American Journal of Occupational Therapy

OBJECTIVE. The purpose of this investigation was to determine whether hippotherapy increased function and participation in children with autism spectrum disorder (ASD). We hypothesized improvements in motor control, which might increase adaptive behaviors and participation in daily activities.

METHOD. Six children with ASD ages 5–12 participated in 12 weekly 45-min hippotherapy sessions. Measures pre- and post-hippotherapy included the Vineland Adaptive Behavior Scales–II and the Child Activity Card Sort. Motor control was measured preintervention and postintervention using a video motion capture system and force plates.

RESULTS. Postural sway significantly decreased postintervention. Significant increases were observed in overall adaptive behaviors (receptive communication and coping) and in participation in self-care, low-demand leisure, and social interactions.

CONCLUSION. These results suggest that hippotherapy has a positive influence on children with ASD and can be a useful treatment tool for this population.

Vehicle crashes are a leading cause of death among teens. Teens with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or both (ADHD–ASD) may have a greater crash risk. We examined the between-groups demographic, clinical, and predriving performance differences of 22 teens with ADHD–ASD (mean age = 15.05, standard deviation [SD] = 0.95) and 22 healthy control (HC) teens (mean age = 14.32, SD = 0.72). Compared with HC teens, the teens with ADHD–ASD performed more poorly on right-eye visual acuity, selective attention, visual–motor integration, cognition, and motor performance and made more errors on the driving simulator pertaining to visual scanning, speed regulation, lane maintenance, adjustment to stimuli, and total number of driving errors. Teens with ADHD–ASD, compared with HC teens, may have more predriving deficits and as such require the skills of a certified driving rehabilitation specialist to assess readiness to drive.

OBJECTIVE. The goal was to develop an objective, comprehensive, near-task home lighting assessment for older adults with low vision.

METHOD. A home lighting assessment was developed and tested with older adults with low vision. Interrater and test–retest reliability studies were conducted. Clinical utility was assessed by occupational therapists with expertise in low vision rehabilitation.

RESULTS. Interrater reliability was high (intraclass correlation coefficient [ICC] = .83–1.0). Test–retest reliability was moderate (ICC = .67). Responses to a Clinical Utility Feedback Form developed for this study indicated that the Home Environment Lighting Assessment (HELA) has strong clinical utility.

CONCLUSION. The HELA provides a structured tool to describe the quantitative and qualitative aspects of home lighting environments where near tasks are performed and can be used to plan lighting interventions. The HELA has the potential to affect assessment and intervention practices of rehabilitation professionals in the area of low vision and improve near-task performance of people with low vision.

OBJECTIVE. Adults with osteoarthritis (OA) experience fatigue in daily life that is negatively related to physical activity; however, it is unclear how task demands affect fatigue and occupational performance. We examined effects of a cognitive task on subsequent symptoms and activity.

METHOD. Adults with knee or hip OA completed a standardized cognitive task during a lab visit. Objective physical activity and symptoms were tracked during two home-monitoring periods (i.e., 4-day period before and 5-day period after the lab visit). Multilevel modeling was used to compare pretask with posttask fatigue, pain, and activity levels.

RESULTS. Fatigue increased and pain decreased for 2 days after performing the lab task. The authors found no pretask to posttask changes in activity levels. At posttask, daily fatigue and activity patterns changed relative to baseline.

CONCLUSION. For adults with symptomatic OA, cognitive task demands may be an important contributor to fatigue and pain.

OBJECTIVE. We examined whether an art-based occupation group using scrapbooking in the neonatal intensive care unit (NICU) would reduce parent stress, operationalized as anxiety. We also wanted to understand the parents’ lived experience of the group.

METHOD. Forty parents from a Level 3 NICU in a large metropolitan hospital participated. We administered the State–Trait Anxiety Inventory preactivity and postactivity along with a brief interview.

RESULTS. The decline in parents’ mean state anxiety (12.7 points, SD = 11.8; p < .0001) was clinically significant. The decline in mean trait anxiety (2.6 points, SD = 5.2; p = .0036) was statistically significant but not clinically meaningful. Parents said that participation offered distraction and engagement, pleasure, relaxation, a sense of hope, and an opportunity to share.

CONCLUSION. An art-based occupation group using scrapbooking was an effective brief intervention to reduce parent anxiety in the neonatal intensive care unit; parent interviews suggested that participation has broad clinical implications for parent well-being.

This article represents the efforts of an interdisciplinary work group, the Dementia Measures Work Group (DWG), composed of representatives of diverse national organizations who convened specifically to define optimal standards of dementia care for individual practitioners as well as multidisciplinary teams. The DWG measurement set includes all stages of dementia in a single measure set, calls for the use of functional staging in planning care, prompts the use of validated instruments in patient and caregiver assessment and intervention, highlights the relevance of using palliative care concepts to guide care prior to the advanced stages of illness, and provides evidence-based support for its recommendations and guidance on the selection of instruments for tracking patient-centered outcomes. In addition, it specifies annual reassessment and updating of interventions and care plans for dementia-related problems that affect families and other caregivers as well as patients.

OBJECTIVE. The purpose of this study was to investigate transportation practices of caregivers who transport children diagnosed with autism spectrum disorders (ASD).

