Recent Chan Publications
Consistent with the Division's ongoing pursuit of innovation and production of knowledge, Chan faculty, staff, and PhD students work at the cutting-edge of their respective fields of expertise. In addition to doing funded research, members of the Chan division generate written publications which contribute to the scholarship of their fields. Peer-reviewed publications authored or co-authored by Chan faculty, staff and PhD students from the last three years are listed below using the American Psychological Association's citation style.
Takata, S. C., Kysh, L., Mack, W. J., & Roll, S. C. (2019). Sonographic reference values of median nerve cross-sectional area: A protocol for a systematic review and meta-analysis. Systematic Reviews, 8(1), 2. https://doi.org/10.1186/s13643-018-0929-9 Show abstract
Background. Median nerve cross-sectional area (CSA) is the primary sonographic parameter for assessing and diagnosing median nerve pathology, such as carpal tunnel syndrome. However, variability in the sensitivity of diagnostic thresholds exists, which may be due to a lack of standardized normative reference values. Current estimates of normal median nerve CSA stem largely from small studies using a local pool of healthy controls. A systematic review and meta-analysis will be conducted to identify all available data for median nerve CSA in healthy, asymptomatic individuals to create a comprehensive set of normative reference values.
Methods. Articles that include sonographic measures of median nerve CSA will be identified through a rigorous search of published evidence, a hand search through tables of contents of key journals, and the gray literature, including ClinicalTrials.gov and conference abstracts. Each abstract and full text will be reviewed by multiple raters to identify studies from 2000 to present that include original data. Any study that provides median nerve CSA values from healthy individuals will be included (e.g., reference value study, control participants in a diagnostic study). Studies will be assessed for quality using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, with primary focus on the use of a detailed and acceptable image acquisition and analysis protocol. Using data from included studies, reference values will be calculated for median nerve CSA by anatomical regions, including the distal forearm, wrist, and carpal tunnel at the level of the pisiform. Reference values will be stratified by gender, ethnicity, and age based upon the specificity of the data provided by the included articles.
Discussion. A comprehensive set of normative reference values of median nerve CSA will reduce variability across studies, allowing future research to more accurately evaluate and establish diagnostic thresholds. Additionally, normative values can serve as a reference for evaluating treatment outcomes and provide a means to investigate and understand minor nuances in CSA changes that may be indicative of preclinical stages of median nerve pathology.
Systematic review registration. PROSPERO 2016 CRD42016037286
Keywords. Meta-analysis, Systematic review, Musculoskeletal sonography, Median nerve, Reference values
Takata, S. C., Wade, E. T., & Roll, S. C. (2019). Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: A mapping review linking research to practice. Journal of Hand Therapy, 32(1), 1–9. https://doi.org/10.1016/j.jht.2017.05.018 Show abstract
Study Design. Mapping review.
Introduction. Although published literature and evidence to support medical practice is becoming more abundant, it is not known how well available evidence supports the full spectrum of hand therapy practice.
Purpose of the Study. The aim of this mapping review was to identify strengths and/or gaps in the available literature as compared with the hand therapy scope of practice to guide future research.
Methods. A systematic search and screening was conducted to identify evidence published from 2006 to 2015. Descriptive data from 191 studies were extracted, and the diagnoses, interventions, and outcomes used in the literature were compared with the hand therapy scope of practice.
Results. Osteoarthritis, tendon surgeries, and carpal tunnel syndrome were most frequently studied. Exercise, education, and orthotic interventions were most common, each used in more than 100 studies; only 12 studies used activity-based interventions. Primary outcome measures included range of motion, pain/symptoms, strength, and functional status.
Discussion. Abundant high-quality research exists for a portion of the hand therapy scope of practice; however, there is a paucity of evidence for numerous diagnoses and interventions.
Conclusions. More evidence is needed for complex diagnoses and activity-based interventions as well as behavioral and quality-of-care outcomes.
Level of Evidence. Not applicable.
Carlson, M., Vigen, C. L., Rubayi, S., Blanche, E. I., Blanchard, J., Atkins, M., Bates-Jensen, B., Garber, S. L., Pyatak, E. A., Díaz, J., Floríndez, L. I., Hay, J. W., Mallinson, T., Unger, J. B., Azen, S. P., Scott, M., Cogan, A., & Clark, F. (2019). Lifestyle intervention for adults with spinal cord injury: Results of the USC-RLANRC Pressure Ulcer Prevention Study. Journal of Spinal Cord Medicine, 42(1), 2–19. https://doi.org/10.1080/10790268.2017.1313931 Show abstract
Context/Objective. Medically serious pressure injuries (MSPrIs), a common complication of spinal cord injury (SCI), have devastating consequences on health and well-being and are extremely expensive to treat. We aimed to test the efficacy of a lifestyle-based intervention designed to reduce incidence of MSPrIs in adults with SCI.
Design. A randomized controlled trial (RCT), and a separate study wing involving a nonrandomized standard care control group.
Setting. Rancho Los Amigos National Rehabilitation Center, a large facility serving ethnically diverse, low income residents of Los Angeles County.
Participants. Adults with SCI, with history of one or more MSPrIs over the past 5 years: N=166 for RCT component, N=66 in nonrandomized control group.
Interventions. The Pressure Ulcer Prevention Program, a 12-month lifestyle-based treatment administered by healthcare professionals, largely via in-home visits and phone contacts.
Outcome Measures. Blinded assessments of annualized MSPrI incidence rates at 12 and 24 months, based on: skin checks, quarterly phone interviews with participants, and review of medical charts and billing records. Secondary outcomes included number of surgeries and various quality-of-life measures.
Results. Annualized MSPrI rates did not differ significantly between study groups. At 12 months, rates were .56 for intervention recipients, .48 for randomized controls, and .65 for nonrandomized controls. At follow-up, rates were .44 and .39 respectively for randomized intervention and control participants.
Conclusions. Evidence for intervention efficacy was inconclusive. The intractable nature of MSPrI threat in high-risk SCI populations, and lack of statistical power, may have contributed to this inability to detect an effect.
Trial Registration. ClinicalTrials.gov NCT01999816.
Schepens Niemiec, S. L., Blanchard, J., Vigen, C. L., Martínez, J., Guzmán, L., Fluke, M., & Carlson, M. (2019). A pilot study of the ¡Vivir Mi Vida! lifestyle intervention for rural-dwelling, late-midlife Latinos: Study design and protocol. OTJR: Occupation, Participation and Health, 39(1), 5-13. https://doi.org/10.1177/1539449218762728 Show abstract
Older, rural-dwelling Latinos face multiple health disparities. We describe the protocol of a pilot study of a community health worker–occupational therapist-led lifestyle program, ¡Vivir Mi Vida! (¡VMV!), designed for delivery in primary care and adapted for late-midlife, Latino rural-living patients. Using mixed methods, we collected feasibility, acceptability, and preliminary efficacy data on ¡VMV!. Forty 50- to 64-year-old Latinos participated in a 16-week lifestyle intervention led by a community health worker–occupational therapist team. We conducted pre- and post-intervention assessments to evaluate the efficacy of ¡VMV! in improving psychosocial and clinical health outcomes. Focus groups and interviews were held post-intervention with participants and key stakeholders to assess feasibility and acceptability. This is the first trial designed to evaluate a lifestyle intervention that includes collaboration between occupational therapists and community health workers within primary care. The detailed description of methodology promotes research transparency and reproducibility of a community health worker–occupational therapist-led lifestyle intervention.
Baranek, G. T., Carlson, M., Sideris, J., Kirby, A. V., Watson, L. R., Williams, K. L., & Bulluck, J. (2019). Longitudinal assessment of stability of sensory features in children with autism spectrum disorder or other developmental disabilities. Autism Research, 12(1), 100–111. https://doi.org/10.1002/aur.2008 Show abstract
Prior research on the stability of sensory processing problems in children with autism spectrum disorder (ASD) or other developmental disabilities (DD) has produced inconsistent results. We employed a longitudinal study design to assess the stability of three clinical sensory response patterns: hyporesponsiveness; hyperresponsiveness; and sensory interests, repetitions, and seeking behaviors (SIRS). Parents of children with ASD (n = 55) or DD (n = 35) responded to sensory questionnaires at two time points (T1 and T2) separated by 3.3 years on average, with the children aged 2–12 years (M = 5.69 ± 2.46) at the first assessment. For each sensory response pattern, regression analysis revealed that, for both ASD and DD groups, scores at T1 were strong predictors of scores at T2. Over the longitudinal assessment interval, there was a significant mean decline in severity for SIRS in both groups and for hyporesponsiveness in the ASD group. Parental estimates of the amount of therapy services received were positively associated with the severity of sensory features at T2, an outcome that may result from increased intervention dosages being administered to children who fail to improve over time. The results are discussed in terms of person‐centered and environmental considerations, which, in combination, have the capacity to affect stability outcomes for sensory features.
Takata, S. C., & Roll, S. C. (2019). Identification of aberrant muscle bellies in the carpal tunnel using sonography. Journal of Diagnostic Medical Sonography, 35(1), 62–68. https://doi.org/10.1177/8756479318807469 Show abstract
Musculoskeletal sonography is being widely used for evaluation of structures within the carpal tunnel. While some anatomical variants, such as bifurcated median nerves and persistent median arteries, have been well documented, limited literature describes the sonographic appearance of aberrant muscle bellies within the carpal tunnel. Multiple examples of the sonographic appearance of flexor digitorum superficialis and lumbrical muscle bellies extending into the carpal tunnel are provided. Techniques for static image acquisition and analysis are discussed, and the use of dynamic imaging to confirm which specific muscle belly is involved is described. Knowledge of the potential presence of muscle bellies in these images and ability to identify these structures is vital to avoid misclassification or misdiagnosis as abnormal pathology. The case examples are situated among current published evidence regarding how such anomalies may be related to the development of pathologies, such as carpal tunnel syndrome.
Keywords. carpal tunnel, aberrant muscle, musculoskeletal sonography
Rafeedie, S. (2018). Special needs of the older adult. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti's occupational therapy: Practice skills for physical dysfunction (8th ed., pp. 1142-1165). St. Louis, MO: Elsevier. Full text
Isaac, N., & Choi, E. (2018). Infant anatomy and physiology for feeding. In S. H. Campbell, J. Lauwers, R., Mannel, & B. Spencer (Eds.), Core curriculum for interdisciplinary lactation care (pp. 37-55). Burlington, MA: Jones & Bartlett Learning. Full text
Watson, L. R., Nowell, S. W., Crais, E. R., Baranek, G. T., Wakeford, L., & Turner-Brown, L. (2018). Supporting families of infants at-risk for ASD identified through community screening and surveillance. In M. Siller & L. Morgan (Eds.), Handbook of parent-implemented interventions for very young children with autism (pp. 25-43). Switzerland: Springer International. https://doi.org/10.1007/978-3-319-90994-3_2 Show abstract
Screening tools have given us the opportunity to identify risk symptoms of autism spectrum disorder (ASD) in infants prior to the full expression of symptoms when a definitive diagnosis can be made. Identification of ASD risk via community screening and surveillance is particularly important for the estimated 89% of infants without known genetic risk factors (such as an older sibling with ASD) who will eventually be diagnosed with ASD. Based on the application of a transactional model of development to infants at-risk for ASD, parent-implemented very early interventions have the potential to attenuate the expression of ASD symptoms in these infants and improve outcomes. In this chapter, we will (1) discuss what is known about identification of infants who are at-risk for ASD through community screening, (2) highlight the research to date examining use of parent-implemented very early interventions for infants who were identified as at-risk for ASD via community screening, and (3) offer insight into some of the advantages and obstacles in intervening with this population based on our own research experiences and those of our colleagues who have done similar work.
Aldrich, R. M., & Heatwole Shank, K. (2018). An occupational science perspective on occupation, adaption, and participation. In L. C. Grajo & A. Boisselle (Eds.), Adaptation through occupation: Multidimensional perspectives (pp. 159-174). Thorofare, NJ: Slack.
Spitzer, S. L., & Bodison, S. C. (2018). Motor and praxis differences in individuals with ASD. In R. Watling & S. L. Spitzer (Eds.), Autism across the lifespan: A comprehensive occupational therapy approach (4th ed.). Bethesda, MD: AOTA Press. Full text
Dieterle, C. (2018). Diabetes. In R. DiZazzo-Miller & F. D. Pociask (Eds.), Preparing for the Occupational Therapy National Board exam: 45 days and counting (2nd ed., pp. 399-412). Burlington, MA: Jones and Bartlett. Full text
Jalaba, T., Smith, L., Rice, C., & Lawlor, M. (2018). Promoting wellness and healthy living for individuals with ASD. In R. Watling & S. L. Spitzer (Eds.), Autism across the lifespan: A comprehensive occupational therapy approach (pp. 447-464). Bethesda, MD: AOTA Press. Full text
Angell, A. M., & Solomon, O. (2018). Understanding parents’ concerns about their children with autism taking public school transportation in Los Angeles County. Autism, 22(4), 401-413. https://doi.org/10.1177/1362361316680182 Show abstract
There are a number of recent US news media reports of children and youth with autism becoming lost, injured, or even dying while taking public school transportation, yet research on this problem is scarce. This ethnographic study examines the experiences of 14 parents whose children with autism take public school transportation in Los Angeles County. We present two case studies of children with autism being “lost” while in transit from school to home on the bus to (1) describe how the situation was experienced, responded to, and managed by the parents; (2) consider three interrelated themes that emerged from interviews with 14 parents, related to children’s safety, independence, and participation, across multiple contexts and analytic levels; and (3) discuss the findings in relation to US news media reports of incidents involving children with autism on school buses to identify specific weaknesses in school transportation infrastructure, particularly in the context of privatization, that create conditions in which children with autism can “fall through the cracks” in potentially life-threatening ways. We argue that there is a critical need to address transportation accessibility for individuals on the autism spectrum to ensure their safety and support their independence and community participation.
Williams, K. L., Kirby, A. V., Watson, L. R., Sideris, J., Bulluck, J., & Baranek, G. T. (2018). Sensory features as predictors of adaptive behaviors: A comparative longitudinal study of children with autism spectrum disorder and other developmental disabilities. Research in Developmental Disabilities, 81, 103-112. https://doi.org/10.1016/j.ridd.2018.07.002 Show abstract
Background. Children with autism spectrum disorder (ASD) and other developmental disabilities (DD) exhibit sensory features that differ from their typically developing peers. Prior cross-sectional research has demonstrated significant associations between elevated sensory features and lower adaptive behavior scores, yet there is limited prospective research examining longitudinal associations.
