American Journal of Occupational Therapy

Difficulty in driving after deployment has emerged as an impediment for servicemembers returning from Operation Iraqi Freedom and Operation Enduring Freedom (OIF–OEF). This study explored postdeployment driving stress and related occupational limitations using two self-report instruments: the Driver’s Stress Profile and the Driving and Occupational Limitations questionnaire. Data gathered from 103 OIF–OEF returnees confirmed that driving and related occupational issues occur postdeployment. Significant low to moderate correlations were found between postdeployment driving stress and limitations in community mobility, leisure, and social participation. The returnees who drove off base more frequently during deployment showed significantly higher levels of postdeployment driving stress than the returnees who drove off base less frequently. Moreover, the returnees who demonstrated higher levels of driving stress and occupational limitations required more time to resume normal driving postdeployment. Findings raise awareness about the need to design effective driver rehabilitation and community reintegration programs for this population.

In this study, we conducted a pretest–posttest investigation of a sports-oriented occupational therapy intervention using surfing in an experiential, skills-based program to support veterans with symptoms of posttraumatic stress disorder (PTSD) in their transition to civilian life. The purpose of this feasibility study was to evaluate the intervention for attendance rates and retention in the program provided in 5 sessions over 5 wk. Fourteen veterans from a specialty postdeployment clinic at a Veterans Affairs hospital were enrolled; 11 completed the study, and 10 attended ≥3 sessions. Participants reported clinically meaningful improvement in PTSD symptom severity (PTSD Checklist—Military Version, Wilcoxon signed rank Z = 2.5, p = .01) and in depressive symptoms (Major Depression Inventory, Wilcoxon signed rank Z = 2.05, p = .04). The results of this small, uncontrolled study suggest that a sports-oriented occupational therapy intervention has potential as a feasible adjunct intervention for veterans seeking mental health treatment for symptoms of PTSD.

Many combat veterans are injured in motor vehicle crashes shortly after returning to civilian life, yet little evidence exists on effective driving interventions. In this single-subject design study, we compared clinical test results and driving errors in a returning combat veteran before and after an occupational therapy driving intervention. A certified driving rehabilitation specialist administered baseline clinical and simulated driving assessments; conducted three intervention sessions that discussed driving errors, retrained visual search skills, and invited commentary on driving; and administered a postintervention evaluation in conditions resembling those at baseline. Clinical test results were similar pre- and postintervention. Baseline versus postintervention driving errors were as follows: lane maintenance, 23 versus 7; vehicle positioning, 5 versus 1; signaling, 2 versus 0; speed regulation, 1 versus 1; visual scanning, 1 versus 0; and gap acceptance, 1 versus 0. Although the intervention appeared efficacious for this participant, threats to validity must be recognized and controlled for in a follow-up study.

OBJECTIVE. This study examined outcomes of an 8-wk residential treatment program for veterans with posttraumatic stress disorder (PTSD) and a history of traumatic brain injury (TBI).

METHOD. Twenty-six veterans completed the Canadian Occupational Performance Measure, Clinician-Administered PTSD Scale, Beck Depression Inventory–2nd Edition, and PTSD Checklist before and after treatment.

RESULTS. Veterans demonstrated significant improvements in occupational performance and satisfaction with their performance, as well as in PTSD and depression symptom severity after residential PTSD/TBI treatment. Additionally, improvements in occupational performance and satisfaction were associated with decreases in depression symptom severity.

CONCLUSION. Although preliminary, results suggest that veterans with PTSD and a history of TBI experienced significant decreases in PTSD and depression symptom severity and improvement in self-perception of performance and satisfaction in problematic occupational areas. Changes in occupational areas and depression symptom severity were related, highlighting the importance of interdisciplinary treatment.

Vision impairment is common in the first year after traumatic brain injury (TBI), including among service members whose brain injuries occurred during deployment in Iraq and Afghanistan. Occupational therapy practitioners provide routine vision screening to inform treatment planning and referral to vision specialists, but existing methods are lacking because many tests were developed for children and do not screen for vision dysfunction typical of TBI. An expert panel was charged with specifying the composition of a vision screening protocol for servicemembers with TBI. A modified nominal group technique fostered discussion and objective determinations of consensus. After considering 29 vision tests, the panel recommended a nine-test vision screening that examines functional performance, self-reported problems, far–near acuity, reading, accommodation, convergence, eye alignment and binocular vision, saccades, pursuits, and visual fields. Research is needed to develop reliable, valid, and clinically feasible vision screening protocols to identify TBI-related vision disorders in adults.

