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.
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
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.
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.
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
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
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
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
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.
Takata, S. C., & Roll, S. C. (2018). Identification of aberrant muscle bellies in the carpal tunnel using sonography. Journal of Diagnostic Medical Sonography. Advance online publication. 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.
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.
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
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
Baranek, G. T., Carlson, M., Sideris, J., Kirby, A. V., Watson, L. R., Williams, K. L., & Bulluck, J. (2018). Longitudinal assessment of stability of sensory features in children with autism spectrum disorder or other developmental disabilities. Autism Research. Advance online publication. 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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Schepens Niemiec, S. L., Blanchard, J., Vigen, C. L., Martínez, J., Guzmán, L., Fluke, M., & Carlson, M. (2018). 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. Advance online publication. 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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, 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.
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.
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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.
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.
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.
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.
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.
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.
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.
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.
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.
Takata, S. C., Wade, E. T., & Roll, S. C. (2017). Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: A mapping review linking research to practice. Journal of Hand Therapy. Advance online publication. 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.
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.
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
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.
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.
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.
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. (2017). Lifestyle intervention for adults with spinal cord injury: Results of the USC-RLANRC Pressure Ulcer Prevention Study. Journal of Spinal Cord Medicine. Advance online publication. 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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
Hegmann, K. T., Melhorn, J. M., Ausfahl, J., Freshwater, M. F., Prezzia, C. P., Rempel, D. M., Roll, S. C., Rollins, R. J., Werner, R. A., & Zaremski, J. (2016). ACOEM hand, wrist, and forearm disorders guideline. Westminster, CO: Reed Group. Full text
Cermak, S. A., & Borreson, A. E. (2016). Occupational therapy. In I. L. Rubin, J. Merrick, D. E. Greydanus, & D. R. Patel (Eds.), Health care for people with intellectual and developmental disabilities across the lifespan (pp. 1053-1067). Switzerland: Springer International. https://doi.org/10.1007/978-3-319-18096-0_90 Show abstract
Occupational therapists contribute to the care of children and adults with intellectual and developmental disabilities (IDD) by focusing on activities and goals that are meaningful to the individuals and their families. Relevant performance areas include cognitive, sensory, perceptual, motor and psychosocial activities. Goals for intervention can range from self-care to supporting participation in a work environment. The ultimate goal is to foster community integration and participation. Occupational therapy assessment is designed to understand the individual's strengths and areas of concern, within the context of the current environment and family/community culture. In this chapter, the types of interventions for individuals with IDD at different life stages are discussed, and examples of evidence-based outcomes are presented.
Pitts, D., & McIntyre, E. (2016). Recovery frameworks. In T. Krupa, B. Kirsch, D. Pitts, & E. Fossey (Eds.), Bruce & Borg's psychosocial frames of reference (4th ed., pp. 37-56). Thorofare, NJ: Slack Publishing. Full text
Pitts, D., & McIntyre, E. (2016). Expression and occupation (psychodynamic perspectives). In T. Krupa, B. Kirsch, D. Pitts, & E. Fossey (Eds.), Bruce & Borg's psychosocial frames of reference (4th ed., pp. 211-226). Thorofare, NJ: Slack Publishing. Full text
Pitts, D., & McIntyre, E. (2016). Health promotion and wellness for persons with psychiatric disabilities. In T. Krupa, B. Kirsch, D. Pitts, & E. Fossey (Eds.), Bruce & Borg's psychosocial frames of reference (4th ed., pp. 245-264). Thorofare, NJ: Slack Publishing. Full text
Braveman, B., & Phipps, S. (2016). Strategic planning. In B. Braveman (Ed.), Leading & managing occupational therapy services: An evidence-based approach (2nd ed., pp. 235-254). Philadelphia, PA: F. A. Davis.
Black, T. M., Roberts, P. S., Livesay, S. L., & Hickey, J. V. (2016). Stroke rehabilitation. In J. V. Hickey & S. L. Livesay (Eds.), The continuum of stroke care: An interprofessional approach to evidence-based care (pp. 259-303). Philadelphia, PA: Wolters Kluwer. Full text
Dieterle, C. (2016). Coaching and Lifestyle Redesign: Coaching as an integral part of preventing and managing chronic conditions. In W. Pentland, J. Isaacs-Young, J. Gash, & A. Heinz (Eds.), Enabling positive change: Coaching conversations in occupational therapy (pp. 93-100). Ottawa, ON: Canadian Association of Occupational Therapists Publishing. Full text
Phipps, S. (2016). Managing change and solving problems. In B. Braveman (Ed.), Leading & managing occupational therapy services: An evidence-based approach (2nd ed., pp. 255-276). Philadelphia, PA: F. A. Davis.
Pfeiffer, B., & Stein Duker, L. I. (2016). The impact of the sensory environment on patient care for individuals with autism spectrum disorders. In E. Giarelli & K. M. Fisher (Eds.), Integrated health care for people with autism spectrum disorder: Interdisciplinary planning and delivery of care (pp. 69-92). Springfield, IL: Charles C. Thomas.
Laliberte Rudman, D., & Aldrich, R. M. (2016). “Activated, but stuck”: Applying a critical occupational lens to examine the negotiation of long-term unemployment in contemporary socio-political contexts. Societies, 6(3), 28. https://doi.org/10.3390/soc6030028 Show abstract
Background: Solutions for the problem of long-term unemployment are increasingly shaped by neoliberally-informed logics of activation and austerity. Because the implications of these governing frameworks for everyday life are not well understood, this pilot study applied a critical occupational science perspective to understand how long-term unemployment is negotiated within contemporary North American socio-political contexts. This perspective highlights the implications of policy and employment service re-configurations for the range of activities that constitute everyday life.
Methods: Using a collaborative ethnographic community-engaged research approach, we recruited eight people in Canada and the United States who self-identified as experiencing long-term unemployment. We analyzed interviews and observation notes concerning four participants in each context using open coding, critical discourse analysis, and situational analysis.
Results: This pilot study revealed a key contradiction in participants’ lives: being “activated, but stuck”. This contradiction resulted from the tension between individualizing, homogenizing frames of unemployment and complex, socio-politically shaped lived experiences. Analysis of this tension revealed how participants saw themselves “doing all the right things” to become re-employed, yet still remained stuck across occupational arenas.
Conclusion: This pilot study illustrates the importance of understanding how socio-political solutions to long-term unemployment impact daily life and occupational engagement beyond the realm of job seeking and job acquisition.
Murphy, S. L., Robinson-Lane, S. G., & Schepens Niemiec, S. L. (2016). Knee and hip osteoarthritis management: A review of current and emerging non-pharmacological approaches. Current Treatment Options in Rheumatology, 2(4), 296–311. https://doi.org/10.1007/s40674-016-0054-7
Roll, S. C. (2016). Current evidence and opportunities for expanding the role of occupational therapy for adults with musculoskeletal conditions. American Journal of Occupational Therapy, 71(1), 7101170010p1-7101170010p5. https://doi.org/10.5014/ajot.2017.711002 Show abstract
Musculoskeletal conditions are the second greatest cause of disability worldwide, and chronic musculoskeletal conditions affect nearly the same percentage of the general population as chronic circulatory and respiratory conditions combined. Moreover, people with musculoskeletal conditions experience a significant decline in independence with daily activities and occupational performance, key areas targeted by occupational therapy interventions. This special issue of the American Journal of Occupational Therapy provides comprehensive summaries of evidence for the care of common musculoskeletal conditions, highlights important implications that support evidence-informed practice, and proposes ways to advance the practice of occupational therapy to improve the lives of people with musculoskeletal conditions.
