Erna Blanche PhD, OTR/L, FAOTA

A. Jean Ayres, an occupational therapist and psychologist, developed sensory integration (SI) theory in the early 1960s. Ayres believed that sensory processing impacted development and occupational engagement across the lifespan. She focused on the impact of three proximal sensory systems that develop early in life and influence motor, social-emotional, and cognitive development, constituting the SI theory: tactile, vestibular, and proprioceptive. Based on these ideas, she created one of the earliest standardized test batteries in occupational therapy (the Southern California Sensory Integration Test). She used statistical methods to investigate the relationships among the above-discussed constructs. Initially, Ayres described her theory as applicable to children with learning disabilities (1968, 1972a). However, later, she and other researchers identified SI challenges in other conditions such as autism, mental health disorders, attention deficit disorder, and cerebral palsy. Current research indicates that sensory processing disorders are a concern for various ages and conditions.

Importance. Play has been viewed as a critical occupation supporting health since the founding of occupational therapy, but the complexity of play presents challenges to scholars who study adults. Researchers in occupational science and occupational therapy often address experiential qualities of occupations, including those considered to be play. However, the literature lacks clear descriptions of what constitutes adult play as well as the experiences of adults during preferred activities.

Objective. To contribute to the body of knowledge on the wide range of preferred activities adults in the United States pursue and may perceive as play experiences. We refer to these activities as adult play because they contain experiential qualities of play described in key play literature.

Design. Cross-sectional survey study.

Setting. A 31-item survey, the Daily Occupational Experience Survey–revised (DOESr), was uploaded to Qualtrics for data collection using snowball sampling. The online survey link was distributed to participants aged 18–64 years.

Participants. The survey was completed by 491 participants. Exploratory factor analysis was used to extract the most prevalent patterns of play experiences reported. Internal consistency and content validity were also examined.

Results. The factor analysis yielded an optimal solution of five factors representing distinct patterns of adult play experiences: Creativity–Adventure, Restoration, Deep Engagement, Ludos, and Mastery.

This study examined the response to sensory integration therapy (SIT) in a group of children with learning disabilities. Ninety-two children were divided into two groups of 46. The control group received special education alone. The experimental group received both SIT and special education. Children in both groups were tested with the Southern California Postrotary Nystagmus Test (SCPNT) and language and academic tests. In the experimental group, children who tested below –1.0 standard deviation in the SCPNT (hyporesponsive to vestibular input) were better responders to SIT than children who were not hyporesponders. In the control group, fewer children with hyporesponsiveness to vestibular input benefited from special education compared to those without hyporesponsiveness. Hyporesponsiveness to vestibular input was also linked to language concerns. Children who were hyperresponsive to vestibular input exhibited more generalized sensory-motor problems than children who were hyporesponsive.

Keywords. sensory integration treatment, intervention, sensory processing, vestibular function, postrotary nystagmus, occupational therapy

Aims. There is limited research on the type and quantity of actions (activities) occupational therapy practitioners utilize when providing sensory integration treatment to children with Autism Spectrum Disorders (ASD).

Methods. A coding scheme identifying specific aspects of sensory integration treatment was developed and used to analyze 34 videos of 9 children with ASD, aged between 18 and 56 months, treated by 8 occupational therapists. Occupational therapists providing sensory integration treatment to children with ASD were behaviorally coded and rated using Observer XT, a software package designed for analysis of behavioral processes.

Results. Verbal communications, including offers, positive commands, and feedback, to facilitate engagement were the most frequent actions enacted by therapists. Proprioceptive activities were the most frequent sensory opportunities presented. Therapists received high ratings for sensitivity qualities.

Conclusions. The number of sensory opportunities and interactions the therapists provided suggest concordance with sensory integration treatment components in the clinical setting. General impression ratings indicate engagement between child and therapist may be an important aspect of sensory integration treatment for young children with ASD. Quantification of therapists’ actions can provide insight into the moment-to-moment decision-making and relationships between therapist and child during daily practice of sensory integration treatment.

La prevalencia de trastornos del espectro autista (TEA) ha aumentado de manera alarmante a nivel global, estimando que 1 de cada 54 niños tiene TEA (Maenner et al. 2020). En América Latina las estadísticas son menos claras, pero se estima un número similar. En la mayoría de los países el diagnóstico se realiza varios meses o años después de la aparición de los primeros signos, esto representa un periodo estresante para las familias debido a los comportamientos inusuales de sus hijos y la posible incapacidad o retraso del desarrollo (Schieve et al. 2007). Objetivos. El propósito de este estudio fue explorar la experiencia de las familias con niños con TEA antes e inmediatamente después del diagnóstico. Se analizaron las respuestas de 48 familias de Chile, Argentina, Perú y Guatemala obtenidas mediante una encuesta on-line. Resultados. Los resultados indican que las familias son conscientes de las peculiaridades en el desarrollo de sus hijos antes de recibir un diagnóstico e intervención, muchas de estas peculiaridades tienen características sensoriales. Conclusión. Este estudio valida la experiencia de los padres y a la vez contribuye a la comprensión de los primeros signos de TEA en familias hispanas y el efecto que éstos producen en la dinámica familiar. Muchos de estos primeros signos están relacionados a procesamiento sensorial.

