American Journal of Occupational Therapy

We examined the effects of a cotaught handwriting and writing program on first-grade students grouped by low, average, and high baseline legibility. The program’s aim was to increase legibility, handwriting speed, writing fluency, and written expression in students with diverse learning needs. Thirty-six first-grade students in two classrooms participated in a 12-wk handwriting and writing program cotaught by teachers and an occupational therapist. Students were assessed at pretest, posttest, and 6-mo follow-up using the Evaluation Tool of Children’s Handwriting–Manuscript (ETCH–M) and the Woodcock–Johnson Writing Fluency and Writing Samples tests. Students made large gains in ETCH–M legibility (η² = .74), speed (η²s = .52–.65), Writing Fluency (η² = .58), and Writing Samples (η² = .59). Students with initially low legibility improved most in legibility; progress on the other tests was similar across low-, average-, and high-performing groups. This program appeared to benefit first-grade students with diverse learning needs and to increase handwriting legibility and speed and writing fluency.

OBJECTIVE. This article describes the development of a brief, ecologically valid, self-report questionnaire, the Adolescents and Adults Coordination Questionnaire (AAC–Q), used to identify developmental coordination disorder (DCD) in adolescents and adults.

METHOD. The AAC–Q was completed by 28 adolescents and adults with suspected DCD ages 16–35 yr (mean [M] age = 21.18 yr) and 28 peers without DCD (M age = 27.64 yr). Cutoff scores for suspected DCD were established using data from a sample of 2,379 participants ages 19–25 yr (M age = 20.68 yr).

RESULTS. Reliability of the AAC–Q was determined using Cronbach’s α (α = .88) and test–retest reliability (r = .94, p < .001). Independent-sample t tests to assess construct validity revealed significant differences between participants with and without DCD, t(27) = 9.37, p < .001.

CONCLUSION. The AAC–Q is a standardized, reliable, and valid tool with potential for both research and clinical use.

In this study we sought to validate the discriminant ability of the Evaluation Tool of Children’s Handwriting–Manuscript in identifying children in Grades 2–3 with handwriting difficulties and to determine the percentage of change in handwriting scores that is consistently detected by occupational therapists. Thirty-four therapists judged and compared 35 pairs of handwriting samples. Receiver operating characteristic (ROC) analyses were performed to determine (1) the optimal cutoff values for word and letter legibility scores that identify children with handwriting difficulties who should be seen in rehabilitation and (2) the minimal clinically important difference (MCID) in handwriting scores. Cutoff scores of 75.0% for total word legibility and 76.0% for total letter legibility were found to provide excellent levels of accuracy. A difference of 10.0%–12.5% for total word legibility and 6.0%–7.0% for total letter legibility were found as the MCID. Study findings enable therapists to quantitatively support clinical judgment when evaluating handwriting.

In this retrospective, longitudinal cohort study, the Pediatric Evaluation of Disability Inventory was used to predict the effects of cerebral palsy (CP) on self-care, mobility, and social function for 2,768 children, adolescents, and young adults with CP. Multiple linear regression was used to predict functional performance and level of caregiver assistance and found that CP severity, as measured by the Gross Motor Function Classification System and the Manual Ability Classification System, had the strongest effect. More severe levels of gross motor and fine motor dysfunction resulted in lower levels of self-care, mobility, and social function and increased levels of caregiver assistance. This study provides critical evidence regarding the importance of CP severity as a predictor of self-care, mobility, and social function that can be tested in future research to improve therapy treatment planning, caregiver education, and clinical resource utilization.

OBJECTIVE. Hospitalized older people are at risk of functional decline, and risk increases with length of stay (LOS). We measured the impact on LOS and discharge destination of targeted occupational therapy and a functional conditioning program (FCP) for older adults admitted to a metropolitan trauma unit.

METHOD. The intervention group consisted of 50 participants >65 yr old living independently in the community before admission. Outcomes were compared with historical control group data (N = 105).