OBJECTIVE. We sought to understand the lived experience of 2 student veterans and identify factors influencing their higher education.

METHOD. A qualitative research design was used with 2 student veterans who engaged in photovoice methodology. We analyzed their photographs, accompanying narratives, and discussion session transcripts using descriptive coding and thematic analysis.

RESULTS. Data analysis revealed four themes: (1) reminiscence of past duty and reflections on military life, (2) transition from military life to civilian student life, (3) entry to a new stage of life, and (4) influence of the university and community environment.

CONCLUSION. Findings from this study revealed factors influencing student veterans’ education and can be used to develop occupation-based interventions to assist veterans who engage in higher education.

OBJECTIVES. Executive functioning deficits may result from concussion. The Charge of Quarters (CQ) Duty Task is a multitask assessment designed to assess executive functioning in servicemembers after concussion. In this article, we discuss the rationale and process used in the development of the CQ Duty Task and present pilot data from the preliminary evaluation of interrater reliability (IRR).

METHOD. Three evaluators observed as 12 healthy participants performed the CQ Duty Task and measured performance using various metrics. Intraclass correlation coefficient (ICC) quantified IRR.

RESULTS. The ICC for task completion was .94. ICCs for other assessment metrics were variable.

CONCLUSION. Preliminary IRR data for the CQ Duty Task are encouraging, but further investigation is needed to improve IRR in some domains. Lessons learned in the development of the CQ Duty Task could benefit future test development efforts with populations other than the military.

OBJECTIVE. We investigated the feasibility of delivering an individualized, progressive, high-repetition upper-extremity (UE) task-specific training protocol for people with stroke in the inpatient rehabilitation setting.

METHOD. Fifteen patients with UE paresis participated in this study. Task-specific UE training was scheduled for 60 min/day, 4 days/wk, during occupational therapy for the duration of a participant’s inpatient stay. During each session, participants were challenged to complete ≥300 repetitions of various tasks.

RESULTS. Participants averaged 289 repetitions/session, spending 47 of 60 min in active training. Participants improved on impairment and activity level outcome measures.

CONCLUSION. People with stroke in an inpatient setting can achieve hundreds of repetitions of task-specific training in 1-hr sessions. As expected, all participants improved on functional outcome measures. Future studies are needed to determine whether this high-repetition training program results in better outcomes than current UE interventions.

PURPOSE. To describe parents’ concerns and hopes for their children who would be receiving occupational therapy using a sensory integration approach.

METHOD. Content analysis of 275 parental responses to three open-ended questions on developmental–sensory history intake forms.

FINDINGS. Parents’ descriptions of why they sought for their children were categorized into four overarching concerns about their children’s challenges: self-regulation, interacting with peers, participating in skilled motor activities, and self-confidence. Parents often linked these concerns together, revealing explanatory models of how they make sense of potential relationships among their children’s challenges and how these challenges affect occupational performance. Parents hoped occupational therapy would help their children develop self-understanding and frustration tolerance to self-regulate their behavior in socially acceptable ways.

IMPLICATIONS. Assessment and intervention should explicitly focus on links among self-regulation, social participation, skills, and perceived competence to address parents’ expectations.

PURPOSE. To examine the visual status of a cohort of older adults on an orthopedic unit to determine their level of available vision to complete everyday activities in the hospital setting.

METHOD. A convenience sample of 50 people was recruited. A visual history was obtained, and participants’ glasses were inspected. Distance acuity, reading acuity, and contrast sensitivity were assessed using standardized screening charts.

RESULTS. Of participants, 26% did not have their glasses with them until prompted, and 85% had glasses in poor condition. When tested wearing their habitual correction, 6% had low vision, 2% were blind, 41% had reading acuities worse than 20/25, and 28% had contrast sensitivity deficits.

CONCLUSION. Visual impairment is prevalent in older adults, yet visual function is not routinely screened in hospitals. Occupational therapists should routinely inquire about patients’ visual status, inspect their glasses, and encourage regular eye examinations. Failure to address vision could lead to inaccurate evaluation results.

OBJECTIVE. We explored whether sensory processing disorder (SPD) is related to dysfunctional elimination syndrome (DES).

