9), parent–child interaction therapy (PCIT; n = 4), and instruction-based interventions (n = 33). Statistically significant findings and overall risk of bias supported the use of touch-based interventions, PCIT, and parent training.Conclusions and Relevance: The evidence indicates that touch-based interventions can improve infant self-regulation (strong), social behavior, and attachment (moderate) and reduce maternal stress, anxiety, and depression (low). Moderate-strength evidence supports PCIT to improve child behavior. The evidence indicates that parent training can improve parent behavior, maternal–infant attachment (strong), and parent mental health (moderate). Teacher training can improve mental health and behavior (moderate). Group-based parent training and sleep training have insufficient support (low).What This Article Adds: Occupational therapy professionals working with children younger than age 5 yr can use the results of this systematic review to guide clinical decision making related to mental health and behavioral outcomes.
      PubDate: Thu, 12 Mar 2020 00:00:00 GMT
       
  • Rehabilitation Is a Global Health Priority
    • Authors: Heinemann AW; Feuerstein M, Frontera WR, et al.
      Abstract: Optimizing functioning at all ages is a major global public health goal. Rehabilitation is unique in its contribution to this public health agenda because of its focus on optimizing function. In this editorial, the editors of leading rehabilitation journals make the case for fully integrating rehabilitation into a nation’s health system and strengthening it specifically at the primary care level to increase access and achieve its full potential.
      Authors submitting papers to rehabilitation journals are encouraged to consider the global health policy implications of their research when they prepare their research reports for publication and to make these implications explicit.
      PubDate: Thu, 12 Mar 2020 00:00:00 GMT
       
  • Effectiveness of Social Skills Interventions Incorporating Peer
           Interactions for Children With Attention Deficit Hyperactivity Disorder: A
           Systematic Review
    • Authors: Fox A; Dishman S, Valicek M, et al.
      Abstract: Importance: Few studies examining the use of peers during interventions have been published, and no systematic review has been conducted to evaluate the available literature.Objective: To examine the effectiveness of social skills interventions incorporating peers for children with attention deficit hyperactivity disorder (ADHD) to improve social interactions.Data Sources: A search of five databases (CINAHL, PubMed, Web of Science, Google Scholar, and PsycINFO) produced 697 articles. Sixty-one were retrieved for full-text review, and 15 articles met inclusion criteria.Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to abstract data. Inclusion criteria: Participants younger than age 18 yr with any ADHD pattern, social skills interventions with peer involvement, outcome measures within the domain of occupational therapy, written in English, and involved a peer as the sole or primary component at some point in the social skills intervention. Exclusion criteria: Studies older than 20 yr or that used participants with comorbidities or multiple conditions.Findings: Interventions incorporating both peer categories were effective for increasing play skills, reducing undesirable social behaviors (e.g., inappropriate verbalizations, dominant behaviors, aggression), and improving communication (e.g., pragmatic language, collaboration, joint participation) and social participation. Improvements were maintained over time, as evidenced by follow-up studies.Conclusions and Relevance: Outcomes of these studies demonstrate moderate evidence that supports the use of social skills interventions incorporating peers for children with ADHD to improve social interactions, supporting their use by occupational therapists and the need for more studies.What This Article Adds: This article provides guidance to occupational therapy practitioners on social skills intervention options for children with ADHD.
      PubDate: Mon, 09 Mar 2020 00:00:00 GMT
       
  • Occupational Therapy Practice Guidelines for Older Adults With Low Vision
    • Authors: Kaldenberg J; Smallfield S.
      Abstract: Importance: The aging of the population is generating increased demand for occupational therapy practitioners to address the occupational performance of those experiencing low vision.Objective: This Practice Guideline, which is informed by systematic reviews on interventions for older adults with low vision, is meant to serve as a reference for occupational therapy practitioners to guide best practice in service delivery, improve quality of care, enhance consumer satisfaction, and justify occupational therapy services to external stakeholders. Interventions included in this guideline address performance of activities of daily living (ADLs) and instrumental activities of daily living (IADLs), reading, and leisure and social participation.Method: We examined, synthesized, and integrated the results of three systematic reviews into recommendations for practice, education, and research.Results: Thirty-eight articles were included in the systematic reviews, which served as the basis for clinical recommendations. A case study describes translation and application of the recommendations to clinical practice.Conclusions and Recommendations: Strong evidence supports the role of occupational therapy for older adults with low vision. On the basis of the evidence, we recommend routine use of low vision rehabilitation for ADL and IADL impairments, multicomponent interventions to improve ADL and IADL performance and leisure and social participation, stand-based electronic magnification to enhance reading, and visual skills training to enhance reading for clients with a central field impairment. We recommend using client-centered problem-solving training to enhance ADL and IADL performance, reading, and leisure and social participation. Mainstream technology may be considered for use on a case-by-case basis to enhance reading performance. Finally, adapted tango may be considered for use on a case-by-case basis to enhance ADL and IADL performance and leisure and social participation.What This Article Adds: This Practice Guideline provides a summary of the current evidence supporting occupational therapy intervention for older adults with low vision. It summarizes the emerging literature supporting the use of mainstream technology and provides additional support for the use of multicomponent intervention strategies.
      PubDate: Wed, 04 Mar 2020 00:00:00 GMT
       
