American Journal of Occupational Therapy

OBJECTIVE. This pilot study compared the effectiveness of 3 postoperative rehabilitation protocols for patients with Zones V and VI extensor tendon lacerations.

METHOD. Twenty-seven patients were recruited from 3 sites and randomly assigned to 1 of 3 established treatment protocols: immobilization, early passive motion (EPM), and early active motion (EAM). Outcome measures were collected at 3, 6, and 12 wk after treatment and included total active motion (TAM).

RESULTS. At the end of Week 12, data on 24 injured digits of 18 patients were available for analysis. When data at Weeks 3, 6, and 12 were compared, patients in all groups showed steady improvement in TAM, but digits under the EAM treatment improved to a greater extent over time (F[2, 46] = 75.6, p < .001).

CONCLUSION. Patients with Zones V and VI extensor tendon injuries treated with the EAM protocol recovered range of motion more rapidly.

OBJECTIVE. This study was a retrospective chart analysis spanning 5 yr that investigated associations between occupational therapy interventions and goal-based positive outcomes in patients with multiple sclerosis (MS) and related disorders at discharge in an urban inpatient rehabilitation setting.

METHOD. Using descriptive statistics, we examined demographic characteristics in the first analysis phase. In the second phase, we performed a series of correlational analyses to identify treatment variables associated with positive outcomes.

RESULTS. Generally, patients improved in their FIM™ scores at discharge. Increasing occupational therapy intensity had a positive effect on functional performance in all categories except feeding, with significant correlations in upper-extremity dressing (r = .153, p < .05) and memory (r = .204, p < .01).

CONCLUSION. Occupational therapy was associated with positive functional outcomes for patients with MS. Future treatment protocols should include cognitive skills training, community reintegration, and self-care, because these treatments were found to be significantly correlated with positive changes in FIM scores.

OBJECTIVE. We sought to determine whether mental practice is an effective intervention to improve upper-limb recovery after stroke.

METHOD. We conducted a systematic review of the literature, searching electronic databases for the years 1985 to February 2009. We selected studies according to specified criteria, rated each study for level of evidence, and summarized study elements.

RESULTS. Studies differed with respect to design, patient characteristics, intervention protocols, and outcome measures. All studies used imagery of tasks involving movement of the impaired limb. The length of the interventions and number of practice hours varied. Results suggest that mental practice combined with physical practice improves upper-limb recovery.

CONCLUSION. When added to physical practice, mental practice is an effective intervention. However, generalizations are difficult to make. Further research is warranted to determine who will benefit from training, the dosing needed, the most effective protocols, whether improvements are retained, and whether mental practice affects perceived occupational performance.

OBJECTIVE. We assessed evidence for post–acute traumatic brain injury (TBI) rehabilitation interventions used to enhance community integration (CI) relevant to occupational therapy.

METHOD. We conducted a systematic review of intervention studies on TBI rehabilitation from 1990 to 2007.

RESULTS. We analyzed and summarized 10 studies that met the inclusion criteria. Of 10 studies, 7 found that post–acute TBI rehabilitation benefits CI; all effective studies involved occupational therapy or involved interventions occupational therapists can do.

CONCLUSION. Many CI programs show positive results and should be studied more rigorously. Such promising programs should also be considered when decisions about post–acute TBI rehabilitation services for clients are being made. To further establish that post–acute TBI rehabilitation interventions improve CI, future studies should include intervention strategies based on injury severity, a control group, and longer term follow-up. The role of occupational therapy in these effective programs should be further explored.

OBJECTIVE. Conventional methods for managing upper-extremity (UE) spasticity are invasive, usually require readministration after a certain time period, and do not necessarily increase UE function. This study examined efficacy of combining two singularly efficacious modalities—UE bracing and electrical stimulation—with functional training to reduce UE spasticity and improve function.

METHOD. Two chronic stroke patients exhibiting UE spasticity were administered the Modified Ashworth Scale (MAS), the upper-extremity section of the Fugl-Meyer Impairment Scale (FM), the Box and Block Test (B&B), and the Arm Motor Ability Test (AMAT). They were then individually fitted for a brace and subsequently participated in treatment sessions occurring 2 days/wk for 5 wk, consisting of (1) 30-min clinical sessions, during which the UE was braced in a functional position while cyclic electrical stimulation was applied to the antagonist extensors of the tricep and forearm, and (2) 15-min, clinically based training sessions, occurring directly after the clinical session.

RESULTS. After intervention, participants exhibited 1-point reductions in MAS scores for the affected fingers, FM score increases, and increased ability to perform AMAT activities,. Three months later, both participants retained these changes.

