American Journal of Occupational Therapy

Sensory interests, repetitions, and seeking behaviors (SIRS) are common among children with autism spectrum disorder (ASD) and other developmental disabilities (DD) and involve unusual actions that intensify or reinforce a sensory experience. Researchers and practitioners typically use parent-report measures or informal clinical observations to understand the presence and nature of SIRS. In this study, we used a scoring supplement to the Sensory Processing Assessment for Young Children, an observational measure, to characterize SIRS across three groups of children—those with ASD (n = 40), DD (n = 37), and typical development (n = 39). Group differences were identified in frequency and intensity of overall SIRS, complexity of SIRS, and incidence of particular types of SIRS (i.e., posturing, sighting, proprioceptive seeking, spinning). Facial affect was also explored and found to be primarily neutral during engagement in SIRS across groups. Implications for practice and future research are discussed.

OBJECTIVE. To provide an example of an occupational therapy feasibility study and evaluate the implementation of a randomized controlled pilot and feasibility trial examining the impact of a sensory-adapted dental environment (SADE) to enhance oral care for children with autism spectrum disorder (ASD).

METHOD. Twenty-two children with ASD and 22 typically developing children, ages 6–12 yr, attended a dental clinic in an urban hospital. Participants completed two dental cleanings, 3–4 mo apart, one in a regular environment and one in a SADE. Feasibility outcome measures were recruitment, retention, accrual, dropout, and protocol adherence. Intervention outcome measures were physiological stress, behavioral distress, pain, and cost.

RESULTS. We successfully recruited and retained participants. Parents expressed satisfaction with research study participation. Dentists stated that the intervention could be incorporated in normal practice. Intervention outcome measures favored the SADE condition.

CONCLUSION. Preliminary positive benefit of SADE in children with ASD warrants moving forward with a large-scale clinical trial.

OBJECTIVE. To adapt the Handwriting Proficiency Screening Questionnaire (HPSQ), previously designated for adults, into a children’s self-report version (the HPSQ for Children, or HPSQ–C) and to examine its reliability and validity.

METHOD. Participants included 230 children ages 7–14 yr from regular schools in Israel. The questionnaire’s content validity, internal consistency, and concurrent and construct validity were assessed.

RESULTS. The tool demonstrated good internal consistency (α = .77). We found a significant moderate correlation between final HPSQ–C scores and the HPSQ, r = .51, p < .001, establishing the HPSQ–C’s concurrent validity. Construct validity was also confirmed. Results demonstrated that the HPSQ–C significantly distinguished between children with and without handwriting deficiencies on the basis of measures of handwriting product (Hebrew Handwriting Evaluation) and handwriting process (Computerized Penmanship Evaluation Tool).

CONCLUSION. The HPSQ–C is suitable for identification of handwriting deficiency among school-aged children and is appropriate for varied academic and clinical uses.

OBJECTIVE. To test functional improvement after a group cognitive–functional occupational therapy intervention for preschoolers with attention deficit hyperactivity disorder (ADHD).

METHOD. Seventeen preschooler–parent dyads attended 11 weekly group sessions focused on acquiring executive strategies through occupational performance. Functional improvement was measured using the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS); executive function, using the Behavior Rating Inventory of Executive Function–Pediatric; ADHD symptomatology, using Conners’ Parent Rating Scale–Revised and Conners’ Teacher Rating Scale–Revised; and social functioning, using the Social Participation scale of the Sensory Processing Measure.

RESULTS. Significant improvement was found on the COPM and GAS measures, whereas mixed results were found on the other measures, with improvements found in children whose scores indicated impairment at baseline.

CONCLUSIONS. Cognitive–functional group intervention appears to significantly improve daily functioning, executive function, and social functioning for children who demonstrate clinical impairment. Further research with a larger sample, a control group, and follow-up is required.

OBJECTIVE. To present the findings of an exploratory study regarding the experience of play as an everyday occupation for children with severe cerebral palsy from their parents’ perspective.

