American Journal of Occupational Therapy

Note from the AJOT Editor-in-Chief: Since 2010, the American Journal of Occupational Therapy (AJOT) has adopted reporting standards based on the Consolidated Standards of Reporting Trials (CONSORT) Statement and American Psychological Association (APA) guidelines in an effort to publish transparent clinical research that can be easily evaluated for methodological and analytical rigor (APA Publications and Communications Board Working Group on Journal Article Reporting Standards, 2008; Moher, Schulz, & Altman, 2001). AJOT has now joined 28 other major rehabilitation and disability journals in a collaborative initiative to enhance clinical research reporting standards through adoption of the EQUATOR Network reporting guidelines, described below. Authors will now be required to use these guidelines in the preparation of manuscripts that will be submitted to AJOT. Reviewers will also use these guidelines to evaluate the quality and rigor of all AJOT submissions. By adopting these standards we hope to further enhance the quality and clinical applicability of articles to our readers.

OBJECTIVE. Our objective was to perform a meta-analysis to investigate whether low birthweight (LBW) or preterm birth was associated with difficulty in mental, neuromusculoskeletal, and movement-related school function tasks.

METHOD. Two search strategies produced 40 studies that met the inclusion criteria for the meta-analysis and yielded 549 effect sizes (d). Heterogeneity was evaluated by obtaining Q and I-squared values. Egger’s regression intercept test and a funnel plot were used to check for publication bias.

RESULTS. Children born LBW exhibited considerable difficulties in mental (d = −0.655, p < .0001) and neuromusculoskeletal and movement-related tasks (d = −0.391, p < .0001) compared with children of normal birthweight. Children born preterm also exhibited significant difficulties compared with full-term children in mental, neuromusculoskeletal, and movement-related tasks (d = −0.237, p < .0001).

CONCLUSION. Deficits in mental and motor functions in children born LBW or preterm appear to have significant effects on school readiness and academic achievement.

OBJECTIVE. In this study, we examined the effectiveness of using weighted vests for improving attention, impulse control, and on-task behavior in children with attention deficit hyperactivity disorder (ADHD).

METHOD. In a randomized, two-period crossover design, 110 children with ADHD were measured using the Conners’ Continuous Performance Test–II (CPT–II) task.

RESULTS. In the weighted vest condition, the participants did show significant improvement in all three attentional variables of the CPT–II task, including inattention; speed of processing and responding; consistency of executive management; and three of four on-task behaviors, including off task, out of seat, and fidgets. No significant improvements in impulse control and automatic vocalizations were found.

CONCLUSION. Although wearing a weighted vest is not a cure-all strategy, our findings support the use of the weighted vest to remedy attentional and on-task behavioral problems of children with ADHD.

OBJECTIVE. Our objective was to identify predictors for treatment outcomes after home-based constraint-induced therapy (CIT) in children with cerebral palsy (CP).

METHOD. Forty-three children (aged 4–12 yr) with CP were treated with individualized CIT at home for 4 wk. Potential predictors were age, sex, affected hand, and upper-extremity motor capacity measured by the Peabody Developmental Motor Scale, 2nd edition (PDMS–2). Outcomes were the Pediatric Motor Activity Log (PMAL) Amount of Hand Use and Quality of Hand Use subscales and the Functional Independence Measure for Children (WeeFIM).

RESULTS. A higher PDMS–2 Visual–Motor Integration subscale score predicted a better WeeFIM score after home-based CIT (adjusted R ² = .35). Younger age predicted better performance on the PMAL Amount of Hand Use and Quality of Hand Use subscales (adjusted R ² = .06–.08) after home-based CIT.

CONCLUSION. The potential predictors may allow occupational therapy practitioners to target those children who will benefit most after home-based constraint-induced therapy.

People with Down syndrome (DS) are predisposed to specific areas of relative developmental strength and challenge, but it is unclear whether and how this profile affects participation in school and community settings. In this study we characterized the nature of school participation and performance of functional tasks in the school context for 26 elementary students with DS (mean age = 7.86 yr; standard deviation = 1.75). Students participated in assessments of cognitive status and language development. Their teachers completed the School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998) questionnaire and a standardized questionnaire on executive functioning (EF). Students demonstrated a pronounced pattern of assistance- and adaptation-related needs across various domains of school function. The strongest predictor of school function was EF skills, as reported by teachers (adjusted R ² = .47, p = .003). Findings from this study should inform future intervention and school-related planning for elementary school students with DS.