CONCLUSION. Data point to a noninvasive, promising method of managing spasticity and rendering functional changes.

This case report describes the use of the Occupational Therapy Task-Oriented Approach with a client with occupational performance limitations after a cerebral vascular accident. The Occupational Therapy Task-Oriented Approach is often suggested as a preferred neurorehabilitation intervention to improve occupational performance by optimizing motor behavior. One common critique of this approach, however, is that it may seem inappropriate or have limited application for clients with cognitive deficits. This case report demonstrates how an occupational therapist working in an inpatient rehabilitation setting used the occupational therapy task-oriented evaluation framework and treatment principles described by Mathiowetz (2004) with a person with significant cognitive limitations. This approach was effective in assisting the client in meeting her long-term goals, maximizing her participation in meaningful occupations, and successfully transitioning to home with her daughter.

OBJECTIVE. This case report addresses the use of therapeutic occupations and activities within a modified constraint-induced movement therapy (mCIMT) approach for a 52-yr-old female violinist 4 yr after ischemic stroke.

METHOD. Analysis of occupational performance was completed before and after intervention using a modified version of the Fugl-Meyer Sensorimotor Evaluation, the Motor Functioning Assessment, the Arm Improvement and Movement Checklist, and information obtained from a client journal maintained throughout treatment. The mCIMT protocol included use of constraint of the affected arm, with emphasis placed on participation in meaningful occupations and activities.

RESULTS. Improved function in the affected extremity was noted at the conclusion of mCIMT. After completion of therapy, the client reported a return to playing violin.

DISCUSSION. The findings from this case report suggest that use of meaningful occupations and activities integrated into a mCIMT protocol may be effective in addressing skills deficits for clients with upper-extremity chronic hemiparesis.

OBJECTIVE. We studied whether Grade 4–6 students who participated in a kinesthetic writing intervention improved in legibility, speed, and personal satisfaction with cursive handwriting.

METHOD. Small groups of students with handwriting difficulties were seen weekly for 7 wk using a kinesthetic writing system. A repeated measures design was used to evaluate change in global legibility, individual letter formation, specific features of handwriting, and personal satisfaction.

RESULTS. Analysis revealed (1) a significant increase in ratings of global legibility (p < .01; clinically significant improvements in 39% of students); (2) significant improvements in letter formation and legibility features of baseline, closure, and line quality (all p < .05); (3) increased handwriting speed (p < .05; not clinically significant); and (4) significant increase in measures with personal satisfaction of handwriting (p < .01).

CONCLUSION. A kinesthetic handwriting intervention may be effective in improving the skills of students with handwriting challenges.

OBJECTIVE. We developed the Assessment of Children’s Hand Skills (ACHS) to evaluate hand skills using naturalistic observation and examined the assessment's interrater and test–retest reliability.

METHOD. We developed the hand skill framework, performed expert review, and pilot tested the ACHS. The ACHS's reliability was examined by recruiting 54 children (30 typically developing children and 24 children with disabilities).

RESULTS. The test–retest reliability for the ACHS was satisfactory at the individual item level (0.42 ≤ κ ≤ 0.79) and the total scale level (Spearman’s ρ = 0.78, p < .01). Moderate interrater agreement of the total scale scores was demonstrated (ρ = 0.63, p < .01), but individual items exhibited varied interrater agreement.

CONCLUSION. The ACHS demonstrated adequate content validity and preliminary reliability evidence and could be used to quantify children’s hand skill use. Construct validity should be established in a clinical setting.

OBJECTIVE. The objective was to determine whether the School Version of the Assessment of Motor and Process Skills (School AMPS) is valid when used to evaluate students in different world regions.

METHOD. Participants were 984 students, ages 3–13 yr, from North America, Australia and New Zealand, United Kingdom, and the Nordic countries, matched for age and diagnoses. We used FACETS many-faceted Rasch analyses to generate item difficulty calibrations by region and evaluate for significant differential item functioning (DIF) and differential test functioning (DTF).

RESULTS. Four School AMPS items demonstrated DIF but resulted in no DTF.

CONCLUSION. This study provided support for occupational therapists using the School AMPS to evaluate students’ quality of schoolwork task performances across regions because the School AMPS measures are free of bias associated with world region.