METHOD. We reviewed documented transportation evaluations of children with ASD. The evaluations were conducted by pediatric occupational therapists at an outpatient center of a large children’s hospital.

RESULTS. A review of 82 charts of patients diagnosed with ASD revealed that 74% of children with ASD were escaping their child safety restraint. More than 20% of parents reported that their child demonstrated aggressive or self-injurious behavior during travel, affecting not only their own safety but also that of others in the vehicle, including the driver.

CONCLUSION. Escaping from a child restraint can be a life-threatening problem among children with ASD. Parents, caregivers, and health care professionals should be aware of services available from trained therapists, certified child passenger safety technicians, or both to maximize safety during personal travel in the family vehicle.

OBJECTIVE. The purpose of this study was to develop a normative database of results of the Functional Test for the Hemiparetic Upper Extremity (FTHUE) from able-bodied participants.

METHOD. Ninety healthy adults, aged 20–80, were assessed on the timed tasks of the FTHUE with their nondominant upper extremity serving as the weaker side.

RESULTS. A normative table with means and standard deviations for the timed tasks of the FTHUE was created to provide reference values for upper-extremity performance. Significant differences were found among participants by gender and age.

CONCLUSION. The FTHUE is an easy-to-administer, inexpensive, quick evaluation. It yields standardized data that allow clinicians to observe their clients performing functional tasks. The table of normative data will further assist clinicians in their assessment of clients with hemiparesis.

We describe the results of a systematic review of the literature on children’s mental health using a public health model consisting of three levels of mental health service: universal, targeted, and intensive. At the universal level, strong evidence exists for the effectiveness of occupation- and activity-based interventions in many areas, including programs that focus on social–emotional learning; schoolwide bullying prevention; and after-school, performing arts, and stress management activities. At the targeted level, strong evidence indicates that social and life skills programs are effective for children who are aggressive, have been rejected, and are teenage mothers. The evidence also is strong that children with intellectual impairments, developmental delays, and learning disabilities benefit from social skills programming and play, leisure, and recreational activities. Additionally, evidence of the effectiveness of social skills programs is strong for children requiring services at the intensive level (e.g., those with autism spectrum disorder, diagnosed mental illness, serious behavior disorders) to improve social behavior and self-management.

OBJECTIVE. We sought to determine the extent to which perceptions of participation in everyday occupations were affected in a sample of people with predominantly mild stroke. Demographic variables, stroke severity, community integration, participation in everyday occupations, and perceptions of recovery were examined as potential contributors to their perceptions of participation.

METHOD. We conducted a cross-sectional study with 116 people with mild to moderate first stroke assessed approximately 6 mo after stroke.

RESULTS. Perceptions of participation assessed using the Stroke Impact Scale varied (range = 19–100), with a mean score of 82. Regression analyses revealed three factors that contributed to perceptions of participation: retention of previous activities, reintegration in home and community, and perception of stroke recovery.

CONCLUSION. Although the majority of participants reported a high level of perceived participation, more than a third failed to report successful participation.

OBJECTIVE. Attention to executive functioning (EF) and its effect on occupational performance is increasing in the occupational therapy literature. This study explored occupational therapists’ perceptions of how EF is recognized and addressed within occupational therapy for children and youth.

METHOD. Inductive qualitative content analysis was used to analyze the in-depth interview data from 13 occupational therapists with a range of practice contexts and experience.

RESULTS. EF should be explicitly considered during clinical reasoning. System and professional barriers create challenges to occupational therapists, constraining their ability to recognize, label, and address EF performance issues. Occupational therapists who have integrated EF into their practice perspective have acquired knowledge and skills through interprofessional collaborations, client interactions, and professional development opportunities.

CONCLUSION. Occupational therapists working with children and youth need an occupational EF framework and practice resources if they are to integrate an EF lens to more broadly enable occupational performance.

People who experience the toxic stress of recurrent traumatic events in childhood have a higher risk for mental and physical health problems throughout life. Occupational therapy practitioners have a remarkable opportunity to be involved in addressing this significant public health problem. As health care practitioners already situated in the community, we have a responsibility to lead and assist in establishing and implementing occupation-based programs and to nurture the links between the child welfare system and existing intervention systems. In this article, we review the current research on toxic stress and recommendations made by other health care disciplines and offer strategies for occupational therapy practitioners to begin a dialogue on this critical, emerging issue.

We reviewed 11 articles, including efficacy and effectiveness studies, addressing intervention effectiveness for children and youth published in 2012 in the American Journal of Occupational Therapy and organized them by level and type of research according to a framework adapted from the International Classification of Functioning, Disability and Health . Compared with articles published in previous years, these studies showed improvement in their ability to guide practitioners to make evidence-based decisions by increasing understanding of the intervention’s pragmatic relevance and the extent to which it promotes participation in childhood and adolescent occupations. Studies’ evidence levels have increased along with efforts to increase scientific rigor. Intervention fidelity was included in several of the studies, but not consistently. Siblings and other family members were not examined, and none of the articles reviewed described longitudinal studies. Measures of client acceptability and cost–benefit analysis need more attention in future studies.