Wu, A. H., Vigen, C. L., Lee, E., Tseng, C.-C., & Butler, L. M. (2016). Traditional breast cancer risk factors in Filipina Americans compared with Chinese and Japanese Americans in Los Angeles County. Cancer Epidemiology, Biomarkers & Prevention, 25(12), 1572–1586. https://doi.org/10.1158/1055-9965.EPI-16-0203 Show abstract
Background. Filipina Americans have one of the highest breast cancer incidence rates among Asian Americans for poorly understood reasons.
Methods. Breast cancer risk factors were investigated in a population-based study of Filipina (790 cases, 587 controls), Japanese (543 cases, 510 controls), and Chinese (913 cases, 904 controls) Americans. Cases were identified by the Los Angeles County Cancer Surveillance Program, and controls were matched to cases on age, ethnicity, and neighborhood. Multivariable conditional logistic regression was performed by Asian ethnicity.
Results. In Filipina, Chinese, and Japanese Americans, breast cancer risk decreased significantly with increasing parity (all Ptrend < 0.0001). Breast cancer risk increased with increasing quartiles of cumulative menstrual months in premenopausal (Ptrend = 0.019) and postmenopausal Filipina (Ptrend = 0.008), in premenopausal (Ptrend = 0.0003) but not postmenopausal Chinese (Ptrend = 0.79), and in neither premenopausal (Ptrend = 0.092) nor postmenopausal (Ptrend = 0.75) Japanese Americans. For postmenopausal Filipina and Japanese, greater weight gain since age 18 (Ptrend = 0.019 and 0.053, respectively), high current body mass index (both Ptrend < 0.01), and greater waist circumferences (both Ptrend < 0.04) were statistically significant; these associations were weaker for postmenopausal Chinese women.
Conclusions. Cumulative menstrual months and body size factors were statistically significant risk factors for Filipina. Total menstrual months were associated with breast cancer among Chinese but not for Japanese, while body size factors were significantly associated with risk among Japanese but not among Chinese.
Impact. Characterization of breast cancer risk factors in Filipina will help to generate hypotheses for their high breast cancer incidence.
Craddock, R. C., Margulies, D. S., Bellec, P., Nichols, B. N., Alcauter, S., Barrios, F. A., Burnod, Y., Cannistraci, C. J., Cohen-Adad, J., De Leener, B., Dery, S., Downar, J., Dunlop, K., Franco, A. R., Froehlich, C. S., Gerber, A. J., Ghosh, S. S., Grabowski, T. J., Hill, S., Heinsfeld, A. S., Hutchison, R. M., Kundu, P., Laird, A. R., Liew, S.-L., Lurie, D. J., McLaren, D. G., Meneguzzi, F., Mennes, M., Mesmoudi, S., O'Connor, D., Pasaye, E. H., Peltier, S., Poline, J., Prasad, G., Pereira, R. F., Quirion, P., Rokem, A., Saad, Z. S., Shi, Y., Strother, S. C., Toro, R., Uddin, L. Q., Van Horn, J. D., Van Meter, J. W., Welsh, R. C., & Xu, T. (2016). Brainhack: A collaborative workshop for the open neuroscience community. GigaScience, 5(1), 1-8. https://doi.org/10.1186/s13742-016-0121-x Show abstract
Brainhack events offer a novel workshop format with participant-generated content that caters to the rapidly growing open neuroscience community. Including components from hackathons and unconferences, as well as parallel educational sessions, Brainhack fosters novel collaborations around the interests of its attendees. Here we provide an overview of its structure, past events, and example projects. Additionally, we outline current innovations such as regional events and post-conference publications. Through introducing Brainhack to the wider neuroscience community, we hope to provide a unique conference format that promotes the features of collaborative, open science.
Fogelberg, D. J., Powell, J. M., & Clark, F. A. (2016). The role of habit in recurrent pressure ulcers following spinal cord injury. Scandinavian Journal of Occupational Therapy, 23(6), 467-476. https://doi.org/10.3109/11038128.2015.1130170 Show abstract
Background. Despite the existence of numerous prevention strategies, pressure ulcers remain highly prevalent in those with spinal cord injury (SCI). The concept of habit, broadly defined, may help understand the persistence of this problem and offer strategies for its mitigation by occupational therapy.
Aim. The aim of this paper is to describe the relationship between habits established prior to sustaining an SCI and post-injury habits that impacted on pressure ulcer risk.
Methods. Secondary analysis of qualitative data collected during an ethnographic study of community-dwelling adults with SCI.
Results. Participants' habits appeared to substantially affect their risk of developing pressure ulcers. Habits established before incurring the SCI either facilitated or hindered the acquisition of new habits intended to prevent pressure ulcers.
Conclusions. An understanding of the individual's pre-existing habits may be important when designing a rehabilitation programme intended to minimize risk of pressure ulcer development following SCI. Habit-change strategies could be used to supplement education in pressure ulcer prevention techniques.
Significance. Occupational therapists have a longstanding interest in habit. A more comprehensive understanding of this concept may provide important insights into the persistence and management of pressure ulcers following SCI.
Leland, N. E., Fogelberg, D. J., Halle, A. D., & Mroz, T. M. (2016). Occupational therapy and management of multiple chronic conditions in the context of health care reform. American Journal of Occupational Therapy, 71(1), 7101090010p1-7101090010p6. https://doi.org/10.5014/ajot.2017.711001 Show abstract
One in four individuals living in the United States has multiple chronic conditions (MCCs), and the already high prevalence of MCCs continues to grow. This population has high rates of health care utilization yet poor outcomes, leading to elevated concerns about fragmented, low-quality care provided within the current health care system. Several national initiatives endeavor to improve care for the population with MCCs, and occupational therapy is uniquely positioned to contribute to these efforts for more efficient, effective, client-centered management of care. By integrating findings from the literature with current policy and practice, we aim to highlight the potential role for occupational therapy in managing MCCs within the evolving health care system.
Ausderau, K. K., Sideris, J., Little, L. M., Furlong, M., Bulluck, J. C., & Baranek, G. T. (2016). Sensory subtypes and associated outcomes in children with autism spectrum disorders. Autism Research, 9(12), 1316-1327. https://doi.org/10.1002/aur.1626 Show abstract
Sensory features are prevalent and heterogeneous across children with ASD and these features have been associated with child outcomes. Identification of clinically defined sensory subtypes may enhance our understanding of unique phenotypes that have implications for etiology, prognosis, and intervention. This longitudinal study used a national online survey aimed to identify associations of previously validated sensory subtypes to specific child and family characteristics and functional outcomes [Vineland Adaptive Behavior Scale-II (VABS) and Parenting Stress Index short form (PSI)]. The sensory experiences questionnaire-3.0 was collected from caregivers with children with ASD, ages 2-12, at two time points (Time 1, n = 1307, Time 2, n = 884), 1 year apart. Functional outcomes assessments were collected at the second time point. A latent profile transition analysis (LPTA) was used to test associations, and results indicated that the attenuated-preoccupied subtype presented with the significantly lowest levels of VABS adaptive behavior composite scores compared to the other three sensory subtypes. Both the VABS maladaptive behavior index and the total PSI score were significantly highest in the extreme-mixed subtype. These results underscore the clinical utility of this subtyping approach for differentiating characteristics and functional outcomes associated with clinically defined sensory phenotypes. These findings may have implications for better understanding etiology, prognosis, and more precise targets for interventions designed to ameliorate sensory difficulties, and ultimately mitigate negative developmental consequences and parenting stress.