Aims. To examine the longitudinal prediction of early sensory response patterns (i.e., hyperresponsiveness, hyporesponsiveness, and sensory interests, repetitions, and seeking behaviors) to later adaptive behavior outcomes in children with ASD and DD.
Methods and procedures. Children with ASD (n = 51) and DD (n = 30) were seen at two time points (Time 1: M(SD) = 5.6(2.5) years; Time 2: M(SD) = 9.0(2.2) years). We used a series of regression models with both observational and parent-report measures of sensory response patterns, and including group interactions.
Outcomes and results. All three sensory response patterns significantly predicted aspects of adaptive behaviors, with some differences based on assessment format and diagnostic group. Across groups and sensory patterns, we found some evidence that elevated sensory features early in childhood predicted lower adaptive behavior skills later in childhood.
Conclusions and implications. Sensory features may interfere with development of adaptive behaviors, suggesting a need for effective interventions addressing sensory features early in development.
Keywords. Autism; Child development disorders; Longitudinal analysis; Sensory processing; Adaptive behaviors
Gardner-Neblett, N., & Sideris, J. (2018). Different tales: The role of gender in the oral narrative-reading link among African American children. Child Development, 89(4), 1328-1342. https://doi.org/10.1111/cdev.12803 Show abstract
Evidence suggests that oral narrative skills are a linguistic strength for African American children, yet few studies have examined how these skills are associated with reading for African American boys and girls. The current study uses longitudinal data of a sample of 72 African American 4-year-olds to examine how preschool oral narrative skills predict reading from first through sixth grades and explores differences by gender. Findings indicate that although girls demonstrated stronger narrative skills, their narrative skills did not moderate change in reading. For boys, narrative skills moderated change in reading over time such that as preschool narrative skills increased, their reading scores showed greater change over time. Educational implications and directions for future research are discussed.
Rafeedie, S., Metzler, C., & Lamb, A. J. (2018). Opportunities for occupational therapy to serve as a catalyst for culture change in nursing facilities. American Journal of Occupational Therapy, 72(4), 7204090010p1-7204090010p6. https://doi.org/10.5014/ajot.2018.724003 Show abstract
Ensuring that older adults are receiving quality and effective rehabilitation and skilled nursing services must be a priority to society and to the health care system, but health care policies and systems driving reimbursement continue to challenge the delivery of services. A review of the literature indicates significant problems among residents of skilled nursing facilities (SNFs) that could be alleviated by meaningful occupational therapy. Research and practice in the occupational therapy community should focus on this large area of practice. Advocacy by individual practitioners—challenging themselves and others to provide more patient-centered care—can lead to changes that benefit clients, facilities, and payment systems as well as contribute to career satisfaction of occupational therapy practitioners. Occupational therapy can and should serve as catalyst for culture change in SNFs by providing meaningful interventions and opportunities that support engagement and health.
Solomon, O., & Lawlor, M. C. (2018). Beyond V40.31: Narrative phenomenology of wandering in autism and dementia. Culture, Medicine, and Psychiatry, 42(2), 206–243. https://doi.org/10.1007/s11013-017-9562-7 Show abstract
Research on autism spectrum disorder (ASD) and on Alzheimer's Disease (AD) and other types of dementia describes a behaviour called 'wandering', a term that denotes movement through space lacking intention or exact destination, as when a person is disoriented or not self-aware. In the U.S., 'wandering' in both ASD and AD has been examined mostly from a management and prevention perspective. It prioritizes safety while primarily overlooking personal experiences of those who 'wander' and their families, thus limiting the range of potentially effective strategies to address this issue. Communicative challenges faced by many people diagnosed with ASD and AD further obscure the experiential, existential aspects of 'wandering'. This article reflects an increasing concern of social science scholars interested in whether and how the conceptual and practical strategies to address 'wandering' are informed by the situated experiences of people with cognitive and developmental disabilities and their families. We examine 'wandering' at the intersections of personal experience, family life, clinical practice, public health policy, and legislation, as a conceptually rich site where notions of personhood, subjectivity, intentionality, and quality of life powerfully and consequentially converge to impact the lives of many people with ASD and AD, and their families. We draw upon critical autism studies describing how attributions of personhood, subjectivity, intentionality, rational agency, and moral autonomy of people with ASD have been contingent upon the norms and conventions governing movement of the human body through space (Hilton, Afr Am Rev 50(2):221-235, 2017). When this movement is deemed aberrant, the person may be construed as irrational, a danger to self because of a lack of self-awareness, and a danger to others because of a lack of empathy. These attributions put the person at risk of being excluded from the considerations and, more importantly, the obligations of the 'moral community' to ensure that he or she has a 'good human life' (Barnbaum, The Ethics of Autism: Among Them but not of Them. Indiana University Press, Bloomington, 2008; Silvers and Francis, Metaphilosophy 40(3/4):475-498, 2009). Using ethnographic, narrative phenomenological (Mattingly, The Paradox of Hope: Journeys through a Clinical Borderland. Berkeley: University of California Press, 2010), and medical humanities (Charon, JAMA 286:1897-1902, 2001; Narrative Medicine: Honoring the Stories of Illness. New York: Oxford University Press, 2006) approaches, we examine multiple perspectives on 'wandering' in ASD and AD across narrative discourse genres, institutional contexts, and media of representation. We argue for an extension of the prevention and management view to focus not only on safety but also on what phenomenologist Merleau-Ponty (1962) called "having a world" (p. 146). The analysis is intended to inform clinical practice, policy and public health efforts to enhance understanding of first and second person perspectives on 'wandering' in order to improve the participation and quality of life of people with ASD and AD who 'wander', and their families.
Nowell, S. W., Watson, L. R., Faldowski, R. A., & Baranek, G. T. (2018). An initial psychometric evaluation of the Joint Attention Protocol. Journal of Autism and Developmental Disorders, 48(6), 1932–1944. https://doi.org/10.1007/s10803-017-3458-9 Show abstract
The goal of this paper is to examine the psychometric properties of a live-coded behavioral measure of joint attention, the Attention-Following and Initiating Joint Attention Protocol (JA Protocol), in order to assist researchers and clinicians in identifying when this measure may meet their joint attention assessment needs. Data from 260 children with autism spectrum disorder, developmental delay, or typical development between the ages of 2 and 12 years were used to evaluate this measure using quality standards for measurement. Overall, the JA Protocol demonstrated good psychometric properties. Recommendations and limitations for use of this measure based on psychometric analysis results are reported.
Liew, S.-L., Garrison, K. A., Ito, K. L., Heydari, P., Sobhani, M., Werner, J., Damasio, H., Winstein, C. J., & Aziz-Zadeh, L. (2018). Laterality of poststroke cortical motor activity during action observation is related to hemispheric dominance. Neural Plasticity, 2018, 3524960. https://doi.org/10.1155/2018/3524960 Show abstract
Background. Increased activity in the lesioned hemisphere has been related to improved poststroke motor recovery. However, the role of the dominant hemisphere—and its relationship to activity in the lesioned hemisphere—has not been widely explored.
Objective. Here, we examined whether the dominant hemisphere drives the lateralization of brain activity after stroke and whether this changes based on if the lesioned hemisphere is the dominant hemisphere or not.
Methods. We used fMRI to compare cortical motor activity in the action observation network (AON), motor-related regions that are active both during the observation and execution of an action, in 36 left hemisphere dominant individuals. Twelve individuals had nondominant, right hemisphere stroke, twelve had dominant, left-hemisphere stroke, and twelve were healthy age-matched controls. We previously found that individuals with left dominant stroke show greater ipsilesional activity during action observation. Here, we examined if individuals with nondominant, right hemisphere stroke also showed greater lateralized activity in the ipsilesional, right hemisphere or in the dominant, left hemisphere and compared these results with those of individuals with dominant, left hemisphere stroke.
Results. We found that individuals with right hemisphere stroke showed greater activity in the dominant, left hemisphere, rather than the ipsilesional, right hemisphere. This left-lateralized pattern matched that of individuals with left, dominant hemisphere stroke, and both stroke groups differed from the age-matched control group.
Conclusions. These findings suggest that action observation is lateralized to the dominant, rather than ipsilesional, hemisphere, which may reflect an interaction between the lesioned hemisphere and the dominant hemisphere in driving lateralization of brain activity after stroke. Hemispheric dominance and laterality should be carefully considered when characterizing poststroke neural activity.
Zhang, W., Baranek, G. T., & Boyd, B. (2018). Brief report: Factors associated with emergency department visits for epilepsy among children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(5), 1854-1860. https://doi.org/10.1007/s10803-017-3433-5 Show abstract
We examined how demographic and clinical characteristics differ between emergency department (ED) visits for epilepsy (EP cohort) and ED visits for other reasons (non-EP cohort) in children with ASD. The data were drawn from the 2009 and 2010 Nationwide Emergency Department Sample. We performed both univariate and multivariate analyses to compare and contrast similarities and differences between EP cohort and non-EP cohort among children with ASD. The results showed ED visits in EP cohort were more likely to occur among adolescents aged 13–17 years, less likely to occur among children with co-occurring psychiatric conditions, and were more likely to co-occur with injury. We discussed some unique challenges for managing children with both ASD and epilepsy.
Pyatak, E. A., Carandang, K., Vigen, C. L., Blanchard, J., Díaz, J., Concha-Chavez, A., Sequeira, P. A., Wood, J. R., Whittemore, R., Spruijt-Metz, D., & Peters, A. L. (2018). Occupational therapy intervention improves glycemic control and quality of life among young adults with diabetes: The Resilient, Empowered, Active Living With Diabetes (REAL Diabetes) randomized controlled trial. Diabetes Care, 41(4), 696-704. https://doi.org/10.2337/dc17-1634 Show abstract
Objective. To assess the efficacy of a manualized occupational therapy (OT) intervention (Resilient, Empowered, Active Living with Diabetes [REAL Diabetes]) to improve glycemic control and psychosocial well-being among ethnically diverse young adults with low socioeconomic status (SES) who have type 1 or type 2 diabetes.
Research Design and Methods. Eighty-one young adults (age 22.6 ± 3.5 years; hemoglobin A1c [HbA1c] = 10.8%/95 mmol/mol ± 1.9%/20.8 mmol/mol) were randomly assigned to the REAL Diabetes intervention group (IG) or an attention control group (CG) over 6 months. IG participants received biweekly sessions guided by a manual composed of seven content modules; CG participants received standardized educational materials and biweekly phone calls. Blinded assessors collected data at baseline and 6 months. The primary outcome was HbA1c; secondary outcomes included diabetes self-care, diabetes-related quality of life (QOL), diabetes distress, depressive symptoms, and life satisfaction. Change scores were analyzed using Wilcoxon rank sum tests.
Results. Intent-to-treat analyses showed that IG participants showed significant improvement in HbA1c (-0.57%/6.2 mmol/mol vs. +0.36%/3.9 mmol/mol, P = 0.01), diabetes-related QOL (+0.7 vs. +0.15, P = 0.04), and habit strength for checking blood glucose (+3.9 vs. +1.7, P = 0.05) as compared with CG participants. There was no statistically significant effect modification by sex, ethnicity, diabetes type, recruitment site, or SES. No study-related serious adverse events were reported.
Conclusions. The REAL Diabetes intervention improved blood glucose control and diabetes-related QOL among a typically hard-to-reach population, thus providing evidence that a structured OT intervention may be beneficial in improving both clinical and psychosocial outcomes among individuals with diabetes.
Juang, C., Knight, B. G., Carlson, M., Schepens Niemiec, S. L., Vigen, C., & Clark, F. A. (2018). Understanding the mechanisms of change in a lifestyle intervention for older adults. The Gerontologist, 58(2), 353–361. https://doi.org/10.1093/geront/gnw152 Show abstract
Purpose of the Study. This study investigated the mechanisms of change underlying an activity-based lifestyle intervention, an occupational therapy program aimed at promoting healthy habits, and routines in older adults. We examined two activity-relevant factors as potential mediators linking the intervention to reduced symptoms of depression: activity frequency and global perceptions of activity significance. Social connections and perceived control were assessed to understand how activity-related factors relate to reduced symptoms of depression.
Design and Methods. The sample consisted of 460 multiethnic community-dwelling older adults aged 60-95 years. Participants were randomly assigned to a 6-month lifestyle redesign intervention (n = 232) or a no-treatment control (n = 228) condition. After the 6-month period, 360 individuals completed post-testing. Latent change score models were used to represent changes from baseline over the experimental interval. Structural equation models were applied to examine the indirect effects of the intervention on reduced depressive symptoms.
Results. The results demonstrated significant indirect effects from intervention receipt to decreased depressive symptoms via increased activity frequency and activity significance. Higher activity frequency was linked to fewer depressive symptoms via heightened social connections, whereas increased activity significance was associated with fewer depressive symptoms via enhanced perceived control.
Implications. The results support basic principles of occupational therapy by highlighting important mediating roles of activity frequency and activity significance in reducing depressive symptoms. Understanding of these change mechanisms can help optimize activity-centered interventions to reduce depressive symptoms.
Weigensberg, M. J., Vigen, C., Sequeira, P., Spruijt-Metz, D., Juarez, M., Florindez, D., Provisor, J., Peters, A., & Pyatak, E. A. (2018). Diabetes Empowerment Council: Integrative Pilot Intervention for Transitioning Young Adults With Type 1 Diabetes. Global Advances in Health and Medicine. Advance online publication. https://doi.org/10.1177/2164956118761808 Show abstract
Background. The transition of young adults with type 1 diabetes (T1D) from pediatric to adult care is challenging and frequently accompanied by worsening of diabetes-related health. To date, there are no reports which prospectively assess the effects of theory-based psycho-behavioral interventions during the transition period neither on glycemic control nor on psychosocial factors that contribute to poor glycemic control. Therefore, the overall aim of this study was to develop and pilot test an integrative group intervention based on the underlying principles of self-determination theory (SDT), in young adults with T1D.
