American Journal of Occupational Therapy

OBJECTIVE. We sought to determine whether children with sensory processing disorder (SPD) differ from typically developing children on a neurophysiological measure, the P300 component of event-related potentials produced in response to brief auditory stimulation.

METHOD. We used electroencephalographic measures (i.e., N200 and P300 components) to examine auditory processing in 20 children with SPD and 71 typically developing children, ages 5–10 yr.

RESULTS. Children with SPD demonstrated significantly smaller P300 amplitudes and shorter N200 latencies than typically developing children. Brain activity correctly distinguished children with SPD from typically developing children with 77% accuracy. We also found a significant relationship between the neurophysiological measures and functional performance on sensory and motor tasks.

CONCLUSION. This study presents empirical evidence that children with SPD display unique brain processing mechanisms compared with typical children and, therefore, provide further evidence for the neural deviations associated with SPD.

OBJECTIVE. We examined the interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function.

METHOD. Three occupational therapists independently scored 34 videotaped assessments of children with hemiplegic cerebral palsy aged 6 yr, 1 mo, to 14 yr, 5 mo. Intraclass correlation coefficients (ICCs) at a 95% confidence interval were calculated for total scores, category scores, and item scores.

RESULTS. The correlation between raters’ total scores was high (ICC = .961). The highest correlation for test components between raters was found for fluency (ICC = .902), followed by range of movement (ICC = .866), and the lowest correlation was found for quality of movement (ICC = .683). The ICCs for individual test item scores varied and ranged from .368 to .899.

CONCLUSION. This study demonstrated high interrater reliability for total scores, with scoring of some individual components and items requiring further consideration from both a clinical and a research perspective.

The executive function (EF) deficits of children with attention deficit hyperactivity disorder (ADHD) hinder their performance of complex daily functions. Despite the existing evidence-based pharmacological interventions for ADHD symptoms, no intervention has yet been found that deals directly with EFs in daily tasks. Fourteen children and their parents participated in the Cognitive–Functional (Cog–Fun) program in occupational therapy, which is tailored to the executive dysfunction of ADHD and focuses on enabling cognitive strategies for occupational performance. The study included initial assessment of EFs (Behavior Rating Inventory of Executive Functions; Tower of London^DX), occupational performance (Canadian Occupational Performance Measure), 10 sessions of Cog–Fun intervention with each child–parent dyad, and postintervention and 3-month follow-up assessments. We found significant improvements with medium to large effects on outcome measures after intervention, and most effects were maintained at follow-up. The findings warrant controlled studies examining the effectiveness of this intervention for children with ADHD.

We evaluated the effects of stability balls on in-seat and on-task behavior of students with attention and hyperactivity concerns. A group of 8 students in the 4th and 5th grades was observed 3 times/wk for 12 wk using a single-subject A–B continuous time-series design. We analyzed data collected from standardized measures and classroom observations for mean differences across pre- and postintervention phases. Results of the stability ball intervention revealed increased levels of attention, decreased levels of hyperactivity, and increased time on task and in seat or on ball. Findings from the social validity questionnaire demonstrated that teachers preferred the stability balls over chairs. This study provides additional evidence for the effectiveness of stability balls in the general education classroom for children who exhibit difficulties with attention and hyperactivity.

OBJECTIVE. We report the results of a preschool-based multidisciplinary intervention program.

METHOD. This study took place in two educational settings and included 81 preschool boys from unique cultural backgrounds and of low social economic status (SES). The settings were randomly assigned to an intervention or control group. In the intervention group, boys identified as at risk for or with developmental delays received 8 mo. of intervention through a monitoring model. Additionally, a collaborative consultation model was used with all participants. Performance skills (visual–motor integration, motor, and cognitive) and performance and participation in preschool activities were evaluated at pretest and posttest.

RESULTS. At termination of intervention, all children in the intervention group scored significantly better than control children on most performance skills and more fully participated in preschool activities.

CONCLUSION. A multidisciplinary preschool early intervention program appears to assist children of low SES with improving their performance skills, and participation in preschool activities.

A growing body of research, including evidence from numerous randomized controlled trials, suggests that constraint-induced movement therapy (CIMT) reduces impairment. The mean age of participants in most studies has been <65 yr, even though most stroke survivors are older than that. We investigated the efficacy of a modified CIMT protocol on participation, activity, and impairment in a population of older adults experiencing subacute stroke. Using an interrupted time series design, 4 older adults (mean age = 82) were assessed before and after intervention. Although none of the participants adhered to the 6-hr per day self-practice aspect of the CIMT protocol, considerable improvements were noted in participation, as measured using the Canadian Occupational Performance Measure. Some improvements were also noted at the level of impairment and activity. This work accords with previous literature on CIMT and has important implications for the evolution of stroke rehabilitation in elderly people.

OBJECTIVE. We determined differences in driving errors between combat veterans with mild traumatic brain injury and posttraumatic stress disorder and healthy control participants.

METHOD. We compared 18 postdeployed combat veterans with 20 control participants on driving errors in a driving simulator.

RESULTS. Combat veterans were more likely to be male; were younger; and had more racial diversity, less formal education, and lower cognitive scores than control participants. Control participants made more signaling errors (t [19] = −2.138, p = .046, SE = 0.395), but combat veterans made more overspeeding (t [17.3] = 4.095, p = .001, SE = 0.708) and adjustment-to-stimuli (t [17] = 2.380, p = .029, SE = 0.140) errors. Young age was related to overspeeding.

CONCLUSION. Combat veterans made more critical driving errors than did control participants. Such errors made on the road may lead to crashes or injuries. Although limited in generalizability, these findings provide early support for developing safe driving interventions for combat veterans.