  • Improving Temporomandibular Range of Motion in People With Duchenne
           Muscular Dystrophy and Spinal Muscular Atrophy
    • Authors: Lloyd Morris E; Estilow T, Glanzman AM, et al.
      Abstract: Importance: People with Duchenne muscular dystrophy (DMD) and spinal muscular atrophy (SMA) develop impaired oral function because of reduced temporomandibular joint range of motion (ROM), which affects feeding and oral hygiene activities of daily living (ADLs).Objective: To assess whether the TheraBite®, an intraoral stretching device, improves ROM.Design: Case series, with intervention duration varying from 7 to 30 mo. Treatment frequency varied from weekly to consultative (several times per year).Setting: Varied depending on the ease of transportation for the participant and caregivers. Two participants were treated in an outpatient medical clinic. The other was provided consultative care during multidisciplinary medical clinics and completed a home program.Participants: Two adults with DMD and one with SMA.Intervention: Stretching protocol using the TheraBite.Outcomes and Measures: Temporomandibular active ROM (AROM) was determined using a disposable TheraBite oral goniometer. Passive ROM (PROM) was determined using the adhesive scale on the TheraBite. Measures were taken at baseline, each intervention or consultation, and the end of care. ADL participation and caregiver burden were measured at the end of intervention.Results: For participants with DMD, AROM remained unchanged, but PROM increased by 40%–65%. The participant with SMA demonstrated 33% and 47% improvements in AROM and PROM, respectively. Participants or caregivers reported improved feeding function, improved oral hygiene, or reduced fatigue.Conclusion: TheraBite may improve temporomandibular PROM in people with DMD and temporomandibular AROM and PROM in people with SMA. It may also improve ADL function and consequently reduce caregiver burden. Further investigation is warranted.What This Article Adds: Temporomandibular contracture in people with DMD and SMA contributes to reduced lifespan and loss of function. Use of the TheraBite with this population may preserve temporomandibular ROM and improve feeding, hygiene, and quality-of-life outcomes.
      PubDate: Tue, 03 Mar 2020 00:00:00 GMT
       
  • Interventions Within the Scope of Occupational Therapy Practice to Improve
           Activities of Daily Living, Rest, and Sleep for Children Ages 0–5 Years
           and Their Families: A Systematic Review
    • Authors: Gronski M; Doherty M.
      Abstract: Importance: Research studies supporting occupational therapy interventions to address feeding, toileting, and sleep can be applied to practice in early intervention and preschool settings to improve the outcomes of young children and their families.Objective: To examine the effectiveness of interventions within the scope of occupational therapy practice to improve activities of daily living, rest, and sleep for children ages 0–5 yr and their families.Data Sources: Five databases (MEDLINE, PsycINFO, CINAHL, OTseeker, ERIC) and Evidence-Based Medicine Reviews, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, and Database of Abstracts of Reviews of Effectiveness were searched for studies published between January 2000 and March 2017.Study Selection and Data Collection: Inclusion criteria were Levels I–III evidence, being within occupational therapy’s scope of practice, including participants with a mean age younger than 6 yr, and addressing self-care, activities of daily living, and rest and sleep.Findings: Forty articles were appraised, and three themes emerged: interventions to address feeding and eating, interventions to address toileting, and interventions to address rest and sleep. Additional subthemes of behavioral approaches, parent and caregiver education, and contextual intervention were revealed.Conclusions and Relevance: Occupational therapy practitioners should consider the use of interventions with moderate or strong evidence as described in this review. Limitations include risk of bias and limited evidence for several interventions.What This Article Adds: This article provides a broader perspective on evidence-based practice by examining studies within the scope of occupational therapy practice published outside of current occupational therapy publications. The review includes studies from nutrition, nursing, and psychology, which address interdisciplinary care, family coaching and education, and behavioral approaches within the professional scope of occupational therapy to improve the functional performance, routines, and quality of life for young children and their caregivers.
      PubDate: Tue, 03 Mar 2020 00:00:00 GMT
       
