American Journal of Occupational Therapy

Systematic reviews of literature relevant to adults with Alzheimer’s disease and their families are important to the practice of occupational therapy. We describe the seven questions that served as the focus for systematic reviews of the effectiveness of occupational therapy interventions for adults with Alzheimer’s disease and their families. We include the background for the reviews; the process followed for each question, including search terms and search strategy; the databases searched; and the methods used to summarize and critically appraise the literature. The final number of articles included in each systematic review; a summary of the results; the strengths and limitations of the findings; and implications for practice, education, and research are presented for the six questions addressing interventions in the areas of occupation, perception, environment, activity demands, fall prevention, and caregiver strategies.

An evidence-based review was undertaken to answer the question, “What is the evidence for the effect of interventions designed to establish, modify, and maintain activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure, and social participation on quality of life (QOL), health and wellness, and client and caregiver satisfaction for people with Alzheimer’s disease and related dementias?” A systematic search of electronic databases and application of inclusion and exclusion criteria guided the selection of 26 articles. Limited high-level evidence on ADL interventions was identified. IADL interventions for people living in the community showed promise. Tailored and activity-based leisure interventions were common and seemed to have positive impacts on caregiver satisfaction, and some interventions had positive results for client well-being and QOL. Social participation interventions focused on people with dementia still able to engage in verbal social interactions; these interventions had at least short-term positive effects.

An evidence-based review was undertaken to answer the question, “What is the evidence for the effect of interventions designed to modify and maintain perceptual abilities on the occupational performance of people with Alzheimer’s disease and related dementias?” A systematic search of electronic databases and application of inclusion and exclusion criteria guided the selection of 31 articles. Each article was critically appraised, and the evidence was synthesized. Some interventions use remaining perceptual abilities to enable people to find their way in a facility and decrease attempts at exiting. Preliminary evidence has supported use of visual stimulation and barriers. We found some evidence for the use of auditory stimuli and group therapy that aim to change perceptual abilities. Research with high-level evidence is required to validate these findings. Evidence on the benefits of Snoezelen® is not conclusive for occupational performance outcomes; further research to justify its use as an occupational therapy intervention may be warranted.

A systematic review of evidence for the efficacy of environment-based interventions on the affect, behavior, and performance of people with Alzheimer’s disease and related dementias was conducted as part of the American Occupational Therapy Association’s Evidence-Based Literature Review Project. Thirty-three reports met inclusion criteria. Results suggest that ambient music, aromatherapy, and Snoezelen^® are modestly effective in reducing agitation but do not consistently have long-term effects. Visually complex environments that give the illusion of barriers deter people from wandering to unsafe places but do not reduce the urge to wander. Evidence that bright light therapy can aid in regulating mood and the sleep–wake cycle and thus help people remain awake during the day is preliminary. Montessori-based programming can be useful in matching activities to the person’s remaining skills. Further research is needed to evaluate the long-term effect, contraindications, and best dosages of these interventions.

A systematic review of evidence for the effectiveness of modification of activity demands in the care of people with Alzheimer’s disease (AD) was conducted as part of the American Occupational Therapy Association’s Evidence-Based Literature Review Project. The review included 10 articles addressing occupations of self-care and leisure. No reports related to work and social participation were located. Results suggest that evidence for this intervention’s effectiveness is strong. Four practice principles were derived from this appraisal: (1) Occupational therapy programs should be individualized to elicit the person’s highest level of retained skill and interest, (2) cues used while assisting people with AD to complete tasks should be short and provide clear direction, (3) compensatory strategies in the form of environmental modifications and simple adaptive equipment should be specifically implemented on the basis of the unique needs of the person, and (4) caregiver training and involvement are essential in implementing individualized programs.

A systematic review was conducted to determine the effectiveness of interventions to prevent falls in people with Alzheimer’s disease (AD) and related dementias. Twelve research reports met inclusion criteria. Studies reported on three types of intervention: (1) exercise- and motor-based interventions, (2) nursing staff–directed interventions, and (3) multidisciplinary interventions. Strategies were offered as single or multifaceted intervention programs. All types of intervention resulted in benefit, although the evidence for effectiveness is tentative because of the studies’ limitations. More research is needed to better understand appropriate dosages of intervention. No evidence was found for the effectiveness of prevention programs accessed as part of occasional respite care. Occupational therapy was seldom involved in the interventions researched. Because effective fall prevention programs are embedded in people’s daily routines and encouraged participation in occupation, the contribution occupational therapy practitioners can make to the care of people with AD has yet to be fully realized.

A systematic review of evidence of the effectiveness of educational and supportive strategies for enabling caregivers of people with Alzheimer’s disease (AD) or related dementias to maintain participation in that role was conducted as part of the American Occupational Therapy Association’s Evidence-Based Literature Review Project. Forty-three articles met inclusion criteria. Results suggest that interventions that jointly engage people with AD and their caregivers in education and training in the home setting are more successful than strategies that focus solely on people with AD. Greater carryover is noted when education and training are implemented at the time that the caregiver identifies concerns. Interventions should provide caregivers with problem solving, technical skills, support, simple home modification strategies, and referral to community resources. Interventions mediated by technology have a positive effect on the caregiver and are especially important for those who live in rural areas.

