American Journal of Occupational Therapy

OBJECTIVE. We compared the effectiveness of constraint-induced movement therapy (CIMT) with bilateral treatment of equal intensity for chronic upper-extremity (UE) dysfunction caused by cerebrovascular accident (CVA).

DESIGN. We conducted a 2-group, randomized intervention trial with stratification by severity of UE dysfunction. Twelve community-dwelling adults were provided with 6 hr of occupational therapy for 10 days plus additional home practice. Six participants wore a mitt on the unimpaired UE, and 6 participants were intrusively and repetitively cued to use both UEs. The Wolf Motor Function Test (WMFT) and the Canadian Occupational Performance Measure (COPM) were administered before and after treatment and at 6-mo follow-up.

RESULTS. Significant improvements were found in WMFT and COPM scores across time in both groups. No significant between-group differences were found on the WMFT.

CONCLUSION. High-intensity occupational therapy using a CIMT or a bilateral approach can improve UE function in people with chronic UE dysfunction after CVA. Treatment intensity rather than restraint may be the critical therapeutic factor.

People with traumatic brain injury (TBI) experience memory and learning difficulties. Difficulty in the initial acquisition of information is a primary reason people with TBI experience difficulties in learning and memory. Treatment focusing on improving the acquisition of information will likely improve both recall and recognition performance. In the “generation effect,” items self-generated are remembered better than items read or otherwise provided. The purpose of this study was to examine the application of the generation effect in improving memory for functional activities. The study used a within-subjects design and included 10 participants with TBI and 15 healthy control participants. Results demonstrated that material learned under the generated learning conditions was recalled better than when generated under provided learning conditions. This finding was true in both the TBI and the control groups. These results provide initial evidence supporting the use of self-generation to improve new learning of functional tasks for people with TBI.

OBJECTIVE. We assessed mobility device skills in a lived-in environment on a community mobility skills course (CMSC) and related those skills to previously demonstrated skills in a controlled environment on an inside mobility skills course (IMSC).

METHOD. Six mobility device users were selected from 91 adults who had previously completed the IMSC. Each of the following device groups was represented: power wheelchair, manual wheelchair, scooter, cane, crutch, and walker. CMSC tasks were modified from IMSC tasks and designed using materials in the community.

RESULTS. All participants completed at least half of the CMSC tasks faster than they completed the corresponding IMSC tasks. The number of tasks on which participants improved and the amount of improvement varied by difficulty of task and mobility device used.

CONCLUSION. Some mobility device skills used in controlled environments appear to transfer to community settings; others do not. Skills required for community participation may partially depend on mobility device used.

Intrarater and interrater reliability were determined for middle finger range of motion (ROM) using the Rolyan finger goniometer. Seven raters measured ROM 3 times (trials) on 20 healthy adults. Intraclass reliability analysis and analysis of variance was used to assess the consistency and stability of measures. Level of significance was set at p ≤ .05. Significant differences (p < .05) existed between raters for metacarpophalangeal, proximal interphalangeal, and distal interphalangeal active finger ROM measurements and for metacarpophalangeal and proximal interphalangeal passive range of motion. Intrarater reliability ranged from .43 to .99 (single measure intraclass coefficient). Interrater reliability ranged from .24 to .95, with passive measures lower than active measures. These results provide clinicians with evidence for using this specific goniometer and issues associated with various therapists assessing finger ROM.

OBJECTIVE. We assessed the psychometrics of a self-administered survey modification of the Activity Card Sort (modified; ACSm) when used to track activity resumption after stem cell transplantation (SCT).

METHOD. Thirty-six participants completed the ACSm for a descriptive pilot study of recovery after SCT. Reliability was assessed by determining the longitudinal consistency of participants’ designation of an activity as never done versus done previously and by calculating internal consistency. Construct validity was assessed by correlating the ACSm scores with measures of quality of life, performance status, and perceived cognitive impairment.

RESULTS. Participants gave consistent designations for 72% of items. Internal consistency of the total score was α > 0.86 at all assessments. The ACSm scores were correlated with quality of life (r = 0.51, p = .0019), functional well-being (r = 0.59, p = .0002), and performance status (r = 0.42, p = 0.011) and not associated with cognitive impairment (r = .22, p = .19).

CONCLUSION. The ACSm demonstrated provisional evidence of reliability, internal consistency, and construct validity.

OBJECTIVE. To determine whether changes in hearing, cognition, depression, and vision affect daily life participation and whether screening tests that identify problems could be used in the home.