The prevalence of autism spectrum disorders (ASD) has increased alarmingly globally, estimating that 1 in 54 children has ASD (Maenner et al., 2020). In Latin America the statistics are less clear, but a similar number is estimated. In most countries the diagnosis is made several months or years after the appearance of the first signs, this represents a stressful period for families due to the unusual behaviors of their children and the possible disability or developmental delay (Schieve et al. al., 2007). Objectives. The purpose of this study was to explore the experience of families with children with ASD before and immediately after diagnosis. The responses of 48 families from Chile, Argentina, Peru and Guatemala obtained through an online survey were analyzed. Results. The results indicate that families are aware of the peculiarities in the development of their children before receiving a diagnosis and intervention, many of these peculiarities have sensory characteristics. Conclusion. This study validates the parents’ experience and at the same time contributes to the understanding of the first signs of ASD in Hispanic families and the effect that these have on family dynamics. Many of these early signs are related to sensory processing

Purpose. Medically underserved adults with spinal cord injury (SCI) remain at high risk of incurring medically serious pressure injuries even after receiving education in prevention techniques. The purpose of this research is to identify circumstances leading to medically serious pressure injury development in medically underserved adults with SCI during a lifestyle-based pressure injury prevention program, and provide recommendations for future rehabilitation approaches and intervention design.

Methods. This study entailed a qualitative secondary case analysis of treatment notes from a randomized controlled trial. Participants were 25 community-dwelling, medically underserved adults with SCI who developed medically serious pressure injuries during the course of the intervention of the RCT.

Results and conclusions. Among the 25 participants, 40 unique medically serious pressure injuries were detected. The six themes related to medically serious pressure injury development were: (1) lack of rudimentary knowledge pertaining to wound care; (2) equipment and supply issues; (3) comorbidities; (4) non-adherence to prescribed bed rest; (5) inactivity; and (6) circumstances beyond the intervention’s reach. Together, these factors may have undermined the effectiveness of the intervention program. Modifications, such as assessing health literacy levels of patients prior to providing care, providing tailored wound care education, and focusing on equipment needs, have potential for altering future rehabilitation programs and improving health outcomes.

Keywords. Spinal cord injuries, pressure injury, lifestyle, intervention, cultural diversity

Objetivo. Establecer las propiedades psicométricas de una Evaluación de Procesamiento Táctil para niños con autismo, un nuevo instrumento de medición que tiene como objetivo identificar problemas de procesamiento táctil en niños. Método. El estudio piloto y la validación del instrumento Evaluación de Procesamiento Táctil se llevó a cabo a partir de una revisión sistemática de la literatura y encuesta a los expertos en el tema, se retiraron los ítems que los expertos no consideraron que representaban al sistema táctil, quedando un total de 21 ítem. Se determinaron 3 categorías de ítem y la puntuación de la evaluación. Se administró la evaluación a 30 niños de desarrollo típico y 30 niños con diagnóstico de autismo entre 4.0 y 5.11 años. Se analizaron los resultados de ambos grupos comparativamente. Resultados. De los 21 ítem originales, 13 ítem mostraron una diferencia significativa entre puntajes totales obtenidos de niños típicos y niños con diagnóstico de autismo. Se desestimaron 8 ítem por no mostrar una diferencia significativa en los puntajes de los totales obtenidos de los niños típicos y con diagnóstico de autismo. La evidencia generada apoya la inclusión de esta evaluación para suplementar los cuestionarios y entrevistas a los padres y maestros que se utilizan actualmente en la práctica clínica. Se exploran además limitaciones y direcciones futuras de esta investigación.

Goal. To establish the psychometric proprieties of the Tactile Processing Assessment for children with autism. It is a new measuring instrument that aims to identify tactile processing problems in children. Method. The Tactile Processing Assessment was developed and validated from systematic literature review and a survey of experts in the field. All items that experts did not consider representative of the tactile system were removed, leaving a total of 21 items. The items were applied on 3 body parts: face, arms and legs. The assessment was administrated to 30 typically developing children and 30 children diagnosed with autism between the ages of 4.0 and 5.11 years. The results of both groups were analyzed comparatively. Results. From the original 21 items, 13 items showed a significant difference between the total scores obtained from typical children and children diagnosed with autism. 8 items were dismissed because they did not show a significant difference between the total scores obtained from typical children and children with a diagnosis of autism. The evidence generated supports the inclusion of this assessment to supplement the questionnaires and interviews for parents and teachers that are currently used in clinical practice. Further limitations and future direction of this research are explored.

