American Journal of Occupational Therapy

We describe the results of a systematic review of the literature on occupational therapy–related interventions for people with amyotrophic lateral sclerosis (ALS). The review included 14 studies. We found limited to moderate evidence that people involved in multidisciplinary programs have longer survival than those in general care and limited evidence that those in multidisciplinary programs have a higher percentage of appropriate assistive devices and higher quality of life in social functioning and mental health. Limited evidence indicates that people with ALS are satisfied with the comfort and ease of use of their power wheelchairs (PWCs). In addition, limited evidence is available that PWCs allow people to have increased interaction in the community. Evidence also is limited that some assistive devices are more helpful than others. Moderate evidence indicates that a home exercise program of daily stretching and resistance exercise results in improved function. The implications for practice, education, and research are discussed.

This article is the first part of a systematic review of studies on occupational therapy–related intervention for people with multiple sclerosis (MS). The objective of this systematic review was to critically appraise and synthesize the applicable findings to address the following focused question: What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice for people with multiple sclerosis? This article focuses on occupational therapy interventions aimed at activity and participation, including programs (e.g., inpatient and outpatient rehabilitation) in which an occupational therapy practitioner was one member of the team. Part 2 (Yu & Mathiowetz, 2014) focuses on interventions within the scope of occupational therapy to remediate impairment (e.g., exercise, cognition, emotional regulation).

This article is the second part of a systematic review of studies on occupational therapy–related intervention for people with multiple sclerosis (MS). The objective of this systematic review was to critically appraise and synthesize the applicable findings to address the following focused question: What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice for people with multiple sclerosis? Part 1 (Yu & Mathiowetz, 2014) reviewed evidence for the effectiveness of activity- and participation-based interventions for people with MS. In contrast to the top-down approach, enabling occupational performance can be achieved through remediating impaired personal abilities. Therefore, Part 2 focuses on occupational therapy interventions targeting impairment. Studies included in this review focused on improving client factors and performance skills in people with MS, including cognition, emotional regulation, and motor and praxis skills.

We describe the results of a systematic review of the literature on occupational therapy–related interventions for people with Parkinson’s disease (PD). Three broad categories of intervention emerged: (1) exercise or physical activity; (2) environmental cues, stimuli, and objects; and (3) self-management and cognitive–behavioral strategies. Moderate to strong evidence exists for task-specific benefits of targeted physical activity training on motor performance, postural stability, and balance. Low to moderate evidence indicates that more complex, multimodal activity training supports improvement in functional movement activities. The evidence is moderate that the use of external supports during functional mobility or other movement activities has positive effects on motor control. In addition, moderate evidence is available that individualized interventions focused on promoting participant wellness initiatives and personal control by means of cognitive–behavioral strategies can improve targeted areas of quality of life. The implications for practice, education, and research are discussed.

OBJECTIVE. Alzheimer’s disease (AD) results in a loss of independence in activities of daily living (ADLs), which in turn affects the quality of life of affected people and places a burden on caretakers. Limited research has examined the influence of physical training (aerobic, balance, and strength training) on ADL performance of people with AD.

METHOD. Six randomized controlled trials (total of 446 participants) fit the inclusion criteria. For each study, we calculated effect sizes for primary and secondary outcomes.

RESULTS. Average effect size (95% confidence interval) for exercise on the primary outcome (ADL performance) was 0.80 (p < .001). Exercise had a moderate impact on the secondary outcome of physical function (effect size = 0.53, p = .004).

CONCLUSION. Occupational therapy intervention that includes aerobic and strengthening exercises may help improve independence in ADLs and improve physical performance in people with AD. Additional research is needed to identify specific components of intervention and optimal dosage to develop clinical guidelines.

Executive function (EF) and motor deficits have consistently been documented in studies of people with autism spectrum disorders (ASD). We investigated the effects of a pilot 30-session Makoto arena training intervention, a light and sound speed-based exergame, on response speed, EF, and motor skills in school-aged children with ASD. Strong correlations were seen between certain EF and motor scores, suggesting a relationship between the two constructs. Participants increased their average reaction speed (effect size = 1.18). Significant improvement was seen in the EF areas of working memory and metacognition and the motor area of strength and agility. Findings suggest that use of exergaming, specifically the Makoto arena, has the potential to be a valuable addition to standard intervention for children with ASD who have motor and EF impairments.

