American Journal of Occupational Therapy

The American Journal of Occupational Therapy (AJOT) has maintained its top-ranked status in the field of occupational therapy and increased its standing among all rehabilitation journals, buoyed by an increase in its 5-yr impact factor. Key outcomes for 2024 showcase the journal’s breadth and depth, with 139 articles published. AJOT published a special issue on the topic of Recovery of Function After Neurological Injury and a special section on Play in Occupational Therapy. The AJOT Authors & Issues interview series has reached more than 11,000 views, and the AJOT Instagram account now has more than 1,000 followers. AJOT editorial team members have also been recognized for their expertise as leaders in the field of scholarly publishing with opportunities to participate in national and international initiatives. As AJOT looks ahead to 2025, we will focus on leading the profession in the use and adoption of new research reporting guidelines, as well as continuing to maintain our commitment to publishing articles that will move research in the profession forward.

Key outcomes for 2024 showcase the journal’s breadth and depth, with more than 139 articles published, as well as maintaining its top-ranked status among all rehabilitation journals, buoyed by an increase in its 5-yr impact factor.

In her Presidential Address at the AOTA INSPIRE 2024 Annual Conference & Expo in Orlando, Florida, AOTA President Alyson Stover highlights some of the unique ways occupational therapists and occupational therapy assistants are practicing today and come away inspired by the positive impacts we are making in the world. Occupational therapy is the ultimate contradiction: We are the same, but can look so different.

In her Presidential Address at the AOTA INSPIRE 2024 Annual Conference & Expo in Orlando, Florida, AOTA President Alyson Stover highlights some of the unique ways occupational therapists and occupational therapy assistants are practicing today.

Supporting clients and their families to live ordinary lives lies at the heart of occupational therapy. But an ordinary life—no matter who is living it—is full of risks, and risks often make us a little anxious. What if I, as a practitioner, encourage a client to take a risk and something undesirable does happen? Will I have shirked my duty of care? Not all experiences we label risky lead to undesirable outcomes. Some simply involve challenges: pushing people beyond their comfort zone so they can achieve more than ever before. Self-esteem is born out of meeting challenges; so is respect. In supporting clients and families to meet the challenges of an ordinary life, we balance duty of care with dignity of risk.

In this Eleanor Clarke Slagle Lecture, Dr. Anita Bundy discusses how supporting clients and their families to live ordinary lives lies at the heart of occupational therapy.

Importance: Children with sensory processing challenges often need supports to access, participate in, and achieve at school. However, research on best practice is varied, presenting difficulty for practitioners to assess the appropriateness of each support.

Objective: To provide evidence-informed recommendations regarding best practices in school-based supports for students with sensory processing challenges via a Rapid Evidence Assessment of current literature.

Data Sources: Searches were run in CINAHL Complete, Education Research Complete, ERIC, MEDLINE, PsycINFO, and Scopus (for articles published 2010 to 2023). Informed by a 2010 review, articles citing publications identified in the prior review were also included.

Study Selection and Data Collection: A reviewer screened the title and abstract of each article for inclusion, and another screened the full texts, with 10% of each reviewer’s articles assessed by the other. Interrater reliability was excellent.

Findings: The review included 61 articles, with only 15% constituting good evidence (38% provided adequate evidence, 31% provided poor evidence, and 16% were reviews). No support could be wholly recommended without caveats, but there was some evidence that sound amplification systems, alternate seating, and multisensory environments may be beneficial in certain conditions or with certain populations. The use of weighted vests is not recommended.

Conclusions and Relevance: Most research had small sample sizes and inconsistent protocols, highlighting the importance of ongoing research. Evidence-informed practitioners should review research findings carefully and integrate evidence from comprehensive clinical assessment and understanding of the child, school, and family contexts when assessing the appropriateness of a support for each student.

Plain-Language Summary: Children with sensory processing challenges often need supports to access, participate in, and achieve at school. Occupational therapists provide school-based supports for children with sensory processing challenges with the goal of enabling access, participation, and achievement. It is difficult, however, for practitioners to assess the appropriateness of each support because research on best practice varies. This review of the current literature provides practitioners with evidence on supports for school children with sensory processing challenges to inform decision-making and the selection of appropriate supports for their clients. When assessing the appropriateness of a support for a student, practitioners should carefully review current research findings and integrate evidence from comprehensive clinical assessments along with an understanding of the student, school, and family contexts.

This rapid review of the current literature provides practitioners with evidence on supports for school children with sensory processing challenges.

Importance: Work and industry (W&I) is a vital yet underrepresented area of occupational therapy practice. Describing the current practice trends, challenges, and opportunities in W&I provides a foundation for future development and advancements.

Objective: To describe the state of W&I occupational therapy practice and to identify challenges and opportunities in this specialty practice area.

Design: Cross-sectional survey conducted June 12 to July 17, 2020.