Methods. Fifty-one young adults with T1D participated in an education and case management-based transition program, of which 9 took part in the Diabetes Empowerment Council (DEC), a 12-week holistic, multimodality facilitated group intervention consisting of “council” process based on indigenous community practices, stress-reduction guided imagery, narrative medicine modalities, simple ritual, and other integrative modalities. Feasibility, acceptability, potential mechanism of effects, and bio-behavioral outcomes were determined using mixed qualitative and quantitative methods.
Results. The intervention was highly acceptable to participants, though presented significant feasibility challenges. Participants in DEC showed significant reductions in perceived stress and depression, and increases in general well-being relative to other control participants. Reduction in perceived stress, independent of intervention group, was associated with reductions in hemoglobin A1C. A theoretical model explaining the effects of the intervention included the promotion of relatedness and autonomy support, 2 important aspects of SDT.
Conclusions. The DEC is a promising group intervention for young adults with T1D going through transition to adult care. Future investigations will be necessary to resolve feasibility issues, optimize the multimodality intervention, determine full intervention effects, and fully test the role of the underlying theoretical model of action.
Leland, N. E., Lepore, M., Wong, C., Chang, S. H., Freeman, L., Crum, K., Gillies, H., & Nash, P. (2018). Delivering high quality hip fracture rehabilitation: The perspective of occupational and physical therapy practitioners. Disability and Rehabilitation, 40(6), 646-654. https://doi.org/10.1080/09638288.2016.1273973 Show abstract
Aim. The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners' perspectives on the practices that constitute high quality hip fracture rehabilitation.
Methods. Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners' perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach.
Results. Seven themes emerged: objectives of care; first 72h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration.
Conclusions. Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners' perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes. Implications for Rehabilitation This study highlights occupational and physiotherapy therapy practitioners' perspectives on the cumulative best practices that reflect high quality care, which should be delivered during hip fracture rehabilitation. While this study was limited to two professions within the broader interdisciplinary team, consistently occupational and physiotherapy therapy practitioners situated their role and practices within the team, emphasizing that high quality care was driven by collaboration among all members of the team as well as the patient and caregivers. Future research needs to evaluate the (a) frequency at which these practices are delivered and the relationship to patient-centered outcomes, and (b) perspectives of rehabilitation practitioners working in other PAC settings, patients, caregivers, as well as the other members of the interdisciplinary PAC team.
Dayan, E., López-Alonso, V., Liew, S.-L., & Cohen, L. G. (2018). Distributed cortical structural properties contribute to motor cortical excitability and inhibition. Brain Structure and Function, 223(8), 3801–3812. https://doi.org/10.1007/s00429-018-1722-1 Show abstract
The link between the local structure of the primary motor cortex and motor function has been well documented. However, motor function relies on a network of interconnected brain regions and the link between the structural properties characterizing these distributed brain networks and motor function remains poorly understood. Here, we examined whether distributed patterns of brain structure, extending beyond the primary motor cortex can help classify two forms of motor function: corticospinal excitability and intracortical inhibition. To this effect, we recorded high-resolution structural magnetic resonance imaging scans in 25 healthy volunteers. To measure corticospinal excitability and inhibition in the same volunteers, we recorded motor evoked potentials (MEPs) elicited by single-pulse transcranial magnetic stimulation and short-interval intracortical inhibition (SICI) in a separate session. Support vector machine (SVM) pattern classification was used to identify distributed multi-voxel gray-matter areas, which distinguished subjects who had lower and higher MEPs and SICIs. We found that MEP and SICI classification could be predicted based on a widely distributed, largely non-overlapping pattern of voxels in frontal, parietal, temporal, occipital, and cerebellar regions. Thus, structural properties distributed over the brain beyond the primary motor cortex relate to motor function.
Cortical excitability; Cortical inhibition; TMS; MRI
Gupta, O. T., Wiebe, D. J., Pyatak, E. A., & Beck, A. M. (2018). Improving medication adherence in the pediatric population using integrated care of companion animals. Patient Education and Counseling, 101(10), 1876–1878. https://doi.org/10.1016/j.pec.2018.05.015 Show abstract
Medication non-adherence occurs in more than half of children with chronic conditions. Unfortunately, most strategies for improving adherence have had limited success in the pediatric population highlighting the need for novel interventions that establish healthy self-management habits for children and adolescents. In this paper we discuss innovative strategies to improve adherence by embedding a medical regimen within a pet care routine, thereby capitalizing on the benefits of a structured habit while providing opportunities for development of autonomy in children and fostering collaborative parent interactions.
Schepens Niemiec, S. L., Blanchard, J., Vigen, C., Martínez, J., Guzmán, L., Concha, A., Fluke, M., & Carlson, M. (2018). Evaluation of ¡Vivir Mi Vida! to improve health and wellness of rural-dwelling, late middle-aged Latino adults: Results of a feasibility and pilot study of a lifestyle intervention. Primary Health Care Research & Development, 19, 448-463. https://doi.org/10.1017/S1463423617000901 Show abstract
The aim of this study was to determine the feasibility and efficacy of a culturally tailored lifestyle intervention, ¡Vivir Mi Vida! (Live My Life!). This intervention was designed to improve the health and well-being of high risk late middle-aged Latino adults and to be implemented in a rural primary care system.
Background. Rural-dwelling Latino adults experience higher rates of chronic disease compared with their urban counterparts, a disparity exacerbated by limited access to healthcare services. Very few lifestyle interventions exist that are both culturally sensitive and compatible for delivery within a non-metropolitan primary care context.
Methods. Participants were 37 Latino, Spanish-speaking adults aged 50–64-years-old, recruited from a rural health clinic in the Antelope Valley of California. ¡Vivir Mi Vida! was delivered by a community health worker-occupational therapy team over a 16-week period. Subjective health, lifestyle factors, and cardiometabolic measures were collected pre- and post-intervention. Follow-up interviews and focus groups were held to collect information related to the subjective experiences of key stakeholders and participants.
Findings. Participants demonstrated improvements in systolic blood pressure, sodium and saturated fat intake, and numerous patient-centered outcomes ranging from increased well-being to reduced stress. Although participants were extremely satisfied with the program, stakeholders identified a number of implementation challenges. The findings suggest that a tailored lifestyle intervention led by community health workers and occupational therapists is feasible to implement in a primary care setting and can improve health outcomes in rural-dwelling, late middle-aged Latinos.
Boyd, B. A., Watson, L. R., Reszka, S. S., Sideris, J., Alessandri, M., Baranek, G. T., Crais, E. R., Donaldson, A., Gutierrez, A., Johnson, L., & Belardi, K. (2018). Efficacy of the ASAP intervention for preschoolers with ASD: A cluster randomized controlled trial. Journal of Autism and Developmental Disorders, 48(9), 3144–3162. https://doi.org/10.1007/s10803-018-3584-z Show abstract
The advancing social-communication and play (ASAP) intervention was designed as a classroom-based intervention, in which the educational teams serving preschool-aged children with autism spectrum disorder are trained to implement the intervention in order to improve these children’s social-communication and play skills. In this 4-year, multi-site efficacy trial, classrooms were randomly assigned to ASAP or a business-as-usual control condition. A total of 78 classrooms, including 161 children, enrolled in this study. No significant group differences were found for the primary outcomes of children’s social-communication and play. However, children in the ASAP group showed increased classroom engagement. Additionally, participation in ASAP seemed to have a protective effect for one indicator of teacher burnout. Implications for future research are discussed.
Keywords. Autism spectrum disorder; ASAP; Randomized controlled trial; School interventions; Engagement; Social-communication
Wong, C., Martínez, J., Fagan, B., & Leland, N. E. (2018). Understanding communication between rehabilitation practitioners and nurses: Implications for post-acute care quality. Journal of Applied Gerontology. Advance online publication. https://doi.org/10.1177/0733464818794148 Show abstract
Objective. This study examined post-acute care (PAC) rehabilitation practitioner’s perspectives on communication.
Method. This is a secondary data analysis of a larger qualitative study, which included PAC rehabilitation provider (n = 99) focus groups that were held in a purposive sample of 13 skilled nursing facilities (SNFs).
Results. Participants emphasized the importance of bidirectional communication between rehabilitation and nursing. Three themes were identified: (a) communication between rehabilitation practitioners and registered nurses or licensed practical nurses, (b) communication between rehabilitation practitioners and certified nursing assistants, and (c) communication between rehabilitation practitioners and nursing leaders. Two subthemes within each of the three themes were further characterized to understand how information was exchanged: (a) static communication and (b) action-oriented communication.
Conclusion. Our findings highlight opportunities for better communication in PAC between rehabilitation practitioners and nursing and thus lay a foundation for future efforts to improve care coordination through enhancing interdisciplinary communication.
Failla, M. D., Moana-Filho, E. J., Essick, G. K., Baranek, G. T., Rogers, B. P., & Cascio, C. J. (2018). Initially intact neural responses to pain in autism are diminished during sustained pain. Autism, 22(6), 669-683. https://doi.org/10.1177/1362361317696043 Show abstract
Pain assessments typically depend on self-report of the pain experience. Yet, in individuals with autism spectrum disorders, this can be an unreliable due to communication difficulties. Importantly, observations of behavioral hypo- and hyperresponsivity to pain suggest altered pain sensitivity in autism spectrum disorder. Neuroimaging may provide insight into mechanisms underlying pain behaviors. The neural pain signature reliably responds to painful stimulation and is modulated by other outside regions, affecting the pain experience. In this first functional magnetic resonance imaging study of pain in autism spectrum disorder, we investigated neural responses to pain in 15 adults with autism spectrum disorder relative to a typical comparison group (n = 16). We explored temporal and spatial properties of the neural pain signature and its modulators during sustained heat pain. The two groups had indistinguishable pain ratings and neural pain signature responses during acute pain; yet, we observed strikingly reduced neural pain signature response in autism spectrum disorder during sustained pain and after stimulus offset. The posterior cingulate cortex, a neural pain signature modulating region, mirrored this late signal reduction in autism spectrum disorder. Intact early responses, followed by diminished late responses to sustained pain, may reflect altered pain coping or evaluation in autism spectrum disorder. Evidence of a dichotomous neural response to initial versus protracted pain may clarify the coexistence of both hypo- and hyperresponsiveness to pain in autism spectrum disorder.
Liew, S.-L., Thompson, T., Ramirez, J., Butcher, P., Taylor, J. A., & Celnik, P. A. (2018). Variable neural contributions to explicit and implicit learning during visuomotor adaptation. Frontiers in Neuroscience, 12, 610. https://doi.org/10.3389/fnins.2018.00610 Show abstract
We routinely make fine motor adjustments to maintain optimal motor performance. These adaptations have been attributed to both implicit, error-based mechanisms, and explicit, strategy-based mechanisms. However, little is known about the neural basis of implicit versus explicit learning. Here, we aimed to use anodal transcranial direct current stimulation (tDCS) to probe the relationship between different brain regions and learning mechanisms during a visuomotor adaptation task in humans. We hypothesized that anodal tDCS over the cerebellum (CB) should increase implicit learning while anodal tDCS over the dorsolateral prefrontal cortex (dlPFC), a region associated with higher-level cognition, should facilitate explicit learning. Using a horizontal visuomotor adaptation task that measures explicit/implicit contributions to learning (Taylor et al., 2014), we found that dlPFC stimulation significantly improved performance compared to the other groups, and weakly increased explicit learning. However, CB stimulation had no effects on either target error or implicit learning. Previous work showed variable CB stimulation effects only on a vertical visuomotor adaptation task (Jalali et al., 2017), so in Experiment 2, we conducted the same study using a vertical context to see if we could find effects of CB stimulation. We found only weak effects of CB stimulation on target error and implicit learning, and now the dlPFC effect did not replicate. To resolve this discrepancy, in Experiment 3, we examined the effect of context (vertical vs. horizontal) on implicit and explicit contributions and found that individuals performed significantly worse and used greater implicit learning in the vertical screen condition compared to the horizontal screen condition. Across all experiments, however, there was high inter-individual variability, with strong influences of a few individuals, suggesting that these effects are not consistent across individuals. Overall, this work provides preliminary support for the idea that different neural regions can be engaged to improve visuomotor adaptation, but shows that each region’s effects are highly context-dependent and not clearly dissociable from one another. This holds implications especially in neurorehabilitation, where an intact neural region could be engaged to potentially compensate if another region is impaired. Future work should examine factors influencing interindividual variability during these processes.
Keywords: Visuomotor adaptation-learning, tDCS, Explicit learning, implicit learning, Cerebellum, dorsolateral prefrontal cortex (DLPFC), Context-dependent learning
Aldrich, R. M. (2018). Strengthening associated living: A Deweyan approach to occupational justice. Journal of Occupational Science, 25(3), 337-345. https://doi.org/10.1080/14427591.2018.1484386 Show abstract
The transactional perspective informed by John Dewey’s philosophy continues to mature in occupational science. Scholars have called for more attention to the community orientation within a transactional perspective, necessitating deeper engagement with Dewey’s political writings. As a contribution to that effort, this article outlines Dewey’s political philosophy and connects his notions of occupation and associated living with his broader ideas about freedom, equality, growth, and justice. Dewey’s enduring attention to democracy throughout his career established a particular function for occupation vis-à-vis the intentionally constructed social relations that constitute associated living. Culminating in his vision of a Great Community, Dewey’s focus on the conditions of associated living provides compelling directions for thinking about and pursuing occupational justice.
Odom, S. L., Cox, A., Sideris, J., Hume, K. A., Hedges, S., Kucharczyk, S., Shaw, E., Boyd, B. A., Reszka, S., & Neitzel, J. (2018). Assessing quality of program environments for children and youth with autism: Autism Program Environment Rating Scale (APERS). Journal of Autism and Developmental Disorders, 48(3), 913–924. https://doi.org/10.1007/s10803-017-3379-7 Show abstract
The purpose of this study was to examine the psychometric properties of the Autism Program Environment Rating Scale (APERS), an instrument designed to assess quality of program environments for students with autism spectrum disorder. Data sets from two samples of public school programs that provided services to children and youth with autism spectrum disorder were utilized. Cronbach alpha analyses indicated high coefficients of internal consistency for the total APERS and moderate levels for item domains for the first data set, which was replicated with the second data set. A factor analysis of the first data set indicated that all domain scores loaded on one main factor, in alignment with the conceptual model, with this finding being replicated in the second data set. Also, the APERS was sensitive to changes resulting from a professional development program designed to promote program quality.