  • Activity- and Occupation-Based Interventions to Support Mental Health,
           Positive Behavior, and Social Participation for Children and Youth: A
           Systematic Review
    • Authors: Cahill SM; Egan BE, Seber J.
      Abstract: Importance: Children and youth are often challenged to maintain well-being, positive behavior, and social participation.Objective: To identify evidence for occupational therapy interventions for children and youth with and at risk for mental health concerns.Data Sources: Articles published in English-language peer-reviewed journals between January 2010 and March 2017 identified through searches of MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane databases.Study Selection and Data Collection: The methodology in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to complete the review. Of 5,310 articles screened by title and abstract, 357 were retrieved for full-text review, and 62 met inclusion criteria. Articles describing interventions that were activity or occupation based were included. Conference proceedings, non–peer reviewed publications, dissertations, theses, and presentations were excluded.Findings: Of the 62 studies included in the review, 20 (32%) were Level I studies, 22 (36%) were Level II studies, and 20 (32%) were Level III studies. Articles were categorized by type: outdoor camps, video and computer games, productive occupations and life skills, meditation, animal-assisted interventions, creative arts, play, sports, and yoga. Moderate to strong evidence supports the use of yoga and sports. Moderate-strength evidence supports the use of play and creative arts. Evidence for the use of animal-assisted interventions, meditation, video and computer games, and productive occupations was of low strength.Conclusion and Relevance: Substantial evidence exists to support the use of activity- and occupation-based interventions to address the mental health, behavioral, and social participation concerns of children and youth. Occupational therapy practitioners should match the desired outcome of therapy with the appropriate intervention to provide the best and most effective services to their clients.What This Article Adds: This review provides additional support for the use of activity- and occupation-based interventions (i.e., those that involve active participation) to improve the behavior, social participation, and mental health of children and youth.
      PubDate: Mon, 02 Mar 2020 00:00:00 GMT
       
  • Spatial Attention Disregard in Children With Hemiplegic Cerebral Palsy
    • Authors: Wang T; Liang K, Howe T, et al.
      Abstract: Importance: Children with hemiplegic cerebral palsy (CP) demonstrate spatial attention disregard, but the rehabilitation approach to CP is traditionally motor oriented.Objective: To explore spatial attention disregard in children with hemiplegic CP and its relationship to their motor performance in daily activities.Design: Cross-sectional study.Setting: Community.Participants: Twenty-five children with hemiplegic CP and 25 age-matched typically developing children.Outcomes and Measures: For spatial attention performance, the Random Visual Stimuli Detection Task; for developmental disregard, the Observatory Test of Capacity, Performance, and Developmental Disregard; and for motor performance, the Melbourne Assessment 2.Results: Children with hemiplegic CP evidenced spatial attention disregard on their more affected sides, and this phenomenon was correlated with developmental disregard.Conclusions and Relevance: Children with hemiplegic CP demonstrate developmental disregard in both the motor and the visual–spatial attention domains. Including evaluation of and intervention for visual–spatial attention for children with hemiplegic CP in the traditionally motor-oriented rehabilitation approach is recommended.What This Article Adds: This research provides evidence that children with hemiplegic CP demonstrate disregard in the domain of visual–spatial attention. The findings suggest that evaluation of and intervention for visual–spatial attention should be included in CP rehabilitation in addition to the traditionally motor-oriented approach.
      PubDate: Wed, 26 Feb 2020 00:00:00 GMT
       
  • Understanding Policy Influences on Health and Occupation Through the Use
           of the Life Course Health Development (LCHD) Framework
    • Authors: Pitonyak JS; Pergolotti M, Gupta J.
      Abstract: Life course health development (LCHD) is a framework that considers the transactional nature of risks and protective factors along the life trajectory and how this context influences health. Public policies, from health care to education to social services to labor laws, have many goals, including lessening and eliminating health disparities, yet inequities in health services and outcomes remain. Policy is a contextual factor that may be overlooked when examining influences on health and occupation. As such, the LCHD framework may assist occupational therapy practitioners in understanding the influences of policy—both successes and failures—on occupation. In this article, we introduce the principles of LCHD and use this framework to illustrate analysis of a policy example of paid family leave, demonstrating how gaps in or unintended consequences of policy may contribute to disparities in health and occupation for certain populations.
      PubDate: Wed, 05 Feb 2020 00:00:00 GMT
       