Setting: Online survey distributed through direct email invitations and online platforms (i.e., CommunOT, LinkedIn).

Participants: One hundred twenty occupational therapy practitioners who had worked in W&I within the most recent 5 yr.

Outcomes and Measures: We used 30 multiple-choice, Likert-scale, and free-response questions across three topics: (1) training, resources, and research; (2) challenges and barriers; and (3) opportunities.

Results: Most respondents were occupational therapy practitioners working in clinical settings with >5 yr of experience; 29.2% identified as male. The most frequently provided services were ergonomic consultation and worksite evaluation; clinic-based W&I services were less frequently provided. Workplace injury prevention, management of psychosocial issues, and employee wellness programs were ranked as the top opportunities for occupational therapy in W&I. A shortage of accessible training and resources to support W&I practice was found, particularly mentoring and occupational therapy–focused research evidence. Maintaining referrals, competition from other professions, and limited support from professional organizations were key challenges.

Conclusions and Relevance: This study illustrates the evolution of W&I occupational therapy practice and highlights an urgent need for increased professional recognition and educational support to maintain occupational therapy’s presence in this practice area.

Plain-Language Summary: In this study, we describe the current practice trends in work and industry occupational therapy practice. We identify challenges related to resources and training in this practice area and provide insights into opportunities for future development. The study findings show the evolution of work and industry occupational therapy practice and highlight an urgent need for more professional recognition and educational support to maintain occupational therapy’s presence in this practice area.

This study describes the current practice trends in work and industry occupational therapy practice, identifies challenges related to resources and training in this practice area, and provides insights into opportunities for future development.

Importance: A key assumption of occupational therapy is that engagement in meaningful activities is fundamental to one’s health and well-being. Preliminary findings suggest a link between childhood adversity and engagement in meaningful activity. Childhood adversity is also linked to attachment insecurity in adulthood, and both represent barriers to health and well-being. It is unknown whether attachment insecurity is associated with meaningful activity engagement or how attachment insecurity influences the relationship between childhood adversity and meaningful activity engagement.

Objective: To investigate the association between attachment insecurity and meaningful activity engagement and the role of attachment insecurity in the relationship between childhood adversity and engagement in meaningful activities in adulthood.

Design: Cross-sectional online survey.

Setting: Community.

Participants: Community-dwelling adults ages 18 yr or older, healthy, and able to understand standard English to complete the questionnaires. Participants were recruited through snowball sampling.

Outcomes and Measures: Participants answered demographic questions and completed three questionnaires: the Engagement in Meaningful Activities Survey, Risky Families Questionnaire, and Experiences in Close Relationships–Short Form.

Results: Participants (N = 329) completed at least two of the three surveys, with most (n = 312) completing all three. More insecurely attached participants reported less engagement in meaningful activities. Both attachment avoidance and attachment anxiety mediated the relationship between childhood adversity and meaningful activity engagement.

Conclusions and Relevance: The findings offer support for interrelations among childhood adversity, attachment insecurity, and engagement in meaningful activity. Further research is required to support the application of these findings in clinical settings.

Plain-Language Summary: To our knowledge, this is the first study to establish a connection between attachment insecurity in adults and lower levels of engagement in meaningful activities during adulthood. The findings highlight the heightened vulnerability of adults who have a history of childhood adversity. The findings also emphasize the significance of (1) considering clients’ childhood adversity and attachment patterns when assessing for and providing occupational therapy services and (2) advocating for the inclusion of trauma-informed practices for those with lower levels of meaningful occupational engagement.

This is the first study to establish a connection between attachment insecurity in adults and lower levels of engagement in meaningful activities during adulthood.

Importance: High stress and compromised mental health are well-documented among mothers of children with disabilities, but less is known about the factors that influence their participation and well-being, especially among Chinese mothers. Identifying these factors could lead to strategies to mitigate potential risks to maternal well-being.

Objective: To explore the relationships among participation in health-promoting activities, perceived stigma, perceived support, and well-being of ethnic Chinese mothers who have children with disabilities.

Design: Cross-sectional survey.

Setting: Community.

Participants: Ethnic Chinese mothers (N = 261) with children with disabilities of any age residing in Australia, Singapore, or Taiwan.

Outcomes and Measures: Health Promoting Activities Scale, Personal Wellbeing Index, Warwick–Edinburgh Mental Wellbeing Scale; Kessler Psychological Distress Scale, Parental Perceptions of Public Attitudes Scale, and Multidimensional Scale of Perceived Social Support.

Results: Moderate to strong correlations were found between mental well-being and all measures. The frequency of participation in health-promoting activities was a predictor of mental well-being (β = .21, p = .001). Perceived support was the strongest predictor of participation in health-promoting activities (β = .25, p = .005), mental well-being (β = .39, p < .001), and personal well-being (β = .45, p < .001). Perceived stigma predicted psychological distress (β = .32, p < .001) and mental well-being (β = −0.29, p < .001).

