Recent Publications

While it has been suggested that alterations in the composition of gut microbial metabolites may play a causative role in the pathophysiology of autism spectrum disorder (ASD), it is not known how gut microbial metabolites are associated with ASD-specific brain alterations. In this cross-sectional, case-control observational study, (i) fecal metabolomics, (ii) task-based functional magnetic resonance imaging (fMRI), and (iii) behavioral assessments were obtained from 43 ASD and 41 neurotypical (NT) children, aged 8–17. The fMRI tasks used socio-emotional and sensory paradigms that commonly reveal strong evoked brain differences in ASD participants. Our results show that fecal levels of specific tryptophan-related metabolites, including kynurenate, were significantly lower in ASD compared to NT, and were associated with: 1) alterations in insular and cingulate cortical activity previously implicated in ASD; and 2) ASD severity and symptoms (e.g., ADOS scores, disgust propensity, and sensory sensitivities). Moreover, activity in the mid-insula and mid-cingulate significantly mediated relationships between the microbial tryptophan metabolites (indolelactate and tryptophan betaine) and ASD severity and disgust sensitivity. Thus, we identify associations between gut microbial tryptophan metabolites, ASD symptoms, and brain activity in humans, particularly in brain regions associated with interoceptive processing.

Keywords. Autism spectrum disorders, Neuroimmunology

This special section of the American Journal of Occupational Therapy presents important international developments in occupational therapy research related to sensory processing and participation across a range of contexts and occupations. Taken as a whole, this collection of articles provides evidence that sensory processing differences affect children across the developmental continuum, transcending specific diagnostic criteria and significantly influencing participation in diverse occupational environments. Although this may not seem like a novel insight to experienced occupational therapy practitioners, its significance lies in strengthening the empirical support underlying these practice-based “commonsense” claims.

Tags. children and youth, contexts, occupations and everyday activity, sensory processing disorder, child, evidence-based practice, sensory processing, occupational therapists

A recent integrative review was completed to understand oral motor interventions used to support the development of feeding skills in preterm infants. The interventions identified in the scientific literature were nonnutritive sucking, applied oral motor stimulation, swallowing exercises, and use of a pacifier that elicits a sensory pulse to stimulate sucking called the NTrainer. However, there was no published information regarding which (if any) of these interventions are actually used in clinical practice and how parents may be involved in their implementation at the neonatal intensive care unit bedside. Therefore, this qualitative study sought to understand oral motor interventions used in clinical practice. All of the interventions identified in the scientific literature were identified as being used in practice, although at varying rates. An additional intervention, milk drops, was also identified. Nonnutritive sucking and milk drops were most commonly used by the study participants and were most commonly taught to parents to implement with their infants. These findings support neonatal therapists’ implementation of evidence-based practice in the clinical setting.

Tags. ADLs, age 0-5, evidence-based practice/knowledge translation, feeding, eating, and swallowing deficits, habilitation and rehabilitation, health promotion, interprofessional practice and intraprofessional practice, interventions to support occupations, prevention, neonatal intensive care units, oral motor function, newborn, caregivers, milk, infant

Starting with the foundation established by Black feminist scholar Kimberlé Crenshaw, intersectionality has been adopted and adapted within various disciplinary contexts. The purpose of this chapter is to present the origin, key principles, and current use of intersectionality theory and to consider its contribution to understanding occupation and occupational therapy by addressing its key postulations and constructs. As further discussed below, integrating an intersectionality lens in occupational therapy and occupational science is relatively recent. There is a growing recognition in the occupation-based literature of the need to examine intersections of diverse social positionings. More recent studies have also begun extending the analysis beyond an initial focus on race and gender. Explicitly applying an intersectionality lens to occupation-based knowledge, theories, and frameworks can further advance understanding of how diverse identities intersect within power structures and the implications of these complex intersections for occupation.

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

Cultural humility presents a promising opportunity to re-envision how occupational therapists are educated, interact with clients, and engage in community development and advocacy. In this chapter, we build on past work that defines cultural humility and argue for its application in occupational therapy. We expand on the core tenets of cultural humility, linking it with extant theory and considering our insights as to how this theoretical framework can be applied in occupational therapy settings. Specifically, we examine the multidimensionality of culture and power, approaches to advocacy, challenges to enacting cultural humility, and strategies to overcome them.

Amid calls for inclusion of autistic people in research, we present findings from our community-engaged study on the experiences of families of autistic girls, who experience disparities in autism identification, and show how the Autistic Lived Experience Collaborators (ALEC) in the Disparity Reduction and Equity in Autism Services (DREAmS) Lab influenced our findings. In Part 1 of our multimethod study, 21 caregivers completed interviews and survey questions. In Part 2, 10 Hispanic/Latino caregivers from Part 1 completed 1 to 3 interviews. Analysis used descriptive statistics and a narrative thematic approach. We also drew from analysis meeting notes. Girls from Spanish-speaking families had later ages of autism identification, which informed our qualitative themes: Survival Explains Stigma, a view of Hispanic/Latino culture that clarified the “stigma” that impacted the diagnostic process; and Intergenerational Influences on staying safe, which could include masking autistic traits. ALEC quotes show their contributions. Our community-engaged approach contributed to our findings and a more complex view of culture.

Background. Lifestyle Redesign® occupational therapy (LR-OT) originated in the Well Elderly studies as a preventive intervention for older adults, demonstrating positive health and cost outcomes. Although LR-OT later expanded to chronic condition management and inspired numerous programme adaptations for different contexts and populations, systematic reporting of intervention modifications remains scarce. This gap extends beyond OT, reflecting a broader movement in implementation science.

Purpose. This study applies the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to systematically document adaptations across four LR-OT programmes. Additionally, we examine fidelity-consistency by mapping programme components to the Well Elderly programme and core LR-OT elements.

Methods. Four teams implementing adapted programmes—diabetic foot ulcer self-management, primary care chronic condition management, Remodeler sa Vie for French-Canadian older adults, and LR weight management—participated in a structured mapping exercise to align programmes with FRAME and LR-OT principle components.

Results. Adaptation approaches varied from highly structured to loosely standardized methods. Despite numerous modifications, all programmes strongly aligned with LR-OT's core characteristics and domains.

Conclusion. This study highlights LR-OT's adaptability across diverse contexts while maintaining fidelity to its foundational framework. Findings contribute to implementation research, providing a model for systematically documenting and characterizing adaptations made to client-centred, evidence-based OT programmes.

Objective. Supporting sonographers’ health and well-being requires targeting the workplace factors they identify as most influential. This study examined sonographers’ perspectives to guide priorities for resource allocation and solution development.

Materials and Methods. An online survey of 1276 U.S. and Canadian sonographers asked participants to rate 30 workplace factors across four categories—workflow, equipment/physical environment, administrative/organizational environment, and training/health practices—on their perception of impact on well-being and importance for understanding and improving. Respondents selected up to five factors as the highest priorities for immediate action and resource allocation.

Results. Five factors ranked among the top 10 across specialties and were rated as significantly impactful and important by more than two-thirds of respondents: productivity requirements (76.9% impact, 74.3% importance), staff scheduling policies (73.2%, 74.4%), supervisor support (72.1%, 71.2%), exam room furniture (73.1%, 68.0%), and ultrasound machine design (69.3%, 75.6%). Exam scheduling was the top priority across all practice areas and the only factor identified in the top five by a majority of all respondents.

Conclusion. While specialty area differences exist, sonographers consistently identified administrative and organizational factors as the most impactful, important, and of highest priority for immediate action. Addressing these concerns requires contextualized solutions developed with direct practitioner input.

Objective. The aim of the study was to identify the self-care and mobility functional response in patients with and without COVID-19 who were admitted to inpatient rehabilitation.

Design. Cross-sectional retrospective multisite study using data collected from routine care data from the Rehabilitation Registry of COVID-19 patients within 12 inpatient rehabilitation facilities across the United States from March 1 through December 31, 2020, was used.

Results. Data included 11,734 patients admitted to one of the participating hospitals. Of the patients admitted, 868 had active or had recently recovered from COVID-19 before their admission to the rehabilitation hospital. Patients with active or who had recently recovered from COVID-19 were younger with a mean age 65.74 yrs, over half being male (60.0%) and White (64.4%), with significance seen in the African American population. Fewer patients with COVID returned home, and the majority in both groups had neurological diagnoses, longer lengths of stay, fewer minutes of therapy, and a lower functional response in the self-care domain.

Conclusions. This study demonstrates patients with active and recovered COVID-19 who received inpatient rehabilitation made significant gains in self-care and mobility. These findings suggest that a structured inpatient rehabilitation program may provide benefit in patients with active and recovered COVID-19.

Objectives: To describe current practice and roles of the neonatal therapist.

Study design: A Neonatal Therapy Practice Analysis was distributed to neonatal therapists (physical therapists, occupational therapists, and speech-language pathologists) in 2019–2020 via social media, email, newsletters, and conference materials.