Se realizó una réplica de un estudio anterior1, en el marco del desarrollo de tesis de especialización. El presente trabajo tiene por objetivo determinar el impacto en el progreso de niños con retrasos en el de- sarrollo, del Programa Grupal Interdisciplinario de Intervención Temprana Enriquecido Sensorialmente (ISEEI). Se realizó una revisión retrospectiva de 186 niños con retraso en el desarrollo que iniciaron entre los 18 y los 36 meses, dicho Programa llevado a cabo en Estados Unidos. Los niños fueron evaluados con BayleyIII, y reevaluados entre los 3 a 9 meses posteriores. Los resultados revelan que al momento de la reevaluación la mayoría de los niños alcanzan puntajes escalares superiores a los obtenidos al momento de la admisión, expresando un progreso positivo. El 76% de los niños mostró puntajes más altos en 2 o más áreas reevaluadas. Es posible afirmar que el Programa Grupal de Intervención Temprana Sensorialmente Enriquecido es efectivo. Esta experiencia evidencia la necesidad de enfocar los esfuerzos en la prevención primaria, intervención temprana, detección y diagnóstico precoz. En ese sentido, la creación de progra- mas con estas características, ajustados a las necesidades poblacionales de los países de América Latina podrían contribuir a mejorar la calidad de vida de niños con desafíos en el desarrollo y sus familias.

A replication of an earlier study was carried out, within the framework of the development of specialty thesis. The purpose of this paper is to determine the impact on the progress of children with developmental delays, based on the Group Interdisciplinary Program for Early Sensory Intervention (ISEEI). A retrospective review of 186 clinical charts of children with developmental delays that participated in the program between the age of 18 and 36 months in the United States was completed. The children were evaluated with the Bayley III and reevaluated 3 to 9 months later. The results revealed that at re-evaluation, most children reach higher scores than when admitted. Seventy six percent of the children selected showed higher scores in 2 or more areas. It is possible to affirm that the Sensory-Enriched Early Intervention Group Program for Children with Developmental Disabilities is highly effective. This experience demonstrates the need to focus efforts on primary prevention, early intervention, detection and early diagnosis. In that sense, the creation of programs with these characteristics, adjusted to the needs of the population of Latin American countries, could contribute to improving the quality of life of children with development challenges and their families.

La evidencia científica acerca de la efectividad de la intervención en integración sensorial es lo que valida la práctica clínica, de ahí la importancia de sistematizar los procesos de evaluación. En Latinoamérica, la validez y confiabilidad de la mayoría de las evaluaciones no han sido estableci- das mediante estudios empíricos, lo que dificulta el análisis, diseño y medición de la efectividad de la intervención. El objetivo central del presente trabajo es medir la efectividad de herramientas de evaluación durante la intervención de terapia ocupacional en una población latinoamericana. Se evaluaron 27 niños de Argentina de 3.0 a 11.5 años, con MFUN (Escala de Función y Participa- ción) (Miller, 2006), Beery VMI (Prueba de Desarrollo de Integración Visual-Motor) (Beery y Beery, 2010), y Perfil Sensorial II (Dunn, 2014). Los resultados de MFUN (Escala de Función y Participa- ción) (Miller, 2006) y Beery VMI (Prueba de Desarrollo de Integración Visual-Motor) (Beery y Beery, 2010) mostraron cambios positivos en los usuarios, lo que podría evidenciar que pese a no estar estudiadas en la población argentina, podrían ser sensibles a los avances de los usuarios en trata- miento. Por el contrario, el Perfil Sensorial II (Dunn, 2014), aunque no es capaz de mostrar progre- sos, parece evidenciar cambios en lo que los padres/cuidadores son capaces de percibir respecto del desempeño del niño ante las demandas y desafíos sensoriales del entorno. Esta tendencia se observó también en una muestra de 7 niños en Estados Unidos, mismo país de la población en la que fue validado el instrumento. Por lo que, si bien el Perfil Sensorial aporta información valiosa, es visible la necesidad de utilizar diferentes herramientas de evaluación que complementen la observación clínica y la entrevista a la familia.