Conclusions and Relevance: Perceived support and stigma affected mothers’ participation in health-promoting activities and well-being. Therapists can facilitate mothers’ engagement in health-promoting activities and develop strategies to address stigma and enhance support.

Plain-Language Summary: This research highlights factors that affect the well-being of ethnic Chinese mothers who have children with disabilities and provides cultural insights for occupational therapists who work with Chinese families. The article also encourages pediatric occupational therapists to address the occupational needs and well-being of mothers in parallel with therapy for their children. We discuss occupation-focused strategies, family-centered perspectives, and health promotion approaches in relation to improving the participation and well-being of ethnic Chinese mothers in their cultural context.

This study highlights factors that affect the well-being of ethnic Chinese mothers who have children with disabilities and provides cultural insights for occupational therapists who work with Chinese families.

Importance: Globally, drowning is the third leading cause of unintentional injury death, and children on the autism spectrum are at a higher risk of drowning. Several factors affect limited water competency (swim skills and water safety) and engagement in swimming as a meaningful leisure activity.

Objective: To identify baseline water competency among children on the autism spectrum, examine caregiver goals for swim skill intervention, and examine factors associated with water competency.

Design: Cross-sectional analysis of baseline assessment from a larger randomized controlled trial.

Setting: Franklin County Board of Developmental Disabilities Therapy Pool.

Participants: Children on the autism spectrum (N = 37; 28 boys, 9 girls), ages 5 to 9 yr, recruited from the local community.

Outcomes and Measures: Water competency was assessed using the Water Orientation Test–Alyn 1 and 2 (WOTA 1 and 2). Caregivers completed the Canadian Occupational Performance Measure (COPM), the Sensory Profile–2 (SP–2), and a prior aquatic exposure questionnaire.

Results: Children on the autism spectrum showed limited water competency skills on the WOTA 1 and 2. A majority of caregivers identified safety in and around water as a goal for their child, using the COPM. Higher conduct processing and low registration scores on the SP–2 significantly correlated with lower water competency. Exposure to group lessons significantly correlated with better water competency.

Conclusions and Relevance: Children on the autism spectrum demonstrated limited swim and water safety skills, highlighting the need for programs that teach swim and water safety skills in this population.

Plain-Language Summary: This study examined water competency, including swim safety skills, among children on the autism spectrum. The results suggest that these children lacked basic water competency and safety skills. Caregivers of children on the autism spectrum identified water safety in and around bodies of water to be a high-priority goal. A child’s sensory characteristics and prior exposure to water activities affect their water competency. Our results highlight the need for programs that teach swim and water safety skills for children on the autism spectrum.

This study examined water competency, including swim safety skills, among children on the autism spectrum.

Importance: Persistent postconcussion symptoms (PPCS) may negatively affect youth’s occupational performance in activities of daily living, education, play and leisure, social participation, and rest and sleep.

Objective: This review provides occupational therapists with evidence related to interventions for youth with PPCS.

Data Sources: Searches were performed in Embase, PubMed, SportDiscus, CINAHL, and Web of Science.

Study Selection and Data Collection: Inclusion criteria were as follows: studies published in English from January 1, 2013, to February 7, 2023; youth ages 3 to 18 yr old; PPCS for at least 2 wk after injury; interventions within the scope of occupational therapy; and outcomes related to areas of occupation. All levels of evidence (1–5) were included and graded for quality using the Oxford Centre for Evidence-Based Medicine (2009) levels of evidence. This review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.

Findings: Twenty articles met inclusion criteria (7 randomized controlled trials, 1 nonrandomized controlled group design, 3 single-group designs, 5 case series, and 4 single-subject designs). Interventions reviewed were active rehabilitation, vision-related interventions, psychoeducation, cognitive–behavioral therapy (CBT) techniques, the Cognitive Orientation to daily Occupational Performance (CO-OP), and music therapy. Strong evidence supports CBT, with significant clinical outcomes in sleep and education. Moderate strength of evidence supports psychoeducation and active rehabilitation for improving functional outcomes. More evidence is needed to make clinical recommendations regarding vision-related interventions, the CO-OP, and music therapy.

Conclusions and Relevance: Occupational therapists should consider CBT, psychoeducation, and active rehabilitation to improve occupational performance among youth with PPCS.

Plain-Language Summary: Some youth will have persistent symptoms that do not resolve within 2 weeks after a concussion. Because of these persistent symptoms, they may have difficulty completing everyday activities. This review evaluated evidence addressing the ability of youth with persistent postconcussion symptoms (PPCS) to complete everyday activities. The authors found that cognitive–behavioral therapy, psychoeducation (aimed at helping youth understand and cope with their concussion symptoms), and active rehabilitation (aerobic and coordination exercises, such as jumping jacks and ball skills) should be considered when working with youth (ages 3–18 years) with PPCS. Using these interventions in occupational therapy sessions may improve the ability of youth to complete their everyday activities after a concussion.