OBJECTIVE. We reviewed the evidence regarding the effectiveness of community occupational therapy interventions, delivered alone or within a multidisciplinary team, in improving occupational outcomes for adults with selected chronic diseases.

METHOD. We completed a scoping review of randomized controlled trials published from 1988 through 2008. Studies included participants with heart disease, depression, rheumatoid arthritis, osteoarthritis, chronic obstructive pulmonary disorder, or diabetes.

RESULTS. Sixteen studies met the inclusion criteria. Ten studies found significant differences between intervention and control groups for at least one outcome of function in activities of daily living, functional self-efficacy, social or work function, psychological health, general health, or quality of life. Conflicting evidence exists regarding the impact of intervention on physical function and health.

CONCLUSION. Occupational therapy can improve occupational outcomes in adults with chronic diseases. Using and building on this evidence, occupational therapists can continue to promote their role in helping to meet this population's needs.

OBJECTIVE. We explored expectations for outcomes during a research intervention for people with stroke.

METHOD. Twelve people with chronic stroke participated in this secondary analysis from a pilot trial of a high-repetition, task-specific, upper-extremity intervention. First, we examined relationships between individual expectancy and session-by-session achievement of high numbers of repetitions. Second, we examined the relationship between expectancy for the intervention as a whole and improvements in upper-extremity motor function. We used Spearman rank-order correlation coefficients to evaluate the relationships.

RESULTS. Correlations between individual expectancy and session-by-session achievement ranged from 0 to .84. Expectancy for improvement from the intervention was good (average = 7 of 10) but had a low correlation (.17) with actual improvement.

CONCLUSION. Individual expectancy ratings were inconsistently related to session-by-session achievement. Expectancy for the invention as a whole was not related to improvement in upper-extremity motor function.

OBJECTIVE. We examined the predictive validity of a job-specific functional capacity evaluation (FCE) in relation to the return to work of patients with a distal radius fracture.

METHOD. Return-to-work recommendations for 194 participants with a distal radius fracture were based on FCE performance. Three months after the evaluation, participants were contacted to ascertain their employment status to examine the predictive validity of each FCE-based rating.

RESULTS. The recommendation return to previous job (94.83%) was correct more often than the recommendations do not work at the moment (60.47%), change job (52.63%), and return to previous job with modifications (9.38%). A longer period from injury to FCE and compensable injury reduces the predictive ability of job-specific FCE.

CONCLUSION. Job-specific FCE shows a better predictive validity in relation to the return to work of patients with a specific injury, such as a distal radius fracture, than of patients with a nonspecific injury.

OBJECTIVE. We compared the pattern of cognitive deficits exhibited by people with schizophrenia at Allen Cognitive Level (ACL) 4 with that of people at Level 5.

METHOD. Participants were classified into two groups on the basis of their ACL Screen scores: ACL 4 (n = 35) and ACL 5 (n = 41). We assessed cognitive functions and psychotic symptoms in all participants.

RESULTS. Multivariate analysis of covariance controlling for gender and negative symptoms revealed that people at ACL 4 performed significantly worse than those at ACL 5 on processing speed, verbal memory, and working memory. The discriminant analysis with all cognitive variables produced a classification accuracy of 78% in differentiation of cognitive levels.

CONCLUSION. We verified the validity of the hierarchy of cognitive disability for ACLs 4 and 5 in people with schizophrenia.

I present the findings of a study aimed at developing an in-depth understanding of how engagement in occupation influences young adults’ ability to effectively manage diabetes and, conversely, how their diabetes self-management strategies shape their occupational participation. The qualitative interview-based study of 8 people ages 19–25 with Type 1 diabetes revealed that study participants often experienced tension between diabetes self-management and participation in valued occupations, which required them to make calculated decisions about how to balance these competing priorities in their everyday lives. Seven themes are discussed in detail that characterized the relationship between participating in valued occupations and attending to the complex factors that dictate successful diabetes self-management. This research offers a preliminary framework for occupational therapists to assist young adults with diabetes and other chronic illnesses in reconciling these competing demands.

OBJECTIVE. To begin to address the shortage of driving rehabilitation and community mobility programs to meet the community mobility needs of older adults and clients with rehabilitative needs, we sought to identify the key barriers to developing and sustaining such programs.

METHOD. We used a survey design to solicit input from a nationally representative sample of occupational therapy practitioners, rehabilitation managers, and health care administrators.

RESULTS. The 2,869 completed surveys revealed widespread and largely contextual barriers related to fiscal support, infrastructure, physical environment, and institutional culture. The barriers were highly correlated with each other and did not differ across regions, practitioner experience levels, or facility types.

CONCLUSION. This study was an important preliminary step in constructing a resource toolkit with strategies to overcome the identified barriers to developing and sustaining driving and community mobility programs that meet the needs of older adults and clients with rehabilitative needs. This toolkit, which is available on the American Occupational Therapy Association’s Web site, is a necessary resource for use in all practice settings to meet the driving and community mobility needs of this population in support of engagement in community-based occupations.

I reviewed articles published in the American Journal of Occupational Therapy (AJOT) in 2009 and 2010 to assess (1) whether research was published in the practice area of rehabilitation, disability, and participation and (2) the evidence being produced in an underdeveloped subcategory of this practice area: cognitive rehabilitation after stroke. The review revealed one intervention effectiveness study that addressed cognitive rehabilitation poststroke published in the 2-year period. Further analysis of outside repositories of evidence in this area revealed that although some evidence supports rehabilitation approaches for people with cognitive dysfunction after a stroke, little research has been devoted to this practice area. The poststroke cognitive intervention approaches in use have been shown to have little or no effect on improving everyday life activity. Occupational therapy has a key research and practice role with the poststroke population, and occupational therapists should be at the forefront in developing the science to support the effectiveness of their services.