METHOD. We used the Vancouver Nonneurogenic Lower Urinary Tract Dysfunction/Dysfunctional Elimination Syndrome Questionnaire and the Short Sensory Profile with participants who sought treatment of DES (n = 19) and healthy control participants (n = 55).

RESULTS. Significantly more children with DES (53%) had SPD than was reported for the general population (p < .001; Ahn, Miller, Milberger, & McIntosh, 2004). Control participants did not have a greater rate of SPD (p = .333). We found a significant association between the occurrence of DES and SPD, χ²(1) = 20.869, p < .001, and a significant correlation between test scores (Spearman’s ρ = −.493, R _s ² = .243, p < .001).

CONCLUSION. Many children with DES may also have SPD, suggesting that a child’s sensory processing pattern would be an important aspect that could influence the plan of care.

More than 2 million U.S. military servicemembers have deployed to Afghanistan or Iraq since September 11, 2001. Unlike during prior conflicts, many servicemembers leave spouses and children behind. Long, multiple deployments cause strain on family at home, with new challenges arising when servicemembers return from combat and reintegrate into family and civilian life. In World Wars I and II, occupational therapy practitioners played a significant role in supporting servicemember reintegration. However, their presence in program delivery in this practice area is limited. Occupational therapy researchers and practitioners can make a valuable contribution by helping families tailor daily activities and routines to address challenges and optimize health and wellness. However, barriers such as reimbursement for services, workforce availability, and access to military families have limited the profession’s full engagement. Advocacy is needed to help establish occupational therapy as a key component of the mental and preventive health care teams serving military servicemembers.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities on adults with serious mental illness. 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 AOTA's Occupational Therapy 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. To conduct an evidence-based review of intervention studies of older drivers with medical conditions.

METHOD. We used the American Occupational Therapy Association’s classification criteria (Levels I–V, I = highest level of evidence) to identify driving interventions. We classified studies using letters to represent the strength of recommendations: A = strongly recommend the intervention; B = recommend intervention is provided routinely; C = weak evidence that the intervention can improve outcomes; D = recommend not to provide the intervention; I = insufficient evidence to recommend for or against the intervention.

RESULTS. For clients with stroke, we recommend a graded simulator intervention (A) and multimodal training in traffic theory knowledge and on-road interventions (B); we make no recommendation for or against Dynavision, Useful Field of View, or visual–perceptual interventions (I). For clients with visual deficits, we recommend educational intervention (A) and bioptic training (B); we make no recommendation for or against prism lenses (I). For clients with dementia, we recommend driving restriction interventions (C) and make no recommendation for or against use of compensatory driving strategies (I).

CONCLUSION. Level I studies are needed to identify effective interventions for medically at-risk older drivers.

OBJECTIVE. To analyze the content of publications in 5 occupational therapy journals to determine the strengths and weaknesses of the literature base from 2006 to 2010.

METHOD. A content analysis for 2006 through 2010 of the American Journal of Occupational Therapy (AJOT), Australian Occupational Therapy Journal (AOTJ), British Journal of Occupational Therapy (BJOT), Canadian Journal of Occupational Therapy (CJOT), and Scandinavian Journal of Occupational Therapy (SJOT) was completed.

RESULTS. AJOT and SJOT had the highest percentage of articles focusing on physical disabilities, whereas a majority of articles in AOTJ, BJOT, and CJOT focused on education. SJOT published articles with the highest median number of participants in all research designs excluding descriptive studies. The majority of the research articles were descriptive for all journals.

CONCLUSION. From 2006 to 2010, AJOT provided stronger evidence conducted at higher levels than the other journals by publishing more articles investigating interventions used to support clinical practice.

Halfway into the 10-yr American Occupational Therapy Association Centennial Vision initiative, occupational therapy has made notable progress in establishing itself as a science-driven profession. Through the diligent work of many talented occupational therapy scholars, 42 research studies exploring interventions used in rehabilitation research were published in the past 5 years. A variety of both novel and established intervention strategies were investigated using diverse research designs and measurement tools. A predominant number of studies were conducted with the poststroke population. Moving forward to 2017 and building on our success, we can recognize our full potential by fostering knowledge translation, expanding participant numbers, exploring less-studied populations, increasing the volume of systematic reviews published, and reporting occupation-centered outcomes, the unique and defining component of our profession.