OBJECTIVE. The purpose of this study was to empirically derive dimensions of activity participation among a sample of school-age children with autism spectrum disorder (ASD; n = 713). Additionally, we examined the associations between dimensions of activity participation and child characteristics (i.e., chronological age, autism severity, gender) and family demographics (i.e., maternal education).

METHOD. Exploratory factor analysis was used to determine the factors on the Home and Community Activities Scale (HCAS). Multiple regression was used to examine the extent to which child characteristics and family demographics were related to HCAS dimensions.

RESULTS. A six-factor model best characterized activity participation among the school-age children with ASD, and child characteristics and family demographics were differentially associated with HCAS dimensions.

CONCLUSION. The findings have implications for how activities may be categorized for children with ASD and suggest that the frequency of specific activities is affected by child characteristics and maternal education.

OBJECTIVE. To examine the responsiveness of the Manual Ability Measure–36 (MAM–36) compared with a clinician-administered functional assessment.

METHOD. The MAM–36 was administered to 46 patients (Cohort A, n = 20; Cohort B, n = 26) with various upper-extremity conditions. All patients received occupational therapy intervention for 2–37 wk and were retested at discharge. Additionally, the Smith Hand Function Test (SHFT), including task performance speeds and grip strength measurements, was administered to Cohort B at intake and discharge.

RESULTS. Manual ability improved significantly at discharge in all patients. Patients also showed significant improvement on the SHFT. The correlation between gain in MAM–36 and gain in grip strength was moderate. The standardized response mean for the MAM–36 was 1.18.

CONCLUSION. The MAM–36 was responsive to changes in hand function in patients receiving occupational therapy services. MAM–36 results correlated positively with improvements in task performance speeds and grip strength.

OBJECTIVE. The purpose of this study was to examine the effects of partnerships between people with disabilities and service dogs on functional performance and social interaction.

METHOD. A single-subject, alternating treatment design was used. The participants were 3 women with mobility challenges who owned service dogs. For each participant, time and perceived amount of effort for two tasks were measured for functional performance. Interaction and satisfaction levels were measured for social interactions.

RESULTS. Primary findings were that service dog partnerships decreased performance time for four of the six tasks, decreased effort for five of the six tasks, increased social interactions for 2 of the participants, and increased levels of satisfaction with social interactions for all participants.

CONCLUSION. For adult women with mobility challenges, service dog partnerships may contribute to energy conservation through decreased time and effort required to complete some tasks and may increase social interactions.

OBJECTIVE. To explore the efficacy of low- and high-stretch compression bandaging for edema management in the stroke-affected upper limb.

METHOD. A single-case, ABA-design study was conducted with 8 participants alternately allocated to receive low- or high-stretch bandaging. Edema was measured with circumferential tape at four specified points from the hand to the mid-forearm. All measurements were represented graphically for visual analysis, and celeration lines were calculated to indicate the degree of slope in each phase.

RESULTS. Visual analysis indicated fluctuating edema volume in the first baseline phase, decreasing edema volume in the intervention phase, and increasing edema volume in the second baseline phase. The results did not clearly distinguish between the two bandaging groups.

CONCLUSION. Compression bandaging may have benefits in the management of edema after stroke. Further research is required to identify factors contributing to the long-term maintenance of reductions gained after compression bandaging.

OBJECTIVE. The purpose of this study was to examine the feasibility and efficacy of the Family Caregiver Training Program for assisting with the basic activities of daily living of people with dementia.

METHOD. A one-group pretest–posttest research design with a 3-mo follow-up was used to examine the efficacy of a manualized education program for caregivers. The 6-hr training was delivered to 72 family caregivers over 3 consecutive weeks (2 hr/wk) by trained clinicians.

RESULTS. Caregivers showed a significant gain in knowledge of how to effectively assist with communication and nutrition, t(52) = 7.05, p < .000; transfers and toileting, t(45) = 3.10, p < .003; and bathing and dressing, t(44) = 2.71, p < .01, of their care recipients.

CONCLUSION. Our findings demonstrate that this manualized intervention protocol is a promising method of equipping family members with the skills needed to face their everyday challenges in caring for people with dementia.

OBJECTIVE. The aim of this study was to develop a brief screening battery to predict the on-road performance of drivers who had experienced a stroke.

METHOD. We examined 72 people with stroke referred by community physicians to an academic rehabilitation center. The outcome variable was pass or fail on the modified Washington University Road Test. Predictor measures were tests of visual, motor, and cognitive functioning.