Wheeler, A. C., Sideris, J., Hagerman, R., Berry-Kravis, E., Tassone, F., & Bailey Jr, D. B. (2016). Developmental profiles of infants with an FMR1 premutation. Journal of Neurodevelopmental Disorders, 8, 40. https://doi.org/10.1186/s11689-016-9171-8 Show abstract
Background. Emerging evidence suggests that a subset of FMR1 premutation carriers is at an increased risk for cognitive, emotional, and medical conditions. However, because the premutation is rarely diagnosed at birth, the early developmental trajectories of children with a premutation are not known.
Methods. This exploratory study examined the cognitive, communication, and social-behavioral profiles of 26 infants with a premutation who were identified through participation in a newborn screening for fragile X syndrome pilot study. In this study, families whose newborn screened positive for an FMR1 premutation were invited to participate in a longitudinal study of early development. Twenty-six infants with the premutation and 21 matched, screen-negative comparison babies were assessed using validated standardized measures at 6-month intervals starting as young as 3 months of age. The babies were assessed up to seven times over a 4-year period.
Results. The premutation group was not statistically different from the comparison group on measures of cognitive development, adaptive behavior, temperament, or overall communication. However, the babies with the premutation had a significantly different developmental trajectory on measures of nonverbal communication and hyperresponsivity to sensory experiences. They also were significantly more hyporesponsive at all ages than the comparison group. Cytosine-guanine-guanine repeat length was linearly associated with overall cognitive development.
Conclusions. These results suggest that infants with a premutation may present with subtle developmental differences as young as 12 months of age that may be early markers of later anxiety, social deficits, or other challenges thought to be experienced by a subset of carriers.
Murphy, S. L., Schepens Niemiec, S., Lyden, A. K., & Kratz, A. L. (2016). Pain, fatigue, and physical activity in osteoarthritis: The moderating effects of pain- and fatigue-related activity interference. Archives of Physical Medicine and Rehabilitation, 97(9, Supplement), S201-S209. https://doi.org/10.1016/j.apmr.2015.05.025 Show abstract
Objective. To examine how self-reported pain- and fatigue-related activity interference relates to symptoms and physical activity (PA) in daily life among people with knee or hip osteoarthritis.
Design. Cross-sectional study with a 7-day repeated-measures assessment period.
Setting. General community.
Participants. Participants (N=154; mean age, 65y; 60% women [n=92]) with knee or hip osteoarthritis and pain lasting ≥3 months.
Interventions. Not applicable.
Main Outcome Measures. Pain- or fatigue-related activity interference items on the Brief Pain Inventory or Brief Fatigue Inventory, respectively, from baseline survey, momentary pain and fatigue severity (measured 5 times/d for 7d), and PA measured with a wrist-worn accelerometer over 7 days. We hypothesized that perception of pain- and fatigue-related activity interference would moderate the association between symptoms (pain or fatigue) and PA. People with higher pain- or fatigue-related activity interference were thought to have stronger negative associations between momentary ratings of pain and fatigue and PA than did those with lower activity interference.
Results. Pain-related activity interference moderated the association between momentary pain and PA, but only in the first part of the day. Contrary to expectation, during early to midday (from wake-up time through 3 pm), low pain-related interference was associated with stronger positive associations between pain and PA but high pain-related interference was associated with a small negative association between pain and PA. Fatigue-related activity interference did not moderate the relation between fatigue and activity over the course of a day.
Conclusions. Depending on a person's reported level of pain-related activity interference, associations between pain and PA were different earlier in the day. Only those with high pain-related activity interference had lower levels of PA as pain increased and only in the morning. High pain-related activity interference may be important to address, particularly to maintain PA early in the day despite pain.
Cascio, C. J., Woynaroski, T., Baranek, G. T., & Wallace, M. T. (2016). Toward an interdisciplinary approach to understanding sensory function in autism spectrum disorder. Autism Research, 9(9), 920-925. https://doi.org/10.1002/aur.1612 Show abstract
Heightened interest in sensory function in persons with autism spectrum disorder (ASD) presents an unprecedented opportunity for impactful, interdisciplinary work between neuroscientists and clinical practitioners for whom sensory processing is a focus. In spite of this promise, and a number of overlapping perspectives on sensory function in persons with ASD, neuroscientists and clinical practitioners are faced with significant practical barriers to transcending disciplinary silos. These barriers include divergent goals, values, and approaches that shape each discipline, as well as different lexical conventions. This commentary is itself an interdisciplinary effort to describe the shared perspectives, and to conceptualize a framework that may guide future investigation in this area. We summarize progress to date and issue a call for clinical practitioners and neuroscientists to expand cross-disciplinary dialogue and to capitalize on the complementary strengths of each field to unveil the links between neural and behavioral manifestations of sensory differences in persons with ASD. Joining forces to face these challenges in a truly interdisciplinary way will lead to more clinically informed neuroscientific investigation of sensory function, and better translation of those findings to clinical practice. Likewise, a more coordinated effort may shed light not only on how current approaches to treating sensory processing differences affect brain and behavioral responses to sensory stimuli in individuals with ASD, but also on whether such approaches translate to gains in broader characteristics associated with ASD. It is our hope that such interdisciplinary undertakings will ultimately converge to improve assessment and interventions for persons with ASD.
Blanche, E. I., Chang, M. C., Gutierrez, J., & Gunter, J. S. (2016). Effectiveness of a sensory-enriched early intervention group program for children with developmental disabilities. American Journal of Occupational Therapy, 70(5), 7005220010p1-7005220010p8. https://doi.org/10.5014/ajot.2016.018481 Show abstract
Objective. The study's objective was to evaluate the effectiveness of the Interdisciplinary Sensory-Enriched Early Intervention (ISEEI) group program for children with developmental delays.
Method. We conducted a retrospective chart review of 63 children ages 18-36 mo who participated in ISEEI. We evaluated participants with the Bayley Scales of Infant and Toddler Development III (Bayley-III) and the Infant/Toddler Sensory Profile (ITSP) at enrollment and after 3-9 mo. We conducted a paired t test to examine changes in the Bayley-III between pre- and posttests.
Results. At enrollment, 70% of children presented atypical scores in two or more areas of sensory processing in the ITSP. Results revealed that children with sensory processing difficulties demonstrated significant improvement in all areas of development except fine motor skills; children without sensory processing difficulties showed significant improvement in language and cognition.
Conclusion. The ISEEI group program is an effective method to ameliorate developmental delays.
Liew, S.-L., Rana, M., Cornelsen, S., Fortunato de Barros Filho, M., Birbaumer, N., Sitaram, R., Cohen, L. G., & Soekadar, S. R. (2016). Improving motor corticothalamic communication after stroke using real-time fMRI connectivity-based neurofeedback. Neurorehabilitation and Neural Repair, 30(7), 671-675. https://doi.org/10.1177/1545968315619699 Show abstract
Background. Two thirds of stroke survivors experience motor impairment resulting in long-term disability. The anatomical substrate is often the disruption of cortico-subcortical pathways. It has been proposed that reestablishment of cortico-subcortical communication relates to functional recovery.