Results: There were 1,313 respondents from 1,110 different hospitals. 41.7% (n = 277) were occupational therapists, 29.3% (n = 195) were physical therapists, and 29.0% (n = 193) were speech-language pathologists. 760 (59.1%) worked in level III NICUs, while 248 (19.3%) worked in level II NICUs and 273 (21.2%) in level IV NICUs. 166 (28.1%) of respondents were Certified Neonatal Therapists (CNTs), which was related to higher number of full-time equivalent (FTE) positions per bed (β = 1.066, SE = 0.478, p = 0.026) and higher percentage of infants served in the NICU (β = −3.2, SE = 0.589, p < 0.001). We observed a median of one therapy FTE per 17 NICU beds (range of 1 FTE per 10–200 beds). Higher acuity NICU levels (β = 2.23, SE = 0.197, p < 0.001) and NICUs with higher number of beds (β = 2.497, SE = 0.285, p < 0.001) had more neonatal therapy FTEs. Survey respondents reported working with a median of 76.0% of infants in their respective NICUs (IQR 65%–90%, range 1%–100%). There was a higher percentage of infants served in higher acuity NICUs (β = 4.358, SE = 1.517, p = 0.004), in NICUs with a higher number of beds (β = 0.058, SE = 0.029, p = 0.047), when there was a productivity standard (β=11.47, SE = 1.9, p < 0.001), and where there was a higher number of neonatal therapy FTEs (β = 1.0, SE = 0.239, p < 0.001). 294 (46%) of respondents reported having standing orders, which was related to a higher percentage of infants served in the NICU (β = −1.109, SE = 0.393, p < 0.001) and to having a productivity standard (β = −0.467, SE = 0.139, p < 0.001). 65.3% (n = 415) of respondents reported having productivity standards to meet each day, with a range between 50%–80%.

Conclusion: This practice analysis provides insights into the changing landscape of neonatal therapy.

Community advisory boards (CABs) can improve the relevance and impact of research. CABs often guide timebound research projects or inform strategy at large institutions. By contrast, we developed a CAB for collaborative neurorehabilitation research as an arm of a research laboratory. Community members (e.g., stroke survivors, care partners, therapists) engage in research and community initiatives around a shared vision. Existing CAB literature and implementation resources primarily describe project and institutional CABs, with less evidence of alternative CAB models. Therefore, this article describes the development of an ongoing CAB partnership and the evaluation of community member engagement over time. Two years after establishing the NPNL Stroke Advisory Board, we describe the Board’s activities, evaluation process, and early successes and challenges with the intention of promoting transparency of community-engaged approaches and empower similar partnerships to form.

Keywords. community advisory board; community engagement; stroke.

Background. Health behaviors significantly influence health outcomes after cancer. However, few studies have tested occupational therapy (OT) self-management training to catalyze health behavior change.

Objectives. To establish proof of concept of a 12-week OT intervention designed to improve occupational performance and/or satisfaction in cancer survivors.

Methods. This single-arm, prospective study used the Canadian Occupational Performance Measure to measure change in occupational performance and satisfaction related to health behaviors in a convenience sample of 20 cancer survivors.

Results. Both occupational performance and occupational satisfaction scores increased for all participants (n = 20) post-intervention. A total of 18 participants (86%) demonstrated a clinically significant change in performance scores (≥2), and 19 participants (95%) demonstrated a clinically significant change in satisfaction scores (≥2).

Conclusion. OT, when leveraged for a health self-management intervention, may result in improvements in both occupational performance and satisfaction related to health behavior in cancer survivors.

The pursuit of justice is inherently political, shaped by the structures that govern access to power, privileges, resources, and opportunities (Cummings et al., Citation2025). This dialogue is an intellectual exercise, envisioning how the late Nawal El Saadawi, the radical Egyptian thinker, feminist, physician, and writer, might engage with occupational science and occupational justice and what she could teach occupational scientists. Through this imagined conversation, I examine further the connections between occupational justice and social justice, questioning whether a truly just society is possible. El Saadawi’s revolutionary thoughts, drawn from her writings, critique the structural inequalities, colonial legacies, and capitalist systems and societies that shape human occupations. Her work challenges patriarchal oppression and the epistemological dominance of Western, Eurocentric paradigms. Through her lens, justice is not merely about individual well-being but a collective, political struggle against the systems that dictate access to meaningful occupations and agency over one’s daily life. This dialogue further critically examines whether occupational science can move beyond Western frameworks and truly address the root causes of injustice, envisaging justice as a radical process of decolonization and social transformation.

Objective. To characterize current infant massage practices in neonatal intensive care units (NICUs) and identify variability inapproaches among neonatal therapists.

Study Design. A cross-sectional survey was distributed to NICU-based occupational therapists, physical therapists, and speechlanguage pathologists. The survey inquired about massage use, training, protocols, techniques, and safety concerns. Descriptivestatistics were used for analysis.

Results. Among 101 respondents from 32 states, 90 (90%) used infant massage, with 64 (71%) considering it standard care. Infantmassage was most often administered by occupational therapists (77, 76%), physical therapists (70, 69%), and parents (46, 46%).Despite high training rates (87, 97%), only 48 (53%) followed a specific protocol. Techniques, frequency, and use of emollientsvaried widely. Safety concerns included infant stress and physiological instability, though adverse events were rare.

Conclusion. Despite widespread use of infant massage in NICUs, variability in findings underscores the need for standardizationto ensure safe, effective delivery of massage.

Keywords. Health Occupations, Rehabilitation

In her Inaugural Presidential Address at the AOTA INSPIRE 2025 Annual Conference & Expo in Philadelphia, Dr. Arameh Anvarizadeh encouraged conference attendees to “remain in community and to acknowledge that dehumanization has no room in anyone’s space.” She also challenged the profession to adopt a growth mindset by fostering and embracing a collective diversity. Celebrating and harnessing the strengths of different perspectives, experiences, and backgrounds drives social change and occupational justice, fosters problem-solving and better decision-making, creates collaborative learning opportunities, and promotes empathy and compassion, two of the profession’s greatest strengths.

Homelessness affects approximately 13.5 million individuals in the United States across their lifetime and is strongly associated with debilitating health outcomes, including premature mortality. Despite these risks, unhoused individuals experience social stigma and reduced moral concern. In this study, we tested whether negative perceptions toward unhoused individuals can be modified, or erased, through a targeted intervention during functional neuroimaging. On 40 participants, our intervention increased prosocial attitudes toward the unhoused, corresponding to brain activity changes in regions involved in somato-affective processing, including the insula and opercular regions. Greatest intervention-related neural change in these regions was observed in individuals who showed the least prosocial inclinations at baseline. Among five tested strategies, emphasizing an individual’s similarity with the unhoused (self-similarity strategy) produced the strongest effect. Our findings reveal a plausible neural basis for humanization, identifying self-similarity as a scalable strategy to enhance societal cohesion.

Despite the benefits of remotely operated compact demolition machines in constrained and hazardous environments, many safety and occupational risks remain. Operators often stay close to the machines, exposing themselves to the risks of structural collapses, falling debris, dust, and noise. In this study, we employed a generative user experience (UX) framework with six demolition industry professionals to inform the design considerations for a sensory-enhanced teleoperation interface for demolition robots. Through narrative interviews and focus groups, we identified demolition operators’ sensory needs during traditional demolition tasks involving manned and remotely operated machines and explored potential sensory features for a teleoperation interface for demolition robots. To increase the trustworthiness of the findings, we subsequently conducted a verification strategy where over 60 demolition stakeholders tested and provided feedback on the proposed teleoperation interface features within a virtual environment. Findings indicate that demolition operators use multiple sensory channels to perceive and interact with the environment during traditional demolition tasks. However, certain site conditions (e.g., noise, constrained spaces, clutter) still compromise their performance, safety, and well-being. Multimodal, simple, safe, and personalizable teleoperation interfaces that provide appropriate levels of control over the robots are preferred. Key suggestions included improvements in the robot’s controllers and the inclusion of mechanisms to facilitate communications with on-site workers and the perception of hazards. The findings inform the design considerations for a sensory-enhanced teleoperation interface for compact demolition robots. Additionally, the proposed generative UX framework can be applied to other construction applications to facilitate identifying operators’ needs and designing teleoperation interfaces

The Measure of Experiential Aspects of Participation (MeEAP) has strong potential for use in mental health and community settings, such as Clubhouses, as it addresses subjective aspects of participation. Thus, this study analyzes the MeEAP’s psychometric properties and descriptively examines experiential aspects of participation among 206 Clubhouse members. Results indicated good model fit, high internal consistency, and associations with health-related quality of life. Members rated autonomy, belonging, challenge, engagement, mastery, and meaning in Clubhouses very highly. However, members with activity limitations reported lower experiential participation than those without, suggesting opportunities to improve Clubhouse engagement for members with concurrent nonpsychiatric disabilities.

Keywords. Participation measurement, community participation, quality of participation, serious mental illness, community mental health settings, Clubhouse

While musician health literature has grown significantly in the past three decades, a holistic understanding of musician well-being remains lacking. This mapping review aimed to create a topographical review of existing literature on musician well-being to identify key knowledge gaps. This review sought to identify the aspects of musician well-being that have recently been studied, the musician populations that have been studied, and the study designs that have been used to assess musician well-being. This mapping review design was informed by the Focused Mapping Review and Synthesis (FMRS) approach. Studies were categorized and visualized based on study design, type of musician sampled (i.e., profession, instrument, musical genre), and well-being determinants, using the Ecology of Musical Performance (EMP) Model as a foundational framework. This review found that the majority of well-being studies identified focused on musculoskeletal health. Additionally, few intervention studies were identified, and all involved samples of music students in intervention studies were in K-12 or higher education programs. While the EMP model proposes a holistic approach to understanding musician well-being, many crucial well-being determinants highlighted by the model have not been recently studied within the musician health research. Addressing these gaps will provide a more comprehensive foundation for improving the health and well-being of all musicians.

