American Journal of Occupational Therapy

Occupational therapy practitioners must advocate for clients in multiple ways. The Occupational Therapy Practice Framework: Domain and Process as well as the Occupational Therapy Code of Ethics lend support to advocacy. Recognizing one’s responsibility to provide advocacy for clients is different from knowing how to provide that advocacy. One aspect of health care affected by the Patient Protection and Affordable Care Act (ACA) is the definition and implementation of medical necessity. This article outlines some major concepts around medical necessity, particularly in relation to the passage of the ACA, and outlines guidance on how to advocate effectively to meet both individual and community needs.

Obesity is a complex, multidimensional challenge that compromises occupational participation for children and families. Children who are overweight or obese are at serious risk for being stigmatized, bullied, or marginalized, and they often are medically compromised. They cope daily with occupational participation issues at home, in school, on playgrounds, and in their communities. Prevention and health promotion assessment and intervention in occupational therapy are imperative for the profession to make a significant and sustainable difference in the lives of these children and families. Innovative client- and occupation-centered programming promotes health, well-being, and quality of life for this population. It is incumbent upon occupational therapy practitioners to prevent occupational marginalization, deprivation, and alienation while promoting occupational justice for children who are overweight or obese.

OBJECTIVE. In this study, we explored the impact of an occupational therapy wellness program on daily habits and routines through the perspectives of youth and their parents.

METHOD. Data were collected through semistructured interviews with children and their parents, the Pizzi Healthy Weight Management Assessment^©, and program activities.

RESULTS. Three themes emerged from the interviews: Program Impact, Lessons Learned, and Time as a Barrier to Health. The most common areas that both youth and parents wanted to change were time spent watching television and play, fun, and leisure time. Analysis of activity pie charts indicated that the youth considerably increased active time in their daily routines from Week 1 to Week 6 of the program.

CONCLUSION. An occupational therapy program focused on health and wellness may help youth and their parents be more mindful of their daily activities and make health behavior changes.

As children and youth with diabetes grow up, they become increasingly responsible for controlling and monitoring their condition. We conducted a scoping review to explore the research literature on self-management interventions for children and youth with diabetes. Eleven studies met the inclusion criteria. Some of the studies reviewed combined the participant population so that children with Type 1 as well as children with Type 2 diabetes were included. The majority of the studies focused on children age 14 yr or older and provided self-management education, self-management support, or both. Parent involvement was a key component of the majority of the interventions, and the use of technology was evident in 3 studies. The findings highlight factors that occupational therapy practitioners should consider when working with pediatric diabetes teams to select self-management interventions.

This phenomenological study revealed the lived experiences of occupational therapy students as they embarked on a semester-long volunteer health promotion service-learning project during their entry-level master’s program. Data analysis extrapolated themes from student journals, transcriptions of pre- and postinterviews, and field notes. Student roles were exemplified by what students wanted to learn, what they actually learned, and the unexpected benefits they experienced. In particular, issues with teaming, interprofessional development, and time management were discovered. The findings add to the growing literature about the benefits of service learning as a teaching strategy and how it facilitates mindfulness of community service, communication, and clinical reasoning of future therapists. Implications for learning and practice are discussed.

OBJECTIVE. Immigrant youth in the United States are at greater risk for weight management problems than non-Hispanic White youth. We used the Pizzi Healthy Weight Management Assessment (PHWMA) to capture data on health perceptions and weight management behaviors among adolescent Burmese refugees.

METHOD. We conducted a retrospective descriptive study of 20 Burmese refugee high school students.

RESULTS. The results captured an understanding of health perceptions and weight management behaviors of the program participants. The PHWMA was found to be a valid and reliable tool for use by occupational therapy practitioners.

CONCLUSION. Findings from this study can inform program development and evaluation in outreach efforts to enhance minority youths’ health and well-being.

Children with physical disabilities who use assistive mobility devices (AMDs) are at risk for obesity and other secondary health conditions. Habitual physical activity is one lifestyle factor that may prevent obesity and contribute to overall health, and an active lifestyle in childhood improves prospects for lifelong healthy behaviors. Child, family, and environmental facilitators and barriers influence health-promoting physical activity (HPPA) for children without disabilities, but comparable models and levels of understanding for children who use AMDs are lacking. In this scoping review, we identified a similar set of child, family, and environmental facilitators and barriers relevant to HPPA participation among children who use AMDs. Noted gaps in the literature included limited reporting of AMD use, inconsistent HPPA definitions, and inadequate measurement tools for children who are nonambulatory. The identified child, family, and environmental factors provide a framework for occupational therapy practitioners and interprofessional teams to develop HPPA opportunities and interventions for an underserved population.