RESULTS. The intervention group’s mean LOS was 2 days less than that of the control group (p = .04). A higher proportion in the intervention group was also discharged to home, but the difference was not statistically significant. Referrals to occupational therapy increased significantly (p = .05), and participants were seen 1.5 days sooner (p = .003) than the control group. Referral to FCP was 7 times higher in the intervention group (p = .001).

CONCLUSION. Targeted occupational therapy and FCP can improve LOS in older trauma patients.

OBJECTIVE. We examined the effects of engaging in the occupation-based intervention of life review through writing on expressed depressive symptoms as measured with the Geriatric Depression Scale in older adults residing in senior residences.

METHOD. The study design was a randomized controlled trial that took place in four senior residences in New York City. Forty-five participants (23 treatment, 22 wait-list control) ≥65 yr old participated in the 8-wk, once-weekly autobiographical writing workshop, Share Your Life Story (Sierpina, 2002).

RESULTS. Depressive symptoms were significantly less prevalent for the treatment group than for the control group after the 8-wk life review program (repeated-measures analysis of variance p = .03).

CONCLUSION. The results suggest that the Share Your Life Story writing workshop is an effective occupation-based intervention for occupational therapists to use with older adults who reside in senior residences.

OBJECTIVE. I evaluated the effect of a culturally tailored, peer-led support group intervention on improvement in adherence behaviors of Mexican-American older adults with type 2 diabetes mellitus and obtained feedback on the cultural relevance of the manual that structured the intervention.

METHOD. The one-group pretest–posttest design used five self-report questionnaires and blood testing to measure change among 4 men and 12 women, ages 60–85.

RESULTS. Empowerment, self-efficacy, and attitude were highly significant at 2-, 4-, and 6-mo posttests. Glycosylated hemoglobin test results were significant at p < .05 between pretest and 2-mo posttest with a stabilizing effect on the 6-mo posttest.

CONCLUSION. Mexican-American older adults’ adherence may improve with a culturally sensitive, structured peer-led program with indirect consultation from an occupational therapist.

Ottenbacher (1986) showed the usefulness of single-subject design (SSD) in occupational therapy. However, SSD methodology is not regarded by the wider research community as providing statistically reliable and valid evidence of effectiveness of treatment partly because of its observational nature. Although statistical estimations can also be made from least squares regression or by a trend line, a new methodology has great potential to influence research in occupational therapy. The new model enables the use of initial client data from the beginning of treatment (for single subjects or small groups) to determine a point in the linear regression at which predictions can be made for the number of treatments needed for stability or improvement. This model is invaluable for third-party payment as well as for client motivation. The purpose of this article is to present this new methodology, the semiparametric ratio estimator (SPRE), illustrated by case application to treatment of obesity.

Sixteen of 100 full-time occupational therapists are injured while performing manual patient handling techniques. We developed a Theory of Planned Behavior self-report questionnaire to determine what educators teach and the behavioral constructs that best predict intention to change curriculum content. Traditional manual patient handling and safe patient handling methods were investigated. The results showed that both methods are taught in most programs; however, only 22% stated that they teach safe patient handling as the standard of practice. Stepwise regression analysis demonstrated that attitude and perceived behavioral control are the best predictors of intention to continue teaching manual transfers as the standard; however, normative belief and attitude best predict intention to teach safe patient handling as the standard. Knowing these predictors will assist in developing strategies to promote a paradigm shift in the way patient transfers are taught.

OBJECTIVE. This study investigated the immediate effects of repetitive neuromuscular electrical stimulation (NMES)–assisted grasp-and-release activities on the hand of patients with tetraplegia.

METHOD. Three participants with C-5–C-6 tetraplegia underwent grasp training with sequential application of NMES to wrist extensors, finger flexors, and finger extensors to assist participants in grasping and then releasing balls. Before the intervention, participants were assessed with the Jebsen–Taylor Hand Function Test and the Box and Block Test. They were evaluated with the same measures after the first and eighth sessions of intervention. Participants participated in eight 30-min sessions over 14 days.

RESULTS. Within-participant improvements in performance were observed in all outcome measures. Subtests of the Jebsen–Taylor Hand Function Test requiring grasping function showed the greatest improvements. Participants reported reduction of spasticity and more effective grasp.