  • Pediatric Persistent Pain: Associations Among Sensory Modulation,
           Attachment, Functional Disability, and Quality of Life
    • Authors: Sinclair C; Meredith P, Strong J.
      Abstract: Importance: Although attachment is associated with sensory modulation among children and adolescents and insecure attachment is associated with pain severity among adolescents, relationships among sensory modulation, attachment, and function have not previously been demonstrated in a clinical sample of children and adolescents with complex persistent pain.Objective: To investigate relationships among sensory modulation, attachment, function, and quality of life (QOL) in a pediatric population with persistent pain.Design: Cross-sectional quantitative design. From October 2015 to July 2017, all children, adolescents, and parents attending a clinic for assessment completed questionnaires and were provided information and consent forms. Those who consented completed sensory modulation and attachment questionnaires.Setting: Tertiary pain management clinic.Participants: Children (ages 8–12 yr) and adolescents (ages 13–18 yr) with persistent pain (pain of >3 mo duration or a specific pain disorder) and the capacity to answer questionnaires independently.Measures: Standardized sensory modulation, attachment, pain intensity, functional disability, and QOL questionnaires. Hypotheses were generated before data collection.Results: Of 152 children and adolescents, 114 children (30 girls, 9 boys) and adolescents (68 girls, 7 boys) met study criteria and consented to participate. Hierarchical multiple regression analyses revealed that sensory sensitivity predicted disability for children and adolescents, and attachment anxiety mediated the relationship between low registration and poorer school-related QOL.Conclusion and Relevance: Behaviors related to insecure attachment patterns provide a mediating pathway from sensory modulation to functional disability; addressing such behaviors clinically may facilitate engagement in daily activities for children and adolescents with persistent pain.What This Article Adds: Results support the need to consider the interactions between sensory modulation and attachment when addressing functional abilities with occupational therapy treatment.
      PubDate: Wed, 05 Feb 2020 00:00:00 GMT
       
  • Brain Mapping Performance as an Occupational Therapy Assessment Aid in
           Attention Deficit Hyperactivity Disorder
    • Authors: Chatthong W; Khemthong S, Wongsawat Y.
      Abstract: Importance: Brain mapping performance (BMP) may provide strong predictors to analyze primary functional outcomes and support occupational therapy with clients with attention deficit hyperactivity disorder (ADHD).Objective: To clarify the value of quantitative electroencephalography to indicate BMP in children with ADHD.Design: One-year cross-sectional study.Setting: Brain Computer Interface Laboratory, Mahidol University, Salaya, Nakhon Pathom, Thailand.Participants: Thai school-age children with and without ADHD (N = 305).Outcomes and Measures: We used θ relative power in concordance with stepwise multiple regression analysis. Outcomes included measures of 12 brain locations that were compared between children with and without ADHD.Results: Significant differences were found between the groups, especially for Cz, T3, Fp1, Fz, F4, and F7. According to BMP, the group with ADHD had higher emotional awareness and language comprehension than the group without ADHD.Conclusions and Relevance: Occupational therapy practitioners can use BMP as a valuable tool for setting occupational goals to help children with ADHD improve their social–emotional learning performance in school and in the community. BMP may provide an evaluation to support occupational therapy services for clients with ADHD. The result can be applied in clinical settings by quantitative electroencephalography training.What This Article Adds: BMP can be used as a neuropsychological and behavioral assessment tool for setting SMART (specific, measurable, attainable, relevant, and time-oriented) goals for occupational therapy services for clients with ADHD.
      PubDate: Fri, 31 Jan 2020 00:00:00 GMT
       