Cogan, A. M., & Carlson, M. (2018). Deciphering participation: An interpretive synthesis of its meaning and application in rehabilitation. Disability and Rehabilitation, 40(22), 2692-2703. https://doi.org/10.1080/09638288.2017.1342282 Show abstract
Purpose. Participation is widely recognized as an important outcome for rehabilitation. However, it lacks a universally accepted definition. The purpose of this review is to synthesize the literature about participation in rehabilitation in order to clarify the term and increase its usefulness for rehabilitation providers and researchers.
Methods. We undertook an interpretive synthesis of the literature, drawing from a broad and varied selection of the vast number of publications on the subject of participation. The search and analysis was iterative and continued until saturation of themes was achieved.
Results and Conclusions. Seventy-six articles were included in our analysis. We argue that three essential dimensions — performance, subjective experience, and interpersonal connection — constitute participation. We further divide participation into community-based and interventional contexts. Interventional participation is circumscribed by the treatment setting, whereas community-based encompasses all other areas. Participation in either interventional or community-based contexts is largely determined by the available opportunities from which a person can choose, with such opportunities affected by conditions that are either internal or external to the individual. As defined in this framework, participation is not inherently good or bad; rather, its effect is determined by a person's unique life circumstances and the impact may not always be apparent. We posit this model as a resource for future research as well as clinical reasoning.
Implications for Rehabilitation. The often tacit assumption that increasing participation is a desirable outcome needs to be challenged and considered in each patient's life situation. Treatment settings constitute a unique context in which patients participate. Intervention goals should be clearly connected with patients' personal goals for community-based participation.
Costa, L.-J., Green, M., Sideris, J., & Hooper, S. R. (2018). First-grade cognitive predictors of writing disabilities in grades 2 through 4 elementary school students. Journal of Learning Disabilities, 51(4), 351-362. https://doi.org/10.1177/0022219417721182 Show abstract
The primary aim of this study was determining Grade 1 cognitive predictors of students at risk for writing disabilities in Grades 2 through 4. Applying cognitive measures selected to align with theoretical and empirical models of writing, tasks were administered to Grade 1 students assessing fine-motor, linguistic, and executive functions: 84 at risk (bottom quartile for age-base expectations) and 54 typically developing. A model with individual predictors was compared to a previously developed latent trait model to determine the relative predictive worth of each approach. Data analysis primarily involved stepwise logistic regression. Results revealed that the individual measures of orthographic choice, working memory, inhibitory control, visual memory recognition, and planning all were significant predictors of at risk status in Grades 2 through 4. The latent trait model also fared well but did not account for the same amount of variance as any of the individual measurement models for any of the grades. The findings lay the foundation for an empirically based approach to cognitive assessment in Grade 1 for identifying potential at-risk students in later elementary grades and suggest potential underlying neurocognitive abilities that could be employed with educational interventions for students with later-emerging writing disabilities.
Aldrich, R. M., Gupta, J., & Laliberte Rudman, D. (2018). “Academic innovation in service of” what? The scope of North American occupational science doctoral graduates’ contributions from 1994–2015. Journal of Occupational Science, 25(2), 270-282. https://doi.org/10.1080/14427591.2017.1365257 Show abstract
More than 100 people have graduated with occupational science doctoral degrees in North America. Accordingly, there is a body of work that can be examined to assess what qualities have characterized doctoral-level occupational science inquiry to-date. In this preliminary study, we performed a directed content analysis of 101 dissertation abstracts published between 1994 and 2015 from four occupational science doctoral programs in the United States and Canada. Our analysis explored the extent to which the 101 doctoral studies, as evidenced by their abstracts, directly contributed to knowledge of occupation or humans as occupational beings. Our findings suggested that 40 studies made a direct contribution, 29 made an indirect contribution, and 32 made no contribution to the study of occupation or humans as occupational beings. Additional analyses revealed that studies in the direct and indirect categories relied heavily (80% and 69%, respectively) on qualitative methodologies, whereas studies in the no contribution category were more evenly split across qualitative (37%) and quantitative (47%) methodologies. A variety of topics and themes characterized studies in each category, and further research on 92 doctoral students’ post-graduation publications showed that 50 made contributions to occupational science’s knowledge base through published articles or book chapters. The findings from this preliminary inquiry provide a basis to critically reflect on the goals, outcomes, and functions of occupational science doctoral education as well as how the discipline has developed through doctoral work within evolving academic, scientific, and political landscapes.
Schertz, H. H., Odom, S. L., Baggett, K. M., & Sideris, J. H. (2018). Mediating parent learning to promote social communication for toddlers with autism: Effects from a randomized controlled trial. Journal of Autism and Developmental Disorders, 48(3), 853–867. https://doi.org/10.1007/s10803-017-3386-8 Show abstract
A randomized controlled trial was conducted to evaluate effects of the Joint Attention Mediated Learning (JAML) intervention. Toddlers with autism spectrum disorders (ASD) aged 16–30 months (n = 144) were randomized to intervention and community control conditions. Parents, who participated in 32 weekly home-based sessions, followed a mediated learning process to target preverbal social communication outcomes (social visual synchrony, reciprocity, and responding and initiating forms of joint attention) throughout daily interactions. The analysis found post-intervention effects for all outcomes, with all except initiating joint attention sustaining 6 months post-intervention. Findings support the value of very early intervention targeting explicitly social functions of preverbal communication and of promoting active engagement in the learning process for both toddlers and parents.
Gerlach, A. J., Teachman, G., Laliberte Rudman, D., Aldrich, R. M., & Huot, S. (2018). Expanding beyond individualism: Engaging critical perspectives on occupation. Scandinavian Journal of Occupational Therapy, 25(1), 35-43. https://doi.org/10.1080/11038128.2017.1327616 Show abstract
Background: Perspectives that individualize occupation are poorly aligned with socially responsive and transformative occupation-focused research, education, and practice. Their predominant use in occupational therapy risks the perpetuation, rather than resolution, of occupational inequities.
Aim: In this paper, we problematize taken-for-granted individualistic analyses of occupation and illustrate how critical theoretical perspectives can reveal the ways in which structural factors beyond an individual’s immediate control and environment shape occupational possibilities and occupational engagement.
Method: Using a critically reflexive approach, we draw on three distinct qualitative research studies to examine the potential of critical theorizing for expanding beyond a reliance on individualistic analyses and practices.
Results: Our studies highlight the importance of addressing the socio-historical and political contexts of occupation and demonstrate the contribution of critical perspectives to socially responsive occupational therapy.
Conclusion and significance: In expanding beyond individualistic analyses of occupation, critical perspectives advance research and practices towards addressing socio-political mediators of occupational engagement and equity.
Lopez-Alonso, V., Liew, S.-L., del Olmo, M. F., Cheeran, B., Sandrini, M., Abe, M., & Cohen, L. G. (2018). A preliminary comparison of motor learning across different non-invasive brain stimulation paradigms shows no consistent modulations. Frontiers in Neuroscience, 12, 253. https://doi.org/10.3389/fnins.2018.00253 Show abstract
Non-invasive brain stimulation (NIBS) has been widely explored as a way to safely modulate brain activity and alter human performance for nearly three decades. Research using NIBS has grown exponentially within the last decade with promising results across a variety of clinical and healthy populations. However, recent work has shown high inter-individual variability and a lack of reproducibility of previous results. Here, we conducted a small preliminary study to explore the effects of three of the most commonly used excitatory NIBS paradigms over the primary motor cortex (M1) on motor learning (Sequential Visuomotor Isometric Pinch Force Tracking Task) and secondarily relate changes in motor learning to changes in cortical excitability (MEP amplitude and SICI). We compared anodal transcranial direct current stimulation (tDCS), paired associative stimulation (PAS25), and intermittent theta burst stimulation (iTBS), along with a sham tDCS control condition. Stimulation was applied prior to motor learning. Participants (n = 28) were randomized into one of the four groups and were trained on a skilled motor task. Motor learning was measured immediately after training (online), 1 day after training (consolidation), and 1 week after training (retention). We did not find consistent differential effects on motor learning or cortical excitability across groups. Within the boundaries of our small sample sizes, we then assessed effect sizes across the NIBS groups that could help power future studies. These results, which require replication with larger samples, are consistent with previous reports of small and variable effect sizes of these interventions on motor learning.
Ito, K. L., Kumar, A., Zavaliangos-Petropulu, A., Cramer, S. C., & Liew, S.-L. (2018). Pipeline for Analyzing Lesions After Stroke (PALS). Frontiers in Neuroinformatics, 12, 63. https://doi.org/10.3389/fninf.2018.00063 Show abstract
Lesion analyses are critical for drawing insights about stroke injury and recovery, and their importance is underscored by growing efforts to collect and combine stroke neuroimaging data across research sites. However, while there are numerous processing pipelines for neuroimaging data in general, few can be smoothly applied to stroke data due to complications analyzing the lesioned region. As researchers often use their own tools or manual methods for stroke MRI analysis, this could lead to greater errors and difficulty replicating findings over time and across sites. Rigorous analysis protocols and quality control pipelines are thus urgently needed for stroke neuroimaging. To this end, we created the Pipeline for Analyzing Lesions after Stroke (PALS; DOI: https://doi.org/10.5281/zenodo.1266980), a scalable and user-friendly toolbox to facilitate and ensure quality in stroke research using T1-weighted MRIs. The PALS toolbox offers four modules integrated into a single pipeline, including (1) reorientation to radiological convention, (2) lesion correction for healthy white matter voxels, (3) lesion load calculation, and (4) visual quality control. In the present paper, we discuss each module and provide validation and example cases of our toolbox using multi-site data. Importantly, we also show that lesion correction with PALS significantly improves similarity between manual lesion segmentations by different tracers (z=3.43, p=0.0018). PALS can be found online at https://github.com/npnl/PALS. Future work will expand the PALS capabilities to include multimodal stroke imaging. We hope PALS will be a useful tool for the stroke neuroimaging community and foster new clinical insights.
Vigen, C. L., Carandang, K., Blanchard, J., Sequeira, P. A., Wood, J. R., Spruijt-Metz, D., Whittemore, R., Peters, A. L., & Pyatak, E. A. (2018). Psychosocial and behavioral correlates of A1C and quality of life among young adults with diabetes. The Diabetes Educator, 44(6), 489–500. https://doi.org/10.1177/0145721718804170 Show abstract
Purpose. The purpose of this study was to evaluate relationships between behavioral and psychosocial constructs, A1C, and diabetes-dependent quality of life (DQoL) among low-socioeconomic status, ethnically diverse young adults with diabetes.
Methods. Using baseline data of 81 participants in the Resilient, Empowered, Active Living (REAL) randomized controlled trial, behavioral, cognitive, affective, and experiential variables were correlated with A1C and DQoL while adjusting for demographic characteristics, and these relationships were examined for potential effect modification.
Results. The data indicate that depressive symptoms and satisfaction with daily activities are associated with both A1C and DQoL, while diabetes knowledge and participation in daily activities are associated with neither A1C nor DQoL. Two constructs, diabetes distress and life satisfaction, were associated with DQoL and were unrelated to A1C, while 2 constructs, self-monitoring of blood glucose and medication adherence, were associated with A1C but unrelated to DQoL. These relationships were largely unchanged by adjusting for demographic characteristics, while numerous effect modifications were found.
Conclusion. The data suggest that when tailoring interventions, depressive symptoms and satisfaction with daily activities may be particularly fruitful intervention targets, as they represent modifiable risk factors that are associated with both A1C and DQoL.
Halle, A. D., Mroz, T. M., Fogelberg, D. J., & Leland, N. E. (2018). Health policy perspectives—Occupational therapy and primary care: Updates and trends. American Journal of Occupational Therapy, 72(3), 7203090010p1-7203090010p6. https://doi.org/10.5014/ajot.2018.723001 Show abstract
As our health care system continues to change, so do the opportunities for occupational therapy. This article provides an update to a 2012 Health Policy Perspectives on this topic. We identify new initiatives and opportunities in primary care, explore common challenges to integrating occupational therapy in primary care environments, and highlight international works that can support our efforts. We conclude by discussing next steps for occupational therapy practitioners in order to continue to progress our efforts in primary care.
Hopkins, J., Cermak, S. A., & Merritt, R. J. (2018). Oral feeding difficulties in children with short bowel syndrome: A narrative review. Nutrition in Clinical Practice, 33(1), 99-106. https://doi.org/10.1177/0884533617707493 Show abstract
Children with short bowel syndrome (SBS) with associated intestinal failure may be unable to absorb sufficient nutrients to sustain life. Improvements in the medical management of SBS, including use of parenteral nutrition, has significantly increased life expectancy. Independence from parenteral nutrition further improves quality of life. However, children living with SBS often develop oral aversions and feeding difficulties. There is limited research and information on which to base interventions that will preserve and develop oral motor and feeding skills. The aims of this article are to explore what is known about children with SBS who exhibit oral aversion/feeding difficulties and to suggest research for possible future interventions that could help these children overcome oral aversion, eat orally, and increase participation and satisfaction in mealtimes. This review explores the complexity of feeding children with SBS. Three underlying themes emerged: physical, developmental, and social aspects of eating and mealtimes. Interdisciplinary teams are needed to effectively address these complex oral feeding problems. Accurate identification the underlying issues will allow healthcare providers to develop interventions to improve feeding outcomes for children with SBS. Future research should focus on evaluating the effectiveness of interventions that address each of the underlying issues.
Hume, K., Dykstra Steinbrenner, J., Sideris, J., Smith, L., Kucharczyk, S., & Szidon, K. (2018). Multi-informant assessment of transition-related skills and skill importance in adolescents with autism spectrum disorder. Autism, 22(1), 40-50. https://doi.org/10.1177/1362361317722029 Show abstract
Adolescents with autism spectrum disorder have limited participation in the transition planning process, despite the link between active participation and an improvement in postsecondary education and employment outcomes. The Secondary School Success Checklist was designed to support transition planning for adolescents with autism spectrum disorder by incorporating their own assessments of strengths, skill deficits, and prioritization for instruction along with those of their parents and teachers across multiple skill domains. Findings from more than 500 adolescents with autism spectrum disorder across the United States indicate discrepancies between adolescent, teacher, and parent ratings of skills highlighting the importance of the inclusion of multiple perspectives in transition planning. Although ratings varied, agreement between adolescents with autism spectrum disorder, parents, and teachers across the highest and lowest rated skills suggests the need to broaden the focus on critical transition skills to include problem-solving, planning for life after high school, and self-advocacy.