METHOD. We took a qualitative methodology and interpretive descriptive approach. After ethical approval, 7 participants were recruited and completed an interview and contextual information sheet.

RESULTS. The interview data led to the exploration of four themes: typical play, burden of play, expanding the concept of play, and therapy and play. These components were interlinked and contributed to parents’ understanding of play.

CONCLUSION. Occupational therapy practitioners can aim to further understand the importance of affirming typical play, recognizing the burden of play, explaining expanded play, and explaining the importance of play for play’s sake.

OBJECTIVE. We developed and investigated the psychometric properties of the Lifestyle History Questionnaire (LHQ), a self-report instrument designed to measure the extent of occupational dysfunction attributable to substance abuse.

METHOD. The instrument was developed using concepts in the ecological models of occupational therapy and in the work of William L. White, who defined addiction culture in terms of the patterns of life in context. We analyzed data from two field tests using both classical test theory and item response theory.

RESULTS. The final version of the instrument has 70 items, 1 unifying construct, and 8 subscales. We found it to be valid and reliable (α = .93) for measuring the extent of occupational dysfunction and specific areas of strengths and weaknesses.

CONCLUSION. The LHQ is a promising new instrument, the first of its kind to measure occupational dysfunction in context for people with substance addictions.

OBJECTIVE. This study investigated separate and concurrent performance on cognitive and hand dexterity tasks and the relationship to daily functioning in 16 people with schizophrenia and 16 healthy control participants.

METHOD. Participants performed the Purdue Pegboard Test and the Serial Seven Subtraction Test under single- and dual-task conditions and completed two daily functioning evaluations.

RESULTS. The hand dexterity of all participants declined in the dual-task condition, but the discrepancy between single-task and dual-task hand dexterity was greater in the schizophrenia group than in the control group (p < .03, d > .70, for all). The extent of discrepancy in hand dexterity was negatively correlated with daily functioning in the schizophrenia group (rs = −.3 to −.5, ps = .04–.26).

CONCLUSION. Ability to perform dual tasks may be an indicator of daily functioning in people with schizophrenia. Use of dual-task training may be considered as a therapeutic activity with these clients.

This observational study investigated family caregiver and clinician ratings of 75 drivers with Alzheimer’s disease against scores on a standardized road test and a naturalistic driving evaluation. Clinician ratings by a physician specialized in dementia were significantly associated with road test error scores (r = .25, p = .03) but not naturalistic driving errors or global ratings of road test and naturalistic driving performance. Caregiver ratings were unrelated to either driving assessment, with two exceptions; adult child ratings of driving ability were correlated with road test error scores (r = .43, p = .02), and spousal ratings were inversely correlated with global ratings. Clinician ratings of driving competence were modestly correlated with road test performance, but caregiver ratings were more complex. Adult children may be more accurate reporters of driving ability than spouses, possibly because of less personal bias, but the reasons behind this discrepancy need further investigation.

Setting goals can be a valuable skill to self-manage multiple sclerosis (MS) fatigue. A better understanding of the goals set by people with MS after completing a fatigue management program can assist health care professionals with tailoring interventions for clients. This study aimed to describe the focus of goals set by people with MS after a teleconference-delivered fatigue management program and to evaluate the extent to which participants were able to achieve their goals over time. In total, 485 goals were set by 81 participants. Over a follow-up period, 64 participants rated 284 goals regarding progress made toward goal achievement. Approximately 50% of the rated goals were considered achieved. The most common type of goal achieved was that of instrumental activities of daily living. Short-term goals were more likely to be achieved. This study highlights the need for and importance of promoting and teaching goal-setting skills to people with MS.

OBJECTIVE. The study aim was to determine natural variability in somatosensation across age groups using brief measures. We validated measures in a community-dwelling population as part of the National Institutes of Health (NIH) Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox; http://www.nihtoolbox.org).

