Recent Chan Publications

50 Studies Every Occupational Therapist Should Know presents a curated collection of the most influential studies guiding occupational therapy practice today. The text is organized into six practice areas, following the American Occupational Therapy Association (AOTA) framework for OT practice: productive aging, health and wellness, work and industry, rehabilitation and disability, children and youth, and mental health. Each section contains a series of chapters, each of which outlines the design, findings, and implications of a key study from that area of practice. Each chapter also includes a case scenario designed to illustrate how the findings of the study relate to clinical practice. This text will be a valuable resource for occupational therapy students and practitioners seeking to understand the breadth, rigor, and trustworthiness of research informing occupational therapy practice, and for others interested in better understanding the profession.

Keywords. Occupational therapy, evidence-based practice, qualitative research, quantitative research, rehabilitation, allied health

This chapter will address the various gastrointestinal disorders and the issues that the occupational therapy practitioner can address in primary care. The chapter will outline the basic role of the primary care physician, as well as the evaluation techniques and intervention strategies employed by the occupational therapy practitioner.

To successfully integrate occupational therapy services in a primary care setting, it is essential to consider the administrative needs of the organization. This chapter addresses creating a strategic plan, considerations for the primary care environment, reimbursement, populations served, regulatory bodies, and service delivery models of primary care occupational therapy.

This chapter will address anxiety and related issues that the occupational therapy practitioner can address in primary care. The chapter will outline the basic role of the primary care physician, as well as the evaluation techniques and intervention strategies employed by the occupational therapy practitioner.

This chapter will address diabetes and the related issues that the occupational therapy practitioner can address in primary care. The chapter will outline the basic role of the primary care physician, as well as the evaluation techniques and intervention strategies employed by the occupational therapy practitioner.

This chapter will address depression and related issues that the occupational therapy practitioner can address in primary care. The chapter will outline the basic role of the primary care physician, as well as the evaluation techniques and intervention strategies employed by the occupational therapy practitioner.

Occupational therapists apply a holistic and transactional approach that differentiates them from other professionals who provide injury prevention services. The study reviewed in this chapter provides one example of how occupational therapists can provide an ergonomics intervention to promote healthy habits and postures, even in non-work settings. Specifically, the study by Feingold and Jacobs describes how a 30-minute ergonomics education session tailored to middle school children resulted in a change in backpack-wearing habits and reports of discomfort. This study is related to a national campaign led by occupational therapists for backpack safety awareness that includes an annual backpack awareness day at the start of each school year in the fall. Additional studies are noted that provide support for occupational therapy’s role in promoting healthy behaviors and reducing occupational and work-related injuries both within the profession and in other areas through ergonomic assessments, education, intervention, and product design.

Keywords. ergonomics, posture, school-aged child, trunk, musculoskeletal, occupational therapy, health education, prevention

This chapter describes the OPTIMAL study, a randomized controlled trial of an occupational therapy-led community-based program for adults with multiple chronic conditions referred to the program from a network of primary care clinics. Participants in the OPTIMAL program, compared to those in a wait-list control condition, had improved activity participation, self-efficacy, and quality of life. The OPTIMAL study adds to the literature demonstrating that occupational therapy is effective in improving function and quality of life among individuals with chronic conditions. The chapter summarizes the study methodology and findings, reviews related literature, and provides an illustrative case example relating the findings of the OPTIMAL study to occupational therapy practice.

Keywords. occupational therapy, multiple chronic conditions, chronic disease management, primary care, self-management

The “Combined Cognitive-Strategy and Task-Specific Training Improve Transfer to Untrained Activities in Subacute Stroke: An Exploratory Randomized Controlled Trial” article analyzed the effect of the Cognitive Orientation to Daily Occupational Performance (CO-OP) approach against regular outpatient occupational therapy (OT) on improving participants’ occupational performance and participation post-stroke. It employed an exploratory, randomized controlled trial at two outpatient OT clinics in Canada and the United States. Outcomes were measured using the Canadian Occupational Performance Measure, the Performance Quality Rating Scale (PQRS), the Community Participation Index, the Stroke Impact Scale, and the Self-Efficacy Gauge. Twenty-six participants were evaluated. At post-intervention, CO-OP over usual care had a medium effect size for PQRS trained activities and a large effect for PQRS untrained activities. At 3-month follow-up, CO-OP over usual care had large effect sizes for PQRS trained and untrained activities and medium effect sizes for change in participation via the Community Participation Index and self-efficacy.

Keywords. occupational therapy, neurorehabilitation, outpatient therapy, CO-OP, stroke, rehabilitation, cognition, self-efficacy

Clinical Reasoning: Forms of Inquiry in a Therapeutic Practice presents the findings of a multiyear qualitative study of the clinical reasoning of occupational therapists through ethnographic and action research methods. The clinical reasoning of 14 therapists in a large teaching hospital was examined by a team of researchers, including several of the therapists themselves, through participant observation, review of videos, and extensive interviews with the therapists and some patients. Findings revealed three different types of clinical reasoning, procedural, interactive, and conditional, which expert therapists combined in what authors named a three-track mind. Due to the profession’s core values and commitment to treating the whole person and, especially, the phenomenological or lived experience of illness or disability, many occupational therapists experienced tensions between expectations of the institution’s focus on the medical model and their professional commitment to treating the personal and complex experiences associated with navigating disability and illness in everyday life.

Keywords. clinical reasoning, three-track mind, novice versus expert, underground practice, phenomenology, occupational therapy

This chapter outlines the findings of Donnelly et al.’s article describing the integration of occupational therapy on interprofessional primary healthcare teams. A case study approach was used to identify the structures and processes that support successful integration of occupational therapy within family health teams. The findings illustrate that key factors supporting integration include developing team members’ understanding of the role of occupational therapy in primary care, creating a culture of collaboration, and developing trust and understanding among team members. The chapter outlines key findings of the Donnelly et al. article, highlights related studies evaluating the role and outcomes of occupational therapy in primary care settings, and provides a descriptive case study relating the chapter content to current occupational therapy practice.

Keywords. primary healthcare, patient care team, interprofessional care, collaborative care, occupational therapy, organizational case study

The chapter describes a study, “Autism during Infancy: A Retrospective Video Analysis of the Sensory-Motor and Social Behaviors at 9–12 Months of Age,” that used retrospective video analysis to identify several sensory-motor and social behaviors that discriminated between children with autism, children with developmental disabilities, and neurotypical children between the ages of 9 and 12 months. There were 19 boys and 13 girls whose families had taken high-quality home videos of them. Nine categories of behaviors were identified and coded: affective expressions, looking, gaze aversion, response to name, social touch responses, anticipatory posture, motor stereotypies, object stereotypes, and sensory modulation. This was the first retrospective study to identify early sensory-motor indicators of autism in children.

Keywords. autism, early identification, sensory-motor, social behavior, occupational therapy

The Canadian Occupational Performance Measure is a standardized outcome measure that assists in structuring and focusing the occupational therapy assessment, reassessment, and intervention process. Using a semi-structured interview with patients who have a wide range of diagnoses in various practice settings, the information gathered by the Canadian Occupational Performance Measure reflects the importance of the skill or activity to the client in the areas of self-care, productivity, and leisure. The Canadian Occupational Performance Measure is designed to assist the occupational therapist in establishing occupational performance goals based on client perceptions of need and measures the change in defined problem areas.

Keywords. COPM, client-centered interview, outcome measure, self-care, productivity, leisure

The purpose of this study was to examine the reliability and validity of the Test of Playfulness (ToP) with children with physical disabilities and no known cognitive limitations, compare their scores with those of able-bodied peers, and examine patterns of difference in test items. Data from all of the children in the normative data set meeting inclusion criteria (n = 25) were paired with those from able-bodied children matched on gender and age. Data were gathered during two 15-minute videotaped free-play sessions. Rasch analysis revealed 100% rater reliability, and 88% of the children with physical disabilities conformed to playfulness patterns represented in the normative data. Mean ToP scores did not differ between groups. Based on the study results, the ToP is a highly reliable assessment for children with physical disabilities. However, person-response validity did not achieve 95%. Further investigation is needed to determine ToP validity for children with physical disabilities and environmental influences on playfulness.

Keywords. physical disability, play, assessment, Rasch analysis, reliability, validity, occupational therapy

The articles “Systematic Review of Occupational Therapy and Adult Cancer Rehabilitation,” part 1 and part 2, examine the evidence of the effectiveness of occupational therapy interventions on adults with cancer. The systematic review highlights the importance of interventions including physical activity, symptom management, multidisciplinary rehabilitation programs, and interventions targeting psychosocial concerns, sexuality, and return to work. Strong evidence indicates that physical exercise is safe and beneficial for most cancer survivors, most notably to address cancer-related fatigue. Strong evidence supports the benefit of multidisciplinary rehabilitation for cancer survivors as well as the benefit of psychosocial intervention in reducing anxiety and depression. Moderate evidence supports the effectiveness of interventions on sexuality and return to work; however, further research in this area is needed. This systematic review provides support for occupational therapy intervention in addressing the activity and participation needs of adult cancer survivors.

Keywords. adult cancer rehabilitation, occupational therapy, oncology rehabilitation, activity, participation, exercise, psychosocial, physical activity

This chapter explores the content validity of the Pediatric Evaluation of Disability Inventory (PEDI). Rather than concentrating on developmental items (e.g., stacking blocks) that may not be relevant to each family and child, the authors set out to explore daily-level activities and items. The authors developed and defined 20 complex activities related to mobility, self-care, toileting, and social cognition. Similarly, they provided opinions about the appropriateness on three measurement scales (functional skills/behaviors, caregiver assistance, and modifications). These items and domains were reviewed by a panel of experts in the fields of occupational therapy, physical therapy, physiatry, speech and language therapy, and special education, who were not familiar with items or domains. Results were positive, with 80% of experts rating the overall PEDI as either good or excellent on the two major content validity issues including measuring functional disability in children and determining the comprehensiveness of the item sampling.

Keywords. pediatric assessment, content validity, self-care, adaptive testing, occupational therapy

This chapter presents findings from a study analyzing occupational therapy intervention outcomes to elucidate the relationship between lifestyle changes and pressure ulcer development. The complexities of lifestyle and behavior changes contributed to different patterns which impacted the development and progression of pressure ulcers. The four identified patterns included positive pressure ulcer changes accompanied by positive lifestyle and behavior changes, negative or no pressure ulcer changes accompanied by positive lifestyle and behavior changes, positive pressure ulcer changes accompanied by minor or no lifestyle or behavior changes, and negative or no pressure ulcer changes accompanied by minor or no lifestyle changes. Community-based occupational therapy practice provides an opportunity to comprehensively address important lifestyle factors impacting pressure ulcer development.

Keywords. occupational therapy, lifestyle, behavior, pressure ulcer, community-based practice

The chapter “An Adapted Model of Constraint-Induced Movement Therapy for Young Children with Hemiplegic Cerebral Palsy” describes a study examining the effects of a modified constraint-induced movement therapy on children between 18 months and 4 years of age who were diagnosed with hemiplegic cerebral palsy. The results showed that the 6-month modified constraint-induced movement therapy significantly improved voluntary hand use on the affected hand after 2 months of treatment with 2 hours of use daily. The chapter also provides information about related research evaluating the modified constraint-induced movement therapy among children with cerebral palsy and presents a case study applying the study’s findings to clinical practice.

Keywords. constraint, movement therapy, pediatric rehabilitation, hemiplegia, cerebral palsy, occupational therapy

This systematic review highlights the effectiveness of activity- and occupation-based interventions utilized with people recovering from traumatic brain injury (TBI), to improve participation in daily activities and social participation. Five themes emerged from the synthesis of 19 studies: the use of multidisciplinary and interdisciplinary intervention approaches, community-based rehabilitation programs, client-centered goals and relevant contexts, interventions including social skills training and peer mentoring, and community mobility interventions. There was moderate evidence that multidisciplinary and interdisciplinary approaches, community-based rehabilitation programs, and a focus on client-centered goals delivered in a relevant context by an occupational therapist could improve occupational performance following TBI. Limited evidence was found for the best approach to improving social skills and community mobility. The specific contribution of occupational therapy intervention for this patient population has not been well studied, and additional research is needed to determine the nature and extent of occupational therapy intervention for individual patients.

Keywords. traumatic brain injury, occupation-based practice, comprehensive rehabilitation, interdisciplinary team, community-based rehabilitation, client-centered rehabilitation, occupational therapy

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

This chapter explores how people with psychiatric disorders use personal medicine, non-pharmaceutical personal coping tools, as a mechanism for their recovery from mental illness. Personal medicine involves engaging in activities that are meaningful or activities to support self-care. The study examined how individuals use personal medicine to cope with symptoms, to improve wellness, and to bring greater meaning and purpose to their lives. The study includes narratives illustrating how individuals use personal medicine, why they often do not share these experiences with their providers, and how experiences of personal medicine intersect with use of psychiatric medications. Suggestions are provided for how providers can support recovery by eliciting information about personal medicine and supporting individuals to identify and use it.

Keywords. resilience, coping, psychiatric disorder, mental illness, mental health recovery, psychiatric medication, non-pharmaceutical therapy

Traditional assessment measurements fail the disability community in that “participation” has unique qualities for people who have different abilities, resources, and needs. Participation includes not only active engagement in life situations at the societal level, but also the personal meaning and satisfaction resulting from that engagement. Participation is a right based on access, opportunity, respect, and inclusion. Participation should include not only the physical aspects of “doing,” but also the choice and control to participate in ways individually perceived as meaningful. The medical and rehabilitation fields need subjective and value-based participation assessment tools that reflect a non-hierarchical conceptualization of participation created with the voice of the disability community, which is contrary to the assumptions of traditional measurement. Researchers must critically examine conventional means of measuring participation via performance of a standard set of roles and activities that do not make sense for all people.

Keywords. disability community, disability perspective, participation, inclusion, social justice, assessment, occupational therapy

Occupational therapy (OT) has the potential to mitigate against the health risks associated with older adulthood but traditionally has been applied only after catastrophic health events. The Well Elderly study included a randomized controlled trial comparing preventive OT services to non-professionally led social activity and a non-treatment control condition in 361 independent-living, multiethnic older adults (60+ years old). Physical, social, and mental health outcomes were measured at baseline, 9 months (intervention end), and 15 months. Results showed significant benefits for the OT group in overall health, functional status, and life satisfaction compared with both control conditions. The social activity control group did not differ significantly in outcomes compared with the non-treatment control. This study provides support for preventive OT service provision to promote the health and well-being of independent-living older adults, above and beyond mere participation in group-based social activities.

Keywords. occupational therapy, older adult, independent living, Well Elderly, health promotion, well-being, function, social activity, life satisfaction

Despite falls being a common reason older adults present to the emergency room, current practice lacks systematic assessment processes to determine cause, consequence, and prevention of falls in this population. A randomized controlled trial was undertaken to compare a combined medical and occupational therapy interdisciplinary approach to assessment and referral (n = 184) versus usual care (n = 213). Outcomes were analyzed at 4, 8, and 12 months. Cumulative number of falls was significantly lower in the intervention group (183) versus the control group (510; p = 0.0002) at 1-year follow-up. The intervention group demonstrated reduced risk of falling (odds ratio 0.39; 95% confidence interval 0.23–0.66), reduced risk of recurrent falls (0.33; 0.16–0.68), and reduced likelihood to return to hospital (0.61; 0.35–1.05). The control group had a more significant decline in function (p < 0.00001). The study concluded that the medical–occupational therapy interdisciplinary approach to assessment and referral reduces falls risk and slows functional decline.

Keywords. fall, older adult, randomized controlled trial, occupational therapy, interdisciplinary, fall prevention, hospital admission, functional status

Lawlor and Mattingly utilize data collected from three different studies to illustrate the need for a model of family-centered care that addresses the challenges, or “daily dilemmas,” that arise when attempting to create family–practitioner partnerships. Two macro-categories, Situating Family-Centered Care in Cultural Contexts and Daily Dilemmas within Family-Centered Care, were identified. Practitioners often have to overcome the expert model of treatment, the dilemma of “real work,” “turf battles,” and the blurring of professional boundaries while also recognizing the efforts that parents, often mothers, have to make to engage in these partnerships. To be implemented successfully, effective family-centered care requires a radical shift in traditional power dynamics.

Keywords. family-centered care, patient-centered care, special healthcare need, pediatrics, barrier, occupational therapy

The objective of this study was to examine the application of moderate-pressure massage and kinesthetic stimulation versus light-pressure massage and kinesthetic stimulation on preterm infant behavioral states, heart rate/vagal tone, and weight. Preterm infants (n = 68; M gestational age = 30 weeks) in the neonatal intensive care unit (NICU) were randomly assigned to a moderate- or light-pressure massage therapy plus kinesthetic stimulation condition, receiving massages three times per day for 15 minutes each for 5 consecutive days. Infants who received moderate-pressure massage therapy demonstrated significant improvements in behavioral states (e.g., active sleep, fussing, crying, movement, stress behavior), deep sleep, heart rate/vagal tone, and weight gain compared to the light-pressure massage therapy group. Overall, the data indicate that providing moderate-pressure massage therapy and kinesthetic stimulation has the potential to improve outcomes for stable preterm infants in the NICU.

Keywords. occupational therapy, massage therapy, preterm infant, weight gain, vagal tone, tactile-kinesthetic stimulation

The chapter “Energy Conservation Interventions for Multiple Sclerosis” provides a detailed review of a randomized controlled trial studying the impact of an occupational therapy delivered 6-week energy conservation course on fatigue, self-efficacy, and quality of life for individuals with multiple sclerosis. Additionally, this chapter reviews related relevant literature, including 1-year follow-up data, energy conservation group delivery for individuals with progressive multiple sclerosis, teleconference delivery of the energy conservation protocol, and one-to-one implementation of the energy conservation protocol. The chapter concludes with clinical implications and a case study to demonstrate clinical decision-making recommendations for energy conservation programming in the multiple sclerosis population.

Keywords. multiple sclerosis, fatigue, energy conservation, group intervention, quality of life, self-efficacy, occupational therapy

Dyads of 427 parents and children, aged 6–14 years and with a range of health and developmental difficulties, were surveyed, interviewed, and scored on three structured tools to evaluate the perceptions of barriers to participation in school, recreation, and community activities. Perceived barriers were noted in all contexts, ranked highest to lowest in school and work, natural and built environments, policies, services and assistance, and attitudes, respectively. The authors recorded environmental characteristics of accessibility, accommodation, resource availability, social support, and equality as interfering factors and barriers to participation. Adolescents, children with behavioral challenges, and young children with physical limitations were demographic groups with greater perceived barriers.

Keywords. children, adolescent, physical disability, participation, parent perception, environmental barrier, social barrier, cerebral palsy, behavior challenge, occupational therapy

Occupational therapy is the only hospital cost category in which increased spending is statistically significantly associated with reduced readmission rates for conditions covered in the Centers for Medicare and Medicaid Services’ Hospital Readmission Reduction Program. These conditions are heart failure, acute myocardial infarction, and pneumonia. With approximately 75% of patients with heart failure, acute myocardial infarction, or pneumonia who are admitted not typically receiving occupational therapy services, the findings of this study suggest a low-cost and high-yield way for hospitals to improve the quality of care and reduce the number of readmissions by investing in occupational therapy services for more patients.

Keywords. hospital, readmission, quality, cardiovascular, pulmonary, rehabilitation

This chapter highlights the results of a two-part meta-analysis that was completed to examine the effectiveness of occupational therapy interventions on activity and task performance, role restoration, and the remediation of bodily impairment functions for persons who have had a stroke. The first part of the meta-analysis synthesizes the research findings regarding the impact of occupational therapy interventions on client participation in life roles, basic activities of daily living, and instrumental activities of daily living. The second part of the meta-analysis synthesizes the research findings regarding the impact of occupational therapy interventions on the remediation of psychosocial, cognitive-perceptual, and sensorimotor impairments experienced by persons with stroke. It was concluded that occupational therapy improves client participation in activities after a stroke and facilitates improved cognitive-perceptual skills and motor coordination when specific task practice in client-identified activities and feedback are provided. It was determined that additional research is needed in these areas to verify these findings and provide further guidance for clinical practice.

Keywords. stroke, occupational therapy, meta-analysis, task-specific training, bodily function impairment

With therapy minutes generally closely aligned with regulatory and reimbursement requirements, there is little room to consider patient characteristics, time (length of stay [LOS]), and clinical judgment in determining the most cost-effective and clinically optimal plan of care. This study provides valuable insight into client-centered variables (comorbidities, functional outcomes, burden of care) that bring meaning and perspective into determining a value-based rehabilitation plan rather than one based on arbitrary required and assigned minutes. In this study, patients are assigned to one of nine recovery groups following hip fracture surgery. Recovery groups are based on therapy minutes per LOS as low, medium, or high and functional gains in self-care and mobility as measured by the Functional Independence Measure as low, medium, or high. All groups are compared on LOS, providing insight into the role of clinical decision-making and consideration of patient characteristics in determining the dose and intensity of therapy services.

Keywords. post-acute, skilled nursing facility, inpatient rehabilitation facility, acute rehabilitation unit, hip fracture, length of stay, fee-for-service, burden of care, value-based, occupational therapy

The involvement of occupational therapy (OT) providers in work and industry (W&I) has noticeably diminished despite the historical and ontological connection between work and occupation. Clear career expectations are necessary to introduce and retain the OT workforce in this underrepresented yet essential practice area. This study aimed to describe OT practitioners’ experiences exploring and developing careers in the W&I practice area. We used an inductive thematic analysis in a multi-step, iterative process to explore experiences shared through comments and stories in response to an open-ended question in a cross-sectional online survey. Four semantic-level themes emerged, including career pathways, accumulation of expertise, professional identity, and challenges in W&I practice. Novel career paths revealed in the article underlined the limited recognition of W&I practice in OT. Structured career planning support is needed to promote the growth of this practice area.

Background. The Neonatal Eating Outcome Assessment determines feeding performance based on the infant’s postmenstrual age (PMA).

Objective. To examine item-level measurement properties of this assessment’s rating scale.

Methodology. In this retrospective study, Rasch analysis was completed on clinical data from the Neonatal Eating Outcome Assessment for 100 infants (52 preterm and 48 full-term) using Winsteps version 3.93.1. Instead of PMA-based scores, ordered letters converted to numerical scores were analyzed.

Results. Analysis demonstrated that Section I (Pre-Feeding Skills) represents a separate construct from Sections II and III (Oral Feeding and End of Feeding, respectively). Sections II and III were adequately unidimensional to complete Rasch analysis. These sections fit the Rasch model overall, but rating scale category underuse was common, which may be attributed to sample characteristics.

This research pioneers the application of a machine learning framework to predict the perceived productivity of office workers using physiological, behavioral, and psychological features. Two approaches were compared: the baseline model, predicting productivity based on physiological and behavioral characteristics, and the extended model, incorporating predictions of psychological states such as stress, eustress, distress, and mood. Various machine learning models were utilized and compared to assess their predictive accuracy for psychological states and productivity, with XGBoost emerging as the top performer. The extended model outperformed the baseline model, achieving an R² of 0.60 and a lower MAE of 10.52, compared to the baseline model’s R² of 0.48 and MAE of 16.62. The extended model’s feature importance analysis revealed valuable insights into the key predictors of productivity, shedding light on the role of psychological states in the prediction process. Notably, mood and eustress emerged as significant predictors of productivity. Physiological and behavioral features, including skin temperature, electrodermal activity, facial movements, and wrist acceleration, were also identified. Lastly, a comparative analysis revealed that wearable devices (Empatica E4 and H10 Polar) outperformed workstation addons (Kinect camera and computer-usage monitoring application) in predicting productivity, emphasizing the potential utility of wearable devices as an independent tool for assessment of productivity. Implementing the model within smart workstations allows for adaptable environments that boost productivity and overall well-being among office workers.

Keywords. productivity; stress; mood; eustress; distress; psychological state; physiological features; behavioral features

We investigated the physiological (heart rate variability) and psychological (state of anxiety, pleasantness, and comfort) effects of ambient bergamot scent on the stress levels of office workers by exposing them to the scent while stressors persisted as the workers continued to work on the office tasks. Forty-eight young adults were randomly assigned to either a control or scent group. Our results show that the stress restoration effect of bergamot scent depends on gender. The change in heart rate variability revealed that bergamot scent increased stress among males but not for females. The reported pleasantness and comfort followed the same trend. Compared to the control groups, females in the scent group thought the office smelled pleasant and felt more comfortable, but males in the scent group reported the opposite. However, no gender effect was found in the level of state anxiety. Specifically, compared to the control groups, both males and females exposed to the bergamot scent self-reported decreasing stress levels. This inconsistency between self-reported stress and physiological measurements is not uncommon, especially among males who are socialized to downplay emotional experiences. Our data suggest that there is indeed a gender difference in the effectiveness of the bergamot scent for reducing stress in office workers.

Despite documented healthcare disparities among Latino autistic children, little is known about how their families experience the autism “diagnostic odyssey.” Pediatricians have a critical role in the “diagnostic odyssey,” but when it becomes arduous, parents may also use complementary health approaches, particularly when conventional care does not adequately address their concerns. Shared decision-making is important in healthcare for autistic children, especially when parents also choose complementary health approaches; but little is known about shared decision-making among Latino parents of autistic children. We conducted a 12-month ethnography with 12 bicultural/bilingual Latino families of autistic children to understand their healthcare experiences (conventional and complementary health approaches) for their children, focusing on shared decision-making. Thematic analysis revealed: (1) most pediatricians were involved early in the “diagnostic odyssey” but were largely uninvolved thereafter; (2) conventional healthcare was satisfactory to the parents for physical health, but not developmental issues; and (3) parents who used complementary health approaches were more frustrated about a lack of autism information from pediatricians than those who did not. Finally, (4) we describe two exemplars of successful shared decision-making between Latino parents and pediatricians. Increasing pediatricians’ autism knowledge and ability to discuss complementary health approaches may facilitate shared decision-making and reduce healthcare disparities for Latino autistic children.

Background. Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation.

Objective. To explore therapists’ perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services.

Methods. Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results.

Results. SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts.

Conclusion. In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.

Keywords. Qualitative research, occupational therapy, musculoskeletal diseases, return to work

Objective. This study examined the implementation of a Doppler sonography imaging protocol to assess intraneural blood flow, within the median nerve, in healthy individuals.

Materials and Methods. A total of 176 participants were examined, and this involved 717 retrospective observations of the images collected. The implemented imaging protocol was assessed, and the data that were collected were cleaned and checked for fidelity and validity.

Results. A large percentage of missing evidence (11%–35%) across proximal, mid, and distal carpal tunnel locations. Only a quarter of cases with evidence of intraneural blood flow had the strongest evidence of a power Doppler video clip, of which only three-quarters were valid. The study identified potential areas for improving the imaging protocol to reduce missing data and improve data quality.

Conclusion. This study demonstrates the significance of a standardized imaging protocol to guide the sonographic acquisition of Doppler images and provides important insights into potential issues with data quality. The recommendations have the potential to help future studies assess intraneural blood flow in healthy populations in a more rigorous and reliable way. Incorporating the study’s recommendations into a standardized protocol, there is potential to enhance the diagnostic accuracy of carpal tunnel syndrome and improve diagnosis and treatment.

Purpose. This two-phased study aimed to collate, summarize and characterize – through the lens of an occupation-based, person-centred framework – ongoing research and practice featuring activity participation-supportive digital health technology (DHT) for direct use by older persons with mild cognitive impairment or Alzheimer’s disease and related dementias (PwMCI/ADRD).

Materials and methods. Phase 1: Using scoping review procedures, PubMed, MEDLINE and PsycInfo were searched to identify primary research studies. Phase 2: Semi-structured interviews were completed with MCI/ADRD expert stakeholders identified through publicly available biographies and snowball referral. Thematic analysis was used to identify, synthesize and cross-compare emergent themes from both data sources that were subsequently organized into core facets of the Human Activity Assistive Technology (HAAT) model.

Results. The scoping review resulted in 28 studies, which were primarily feasibility work with small sample sizes. Interviewed experts (N = 17) had 4+ years of MCI/ADRD experience, came from a variety of settings, and held myriad roles. Real world and research-based use of DHTs held some commonalities, particularly around support for social participation and instrumental activities of daily engagement. No DHT for sleep or work/volunteerism were noted in either phase. People with milder MCI/ADRD conditions were most often targeted users. Soft technology strategies facilitating implementation centred on product design (e.g., prompting software, customisability, multimedia/multisensory experiences), instructional methods and technology partner involvement.

Conclusions. This study demonstrates that although DHT supportive of activity participation is being studied and integrated into the lives of PwMCI/ADRD, there are still key opportunities for growth to meet the needs of diverse MCI/ADRD end users.

Keywords. Alzheimer’s disease and related dementias; digital health technology; activity participation; scoping review; older adults; activities of daily living; digital divide

Objective. Explore the differing associations of Sonography Work Systems (SWS) model factors with work-related discomfort outcomes among sonographers in four sonographic practice areas.

Materials and Methods. Survey data from a national cross-disciplinary cohort of sonographers was analyzed to explore experiences of work factors and work-related discomfort in sonographers across four practice areas: abdominal (ABD+), adult echocardiography (Echo), obstetrics/gynecology (OB/GYN), and vascular technology (VT). One-way analyses of variance (ANOVAs) and chi-square tests were conducted on SWS factors and work-related discomfort to examine differences across practice area groups. Associative analyses were conducted between upper extremity musculoskeletal discomfort and hand used during sonography examinations. For each practice group, regression analyses examined associations of SWS factors with work-related discomfort (i.e., musculoskeletal and visual discomfort, headaches).

Results. 2924 survey respondents (n = 1747 ABD+, n = 519 Echo, n = 351 VT, and n = 307 OB/GYN) were identified. Descriptive differences were identified in SWS factors and discomfort across practice area groups. Significant differences were noted in distribution of upper extremity pain compared with the hand used to complete sonography examinations (P < .001).

Conclusion. This study identified multiple organizational, tool, and process factors commonly associated with discomfort across specialties, which underscores the need for multidimensional approaches to worker health that include effective administrative and engineering controls.

Study Design. This study was a scoping review.

Background. Continued advances in musculoskeletal sonography technology and access have increased the feasibility of point-of-care use to support day-to-day clinical care and decision-making. Sonography can help improve therapeutic outcomes in upper extremity (UE) rehabilitation by enabling clinicians to visualize underlying structures during treatment.

Purpose of the Study. This study aimed to (1) evaluate the growth, range, extent, and composition of sonography literature supporting UE rehabilitation; (2) identify trends, gaps, and opportunities with regard to anatomic areas and diagnoses examined and ultrasound techniques used; and (3) evaluate potential research and practice utility.

Methods. Searches were completed in PubMed, CINAHL, SPORTDiscus, PsycINFO, and BIOSIS. We included data-driven articles using ultrasound imaging for upper extremity structures in rehabilitation-related conditions. Articles directly applicable to UE rehabilitation were labeled direct articles, while those requiring translation were labeled indirect articles. Articles were further categorized by ultrasound imaging purpose. Article content between the two groups was descriptively compared, and direct articles underwent an evaluation of evidence levels and narrative synthesis to explore potential clinical utility.

Results. Average publication rates for the final included articles (n = 337) steadily increased. Indirect articles (n = 288) used sonography to explore condition etiology, assess measurement properties, inform medical procedure choice, and grade condition severity. Direct articles (n = 49) used sonography to assess outcomes, inform clinical reasoning, and aid intervention delivery. Acute UE conditions and emerging sonography technology were rarely examined, while tendon, muscle, and soft tissue conditions and grayscale imaging were common. Rheumatic and peripheral nerve conditions and Doppler imaging were more prevalent in indirect than direct articles. Among reported sonography service providers, there was a high proportion of nonradiologist clinicians.

Conclusion. Sonography literature for UE rehabilitation demonstrates potential utility in evaluating outcomes, informing clinical reasoning, and assisting intervention delivery. A large peripheral knowledge base provides opportunities for clinical applications; however, further research is needed to determine clinical efficacy and impact for specific applications.

Keywords. Ultrasound imaging; Sonography; Upper extremity; Musculoskeletal; Scoping review

Previous studies have solely focused on establishing Machine Learning (ML) models for automated detection of stress arousal. However, these studies do not recognize stress appraisal and presume stress is a negative mental state. Yet, stress can be classified according to its influence on individuals; the way people perceive a stressor determines whether the stress reaction is considered as eustress (positive stress) or distress (negative stress). Thus, this study aims to assess the potential of using an ML approach to determine stress appraisal and identify eustress and distress instances using physiological and behavioral features. The results indicate that distress leads to higher perceived stress arousal compared to eustress. An XGBoost model that combined physiological and behavioral features using a 30 second time window had 83.38% and 78.79% F₁-scores for predicting eustress and distress, respectively. Gender-based models resulted in an average increase of 2-4% in eustress and distress prediction accuracy. Finally, a model to predict the simultaneous assessment of eustress and distress, distinguishing between pure eustress, pure distress, eustress-distress coexistence, and the absence of stress achieved a moderate F₁-score of 65.12%. The results of this study lay the foundation for work management interventions to maximize eustress and minimize distress in the workplace.

Introduction. Children born very preterm (VP) remain at risk for long-term neurodevelopmental impairment. Patterns of brain growth and injury, and how early neuropromotive therapies might mitigate developmental risk in VP infants remain insufficiently understood.