Wong, C., & Leland, N. E. (2018). Clinicians' perspectives of patient engagement in post-acute care: A social ecological approach. Physical & Occupational Therapy In Geriatrics, 36(1), 29-42. https://doi.org/10.1080/02703181.2017.1407859 Show abstract
Aims. To identify rehabilitation providers' perspectives on barriers and facilitators of patient engagement in hip fracture patients in skilled nursing facilities (SNFs) within the social ecological model.
Methods. We conducted 13 focus groups in SNFs throughout Los Angeles County comprised of rehabilitation staff (n = 99). Focus groups were audio-recorded and transcribed. A secondary analysis of themes related to patient engagement were identified and organized within the social ecological model.
Results. Clinicians identified barriers and facilitators of patient engagement across all levels of the social ecological model: public policy (e.g., insurance), organizational (e.g., facility culture), interpersonal (e.g., clinicians fostering self-reflection), and intrapersonal (e.g., patients' anxiety).
Conclusions. Examining barriers and facilitators to patient engagement has highlighted areas which need to be sustained and improved. Thus, these findings will inform future efforts to enhance patient engagement in order can to optimize patient healthcare decisions.
Carandang, K., & Pyatak, E. A. (2018). Analyzing occupational challenges through the lens of body and biography. Journal of Occupational Science, 25(2), 161-173. https://doi.org/10.1080/14427591.2018.1446353 Show abstract
Introduction. Occupational scientists are tasked with the responsibility of examining the relationship between occupational engagement and health, yet as occupations are explored in situ, these concepts only become more complex. For example, lifestyle trade-offs occur when individuals make conscious decisions between two competing sets of actions: actions taken in promotion of physical health versus actions in agreement with an identity-driven biography. In this study, these dilemmas are viewed as parts of an ongoing occupational challenge to balance physical health with subjective well-being in everyday life.
Methods. Anselm Strauss’s concepts of body state and biographical moment are conceptualized as analytic tools to study dimensions within which occupation is performed. A descriptive, single-case analysis of a young adult diagnosed with diabetes is presented as an exemplar of how Strauss’s tools may be utilized.
Results. Four themes emerged within the presented narrative: (1) by the book versus reality, (2) testing the boundaries of diabetes, (3) diabetes burnout and the struggle for perfection, and (4) the inevitable merge between body and biography.
Conclusion. Sadie’s narrative exemplifies the multiple contexts in which agentic decisions to engage in specific occupations are made. Sadie’s experiences of diabetes burnout and actions taken while “on vacation” are not uncommon within chronic illness literature and warrant further analyses that consider physical and psychological domains of health. By dismantling situational factors using analytic tools, such as Strauss’s body state and biographical moment, occupational scientists may further understand lived experiences and clarify the link between occupation and health.
Bodison, S. C., & Parham, L. D. (2018). Specific sensory techniques and sensory environmental modifications for children and youth with sensory integration difficulties: A systematic review. American Journal of Occupational Therapy, 72(1), 7201190040p1-7201190040p11. https://doi.org/10.5014/ajot.2018.029413 Show abstract
This systematic review examined the effectiveness of specific sensory techniques and sensory environmental modifications to improve participation of children with sensory integration (SI) difficulties. Abstracts of 11,436 articles published between January 2007 and May 2015 were examined. Studies were included if designs reflected high levels of evidence, participants demonstrated SI difficulties, and outcome measures addressed function or participation. Eight studies met inclusion criteria. Seven studies evaluated effects of specific sensory techniques for children with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder: Qigong massage, weighted vests, slow swinging, and incorporation of multisensory activities into preschool routines. One study of sensory environmental modifications examined adaptations to a dental clinic for children with ASD. Strong evidence supported Qigong massage, moderate evidence supported sensory modifications to the dental care environment, and limited evidence supported weighted vests. The evidence is insufficient to draw conclusions regarding slow linear swinging and incorporation of multisensory activities into preschool settings.
Liew, S.-L., Anglin, J. M., Banks, N. W., Sondag, M., Ito, K. L., Kim, H., Chan, J., Ito, J., Jung, C., Khoshab, N., Lefebvre, S., Nakamura, W., Saldana, D., Schmiesing, A., Tran, C., Vo, D., Ard, T., Heydari, P., Kim, B., Aziz-Zadeh, L., Cramer, S. C., Liu, J., Soekadar, S., Nordvik, J.-E., Westlye, L. T., Wang, J., Winstein, C., Yu, C., Ai, L., Koo, B., Craddock, R. C., Milham, M., Lakich, M., Pienta, A., & Stroud, A. (2018). A large, open source dataset of stroke anatomical brain images and manual lesion segmentations. Scientific Data, 5, 180011. https://doi.org/10.1038/sdata.2018.11 Show abstract
Stroke is the leading cause of adult disability worldwide, with up to two-thirds of individuals experiencing long-term disabilities. Large-scale neuroimaging studies have shown promise in identifying robust biomarkers (e.g., measures of brain structure) of long-term stroke recovery following rehabilitation. However, analyzing large rehabilitation-related datasets is problematic due to barriers in accurate stroke lesion segmentation. Manually-traced lesions are currently the gold standard for lesion segmentation on T1-weighted MRIs, but are labor intensive and require anatomical expertise. While algorithms have been developed to automate this process, the results often lack accuracy. Newer algorithms that employ machine-learning techniques are promising, yet these require large training datasets to optimize performance. Here we present ATLAS (Anatomical Tracings of Lesions After Stroke), an open-source dataset of 304 T1-weighted MRIs with manually segmented lesions and metadata. This large, diverse dataset can be used to train and test lesion segmentation algorithms and provides a standardized dataset for comparing the performance of different segmentation methods. We hope ATLAS release 1.1 will be a useful resource to assess and improve the accuracy of current lesion segmentation methods.
Chistol, L. T., Bandini, L. G., Must, A., Phillips, S., Cermak, S. A., & Curtin, C. (2018). Sensory sensitivity and food selectivity in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(2), 583-591. https://doi.org/10.1007/s10803-017-3340-9 Show abstract
Few studies have compared atypical sensory characteristics and food selectivity between children with and without autism spectrum disorder (ASD). We compared oral sensory processing between children with (n = 53) and without ASD (n = 58), ages 3–11 years. We also examined the relationships between atypical oral sensory processing, food selectivity, and fruit/vegetable consumption in children with ASD. We found that more children with ASD presented with atypical sensory processing than children without ASD. Among children with ASD, those with atypical oral sensory sensitivity refused more foods and ate fewer vegetables than those with typical oral sensory sensitivity. The findings suggest that efforts to address food selectivity in children with ASD may be enhanced by including strategies that address oral sensory processing.
Pfeiffer, B., May-Benson, T. A., & Bodison, S. C. (2018). State of the science of sensory integration research with children and youth [Editorial]. American Journal of Occupational Therapy, 72(1), 7201170010p1-7201170010p4. https://doi.org/10.5014/ajot.2018.721003 Show abstract
Many children and youth with and without disabilities are affected by challenges in processing and integrating sensations. Occupational therapy practitioners serve a pivotal role in the evaluation and treatment of this population. This special section of the American Journal of Occupational Therapy includes articles that elucidate the relationship between sensory processing and participation in valued occupations as well as articles that guide best practice, including systematic reviews on common occupational therapy interventions for children and youth with challenges in processing and integrating sensation. This editorial elaborates on key issues for future research.
Floríndez, L. I., & Floríndez, D. C. (2018). Gangs in Los Angeles: Limited occupational possibilities for Latino male adolescents. Journal of Occupational Science, 25(2), 191-199. https://doi.org/10.1080/14427591.2018.1445009 Show abstract
An occupational perspective is relevant in examining how the unique context of a person’s life and environment can impact the types of occupations in which he or she participates, and the dilemmas that can occur when restrictive surroundings or perceived lack of lifestyle options constrain occupational choices. This paper examines how participation in gangs by Latino adolescent males may be due to the limited options for other occupations that low socioeconomic status (SES) neighborhoods afford. By presenting narrative from the memoir of a former gang member, alongside county public health records, the engaging and health-promoting occupations as well as health-threatening occupations of gang life are explored. This scholarly discussion contributes to occupational science by evaluating the relationship between context and occupational possibilities for Latino male adolescents living in constrained environments.
Baranek, G. T., Woynaroski, T. G., Nowell, S., Turner-Brown, L., DuBay, M., Crais, E. R., & Watson, L. R. (2018). Cascading effects of attention disengagement and sensory seeking on social symptoms in a community sample of infants at-risk for a future diagnosis of autism spectrum disorder. Developmental Cognitive Neuroscience, 29, 30-40. https://doi.org/10.1016/j.dcn.2017.08.006 Show abstract
Recent work suggests sensory seeking predicts later social symptomatology through reduced social orienting in infants who are at high-risk for autism spectrum disorder (ASD) based on their status as younger siblings of children diagnosed with ASD. We drew on extant longitudinal data from a community sample of at-risk infants who were identified at 12 months using the First Year Inventory, and followed to 3–5 years. We replicate findings of Damiano et al. (in this issue) that a) high-risk infants who go on to be diagnosed with ASD show heightened sensory seeking in the second year of life relative to those who do not receive a diagnosis, and b) increased sensory seeking indirectly relates to later social symptomatology via reduced social orienting. We extend previous findings to show that sensory seeking has more clinical utility later in the second year of life (20–24 months) than earlier (13–15 months). Further, this study suggests that diminished attention disengagement at 12–15 months may precede and predict increased sensory seeking at 20–24 months. Findings add support for the notion that sensory features produce cascading effects on social development in infants at risk for ASD, and suggest that reduced attention disengagement early in life may set off this cascade.
Carandang, K. M., & Pyatak, E. A. (2018). Feasibility of a manualized occupation-based diabetes management intervention. American Journal of Occupational Therapy, 72(2), 7202345040p1–7202345040p6. https://doi.org/10.5014/ajot.2018.021790 Show abstract
Objective. We investigated the feasibility and acceptability of an occupational therapy intervention targeting diabetes management for underserved young adults.
Method. Eight participants completed the intervention and a battery of assessments at baseline and after the intervention. At completion, the participants and occupational therapist were interviewed about their experiences with the study. Four categories of assessment questions were used to guide the study: process, resource, management, and scientific.
Results. Successes included recruitment; fulfillment of tasks by staff and partnering clinics; adequate space, financial support, and equipment; and meaningfulness of the intervention for participants. Challenges included scheduling participants for the intervention and follow-up focus groups and providing client centeredness and flexibility while reducing burden on the intervener.
Conclusion. This feasibility study allowed us to make necessary revisions to our study protocol before implementing a larger pilot study.
Phipps, S. (2017). Evaluation and intervention for perceptual dysfunction. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti's occupational therapy: Practice skills for physical dysfunction (8th ed., pp. 631-644). St. Louis, MO: Elsevier.
Phipps, S., & Roberts, P. (2017). Motor learning. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti's occupational therapy: Practice skills for physical dysfunction (8th ed., pp. 798-808). St. Louis, MO: Elsevier.
Laliberte Rudman, D., & Aldrich, R. M. (2017). Occupational science. In M. Curtin, M. Egan, & J. Adams (Eds.), Occupational therapy for people experiencing illness, injury or impairment (7th ed., pp. 17-27). Oxford, UK: Elsevier.
Bodison, S. C. (2017). Neuroimaging. In A. Wenzel (Ed.), The SAGE encyclopedia of abnormal and clinical psychology (pp. 259-265). Thousand Oaks, CA: Sage.
Bodison, S. C. (2017). Magnetic resonance imaging. In A. Wenzel (Ed.), The SAGE encyclopedia of abnormal and clinical psychology (p. 1993). Thousand Oaks, CA: Sage.
Wu, A. H., Vigen, C. L., Butler, L. M., & Tseng, C.-C. (2017). Metabolic conditions and breast cancer risk among Los Angeles County Filipina Americans compared with Chinese and Japanese Americans. International Journal of Cancer, 141(12), 2450-2461. https://doi.org/10.1002/ijc.31018 Show abstract
Accumulating evidence suggests that the aggregation of common metabolic conditions (high blood pressure, diabetes and dyslipidemia) is a risk factor for breast cancer. Breast cancer incidence has risen steadily in Asian American women, and whether these metabolic conditions contribute to breast cancer risk in certain Asian American subgroups is unknown. We investigated the role of physician-diagnosed hypertension, high cholesterol and diabetes separately, and in combination, in relation to the risk of breast cancer in a population-based case–control study of 2,167 Asian Americans diagnosed with breast cancer and 2,035 age and ethnicity matched control women in Los Angeles County. Compared to Asian American women who did not have any of the metabolic conditions, those with 1, 2 or 3 conditions showed a steady increase in risk (respective odds ratios were 1.12, 1.42 and 1.62; P trend = 0.001) with adjustment for covariates including body mass index. Similar significant trends were observed in Filipina Americans (P trend = 0.021), postmenopausal women (P trend =0.001), Asian women who were born in the United States (US) (P trend = 0.052) and migrants who have lived in the US for at least 20 years (P trend = 0.004), but not migrants who lived in the US for <20 years (P trend = 0.64). These results suggest that westernization in lifestyle (diet and physical inactivity) and corresponding increase in adiposity have contributed to the rising prevalence of these metabolic conditions, which in turn, are associated with an increase in breast cancer.
Watson, L. R., Crais, E. R., Baranek, G. T., Turner-Brown, L., Sideris, J., Wakeford, L., Kinard, J., Reznick, J. S., Martin, K. L., & Nowell, S. W. (2017). Parent-mediated intervention for one-year-olds screened as at-risk for autism spectrum disorder: A randomized controlled trial. Journal of Autism and Developmental Disorders, 47(11), 3520-3540. https://doi.org/10.1007/s10803-017-3268-0 Show abstract
Theoretically, interventions initiated with at-risk infants prior to the point in time a definitive autism spectrum disorder (ASD) diagnosis can be made will improve outcomes. Pursuing this idea, we tested the efficacy of a parent-mediated early intervention called Adapted Responsive Teaching (ART) via a randomized controlled trial with 87 one-year-olds identified by community screening with the First Year Inventory as at-risk of later ASD diagnoses. We found minimal evidence for main effects of ART on child outcomes. However, ART group parents showed significantly greater increases in responsiveness to their infants than control group parents. Further, significant indirect (mediation) effects of assignment group on multiple child outcomes through changes in parent responsiveness supported our theory of change.
