Sofronia M. Ringold BA, CCRP(she/her/hers)

Neuro-occupation was developed to study the relationship between the nervous system and occupation. Pragmatic implications of neuro-occupation have not been previously summarized. This study aimed to determine how neuro-occupation has been defined, applied across relevant fields, and evolved over time. We performed a scoping review following the Arksey and O’Malley framework. Twenty-five works related to neuro-occupation published between 1997 and 2020 were included. We found that neuro-occupation evolved from utilization primarily in the United States to an international term applied to different clinical populations. Common themes were: (a) the reciprocal relationship between the nervous system and occupations; (b) the Intention, Meaning, and Perception (IMP) model of neuro-occupation; and (c) pragmatic implications for occupational therapy practice and interventions. We suggest an updated definition of neuro-occupation. In addition, we contend that although the term neuro-occupation was developed in response to historical debates in occupational therapy, continued use creates more confusion than clarity.

While exteroceptive sensory processing is a hallmark of autism spectrum disorder, how interoceptive processing may impact and contribute to symptomatology remains unclear. In this comprehensive narrative review on interoception in autism, we discuss: 1) difficulties with assessing interoception; 2) potential interoceptive differences; 3) interactions between neural systems for interoception, attention, sensorimotor processing, and cognition; and 4) potential differences in neural circuits involved in interoception. In general, there are mixed findings on potential interoception differences in autism. Nevertheless, some data indicate differences in integration of interoceptive and exteroceptive information may contribute to autism symptomatology. Neurologically, interoceptive processing in autism may be impacted by potential differences in the development, morphometry, and connectivity of key interoceptive hubs (vagal processing, brainstem, thalamus, insula), though much work is needed on this topic.

Prior studies show differences in empathy and affect-recognition ability between those with autism spectrum disorder (ASD) and typically developing (TD) individuals. Autistic individuals also exhibit increased behavioral, gastrointestinal, and sleep issues. In the current study, we explored the differences in empathy and affect recognition between the ASD and TD groups; and we investigated their associations with conditions co-occurring in ASD. A total of 54 TD and 56 ASD children (8–17 years) were included. As compared to the TD group, the ASD group showed lower scores for affect recognition and perspective taking (PT) and higher scores for personal distress (PD). Interestingly, results from hierarchical linear regressions suggested that disparities in the PD and PT between the groups were primarily attributable to attenuated levels of alexithymia, rather than being mediated by the presence of an autism diagnosis. Differences in affect-recognition ability, however, were mediated by both an autism diagnosis and alexithymia. We also found significant correlations between empathy and affect recognition and measures of related conditions common in ASD. Alexithymia, hence, contributes to difficulties in empathy while both alexithymia and autism are associated with affect-recognition ability in ASD. Additionally, the association between affect recognition and empathic ability with co-occurring conditions in ASD needs to be considered during assessments and interventions.

Keywords. autism; alexithymia; empathy; affect recognition; anxiety; sleep; gastrointestinal issues

Developmental Coordination Disorder (DCD) is one of the least studied and understood developmental disorders. One area that has been minimally investigated in DCD is potential issues with sensory modulation. Further, in other neurodevelopmental disorders (e.g., autism spectrum disorder (ASD)) sensory modulation is related to many other challenges (e.g., social issues, repetitive behaviors, anxiety); however, such potential relationships in children with DCD have been largely unexplored. The purpose of this study is to explore sensory modulation differences in DCD and to understand the relationships between sensory modulation and social emotional measures, behavior, and motor skills in DCD in comparison to ASD and typically developing (TD) peers. Participants (aged 8–17) and their caregivers (DCD, N = 26; ASD, N = 57; and TD, N = 53) completed behavioral and clinical measures. The results indicated that 31% of the DCD group showed sensory modulation difficulties, with the DCD group falling between the ASD and TD groups. In the DCD group, sensory modulation was significantly associated with anxiety, empathic concern, repetitive behaviors, and motor skills. Data are compared to patterns seen in ASD and TD groups and implications for interventions are discussed.