Methods. This is a prospective cohort study of VP infants born at/before 32 weeks gestation. The study will enroll n = 75 consecutively-born VP infants in a level-III NICU. Exposed infants will be categorized into two groups (group 1: low-risk, n = 25 or group 2: high-risk, n = 25) based on the degree of neurological injury on early brain magnetic resonance imaging (MRI) at enrollment. Infants in the low-risk group (i.e., without significant injury defined as intraventricular hemorrhage with dilation, moderate or severe white matter injury, or cerebellar hemorrhage) will receive neurodevelopmental support utilizing the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, while infants in the high-risk group (with neurological injury) will receive more intensive neurorehabilitative support (SENSE-plus). Age-specific, tailored sensory experiences will be facilitated contingently, preferentially by the infant's family with coaching from NICU staff. VP infants in exposure groups will undergo a brain MRI approximately every 2 weeks from enrollment until term-equivalent to monitor brain growth and evolution of injury. Exposed infants will be compared with a reference group (group 3: n = 25), i.e. VP infants whose families decline initial enrollment in SENSE, and subsequently undergo a term-equivalent brain MRI for other purposes. The primary aim of this study is characterization of term-equivalent brain growth and development among VP infants receiving NICU-based neuropromotive interventions compared to VP infants receiving the standard of care. Secondary aims include defining the timing and factors associated with total and regional brain growth on serial brain MRI among VP infants, (Aim 2), and using early imaging to tailor developmental intervention in the NICU while exploring associations with outcomes in VP infants at discharge and at two years corrected age (Aim 3).

Discussion. This study will address gaps in understanding patterns of brain growth and injury drawing on serial MRI of hospitalized VP infants. These data will also explore the impact of intensive, tailored neuropromotive support delivered prior to term-equivalent on child and family outcomes.

Keywords. preterm, neurodevelopment, neurorehabilitation, multisensory experience, developmental care, NICU environment

The contemporary increase in precarious employment has shaped lives marked by employment, economic, and social instability for many workers. While research has demonstrated deleterious physical and mental implications of precarious work, less attention has been paid to social implications, including heightened risk for social isolation. Using a 5-step scoping review process, this paper investigates what is known about the types and characteristics of physical and virtual ‘third places’ outside of home and work that help maintain social connectedness and ameliorate social isolation in the lives of precarious workers. Descriptive and thematic analysis of 24 interdisciplinary articles revealed that precarious workers navigating conditions marked by spatial exclusion enact collective agency to create and sustain alternative ‘third places’ that align with the conditions of precarious lives. Although places created could be associated with social risks, obligations, and exclusions, they were also mobilised to address diverse social needs, including: a sense of belonging to a collective of ‘similar’ others; temporary respite from the conditions of precarity; assertion of presence and visibility; and exchange of diverse resources and forms of care. These results inform critical reflections on the kinds of spaces that can serve as ‘third places’ within societies marked by growing precarity.

Keywords. Work; precariousness; place; social isolation

While Indoor Environmental Quality (IEQ) factors in an environment co-exist, the interaction effects of these factors and their impacts on cognitive functioning and perceived comfort have not been comprehensively examined. In this study, the interaction effects between temperature, lighting Correlated Color Temperature (CCT), and noise levels on selective attention, sustained attention, creativity, acoustics, thermal, visual, and overall IEQ comfort of young adults in open-plan offices in North American Mediterranean climate were presented. In a mixed-design controlled experimental setting, 52 young adults were recruited, and their objective cognitive performance and subjective comfort were assessed through statistical analysis. The experimental set points included [20 °C, 25 °C], [2700 K, 6500 K], and [50 dB, 65 dB] for temperature, lighting color, and noise, respectively. Additionally, the work took into consideration the gender and Body Mass Index (BMI) of participants. The results show that temperature moderated the effect of noise level and lighting CCT on selective attention, while no effect of IEQ factors on sustained attention was found. Creativity was influenced by gender and its interaction with the noise level. Concerning perceived comfort, acoustic comfort varied significantly with temperature. Thermal comfort was influenced by the combined moderating effect of lighting CCT and BMI on temperature, while visual comfort was driven by the moderation effect of gender on lighting CCT. Overall comfort was affected by the noise level and temperature. Finally, cognitive performance indicators were correlated with perceived IEQ comfort votes. Based on the findings of this study, considerations of interactions between noise, lighting CCT, temperature, gender, and BMI can shape occupant-centric priorities for enhanced cognitive functioning and comfort.

The Supporting and Enhancing NICU Sensory Experiences (SENSE) program was developed in 2017 to guide parents in providing age-appropriate positive sensory exposures to their preterm infants each day of NICU hospitalization. The development of the guideline followed a systematic process with an integrative review to identify evidence-supported sensory exposures, interviews and focus groups with stakeholders, and a pilot study and a randomized controlled trial. Recently, another integrative review was conducted to identify newly published studies on sensory exposures in the NICU, and a SENSE advisory team was recruited to inform updates to the guideline to ensure that the latest evidence related to sensory exposures in the NICU was incorporated. Daily sensory activities that are supported by evidence are listed in the parent education booklet, allowing parents autonomy in selecting appropriate sensory activities to engage in with their infants as they grow and develop in the NICU, as well as enabling choices of activities to provide for infants with different levels of medical support. The healthcare team regularly monitors infant tolerance and development as described in the SENSE implementation manual. While implementation training is available, the program can be implemented by NICUs following a self-paced review of the implementation materials. The SENSE program implementation aims to optimize the NICU environment to improve infant brain development and parent confidence while facilitating their transition into their parental roles.

Keywords. high-risk infants, parenting, NICU, sensory stimulation, environmental modification, program, premature

Few studies have investigated the short-term, momentary relationships between physical activity (PA) and well-being. This study focuses on investigating the dynamic relationships between PA and affective well-being among adults with type 1 diabetes. Participants (n = 122) wore an accelerometer and completed daily EMA surveys of current activities and affective states (e.g., happy, stressed, excited, anxious) via smartphone over 14 days. Within-person, increased sedentary time was associated with less positive affect (r = − 0.11, p < 0.001), while more PA of any intensity was associated with greater positive affect and reduced fatigue, three hours later. Between-person, increased light PA was associated with increased stress (r = 0.21, p = 0.02) and diabetes distress (r = 0.30, p = 0.001). This study provides evidence that positive affect and fatigue are predicted by previous activity regardless of the different activities that people engaged in. Positive affect increased after engaging in PA. However, participants with higher amounts of light PA reported higher stress ratings.

Keywords. Ecological momentary assessments; Accelerometry; Physical activity; Mood; Type 1 diabetes

Purpose of Review. While there are reports of differences in emotion processing in autism, it is less understood whether the emotion of disgust, in particular, plays a significant role in these effects. Here, we review literature on potential disgust processing differences in autism and its possible associations with autistic traits.

Recent Findings. In autism, there is evidence for differences in physical disgust processing, pica behaviors, attention away from other’s disgust facial expressions, and differences in neural activity related to disgust processing. In typically developing individuals, disgust processing is related to moral processing, but modulated by individual differences in interoception and alexithymia.

Summary. Autistic individuals may experience atypical disgust, which may lead to difficulty avoiding contaminants and affect socio-emotional processing. In autism, such outcomes may lead to increased occurrences of illness, contribute to gastrointestinal issues, diminish vicarious learning of disgust expression and behaviors, and potentially contribute to differences in processes related to moral reasoning, though further research is needed.

In this paper, I explore how autistic behaviors are rendered Othered transgressive acts in general research and in the figured world of occupation. I assess how the normalization agenda, which aims to condition autistic people into appearing abled, is associated with endemic disparities. I contend that occupational science has often countered anti-autistic stigma. However, I analyze how the field has perpetuated ableism by replicating normalization ideology and through its silence on the occupational significance of autistic behaviors. To contrast dominant assumptions, I examine autistic ways of being within occupational frameworks. I propose that the field can foster inclusion, rethink its figured worlds, and recognize autistic behaviors to promote social responsiveness. I argue these steps are ethically imperative as evidence on the harms of normalization accumulates.

Keywords. Occupational science; Autism; Intersectionality; Occupational justice; Social justice; Ableism

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.

As the U.S. population shifts away from a White majority, it is imperative that the health care workforce reflect the diversity of client populations served. Increased diversity in the health care workforce fosters access to more personalized, culturally responsive, and client-centered care, thereby facilitating improved outcomes and reduced health disparities. Occupational therapy education programs function as gatekeepers for diversity and need to be accountable for representation in the profession and to produce graduates who reflect the diversity of the broader population. Holistic admission practices, which ensure that no single factor excludes an applicant from admission, are recognized as a meaningful strategy for increasing student diversity in higher education and provide a pathway to create a representative workforce with the ability to improve care disparities and client outcomes. As one of the largest occupational therapy programs in the country, and located in a diverse urban area, the University of Southern California’s Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy has embraced the profession’s responsibility toward greater health equity through holistic admissions. In this column, we discuss holistic admission best practices and report diversity outcomes resulting from enactment of these practices within our occupational therapy education program.

Background. Integrity of the corticospinal tract (CST) is an important biomarker for upper limb motor function following stroke. However, when structurally compromised, other tracts may become relevant for compensation or recovery of function.

Methods. We used the ENIGMA Stroke Recovery data set, a multicenter, retrospective, and cross-sectional collection of patients with upper limb impairment during the chronic phase of stroke to test the relevance of tracts in individuals with less and more severe (laterality index of CST fractional anisotropy ≥0.25) CST damage in an observational study design. White matter integrity was quantified using fractional anisotropy for the CST, the superior longitudinal fascicle, and the callosal fibers interconnecting the primary motor cortices between hemispheres. Optic radiations served as a control tract as they have no a priori relevance for the motor system. Pearson correlation was used for testing correlation with upper limb motor function (Fugl-Meyer upper extremity).

Results. From 1235 available data sets, 166 were selected (by imaging, Fugl-Meyer upper extremity, covariates, stroke location, and stage) for analyses. Only individuals with severe CST damage showed a positive association of fractional anisotropy in both callosal fibers interconnecting the primary motor cortices (r[21]=0.49; P=0.025) and superior longitudinal fascicle (r[21]=0.51; P=0.018) with Fugl-Meyer upper extremity.

Conclusions. Our data support the notion that individuals with more severe damage of the CST depend on residual pathways for achieving better upper limb outcome than those with less affected CST.

Keywords. corticospinal tract; white matter; neuroimaging; diffusion tensor imaging; stroke; upper extremity

Background. Microstructural changes in the corpus callosum (CC) are associated with more severe motor impairment in the paretic hand, poor recovery, and general disability. The purpose of this study was to determine if CC microstructure predicts bimanual motor performance in chronic stroke survivors.

Methods. We examined the relationship between the fractional anisotropy (FA) across the CC, in both the sensorimotor and non-sensorimotor regions, and movement times for two self-initiated and self-paced bimanual tasks in 41 chronic stroke survivors. Using publicly available control datasets (n = 52), matched closely for imaging acquisition parameters, we also explored the effect of stroke and age on callosal microstructure.

Results. In mild-to-moderate chronic stroke survivors with relatively localized lesions to the motor areas, lower callosal FA values, suggestive of a more disorganized microstructure, were associated with slower bimanual performance. Associations were strongest for the primary motor fibers (b = −2.19 ± 1.03, p = .035), followed closely by premotor/supplementary motor (b = −2.07 ± 1.07, p = .041) and prefrontal (b = −1.92 ± 0.97, p = .05) fibers of the callosum. Secondary analysis revealed that compared to neurologically age-similar adults, chronic stroke survivors exhibited significantly lower mean FA in all regions of the CC, except the splenium.

Conclusion. Remote widespread changes in the callosal genu and body are associated with slower performance on cooperative bimanual tasks that require precise and interdependent coordination of the hands. Measures of callosal microstructure may prove to be a useful predictor of real-world bimanual performance in chronic stroke survivors.

Keywords. Diffusion tensor imaging; stroke; corpus callosum; bimanual; recovery; behavior

Objective. This work aimed to explore how the COVID-19 pandemic affected the work of sonographers and vascular technologists.

Materials and Methods. A follow-up questionnaire was sent to an established registry of ultrasonography users who opted into a longitudinal research study examining worker health and wellbeing. Multiple questions related to the general impacts of COVID-19 on sonography work practices, workload, and considerations of remaining or leaving their current job were included; responses to these questions were descriptively tabulated. Participants indicated specific changes that occurred and provided general comments related to COVID-19 impacts in two free-text questions. These comments were qualitatively analyzed by two sonographers who used an interpretive grounded theory approach to formatively code and memo the comments. Four summative interviews were conducted with participants who represented varied practice areas to gain deeper insights into the experiences expressed by the total respondent pool. Qualitative coding of the free-text responses and interview transcripts was completed independently by the two sonographers using the Sonography Work Systems (SWS) framework, and the full research team contributed to the interpretation of the findings.

Results. A total of 1389 ultrasonography users completed the questionnaire. The pandemic changed the ways in which examinations were performed for approximately half of the respondents. A higher or somewhat higher workload was noted by 48% of the sample, while only 10% experienced a lower or somewhat lower workload. Components of the work system were a major concern for respondents, and a lack of support from supervisors and hospital administration was a key finding. Participants felt limited in their ability to provide care, experienced posttraumatic stress, and reported a lack of reciprocity, which were all underscored as undesirable outcomes.

Conclusion. Sonographers and vascular technologists suffered negative consequences during the COVID-19 pandemic. The most marked outcome was the undesirable effects on the work system, which resulted in the need for these workers to engage in herculean efforts over a sustained period. Findings suggest that these health care heroes may have experienced physical and mental harm while trying to provide health care services, despite numerous institutional challenges.

Objective. Establish median nerve cross-sectional area (CSA) reference values and identify patient-level factors impacting diagnostic thresholds.

Materials and Methods. Studies were identified through a robust search of multiple databases, and quality assessment was conducted using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A meta-analysis was performed to identify normative values stratified by anatomic location. A meta-regression was conducted to examine heterogeneity effects of age, sex, and laterality.

Results. The meta-analysis included 73 studies; 41 (56.2%) were high quality. The median nerve CSA [95% confidence interval, CI] was 6.46 mm² [6.09–6.84], 8.68 mm² [8.22–9.13], and 8.60 mm² [8.23–8.97] at the proximal forearm, the carpal tunnel inlet, and the proximal carpal tunnel, respectively. Age was positively associated with CSA at the level of proximal carpal tunnel (β = 0.03 mm², P = .047). Men (9.42 mm² [8.06–10.78]) had statistically larger proximal tunnel CSA (P = .03) as compared with women (7.71 mm² [7.01–8.42]). No difference was noted in laterality.

Conclusion. A reference value for median nerve CSA in the carpal tunnel is 8.60 mm². Adjustments may be required in pediatrics or older adults. The diagnostic threshold of 10.0 mm² for male patients should be cautiously applied as the upper limit of normative averages surpasses this threshold.

Objective. Social support is an important component of recovery-based interventions for individuals living with severe mental illness (IWSMI). Clubhouses are local community centers that facilitate the development of meaningful relationships among IWSMI through an empowering structure and engagement with the work-ordered day. This review synthesizes research on social networks in Clubhouses to provide insights on the role of supportive relationships in mental illness recovery, including the size and features of social networks of Clubhouse members, methodological trends and gaps, and the associations between social networks and demographic variables, recovery, health, and perceived social support.

Method. Research on social networks within Clubhouses were identified and analyzed following a systematic six-stage scoping review design.

Results. Twelve articles across six studies were included. Results revealed considerable variation in social network interview methods and network size and features. Overall findings suggest that network size is not consistently associated with reported loneliness, social support, recovery, or quality of life. A deep relationship with at least one supportive person, level of perceived affiliation with Clubhouses, or positive comments from network members may be more or equally valuable than a larger network. Some studies found that types of relationships were associated with unique benefits. Stronger peer networks were associated with relationship satisfaction, while increased connections with health care professionals and family were associated with reduced hospitalizations.

Conclusions and Implications for Practice. Future research should diversify research designs, expand the use of social network analysis and visualization, measure additional outcomes including recovery and health, and increase sample diversity.

Introduction. A positive therapeutic relationship is characterized by trust and mutually perceived genuineness. It is positively associated with patients’ adherence to treatment, satisfaction, and health outcomes. When service members with a history of mild traumatic brain injury (mTBI) present to rehabilitation clinics with nonspecific symptoms, a disparity between their experience of disability and clinical expectations of mTBI may disrupt the establishment of a positive therapeutic relationship between patients and providers. The objectives of this study are to (1) explore disparities between military service members and rehabilitation clinicians about the clinical diagnosis and illness experience of mTBI and (2) identify barriers to the establishment of a positive therapeutic relationship.

Materials and Methods. This is a qualitative descriptive study of military service members with prior mTBI (n = 18) and clinicians (n = 16) who participated in interviews and focus groups. Data were analyzed thematically using Kleinman’s framing of illness experience and clinical diagnosis.

Results. Three themes reflected the potential breakdowns in the therapeutic relationship. The first theme, clinical expectations for post-injury recovery versus patients’ experience of ongoing disability, reflects the inconsistency between clinicians’ expectations of symptom resolution within 90 days following mTBI and service members’ experiences of symptoms that worsened over several months or years. The second theme, symptom attribution to mental health conditions versus tissue injury, describes the difficulty in attributing symptoms to the physical impact of the mTBI or mental health diagnoses that may also stem from the injury event. The third theme, suspected malingering versus valid disability, describes clinicians’ reports of frustration with cases in which they suspected malingering for secondary gains in contrast with service members’ feelings that their problems were not taken seriously by clinicians.

Conclusions. This study extended previous research on therapeutic relationships by examining the situation of mTBI rehabilitation services for military service members. The findings reinforce the best practice recommendations of acknowledging patients’ experiences, addressing the presenting symptoms and problems, and encouraging progressive return to activity following mTBI. Acknowledgment of and attention to patients’ illness experience by rehabilitation clinicians is necessary and important for supporting a positive therapeutic relationship and ultimately to optimize patients’ health outcomes and reduce disability.

Background. Health-Related Quality of Life (HRQoL) values based on the accurate and reliable European Quality of Life Five Dimension (EQ-5D) questionnaire gives health-state utilities as a helpful data set for studying socio-demographic and socio-economic inequalities in health status in the general population. We aimed to do a population-based study to see how HRQoL varies by socio-demographics and socioeconomic status (SES).

Materials and Methods. The study was a cross-sectional population-based study in Shiraz, Iran's southwest. Data was gathered utilizing a personal digital assistant (PDA). A trained interviewer administered the EQ-5D questionnaire to a representative sample of 1036 inhabitants. Principal component analysis (PCA) was used to create SES indices. Because of the skewed distribution, quantile regression was utilized to model the quartiles of HRQoL values. STATA 12.0 was used to perform all statistical analyses. P <0.05 was considered statistically significant.

Results. In 1036 study respondents, women had a mean HRQoL of 0.67 ± 0.28, whereas men had a mean HRQoL of 0.78 ± 0.25. Gender and age remained significant in all quartiles of HRQoL value. Participants with insurance showed 0.14 and 0.08 higher HRQoL values in the first and second HRQoL quartiles than those without coverage, respectively. Education [95% CI: 0.034, 0.111)], economy [95% CI: 0.013, 0.077], and assets [95% CI: 0.003, 0.069] all had an impact on HRQoL value in the lowest quintile.

Conclusion. In all quartiles of HRQoL value, women had lower reported HRQoL than men. Insurance programs aimed at more disadvantaged groups with poorer HRQoL may help to minimize inequity. Education, economics, and assets all had an impact on the lower quartiles of HRQoL value, emphasizing the importance of general policies in determining public health status.

Keywords. Health-related quality of life, Iran, socioeconomic status

Relationships between activity engagement and health related quality of life (HRQOL) can differ based on the level of analyses. For instance, greater exercise on average may be linked with lower fatigue across individuals (between-person level), whereas the momentary experience of exercise may be associated with increased fatigue within an individual (within-person level). Disentangling the between- and within-person associations between everyday activities and HRQOL outcomes may provide insights for personalized lifestyle-oriented health promotion efforts for individuals with chronic conditions. The purpose of this paper was to examine the between- and within-person relationships between activity engagement and HRQOL relevant measures in a sample of 92 workers with type 1 diabetes (T1D), from whom we collected ecological momentary assessment (EMA) data 5–6 times daily over 14 days. At each EMA prompt, information was collected on the activity participants just engaged in, and HRQOL relevant metrics (e.g. mental health, blood glucose, fatigue, functioning). Momentary reports of “caring for others”, and more frequently “caring for others”, were both associated with decreased HRQOL. Reporting napping 10% or more of the time during a person’s waking hours, but not the momentary experience of napping, was associated with decreased HRQOL. Momentary reports of sleeping were associated with low activity satisfaction relative to other activities, but higher activity importance. Study results provided a quantitative representation of the lived experience of T1D covering multiple types of activity engagement, which potentially has health promotion implications for workers with T1D.

Keywords. Ecological momentary assessment; Health promotion; Human activities; Type 1 diabetes; Workers

Background. Occupational science scholarship has long recognized the relationship of person, occupation, and context, with less focus on the role of occupation in placemaking. Inquiries about ‘third places’ beyond home and work can develop knowledge about how occupations help (re)create and maintain places; such knowledge is especially relevant for understanding how people navigate precarious social and economic conditions.

Methods. Through a 5-step scoping review, we surveyed the state of knowledge about ‘third places’ and the roles they play in the lives of precariously employed individuals. Our review covered English-language literature published between 2012 and 2022 that was indexed in eight academic journal databases. We descriptively and thematically analyzed 24 multidisciplinary articles.

Findings. Included articles were concentrated among relatively few disciplinary, geographical, and methodological bases. Within these studies, situations of financial precarity and social exclusion prompted precarious workers to access and create alternative physical and virtual third places; these third places were characterized by having low barriers to entry, affording diverse forms of participation, and engendering few obligations or commitments. Occupations occurring through these places played a central role in placemaking and reflected the multifaceted purposes of third places and the diverse needs experienced within precarious lives.

Implications. These findings support the need to reconceptualize ‘third places’ in ways that attend to occupation and foreground inclusionary and exclusionary potentials. Further research on third places can extend occupational science theorization of dynamic person-occupation-place relationships and advance interdisciplinary social transformation efforts through occupation-based community development work.

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

Background. Parents report elevated stress during their infant's NICU hospitalization. Real-time measures may improve our understanding of parental stress in the NICU.

Aim. Examine the feasibility of wearable sensors to describe parental stress in the NICU.

Study design. In this prospective feasibility study of 12 parent-infant dyads, parents wore an Empatica E4 wristband to measure psychophysiological stress via electrodermal activity (EDA) during sensory interventions (holding, massage, reading, touch, etc.) with their babies. Baseline and intervention periods were delineated during which concurrent monitoring and clinical observations of infant behavior and environmental factors were recorded. Feasibility was assessed by investigating recruitment/enrollment, retention/adherence, acceptability, sensor usability, and changes in EDA waveforms based on potential stressors. For the latter, independent samples t-tests and ANOVA were used to examine differences in EDA from baseline to intervention, and the impact of environmental and infant factors on parent stress were visually analyzed against EDA waveforms.

Results. Wearable sensor use in the NICU appeared feasible as assessed by all methods. Preliminary data analysis indicated that overall parent EDA levels during parent-infant interactions were low, and engagement in sensory intervention(s) led to a non-significant increase in parental EDA, measured by both skin conductance levels and non-specific skin conductance responses. Three main patterns of EDA emerged: a temporary increase in EDA at the beginning of the intervention followed by a decrease and plateau, a plateau in EDA from baseline to intervention, and a gradual rise in EDA throughout intervention. Specific environmental and infant factors, such as infant stress and health care providers entering the room, appeared to impact parent stress levels.

Conclusion. Although these preliminary findings provide support for use of EDA in the NICU, future studies are needed.

Objective. To develop new diagnostic criteria for mild traumatic brain injury (TBI) that are appropriate for use across the lifespan and in sports, civilian trauma, and military settings.

Design. Rapid evidence reviews on 12 clinical questions and Delphi method for expert consensus.

Participants. The Mild Traumatic Brain Injury Task Force of the American Congress of Rehabilitation Medicine Brain Injury Special Interest Group convened a Working Group of 17 members and an external interdisciplinary expert panel of 32 clinician-scientists. Public stakeholder feedback was analyzed from 68 individuals and 23 organizations.

Results. The first two Delphi votes asked the expert panel to rate their agreement with both the diagnostic criteria for mild TBI and the supporting evidence statements. In the first round, 10 of 12 evidence statements reached consensus agreement. Revised evidence statements underwent a second round of expert panel voting, where consensus was achieved for all. For the diagnostic criteria, the final agreement rate, after the third vote, was 90.7%. Public stakeholder feedback was incorporated into the diagnostic criteria revision prior to the third expert panel vote. A terminology question was added to the third round of Delphi voting, where 30 of 32 (93.8%) expert panel members agreed that ‘the diagnostic label ‘concussion’ may be used interchangeably with ‘mild TBI’ when neuroimaging is normal or not clinically indicated.’

Conclusions. New diagnostic criteria for mild TBI were developed through an evidence review and expert consensus process. Having unified diagnostic criteria for mild TBI can improve the quality and consistency of mild TBI research and clinical care.

Keywords. Craniocerebral Trauma, Concussion, Brain Injury, Diagnostic, Consensus

Importance. Although occupational balance (OB) is a construct of importance to occupational therapy, existing OB assessments have not been validated in clinical populations.

Objective. To examine the validity and reliability of the 11-item version of the Occupational Balance Questionnaire (OBQ11) in U.S. adults with Type 1 diabetes.

Design. Data were analyzed from adults with Type 1 diabetes enrolled in a larger longitudinal study examining the relationships among blood glucose, emotion, and functioning. Dimensionality of the OBQ11 was assessed with item response theory (IRT); convergent validity was tested by examining whether associations between the OBQ11 and other constructs were consistent with a priori hypotheses.

Setting. Three outpatient clinical sites in the United States.

Participants. Data from 208 U.S. adults with Type 1 diabetes were included in the analyses (42% Latino, 29% White, 14% African American, 7% multiethnic, and 8% other).

Outcomes and Measures. Assessments administered include the OBQ11, Patient Health Questionnaire (depression), and Diabetes Self-Management Questionnaire.

Results. Overall, results from IRT models and correlational tests supported the reliability and validity of the OBQ11. For instance, higher scores on the OBQ11 were significantly associated with better self-ratings of diabetes management behaviors (r = .28, p < .001), lower depression symptoms (r = −.53, p < .001), and greater positive affect (r = .32, p < .001). A single-factor generalized partial credit model fit the OBQ11 acceptably well, supporting its unidimensionality.

Conclusions and Relevance. The OBQ11 may be a reliable and valid measure of OB appropriate for use in clinical populations such as adults with diabetes.

Keywords. adult, blood glucose, depressive disorders, diabetes mellitus, diabetes mellitus, type 1, diabetes mellitus, type 2, health, self-management, chronic disease, personal satisfaction

Electromyography (EMG) biofeedback delivered via telerehabilitation can increase access to occupational therapy services for stroke survivors with severe impairment, but there is limited research on its acceptability. This study identified factors influencing the acceptability of a complex, muscle biofeedback system (Tele-REINVENT) for upper extremity sensorimotor stroke telerehabilitation among stroke survivors. We conducted interviews with stroke survivors (n = 4) who used Tele-REINVENT at home for 6 weeks and analyzed the data with reflexive thematic analysis. Biofeedback, customization, gamification, and predictability affected the acceptability of Tele-REINVENT among stroke survivors. Across themes, features and experiences that gave participants agency and control were more acceptable. Our findings contribute to the design and development of at-home EMG biofeedback interventions, which can improve access to advanced occupational therapy treatment options for those who need it most.

Telehealth is effective for service delivery in pediatric occupational therapy across ages and diagnoses. Remote parent coaching provides unique benefits for both parents and infants. As a result of COVID-19, practitioners and researchers pivoted to remote assessment and intervention without much preparation or training. It is critical that we evaluate the quality of these telehealth services. One important component of remote evaluations is assessment fidelity. To examine assessment fidelity of a telehealth-delivered observational autism screening tool for infants. An assessment fidelity checklist was applied as the primary outcome measure. Parents conducted assessments with 82% adherence to the fidelity checklist. Implications: A parent coaching telehealth approach may be valid for assessment in pediatric telehealth. Continually monitoring the assessment fidelity of a tool is critical for the valid administration of remote services.

Telehealth delivery of Lifestyle Redesign®, an occupational therapy intervention framework addressing health and quality of life among people with chronic conditions, is understudied. The objective of this study was to evaluate the effectiveness, satisfaction, and engagement of telehealth Lifestyle Redesign for young adults with diabetes. Using process data from two randomized controlled trials, we compared in-person and telehealth intervention effects. Among telehealth clients, effectiveness was assessed using pre-post changes in occupational performance, occupational satisfaction, and health management; a survey captured telehealth satisfaction. Attendance and engagement in in-person versus telehealth therapy were compared. Preliminary results indicate telehealth clients had significant increases in occupational performance, occupational satisfaction, and health management (all p < .02), and high levels of telehealth satisfaction. Intervention engagement (p = .59) and attendance (p = .42) were similar across treatment modalities. Telehealth delivery of Lifestyle Redesign occupational therapy is feasible and potentially efficacious, and continued advocacy is needed to ensure access to occupational therapy through telehealth.

Objective. While there is evidence that functioning, or ability to perform daily life activities, can be adversely influenced by type 1 diabetes, the impact of acute fluctuations in glucose levels on functioning is poorly understood.

Research design and methods. Using dynamic structural equation modeling, we examined whether overnight glucose (coefficient of variation[CV], percent time <70 mg/dL, percent time >250 mg/dL) predicted seven next-day functioning outcomes (mobile cognitive tasks, accelerometry-derived physical activity, self-reported activity participation) in adults with type 1 diabetes. We examined mediation, moderation, and whether short-term relationships were predictive of global patient-reported outcomes.

Results. Overall next-day functioning was significantly predicted from overnight CV (P = 0.017) and percent time >250 mg/dL (P = 0.037). Pairwise tests indicate that higher CV is associated with poorer sustained attention (P = 0.028) and lower engagement in demanding activities (P = 0.028), time <70 mg/dL is associated with poorer sustained attention (P = 0.007), and time >250 mg/dL is associated with more sedentary time (P = 0.024). The impact of CV on sustained attention is partially mediated by sleep fragmentation. Individual differences in the effect of overnight time <70 mg/dL on sustained attention predict global illness intrusiveness (P = 0.016) and diabetes-related quality of life (P = 0.036).

Conclusions. Overnight glucose predicts problems with objective and self-reported next-day functioning and can adversely impact global patient-reported outcomes. These findings across diverse outcomes highlight the wide-ranging effects of glucose fluctuations on functioning in adults with type 1 diabetes.

Objective. Work-related discomfort is a pervasive issue among ultrasonography users. The Sonography Work Systems (SWS) framework was constructed as a means of examining relationships within and across components of the sonography work systems, work processes, and work/worker outcomes. A database of ultrasonography users was established as a foundation for a longitudinal survey study to examine worker health and well-being and explore the most salient work systems and process factors associated with work-related discomfort.

Materials and Methods. An estimated 100 000 unique ultrasonography users were invited to complete the online questionnaire through an e-mail campaign. Snowball sampling occurred through social media posts and encouragement for respondents to share the survey link with colleagues. The questionnaire included items that examined participant demographics, selected constructs from the SWS, and the prevalence of work-related musculoskeletal discomfort, visual discomfort, and headaches. Individual and multi-factorial regression models were conducted to examine SWS factors associated with the likelihood of experiencing the three types of work-related discomfort.

Results. A total of 3659 valid responses were included in the analysis, with 86% of respondents reporting that they regularly experienced musculoskeletal discomfort that they directly attributed to their work. About half (54.2%) of the respondents have engaged in sonography-related ergonomics training, and respondents indicated using adjustable equipment approximately 74% of the time. Workplace culture was rated as primarily positive, but respondents indicated that employers implement only two of seven commonly recommended ergonomic policies and procedures. Working in an organization with more policies, using adjustable equipment more frequently, taking more work breaks, engaging in a positive work culture, and minimizing interruptions to workflow were key factors associated with reduced likelihood of work-related discomfort.

Conclusion. This study provides a new framework for examining and addressing factors that contribute to ultrasonography users’ experience of work-related discomfort. Despite increased participation in ergonomics training and the use of adjustable equipment, the prevalence of work-related discomfort remains high among ultrasonography users. The findings highlight the need for attention to be directed at organizational factors and work processes to identify and implement evidence-based solutions to improve the health and well-being of medical ultrasound users.

Pre-pandemic, telehealth occupational therapy (OT) for autistic children appeared promising, but research was limited. The pandemic provided a unique opportunity to investigate how clinics transitioned to telehealth. The purpose of this study was to examine barriers and facilitators that influenced delivery of OT services through telehealth for autistic children during the pandemic. We conducted semi-structured qualitative interviews with 13 participants (three administrators, six OTs, and four parents of autistic children) at three Los Angeles area clinics over a 7-month period. We used narrative and thematic analysis to identify four themes. We identified (a) Challenges and (b) Facilitators to Conducting Telehealth OT, including practical strategies for successful facilitation, and (c) Negative and (d) Positive Outcomes of Conducting Telehealth OT. As telehealth will likely remain a viable means of OT service delivery in the future, our findings provide insight into ways that it can be improved and sustained.

Background. Type one diabetes (T1D) management is challenging for adolescents and young adults (AYAs) due to physiological changes, psychosocial challenges, and increasing independence, resulting in increased diabetes distress and hemoglobin A1c (HbA1c). Alternative care models that engage AYAs and improve diabetes-related health outcomes are needed.