Laliberte Rudman, D., & Aldrich, R. M. (2017). Discerning the social in individual stories of occupation through critical narrative inquiry. Journal of Occupational Science, 24(4), 470-481. https://doi.org/10.1080/14427591.2017.1369144 Show abstract
Calls to ‘transcend the individual’ in occupational science have emerged in recognition of the boundaries of individualistic perspectives and the drive to develop a socially responsive science. In this article, we contend that transcending the individual does not equate to neglecting how individuals make sense of and experience occupation; rather, it requires looking at individual constructions of experiences and occupations in critically informed ways that highlight the socio-political influences on those constructions. This discussion article considers how critical narrative inquiry can be taken up as a methodological approach to interpretively link individual ‘stories’ with social ‘stories’ or discourses, enabling further understanding of occupation as a situated and transactional phenomenon. Drawing on data from a study that is attending to transactions of policy, service, and individual perspectives of long-term unemployment, we illustrate how a critical approach to narrative interpretation highlights boundaries, resistance, contradictions, and tensions that provide insights into the situated nature of occupation.
Sahai-Srivastava, S., Sigman, E., Uyeshiro Simon, A., Cleary, L., & Ginoza, L. (2017). Multidisciplinary team treatment approaches to chronic daily headaches. Headache, 57(9), 1482-1491. https://doi.org/10.1111/head.13118 Show abstract
Objective. In this review, we focus on nonmedication treatment approaches to chronic daily headaches and chronic migraine. We review the current scientific data on studies using multimodal treatments, especially physical therapy and occupational therapy, and provide recommendations on the formation of interdisciplinary headache teams.
Background. Chronic daily headache, which includes chronic migraine, is a particularly challenging clinical entity which often involves multiple headache types and comorbidities. A team approach in treating these patients may be particularly useful.
Design/Methods. We review all current studies performed with at least one or more other modality in addition to usual medical treatment, with a focus on physical and occupational therapy. Emphasis on physical and occupational therapy with an explanation of their methods and role in multidisciplinary treatment is a pivotal part of this review. We also suggest approaches to setting up a multimodality clinic for the busy headache clinician.
Conclusion. Setting up a collaborative, multidisciplinary team of specialists in headache practices with the goal of modifying physical, environmental, and psychological triggers for chronic daily headaches may facilitate treatment of these refractory patients.
Aldrich, R. M., & Cutchin, M. P. (2017). Filling in the gaps: A case for enhancing Madsen and Josephsson’s assertions about occupation, situation, and inquiry. Journal of Occupational Science, 24(4), 425-429. https://doi.org/10.1080/14427591.2017.1336736 Show abstract
Madsen and Josephsson’s rich account of ideas from John Dewey’s philosophical writings urges occupational scientists to understand occupation as “something that goes on ... because of a situation, not only by or because of the individual” (p. 12). Although many aspects of their article helpfully re-emphasize important points about pragmatism, occupation, and transformation, their article also suggests issues noted by other Deweyan scholars and omits arguments previously put forth by those working with a Deweyan interpretation of occupation. In this commentary, we offer suggestions for acknowledging and more fully incorporating existing contributions on the topics of occupation, situation, and inquiry. We also highlight potential connections and developments that Madsen and Josephsson’s work may foster in future occupational science scholarship.
Dhyani, M., Roll, S. C., Gilbertson, M. W., Orlowski, M., Anvari, A., Li, Q., Anthony, B., & Samir, A. E. (2017). A pilot study to precisely quantify forces applied by sonographers while scanning: A step toward reducing ergonomic injury. Work, 58(2), 241-247. https://doi.org/10.3233/WOR-172611 Show abstract
There is a significantly high rate of work-related musculsokeletal injuries in sonography professionals. To date, assessment of risk factors for work- related injuries in sonographers has been based primarily on surveys, subjective reports, and observational methods. There is a need to develop quantitative techniques to better understand risk factors and develop preventive interventions.
Objective. We pilot tested a high-resolution force-measuring probe capable of precisely measuring forces applied through the transducer by sonographers and used this novel direct measurement technique to evaluate forces during abdominal imaging.
Methods. Twelve sonographers with varied experience, ranging from 1-33 years, performed routine abdominal scans on 10 healthy volunteers who had varied body mass indices (BMI). Imaging was conducted using the force-measuring probe, which provided real-time measurement of forces, and angles. Data were compared by sonographer years of experience and subject BMI.
Results. In total, 47 abdominal examinations were performed as part of this study, and all images met standards for clinical diagnostic quality. The mean contact force applied across all exams was 8.2±4.3 Newtons (N) (range: 1.2-36.5 N). For subjects in the high BMI group (BMI>25, n = 4) the mean force was 10.5 N (range: 8.9-13.2 N) compared to 7.9 N (range: 5.9-10.9 N) for subjects with normal BMI (BMI = 18.5-25, n = 6). Similarly, the mean maximum force applied for subjects with high BMI (25.3 N) was significantly higher than force applied for subjects with normal BMI (17.4 N). No significant difference was noted in the amount of force applied by sonographers with more than 5 years of experience (n = 6) at 8.2 N (Range: 5.1-10.0 N) compared to less experienced sonographers (n = 6), whose forces averaged 8.1 N (Range: 5.8-10.0 N).
Conclusions. It is feasible to directly measure forces applied by sonographers using a high-resolution force measurement system. Forces applied during abdominal imaging vary widely, are significantly higher when scanning subjects with high BMI, and are not related to sonographer years of experience. This force measurement system has the potential to provide an additional quantitative data point to explore the impact of applied forces on sonographer related musculoskeletal injury, particularly in conjunction with various body positions, exam types and force durations.
Dhyani, M., Roll, S. C., Gilbertson, M. W., Orlowski, M., Anvari, A., Li, Q., Anthony, B., & Samir, A. E. (2017). Direct and precise quantification of forces applied by sonographers during abdominal imaging. Work, 52(2), 241-247. https://doi.org/10.3233/WOR-172611 Show abstract
Background. There is a significantly high rate of work-related musculsokeletal injuries in sonography professionals. To date, assessment of risk factors for work-related injuries in sonographers has been based primarily on surveys, subjective reports, and observational methods. There is a need to develop quantitative techniques to better understand risk factors and develop preventive interventions.
Objective. We pilot tested a high-resolution force-measuring probe capable of precisely measuring forces applied through the transducer by sonographers and used this novel direct measurement technique to evaluate forces during abdominal imaging.
Methods. Twelve sonographers with varied experience, ranging from 1-33 years, performed routine abdominal scans on 10 healthy volunteers who had varied body mass indices (BMI). Imaging was conducted using the force-measuring probe, which provided real-time measurement of forces, and angles. Data were compared by sonographer years of experience and subject BMI.
Results. In total, 47 abdominal examinations were performed as part of this study, and all images met standards for clinical diagnostic quality. The mean contact force applied across all exams was 8.2±4.3 Newtons (N) (range: 1.2-36.5N). For subjects in the high BMI group (BMI>25, n=4) the mean force was 10.5N (range: 8.9-13.2N) compared to 7.9N (range: 5.9-10.9N) for subjects with normal BMI (BMI=18.5-25, n=6). Similarly, the mean maximum force applied for subjects with high BMI (25.3N) was significantly higher than force applied for subjects with normal BMI (17.4N). No significant difference was noted in the amount of force applied by sonographers with more than 5 years of experience (n=6) at 8.2N (Range: 5.1-10.0N) compared to less experienced sonographers (n=6), whose forces averaged 8.1N (Range: 5.8-10.0N).
Conclusions. It is feasible to directly measure forces applied by sonographers using a high-resolution force measurement system. Forces applied during abdominal imaging vary widely, are significantly higher when scanning subjects with high BMI, and are not related to sonographer years of experience. This force measurement system has the potential to provide an additional quantitative data point to explore the impact of applied forces on sonographer related musculoskeletal injury, particularly in conjunction with various body positions, exam types and force durations.
Espinoza, J., Chen, A., Orozco, J., Deavenport-Saman, A., & Yin, L. (2017). Effect of personal activity trackers on weight loss in families enrolled in a comprehensive behavioral family-lifestyle intervention program in the federally qualified health center setting: A randomized controlled trial. Contemporary Clinical Trials Communications, 7, 86-94. https://doi.org/10.1016/j.conctc.2017.06.004 Show abstract
Background. Childhood obesity continues to be a substantial problem despite major public health efforts, and disproportionately impacts children from low-income families. Digital health tools and consumer technology offer promising opportunities for interventions, but few studies have evaluated how they might be incorporated into existing interventions or used to create new types of interventions. It remains unclear which approaches would be most beneficial for underserved pediatric populations.
Purpose. To describe the design and rationale of a single-center randomized, controlled trial evaluating the effects of personal activity tracker (PAT) use by parents on weight-status improvement in both parents and overweight children enrolled in BodyWorks (BW), a comprehensive behavioral family-lifestyle intervention program (CBFLI), in a primary-care clinic serving a predominantly low-income Latino population.
Methods. This study is being conducted in the AltaMed general pediatrics clinic at Children's Hospital Los Angeles. Eligible participants are families (child and adult caregiver) in which the child is between 7 and 18 years of age, has a BMI ≥85th percentile for age and sex, and has been referred to BW by their AltaMed pediatrician. BW consists of one weekly, two-hour session for 7 weeks. In a given cycle, the program is offered on two separate nights: Monday (Spanish) and Wednesday (English). Families self sort into one of two groups based on language preference. To ensure balanced allocation of language preference groups and prevent in-group cross contamination, block randomization is used to assign whole groups to either the intervention or control arms of the study. The control arm consists of usual care, while the intervention arm adds assigning a Fitbit PAT to the parents and training them in its proper use. Study personnel are blinded to group assignment during the analysis phase. Study outcomes include attendance rate, program completion rate, and changes in weight-status improvement, defined as change in weight and BMI for adults and change in BMI z-score for children. We hypothesize that the intervention arm will have better weight-related outcomes than the control arm. Study completion is anticipated in 2017, after the enrollment of approximately 150 families.
Conclusions. The study aim is to evaluate the effects of PATs on weight-related outcomes in overweight children and parents participating in a CBFLI. The results will be important for determining whether wearable devices are an effective addition to weight loss interventions for overweight and obese children.
Liao, Y., Solomon, O., & Dunton, G. F. (2017). Does the company of a dog influence affective response to exercise? Using ecological momentary assessment to study dog-accompanied physical activity. American Journal of Health Promotion, 31(5), 388-390. https://doi.org/10.1177/0890117116666947 Show abstract
Purpose. This study used ecological momentary assessment (EMA), a real-time self-report strategy, to examine (1) whether dog owners were more likely to be physically active when they were with their dogs and (2) whether being with a dog amplifies positive and dampens negative affective response during physical activity.
Design. Electronic EMA surveys for 12 days.
Participants. Seventy-one adult dog owners.
Measures. The EMA survey included 1 question about current activity, 3 questions about positive affect (Cronbach α = .837), 4 questions about negative affect (Cronbach α = .865), and 1 question about the presence of dog.
Analysis. Multilevel modeling.
Results. The company of a dog did not increase the likelihood of being active versus sedentary at any given EMA prompt. However, greater positive affect during physical activity was reported in the company of a dog. Negative affect did not differ between active and sedentary activity, regardless of being with a dog or not.
Conclusion. This study demonstrates the utility of electronic EMA as a promising methodology to study dog-accompanied physical activity. Future studies may use EMA to collect further contextual information about dog-accompanied activity to inform the development of innovative physical activity interventions.
Stein Duker, L. I., Henwood, B. F., Bluthenthal, R. N., Juhlin, E., Polido, J. C., & Cermak, S. A. (2017). Parents’ perceptions of dental care challenges in male children with autism spectrum disorder: An initial qualitative exploration. Research in Autism Spectrum Disorders, 39, 63-72. https://doi.org/10.1016/j.rasd.2017.03.002 Show abstract
Background. Many children with autism spectrum disorders (ASD) experience barriers to oral care in the dental office setting. The purpose of this study was to provide an increased understanding of these challenges experienced during oral care in the dental office by children with ASD.
Method. This study was part of a larger mixed methods design and builds on quantitative results from a survey of parents of children with ASD ages 2–18 in which parents reported difficulties with access to care, sensory processing, and uncooperative behaviors. For this study, we conducted two, three hour, focus groups of parents of male children with ASD age 5–18 years in order to explore the survey results in greater depth. Focus group transcripts were analyzed using a template coding approach based on the three domains of office-based oral care challenges identified in the first phase (survey).
Results. Several related themes emerged including: (1) Access: “Difficult to find the right dentist”, (2) Sensory sensitivities: “All the sensory devices just make him so uncomfortable”, (3) Restraint: “It looked like they were torturing him”, and (4) Drugs: “A mixed bag”.
Conclusions. The qualitative findings from this study both confirmed our previous survey findings and expanded upon them. These findings can help professionals better understand the challenges experienced by children with ASD and their parents as well as help identify priorities for planning efforts to address the oral health-related needs of this population.
Angell, A. M., & Solomon, O. (2017). ‘If I was a different ethnicity, would she treat me the same?’: Latino parents’ experiences obtaining autism services. Disability & Society, 32(8), 1142-1164. https://doi.org/10.1080/09687599.2017.1339589 Show abstract
This article reports on an ethnographic study with 12 Latino families of children on the autism spectrum related to obtaining autism services in Los Angeles County. Using critical discourse analysis of interviews, observations, and records, we consider the experiences of the Latino families in relation to: a discursively constructed ‘autism parent’ subject position that mandates ‘fighting’ service systems to ‘win’ autism services for children, originating from White middle-class parents’ socioeconomic resources and social capital; a neoliberal social services climate that assumes scarcity of available resources and prioritizes austerity in their authorization; and a media and institutional ‘cultural deficit’ discourse that attributes disparities in autism services for Latino children to their parents’ presumed culturally-based ‘passivity.’ We argue that parental discourse about fighting, or not fighting, for autism services is engendered by a tension between a parental logic of care, and the logic of competition of the economic market.