This review evaluated evidence addressing the ability of youth with persistent postconcussion symptoms (PPCS) to complete everyday activities.

Importance: One primary function of occupational therapy state licensure boards (SLBs) is the discipline of ethical misconduct by licensed occupational therapy practitioners. However, SLB sanctioning is poorly understood by practitioners, regulators, and the public.

Objective: To identify predictors of occupational therapy practitioner sanctioning outcomes in the United States.

Design: Retrospective study; all public final consent orders and database entries provided online by SLBs were analyzed. Supervised gradient boosting machine learning, logistic regression, and contingency tables were used to generate odds ratios for variables associated with each sanctioning outcome. Multinomial testing was used to identify attribute overrepresentation among cases and national practitioner distributions.

Participants: A total of 2,400 cases were analyzed across 47 states and Washington, DC.

Intervention: None.

Outcomes and Measures: Numerous complaint and respondent attribute variables were collected from final consent orders and database entries.

Results: Complaint reason, practice setting, and complaint source had the highest influence on predicting sanction outcome; geographic region, number of complaints in a given case, and length of investigation in months were secondarily influential. Being male or a certified occupational therapy assistant was associated with higher odds of severe sanctioning outcomes.

Conclusions and Relevance: Disciplinary actions against occupational therapy practitioners were determined by numerous contextual factors; however, the most influential factors were complaint reason, practice setting, and complaint source. These results provide direction for exploring factors that predict sanctioning outcomes in the United States and also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve implementation and education regarding clinical practice ethics.

Plain-Language Summary: Occupational therapy state licensure boards (SLBs) are responsible for disciplining licensed occupational therapy practitioners for ethical misconduct. SLB sanctioning is poorly understood by practitioners, regulators, and the public. In this study, we identify the factors that predict the sanctioning outcomes of occupational therapy practitioners. The results may help state regulators, educators, and national associations more effectively act in a way that protects the public faith in occupational therapy services by providing contextualized information on practitioner behaviors that result in specific sanctioning outcomes. The study findings also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve the implementation of and education regarding clinical practice ethics.

This study identifies the factors that predict the sanctioning outcomes of occupational therapy practitioners.

Importance: Having a problem-specific hand function test that can be administered easily with children is important for consistency in measuring and monitoring outcomes.

Objective: To introduce basic testing procedures for Hand Accumulation aNd Dexterity FUnctional Limits–Shriner (HANDFULS), a clinically feasible hand outcome measure for two common hand problems, in-hand manipulation and palmar workspace volume; examine its face validity and test–retest reliability; and provide reference values for children and adolescents with typically developed, noninjured hands as a foundation for further study.

Design: Prospective cohort study.

Setting: Pediatric hospital and surrounding community.

Participants: Children and adolescents, ages 2 to 20 yr, with typically developed, noninjured hands.

Intervention: A newly developed hand function test called HANDFULS.

Outcomes: HANDFULS measured palmar workspace volume, represented by the number of marbles children and adolescents could comfortably fit in their hand, and in-hand manipulation, represented by seconds per marble needed to collect the marbles in the hand.

Results: Results for the primary outcomes palmar workspace volume and the HANDFULS scores were reported by age group. For every year increase in age, HANDFULS score decreased by 0.02 s per marble (p < .001). The test showed moderately high test–retest reliability (intraclass correlation coefficient = .84) and was typically administered in less than 5 min with supplies costing about $30.

Conclusions and Relevance: This study proposes a hand outcome measure that addresses a gap in the literature and clinical practice in the measurement of hand function.

Plain-Language Summary: The Hand Accumulation aNd Dexterity FUnctional Limits–Shriners (HANDFULS) offers a new, clinically feasible outcome tool for measuring in-hand manipulation (the number of seconds per marble a child or adolescent needs to collect marbles in one hand). HANDFULS simultaneously considers palmar workspace volume (the number of marbles a child or adolescent can comfortably fit in one hand) as a foundation for future testing with various patient populations to provide meaningful and relevant information about hand function.

The Hand Accumulation aNd Dexterity FUnctional Limits–Shriners (HANDFULS) offers a new, clinically feasible outcome tool for measuring in-hand manipulation.

Importance: Although many hospitals universally screen their patients for functional mobility and activity impairment, there is no common method to do this for cognitive impairment. Establishing an interdisciplinary and standardized process to screen for cognitive impairment is essential for early identification of impairments, optimization of patients’ function, and safe discharge planning. Previously, the reliability and validity of the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form “6-Clicks” (AM-PAC ACISF) were measured among occupational therapy practitioners and speech-language pathologists; however, its reliability among other team members, specifically nurses, is unknown. This study reports the interprofessional interrater reliability of the AM-PAC ACISF in the acute care hospital setting.