Methods. A 15-month study evaluated an adaptation of the Colorado Young Adults with T1D (CoYoT1) Care model. CoYoT1 Care includes person-centered care, virtual peer groups, and physician training delivered via telehealth. AYAs (aged 16-25 years) were partially randomized to CoYoT1 or standard care, delivered via telehealth or in-person. As the study was ending, the COVID-19 pandemic forced all AYAs to transition to primarily telehealth appointments. This secondary analysis compares changes in clinic attendance, T1D-related distress, HbA1c, and device use between those who attended more than 50% of diabetes clinic visits via telehealth and those who attended more sessions in-person throughout the course of the study.

Results. Out of 68 AYA participants, individuals (n = 39, 57%) who attended most (>50%) study visits by telehealth completed more diabetes care visits (3.3 visits) than those (n = 29, 43%) who primarily attended visits in-person (2.5 visits; P = .007). AYAs who primarily attended visits via telehealth maintained stable physician-related distress, while those who attended more in-person visits reported increases in physician-related distress (P = .04).

Conclusions. Greater usage of telehealth improved AYA engagement with their care, resulting in increased clinic attendance and reduced physician-related diabetes distress. A person-centered care model delivered via telehealth effectively meets the needs of AYAs with T1D.

To inform changes to the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, studies investigating sensory-based interventions in the NICU with preterm infants born ≤32 weeks were identified. Studies published between October 2015 to December 2020, and with outcomes related to infant development or parent well-being, were included in this integrative review. The systematic search used databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and Google Scholar. Fifty-seven articles (15 tactile, 9 auditory, 5 visual, 1 gustatory/olfactory, 5 kinesthetic, and 22 multimodal) were identified. The majority of the sensory interventions that were identified within the articles were reported in a previous integrative review (1995–2015) and already included in the SENSE program. New evidence has led to refinements of the SENSE program, notably the addition of position changes across postmenstrual age (PMA) and visual tracking starting at 34 weeks PMA.

While the COVID-19 pandemic introduced wide expansion of telehealth access in health care, evidence concerning telehealth use in occupational therapy (OT) for cancer survivors remains limited. The objective of this study was to identify the prevalence and perceptions of telehealth services among occupational therapy practitioners (OTPs) in oncology. Descriptive statistics and qualitative content analysis were used to analyze data from a pre-pandemic national survey of OTPs (n = 126) focusing on telehealth. Most OTPs in oncology settings support telehealth use, despite a dearth of access prior to the pandemic. The highest levels of telehealth endorsement among OTPs related to ease of accessibility (48%). Treatments rated as best suited for OT oncology telehealth sessions included education (41%), quality of life/well-being/lifestyle (21%), and psychosocial interventions (19%). These data suggest widespread benefits of telehealth-delivered OT treatment in oncology. Advocacy is needed to ensure the continuation of legislation allowing expanded telehealth access and reimbursement for OT.

The Baby Bridge program is an implementation strategy to improve access to in-person early therapy services following neonatal intensive care unit (NICU) discharge. The objective of this study was to evaluate acceptability of Baby Bridge telehealth services among health care providers. Interviews with health care providers were conducted, transcribed, and coded in NVivo. Deductive analysis was used to organize data into negative and positive comments, suggestions for optimization, and perceptions about the first visit. Next, a conventional approach was used to organize the data into themes. Telehealth was viewed as an acceptable, but not necessarily preferable, form of Baby Bridge delivery. Providers identified how telehealth may improve access to care, but with potential challenges in delivery. Suggestions for optimization of the Baby Bridge telehealth model were proposed. Identified themes included delivery model, family demographics, therapist and organizational characteristics, parent engagement, and therapy facilitation. These findings provide important insights to consider when transitioning from in-person therapy to telehealth.

Keywords. family-centered practice; neonate; pediatrics; qualitative research; services.

Importance Autistic children have poorer oral health and greater oral care challenges, which are often associated with sensory overresponsivity, than neurotypical peers. It is important to identify innovative solutions enabling dentists to successfully perform standard clinic-based procedures for this population.

Objective To determine whether a sensory-adapted dental environment (SADE) reduces physiological and behavioral distress in autistic children undergoing dental cleanings, compared with a regular dental environment (RDE).

Design, Setting, and Participants This randomized crossover trial was conducted at a pediatric dentistry clinic in a large urban children’s hospital between May 2016 and April 2022. Coders were blinded to study condition for physiological but not behavioral measurements. Autistic children aged 6 to 12 years were identified and invited to participate. Interested families were enrolled consecutively; after confirmation of autism diagnosis, children were randomized. Analysis for this per-protocol study were conducted from April to October 2022.

Intervention Each child underwent 1 RDE and 1 SADE dental cleaning, administered in randomized and counterbalanced order approximately 6 months apart. SADE included modified visual, auditory, and tactile stimuli.

Main Outcomes and Measures The primary outcome was physiological stress, assessed by electrodermal activity. The secondary outcome was behavioral distress measured from video recordings.

Results Among 452 families invited to participate, 220 children were enrolled, and 162 children (mean [SD] age, 9.16 [1.99] years; 136 [84.0%] male) with confirmed autism were randomized, with 83 children receiving RDE first and 80 children receiving SADE first. Most children (94 children [58.0%]) had moderate autism severity. Children had significantly lower physiological stress during dental care in SADE compared with RDE (mean difference in skin conductance level, −1.22 [95% CI, −2.17 to −0.27] μS), suggesting decreased sympathetic activity and increased relaxation during SADE dental care. No significant differences were found in nonspecific skin conductance responses (mean difference, −0.30 [95% CI, −0.86 to 0.25] per min). Video-coded frequency and duration of behavioral distress (but not questionnaire) measures were significantly lower in SADE vs RDE (Cohen d = −0.84 to −1.19). Physiological stress was associated with behavioral distress during the dental cleaning (eg, nonspecific skin conductance responses associated with the Frankl Scale: β = −0.29; 95% CI, −0.39 to −0.19); age, IQ, and expressive communication moderated the intervention’s success. No participants withdrew due to adverse effects.

Conclusions and Relevance In this randomized crossover trial of autistic children, using SADE was safe and efficacious in decreasing physiological and behavioral distress during dental care. This is important because enhancing oral care is critical for autistic children; this intervention may also be beneficial for populations beyond autism.

Trial Registration ClinicalTrials.gov Identifier: NCT02430051

Objective. To 1) define the number and characteristics of NICUs in the United States (US) and 2) identify hospital and population characteristics related to US NICUs.

Study design. Cohort study of US NICUs.

Results. There were 1424 NICUs identified in the US. Higher number of NICU beds was positively associated with higher NICU level (p < 0.0001). Higher acuity level and number of NICU beds related to being in a children’s hospital (p < 0.0001;p < 0.0001), part of an academic center (p = 0.006;p = 0.001), and in a state with Certificate of Need legislation (p = 0.023;p = 0.046). Higher acuity level related to higher population density (p < 0.0001), and higher number of beds related to increasing proportions of minorities in the population up until 50% minorities. There was also significant variation in NICU level by region.

Conclusions. This study contributes new knowledge by describing an updated registry of NICUs in the US in 2021 that can be used for comparisons and benchmarking.

Photovoice is a participatory, photo-based research method that differs from conventional (non-participatory) research in that the process is meant to be empowering and beneficial. However, empirical research on the Photovoice process remains very limited. Based on feedback from participants who reported Photovoice helped them develop closer relationships, we examine whether engaging in Photovoice fosters social support. Transcripts from a Photovoice study on wellness in mental health Clubhouses (voluntary, community mental health centers) were retrospectively analyzed for instrumental support, appraisal, informational support, and emotional support. Appraisal was the most common form of social support identified, and was primarily expressed through peer praise for photos and insights. Informational support included advice on managing symptoms, promoting wellness, and navigating challenges. Instrumental support was fostered by learning the tangible skill of digital photography and by supporting fellow members with physical or visual limitations to participate in the process. Emotional support was cultivated through encouragement, identification of shared experiences, and connection through humor. In sum, the findings suggest that Photovoice has the potential to foster social support, which may support relational empowerment.

The Supporting and Enhancing NICU Sensory Experiences (SENSE) program promotes consistent, age-appropriate, responsive, and evidence-based positive sensory exposures for preterm infants each day of NICU hospitalization to optimize infant and parent outcomes. The initial development included an integrative review, stakeholder input (NICU parents and healthcare professionals), and feasibility focus groups. To keep the program updated and evidence-based, a review of the recent evidence and engagement with an advisory team will occur every 5 years to inform changes to the SENSE program. Prior to the launch of the 2nd edition of the SENSE program in 2022, information from a new integrative review of 57 articles, clinician feedback, and a survey identifying the barriers and facilitators to the SENSE program’s implementation in a real-world context were combined to inform initial changes. Subsequently, 27 stakeholders (neonatologists, nurse practitioners, clinical nurse specialists, bedside nurses, occupational therapists, physical therapists, speech-language pathologists, and parents) carefully considered the suggested changes, and refinements were made until near consensus was achieved. While the 2nd edition is largely the same as the original SENSE program, the refinements include the following: more inclusive language, clarification on recommended minimum doses, adaptations to allow for variability in how hospitals achieve different levels of light, the addition of visual tracking in the visual domain, and the addition of position changes in the kinesthetic domain.

Keywords. sensory-based interventions; sensory integration; sensation; exposure; environment; preterm; neonatal intensive care unit; NICU; tactile; auditory; multimodal; multisensory; vestibular; kinesthetic; visual; olfactory; gustatory; parenting; SENSE; review; program development

The chronic disease burden among American workers leads to substantial expenditures on healthcare, lost productivity at work, and reduced quality of life. Workers from communities of lower socioeconomic status (SES) shoulder a disproportionate burden of chronic diseases and costs. A promising strategy for addressing this population health burden is to develop and implement participatory worker health promotion interventions in workplaces. Part of this effort to develop and implement these programs entails improving the quality of evaluation tools and approaches. Thus, we completed a series of secondary analyses of a large participatory worker health promotion program trial called Working For You. Our first aim was to explore the structural and content validity of the Multifaceted Organizational Health Climate Assessment (MOHCA), a measure of organizational health climate not previously tested in low SES populations. We found that the MOCHA generates valid and reliable scores of participants’ perceived organizational health climate among a low SES population. Importantly, we found that in our lower SES worker population, model fit was better when the MOCHA organizational climate scale was divided into two subscales, including a novel organizational responsiveness subscale that may represent a unique facet of organizational health climate and inform other work. Our second aim was to develop a program logic model and demonstrate the utility of a new process measure of implementation quality called the Process Evaluation Rating Sheet (PERS) in our sample of workers of lower SES. Included in this aim was the demonstration that our Modified PERS demonstrated associations between implementation quality and program efficacy. Our third aim was to establish an association between upstream organizational health climate and perceived organizational support with downstream health behaviors, namely use of workplace health supports. We demonstrated an association between organizational health climate and use of workplace health supports, and found that use of instrumental and informational health supports differed by age and race. These aims together contributed evidence for the utility of current tools and approaches to evaluate and implement participatory worker health promotion programs among lower SES and minoritized workers.

Background. CAPABLE is a time-limited, evidence-based intervention that helps older adults live independently. It has not been previously tested for use among formerly homeless adults in permanent supportive housing (PSH) who experience accelerated aging that can jeopardize their ability to live independently and age in place.

Methods. A pilot randomized controlled trial with PSH tenants with an average age of 63 years old was conducted to examine the impact of CAPABLE on basic and instrumental activities of daily living (ADL) (and other function-related parameters). Twenty-seven PSH tenants received the intervention and 30 PSH tenants were assigned to a waitlist control group.

Results. Those who received the intervention showed improvements in five of seven health outcomes with small to medium effect sizes (Cohen's d = 0.20–0.47). When compared to the control group, the intervention group showed significantly greater improvements in two health outcomes—namely, reduction in limitations in instrumental ADL (p = 0.03) and depression (p = 0.01)—and greater effect sizes (d = 0.17–0.61).

Conclusions. CAPABLE is an evidence-based practice that can be successfully implemented in PSH to improve outcomes in a population that experiences significant health disparities and premature decline. Further investigation with a larger sample is warranted.

Importance. Feeding difficulties are common among preterm infants during neonatal intensive care unit (NICU) hospitalization. Although most preterm infants achieve full oral feeding by term-equivalent age, whether feeding difficulties persist despite the infant taking full volume and whether these difficulties may relate to other neurobehavioral challenges remain unclear.

Objective. To identify the prevalence of feeding problems among preterm infants and the relationships between infant feeding behaviors and neurobehavior at term-equivalent age.

Design. Cohort study.

Setting. Level 4 NICU with 85 beds.

Participants. Thirty-nine very preterm infants born ≤32 wk gestation (range = 22–32 wk). Exclusion criteria were congenital anomalies, >32 wk gestation at birth, and lack of feeding or neurobehavioral assessment at term-equivalent age.

Outcomes and Measures. Standardized feeding assessments using the Neonatal Eating Outcome Assessment and standardized neurobehavioral evaluation using the NICU Network Neurobehavioral Scale.

Results. Thirty-nine infants (21 female) were included in the final analysis. The mean Neonatal Eating Outcome Assessment score was 66.6 (SD = 13.3). At term-equivalent age, 10 infants (26%) demonstrated feeding challenges, 21 (54%) demonstrated questionable feeding issues, and 8 (21%) demonstrated normal feeding performance. Lower Neonatal Eating Outcome Assessment scores (poorer feeding performance) at term-equivalent age were associated with more suboptimal reflexes (p = .04) and hypotonia (p < .01).

Conclusions and Relevance. Feeding challenges and questionable feeding performance were prevalent among preterm infants at term-equivalent age and appeared in conjunction with suboptimal reflexes and hypotonia. Understanding this finding enables therapists to take a holistic approach to addressing feeding difficulties.

Background and objectives. Functional outcomes after stroke are strongly related to focal injury measures. However, the role of global brain health is less clear. Here, we examined the impact of brain age, a measure of neurobiological aging derived from whole brain structural neuroimaging, on post-stroke outcomes, with a focus on sensorimotor performance. We hypothesized that more lesion damage would result in older brain age, which would in turn be associated with poorer outcomes. Related, we expected that brain age would mediate the relationship between lesion damage and outcomes. Finally, we hypothesized that structural brain resilience, which we define in the context of stroke as younger brain age given matched lesion damage, would differentiate people with good versus poor outcomes.

Methods. We conducted a cross-sectional observational study using a multi-site dataset of 3D brain structural MRIs and clinical measures from ENIGMA Stroke Recovery. Brain age was calculated from 77 neuroanatomical features using a ridge regression model trained and validated on 4,314 healthy controls. We performed a three-step mediation analysis with robust mixed-effects linear regression models to examine relationships between brain age, lesion damage, and stroke outcomes. We used propensity score matching and logistic regression to examine whether brain resilience predicts good versus poor outcomes in patients with matched lesion damage.

Results. We examined 963 patients across 38 cohorts. Greater lesion damage was associated with older brain age (β=0.21; 95% CI: 0.04, 0.38, P=0.015), which in turn was associated with poorer outcomes, both in the sensorimotor domain (β=-0.28; 95% CI: -0.41, -0.15, P<0.001) and across multiple domains of function (β=-0.14; 95% CI: -0.22, -0.06, P<0.001). Brain age mediated 15% of the impact of lesion damage on sensorimotor performance (95% CI: 3%, 58%, P=0.01). Greater brain resilience explained why people have better outcomes, given matched lesion damage (OR=1.04, 95% CI: 1.01, 1.08, P=0.004).

Conclusions. We provide evidence that younger brain age is associated with superior post-stroke outcomes and modifies the impact of focal damage. The inclusion of imaging-based assessments of brain age and brain resilience may improve the prediction of post-stroke outcomes compared to focal injury measures alone, opening new possibilities for potential therapeutic targets.

Objective. To describe extracurricular activity participation and explore its relationship with college students’ health.

Participants. 159 college students majoring in dental hygiene or occupational therapy.

Methods. Data were collected prospectively at baseline, one- and two-year follow-ups. Self-reported participation in extracurricular activities over the past six months was grouped into eight categories: Fitness, Sports, Creative arts, Leisure, Social, Work, Caregiving, and Animal care. Physical and mental health were measured using SF-36, a valid tool measuring general health.

Results. Participation in fitness, sports, creative arts, and work significantly decreased at one-year and two-year follow-ups (p < 0.01). Work/volunteer activity participation was associated with poorer physical health (β = –1.4, 95% CI: (–2.2, −0.5), p < 0.01), but a change from nonparticipation to some participation in work/volunteer activity was associated with better mental health (β = 2.6, 95% CI (0.3, 4.9), p = 0.04).

Conclusions. Educators should consider the potential impact of maintaining extracurricular activities on college students’ health when designing academic courses.

Keywords. College student; extracurricular activity; health; SF-36; well-being

The prevalence of Work-Related Musculoskeletal Disorders (WRMSDs) among ultrasound professionals has been significant. National and international efforts to create industry standards have focused primarily on injuries in sonographers. In addition, the Centers for Disease Control and Prevention (CDC) and National Institute for Occupational Safety & Health (NIOSH) have published documents related to this occupational exposure. There has also been significant attention on equipment utilization and design to help reduce the prevalence of WRMSDs. The American Institute of Ultrasound in Medicine (AIUM) developed the AIUM Practice Principles for Work-Related Musculoskeletal Disorder in collaboration with other organizations whose members use ultrasound [see Collaborating Societies and Representatives]. This document supports the “Industry Standards for the Prevention of Work-Related Musculoskeletal Disorders in Sonography” and aims to expand on these Standards to include safety practices for all health care professionals who utilize ultrasound. These professionals include members of the scientific community, a wide variety of medical professionals, and dental professionals. These ultrasound users and operators will collectively be referred to in this document as “operator(s)” except in those instances where data addressed those holding a specific job title, such as sonographer. In addition, this document will support guidance for quality improvement specific to preventing and reducing injury rates.

Keywords. Ergonomics; occupational exposure; work-related musculoskeletal disorders; WRMSD

People who experience disorders of consciousness (DoC) following a severe traumatic brain injury (TBI) have complex rehabilitation needs addressed by occupational therapy. To examine the effectiveness of interventions to improve arousal and awareness of people with DoC following a TBI. For this systematic review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched six databases in collaboration with a research librarian. Twenty-seven studies were included and grouped thematically. Multimodal sensory stimulation, familiar voices telling structured stories, and transcranial direct current stimulation had a moderate level of evidence. Multimodal sensory stimulation had the strongest evidence in support of its use in clinical practice. Occupational therapy practitioners should administer multimodal stimuli frequently as studies reported administering these interventions at least twice daily. Occupational therapy practitioners should incorporate personally relevant, meaningful, salient stimuli into interventions when treating patients with DoC.

Background. Considering the burden of moderate and severe brain injury on families and society, and that trauma is one of the common causes of death and disability in Iran, this study aimed to investigate the frequency of death from severe to moderate brain injury in children with brain trauma.

Methods. In this cross-sectional study, records of 126 patients under 18 years of age with moderate and severe brain injuries admitted to Namazi Hospital, Shiraz, Iran during 2017-2019 were investigated. The relative frequency of mortality, parents’ education level, day of trauma, types of trauma, age, gender, and length of hospitalization were studied. P values were set at 0.05; Chi-square and T-test were used for variable comparisons.

Results. The study’s male-to-female ratio was almost 2:1, and the mean and standard deviation of the age of all children in the study was 6.84±4.33. The relationship between brain injury severity and hospitalization length was significant (P<0.001). 21.4% of patients with moderate and severe brain injury were Afghan. The highest frequency of trauma was related to accidents, with 69.8%, followed by falling down at 23.8%.

Conclusion. The most common cause of death in children with brain injury was trauma caused by an accident. To decrease the burden of severe and moderate brain injury in children, health policymakers may tailor interventions to two important groups, including parents with a low level of education and Afghan nationals.

Keywords. Child Injuries; Brain; Death

Importance. Limited research has elucidated factors predicting occupational therapy–specific service utilization by children with autism. Such research is needed to inform reasons for receipt of services.

Objective. To examine factors associated with occupational therapy service utilization by children with autism. We hypothesized that elevated sensory hyperresponsiveness; greater sensory interests, repetitions, and seeking; and lower adaptive behavior would predict more service utilization.

Design. Analysis of extant data from a prospective, longitudinal survey study about autism symptom severity, adaptive behavior, sensory features, and demographic and service utilization information of children with autism ages 3 to 13 yr.

Setting. Online parent survey regarding child behaviors during daily activities and contexts.

Participants. 892 parents of children with autism from 50 U.S. states.

Outcomes and Measures. We used scores on the Vineland Adaptive Behavior Scale–Second Edition, the Social Responsiveness Scale, and the Sensory Experiences Questionnaire Version 3.0 and responses to a demographic questionnaire. We formulated hypotheses after data collection but before analysis.

Results. Predictors of higher occupational therapy service utilization were lower enhanced perception; lower adaptive behavior; elevated sensory interests, repetitions, and seeking behaviors; younger child age; and higher household income.

Conclusion and Relevance. Results partially support our hypotheses. Sensory interests, repetitions, and seeking behavior predicted occupational therapy service utilization, whereas other sensory response patterns did not, suggesting a possible referral bias for certain sensory response patterns. Occupational therapy practitioners can educate parents and teachers about the scope of practice, which includes addressing sensory features beyond sensory interests, repetitions, and seeking behaviors.

Keywords. autistic disorder, child, adaptive behavior

Occupational balance is a central concept in occupational science, but it is complex and lacks an agreed-upon definition. Further, the concept has not been given significant attention by scholars outside Western societies. Building upon traditional Chinese culture and Chinese scholars’ Human Complex System Theory, this article presents a proposed Model of Occupational Harmony, offering an Eastern understanding of how the orchestration of everyday occupations relates to health and well-being. The notion of occupational harmony highlights harmonious human-environment transactions as the essence of the phenomenon and integrates multiple perspectives in previous occupational balance literature, including activity patterns, time use, occupational characteristics, need satisfaction, and biological rhythms. It is asserted that occupational harmony can be characterized as complex equilibria among three pairs of two-sided occupational characteristics and achieved via harmony among five dimensions of occupational engagement and coherence across multiple levels of human-environment transactions. This article is a beginning theoretical conceptualization of occupational harmony, allowing occupational scientists to embrace the complexity of the orchestration of occupational engagement.

Keywords. Occupational science, Occupational balance, Culture, Occupational engagement, Systems theory

Among individuals who have recovered from COVID-19 around the world, there is a substantial number who would need support in finding their way back to meaningful and productive work. The aims of this paper are to demonstrate the multitude of factors that shape return to work (RTW) practices across and within several countries, and argue for the need to explore RTW from an international perspective during an on-going pandemic, focusing on working age adults who have recovered from COVID-19. Conditions for RTW differ across countries. Occupational therapy has a central role in medical rehabilitation after injury and illness (including COVID-19), but the occupational therapy community has, to the best of our knowledge, yet to raise awareness and advance evidence regarding its role in post-COVID RTW processes. A robust evidence-based knowledge on RTW that can be utilised by occupational therapists during the present and future pandemics is needed.

Keywords. Employment; rehabilitation; long COVID; post COVID; occupational therapy; role emerging practice; return to work

Background. The Glycemia Risk Index (GRI) was introduced as a single value derived from the ambulatory glucose profile that identifies patients who need attention. This study describes participants in each of the five GRI zones and examines the percentage of variation in GRI scores that is explained by sociodemographic and clinical variables among diverse adults with type 1 diabetes.

Methods. A total of 159 participants provided blinded continuous glucose monitoring (CGM) data over 14 days (mean age [SD] = 41.4 [14.5] years; female = 54.1%, Hispanic = 41.5%). Glycemia Risk Index zones were compared on CGM, sociodemographic, and clinical variables. Shapley value analysis examined the percentage of variation in GRI scores explained by different variables. Receiver operating characteristic curves examined GRI cutoffs for those more likely to have experienced ketoacidosis or severe hypoglycemia.

Results. Mean glucose and variability, time in range, and percentage of time in high, and very high, glucose ranges differed across the five GRI zones (P values < .001). Multiple sociodemographic indices also differed across zones, including education level, race/ethnicity, age, and insurance status. Sociodemographic and clinical variables collectively explained 62.2% of variance in GRI scores. A GRI score ≥84.5 reflected greater likelihood of ketoacidosis (area under the curve [AUC] = 0.848), and scores ≥58.2 reflected greater likelihood of severe hypoglycemia (AUC = 0.729) over the previous six months.

Conclusions. Results support the use of the GRI, with GRI zones identifying those in need of clinical attention. Findings highlight the need to address health inequities. Treatment differences associated with the GRI also suggest behavioral and clinical interventions including starting individuals on CGM or automated insulin delivery systems.

Neonatal intensive care unit (NICU) co-occupations may impact parent–infant outcomes. The main objective of this study was to explore relationships between parent and infant outcomes based on whether sensory-based interventions (co-occupations) occurred most often between parent–infant dyads or provider/volunteer–infant dyads. Thirty-five families received the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, which includes education defining specific amounts of sensory exposures for infants to receive each day of NICU hospitalization (with a preference for parent delivery). Infant sensory experiences in the NICU were logged, and dyads were grouped based on who conducted most of the sensory interventions with the infant in the NICU into a Parent–Infant Co-occupation group or Other Administered group. The Parent–Infant Co-occupation group had infants with less lethargy on the NICU Network Neurobehavioral Scale (p = .04), and parents with lower scores on the Parental Stress Scale (p = .003) and State-Trait Anxiety Inventory-state (p = .047). Parent–infant engagement in co-occupations was related to parental mental health and infant neurobehavior.

Keywords. development; engagement; environment; family-centered care; intervention; parent mental health; parent–infant interaction; participation; sensory.

White matter hyperintensities (WMHs) are a risk factor for stroke. Consequently, many individuals who suffer a stroke have comorbid WMHs. The impact of WMHs on stroke recovery is an active area of research. Automated WMH segmentation methods are often employed as they require minimal user input and reduce risk of rater bias; however, these automated methods have not been specifically validated for use in individuals with stroke. Here, we present methodological validation of automated WMH segmentation methods in individuals with stroke. We first optimized parameters for FSL's publicly available WMH segmentation software BIANCA in two independent (multi-site) datasets. Our optimized BIANCA protocol achieved good performance within each independent dataset, when the BIANCA model was trained and tested in the same dataset or trained on mixed-sample data. BIANCA segmentation failed when generalizing a trained model to a new testing dataset. We therefore contrasted BIANCA's performance with SAMSEG, an unsupervised WMH segmentation tool available through FreeSurfer. SAMSEG does not require prior WMH masks for model training and was more robust to handling multi-site data. However, SAMSEG performance was slightly lower than BIANCA when data from a single site were tested. This manuscript will serve as a guide for the development and utilization of WMH analysis pipelines for individuals with stroke.

Keywords. white matter hyperintensity (WMH), stroke, lesion segmentation, SAMSEG, FSL, BIANCA

Workload experienced over the whole day, not just work periods, may impact worker cognitive performance. We hypothesized that experiencing greater than typical whole day workload would be associated with lower visual processing speed and lower sustained attention ability, on the next day. To test this, we used dynamic structural equation modeling to analyze data from 56 workers with type 1 diabetes. For a two-week period, on smartphones they answered questions about whole day workload at the end of each day, and completed cognitive tests 5 or 6 times throughout each day. Repeated smartphone cognitive tests were used, instead of traditional one- time cognitive assessment in the laboratory, to increase the ecological validity of the cognitive tests. Examples of reported occupations in our sample included housekeeper, teacher, physician, and cashier. On workdays, the mean number of work hours reported was 6.58 (SD 3.5). At the within-person level, greater whole day workload predicted decreased mean processing speed the next day (standardized estimate=-0.10, 95% CI -0.18 to -0.01) using a random intercept model; the relationship was not significant and only demonstrated a tendency toward the expected effect (standardized estimate= -0.07, 95% CI -0.15 to 0.01) in a model with a random intercept and a random regression slope. Whole day workload was not found to be associated with next-day mean sustained attention ability. Study results suggested that just one day of greater than average workload could impact next day processing speed, but future studies with larger sample sizes are needed to corroborate this finding.

Keywords. Whole day workload; Sustained attention; Processing speed; Cognitive performance; Type 1 diabetes

Background. Atypical sensory processing impacts children with intellectual and developmental disabilities (IDD). Research has focused on SP in individuals with autism spectrum disorder (ASD); comparatively, little has been written regarding individuals with Down syndrome (DS) and IDDs.

Aims. We compared patterns of sensory processing in children with DS to children with ASD, other IDDs, and typically developing (TD) peers examining the relationship among different sensory processing measures.

Methods and procedures. We analyzed cross-sectional data using two caregiver questionnaires (SP, SEQ) and one observational measure (SPA). Groups were compared on three sensory processing patterns: hyporesponsiveness; hyperresponsiveness; and sensory interests, repetitions, and seeking (SIRS) via ANOVA. We assessed concordance through correlations.

Outcomes and results. Children with DS, IDD, and ASD demonstrated more atypical sensory processing behaviors than TD peers. Children with ASD exhibited the most atypical responses across all measures, significantly more than DS children on all but one subscale. The IDD and DS groups differed on several measures. Measurement concordance was higher between caregiver-report versus observational assessment.

Conclusions and implications. Differences between three clinical groups indicate that sensory processing features may differ across clinical populations regardless of cognitive functioning. Lower concordance between caregiver-report and observation measures highlights the need to understand sensory processing expression across different tasks and environments.

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme and/or subthemes, related to a specific topic. This Systematic Review Brief summarizes findings from the systematic review on interventions to improve performance and participation in instrumental activities of daily living among adult stroke survivors. This theme reports on the effectiveness of virtual reality, exercise, vision rehabilitation, and community-based stroke empowerment group interventions.

Keywords. adult, cerebrovascular accident, ischemic stroke, survivors, systematic reviews, blind rehabilitation therapy

Baseline child characteristics may predict treatment outcomes in children with or at elevated likelihood of developing autism (EL-ASD). Little is known about the role of child sensory and language features on treatment outcome. Participants were randomly assigned to a parent-mediated intervention or control condition. Analyses explored the relationship between baseline child sensory and language characteristics and changes in ASD symptoms over approximately 9 months. Higher baseline sensory hyporeactivity was significantly related to less improvement in social communication (SC) for the treatment group only. More baseline atypical vocalizations were significantly related to less improvement on SC across treatment and control groups. This work provides an initial framework to encourage the tailoring of interventions for EL-ASD children, suggesting sensory reactivity and atypical vocalizations may be useful behaviors to consider in treatment planning.

The pupil light reflex (PLR), a marker of neuronal response to light, is a well-studied index of autonomic functioning. Studies have found that autistic children and adults have slower and weaker PLR responses compared to non-autistic peers, suggesting lower autonomic control. Altered autonomic control has also been associated with increased sensory difficulties in autistic children. With autistic traits varying in the general population, recent studies have begun to examine similar questions in non-autistic individuals. The current study looked at the PLR in relation to individual differences in autistic traits in non-autistic children and adults, asking how differences in the PLR could lead to variation in autistic traits, and how this might change across development. Children and adults completed a PLR task as a measure of sensitivity to light and autonomic response. Results showed that, in adults, increased levels of restricted and repetitive behaviors (RRB) were associated with a weaker and slower PLR. However, in children, PLR responses were not associated with autistic traits. Differences in PLR were also found across age groups, with adults showing smaller baseline pupil diameter and stronger PLR constriction as compared with children. The current study expanded on past work to examine the PLR and autistic traits in non-autistic children and adults, and the relevance of these findings to sensory processing difficulties is discussed. Future studies should continue to examine the neural pathways that might underlie the links between sensory processing and challenging behaviors.

Background. Mood disturbances have historically remained a core criterion in diagnosing major depressive episode. DSMs have illustrated this criterion with depressed, hopeless, discouraged, cheerless, and irritable mood, suggesting interchangeability. Extant research has examined individual forms of mood disturbance to depression severity. Less examined is the heterogeneity in mood disturbances and its implication to their association to depression presentations and outcomes.

Method. The current study used a nationally representative sample of U.S. adults with unipolar major depressive disorder to study the association between specific forms of mood disturbances to depression severity, chronicity, or symptoms, above and beyond other forms, as well as their relations to functional impairment, suicidal outcomes, and psychiatric comorbidity via generalized linear models.

Results. Cheerless and hopeless mood were associated with depression severity. Hopeless and irritable mood were associated with depression chronicity. Different forms of mood disturbance showed differential relations to depressive symptoms. Cheerless, hopeless, and irritable mood were associated with depression-specific functional interference, incremental to depression severity. Cheerless, hopeless, and discouraged mood were associated with passive suicidal ideation. Hopeless mood was associated with active suicidal ideation. Hopeless and irritable mood were associated with both suicide plan and suicide attempt. Different forms of mood disturbance demonstrated differential associations to comorbid psychiatric conditions.

Discussion. The relations between different forms of mood disturbances and various aspects of depression are nuanced. Theoretically, these relations highlight the potential utility in acknowledging the complexity and heterogeneity in mood disturbances. Clinically, our results suggest potential utility in routinely monitoring mood disturbances.

Keywords. Mood; Depression; Irritability; Hopelessness; Classification

We regularly face stress during our everyday activities, to the extent that stress is recognized by the World Health Organization as the epidemic of the 21st century. Stress is how humans respond physically and psychologically to adjustments, experiences, conditions, and circumstances in their lives. While there are many reasons for stress, work and job pressure remain the main cause. Thus, companies are increasingly interested in creating healthier, more comfortable, and stress-free offices for their workers. The indoor environment can induce environmental stress when it cannot satisfy the individual needs for health and comfort. In fact, office environmental conditions (e.g., thermal, and indoor air conditions, lighting, and noise) and interior design parameters (e.g., office layout, colors, furniture, access to views, distance to window, personal control and biophilic design) have been found to affect office workers' stress levels. A line of research based on the stress recovery theory offers new insights for establishing offices that limit environmental stress and help with work stress recovery. To that end, this paper answers ten questions that explore the relation between the indoor office-built environment and stress levels among workers. The answers to the ten questions are based on an extensive literature review to draw conclusions from what has been achieved to date. Thus, this study presents a foundation for future environmental stress related research in offices.