Wilson, K. P., Carter, M. W., Wiener, H. L., DeRamus, M. L., Bulluck, J. C., Watson, L. R., Crais, E. R., & Baranek, G. T. (2017). Object play in infants with autism spectrum disorder: A longitudinal retrospective video analysis. Autism & Developmental Language Impairments, 2, 1-12. https://doi.org/10.1177/2396941517713186 Show abstract
Background and aims. Early play behaviors may provide important information regarding later-diagnosed developmental delays. Play behaviors of young children with autism spectrum disorder are restricted in diversity, frequency, and complexity. Most autism spectrum disorder research focuses on play in children over 18 months of age. This study examined three groups of infants (later diagnosed with autism spectrum disorder, later diagnosed with other developmental disorders, and typically developing) with the aims of: (1) describing the play behaviors of the three groups of infants at two time points (9–12 months and 15–18 months); (2) examining group differences in four hierarchical levels of play at both time points; (3) comparing groups with respect to the highest level of play achieved; and (4) determining if the highest level of play achieved by infants with autism spectrum disorder and other developmental delays correlated with later developmental outcomes.
Methods. The current study used longitudinal retrospective video analysis to examine object play behaviors of the three groups of infants (total n = 92) at two time points (time 1: 9–12 months of age, and time 2: 15–18 months of age). Coding of play behaviors was based on existing literature and distribution of data from the current study. Developmental outcomes examined were measured using the Vineland Adaptive Behavior Scales, Childhood Autism Rating Scale, and a non-verbal developmental quotient calculated using visual reception scores from the Mullen Scales for Early Learning.
Results. Results indicate group differences in play, with infants later diagnosed with autism spectrum disorder showing significantly less sophisticated play than those with typical development. In addition, modest but significant correlations were found between highest level of play achieved at time 1 (9–12 months) and time 2 (15–18 months) and later outcomes for the autism spectrum disorder group.
Conclusions and implications. Results suggest that examination of infant play behaviors is important for early screening and intervention planning to potentially mitigate effects on later developmental outcomes.
Uljarević, M., Baranek, G. T., Vivanti, G., Hedley, D., Hudry, K., & Lane, A. (2017). Heterogeneity of sensory features in autism spectrum disorder: Challenges and perspectives for future research. Autism Research, 10(5), 703-710. https://doi.org/10.1002/aur.1747 Show abstract
Pronounced heterogeneity is apparent across every facet of autism spectrum disorder (ASD) and it remains difficult to predict likely future potential among individuals who share a common diagnosis of ASD on the basis of early presentation. In this commentary we argue that a fine-grained understanding of individual differences in sensory features and their influence across the life span can constrain noted clinical heterogeneity in ASD. We organize our discussion around the following three critical themes: (a) considering sensory features as dimensional construct; (b) taking an "individual differences" approach; and (c) adopting a comprehensive, multidimensional and multimodal approach to measurement of sensory features. We conclude that future research will need to investigate individual differences in sensory features via: (1) multidimensional and cross-disciplinary examination, (2) prospective longitudinal designs, and (3) dimensional and developmental frameworks that emphasize the potential value of early individual variability as indicators of later outcomes, not only in relation to the categorical diagnostic outcome status but also the presence of other clinical features. This is a key time for sensory-related research and in this commentary we provide some of the steps that, in our opinion, can shape future research in this area.
Uyeshiro Simon, A., & Collins, C. E. (2017). Lifestyle Redesign® for chronic pain management: A retrospective clinical efficacy study. American Journal of Occupational Therapy, 71(4), 7104190040p1-7104190040p7. https://doi.org/10.5014/ajot.2017.025502 Show abstract
Objective. Our objective was to determine the efficacy of a Lifestyle Redesign® intervention for people living with chronic pain on quality of life (QOL), function, self-efficacy, and pain levels.
Method. Clinical outcomes were collected from 45 patients who completed an individual outpatient Lifestyle Redesign occupational therapy program for chronic pain as part of their usual plan of medical care. Outcome measures included the Canadian Occupational Performance Measure, the 36-Item Short-Form Survey, the Brief Pain Inventory, and the Pain Self-Efficacy Questionnaire. We analyzed scores using paired-samples t tests.
Results. Significant changes were observed in occupational performance and satisfaction scores, physical and social functioning, role limitations due to physical and emotional problems, energy and fatigue, general health, and pain self-efficacy.
Conclusion. Lifestyle Redesign interventions, when integrated into a patient's medical plan of care, can improve patient functioning, self-efficacy, and QOL.
Sprugnoli, G., Rossi, S., Emmendorfer, A., Rossi, A., Liew, S.-L., Tatti, E., di Lorenzo, G., Pascual-Leone, A., & Santarnecchi, E. (2017). Neural correlates of Eureka moment. Intelligence, 62, 99-118. https://doi.org/10.1016/j.intell.2017.03.004 Show abstract
Insight processes that peak in “unpredictable moments of exceptional thinking” are often referred to as Aha! or Eureka moments. During insight, connections between previously unrelated concepts are made and new patterns arise at the perceptual level while new solutions to apparently insolvable problems suddenly emerge to consciousness. Given its unpredictable nature, the definition, and behavioral and neurophysiological measurement of insight problem solving represent a major challenge in contemporary cognitive neuroscience. Numerous attempts have been made, yet results show limited consistency across experimental approaches. Here we provide a comprehensive overview of available neuroscience of insight, including: i) a discussion about the theoretical definition of insight and an overview of the most widely accepted theoretical models, including those debating its relationship with creativity and intelligence; ii) an overview of available tasks used to investigate insight; iii) an ad-hoc quantitative meta-analysis of functional magnetic resonance imaging studies investigating the Eureka moment, using activation likelihood estimation maps; iv) a review of electroencephalographic evidence in the time and frequency domains, as well as v) an overview of the application of non-invasive brain stimulation techniques to causally assess the neurobiological basis of insight as well as enhance insight-related cognition.
Insight; Eureka; Aha; Cognition; fMRI; EEG; ERPs; Non-invasive brain stimulation; Neuroenhancement; NIBS; Creativity
Belardi, K., Watson, L. R., Faldowski, R. A., Hazlett, H., Crais, E., Baranek, G. T., McComish, C., Patten, E., & Oller, D. K. (2017). A retrospective video analysis of canonical babbling and volubility in infants with Fragile X syndrome at 9–12 months of age. Journal of Autism and Developmental Disorders, 47(4), 1193-1206. https://doi.org/10.1007/s10803-017-3033-4 Show abstract
An infant’s vocal capacity develops significantly during the first year of life. Research suggests early measures of pre-speech development, such as canonical babbling and volubility, can differentiate typical versus disordered development. This study offers a new contribution by comparing early vocal development in 10 infants with Fragile X syndrome and 14 with typical development. Results suggest infants with Fragile X syndrome produce fewer syllables and have significantly lower canonical babbling ratios compared to infants who are typically developing. Furthermore, the particular measures of babbling were strong predictors of group membership, adding evidence regarding the possible utility of these markers in early identification.
Fogelberg, D. J., Leland, N. E., Blanchard, J., Rich, T. J., & Clark, F. A. (2017). Qualitative experience of sleep in individuals with spinal cord injury. OTJR: Occupation, Participation and Health, 37(2), 89-97. https://doi.org/10.1177/1539449217691978 Show abstract
Poor sleep contributes to adverse health outcomes making it important to understand sleep in medically vulnerable populations, including those with spinal cord injury (SCI). However, little attention has been paid to circumstances specific to SCI that may negatively affect sleep, or to consequences of poor sleep in this population. The objective of this study was to examine the experience of sleep among individuals with SCI. Secondary analysis using thematic coding of qualitative data from an ethnographic study of community-dwelling adults with SCI was conducted. Sleep-related data were found in transcripts for 90% of the sample. Participants described diminished sleep duration and irregular sleep patterns. Several factors contributing to poor sleep were identified, including SCI-related circumstances and sleep environment. Participants also discussed how poor sleep affected occupational engagement. This study highlights the extent of sleep disturbance experienced after SCI and the subsequent impact on occupational performance, and provides direction for clinical practice.
Anglin, J. M., Sugiyama, T., & Liew, S.-L. (2017). Visuomotor adaptation in head-mounted virtual reality versus conventional training. Scientific Reports, 7, 45469. https://doi.org/10.1038/srep45469 Show abstract
Immersive, head-mounted virtual reality (HMD-VR) provides a unique opportunity to understand how changes in sensory environments affect motor learning. However, potential differences in mechanisms of motor learning and adaptation in HMD-VR versus a conventional training (CT) environment have not been extensively explored. Here, we investigated whether adaptation on a visuomotor rotation task in HMD-VR yields similar adaptation effects in CT and whether these effects are achieved through similar mechanisms. Specifically, recent work has shown that visuomotor adaptation may occur via both an implicit, error-based internal model and a more cognitive, explicit strategic component. We sought to measure both overall adaptation and balance between implicit and explicit mechanisms in HMD-VR versus CT. Twenty-four healthy individuals were placed in either HMD-VR or CT and trained on an identical visuomotor adaptation task that measured both implicit and explicit components. Our results showed that the overall timecourse of adaption was similar in both HMD-VR and CT. However, HMD-VR participants utilized a greater cognitive strategy than CT, while CT participants engaged in greater implicit learning. These results suggest that while both conditions produce similar results in overall adaptation, the mechanisms by which visuomotor adaption occurs in HMD-VR appear to be more reliant on cognitive strategies.
Losh, M., Martin, G. E., Lee, M., Klusek, J., Sideris, J., Barron, S., & Wassink, T. (2017). Developmental markers of genetic liability to autism in parents: A longitudinal, multigenerational study. Journal of Autism and Developmental Disorders, 47(3), 834-845. https://doi.org/10.1007/s10803-016-2996-x Show abstract
Genetic liability to autism spectrum disorder (ASD) can be expressed in unaffected relatives through subclinical, genetically meaningful traits, or endophenotypes. This study aimed to identify developmental endophenotypes in parents of individuals with ASD by examining parents' childhood academic development over the school-age period. A cohort of 139 parents of individuals with ASD were studied, along with their children with ASD and 28 controls. Parents' childhood records in the domains of language, reading, and math were studied from grades K-12. Results indicated that relatively lower performance and slower development of skills (particularly language related skills), and an uneven rate of development across domains predicted ASD endophenotypes in adulthood for parents, and the severity of clinical symptoms in children with ASD. These findings may mark childhood indicators of genetic liability to ASD in parents, that could inform understanding of the subclinical expression of ASD genetic liability.
Aldrich, R. M., Laliberte Rudman, D., & Dickie, V. A. (2017). Resource seeking as occupation: A critical and empirical exploration. American Journal of Occupational Therapy, 71(3), 7103260010p1-7103260010p9. https://doi.org/10.5014/ajot.2017.021782 Show abstract
Occupational therapists and occupational scientists are committed to generating and using knowledge about occupation, but Western middle-class social norms regarding particular ways of doing have limited explorations of survival occupations. This article provides empirical evidence of the ways in which resource seeking constitutes an occupational response to situations of uncertain survival. Resource seeking includes a range of activities outside formal employment that aim to meet basic needs. On the basis of findings from 2 ethnographic studies, we critique the presumption of survival in guiding occupational therapy documents and the accompanying failure to recognize occupations that seem at odds with self-sufficiency. We argue that failing to name resource seeking in occupational therapy documents risks alignment with social, political, and economic trends that foster occupational injustices. If occupational therapists truly aim to meet society’s occupational needs, they must ensure that professional documents and discourses reflect the experiences of all people in society.
Roll, S. C. (2017). Embracing the expanding horizons of diagnostic medical sonography: Clinical innovation, interdisciplinary growth, and scientific discovery. Journal of Diagnostic Medical Sonography, 33(2), 81-82. https://doi.org/10.1177/8756479317698665
Zhang, W., Mason, A. E., Boyd, B., Sikich, L., & Baranek, G. T. (2017). A rural-urban comparison in emergency department visits for U.S. children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(3), 590-598. https://doi.org/10.1007/s10803-016-2982-3 Show abstract
We examined rural-urban differences in emergency department visits, and child and clinical characteristics associated with visits for U.S. children aged 3-17 years with autism spectrum disorder (ASD). Rural children with ASD were twice more likely to have emergency department visits in urban hospitals than rural children without ASD. The children with ASD in rural areas were economically disadvantaged and concentrated in the South and Midwest regions. Rural children diagnosed with ASD and multiple comorbidities during emergency department visits were 1.6 times as that of urban children. Rural children with ASD, particularly those with multiple comorbidities, require more emergency department services when compared with urban children with ASD.
Kirby, A. V., Boyd, B. A., Williams, K. L., Faldowski, R. A., & Baranek, G. T. (2017). Sensory and repetitive behaviors among children with autism spectrum disorder at home. Autism, 21(2), 142-154. https://doi.org/10.1177/1362361316632710 Show abstract
Atypical sensory and repetitive behaviors are defining features of autism spectrum disorder and are thought to be influenced by environmental factors; however, there is a lack of naturalistic research exploring contexts surrounding these behaviors. This study involved video recording observations of 32 children with autism spectrum disorder (2-12 years of age) engaging in sensory and repetitive behaviors during home activities. Behavioral coding was used to determine what activity contexts, sensory modalities, and stimulus characteristics were associated with specific behavior types: hyperresponsive, hyporesponsive, sensory seeking, and repetitive/stereotypic. Results indicated that hyperresponsive behaviors were most associated with activities of daily living and family-initiated stimuli, whereas sensory seeking behaviors were associated with free play activities and child-initiated stimuli. Behaviors associated with multiple sensory modalities simultaneously were common, emphasizing the multi-sensory nature of children's behaviors in natural contexts. Implications for future research more explicitly considering context are discussed.