Objective: To examine the nursing–therapist interrater reliability of the AM-PAC ACISF in the acute care hospital setting.

Design: A prospective study using a convenience sample.

Setting: Acute care hospital.

Participants: Fifty adult patients, six nurses, five occupational therapy practitioners, and one speech-language pathologist.

Outcomes and Measures: Interrater reliability for the AM-PAC ACISF among therapists and nurses.

Results: Interrater reliability was good among nurses and therapists, with an intraclass correlation coefficient of .88 (95% confidence interval [.79, .93]) for the AM-PAC ACISF.

Conclusions and Relevance: Findings suggest that the AM-PAC ACISF is reliable for use among interdisciplinary teams, helps to establish a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting.

Plain-Language Summary: Having an interdisciplinary and standardized process to screen patients early for cognitive impairment is essential for identifying impairments, optimizing patients’ function, and facilitating safe discharge planning in the acute care setting. Early identification of cognitive impairment by the interdisciplinary team can also allow for timely occupational therapy and other rehabilitation service interventions. The findings of this study suggest that the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form “6-Clicks” (AM-PAC ACISF) can reliably be used by interdisciplinary teams, establishes a common language for early identification of cognitive impairment, and can be used for guiding clinical discussions around patient cognition in the acute care setting.

The study findings suggest that the Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form “6-Clicks” can reliably be used to identify impairments, optimize patients’ function, and facilitate safe discharge planning in the acute care setting.

Importance: The Cognitive Orientation to daily Occupational Performance (CO-OP) is an evidence-based intervention approach that has significantly increased in popularity over the past two decades. However, how the research literature on this topic is patterned is still unknown, so it is difficult to identify potential areas for research and clinical interest.

Aims: To analyze the literature published on the CO-OP approach to provide a detailed and structured analysis of the publication patterns.

Data Sources: All literature related to CO-OP included in the Web of Science database through June 15, 2024.

Study Selection and Data Collection: All published studies related to CO-OP were included in the bibliometric analysis, which was conducted on the raw data retrieved from the Web of Science database using the Bibliometrix R package.

Findings: The annual growth rate in CO-OP research has been 0.8%, significantly increasing from 2015 onward. Most of the research has been published in occupational therapy and rehabilitation journals by English-speaking research teams, and its scope has expanded from developmental coordination disorder to a wide range of health conditions. In addition, two main lines of research have emerged: one focusing on understanding the underlying cognitive processes involved in CO-OP and the other focusing on its clinical effectiveness.

Conclusions and Relevance: Research on CO-OP has significantly increased over the past decade, and it currently encompasses a wide range of areas. This analysis may facilitate the advancement of research on and the clinical practical application of CO-OP.

Plain-Language Summary: The Cognitive Orientation to daily Occupational Performance (CO-OP) is an evidence-based intervention approach that has significantly increased in popularity over the past two decades. Occupational therapists use it to improve the occupational performance of both children and adults with movement difficulties. However, it is unknown how the research literature on this topic is patterned, so it is difficult to identify potential areas for research and clinical interest. This study found that scientific literature on CO-OP has significantly increased in the past decade and that its scope has expanded from developmental coordination disorder to a wider range of health conditions, such as cerebral palsy. Moreover, research is now focused on two main questions: What are the underlying cognitive processes involved during intervention, and how effective is the CO-OP approach? These findings can be used to further improve occupational performance and participation among occupational therapy clients who struggle with motor performance and planning.

This review found that scientific literature on the Cognitive Orientation to daily Occupational Performance (CO-OP) has significantly increased to include a wider range of clients, including people with developmental coordination disorder (DCD), ADHD, and cerebral palsy.

Importance: The scope of early intervention (EI) programs, which mostly focus on motor skills, needs to be expanded.

Objective: To examine the effects of an EI on developmental domains and parent–child interactions.

Design: Randomized controlled study.

Participants: Children ages 24–36 mo with developmental delay (DD; intervention group, n = 30; control group, n = 40).

Setting: Pediatric occupational therapy unit of Hacettepe University.

Intervention: The intervention group received an intervention that used the Goal Activity and Motor Enrichment (GAME) approach and a home program, whereas the control group received a home program only. Both groups received the same intervention dosage.

Outcomes and Measures: Developmental domains were assessed using the Bayley Scales of Infant and Toddler Development Third Edition (Bayley III) and the Ages and Stages Questionnaires (ASQ). Sensory processing was assessed with the Infant/Toddler Sensory Profile 2 (ITSP–2), social–emotional development with the ASQ:Social–Emotional (ASQ:SE), and parent–child interaction with the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO™). A compliance checklist was used to determine compliance with the home program.