Objective. In this study, we applied a novel training protocol to augment ipsilesional cortico-subcortical connectivity after stroke. Chronic stroke patients with severe motor impairment were provided online feedback of blood-oxygenation level dependent signal connectivity between cortical and subcortical regions critical for motor function using real-time functional magnetic resonance imaging neurofeedback.
Results. In this proof of principle study, 3 out of 4 patients learned to voluntarily modulate cortico-subcortical connectivity as intended.
Conclusions. Our results document for the first time the feasibility and safety for patients with chronic stroke and severe motor impairment to self-regulate and augment ipsilesional cortico-subcortical connectivity through neurofeedback using real-time functional magnetic resonance imaging.
Kim, L. H., & Leland, N. E. (2016). Rehabilitation practitioners' prioritized care processes in hip fracture post-acute care. Physical & Occupational Therapy in Geriatrics, 34(2-3), 155-168. https://doi.org/10.1080/02703181.2016.1267295 Show abstract
Aims. Occupational and physical therapy in post-acute care (PAC) has reached the point where quality indicators for hip fracture are needed. This study characterizes the practitioners' prioritized hip fracture rehabilitation practices, which can guide future quality improvement initiatives.
Methods. Ninety-two practitioners participating in a parent mixed methods study were asked to rank a series of evidence-based best practices across five clinical domains (assessment, intervention, discharge planning, caregiver training, and patient education).
Results. Prioritized practices reflected patient-practitioner collaboration, facilitating an effective discharge, and preventing adverse events. The highest endorsed care processes include: developing meaningful goals with patient input (84%) in assessment, using assistive devices in intervention (75%) and patient education (65%), engaging the patient and caregiver (50%) in discharge planning, and fall prevention (60%) in caregiver education.
Conclusions. Practitioners identified key care priorities. This study lays the foundation for future work evaluating the extent to which these practices are delivered in PAC.
The laterality index (LI) is one way to assess hemispheric dominance in a variety of tasks, such as language, cognitive functions, and changes in laterality in clinical populations, such as after stroke. In stroke neuroimaging, however, an optimal method of calculating the LI remains controversial, largely due to lesion variability in post-stroke brains.
Two main methods of calculating LI have evolved in neuroimaging literature. The first, more traditional approach counts the number of active voxels in a given region of interest (ROI) for each hemisphere. This method has been criticized for its inability to account for differences in signal intensity. Hence, a second approach calculates laterality based on the percent signal change within a given region; however, this method also has problems, such as difficulty handling negative values.
A laterality toolbox that addresses some of these issues has been implemented in the statistical neuroimaging analysis package SPM, which provides users with options of using either method, along with more advanced statistical tests for robust LI calculations  No such toolbox is yet available for FSL. Therefore, we developed a series of scripts to calculate LI in FSL using both voxel count and percent signal change methods. However, in the interest of space, here we present only results from the more robust method of the two (voxel count method).
Kan, E., Anglin, J., Borich, M., Jahanshad, N., Thompson, P., & Liew, S.-L. (2016). Facilitating big data meta-analyses for clinical neuroimaging through ENIGMA wrapper scripts. GigaScience, 5(Suppl. 1), 17-19. https://doi.org/10.1186/s13742-016-0147-0-p Show abstract
A vast number of clinical disorders may involve changes in brain structure that are correlated with cognitive function and behavior (e.g., depression, schizophrenia, stroke, etc.). Reliably understanding the relationship between specific brain structures and relevant behaviors in worldwide clinical populations could dramatically improve healthcare decisions around the world. For instance, if a reliable relationship between brain structure after stroke and functional motor ability was established, brain imaging could be used to predict prognosis/recovery potential for individual patients. However, high heterogeneity in clinical populations in both individual neuroanatomy and behavioral outcomes make it difficult to develop accurate models of these potentially subtle relationships.
Large neuroimaging studies (n > 10,000) would provide unprecedented power to successfully relate clinical neuroanatomy changes with behavioral measures. While these sample sizes might be difficult for any one individual to collect, the ENIGMA Center for Worldwide-Medicine, Imaging, and Genomics has successfully pioneered meta-and mega-analytic methods to accomplish this task. ENIGMA [http://enigma.ini.usc.edu] brings together a global alliance of over 500 international researchers from over 35 countries to pool together neuroimaging data on different disease states in hopes of discovering critical brain-behavior relationships. Individual investigators with relevant data run ENIGMA analysis protocols on their own data and send back an output folder containing the analysis results to be combined with data from other sites for a meta-analysis. In this way, large sample sizes can be acquired without the hassle of large-scale data transfers or actual neuroimaging data sharing.
ENIGMA protocols were initially developed to harmonize processing methods of imaging researchers around the world and they require a moderate level of familiarity with several programming languages and environments. However, ENIGMA’s recent success has attracted greater interest in collaborative neuroimaging and protocols must be adjusted to allow for all levels of experience, as, the success of this approach depends on individual collaborators running these ENIGMA protocols on their data. Here, we worked on simplifying these protocols so even a novice programmer could use them. In this way, we hope to expand the feasibility of collecting critical clinical data from collaborators who may have less experience with neuroim-aging techniques.
Carandang, K., Pyatak, E. A., & Vigen, C. P. (2016). Systematic review of educational interventions for rheumatoid arthritis. American Journal of Occupational Therapy, 70(6), 7006290020p1-7006290020p12. https://doi.org/10.5014/ajot.2016.021386 Show abstract
Objective. In this study, we systematically reviewed the effectiveness of educational interventions falling within the scope of occupational therapy practice for people with rheumatoid arthritis (RA). These interventions included disease education, joint protection and energy conservation, psychosocial techniques, pain management, and a combination category.
Method. Two databases, MEDLINE and CINAHL, and select journals were searched for randomized controlled trials published between January 2002 and June 2015. Qualitative synthesis was used for between-study comparisons.
Results. Twenty-two studies, with approximately 2,600 participants, were included. The interventions were found to have strong evidence for constructs that dealt with increasing coping with pain and fatigue as well as maintaining positive affect. There was limited or no evidence supporting the effectiveness of these interventions on most other measured constructs.
Conclusion. Interventions in which a combination of educational techniques is used may complement pharmacological therapies in the care of people with RA. Future research is needed to identify specific mechanisms of change.
Schertz, H. H., Odom, S. L., Baggett, K. M., & Sideris, J. H. (2016). Parent-reported repetitive behavior in toddlers on the autism spectrum. Journal of Neurodevelopmental Disorders, 46(10), 3308-3316. https://doi.org/10.1007/s10803-016-2870-x Show abstract
Toddlers with autism spectrum disorder (ASD) were assessed on the Repetitive Behavior Scale-Revised (RBS-R), which we found to have acceptable internal consistency. Stereotypical subscale scores showed a negligible association with cognitive level, but correlated more strongly with adaptive and social indicators. Relative to earlier reported RBS-R scores for older age groups, toddlers' scores trended toward higher stereotyped behavior and lower ritualistic/sameness behavior. Our findings on associations with developmental indicators align with those of researchers who used more resource-intensive repetitive behavior measures. The convergence of these findings with those derived from other measurement methods suggests that the RBS-R, a cost effective parent-report measure, is a viable means of assessing repetitive behavior in toddlers with autism.