Keywords. Literature review, mapping review, musician health, well-being

Aim. To examine the relationship between feeding therapy and the timing of independent oral feeding (IOF) in preterm infants in the neonatal intensive care unit (NICU).

Study design. A retrospective analysis of 536 preterm infants (<37 wk gestation) admitted to a level IV NICU between January 2017 and December 2019 was conducted. Clinical and therapy data were extracted from the electronic health record to examine associations between feeding therapy utilization and feeding outcomes.

Results. Medically complex infants were more likely to receive a feeding therapy referral (p = .001), and infants who received feeding therapy achieved IOF an average of 1.5 wk later than those who did not (p < .001). Among infants receiving therapy, earlier initiation was beneficial as each additional week of delay in therapy initiation corresponded to a 0.02-week delay in achieving IOF after adjusting for medical factors (p = .023). No association was found between feeding therapy frequency and postmenstrual age at IOF.

Conclusion. Early initiation of feeding therapy may help expedite IOF. Timely referrals can support oral motor development and improve feeding outcomes in preterm infants. The lack of association with frequency may reflect staffing limitations that impacted consistent therapy delivery rather than a true absence of benefit.

Keywords. Feeding therapy, independent oral feeding, occupational therapy, oral motor development, preterm infants, speech-language pathology

Outcomes and professional characteristics of doctorate level occupational therapy graduates have been examined, yet there has been limited study of professional identity development. This paper highlights outcomes emerging from secondary analysis of data gathered in a qualitative study on the professional identity development of post-professional occupational therapy doctorate (OTD) students. Participants included 16 graduates of a post-professional OTD program. Transcripts from focus groups and final reflection papers were analyzed. Findings revealed a key theme of “Pedagogical Ingredients” that supported the development of professional identity and leadership capacities among Doctors of Occupational Therapy, and the following sub-themes: 1) Mentorship, 2) “Stepping outside of my comfort zone”, 3) “Context is everything”, 4) Extended time in context, and 5) Choice and customization: “Making my own way”. The findings provide a deeper understanding of the pedagogical approaches perceived by graduates to support their professional identity development and leadership capacities. Further study is needed to examine doctorate level pedagogy and respective outcomes.

Keywords. Pedagogy, signature pedagogy, professional identity, doctorate, Doctor of Occupational Therapy

To determine the feasibility and acceptability of the Baby Bridge telehealth model, aimed at expediting the time to therapy activation after neonatal intensive care unit (NICU) discharge. High-risk infants needing therapy after NICU discharge had an in-person therapy visit in the NICU to consent and conduct standardized assessments, followed by weekly telehealth Baby Bridge services starting within 1 week of NICU discharge. Among eight families, the first Baby Bridge telehealth session occurred at an average of 6.0 ± 2.6 days following discharge. They received an average of 8.3 (±2.1) telehealth sessions over 9.2 (±3.5) weeks. All therapy sessions after NICU discharge were accomplished with telehealth rather than in-person sessions. Satisfaction surveys of the eight families indicated they were “very satisfied” with Baby Bridge telehealth services. Telehealth Baby Bridge services appear to be feasible and acceptable when implementing programming to improve early therapy access for high-risk infants.

Background. Decision aids (DAs) are important tools that support shared decision-making (SDM) between clinicians and patients, enabling patients to be more informed and engaged in decisions regarding their care. The use of DAs can increase patient knowledge, reduce decisional regret, and engage the clinician and patient in meaningful dialog. Despite proven effectiveness in enhancing patient-centered care, a gap remains in clinician use of DAs. Known clinician barriers to using DAs include (1) time constraints, (2) concerns about the match between patient need and available DAs, (3) forcing users to leave the electronic health record (EHR) to access DAs, and (4) the burden of manually entering data into the DA.

Objective. This qualitative study identified the needs and requirements of clinicians to inform the design of a clinician-facing, EHR-integrated, Substitutable Medical Applications, Reusable Technologies (SMART; SMART Health IT) on Fast Healthcare Interoperability Resources (FHIR) (HL7) app, the Decision Aid Navigator (DEAN; University of Colorado Anschutz Medical Campus). The Navigator identifies and surfaces DAs that are relevant to a patient’s health care conditions (eg, atrial fibrillation), current care (eg, not on anticoagulation), and demographics (eg, check the youngest age for the stroke prevention), and facilitates documentation of SDM discussions and decisions.

Methods. We conducted 13 semistructured interviews with clinicians who were recruited from 4 academic medical centers. Interviews included a demonstration of an initial, mid-fidelity, DEAN app prototype that was designed to address DA use and barriers described in the literature. The interviews focused on clinician context and use of the prototype, affordances and barriers to using the system, and clinician needs and requirements of the system. We used qualitative content analysis to code and reduce the data, using a consensus-making approach, and identify emerging themes.

Results. We identified 3 overarching themes: (1) streamlined functionality may simplify workflow and decrease the burden of DA use and SDM; (2) clinicians need appropriate competencies to effectively use the Navigator and relevant DAs; and (3) trust that the Navigator suggests prevetted DAs. Unanimously, clinicians shared that the DEAN Navigator should be integrated into the EHR. To accomplish this clear priority, clinicians stated that they needed the requisite competencies to successfully use the tool within their workflow and build trust with the tool itself.

Conclusions. Better tools to support and harness the benefits of SDM are needed. Overcoming the barriers of using DAs is paramount. Tools designed and developed to support DA use must be integrated into the EHR efficiently to create an opportunity for uptake of the technology by busy clinicians. If tools like DEAN can streamline the cumbersome process of documenting the use of DAs, more clinicians may potentially use DAs with their patients, given the right context and appropriate DA.

Keywords. qualitative research; focus groups; user-centered design; shared decision-making; decision aid

Objective. Early alterations in function are evident in preterm infants during their neonatal intensive care unit (NICU) hospitalization. Therefore, it is common for preterm infants to be referred to early intervention (EI) as they transition from hospital to home. Access to EI is often assumed, but understanding gaps in service delivery is important. The aims of this project were to (1) determine rates of EI access at the first high-risk infant follow-up (HRIF) appointment (4–8 months corrected age) at a safety-net hospital in Los Angeles, and (2) identify relationships between infant, clinic, and EI factors with EI service uptake.

Study Design. Through a retrospective medical record review, EI utilization at the first HRIF appointment was documented among 189 NICU-graduate preterm infants born ≤32 weeks estimated gestational age who had their first HRIF visit (4–8 months corrected age) between January 2019 and November 2020.

Results. Ninety-two (49%) of the infants were receiving EI at their first HRIF appointment at 4 to 8 months corrected age. Extremely preterm infants were more likely to receive EI services than those born very preterm (p = 0.005). No other relationships between factors were identified.

Conclusion. Successful uptake of EI services cannot be assumed. Challenges with access to EI persist, even within systems designed to foster identification and access to therapy following NICU discharge. Future research is needed to identify the reasons for the lack of access to EI and to identify the impact of different types of programming to aid access to EI for high-risk populations.

Key Points

• EI access for a safety-net population is challenging.
• Only 49% of preterm infants received EI at 4 to 8 months corrected age.
• Extremely preterm infants were more likely to access EI.
• EI access was higher for infants hospitalized in the NICU associated with the HRIF.

Ethical Approval This study was approved by the USC IRB (approval no.: UP-20-01339). This study had a waiver of informed consent, which enabled data collection of factors related to EI access retrospectively. This research was approved by the Human Research Protection Office at the University of Southern California, Los Angeles, CA.

Keywords. healthcare service delivery, health equity, therapy, infant, preterm

Objective: To determine the performance of autism screeners at 12 and 15 months of age.

Methods: Children were screened either at 12- (n = 1473) or 15-month (n = 1227) primary care visits. Children were screened with both the Infant/Toddler Checklist (ITC) and the First Year Inventory–Lite (FYI-L) at 12 months and FYI-L and the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) at 15 months. After a positive screen and/or clinical concern, families were offered a no-cost diagnostic evaluation.

Results: Of the 1473 toddlers screened at 12 months, 223 screened positive and 107 attended a diagnostic evaluation. Of the 1227 children screened at 15 months, 252 screened positive and 94 attended the evaluation. Overall, specificity for autism was high (>0.94) for all screeners at 12 and 15 months. At 12-month screening, sensitivity for autism was low on the ITC (0.26) and moderate on the FYI-L (0.67). Positive predictive value (PPV) was low for both screeners (0.24 for ITC and FYI-L). At 15 months, both the FYI-L and the M-CHAT-R/F demonstrated moderate sensitivity (0.61 for FYI-L and 0.60 for the M-CHAT-R/F) and low PPV (0.16 for FYI-L and 0.31 for M-CHAT-R/F).

Conclusion: Although data do not support universal screening at younger ages, the study identifies tools that can be used at 12 and 15 months. Importantly, screening at these ages does not identify all cases of autism, and repeat screening at 18 months and beyond is essential to support autism detection as early as possible.