Scientific evidence about the effectiveness of sensory integration intervention validates clinical practice, hence the importance of systematizing the evaluation processes. In Latin America, the validity and reliability of most evaluations have not been established through empirical studies, making it difficult to analyze, design and measure the effectiveness of different interventions. The objective of this paper is to measure the effectiveness of three evaluation tools during the occupational therapy intervention in an Argentine population. Children from Argentina from 3.0 to 11.5 years old were evaluated using the M-FUN (Function and Participation Scales) (Miller, 2006), the Beery VMI (Beery-Buktenica Developmental Test of Visual-Motor Integration) (Beery & Beery, 2010) and the Sensory Profile II (Dunn, 2014). The results of the M-FUN (Function and Participation Scales) (Miller, 2006) and the Beery VMI (Beery-Buktenica Developmental Test of Visual-Motor Integration) (Beery & Beery, 2010) showed positive changes in the users despite the fact that they have not being studied in Argentine samples. Thus, they could be sensitive to the progress as a result of therapeutic intervention. On the other hand, the Sensory Profile Il (Dunn, 2014), although not designed to measure progress, seems to show changes in what parents/caregivers are able to perceive about the child's performance in response to the sensory demands and challenges in different environments. This trend was also observed in a sample of 7 children in the United States where the instrument was developed. Therefore, although the Sensory Profile provides valuable information, there is a need to use performance based measures that supplement data gathered by family interviews and parental questionnaires.

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.

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.

Las dificultades de procesamiento sensorial en niños con Trastorno del Espectro Autista (TEA) están ampliamente descritos en la literatura principalmente mediante el uso de encuestas a padres y observaciones. Con menor frecuencia se han descrito las dificultades de procesamiento sensorial en niños menores de 3 años de edad que han sido posteriormente diagnosticados con TEA. Este estudio retrospectivo está basado en 84 niños (28 diagnosticados con TEA, 28 con retraso en el desarrollo, y 28 niños con desarrollo típico) entre 18 y 36 meses de edad que asistieron a un programa de intervención temprana y cuyos padres completaron el cuestionario Infant Toddler Sensory Profile (Dunn & Daniels, 2002). Los resultados obtenidos en esta encuesta revelan que los niños menores de edad con TEA muestran un patrón específico de procesamiento sensorial en comparación con niños con otros retrasos en el desarrollo.

La utilización de observaciones que proporcionan información acerca del funcionamiento sensorio-motor relacionado a procesamiento sensorial es común en la práctica clínica. Un grupo de observaciones, llamadas observaciones clínicas por A.J. Ayres ayuda a diagnosticar disfunciones sensoriales aunque no existen normas desarrolladas en Chile, ni su validez o confiabilidad establecida estadísticamente para su utilización. Para normar estas pruebas en Chile se entrenaron 4 evaluadores quienes recolectaron datos de niños entre 5 y 7.11 años de edad: 90 típicos y 26 identificados con problemas de procesamiento sensorial. Este estudio proporciona datos preliminares sobre 5 pruebas relacionadas a control postural y planeamiento motor: equilibrio en un pie (ojos cerrados y ojos abiertos), extensión antigravitatoria, flexion antigravitatoria, secuenciación de dígitos, y diadochokinesis. Los resultados indican que estas pruebas se pueden utilizar para diagnosticar niños con disfunciones sensorio-motoras en la práctica clínica e investigación.

Clinical observations that provide information about sensory-motor performance related to sensory processing, are commonly used in clinical practice. A group of these observations, known as clinical observations by A. J. Ayres, help diagnose sensory related dysfunctions even when normative data and statistically established validity and reliability are not available for the Chilean children. In order to develop normative data, we trained 4 independent assessors who collected data on 90 typically developing children 5 to 7.11 years of age and 26 children identified as presenting with sensory processing problems. The present study provides preliminary data about 5 observations that relate to postural control and motor planning: Standing on one foot (eyes open and closed), extensión against gravity, flexion against gravity, sequential finger touching and diadochokinesis. The results of this study indicate that these observations can help diagnose children with sensory-motor dysfunctions and be utilized for clinical applications and research.

Objective. Prior research has documented caregiving difficulties in families of children with autism spectrum disorder (ASD). However, Latino families may encounter unique challenges. The purpose of this study was to understand the caregiving experiences of Latino families with children with ASD, including daily activities, coping strategies, and service utilization.

Method. Fifteen Latino parents of children with ASD were interviewed. The interviews were transcribed for analysis to identify themes of experiences unique to this population.

Results. Latino families of children with ASD encounter many similar issues as non-Latino families but also unique issues that affect service utilization. Four themes were identified: dealing with the diagnosis, dealing with stigma and isolation from family and community, understanding the role of mothers in changing family routines, and utilizing services.

Conclusion. To meet the unique needs of Latino families, services need to be provided in culturally sensitive context that address children's needs within family units.