Results: A significant between-groups difference was found on all Bayley III and PICCOLO subscales and on the Gross Motor, Fine Motor, Problem-Solving, and Social–Emotional domains of the ASQ and ASQ:SE in favor of the intervention group (p < .05). The intervention group showed more typification (normal sensory processing) in sensory quadrants and general processing. Both groups were 100% compliant with the home program.

Conclusions and Relevance: The GAME-based intervention for children with DD, including sensory and cognitive activities, is effective in improving developmental domains and parent–child interactions.

Plain-Language Summary: The scope of early intervention programs mostly focuses on motor skills and needs to be expanded to include the essential roles of children’s sensory and cognitive abilities. This study provides important insights into early interventions by occupational therapists and the impact on children with developmental delay and parent–child interactions. We found that the Goal Activity and Motor Enrichment (GAME) intervention for children with developmental delay, which includes sensory and cognitive activities, is effective in improving developmental domains and parent–child interactions.

This study provides important insights into early interventions by occupational therapists and the impact on children with developmental delay and parent-child interactions.

Importance: The U.S. Supreme Court overturned Roe v. Wade in 2022, changing access to abortion in many states. The impact of these changes on occupational therapy practice has not yet been explored through empirical research.

Objective: To explore the perspectives of occupational therapy practitioners on how restrictions to abortion in the United States may have influenced their clients’ needs and thus their practice.

Design: This was a qualitative research study. We used an interpretivist epistemological approach and an inductive, thematic content analysis. Participants were recruited through state occupational therapy associations and social media. Two independent researchers coded data and had an initial agreement percentage of 88%. Data trustworthiness was enhanced through documentation of decisions, reflexive thinking about our positionality and the data, and team-based discussions.

Participants: Occupational therapy practitioners (N = 15) working in states with new abortion law changes at the time of interviews.

Results: The four key themes of this study were as follows: (1) abortion restriction laws are affecting some occupational therapy clients’ mental health, (2) clients are discussing reproductive health with occupational therapy practitioners across a variety of settings, (3) occupational therapy practitioners are using clinical judgment and their personal beliefs to support clients affected by abortion restrictions, and (4) occupational therapy practitioners are seeking guidance and evidence-based resources to best support clients in the wake of abortion-related legislation changes.

Conclusions and Relevance: Our findings underscore the relevance of reproductive health to occupational therapy practice and highlight the importance of preparing occupational therapy practitioners to respond to client needs related to abortion care.

Plain-Language Summary: We sought to determine whether occupational therapy practitioners perceive that the 2022 abortion-related restrictions are affecting occupational therapy practice; specifically, we wanted to know whether and how practice is being affected and what resources occupational therapy practitioners might need to address clients’ needs. Fifteen occupational therapy practitioners were interviewed and revealed that many of their clients were experiencing stress and anxiety (i.e., mental health challenges) specifically related to abortion access. We also found that occupational therapy practitioners who routinely discuss reproductive health with clients were commonly hearing from clients about abortion-related needs. Overall, this research uncovers a need for resources and guidance from state or national occupational therapy organizations so that occupational therapy practitioners can better support their clients given these new changes in abortion access.

Positionality Statement: We are a team of three researchers who identify as cisgender women, and we reside in an urban area in the northeastern United States. Two of us identify as White, and one identifies as a person of color. We have all participated in reproductive health access advocacy and critically examined our own lenses as we engaged in this analysis.

The authors sought to determine whether and how occupational therapy practice is being affected by the 2022 overturning of Roe v. Wade and subsequent abortion-related restrictions as well as what resources practitioners might need to address clients’ needs.

Importance: Upper extremity (UE) dysfunction resulting from stroke significantly affects a person’s ability to complete self-care activities, consequently diminishing functional independence. Effective interventions that improve UE function in persons with stroke are needed.

Objective: To explore the effectiveness of the Bimanual Arm Trainer (BAT) compared with traditional occupational therapy treatment sessions (i.e., a control group) on improving UE function after acute ischemic stroke.

Design: Clinical trial, two-group, nonrandomized repeated-measures design.

Setting: Inpatient rehabilitation facility.

Participants: Twenty-seven persons with ischemic stroke and an Action Research Arm Test (ARAT) score ≤17.

Intervention: Minimum of three 10-min sessions on the BAT.

Outcomes and Measures: ARAT, Upper Extremity Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA–UE).

Results: Both the intervention and control groups showed significant improvement on the ARAT from evaluation to discharge (main effect of time: p = .02). There was no statistically significant main effect of group and no significant Time × Group interaction (p = .63). FMA–UE scores also improved significantly in the intervention group from evaluation to discharge (p < .001). FMA–UE scores were not available for the control group.