  • Interrater Reliability and Concurrent Validity of the Neonatal Eating
           Outcome Assessment
    • Authors: Pineda R; Liszka L, Kwon J, et al.
      Abstract: Importance: Few neonatal feeding assessments are currently available, and the Neonatal Eating Outcome Assessment is the only one that identifies feeding impairment while considering the developmental changes that occur from preterm birth to term-equivalent age.Objective: To determine the interrater reliability and concurrent validity of the Neonatal Eating Outcome Assessment.Design: Prospective, observational study.Setting: Level 4 neonatal intensive care unit.Participants: A convenience sample of 7 neonatal therapists participated in reliability testing. For concurrent validity, a prospective cohort of 52 preterm infants born ≤32 wk gestation had feeding assessed at term-equivalent age.Outcomes and Measures: Intraclass correlations (ICCs) and Fleiss’s κ statistics were used to define reliability across therapists, who independently scored five videos of preterm infants orally feeding using the Neonatal Eating Outcome Assessment. Concurrent validity was determined by evaluating relationships between the Neonatal Oral Motor Assessment Scale (NOMAS) and the Neonatal Eating Outcome Assessment using an independent-samples t test and χ2 analysis.Results: The ICC for the Neonatal Eating Outcome Assessment total score was 0.90 (confidence interval [CI] [0.70, 0.99]). Fleiss’s κ scores for the 19 scorable items on the Neonatal Eating Outcome Assessment had predominately moderate, fair, and slight agreement, with 3 items having poor agreement. Dysfunctional NOMAS scores were related to lower Neonatal Eating Outcome Assessment scores (t[49.4] = 3.72, mean difference = 12.2, 95% CI [5.60, 18.75], p = .001).Conclusions and Relevance: The Neonatal Eating Outcome Assessment has excellent reliability. Concurrent validity was established.What This Article Adds: This article reports that the final version of the Neonatal Eating Outcome Assessment (Version 5.7) has excellent interrater and concurrent validity and is an important tool to assess the occupation of infant feeding in clinical practice.
      PubDate: Tue, 28 Jan 2020 00:00:00 GMT
       
  • Fine Motor Activities in Elementary School Children: A Replication Study
    • Authors: Caramia S; Gill A, Ohl A, et al.
      Abstract: Importance: The educational landscape is continually changing in response to legislation and the adoption of new standards, such as the Common Core. Currently, little is known about how these changes have influenced the school day.Objective: To examine the motor and technology requirements of kindergarten, second-, and fourth-grade general education classrooms.Design: For 6 full school days, we made unobtrusive observations of and took notes that described classroom activities throughout the day. Data were coded by a committee, allocating each minute of the day into 1 of 10 activity categories.Setting: Kindergarten, second-, and fourth-grade classrooms.Participants: Three general education classrooms with approximately 20 students in each class.Results: Students spent between 37.1% and 60.2% of the school day performing fine motor activities, with handwriting accounting for 3.4%–18.0% of the day. Time spent using technology was relatively sparse in kindergarten (4.8%) and second grade (3.1%) compared with fourth grade (14.3%). Transitions between activities (18.9%–23.4% of time spent) exceeded time spent handwriting.Conclusion and Relevance: This article provides an updated estimate of motor demands throughout the school day. Estimates of fine motor activities were consistent with previous research, but the focus on handwriting appears to have substantially diminished.What This Article Adds: Within the context of their own school, occupational therapists may find transitions to be a good opportunity for providing services within the classroom. In addition, handwriting practice outside of school may be more necessary in the current educational climate than in previous years.
      PubDate: Tue, 28 Jan 2020 00:00:00 GMT
       
  • Reliability and Validity of the Chinese Version of the Infant/Toddler
           Sensory Profile
    • Authors: Yang C; Tseng M, Cermak SA, et al.
      Abstract: Importance: In Chinese-speaking societies, a reliable and valid measure is needed to enable early identification of young children’s challenges in sensory processing.Objective: To examine the psychometric properties of the Chinese version of the Infant/Toddler Sensory Profile (ITSP–C) when used with Taiwanese children.Design: Prospective study.Setting: Multiple settings.Participants: Participants were 367 typically developing (TD) infants ages 0–6 mo (mean [M] age = 3.44 mo, standard deviation [SD] = 1.82) and 677 toddlers ages 7–36 mo (M age = 22.33 mo, SD = 8.15), along with 42 toddlers with developmental disabilities (DD; M age = 28.4 mo, SD = 6.7).Outcomes and Measures: The ITSP, a caregiver questionnaire that measures how children respond to sensory events in daily life, was translated and cross-culturally adapted into a Chinese version (ITSP–C).Results: Internal consistency was high for the 0–6 mo subscale (α = .80) and the 7–36 mo subscale (α = .82). Test–retest reliability was excellent for the 7–36 mo subscale (intraclass correlation coefficient = .94). Logistic regression analysis demonstrated that the ITSP–C discriminated between children with DD and TD children.Conclusions and Relevance: The ITSP was successfully adapted to Chinese with similar reliability and validity to the original ITSP. The 7–36 mo subscale had a higher level of reliability than the 0–6 mo subscale, and quadrant scores were more reliable than section scores. Moreover, the ITSP–C discriminated children with DD from TD children on the basis of their sensory processing patterns.What This Article Adds: The ITSP–C has sound psychometric properties and support for its use in early identification of sensory processing difficulties in young Chinese-speaking children.
      PubDate: Tue, 28 Jan 2020 00:00:00 GMT
       