Pressure ulcers (PrUs) are a major burden to patients with spinal cord injury (SCI), affecting their psychological, physical, and social well-being. Lifestyle choices are thought to contribute to the risk of developing PrUs. This article focuses on the interaction between lifestyle choices and the development of PrUs in community settings among participants in the University of Southern California-Rancho Los Amigos National Rehabilitation Center Pressure Ulcer Prevention Study (PUPS II), a randomized controlled trial of a lifestyle intervention for adults with SCI. We conducted a secondary cross-case analysis of treatment notes of 47 PUPS II participants and identified four patterns relating PrU development to lifestyle changes: positive PrU changes (e.g., healing PrUs) with positive lifestyle changes, negative or no PrU changes with positive lifestyle changes, positive PrU changes with minor lifestyle changes, and negative or no PrU changes with no lifestyle changes. We present case studies exemplifying each pattern.

Implementation into real-world practice of interventions previously studied in randomized controlled trials is an ongoing challenge. In this article, we describe the methodology we used for the first phase of a project for the implementation and outcomes assessment of an occupational therapy pressure ulcer prevention intervention for people with spinal cord injury in the Veterans Health Administration. This first phase of the project was guided by practice-based evidence research methodology and resulted in an intervention manual tailored to meet the needs of Veterans and the establishment of a system for documenting and monitoring care processes, patient characteristics, and intervention outcomes. This system, in turn, will provide the data-gathering template for the next phase in which the beneficial effects of the intervention will be assessed. We conclude by recommending that clinicians explore the utility of this approach for the implementation of other novel interventions.

This article describes the development of the Adult Sensory Processing Scale (ASPS), a sensory processing questionnaire for adults. The ASPS measures self-reported responses to input from distinct sensory systems and is intended to be sensitive to individual differences in the adult population. ASPS construction involved two phases: item development and instrument construction. During item development, content validity of 71 items was assessed by means of expert ratings. During instrument construction, items were evaluated using data from an online survey of 491 adults. Exploratory factor analysis and Rasch analysis yielded an optimal solution of eight factors representing vestibular overresponsiveness, auditory overresponsiveness, visual overresponsiveness, social tactile overresponsiveness, proprioceptive seeking, general underresponsiveness, vestibular—proprioceptive underresponsiveness affecting postural control, and vestibular overresponsiveness—intolerance to movement. The final ASPS contains 39 items and demonstrates acceptable internal consistency, strong content validity, and adequate construct validity.

Objective. We investigated sensory integration (SI) function in children with cochlear implants (CIs).

Method. We analyzed deidentified records from 49 children ages 7 mo to 83 mo with CIs. Records included Sensory Integration and Praxis Tests (SIPT), Sensory Processing Measure (SPM), Sensory Profile (SP), Developmental Profile 3 (DP-3), and Peabody Developmental Motor Scales (PDMS), with scores depending on participants' ages. We compared scores with normative population mean scores and with previously identified patterns of SI dysfunction.

Results. One-sample t tests revealed significant differences between children with CIs and the normative population on the majority of the SIPT items associated with the vestibular and proprioceptive bilateral integration and sequencing (VPBIS) pattern. Available scores for children with CIs on the SPM, SP, DP-3, and PDMS indicated generally typical ratings.

Conclusion. SIPT scores in a sample of children with CIs reflected the VPBIS pattern of SI dysfunction, demonstrating the need for further examination of SI functions in children with CIs during occupational therapy assessment and intervention planning.

Background. Randomized trials of complex, non-pharmacologic interventions implemented in home and community settings, such as the University of Southern California (USC)-Rancho Los Amigos National Rehabilitation Center (RLANRC) Pressure Ulcer Prevention Study (PUPS), present unique challenges with respect to (1) participant recruitment and retention, (2) intervention delivery and fidelity, (3) randomization and assessment, and (4) potential inadvertent treatment effects.

Purpose. We describe the methods employed to address the challenges confronted in implementing PUPS. In this randomized controlled trial, we are assessing the efficacy of a complex, preventive intervention in reducing the incidence of, and costs associated with, the development of medically serious pressure ulcers in people with spinal cord injury.

Methods. Individuals with spinal cord injury recruited from RLANRC were assigned to either a 12-month preventive intervention group or a standard care control group. The primary outcome is the incidence of serious pressure ulcers with secondary endpoints including ulcer-related surgeries, medical treatment costs, and quality of life. These outcomes are assessed at 12 and 24 months after randomization. Additionally, we are studying the mediating mechanisms that account for intervention outcomes.