METHOD. Interviewers assessed presence of medical conditions, social class, distance acuity, cognition, hearing, depression, and participation using valid screening tools. Participation scores were subgrouped according to negative or positive results. Multiple regression analysis determined association of screening tests with participation.

RESULTS. Eighty-eight older adults, ages 62–90, participated. Positive screening tests were found in 43% of participants for distance acuity, 9% for cognitive problems, 8% for depression, and 15% for hearing loss. Relationships were found among age, cognition, depression, and vision and participation.

CONCLUSION. Mild levels of decreased vision, depression, and decreased cognition are associated with lower participation. These conditions can be screened by occupational therapists and managed to help older adults remain active and maintain their health.

OBJECTIVE. We describe the development and preliminary psychometric properties of an assessment to quantify the magnitude of an environmental barrier’s influence on occupational performance.

METHOD. The assessment was developed and then piloted on a group of 77 older adults before and after an occupational therapy intervention focused on environmental barrier removal. Refinements were made to the assessment before it was evaluated for interrater reliability in a sample of 10 older adults using 2 raters.

RESULTS. The In-Home Occupational Performance Evaluation (I–HOPE) is a performance-based measure that evaluates 44 activities in the home. The 4 subscales of Activity Participation, Client’s Rating of Performance, Client’s Satisfaction With Performance, and Severity of Environmental Barriers are sensitive to change in the environment. The subscales’ internal consistency from .77 to .85, and intraclass correlation coefficients ranged from .99 to 1.0.

CONCLUSION. This preliminary study suggests that the I–HOPE is a psychometrically sound instrument that can be used to examine person–environment fit in the home.

OBJECTIVE. Most occupational therapy interventions for caregivers are designed to reduce negative consequences of caregiving by building skills to manage problem behaviors and dependence. However, therapists may be missing an opportunity to provide interventions that directly help caregivers to emphasize and act on positive aspects of care. We describe care-related thinking and action processes of long-term caregivers who report positive effects related to caring for a spouse with dementia.

METHOD. We analyzed data from 15 experienced and uplifted (reporting improved well-being from caregiving) spouse caregivers to describe how they think about and carry out their care duties.

RESULTS. We describe two primary themes of caregiver thinking and action: (1) engaging in positive behaviors and (2) making adjustments in attitudes.

CONCLUSION. These findings support a new focus for occupational therapy caregiver intervention that promotes a positive approach to thinking about and enacting care tasks.

OBJECTIVE. Our goal in this study was to determine the effect of seated position on upper-extremity access to augmentative communication for a child with cerebral palsy.

METHOD. A single-subject ABAB design was used with one 5-yr-old participant. We compared accuracy and speed of selection of targets on a speech-generating device in the participant’s typical position and in an intervention position. The intervention position conformed to current clinical conventions and research on promoting upper-extremity movement. The intervention position was achieved through simple modifications to the participant’s typical seating.

RESULTS. Accuracy of target selection was moderately improved in the intervention position compared with the typical position.

CONCLUSION. Results provide preliminary empirical evidence of the positive effects of functional seating on access to augmentative communication for children with cerebral palsy. Further research is required to confirm the positive effect of the intervention position across other people who use augmentative communication.

OBJECTIVE. To report on a cognitive testing study on newly constructed items designed to evaluate client-reported outcomes of activity performance and participation after spinal cord injury (SCI).

METHOD. Thirty-three children with SCI and 13 caregivers participated in cognitive testing interviews. Open-ended questions were used to gain a better understanding of activity performance and participation. The interviews were transcribed verbatim. A thematic analysis was carried out independently by 2 researchers, and key sentences and phrases from both analyses were merged.

RESULTS. Four themes were defined: (1) apprehension related to activity performance and participation, (2) reference point, (3) missing out, and (4) autonomy.

CONCLUSION. Insight into children’s and caregivers’ perspectives provided important information that helped refine the wording of test items and response scales. The theme of autonomy provided a stronger catalyst to solidify items for both child- and parent-reported outcomes. This study further validated the complexity of the construct of participation.

OBJECTIVE. Our aim in this study was to investigate the relationship between (a) the manual abilities of children with cerebral palsy (CP), assessed with the Manual Ability Classification System (MACS) in a school rehabilitation setting, and (b) the children’s performance of self-care activities at home, assessed with the Pediatric Evaluation of Disability Inventory (PEDI). In addition, we assessed the interobserver reliability of the MACS.

METHOD. Sixty-one children with CP were included (mean age = 10.3 yr, range = 5–14). The MACS was classified by 2 independent raters. The PEDI was scored in a structured interview.

