American Journal of Occupational Therapy

OBJECTIVE. We compared children’s self-care performance and caregivers’ perception of children’s performance on functional goals established for children with hemiplegic cerebral palsy (CP) after unimanual constraint-induced movement therapy (CIMT) or hand–arm bimanual intensive training (HABIT).

METHOD. Sixteen children with CP were randomized to the CIMT or HABIT group. Interventions lasted for 15 days, 6 hr/day, totaling 90 hr. We used the Pediatric Evaluation of Disability Inventory and the Canadian Occupational Performance Measure (COPM) to assess the children’s daily functioning and mixed analyses of variance to compare group means on functional test scores before and after intervention.

RESULTS. Both groups showed significant improvements on functional measures. Group × Assessment interaction in COPM performance revealed greater improvements for the HABIT group after intervention (p = .04).

CONCLUSION. The results suggest that specificity of training exists only for performance of specific goals established by parents and that both CIMT and HABIT can be used to increase children’s daily functioning.

OBJECTIVE. We explored the efficacy of robotic technology in improving handwriting in children with impaired motor skills.

METHOD. Eighteen participants had impairments arising from cerebral palsy (CP), autism spectrum disorder (ASD), attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), or other disorders. The intervention was robotic-guided three-dimensional repetitive motion in 15–20 daily sessions of 25–30 min each over 4–8 wk.

RESULTS. Fine motor control improved for the children with learning disabilities and those ages 9 or older but not for those with CP or under age 9. All children with ASD or ADHD referred for slow writing speed were able to increase speed while maintaining legibility.

CONCLUSION. Three-dimensional, robot-assisted, repetitive motion training improved handwriting fluidity in children with mild to moderate fine motor deficits associated with ASD or ADHD within 10 hr of training. This dosage may not be sufficient for children with CP.

OBJECTIVE. We developed an observational tool, the Comprehensive Observations of Proprioception (COP), for identifying proprioceptive processing issues in children with developmental disabilities.

METHOD. Development of the COP underwent three phases. First, we developed items representing proprioceptive functions on the basis of an extensive literature review and consultation with occupational therapists. We then established interrater reliability and content, construct, and criterion validity. Finally, we completed a factor analysis of COP ratings of 130 children with known developmental disabilities.

RESULTS. Adequate validity and reliability were established. Factor analysis revealed a four-factor model that explained the underlying structure of the measure as it was hypothesized.

CONCLUSION. The COP is a valid criterion-referenced short observational tool that structures the clinician’s observations by linking a child’s behaviors to areas identified in the literature as relevant to proprioceptive processing. It takes 15 min to administer and can be used in a variety of contexts, such as the home, clinic, and school.

OBJECTIVE. We piloted the Weekly Calendar Planning Activity (WCPA), a performance-based measure of executive function (EF), to establish a baseline for at-risk adolescents.

METHOD. Participants were 113 youths ages 16–21 who were enrolled at a charter school for youth returning to high school after dropping out. We administered the WCPA and collected demographic information.

RESULTS. On average, participants spent 15.9 min on the WCPA, made 7.9 errors, and followed 4.0 of 5 possible rules. No ceiling effect was observed in overall accuracy. Participants used a mean of 3.1 strategies (standard deviation = 1.9) while completing the WCPA. Participants who used more strategies spent more time planning and completing the task and were more accurate.

CONCLUSION. The WCPA may be useful to occupational therapists as a performance measure of EF. This assessment allows evaluation of complex task performance, strategy use, self-evaluation of performance, and error patterns, which can be used in developing intervention strategies.

OBJECTIVE. We examined the sensitivity of the Evaluation of Social Interaction (ESI) as a measure of the overall quality of social interaction in children as they engage in social exchanges in a natural context with typical social partners.

METHOD. We compared the ESI measures of 23 children with disabilities with those of 23 children without disabilities, matched by age and gender.

RESULTS. Paired t-test analysis revealed a statistically significant difference, t(22) = −4.065, p = .001, in the quality of social interaction for the two groups of children, indicating sensitivity of the ESI.

CONCLUSION. The results support the use of the ESI to measure quality of social interaction in a natural context.

OBJECTIVE. Pencil grasps other than the dynamic tripod may be functional for handwriting. This study examined the impact of grasp on handwriting speed and legibility.

METHOD. We videotaped 120 typically developing fourth-grade students while they performed a writing task. We categorized the grasps they used and evaluated their writing for speed and legibility using a handwriting assessment. Using linear regression analysis, we examined the relationship between grasp and handwriting.

RESULTS. We documented six categories of pencil grasp: four mature grasp patterns, one immature grasp pattern, and one alternating grasp pattern. Multiple linear regression results revealed no significant effect for mature grasp on either legibility or speed.

CONCLUSION. Pencil grasp patterns did not influence handwriting speed or legibility in this sample of typically developing children. This finding adds to the mounting body of evidence that alternative grasps may be acceptable for fast and legible handwriting.

OBJECTIVE. I evaluated the effectiveness of the California Tri-Pull Taping method for clients with poststroke inferior shoulder subluxation of the glenohumeral joint.

METHOD. Ten participants were followed for 9 wk using an interrupted time series quasi-experimental single-subject ABA design to examine shoulder pain, activities of daily living (ADL) function, active range of motion, tape comfort, and subluxation.