Keywords. Stress; Indoor environmental quality; Stress recovery; Office; Interior design

Objective. To examine by age, the veterans' report on whether components of age-friendly health systems were discussed during primary care visits.

Data Sources and Study Setting. Veterans Affairs (VA) Survey of Healthcare Experience of Patients from October 2015 to September 2019.

Study Design. Cross-sectional survey of VA users by age group (18–44 years, 45–64 years, 65+ years; N = 1,042,318). We used weighted logistic regression models to evaluate disparities in whether veterans discussed with anyone in their provider's office: health goals, depression symptoms, stress, personal problems, and medications. Models were adjusted for socio-demographic characteristics (sex, socioeconomic status, education, rurality) and comorbidity.

Data Collection/Extraction Method. Surveys were administered by mail and online. Additional veteran characteristics were extracted from VA administrative data.

Principal Findings. In unadjusted analyses, VA users age 18–44 had a higher (−8.2%; CI: −9.0, −7.3) and users aged 45 to 64 had lower (4.0%; CI: 3.7, 4.3) predicted, probably discussing health goals compared to age 65+. Fewer VA users age 65+ reported discussing depression symptoms, personal problems, and stress than other age groups, whereas more VA users age 65+ discussed medications. Results were unchanged after adjusting for socio-demographics and comorbidity.

Conclusions. Delivery of goal-concordant care relies on understanding the needs of individual patients. Lower rates of discussing what matters and mood represent potential missed opportunities to deliver age-friendly care for older veterans.

Although automated methods for stroke lesion segmentation exist, many researchers still rely on manual segmentation as the gold standard. Our detailed, standardized protocol for stroke lesion tracing on high-resolution 3D T1-weighted (T1w) magnetic resonance imaging (MRI) has been used to trace over 1,300 stroke MRI. In the current study, we describe the protocol, including a step-by-step method utilized for training multiple individuals to trace lesions (“tracers”) in a consistent manner and suggestions for distinguishing between lesioned and non-lesioned areas in stroke brains. Inter-rater and intra-rater reliability were calculated across six tracers trained using our protocol, resulting in an average intraclass correlation of 0.98 and 0.99, respectively, as well as a Dice similarity coefficient of 0.727 and 0.839, respectively. This protocol provides a standardized guideline for researchers performing manual lesion segmentation in stroke T1-weighted MRI, with detailed methods to promote reproducibility in stroke research.

Keywords. stroke, manual segmentation, MRI segmentation, stroke lesion, segmentation protocol, T1w MRI, ITK-SNAP

Health literacy is the ability to obtain and utilize health information to make health-related decisions and to navigate health systems. Although health literacy has traditionally been understood as an individual-level construct, current research is revealing the impact that social networks can have on health literacy. To date, no studies have examined associations between health literacy and social networks among people with serious mental illness (PWSMI), who are at high risk of physical illness and premature mortality. To begin to fill this gap, this study explores associations between health literacy, relationships with health discussion partners, and self-reported health outcomes in a racially diverse sample of Clubhouse members in Hawai‘i. Clubhouses are community mental health centers that promote recovery from mental illness through destigmatization, meaningful activity, and strong social relationships. Health literacy was assessed using two single-item screeners (SILS). In a sample of 163 members, 56.2% reported adequate ability to understand health-related instructions or pamphlets, and 43.3% reported adequate confidence filling out medical forms independently. This is consistent with other health literacy studies with PWSMI in the United States, and indicates lower health literacy within this group than is reported in national averages. Multivariate logistic regression revealed a larger Clubhouse staff social network and completing high school were significantly associated with requiring less help to read materials. Higher age, male gender, and being Native Hawaiian and/or Pacific Islander were associated with less confidence filling out medical forms, while higher self-efficacy was associated with higher confidence filling out medical forms. This study provides preliminary evidence that relationships fostered within Clubhouses are associated with health literacy among PWSMI, and highlights the need for more research to examine how social networks and health literacy interventions can be leveraged in community mental health settings to improve health outcomes within this vulnerable population.

Keywords. health literacy; serious mental illness; clubhouse; mental health clubhouse; social networks; distributed health literacy; community mental health

Student veterans may find reintegration into civilian life difficult, largely due to social factors. This study used occupational therapy practitioners to facilitate photovoice to gain insight into participants’ social experiences transitioning from military to student civilian life. Fifteen photovoice pieces were generated from discussions, photos, and narratives from the seven male participants. Five themes were identified: Camaraderie, Alienation, Identifying Challenges, Rising to the Challenges, and Diversity and Military and Veteran Students. The study has disseminated the photovoice pieces to generate awareness and shape programs and services on campus consistent with a respectful, radically welcoming, military-affirming campus supporting student academic success.

Keywords. Higher education; social support; military students; community-based participatory action research; personal narratives

Although prominent theories of intimate relationships, and couples themselves, often conceive of relationships as fluctuating widely in their degree of closeness, longitudinal studies generally describe partners’ satisfaction as stable and continuous or as steadily declining over time. The increasing use of group-based trajectory models (GBTMs) to identify distinct classes of change has reinforced this characterization, but these models fail to account for individual differences within classes and within-person variability across classes and may thus misrepresent how couples’ satisfaction changes. The goal of the current analyses was to determine whether accounting for these additional sources of variance through growth mixture models (GMMs) alters characterizations of satisfaction changes over time. Applied to longitudinal data from 12 independent studies of first-married couples (combined N = 1,249 couples), GMMs that allowed for class-specific individual differences and within-person variability fit the data better than the GBTMs that constrained these to be equal across classes. Most notably, considerable within-person variability was evident within each class, consistent with the idea that spouses do indeed fluctuate in their satisfaction. Spouses who dissolved their marriages were 3.8–5.7 times more likely to be in classes characterized by greater volatility in satisfaction. Because the early years of marriage appear to be characterized by within-person fluctuations in satisfaction, time-varying correlates of these fluctuations are likely to be at least as important as time-invariant correlates in explaining why some marriages thrive where others falter. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Sensory-based subtypes among autistic children have been well documented, but little is known about longitudinal sensory subtypes beyond autistic populations. This prospective study aimed to identify subtypes based on trajectories of parent-reported sensory features measured at 6–19 months, 3–4, and 6–7 years of age among a community-based birth cohort (N = 1,517), and to examine their associations with school-age clinical and adaptive/maladaptive outcomes on a subset sample (N = 389). Latent class growth analysis revealed five trajectory subtypes varying in intensity and change rates across three sensory domains. In contrast to an Adaptive-All Improving subtype (35%) with very low sensory features and overall better school-age outcomes, an Elevated-All Worsening subtype (3%), comprised of more boys and children of parents with less education, was associated with most elevated autistic traits and poorest adaptive/maladaptive outcomes. Three other subtypes (62% in total) were generally characterized by stable or improving patterns of sensory features at mild to moderate levels, and challenges in certain outcome domains. Our findings indicate that characterizing children based on early sensory trajectories may contribute to earlier detection of subgroups of children with sensory challenges who are more likely to experience developmental challenges by school age, followed by early targeted interventions for improved long-term outcomes.

Keywords. autism, community sample, latent-class trajectory, school-age outcomes, sensory features

Human-Building Interaction (HBI) is a convergent field that represents the growing complexities of the dynamic interplay between human experience and intelligence within built environments. This paper provides core definitions, research dimensions, and an overall vision for the future of HBI as developed through consensus among 25 interdisciplinary experts in a series of facilitated workshops. Three primary areas contribute to and require attention in HBI research: humans (human experiences, performance, and well-being), buildings (building design and operations), and technologies (sensing, inference, and awareness). Three critical interdisciplinary research domains intersect these areas: control systems and decision making, trust and collaboration, and modeling and simulation. Finally, at the core, it is vital for HBI research to center on and support equity, privacy, and sustainability. Compelling research questions are posed for each primary area, research domain, and core principle. State-of-the-art methods used in HBI studies are discussed, and examples of original research are offered to illustrate opportunities for the advancement of HBI research.

Keywords. Civil engineering; Environmental impact; Mechanical engineering; Occupational health; Quality of life

The most persistent oral health disparities in the United States impact children from racial and ethnic minoritized groups and children diagnosed as autistic. This paper aims to describe barriers to oral care as depicted by Black/African American (B/AA) parents of autistic children to further explore how and why oral health disparities persist in this population. A purposeful sample of eleven caregivers of autistic children, ages 4 to 14 years, who identified as B/AA were interviewed twice for approximately 60–90 min each. Thematic analysis utilizing a narrative approach was employed. Three themes emerged from the data concerning the barriers that affect oral health experiences: (a) difficulty in maintaining good oral health practices, (b) challenges with access to care and resources, and (c) poor patient-provider relationships. Due to the limited research that examines the intersection of autism, B/AA culture, and oral health practices, this study provides a rich picture of the barriers families face when obtaining oral care. Many families raised issues that other parents of autistic children also identified. B/AA caregivers have demonstrated that despite their own negative dental experiences, they understand the value of good oral care practices and are willing to pursue oral care for their children.

Keywords. oral health; autism; African American; barriers; health equity; children

Limited information exists about social network variation and health information sharing during COVID-19, especially for Native Hawaiians (NH), Other Pacific Islanders (OPI), and Filipinos, who experienced COVID-19 inequities. Hawai’i residents aged 18–35 completed an online survey regarding social media sources of COVID-19 information and social network health information measured by how many people participants: (1) talked to and (2) listened to about health. Regression models were fit with age, gender, race/ethnicity, chronic disease status, pandemic perceptions, and health literacy as predictors of information sources (logistic) and social network size (Poisson). Respondents were 68% female; 41% NH, OPI, or Filipino; and 73% conducted a recent COVID-19 digital search for themselves or others. Respondents listened to others or discussed their own health with ~2–3 people. Respondents who talked with more people about their health were more likely to have larger networks for listening to others. In regression models, those who perceived greater risk of acquiring COVID-19 discussed their health with more people; in discussing others’ health, women and those with chronic diseases listened to a greater number. Understanding young adults’ social networks and information sources is important for health literacy and designing effective health communications, especially to reach populations experiencing health inequities.

Keywords. social networks; distributed health literacy; health literacy; COVID-19; native Hawaiian; Pacific islander; Filipino

Objectives. This study explored the association between cognitive impairment at admission with self-care and mobility gain rate (amount of change per week) during a post-acute care stay (admission to discharge) for older adults with stroke.

Design. Retrospective cohort study.

Setting and Participants. Four inpatient rehabilitation and 6 skilled nursing facilities. A total of 100 adults with primary diagnosis of stroke; mean age 79 years (SD 7.7); 67% women.

Methods. Retrospective cohort study. We evaluated the extent to which cognitive impairment at admission explained variation in weekly gain rate separately for self-care and mobility. Additional covariates were occupational and physical therapy minutes per day, self-care and mobility function at admission, age, and number of comorbidities.

Results. Participants were classified as having severe (n = 16), moderate (n = 39), or mild (n = 45) cognitive impairment at admission. Occupational therapy minutes per day (β = 0.04; P < .01) and Functional Independence Measure (FIM) self-care function at admission (β = 0.48; P < .01) were both significantly associated with self-care gain rate (Adjusted R² = 0.18); cognitive impairment group, age, and number of comorbidities were not significant. Only FIM mobility function at admission (β = 0.29; P < .001) was significantly associated with mobility gain rate (Adjusted R² = 0.18); cognitive impairment group, physical therapy minutes, age, and number of comorbidities were not significant.

Conclusions and Implications. These results provide preliminary evidence that patients with stroke who have severe cognitive impairment may benefit from intensive therapy services as well as less severely impaired patients, particularly occupational therapy for improvement in self-care function.

Keywords. Stroke, cognition, rehabilitation, post-acute care, self-care, mobility limitation, recovery of function

Sedentary behavior (SB) is an independent risk for negative health outcomes in older adults. Mobile health (mHealth) technology has potential to address SB in this population. This scoping review aimed to describe, synthesize, and identify gaps in literature on mHealth-supported interventions with potential to reduce sedentariness in older people. Following an iterative search of five major databases, 13 studies were included in the final review. Only three papers described SB-related factors as the primary target of intervention. mHealth-Driven components were frequently paired with nonmobile approaches and aided self-regulation of physical activity as opposed to SB. Most SB-related outcomes were not statistically significant or were inconclusive. This scoping review revealed a paucity of research applying mHealth-supported approaches to directly overcome sedentariness in older people. Protocol studies included in the review provide evidence that efforts to address this research gap continue to be made, but the need for additional high-quality research remains.

Objectives. Given racial disparities in both dementia and coronavirus disease 2019 (COVID-19), non-Hispanic Black (Black) dementia caregivers (CGs) may be at greater risk for care burden during the COVID-19 pandemic than non-Hispanic White (White) CGs. This study investigates the impact of dementia care provision on CGs’ quality of life by race using the 2020 National Health and Aging Trends Study Family Members and Friends COVID-19 data (FF).

Methods. This study features a secondary analysis of FF data (2020–2021), including 216 Black and 1,204 White CGs. We used ANOVA to determine differences in caregiving stressors (i.e., changes in providing help with activities of daily living [ADL], instrumental ADL [IADL], and emotional support). Ordinary least square regression was used to investigate the moderating effects of dementia care on the associations of race with perceived well-being, care burden, and self-reported health and to conduct subgroups analyses of Black and White dementia CGs.

Results. Black dementia CGs provided significantly more help with ADL before and during the COVID-19 pandemic than Black nondementia, White dementia, and White nondementia CGs. Dementia care status did not moderate the associations between race and CG outcomes. For Black dementia CGs, changes in objective stressors (assistance with ADL and IADL) were associated with care burden and well-being. For White CGs, the provision of emotional support was associated with care burden and well-being.

Discussion. This study highlights that increased caregiving demands during the pandemic amplified racial differences in CG stress. Findings suggest that outreach to reduce CG stress and burden is critical for Black dementia CGs.

Keywords. Alzheimer’s and other dementias, Care burden, COVID-19 outbreak, Race, Well-being

This paper seeks to address ten questions that explore the burgeoning field of Human-Building Interaction (HBI), an interdisciplinary field that represents the next frontier in convergent research and innovation to enable the dynamic interplay of human and building interactional intelligence. The field of HBI builds on several existing efforts in historically separate research fields/communities and aims to understand how buildings affect human outcomes and experiences, as well as how humans interact with, adapt to, and affect the built environment and its systems, to support buildings that can learn, enable adaptation, and evolve at different scales to improve the quality-of-life of its users while optimizing resource usage and service availability. Questions were developed by a diverse group of researchers with backgrounds in design, engineering, computer science, social science, and health science. Answers to these questions draw conclusions from what has been achieved to date as reported in the available literature and establish a foundation for future HBI research. This paper aims to encourage interdisciplinary collaborations in HBI research to change the way people interact with and perceive technology within the context of buildings and inform the design, construction, and operation of next-generation, intelligent built environments. In doing so, HBI research can realize a myriad of benefits for human users, including improved productivity, health, cognition, convenience, and comfort, all of which are essential to societal well-being.

Keywords. Building lifecycle; Human-centered; Occupants; Built environment; Well-being; Interaction; Quality of life

Associations between various forms of activity engagement (e.g. work, leisure) and the experience of stress in workers have been widely documented. The mechanisms underlying these effects, however, are not fully understood. Our goal was to investigate if perceived whole day workload accounted for the relationships between daily frequencies of activities (i.e. work hours and leisure/rest) and daily stress. We analysed data from 56 workers with type 1 diabetes (T1D) who completed approximately two weeks of intensive longitudinal assessments. Daily whole day workload was measured with an adapted version of the National Aeronautics and Space Administration Task Load Index (NASA-TLX). A variety of occupations were reported, including lawyer, housekeeper and teacher. In multilevel path analyses, day-to-day changes in whole day workload mediated 67% (p < .001), 61% (p < .001), 38% (p < .001), and 55% (p < .001) of the within-person relationships between stress and work hours, rest frequency, active leisure frequency, and day of week, respectively. Our results provided evidence that whole day workload perception may contribute to the processes linking daily activities with daily stress in workers with T1D. Perceived whole day workload may deserve greater attention as a possible stress intervention target, ones that perhaps ergonomists would be especially suited to address.

Keywords. Workload, stress, rest, work hours, type 1 diabetes

Stroke is a leading cause of adult disability in the United States. High doses of repeated task-specific practice have shown promising results in restoring upper limb function in chronic stroke. However, it is currently challenging to provide such doses in clinical practice. At-home telerehabilitation supervised by a clinician is a potential solution to provide higher-dose interventions. However, telerehabilitation systems developed for repeated task-specific practice typically require a minimum level of active movement. Therefore, severely impaired people necessitate alternative therapeutic approaches. Measurement and feedback of electrical muscle activity via electromyography (EMG) have been previously implemented in the presence of minimal or no volitional movement to improve motor performance in people with stroke. Specifically, muscle neurofeedback training to reduce unintended co-contractions of the impaired hand may be a targeted intervention to improve motor control in severely impaired populations. Here, we present the preliminary results of a low-cost, portable EMG biofeedback system (Tele-REINVENT) for supervised and unsupervised upper limb telerehabilitation after stroke. We aimed to explore the feasibility of providing higher doses of repeated task-specific practice during at-home training. Therefore, we recruited 5 participants (age = 44–73 years) with chronic, severe impairment due to stroke (Fugl-Meyer = 19–40/66). They completed a 6-week home-based training program that reinforced activity of the wrist extensor muscles while avoiding coactivation of flexor muscles via computer games. We used EMG signals to quantify the contribution of two antagonistic muscles and provide biofeedback of individuated activity, defined as a ratio of extensor and flexor activity during movement attempt. Our data suggest that 30 1-h sessions over 6 weeks of at-home training with our Tele-REINVENT system is feasible and may improve individuated muscle activity as well as scores on standard clinical assessments (e.g., Fugl-Meyer Assessment, Action Research Arm Test, active wrist range of motion) for some individuals. Furthermore, tests of neuromuscular control suggest modest changes in the synchronization of electroencephalography (EEG) and EMG signals within the beta band (12–30 Hz). Finally, all participants showed high adherence to the training protocol and reported enjoying using the system. These preliminary results suggest that using low-cost technology for home-based telerehabilitation after severe chronic stroke is feasible and may be effective in improving motor control via feedback of individuated muscle activity.

About 85% of children with autism spectrum disorder (ASD) experience comorbid motor impairments, making it unclear whether white matter abnormalities previously found in ASD are related to social communication deficits, the hallmark of ASD, or instead related to comorbid motor impairment. Here we aim to understand specific white matter signatures of ASD beyond those related to comorbid motor impairment by comparing youth (aged 8–18) with ASD (n = 22), developmental coordination disorder (DCD; n = 16), and typically developing youth (TD; n = 22). Diffusion weighted imaging was collected and quantitative anisotropy, radial diffusivity, mean diffusivity, and axial diffusivity were compared between the three groups and correlated with social and motor measures. Compared to DCD and TD groups, diffusivity differences were found in the ASD group in the mid-cingulum longitudinal and u-fibers, the corpus callosum forceps minor/anterior commissure, and the left middle cerebellar peduncle. Compared to the TD group, the ASD group had diffusivity differences in the right inferior frontal occipital/extreme capsule and genu of the corpus callosum. These diffusion differences correlated with emotional deficits and/or autism severity. By contrast, children with DCD showed unique abnormality in the left cortico-spinal and cortico-pontine tracts.

Trial Registration. All data are available on the National Institute of Mental Health Data Archive: https://nda.nih.gov/edit_collection.html?id=2254.

Background. Primary care is associated with greater access to healthcare services and improved health outcomes. However, autistic adults report challenges accessing and utilizing primary care, in addition to unmet healthcare needs. The need to minimize existing barriers and identify strategies to facilitate successful healthcare encounters is increasingly important as autistic adults represent a growing segment of society. Minimal research has examined primary healthcare encounters for this population.

Methods. As part of a larger convergent parallel design mixed-methods study that recruited autistic adults, caregivers of autistic adults, and primary care providers treating autistic adults, interviews were conducted with 31 caregivers of autistic adults. Caregivers were predominantly female (94%), and the autistic adult they cared for were primarily male (87%), with a mean age of 24 years. Thematic analysis was employed to elucidate the barriers to care, suggestions to mitigate challenges, and/or successful strategies implemented during care encounters for autistic adults, as reported by their caregivers.

Results. Reported here are the results only from the caregiver interviews, in which seven themes emerged: (1) finding a primary care provider; (2) patient-provider communication; (3) anxiety due to unpredictability, an overstimulating sensory environment, and waiting time; (4) participation of consumers in the healthcare process; (5) stigma and assumptions about autism; (6) caregiver experiences; and (7) the impact of culture and ethnicity on care.

Conclusion. Findings from this study have the potential to inform the development of, or improve existing, client-centered interventions to improve primary healthcare services for autistic adults.

Importance. Fibromyalgia is a complex chronic pain condition for which effective nonpharmacological treatment interventions are lacking. Objective: To explore the effects of an occupational therapy intervention for fibromyalgia on client-reported outcomes of pain interference, self-efficacy, mood, and function.

Design. Retrospective cohort study using a chart review method.

Setting. Outpatient clinic.

Participants. Twenty-one adults with fibromyalgia (M age = 54 yr).

Intervention. A 10-wk occupational therapy group intervention using a Lifestyle Redesign® (LRD) approach.

Outcomes and Measures. The Brief Pain Inventory, Pain Self-Efficacy Scale, Beck Depression Inventory (BDI), and the Fibromyalgia Impact Questionnaire (FIQ) or the Revised Fibromyalgia Impact Questionnaire were administered at the first and last sessions of the program.

Results. Between 2015 and 2018, 37 clients entered the program, and 21 completed it. Changes in group averages exceeded the minimal clinically important difference for the BDI and the FIQ. Eighty-one percent of clients who completed the program had a clinically significant improvement on one or more of the outcome measures.

Conclusions and Relevance. The findings demonstrate the potential benefit of occupational therapy as a complementary approach to pharmacological treatment for people with fibromyalgia. Preliminary evidence suggests that a 10-wk occupational therapy group intervention using an LRD approach may reduce symptoms of depression and decrease the impact on daily function for people with fibromyalgia.

Keywords. fibromyalgia, pain, clients, personal satisfaction, self efficacy, life style, depressive disorders

Given the well-established link between control beliefs and well-being, researchers have turned their attention to characterizing mechanisms that help foster this relationship across the second half of life. Cross-sectional, empirical work has identified a mediating relationship among religiosity and spirituality (R/S), control beliefs, and subjective well-being, such that individuals with higher R/S show higher subjective well-being that is mediated by between-person differences in perceived control. Empirical tests of between-person differences, however, may not represent within-person associations. As such, the present study utilized longitudinal data from the Notre Dame Study of Health & Well-being (NDHWB; N = 1,017) to examine concurrent, within-person associations among three R/S dimensions (i.e., religious coping, religious practices, and spirituality), control beliefs, and subjective well-being. Results from our Bayesian multilevel mediation analyses showed significant within-person associations among these constructs, suggesting potential bidirectionality and circularity in these processes. Cross-sectional age differences and time significantly moderated these associations. In terms of age differences, younger, compared to older, individuals showed stronger positive associations among religious coping and spirituality, control beliefs, and subjective well-being and more negative associations among religious practices, control beliefs, and subjective well-being. Contrarily, the effect of time implied that the relationships among religious coping and spirituality, control beliefs, and subjective well-being became more positive across time. Given this disjunction and that the moderating effect of cross-sectional age by time was not significant, cross-sectional age differences in these relationships likely reflect generational differences in the associations among R/S, control beliefs, and subjective well-being.

Purpose. The purpose of this study was to analyze the impact of virtual group appointments (VGA) on self-reported health-related outcomes and care activities for young adults (YA) with type 1 diabetes (T1D).

Methods. Fifty-three YA (ages 18-25 years) with T1D participated in a randomized controlled trial (RCT) of the Colorado Young Adults with T1D (CoYoT1) Clinic intervention, encompassing telehealth (TH) with or without VGA. Both new patients (n = 32) and those who participated in a pilot phase (n = 26) were randomized to CoYoT1 Clinic (TH+VGA; n = 23) or TH-only (n = 35) and followed for 1 year. YA completed the Diabetes Distress Scale (DDS), Diabetes Strengths and Resilience (D-STAR), Self-Efficacy in Diabetes (SED), Self-Management of Type 1 Diabetes in Adolescence (SMOD-A), Center for Epidemiologic Studies Depression (CES-D), and EuroQol (EQ-5D) scales at baseline and study end.

Results. YA were 67% female, 84% white, 10% Latinx, and the mean age was 20.4 years old. At study end, participants in CoYoT1 Clinic reported significantly reduced diabetes distress compared to those in TH-only, who reported increased levels [Effect Size (ES) = −0.40, P = .02]. Specifically, CoYoT1 Clinic participants reported relative reductions in Physician (ES = −2.87, P = .02) and Regimen-related distress (ES = −0.35, P = .01). In addition, participants in CoYoT1 Clinic reported improved self-management of T1D-related problem solving (ES = 0.47, P = .051) and communication with care providers (ES = 0.39, P = .07).

Conclusions. Virtual group attendance in CoYoT1 Clinic was associated with significant improvements in diabetes-related distress. Long-term exposure to VGA should be investigated in YA with T1D and other pediatric chronic conditions.

Objectives. This study aimed to describe the process of adapting an evidence-based patient engagement intervention, enhanced medical rehabilitation (E-MR), for inpatient spinal cord injury/disease (SCI/D) rehabilitation using an implementation science framework.

Design. We applied the collaborative intervention planning framework and included a community advisory board (CAB) in an intervention mapping process.

Setting. A rehabilitation hospital.

Participants. Stakeholders from inpatient SCI/D rehabilitation (N=7) serving as a CAB and working with the research team (N=7) to co-adapt E-MR.

Interventions. E-MR.

Main Outcome Measures. Logic model and matrices of change used in CAB meetings to identify areas of intervention adaptation.

Results. The CAB and research team implemented adaptations to E-MR, including (1) identifying factors influencing patient engagement in SCI/D rehabilitation (e.g., therapist training); (2) revising intervention materials to meet SCI/D rehabilitation needs (e.g., modified personal goals interview and therapy trackers to match SCI needs); (3) incorporating E-MR into the rehabilitation hospital's operations (e.g., research team coordinated with CAB to store therapy trackers in the hospital system); and (4) retaining fidelity to the original intervention while best meeting the needs of SCI/D rehabilitation (e.g., maintained core E-MR principles while adapting).

Conclusions. This study demonstrated that structured processes guided by an implementation science framework can help researchers and clinicians identify adaptation targets and modify the E-MR program for inpatient SCI/D rehabilitation.

Infants at elevated likelihood of developing autism display differences in sensory reactivity, especially hyporeactivity, as early as 7 months of age, potentially contributing to a developmental cascade of autism symptoms. Caregiver responsiveness, which has been linked to positive social communication outcomes, has not been adequately examined with regard to infant sensory reactivity. This study examined the multiplicative impact of infant sensory hypo- and hyperreactivity on caregiver responsiveness to sensory reactivity and regulation cues in 43 infants at elevated likelihood of autism. Sensory hyperreactivity was found to moderate the association between sensory hyporeactivity and caregiver responsiveness, such that caregivers of infants with moderately high sensory hypo- and hyperreactivity demonstrated higher responsiveness.

Keywords. Early risk signs; Sensory reactivity; Caregiver responsiveness; Community sample

Background. Complex motor tasks in immersive virtual reality using a head-mounted display (HMD-VR) have been shown to increase cognitive load and decrease motor performance compared to conventional computer screens (CS). Separately, visuomotor adaptation in HMD-VR has been shown to recruit more explicit, cognitive strategies, resulting in decreased implicit mechanisms thought to contribute to motor memory formation. However, it is unclear whether visuomotor adaptation in HMD-VR increases cognitive load and whether cognitive load is related to explicit mechanisms and long-term motor memory formation.

Methods. We randomized 36 healthy participants into three equal groups. All groups completed an established visuomotor adaptation task measuring explicit and implicit mechanisms, combined with a dual-task probe measuring cognitive load. Then, all groups returned after 24-h to measure retention of the overall adaptation. One group completed both training and retention tasks in CS (measuring long-term retention in a CS environment), one group completed both training and retention tasks in HMD-VR (measuring long-term retention in an HMD-VR environment), and one group completed the training task in HMD-VR and the retention task in CS (measuring context transfer from an HMD-VR environment). A Generalized Linear Mixed-Effect Model (GLMM) was used to compare cognitive load between CS and HMD-VR during visuomotor adaptation, t-tests were used to compare overall adaptation and explicit and implicit mechanisms between CS and HMD-VR training environments, and ANOVAs were used to compare group differences in long-term retention and context transfer.

Results. Cognitive load was found to be greater in HMD-VR than in CS. This increased cognitive load was related to decreased use of explicit, cognitive mechanisms early in adaptation. Moreover, increased cognitive load was also related to decreased long-term motor memory formation. Finally, training in HMD-VR resulted in decreased long-term retention and context transfer.

Conclusions. Our findings show that cognitive load increases in HMD-VR and relates to explicit learning and long-term motor memory formation during motor learning. Future studies should examine what factors cause increased cognitive load in HMD-VR motor learning and whether this impacts HMD-VR training and long-term retention in clinical populations.

This study aimed to empirically evaluate the hierarchical structure of the Coma Recovery Scale-Revised (CRS-R) rating scale categories and their alignment with the Aspen consensus criteria for determining disorders of consciousness (DoC) following a severe brain injury. CRS-R data from 262 patients with DoC following a severe brain injury were analyzed applying the partial credit Rasch Measurement Model. Rasch Analysis produced logit calibrations for each rating scale category. Twenty-eight of the 29 CRS-R rating scale categories were operationalized to the Aspen consensus criteria. We expected the hierarchical order of the calibrations to reflect Aspen consensus criteria. We also examined the association between the CRS-R Rasch person measures (indicative of performance ability) and states of consciousness as determined by the Aspen consensus criteria. Overall, the order of the 29 rating scale category calibrations reflected current literature regarding the continuum of neurobehavioral function: category 6 “Functional Object Use” of the Motor item was hardest for patients to achieve; category 0 “None” of the Oromotor/Verbal item was easiest to achieve. Of the 29 rating scale categories, six were not ordered as expected. Four rating scale categories reflecting the Vegetative State (VS)/Unresponsive Wakefulness Syndrome (UWS) had higher calibrations (reflecting greater neurobehavioral function) than the easiest Minimally Conscious State (MCS) item (category 2 “Fixation” of the Visual item). Two rating scale categories, one reflecting MCS and one not operationalized to the Aspen consensus criteria, had higher calibrations than the easiest eMCS item (category 2 “Functional: Accurate” of the Communication item). CRS-R person measures (indicating amount of neurobehavioral function) and states of consciousness, based on Aspen consensus criteria, showed a strong correlation (r_s = 0.86; p < 0.01). Our study provides empirical evidence for revising the diagnostic criteria for MCS to also include category 2 “Localization to Sound” of the Auditory item and for Emerged from Minimally Conscious State (eMCS) to include category 4 “Consistent Movement to Command” of the Auditory item.

Background. Aberrant attention patterns have been commonly reported in autistic children. However, few studies have examined attention to non-social stimuli varying in salience and complexity using eye-tracking technology, as well as their links to clinical sensory features.

Method. Forty-one children [16 with autism spectrum disorder (ASD), 10 with developmental delay (DD), and 15 neurotypical (NT)] ages 4 to 13 years were included in this cross-sectional study. Children completed a passive-viewing eye-tracking task designed to measure visual attention (e.g., fixation duration and count) to non-social stimuli with sensory qualities involving motion (spinning or non-spinning) and sound. Parents completed a clinical questionnaire about their child’s sensory behaviors. Eye-tracking metrics were compared across stimulus conditions and diagnostic groups, and their associations with parent-report sensory features were examined.

Results. Overall children showed longer fixation durations and fewer fixation counts to more complex stimuli (e.g., moving or spinning objects), but such facilitatory effects of stimulus properties tended to be less evident in DD versus ASD or NT groups. More clinical sensory features, especially hyperresponsiveness, were moderately to highly associated with quicker initial fixations and longer fixation durations across stimulus conditions in ASD, but not in DD and NT groups.

Conclusion. The overall attention and initial orientation to non-social stimuli were comparable across autistic children and their non-autistic peers, with some sensory properties such as dynamic motion producing a facilitatory effect (i.e., fewer fixations of longer durations) on attention. However, sensory differences, particularly hyperresponsiveness, might underlie attention patterns as impacted by stimulus properties specifically in autism.

As occupation-focused discussions and applications of critical theoretical perspectives increase, attention must also be paid to how different spaces of knowledge dissemination, exchange, and production support critically informed learning and knowing about occupation. This paper presents the reflections of a group of international scholars and lecturers whose shared interest in critical theoretical perspectives prompted the incremental co-development of a series of conference engagements. We describe how our group came together, what kinds of learning experiences we developed to promote and support engagement with critical theoretical perspectives, and what understandings we gained through ongoing critical reflexivity about those learning experiences. Our discussion addresses two problematics related to conferences as learning spaces: inclusion, and sustained engagement with epistemic communities and ideas that may form through critically oriented conference sessions. We also discuss how enacting critical pedagogies and principles of ‘unconferencing’ may better promote critically informed ways of learning and knowing occupation than typical conference structures. The paper ends with a call for continued integration of varied critically informed teaching and learning opportunities at conferences, as a means of further encouraging diverse types of knowledge production, sharing, and learning about occupation.