Lefebvre, S., & Liew, S.-L. (2017). Anatomical parameters of tDCS to modulate the motor system after stroke: A review. Frontiers in Neurology, 8, 29. https://doi.org/10.3389/fneur.2017.00029 Show abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method to modulate the local field potential in neural tissue and consequently, cortical excitability. As tDCS is relatively portable, affordable, and accessible, the applications of tDCS to probe brain-behavior connections have rapidly increased in the last 10 years. One of the most promising applications is the use of tDCS to modulate excitability in the motor cortex after stroke and promote motor recovery. However, the results of clinical studies implementing tDCS to modulate motor excitability have been highly variable, with some studies demonstrating that as many as 50% or more of patients fail to show a response to stimulation. Much effort has therefore been dedicated to understand the sources of variability affecting tDCS efficacy. Possible suspects include the placement of the electrodes, task parameters during stimulation, dosing (current amplitude, duration of stimulation, frequency of stimulation), individual states (e.g., anxiety, motivation, attention), and more. In this review, we first briefly review potential sources of variability specific to stroke motor recovery following tDCS. We then examine how the anatomical variability in tDCS placement [e.g., neural target(s) and montages employed] may alter the neuromodulatory effects that tDCS exerts on the post-stroke motor system.
Pyatak, E. A., Sequeira, P. A., Vigen, C. L., Weigensberg, M. J., Wood, J. R., Montoya, L., Ruelas, V., & Peters, A. L. (2017). Clinical and psychosocial outcomes of a structured transition program among young adults with type 1 diabetes. Journal of Adolescent Health, 60(2), 212-218. https://doi.org/10.1016/j.jadohealth.2016.09.004 Show abstract
Purpose. We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care.
Methods. Individuals in their last year of pediatric care (CC group, n = 51) and individuals lost to follow-up in the transfer to adult care ("lapsed care" [LC] group, n = 24) were followed prospectively for 12 months. All participants were provided developmentally tailored diabetes education, case management, and clinical care through a structured transition program.
Results. At baseline, LC participants reported lapses in care of 11.6 months. Compared with CC participants, they had higher hemoglobin A1C (A1C; p = .005), depressive symptoms (p = .05), incidence of severe hypoglycemia (p = .005), and emergency department visits (p = .004). At 12-month follow-up, CC and LC participants did not differ on the number of diabetes care visits (p = .23), severe hypoglycemia (no events), or emergency department visits (p = .22). Both groups' A1C improved during the study period (CC: p = .03; LC: p = .02). LC participants' depressive symptoms remained elevated (p = .10), and they reported a decline in life satisfaction (p = .007). There was greater loss to follow-up in the LC group (p = .04).
Conclusions. Our study suggests that, for young adults with a history of lapses in care, a structured transition program is effective in lowering A1C, reducing severe hypoglycemia and emergency department utilization, and improving uptake of routine diabetes care. Loss to follow-up and psychosocial concerns remain significant challenges in this population.
Sainburg, R. L., Liew, S.-L., Frey, S. H., & Clark, F. (2017). Promoting translational research among movement science, occupational science, and occupational therapy. Journal of Motor Behavior, 49(1), 1-7. https://doi.org/10.1080/00222895.2016.1271299 Show abstract
Integration of research in the fields of neural control of movement and biomechanics (collectively referred to as movement science) with the field of human occupation directly benefits both areas of study. Specifically, incorporating many of the quantitative scientific methods and analyses employed in movement science can help accelerate the development of rehabilitation-relevant research in occupational therapy (OT) and occupational science (OS). Reciprocally, OT and OS, which focus on the performance of everyday activities (occupations) to promote health and well-being, provide theoretical frameworks to guide research on the performance of actions in the context of social, psychological, and environmental factors. Given both fields' mutual interest in the study of movement as it relates to health and disease, the authors posit that combining OS and OT theories and principles with the theories and methods in movement science may lead to new, impactful, and clinically relevant knowledge. The first step is to ensure that individuals with OS or OT backgrounds are academically prepared to pursue advanced study in movement science. In this article, the authors propose 2 strategies to address this need.
Keywords: occupational therapy, occupational science, movement science, neural control of movement, neuroscience
Reynolds, S., Glennon, T. J., Ausderau, K., Bendixen, R. M., Kuhaneck, H. M., Pfeiffer, B., Watling, R., Wilkinson, K., & Bodison, S. C. (2017). Using a multifaceted approach to working with children who have differences in sensory processing and integration. American Journal of Occupational Therapy, 71(2), 7102360010p1-7102360010p10. https://doi.org/10.5014/ajot.2017.019281 Show abstract
Pediatric occupational therapy practitioners frequently provide interventions for children with differences in sensory processing and integration. Confusion exists regarding how best to intervene with these children and about how to describe and document methods. Some practitioners hold the misconception that Ayres Sensory Integration intervention is the only approach that can and should be used with this population. The issue is that occupational therapy practitioners must treat the whole client in varied environments; to do so effectively, multiple approaches to intervention often are required. This article presents a framework for conceptualizing interventions for children with differences in sensory processing and integration that incorporates multiple evidence-based approaches. To best meet the needs of the children and families seeking occupational therapy services, interventions must be focused on participation and should be multifaceted.
Gray, J. M., Frank, G., & Roll, S. C. (2017). Integrating musculoskeletal sonography into rehabilitation: Therapists' experiences with training and implementation. OTJR: Occupation, Participation and Health, 37(1), 40-49. https://doi.org/10.1177/1539449216681275 Show abstract
Musculoskeletal sonography is rapidly extending beyond radiology; however, best practices for successful integration into new practice contexts are unknown. This study explored non-physician experiences with the processes of training and integration of musculoskeletal sonography into rehabilitation. Qualitative data were captured through multiple sources, and iterative thematic analysis was used to describe two occupational therapists' experiences. The dominant emerging theme was competency, in three domains: technical, procedural, and analytical. In addition, three practice considerations were illuminated: (a) understanding imaging within the dynamics of rehabilitation, (b) navigating nuances of interprofessional care, and (c) implications for post-professional training. Findings indicate that sonography training for rehabilitation providers requires multi-level competency development and consideration of practice complexities. These data lay a foundation on which to explore and develop best practices for incorporating sonographic imaging into the clinic as a means for engaging clients as active participants in the rehabilitation process to improve health and rehabilitation outcomes.
Kinard, J. L., Sideris, J., Watson, L. R., Baranek, G. T., Crais, E. R., Wakeford, L., & Turner-Brown, L. (2017). Predictors of parent responsiveness to 1-year-olds at-risk for autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(1), 172-186. https://doi.org/10.1007/s10803-016-2944-9 Show abstract
Parent responsiveness is critical for child development of cognition, social-communication, and self-regulation. Parents tend to respond more frequently when children at-risk for autism spectrum disorder (ASD) demonstrate stronger social-communication; however, it is unclear how responsiveness is associated with sensory characteristics of children at-risk for ASD. To address this issue, we examined the extent to which child social-communication and sensory reactivity patterns (i.e., hyper- and hypo-reactivity) predicted parent responsiveness to 1-year-olds at-risk for ASD in a community sample of 97 parent-infant pairs. A combination of child social-communication and sensory hypo-reactivity consistently predicted how parents played and talked with their 1-year-old at-risk for ASD. Parents tended to talk less and use more play actions when infants communicated less and demonstrated stronger hypo-reactivity.
Sugiyama, T., & Liew, S.-L. (2017). The effects of sensory manipulations on motor behavior: From basic science to clinical rehabilitation. Journal of Motor Behavior, 49(1), 67-77. https://doi.org/10.1080/00222895.2016.1241740 Show abstract
Modifying sensory aspects of the learning environment can influence motor behavior. Although the effects of sensory manipulations on motor behavior have been widely studied, there still remains a great deal of variability across the field in terms of how sensory information has been manipulated or applied. Here, the authors briefly review and integrate the literature from each sensory modality to gain a better understanding of how sensory manipulations can best be used to enhance motor behavior. Then, they discuss 2 emerging themes from this literature that are important for translating sensory manipulation research into effective interventions. Finally, the authors provide future research directions that may lead to enhanced efficacy of sensory manipulations for motor learning and rehabilitation.
Hardison, M. E., & Roll, S. C. (2017). Factors associated with success in an occupational rehabilitation program for work-related musculoskeletal disorders. American Journal of Occupational Therapy, 71(1), 7101190040p1-7101190040p8. https://doi.org/10.5014/ajot.2016.023200 Show abstract
Work-related musculoskeletal disorders are a significant burden; however, no consensus has been reached on how to maximize occupational rehabilitation programs for people with these disorders, and the impact of simulating work tasks as a mode of intervention has not been well examined. In this retrospective cohort study, the authors used logistic regression to identify client and program factors predicting success for 95 clients in a general occupational rehabilitation program and 71 clients in a comprehensive occupational rehabilitation program. The final predictive model for general rehabilitation included gender, number of sessions completed, and performance of work simulation activities. Maximum hours per session was the only significant predictor of success in the comprehensive rehabilitation program. This study identifies new factors associated with success in occupational rehabilitation, specifically highlighting the importance of intensity (i.e., session length and number of sessions) of therapy and occupation-based activities for this population.
Marik, T. L., & Roll, S. C. (2017). Effectiveness of occupational therapy interventions for musculoskeletal shoulder conditions: A systematic review. American Journal of Occupational Therapy, 71(1), 7101180020p1-7101180020p11. https://doi.org/10.5014/ajot.2017.023127 Show abstract
People with musculoskeletal disorders of the shoulder commonly experience pain, decreased strength, and restricted range of motion (ROM) that limit participation in meaningful occupational activities. The purpose of this systematic review was to evaluate the current evidence for interventions within the occupational therapy scope of practice that address pain reduction and increase participation in functional activities. Seventy-six studies were reviewed for this study-67 of Level I evidence, 7 of Level II evidence, and 2 of Level III evidence. Strong evidence was found that ROM, strengthening exercises, and joint mobilizations can improve function and decrease pain. The evidence to support physical modalities is moderate to mixed, depending on the shoulder disorder. Occupational therapy practitioners can use this evidence to guide daily clinical decision making.
Roll, S. C., & Hardison, M. E. (2017). Effectiveness of occupational therapy interventions for adults with musculoskeletal conditions of the forearm, wrist, and hand: A systematic review. American Journal of Occupational Therapy, 71(1), 7101180010p1-7101180010p12. https://doi.org/10.5014/ajot.2017.023234 Show abstract
Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity. It is imperative that practitioners understand the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purposeful occupations. This systematic review provides an update to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question, What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm, wrist, and hand? A total of 59 articles were reviewed. Evidence for interventions was synthesized by condition within bone, joint, and general hand disorders; peripheral nerve disorders; and tendon disorders. The strongest evidence supports postsurgical early active motion protocols and splinting for various conditions. Very few studies have examined occupation-based interventions. Implications for occupational therapy practice and research are provided.
Murphy, S. L., Kratz, A. L., & Schepens Niemiec, S. L. (2017). Assessing fatigability in the lab and in daily life in older adults with osteoarthritis using perceived, performance, and ecological measures. The Journals of Gerontology Series A: Biological Science and Medical Sciences, 72(1), 115-120. https://doi.org/10.1093/gerona/glw173 Show abstract
Background. Fatigue in older adults is associated with functional decline and reduced participation in daily life; however, it is not well characterized. Examining fatigue within activity performance, or "fatigability," is a recommended approach to begin to understand fatigue and its underlying mechanisms. This study examined the construct validity of lab-based measures of fatigability and compared these measures with fatigability in daily life (termed ecological fatigability).
Methods. Participants with osteoarthritis and fatigue (n = 163) underwent laboratory assessments, completed questionnaires, and wore accelerometers for 7 days while tracking symptoms and behaviors. Lab-based fatigability measures were quantified using the 6-minute walk test. Perceived fatigability was assessed by asking participants before and after the test to report: (i) fatigue severity and (ii) perceived exertion. Performance fatigability was calculated using change in walking speed divided by total distance walked. Ecological fatigability was calculated from the 7-day assessment in which fatigue severity was reported five times a day and physical activity was continuously measured. Additional ecological measures (eg, self-pacing) were examined.
Results. Lab-based perceived and performance fatigability measures were highly inter-correlated, moderately correlated with gait speed and metabolic measures, and weakly correlated with physical activity. Although ecological fatigability was weakly correlated with lab-based measures, participants with high fatigability on lab-based measures demonstrated more self-pacing behaviors than participants with low fatigability.
Conclusion. Lab-based fatigability measures are related to physical capacity measured both in the lab and daily life. Lab-based fatigability measures provide important information regarding daily life fatigability useful for future intervention development.
Pyatak, E. A., Carandang, K., Vigen, C., Blanchard, J., Sequeira, P. A., Wood, J. R., Spruijt-Metz, D., Whittemore, R., & Peters, A. L. (2017). Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomized controlled trial evaluating an occupation-based diabetes management intervention for young adults. Contemporary Clinical Trials, 54, 8-17. https://doi.org/10.1016/j.cct.2016.12.025 Show abstract
Overview. This paper describes the study protocol used to evaluate the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) intervention and reports on baseline characteristics of recruited participants. REAL Diabetes is an activity-based intervention designed to address the needs of young adults diagnosed with type 1 (T1D) or type 2 diabetes (T2D) from low socioeconomic status or racial/ethnic minority backgrounds. The REAL intervention incorporates tailored delivery of seven content modules addressing various dimensions of health and well-being as they relate to diabetes, delivered by a licensed occupational therapist.
Methods. In this pilot randomized controlled trial, participants are assigned to the REAL Diabetes intervention or an attention control condition. The study's primary recruitment strategies included in-person recruitment at diabetes clinics, mass mailings to clinic patients, and social media advertising. Data collection includes baseline and 6-month assessments of primary outcomes, secondary outcomes, and hypothesized mediators of intervention effects, as well as ongoing process evaluation assessment to ensure study protocol adherence and intervention fidelity.
Results. At baseline, participants (n=81) were 51% female, 78% Latino, and on average 22.6years old with an average HbA1c of 10.8%. A majority of participants (61.7%) demonstrated clinically significant diabetes distress and 27.2% reported symptoms consistent with major depressive disorder. Compared to participants with T1D, participants with T2D had lower diabetes-related self-efficacy and problem-solving skills. Compared to participants recruited at clinics, participants recruited through other strategies had greater diabetes knowledge but weaker medication adherence.
Discussion. Participants in the REAL study demonstrate clinically significant medical and psychosocial needs.