CONCLUSION. NMES-assisted grasp paired with repetitive task practice resulted in improved performance on functional tests and subjectively improved hand function in the participants.

OBJECTIVE. This study sought to validate the use of the Self-Report Assessment of Functional Visual Performance (SRAFVP) as a measure of the severity of activity of daily living (ADL) limitations in people with homonymous hemianopia (HH).

METHOD. Thirty adults with HH from stroke rated their level of difficulty in completing the SRAFVP.

RESULTS. The Cronbach’s αs of the SRAFVP and its three subscales (Reading, Eye–Hand Coordination, and Functional Mobility) ranged from .73 to .99. All three subscales were significantly correlated with each other and with the total SRAFVP score. Paired t tests revealed that Functional Mobility was significantly less difficult for participants to complete than Reading or Eye–Hand Coordination. Participants with complete HH reported greater difficulty in completing the Reading tasks than those with macular sparing.

CONCLUSION. The SRAFVP demonstrated acceptable reliability and validity in evaluating the severity of ADL impairment in people with HH.

OBJECTIVE. We examined the test–retest reliability and internal consistency of the Sensory Profile Caregiver Questionnaire (SP).

METHOD. Fifty-five primary caregivers of children 36–72 mo old participated in the study. Participants completed the SP on two separate occasions 7–14 days apart. Participant data were analyzed using intraclass correlation coefficients (ICCs) and Cronbach’s α coefficients.

RESULTS. Test–retest reliability was good across quadrant scores (ICC_{[2, 1]} = .80–.90) and moderate to good across factor (ICC_{[2, 1]} = .69–.88) and section scores (ICC_{[2, 1]} = .50–.87). Internal consistency was high across quadrant (αs = .89–.95) and factor scores (αs = .82–.93) and moderate to high across section scores (αs = .67–.93).

CONCLUSION. This study suggests the SP has acceptable test–retest reliability and internal consistency and supports the use of quadrant scores over factor and section scores to analyze children’s sensory processing patterns.

Occupational therapists have many intervention tools available for working with clients having a neurological injury; however, some of the most innovative and effective methods have not gained acceptance by many clinicians. Emerging research and new technologies provide occupational therapists with a multitude of treatment strategies and novel devices, but incorporation of those tools into clinical practice appears to be limited by the time necessary to learn about the intervention, educational requirements associated with implementation, or lack of awareness regarding the evidence supporting the use of such tools. Strategies to combat this trend include educating clinicians on evidence-based methods for neurological rehabilitation, aligning academics with practitioners to translate evidence into practical treatment strategies, and accepting that occupational therapy can use these innovations as a means toward state-of-the art, occupation-based practice.

OBJECTIVE. This study examined the ability of a two-part self-report instrument, the McDonald Play Inventory, to reliably and validly measure the play activities and play styles of 7- to 11-yr-old children and to discriminate between the play of neurotypical children and children with known learning and developmental disabilities.

METHOD. A total of 124 children ages 7–11 recruited from a sample of convenience and a subsample of 17 parents participated in this study.

RESULTS. Reliability estimates yielded moderate correlations for internal consistency, total test intercorrelations, and test–retest reliability. Validity estimates were established for content and construct validity.

CONCLUSION. The results suggest that a self-report instrument yields reliable and valid measures of a child’s perceived play performance and discriminates between the play of children with and without disabilities.

A review of the productive aging articles published in the American Journal of Occupational Therapy during 2011 was conducted and discussed in light of meeting the Centennial Vision charge of supporting practice through evidence. Twelve articles that specifically addressed productive aging were published in AJOT in 2011. The review of these 12 articles found seven Level I studies. Six of the articles were systematic reviews identifying effective interventions for people with Alzheimer’s disease and related dementias and their caregivers, and 1 was a randomized controlled trial of fall prevention in community-dwelling older adults. Five were basic research studies. Two of the 5 studies researched professional issues, and 3 addressed client-based issues. The quantity of productive aging research published in 2011 was consistent with the quantity reported in 2009 and 2010. More studies building the body of evidence about the effectiveness of occupational therapy with older adults are needed.