Results. PUPS has been successfully implemented, including recruitment of the target sample size of 170 participants, assurance of the integrity of intervention protocol delivery with an average 90% treatment adherence rate, and enactment of the assessment plan. However, implementation has been replete with challenges. To meet recruitment goals, we instituted a five-pronged approach customized for an underserved, ethnically diverse population. In intervention delivery, we increased staff time to overcome economic and cultural barriers to retention and adherence. To ensure treatment fidelity and replicability, we monitored intervention protocol delivery in accordance with a rigorous plan. Finally, we have overcome unanticipated assessment and design concerns related to (1) determining pressure ulcer incidence/severity, (2) randomization imbalance, and (3) inadvertent potential control group contamination.

Limitations. We have addressed the most daunting challenges encountered in the recruitment, assessment, and intervention phases of PUPS. Some challenges and solutions may not apply to trials conducted in other settings.

Conclusions. Overcoming challenges has required a multifaceted approach incorporating individualization, flexibility, and persistence, as well as the ability to implement needed mid-course corrections.

Randomized controlled trials (RCTs) are considered the criterion standard in research design for establishing treatment efficacy. However, the rigorous and highly controlled conditions of RCTs can be difficult to attain when conducting research among individuals living with a confluence of disability, low socioeconomic status, and being a member of a racial/ethnic minority group, who may be more likely to have unstable life circumstances. Research on effective interventions for these groups is urgently needed, because evidence regarding approaches to reduce health disparities and improve health outcomes is lacking. In this methodologic article, we discuss the challenges and lessons learned in implementing the Lifestyle Redesign for Pressure Ulcer Prevention in Spinal Cord Injury study among a highly disadvantaged population. These issues are discussed in terms of strategies to enhance recruitment, retention, and intervention relevance to the target population. Recommendations for researchers seeking to conduct RCTs among socioeconomically disadvantaged, ethnically diverse populations are provided.

Objective. We developed an observational tool, the Comprehensive Observations of Proprioception (COP), for identifying proprioceptive processing issues in children with developmental disabilities.

Method. Development of the COP underwent three phases. First, we developed items representing proprioceptive functions on the basis of an extensive literature review and consultation with occupational therapists. We then established interrater reliability and content, construct, and criterion validity. Finally, we completed a factor analysis of COP ratings of 130 children with known developmental disabilities.

Results. Adequate validity and reliability were established. Factor analysis revealed a four-factor model that explained the underlying structure of the measure as it was hypothesized.

Conclusion. The COP is a valid criterion-referenced short observational tool that structures the clinician’s observations by linking a child’s behaviors to areas identified in the literature as relevant to proprioceptive processing. It takes 15 min to administer and can be used in a variety of contexts, such as the home, clinic, and school.

Objectives. We examined whether children with and without autism spectrum disorder (ASD) differ in autonomic activity at rest and in response to auditory stimuli and whether behavioral problems related to sounds in everyday life are associated with autonomic responses to auditory stimuli.

Method. We measured skin conductance (SC) at rest and in response to auditory stimuli as well as behavioral responses using the Sensory Processing Measure (SPM) Home Form. Participants were 25 children with ASD and 25 typically developing (TD) children, aged 5–12 yr.

Results. The ASD group had significantly higher resting SC and stronger SC reactivity to tones than the TD group. Correlations between SC and SPM indicated that more severe auditory behavioral difficulties were associated with higher sympathetic activation at rest and stronger sympathetic reactivity to sound.

Conclusion. High sympathetic reactivity to sound may underlie the difficult behavioral responses to sound that children with ASD often demonstrate.

Objective. Sensory processing difficulties among children with autism spectrum disorders (ASD) have been extensively documented. However, less is known about this population’s ability to process proprioceptive information.

Method. We used the Comprehensive Observations of Proprioception (COP; Blanche, Bodison, Chang, & Reinoso, in press) to describe the proprioceptive difficulties experienced by children with ASD. A sample of 32 children with ASD, 26 children with developmental disabilities excluding ASD, and 28 typically developing control children were studied using the COP.

Results. Children with ASD present with proprioceptive processing difficulties that are different from those of children with developmental disabilities and their typically developing counterparts. Specific data, potential clinical applications, and directions for future research are described.

Conclusion. Results suggest that the COP has useful clinical research applications. Further assessment of psychometric properties, clinical utility, and meaningful differences among diverse clinical populations are needed.

The manualization of a complex occupational therapy intervention is a crucial step in ensuring treatment fidelity for both clinical application and research purposes. Toward the latter end, intervention manuals are essential for ensuring trustworthiness and replicability of randomized controlled trials that aim to provide evidence of the effectiveness of occupational therapy. In this article, we review the literature on the process of intervention manualization. We then illustrate the prescribed steps through our experience in implementing the University of Southern California/Rancho Los Amigos National Rehabilitation Center's collaborative Pressure Ulcer Prevention Project. In this research program, qualitative research provided the initial foundation for manualization of a multifaceted occupational therapy intervention designed to reduce the incidence of medically serious pressure ulcers in adults with spinal cord injury.

