American Journal of Occupational Therapy

The American Journal of Occupational Therapy (AJOT) had a successful 2016. From September 2015 to September 2016, the number of manuscripts submitted remained steady at 255. Manuscripts were received from 30 non-U.S. countries, compared with 23 countries in 2015. AJOT continues to have the highest impact factor and to be the highest ranked of the occupational therapy journals listed in Journal Citation Reports. AJOT continues to focus on publishing research articles on aspects of occupational therapy among varied populations with diverse acute and chronic conditions. Changes in 2016 include requiring authors to register clinical trials at public trial registration sites and welcoming new associate editors and reviewers to the AJOT family.

Family is a metaphor for the connectedness that occupational therapy practitioners and students feel for one another, for the American Occupational Therapy Association (AOTA), and toward those served. Exploring values and cultural practices that emanate from family experiences affects how we practice occupational therapy and engage with families; how we serve and lead; and how, as the profession approaches its 100th anniversary in the United States, we strengthen AOTA by welcoming all 213,000 practitioners and students who could become active, engaged members. The heartfelt connections experienced across our worldwide occupational therapy communities, giving support and nurturance to those who show promise, breaking down barriers and creating community as extended family, creating a sense of home and belonging, encouraging participation, and building excellence, strengthen the AOTA family. AOTA Vision 2025 serves as a means to facilitate the profession's future, where health, well-being, and quality of life are the outcomes of effective occupational therapy.

Occupational therapy practitioners can embrace the distinct value of occupational therapy by harnessing the power of authenticity in our daily practice. Practitioners, educators, students, and researchers being true to our core values, as well as the historical roots of the profession, will demonstrate how occupational therapy enhances clients' quality of life and positively affects their everyday lives. By harnessing the power of authenticity, we can drive the profession of occupational therapy into the future as practitioners with influence to meet the dynamic needs of health care and education systems.

Every day, in clinics and hospitals around the world, occupational therapists care for patients with serious problems requiring viable solutions. Each patient is unique, and his or her problem does not necessarily correspond to existing practice models. Practitioners must adapt standard approaches to provide effective outcomes, yet problems exist for which few or no beneficial approaches have been identified. Such clinical issues require solutions to be generated de novo from the practitioner’s body of knowledge and past experience. Yet, no single new intervention can be used without prior validation of its efficacy. Only a therapist with a prepared mind can accept such challenges, recognize what is known and not yet known, design studies to acquire that needed knowledge, and translate it into successful clinical treatment strategies. The occupational therapist with a prepared mind is one willing to seize unexpected opportunities and construct new paradigms of practice. Innovation through scientific inquiry requires a prepared mind.

OBJECTIVE. We compared health-related quality-of-life (HRQOL) perceptions of children with celiac disease (CD) with those of their parents to determine whether their leisure participation differs from that of children without CD and whether relationships exist between leisure participation and HRQOL.

METHOD. Children with CD and their parents completed a disease-specific HRQOL self-report questionnaire, the Celiac Disease DUX. These children and matched controls without CD completed the Children’s Leisure Assessment Scale (CLASS).

RESULTS. Parents perceived HRQOL significantly more negatively than did children. No significant group differences were found in leisure participation. However, specific CLASS food-related activities and HRQOL significantly correlated.

CONCLUSION. Hearing the child’s voice in addition to the parents’ is important in determining the HRQOL of children with a chronic condition. Findings contribute to understanding of CD in the context of participation and well-being and can lead to development of occupational performance–based assessments and interventions for children with CD.

This study investigates handwriting characteristics and potential predictors of handwriting legibility among typically developing elementary school children in Taiwan. Predictors of handwriting legibility included visual–motor integration (VMI), visual perception (VP), eye–hand coordination (EHC), and biomechanical characteristics of handwriting. A total of 118 children were recruited from an elementary school in Taipei, Taiwan. A computerized program then assessed their handwriting legibility. The biomechanics of handwriting were assessed using a digitizing writing tablet. The children’s VMI, VP, and EHC were assessed using the Beery–Buktenica Developmental Test of Visual–Motor Integration. Results indicated that predictive factors of handwriting legibility varied in different age groups. VMI predicted handwriting legibility for first-grade students, and EHC and stroke force predicted handwriting legibility for second-grade students. Kinematic factors such as stroke velocity were the only predictor for children in fifth and sixth grades.

OBJECTIVE. We established test–retest reliability of electrodermal markers used to quantify physiological response to sensation using the Sensory Challenge Protocol in children with and without autism spectrum disorder (ASD).

