American Journal of Occupational Therapy

Note from the AJOT Editor-in-Chief: AJOT has joined several other major rehabilitation and disability journals in a collaborative initiative to mandate clinical trial registration. Authors of manuscripts reporting clinical trials must ensure that the trials are registered before submitting their manuscript. For trials that are underway and are already enrolling patients, registration will be retrospective. This interim step achieves the goals of educating authors about trial registration and providing documentation of original study designs and primary outcome measures. Multiyear studies that were not registered before enrolling participants, are ongoing at the time of this editorial, and will not be completed before the January 1, 2017, deadline may be considered for publication in AJOT with special permission from the Editor-in-Chief. This permission must be obtained before submitting the manuscript for publication. By adopting these standards, we hope to further enhance the quality of AJOT articles.

This editorial is reprinted from the Archives of Physical Medicine and Rehabilitation, 96, 2093. http://dx.doi.org/10.1016/j.apmr.2015.09.005

Occupational therapy practitioners play an important role in improving the health of populations through the development of occupational therapy interventions at the population level and through advocacy to address occupational participation and the multiple determinants of health. This article defines and explores population health as a concept and describes the appropriateness of occupational therapy practice in population health. Support of population health practice as evidenced in the official documents of the American Occupational Therapy Association and the relevance of population health for occupational therapy as a profession are reviewed. Recommendations and directions for the future are included related to celebration of the achievements of occupational therapy practitioners in the area of population health, changes to the Occupational Therapy Practice Framework and educational accreditation standards, and the importance of supporting, recognizing, rewarding, and valuing occupational therapy practitioners who assume roles in which direct care is not their primary function.

OBJECTIVE. To investigate changes in head lag across postmenstrual age and define associations between head lag and (1) perinatal exposures and (2) neurodevelopment.

METHOD. Sixty-four infants born ≤30 wk gestation had head lag assessed before and at term-equivalent age. Neurobehavior was assessed at term age. At 2 yr, neurodevelopmental testing was conducted.

RESULTS. Head lag decreased with advancing postmenstrual age, but 58% (n = 37) of infants continued to demonstrate head lag at term. Head lag was associated with longer stay in the neonatal intensive care unit (p = .009), inotrope use (p = .04), sepsis (p = .02), longer endotracheal intubation (p = .01), and cerebral injury (p = .006). Head lag was related to alterations in early neurobehavior (p < .03), but no associations with neurodevelopment were found at 2 yr.

CONCLUSION. Head lag was related to medical factors and early neurobehavior, but it may not be a good predictor of outcome when used in isolation.

Health care and educational legislation and policy require that clinicians demonstrate, using measurement and report of outcomes, accountability for services rendered. Clinical algorithms have been developed and are used by various health care professionals to assist with hypothesis generation and systematic clinical reasoning; however, they do not explicitly guide measurement of outcomes as part of the reasoning process. Schaaf and colleagues developed the Data-Driven Decision Making (DDDM) process to address the greater need for outcome measurement, systematically support decision making, target intervention more precisely, and measure and document outcomes. This article describes the application of the DDDM process with a child with ASD who received occupational therapy using Ayres Sensory Integration^®.

This systematic review describes the published evidence related to the effectiveness of frequency modulation (FM) devices in improving academic outcomes in children with auditory processing difficulties. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were used to identify articles published between January 2003 and March 2014. The Cochrane Population, Intervention, Control, Outcome, Study Design approach and the American Occupational Therapy Association process forms were used to guide the article selection and evaluation process. Of the 83 articles screened, 7 matched the systematic review inclusion criteria. Findings were consistently positive, although limitations were identified. Results of this review indicate moderate support for the use of FM devices to improve children’s ability to listen and attend in the classroom and mixed evidence to improve specific academic performance areas. FM technology should be considered for school-age children with auditory processing impairments who are receiving occupational therapy services to improve functioning in the school setting.

OBJECTIVE. This cross-sectional, descriptive study evaluated the performance in activities of daily living (ADLs) of youth and young adult survivors of childhood brain tumor (BT) and explored associations with health-related quality of life (HRQoL).

METHOD. Thirty-six participants were examined using the Assessment of Motor and Process Skills to evaluate their quality of ADL task performance and the Medical Outcomes Study 12-Item Short-Form Health Survey (SF–12) to evaluate HRQoL.

RESULTS. Participants had significantly lower performance in ADLs compared with age norms (p < .05), and their functional level was positively associated with the SF–12 Physical (r ² = .5) and Mental (r ² = .3) scales.

CONCLUSION. Participants had significant limitations in both motor and process skills, which affected their performance in ADLs. Study results emphasize the importance of long-term follow-up and rehabilitation services aimed at improving the functional level and HRQoL of BT survivors.

OBJECTIVE. We describe the prevalence and type of sensory processing differences in children born very preterm and determine associations with neonatal risk factors.

METHOD. We assessed sensory processing patterns using the Short Sensory Profile in a retrospective cohort of 160 children age 4 yr born very preterm (≤32 wk gestational age). Data analyses included descriptive statistics to describe the prevalence of sensory processing patterns and logistic regression to examine associations with neonatal risk factors.