Conclusions and Relevance:Both the intervention and control groups demonstrated significant improvements in UE function from evaluation to discharge. There were no statistically significant differences between groups, indicating that the BAT results in similar improvements in UE function, as would be expected in traditional occupational therapy. Further research is warranted to examine additional BAT programs, use different outcome measures, and assess participants over a longer time span.

Plain-Language Summary: The Bimanual Arm Trainer (BAT) is a novel device that can be used in occupational therapy to improve arm function among stroke patients. There is limited research on BAT’s effectiveness in improving arm function among stroke patients. In an acute inpatient rehabilitation setting, we compared outcome scores of patients who received traditional occupational therapy services with those who also used the BAT. Both groups achieved significant improvements in arm function from evaluation to discharge. We found that the addition of the BAT interventions did not significantly affect the outcome measure scores for either group. We conclude that more research is needed to examine additional BAT programs, use different outcome measures, and assess participants over a longer period of time.

The Bimanual Arm Trainer (BAT) is a novel device that can be used in occupational therapy to improve arm function after a stroke.

Importance: The Adult Executive Functioning Inventory (ADEXI)—a short, practical, self-report questionnaire accessible across diverse adult populations and languages—was used to assess executive functions (EFs), primarily inhibition and working memory.

Objective: To examine the construct validity of the ADEXI Hebrew version through exploratory factor analysis (EFA) and convergent validity by correlating scores with similar measures of EF.

Design and Setting: Cross-sectional study using online anonymous surveys.

Participants: Nonclinical sample of 239 adults, 74.1% women, ages 18 to 80 yr (M _age = 44.19 yr, SD = 12.89).

Outcomes and Measures: The Hebrew version of the 14-item ADEXI, a demographic questionnaire, and the Dysexecutive Questionnaire (DEX).

Results: Descriptive statistics, Cronbach’s α EFA using varimax rotation, and Pearson’s correlations were used. Total internal consistency was good (α = .86). Unlike the two factors in the original English version, our construct validity through EFA revealed three factors—inhibition, working memory, and, uniquely, flexibility—that accounted for 55.71% of the variance. Convergent validity was supported by medium to large significant correlations (r =.29–.76) between the ADEXI and the DEX subscales and total scores.

Conclusions and Relevance: Our findings offer psychometric evidence to support using the Hebrew version of the ADEXI for EF assessments in adult Hebrew-speaking populations.

Plain-Language Summary: The Adult Executive Functioning Inventory (ADEXI) assesses three key components: inhibition, working memory, and cognitive flexibility. In this study, we examined the construct validity of the Hebrew version of the ADEXI to assess executive functions. Our findings support using the ADEXI in Hebrew-speaking populations. The ADEXI offers occupational therapy practitioners serving Hebrew-speaking populations in their practice a validated tool for assessing executive functions.

The Adult Executive Functioning Inventory (ADEXI) offers occupational therapy practitioners serving Hebrew-speaking populations a validated tool for assessing executive functions.

Importance: Community social participation aids dementia prevention and alleviates loneliness among older adults. Incorporating occupational therapy using information and communications technology (ICT) could potentially delay dementia onset and reduce loneliness.

Objective: To quantify how meaningful social participation, participation frequency, ICT use, and expanded social networks influence cognitive function and loneliness among socially active older Japanese adults.

Design: Cross-sectional exploratory study using structural equation modeling.

Setting: Meetings organized by older adults at seven community gathering places in Osaka Prefecture, Japan.

Participants: One hundred thirteen healthy older adult cohort members.

Measures: Cognitive function assessed via Mini-Cog; loneliness assessed via the condensed UCLA Loneliness Scale.

Results: The final model demonstrated excellent fit, χ²(23) = 28.291, p = .205 (root mean square error of approximation = .045, 90% confidence interval [.000, .094]; confirmatory factor index = .995; Tucker–Lewis Index = .993). ICT use directly affected social networks (β = 0.472), which directly influenced participation frequency (β = 0.324) and meaningful social participation (β = 0.381). The indirect effect of meaningful participation significantly improved cognitive function (β = 0.237). The only indirect effect of meaningful interpersonal participation was a reduction in loneliness (β = −0.235).

Conclusions and Relevance: ICT use contributes to the expansion of social networks among elderly people. Furthermore, the frequency of social participation and the meaningfulness of such participation are related to reduction in loneliness and maintenance of cognitive function. Although the frequency of social participation was not directly related to these outcomes, the results suggest that meaningful social participation may play an important role in reducing loneliness and maintaining cognitive function.

