American Journal of Occupational Therapy

Specific aspects of the profession of occupational therapy support a distinct value for its practitioners participating fully in the development of case management and care coordination systems. The expectation in the 21st century is that the U.S. health care system must be transformed from one that promotes volume of service to one that promotes value of care. Case management and care coordination will be critical components of that transformation. Occupational therapy’s principles, education, practice, approach, and perspective offer much to benefit this increased attention to case management and care coordination. Occupational therapy practitioners should promote themselves and their profession as these system changes develop.

OBJECTIVE. Physical activity is positively related to improved student behaviors. Stability balls have been used as interventions to affect student behavior. The objective of this study was to determine whether the use of stability balls elicits more physical activity than the use of regular chairs and whether stability balls positively influence behavior.

METHOD. Participants (n = 43 fourth graders) sat on stability balls during class and wore accelerometers. Eight were randomly selected for behavioral observations using momentary time sampling.

RESULTS. Significant decreases in accelerometer counts were found. No obvious difference for on-task behaviors was found between students using stability balls and those using chairs.

CONCLUSION. Stability balls do not necessarily elicit more physical activity than do chairs; however, students accumulate light-intensity physical activity when using them. Classroom behavior was not detrimentally affected by stability ball use; thus, stability balls do not appear to detract from the classroom instructional atmosphere.

OBJECTIVE. This study's objective was to investigate the effects of a community playgroup on the playfulness of children with special needs ages 15 mo to 3 yr and the responsiveness of their caregivers.

METHOD. Using a pretest–posttest, repeated-measures design, we evaluated 8 child–caregiver dyads participating in an 8-wk occupational therapist–led community playgroup recruited from a purposive sample enrolled in early intervention. Video recordings from four time points over 4 mo were used to determine playfulness (Test of Playfulness) of the child and the responsiveness of the caregiver.

RESULTS. Blinded raters assessed playfulness and responsiveness outcomes. A repeated-measures analysis of variance demonstrated that participation in the playgroup significantly increased child playfulness (η_p ² = .89, p < .01). Analysis did not detect a change in caregiver responsiveness.

CONCLUSION. The results of this study have implications for the use of playgroups in comprehensive occupational therapy practice in early intervention.

OBJECTIVE. This single-case study investigated the effectiveness of compression bandaging from the finger to the axilla in reducing poststroke edema in the upper limb.

METHOD. Repeated circumferential measurements were recorded at five points along the participants’ hand and forearm. Analysis of the data included the generation of graphs, celeration lines, and visual analysis.

RESULTS. Five participants with edema (mean 38 days poststroke) were recruited to the study. Fluctuations in edema were observed in all three study phases, with an increasing to decreasing trend in edema between the baseline and intervention phases. There was no clear trend from the intervention to second baseline phase.

CONCLUSION. Bandaging from the fingers to the axilla appears to be effective in reducing edema in the hand and forearm. However, return of edema after removal of the bandaging suggest that a greater understanding of underlying mechanisms and the appropriate intervention protocols is warranted.

OBJECTIVE. Research regarding sensory processing and adults with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) is limited. This study aimed to compare sensory processing patterns of groups of higher education students with ADHD or ASD and to explore the implications of these disorders for their college life.

METHOD.The Adolescent/Adult Sensory Profile was administered to 28 students with ADHD and 27 students with ASD. Students and professionals were interviewed.

RESULTS. The majority of students received scores that differed from those of the general population. Students with ADHD received significantly higher scores than students with ASD in relation to sensation seeking; however, there were no other major differences.

CONCLUSION. Few differences exist between the sensory processing patterns of students with ADHD and ASD; however, both groups differ significantly from the general population. Occupational therapists should consider sensory processing patterns when designing supports for these groups.

OBJECTIVE. A systematic search and critical appraisal of interdisciplinary literature was conducted to evaluate the evidence for practicing mindfulness to treat job burnout and to explore implications for occupational therapy practitioners.

METHOD. Eight articles met inclusion criteria. Each study was assessed for quality using the Physiotherapy Evidence Database scale. We used the U.S. Agency for Health Care Policy and Research guidelines to determine strength of evidence.

RESULTS. Of the studies reviewed, participants included health care professionals and teachers; no studies included occupational therapy practitioners. Six of the 8 studies demonstrated statistically significant decreases in job burnout after mindfulness training. Seven of the studies were of fair to good quality.

CONCLUSION. There is strong evidence for the use of mindfulness practice to reduce job burnout among health care professionals and teachers. Research is needed to fill the gap on whether mindfulness is effective for treating burnout in occupational therapy practitioners.

OBJECTIVE. This study explored the perceptions, preparedness, and practices of college personnel regarding support for students with autism spectrum disorder (ASD).