A recent randomized controlled trial (RCT) of a dual parent and trainer-delivered qigong massage intervention for young children with autism resulted in improvement of measures of autism as well as improvement of abnormal sensory responses and self-regulation. The RCT evaluated the effects of the parent-delivered component of the intervention. Forty-seven children were randomly assigned to treatment and wait-list control groups. Treatment group children received the parent-delivered program for 4 mo. Trained therapists provided parent training and support. Improvement was evaluated in two settings—preschool and home—by teachers (blind to group) and parents. Results showed that the parent-delivered program was effective in improving measures of autism (medium effect size) and sensory and self-regulatory responses (large effect size). Teacher data on measures of autism were confirmed by parent data. Results indicate that the parent-delivered component of the program provided effective early intervention for autism that was suitable for delivery at home.

OBJECTIVE. This study measured skill improvement in prewriting skills, kindergarten readiness, first-name writing, and handwriting-nonspecific fine motor skills of students at Head Start who participated in Handwriting Without Tears®–Get Set for School (HWT–GSS) programming.

METHOD. We conducted a two-group, nonrandomized controlled trial using a pretest–posttest design at a rural Head Start. The effectiveness of adding the HWT–GSS curriculum in one preschool classroom was compared with a control classroom.

RESULTS. On posttesting, the experimental group made significant improvements compared with the control group in prewriting, kindergarten readiness, and fine motor skills. Both groups made significant improvements between pretesting and posttesting in prewriting, first name writing, and school readiness.

CONCLUSION. Adding HWT–GSS to the Head Start program would be beneficial in improving handwriting readiness skills.

OBJECTIVE. We examined rater and test–retest reliability of the Preschool Imitation and Praxis Scale (PIPS).

METHOD. We administered the PIPS to 119 typically developing children ages 1.5–4.9 yr.

RESULTS. The PIPS demonstrated acceptable intra- and interrater reliability on item level (k_w = 0.45–1) and scale level (intraclass correlation coefficient ICC = 0.996; 95% CI: 0.968–0.999 and ICC = 0.995; 95% CI: 0.990–0.997, respectively). The smallest detectable difference of the PIPS was 5.6%, indicating that the change score rated by different raters for an individual child is valid and that the PIPS can be used by different raters as an outcome measure to determine children’s improvement or maturation. Results of test–retest analysis revealed that the PIPS score is stable over time (r = .93).

CONCLUSION. The PIPS appears to meet the required standards regarding objectivity and stability. The PIPS may assist clinicians and researchers in evaluating and reevaluating preschoolers’ imitation ability, which is a primary learning strategy of young children.

OBJECTIVE. We used screening tests administered by a certified driving rehabilitation specialist and by Parkinson’s disease (PD) specialty neurologists to develop a model to predict on-road outcomes for patients with PD.

METHOD. We administered a battery of screening tests to 41 patients with PD and 41 age-matched control participants before on-road testing. We used statistical models to predict actual on-road performance.

RESULTS. The PD group had a higher failure rate, indicating more on-road errors. For the PD participants, the Useful Field of View (UFOV) Subtest 2 and Rapid Pace Walk were responsible for most of the variance in the on-road test. The model accurately categorized pass–fail outcomes for 81% of PD patients.

CONCLUSION. Clinical screening batteries may be predictive of driving performance in PD. The UFOV Subtest 2, administered in approximately 15 min, may be the single most useful clinical test for such predictions.

The practicality and patient compliance of constraint-induced movement therapy limit its application in many clinical environments. For more than a decade, the principal investigator's laboratory has shown efficacy of an outpatient, modified constraint-induced therapy (mCIT). The current study examined whether participants administered mCIT retained motor changes 3 mo after intervention. The upper-extremity section of the Fugl-Meyer Impairment Scale (FM) and the Action Research Arm Test (ARA) were administered directly after mCIT intervention. Thirteen patients poststroke were tracked prospectively from directly after intervention concluded to 3 mo after intervention, at which time the FM and ARA were readministered. Three months after intervention, 25 of the 26 scores on the FM and ARA increased between the time after intervention and 3 months after intervention, reflecting continued increases in affected extremity movement ability. It is believed that the continued motor changes were caused by the comparatively larger number of extremity-use opportunities during the 10-wk mCIT intervention period. These opportunities encourage habitual extremity use even after the intervention period has concluded, leading to the changes observed.

Nearly 50 million Americans report some level of disability in activities of daily living or instrumental activities of daily living. Public health officials advocate for a fresh perspective on disability by considering disability through an epidemiological approach. Should occupational therapists perform this research, and what are the benefits for our profession if we do? This article advocates for enhancing our research knowledge base by including an epidemiological perspective in our research design. The benefits to occupational therapy of this research include (1) increased understanding of the extent and nature of occupational performance disability, (2) advancement of the scope and depth of research for prevention and intervention programs, and (3) improved visibility of the profession as informants for public health policy. Suggestions for preparing researchers to perform these studies and students and practitioners to interpret the studies are provided.

OBJECTIVE. The relation between prenatal cocaine exposure and quality of movement was studied at 4 mo using the Posture and Fine Motor Assessment of Infants (PFMAI–I).

METHOD. Posture and fine motor scores of 4-month-old infants exposed to cocaine in utero (n = 370) were compared with an unexposed group (n = 533) within the context of gestational age, medical and demographic characteristics, and level of prenatal substance exposure using the PFMAI–I.

RESULTS. Infants prenatally exposed to cocaine had significantly lower posture scores than infants in the unexposed group. There was no main effect of cocaine exposure on fine motor scores; however, there were independent effects of gestational age at birth on both posture and fine motor scores at 4-mo corrected age.

CONCLUSION. These findings demonstrate independent contributions of prenatal cocaine exposure and prematurity to risk of motor delay and support the validity of the PFMAI–I as a measure of motor competence in early infancy.