This study investigated early intervention occupational therapists’ use of strategies to teach caregivers. A sample of 40 videotapes made by early intervention occupational therapists was randomly selected from an archival videotape data set of provider home visits. The sample included 20 videotapes illustrating traditional services and 20 videotapes illustrating therapists providing participation-based services. Videotapes were rated using the Teaching Caregivers Scale, which rates three variables on 30-s intervals: (1) routine, (2) provider role, and (3) strategies used to teach caregivers during early intervention home visits. Regardless of the model of service, explicit teaching strategies were rarely used during home visits.

This study was conducted to develop and validate the Health Enhancement Lifestyle Profile (HELP), a self-report measure for examining various aspects of health-related lifestyle in older adults. Data derived from 253 community-dwelling older adults were analyzed through the Rasch measurement model. Unidimensionality and data-model fit of HELP were largely supported through the analyses of principal components of residuals, fit statistics, local dependency, and differential item functioning. The item hierarchy formed through logits provided an expected pattern of healthy lifestyle behaviors. Acceptable to good person separation and reliability statistics supported the clinical applicability and consistency of the HELP scores. Finally, analysis of the rating scale structure confirmed the functioning of the 0- to 5-point rating scale used. HELP can assist in monitoring lifestyle risk factors and measuring the outcome of services aimed at promoting healthy lifestyles among older adults.

We describe the development and evaluation of a clinical research training program designed specifically for such health professionals as occupational and physical therapists. Outcomes of program success included trainees’ self-rating of research skills before and after the program, as well as submission of a formal grant application to a grant competition for program participants. At program completion, participants reported improvements in their research skills, with the most gain in formulating research questions and writing a testable hypothesis and the least gain in understanding statistics. Of the 21 participants, 43% submitted a grant proposal to a competitive intramural grant program. In the next year, grantees of the program will continue to be mentored by the program mentors while conducting their research projects. Given the initial successes, this program represents a promising model for providing research training to practicing clinicians.

OBJECTIVE. We compared observed and reported practice among children with special health care needs transported in wheelchairs with the recommendations from the American National Standards Institute/Rehabilitation Engineering and Assistive Technology Society of North America Committee on Wheelchairs and Transportation voluntary standards for best practice for using wheelchairs in vehicles.

METHOD. A convenience sample of vehicles exiting the garage of a children’s hospital was observed. Certified child passenger safety technicians gathered driver demographics and the child’s reported medical condition, weight, age, clinic visited, and relation to the driver. Technicians observed how the wheelchair and occupant were secured.

RESULTS. A sample of 20 vehicles showed that 90% used four-point tie-down systems to secure the wheelchairs. A total of 88% of drivers tied the wheelchairs down correctly; only 20% used a separate lap–shoulder belts to secure the occupants. Twenty-five percent used lap trays, which are not recommended. Fifteen participants traveled with medical equipment secured inappropriately.

CONCLUSION. Many deviations from best practice were observed and highlight areas for increased awareness, education, and resources for caregivers.

OBJECTIVE. The objective was to determine the reliability of a portable forearm strength hydraulic dynamometer with a doorknob handle and assess its validity compared with a Cybex 6000 (Cybex International, Inc., Medway, MA) isometric torque assessment.

METHOD. Eighteen volunteers (with a total of 30 forearms) participated in this one-session methodological study to determine the intra- and interrater reliability and criterion validity of a forearm dynamometer.

RESULTS. Intrarater reliability for both assessors for pronation was (intraclass correlation coefficient [ICC]_3,1 = .937–.961) and for supination was (ICC_3,1 = .923–.968). Interrater reliability for pronation was ICC_3,2 = .927 and for supination was ICC_3,2 = .847. Criterion validity of the Baseline hydraulic dynamometer (Fabrication Enterprises Inc., White Plains, NY) compared with the Cybex 6000 was .574–.664 for pronation and .749–.750 for supination.

CONCLUSION. The Baseline hydraulic dynamometer with a more functional doorknob handle had good intra- and interrater reliability and demonstrated moderate validity compared with Cybex 6000 strength testing.

In this review, 39 articles published in the American Journal of Occupational Therapy in 2008 and 2009 that were categorized in the practice area of children and youth were examined using content analysis. The most frequent type of research published was basic research, which accounted for 38.5% (n = 15) of the 39 studies published on the topic. Instrument development and testing and effectiveness studies were the next two most frequently noted research approaches, accounting for 25.6% (n = 10) and 20.5% (n = 8) of the studies, respectively. Among the 8 effectiveness studies, the level of evidence distribution was as follows: Level I, 3; Level III, 2; Level IV, 1; and Level V, 2. Quantitative studies were the predominant research paradigm used with 76.9% (n = 30) of the studies.