American Journal of Occupational Therapy

OBJECTIVE. Fear of falling (FoF) after stroke is not well understood. We assessed change in FoF over the first 6 mo after a stroke and compared 6-mo anxiety, depression, balance, and quality of life (QoL) scores between people with and without baseline FoF (at the time of hospital discharge).

METHOD. Data for this longitudinal study were collected at baseline and 6 mo. Of the 28 people included at baseline, 18 remained in the study 6 mo later.

RESULTS. FoF significantly decreased over time (p = .015). Participants with baseline FoF had higher 6-mo anxiety and depression scores (s = .002 and .005, respectively) and lower QoL scores (p < .001) than did those without baseline FoF.

CONCLUSION. The results are suggestive of the need for occupational therapists and their colleagues to consider anxiety and depression variables in managing the needs of poststroke participants experiencing FoF.

OBJECTIVE. We developed a reliable and valid fidelity measure for use in research on Ayres Sensory Integration (ASI) intervention.

METHOD. We designed a fidelity instrument to measure structural and process aspects of ASI intervention. Because scoring of process involves subjectivity, we conducted a series of reliability and validity studies on the process section. Raters were trained to score therapist strategies observed in video recordings of adult–child dyads. We examined content validity through expert ratings.

RESULTS. Reliability of the process section was strong for total fidelity score (ICC = .99, Cronbach’s α = .99) and acceptable for most items. Total score significantly differentiated ASI from four alternative interventions. Expert ratings indicated strong agreement that items in the structural and process sections represent ASI intervention.

CONCLUSION. The Ayres Sensory Integration Fidelity Measure has strong content validity. The process section is reliable and valid when scored by trained raters with expertise in ASI.

Building on established relationships between the constructs of sensory integration in typical and special needs populations, in this retrospective study we examined patterns of sensory integrative dysfunction in 273 children ages 4–9 who had received occupational therapy evaluations in two private practice settings. Test results on the Sensory Integration and Praxis Tests, portions of the Sensory Processing Measure representing tactile overresponsiveness, and parent report of attention and activity level were included in the analyses. Exploratory factor analysis identified patterns similar to those found in early studies by Ayres (1965, 1966a, 1966b, 1969, 1972b, 1977, & 1989), namely Visuodyspraxia and Somatodyspraxia, Vestibular and Proprioceptive Bilateral Integration and Sequencing, Tactile and Visual Discrimination, and Tactile Defensiveness and Attention. Findings reinforce associations between constructs of sensory integration and assist with understanding sensory integration disorders that may affect childhood occupation. Limitations include the potential for subjective interpretation in factor analysis and inability to adjust measures available in charts in a retrospective research.

OBJECTIVE. We investigated the effects of therapy cushions on the in-seat and on-task behaviors of 2 kindergarten students with autism spectrum disorder during math activities.

METHOD. We used a single-subject A–B–A–B–C design across 2 male participants who used chairs during baseline phases (A) and cushions during intervention phases (B). We included a choice phase (C) to determine participant seating preferences. Social validity was addressed by assessing teacher and participant seating preferences. Data were graphed and visually analyzed for functionally relevant changes between phases.

RESULTS. No clinically relevant changes in the in-seat or on-task behaviors of either participant were observed with cushion use.

CONCLUSION. Therapy cushions may not impose sufficient postural demands or provide adequate sensory input to produce behavioral changes. Continued research in this area is needed.

This study describes change in functional performance and self-perception after participation in combined training with physical practice followed by mental practice. The patient was a 44-yr-old White man who experienced a single left ischemic stroke 7 mo before enrollment in the study. He engaged in physical and mental practice of two functional tasks: (1) reaching for and grasping a cup and (2) turning pages in a book with the more-affected arm. Practice took place 3 times per week during 60-min sessions for 6 consecutive wk. Primary outcome measures were the Arm Motor Ability Test (AMAT) and the Canadian Occupational Performance Measure (COPM). An abbreviated version of the Florida Apraxia Battery gesture-to-verbal command test approximated severity of ideomotor apraxia. After intervention, the patient demonstrated increased functional performance (AMAT) and self-perception of performance (COPM) despite persistent ideomotor apraxia. The results of this single-case report indicate functional benefit from traditional rehabilitation techniques despite comorbid, persisting ideomotor apraxia.

OBJECTIVE. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a global scale evaluating the impact of upper-extremity disorders. We sought to validate or challenge the unidimensional factor structure of the DASH.

METHOD. Secondary analysis was performed on data collected from outpatient clinics. Factor analysis was performed in two steps, exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). To provide further support for unidimensionality, fit statistics were calculated using the Andrich Rasch rating-scale model.

RESULTS. EFA revealed three potential factors (eigenvalues = 18.40, 1.56, and 1.54). CFA was performed fitting a three-factor model. Tucker-Lewis Index (.99) and standardized root mean square residual (.05) values indicated good fit. Comparative fit index (.89) and root mean square error of approximation (.13) did not. When divided into three constructs, only one item misfit.

CONCLUSION. More research is needed to determine situations in which division of the DASH may enhance interpretability.

OBJECTIVE. Guided by the Occupational Therapy Practice Framework: Domain and Process (2nd edition; American Occupational Therapy Association, 2008), we conducted an evidence-based review on simulator sickness (SS).

METHOD. We searched Web of Science, PubMed, SafetyLit, Google Scholar, and recently published literature. We used the American Academy of Neurology’s classification criteria to extract data from 10 studies and assign each a level of 1–4, with “1” indicating the highest level of evidence. We grouped studies that addressed SS into client factors, context and environment factors, and activity demands.

