American Journal of Occupational Therapy

The American Journal of Occupational Therapy (AJOT) continues to be the most highly ranked occupational therapy journal as measured by its Journal Citation Reports impact factor (its 5-yr impact factor is now 3.325). AJOT’s goal is to remain occupational therapy’s leading research journal with disciplinary and interdisciplinary impact. AJOT instituted measures starting in January 2018 to address increasing concerns about research reproducibility and study reporting methods. Starting in 2019, AJOT will be distributed online only and will offer an annual “Best of” print compendium to AOTA members.

Change is inevitable, progress is not. As we work to lay the foundation for the second century of occupational therapy it is important to explore how our perspective adds distinct value to the people, populations, and communities we serve. Speak up; be heard; be the spark of change.

The author describes personal and professional milestones in becoming an occupational therapist and his early experience in the first behavior disorder program for neurologically based aggression in the world. A real clinical example is used to bring these early lessons into vivid focus. New evidence underlines occupational therapists’ unique role in skill–habit training in clients with severe neurological impairment. For clients with milder impairments, irrespective of diagnosis, strategy training may maximize community independence and reduce hospital recidivism. The concept of functional cognition is described as an important development for the profession. Even in an environment of rapid innovation, occupational therapists need to recognize that it is the commonplace activities that have meaning for the individual that really matter. This is both the art and science of occupational therapy, and it will never be superseded by technological innovation because true creativity and genuine empathy cannot be mechanized.

OBJECTIVE. We examined the effectiveness of modified constraint-induced movement therapy (mCIMT) in treating infants with hemiplegic cerebral palsy and compared therapy outcomes with a nonconstraining bimanual therapy (BIM) of equal intensity.

METHOD. In a single-blinded randomized controlled trial, 33 infants with hemiplegia (mean corrected age = 11.1 mo, standard deviation = 2.2) received either mCIMT (n = 17) or BIM (n = 16). Both interventions included home programs encouraging the use of the affected hand during daily 1-hr play sessions for 8 wk. Outcome measures were administered pre- and posttreatment and included the Mini-Assisting Hand Assessment for babies and the Functional Inventory. At baseline, parents also filled out the Dimensions of Mastery Questionnaire.

RESULTS. Both groups demonstrated a significantly large and equal improvement in hand and gross motor function posttreatment (p < .001) and high treatment compliance.

CONCLUSION. mCIMT and BIM are equally effective methods for treating infants with hemiplegia.

This study examined whether sensory modulation disorder–sensory overresponsivity (SMD–SOR) and attention deficit hyperactivity disorder (ADHD) have a significant effect on the perception of aversive auditory stimuli. Participants were 66 young adult women. The diagnosis of SOR was made using the Sensory Responsiveness Questionnaire, and ADHD was diagnosed by a qualified psychiatrist or neurologist using criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Participants were presented with the Battery of Aversiveness to Sounds, short presentations of daily life sounds, and rated each sound stimulus verbally according to its perceived unpleasantness. Participants with SOR rated low-intensity aversive sounds as significantly more aversive than participants without SOR. High-intensity sounds obtained a marginal significant difference exclusively in participants with ADHD. The perception of aversive auditory stimuli in adults with SOR appears to be unique and different than the profile of adults with ADHD.

OBJECTIVE. Systematic approaches are needed to help parents with young children adopt healthy routines. This study examined the feasibility (home data collection, protocol adherence, intervention acceptance) of using a behavioral activation (BA) approach to train parents of children with sensory food aversions.

METHOD. Parents of young children (18–36 mo) were trained using the novel Promoting Routines of Exploration and Play During Mealtime intervention. Measures included video-recorded meals, Fidelity Checklist, Treatment Acceptability Questionnaire, and Behavioral Pediatrics Feeding Assessment Scale. Descriptive statistics were used.

RESULTS. Eleven children and their parents completed the study. Two of three feasibility benchmarks were met. Intervention acceptance was high (mean score = 43/48). On average, parents used three more intervention strategies after training than at baseline.

CONCLUSION. Using a BA approach to parent training shows promise for altering daily mealtime routines. Delivering this intervention in the home is feasible and received acceptable ratings among this sample.

OBJECTIVE. We compared performance level and muscle activity patterns during shape copying and tracing in two positions, while sitting at a desk and while standing in front of a wall, between typically developing (TD) preschool children and children with mild disabilities (MD).

METHOD. Twenty-two TD children (8 boys, 14 girls; mean [M] age = 5.2 yr, standard deviation [SD] = 0.1) and 13 children with MD (9 boys, 4 girls; M age = 4.9 yr, SD = 0.5) participated in this study.

RESULTS. The children performed faster and smoother movements when copying shapes on the vertical surface, with no reduction of accuracy, than on the horizontal surface. Children with MD exerted their upper trapezius while performing the short tasks on the vertical surface compared with their muscle activity on the horizontal surface.

CONCLUSION. Incorporating short copying or drawing tasks on a vertical surface may increase the control of proximal muscles and ease graphomotor performance in children with MD.