Community-based participatory research (CBPR) principles share foundational elements with occupational justice, including empowerment, self-determination, and meaningful engagement. However, most research follows conventional methods that reinforce expert-novice hierarchies and do not engage participants as equal partners throughout the research process. This may be due, in part, to the fact that transitioning from conventional research to CBPR requires thinking differently about the research process from beginning to end. CBPR often conflicts with conventional research protocols and timelines and necessitates re-framing the roles of participant and researcher. Unfortunately, it is difficult to change habits in any context, including habits of mind, which shape how researchers think and interact. In this article, the author uses a critically reflexive process to describe challenges transitioning from conventional research to CBPR with mental health Clubhouses in Hawai‘i and provides seven practical lessons for researchers who aspire to begin using CBPR. These focus broadly on question development, community representation, engaging an internal research team, transparency, capacity, power, and preparedness. Ideally, this work can assist other researchers and practice scholars aspiring to support social transformation through participatory research practices, thereby shifting the status quo.

Keywords. Occupational science, community-based participatory research, social transformation, occupational justice, action research, critical reflexivity, habits of mind

A virtual participatory workshop was held to address the issue of prioritizing image quality over the risk of work-related musculoskeletal injury (WRMSI) and burnout. The data that were collected from the session was analyzed qualitatively to discover the possible factors that could negatively affect the quality of sonographic examinations, without blaming the sonographer. The capture of rich discussion centered on the need to strike a proper balance between a high-quality sonogram without contributing to negative effects to a sonographers’ health and safety. As a sonographer’s health declines, the physical abilities and cognitive focus required to perform one’s best also declines, resulting in lower overall quality and a downward spiral of declining health and quality. Identifying solutions to maintain a proper balance between image quality and sonographer health and safety is paramount. To successfully implement and maintain workplace solutions, sonographers, clinic staff, and administrators must work together to determine which solutions can be trialed in the workplace. Further practical research is needed to quantitatively measure some of the key themes from the workshop: the need for structural change to reinforce the necessity of WRMSI risk reduction, ongoing prioritization of quality over WRMSI risk reduction, and an urgent need to teach students WRMSI risk reduction.

Can metaphorical reasoning involving embodied experience—such as color perception—be learned from the statistics of language alone? Recent work finds that colorblind individuals robustly understand and reason abstractly about color, implying that color associations in everyday language might contribute to the metaphorical understanding of color. However, it is unclear how much colorblind individuals’ understanding of color is driven by language versus their limited (but no less embodied) visual experience. A more direct test of whether language supports the acquisition of humans’ understanding of color is whether large language models (LLMs)—those trained purely on text with no visual experience—can nevertheless learn to generate consistent and coherent metaphorical responses about color. Here, we conduct preregistered surveys that compare colorseeing adults, colorblind adults, and LLMs in how they (1) associate colors to words that lack established color associations and (2) interpret conventional and novel color metaphors. Colorblind and colorseeing adults exhibited highly similar and replicable color associations with novel words and abstract concepts. Yet, while GPT (a popular LLM) also generated replicable color associations with impressive consistency, its associations departed considerably from colorseeing and colorblind participants. Moreover, GPT frequently failed to generate coherent responses about its own metaphorical color associations when asked to invert its color associations or explain novel color metaphors in context. Consistent with this view, painters who regularly work with color pigments were more likely than all other groups to understand novel color metaphors using embodied reasoning. Thus, embodied experience may play an important role in metaphorical reasoning about color and the generation of conceptual connections between embodied associations.

Introduction. We report on the process of using a learning health systems (LHS) approach to design a data visualization dashboard to monitor the rehabilitation progress of patients with disorders of consciousness (DoC) after severe brain injury.

Methods. Our team conducted a qualitative study using informational interviews with key informants to understand informational needs and priorities for the dashboard from the perspectives of rehabilitation therapists, family members of patients with DoC, and third-party payors. We used a thematic survey approach to organize the findings with the following categories: (a) how the dashboard will be used; (b) content to be displayed; (c) organization and design of content; and (d) technical requirements. We used an iterative process to develop the dashboard, with multiple opportunities for stakeholder feedback.

Results. Seven people participated in informational interviews (n = 2 rehabilitation therapists; n = 2 family members; n = 3 third-party payor representatives). The primary intended use of the dashboard is communication and facilitation of shared understanding across clinical teams, rehabilitation teams, and patients' families, and between payors and facilities. Desired content includes core metrics applied by the DoC program for diagnosis and monitoring. There is a high priority for making the display easily understandable and interpretable. Technical requirements include the ability to pull data for display from existing items in the electronic health record to minimize additional burden on therapists. User feedback on the design resulted in a streamlined main screen, with additional detail accessible by clicking into each assessment.

Conclusions. In the unique case of patients with DoC, who cannot speak for themselves, effective communication among rehabilitation clinicians, family members or care partners, and third-party payors is highly important for optimal care. The key benefit of using an LHS approach is positioning the team to proactively design the dashboard to account for the needs and preferences of different end users.

The purpose of this study was to describe development, application, and satisfaction of a mentoring match algorithm created for the ACRM CDNG Leadership Mentoring Program. We conducted sequential, mixed methods evaluation of a mentoring-match algorithm. Interdisciplinary rehabilitation professionals participated in the program as mentees and mentors. We assessed mentoring matches made and frequency of mentees being matched with their first, second, or third recommended mentor. We also conducted focus groups to explore satisfaction with mentoring matches. There were 13 mentoring matches made (26 participants: 13 mentees and 13 mentors), including 7 mentees (53.8%) matched with their first recommended mentor, 5 (38.7%) with their second, and 1 (7.6%) with their third. Key qualitative findings included quality and structure of the mentoring matches and recommendations for improvements. This novel, interdisciplinary mentoring match algorithm shows promise for use across disciplines, settings, and organizations. More research is needed to evaluate program outcomes.

Keywords. Mentoring, physical and rehabilitation medicine, research personnel, health personnel, leadership

Medicaid-funded home and community-based services (HCBS) allow older adults with disabilities to avoid long-term institutionalization in nursing homes or hospitals. Past research has shown mixed results on the positive impacts of HCBS. These inconsistent results may stem from studies combining varied HCBS settings, obscuring their differential impacts on older adults’ health and well-being. In Hawaii, HCBS settings primarily include private residences and community care foster homes. There is very little research on adult foster homes, and it remains unclear whether adult foster homes are associated with differential rates of functional decline over time compared to private homes or nursing homes. This research contributes to these literature gaps by comparing functional decline (measured using Hawaii Medicaid level-of-care assessments) across three settings: private homes, adult foster homes, and nursing homes from 2014 to 2021. Among 5,315 dual eligible Medicaid recipients, we found distinct characteristics in initial placement. Individuals placed at home were younger and had lower functional impairment scores compared to individuals in foster homes or nursing homes. To increase comparability despite these differences, we matched older adults (n = 852) on baseline functional status, age, sex, marital status, and race/ethnicity using propensity score matching and performed sensitivity analyses on cognitive status. After matching, linear mixed-effects modeling revealed a notably slower rate of functional decline at home compared to nursing homes or foster homes. Individuals at home had fairly stable functional status (low deterioration) over the eight years. Nursing home residents had the fastest rate of decline, followed closely by individuals in foster homes. These findings of the varying functional outcomes across care settings can inform policymakers, families, and caregivers in selecting effective care options.

Keywords. Nursing homes, Elderly, Caregivers, Disabilities, Behavioral and social aspects of health, Medical risk factors, Hawaii, Long-term care

Objective. This study examined how structural and contextual barriers, including social needs and gender, influence diabetes self-management (DSM) through psychosocial pathways, particularly diabetes distress (DD) and self-efficacy (SE). Although these barriers are well documented, their interactions with psychosocial factors remain underexplored.

Research Designs and Methods. We analyzed cross-sectional baseline data from the REAL-T (Resilient Empowered Active Living Telehealth) study (n = 198). Using hierarchical regression, we assessed factors influencing DSM. Structural predictors included unmet social needs and limited insulin access; contextual predictors included gender and ethnicity. Hypothesized mediators were the scores on the Diabetes Distress Scale, the Diabetes Empowerment Scale, and the Audit of Diabetes Dependent Quality of Life. After identifying significant predictors and potential mediators through hierarchical multivariate regression analysis, separate path models were tested for each hypothesized mediator.

Results. Unmet social needs, as well as female and nonconforming genders, were found likely to increase DSM challenges. All selected predictors became nonsignificant when accounting for all psychosocial variables. DD mediated all tested relationships, and SE partially mediated the relationship between unmet social needs and DSM.

Conclusion. The proposed model suggests the need for targeted interventions addressing psychosocial pathways, particularly DD and SE, to mitigate the downstream effects of structural barriers to DSM. Inclusive gender-specific care models and systemic reforms to reduce social inequities are crucial for improving DSM outcomes and overall well-being.

This article describes a unique community-based geriatric interprofessional training program that has been in existence for more than 10 years and includes faculty and students from seven health professional schools. Although this program was developed prior to the pandemic, it was delivered without interruption during the pandemic and was adapted to virtual and hybrid models. The training program is designed to teach students how to work collaboratively with older adults over a 6-month period. Students are grouped in interprofessional teams and coupled with faculty and older adults in the community who volunteer to participate in the program. It consists of didactic and experiential components, where students learn standardized tools from different health professions and how to practice using these tools as a team with an older adult. The impact of this program on post-graduation geriatric clinical practice of the participating health professionals is also described. Finally, sustainability factors for a program like this and its application to other patient populations are addressed.