METHOD. Members of the Association on Higher Education and Disability were invited to complete an online survey in 2012. The survey gathered data on training level, understanding of student needs, and supports provided to students with ASD in the areas of academic transitional situations, social activities, sensory needs, attention and organization, self-advocacy and self-disclosure, and emotional regulation.

RESULTS. Of the 315 respondents who completed the survey, 94% were involved in designing needed supports for students with ASD. Of those involved in designing needed supports, 55% indicated the need for additional information and 63% indicated that their institution struggled with outlining the supports needed and would have liked to know more about how to support these students.

CONCLUSION. Opportunities exist for occupational therapy collaboration, consultation, case management, and direct intervention to support college students with ASD.

OBJECTIVE. We explored driving rehabilitation specialists’ (DRSs’) perspectives on older driver evaluations.

METHOD. We conducted interviews with 26 DRSs across the United States who evaluate older drivers. Transcript analysis followed general inductive techniques to identify themes related to current systems and barriers to use.

RESULTS. Themes, by Social–Ecological Model level, were as follows: (1) individual occupational therapists’ commitment to mobility and safety, perceived responsibilities, and experience; (2) DRSs’ relationships with drivers, medical providers, and licensing bureaus; (3) the community surrounding the DRSs, including the health care system and transportation resources; and (4) societal factors, including DRS reimbursement, reporting requirements and liability coverage, and role of national organizations.

CONCLUSIONS. This qualitative study identified barriers to the development of an effective system for older driver evaluations. Future work should verify, refine, and expand these findings by targeting other stakeholder groups.

OBJECTIVE. The objective of this study was to compare environmental barriers, housing accessibility, and usability before and after relocation of very old, single-living people in the community. It also examined whether accessibility improved after relocation compared with a simulated scenario in which participants would have remained in their former dwellings.

METHOD. Data from the Swedish part of the longitudinal Enabling Autonomy, Participation, and Well-Being in Old Age: The Home Environment as a Determinant for Healthy Ageing database were analyzed with a before-and-after design (N = 29). Mean time from before to after data collection was 2.6 yr.

RESULTS. The number of environmental barriers was significantly reduced after relocation, especially barriers at entrances and in bathrooms. In addition, usability was stable and accessibility improved compared with the simulated scenario of remaining in the former dwelling.

CONCLUSION. Community-based moves to new dwellings may lead to fewer environmental barriers and stable levels of usability and accessibility. This relocation is a positive outcome, considering the expected functional decline in old age.

This study examined whether a sign recall task on a driving simulator, self-report of driving ability, or age predicted differences in performance between drivers with mild cognitive impairment (MCI) and control participants. For the dependent measure, gathered using a driving simulator, working memory was subjected to interference at varying levels of driving task demands. Reliable between-groups differences in sign recall accuracy were demonstrated; recall declined under higher task demands. Recall scores, self-reported frequency of avoiding driving, and driver age did not predict MCI; only self-reported decline in global driving ability was significant. Findings support the use of driving simulators in practice and suggest that screening for age-related cognitive impairment should incorporate self-reported changes in driving proficiency for early identification of drivers who merit medical review. The results, although exploratory, have implications for practitioners.

OBJECTIVE. This study evaluated the reliability, minimal detectable change (MDC), and construct validity of the Evidence-Based Practice Confidence (EPIC) scale among occupational therapists.

METHOD. In a cross-sectional mail survey, 126 occupational therapists completed the EPIC scale and a questionnaire to provide data for validity testing. Seventy-nine occupational therapists (63%) completed a second EPIC scale a median of 24 days later.

RESULTS. Test–retest reliability was .92 (95% confidence interval [.88, .95]). The MDC values at the 90% and 95% confidence levels were 3.9 percentage points and 4.6 percentage points, respectively. The total EPIC score was significantly associated with holding a master’s or doctoral degree; education in evidence-based practice (EBP); higher EBP knowledge and skill; and frequently searching, reading, and using research findings in clinical decision making (p < .05).

CONCLUSION. The EPIC scale has excellent reliability and acceptable construct validity for use in evaluating EBP self-efficacy among occupational therapists.

The purpose of this study was to estimate the effect of Cognitive Orientation to Daily Occupational Performance (CO–OP) compared with usual occupational therapy on upper-extremity movement, cognitive flexibility, and stroke impact in people less than 3 mo after stroke. An exploratory, single-blind randomized controlled trial was conducted with people referred to outpatient occupational therapy services at two rehabilitation centers. Arm movement was measured with the Action Research Arm Test, cognitive flexibility with the Delis–Kaplan Executive Function System Trail Making subtest, and stroke impact with subscales of the Stroke Impact Scale. A total of 35 participants were randomized, and 26 completed the intervention. CO–OP demonstrated measurable effects over usual care on all measures. These data provide early support for the use of CO–OP to improve performance and remediate cognitive and arm movement impairments after stroke over usual care; however, future study is warranted to confirm the effects observed in this trial.

