American Journal of Occupational Therapy

The passage of the Patient Protection and Affordable Care Act of 2010 (ACA; Pub. L. 111–148) represents the largest expansion in government funding of health care since Medicare and Medicaid were established in 1965 (Curfman, Abel, & Landers, 2012). Although the health insurance mandate and Medicaid expansion have received the most attention as a result of legal challenges and the July 2012 Supreme Court ruling on the legality of the ACA (Henry J. Kaiser Family Foundation, 2012), other ACA initiatives may have even greater implications for occupational therapy. The ACA includes sections on improving quality and health systems performance for Medicare recipients, with some sections also applying to Medicaid recipients. Insurance companies commonly follow Medicare rules; therefore, the Medicare reforms are likely to spread across all payers, health care settings, and care recipients.

OBJECTIVE. This study examined the efficacy of a 10-wk Tier 1 Response to Intervention (RtI) program developed in collaboration with classroom teachers to improve the fine motor and visual–motor skills of general education kindergarten students.

METHOD. We recruited 113 students in six elementary schools. Two general education kindergarten classrooms at each school participated in the study. Classrooms were randomly assigned to the intervention and control groups. Fine motor skills, pencil grip, and visual–motor integration were measured at the beginning of the school year and after the 10-wk intervention.

RESULTS. The intervention group demonstrated a statistically significant increase in fine motor and visual–motor skills, whereas the control group demonstrated a slight decline in both areas. Neither group demonstrated a change in pencil grip.

CONCLUSION. This study provides preliminary evidence that a Tier 1 RtI program can improve fine motor and visual–motor skills in kindergarten students.

OBJECTIVE. We compared abilities and strategy use of at-risk youth aged 16–21 yr with those of a community sample of high school students using a performance measure of executive function, the Weekly Calendar Planning Activity (WCPA).

METHOD. We recruited students from an alternative school for at-risk youth (n = 113) and from community high schools in the same region (n = 49). We collected demographic information from and administered the WCPA to both groups.

RESULTS. The at-risk group made more errors, used fewer strategies, and broke more rules than the community group; however, the groups were similar in average time for planning and task completion. Moderate relationships were found between WCPA and academic performance in the at-risk group.

CONCLUSION. Comparison of at-risk and community youth provides support for discriminant validity of the WCPA and indicates that the WCPA is useful in identifying adolescents who are at risk for occupational performance deficits.

This study examined the psychometric properties of item pools relevant to upper-extremity function and activity performance and evaluated simulated 5-, 10-, and 15-item computer adaptive tests (CATs). In a multicenter, cross-sectional study of 200 children and youth with brachial plexus birth palsy (BPBP), parents responded to upper-extremity (n = 52) and activity (n = 34) items using a 5-point response scale. We used confirmatory and exploratory factor analysis, ordinal logistic regression, item maps, and standard errors to evaluate the psychometric properties of the item banks. Validity was evaluated using analysis of variance and Pearson correlation coefficients. Results show that the two item pools have acceptable model fit, scaled well for children and youth with BPBP, and had good validity, content range, and precision. Simulated CATs performed comparably to the full item banks, suggesting that a reduced number of items provide similar information to the entire set of items.

Handwriting is a critical skill for school success. Children with fetal alcohol spectrum disorders (FASD) often present with fine motor and visual–motor impairments that can affect handwriting performance, yet handwriting skills have not been systematically investigated in this clinical group. This study aimed to comprehensively describe handwriting skills in 20 school-age children with FASD. Children were tested with the Process Assessment of the Learner, 2nd Edition (PAL–II), and the Visuomotor Precision subtest of NEPSY, a developmental neuropsychological assessment. Participants performed below average on PAL–II measures of handwriting legibility and speed and on NEPSY visual–motor precision tasks. In contrast, PAL–II measures of sensorimotor skills were broadly within the average range. Results provide evidence of functional handwriting challenges for children with FASD and suggest diminished visual–motor skills and increased difficulty as task complexity increases. Future research is needed to further describe the prevalence and nature of handwriting challenges in this population.

OBJECTIVE. The Western Neuro Sensory Stimulation Profile (WNSSP) presents a hierarchy of items suggestive of a sequence of recovery. The aim of this study was to understand the sequence of recovery of neurobehavioral function in patients with brain injury and determine whether this sequence was consistent with the WNSSP test item order.