Keywords. Occupational science; Conferences; Critical theory; Occupation-based Social Transformation; Praxis

Objectives. Past research shows mixed outcomes in terms of HIV-related disparities among Native Hawaiians and Pacific Islanders (NHOPI). This study investigates HIV-related disparities among NHOPI living with HIV in Hawai‘i.

Design. An explanatory sequential design was utilized. The quantitative portion analyzed survey data from a statewide Ryan White Needs Assessment (N = 398) to examine the differences in viral suppression and satisfaction with care between NHOPI and other ethnic groups. Utilizing the behavioral model for vulnerable populations (BMVP), semi-structured interviews (N = 16) were conducted next to explain what factors play a role in satisfaction with care and viral suppression when it comes to NHOPI living with HIV in Hawai‘i.

Results. Among the 398 participants 13% were NHOPI. NHOPI were more likely to have a viral load of ≥10,000 copies/mL compared to those who didn’t identify as NHOPI. However, there were no significant differences for other viral load levels (20–199 or 200–9999), and only 20 participants (5.2%) had a viral load of 10,000 copies/mL or more. No significant ethnic differences were found in satisfaction with medical care. In the qualitative phase, factors from all domains of the BMVP were represented within the four themes identified: (1) Care coordination is essential — with AIDs service organizations taking the lead; (2) HIV care, as well as overall health, is defined by the effectiveness of medication; (3) Initial diagnosis is a critical moment for intervention; and (4) Aspects of culture are intangible.

Conclusion. Among NHOPI in Hawai‘i who are engaged in case management, there appears to be no substantial disparities in either viral load or satisfaction with care compared to other ethnic groups. Despite this, qualitative findings provide insights on how ethnicity and culture may still be playing a role. Addressing all domains of the BMVP is crucial to addressing this.

Keywords. Native Hawaiian; Pacific Islander; HIV; AIDS; healthcare utilization; HIV care continuum; viral suppression; culturally-relevant care; culture and healthcare

Oral health is a vital component of overall health. Children from underserved, minoritized populations (i.e., Black/African Americans, autistic children) are at even greater risk for experiencing oral health disparities. This study aims to illuminate the oral health knowledge, attitudes, and practices of Black/African American caregivers of autistic and non-autistic children. Black/African American caregivers of children (4-to-14 years) on the autism spectrum (n = 65) or not on the autism spectrum (n = 60), participated in a survey, with input from literature reviews, interviews, previous research, and reviews by experts. Caregivers demonstrated basic knowledge of oral health with significantly lower scores for caregivers of autistic children. Caregivers care about oral health and would like to increase their knowledge. Significant differences in oral care practices were found between the autistic and non-autistic groups. Caregivers reported they can access dental services with relative ease, including finding their child a dentist, scheduling a dental appointment, and accessing transportation (personal or public) to attend the visit. Black/African American caregivers of autistic children and children without autism seem to have foundational knowledge about oral health and basic practices; however, they are interested in learning more. Therefore, tailored oral health education programs may help mitigate oral health disparities for Black/African American families.

Keywords. autism; African Americans; oral health; health equity; children

Objectives. Reducing potentially preventable hospitalizations (PPH) for chronic disease is a research and practice priority. Native Hawaiians and other Pacific Islanders (NHOPI) have disparities in PPH, and are understudied in both health literacy and social network research. Greater inclusion of social and familial networks can help address health disparities among people with chronic illness and enhance culturally relevant healthcare.

Methods. Adults hospitalized with a heart disease or diabetes-related PHH in Hawai‘i (N = 22) were assessed for health literacy and social network membership (“alters”).

Results. Sixty-nine percent of respondents were NHOPI. Three respondents (14%) had no alters (“isolates”). Among non-isolates, 79% desired the participation of at least one alter in chronic disease management-related interventions. Fifty-nine percent of respondents had low health literacy. While the mean number of alters did not vary significantly by health literacy, those with lower health literacy had a trend (p = .055) towards less interest in social network engagement.

Discussion. In a sample primarily comprised of NHOPI with chronic disease, many patients wished to include social network members in interventions. Engagement varied by health literacy with implications for health disparities. Not all patients were interested in social network engagement, which must be considered in intervention planning.

Keywords. Social networks, ambulatory care sensitive conditions, Native Hawaiians, Pacific Islanders, chronic disease, diabetes, heart disease, medications

Importance. Occupational therapy practitioners play an important role in addressing the occupational performance and participation needs of adults with multiple sclerosis (MS) and their caregivers.

Objective. This Practice Guideline aims to help occupational therapy practitioners, as well as the people who manage, reimburse, or set policy regarding occupational therapy services, understand occupational therapy’s role in providing services to adults with MS and their caregivers. This guideline can also serve as a reference for health care professionals, health care managers, educators, regulators, third-party payers, managed care organizations, and researchers.

Method. We examined, synthesized, and integrated the results of four systematic reviews into clinical recommendations. Three systematic reviews specified occupational domains as outcomes of interest, and one focused on interventions for caregivers of people with MS.

Results. Twenty-one articles from the systematic reviews with strong or moderate strength of evidence served as the basis for the clinical recommendations.

Keywords. adult, multiple sclerosis, occupational therapists, practice guidelines, sleep, systematic reviews, caregivers, clients, health, fatigue

This article discusses the importance of conducting a longitudinal data collection concerning well-being and the risk for work-related musculoskeletal injuries (WRMSI) among sonographers and vascular technologists. There is a need for changes in the manner that sonographic work is done, but this should be nested in empirical evidence. This gives the rational for conducting the study titled Documenting the overall wellness of ultrasound users and the risk of progressive WRMSI: A national longitudinal study. The objective of this longitudinal work is to better understand collective practice patterns and examine the relationship of sonographic work conditions and performance to the user’s health and well-being. This symposium provides the foundational understanding of the strength of this type of study and how it may help to influence behavior and organizational change.

Importance. Lifestyle Redesign® originated as a preventive occupational therapy intervention for healthy older adults, and it was found to be both effective and cost effective in the Well Elderly Studies initiated in the 1990s. Building on that empirical foundation, the scope of Lifestyle Redesign has been greatly expanded as a general intervention framework addressing prevention and chronic condition management in a wide range of populations, settings, and conditions. Yet until now, its full scope, defining characteristics, and supporting evidence have not been clearly and succinctly described, limiting its potential reach and impact.

Objective. To outline the definition and key characteristics of Lifestyle Redesign, provide a scoping review of its evidence base and future directions for research, describe its current applications, and make recommendations for its use in clinical practice.

Evidence Review. We searched PubMed and CINAHL, tables of contents of 10 occupational therapy journals, and citations in two seminal Lifestyle Redesign publications to identify articles published in 1997–2020 that described quantitative outcomes (for n ≥ 20) of interventions meeting the defining characteristics of Lifestyle Redesign.

Findings. Our scoping review yielded 12 publications providing supportive evidence for Lifestyle Redesign’s positive impact on a range of health and well-being outcomes among both well populations and those with chronic conditions.

Conclusions and Relevance. Lifestyle Redesign has the potential to meet a growing need in clinical and community settings for health care services that address prevention, health promotion, and chronic disease management.

Keywords. clients, health, life style, personal satisfaction

Objectives. Mobile health (mHealth) delivered through smartphone apps is a viable means of improving health behaviors. Technologies can be strengthened and made more age-inclusive by involving older adults as co-designers, resulting in more accessible and effective products. This study's purpose is to describe preliminary acceptability and feasibility of a physical activity (PA) app tailored to underactive older people.

Methods. Moving Up is a multi-feature app designed to increase PA and reduce sedentary behaviors in underactive older adults. The suite houses a core activity tracker and three add-on features that target correlates of inactivity: sedentary behavior, stereotypes about aging, and PA knowledge and routines. Three groups of 4–5 older adult smartphone owners were provided with and oriented to the Moving Up app activity tracker and one add-on feature. Participants beta-tested the app for two weeks, after which each cohort reconvened to discuss experiences, make recommendations for app improvements, and complete a usability questionnaire on their assigned feature.

Results. Thirteen participants (median age, 71 years; iOS users, n=8; females, n=12) completed the beta-testing period and returned for follow-up. Reported usability was moderate across the features. Sentiments about app content and general impressions were mainly positive, although users made several recommendations for app improvements such as more individualized messaging and timely notifications.

Conclusions. A PA app for older adults demonstrated generally good usability and acceptability. Integrating the impressions and recommendations from older adults into the design of mHealth tools will enhance overall usability and likelihood to positively influence PA behaviors long-term.

Keywords. Older adults; Mobile app; Physical activity; mHealth; Technology; Feasibility

The 2008 recession had long-lasting economic effects that made everyday experiences of precarity more prevalent in many countries. Within a broader neoliberal context, however, the prevalence of precarity and its social production tends to be obscured, leading to a need for actions aimed at enhancing social awareness and informing social change. In this article, we illustrate how the precarity associated with long-term unemployment, which persisted at historically high levels through 2018, can be made visible by analyzing the mobilities of occupational engagement. Our illustrations derive from a larger four-phase collaborative ethnography conducted in the United States and Canada between 2014 and 2018. Informed by a critical occupational science perspective, the study utilized multiple methods to generate data with participants who self-identified as being long-term unemployed. One of those methods, occupational mapping, explored how participants negotiated daily routines and occupations at the local scale during their unemployment. Analysis of four exemplar cases, as informed by the mobilities paradigm, illuminates the lived impacts and geospatial effects of precarity on everyday occupations in situations of long-term unemployment. Findings contribute to the wider examination of how precarity is spatially experienced within the situation of long-term unemployment as reflected in people’s (im)mobilities and occupational engagement.

Keywords. Occupational science; Activation; Ethnography; Mobilities; Occupational mapping; Long-term unemployment; Precarity

Previous research has shown that individuals with autism spectrum disorder (ASD) and developmental coordination disorder (DCD) may have overlapping social and motor skill impairments. This study compares ASD, DCD, and typically developing (TD) youth on a range of social, praxis and motor skills, and investigates the relationship between these skills in each group. Data were collected on participants aged 8–17 (n = 33 ASD, n = 28 DCD, n = 35 TD). Overall, the clinical groups showed some similar patterns of social and motor impairments but diverged in praxis impairments, cognitive empathy, and Theory of Mind ability. When controlling for both social and motor performance impairments, the ASD group showed significantly lower accuracy on imitation of meaningful gestures and gesture to command, indicating a prominent deficit in these praxis skills in ASD.

This publication develops a keynote presented at the 27th USC Chan Occupational Science Symposium, “Occupations disrupted: Pandemics and the reshaping of everyday life,” on November 5, 2021. I used the social theory of occupational reconstructions — shared problem-solving through narrative alignments and collective action — to reflect on occupational science’s progress since its founding 30 years ago. I argue that (1) the science of occupation has stalled in today’s neoliberal university; and that (2) ‘consequential questions’ must be formulated across the discipline to develop useful knowledge from different locations, positionalities, and contexts. A ‘consequential question,’ I propose, produces knowledge useful to solving problems of wide concern to the discipline, other disciplines, and the public; and sets up a scientific research program that progresses empirically and theoretically. I explain why the founders’ pragmatist framing of occupation as mind-body experience remains important to recent critiques of the discipline and its future advancement. Likewise, I explain how pragmatism can and must transact with various critical (Marxist, poststructuralist) philosophies and other (positivist, alternative) epistemologies regarding societal problems such as occupational justice, human rights, decolonization, political polarization, and the erosion of democracy. I suggest that federally funded biomedical research in the neoliberal university is not currently designed to advance a science of occupation, although it could if occupational scientists were to face the discipline’s contradictions under neoliberalism and reconstruct its common purpose.

Keywords. Occupational science; Pragmatism; Critical social theory; Racial justice

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

Noise is often considered a distractor; however recent studies suggest that sub-attentive individuals or individuals diagnosed with attention deficit hyperactivity disorder can benefit from white noise to enhance their cognitive performance. Research regarding the effect of white noise on neurotypical adults presents mixed results, thus the implications of white noise on the neurotypical population remain unclear. Thus, this study investigates the effect of 2 white noise conditions, white noise level at 45 dB and white noise level at 65 dB, on the cognitive performance, creativity, and stress levels of neurotypical young adults in a private office space. These conditions are compared to a baseline condition where participants are exposed to the office ambient noise. Our findings showed that the white noise level at 45 dB resulted in better cognitive performance in terms of sustained attention, accuracy, and speed of performance as well as enhanced creativity and lower stress levels. On the other hand, the 65 dB white noise condition led to improved working memory but higher stress levels, which leads to the conclusion that different tasks might require different noise levels for optimal performance. These results lay the foundation for the integration of white noise into office workspaces as a tool to enhance office workers’ performance.

Immersive virtual reality using a head-mounted display (HMD-VR) is increasing in use for motor learning and motor skill training. However, it remains unclear how visual information for action is processed in an HMD-VR environment. In the real world, actions towards three-dimensional (3D) objects are processed analytically and are immune to perceptual effects, such as processing object dimensions irrelevant to performing the action (i.e., holistic processing). However, actions towards two-dimensional (2D) objects are processed holistically and are susceptible to perceptual effects. In HMD-VR, distances are often underestimated, and the environment can appear flatter compared to the real world. Thus, actions towards virtual 3D objects in HMD-VR may be processed more like 2D objects and involve holistic processing, which is susceptible to perceptual effects. In an initial study, we used a Garner interference task to examine whether vision-for-action in HMD-VR is processed holistically and hypothesized that vision-for-action towards virtual 3D objects in HMD-VR would result in a Garner interference effect, suggesting holistic processing. We found Garner interference effects for reaction times to reach maximum grip aperture and to complete movement. These results show that visual processing of actions towards virtual 3D objects in HMD-VR may involve holistic processing of object shape. These findings demonstrate that visual information for action in HMD-VR is processed differently compared to real 3D objects and is susceptible to perceptual effects, which could affect motor skill training in HMD-VR.

Keywords. immersive virtual reality, head-mounted display, virtual 3D grasping, vision-for-action, garner interference

Assessment of anxiety in children with autism spectrum disorder (ASD) most commonly includes parent questionnaires. However, due to the nature of the questions and verbal limitations often present in children with ASD, caregivers may have difficulty completing such measures. Caregivers of 144 children with ASD ages 6 to 12 completed the Child and Adolescent Symptom Inventory-4 ASD Anxiety Scale and rated their level of confidence in responding to each item. Results indicated that parents had a moderate to high level of confidence in rating their children’s anxiety symptoms. Parent confidence was not influenced by their child’s age, expressive language ability, or intellectual functioning, but was related to their child’s anxiety symptom count and ASD severity.

Background and objectives. It is difficult to predict post-stroke outcome for people with severe motor impairment, as both clinical tests and corticospinal tract (CST) microstructure may not reliably indicate severe motor impairment. Here, we test whether imaging biomarkers beyond the CST relate to severe upper limb impairment post-stroke by evaluating white matter microstructure in the corpus callosum (CC). In an international, multisite hypothesis-generating observational study we determined if: a) CST asymmetry index can differentiate between individuals with mild-moderate and severe upper limb impairment; and b) CC biomarkers relate to upper limb impairment within individuals with severe impairment post-stroke. We hypothesised that CST asymmetry index would differentiate between mild-moderate and severe impairment, but CC microstructure would relate to motor outcome for individuals with severe upper limb impairment.

Methods. Seven cohorts with individual diffusion imaging and motor impairment (Fugl Meyer-Upper Limb) data were pooled. Hand-drawn regions-of-interest were used to seed probabilistic tractography for CST (ipsilesional/contralesional) and CC (prefrontal/premotor/motor/sensory/posterior) tracts. Our main imaging measure was mean fractional anisotropy. Linear mixed-effect regression explored relationships between candidate biomarkers and motor impairment, controlling for observations nested within cohorts, as well as age, sex, time post-stroke and lesion volume.

Results. Data from 110 individuals (30 mild-moderate, 80 with severe motor impairment) were included. In the full sample, greater CST asymmetry index (i.e., lower fractional anisotropy in the ipsilesional hemisphere, p<.001) and larger lesion volume (p=.139) were negatively related to impairment. In the severe subgroup, CST asymmetry index was not reliably associated with impairment across models. Instead, lesion volume and CC microstructure explained impairment in the severe group beyond CST asymmetry index (p’s<.010).

Conclusions. Within a large cohort of individuals with severe upper limb impairment, CC microstructure related to motor outcome post-stroke. Our findings demonstrate that CST microstructure does relate to upper limb outcome across the full range of motor impairment but was not reliably associated within the severe subgroup. Therefore, CC microstructure may provide a promising biomarker for severe upper limb outcome post-stroke, which may advance our ability to predict recovery in people with severe motor impairment after stroke.

Background. Arthritis is the leading cause of disability in adults, and research shows that people living with arthritis experience work instability, loss of independence, financial difficulties, and overall decreased quality of life. Current nonpharmacological treatments can be beneficial for short term relief; however, the evidence on these long-term treatments is limited. Ergonomic modifications have been used in the workplace to address musculoskeletal conditions to ensure proper fit of one's environment, and research shows that these modifications can decrease pain and injury and increase work productivity. A broader perspective on ergonomic approaches may be important to supporting individuals with arthritis within hand therapy.

Purpose of the Study. This review proposes an expanded perspective on ergonomic approaches within hand therapy and explores published literature to identify potential benefits of applying ergonomic approaches for individuals with upper extremity arthritis.

Methods. A systematic search and screening process was conducted to identify articles that implemented an ergonomic approach for the support of individuals with upper extremity osteoarthritis or rheumatoid arthritis.

Results. A total of 34 articles described interventions that employed ergonomics including task-based or general ergonomics (n = 17), contextualized supports (n = 8), or holistic, lifestyle approaches (n = 9). Only one study focused solely on individuals with osteoarthritis, whereas interventions for individuals with rheumatoid arthritis showed positive outcomes across these categories. Situational learning, building of patient self-efficacy, and development of new habits and routines are vital for carryover and implementation to support performance in daily life.

Conclusion. There is an opportunity for hand therapists to extend the scope of interventions provided as part of an ergonomic approach to supporting patients. Specifically, therapists can consider use of emerging technologies and telehealth that promote contextualization and follow-up for long-term outcomes.

Keywords. Ergonomics, Osteoarthritis, Rheumatoid arthritis

Some studies suggest that individuals with autism spectrum disorder have reduced emotional empathy while others do not. The presence of co-occurring alexithymia in autism spectrum disorder and differences in interoception have been associated with reductions in empathic ability. To fully explore the relationships between interoception, alexithymia, and emotional empathy, we collected self-report and interview data in 35 youth with autism spectrum disorder and 40 typically developing controls (ages 8–17 years). The autism spectrum disorder sample had increased alexithymia and physiological hyperarousal compared to typically developing controls, but there were no group differences in interoception or emotional empathy. Alexithymia severity correlated with higher personal distress in both groups and with lower empathic concern in the autism spectrum disorder group. Within the autism spectrum disorder group, higher incidence of reports of bodily sensation when describing emotional experience correlated with lower personal distress and lower alexithymia. In addition, although empathic concern was negatively correlated with alexithymia in the autism spectrum disorder group, across groups, the alexithymia hypothesis was supported in only the personal distress domain of emotional empathy. These results suggest emotional empathy; personal distress, in particular, is not intrinsically impaired in autism spectrum disorder.

Contemporary stroke assessment protocols have a limited ability to detect vascular cognitive impairment (VCI), especially among those with subtle deficits. This lesser-involved categorization, termed mild stroke (MiS), can manifest compromised processing speed that negatively impacts cognition. From a neurorehabilitation perspective, research spanning neuroimaging, neuroinformatics, and cognitive neuroscience supports that processing speed is a valuable proxy for complex neurocognitive operations, insofar as inefficient neural network computation significantly affects daily task performance. This impact is particularly evident when high cognitive loads compromise network efficiency by challenging task speed, complexity, and duration. Screening for VCI using processing speed metrics can be more sensitive and specific. Further, they can inform rehabilitation approaches that enhance patient recovery, clarify the construct of MiS, support clinician-researcher symbiosis, and further clarify the occupational therapy role in targeting functional cognition. To this end, we review relationships between insult-derived connectome alterations and VCI, and discuss novel clinical approaches for identifying disruptions of neural networks and white matter connectivity. Furthermore, we will frame knowledge translation efforts to leverage insights from cutting-edge structural and functional connectomics research. Lastly, we highlight how occupational therapists can provide expertise as knowledge brokers acting within their established scope of practice to drive substantive clinical innovation.

The neonatal intensive care unit (NICU) is a dynamic system with multiple stakeholders and contextual factors impacting the implementation of novel practices. This qualitative study aimed to (a) define health care professionals’ perceptions on the feasibility of implementing a sensory intervention to study its efficacy, and (b) elaborate on transactions occurring between NICU health care professionals and the proposed research. Eleven NICU professionals participated in one of three focus groups that were audio-recorded, transcribed, and analyzed thematically in NVivo first descriptively and then interpretively through a transactionalism lens. The health care professionals implied the intervention was feasible, but provided multiple suggestions to enhance implementation. The modification of familiar occupational practices, ingrained habits, and the potential impact on the collective occupational performance of NICU community members arose. Understanding occupations within the NICU as transactional allows for a broader view of occupational engagement and enhances knowledge of the nuances related to implementing clinical changes.

Keywords. qualitative research, neonate, occupational engagement, occupational science, occupational performance

Background. Parent-infant interaction is poorly understood among high-risk dyads in NICU settings. No parent-infant interaction measures are specifically designed for preterm infants within the NICU nor account for the education NICU parents receive to tailor their interactions based on the infant's cues.

Aim. To improve our understanding of a measure of parent-infant interaction in the NICU, we investigated relationships between parent-infant interaction scores on the Nursing Child Assessment Feeding Scale (NCAFS) and 1) socio-demographic and medical factors, 2) parent mental health and confidence, and 3) enhanced parental education (delivered as part of the Supporting and Enhancing NICU Sensory Experiences program) on tailoring interactions based on the infant's cues.

Method. Twenty-six preterm infants (born ≤32 weeks) had a video recorded oral feeding conducted by a parent in the NICU when the infant was 34–48 weeks postmenstrual age. A certified evaluator scored parent-infant interaction from the videos using the NCAFS.

Results. Seventeen (65 %) parent-infant dyads scored below the 10th percentile on the total NCAFS score. Despite it being well-understood that parent-infant interaction is related to sociodemographic factors and parental mental health, there were no relationships between these factors and NCAFS scores in this study. Dyads who received enhanced parent education (n = 15) had lower NCAFS scores than dyads receiving usual care (n = 11) (p = 0.01).

Conclusion. It remains unclear if the standard measure of parent-infant interaction, NCAFS, captured positive and negative interactions in context of assessment of a high-risk dyad within the NICU setting. The utility of the NCAFS with preterm infants in the NICU was not supported by this study.

Keywords. Premature infant; Human development; Parents; Interactions

This prospective study examined the latent growth trajectories of sensory patterns among a North Carolina birth cohort (N = 1517; 49% boys, 87% White) across infancy (6–19 months), preschool (3–4 years), and school years (6–7 years). Change rates of sensory hyper- and hyporesponsiveness better differentiated children with an autism diagnosis or elevated autistic traits from those with other developmental conditions, including non-autistic children with sensory differences. More sensory hyper- and hyporesponsiveness at infancy followed by steeper increases differentially predicted more autistic traits at school age. Further, children of parents with higher education tended to show stable or improving trajectories. These findings highlight the importance of tracking sensory patterns from infancy for facilitating early identification of associated challenges and tailored support for families.

Background. Sensory over-responsivity has been linked to oral care challenges in children with special healthcare needs. Parents of children with Down syndrome (cDS) have reported sensory over-responsivity in their children, but the link between this and oral care difficulties has not been explored.

Aim. Investigate relationship between sensory over-responsivity and oral care challenges in cDS.

Design. Online survey examined parent-report responses describing their cDS’s oral care (5-14yrs; n=367); children were categorized as sensory over-responders (SORs) or sensory not over-responders (SNORs). Chi-square analyses tested associations between groups (SORs vs. SNORs) and dichotomous oral care variables.

Results. More parents of SOR children, compared to SNOR, reported that: child behavior (SOR:86%, SNOR:77%; p<.05) and sensory sensitivities (SOR:34%, SNOR:18%; p<.001) make dental care challenging, their child complains about ≥3 types of sensory stimuli encountered during care (SOR:39%, SNOR:28%; p=.04), their dentist is specialized in treating children with special needs (SOR:45%, SNOR:33%; p=.03), and their child requires full assistance to brush teeth (SOR:41%, SNOR:28%; p=.008). No group differences were found in items examining parent-reported oral health or care access.

Conclusions. Parents of SOR children report greater challenges than parents of SNOR children at the dentist and in the home, including challenging behaviors and sensory sensitivities.

The COVID-19 pandemic led to stay-at-home mandates and lockdowns around the globe. During this time of occupational disruption and social distancing measures, many engaged through online environments. Social media are ever-increasing hosts of occupation and participation, rich with research opportunities. In this study, we explored COVID-19 experiences by analyzing parody videos posted on YouTube by various content creators. We analyzed the lyrics of 27 viral videos (accrued 1 million or more views) by 20 content creators. Using a transactional framework, we identified five themes related to occupational disruption in the lyrics and explored the polarity of the concepts within each theme: old norms vs. new normal, time expanded vs. time condensed, control seeking vs. lack of control, social isolation vs. excess socialization, and cynicism vs. hope. Our findings demonstrated the complex transactions between previous habits and routines, changing spaces of occupation, and meaning of daily occupations within evolving social, economic, and physical contexts. While this study showcased YouTube videos as one untapped source of contextualized knowledge for occupational science, there is a need for further exploration of methodological and ethical challenges of studying digital content.

Our objective was to investigate the validity of four-item and six-item versions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX, or TLX for short) for measuring workload over a whole day in the repeated measures context. We analyzed data on 51 people with type 1 diabetes from whom we collected ecological momentary assessment and daily diary data over 14 days. The TLX was administered at the last survey of every day. Confirmatory factor analysis fit statistics indicated that neither the TLX-6 nor TLX-4 were a unidimensional representation of whole day workload. In exploratory analyses, another set of TLX items we refer to as TLX-4v2 was sufficiently unidimensional. Raw sum scores from the TLX-6 and TLX-4v2 had plausible relationships with other measures, as evidenced by intra-person correlations and mixed-effects models. TLX-6 appears to capture multiple factors contributing to workload, while TLX-4v2 assesses the single factor of “mental strain.”

The COVID-19 pandemic emerged in early 2020, as did calls to bring an occupational perspective to an evolving situation. However, the role of occupation-focused education in facilitating responses to the global crisis was missing from this dialogue. This paper aims to address that gap by describing the development of a new course delivered at the University of Southern California in 2020 and 2021. Grounded in occupational science, this special topics course aimed to meet various teaching and learning needs for the post-professional occupational therapy doctorate program. This paper describes how the focus, format, and content of the course developed through a backward design approach to address topics related to the COVID-19 pandemic and intersecting, ongoing crises of structural racism and health and social inequalities. The primary course assignment, a knowledge mobilization product, provided students novel opportunities to leverage their occupational perspectives in response to emergent issues. The paper concludes by addressing three interrelated topics: the importance of institutional mechanisms that facilitate responsive educational innovations; the need to track the teaching and learning impacts of such innovations; and how such innovations reflect the importance of occupational science education.

Keywords. Occupational science; Backward design; Knowledge mobilization; Professional education; Occupational therapy

Introduction. Historically, heterogeneous outcome assessments have been used to measure recovery of consciousness in patients with disorders of consciousness (DoC) following traumatic brain injury (TBI), making it difficult to compare across studies. To date, however, there is no comprehensive review of clinical outcome assessments that are used in intervention studies of adults with DoC. The objective of this scoping review is to develop a comprehensive inventory of clinical outcome assessments for recovery of consciousness that have been used in clinical studies of adults with DoC following TBI.

Methods and analysis. The methodological framework for this review is: (1) identify the research questions, (2) identify relevant studies, (3) select studies, (4) chart the data, (5) collate, summarise and report results and (6) consult stakeholders to drive knowledge translation. We will identify relevant studies by searching the following electronic bibliographic databases: PubMed, Scopus, EMBASE, PsycINFO and The Cochrane Library (including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and Cochrane Methodology Register). Criteria for article inclusion are published in the English-language, peer-reviewed studies of interventions aimed at facilitating recovery of consciousness among adults (> 18 years) with DoC following a severe TBI, published from January 1986 to December 2020. Articles meeting inclusion criteria at this stage will undergo a full text review. We will chart the data by applying the WHO International Classification of Functioning, Disability and Health Framework to identify the content areas of clinical outcome assessments. To support knowledge translation efforts, we will involve clinicians and researchers experienced in TBI care throughout the project from conceptualisation of the study through dissemination of results.

Accurate lesion segmentation is critical in stroke rehabilitation research for the quantification of lesion burden and accurate image processing. Current automated lesion segmentation methods for T1-weighted (T1w) MRIs, commonly used in stroke research, lack accuracy and reliability. Manual segmentation remains the gold standard, but it is time-consuming, subjective, and requires neuroanatomical expertise. We previously released an open-source dataset of stroke T1w MRIs and manually-segmented lesion masks (ATLAS v1.2, N = 304) to encourage the development of better algorithms. However, many methods developed with ATLAS v1.2 report low accuracy, are not publicly accessible or are improperly validated, limiting their utility to the field. Here we present ATLAS v2.0 (N = 1271), a larger dataset of T1w MRIs and manually segmented lesion masks that includes training (n = 655), test (hidden masks, n = 300), and generalizability (hidden MRIs and masks, n = 316) datasets. Algorithm development using this larger sample should lead to more robust solutions; the hidden datasets allow for unbiased performance evaluation via segmentation challenges. We anticipate that ATLAS v2.0 will lead to improved algorithms, facilitating large-scale stroke research.

Background. Mothers play an important role in providing positive sensory experiences to their infants during NICU hospitalization. However, little is known regarding maternal perceptions about sensory-based interventions in the NICU. Further, understanding maternal perceptions was an important part of the process during development of the Supporting and Enhancing NICU Sensory Experiences (SENSE) program.

Methods. Twenty mothers of very preterm infants were interviewed after NICU discharge and asked open-ended questions about sensory-based interventions they performed in the NICU and probed about their perceptions related to the development of a sensory-based guideline and the use of volunteers to provide sensory-based interventions when unable to be present in the NICU. Interviews were transcribed and uploaded into NVivoV.12 for content analysis.

Results. Mothers reported that kangaroo care was a common sensory intervention they performed in the NICU. Of the 18 mothers who commented on the development of a sensory-based guideline, 17 (94%) said they would be accepting of one. Among 19 mothers, 18 (95%) supported volunteers conducting sensory-based interventions in their absence. Identified themes included: 1) Perceptions about development of a sensory-based guideline, 2) Perceptions of interactions with healthcare providers, 3) Maternal participation in sensory interventions, 4) Maternal experience, and 5) Emotions from mothers.

Conclusion. Maternal perceptions regarding the development of a sensory-based guideline were favorable, and the SENSE program has since been finalized after incorporating important insights learned from stakeholders in this study. Mothers' perceptions were tied to their NICU experiences, which elicited strong emotions. These findings highlight important considerations when developing family-centered interventions.

Keywords. development, sensory, therapy, NICU (neonatal intensive care unit), qualitative study

Scientific research has become highly intertwined with digital information, however scientific publication remains based on the static text and figures of principal articles. This discrepancy constrains complex scientific data into 2D static figures, hindering our ability to effectively exchange the complex and extensive information that underlies modern research. Here, we demonstrate how the viewing of digital data can be directly integrated into the existing publication system through both web based and augmented reality (AR) technologies. We additionally provide a framework that makes these capabilities available to the scientific community. Ultimately, augmenting articles with data can modernize scientific communication by bridging the gap between the digital basis of present-day research and the natural limitations of printable articles.

Background. Autistic children and youth have high rates of co-occurring conditions,but little is known about how autism subgroups (girls, non-White children) access healthcare to treat them. The purpose of this longitudinal retrospective cohort study was to investigate differences by sex, race, and ethnicity in non-acute (primary and subspecialty) healthcare use by autistic children and youth.

Method. We used the OneFlorida Data Trust to measure healthcare use for 82,566 autistic children ages 1–21 (2012–2018). We investigated (1) the odds of using any healthcare and (2) annual healthcare usage rates. We adopted a logistic regression and multiple linear regression for each of the dependent variables (total non-acute, primary care, gastroenterology (GI), developmental-behavioral pediatrics (DBP), psychiatry/psychology, neurology, and total subspecialty visits), adjusting for potential confounders (sex, race, ethnicity, age at visit, insurance type, urbanicity, and co-occurring conditions).

Results. Autistic boys had significantly higher odds of any neurology and psychiatry/psychology visits, but lower annual rates of primary care, GI, and neurology visits. Black/African American autistic children had significantly higher odds of any primary care, DBP, and neurology visits, but lower odds of any GI visits, and lower annual rates of primary care, GI, DBP, and neurology visits. Hispanic/Latinx autistic children had significantly higher odds of any primary care, DBP, and neurology visits, but lower odds of psychiatry/psychology visits; and higher annual rates of neurology visits, but lower annual rates of GI, DBP, and psychiatry/psychology visits.

Conclusions. We found significant differences by sex, race, and ethnicity in non-acute healthcare use by autistic children.