Plain-Language Summary: The promotion of social participation among older people is a global phenomenon, driven by the recognition of its positive relationship with cognitive function and the alleviation of loneliness. Nevertheless, older people’s social participation is constrained by a combination of physical and social factors. To address this issue, there has been a push to promote social participation based on information and communications technology (ICT). However, no specific study has been conducted on occupational therapists’ perspective in capturing social participation and the use of ICT. The findings of this study show that using ICT has the potential to enhance opportunities for social interaction for older adults, thereby improving the quality and quantity of social participation. The quality of social participation was identified as the sole factor that had a positive impact on cognitive function and loneliness. This study suggests the need for occupational therapists to consider means of facilitating the use of ICTs among older adults as well as interventions that use occupational therapy theory to enhance the meaningfulness of existing social participation opportunities.

This study found that using information and communications technology has the potential to enhance opportunities for older adults’ social interaction, thereby improving the quality and quantity of social participation.

Importance: Because depressive symptoms are momentarily associated with lower levels of participation poststroke, it is crucial to investigate what moderates such associations to identify a potential intervention target to reduce the momentary links between depressive symptoms and participation poststroke. Self-regulation seems to be a potential moderator of such associations.

Objective: To investigate the extent to which difficulties in self-regulation moderate the momentary associations between depressive symptoms and participation poststroke.

Design: This study uses a real-time, repeated-measures design using smartphone-based ecological momentary assessment surveys five times a day for 10 days. We performed multilevel modeling to uncover the momentary associations among the study variables.

Setting: Community.

Participants: 39 people with stroke.

Outcomes and Measures: We obtained real-time data for difficulties in self-regulation (total, cognitive, behavioral, and emotion regulation), depressive symptoms, and participation in daily activities (performance in daily activities and satisfaction with performing daily activities).

Results: We included 1,612 survey responses in the analysis. Higher depressive symptoms were momentarily associated with lower levels of performance (β = −0.05 to −0.07, p < .001) and satisfaction (β = −0.04 to −0.06, p < .05), regardless of adjusting for self-regulation variables and other covariates. Difficulties in total self-regulation (β = −0.01, p < .001) and emotion regulation (β = −0.02, p < .001) magnified the negative associations between depressive symptoms and satisfaction with performing daily activities.

Conclusions and Relevance: Using self-regulation and emotion regulation strategies may be a target for just-in-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke.

Plain-Language Summary: Depressive symptoms have immediate and real-time associations with lower levels of participation in daily activities in people with stroke. Self-regulation, including cognitive regulation (e.g., goal setting, planning strategies), behavioral regulation (e.g., controlling impulsive behaviors), and emotion regulation (e.g., managing negative feelings), may be an intervention target for reducing the immediate associations between depressive symptoms and lower levels of participation poststroke. Thus, we investigated whether difficulties in self-regulation variables magnify the negative real-time associations between depressive symptoms and participation poststroke. To obtain real-time data on difficulties in self-regulation variables, depressive symptoms, and participation (i.e., performance and satisfaction), we asked 39 community-dwelling people with stroke to answer smartphone surveys. The results showed that difficulties in total self-regulation and emotion regulation magnified the negative associations between depressive symptoms and satisfaction with performing daily activities. Our findings suggest that self-regulation and emotion regulation strategies may be a target for real-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke.

The authors investigated whether difficulties in self-regulation magnify the negative real-time associations between depressive symptoms and participation in daily activities in people poststroke.

Several necessary shifts have been proposed in occupational therapy education, including antiracist pedagogies, inclusive teaching, competency-based education, and holistic admissions. These shifts are intended to prepare competent practitioners who serve diverse groups of clients and advocate for themselves and the profession. This shift may also call for significant changes to curriculum designs and instructional methods. Such changes require not only time, effort, and resources, but also a mindset open to change. Educators may resist this change for various reasons, including personal views on the proposed changes, limited time and resources, professional obligations, and lack of training necessary for successful implementation of change. Fostering a growth mindset for educators may facilitate accepting, implementing, or transitioning to new educational practices. Here, we propose an eight-step model for implementing change while following Kotter’s model for implementing major changes. The model provides a road map for implementing major changes at various levels of systems that shape occupational therapy education.

The authors outline eight action steps that can prepare educators for the impending and necessary shifts in occupational therapy education. Guided by a growth mindset approach, these steps emphasize educators’ ability to adapt, modify, or create new educational methods and strategies when navigating change at the national or local level.

All humans have the occupational right to sleep; therefore, occupational therapy practitioners must prioritize sleep with their clients. In this column, we identify ways to incorporate sleep health into the education and training of occupational therapy practitioners. This starts with identifying entry-level and continuing education opportunities to proclaim sleep as an occupation and a basic biological need. Current practitioners must recognize that sleep health is multidisciplinary, and existing interventions can help clients achieve good sleep health throughout their lifespan. Given the paucity of sleep research in occupational therapy, the potential exists to investigate new, occupation-based assessments and interventions. We provide specific approaches to expand sleep and sleep health knowledge in occupational therapy education, practice, and research.

In this The Issue Is column, the authors identify ways to incorporate sleep health into the education and training of occupational therapy practitioners.