OBJECTIVE. This article describes current trends in cognitive assessment use for adults with mild stroke by home health practitioners in the United States.

METHOD. Participants were 56 home health occupational therapists and occupational therapy assistants. A self-administered survey about use of cognitive assessment tools in home health care and influences on their use was conducted.

RESULTS. Ninety-six percent of participants assessed cognition in adults with mild stroke. Nonstandardized assessments were the most widely used method for evaluating cognition in the home health setting. Influences such as specialized training in specific assessments, confidence, and productivity requirements may have affected the practitioners’ cognitive assessment decisions in home health care.

CONCLUSION. Although cognitive assessments are widely used in home health care, occupational therapy practitioners are selecting nonstandardized assessments most frequently to assess cognition.

OBJECTIVE. We explored the efficacy of compression gloves in maintaining the benefits gained from compression bandaging of the stroke-affected upper limb.

METHOD. Four participants completed a single-case (ABC) design study consisting of a baseline period (Phase A) and compression bandaging of the hand and upper limb (Phase B), followed by the application of a compression glove (Phase C). Edema was measured with circumferential tape at five specified points from the phalanx to the midforearm. All measurements were represented graphically for visual analysis, and celeration lines were calculated to indicate the degree of slope within each phase.

RESULTS. Visual analysis indicated fluctuating edema volume during Phase A, decreasing edema volume during Phase B, and a mixed trend during Phase C.

CONCLUSION. Compression gloves had mixed benefits in managing reductions in edema volume poststroke. Further research may consider the material, sizing, and style of glove in the development of a maintenance strategy.

OBJECTIVE. This study establishes the concurrent validity, predictive validity, and responsiveness of the Revised Nottingham Sensation Assessment (rNSA) during rehabilitation for people with stroke.

METHOD. The study recruited 147 patients with stroke. The main assessment used was the rNSA, and outcome measures were the Fugl-Meyer Assessment sensory subscale (FMA–S) and motor subscale (FMA–M) and the Nottingham Extended Activities of Daily Living (NEADL) scale.

RESULTS. Correlation coefficients were good to excellent between the rNSA and the FMA–S. The rNSA proprioception measure was a predictor for the FMA–S. The rNSA stereognosis and tactile-pinprick measures for the proximal upper limb were predictors for the FMA–M and the NEADL scale, respectively. Responsiveness was moderate to large for three subscales of the rNSA (standardized response mean = .51–.83).

CONCLUSION. This study may support the concurrent validity, predictive validity, and responsiveness of the rNSA for people with stroke.

OBJECTIVE. We evaluated the test–retest reliability, internal consistency, and construct validity of the Brazilian version of the Late-Life Function and Disability Instrument.

METHOD. A sample of 118 older adults provided data for testing construct validity and internal consistency, and 14 provided data for testing test–retest reliability. Factor analysis with varimax rotation was used to assess construct validity.

RESULTS. The Function component had excellent test–retest and total internal consistency reliability. Factor analysis revealed that the Upper Extremity Function and Advanced Lower Extremity Function domains were similar to the original analysis. The Disability component showed adequate to excellent test–retest reliability, except in the Management role; total internal consistency was excellent. Factor analysis revealed that its domains were similar to the original analysis, except for some items.

CONCLUSION. The Late-Life Function and Disability Instrument is recommended for assessment of Brazilian community-dwelling older adults who are functionally independent and who do not require mobility assistance.

Some people without independent mobility are candidates for powered mobility but are unable to use a traditional power wheelchair joystick. This proof-of-concept study tested and further developed an innovative method of driving power wheelchairs for people whose impairments prevent them from operating commercial wheelchair controls. Our concept, Self-referenced Personal Orthotic Omni-purpose Control Interface (SPOOCI), is distinguished by referencing the control sensor not to the wheelchair frame but instead to the adjacent proximal lower-extremity segment via a custom-formed orthosis. Using a descriptive case-series design, we compared the pre–post functional power wheelchair driving skill data of 4 participants, measured by the Power Mobility Program, using descriptive analyses. The intervention consisted of standard-care power wheelchair training during 12 outpatient occupational or physical therapy sessions. All 4 participants who completed the 12-wk intervention improved their functional power wheelchair driving skills using SPOOCI, but only 3 were deemed safe to continue with power wheelchair driving.

The occupational therapy Centennial Vision reinforces the importance of informing consumers about the benefit of occupational therapy and continuing to advocate for the unique client-centered role of occupational therapy. Occupational therapy practitioners working in hand therapy have traditionally found it difficult to combine the biomechanical foundations of hand therapy with the fundamental client-centered tenets of occupational therapy. Embracing our historical roots will become more important as health care evolves and third-party payers continue to scrutinize the need for the profession of occupational therapy. This article outlines a client-centered approach for hand therapists for the treatment of lateral epicondylitis using the Occupational Adaptation Model.