Keywords. developmental coordination disorder; sensory processing; autism spectrum disorder; behavior; social emotional; motor skills; dyspraxia; empathy; sensory modulation; anxiety

Objectives. Anxiety and anticipatory stressors are commonly experienced by children visiting the Pediatric Emergency Department (PED), but little research exists that addresses the efficacy of interventions to decrease this stress. This one-sample pretest-postest pilot study gathered preliminary data on the feasibility and effectiveness of utilizing audiobooks to reduce fear and state anxiety in children in the PED.

Methods. Participants were 131 children in kindergarten through 8th grade (M = 9.4 years, 54% female), triaged urgent or emergent, presenting to the PED. Participants self-reported fear (Children's Fear Scale) and state anxiety (modified State-Trait Anxiety Inventory for Children; mSTAIC) before and after listening to an age-appropriate audiobook (two options). Data regarding patient experience were also collected. Paired samples t-test was used to examine pre–post intervention changes in fear and state anxiety.

Results. Significant, albeit small, improvements in fear and the mSTAIC states of nervous, calm, happy, and relaxed were found after use of the audiobook (Cohen's d_z = 0.22–0.35). Small, yet significant correlations were found between child age/grade level and improvements in fear and in the mSTAIC states of scared and relaxed, suggesting that the audiobook was more beneficial for older participants. Over 60% of participants liked the audiobook content “a lot” as well as enjoyed listening to the audiobook “a lot.” Without prompting, 15% of participants requested to listen to an additional audiobook.

Conclusions. Listening to an audiobook is feasible and could be effective in decreasing fear and state anxiety for children during a waiting period in the PED. The technology is low-cost, simple, and portable. The results of this study should be interpreted with prudence due to the lack of a control group and results that, although significant, were modest based on effect size conventions; future studies should explore the impact of audiobooks on patient stress with an expanded sample size and control group.

Keywords. distraction, environment, pediatrics, audiobook, fear, state anxiety, emergency department (ED)

Due to COVID-19 related conference cancellation, this peer-reviewed abstract and/or presentation was disseminated on 4/30/2020 to the PAS 2020 Meeting Program Guide.

Background. Anxiety and anticipatory stressors are commonly experienced by children visiting the pediatric Emergency Department (PED). Little research exists that addresses the efficacy of interventions to decrease anticipatory anxiety, stress, and fear in the PED. Thus far, research has examined the use of ambient lighting, music, aromatherapy, Child Life, and hospital clowning, with varying success.

Objective. This pilot study sought to gather preliminary data on the feasibility and effectiveness of utilizing audiobooks to reduce fear and state anxiety in children in the PED.

Design/Methods. Participants were 131 children in kindergarten through 8th grade, triaged urgent or emergent, presenting to the PED. During a waiting gap in care, participants self-reported fear (Children's Fear Scale) and state anxiety (modified State-Trait Anxiety Inventory for Children; mSTAIC) before and after listening to an age-appropriate audiobook (two options). Data regarding patient experience were also collected. Paired samples t-test was used to examine pre-post intervention changes in fear and state anxiety.

Results. Significant mean decreases in fear and in the mSTAIC states of nervous, calm, happy, and relaxed were found after use of the audiobook. Child age and grade level were significantly correlated with pre-post differences in fear and in the mSTAIC states of scared and relaxed, suggesting that the audiobook was more beneficial for older participants. Over 60% of participants liked the audiobook content 'a lot' as well as enjoyed listening to the audiobook 'a lot'. Despite 80 participants experiencing medically-related interruptions during the audiobook experience, over 80% reported only being bothered a little or not at all by the interruption. Without prompting, 15% of participants requested to listen to an additional audiobook.

Conclusion(s). Listening to an audiobook is feasible and indicates preliminary effectiveness in decreasing fear and state anxiety for children during a waiting period in the PED. This is a low cost, simple, portable intervention with the potential to improve patient experience in the PED.

Due to COVID-19 related conference cancellation, this peer-reviewed abstract and/or presentation was disseminated on 4/30/2020 to the PAS 2020 Meeting Program Guide.