Introduction. Autism is characterized by a wide range of core and associated behavioral features that can be influenced by co-occurring conditions such as attention-deficit hyperactivity disorder (ADHD) and anxiety disorders. Executive function difficulties are proposed as a common feature of autism and ADHD and are also evident in persons with anxiety disorders. However, little is known about how anxiety disorders or ADHD differentially impact executive functioning or how these difficulties may influence the presentation of core and associated autistic features in young children. In the current study, we explored the unique executive function difficulties associated with co-occurring anxiety and/or ADHD and elucidated how they differentially impact the clinical presentation of autism in young children.

Methods. We assessed 69 autistic children, aged 3 to 5 years. Anxiety and ADHD were assessed through parent interview using the Preschool Age Psychiatric Assessment (PAPA). Executive functions were assessed using the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P). Core autistic features were measured with the Autism Diagnostic Observation Schedule—Second Edition (ADOS-2) and additional features were measured with the Restricted and Repetitive Behaviors Scale, Revised (RBS-R) and the Sensory Experiences Questionnaire (SEQ). Using an additive main effect general linear model, we examined the unique contributions of an anxiety disorder and/or ADHD on core and associated autistic features as well as executive function. Mediation analyses explored the contribution of the executive function profiles to specific features of autism.

Results. Results showed that greater difficulty with attentional shifting was uniquely associated with anxiety, whereas greater difficulty inhibiting behavioral responses was uniquely associated with ADHD. Attentional shifting mediated the relationship between anxiety and ritualistic behaviors, sameness behaviors, sensory hyper-responsivity, and overall autistic features. Conversely, inhibitory control mediated the relationship between ADHD and both irritability and self-injurious behaviors.

Discussion. These findings implicate components of executive functioning as important cognitive processes associated with co-occurring psychiatric conditions in autism. Future research should investigate the impact of early intervention for executive function difficulties on psychiatric and neurodevelopmental outcomes in autistic children.

Keywords. autism, executive function, anxiety, ADHD, pediatric

Autism has historically been defined by the presence of differences in social communication and restricted, repetitive patterns of behavior, interests, or activities (RRBs). Since 2013 when the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was published, sensory features were added as one of the polythetic restricted and repetitive behavior diagnostic criteria of autism, though it has remained understudied. Here, we summarize theory and research to provide support for the perspective that early sensory functions and experiences play a primary role in autism and have downstream effects on social communication and repetitive behavioral features of autism. The goals of this article are to provide an understanding of the current sensory research landscape over the early developmental period; to contextualize our knowledge autism within a developmental framework; to delineate a cascading developmental model that provides testable hypotheses; and to identify current gaps in research that would allow us to further our understanding of the role, and primacy of sensory differences in the development of the autistic phenotype. We close by offering a set of recommendations for the field.

In modern workplaces, the well-being and productivity of employees are increasingly recognized as essential for organizational success. This study explores the impact of lighting interventions—specifically, Correlated Color Temperature (CCT) and illumination intensity—on stress and cognitive function restoration among office workers. A between-subjects experimental design involving 100 participants assessed the effects of various lighting conditions on stress responses and cognitive performance after exposure to stress-inducing and cognitive fatigue tasks. Five experimental conditions were studied: 100 lux & 7000 K, 100 lux & 3000 K, 1000 lux & 7000 K, 1000 lux & 3000 K, and a baseline condition of 500 lux at 3700 K. Results indicated that lighting conditions significantly influence both physiological stress markers (such as skin conductance level and heart rate) and cognitive performance. Specifically, warm, and dimmed lighting (3000 K, 100 lux) effectively reduced stress markers and perceived stress levels, aligning with theories suggesting the calming effects of warmer white light tones. Conversely, cooler lighting (7000 K) was associated with enhanced cognitive performance and reduced cognitive fatigue, potentially due to its similarity to natural daylight, stimulating an alert state conducive to mental tasks. These findings suggest that lighting interventions offer a non-intrusive strategy to improve well-being and productivity in office environments, particularly addressing acute symptoms.

Importance. Limited availability of Spanish-translated clinical assessment tools perpetuates disparities in health care access for Spanish-speaking Latinos in the United States. The Measure Yourself Medical Outcome Profile® (MYMOP) is a patient-reported outcome measure that has demonstrated utility for use with older Latinos, but a licensed Spanish-language version is not available.

Objective. To develop, validate, and assess the readability of a culturally relevant translation of the MYMOP for U.S. Spanish-speaking Latinos.

Design. A multiphase, systematic translation process involving cognitive debriefing with target respondents and validity and readability analysis.

Setting. Data collected in-person or online within the general Latino community.

Participants. Forty Spanish-speaking volunteers age 45 years or older identifying as Latino/Hispanic, living in the United States, and reporting one or more chronic health conditions were recruited.

Outcomes and Measures. The Latin-American Spanish translation of the MYMOP (MYMOP–LAS), a person-centered tool that evaluates overall well-being, symptom severity, and symptom impact on daily activities, was cross-sectionally compared with the EuroQol Five-Dimension Five-Level (EQ-5D-5L) health-related quality of life measure.

Results. Participants found the MYMOP–LAS generally understandable but recommended revisions to improve clarity and alignment with colloquial Spanish. The MYMOP–LAS baseline profile score and three of four subscales correlated significantly with the EQ-5D-5L utility index score (r = −.473 to −.519, ps ≤ .013). The MYMOP–LAS met expectations for readability (approximately fifth-grade reading level).

Conclusions and Relevance. Preliminary evidence supports the validity and readability of the MYMOP–LAS for use with the U.S. Latino Spanish-speaking community. Additional research on the MYMOP–LAS’s psychometric properties is warranted.

Plain-Language Summary. In the United States, there is a shortage of clinical assessment tools for Spanish-speaking Latinos. This study aimed to develop a culturally relevant and readable Latin-American Spanish translation of the Measure Yourself Medical Outcome Profile® 2 (MYMOP–LAS). Forty Latinos age 45 yr and older living in the United States completed and critiqued a draft of the MYMOP–LAS. Participants understood the questionnaire but suggested changes to improve its clarity and alignment with more casual Spanish language. MYMOP–LAS scores aligned with another quality of life measure, corroborating MYMOP-LAS’s validity. The tool was readable at about a fifth-grade reading level. This study provides support for using the MYMOP–LAS with Spanish-speaking Latino communities in the United States.

Positionality Statement. The authors use Latino or Hispanic as a gender-inclusive term to describe participants but recognize the complexities of labeling ethnic and cultural identity. Three authors identify as Spanish–English bilingual Latino and two as English monolingual, non-Hispanic White. All authors have advanced training; most hold graduate or postgraduate degrees.

AOTA Taxonomy. age 40-64, diversity, equity, and inclusion, older adults, prevention, health and wellness, prevention/wellness community practice, standardized assessment tools

Keywords. angiosarcoma associated with lymphedema, ligamentous articular strain technique, lung allocation score

Objective. Currently, no standardized sonography protocol for evaluating the distal flexor tendons in the hand exists. The aims of this research were to (1) establish an image acquisition protocol to standardize assessment and (2) describe typical variations in the morphology of flexor tendons in healthy individuals.

Materials and Methods. A sonography protocol was developed, refined, and deployed in a cohort of healthy volunteers to collect images and cine clips of flexor tendons beginning at the mid-palm through insertion at the distal phalanx. Longitudinal and cross-sectional images of the tendons were measured at each joint space (e.g., the metacarpophalangeal, proximal interphalangeal, and distal phalangeal joints). Through an iterative process, images from each location were compared across participants.

Results. The anatomic patterns and unique presentations of hand flexor tendons in 15 healthy volunteers were identified and described, including the bifurcation of the flexor digitorum superficialis tendon and the atypical presentation of muscle bellies in the distal hand. Best practices for imaging and morphologic variability were described in a final detailed imaging protocol.

Conclusion. A detailed sonography protocol was established, and standardization in imaging practices using such a protocol should be considered when scanning tendons in the distal hand to enhance rigor and reliability in clinical and research evaluations of the flexor tendons.

Objective. To describe the characteristics of patients enrolled in disorders of consciousness (DoC) rehabilitation programs and to examine factors associated with improvement beyond measurement error on neurobehavioral function. Outcomes for adults with DoC after severe brain injury are highly variable and difficult to predict. Applying a minimal detectable change (MDC) threshold to change measures can identify help to distinguish true improvement or decline from random fluctuation. We also evaluated whether change in neurobehavioral function during the first 2 weeks of rehabilitation was associated with change between 2 and 4 weeks.

Design. Retrospective cohort study. Data were generated as part of standard clinical care.

Setting. Postacute inpatient facilities with specialized DoC programs at 2 large, urban health care systems.

Participants. Adults with DoC after severe brain injury (N=696).

Interventions. Not applicable.

Main Outcome Measure. Improvement beyond measurement error, calculated as the MDC with a 90% confidence interval (9 units) on the Coma Recovery Scale-Revised (CRS-R), using an equal-interval 0-100 unit transformed total measure. The MDC threshold was applied to change in CRS-R total measure from first to last CRS-R administration (up to 60 elapsed).

Results. Two-thirds of the sample (n=445) improved beyond the MDC on the CRS-R; 23 participants declined beyond measurement error, and 228 participants changed less than the MDC. Patients with less time elapsed between injury and first CRS-R assessment were more likely to improve beyond the MDC. Change during the first 2 weeks of rehabilitation was not associated with change between 2 and 4 weeks.