Angell, A. M., Frank, G., & Solomon, O. (2016). Latino families' experiences with autism services: Disparities, capabilities, and occupational justice. OTJR: Occupation, Participation and Health, 36(4), 195-203. https://doi.org/10.1177/1539449216666062 Show abstract
This article examines six cases of publicly funded Applied Behavior Analysis (ABA) therapy for Latino children with autism spectrum disorder (ASD) to contribute to thinking about occupational justice. In this ethnographic study of six Latino families of children with ASD in Los Angeles County, all families were offered ABA for their children, but five families experienced occupational challenges leading them to insist on modifications of ABA or to opt out of the service. We consider in each case (a) how the families' experiences can be understood occupationally, (b) how ABA affected the functionings and capabilities of the children and their families, and (c) how the parents' accounts relate to occupational justice. Applying the capabilities approach can help operationalize the concept of occupational justice as a tool to evaluate social policy across cases.
Zhang, W., & Baranek, G. T. (2016). The impact of insurance coverage types on access to and utilization of health services for U.S. children with autism. Psychiatric Services, 67(8), 908-911. https://doi.org/10.1176/appi.ps.201500206 Show abstract
Objective. The study examined the association of insurance type with access to and utilization of essential health services among children with autism spectrum disorder (ASD).
Methods. Multivariate logistic regressions were used to illustrate the relationship between the indicators of health services utilization and insurance coverage types among U.S. children with ASD (N=2,041). Analyses used secondary data from the 2011-2012 National Survey of Children's Health.
Results. Privately insured children with ASD were significantly less likely than their publicly insured counterparts to receive therapy (OR=.49). The odds of having any out-of-pocket medical expenses for families with private insurance were 11.0 times greater than for families with public insurance.
Conclusions. The findings reflect current gaps between public and private insurance coverage in the health system for access to and utilization of health services for children with ASD. Special attention should be directed to private insurance plans, where needed health services may be inadequately covered.
McLafferty, F. S., Barmparas, G., Ortega, A., Roberts, P., Ko, A., Harada, M., Nuno, M., Black, K. L., & Ley, E. J. (2016). Predictors of improved functional outcome following inpatient rehabilitation for patients with traumatic brain injury. NeuroRehabilitation for traumatic brain injury, 39(3), 423-430. https://doi.org/10.3233/NRE-161373 Show abstract
Objective. To determine factors associated with response to inpatient rehabilitation treatment among TBI patients.
Setting. Inpatient rehabilitation service at a Level I trauma center.
Participants. Moderate-severe TBI patients ages = 18 years old admitted between January 1, 2002 and December 31, 2012.
Main Measures. Response to inpatient rehabilitation, measured by the Functional Independence Measure (FIM) score.
Design. Retrospective cohort study.
Results. Of 1,984 patients treated for TBI, 184 (10.8%) underwent inpatient rehabilitation. The largest proportion of patients improved in mobility (98.9%), followed by self-care (93.7%), communication/social cognition (84.0%), and sphincter control (65.7%). Of these, 99 (53.8%) improved by 2 or more levels of functional independence and were considered rehabilitation responders. Responders were younger (53.1 years vs. 63.8, p < 0.01), had longer average rehabilitation stays (15.4 days vs. 12.2, p < 0.01), and were less likely to have an admission SBP <100mmHg (7.1% vs. 17.1%, p < 0.01). On multivariate analysis, normotension at admission (AOR 0.06, p < 0.01) and longer rehabilitation LOS (AOR 1.11, p < 0.01) were associated with a response to inpatient rehabilitation.
Conclusion. Of the TBI patients who qualified for same-center inpatient rehabilitation, approximately half responded to treatment. Longer rehabilitation time and normotension at admission predicted response to rehabilitation. Further efforts are necessary to identify and optimize TBI patients for inpatient rehabilitation.
Bar-Shalita, T., & Cermak, S. A. (2016). Atypical sensory modulation and psychological distress in the general population. American Journal of Occupational Therapy, 70(4), 7004250010p1-9. https://doi.org/10.5014/ajot.2016.018648 Show abstract
Objective. Atypical sensory modulation (ASM) is characterized by over- or underresponsiveness to sensory stimuli in one or more sensory systems. Faulty sensory information processing could result in anxiety. Because the relation between ASM and psychological distress has not been examined, we explored psychological distress and ASM in the general population.
Method. A community-based sample of 204 adults (105 men; mean age = 27.4 yr, standard deviation = 3.71) completed the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS; Bar-Shalita, Seltzer, Vatine, Yochman, & Parush, 2009); the Brief Symptom Inventory (BSI; Derogatis & Coons, 1993); and the Short Form-36 Health Survey, Version 2 (SF-36; Ware, Kosinski, & Gandek, 2005).
Results. The ASM group displayed considerably more distress symptoms than the comparison group. Multivariate linear regression showed SRQ-IS and SF-36 scores as significant predictors of BSI score (r = .64).
Conclusion. ASM may be a risk factor for developing other mental health concerns.
Sleight, A. G., & Stein Duker, L. I. (2016). Toward a broader role for occupational therapy in supportive oncology care. American Journal of Occupational Therapy, 70(4), 7004360030p1-8. https://doi.org/10.5014/ajot.2016.018101 Show abstract
Supportive care in oncology helps people cope with cancer and its psychological, physical, and emotional side effects. However, cancer survivors report dissatisfaction with supportive care and a need for more psychosocial and self-management services. Occupational therapy practitioners represent an integral part of the supportive care team because their scope of practice emphasizes function. Through a focus on function, practitioners address the full spectrum of physical and psychosocial care. Currently, conceptualizations of occupational therapy for cancer survivors often focus solely on physical interventions and, therefore, do not represent the unique involvement of the profession in supportive oncology care. We advocate for a focused framework for occupational therapy practitioners in oncology as experts in function and providers of both physical and psychosocial treatments. Barriers to a focus on function are identified, and strategies are suggested for expanding involvement for the profession in supportive oncology care.
Sposto, R., Keegan, T. H., Vigen, C. L., Kwan, M. L., Bernstein, L., John, E. M., Cheng, I., Yang, J., Koo, J., Kurian, A. W., Caan, B. J., Lu, Y., Monroe, K. R., Shariff-Marco, S., Gomez, S. L., & Wu, A. H. (2016). The effect of patient and contextual characteristics on racial/ethnic disparity in breast cancer mortality. Cancer Epidemiology, Biomarkers & Prevention, 25(7), 1064-1072. https://doi.org/10.1158/1055-9965.EPI-15-1326 Show abstract
Background. Racial/ethnic disparity in breast cancer–specific mortality in the United States is well documented. We examined whether accounting for racial/ethnic differences in the prevalence of clinical, patient, and lifestyle and contextual factors that are associated with breast cancer–specific mortality can explain this disparity.
Methods. The California Breast Cancer Survivorship Consortium combined interview data from six California-based breast cancer studies with cancer registry data to create a large, racially diverse cohort of women with primary invasive breast cancer. We examined the contribution of variables in a previously reported Cox regression baseline model plus additional contextual, physical activity, body size, and comorbidity variables to the racial/ethnic disparity in breast cancer–specific mortality.
Results. The cohort comprised 12,098 women. Fifty-four percent were non-Latina Whites, 17% African Americans, 17% Latinas, and 12% Asian Americans. In a model adjusting only for age and study, breast cancer–specific HRs relative to Whites were 1.69 (95% CI, 1.46–1.96), 1.00 (0.84–1.19), and 0.52 (0.33–0.85) for African Americans, Latinas, and Asian Americans, respectively. Adjusting for baseline-model variables decreased disparity primarily by reducing the HR for African Americans to 1.13 (0.96–1.33). The most influential variables were related to disease characteristics, neighborhood socioeconomic status, and smoking status at diagnosis. Other variables had negligible impact on disparity.