OBJECTIVE. This study examined the relationship between childhood obesity and overweight and functional activity and its enjoyment.

METHOD. A cross-sectional design was used to analyze data from the 2012 National Health and Nutrition Examination Survey National Youth Fitness Survey. Multivariate logistic regression models were used.

RESULTS. Data for 1,640 children ages 3–15 yr were retrieved. Physical activity was negatively associated with risk of obesity (odds ratio [OR] = 0.93; 95% confidence interval [CI] [0.87, 0.98]). Although children who were obese and overweight were more likely to have functional limitations (ORs = 1.58–1.61), their enjoyment of physical activity participation was not significantly different from that of the healthy-weight group.

CONCLUSION. Physical activity lowered the risk of obesity. Children who were obese had functional limitations compared with healthy-weight children, but both groups enjoyed physical activity equally. Future studies are needed to determine barriers to participation among these children in recreation and sporting activities.

Obesity is a public health concern for the population in general and for children with autism spectrum disorder (ASD) specifically. The purpose of this study was to understand relationships between sensory patterns, obesity, and physical activity engagement of children with ASD (N = 77) sampled from a specialized community-based swimming program. This retrospective correlational study analyzed program data. Results show that almost half (42.2%) of the children were overweight or obese, and sensory avoiding behaviors were related to higher body mass index (BMI). Children participated in few formal and informal physically active recreation activities. Sensory seeking behaviors were associated with increased participation in informal activities, and higher BMI was associated with less participation in both formal and informal activities. Practitioners should consider sensory processing patterns and BMI when developing community-based programs to promote physical activity of children with ASD.

Little research is available about youth with disabilities, who experience numerous inequalities in health outcomes compared with youth without disabilities. Youth with disabilities experience many environmental and attitudinal barriers in maintaining healthy lifestyles, which put them at risk for obesity. Strong evidence has suggested that obesity rates are higher among youth with disabilities than among their nondisabled peers. The purpose of this study was to implement and examine the benefits of a culturally tailored healthy lifestyles program for Latino youth with disabilities and their families. Several cultural adaptations were made to align with the target population’s cultural norms. Seventeen Latino families identified 67 behaviors they wanted to change or new habits they wanted to establish. The postassessment data showed that several family routines improved, and families reported engaging in many of the healthy habits they had identified for themselves. Implications of culturally appropriate and accessible programming are discussed.

OBJECTIVE. The study’s objective was to evaluate the effectiveness of the Interdisciplinary Sensory-Enriched Early Intervention (ISEEI) group program for children with developmental delays.

METHOD. We conducted a retrospective chart review of 63 children ages 18–36 mo who participated in ISEEI. We evaluated participants with the Bayley Scales of Infant and Toddler Development III (Bayley–III) and the Infant/Toddler Sensory Profile (ITSP) at enrollment and after 3–9 mo. We conducted a paired t test to examine changes in the Bayley–III between pre- and posttests.

RESULTS. At enrollment, 70% of children presented atypical scores in two or more areas of sensory processing in the ITSP. Results revealed that children with sensory processing difficulties demonstrated significant improvement in all areas of development except fine motor skills; children without sensory processing difficulties showed significant improvement in language and cognition.

CONCLUSION. The ISEEI group program is an effective method to ameliorate developmental delays.

OBJECTIVE. We examined the effects of a guided imagery intervention on perceived stress in pregnant adolescents.

METHOD. Thirty-five pregnant adolescents recruited from a local alternative education program participated in a guided imagery intervention. Participants listened to a pregnancy-specific guided imagery recording on four separate occasions during their pregnancies. Perceived stress was measured immediately before and after each session using the Perceived Stress Measure–9 (PSM–9).

RESULTS. Participants’ pre- and postsession PSM–9 scores for three of the four sessions demonstrated a significant reduction in stress. Participants’ baseline stress levels also decreased significantly across the four listening sessions. The greatest reductions in stress within and between sessions occurred in the early sessions, with effects diminishing over time.

CONCLUSION. Pregnant teens experienced initial short- and long-term stress reduction during a guided imagery intervention, supporting the use of guided imagery to reduce stress in pregnant adolescents.