Conclusions. Our results underscore the importance of measuring change with greater precision for adults with DoC, as within-state change (or lack thereof) could inform rehabilitation treatment decisions about whether interventions are working as intended.

Keywords. Brain injuries, Consciousness disorders, Neurologic rehabilitation, Outcome assessment, Recovery of function, Rehabilitation

This response critically examines the AnonymOT Collective’s commentary on occupational therapy’s role in advocating justice for Palestine. Written from the perspective of a Palestinian occupational therapist, it challenges the authors’ use of anonymity, highlighting the contradiction it poses to their call for open discourse. The response critiques the possible exclusion of Palestinian voices, the lack of actionable proposals, and the performative framing of advocacy. It emphasizes the need for transparency, accountability, and the inclusion of lived experiences in justice-oriented efforts. This piece calls for genuine solidarity and meaningful action to support occupational therapists and healthcare workers in the Gaza Strip and the West Bank in Palestine.

While it has been suggested that alterations in the composition of gut microbial metabolites may play a causative role in the pathophysiology of autism spectrum disorder (ASD), it is not known how gut microbial metabolites are associated with ASD-specific brain alterations. In this cross-sectional, case-control observational study, (i) fecal metabolomics, (ii) task-based functional magnetic resonance imaging (fMRI), and (iii) behavioral assessments were obtained from 43 ASD and 41 neurotypical (NT) children, aged 8–17. The fMRI tasks used socio-emotional and sensory paradigms that commonly reveal strong evoked brain differences in ASD participants. Our results show that fecal levels of specific tryptophan-related metabolites, including kynurenate, were significantly lower in ASD compared to NT, and were associated with: 1) alterations in insular and cingulate cortical activity previously implicated in ASD; and 2) ASD severity and symptoms (e.g., ADOS scores, disgust propensity, and sensory sensitivities). Moreover, activity in the mid-insula and mid-cingulate significantly mediated relationships between the microbial tryptophan metabolites (indolelactate and tryptophan betaine) and ASD severity and disgust sensitivity. Thus, we identify associations between gut microbial tryptophan metabolites, ASD symptoms, and brain activity in humans, particularly in brain regions associated with interoceptive processing.

Keywords. Autism spectrum disorders, Neuroimmunology

Aim. To describe the supporting and enhancing neonatal intensive care unit (NICU) sensory experiences (SENSE) program, associated research and opportunities for further study.

Methods. A review of current materials on SENSE program implementation, publications related to SENSE development, and research on program implementation and patient outcomes was conducted to describe the SENSE program and its associated research.

Results. The SENSE program combines structured, evidence-based, multisensory interventions with parent engagement in order to optimise outcomes in the complex NICU environment. Through a stepwise and scientific process, the SENSE program was developed to include specific doses and targeted timing (based on the infant's postmenstrual age, PMA) of evidence-based interventions such as massage, auditory exposure, rocking, holding and skin-to-skin care for parents to provide their infants each day of NICU hospitalisation. It is adapted in context of concurrent medical interventions, infant behavioural responses, as well as NICU culture. The program is feasible to implement, acceptable to staff, and related to infants receiving more developmentally appropriate sensory exposures. Adaptations related to NICU culture and parent involvement have been reported. Research has identified relationships of the SENSE program to improved parent confidence, neurobehaviour and feeding at term age as well as improved communication 1 year of age.

Conclusion. The literature related to the SENSE program is promising, but more research on efficacy and implementation is needed.

Keywords. brain; development; multisensory; parent; preterm

Purpose. The purpose of this retrospective cohort analysis was to investigate sex differences in receipt of standard of care sleep and constipation drug treatments among autistic children and youth with sleep disorder and constipation, respectively.

Methods. We used the data from the OneFlorida + Data Trust to analyze healthcare claims for 19,877 autistic patients with sleep disorder and 32,355 patients with constipation, ages 1 to 22. We used logistic regression to examine sex differences in receiving sleep and constipation treatments, and a multivariate logistic regression model to further assess sex differences in ever receiving sleep and constipation treatments, adjusting for age, race, ethnicity, and urbanicity.

Results. In our multivariate analysis, autistic girls with sleep disorder were 1.27 times more likely than boys to receive sleep treatment (p < 0.0001). Although autistic girls with constipation appeared to be 1.10 times more likely than boys to receive treatment, it was not significantly different after adjusting for demographic and socio-economic characteristics (p = 0.372). Older children were 1.09 times more likely than younger children to receive sleep treatment (p < 0.0001) and 1.07 times more likely to receive constipation treatment (p < 0.0001).

Conclusion. We did not find sex differences among autistic children for treatment of constipation, but autistic girls with sleep disorder were significantly more likely to have ever received treatment, which could indicate that girls experience more significant sleep disorders.

Background. Young adults with type 1 diabetes mellitus often face challenges managing their condition, leading to elevated glucose and heightened psychosocial distress. Diabetes care traditionally focuses on biomedical outcomes, with less emphasis on well-being. Occupational therapy offers a holistic approach to managing diabetes by integrating changes to daily habits and routines and psychosocial support.

Methods. This randomized controlled trial involved participants aged 18–30 with HbA1c ≥ 7.5 % (≥58 mmol/mol). Participants received either telehealth occupational therapy or usual care. The intervention addressed diabetes management, daily habits and routines, and emotional well-being. Data collected at baseline, 3 months, and 6 months included HbA1c, continuous glucose monitoring metrics, and psychosocial outcomes. Analyses employed intent-to-treat principles, using ANCOVA to evaluate between-group differences.

Results. Participants (n = 209) were 24.3 (±3.7) years old, 59.8 % female, 44.5 % non-Hispanic White, and 47.4 % publicly insured. No significant differences were found in glycemic outcomes. Intervention participants had improved diabetes-related quality of life (DQoL; least-squares [LS] mean 0.67, 95 % CI 0.02 to 1.32, p = 0.045) and reduced diabetes distress (LS-mean −0.36, CI −0.65 to −0.07, p = 0.01).

Conclusion. Generalizability may be impacted by external factors related to COVID-19. The findings suggest occupational therapy may be beneficial for young adults experiencing diabetes-related distress and poor DQoL.

Purpose. Intentional communication acts, or purposefully directed vocalizations and gestures, are particularly difficult for infants at elevated likelihood for eventual diagnosis of autism. The ability to measure and track intentional communication in infancy thus has the potential to aid early identification and intervention efforts. This study assesses the validity of a novel measure of intentional communication intended for use within semistructured caregiver–infant interactions.

Method. The Intentional Communication Coding Scale (IC Coding Scale) captures infants' Vocalizations, Gestures, and Combined (vocalizations paired with gestures) acts. Using data from 36 infants at elevated likelihood for autism, we tested the convergent and discriminant validity of the IC Coding Scale with established language measures using Spearman's rho. We tested interrater reliability using intraclass correlation coefficient (ICC) calculations. Finally, we tested responsiveness (i.e., sensitivity to change) using Wilcoxon signed-ranks tests and Spearman's rho.

Results. Our initial psychometric tests suggested adequate levels of convergent and discriminant validity. ICCs ranged from .77 to .92, while confidence intervals were wide, suggesting that Gestures and Combined acts were coded more variably than Vocalizations were among raters. Tests of the scale's responsiveness suggested adequate sensitivity to change across a 12-week period.

Conclusions. This study is an important first step toward validating the IC Coding Scale for use in measuring and tracking intentional communication behaviors in infants at elevated likelihood for autism within more naturalistic, semistructured activities. Additional studies are needed to disentangle the effects of intervention from maturation and to examine types of intentional communication acts in more detail.

Purpose/Objectives. This study examined the relationship between environmental factors (e.g., working position, patient position, and scaling instruments) and poor posture in dental hygiene students.

Methods. A longitudinal cohort study was conducted from 2017 to 2019 to observe dental hygiene students' clinical rotation performance at two undergraduate universities. Samples of video observations (n = 1487) of dental hygiene students performing scaling activities during oral care sessions were evaluated using the Rapid Upper Limb Assessment (RULA). Descriptive analysis and exploratory prediction modeling were performed to assess clinical environmental factors that predicted higher risks of developing WMSDs.

Results. RULA scores (mean = 4.8, median = 5, range = 2–7) indicate dental hygiene students are at high risk of developing upper extremity MSDs. The type of scaling instrument, clock positioning relative to the patient, and sitting versus standing had statistically significant associations (p < 0.001) with the RULA outcome. In univariate analyses, clock positions 7 and 8 were the worst, having an increased risk of poor RULA outcomes (scores 5–7) by nearly nine times over working in clock position 12 (odds ratio [OR] 9.11, 95% CI 5.48–15.60). Multivariate predictive modeling indicated that the riskiest combination of factors is using a manual scaling instrument (OR 1.67, 95% CI 1.28–2.18), standing (OR 1.42, 95% CI 1.03–1.96), and working clock positions 7 and 8 (OR 8.4, 95% CI 5.02–14.50).

Conclusions. There is a need to consider the combined contribution of multiple environmental factors on working positions to optimize ergonomic training during dental hygiene and protect emerging dental health professionals from the negative health impacts of prolonged awkward postures.