Conclusions. Although contextual, physical activity, body size, and comorbidity variables may influence breast cancer–specific mortality, they do not explain racial/ethnic mortality disparity.
Impact. Other factors besides those investigated here may explain the existing racial/ethnic disparity in mortality.
Kirby, A. V., Little, L. M., Schultz, B., Watson, L. R., Zhang, W., & Baranek, G. T. (2016). Development and pilot of the Caregiver Strategies Inventory. American Journal of Occupational Therapy, 70(4), 7004360010p1-6. https://doi.org/10.5014/ajot.2016.019901 Show abstract
Children with autism spectrum disorder often demonstrate unusual behavioral responses to sensory stimuli (i.e., sensory features). To manage everyday activities, caregivers may implement strategies to address these features during family routines. However, investigation of specific strategies used by caregivers is limited by the lack of empirically developed measures. In this study, we describe the development and pilot results of the Caregiver Strategies Inventory (CSI), a supplement to the Sensory Experiences Questionnaire Version 3.0 (SEQ 3.0; Baranek, 2009) that measures caregivers' strategies in response to their children's sensory features. Three conceptually derived and empirically grounded strategy types were tested: cognitive-behavioral, sensory-perceptual, and avoidance. Results indicated that the CSI demonstrated good internal consistency and that strategy use was related to child age and cognition. Moreover, parent feedback after completing the CSI supported its utility and social validity. The CSI may be used alongside the SEQ 3.0 to facilitate a family-centered approach to assessment and intervention planning.
Roberts, P. S., Mix, J., Rupp, K., Younan, C., Mui, W., Riggs, R. V., & Niewczyk, P. (2016). Using functional status in the acute hospital to predict discharge destination for stroke patients. American Journal of Physical Medicine & Rehabilitation, 95(6), 416-424. https://doi.org/10.1097/PHM.0000000000000412 Show abstract
Objective. The aim of this study was to determine whether functional status, as measured by the AcuteFIM instrument, can be used to predict discharge destination of stroke patients from the acute hospital setting.
Design. A retrospective cohort study was carried out in an urban academic medical center. Data were collected on 481 new-onset stroke patients 18 yrs or older in an acute hospital between January 1 and September 30, 2013. Functional Independence Measure (FIM) instrument data were linked to a subset of 54 patients who received additional services at an inpatient rehabilitation facility. A receiver operator characteristic curve was constructed to validate the predictive ability of the AcuteFIM instrument and to determine the optimal cutoff score associated with discharge to a community setting.
Results. All AcuteFIM items in stroke patients at admission demonstrated strong interitem correlation coefficients (all above 0.6) and high internal consistency (Cronbach α = 0.94). The AcuteFIM total score was positively associated with discharge to the community from the acute hospital (odds ratio, 1.06; 95% confidence interval, 1.05-1.07). Receiver operator characteristic curve analysis generated a c statistic of 0.89 (95% confidence interval, 0.87-0.92), indicating that the AcuteFIM instrument is predictive of patient discharge to the community setting.
Conclusion. This study suggests that the AcuteFIM instrument is a reliable tool that can be used to predict discharge destination from the acute hospital among stroke patients.
Cogan, A. M., Blanchard, J., Garber, S. L., Vigen, C. L., Carlson, M., & Clark, F. A. (2016). Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury. Clinical Rehabilitation, 31(7), 871-880. https://doi.org/10.1177/0269215516660855 Show abstract
Objective. To investigate the efficacy of behavioral or educational interventions in preventing pressure ulcers in community-dwelling adults with spinal cord injury (SCI).
Data Sources. Cochrane, Clinical Trials, PubMed, and Web of Science were searched in June 2016. The search combined related terms for pressure ulcers, spinal cord injury, and behavioral intervention. Each database was searched from its inception with no restrictions on year of publication.
Review Methods. Inclusion criteria required that articles were (a) published in a peer-reviewed journal in English, (b) evaluated a behavioral or educational intervention for pressure ulcer prevention, (c) included community-dwelling adult participants aged 18 years and older with SCI, (d) measured pressure ulcer occurrence, recurrence, or skin breakdown as an outcome, and (e) had a minimum of 10 participants. All study designs were considered. Two reviewers independently screened titles and abstracts. Extracted information included study design, sample size, description of the intervention and control condition, pressure ulcer outcome measures, and corresponding results.
Results. The search strategy yielded 444 unique articles of which five met inclusion criteria. Three were randomized trials and two were quasi-experimental designs. A total of 513 participants were represented. The method of pressure ulcer or skin breakdown measurement varied widely among studies. Results on pressure ulcer outcomes were null in all studies. Considerable methodological problems with recruitment, intervention fidelity, and participant adherence were reported.
Conclusions. At present, there is no positive evidence to support the efficacy of behavioral or educational interventions in preventing pressure ulcer occurrence in adults with SCI.
Cascio, C. J., Lorenzi, J., & Baranek, G. T. (2016). Self-reported pleasantness ratings and examiner-coded defensiveness in response to touch in children with ASD: Effects of stimulus material and bodily location. Journal of Autism and Developmental Disorders, 46(5), 1528-1537. https://doi.org/10.1007/s10803-013-1961-1 Show abstract
Tactile defensiveness, characterized by behavioral hyperresponsiveness and negative emotional responses to touch, is a common manifestation of aberrant sensory processing in autism spectrum disorders (ASD) and other developmental disabilities (DD). Variations in tactile defensiveness with the properties of the stimulus and the bodily site of stimulation have been addressed in adults with self-report of perceived tactile pleasantness, but not in children. We presented three materials (pleasant, unpleasant, social) at three bodily sites and measured both examiner-coded defensiveness and self-reported pleasantness from a group of children with ASD and two comparison groups (one with DD, one with typical development (TD)). The main findings were: (1) children with ASD and DD showed significantly more defensiveness reactions and lower pleasantness ratings than the TD group, with higher variability, (2) there was a double dissociation for the effects of material and bodily site of stimulation: while bodily site predicted behavioral defensiveness, material predicted pleasantness rating. Additionally, it was noted that (3) the most pleasant material and the social touch conditions best distinguished ASD and DD from TD on defensiveness, and (4) within the ASD group, social impairment and defensiveness in bodily sites associated with social touch were positively correlated, suggesting a clinically relevant distinction between social and discriminative touch in ASD.
Hardison, M. E., & Roll, S. C. (2016). Mindfulness interventions in physical rehabilitation: A scoping review. American Journal of Occupational Therapy, 70(3), 7003290030p1-7003290030p9. https://doi.org/10.5014/ajot.2016.018069 Show abstract
A scoping review was conducted to describe how mindfulness is used in physical rehabilitation, identify implications for occupational therapy practice, and guide future research on clinical mindfulness interventions. A systematic search of four literature databases produced 1,524 original abstracts, of which 16 articles were included. Although only 3 Level I or II studies were identified, the literature included suggests that mindfulness interventions are helpful for patients with musculoskeletal and chronic pain disorders and demonstrate trends toward outcome improvements for patients with neurocognitive and neuromotor disorders. Only 2 studies included an occupational therapist as the primary mindfulness provider, but all mindfulness interventions in the selected studies fit within the occupational therapy scope of practice according to the American Occupational Therapy Association's Occupational Therapy Practice Framework: Domain and Process. Higher-level research is needed to evaluate the effects of mindfulness interventions in physical rehabilitation and to determine best practices for the use of mindfulness by occupational therapy practitioners.