RESULTS. Almost half of our cohort (46%) exhibited atypical sensory processing patterns. Lower Apgar scores (p = .03) and longer length of stay in the neonatal intensive care unit (NICU; p = .02) independently predicted atypical sensory processing patterns.

CONCLUSION. Children born very preterm are at increased risk for sensory processing differences, which are associated with perinatal risk factors and length of stay in the NICU. Routine evaluation for sensory processing differences of children born preterm is recommended.

OBJECTIVE. To better understand the ways in which adult attachment, sensory processing, and distress may be interrelated in healthy adults.

METHOD. A cross-sectional study design was used with a convenience sample of 116 healthy participants who completed questionnaires before participating in a cold pressor pain-inducement task.

RESULTS. Attachment anxiety was significantly positively correlated with sensory sensitivity as measured using the Highly Sensitive Persons Scale and the Sensory Profile and with distress (i.e., stress, anxiety, and depression). Associations between attachment anxiety and both sensory sensitivity variables were lost when controlling for stress. Attachment avoidance was correlated only with sensory sensitivity measured using the Sensory Profile, and this relationship was retained when controlling for stress. Neither the attachment nor the stress variables were associated with sensation seeking.

CONCLUSION. Findings suggest that developing active coping approaches to deal with sensory sensitivities may be a valuable way to minimize distress. Recommendations for future research are provided.

OBJECTIVE. To examine differences in psychosocial protective factors (social support, meaningful occupation, and academic self-efficacy) and health-related vulnerability factors (posttraumatic stress, depression, and somatic symptoms) contributing to resilience in post-9/11 veterans with service-related injuries and nonveterans in postsecondary education.

METHOD. A cross-sectional, matched-participants design using propensity score matching was used to test differences in mean levels of protective and vulnerability factors between injured veterans (n = 26) and nonveterans (n = 19); zero-order correlations explored relationships among study variables.

RESULTS. The veteran sample demonstrated lower levels of psychosocial protective factors and higher levels of health-related vulnerability factors compared with nonveterans (|0.49| to |1.56|). Psychosocial protective factors were consistently negatively associated with health-related vulnerability factors (−.27 to −.63).

CONCLUSION. Post-9/11 veterans with service-related injuries are at a substantial disadvantage in terms of resilience; lower protective factors and elevated vulnerability factors may increase their risk for poor campus integration and impede academic achievement.

OBJECTIVE. Little is known about sons’ roles in caring for a parent with dementia. To ensure that interventions and practices appropriately match sons’ needs, we investigated their experiences.

METHOD. A qualitative descriptive approach was used; 20 sons of a parent with dementia participated in semistructured interviews.

RESULTS. Participants reported varied paths to becoming a caregiver, primarily undertaking a care management role and managing by using their own occupational experiences and receiving support from other family members, peers, and private and public community services. They experienced negative consequences such as participation restriction and stress and positive consequences such as feelings of satisfaction. Strategies used to cope included boundary setting and practicing self-care.

CONCLUSION. This study highlights the need to consider sons’ role as care managers for their parent with dementia in community-based settings, as well as their need for education and intervention. Occupational therapy practitioners can use this information to inform their practices and support clients and their families.

Postural control requires the integration of sensorimotor information to maintain balance and to properly position and orient the body in response to external stimuli. Age-related declines in peripheral and central sensory and motor function contribute to postural instability and falls. This study investigated the contribution of head position, standing surface, and vision on postural sway in 26 community-dwelling older adults. Participants were asked to maintain a stable posture under conditions that varied standing surface, head position, and the availability of visual information. Significant main and interaction effects were found for all three factors. Findings from this study suggest that postural sway responses require the integration of available sources of sensory information. These results have important implications for fall risks in older adults and suggest that when standing with the head extended and eyes closed, older adults may place themselves at risk for postural disequilibrium and loss of balance.

OBJECTIVE. The purpose of this review was twofold: (1) to gain insight into what is known from the literature about home modifications for people with Alzheimer’s disease (AD) and (2) to identify gaps in the literature that could lead to opportunities for research.

METHOD. A systematic scoping review of peer-reviewed articles published from 1994 through 2014 explored home modifications and AD.

RESULTS. Seventeen articles met the inclusion criteria. The three major findings pertain to (1) the caregiver role and caregiver training, (2) a client-centered collaborative approach to assessment and intervention, and (3) modifications for safety and function. Home modifications involved the physical and social environments as well as cognitive strategies at the task level.

CONCLUSION. Opportunities exist for the development of assessment procedures, the exploration of home modifications in the later stages of AD, and the study of home modification needs of people with dementia who live alone.