RESULTS. The Spearman correlation coefficient between the MACS and the self-care domain of the PEDI Caregiver Assistance Scale was high and statistically significant (r = .72). The interobserver reliability of the MACS was good (weighted κ = .86).

CONCLUSION. The MACS is a reliable instrument in a school environment and is related to the performance of daily life self-care activities at home.

To ensure that researchers and practitioners make valid interpretations from children’s self-reports, evidence must demonstrate that the self-report has appropriate psychometric properties. The Child Occupational Self Assessment (COSA) is a self-report of occupational competence and value for everyday activities designed to involve children in identifying goals and assessing outcomes. Five hundred two children with disabilities, ages 6–17, completed the COSA. We used a Rasch Partial Credit model and parametric and nonparametric statistics to obtain validity evidence. Evidence suggests that the COSA has good content, structural, and substantive validity as given by item and child fit statistics and unidimensionality evaluation. Evidence for external validity was mixed because child fit status and measures varied with some demographic and assessment administration variables. Evidence suggests that most children’s responses to the COSA can be validly interpreted as indicators of occupational competence and value for everyday activities.

OBJECTIVE. We examined the internal consistency and construct validity of the Children’s Leisure Assessment Scale (CLASS), which measures multidimensional participation in children’s and adolescents’ leisure activities.

METHOD. The questionnaire’s content and face validity were first established, followed by a factor analysis of the CLASS’s frequency domain of the responses of 249 children and adolescents. Internal consistency was evaluated for each of the factors, and construct validity was established by examining gender differences.

RESULTS. The factors showed acceptable levels of internal reliability (Cronbach’s α ranged from .57 to .83). We found that girls participated in significantly more self-enrichment activities and instrumental indoor activities, with greater preference. However, boys participated in significantly more games and sports activities.

CONCLUSION. The CLASS shows good internal reliability and may be useful in the future as a clinical and research tool in occupational therapy for evaluating leisure activities among typically developing children and adolescents.

OBJECTIVE. Physical and psychological health indicators of mothers who gave birth to medically complex infants were examined to explore potential risk factors for the development of chronic conditions and to develop a scholarly base that supports the inclusion of maternal health in the scope of early intervention practice.

METHOD. Ten mothers completed the Perinatal Posttraumatic Stress Disorder Questionnaire and the State Trait Anxiety Form Y–1. Nine women completed 24-h Holter recording. Frequency of symptoms of posttraumatic stress disorder (PTSD) and anxiety were determined. High frequency heart rate variability was examined for indicators of autonomic dysregulation.

RESULTS. Nine of 10 women reported symptoms associated with PTSD, and 2 of these women reported more severe symptoms. Two women demonstrated indicators of autonomic dysregulation.

CONCLUSION. Further research examining psychological and physical characteristics in mothers of infants at high risk is important to determine whether these women are at greater risk for chronic health conditions.

OBJECTIVE. We examined the relation of health-promoting behaviors to participation in life roles and health-related quality of life (HR–QOL) in women with multiple sclerosis.

METHOD. We used a correlational design. Frequency of health-promoting behaviors was obtained from the Health-Promoting Lifestyle Profile–II. Role participation was measured by the SF–36 Role-Physical, Role-Emotional, and Social Functioning scales, and HR–QOL was measured with the Physical and Mental Component scales.

RESULTS. Eleven significant positive correlations were found among specific health-promoting behaviors (e.g., nutrition, stress management, physical activity, positive interpersonal relations, spiritual growth), role participation, and HR–QOL.

CONCLUSION. The findings suggest that involvement in health-promoting behaviors is associated with greater participation in life roles and HR–QOL for women with multiple sclerosis. This study provides preliminary evidence for the use and development of health promotion in occupational therapy treatment.

We reviewed the mental health articles published in the American Journal of Occupational Therapy (AJOT) from 2008 through 2009 in light of meeting the Centennial Vision charge of supporting practice through evidence. Seven articles that addressed mental health practice were published in AJOT over these years. Review of the articles found that only two addressed effectiveness of occupational therapy intervention; one was rated as Level II evidence, and the other was rated as Level V evidence. Two articles addressed instrument development and testing. Three articles were basic research studies that expanded consideration about the needs of people with mental health conditions. Scholars and clinicians have begun to embrace the charge of the Centennial Vision to support practice with evidence and continue to embrace mental health practice but have a distance to travel. We hope that in the coming years, the profession will see more evidence published in AJOT supporting mental health as practiced by occupational therapists.