Keywords. Autism spectrum disorders; Sex/gender; Healthcare utilization

Background. Persistent sensorimotor impairments after stroke can negatively impact quality of life. The hippocampus is vulnerable to poststroke secondary degeneration and is involved in sensorimotor behavior but has not been widely studied within the context of poststroke upper-limb sensorimotor impairment. We investigated associations between non-lesioned hippocampal volume and upper limb sensorimotor impairment in people with chronic stroke, hypothesizing that smaller ipsilesional hippocampal volumes would be associated with greater sensorimotor impairment.

Methods and Results. Cross-sectional T1-weighted magnetic resonance images of the brain were pooled from 357 participants with chronic stroke from 18 research cohorts of the ENIGMA (Enhancing NeuoImaging Genetics through Meta-Analysis) Stroke Recovery Working Group. Sensorimotor impairment was estimated from the FMA-UE (Fugl-Meyer Assessment of Upper Extremity). Robust mixed-effects linear models were used to test associations between poststroke sensorimotor impairment and hippocampal volumes (ipsilesional and contralesional separately; Bonferroni-corrected, P<0.025), controlling for age, sex, lesion volume, and lesioned hemisphere. In exploratory analyses, we tested for a sensorimotor impairment and sex interaction and relationships between lesion volume, sensorimotor damage, and hippocampal volume. Greater sensorimotor impairment was significantly associated with ipsilesional (P=0.005; β=0.16) but not contralesional (P=0.96; β=0.003) hippocampal volume, independent of lesion volume and other covariates (P=0.001; β=0.26). Women showed progressively worsening sensorimotor impairment with smaller ipsilesional (P=0.008; β=−0.26) and contralesional (P=0.006; β=−0.27) hippocampal volumes compared with men. Hippocampal volume was associated with lesion size (P<0.001; β=−0.21) and extent of sensorimotor damage (P=0.003; β=−0.15).

Conclusions. The present study identifies novel associations between chronic poststroke sensorimotor impairment and ipsilesional hippocampal volume that are not caused by lesion size and may be stronger in women.

Background. Healthcare Information for All (HIFA) is a multidisciplinary global campaign consisting of more than 20,000 members worldwide committed to improving the availability and use of health care information in low- and middle-income countries (LMICs). During the COVID-19 pandemic, online HIFA forums saw a tremendous amount of discussion regarding the lack of information about COVID-19, the spread of misinformation, and the pandemic’s impact on different communities.

Objective. This study aims to analyze the themes and perspectives shared in the COVID-19 discussion on English HIFA forums.

Methods. Over a period of 8 months, a qualitative thematic content analysis of the COVID-19 discussion on English HIFA forums was conducted. In total, 865 posts between January 24 and October 31, 2020, from 246 unique study participants were included and analyzed.

Results. In total, 6 major themes were identified: infodemic, health system, digital health literacy, economic consequences, marginalized peoples, and mental health. The geographical distribution of study participants involved in the discussion spanned across 46 different countries in every continent except Antarctica. Study participants’ professions included public health workers, health care providers, and researchers, among others. Study participants’ affiliation included nongovernment organizations (NGOs), commercial organizations, academic institutions, the United Nations (UN), the World Health Organization (WHO), and others.

Conclusions. The themes that emerged from this analysis highlight personal recounts, reflections, suggestions, and evidence around addressing COVID-19 related misinformation and might also help to understand the timeline of information evolution, focus, and needs surrounding the COVID-19 pandemic.

Keywords. infodemic; infodemiology; COVID-19; pandemic; misinformation; health information; theme; public health; qualitative study; global health

Importance. Veterans with mild traumatic brain injury (mTBI) and associated symptoms are at risk for suicide. Postconcussive symptoms (PCS) may heighten risk for suicidal thoughts by limiting veterans’ participation.

Objective. To investigate whether participation mediates the relationship between PCS and suicidal ideation.

Design. Cross-sectional, exploratory design. Structural equation models were used to investigate whether participation mediated the relationship between PCS and suicidal ideation.

Setting. Community.

Participants. Veterans with mTBI (N = 145).

Outcomes and Measures. The Ohio State University TBI Identification Method was used to establish mTBI diagnosis. We identified latent variables for PCS and participation using the Neurobehavioral Symptom Inventory and select domains of the Medical Outcomes Study Short Form–36, respectively. We used the Beck Scale for Suicide Ideation to measure the presence of suicidal ideation.

Results. Participation mediated the relationship between PCS and the presence of suicidal ideation (odds ratio [OR] = 1.09, p = .011). More severe PCS were associated with lesser participation (β = –.86, p < .001); greater participation was associated with lower odds of suicidal ideation (OR = 0.92, p = .007).

Conclusions and Relevance. PCS may heighten risk for suicidal thoughts among veterans by limiting successful participation, a primary target of occupational therapy intervention. Thus, the results suggest that occupational therapy practitioners can play a substantial role in suicide prevention services for veterans with mTBI. Preventive services could mitigate suicide risk among veterans with mTBI by enabling sustained engagement in meaningful and health-promoting activity (e.g., reasons for living) and targeting PCS.

Keywords. post-concussion syndrome, traumatic brain injury, mild, veterans, suicidal behavior

Importance. Although three sensory factors (hyperresponsiveness [HYPO]; hyporesponsiveness [HYPER]; and sensory interests, repetitions, and seeking behaviors [SIRS]) have been demonstrated among a wide age range of clinical populations, they have not been well validated in the general population, especially with a large community sample of young children.

Objective. To validate the factor structure of the Sensory Experiences Questionnaire (Version 2.1, Short Form; SEQv2.1) in a community sample and to confirm the factor structure’s existence in this sample.

Design. Caregivers completed the SEQv2.1, a parent-reported questionnaire designed to capture children’s everyday sensory experiences. The latent factors of the SEQv2.1 were examined using confirmatory factor analysis.

Setting. North Carolina.

Participants. Caregivers of 2,195 children age 3 yr were initially recruited through state birth records and were eligible to participate if the child did not have a history of serious medical problems and English was the family’s primary language.

Outcomes and Measures. SEQv2.1.

Results. The SEQv2.1 showed validity in the community sample. Similar to previous research with clinical populations, the three broad patterns of sensory responsiveness were also confirmed in this large community sample of young children, but associations among the factors differed.

Conclusions and Relevance. Validation of the three-sensory-factor structure in the general population suggests that these constructs are similar to those found with samples of participants with autism spectrum disorder and developmental disabilities. This finding underscores the importance of understanding the normative development of sensory features across a wider age range to better delineate qualitative differences underlying sensory features between clinical and general populations.

Keywords. child, systemic inflammatory response syndrome, autism spectrum disorder

Importance. Children diagnosed with autism spectrum disorder (ASD) are often referred to occupational therapy practitioners so their sensory features and their repetitive and restricted behaviors and interests (RRBIs) can be addressed. RRBIs include an insistence on sameness, narrow interests, rigid routines, and rituals. However, there is a paucity of knowledge concerning the association between sensory features—across patterns, modalities, and contexts—and high-order RRBIs among children with ASD who are cognitively able.

Objective. To examine the association between sensory features across sensory patterns, modalities, and contexts and high-order RRBIs in children with ASD.

Design. Correlational clinical study based on parent questionnaire responses.

Setting. General education system in Israel.

Participants. Parents of 39 cognitively able school-age children with ASD (ages 6–10 yr; 34 boys and 5 girls), recruited by means of convenience sampling.

Outcomes. High-order RRBIs were assessed with relevant subscales from the Repetitive Behavior Scale–Revised (RBS–R), and sensory features across patterns, modalities, and contexts were examined with the Sensory Experiences Questionnaire, Version 2.1. The study hypotheses were formulated before data were collected.

Results. Significant correlations were observed between the high-order RRBIs of children with ASD and their sensory features across patterns, sensory modalities, and contexts. Fifty-one percent of the total RBS–R scores were predicted by sensory hyperresponsiveness, and an additional 11% were predicted by sensory-seeking behaviors.

Conclusions and Relevance. The hypotheses concerning the association between sensory features and high-order RRBIs were confirmed. The findings enhance occupational therapy practitioners’ understanding of this association and may assist in the planning of more efficient interventions.

Keywords. autism spectrum disorder, child

Early detection of autism risk in the community is critical to increasing families' access to early intervention, yet few measures have been developed and tested for the general population of infants <16 months to tap a broader range of autism risk constructs. This study aimed to (a) examine the factor structure of the First Years Inventory, version 3.1 (FYIv3.1), with a sample of 6454 infants 6–16 months, and (b) determine the ability of the resulting factors to discriminate clinical outcome groups at 3 years of age. The FYIv3.1 is a parent-report tool designed to detect early behavioral risk signs that may be associated with a later diagnosis of ASD and related neurodevelopmental conditions. Factor analytic models were used to determine the number of constructs and inter-factor correlations. Findings supported a seven-factor structure: communication, imitation and play (CIP); social attention and affective engagement (SAE); sensory hyperresponsiveness (HYPER); sensory hyporesponsiveness (HYPO); self-regulation in daily routines (SREG); sensory interests, repetitions, and seeking behaviors (SIRS); motor coordination and milestones (MCM). Mean comparisons on these factors demonstrated significant discrimination of the three outcome groups at age 3 years including those classified as having an ASD diagnosis and/or high autism symptoms, those classified as having other developmental disorders/conditions/concerns, and those classified with no known conditions/concerns. These findings support the validity and multidimensionality of early ASD risk constructs, as well as the potential use of the FYIv3.1 for phenotypic subtyping in the general population, and early detection in a broader age range of 6–16 months in future clinical studies.

International students who enroll in American occupational therapy academic programs must quickly adapt to the academic demands and everyday life rhythms within the United States. This qualitative study contributes to the body of knowledge of lived experiences of international occupational therapy students, specific to their transition to graduate occupational therapy education and daily life in a new country. Thirteen (13) international occupational therapy graduate students and alumni participated in an individual or joint interview. Three key themes emerged from the findings and include the following: 1) Challenges: Inside and Outside of the Classroom, 2) A Support System: A Home Away from Home, and 3) Giving Back to my Home Country: Improving Occupational Therapy Education, Practice, and Research. This study provides insights into the challenges experienced by international graduate occupational therapy students and alumni, strategies that are beneficial in supporting them as they transition into graduate level education and daily life within the United States, and their motivations for giving back to their home countries.

Although occupational therapy (OT) practitioners are well suited to address spirituality within client care, evidence suggests many practitioners feel discomfort or lack of knowledge of this subject. Few studies have delved into OTs’ experiences and encapsulated if and how spirituality has been experienced in practice. This study aimed to gain a deeper and more updated insight into this phenomenon. Utilizing a phenomenological approach with interviews, this study explored OT practitioners’ (n = 15) experiences with spirituality in client care. (a) Losing spirit: the inadequacy of only addressing mind and body, (b) spirituality as a vehicle for reaffirming purpose in both client and therapist, and (c) addressing spirituality through functional and measurable treatments. Although the concept of mind, body, and spirit is not new, occupational therapists often do not consistently address these components simultaneously, leading to missed opportunities in client practice.

Keywords. spirituality, occupational therapy, qualitative research

Sedentary activity and static postures are associated with work-related musculoskeletal disorders (WMSDs) and worker discomfort. Ergonomic evaluation for office workers is commonly performed by experts using tools such as the Rapid Upper Limb Assessment (RULA), but there is limited evidence suggesting sustained compliance with expert’s recommendations. Assessing postural shifts across a day and identifying poor postures would benefit from automation by means of real-time, continuous feedback. Automated postural assessment methods exist; however, they are usually based on ideal conditions that may restrict users’ postures, clothing, and hair styles, or may require unobstructed views of the participants. Using a Microsoft Kinect camera and open-source computer vision algorithms, we propose an automated ergonomic assessment algorithm to monitor office worker postures, the 3D Automated Joint Angle Assessment, 3D-AJA. The validity of the 3D-AJA was tested by comparing algorithm-calculated joint angles to the angles obtained from manual goniometry and the Kinect Software Development Kit (SDK) for 20 participants in an office space. The results of the assessment show that the 3D-AJA has mean absolute errors ranging from 5.6° ± 5.1° to 8.5° ± 8.1° for shoulder flexion, shoulder abduction, and elbow flexion relative to joint angle measurements from goniometry. Additionally, the 3D-AJA showed relatively good performance on the classification of RULA score A using a Random Forest model (micro averages F1-score = 0.759, G-mean = 0.811), even at high levels of occlusion on the subjects’ lower limbs. The results of the study provide a basis for the development of a full-body ergonomic assessment for office workers, which can support personalized behavior change and help office workers to adjust their postures, thus reducing their risks of WMSDs.

Keywords. Ergonomic assessment; RULA; Engineering office environments; Depth camera; Computer vision; Machine learning

Background. Psychosocial sequelae are common for individuals with physical injuries to the upper extremity. However, psychosocially oriented interventions are not common in this occupational therapy practice area.

Purpose. This study implemented an online survey of hand therapy patients’ psychological symptoms. Second, it explored patients’ interest in one psychosocially oriented intervention: mindfulness meditation.

Methods. The design was a cross-sectional survey of 120 consecutively recruited hand therapy patients. Survey measures included functioning, psychosocial factors, and trait mindfulness.

Findings. Anxiety was prevalent in this sample, and moderately correlated with trait mindfulness (r = −0.542, p < .001). While most participants (77%) indicated mindfulness meditation would be an acceptable intervention, women were 2.8 times as likely to be interested (p = .044).

Implications. Psychosocially oriented interventions are indicated in hand therapy based on the prevalence of these symptoms. Further examination of using mindfulness meditation in hand therapy is warranted due to patient interest.

Evidence Connection articles provide examples of how evidence from systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Project can be directly translated into clinical practice. These articles present a summary of the topic and case studies that demonstrate how the evidence from these reviews can inform clinical decision making. This Evidence Connection article includes findings from a systematic review of interventions within the scope of occupational therapy practice that improve or maintain performance of or participation in instrumental activities of daily living for people living with multiple sclerosis.

Keywords. adult, health, multiple sclerosis, systematic reviews, treatment goals, cognitive-behavioral therapy

Background. Stroke is considered a common and major problem in the field of healthcare because of its high prevalence and long-term disabilities. The main aim of rehabilitation is to increase the participation of stroke patients in different areas of life. The current study purposed to review the factors influencing the participation of Iranian stroke patients in life areas.

Methods. Databases including ISI-Web of Knowledge, PubMed, Google Scholar, and Scopus were searched using keywords such as occupational therapy, participation, activities of daily living (ADL), instrumental activities of daily living (IADLs), work, play, leisure, education, social participation, sleep, and rest in combination with Iranian stroke patients and CVA. The quality of the studies was evaluated using the PEDro scale. All papers reviewed in this study concerned factors influencing the participation of Iranian stroke patients and were published from 2000-2020.

Results. In total, 178 articles were identified as eligible for an Iranian stroke study. Of these, 104 articles were discarded, and an additional 38 were removed because of repetition and duplication. After careful evaluation of the papers, 34 were selected for final analysis. Most of the included studies concerned the ADL area of participation (N=32), and the lowest number of articles were in the areas of play (N=1), sleep/rest (N=2), and health management (N=3).

Conclusion. In Iran, researchers have not paid enough attention to the participation of stroke patients in areas of life. Most studies focus mainly on patient’s performance components, such as sensory and motor skills.

Keywords. stroke; cerebrovascular accident; participation; life area

Lesion load of the corticospinal tract (CST-LL), a measure of overlap between a stroke lesion and the CST, is one of the strongest predictors of motor outcomes following stroke. CST-LL is typically calculated by using a probabilistic map of the CST originating from the primary motor cortex (M1). However, higher order motor areas also have projections that contribute to the CST and motor control. In this retrospective study, we examined whether evaluating CST-LL from additional motor origins is more strongly associated with post-stroke motor severity than using CST-LL originating from M1 only. We found that lesion load to both the ventral premotor (PMv) cortex and M1 were more strongly related to stroke motor severity indexed by Fugl-Meyer Assessment cut-off scores than CST-LL of M1 alone, suggesting that higher order motor regions add clinical relevance to motor impairment.

Low-intensity transcranial electrical stimulation (tES), including alternating or direct current stimulation, applies weak electrical stimulation to modulate the activity of brain circuits. Integration of tES with concurrent functional MRI (fMRI) allows for the mapping of neural activity during neuromodulation, supporting causal studies of both brain function and tES effects. Methodological aspects of tES-fMRI studies underpin the results, and reporting them in appropriate detail is required for reproducibility and interpretability. Despite the growing number of published reports, there are no consensus-based checklists for disclosing methodological details of concurrent tES-fMRI studies. The objective of this work was to develop a consensus-based checklist of reporting standards for concurrent tES-fMRI studies to support methodological rigor, transparency and reproducibility (ContES checklist). A two-phase Delphi consensus process was conducted by a steering committee (SC) of 13 members and 49 expert panelists through the International Network of the tES-fMRI Consortium. The process began with a circulation of a preliminary checklist of essential items and additional recommendations, developed by the SC on the basis of a systematic review of 57 concurrent tES-fMRI studies. Contributors were then invited to suggest revisions or additions to the initial checklist. After the revision phase, contributors rated the importance of the 17 essential items and 42 additional recommendations in the final checklist. The state of methodological transparency within the 57 reviewed concurrent tES-fMRI studies was then assessed by using the checklist. Experts refined the checklist through the revision and rating phases, leading to a checklist with three categories of essential items and additional recommendations: (i) technological factors, (ii) safety and noise tests and (iii) methodological factors. The level of reporting of checklist items varied among the 57 concurrent tES-fMRI papers, ranging from 24% to 76%. On average, 53% of checklist items were reported in a given article. In conclusion, use of the ContES checklist is expected to enhance the methodological reporting quality of future concurrent tES-fMRI studies and increase methodological transparency and reproducibility.

Importance. Occupational therapy practitioners need updated information about interventions that may improve or maintain functional changes in instrumental activity of daily living (IADL) engagement caused by multiple sclerosis (MS).

Objective. To conduct a narrative synthesis of updated evidence on interventions within the scope of occupational therapy to improve or maintain performance of and participation in IADLs among adults with MS.

Data Sources. CINAHL, MEDLINE in PubMed, Cochrane, OTseeker, and PsycINFO.

Study Selection and Data Collection. This systematic review followed the Cochrane Collaboration methodology and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting a systematic review. Inclusion criteria were Level 1 or 2 evidence, published in English, published from January 2011 to December 2018, intervention within the occupational therapy scope of practice, and at least one IADL outcome measure.

Findings. Nineteen randomized controlled trials (including pilot and feasibility trials) and 1 preintervention–postintervention study met inclusion criteria. Results of this review show strong strength of evidence for coaching interventions in addressing physical activity (PA) routines and moderate support in addressing medication routines. Moderate strength of evidence was found with mixed results for interventions involving coaching plus prescribed PA in improving PA participation.

Conclusions and Relevance. This systematic review supports occupational therapy practitioners addressing PA and medication health management and maintenance IADLs through the use of coaching interventions when treating people with MS. Other IADLs were addressed by the articles in this review but require more evidence to make clinical recommendations.

Keywords. adult, health, multiple sclerosis, systematic reviews, occupational therapists

Previous studies indicate that damage to motor brain regions impacts comprehension of literal action-related language. However, whether such damage also impacts comprehension of action-metaphors remains unknown. Such a finding would support the notion that metaphors are grounded in sensorimotor representations. Here we tested this hypothesis by comparing comprehension of novel, conventional, and frozen action and non-action metaphors in 14 right-handed adults with right-sided mild to moderate paresis following left hemisphere motor stroke and 23 neurotypical participants. Consistent with our hypothesis, results indicated that only in the stroke group, accuracy for action metaphors was significantly lower than for non-action metaphors. Further, in the stroke group, accuracy was significantly worse in the following pattern: novel < conventional < frozen action metaphors. These results strongly support the notion that motor-related brain regions are important not only for literal action-related language comprehension, but also for action-related metaphor comprehension, especially for less familiar metaphors.

Keywords. Embodied semantics theory; Motor stroke; Motor metaphor; Abstract language; Graded Salience Hypothesis

Dental fear and anxiety (DFA) is common across the lifespan and represents a barrier to proper oral health behaviors and outcomes. The aim of this study is to present a conceptual model of the relationships between DFA, general anxiety/fear, sensory over-responsivity (SOR), and/or oral health behaviors and outcomes. Two rounds of literature searches were performed using the PubMed database. Included articles examined DFA, general anxiety/fear, SOR, catastrophizing, and/or oral health behaviors and outcomes in typically developing populations across the lifespan. The relationships between the constructs were recorded and organized into a conceptual model. A total of 188 articles were included. The results provided supporting evidence for relationships between DFA and all other constructs included in the model (general anxiety/fear, SOR, poor oral health, irregular dental attendance, dental behavior management problems [DBMP], and need for treatment with pharmacological methods). Additionally, SOR was associated with general anxiety/fear and DBMP; general anxiety/fear was linked to poor oral health, irregular attendance, and DBMP. This model provides a comprehensive view of the relationships between person factors (e.g., general anxiety/fear, SOR, and DFA) and oral health behaviors and outcomes. This is valuable in order to highlight connections between constructs that may be targeted in the development of new interventions to improve oral health behaviors and outcomes as well as the experience of DFA.

Keywords. dental anxiety; dental fear; oral health behaviors; general anxiety; sensory over-responsivity; dental behavior management problems

Background. The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of psychological factors such as anxiety and depression. This study determined the incidence of shoulder pain in novice individuals exposed to repetitive shoulder tasks, and the associated change in outcomes of supraspinatus tendon morphology and measures of anxiety and depression.

Methods. We recruited dental hygiene (DH) students (N = 45, novice and exposed to shoulder repetitive tasks) and occupational therapy (OT) students (N = 52, novice, but not exposed to shoulder repetitive tasks), following them over their first year of training. We measured shoulder pain, supraspinatus morphology via ultrasound, psychosocial distress via the Hospital Anxiety and Depression Scale. We compared the incidence of shoulder pain (defined as a change of visual analog pain scale greater than minimal clinically important difference) between DH and OT students using Fisher’s exact test. We used mixed-effects models to longitudinally compare the change in outcomes between three groups: DH students that develop and did not develop shoulder pain, and OT students.

Results. The incidence of shoulder pain is higher in DH students [relative risk = 4.0, 95% confidence interval (CI): 1.4, 11.4]. After one year, DH students with pain had the greatest thickening of the supraspinatus (0.7mm, 95%CI: 0.4, 0.9). The change in supraspinatus thickness of DH students with pain was greater than both DH students with no pain (0.4mm, 95%CI: 0.1, 0.8) and OT students (0.9mm, 95%CI: 0.5, 1.2). Anxiety score increased 3.8 points (95%CI: 1.6, 5.1) in DH students with pain, and 43% of DH students with pain had abnormal anxiety score at one-year (relative risk = 2.9, 95%CI: 1.0; 8.6).

Conclusion. Our results provide support for the theoretical model of repetitive load as a mechanism of tendinopathy. The supraspinatus tendon thickens in the presence of repetitive tasks, and thickens the most in those who develop shoulder pain. Concurrently, anxiety develops with shoulder pain, indicating a potential maladaptive central mechanism that may impact the perception of pain.

Keywords. supraspinatus; tendinopathy; anxiety; pain; shoulder

Objective. To evaluate the quality of carpal tunnel syndrome (CTS) patient education handouts and identify the best resources for patients and clinicians.

Design. A document content analysis of handouts identified through a systematic internet search using 8 search terms on Google and Bing and a hand search of professional association websites.

Setting. Not Applicable.

Participants. Documents were identified from the top 50 search results across 16 individual searches. Included documents provided general patient education for CTS; descriptive websites, videos, and research studies were excluded.

Interventions. Not applicable.

Main Outcome Measures. Content analysis was conducted using the Information Score (IS) tool to evaluate completeness of information [0%-100%], and misleading treatment recommendations were identified. Design analysis was conducted using the Patient Material Assessment Tool (PEMAT-P) [0-100%] and two widely-used readability formulas, Flesch Reading Ease (FRE) and Flesch Kincaid Grade Level (FKGL). Using these results, all handouts were rated with a summative 12-point scale.

Results. Of 805 unique search results, we included 56 CTS handouts. The average IS was 74.6% ± 17.9%. 78.6% of the handouts mentioned non-evidence-based treatment recommendations. The average PEMAT-P score was 70.2% ± 10.9% and the average readability grade level was 7.7 ± 1.7. Only 3 handouts were identified as high quality based on the 12-point summative scores, while 22 handouts had mixed quality and 17 handouts had low quality on both content and design.

Conclusions. Findings of this study suggest a lack of high-quality and easily understandable CTS patient education handouts. Most handouts contained unreliable treatment information. Improvements are needed to ensure patients’ ability to understand and manage this condition.

Keywords. Carpal Tunnel Syndrome; Health Literacy; Patient Education

Objective. This study aimed to (1) define the prevalence of motor, cognitive, and language delays in preterm infants born <32 weeks estimated gestational age (EGA); and (2) identify the relationship between the timing of discharge from the neonatal intensive care unit (NICU) and neurodevelopmental outcome in early childhood.

Study Design. This retrospective study of 172 preterm infants born <32 weeks EGA and hospitalized in a level-IV NICU captured medical factors, including timing of discharge, from the NICU stay. Standardized developmental testing at 1 to 2 years corrected age was conducted in the newborn follow-up clinic.

Results. At 1 to 2 years corrected age, the sample had an average Bayley Scales of Infant and Toddler Development (Bayley-III) cognitive composite score of 91.5 ± 17.4, language composite score of 84.5 ± 17.3, and motor composite score of 88.9 ± 18.4. Lower EGA at birth, necrotizing enterocolitis, patent ductus arteriosus, and oxygen requirement for >28 days were independently associated with higher postmenstrual age (PMA) at NICU discharge. Higher PMA at discharge was associated with poorer cognitive outcome [p < 0.001, β = −1.1 (−1.6, −0.7)], poorer language outcome [p = 0.049, β = −0.5 (−0.9, −0.003)], and poorer motor outcome [p <0.001, β = −1.0 (−1.5, −0.5)]. For every additional week of hospitalization, scores were an average of 1.1 points lower in cognitive, 1.0 point lower in motor, and 0.5 points lower in language domains of the Bayley-III assessment.

Conclusion. Poorer cognitive, language, and motor outcomes were associated with longer hospitalization, even after controlling for medical risk factors known to be associated with poorer outcome. This provides further evidence for the potential role of the environment in impacting developmental outcomes of infants hospitalized in the NICU.

Keywords. hospitalization; neonatal intensive care unit; length of stay; postmenstrual age; outcomes; child development; risk factors; environment

Objective. To quantify the economic burden of all-cause health care resource utilization (HCRU) among adults with and without chronic vestibular impairment (CVI) after a mild traumatic brain injury (mTBI).

Design. Retrospective matched cohort study.

Setting. IQVIA Integrated Data Warehouse.

Participants. People with mTBI+CVI (n=20,441) matched on baseline age, sex, year of mTBI event, and Charlson Comorbidity Index (CCI) score to people with mTBI only (n=20,441) (N=40,882).

Interventions. Not applicable.

Main Outcome Measures. All-cause health HCRU and costs at 12 and 24 months post mTBI diagnosis.

Results. People with mTBI+CVI had significantly higher all-cause HCRU and costs at both time points than those with mTBI only. Multivariable regression analysis showed that, when controlling for baseline variables, costs of care were 1.5 times higher for mTBI+CVI than mTBI only.

Conclusions. People who developed CVI after mTBI had greater overall HCRU and costs for up to 2 years after the injury event compared with people who did not develop CVI after controlling for age, sex, region, and CCI score. Further research on access to follow-up services and effectiveness of interventions to address CVI is warranted.

Keywords. Brain concussion; Costs and cost analysis; Health care costs; Postural balance; Rehabilitation

The nature and extent of persistent neuropsychiatric symptoms after COVID-19 are not established. To help inform mental health service planning in the pandemic recovery phase, we systematically determined the prevalence of neuropsychiatric symptoms in survivors of COVID-19. For this pre-registered systematic review and meta-analysis (PROSPERO ID CRD42021239750), we searched MEDLINE, EMBASE, CINAHL and PsycINFO to 20 February 2021, plus our own curated database. We included peer-reviewed studies reporting neuropsychiatric symptoms at post-acute or later time-points after COVID-19 infection and in control groups where available. For each study, a minimum of two authors extracted summary data. For each symptom, we calculated a pooled prevalence using generalized linear mixed models. Heterogeneity was measured with I². Subgroup analyses were conducted for COVID-19 hospitalization, severity and duration of follow-up. From 2844 unique titles, we included 51 studies (n = 18 917 patients). The mean duration of follow-up after COVID-19 was 77 days (range 14–182 days). Study quality was most commonly moderate. The most prevalent neuropsychiatric symptom was sleep disturbance [pooled prevalence = 27.4% (95% confidence interval 21.4–34.4%)], followed by fatigue [24.4% (17.5–32.9%)], objective cognitive impairment [20.2% (10.3–35.7%)], anxiety [19.1% (13.3–26.8%)] and post-traumatic stress [15.7% (9.9–24.1%)]. Only two studies reported symptoms in control groups, both reporting higher frequencies in COVID-19 survivors versus controls. Between-study heterogeneity was high (I² = 79.6–98.6%). There was little or no evidence of differential symptom prevalence based on hospitalization status, severity or follow-up duration. Neuropsychiatric symptoms are common and persistent after recovery from COVID-19. The literature on longer-term consequences is still maturing but indicates a particularly high prevalence of insomnia, fatigue, cognitive impairment and anxiety disorders in the first 6 months after infection.

Keywords. COVID-19, neuropsychiatry, Long COVID, post-acute sequelae of COVID-19, chronic COVID syndrome

As stroke mortality rates decrease, there has been a surge of effort to study poststroke dementia (PSD) to improve long‐term quality of life for stroke survivors. Hippocampal volume may be an important neuroimaging biomarker in poststroke dementia, as it has been associated with many other forms of dementia. However, studying hippocampal volume using MRI requires hippocampal segmentation. Advances in automated segmentation methods have allowed for studying the hippocampus on a large scale, which is important for robust results in the heterogeneous stroke population. However, most of these automated methods use a single atlas‐based approach and may fail in the presence of severe structural abnormalities common in stroke. Hippodeep, a new convolutional neural network‐based hippocampal segmentation method, does not rely solely on a single atlas‐based approach and thus may be better suited for stroke populations. Here, we compared quality control and the accuracy of segmentations generated by Hippodeep and two well‐accepted hippocampal segmentation methods on stroke MRIs (FreeSurfer 6.0 whole hippocampus and FreeSurfer 6.0 sum of hippocampal subfields). Quality control was performed using a stringent protocol for visual inspection of the segmentations, and accuracy was measured as volumetric correlation with manual segmentations. Hippodeep performed significantly better than both FreeSurfer methods in terms of quality control. All three automated segmentation methods had good correlation with manual segmentations and no one method was significantly more correlated than the others. Overall, this study suggests that both Hippodeep and FreeSurfer may be useful for hippocampal segmentation in stroke rehabilitation research, but Hippodeep may be more robust to stroke lesion anatomy.

Keywords. convolutional neural network, hippocampus, image segmentation, lesion, MRI, stroke

Introduction/Aims. There is a lack of consensus regarding median nerve movement in the carpal tunnel during composite finger flexion in healthy individuals. This study aimed to examine the amount and direction of median nerve movement and differentiate nerve mobility between dominant and non-dominant sides in a large healthy young adult cohort.

Methods. Sonographic videos of the median nerve during composite finger motion from extension to full flexion were analyzed in 197 participants without median nerve pathology. Displacement of the nerve’s centroid was calculated based on a change in the relative location of the nerve. Longitudinal nerve sliding was categorized as none, independently from the tendons, or with the tendons.

Results. In short axis, median nerves moved within 1 mm vertically and 3 mm horizontally; no direction was predominant. About half of the nerves (52.5%) slid independently while 26.9% slid with the tendons; 21.3% did not slide at all. On the non-dominant side, median nerves that slid with the tendons had a larger absolute vertical displacement than nerves that slid independently or did not slide at all (p<0.01). Nerves on the dominant side moved in a radial direction more frequently than on the non-dominant side (p=0.02).

Discussion. Transverse nerve movement during composite finger flexion in healthy individuals varies widely with no clear pattern in the direction of transverse movement or amount of longitudinal sliding. These data provide a foundation for future research to better understand the biomechanical contribution of nerve movement to median nerve pathologies.

The goal of the Enhancing Neuroimaging Genetics through Meta‐Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well‐powered meta‐ and mega‐analytic approaches. ENIGMA Stroke Recovery has data from over 2,100 stroke patients collected across 39 research studies and 10 countries around the world, comprising the largest multisite retrospective stroke data collaboration to date. This article outlines the efforts taken by the ENIGMA Stroke Recovery working group to develop neuroinformatics protocols and methods to manage multisite stroke brain magnetic resonance imaging, behavioral and demographics data. Specifically, the processes for scalable data intake and preprocessing, multisite data harmonization, and large‐scale stroke lesion analysis are described, and challenges unique to this type of big data collaboration in stroke research are discussed. Finally, future directions and limitations, as well as recommendations for improved data harmonization through prospective data collection and data management, are provided.

Gastrointestinal dysfunction is one of the most prevalent physiological symptoms of autism spectrum disorder (ASD). A growing body of largely preclinical research suggests that dysbiotic gut microbiota may modulate brain function and social behavior, yet little is known about the mechanisms that underlie these relationships and how they may influence the pathogenesis or severity of ASD. While various genetic and environmental risk factors have been implicated in ASD, this review aims to provide an overview of studies elucidating the mechanisms by which gut microbiota, associated metabolites, and the brain interact to influence behavior and ASD development, in at least a subgroup of individuals with gastrointestinal problems. Specifically, we review the brain-gut-microbiome system and discuss findings from current animal and human studies as they relate to social-behavioral and neurological impairments in ASD, microbiota-targeted therapies (i.e., probiotics, fecal microbiota transplantation) in ASD, and how microbiota may influence the brain at molecular, structural, and functional levels, with a particular interest in social and emotion-related brain networks. A deeper understanding of microbiome-brain-behavior interactions has the potential to inform new therapies aimed at modulating this system and alleviating both behavioral and physiological symptomatology in individuals with ASD.