METHOD. Electrodermal activity (EDA) was measured during rest and in response to sensory inputs. Fourteen children with ASD and 18 typically developing children were tested and retested after 2–6 wk on skin conductance response, skin conductance level, nonspecific skin conductance response, and habituation.

RESULTS. Test–retest reliability was evaluated with intraclass correlation coefficients (ICCs). Rest-phase coefficients for both groups were moderate (.65–.73). ICCs during response to sensation ranged from moderate to good for amplitude (.60–.81) and magnitude (.50–.75). In addition, moderate to excellent reliability (.51–.93) was observed for nonspecific response measures.

CONCLUSION. EDA measures are reliable physiological markers that can quantify response to sensation in children with and without ASD.

Engagement in meaningful activities is essential to development and is often reduced in children with autism spectrum disorder (ASD) who have limited engagement in activities or relationships. A multiple-baseline design was used with 7 children with ASD ages 4–8 yr to assess the effect of including a horse in occupational therapy intervention on task engagement. The children showed improvements in engagement. Including horses in occupational therapy sessions may be a valuable addition to conventional treatments to increase task engagement of children with ASD. Factors related to the environment, therapeutic strategies, and individual participation need to be considered in understanding why this intervention may be effective and developing a theoretical basis for implementation.

OBJECTIVE. This investigation was a pilot feasibility trial evaluating the use of an arm-weight–supported training device to improve upper-extremity function in children with hemiplegia.

METHOD. A single-group within-subject design was used. Participants were 6 children ages 7–17 yr with upper-extremity weakness secondary to hemiplegia. The intervention consisted of 15–18 treatment sessions using an arm-weight–supported training device with the affected upper extremity. Fine motor function was assessed using the Jebsen–Taylor Hand Function Test, the Box and Block Test, and the Assisting Hand Assessment. We examined participants’ interactions with the device and assessment scores pre- and postintervention.

RESULTS. Five of the 6 children exhibited some changes after the therapy. The system required significant modifications to ensure appropriate positioning.

CONCLUSION. The arm-weight–supported system may be viable for therapeutic use. Future studies should use randomized controlled designs and compare effectiveness of weight-supported training with that of other rehabilitation strategies.

OBJECTIVE. This study describes how women with physical disability experience caregiving for a new infant and how they adapt their home environment and care tasks.

METHOD. In 2013, we conducted 2-hr telephone interviews with 22 women with significant physical disability who had delivered babies within the previous 10 yr. The semistructured, open-ended interview protocol addressed wide-ranging pregnancy-related topics. NVivo was used to sort the texts for content analysis.

RESULTS. Night care, bathing, and carrying the baby were identified as the biggest challenges. Typical adaptations (with and without occupational therapy consultation) included use of a wrap for carrying the infant, furniture adaptations for mothers using wheelchairs, and assistance from caregivers.

CONCLUSION. Women with physical disability can be fully capable of caring for an infant and can find ways to adapt their environment. Further research may determine the role of occupation therapy.

Research involving working memory has indicated that stress and anxiety compete for attentional resources when a person engages in attention-dependent cognitive processing. The purpose of this study was to investigate the impact of perceived stress and state anxiety on working memory and academic performance among health science students and to explore whether the reduction of stress and anxiety was achieved through progressive muscle relaxation (PMR) training. A convenience sample of 128 graduate students participated in this study. Using an experimental pretest–posttest design, we randomly assigned participants to a PMR group or a control group. Results indicated that PMR reduced state anxiety, F(1, 126) = 15.58, p < .001, thereby freeing up working memory and leading to improved academic performance in the treatment group. The results of this study contribute to the literature on Attentional Control Theory by clarifying the process through which working memory and anxiety affect cognitive performance.

OBJECTIVE. Many people with chronic health conditions fail to take their medications as prescribed, resulting in declines in health and function. The purpose of this study was to perform a Phase I feasibility study to understand whether an integrated occupational therapy intervention could help people with chronic health conditions improve their adherence to medications.

METHOD. Using a small-N design, we report single-subject analyses of the medication adherence of 11 participants before and after either an occupational therapy intervention or a standard care intervention. We used a multiple baseline approach with intersubject replication and blinding.

RESULTS. The occupational therapy intervention was found to decrease performance variability and to increase medication adherence rates in some people with chronic conditions.

CONCLUSION. These findings suggest that an occupational therapy intervention can improve medication adherence in people with chronic health conditions. The intervention tested in this study is feasible and would benefit from further research.