Bob Simon has made many wonderful contributions to the philosophy of sport literature. To my mind, however, at the top of that impressive list is his development of the normative theory of sport he called broad internalism or simply interpretivism. The important advance his theory made was showing how we can rely on general principles of athletic conduct to guide our actions in sport in those hard normative cases when the rules fail us, that is when there is no applicable rule to appeal to, or the rules prove to be indeterminate or contradictory, or when the rules give us the wrong sort of guidance. This is an impressive accomplishment, to say the least, and one those of us who work in this normative domain owe Simon a great debt. However, in this paper, I want to explore a different set of hard normative cases in which conflicting conceptions of the point and purpose of sport raise normative quandaries that are not solvable either by appealing to the rules or the general principles of athletic excellence that Simon champions. My aim in pursuing this critical line is not to discredit broad internalism, but rather to nudge it in a more historicist direction that can better handle the kinds of normative dilemmas that crop up when we are not of one mind as to what is the aim of athletic striving.
Leland, N. E., Fogelberg, D., Sleight, A., Mallinson, T., Vigen, C., Blanchard, J., Carlson, M., & Clark, F. (2016). Napping and nighttime sleep: Findings from an occupation-based intervention. American Journal of Occupational Therapy, 70(4), 7004270010p1-7. https://doi.org/10.5014/ajot.2016.017657 Show abstract
Objective. To describe sleeping behaviors and trends over time among an ethnically diverse group of community-living older adults.
Method. A descriptive secondary data analysis of a subsample (n = 217) from the Lifestyle Redesign randomized controlled trial was done to explore baseline napping and sleeping patterns as well as 6-mo changes in these outcomes.
Results. At baseline, the average time sleeping was 8.2 hr daily (standard deviation = 1.7). Among all participants, 29% reported daytime napping at baseline, of which 36% no longer napped at follow-up. Among participants who stopped napping, those who received an occupation-based intervention (n = 98) replaced napping time with nighttime sleep, and those not receiving an intervention (n = 119) experienced a net loss of total sleep (p < .05).
Conclusion. Among participants who stopped napping, the occupation-based intervention may be related to enhanced sleep. More research examining the role of occupation-based interventions in improving sleep is warranted.
Sabatos-DeVito, M., Schipul, S. E., Bulluck, J. C., Belger, A., & Baranek, G. T. (2016). Eye tracking reveals impaired attentional disengagement associated with sensory response patterns in children with autism. Journal of Autism and Developmental Disorders, 46(4), 1319-1333. https://doi.org/10.1007/s10803-015-2681-5 Show abstract
This study used a gap-overlap paradigm to examine the impact of distractor salience and temporal overlap on the ability to disengage and orient attention in 50 children (4-13 years) with ASD, DD and TD, and associations between attention and sensory response patterns. Results revealed impaired disengagement and orienting accuracy in ASD. Disengagement was impaired across all groups during temporal overlap for dynamic stimuli compared to static, but only ASD showed slower disengagement from multimodal relative to unimodal dynamic stimuli. Attentional disengagement had differential associations with distinct sensory response patterns in ASD and DD. Atypical sensory processing and temporal binding appear to be intertwined with development of disengagement in ASD, but longitudinal studies are needed to unravel causal pathways.
Kirby, A. V., Baranek, G. T., & Fox, L. (2016). Longitudinal predictors of outcomes for adults with autism spectrum disorder: Systematic review. OTJR: Occupation, Participation and Health, 36(2), 55-64. https://doi.org/10.1177/1539449216650182 Show abstract
To generate an evidence-based understanding of longitudinal predictors of social outcomes (i.e., employment, social relationships/participation, independent living) of adults with autism spectrum disorder (ASD), we conducted a systematic literature review of publications since 2000. Twelve publications deriving from eight study samples fit inclusion/exclusion criteria for the review. In these publications, statistically significant predictors of social outcomes fell into five categories: (a) personal characteristics, (b) individual functioning, (c) family context, (d) services, and (e) other factors (i.e., peer influence, health status). However, only two studies demonstrated high methodological quality, and only one category of predictors-individual functioning-was identified across multiple study samples. To inform practices for youth with ASD, there remains a need for high-quality outcome research related to adults with ASD to better understand predictors, especially related to environmental factors such as related to the family and services received.
Roll, S. C., Asai, C., & Tsai, J. (2016). Clinical utilization of musculoskeletal sonography involving non-physician rehabilitation providers: A scoping review. European Journal of Physical and Rehabilitation Medicine, 52(2), 253-262. Full text Show abstract
Background. Musculoskeletal sonography use in point-of-care physical medicine and rehabilitation is rapidly expanding, not only by physiatrists, but also by non-physician rehabilitation providers.
Aim. To evaluate the current range, extent and nature of literature and to identify emerging areas of evidence for the use of musculoskeletal sonography involving non-physician rehabilitation providers to guide research and clinical practice.
Design. Scoping Review
Setting. Inpatient, Outpatient, Other
Population. Musculoskeletal conditions
Methods. Five databases were searched and 578 unique abstracts were identified and screened for eligibility. Three raters independently read 68 full texts and 36 articles that reported on applied uses of sonography by non-physician rehabilitation providers were included.
Results. Eighteen studies described direct clinical use, primarily for outcomes measurement (n=12) or as a biofeedback intervention (n=10). Twelve laboratory studies were included that related morphology to patient reports or validated clinical interventions. Six additional studies, although not involving non-physician providers, were included as they presented potential valuable uses that were not noted in the other included studies, such as monitoring bone healing, tendon repair, and evaluation of idiopathic symptom reports or non-specific primary diagnoses.
Conclusion. This review indicates that non-physician rehabilitation providers use sonography for outcomes measurement and biofeedback interventions. Research is needed to evaluate effects of these uses on patient outcomes and to explore additional potential uses for clinical reasoning, treatment planning, and monitoring of tissue healing related to intervention.
Clinical Rehabilitation Impact. Implementation of musculoskeletal sonography by non-physician rehabilitation providers has the potential to be a critically advantageous addition to improve care.
Siebens, H. C., Sharkey, P., Aronow, H. U., Deutscher, D., Roberts, P., Munin, M. C., Radnay, C. S., & Horn, S. D. (2016). Variation in rehabilitation treatment patterns for hip fracture treated with arthroplasty. PM&R, 8(3), 191-207. https://doi.org/10.1016/j.pmrj.2015.07.005 Show abstract
Background. Recommendations for health care redesign often advocate for comparative effectiveness research that is patient-centered. For patients who require rehabilitation services, a first step in this research process is to understand current practices for specific patient groups.
Objective. To document in detail the physical and occupational therapy treatment activities for inpatient hip fracture rehabilitation among 3 patient subgroups distinguished by their early rate of functional recovery between time of surgery to rehabilitation admission.
Design. Multicenter prospective observational cohort, practice-based evidence, study.
Setting. Seven skilled nursing facilities and 11 inpatient rehabilitation facilities across the United States.
Participants. A total of 226 patients with hip fractures treated with hip arthroplasty.
Methods. Comparisons of physical and occupational therapy treatment activities among 3 groups with different initial recovery trajectory (IRT) rates (slower, moderate, faster).