Objective. The objectives of the study were to sensitize practitioners working with individuals with spinal cord injury (SCI) to the complex life circumstances that are implicated in the development of pressure ulcers (PrUs) and to document the ways that interventions can be adapted to target individual needs.

Methods. This study was a content analysis of weekly fidelity/quality control meetings that were undertaken as part of a lifestyle intervention for PrU prevention in community-dwelling adults with SCI.

Results. Four types of lifestyle-relevant challenges to ulcer prevention were identified: risk-elevating life circumstances, communication difficulties, equipment problems, and individual personality issues. Intervention flexibility was achieved by changing the order of treatment modules, altering the intervention content or delivery approach, or going beyond the stipulated content.

Conclusion. Attention to recurrent types of individual needs, along with explicit strategies for tailoring interventions published in a manual, has the potential to enhance PrU prevention efforts for adults with SCI.

Building on established relationships between the constructs of sensory integration in typical and special needs populations, in this retrospective study we examined patterns of sensory integrative dysfunction in 273 children ages 4–9 who had received occupational therapy evaluations in two private practice settings. Test results on the Sensory Integration and Praxis Tests, portions of the Sensory Processing Measure representing tactile overresponsiveness, and parent report of attention and activity level were included in the analyses. Exploratory factor analysis identified patterns similar to those found in early studies by Ayres (1965, 1966a, 1966b, 1969, 1972b, 1977, & 1989), namely Visuodyspraxia and Somatodyspraxia, Vestibular and Proprioceptive Bilateral Integration and Sequencing, Tactile and Visual Discrimination, and Tactile Defensiveness and Attention. Findings reinforce associations between constructs of sensory integration and assist with understanding sensory integration disorders that may affect childhood occupation. Limitations include the potential for subjective interpretation in factor analysis and inability to adjust measures available in charts in a retrospective research.

The overall goal of this study was to determine if parasympathetic nervous system (PsNS) activity is a significant biomarker of sensory processing difficulties in children. Several studies have demonstrated that PsNS activity is an important regulator of reactivity in children, and thus, it is of interest to study whether PsNS activity is related to sensory reactivity in children who have a type of condition associated with sensory processing disorders termed sensory modulation dysfunction (SMD). If so, this will have important implications for understanding the mechanisms underlying sensory processing problems of children and for developing intervention strategies to address them. The primary aims of this project were: (1) to evaluate PsNS activity in children with SMD compared to typically developing (TYP) children, and (2) to determine if PsNS activity is a significant predictor of sensory behaviors and adaptive functions among children with SMD. We examine PsNS activity during the Sensory Challenge Protocol; which includes baseline, the administration of eight sequential stimuli in five sensory domains, recovery, and also evaluate response to a prolonged auditory stimulus. As a secondary aim we examined whether subgroups of children with specific physiological and behavioral sensory reactivity profiles can be identified. Results indicate that as a total group the children with severe SMD demonstrated a trend for low baseline PsNS activity, compared to TYP children, suggesting this may be a biomarker for SMD. In addition, children with SMD as a total group demonstrated significantly poorer adaptive behavior in the communication and daily living subdomains and in the overall Adaptive Behavior Composite of the Vineland than TYP children. Using latent class analysis, the subjects were grouped by severity and the severe SMD group had significantly lower PsNS activity at baseline, tones and prolonged auditory. These results provide preliminary evidence that children who demonstrate severe SMD may have physiological activity that is different from children without SMD, and that these physiological and behavioral manifestations of SMD may affect a child's ability to engage in everyday social, communication, and daily living skills.

Purpose. The aim of this article is to identify overarching principles that explain how daily lifestyle considerations affect pressure ulcer development as perceived by adults with spinal cord injury (SCI).

Method. Qualitative in-depth interviews over an 18-month period with 20 adults with spinal injury and a history of pressure ulcers were conducted using narrative and thematic analyses.

Results. Eight complexly interrelated daily lifestyle principles that explain pressure ulcer development were identified: perpetual danger; change/disruption of routine; decay of prevention behaviors; lifestyle risk ratio; individualization; simultaneous presence of prevention awareness and motivation; lifestyle trade-off; and access to needed care, services and supports.