This letter addresses the article by Lipskaya-Velikovsky et al. (2025), which examined mental health and contributing factors among Hebrew-speaking higher education students in Israel during the onset of the Swords of Iron war. Their study’s focus on the population-level impacts of trauma and factors that influence mental health offers valuable insights for occupational therapy practitioners. The authors’ methodology and analysis highlight occupational therapy’s role in supporting mental health at individual, community, and population levels. However, methodological and contextual limitations bound the study’s findings, reducing its applicability to gaining an understanding of the broader occupational and mental health impacts.

Tags. across the lifespan, diversity, equity, and inclusion, Education, environmental factors, ethics, evidence-based practice/knowledge translation, group, international, mental, behavioral and neurodevelopmental topics, occupational justice, scope of practice

Introduction. Occupational therapists are tasked with developing technical, political, and ethical actions that address the suffering and isolation of diverse groups, particularly those historically marginalized. This study focuses on gender and sexual dissidences – a term encompassing individuals who exist beyond or outside of identity categories (such as lesbians, gays, bisexuals, transgenders, among others).

Objectives. To present an overview of the practices of occupational therapists in Brazil with the population who experience dissidence of gender and sexuality.

Method. Data were collected through an online survey using snowball sampling, initially reaching out to seed informants, professional entities, and social media networks. Data organization, analysis, and discussion were conducted using descriptive statistics, supplemented by the theoretical background of social occupational therapy, queer studies, and critical occupational science.

Results. Ninety-five responses were analyzed, with informants reporting various motivations for their involvement with the topic, including personal and familial affinities and needs encountered within their professional contexts. A wide array of practices emerged, developed from distinct approaches across various professional domains. These were grouped into four main categories: individual consultations, group consultations, academic activities, and network articulation. Despite the relevance of theoretical-methodological frameworks, informants infrequently mentioned studies specifically addressing gender, sexuality, or occupational therapy in their responses.

Conclusion: While contributions to the population who experience dissidence of gender and sexuality were noted, we identified no practices explicitly tailored to these populations or themes. Occupational therapists predominantly employ resources aligned with their core professional training and general education.

Keywords. Sexual and gender minorities; Professional Practice; Occupational Therapy; Social Occupational Therapy; Critical Occupational Science.

Early signs of autism can be identified in children as young as 6–9 months; however, screening tools to identify characteristics of autism in young children are underutilized by pediatricians. This qualitative study aimed to 1) understand the role of occupational therapists (OTs) in early intervention teams when identifying and intervening with infants and toddlers demonstrating early markers of autism, and 2) determine the readiness and capability of OTs within early intervention to utilize autism screening tools in practice. Two semi-structured 90-minute focus groups were conducted with 13 OTs with current or past work experience in early intervention settings across Los Angeles, California. Participants expressed pride in their versatile role on early intervention teams; however, they had mixed feelings about the value of formal autism screening. Even when they were confident about their ability to detect early autism signs, participants cited numerous barriers related to knowledge of screening, stigma related to autism, and reliance on other providers such as pediatricians. These qualitative findings illuminate a need for mitigating expressed barriers to service delivery, bolstering education on screening procedures, and capitalizing on the adaptability of OTs in early intervention practice in order to advance the role of OTs in initiating the early autism screening process.

Keywords. Early intervention; screening; autism; occupational therapy; practitioner perspectives

This study drew on familial autoethnographic and narrative methodologies to analyze the lived experiences of a mother (Ruth), the first author’s grandmother, situated within the cultural and societal context of 1950s America, to understand the choice she made at that time to care for her son with Down syndrome rather than place him in an institution. This study sought to better understand the contextual factors that influenced this mother to make decisions outside of her cultural contexts, while also recognizing the cultural and personal factors that may support or enable such decisions. We then discuss how such factors may be relevant for contemporary contexts.

Keywords. Disability; lived experiences; narrative; familial autoethnography; motherhood; cultural context

Health services research (HSR) is a field of study that examines how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and health and well-being. HSR approaches can help build the occupational therapy evidence base, particularly in relation to population health. Data from electronic health record (EHR) systems provide a rich resource for applying HSR approaches to examine the value of occupational therapy services. Transparency about data preparation procedures is important for interpreting results. Based on our findings, we describe a six-step cleaning protocol for preparing EHR and billing data from an inpatient rehabilitation facility for research and provide recommendations for the field based on our experience. Using and reporting similar strategies across studies will improve efficiency and transparency, and facilitate comparability of results.

Purpose. The purposes of this article were (a) to compare the developmental skills of toddlers whose scores on the First Years Inventory–Lite (FYI-Lite), an early screening tool, indicated an elevated likelihood of a later diagnosis of autism (ELA) to the developmental skills of toddlers at a lower likelihood of a later diagnosis of autism (LLA) and (b) to examine how autism characteristics are correlated with communication measures in toddlers at an ELA.

Method. We assessed the language, social communication (SC) skills, and characteristics of autism demonstrated by 45 toddlers at an ELA and 37 toddlers at an LLA between the ages of 11 and 18 months and compared group scores on these measures. We also examined the correlations between the characteristics of autism and language measures within the ELA group.

Results. Toddlers at an ELA demonstrated lower scores on measures of global expressive and receptive language, receptive vocabulary, gestures, and response to joint attention bids as well as SC characteristics of autism when compared to those demonstrated by toddlers at an LLA. There were no significant differences between groups on expressive vocabulary, language profiles (i.e., the relationship between receptive and expressive scores), or restrictive and repetitive behaviors. Within the ELA group, the SC characteristics of autism were significantly associated with their global receptive and expressive language skills.

Conclusions. On the basis of the FYI-Lite screening tool, toddlers at an ELA are demonstrating delays in language and SC skills when compared to toddlers identified with an LLA. For toddlers at an ELA, the SC characteristics of autism are significantly associated with early language skills.

Autism spectrum disorder (ASD) and Developmental Coordination Disorder (DCD) are distinct clinical groups with overlapping motor features. We attempted to (1) differentiate children with ASD from those with DCD, and from those typically developing (TD) (ages 8–17; 18 ASD, 16 DCD, 20 TD) using a 5-min coloring game on a smart tablet and (2) identify neural correlates of these differences. We utilized standardized behavioral motor assessments (e.g. fine motor, gross motor, and balance skills) and video recordings of a smart tablet task to capture any visible motor, behavioral, posture, or engagement differences. We employed machine learning analytics of motor kinematics during a 5-min coloring game on a smart tablet. Imaging data was captured using functional magnetic resonance imaging (fMRI) during action production tasks. While subject-rated motor assessments could not differentiate the two clinical groups, machine learning computational analysis provided good predictive discrimination: between TD and ASD (76% accuracy), TD and DCD (78% accuracy), and ASD and DCD (71% accuracy). Two kinematic markers which strongly drove categorization were significantly correlated with cerebellar activity. Findings demonstrate unique neuromotor patterns between ASD and DCD relate to cerebellar function and present a promising route for computational techniques in early identification. These are promising preliminary results that warrant replication with larger samples.

Keywords. Autism spectrum disorders, Developmental coordination disorder, Machine learning, fMRI, Early detection, Smart tablet

Abstract. Practitioners need to demonstrate the value of occupational therapy services in achieving effective patient outcomes. To intervene effectively, we must have adequate assessment practices. This study examines variation in occupational therapy assessment practices by facility type, areas addressed, and types of instruments. The study characterizes commonly and frequently used assessment practices in core occupational domains and identifies potential practice gaps related to assessment. A cross-sectional online survey across six domains central to adult occupational therapy practice (activities of daily living [ADL], instrumental activities of daily living [IADL], fear of falling, functional cognition, psychosocial, and vision) was administered to practitioners in various settings. Surveys were obtained from 1,198 respondents. Survey responses identified differences in domains being assessed and assessment methods used by occupational therapy practitioners across hospital inpatient post-acute care facilities and community settings. There is variability in the methods used to assess domains critical to occupational therapy practice and the degree to which occupational therapists evaluate domains in practice settings.

Importance. Patients in intensive care units (ICUs) experience complex functional, physical, and cognitive needs that affect their engagement in activities of daily living (ADLs). Occupational therapy practitioners are uniquely positioned to address these needs to optimize patients’ functional recovery.

Objective. To examine occupational therapy–specific interventions as they relate to early engagement for patients in the ICU.

Data Sources. CINAHL, PubMed, ProQuest, OTseeker, and Cochrane Library databases.

Study Selection and Data Collection. The Cochrane methodology was used to collect, evaluate, and analyze articles, then reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for conducting a systematic review. Articles published from January 2012 to December 2021 evaluating adults who received occupational therapy interventions in ICUs with Level 1b, 2b, or 3b evidence were included.

Findings. Nine articles met the inclusion criteria and the research objective. Findings showed moderate evidence for ADLs, physical rehabilitation, and cognitive interventions in promoting functional outcomes for patients in the ICU.

Conclusions and Relevance. This systematic review introduces the term early engagement to describe occupational therapy–specific interventions for patients recovering in the ICU and supports occupational therapy’s role in this setting. Further research is needed to strengthen the evidence for occupational therapy–specific interventions and early engagement in the ICU.

Plain-Language Summary. Patients in the intensive care unit experience complex needs that affect their participation in activities of daily living (ADLs). Current research demonstrates moderate evidence for early engagement with ADLs, physical rehabilitation, and cognitive interventions performed by occupational therapy practitioners. This systematic review introduces the term early engagement, which captures how occupational therapy practitioners provide holistic interventions for patients in the intensive care unit to promote patient well-being and functional recovery.