RESULTS. The best predictive model for failure on the road test included Trail Making Test Part A and the Snellgrove Maze Task^®.

CONCLUSION. A screening battery that can be performed in less than 5 min was able to assist in the prediction of road test performance in a sample of drivers with stroke. A probability of failure calculator may be useful for clinicians in their decision to refer clients with stroke for a comprehensive driving evaluation.

Schizophrenia affects not only mental function but also movement. We compared the movement of patients with mild schizophrenia and healthy control participants during a bimanual assembly task and examined whether changes in object size affected unimanual and bimanual movements. Fifteen patients with schizophrenia and 15 age- and gender-matched control participants were instructed to bimanually reach for and assemble objects. We manipulated the object size for the left hand (large vs. small) and measured movement time, peak velocity, and bimanual synchronization to represent movement speed, forcefulness, and bimanual coordination. Patients with schizophrenia showed slower and less forceful unimanual movements and less coordinated bimanual movements than control participants. Increasing the object size elicited faster and more forceful unimanual movements and more coordinated bimanual movements in patients. The results suggest the need for movement rehabilitation in patients with schizophrenia and the possibility of manipulating object size to optimize patients’ movements. These results benefit the practice of evidence-based therapy.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities on children and adolescents with challenges in sensory processing and sensory integration. 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.

American Occupational Therapy Association. (2014). Research opportunities in the area of children and adolescents with challenges in sensory processing and sensory integration. American Journal of Occupational Therapy, 68, 242–244. http://dx.doi.org/10.5014/ajot.2014.682003

OBJECTIVE. We examined the empirical evidence to answer the research question, What is the relationship between play and sensory processing in children ages 3–12 yr?

METHOD. The PRISMA guidelines were followed to complete a systematic review. Academic databases were searched using play, leisure, sensory processing, and sensory integration as primary search terms. Of 6,230 articles initially identified, 35 full-text articles were screened for eligibility. Of these, 8 met the inclusion criteria.

RESULTS. All 8 studies were conducted within the United States. The evidence of the relationship between play and sensory processing fell mainly into the low levels of evidence: case studies and cohort studies.

CONCLUSION. This review provides occupational therapists with an emerging understanding of the relationship between play and sensory processing based on current evidence and its importance in the occupational development of children. Rigorous research is needed in the area.

We studied students’ perceptions regarding their professional and personal skills and compared the findings for those who completed community fieldwork (CF) with those completing traditional fieldwork (TF). We also compared the perceptions of CF students whose placement settings had an active occupational therapist present versus those whose settings did not. Results showed no significant differences in perceptions of professional and personal skills between the students involved in CF and those involved in TF. However, students who completed CF in a setting without an active occupational therapist present scored significantly higher in their perception of their personal responsibility, cultural competence, and overall personal skills than students whose fieldwork location had an active occupational therapist present. Our study indicates the value of using various supervisory strategies for occupational therapy students during fieldwork. Further studies are warranted.

This article presents a rationale for the development of professional occupational therapy doctorate (OTD) programs. As more universities transition to the entry-level OTD degree, opportunities are becoming available to advance the profession and increase benefits to clients. We analyzed the current health care environment and developed the following proposed outcomes for doctoral-trained practitioners: (1) Demonstrate advanced clinical skills; (2) attain proficiency in outcomes measurement and analysis and synthesis of outcomes data; (3) routinely use standardized evidence-based practice clinical guidelines that translate research into practice; (4) develop, implement, and lead health promotion services; and (5) excel as partners in interprofessional teams.

PURPOSE. We conducted a systematic review examining the extent to which pediatric intervention research recently published in the American Journal of Occupational Therapy reflects occupational therapy’s holistic occupation-based tenets.

METHOD. We surveyed 10 systematic reviews and analyzed 38 single effectiveness studies for intervention approach, type, level of environmental targeting, level of occupational task and participation practice, and measures used.

RESULTS. Of the 38 single effectiveness studies, 12 (32%) explicitly incorporated both environmental targets of intervention and practice of complex or in vivo occupational tasks, with steady increases during the 2009–2013 time frame.

CONCLUSION. In the area of children and youth, occupational therapy is making steady gains in reflecting and demonstrating the effectiveness of the profession’s holistic, occupation-based tenets. Occupational therapy researchers must be mindful to ensure that despite the reductionist nature of intervention research, interventions reflect the profession’s holistic understanding of the interplay between the child, environment, and occupations.