OBJECTIVE. The Multiple Errands Test (MET) was designed to measure the effect of executive dysfunction on everyday life activities, but little is known about the cognitive requirements for successful performance. This study’s objective was to investigate cognitive functions associated with successful MET performance, specifically, the Baycrest-MET.

METHOD. Correlation analysis examined relationships between Baycrest-MET performance and neuropsychological functioning in participants with acquired brain injury (ABI; N = 27).

RESULTS. The association of tasks omitted with executive function (EF) accounted for 15.2%–42.3% of the variance; the association of tasks omitted with attention and processing speed, for 16.8%–24.0%; and the association of tasks omitted and total rule breaks with visuospatial memory, for 18.5%–31.4%.

CONCLUSION. Poor performance on the Baycrest-MET in people with ABI is associated with impairments of EF, attention, memory, and processing speed. Different patterns of performance may arise from different constellations of impairments.

Natural contexts and family involvement are key features of effective intervention approaches. However, the measurement of community participation and parent engagement with children remains complex. Therefore, we examined the feasibility of combining use of the Language ENvironment Analysis (LENA^®) system and a global positioning system (GPS; i.e., Qstarz^® BT-Q1000XT). The LENA is a small speech recognition device that captures and quantifies full-day recordings of the natural language environment. The Qstarz BT-Q1000XT is a wearable GPS data logger that allows identification of the locations a person visits. The marrying of these measures allows for an accurate representation of community settings that afford children greater social communication opportunities. Our results show that the combination of measures provides meaningful social communication location data. Also, the participating caregiver reported that the collection of measures was feasible across community settings.

OBJECTIVE. This study examined the parallel-forms reliability of a web application (app) of the Activity Card Sort Australia for adults ages 18–64 and assessed its clinical utility.

METHOD. Forty-eight participants completed the app and card versions of the tool within a 2- to 3-wk interval and provided feedback via a purpose-designed survey. Intraclass correlation analysis tested parallel-forms reliability.

RESULTS. The app demonstrated acceptable parallel-forms reliability for overall retained activity level (r = .75, p < .001), the daily life domain (r = .77, p < .001), and the recreation and relaxation domain (r = .74, p < .001), but not for the physical activity domain (r = .59, p < .001). Clinical utility responses suggested good acceptance of both versions.

CONCLUSION. The results suggest that further studies are required before the app version can be used for research or in clinical settings.

OBJECTIVE. The dart-throwing motion (DTM) is a multiplane wrist motion that is needed for many daily occupations. Mobilization along the DTM plane may be essential for rehabilitation after wrist injury, but DTM angles are reported for the dominant hand alone, so their relevance to injury in the nondominant hand cannot be surmised. The aim of this study was to quantify the DTM plane angles for both hands during different activities of daily living (ADLs).

METHOD. Forty-three healthy participants wore a twin-axis electrogoniometer during ADLs.

RESULTS. No significant differences were found between the DTM plane angles of the dominant (20°–45°) and nondominant (15°–40°) hands. These angles varied by task and across participants.

CONCLUSION. The DTM plane is a functional motion used by both hands during ADLs. Because the DTM plane angle differs among hands, tasks, and individual clients, wrist rehabilitation involving the DTM plane should not be limited to a singular DTM plane angle.

Providing person-centered care (PCC) that focuses on meaningful engagement in residential care settings for older adults with moderate to advanced dementia is an internationally recognized challenge. In this study, we aimed to identify best-practice scenarios for supporting older adults with moderate to advanced dementia from culturally and linguistically diverse backgrounds who lived in care facilities. A mixed-methods study with a concurrent triangulation strategy was adopted. Data collection occurred with care partners by means of a preworkshop questionnaire, an appreciative-inquiry workshop, and an adapted Delphi technique. The findings indicate that care partners valued the care facilities’ residents’ needs for doing, being, and belonging. Collaborative data generation reflected the setting-specific PCC practices. Leadership team members agreed that enabling inclusion and celebrating cultural diversity were important but that cultural humility needed to be promoted.

The Jebsen Hand Function Test (JHFT) is a standardized assessment that has been used as a clinical outcome measure. To appropriately interpret the effects of an intervention on hand function (as measured by the JHFT), the extent to which this instrument shows significant practice effects must be quantified. The purpose of this study was to determine whether the JHFT is susceptible to within-session practice effects. The results showed that the dominant and nondominant hands significantly improved on the JHFT and many of its subtests over six consecutive trials. Although practice effects might complicate the interpretation of change due to intervention, we briefly relate our findings to emerging neuropsychological evidence that practice effects may indicate a person’s motor learning potential or treatment responsiveness.

Occupational therapists have an established and important role in helping people work while living with an illness or a disability. Although workplace accommodations and rehabilitation efforts can extend paid work for workers with progressive health conditions, the reality is that these populations often cease work earlier in the life trajectory than expected. Evidence suggests that transitioning out of paid work is difficult for people with disabilities. For example, factors such as poor health, low income, and involuntary retirement put people with multiple sclerosis at risk for poor adjustment. Given society’s emphasis on paid work, the transition to unpaid work has received little attention. Occupational therapy practitioners are well positioned to contribute to enhancing the quality of life of people in work-cessation transitions who are not of traditional retirement age.