Keywords. autism spectrum disorder; brain-gut-microbiome system; gut-brain axis; microbiome; probiotics; tryptophan pathway

Introduction. Repetitive peripheral sensory stimulation (RPSS) followed by 4-hour task-specific training (TST) improves upper limb motor function in subjects with stroke who experience moderate to severe motor upper limb impairments. Here, we compared effects of RPSS vs sham followed by a shorter duration of training in subjects with moderate to severe motor impairments in the chronic phase after stroke.

Methods. This single-center, randomized, placebo-controlled, parallel-group clinical trial compared effects of 18 sessions of either 1.5 h of active RPSS or sham followed by a supervised session that included 45 min of TST of the paretic upper limb. In both groups, subjects were instructed to perform functional tasks at home, without supervision. The primary outcome measure was the Wolf Motor Function Test (WMFT) after 6 weeks of treatment. Grasp and pinch strength were secondary outcomes.

Results. In intention-to-treat analysis, WMFT improved significantly in both active and sham groups at 3 and 6 weeks of treatment. Grasp strength improved significantly in the active, but not in the sham group, at 3 and 6 weeks. Pinch strength improved significantly in both groups at 3 weeks, and only in the active group at 6 weeks.

Conclusions. The between-group difference in changes in WMFT was not statistically significant. Despite the short duration of supervised treatment, WMFT improved significantly in subjects treated with RPSS or sham. These findings are relevant to settings that impose constraints in duration of direct contact between therapists and patients. In addition, RPSS led to significant gains in hand strength.

This review aimed to quantify correlations between heart rate variability (HRV) and functional outcomes after acquired brain injury (ABI). We conducted a literature search from inception to January 2020 via electronic databases, using search terms with HRV, ABI, and functional outcomes. Meta-analyses included 16 studies with 906 persons with ABI. Results demonstrated significant associations: Low frequency (LF) (r = −0.28) and SDNN (r = −0.33) with neurological function; LF (r = −0.33), High frequency (HF) (r = −0.22), SDNN (r = −0.22), and RMSSD (r = −0.23) with emotional function; and LF (r = 0.34), HF (r = 0.41 to 0.43), SDNN (r = 0.43 to 0.51), and RMSSD (r = 0.46) with behavioral function. Results indicate that higher HRV is related to better neurological, emotional, and behavioral functions after ABI. In addition, persons with stroke showed lower HF (SMD = −0.50) and SDNN (SMD = −0.75) than healthy controls. The findings support the use of HRV as a biomarker to facilitate precise monitoring of post-ABI functions.

Background. Early parent engagement in the neonatal intensive care unit (NICU) is important for both parent and infant mental health and for improving developmental outcomes. It remains unclear how different programs, such as the Supporting and Enhancing NICU Sensory Experiences (SENSE) program, may empower parents from various socio-demographic groups to engage in the NICU. An improved understanding could aid in individualizing interventions for those at the highest risk for health disparities.

Aims. This exploratory study, which was part of a larger study, sought to explore 1) socio-demographic factors related to parent presence and engagement in the NICU and 2) if the Supporting and Enhancing NICU Sensory Experiences (SENSE) program related to increased parent presence and engagement among different socio-demographic groups.

Methods. Seventy mother-infant dyads (≤ 32 weeks gestation) were randomized to SENSE programming (parent education and age-appropriate, positive sensory interventions for parents to conduct with their infants every day of hospitalization) or standard care after admission to the NICU. The amount of parent presence and participation in sensory activities was tracked using bedside logs, nursing records, and research team documentation.

Results. Being married (p=0.048; p=0.01), having private insurance (p<0.001; p=0.01), and having fewer children (p=0.004; p=0.03) related to more parent presence and engagement. Parents who were Black had less presence and engagement in the NICU (p=.04; p=0.02). Participation in the SENSE program was related to more parent presence and engagement among younger mothers (p=.002; p=<0.001) and among parents living farther distances from the hospital (p<0.001; p=0.004).

Conclusion. Programming, such as SENSE, can improve engagement among high-risk groups.

Objective. To evaluate the structural validity of the Mayo-Portland Adaptability Inventory Participation Index (M2PI) in a sample of veterans and to assess whether the tool functioned similarly for male and female veterans.

Design. Rasch analysis of M2PI records from the National Veterans Traumatic Brain Injury Health Registry database from 2012-2018.

Setting. National VA Polytrauma System of Care outpatient settings.

Participants. Veterans with a clinically confirmed history of traumatic brain injury (TBI) (N=6065; 94% male).

Interventions. Not applicable.

Main Outcome Measures. M2PI, a 5-point Likert-type scale with 8 items. For this analysis, the 2 employment items were treated individually for a total of 9 items.

Results. The employment items misfit the Rasch Measurement model (paid employment mean square [MnSq]=1.40; other employment MnSq=1.34) and were removed from subsequent iterations. The final model had eigenvalue 1.87 on the first contrast, suggesting unidimensionality of the remaining 7 items. Item order from least to most participation restriction was transportation, self-care, residence management, financial management, initiation, leisure, and social contact. Wright's person separation reliability for nonnormal distributions was 0.93, indicating appropriateness of M2PI for making individual-level treatment decisions. Mean person measure was −0.92±1.34 logits, suggesting that participants did not report restrictions on most items (item mean=0 logits). A total of 3.8% of the sample had the minimum score (no impairment on all items), and 0.2% had the maximum score. Four items had different item calibrations (≥0.25 logits) for female compared with male veterans, but the hierarchy of items was unchanged when the female sample was examined separately.

Conclusions. These findings suggest that, although employment is a poor indicator of participation restrictions among veterans with TBI, the M2PI is unidimensional. Because of subtle differences in scale function between male and female participants, M2PI should be part of a more thorough clinical interview about participation strengths and restrictions.

Keywords. Brain injuries, traumatic; Community participation; Psychometrics; Rehabilitation; Veterans

Carpal tunnel syndrome (CTS) treatment contains ambiguities across and within disciplines. This meta-synthesis of professional guidelines consolidates clinical treatment recommendations for CTS treatment and classifies them by strength of evidence. We conducted a search of Google, Google Scholar, and PubMed for published clinical treatment recommendations for CTS. A systematic hand search was completed to identify additional professional organizations with published recommendations. We extracted any mentioned treatment from all sources but developed our final consolidated clinical treatment recommendations only from select rigorous guidelines based on the Institute of Medicine (IOM) criteria for trustworthy guidelines. We translated rating systems of the primary guidelines into a universal rating system to classify recommendations for consolidated clinical treatment recommendations. Our search yielded 30 sources that mentioned a total of 55 CTS treatments. Six of the sources met the IOM inclusion criteria. These primary guidelines provided recommendations for 46 of the 55 treatments, which were consolidated into 12 broad treatment categories. Surgery, positioning, and steroids were strongly supported. Conservative treatments provided by rehabilitation professionals were conditionally supported. Pharmaceuticals, supplements, and alternative treatments were not generally supported. CTS is a complex condition with a wide variety of treatments provided by a multitude of disciplines. Our consolidated clinical treatment recommendations offer a comprehensive outline of available treatments for CTS and contributes to the process of developing best practices for its treatment.

Keywords. Carpal tunnel syndrome; Guideline; Rehabilitation; Systematic review

Importance. Virtual reality in head-mounted displays (HMD-VR) may be a valuable tool in occupational therapy to address anxiety. Findings from the virtual reality exposure therapy (VRET) literature may facilitate translation of HMD-VR to occupational therapy psychosocial practice.

Objective. To explore how HMD-VR has been used to treat anxiety through VRET and could be translated to occupational therapy.

Data Sources. We searched seven electronic databases for articles published between 2000 and 2020: CINAHL, Cochrane Library, Embase, ERIC, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms included HMD-VR constructs, products, and therapy concepts.

Study Selection and Data Collection. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to report studies implementing VRET to treat anxiety. At least two reviewers assessed each citation, and a third resolved disagreements. Articles were included if they were in English, reported experimental data, and used HMD-VR. Letters, commentaries, book chapters, technical descriptions, theoretical papers, conference proceedings (≤4 pages), and reviews were excluded.

Findings. Twenty-eight studies used HMD-VR to treat posttraumatic stress disorder (n = 3), specific phobias (n = 19), and performance-based social anxiety (n = 6); protocols and levels of evidence varied (randomized controlled trials, n = 11; controlled trials without randomization, n = 6; case–control or cohort studies, n = 11). Qualitative examination indicates HMD-VR is an effective treatment tool.

Conclusions and Relevance. HMD-VR can be a valuable tool for occupational therapy to simulate environments where clients with anxiety disorders participate. Eliciting presence through multisensory features and body representation may enhance outcomes.

The outbreak of SARS-CoV-2 virus forced office workers to conduct their daily work activities from home over an extended period. Given this unique situation, an opportunity emerged to study the satisfaction of office workers with indoor environmental quality (IEQ) factors of their houses where work activities took place and associate these factors with mental and physical health. We designed and administered a questionnaire that was open for 45 days during the COVID-19 pandemic and received valid data from 988 respondents. The results show that low satisfaction with natural lighting, glare and humidity predicted eye related symptoms, while low satisfaction with noise was a strong predictor of fatigue or tiredness, headaches or migraines, anxiety, and depression or sadness. Nose and throat related symptoms and skin related symptoms were only uniquely predicted by low satisfaction with humidity. Low satisfaction with glare uniquely predicted an increase in musculoskeletal discomfort. Symptoms related to mental stress, rumination or worry were predicted by low satisfaction with air quality and noise. Finally, low satisfaction with noise and indoor temperature predicted the prevalence of symptoms related to trouble concentrating, maintaining attention or focus. Workers with higher income were more satisfied with humidity, air quality and indoor temperature and had better overall mental health. Older individuals had increased satisfaction with natural lighting, humidity, air quality, noise, and indoor temperature. Findings from this study can inform future design practices that focus on hybrid home-work environments by highlighting the impact of IEQ factors on occupant well-being.

Up to two-thirds of stroke survivors experience persistent sensorimotor impairments. Recovery relies on the integrity of spared brain areas to compensate for damaged tissue. Deep grey matter structures play a critical role in the control and regulation of sensorimotor circuits. The goal of this work is to identify associations between volumes of spared subcortical nuclei and sensorimotor behaviour at different timepoints after stroke. We pooled high-resolution T1-weighted MRI brain scans and behavioural data in 828 individuals with unilateral stroke from 28 cohorts worldwide. Cross-sectional analyses using linear mixed-effects models related post-stroke sensorimotor behaviour to non-lesioned subcortical volumes (Bonferroni-corrected, P < 0.004). We tested subacute (≤90 days) and chronic (≥180 days) stroke subgroups separately, with exploratory analyses in early stroke (≤21 days) and across all time. Sub-analyses in chronic stroke were also performed based on class of sensorimotor deficits (impairment, activity limitations) and side of lesioned hemisphere. Worse sensorimotor behaviour was associated with a smaller ipsilesional thalamic volume in both early (n = 179; d = 0.68) and subacute (n = 274, d = 0.46) stroke. In chronic stroke (n = 404), worse sensorimotor behaviour was associated with smaller ipsilesional putamen (d = 0.52) and nucleus accumbens (d = 0.39) volumes, and a larger ipsilesional lateral ventricle (d = −0.42). Worse chronic sensorimotor impairment specifically (measured by the Fugl-Meyer Assessment; n = 256) was associated with smaller ipsilesional putamen (d = 0.72) and larger lateral ventricle (d = −0.41) volumes, while several measures of activity limitations (n = 116) showed no significant relationships. In the full cohort across all time (n = 828), sensorimotor behaviour was associated with the volumes of the ipsilesional nucleus accumbens (d = 0.23), putamen (d = 0.33), thalamus (d = 0.33) and lateral ventricle (d = −0.23). We demonstrate significant relationships between post-stroke sensorimotor behaviour and reduced volumes of deep grey matter structures that were spared by stroke, which differ by time and class of sensorimotor measure. These findings provide additional insight into how different cortico-thalamo-striatal circuits support post-stroke sensorimotor outcomes.

Objectives. To 1) estimate the total pool of neonatal therapists and the average number represented in each US-based NICU, and 2) investigate the relationships between the number and type of neonatal therapy team members to NICU/hospital, population, and therapy factors.

Study Design. This study used several methods of data collection (surveys, phone calls, website searches) that were combined to establish a comprehensive list of factors across each NICU in the US.

Results. We estimate 2333 neonatal therapy FTEs, with 4232 neonatal therapists covering those FTEs in the US. Among 564 NICUs, 432 (76%) had a dedicated therapy team, 103 (18%) had PRN therapy coverage only, and 35 (6%) had no neonatal therapy team. Having a dedicated therapy team was more likely in level IV (n=112; 97%) and III (n=269; 83%) NICUs compared to level II NICUs (n=51; 42%) (p<0.001). Having a dedicated therapy team was related to having more NICU beds (p<0.001), being part of a free-standing children’s hospital or children’s hospital within a hospital (p<0.001), and being part of an academic medical center or community hospital (p<0.001). Having a dedicated therapy team was more common in the Southeast, Midwest, Southwest, and West (p=0.001), but was not related to the proportion of the community living in poverty or belonging to racial/ethnic minorities (p>0.05). There was an average of 17 beds per neonatal therapy FTE, a good marker of therapy coverage based on NICU size. Three-hundred US-based NICUs (22%) had at least one Certified Neonatal Therapist (CNT) in early 2020, with CNT presence being more likely in higher acuity NICUs (59% of Level IV NICUs had at least one CNT).

Conclusions. Understanding the composition of neonatal therapy teams at different hospitals across the US can drive change to expand neonatal therapy aimed at optimizing outcomes of high-risk families.

Background. While short-term blood glucose (BG) levels and variability are thought to underlie diminished function and emotional well-being in people with T1D, these relationships are poorly understood. The Function and Emotion in Everyday Life with T1D (FEEL-T1D) study focuses on investigating these short-term dynamic relationships among BG, function, and emotional well-being in adults with T1D.

Objective. To present the FEEL-T1D study design, methods, and study progress to date, including adaptations necessitated by the COVID-19 pandemic to implement the study fully remotely.

Methods. The FEEL-T1D study will recruit 200 adults 18-75 years old with T1D. Data collection includes a comprehensive survey battery, along with 14 days of intensive longitudinal data using blinded continuous glucose monitoring (CGM), ecological momentary assessments (EMA), ambulatory cognitive tasks, and accelerometers. All study procedures are conducted remotely, through mailing study equipment and using videoconferencing for study visits.

Results. To date, after 12 months of recruitment, 124 participants have enrolled in the FEEL-T1D study. Over 80% have provided concurrent CGM, EMA, and accelerometer data for at least 10 of the 14 days of data collection, and nearly 90% of EMA surveys have been completed, with minimal missing data.

Conclusions. Thus far, our reconfiguration of the FEEL-T1D protocol to be implemented remotely during the COVID-19 pandemic has been a success. The FEEL-T1D study will elucidate the dynamic relationships between blood glucose, emotional well-being, cognitive function and participation in daily activities. In doing so, it will pave the way for innovative just-in-time interventions and produce actionable insights to facilitate tailoring of diabetes treatment to optimize function and well-being among individuals with T1D.

Occupational health and safety is experiencing a paradigm shift from focusing only on health at the workplace toward a holistic approach and worker well-being framework that considers both work and non-work factors. Aligned with this shift, the purpose of this pilot study was to examine how, within a person, frequencies of high-workload and recovery activities from both work and non-work periods were associated with same day well-being measures. We analyzed data on 45 workers with type 1 diabetes from whom we collected activity data 5–6 times daily over 14 days. More frequent engagement in high-workload activities was associated with lower well-being on multiple measures including higher stress. Conversely, greater recovery activity frequency was mostly associated with higher well-being indicated by lower stress and higher positive affect. Overall, our results provide preliminary validity evidence for measures of high-workload and recovery activity exposure covering both work and non-work periods that can inform and support evaluations of worker well-being.

Keywords. workload; recovery; ecological momentary assessment; type 1 diabetes; workweek; healthy work design and well-being; future of work

Stay-at-home mandates following the COVID-19 pandemic increased work from home (WFH). While WFH offers many benefits, navigating work in nontraditional contexts can be a challenge. The objective of this study was to explore the benefits and challenges of WFH during COVID-19 to identify supports and resources necessary. Comments from two free-response questions on a survey regarding experiences of WFH (N = 648, N = 366) were analyzed using inductive qualitative content analysis. Four themes emerged: time use, considerations of working in the home space, intersections between work-life and home-life, and temporality of WFH as situated within a pandemic. Across all themes were concerns related to participation in both work and home roles, work performance, and well-being. Findings highlight the importance of support during times of disruption of occupational patterns, roles, and routines. Despite challenges, many individuals hoped to continue WFH. Organizations should consider the complex intersections of work-life and home-life to develop supportive policies and resources.

Keywords. work; survey; context; health; occupational balance

Older adults may benefit from interventions to successfully age in place. Research has an opportunity to test interventions and implementation strategies to fulfill the needs of older adults through collective evidence building. The purpose of this article is to describe the proceedings of the American Occupational Therapy Foundation (AOTF) 2019 Planning Grant Collective and describe the areas of research that were identified as critical. The AOTF convened scientists with expertise in the area of aging in place to catalyze research on aging in place for older adults. Four priority areas in the aging in place literature were highlighted: (a) identification of factors that support aging in place, (b) classification of processes by which family members and care partners are included in aging in place efforts, (c) categorization of technology supporting older adults to age in place, and (d) development of science that clarifies implementation of evidence-based practice.

Objective. Evaluate the effect of a manualized multisensory program, applied across NICU hospitalization, on infant and parent outcomes.

Study design. Seventy parent-infant dyads (born ≤32 weeks gestation) in a Level IV NICU were randomized at birth to the multisensory program or standard-of-care. Parents in the multisensory group administered prespecified amounts of age-appropriate, evidence-based sensory interventions to their infants each day during NICU hospitalization according to the Supporting and Enhancing NICU Sensory Experiences (SENSE) program.

Results. Infants who received the SENSE program had more lethargy on the NICU Network Neurobehavioral Scale (NNNS) (p = 0.05), even after controlling for medical and social risk (p = 0.043), and had higher Communication scores on the Ages and Stages Questionnaire (p = 0.04) at 1-year corrected age, but this relationship failed to reach significance after controlling for medical and social risk (p = 0.12).

Conclusion. The SENSE program shows promise for improving outcomes, but more research with larger sample sizes is needed.

Autistic children have a high prevalence of co-occurring mental health, developmental/behavioral, and medical conditions, but research on sex/gender differences has been mixed. We used Florida healthcare claims data to characterize sex differences (female/male) in co-occurring conditions among autistic children ages 1–21 (N = 83,500). After adjusting for age, race, ethnicity, urbanicity, and insurance, autistic girls had significantly higher odds of anxiety disorders, mood disorders, intellectual disability, developmental disorders, epilepsy, metabolic disorders, gastrointestinal disorders, and sleep disorders compared to autistic boys. Autistic girls had significantly lower odds of ADHD. The findings contribute to the growing body of research on the unique healthcare needs of autistic girls.

Keywords. Autism spectrum disorder, Co-occurring condition, Sex, Gender, Healthcare claims, Girls

Unpaid caregivers are often expected to help family members or friends overcome activity limitations and participation restrictions to successfully age in place. Caregivers assume multiple responsibilities, such as managing their own physical and psychosocial needs and navigating a complex health care system, and many feel ill equipped to fulfill the necessary health care responsibilities for their care recipients. Underprepared caregivers may cause poor outcomes for care recipients. Federal and state policy proposals call attention to the need to better support caregivers, especially as their numbers increase. Occupational therapy practitioners are well positioned to effectively engage caregivers as they navigate the health care system. The occupational therapy process looks broadly at the functional abilities, environmental contexts, and occupational demands that play a pivotal role in successful aging in place for clients and better outcomes for their caregivers. Now is the time to define occupational therapy’s distinct value to this area.

Keywords. aging, caregivers, health, clients, productive aging, occupational therapists, interdisciplinary treatment approach

Background. With the COVID-19 pandemic, organizations embraced Work From Home (WFH). An important component of transitioning to WFH is the effect on workers, particularly related to their productivity and work experience.

Objectives. The objective of this study is to examine how worker-, workspace-, and work-related factors affected productivity and time spent at a workstation on a typical WFH day during the pandemic.

Methods. An online questionnaire was designed and administered to collect the necessary information. Data from 988 respondents were included in the analyses.

Results. Overall perception of productivity level among workers did not change relative to their in-office productivity before the pandemic. Female, older, and high-income workers were likely to report increased productivity. Productivity was positively influenced by better mental and physical health statuses, having a teenager, increased communication with coworkers and having a dedicated room for work. Number of hours spent at a workstation increased by approximately 1.5 hours during a typical WFH day. Longer hours were reported by individuals who had school age children, owned an office desk or an adjustable chair, and had adjusted their work hours.

Conclusion. The findings highlight key factors for employers and employees to consider for improving the WFH experience.

Real-time fMRI neurofeedback is an increasingly popular neuroimaging technique that allows an individual to gain control over his/her own brain signals, which can lead to improvements in behavior in healthy participants as well as to improvements of clinical symptoms in patient populations. However, a considerably large ratio of participants undergoing neurofeedback training do not learn to control their own brain signals and, consequently, do not benefit from neurofeedback interventions, which limits clinical efficacy of neurofeedback interventions. As neurofeedback success varies between studies and participants, it is important to identify factors that might influence neurofeedback success. Here, for the first time, we employed a big data machine learning approach to investigate the influence of 20 different design-specific (e.g. activity vs. connectivity feedback), region of interest-specific (e.g. cortical vs. subcortical) and subject-specific factors (e.g. age) on neurofeedback performance and improvement in 608 participants from 28 independent experiments.

With a classification accuracy of 60% (considerably different from chance level), we identified two factors that significantly influenced neurofeedback performance: Both the inclusion of a pre-training no-feedback run before neurofeedback training and neurofeedback training of patients as compared to healthy participants were associated with better neurofeedback performance. The positive effect of pre-training no-feedback runs on neurofeedback performance might be due to the familiarization of participants with the neurofeedback setup and the mental imagery task before neurofeedback training runs. Better performance of patients as compared to healthy participants might be driven by higher motivation of patients, higher ranges for the regulation of dysfunctional brain signals, or a more extensive piloting of clinical experimental paradigms. Due to the large heterogeneity of our dataset, these findings likely generalize across neurofeedback studies, thus providing guidance for designing more efficient neurofeedback studies specifically for improving clinical neurofeedback-based interventions. To facilitate the development of data-driven recommendations for specific design details and subpopulations the field would benefit from stronger engagement in open science research practices and data sharing.

Patients suffering from body integrity dysphoria (BID) desire to become disabled, arising from a mismatch between the desired body and the physical body. We focus here on the most common variant, characterized by the desire for amputation of a healthy limb. In most reported cases, amputation of the rejected limb entirely alleviates the distress of the condition and engenders substantial improvement in quality of life. Since BID can lead to life-long suffering, it is essential to identify an effective form of treatment that causes the least amount of alteration to the person’s anatomical structure and functionality. Treatment methods involving medications, psychotherapy, and vestibular stimulation have proven largely ineffective. In this hypothesis article, we briefly discuss the characteristics, etiology, and current treatment options available for BID before highlighting the need for new, theory driven approaches. Drawing on recent findings relating to functional and structural brain correlates of BID, we introduce the idea of brain–computer interface (BCI)/neurofeedback approaches to target altered patterns of brain activity, promote re-ownership of the limb, and/or attenuate stress and negativity associated with the altered body representation.

In this paper, we explore how socially constructed hegemonic masculinity permeates military culture, and how this cultural context intersects with the seeking and receiving of health care by active-duty US military service members with chronic mild traumatic brain injury (mTBI) (n = 18). Data were collected through individual interviews and focus groups. Using Bourdieu’s theory of practice as an analytical framework, we identified four themes: maintenance of social capital, remaining in the field, reframing health care use to bolster social capital, and risk of health care use as not being rewarded. Each emerged from statements about why participants had avoided seeking health care for physical and psychological needs during their military service. We consider our findings in the context of maintaining status within an institutional steeped in hegemonic masculinity and describe implications for reframing caring for the body and dealing with problems as masculine acts.

Keywords. mild traumatic brain injury, military personnel, culture, masculinity

The right hemisphere is involved with the integrative processes necessary to achieve global coherence during reasoning and discourse processing. Specifically, the right temporal lobe has been proven to facilitate the processing of distant associate relationships, such as generating novel ideas. Previous studies showed a specific swing of alpha and gamma oscillatory activity over the right parieto-occipital lobe and the right anterior temporal lobe respectively, when people solve semantic problems with a specific strategy, i.e., insight problem-solving. In this study, we investigated the specificity of the right parietal and temporal lobes for semantic integration using transcranial Random Noise Stimulation (tRNS). We administered a set of pure semantics (i.e., Compound Remote Associates [CRA]) and visuo-semantic problems (i.e., Rebus Puzzles) to a sample of 31 healthy volunteers. Behavioral results showed that tRNS stimulation over the right temporal lobe enhances CRA accuracy (+12%), while stimulation on the right parietal lobe causes a decrease of response time on the same task (−2,100 ms). No effects were detected for Rebus Puzzles. Our findings corroborate the involvement of the right temporal and parietal lobes when solving purely semantic problems but not when they involve visuo-semantic material, also providing causal evidence for their postulated different roles in the semantic integration process and promoting tRNS as a candidate tool to boost verbal reasoning in humans.

Background. Work-related musculoskeletal disorders are prevalent in dental hygienists. Although engineering controls and ergonomic training is available, it is unclear why this intransigent problem continues. One possible barrier is that a comprehensive, standardized protocol for evaluating dental hygiene work does not exist.

Objective. This study aimed to generate a valid and reliable observational protocol for the assessment of dental hygiene work.

Methods. An iterative process was used to establish and refine an ecologically valid video acquisition and observation protocol to assess key activities, tasks, and performance components of dental hygiene work.

Results. Good inter-rater reliability was achieved across all variables when the final coding scheme was completed by three independent raters.

Conclusions. This work provides an exemplar of the process required to generate a comprehensive protocol for evaluating the work components of a particular job, and provides standardized nomenclature for use by scientists and practitioners interested in understanding and addressing the pervasive issue of work-related disorders in dental hygienists.

Keywords. Dental hygienists; clinical; ergonomics; research protocol.

Background. Carpal tunnel syndrome (CTS) symptoms are problematic especially when signs and symptoms are not substantial enough to require surgical intervention. Conservative treatments have mixed effectiveness, yet are one of the best options for mild to moderate CTS. Kinesio tape is an emerging modality, as it provides biomechanical support while allowing movement.

Purpose. The purpose of this study was to determine the efficacy of dorsal application of Kinesio tape on occupational performance as measured by pain and function in individuals with mild to moderate CTS, as compared with the accepted nonsurgical intervention of general cockup orthosis and lumbrical stretching exercises versus sham tape.

Study Design. Single-blind randomized controlled trial.

Methods. Forty-four participants (68 wrists) with CTS were randomized to one of three interventions: Kinesio tape group, sham group, or standard protocol group. Each completed baseline and four subsequent measurements of numeric pain rating scale, visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), grip and pinch, with application of intervention every three days. Daily symptom journals were completed, standard protocol group recorded wearing schedule and exercises.

Results. In the forearm and wrist, a significant reduction in median numeric pain rating scale pain scores in Kinesio tape group was observed (r = 0.76, P = .01; r = 0.77, P = .01; respectively), but not in the standard protocol group (r = 0.51, P = .17; r = 0.53, P = .11) and sham group (r = 0.46, P = .30; r = 0.39, P = .43) with a minimal clinically important difference of 1.0. In the Kinesio tape group, the forearm (24%) and wrist (36%) reached the clinical significance as compared with the standard protocol forearm (18%) and wrist (32%).

The minimal clinically important difference for pain reduction on the visual analog scale was 1.64. Kinesio tape and sham group had significant improvement in function, but not the standard protocol group.

Discussion. This study provides promising evidence for the use of Kinesio tape as a possible conservative intervention for management of symptoms in individuals with mild to moderate CTS. The study also illuminates new considerations of younger, active individuals reporting signs and symptoms of CTS as well as mechanism of effects on pain reduction.

Conclusions. Kinesio tape provided additional improvement in pain and function as compared to the standard approach.

Keywords. Carpal tunnel syndrome, Kinesio tape, Conservative interventions, Functional performance

During movement, groups of muscles may be controlled together by the nervous system as an adaptable functional entity, or ‘synergy’. The rules governing when (or if) this occurs during voluntary behaviour in humans are not well understood, at least in part because synergies are usually defined by correlated patterns of muscle activity without regard for the underlying structure of their neural control. In this study, we investigated the extent to which comodulation of muscle output (i.e. correlation of electromyographic (EMG) amplitudes) implies that muscles share intermuscular neural input (assessed via EMG–EMG coherence analysis). We first examined this relationship among pairs of upper limb muscles engaged in an arm cycling task. We then applied a novel multidimensional EMG–EMG coherence analysis allowing synergies to be characterized on the basis of shared neural drive. We found that alpha-band coherence (8–16 Hz) is related to the degree to which overall muscle activity levels correlate over time. The extension of this coherence analysis to describe the cross-muscle distribution and temporal modulation of alpha-band drive revealed a close match to the temporal and structural features of traditionally defined muscle synergies. Interestingly, the coherence-derived neural drive was inversely associated with, and preceded, changes in EMG amplitudes by ∼200 ms. Our novel characterization of how alpha-band neural drive is dynamically distributed among muscles is a fundamental step forward in understanding the neural origins and correlates of muscle synergies.

Keywords. alpha-band; coherence; EMG; synergy.

Prolonged symptoms from the novel coronavirus disease 2019 (COVID-19), otherwise known as long COVID, postacute sequelae of COVID-19 (PASC), or post-COVID syndrome, are affecting an increasingly high number of patients after severe, moderate, and mild acute COVID-19 infections. Using evidence-based practice strategies, this case report describes occupational therapy evaluation and treatment approaches, plan of care, and associated outcomes for one client experiencing long COVID symptoms in the outpatient setting.

The coronavirus disease 2019 (COVID-19) pandemic has presented unique challenges for occupational therapy practitioners working in acute and critical care settings. Using the best available evidence, this case report overviews a prototypical COVID-19 disease course and discusses key aspects of clinical reasoning for practitioners working with this novel population. Following a single patient admitted to a tertiary academic medical center, the authors review the occupational profile and medical history, common impairments, the intervention plan, and strategies to align the occupational therapy and medical goals of care.

Everyday decision-making is supported by a dual-system of control comprised of parallel goal-directed and habitual systems. Over the past decade, the two-stage Markov decision task has become popularized for its ability to dissociate between goal-directed and habitual decision-making. While a handful of studies have implemented decision-making tasks online, only one study has validated the task by comparing in-person and web-based performance on the two-stage task in children and young adults. To date, no study has validated the dissociation of goal-directed and habitual behaviors in older adults online. Here, we implemented and validated a web-based version of the two-stage Markov task using parameter simulation and recovery and compared behavioral results from online and in-person participation on the two-stage task in both young and healthy older adults. We found no differences in estimated free parameters between online and in-person participation on the two-stage task. Further, we replicate previous findings that young adults are more goal-directed than older adults both in-person and online. Overall, this work demonstrates that the implementation and use of the two-stage Markov decision task for remote participation is feasible in the older adult demographic, which would allow for the study of decision-making with larger and more diverse samples.

There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations.

We searched MEDLINE, Embase, PsycINFO and CINAHL up to 18 July 2020 for randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and case series. Studies reporting prevalences of neurological or neuropsychiatric symptoms were synthesised into meta-analyses to estimate pooled prevalence.

13 292 records were screened by at least two authors to identify 215 included studies, of which there were 37 cohort studies, 15 case-control studies, 80 cross-sectional studies and 83 case series from 30 countries. 147 studies were included in the meta-analysis. The symptoms with the highest prevalence were anosmia (43.1% (95% CI 35.2% to 51.3%), n=15 975, 63 studies), weakness (40.0% (95% CI 27.9% to 53.5%), n=221, 3 studies), fatigue (37.8% (95% CI 31.6% to 44.4%), n=21 101, 67 studies), dysgeusia (37.2% (95% CI 29.8% to 45.3%), n=13 686, 52 studies), myalgia (25.1% (95% CI 19.8% to 31.3%), n=66 268, 76 studies), depression (23.0% (95% CI 11.8% to 40.2%), n=43 128, 10 studies), headache (20.7% (95% CI 16.1% to 26.1%), n=64 613, 84 studies), anxiety (15.9% (5.6% to 37.7%), n=42 566, 9 studies) and altered mental status (8.2% (95% CI 4.4% to 14.8%), n=49 326, 19 studies). Heterogeneity for most clinical manifestations was high.