RESULTS. Client factors (i.e., older clients [>70 yr; Level B], women [Level B]) and context/environment factors (e.g., refresh rates, scenario design and duration, simulator configuration, and calibration; Level B) probably increase the rates of SS, whereas activity demands (vection, speed of driving, and postural instability; Level C) possibly contribute to SS.

CONCLUSION. We classified factors contributing to SS and identified the need for randomized trials to identify causes of SS.

In the campaign to implement evidence-based practice, the current single-hierarchy model of levels of evidence fails to incorporate at parity all types of research evidence that are valuable in the practice of occupational therapy. A new model, originally developed by Borgetto et al. (2007) and modified and expanded, is presented. By separating the evidence-level criteria of internal and external validity, by incorporating explicitly the evidence provided by qualitative studies, and by retaining the critical notion of rigor, a pyramidal evidence model emerges. This model, the Research Pyramid, aligns itself with the revised model of evidence-based medicine and, more important, with the basic modes of clinical reasoning in occupational therapy. It constitutes a beginning attempt to order evidence-based practice in accordance with the epistemology of the profession. It may better guide occupational therapy research and meta-synthesis and their incorporation into practice decisions.

The American Occupational Therapy Association’s Centennial Vision American Occupational Therapy Association (2007) articulates the strategic goals for the profession to be science driven and evidence based in major practice areas. In the practice area of productive aging, a previous review of research published in the American Journal of Occupational Therapy (AJOT Murphy, 2010) found mostly basic research with far fewer effectiveness studies. The current review article is divided into two parts. Part 1 provides an update on the types of research published on productive aging in AJOT in the past 2 yr (2009–2010). Part 2 examines the range and scope of occupational therapy effectiveness research on productive aging published in a similar time frame in other occupational therapy journals and outside of the discipline.

INTRODUCTION. We evaluated the psychometric properties of the Sensory Experiences Questionnaire (Version 1; Baranek, David, Poe, Stone, & Watson 2006), a brief caregiver questionnaire for young children with autism and developmental delays used to identify sensory processing patterns in the context of daily activities.

METHOD. Caregiver questionnaires (N = 358) were analyzed to determine internal consistency. The test–retest subsample (n = 24) completed two assessments within 2–4 wk. Internal consistency and test–retest reliability were analyzed using Cronbach’s coefficient α and intraclass correlation coefficients, respectively.

RESULTS. Internal consistency for the SEQ was α = .80. Test–retest reliability for the total score was excellent, with ICC = .92.

DISCUSSION. The SEQ is an internally consistent and reliable caregiver report measure of young children’s sensory processing patterns of hypo- and hyperresponsiveness. The SEQ can be used as an early tool for identifying sensory patterns in young children with autism and other developmental disabilities.

We compared anteroposterior and mediolateral range of motion and velocity of the center of pressure (COP) on the horse’s back between riders without disabilities and riders with cerebral palsy. An electronic pressure mat was used to track COP movements beneath the saddle in 4 riders without disabilities and 4 riders with cerebral palsy. Comparisons between rider groups were made using the Mann–Whitney test (p < .05). The two rider groups differed significantly in anteroposterior range of COP motion, mediolateral range of COP motion, and mediolateral COP velocity. Anteroposterior COP velocity did not differ between groups. The results suggest that measurements of COP range of motion and velocity are potentially useful for monitoring changes in balance as an indicator of core stability during equine-assisted activities.

OBJECTIVE. Our purpose in this study was to examine the preclinical curricular content pertaining to driving evaluation and rehabilitation (DE/R) included in professional entry-level occupational therapy programs.

METHOD. An e-mail survey containing questions about the program’s structure and extent of course material related to DE/R in the curriculum was sent to directors of all 144 U.S. accredited professional entry-level occupational therapy programs.

RESULTS. Ninety programs responded (62.5% response rate), of which 80 included content related to DE/R in some required courses, and 9 programs offered a required course specifically in DE/R. Approximately 18% of the respondent programs offered electives with DE/R content.

CONCLUSION. Of the respondent professional entry-level occupational therapy programs, few offer a required course specifically devoted to DE/R, but almost all programs integrate DE/R content into required coursework, thus satisfying the Accreditation Council for Occupational Therapy Education standards related to driver rehabilitation.

The American Occupational Therapy Association (AOTA) has challenged occupational therapy practitioners to advance the profession so that we may become more “powerful” and “widely recognized” by the year 2017 (AOTA, 2007a). To fully achieve this vision, this article argues that the profession should encourage occupational therapy entrepreneurship. As Herz, Bondoc, Richmond, Richman, and Kroll (2005, p. 2) stated, “Entrepreneurship may provide us with the means to achieve the outcomes we need to succeed in the current health care environment.” This article also argues the urgency of seizing the many opportunities that entrepreneurship offers and recommends specific actions to be taken by AOTA and by therapists.

We examined the psychometric characteristics of the Occupational Self Assessment (OSA), which measures clients’ perceptions of their own competence and the value they assign to occupations. Two hundred ninety-six adolescents with acute mononucleosis completed the OSA, the Fatigue Scale, the Checklist of Infectious Symptoms, the Child Health Questionnaire, and the Perceived Stress Scale. OSA items coalesced to capture the intended constructs; the rating scales functioned as intended. More than 90% of adolescents were validly measured. The OSA showed adequate sensitivity and was stable over time. OSA measure of competence was moderately associated with infectious symptoms, fatigue severity, health status, and stress, and the measure of values was not. Neither measure was associated with age, gender, or ethnicity. Finally, adolescents who had not recovered from mononucleosis after 12 mo showed lower competence scores yet attached the same value or importance to occupational participation as adolescents who had recovered.