RESULTS. The California Tri-Pull Taping method decreased inferior subluxation significantly from baseline to intervention but not at postintervention. Active range of motion was significantly increased in shoulder flexion and abduction between the baseline and intervention and the intervention and postintervention phases. Functional ADL scores were significant. The taping was reported to be comfortable. No significant difference in pain was found.

CONCLUSION. This intervention is a promising adjunct to the management of the hemiplegic subluxed shoulder that warrants further research.

This study is the first phase of research aimed at developing new educational approaches to enhance occupational therapy students’ orthosis fabrication skills. Before the effectiveness of training can be determined, a method for evaluating performance must be established. Using the Delphi method, we developed a global rating scale and checklist for evaluating technical competence when fabricating metacarpophalangeal (MCP) joint–stabilizing orthoses. To determine the reliability and validity of these tools, three evaluators used them to assess and score orthotic fabrication performance by experienced and student occupational therapists. The results suggest that these measurement tools are valid and reliable indicators of the technical skills involved in fabricating an MCP joint–stabilizing orthosis. Future studies should focus on building on these tools to evaluate communication skills, technical skills for making other types of orthoses, and effectiveness of training programs.

To clarify expectations for mature cutting skills and investigate the influences of cutting task and scissor type, we videotaped 60 typical adults cutting three shapes with two different types of scissors. The videotapes were reviewed, and 38 aspects of grasp and cutting motions were rated. Percentages of participants who used a particular grip or cutting motion for each shape with each scissor type were reported and compared. Findings included variations in grasp that depended on the scissor type used and variations in cutting motions that depended on the shape being cut. Improved understanding of mature scissor skills and the effect of variations in the cutting task and scissor type used will allow more effective assessment of and intervention for children and adults with cutting difficulties. Specific implications for practice are discussed.

The Health Enhancement Lifestyle Profile–Screener (HELP–Screener) is a 15-item self-report questionnaire conceptually excerpted from the original 56-item HELP. This article describes the development and validation of the HELP–Screener with a sample of 483 community-dwelling older adults. Data derived from the sample were first analyzed using the Rasch dichotomous model. Unidimensionality and data–model fit of the HELP–Screener were largely supported by the analyses of principal components of residuals, fit statistics, local dependency, differential item functioning, and item hierarchy. To delineate the clinical significance of the test results, the cutoff score for the HELP–Screener was established through the mean and standard deviation generated from the study sample. The HELP–Screener can serve as a time-efficient screening for identifying older adults who may require a comprehensive evaluation through HELP and, as a result, who may benefit from a lifestyle intervention. Of note, more studies are planned to further corroborate psychometric properties of this new instrument.

OBJECTIVE. We evaluated the effects of occupation-based intervention on poststroke upper-extremity (UE) motor recovery, neuroplastic change, and occupational performance in 1 research participant.

METHOD. A 55-yr-old man with chronic stroke and moderately impaired UE motor function participated in 15 sessions of occupation-based intervention in a hospital setting designed to simulate a home environment. We tested behavioral motor function (Fugl-Meyer Assessment, Stroke Impact Scale, Canadian Occupational Performance Measure) and neuroplasticity (transcranial magnetic stimulation [TMS]) at baseline and at completion of intervention. We collected descriptive data on occupational participation throughout the study.

RESULTS. All behavioral outcomes indicated clinically relevant improvement. TMS revealed bihemispheric corticomotor reorganization. Descriptive data revealed enhanced occupational performance.

CONCLUSION. Occupation-based intervention delivered in a hospital-based, homelike environment can lead to poststroke neuroplastic change, increased functional use of the affected UE, and improved occupational performance.

OBJECTIVE. We examined the preclinical curricular content pertaining to low vision rehabilitation (LVR) included in occupational therapy (OT) and occupational therapy assistant (OTA) programs.

METHOD. An e-mail survey containing questions about program structure and the extent of course material related to LVR in the curriculum was sent to directors of all accredited OT and OTA programs in the United States.

RESULTS. One hundred nineteen programs responded. The curricula of all but 1 program included LVR content. Twenty-four programs included a required course with a primary emphasis on LVR. Forty-four programs had faculty with advanced training in LVR or experience working in a LVR clinic.

CONCLUSION. Given that almost all respondent programs integrate LVR content into their required preclinical coursework, we recommend that LVR be incorporated into the Accreditation Council for Occupational Therapy Education standards so as to ensure knowledge of LVR within existing programs and enhance the quality of education in LVR.

The Centennial Vision articulated by the American Occupational Therapy Association includes moving the profession to being science driven and evidence based. The American Journal of Occupational Therapy contributes to this vision by publishing high-quality research. I reviewed research in the practice area of neurological rehabilitation published between May 2010 and October 2011. In particular, I reviewed effectiveness and efficacy studies, instrument development and testing, and basic research studies. Concerns emerging from the review were (1) few studies in neurological rehabilitation; (2) many disorders not represented; (3) exclusive use of impairment-level outcomes in some studies; and (4) high preponderance of case series designs in effectiveness studies. To achieve the Centennial Vision, the field needs to improve the volume and diversity of research in neurological rehabilitation. It is also important to modify academic and clinical practice to enable occupational therapists to spend more time in producing high-quality evidence to support the crucial role they play in neurological rehabilitation.