Neurological and neuropsychiatric symptoms of COVID-19 in the pandemic’s early phase are varied and common. The neurological and psychiatric academic communities should develop systems to facilitate high-quality methodologies, including more rapid examination of the longitudinal course of neuropsychiatric complications of newly emerging diseases and their relationship to neuroimaging and inflammatory biomarkers.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

This article proposes that ‘meliorism’—a philosophical belief in people’s abilities to improve lived experience through engaged problem-solving—is a useful concept to describe and orient occupational science research, given the challenges of our time. This proposal derives from an intensive period of discussion through occupational science seminars, strategic planning sessions, and other activities at the University of Southern California’s Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, including preparations for the 26th Occupational Science Symposium in 2019. While many disciplines and professions express a melioristic intent, we believe that occupational science and occupational therapy exemplify a particular understanding of meliorism, given the view of occupation that they share, as: 1) engaged activity that has meaning and purpose; and 2) a powerful tool that builds consciousness and practices that can promote desired change. We suggest that occupational scientists’ aim to develop impactful research manifests these conceptual foundations. Further, we argue that a commitment to meliorism requires concerted efforts to mobilize knowledge by intentionally planning for stakeholder engagement and societal impact across all phases of research. We suggest that active knowledge mobilization will enhance the knowledge base of occupational science and help to realize its meliorist potential in both research and practice contexts.

Keywords. Occupational science; Knowledge mobilization; Meliorism; History of academic disciplines; Pragmatism

This article introduces social network analysis (SNA), a theoretical perspective accompanied by a set of methodologies, to occupational science. The convergence of SNA and occupational science is timely for both fields. By providing methodological approaches that flesh out a structural view of social networks, SNA measurements and mathematical terminology can effectively bridge the complexity of diverse interpretive frameworks used to understand occupational engagement and other constructs for humans as socially occupied beings. By focusing attention on the relationship of occupations to connectivity between agents, occupational science can make significant contributions to the ways in which the mattering or meaning of what people do with others nurtures the development and sustainability of social networks. We provide a brief history and roots of SNA in naturalistic observation, current terminology, and four widely used SNA research designs: egocentric, sociometric, sequenced, and two-mode. Drawing examples from our decade-long journey using SNA with narrative phenomenological conceptual frameworks, we illustrate how we used SNA with experience-near ethnographies to meet different objectives. In the discussion, we reflect on the parallax view created by the synergies between the disciplines and how the disruptive-productive effects that occur with mixing narrative phenomenology and SNA methods could address (mutual) methodological gaps that have seemingly limited conceptual development in the social sciences.

Keywords. Occupational science, Sociality, Intersubjectivity, Connectivity, Social network analysis, Social structure, Network interventions

Objectives. To explore the association between therapy minutes per length of stay (LOS) day (TMLD), functional outcomes, and rate of functional recovery among older adults after elective hip or knee replacement surgery across postacute (PAC) settings.

Design. Secondary analysis of data collected for an observational cohort study from 2005 to 2010.

Setting. Four inpatient rehabilitation facilities (IRF) and 7 skilled nursing facilities (SNF).

Participants. Adults aged 65 years or older (N=162) with Medicare fee-for-service insurance and a primary diagnosis of elective hip or knee replacement.

Interventions. Not applicable.

Main Outcome Measures. FIM mobility and self-care measures at discharge.

Results. The TMLD was divided into high, medium, and low categories. Participants were grouped into low, medium, and high gain rate groups based on their average change in mobility and self-care FIM measures per LOS day. Gain rate and TMLD groups were crossmapped to create 9 gain-TMLD groups separately for mobility and self-care. There were no significant differences in admission mobility or self-care measures by gain rate and TMLD trajectory or by facility type (IRF or SNF). TMLD was not significantly associated with discharge mobility measures. Participants in high gain trajectories attained independence with mobility and self-care tasks at discharge regardless of TMLD. Those in low gain trajectories needed supervision or assistance on all mobility tasks. Older age and greater pain at discharge were significantly associated with lower odds of being in the medium or high gain rate groups.

Conclusions. For clinicians and facility managers who must care for patients with constrained resources, the shift to value-based reimbursement for rehabilitation services in PAC settings has reinvigorated the question of whether the duration of therapy provided influences patient outcomes. Three hours of daily therapy after joint replacement surgery may exceed what is necessary for recovery. Postsurgical pain management remains a significant challenge in older adults.

Keywords. Arthroplasty; Geriatrics; Pain management; Rehabilitation

Two independent research teams led by graduate students from clinical disciplines studied the lived experiences of student veterans transitioning from the military into higher education. Additionally, these projects provided graduate students with training in the research process, application of evidence-based practice in preparation for professional responsibilities and advancement, and collaboration with student veteran stakeholders as coinvestigators and project team members. One study piloted a student veteran orientation course with the aid of veteran stakeholders to better address the overall needs of student veterans on campus. The other study engaged student veteran participants as coinvestigators using the photovoice methodology to illuminate their perspectives on social relationships. Findings in each study added greater depth to previously discovered trends, and revealed insights into student veteran educational priorities, the impact of the transition process on social roles and relationships, graduate research project design, and community advocacy. This study added insight into the factors that affect student veterans’ higher education experience, which can be used to inform future studies conducted at the graduate level, examine interdisciplinary approaches to research and advocacy, amplify the voice of student veterans, and encourage interaction in research between civilian and veteran students.

Background. People with neurological dysfunction have been significantly affected by the ongoing coronavirus disease 2019 (COVID-19) crisis in receiving adequate and quality rehabilitation services. There are no clear guidelines or recommendations for rehabilitation providers in dealing with patients with neurological dysfunction during a pandemic situation especially in low- and middle-income countries. The objective of this paper was to develop consensus-based expert recommendations for in-hospital based neurorehabilitation during the COVID-19 pandemic for low- and middle-income countries based on available evidence.

Methods. A group of experts in neurorehabilitation consisting of neurologists, physiotherapists and occupational therapists were identified for the consensus groups. A scoping review was conducted to identify existing evidence and recommendations for neurorehabilitation during COVID-19. Specific statements with level 2b evidence from studies identified were developed. These statements were circulated to 13 experts for consensus. The statements that received ≥80% agreement were grouped in different themes and the recommendations were developed.

Results. 75 statements for expert consensus were generated. 72 statements received consensus from 13 experts. These statements were thematically grouped as recommendations for neurorehabilitation service providers, patients, formal and informal caregivers of affected individuals, rehabilitation service organizations, and administrators.

Conclusions. The development of this consensus statement is of fundamental significance to neurological rehabilitation service providers and people living with neurological disabilities. It is crucial that governments, health systems, clinicians and stakeholders involved in upholding the standard of neurorehabilitation practice in low- and middle-income countries consider conversion of the consensus statement to minimum standard requirements within the context of the pandemic as well as for the future.

Keywords. COVID-19, Pandemic, Neurorehabilitation, Guidelines, Consensus, Health Systems

Aim. Early therapy can improve developmental outcomes for preterm infants. However, preterm infants who are referred have low enrollment in early therapy services following neonatal intensive care unit (NICU) discharge. This manuscript aims to investigate the relationship between infant medical and sociodemographic factors and enrollment in early therapy services post‐NICU discharge, when system‐related barriers to access are minimized.

Methods. This was a retrospective investigation of 89 families with infants born ≤ 32 weeks gestation. Families were approached for enrollment into early therapy services following NICU discharge through Baby Bridge programming, which aims to improve access to therapy services following NICU discharge.

Results. Seventy‐three (82%) families enrolled in early therapy services, and 16 (18%) families declined. Parents were more likely to enroll in early therapy if they had public insurance (p=0.01), a maternal psychiatric diagnosis (p=0.02), or additional children under 18 years in the home (p=0.01). No infant medical factors were related to enrollment.

Conclusion. Although enrollment rates were high, 18% of families refused therapy services, despite removing system‐related barriers to access. Targeted interventions can be developed to increase enrollment in early therapy services among populations who are most likely to refuse therapy services after NICU discharge.

Keywords. Baby Bridge program; birth to three; development; early intervention; preterm infant

Background. Autistic individuals exhibit core and co-occurring features that can be disabling to daily functioning and impede quality of life. The combined expression of three closely related features: sensory hyperresponsiveness, restricted interests and repetitive behaviors, and anxiety, may be a sign to practitioners that experiences in the environment are particularly challenging. These are investigated through many approaches, including animal modelling, neurological or physiological measures, behavioral observation, and first-hand accounts. However, little work has been done to review evidence across approaches to better understand their expression.

Method. This study was an integrated systematic review to identify factors that contribute to the collective expression of three constructs of interests (COIs; hyperresponsiveness, restricted interests and repetitive behaviors, and anxiety). Twenty-two articles were analyzed for both structural and thematic patterns. This review is unique in its inclusion of articles from a variety of disciplines and grouping of studies based on similarities over methodological techniques (i.e. quantitative, qualitative, or mixed methods).

Results. Three overall structural approaches relating the constructs of interest were identified (parallel, relational, and contingent). Three overarching themes also emerged: 1) the broader social context, 2) predictability of environmental factors, and 3) overlap with cognitive and behavioral coping strategies.

Conclusions. Results highlight clinically relevant information about the combined expression of the three COIs and demonstrate possibilities for increased collaboration across disciplines through common themes and study structures to further understand the experiences of autistic people.

Heating, ventilation, and air conditioning (HVAC) systems account for 43% of building energy consumption, yet only 38% of commercial building occupants are satisfied with the thermal environment. The primary reasons for low occupant satisfaction are that HVAC operations do not integrate occupant comfort requirements nor control the thermal environment at the individual level. Personal comfort systems (PCS) enable local control of the thermal environment around each occupant. However, full manual control of PCS can be inefficient, and fully automated PCS reduces an occupant’s perceived control over the environment, which can then lead to lower satisfaction. A better solution might lie somewhere between fully manual and fully automated environmental control. In this paper, we describe the development and implementation of an internet of things (IoT) based intelligent agent that learns individual occupant comfort requirements and controls the thermal environment using PCS (i.e., a local fan and a heater). We tested different levels of automation where control is shared between an intelligent agent and the end user. Our results show that PCS use improves occupant satisfaction and including some level of automation can improve occupant satisfaction further than what is possible with manually operated PCS. Among the levels of automation investigated, Inquisitive Automation, where the user approves/declines the control actions of the intelligent agent before execution, led to highest occupant satisfaction with the thermal environment.

Keywords. building automation, thermal comfort, smart systems, smart buildings, indoor environments

A deficit in pre‐cognitively mirroring other people's actions and experiences may be related to the social impairments observed in autism spectrum disorder (ASD). However, it is unclear whether such embodied simulation deficits are unique to ASD or instead are related to motor impairment, which is commonly comorbid with ASD. Here we aim to disentangle how, neurologically, motor impairments contribute to simulation deficits and identify unique neural signatures of ASD. We compare children with ASD (N = 30) to children with Developmental Coordination Disorder (DCD; N = 23) as well as a typically developing group (N = 33) during fMRI tasks in which children observe, imitate, and mentalize about other people's actions. Results indicate a unique neural signature in ASD: during action observation, only the ASD group shows hypoactivity in a region important for simulation (inferior frontal gyrus, pars opercularis, IFGop). However, during a motor production task (imitation), the IFGop is hypoactive for both ASD and DCD groups. For all tasks, we find correlations across groups with motor ability, even after controlling for age, IQ, and social impairment. Conversely, across groups, mentalizing ability is correlated with activity in the dorsomedial prefrontal cortex when controlling for motor ability. These findings help identify the unique neurobiological basis of ASD for aspects of social processing. Furthermore, as no previous fMRI studies correlated brain activity with motor impairment in ASD, these findings help explain prior conflicting reports in these simulation networks.

Diet and food choices significantly impact teeth, including enamel quality and development of dental caries. However, studies focusing on diet and its relation to oral care in Latinx children with and without Autism Spectrum Disorders (ASD) have been minimally addressed in research. This qualitative study used an inclusive visual methodology to explore what Latinx caregivers learned about their child’s diet preferences and food routines in relation to their oral health. As a secondary aim, the study sought to explore whether notable differences in diet emerged between Latinx children with and without ASD. Participants were 32 Latinx caregivers from 18 families with children with and without Autism (n = 8 with a typically developing child and n = 10 with a child with ASD) who completed a food journal activity and photo elicitation interview. Interviews were thematically coded for themes pertaining to parents’ perceptions of their child’s diet and oral health. Findings of this study indicate that the process of taking photos helped Latinx caregivers to better situate the barriers and behaviors influencing everyday food routines in their children within the context of relating to their overall oral health. Via their active participation in the research process, parents were empowered to note strategies they could employ that would directly impact their child’s oral health outcomes, such as reducing juice intake and monitoring sugar consumption. Therefore, visual research methodologies are an important strategy for researchers to consider in order to empower participants to be part of the research process and part of the outcomes, and to offer better understanding of the lived experience of populations underrepresented in the literature, such as Latinx children with and without ASD and their families.

Keywords. Autism Spectrum Disorder; children; families; health disparities; Latinxs; nutrition; oral care; photo elicitation; qualitative

Aim. To describe neurodevelopmental outcomes during early childhood among infants born very preterm and define the relationships between neurobehavior of very preterm infants and neurodevelopmental outcomes at 4 years.

Methods. Forty‐eight infants born ≤32 weeks gestation had neurobehavior assessed at term equivalent age using the NICU Network Neurobehavioral Scale (NNNS). Outcomes at 4 years were assessed with the Ages and Stages Questionnaire (ASQ‐3), the Sensory Profile – Short Form (SF), and the Behavior Rating Inventory of Executive Function – Preschool version (BRIEF‐P).

Results. At 4 years, 23 (48%) children had at least one below average score on the ASQ‐3, 15 (31%) had a below average total score on the Sensory Profile‐SF, and 3 (6%) had an abnormal total score on the BRIEF‐P. Children with lower fine motor scores at 4 years had poorer orientation (p=.03) and self‐regulation (p=.03), hypertonia (p=.01), and more sub‐optimal reflexes (p=.02) as neonates. Children with lower gross motor scores at 4 years of age had more sub-optimal reflexes (p=.03) and lethargy (p=.046) as neonates. Children with tactile sensitivity at 4 years of age had poorer orientation (p=.01) and tolerance of handling (p=.03) as neonates. Children with decreased responsiveness at 4 years of age had low arousal (p=.02) as neonates, and those with poor auditory filtering at age 4 years had hypotonia (p=.03) as neonates.

Conclusion. Early neurobehavior is related to neurodevelopmental outcome in early childhood.

This article draws on empirically derived illustrations of return to work and unemployment to critically explore how a narrow understanding of work pervades contemporary social policies and programmes. This is particularly relevant in economic and labour market transitions aligned with neoliberalism that individualise the social problem of unemployment and thus restrict occupational possibilities related to work. An overview of how work and related concepts have been conceptualised in occupational science scholarship is presented. After describing the theoretical orientation of the paper, three illustrations derived from a secondary analysis of data from projects conducted in Sweden and the United States are presented. The three empirically grounded illustrations are integrated with theory to highlight tensions between the politically informed structures that shape social policies and programmes and the individual experiences of work, unemployment, and return to work that users and providers of these programmes communicate. By asserting that success in work-related placement programmes is not synonymous with meaningful employment, we attempt to heighten awareness of the potential risks associated with a reliance on measuring work by merely being in paid formal employment.

Keywords. Critical occupational science; Labour market; Return to work; Unemployment

The COVID-19 pandemic has been accompanied by rapidly emerging evidence, changing guidance, and misinformation, which present new challenges for health literacy (HL) and digital health literacy (DHL) skills. This study explored whether COVID-19-related information access, attitudes, and behaviors were associated with health literacy and digital health literacy among college students in the United States. Self-reported measures of health literacy, along with items on pandemic-related attitudes, behaviors, information sources, and social networks, were collected online using a managed research panel. In July 2020, 256 responses were collected, which mirrored the racial/ethnic and gender diversity of U.S. colleges. Only 49% reported adequate HL, and 57% found DHL tasks easy overall. DHL did not vary by HL level. In multivariable models, both HL and DHL were independently associated with overall compliance with basic preventive practices. Higher DHL, but not HL, was significantly associated with greater willingness to get a COVID-19 vaccine and the belief that acquiring the disease would negatively impact their life. On average, respondents discussed health with 4–5 people, which did not vary by HL or DHL measures. The usage of online information sources varied by HL and DHL. The study findings can inform future student-focused interventions, including identifying the distinct roles of HL and DHL in pandemic information access, attitudes, and behaviors.

Keywords. COVID-19; coronavirus; health literacy; digital health literacy; eHealth literacy; college student; online survey; social network

Background. To maximize the benefit of parent-directed, positive sensory exposures in the NICU, a structured sensory-based program titled the Supporting and Enhancing NICU Sensory Experiences (SENSE) program was developed that includes specific doses and targeted timing of evidence-based sensory exposures.

Methods. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was used to systematically evaluate the SENSE program as an implementation strategy. One-hundred preterm infants ≤32 weeks gestation were studied (61 receiving the SENSE program and 39 standard-of-care). Parent education time and infant sensory exposures were tracked, and parents completed a questionnaire that probed their perceptions about the SENSE program.

Results. One-hundered thirty-one families were recruited, and 100 (76%) enrolled. The SENSE program was initiated at an average postmenstrual age of 29.8 (±2.4) weeks; 4.9 (±5.6) days after birth. The average number of education sessions with families was 4.8 (±3.7) amounting to 72.3 (±37.4) total minutes over hospitalization. The total time of logged tactile and auditory exposures among SENSE recipients over the length of hospitalization was a median (IQ range) of 9325 (5295-15,694) minutes over an average of 10.1 (±7.6) weeks of hospitalization. There were differences in the proportion of tactile and auditory exposure targets received by the infant among those receiving the SENSE program compared to standard-of-care (91% compared to 48%; p < 0.0001). Ninety-five percent of infants tolerated the SENSE program as defined, with 5% of infants requiring intermittent adaptations or the interventions being stopped for a period that typically lasted 1–2 weeks. Earlier parent education was related to more parent participation in SENSE program interventions (p = 0.04). Eighty-five percent of participants receiving the SENSE program had most of the sensory interventions completed by parents, as opposed to the medical or sensory support team. Seventy-two percent of infants had at least 100% of the auditory and tactile doses conducted over the length of stay. Parents reported acceptability.

Conclusion. The SENSE program had good reach, was effective and acceptable with minimal cost, was adopted, and had good fidelity. Insights from implementation of the SENSE program (within a research study) informed future strategies to aid maintenance during dissemination.

Variability in muscle force is a hallmark of healthy and pathological human behavior. Predominant theories of sensorimotor control assume ‘motor noise’ leads to force variability and its ‘signal dependence’ (variability in muscle force whose amplitude increases with intensity of neural drive). Here, we demonstrate that the two proposed mechanisms for motor noise (i.e. the stochastic nature of motor unit discharge and unfused tetanic contraction) cannot account for the majority of force variability nor for its signal dependence. We do so by considering three previously underappreciated but physiologically important features of a population of motor units: 1) fusion of motor unit twitches, 2) coupling among motoneuron discharge rate, cross-bridge dynamics, and muscle mechanics, and 3) a series-elastic element to account for the aponeurosis and tendon. These results argue strongly against the idea that force variability and the resulting kinematic variability are generated primarily by ‘motor noise.’ Rather, they underscore the importance of variability arising from properties of control strategies embodied through distributed sensorimotor systems. As such, our study provides a critical path toward developing theories and models of sensorimotor control that provide a physiologically valid and clinically useful understanding of healthy and pathologic force variability.

Stroke is a leading cause of long-term disability in the United States. Recent studies have shown that high doses of repeated task-specific practice can be effective at improving upper-limb function at the chronic stage. Providing at-home telerehabilitation services with therapist supervision may allow higher dose interventions targeted to this population. Additionally, muscle biofeedback to train patients to avoid unwanted simultaneous activation of antagonist muscles (co-contractions) may be incorporated into telerehabilitation technologies to improve motor control. Here, we present the development and feasibility of a low-cost, portable, telerehabilitation biofeedback system called Tele-REINVENT. We describe our modular electromyography acquisition, processing, and feedback algorithms to train differentiated muscle control during at-home therapist-guided sessions. Additionally, we evaluated the performance of low-cost sensors for our training task with two healthy individuals. Finally, we present the results of a case study with a stroke survivor who used the system for 40 sessions over 10 weeks of training. In line with our previous research, our results suggest that using low-cost sensors provides similar results to those using research-grade sensors for low forces during an isometric task. Our preliminary case study data with one patient with stroke also suggest that our system is feasible, safe, and enjoyable to use during 10 weeks of biofeedback training, and that improvements in differentiated muscle activity during volitional movement attempt may be induced during a 10-week period. Our data provide support for using low-cost technology for individuated muscle training to reduce unintended coactivation during supervised and unsupervised home-based telerehabilitation for clinical populations, and suggest this approach is safe and feasible. Future work with larger study populations may expand on the development of meaningful and personalized chronic stroke rehabilitation.

Keywords. biofeedback; stroke; telerehabilitation; electromyography; human-computer interface

The coronavirus disease 2019 (COVID-19) pandemic reshaped the health care landscape, leading to the reassignment of essential health care workers to critical areas and widespread furloughs of providers deemed nonessential, including occupational therapy practitioners. Although multidisciplinary critical care teams often include occupational therapy practitioners, efforts to define, measure, and disseminate occupational therapy’s unique contributions to critical care outcomes have been overlooked. This editorial provides recommendations to improve the occupational therapy profession’s readiness to meet society’s current and future pandemic needs. We propose a three-pronged strategy to strengthen occupational therapy clinical practice, education, and advocacy to illuminate the distinct value of occupational therapy in critical care.

Objective. To understand impacts of social, behavioral and physical factors on well-being of office workstation users during COVID-19 work from home (WFH).

Methods. A questionnaire was deployed from April 24 to June 11, 2020 and 988 responses were valid. Linear regression, multinomial logistic regression and chi-square tests were used to understand factors associated with overall physical and mental health statuses and number of new physical and mental health issues.

Results. Decreased overall physical and mental well-being after WFH were associated with physical exercise, food intake, communication with coworkers, children at home, distractions while working, adjusted work hours, workstation set-up and satisfaction with workspace indoor environmental factors.

Conclusion. This study highlights factors that impact workers’ physical and mental health well-being while WFH and provides a foundation for considering how to best support a positive WFH experience.

Keywords. COVID-19 pandemic, home office, mental well-being, physical well-being, work from home

Workplace environments have a significant impact on worker performance, health, and well-being. With machine learning capabilities, artificial intelligence (AI) can be developed to automate individualized adjustments to work environments (e.g., lighting, temperature) and to facilitate healthier worker behaviors (e.g., posture). Worker perspectives on incorporating AI into office workspaces are largely unexplored. Thus, the purpose of this study was to explore office workers’ views on including AI in their office workspace. Six focus group interviews with a total of 45 participants were conducted. Interview questions were designed to generate discussion on benefits, challenges, and pragmatic considerations for incorporating AI into office settings. Sessions were audio-recorded, transcribed, and analyzed using an iterative approach. Two primary constructs emerged. First, participants shared perspectives related to preferences and concerns regarding communication and interactions with the technology. Second, numerous conversations highlighted the dualistic nature of a system that collects large amounts of data; that is, the potential benefits for behavior change to improve health and the pitfalls of trust and privacy. Across both constructs, there was an overarching discussion related to the intersections of AI with the complexity of work performance. Numerous thoughts were shared relative to future AI solutions that could enhance the office workplace. This study’s findings indicate that the acceptability of AI in the workplace is complex and dependent upon the benefits outweighing the potential detriments. Office worker needs are complex and diverse, and AI systems should aim to accommodate individual needs.

Keywords. workspace; office work; computer workstations; artificial intelligence

Objectives. Cognitive impairment is highly prevalent after stroke, with 77% of people having impairment in at least 2 cognitive domains. The purpose of this study is to describe the association between therapy minutes per length of stay (LOS) day and cognitive recovery in patients receiving rehabilitation services in inpatient post-acute care facilities following a stroke.

Design. Secondary analyses of data collected in inpatient rehabilitation and skilled nursing facilities from 2005 to 2010 for an observational cohort study.

Setting and Participants. Participants were adults aged ≥65 years with Medicare insurance and primary diagnosis of stroke (N = 100). Participants who met criteria for dementia (n = 5) were excluded from analyses. We calculated therapy minutes per LOS day for occupational therapy, physical therapy, speech-language pathology, and all therapies combined; therapy times were dichotomized into high or low minutes per LOS day (MLD). We used an ordinary least squares regression model for cognitive outcome at discharge to control for cognitive status at admission, therapy intensity by discipline, and LOS.

Results. At baseline, participants were classified as having severe (n = 11), moderate (n = 39), or mild (n = 45) cognitive impairment. Impairment groups were not significantly different on any demographic variables. The adjusted regression model showed that high occupational therapy MLD (>50 minutes per LOS day) (P = .028) was significantly associated with cognitive measure at discharge compared with low occupational therapy MLD when controlling for cognitive impairment group at baseline (P < .001). Neither high physical therapy MLD nor speech-language pathology MLD was significantly associated with cognitive outcome relative to their respective low TMLD groups.

Conclusions and Implications. Our results show that higher-intensity occupational therapy services were associated with better cognitive outcome at discharge from inpatient rehabilitation after stroke. Findings also suggest that volume of therapy alone does not necessarily produce optimal outcomes. Both amount and type of therapy should be tailored to meet the needs of individual patients.

Keywords. Rehabilitation; cognition; cognitive dysfunction; stroke; occupational therapy; post-acute care

Conventional research involves participants primarily as sources of data (Wallerstein & Duran, 2006), relies upon a positivist tradition wherein researchers are seen as neutral, objective observers (Bhawuk, 2008), and is not necessarily concerned with the application of findings to improve the social conditions of those involved. In many places around the world, this has led to distrusting relationships between communities and researchers, and has also likely limited the potential for research to help ameliorate social problems (Smith, 1999). In this article, action research is presented as an alternative to conventional research practices, and is examined in relation to four community psychology values. A brief history and the main principles of action research are described, followed by a discussion of its evolution to participatory, or community-based participatory research (CBPR), and connection to four values identified by Bond (2016). These include: 1) empowerment, 2) promotion of social justice, equity and social change, 3) attention to diversity in its various forms, and 4) adoption of an ecological perspective and multilevel analyses. Each value is discussed in terms of theoretical alignment as well as challenges and successes in application to research and practice. This work deepens the rationale for the use of action research in community psychology, and may be used as a lens to evaluate practice and research.

Importance. Rural-dwelling Latinos are an underresourced population in need of accessible and effective wellness programs.

Objective. To evaluate patients’ long-term health-related outcomes after lifestyle intervention.

Design. An uncontrolled pilot trial assessing change in health from pretreatment to long-term follow-up (12 mo after intervention completion, no contact) and from posttreatment to long-term follow-up.

Setting. Rural, community-based primary care.

Participants. Latino and Hispanic safety-net primary care patients, ages 50 to 64 yr.

Intervention. A culturally tailored, 4-mo lifestyle intervention co-led by occupational therapy practitioners and Latino community health workers that features telehealth and in-home sessions covering topics such as healthy eating and navigating health care.

Outcomes and Measures. Self-reported and physiological outcomes: symptom–well-being (primary), stress, sleep disturbance, social satisfaction, physical activity, patient activation, blood pressure, and weight. Exit interviews addressed health experiences and intervention impact on participants’ lives.

Results. Participants (N = 27) demonstrated clinically significant pretreatment to long-term follow-up benefits in all symptom–well-being dimensions (Cohen’s d ≥ 0.8, p ≤ .004), with additional gains from posttreatment to long-term follow-up (d ≥ 0.4, p ≤ .05). Significant improvements from pre- to posttreatment in systolic blood pressure, stress, and social role and activity satisfaction were maintained at long-term follow-up. No changes were observed in weight, physical activity, or diastolic blood pressure. Participants described the intervention’s sustained positive effect on their wellness.

Conclusions and Relevance. A lifestyle intervention led by occupational therapy practitioners and community health workers in a primary care context has potential to achieve long-term health benefits in rural-dwelling, late-midlife Latinos.

What This Article Adds. This study reveals that rural, late-midlife Latinos showed long-lasting improvements in psychological and physical health after finishing a program that helped them make healthy lifestyle choices. This finding supports the unique contribution of occupational therapy in primary care settings.

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)

Objectives. This study developed a musculoskeletal ultrasound (MSUS) protocol to evaluate rehabilitation outcomes in systemic sclerosis.

Materials and Methods. Three MSUS methods (gray-scale, Doppler, strain elastography) and two acquisition techniques (long- vs short-axis; transducer on skin vs floating on gel) were examined in the forearm before and after rehabilitation treatment. For gray-scale, tissue thickness measures and intrarater and interrater reliability were calculated (intraclass correlation coefficients [ICCs]), and paired t tests examined differences among techniques.

Results. Five people with diffuse cutaneous systemic sclerosis participated. The most valid and reliable gray-scale technique was with the transducer in long-axis, floating on gel. Doppler and strain elastography did not detect changes. Both dermal and subcutaneous thickness measurement error was small; intrarater and interrater reliability was good to excellent. Preliminary data indicate that treatment may lead to dermal thinning.

Conclusion. A replicable protocol was established and may be an adjunct to rehabilitation outcome measurement in systemic sclerosis.

Keywords. musculoskeletal ultrasound, scleroderma, rehabilitation, protocol

Objective. To combine items from the Functional Independence Measure, Minimum Data Set (MDS) 2.0, and the Outcome and Assessment Information Set (OASIS)-B to reliably measure cognition across postacute care settings and facilitate future studies of patient cognitive recovery.

Design. Rasch analysis of data from a prospective, observational cohort study.

Setting. Postacute care inclusive of inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies.

Participants. Patients (N=147) receiving rehabilitation services.

Interventions. Not applicable.

Main Outcome Measures. Functional Independence Measure, MDS 2.0, and the OASIS-B.

Results. Six cognition items demonstrated good construct validity with no misfitting items, unidimensionality, good precision (person separation reliability, 0.95), and an item hierarchy that reflected a clinically meaningful continuum of cognitive challenge.

Conclusions. This is the first attempt to combine the cognition items from the 3 historically, federally mandated assessments to create a common metric for cognition. These 6 items could be adopted as standardized patient assessment data elements to improve cognitive assessment across postacute care settings.

Keywords. Cognition; Outcome measures; Rehabilitation; Stroke; Subacute care

While student-run free clinic (SRFC) participation is well-documented among many health professions, no study has comprehensively characterized occupational therapy student participation. The purpose of this qualitative study was to understand both the current presence as well as educational impact of occupational therapy student participation in university-based SRFCs in the United States (U.S). Data collection occurred through a national survey and semi-structured interviews. Surveys were sent to representatives (e.g. program directors, faculty advisors, and student leaders) at all 190 accredited occupational therapy schools. Of these, 118 responded, for an overall response rate of 62.1%. Semi-structured interviews were conducted with a purposeful sample of physician’s assistant, medical, pharmacy, and occupational therapy students (N=9). Results showed that 12.7% of schools contributed volunteers to at least one SRFC (N=15). Themes included that occupational therapy students provided a unique perspective to the interprofessional team, educated other students about occupational therapy’s scope, and demonstrated strong patient interviewing skills. They also learned from opportunities to explore future career possibilities, engage in interdisciplinary teamwork, and practice skills in a safe space. Occupational therapy programs have a relatively low rate of participation (12.7%) in SRFCs compared to other health professions nationally. However, occupational therapy and other health professional students report that occupational therapy student participation creates important educational opportunities. These opportunities may strengthen occupational therapy’s role in interprofessional team-based care, especially within the emerging practice area of primary care.

This phenomenological qualitative study employed Photovoice to investigate the experiences of college student service members and veterans (SSM/V) in relation to the transition from the military to higher education. Twelve participants took three photographs per day for seven days that reflected their everyday experiences as SSM/V. Individual interviews and focus groups engaged participants in a discussion of the meaning of the experiences represented in the photographs. Thematic analysis revealed that SSM/V experienced social disconnection upon returning from military service, that they viewed the campus military and veterans center (MVC) as a supportive environment, that newly assumed roles in the context of the MVC provided a new sense of identity and meaning, and that social connections with other veterans provided a key source of support. A campus MVC may serve as a valued campus resource for the development of new social networks and roles that support the successful transition for SSM/V.

Keywords. Photovoice, student service members and veterans, transition, well-being

Non–communicable diseases (NCDs) is an umbrella term used to describe a cluster of diseases constituting of Cardiovascular and Chronic Respiratory complications, Cancer, Diabetes and Mental Health conditions. The World Health Organisation (WHO) estimates that nearly 71% of all deaths worldwide (41 million people) can be attributed to inadequate and untimely intervention for Non–communicable diseases. Out of the 41 million people affected, the most vulnerable groups placed at the epicentre to face the repercussions of the growing impacts of NCDs are children, young people, people of lower socio-economic status (SES) and those belonging to lower and lower-middle income countries (LMICs). We call for policies to be more youth-inclusive and suggest further recommendations to incorporate youth voices and interventions to combat the global burden of NCDs as young people constitute of a major demographic widely affected by NCDs yet remain underrepresented in their say on tackling NCDs across local, regional, national and global levels.

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.

Children with autism spectrum disorders (ASD) are at risk for oral health disparities. With the dramatic rise in ASD prevalence to 1 in 54 children, it is likely that an increasing number of dental practitioners will encounter or be asked to treat children with ASD. This paper reviews explanations related to the increasing prevalence of ASD, provides reasons why children with ASD are at increased risk for poor oral health, and discusses unique interprofessional collaborations between dental practitioners and occupational therapists. Occupational therapists and dentists can work together to plan modifications to the dental environment or adapt dental protocols to reduce some of the barriers encountered by those with ASD, provide desensitization strategies before the clinic visit, or help a child with emotional regulation during clinical treatments.

Keywords. autism spectrum disorder; dentistry; interprofessional collaboration; occupational therapy; oral health