Conclusions. Principles pertaining to the relationship between in-context lifestyle and pressure ulcer risk underscore previous quantitative findings, but also lead to new understandings of how risk unfolds in everyday life situations. Pressure ulcer prevention for community-dwelling adults with SCI can potentially be enhanced by incorporating principles, such as the decay of prevention behaviors or lifestyle trade-off, that highlight special patterns indicative of elevated risk. The identified principles can be used to theoretically drive future research or to guide innovative lifestyle-focused intervention approaches. Public policies that promote short-term preventive interventions at critical junctures throughout a person's life should be considered.

Individuals with spinal cord injury (SCI) use wheelchairs for mobility and for full participation in their daily activities. The use of wheelchairs, however, can increase the risk of pressure ulcers. This study focused on wheelchair users’ perceptions of the interplay between their wheeled mobility and the development of pressure ulcers by performing a secondary analysis of data gathered during a 2-year ethnographic study of 20 community-dwelling adults with SCI. Data from a subset of these individuals are described; each of these stories contains a pressure ulcer risk episode related to wheeled mobility or cushion use. Identified risk episodes were associated with wheelchair selection, wheelchair adjustment, habituation to new equipment, lifestyle choices, and challenging life contexts. Examples highlighted the crucial relationship between individuals’ minute-to-minute decision-making and pressure ulcer risk.

During the past century, numerous researchers and theorists have argued that human lives are largely shaped by the nonreflective realm of habit. Beyond this observation, however, scholarly conceptualizations of habit are widely divergent, ranging from neural-level to culturally saturated macro-level constructs. To clarify the multiple ways that habit has been construed and is related to rehabilitation, the authors present a typology of nine categories of habits: habit as tic; habit as neural networks; habit as conditioned responses; habit as addiction; habit as single, everyday activities; habit as routine; habit as custom, ritual, rite, or ceremony; habit as character; and habit as habitus. Although these categories overlap and share common properties, their conceptual features differ along several dimensions. Each category offers a distinct perspective from which to understand the role of habit in the lives of clients undergoing rehabilitation, which the authors illustrate using examples from the Pressure Ulcer Prevention Study (PUPS), a qualitative study on the contextual factors that lead to serious recurrent pressure ulcers in people with spinal cord injuries. The authors argue that habit is a ubiquitous, protean force that presents itself in many interlinking forms, steering the course of human lives in both health-promoting and destructive directions. To have the greatest effect on health and participation, rehabilitation professionals must examine the nuanced ways that habit may operate both in the lives of clients and in professional practice.

The authors provide a simplified version of the theory of Sensory Integration with practical applications for both the lay person and practicing professionals. This book can serve as a quick reference guide for parents of children with sensory processing difficulties and for the general population for recognizing their own and others sensory processing styles throughout the lifespan.

Creativity is widely recognized as a powerful and enriching element of people’s lives. However, the actual experience of creativity is seldom described in occupational science or occupational therapy literature. This research paper focuses on the presence of creativity as a process-oriented, intrinsically motivated activity in the lives of 22 individuals. The study included three methods of data collection: Daily Occupational Experience Survey (DOES), intensive interviews, and participant observations. The participants in this study described the experience of creativity as occurring often during their daily occupations, not only during the performance of primary and secondary or enfolded occupations but also while engaging in extraordinary occupations, when the experience of creating was identified a spiritual or transcendental experience. The three themes that emerged from the data are creativity as a process-oriented experience occurring during the performance of daily occupations, the experience of creativity occurring during primary and secondary occupations, and the manifestation of creativity as a transcendental process. This last type of creative expression often served the purpose of selfactualization.

Leading sensory integration researchers present state-of-the-art research and clinical insights on sensory integration theory and practice. Comprehensive information is presented on the treatment of Sensory Modulation Dysfunction, high-risk infants and young children, visual deficits, cerebral palsy, autism, institutionalized children, and Fragile X Syndrome. Current information on both clinical testing and standardized testing is presented. Learn how the latest neurological research supports and influences SI theory and practice.

This paper explores the interaction between the philosophy of occupational therapy, the science of occupation and the regional ideology of a specific geographical area, and proposes two models to depict the relationship. One model focuses on the interaction between daily occupational therapy practice in a specific geographical region and the international influences on that practice. The international influences include the effect of occupational science. The second model focuses on the relationship between the philosophy of occupational therapy, occupational science and regional ideology. It concludes by showing the importance of developing a global identity through the importation of knowledge from evolving sciences in industrialized countries at the same time as basic and applied knowledge is developed in the scientific community of a geographic region.

This article raises questions about the ways culture affects the nature of health care services. By examining the life story of Alma, a Central American woman who has a daughter with disabilities; her interactions with health care providers; and my own assumptions about cultural differences, I note the impact of cultural differences on coping and adaptation in Alma and in the health care system when working with poor, non-English-speaking clients.