METHOD. We conducted a retrospective clinical chart audit of 37 adult inpatients (mean age = 29 yr; 31 men, 6 women) with a diagnosis of traumatic brain injury and a minimum of two medical record entries on the WNSSP. The sequence of recovery was statistically derived from the content and structure of the WNSSP.

RESULTS. Our analysis did not support the current item ordering of the WNSSP as a function of the sequence of recovery from coma, with the exception of the Arousal/Attention subscale.

CONCLUSION. WNSSP item performance suggested a sequence of recovery; clinicians may consider a revised item order that reflects this observed order.

OBJECTIVE. We sought to determine the association between minimal depression, upper-extremity (UE) impairment, and UE motor function in a cohort of participants with subacute stroke.

METHOD. We conducted a retrospective, secondary analysis of an interventional study. Correlational analyses were performed using the following outcome measures: the UE section of the Fugl-Meyer Assessment (FM), the functional ability section of the Arm Motor Ability Test (AMAT), and the Beck Depression Inventory (BDI–II).

RESULTS. We found a negative correlation between BDI–II and both the FM (−.120, p = .196) and the AMAT (−.110, p = .275); however, this correlation was not statistically significant. Women exhibited higher depression scores (8.75 ± 0.78) than men (6.29 ± 0.46; p = .008).

CONCLUSION. Low levels of depression are not associated with UE motor impairment and function in people with minimal to moderate UE disability levels. Poststroke depression occurs more frequently in women, warranting additional research on sex-specific differences. Given the proliferation of UE therapies targeting this group, this information is important for effective therapy planning and implementation.

Despite the inevitable loss of function seen in people with progressive dementias, interventions for reversing or minimizing functional loss are understudied. Research supports task-oriented training, but practical gaps in how to best evaluate clients for this training and how to implement it in clinical settings may be thwarting translation to occupational therapy practice. We structured an intervention model called STOMP (Skill-building through Task-Oriented Motor Practice) using a unique blend of task-oriented training and motor-learning principles. In this article, we describe through a case study the process and outcome of using STOMP to improve functional skills in a woman with moderate dementia with Lewy bodies. Our findings suggest that STOMP has the potential to serve as a structure for the evaluation and treatment of occupational performance deficits in people with dementia and that this model warrants further investigation.

OBJECTIVE. This article describes the use of assessment tools by North American driver rehabilitation specialists (DRSs).

PARTICIPANTS. Participants were 227 self-identified DRSs from the combined databases of two national associations.

MEASURES. Information was solicited through a self-administered survey about the driving evaluation process, assessment tools, and process for making fitness-to-drive recommendations.

RESULTS. More than 80% of the DRSs reported testing visual acuity, range of motion, muscle strength, and fine motor coordination. The most consistently used cognitive–perceptual tests were the Trail Making Tests, Motor-Free Visual Perception Test–Revised, and short cognitive screening tests. A client’s behind-the-wheel performance was the main factor in making a fitness-to-drive recommendation. Few specialists are using computer-based tests or interactive driving simulators.

CONCLUSION. Although use of the Useful Field of View^® has increased, there continues to be no consistency in cognitive assessments or guidelines for behind-the-wheel assessment. Implications for practice are discussed.

The Useful Field of View^® (UFOV) and Trail Making Test Part B (Trails B) are measures of divided attention. We determined which measure was more accurate in predicting on-road outcomes among drivers (N = 198, mean age = 73.86, standard deviation = 6.05). Receiver operating characteristic curves for the UFOV (Risk Index [RI] and Subtests 1–3) and Trails B significantly predicted on-road outcomes. Contrasting Trails B with the UFOV RI and subtests, the only difference was found between the UFOV RI and Trails B, indicating the UFOV RI was the best predictor of on-road outcomes. Misclassifications of drivers totaled 28 for the UFOV RI, 62 for Trails B, and 58 for UFOV Subtest 2. The UFOV RI is a superior test in predicting on-road outcomes, but the Trails B has acceptable accuracy and is comparable to the other UFOV subtests.

OBJECTIVE. To test the effectiveness of an educational intervention aimed at improving mental health knowledge and skills in occupational therapists working with older rehabilitation patients.

METHOD. The DVD-format educational intervention was evaluated using a two-group randomized wait-list control design. Occupational therapists (n = 75) completed a 32-item knowledge questionnaire at three time points. Patient charts were reviewed (n = 960) at 3 months before and 3 and 6 months after DVD training to evaluate clinical practice change.