Main Outcome Measure(s). Percent of patients in each IRT group exposed to each physical and occupational therapy activity (exposure), and mean minutes per week for each activity (intensity).
Results. The number of patients exposed to different physical or occupational therapy activities varied within the entire sample. More specifically, among the 3 IRT groups, significant differences in exposure occurred for 44% of physical therapy activities and 39% of occupational therapy activities. More patients in the slower recovery group, IRT 1, received basic activities of daily living treatments and more patients in the faster recovery group, IRT 3, received advanced activities. The moderate recovery group, IRT 2, had some treatments similar to IRT 1 group and others similar to IRT 3 group.
Conclusions. Analyses of practice-based evidence on inpatient rehabilitation of hip fracture patients treated with arthroplasty identified differences in therapy activities among three patient groups classified by IRT rates. These results may enhance physiatrists', other physicians', and rehabilitation teams' understanding of inpatient rehabilitation for these patients and help design future comparative effectiveness research.
Vigen, C. L., Kwan, M. L., John, E. M., Gomez, S. L., Keegan, T. H., Lu, Y., Shariff-Marco, S., Monroe, K. R., Kurian, A. W., Cheng, I., Caan, B. J., Lee, V. S., Roh, J. M., Bernstein, L., Sposto, R., & Wu, A. H. (2016). Validation of self-reported comorbidity status of breast cancer patients with medical records: the California Breast Cancer Survivorship Consortium. Cancer Causes & Control, 27(3), 391-401. https://doi.org/10.1007/s10552-016-0715-8 Show abstract
Purpose. To compare information from self-report and electronic medical records for four common comorbidities (diabetes, hypertension, myocardial infarction, and other heart diseases).
Methods. We pooled data from two multiethnic studies (one case–control and one survivor cohort) enrolling 1,936 women diagnosed with breast cancer, who were members of Kaiser Permanente Northern California.
Results. Concordance varied by comorbidity; kappa values ranged from 0.50 for other heart diseases to 0.87 for diabetes. Sensitivities for comorbidities from self-report versus medical record were similar for racial/ethnic minorities and non-Hispanic Whites, and did not vary by age, neighborhood socioeconomic status, or education. Women with a longer history of comorbidity or who took medications for the comorbidity were more likely to report the condition. Hazard ratios for all-cause mortality were not consistently affected by source of comorbidity information; the hazard ratio was lower for diabetes, but higher for the other comorbidities when medical record versus self-report was used. Model fit was better when the medical record versus self-reported data were used.
Conclusions. Comorbidities are increasingly recognized to influence the survival of patients with breast or other cancers. Potential effects of misclassification of comorbidity status should be considered in the interpretation of research results.
Buch, E. R., Liew, S.-L., & Cohen, L. G. (2016). Plasticity of sensorimotor networks: Multiple overlapping mechanisms. Neuroscientist, 23(2), 185-196. https://doi.org/10.1177/1073858416638641 Show abstract
Redundancy is an important feature of the motor system, as abundant degrees of freedom are prominent at every level of organization across the central and peripheral nervous systems, and musculoskeletal system. This basic feature results in a system that is both flexible and robust, and which can be sustainably adapted through plasticity mechanisms in response to intrinsic organismal changes and dynamic environments. While much early work of motor system organization has focused on synaptic-based plasticity processes that are driven via experience, recent investigations of neuron-glia interactions, epigenetic mechanisms and large-scale network dynamics have revealed a plethora of plasticity mechanisms that support motor system organization across multiple, overlapping spatial and temporal scales. Furthermore, an important role of these mechanisms is the regulation of intrinsic variability. Here, we review several of these mechanisms and discuss their potential role in neurorehabilitation.
Solomon, O., Heritage, J., Yin, L., Maynard, D. W., & Bauman, M. L. (2016). 'What brings him here today?': Medical problem presentation involving children with autism spectrum disorders and typically developing children. Journal of Autism and Developmental Disorders, 46(2), 378-393. https://doi.org/10.1007/s10803-015-2550-2 Show abstract
Conversation and discourse analyses were used to examine medical problem presentation in pediatric care.Healthcare visits involving children with ASD and typically developing children were analyzed. We examined how children's communicative and epistemic capabilities, and their opportunities to be socialized into a competent patient role are interactionally achieved. We found that medical problem presentation is designed to contain a 'pre-visit' account of the interactional and epistemic work that children and caregivers carry out at home to identify the child's health problems; and that the intersubjective accessibility of children's experiences that becomes disrupted by ASD presents a dilemma to all participants in the visit. The article examines interactional roots of unmet healthcare needs and foregone medical care of people with ASD.
Wong, C., & Leland, N. E. (2016). Non-pharmacological approaches to reducing negative behavioral symptoms: A scoping review. OTJR: Occupation, Participation and Health, 36(1), 34-41. https://doi.org/10.1177/1539449215627278 Show abstract
The management of negative behavioral symptoms among residents with dementia is a challenge that nursing homes face in delivering quality care. This study examines evidence documenting non-pharmacological interventions that reduce negative behavioral symptoms among nursing home residents with dementia and the role occupational therapy practitioners have in this area. A scoping review was completed for intervention studies published from 1987 to 2014, targeting negative behavioral symptoms among nursing home residents above 60 years of age with dementia. Interventions were categorized based on the American Occupational Therapy Association (AOTA) Occupational Therapy Practice Framework. Twenty-two studies met the inclusion criteria. Four types of interventions were identified: occupation-based interventions, context and environment interventions, exercise interventions, and daily routine-based interventions. The non-pharmacological interventions were found to align with the scope of occupational therapy. This suggests that occupational therapy practitioners can contribute to the development and evaluation of non-pharmacological interventions aimed to reduce negative behavioral symptoms.
Roberts, P. S., Rizzo, J. R., Hreha, K., Wertheimer, J., Kaldenberg, J., Hironaka, D., Riggs, R., & Colenbrander, A. (2016). A conceptual model for vision rehabilitation. Journal of Rehabilitation Research & Development, 53(6), 693-704. https://doi.org/10.1682/JRRD.2015.06.0113 Show abstract
Vision impairments are highly prevalent after acquired brain injury (ABI). Conceptual models that focus on constructing intellectual frameworks greatly facilitate comprehension and implementation of practice guidelines in an interprofessional setting. The purpose of this article is to provide a review of the vision literature in ABI, describe a conceptual model for vision rehabilitation, explain its potential clinical inferences, and discuss its translation into rehabilitation across multiple practice settings and disciplines.
Aldrich, R. M., & Laliberte Rudman, D. (2016). Situational analysis: A visual analytic approach that unpacks the complexity of occupation. Journal of Occupational Science, 23(1), 51-66. https://doi.org/10.1080/14427591.2015.1045014 Show abstract
Concurrent with the development of a transactional perspective, the notion of “the situation” has increasingly been taken up in occupational science scholarship. Accordingly, research methodologies and approaches that capture the multifaceted elements of situations need to be explored. Situational analysis, pioneered by sociologist and grounded theorist Adele Clarke, shows promise for facilitating inquiries into situations of occupational engagement. In this article we review the situational analysis approach and provide an example of its application to research on the situation of long-term unemployment. In this application, situational mapping illuminated the contradiction of simultaneously being “activated” and “stuck”. Situational analysis helped unpack how this contradiction was shaped within North American contexts. Based on this example and others outside the occupational science literature, we discuss how situational analysis can be a useful tool for fostering critical, socially-responsive, and community-engaged occupational science research.