The Functional Loewenstein Occupational Therapy Cognitive Assessment (FLOTCA) was developed to assess integrative higher cognitive abilities in people with traumatic brain injury (TBI). The FLOTCA measures performance on three tasks: navigating on a map, organizing a toolbox, and planning a daily schedule. This study assessed the psychometric properties of the FLOTCA with a sample of 25 participants with TBI ages 18–49 and 25 matched healthy participants. The FLOTCA showed high interrater reliability (intraclass correlation = .996) and internal consistency reliability for the total score (α = .82). Construct validity was supported for the total score, t (48) = −5.48, d = 1.52, and the separate tasks. Moderate ecological validity was obtained with the combined FIM™ and Functional Assessment Measure, r (19) = .44, p < .05. The results indicate that the FLOTCA can be used to assess higher cognitive abilities in functioning and can serve as the basis for intervention planning.

OBJECTIVE. The objective of this study was to determine whether facility-level, structural factors affect the provision of assistive devices and services.

DESIGN. A retrospective design was used. Activities of daily living and mobility-related devices were categorized into 11 types. Logistic regression models were performed for each type of device, controlling for patient-level and facility-level covariates.

RESULTS. Non–veteran-level factors significantly affect the provision of assistive devices, even after covariate adjustment. Increased rehabilitation clinician staffing by 1 full-time equivalent position was associated with increased provision odds of 1%–5% for 5 of 11 types of devices. Lower facility complexity was significantly associated with increased provision odds of 35%–59% for 3 types of devices and with decreased provision odds of 16%–69% for 3 types of devices.

CONCLUSION. System-level factors, in addition to patient need, significantly affect the provision of assistive devices. Provision guidelines could assist clinicians in making decisions about device provision.

OBJECTIVE. We quantified the range of motion (ROM) required for eight upper-extremity activities of daily living (ADLs) in healthy participants.

METHOD. Fifteen right-handed participants completed several bimanual and unilateral basic ADLs while joint kinematics were monitored using a motion capture system. Peak motions of the pelvis, trunk, shoulder, elbow, and wrist were quantified for each task.

RESULTS. To complete all activities tested, participants needed a minimum ROM of −65°/0°/105° for humeral plane angle (horizontal abduction–adduction), 0°–108° for humeral elevation, −55°/0°/79° for humeral rotation, 0°–121° for elbow flexion, −53°/0°/13° for forearm rotation, −40°/0°/38° for wrist flexion–extension, and −28°/0°/38° for wrist ulnar–radial deviation. Peak trunk ROM was 23° lean, 32° axial rotation, and 59° flexion–extension.

CONCLUSION. Full upper-limb kinematics were calculated for several ADLs. This methodology can be used in future studies as a basis for developing normative databases of upper-extremity motions and evaluating pathology in populations.

Surgical arthroplasty of thumb carpometacarpal (CMC) joint osteoarthritis is commonly performed. Postoperative therapeutic protocols aim to improve range of motion and function of the revised thumb. We describe a case in which the thumb CMC joint had been chronically dislocated before surgery, with shortening of the soft-tissue dynamic and static stabilizers of the joint. The postoperative protocol addressed the soft tissues using splinting and exercises aimed at lengthening and strengthening these structures, with good results. It may be beneficial to evaluate soft-tissue tension and the pattern of thumb use after surgery for thumb CMC joint osteoarthritis to improve postoperative functional results.

People with intellectual disabilities may be predisposed to occupational alienation as a result of an inherent need for ongoing support and limited understanding of how they express choice and engagement in occupation. In response to this risk of occupational injustice, this phenomenological study explored the occupational engagement of adults with intellectual disabilities in a community-based day program. Data were collected through interviews using visual supports and through observation of activity groups using the Volitional Questionnaire. Thematic analysis illustrated how participants demonstrated engagement in occupation through doing activity/initiating action, expressing positive affect, and showing focused attention. Findings can inform how occupational therapy practitioners describe and facilitate occupational engagement in adults with intellectual disabilities.

Limited information is available regarding use of the Frazier free water protocol (FWP) with hospitalized patients who have dysphagia and have survived a critical illness with compromised pulmonary status. This pilot study used a two-group nonequivalent comparison group design to evaluate the FWP in 15 adults admitted to a respiratory care unit (RCU) with dysphagia concerns. Inclusion criteria included recommendation for a modified diet with thickened liquids by a dysphagia therapist and ability to follow the specific free water guidelines. The 15 control participants were chosen from a retrospective chart review of consecutive RCU admissions that met the same inclusion criteria. The intervention group for whom the free water guidelines were implemented did not differ significantly from the control group in rate of development of aspiration pneumonia, χ²(30) = .01, p = 1.00.

Despite recognition of the rights of disabled people to sexuality, occupational therapists continue to not address sexuality in practice. This failure can be understood as a consequence of social discourses relating to sexuality and disability and a professional discourse that values certain occupations over others. Given the importance of sexuality to the human experience and the evidence of the link between the opportunity for sexual expression and well-being, occupational therapists need to change their practice in relation to sexuality and disability. One method of achieving this change may be to adopt a rights-based approach to sexuality and disability. This article presents the possibilities offered by such an approach, discusses implications for occupational therapy practitioners, and proposes suggestions for future actions to ensure that the rights of disabled people to sexuality are embedded in occupational therapy practice.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities on adults with stroke. 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.