An increasing number of U.S. military veterans are entering postsecondary education with problems attributed to deployed military service. The primary objective of this research was to describe the lived experiences of student veterans transitioning from active military service to postsecondary education. Phenomenological interviews were performed with 13 student veterans who had transitioned from military deployment to postsecondary education. An overall essential meaning of “emerging in college culture” was manifested from three themes, supported by rich textural and structural descriptions of student veterans’ experiences: (1) repurposing military experiences for life as a student veteran, (2) reconstructing civilian identity, and (3) navigating postsecondary context and interactions. These findings highlight implications that may facilitate occupational therapists’ efforts in supporting the needs of student veterans.

Although the term self-regulation is appearing more frequently in the occupational therapy literature, the extent to which it is consistently conceptualized is not clear. The aim of this scoping review was to examine how the term self-regulation is used by occupational therapists in research and practice literature. A total of 58 publications that included occupational therapy and self-regulation in the title, key words, or abstract were identified. Self-regulation was not explicitly defined by more than half of the authors. Four theoretical orientations seem to guide conceptualization: synactive development, sensory integration, cognitive–behavioral theory, and self-regulation theory. Conceptualization differed according to the population, levels of strategy use, source of strategy implementation, and desired outcomes. A lack of definitional clarity and conceptual consistency of the term self-regulation was noted. Use of an explicit definition in relation to an identified theoretical framework is recommended to promote intra- and interprofessional communication, education, and research.

OBJECTIVE. In this study, we systematically reviewed the effectiveness of educational interventions falling within the scope of occupational therapy practice for people with rheumatoid arthritis (RA). These interventions included disease education, joint protection and energy conservation, psychosocial techniques, pain management, and a combination category.

METHOD. Two databases, MEDLINE and CINAHL, and select journals were searched for randomized controlled trials published between January 2002 and June 2015. Qualitative synthesis was used for between-study comparisons.

RESULTS. Twenty-two studies, with approximately 2,600 participants, were included. The interventions were found to have strong evidence for constructs that dealt with increasing coping with pain and fatigue as well as maintaining positive affect. There was limited or no evidence supporting the effectiveness of these interventions on most other measured constructs.

CONCLUSION. Interventions in which a combination of educational techniques is used may complement pharmacological therapies in the care of people with RA. Future research is needed to identify specific mechanisms of change.

People with mental health conditions (MHCs) frequently experience participation and functional restrictions. Today, hospitals still serve a significant number of people with MHCs. However, there is little evidence for occupation-oriented interventions to support participation, health, and well-being in these hospital settings. This article describes a newly developed, short-term, structured intervention for the inpatient setting, Occupational Connections (OC), that focuses on promoting everyday functions and participation in daily life and presents preliminary findings for its effectiveness. Ten people with schizophrenia participated in the program during their stay in acute open inpatient units and completed evaluations both pre- and postintervention. Statistics for a small-sample study design were applied to investigate OC’s impact. The results showed OC’s contribution to participation dimensions, functional capacity, cognitive functioning, and reduction in schizophrenia symptoms. On the basis of this pilot study’s results, extended research is now being conducted to strengthen the evidence for OC’s effectiveness.

OBJECTIVE. This study’s objective was to discover whether a difference exists in four postural angles while performing a typing task on a laptop and a desktop computer.

METHOD. Twenty healthy participants performed a 5-min typing task on each computer.

RESULTS. Statistically significant differences for all angles were found when comparing sitting at the desktop computer with sitting at the laptop. Neck angle (p < .0005), head tilt (p < .0005), and lumbar lordosis (p = .018) were significantly higher when using the laptop. The greatest posterior pelvic tilt was associated with the desktop (p = .018).

CONCLUSION. A desktop appears to be more appropriate for the cervical and lumbar regions; however, using a laptop may be more suitable for pelvic tilt.

Human trafficking is a modern-day form of slavery that includes sex trafficking, labor trafficking, and trafficking of children. It is estimated that 35.8 million people are enslaved around the world. Because of the traumatic experiences that victims of human trafficking encounter, the needs of victims are extensive and require the services of several providers, including health care providers, for victims to transform into survivors and thrivers. Currently, the role of occupational therapy is minimal and unexplored. The profession of occupational therapy has the capacity of having a profound role in both providing client-centered care services to victims and survivors of human trafficking and partaking in preventive advocacy efforts to combat human trafficking. Further advocacy efforts are required to promote the profession of occupational therapy in combating human trafficking.

The American Occupational Therapy Association (AOTA) Evidence-Based Practice Project has developed a table summarizing the research opportunities in the area of adults with traumatic brain injury. 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 Practice Guidelines Series. Researchers, students, and clinicians can use this information in developing innovative research to answer important questions within the occupational therapy field.