American Journal of Occupational Therapy

This study examined the reliability and validity of the structural section of the Ayres Sensory Integration^® Fidelity Measure© (ASIFM), which provides a method for monitoring the extent to which an intervention was implemented as conceptualized in studies of occupational therapy using sensory integration intervention methods (OT–SI). We examined the structural elements of the measure, including content of assessment reports, availability of specific equipment and adequate space, safety monitoring, and integration of communication with parents and other team members, such as collaborative goal setting with parents or family and teacher education, into the intervention program. Analysis of self-report ratings by 259 occupational therapists from 185 different facilities indicated that the structural section of the ASIFM has acceptable interrater reliability (r ≥ .82) and significantly differentiates between settings in which therapists reportedly do and do not practice OT–SI (p < .001).

This article explores the use of the postrotary nystagmus (PRN) test for children younger than current norms (children 4.0 yr–8.11 yr). In the first study, 37 children ages 4–9 yr were examined in the standard testing position and in an adult-held adapted position to determine whether holding a child affected the reflex. Because the position did not affect the reflex, in the second study, PRN in 44 children ages 2 mo–47 mo was compared with published normative mean raw scores for 44 children age 5 yr to determine whether norms for older children were applicable to younger children. No statistically significant differences were found between <4-yr-old and 5-yr-old children, suggesting that the PRN test can be used in infants and toddlers with valid comparison to current norms for 4-yr-olds on the Sensory Integration and Praxis Tests (4.0 yr–8.11 yr). Future research exploring the predictive value of this measure is warranted.

OBJECTIVE. Sensory modulation issues have a significant impact on participation in daily life. Moreover, understanding phenotypic variation in sensory modulation dysfunction is crucial for research related to defining homogeneous groups and for clinical work in guiding treatment planning. We thus evaluated the new Sensory Processing Scale (SPS) Assessment.

METHOD. Research included item development, behavioral scoring system development, test administration, and item analyses to evaluate reliability and validity across sensory domains.

RESULTS. Items with adequate reliability (internal reliability >.4) and discriminant validity (p < .01) were retained. Feedback from the expert panel also contributed to decisions about retaining items in the scale.

CONCLUSION. The SPS Assessment appears to be a reliable and valid measure of sensory modulation (scale reliability >.90; discrimination between group effect sizes >1.00). This scale has the potential to aid in differential diagnosis of sensory modulation issues.

This article describes the development of the Adult Sensory Processing Scale (ASPS), a sensory processing questionnaire for adults. The ASPS measures self-reported responses to input from distinct sensory systems and is intended to be sensitive to individual differences in the adult population. ASPS construction involved two phases: item development and instrument construction. During item development, content validity of 71 items was assessed by means of expert ratings. During instrument construction, items were evaluated using data from an online survey of 491 adults. Exploratory factor analysis and Rasch analysis yielded an optimal solution of eight factors representing vestibular overresponsiveness, auditory overresponsiveness, visual overresponsiveness, social tactile overresponsiveness, proprioceptive seeking, general underresponsiveness, vestibular–proprioceptive underresponsiveness affecting postural control, and vestibular overresponsiveness–intolerance to movement. The final ASPS contains 39 items and demonstrates acceptable internal consistency, strong content validity, and adequate construct validity.

This study established interrater reliability and preliminary developmental score guidelines for preschool children (ages 3–5 yr) on the Motor Planning Maze Assessment (MPMA). We administered the MPMA to 80 typically developing preschoolers and found age effects for Time, Error, and Total scores for each of three mazes. Five-year-olds obtained lower (better) scores than 4-yr-olds, who scored lower than 3-yr-olds. Older children completed the mazes with significantly fewer errors in significantly less time than younger children. Interrater reliability was excellent on the total MPMA score (intraclass correlation coefficient = 0.96) and individual maze scores (0.90–0.98). Results of this study provide evidence that the MPMA can serve as a reliable, objective screening of a preschooler’s ability to plan and execute motor movements. A larger reference population is needed to increase generalizability.

This study investigated the validity of sensory systems as distinct measurable constructs as part of a larger project examining Ayres’s theory of sensory integration. Confirmatory factor analysis (CFA) was conducted to test whether sensory questionnaire items represent distinct sensory system constructs. Data were obtained from clinical records of two age groups, 2- to 5-yr-olds (n = 231) and 6- to 10-yr-olds (n = 223). With each group, we tested several CFA models for goodness of fit with the data. The accepted model was identical for each group and indicated that tactile, vestibular–proprioceptive, visual, and auditory systems form distinct, valid factors that are not age dependent. In contrast, alternative models that grouped items according to sensory processing problems (e.g., over- or underresponsiveness within or across sensory systems) did not yield valid factors. Results indicate that distinct sensory system constructs can be measured validly using questionnaire data.