Background. Virtual Reality (VR) Simulation is an immersive, cost-effective simulation training modality for resuscitation training in pediatric emergency medicine. Because VR programming must follow a strict algorithm, teaching resuscitation algorithms should be an advantage. However, no evidence exists yet in the literature surrounding VR and resuscitation training.

Objective. To determine if a single VR simulation session improves adherence to an ABC algorithm for pediatric status epilepticus (status)

Design/Methods. This was a pilot cohort study among pediatric interns during their emergency department (ED) rotation, scheduled for 1 month during their year. VR training for status management emphasizing Airway-Breathing-Circulation (ABC) added to ED orientation each month in 2018-2019; this included a VR simulation in which interns managed a decompensating status infant. A manikin-based simulation with an identical status scenario was conducted in the winter to evaluate performance; half the interns had VR training already(Intervention) by winter and the other half did not (Comparison). Outcome variables collected during the manikin simulation were time-to-critical actions the number of actions per ABC or anti-epileptic(d) category. Primary outcomes were: suctioning(A), oxygenation(B), IV access(C), or lorazepam order(D). Actions during the manikin simulation were video reviewed and categorized using by 3 authors. A Student's t-test examined for differences.

Results. Twenty-one interns, 11 Intervention & 10 Comparison, consented to provide data, out of 33 eligible (63%); neither group had resuscitation experience prior to the manikin simulation. In the intervention group, the VR occurred on average 3 months prior to the manikin. Total number of ABC actions were not significantly higher in the intervention group (8.5+/-2.2 vs 7.4+/-1.6, p=0.2 95%CI -2.8 to 0.7). Table 1 illustrates mean time-to-critical actions per ABC category. We noted a trend toward significance for earlier oxygenation(B) among VR-trained interns (39+/-28 vs 75+/-53 sec, p=0.07 95%CI -3.9 to 76), but in no other category. Enrollment was less than expected, and post hoc Power analysis was 0.4.

Conclusion(s). Our data only showed a trend towards significance for an effect on algorithmic behavior in resuscitation training among novice learners. Larger-scale studies are needed to strengthen this conclusion. Further study should focus on dose-response effects of VR training in resuscitation skills and performance.

Background. Academic emergency medicine (EM) is a constant balance between efficiency and education. As part of a process redesign, we developed a new model — called swarming – where the bedside nurse, resident physician, and attending/fellow physician immediately and simultaneously evaluate the patient. Swarming occurs entirely in the patient room and involves initial vital signs, bedside triage, focused history and physical exam, and discussion of the treatment plan, in order to create a shared mental model for communication and care.

Objective. The objectives of the study were to observe and define the swarming model, as well as to explore perceptions about swarming among physicians, nurses, and families.

Design/Methods. This mixed methods study included systematic observations, interviews, and focus groups. A convenience sample of pediatric EM patients was observed by trained research staff who recorded the duration of key swarming aspects, using a multi-timer digital stopwatch. Patients’ families were then interviewed about their perceptions of swarming. Focus groups were conducted with each of the stakeholder groups: nurses, resident physicians, and attending/fellow physicians. Descriptive statistics were used to summarize quantitative data.

Results. 39 swarming encounters were included for analysis. On average, nurses spent 6.8 minutes (SD 3.0) in the room, residents spent 10.4 minutes (SD 4.1), and attending/fellow physicians spent 9.4 minutes (SD 4.3). See figure for additional statistical details. Of all observed swarming encounters, 67% included documentation and 39% included orders initiated at the bedside. On a Likert scale from 1 to 5, mean family satisfaction was 4.8 (SD 0.7). In interviews with families, perceived benefits of swarming included expediency of their ED visit and not having to repeat themselves. From the focus groups, themes identified thus far pertain to efficiency, education, and communication, as well as to the variability in how swarming is being implemented.

Conclusion(s). Swarming is an innovative model, and this study defines how it is being employed within our academic EM setting. Our data suggest that the swarming encounter can be executed quickly with high family satisfaction but also highlight the variability in swarming implementation. These findings provide a foundation to refine and standardize the swarming model to best serve different process contexts. Future research includes formative or developmental evaluation of swarming in terms of efficiency and educational value.