METHOD. Participants included community-dwelling children and adults (N = 367, ages 3–85 yr) across seven sites. We tested haptic recognition, touch detection–discrimination, and proprioception using brief affordable measures as required by the NIH Toolbox.

RESULTS. Accuracy improved from young children to young adults; from young to older adults, the pattern reversed slightly. We found significant differences between adults and older adults. One proprioception test (kinesthesia; p =.003) showed gender differences (females more accurate). We provide expected score ranges for age groups as a basis for understanding age-related expectations for somatosensory perception.

CONCLUSION. The age-related patterns of somatosensory perception from this study refine decision making about performance.

OBJECTIVE. The purpose of this study was to investigate the behavioral intention to use (BIU) regarding a virtual system for practicing instrumental activities of daily living (IADLs) among people with stroke.

METHOD. Fourteen people who had sustained a stroke used a virtual world–based system over four sessions to participate in virtual occupations of preparing meals and putting away groceries. To investigate intention to use the technology, participants responded to a questionnaire based on the Technology Acceptance Model and were interviewed about the experience.

RESULTS. Analysis of questionnaire responses revealed favorable attitudes toward the technology and statistically significant correlations between these attitudes and positive BIU. Analysis of qualitative data revealed four themes to support system use: Use of the affected arm increased, the virtual practice was enjoyable, the technology was user-friendly, and the system reflected real-life activities.

CONCLUSION. This study shows that participants reported a positive BIU for the virtual system for practicing IADLs.

Deep pressure stimulation has been used in therapeutic practice because of the assumption that it changes physiological arousal. The purpose of this study was to test the effects of deep pressure stimulation, applied with a Vayu Vest (Therapeutic Systems), on both autonomic arousal and performance in a normative adult sample. A repeated-measures, repeated-baseline design was used with participants completing a performance test before and after deep pressure application. A convenience sample of 50 adults participated in the study. Results showed that wearing the Vayu Vest for even short periods of time reduced sympathetic arousal and non–stimulus-driven electrical occurrences. Concomitant increases in parasympathetic arousal were found. Performance improvements were noted after wearing the Vayu Vest, potentially because of changes in arousal. We conclude that deep pressure stimulation is capable of eliciting changes in autonomic arousal and may be a useful modality in diagnostic groups seen by occupational therapy practitioners.

OBJECTIVE. We assessed the prevalence of fear of falling (FoF) in a sample of people with chronic stroke and compared multiple variables (balance, anxiety, depression, activity and participation, and stroke severity) in people with and without FoF.

METHOD. This study was a secondary analysis of data collected from a cross-sectional study of mobility after stroke in 77 participants with chronic stroke (>6 mo poststroke).

RESULTS. Of the 77 participants, 51 (66%) reported experiencing FoF. People with FoF had significantly decreased balance (p < .001) and activity and participation (p = .006) and significantly increased anxiety (p = .007). People with FoF also had significantly worse stroke severity (p = .001).

CONCLUSION. FoF is a prevalent concern in the chronic stroke population. The presence of FoF was associated with a variety of negative consequences. Occupational therapy practitioners should address FoF to help clients manage FoF and possibly improve recovery.

Occupational therapy practice is grounded in the delivery of occupation-centered, patient-driven treatments that engage clients in the process of doing to improve health. As emerging technologies, such as medical imaging, find their way into rehabilitation practice, it is imperative that occupational therapy practitioners assess whether and how these tools can be incorporated into treatment regimens that are dually responsive to the medical model of health care and to the profession’s foundation in occupation. Most medical imaging modalities have a discrete place in occupation-based intervention as outcome measures or for patient education; however, sonographic imaging has the potential to blend multiple occupational therapy practice forms to document treatment outcomes, inform clinical reasoning, and facilitate improved functional performance when used as an accessory tool in direct intervention. Use of medical imaging is discussed as it relates to occupational foundations and the professional role within the context of providing efficient, effective patient-centered rehabilitative care.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities on home modifications. 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’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.