OBJECTIVE. In this study, we aimed to assess whether therapeutic taping for scapular stabilization affected scapulothoracic, glenohumeral, and humerothoracic joint function in children with brachial plexus birth palsy and scapular winging.

METHOD. Motion capture data were collected with and without therapeutic taping to assist the middle and lower trapezius in seven positions for 26 children. Data were compared with one-way multivariate analyses of variance.

RESULTS. With therapeutic taping, scapular winging decreased considerably in all positions except abduction. Additionally, there were increased glenohumeral cross-body adduction and internal rotation angles in four positions. The only change in humerothoracic function was an increase of 3° of external rotation in the external rotation position.

CONCLUSION. Therapeutic taping for scapular stabilization resulted in a small but statistically significant decrease in scapular winging. Overall performance of positions was largely unchanged. The increased glenohumeral joint angles with therapeutic taping may be beneficial for joint development; however, the long-term impact remains unknown.

We explored the effectiveness of a sensory-based, family-centered coaching approach to changing problematic routines for young children with autism. Three mothers of young children with autism, atypical sensory processing, and global developmental delay each participated in a single-case experimental ABA design study. Mothers selected a problematic daily routine linked to sensory challenges as the focus of four intervention sessions provided in the home. Changes in mothers’ perceptions of the children’s behavior were the primary outcome, measured daily on a visual analog scale. Visual and descriptive analyses were undertaken. The sensory-based, family-centered coaching approach showed promise for changing sensory-related problem behaviors of young children with autism, but the degree and maintenance of the intervention effect varied among participants.

OBJECTIVE. Despite a strong tradition of education scholarship in occupational therapy, no systematic evaluation of the amount and nature of research in this arena, or its associated challenges, has been conducted. This study examined the scope and range of education-focused research conducted in Canada and identified perceived supports and barriers for this area of inquiry.

METHOD. An online survey was sent to faculty of all 14 Canadian occupational therapy programs. Descriptive statistics were used to summarize areas of study focus, and qualitative thematic analysis captured respondents’ perceptions of personal and environmental factors influencing their engagement in education research.

RESULTS. Respondents (n = 47) reported engagement in education scholarship spanning more than 20 focus areas, often with limited resources.

CONCLUSION. Strategies are proposed to promote the viability of education research in occupational therapy and to improve resources and other supports for this type of research.

OBJECTIVE. We sought to identify strategies and practices that school-based occupational therapy practitioners use in addressing social participation, their perceptions of competence, and factors influencing their strategies and practices.

METHOD. Surveys were sent to 500 randomly selected members of the American Occupational Therapy Association’s Early Intervention and School Special Interest Section; 112 usable surveys were received from 36 states.

RESULTS. Respondents reported focusing on internal client factors when addressing social participation. Fewer than half (46.5%) indicated that they understood their role (mean [M] = 4.23, standard deviation [SD] = 1.22), and 57.1% desired greater understanding or ability (M = 4.64, SD = 1.29). Differences were found based on years of experience, service delivery model used, and services provided by diagnosis category.

CONCLUSION. School-based occupational therapy practitioners may need to expand their current practices in addressing student social participation. Findings may be used to develop interventions to address this area of practice.

The rigor of occupation-based standardized assessments that rely on observational scoring procedures depends on proven reliability among test administrators. This study measured interrater reliability of the Cognitive Performance Test (CPT), a standardized, occupation-based assessment that measures cognitive–functional capacity in older adults with neurocognitive disorders. To capture a range of experience among test administrators, two sets of raters—four expert and three novice—scored video recordings of 10 patients administered the CPT. Interrater reliability results were strong among all raters (intraclass correlation coefficient [ICC] = .93), with expert raters (ICC = .97) yielding higher coefficients than novice raters (ICC = .93). Spearman’s ρ correlation coefficients were high among all raters (rs = .92–1.00). Practitioners can be confident that results of the CPT give accurate and consistent information to the health care team, family members, and patients when administered with fidelity using standardized protocols.

Evidence Connection articles describe a clinical application of a systematic review developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice (EBP) Project. This Evidence Connection provides a case report of a client referred to occupational therapy for home modification assessment and intervention, applying the evidence from the systematic review of home modifications conducted in conjunction with the EBP Project. The client received in-home occupational therapy after side effects of liver disease resulted in increased falls within her home.