OBJECTIVES. The use of cognitive strategies optimizes performance in complex everyday tasks such as shopping. This exploratory study examined the cognitive strategies people with traumatic brain injury (TBI) effectively use in an unstructured, real-world situation.

METHOD. A behavioral analysis of the self-generated strategic behaviors of 5 people with severe TBI using videotaped sessions of an ecological shopping task (Instrumental Activities of Daily Living Profile) was performed.

RESULTS. All participants used some form of cognitive strategy in an unstructured real-world shopping task, although the number, type, and degree of effectiveness of the strategies in leading to goal attainment varied. The most independent person used the largest number and a broader repertoire of self-generated strategies.

CONCLUSION. These results provide initial evidence that occupational therapists should examine the use of self-generated cognitive strategies in real-world contexts as a potential means of guiding therapy aimed at improving independence in everyday activities for people with TBI.

Trainees could benefit from practicing orthotic fabrication on simulated hands with joint deformities. As a first step toward such training, we explored the use of a nonpathological model hand. Twenty-one participants were randomized into one of two groups that practiced using a person’s right hand or a model right hand. One week later, all participants returned for a transfer test in which they made one orthosis on a person’s left hand. All participants’ performance and orthoses were evaluated using a validated checklist and a global rating scale (GRS). Fabrication time for each orthosis also was recorded. The GRS score and fabrication time changed significantly over the course of practice. Trainees who practiced with the model hand made better orthoses during practice and on the transfer test, as measured with the checklist’s final product subscore. Instructional and contextual factors that may affect trainees’ performance and learning are discussed.

Many children within the autism population also have food selectivity, and it is not clear how this comorbid difficulty affects the mealtime experience for families. The purpose of this qualitative interview study was to gain an understanding of the mealtime experience of mothers of children with autism and food selectivity. The transcribed interviews were analyzed using a phenomenological approach. Mothers in this study described mealtime as difficult and stressful. Reasons for mealtime stress included the child’s self-restricted diet and difficulty sitting at the table. The mothers described attempts to improve mealtime but little success. Implications of the findings are discussed in the context of the literature.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities on older adults with low vision. The table provides an overview of the state of current available evidence on interventions within the scope of occupational therapy practice and is based on the systematic reviews from the AOTA Evidence-Based Practice Guidelines Series. Researchers, students, and clinicians can use this information in developing innovative research to answer important questions within the occupational therapy field.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities in the area of productive aging. The table provides an overview of the state of current available evidence on interventions within the scope of occupational therapy practice and is based on the systematic reviews from the AOTA Evidence-Based Practice Guidelines Series. Researchers, students, and clinicians can use this information in developing innovative research to answer important questions within the occupational therapy field.

OBJECTIVE. Our aim was to generate a Hebrew translation of the Miller Function and Participation Scales (M–FUN) and assess the validity of U.S. norms for Israeli children.

METHOD. All components of the M–FUN were translated, and a pilot study revealed a need for further investigation. The Hebrew M–FUN’s fine, gross, and visual–motor (VM) components and M–FUN participation questionnaires were administered to 267 Israeli children (128 boys, 139 girls; mean age = 59.21 mo, standard deviation = 17.84).

RESULTS. Significant correlations supported construct validity between age and all motor and participation scores as well as age-group differences. Significant differences between the U.S. and Israeli samples were found only for the VM score. Participation and motor scores were significantly correlated.

CONCLUSION. Although VM score results should be interpreted with caution, we provide evidence for use of the fine and gross motor norms and the U.S. criterion-referenced participation scores of the M–FUN with Israeli children.

The purpose of this study was to examine the perceived preparedness of practitioners in the early identification of children ages birth to 6 yr with autism spectrum disorder (ASD). Both occupational therapists and occupational therapy assistants were included in this survey study. The online survey instrument consisted of 29 questions within six sections capturing participant demographics, delivery of occupational therapy services, action when autism is suspected, service delivery experience, resource sharing, and barriers to conducting autism screening. The results of the study provide baseline information concerning identified skills, practices, and barriers among 1,396 practitioners. Additionally, opportunities are revealed for professional development necessary to support practitioners in the early identification of children at risk for ASD through surveillance and screening among children ages birth to 6 yr.

In the past 5 years, the number of research articles on occupational therapy in mental health published in the American Journal of Occupational Therapy has steadily declined. This article identifies the strengths and limitations of this body of research and provides directions for practitioners and researchers to enhance the profession’s role as a valued mental health service provider.