  • Parents’ Perspectives: An Expanded View of Occupational and
           Co-Occupational Performance in the Neonatal Intensive Care Unit
    • Authors: Cardin AD.
      Abstract: Importance: One limitation of occupation-based neonatal practice is the lack of clarity surrounding what parent and infant occupations exist in the neonatal intensive care unit (NICU). Without clear definitions and examples of these constructs, occupational therapists may not recognize or value them as part of practice.Objective: To explore concepts of occupational and co-occupational performance in the NICU and provide richly expanded descriptions of parent and infant occupations in this setting.Design: Phenomenological study with convenience sampling. Participants engaged in semistructured interviews. Inductive content analysis, in vivo and process coding methods, and cross-case analysis were used. Member checking and expert review of emergent themes were used to ensure authenticity.Setting: A metropolitan 48-bed Level 3 NICU with single-family rooms in the midwestern United States.Participants: Fourteen parents (mean age = 29.7 yr; range = 19–37 yr) volunteered for the study.Results: Five themes of active occupational engagement emerged: (1) perceiving “they” versus “I”; (2) maintaining proximity; (3) expressing emotions, values, and beliefs; (4) addressing health issues; and (5) analyzing. A matrix framework displayed emergent themes with definitions of parent occupations, infant occupations, and parent–infant co-occupations. Examples of both directly observable and hidden occupations were found at matrix intersections.Conclusions and Relevance: Occupational performance prevalently reflected attempts to balance power differentials and pursue meaningful engagement through observable and hidden participation in caregiving. Findings suggest that beyond typical occupations (e.g., feeding, socializing), neonatal therapists can address the doing, being, and becoming occupations expressed by parents in this study.What This Article Adds: Parents described five broad thematic categories of NICU-based occupation and co-occupation, which may be valuable to therapists seeking to strengthen the occupational focus of neonatal intervention. Neonatal therapists may need to advocate for service provision policy change to fully address the observable and nonobservable doing, being, and becoming occupational and co-occupational needs of parents and infants.
      PubDate: Tue, 28 Jan 2020 00:00:00 GMT
       
  • Interventions Within the Scope of Occupational Therapy to Improve
           Children’s Academic Participation: A Systematic Review
    • Authors: Grajo LC; Candler C, Sarafian A.
      Abstract: Importance: Occupational therapy practitioners evaluate students’ ability to participate in school and may provide services to improve learning, academic performance, and participation.Objective: To examine the effectiveness of interventions within the scope of occupational therapy practice to improve academic participation of children and youth ages 5–21 yr.Data Sources: We searched MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases for articles published from 2000 to 2017 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Study Selection and Data Collection: Within the scope of occupational therapy practice and focused on children ages 5–21 yr.Findings: Forty-six studies were included, based on three themes: (1) interventions to support participation and learning in the classroom; (2) interventions to support motivation and participation in literacy, including combined reading, written expression, and comprehension; and (3) interventions to support handwriting. Low strength of evidence supports the use of weighted vests and stability balls, and moderate strength of evidence supports the use of yoga to enhance educational participation. Moderate strength of evidence supports the use of creative activities, parent-mediated interventions, and peer-supported interventions to enhance literacy participation. Strong evidence supports therapeutic practice for handwriting intervention, and low strength of evidence supports various handwriting programs as replacement or additional instructional strategies to enhance handwriting abilities.Conclusions and Relevance: More rigorous studies are needed that are conducted by occupational therapy practitioners in school-based settings and that use measures of participation and academic outcomes.What This Article Adds: This systematic review provides occupational therapy practitioners with evidence on the use of activity-based and occupation-centered interventions to increase children’s participation and learning in school.
      PubDate: Tue, 28 Jan 2020 00:00:00 GMT
       
 
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