Praxis is the ability of the brain to develop an idea for action and plan, organize, and execute unfamiliar motor actions. It enables purposeful interaction with people and things in the environment. Ideation is central to praxis but has been little researched. This study investigated the reliability of the Test of Ideational Praxis (TIP) and examined ideational praxis in typical preschoolers. TIP performance for 78 preschoolers ages 3, 4, and 5 yr was videotaped and scored by two trained raters. The TIP has strong interrater reliability, supporting earlier findings. Further, we documented test–retest stability over 2 wk. As a group, preschoolers identified 10.6 affordances (ideas) for action on the TIP; no age differences were found. Training is required for accurate scoring of the TIP; following training, clinicians and researchers may find the TIP a useful tool to screen motor ideational abilities in young children.

OBJECTIVE. We investigated sensory integration (SI) function in children with cochlear implants (CIs).

METHOD. We analyzed deidentified records from 49 children ages 7 mo to 83 mo with CIs. Records included Sensory Integration and Praxis Tests (SIPT), Sensory Processing Measure (SPM), Sensory Profile (SP), Developmental Profile 3 (DP–3), and Peabody Developmental Motor Scales (PDMS), with scores depending on participants’ ages. We compared scores with normative population mean scores and with previously identified patterns of SI dysfunction.

RESULTS. One-sample t tests revealed significant differences between children with CIs and the normative population on the majority of the SIPT items associated with the vestibular and proprioceptive bilateral integration and sequencing (VPBIS) pattern. Available scores for children with CIs on the SPM, SP, DP–3, and PDMS indicated generally typical ratings.

CONCLUSION. SIPT scores in a sample of children with CIs reflected the VPBIS pattern of SI dysfunction, demonstrating the need for further examination of SI functions in children with CIs during occupational therapy assessment and intervention planning.

OBJECTIVE. We sought to understand activity choices of older adults when they were depressed.

METHOD. Each community-dwelling participant (n = 27) completed one semistructured interview while in recovery for at least 3 mo. but less than 7 mo. Transcripts were coded to identify relevant themes.

RESULTS. Six themes emerged that explained activities participants continued while depressed, and four themes described activities they stopped.

CONCLUSION. Older adults maintained many instrumental activities of daily living while depressed, and some actively adapted activities so they could continue them. Some intentionally stopped activities to direct limited energy to their highest priority activities. To guide effective intervention, it is critical for occupational therapy practitioners to complete a client-centered qualitative assessment to understand what and, most important, why activities are continued or stopped. Each theme for activities continued and activities stopped lends itself to intervention strategies.

OBJECTIVE. We examined participation in goal planning and development of self-awareness for people with impaired self-awareness after traumatic brain injury.

METHOD. We performed a mixed-methods study of 8 participants recently discharged from inpatient rehabilitation. Self-awareness was measured using discrepancy between self and significant other ratings on the Mayo–Portland Adaptability Index (MPAI–4) at four time points. We calculated effect size to evaluate the change in MPAI–4 discrepancy over time.

RESULTS. Seven participants identified their own goals. We found a large reduction in mean MPAI–4 discrepancy (M = 8.57, SD = 6.59, N = 7, d = 1.08) in the first 6 wk and a further small reduction (M = 5.33, SD = 9.09, N = 6, d = 0.45) in the second 6 wk of intervention. Case data indicated that 7 participants demonstrated some growth in self-awareness.

CONCLUSION. Engagement in occupation-based, goal-directed rehabilitation appeared to foster awareness of injury-related changes to varying extents.

OBJECTIVE. The aim of this study was to determine the effect of a safe patient handling and mobility (SPHM) program on patient self-care outcomes.

METHOD. We used a retrospective cohort design. Data were obtained from the electronic medical records of 1,292 patients receiving inpatient rehabilitation services. Self-care scores from the FIM™ for patients who participated in rehabilitation before implementation of an SPHM program were compared with the scores of patients who participated after implementation of the program.

RESULTS. Patients who received inpatient rehabilitation services with an SPHM program were as likely to achieve at least modified independence in self-care as those who received inpatient rehabilitation services without an SPHM program.

CONCLUSION. SPHM programs may not affect self-care performance in adults receiving inpatient rehabilitation services. However, more work must be done to define specific and effective methods for integrating patient handling technologies into occupational therapy practice.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities on mental health promotion, prevention, and intervention for children and youth. 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.

This article presents the current state of measurement in the area of sensory integration within the field of occupational therapy in three areas: (1) phenotypic characterization, (2) intervention adherence and dosage, and (3) outcome measurement. The need for additional measurement tools in all three areas is addressed. In regard to outcome measurement of occupational therapy using sensory integration, the use of both qualitative and quantitative methods to obtain outcome data is recommended. Further, a strategy is recommended for obtaining outcome data from direct report from the child or other stakeholder.

We extracted 35 articles published between January 2009 and September 2013 in the American Journal of Occupational Therapy (AJOT) that focused on children and youth instrument development and testing, summarized study details and traits of the 37 measures reported in them, and then critiqued the measures. Most of the articles contained Level III evidence (one-group nonrandomized and noncontrolled). The most common types of reliability reported in the articles were internal consistency, test–retest reliability, and interrater reliability; the most frequent types of validity reported were discriminant validity and construct validity. Most pediatric assessment tools were designed for school-age children between ages 5 and 12 yr. The two most common purposes for the assessments were reported as descriptive and discriminative. The continued publication of instruments that measure children and youth participation in meaningful occupations and life roles in home, school, and community environments is recommended.