RESULTS. A two-way analysis of variance showed knowledge scores increased significantly for both groups after DVD training. A significant Group × Time interaction and significant main effects for time and group were found. Chart review data also showed significant increases in desired clinical behaviors in both groups after training. The greatest single item of clinical practice change was use of a standardized depression screen.

CONCLUSION. DVD-based training can significantly improve mental health practice.

PURPOSE. We examined the satisfaction with and engagement in population-centered life skills groups of women in a residential facility for substance dependence.

METHOD. This study was a retrospective, cross-sectional analysis of 561 surveys designed to elicit Likert scale client ratings. Descriptive statistics were used to examine client satisfaction. Differences in client engagement by content focus and activity process were also examined by analyzing the median scores of eight life skills development questions using the Kruskal–Wallis test of medians.

RESULTS. Collectively, 96.8% of those who completed the surveys were satisfied with the living skills groups; 73.3% strongly agreed, and 23.4% agreed. No significant differences (p > .05) were found in the median scores of the engagement responses by either content focus or activity process.

CONCLUSION. Population-centered life skills groups conceptualized within a holistic Person–Environment–Occupation model appear to be satisfactory and engaging interventions for women in recovery.

OBJECTIVE. We present the case report of a 3-yr-old boy with retentive fecal incontinence and sensory overresponsivity. Sensory integration theory was used to address the overresponsivity affecting the child’s ability to acquire age-appropriate toileting habits. We describe the 7 mo of treatment and 3 mo of follow-up in occupational therapy.

METHOD. We analyzed a retrospective chart review of daily defecation log outcome data and parent interview.

RESULTS. Notable improvements in acquiring age-appropriate toileting habits were documented and measured using daily defecation logs. Improvements in sensory processing were documented using the Sensory Profile and corroborated improvements in the child’s ability to participate in toileting routines and parent report of improved quality of life.

CONCLUSION. Occupational therapy using Ayres Sensory Integration^® was a useful framework for addressing this child’s toileting habits. This case explicates occupational therapy using data-driven intervention principles to address the relationship among sensory processing, behavior, and occupational performance.

Cognitive load theory is a field of research used to improve the learning of complex cognitive tasks by matching instruction to the learner’s cognitive architecture. We used an experimental posttest control-group design to test the effectiveness of instruction designed to reduce cognitive load (CL) and improve instructional effectiveness in teaching complex instruction to 24 first-year master’s students under authentic classroom conditions. We modified historically taught instruction using an isolated-to-interacting-elements sequencing approach intended to reduce high CL levels. We compared control and modified instructional formats using written assessment scores, subjective ratings of CL, and task completion times. Analysis of variance revealed significant differences for postinstruction, posttest CL ratings, and delayed written posttest scores (p < .05). No significant differences were identified for posttest completion times. Findings suggest that this approach can be used to improve instructional efficiency in teaching human locomotion to occupational therapy students.

We examined household task participation patterns of 46 children and youth with and without physical disability (PD) and explored the effects of age on roles of and expectations for these children in household task participation. Children with PD did not differ significantly from those without PD in the number of household tasks they performed; however, they did require more assistance than those without PD. In both groups, younger children performed significantly fewer household tasks and required significantly more help than older children. These findings further support the discriminant validity of the Children Helping Out: Responsibilities, Expectations, and Supports (Dunn, 2004) measure of household task participation and its use with adolescents. Assessing such participation would help caregivers and practitioners more successfully prepare children and youths with PD for independent living. Considering the roles and opportunities for social participation inherent in many household tasks will contribute to the usefulness of examining such participation.

The AOTA Centennial Vision outlined in 2007 challenged the occupational therapy profession to become a “powerful, widely recognized, science-driven, and evidence-based” profession that could adapt to changing societal and cultural needs and flourish well into the future. That challenge can be met by simply being effective at what we do; this will increase our value and validate our worth. Neurorehabilitation in occupational therapy can also thrive if we verify that the interventions we use and the strategies we implement are grounded in evidence. Professional effectiveness will emerge by (1) increasing the dissemination of research that supports the methods we use and informs others of the successful patient outcomes we achieve and (2) expanding development and validation of instruments that quantitatively and qualitatively measure functional outcomes. Occupational therapists can individually develop professional effectiveness by fostering greater academic–clinical alliances, objectifying evaluation and intervention methods, and preparing future practitioners appropriately for evidence-driven practice.