AOTA Taxonomy. ADLs, evidence-based practice/knowledge translation, interprofessional practice and intraprofessional practice, occupations and activities, older adults, quality and value-based care, scope of practice

Keywords. intensive care unit, physical rehabilitation, systematic reviews, cognition, intensive care, occupational therapists

Background. Chimeric antigen receptor (CAR) T-cell therapy is an immunotherapy with preliminary success in treating blood cancers, however, it is associated with adverse side effects that can impact patients’ functional statuses. There is a need to further explore side effects associated with CAR T-cell therapy and the role that occupational therapy may serve in addressing affected areas. The purpose of this study was to explore the functional and psychosocial effects patients experience while undergoing CAR T-cell therapy to better understand the rehabilitation needs from an occupational therapy perspective.

Methods. A retrospective chart review was completed to collect data from patients who underwent CAR T-cell therapy at a cancer hospital between February 2024 and July 2024. Patients were included if they received occupational therapy services throughout their inpatient stay, including completion of selected assessments prior to infusion, day +3 following infusion, day +6 following infusion, and day +9 following infusion.

Results. Trends between assessment scores prior to infusion and prior to discharge were explored with each patient. Although with varied results, this study found that CAR Tcell therapy may affect patients’ cognition, psychosocial wellbeing, grip strength, balance, and fatigue levels.

Discussion. Occupational therapy practitioners in acute care oncology can focus on the areas identified in this study to support evaluation and intervention planning for patients undergoing inpatient CAR T-cell therapy.

Keywords. acute care, cancer, CAR T-cell therapy, occupational therapy, oncology, rehabilitation

The noise produced in demolition sites can mask safety-critical sounds that inform operators about task conditions and hazards. These problems are exacerbated in teleoperated demolition, where the separation between operator and site compromises operators' situation awareness and cognitive loads. This paper assessed the effects of environmental sounds with and without attenuation on the operators' performance and response (e.g., stress, attention, task engagement) during teleoperated demolition. Eighty participants completed three virtual demolition tasks under different environmental sound conditions, i.e., no sound (NS), unfiltered sound (US), and filtered sound (FS) with 20-dB attenuation of background noise and robot's sounds to allow focus on safety and task conditions. The results show that US induced more stress than NS and FS. Also, FS resulted in fewer collisions, faster reaction times, and greater attention and task engagement than US. These results can support the design of sound feedback interfaces for teleoperation in construction.

Keywords. Demolition, Electrodermal activity, Environmental sound, Heart rate variability, Performance, Robot, Safety, Stress, Teleoperation

West, S., Schepens Niemiec, S.L., Martínez, J., & Lysack, C. (2024) Occupational therapy intervention process with aging adults. In Occupational Therapy with Aging Adults, 2nd ed. Editors K. Barney and M. Perkinson.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also referred to as the novel coronavirus (Covid-19), belongs to the Sarbecovirus subgenus of the genus Betacoronavirus. In December 2019, unbiased sequencing in samples obtained from a cluster of patients symptomatic for pneumonia of unknown cause led to the discovery of Covid-19. The virus was highly transmittable and rapidly spreading, which led to the declaration of a global pandemic by the World Health Organization in March 2020. The symptoms of infection with Covid-19 replicated those seen in viral pneumonia and included cough, fever, and chest congestion and discomfort. More than two-thirds of patients hospitalized with the disease suffered from damage to the central nervous system in addition to respiratory symptoms. Along with neurological manifestations, evidence of psychiatric and cognitive involvement was also recorded in Covid-19 infection. Commonly reported psychiatric and neuropsychiatric presentations included depression, anxiety, post-traumatic stress disorder, delirium, altered consciousness, and dysexecutive syndrome. Cognitive decline because of Covid-19 infection was observed in functioning related to memory, executive functioning, and verbal fluency. This chapter discusses the multifold acute as well as persistent neuropsychiatric, cognitive, and neurological manifestations of Covid-19.

Keywords. SARS-CoV-2, coronavirus, Covid-19, neuropsychiatric, neurocognitive, neurological, post-Covid-19

Critical perspectives provide concepts and a lens that can be used to problematize and reformulate occupational issues, practices, and assumptions that maintain an individualist focus and neglect socially inequitable conditions that differentially affect groups in society. Critical perspectives provide a broader understanding of the socioeconomic and political conditions that shape occupation. Numerous examples have emerged in the literature to support the value added by integrating these perspectives into occupation-based practices. Applying critical perspectives can contribute to social transformation by shifting ways of thinking and doing, such that the socioeconomic and political roots of occupational inequities are addressed. This chapter interweaves critical reflexive vignettes and examples of the authors’ work to exemplify how critical perspectives have helped reframe issues and solutions in ways that expand beyond a primary focus on individual doing. This chapter builds on previous work that calls for continuous reflexivity and problematization of socially dominant norms as strategies to resist individualistic tendencies and contribute to enacting social transformation and promoting equity-oriented practices.

Unsustainable patterns of human occupation have detrimentally affected the natural world, disrupted ecosystems, and placed the long-term health of humanity at risk, making environmental sustainability a topic of paramount importance to occupational therapists. To minimize damage to the natural environment and promote human health, well-being, and justice, occupational therapists should develop knowledge of environmental sustainability and human occupations. This chapter aims to provide readers with a basic understanding of the impact that human occupation has on the environment, the effects of climate change on human occupation, and the ethical dimensions of sustainability. Additionally, this chapter will introduce readers to the application of occupational therapy theory to environmental sustainability concepts, as well as initiate a discussion of environmental sustainability in occupational therapy practice settings, treatment, and education.

Arguments about human occupation have always acknowledged that context influences various dimensions of what people can do, are expected to do, and cannot do. Occupational science and occupational therapy literature published through the early 2000s particularly emphasized how immediate physical, social, and temporal environments shaped people’s occupational engagements. In recent years, scholars have shown how consideration of broader conditions, such as social power relations, yields more fulsome explanations of how occupation is both shaped by and helps to (re)shape life contexts. These “situated” approaches have generated increasingly rich and complex knowledge about occupation’s political, social, cultural, and historical embeddedness and significance. Through selected examples about cooking and food provisioning occupations, this chapter provokes critical reflexivity regarding evolving understandings about the situated nature of human occupation and how they can inform occupation-based practices from individual to systemic levels.

This chapter discusses a growing body of theoretical and practical work by occupational therapists interested in developing practices around social transformation. A corresponding interest is also developing around the concept of collective occupations. Our intended audience is students and entry-level professionals in occupational therapy who will most likely find themselves in mainly corporatized health care systems. The chapter introduces Occupational Reconstruction Theory to students and practitioners of occupational therapy. Occupational Reconstruction Theory grows out of interdisciplinary scholarship in occupational science, social anthropology, 20th-century pragmatism, narrative studies, social movement studies, and occupational therapy. The purpose of Occupational Reconstruction Theory is to identify the key underlying principles guiding social transformation practice in occupational therapy. The chapter also discusses why practitioners need some familiarity with philosophical frameworks of thought to justify changes they may wish to make to theory and practice, as well as to adequately evaluate and critique changes proposed or enacted by others. Finally, the chapter discusses the Occupational Reconstruction Theory, which identifies a set of elements that appear to be common among documented instances of transformative social action. It also discusses how an occupational therapist could use Occupational Reconstruction Theory as a practical framework for social transformation practice.

Rafeedie, S. (2024). Meeting the needs of the older adult. In H. M. Pendleton & W. Schultz-Krohn (Eds.), Pedretti's occupational therapy: Practice skills for physical dysfunction (9th ed., pp. 1216-1247). St. Louis, MO: Elsevier.

In this chapter the authors engage their personal experiences as “close-to-home” researchers to interrogate knowledge production and practices of inclusion in psychological anthropology. They mobilize abolitionist theory and praxis as exemplified in models of transformative justice and bell hooks’s “love ethic,” to develop a loving critique of our subfield’s disciplinary past and potential future. With the subfield’s emphasis on lived experience, emotion, morality/ethics, care, compassion, and trauma, psychological anthropology is uniquely primed to lead the way in a more liberatory anthropological practice. This depends, however, on how people working in the subfield can move their engagement with lived experience off the page and into our relationships with each other.

Objective. To determine the scope of feeding therapy for preterm infants in the NICU and medical and sociodemographic factors related to feeding therapy referral and service provision.

Study design. Retrospective study of infants born <37 weeks gestation in a level IV NICU between January 2017 and December 2019.

Result. Among 547 infants, 27% of infants received a feeding therapy referral, and 74% of those referrals were problem-based referrals. Feeding therapy referrals were more likely among infants with lower gestational ages and birthweights (both p < 0.001). In addition, infants with greater medical complexity, who required oxygen at 36 weeks, who had a history of mechanical ventilation, and who had a higher postmenstrual age at discharge were more likely to be referred to feeding therapy (all p < 0.001).

Conclusion. While medical factors relate to feeding therapy referrals, there are other complex person and system factors that determine feeding therapy referral and service provision.

This study explored how mental health Clubhouses, an occupation-centered psychosocial rehabilitation model, supported wellness for members and staff during the COVID-19 pandemic through the lens of Maslow’s hierarchy of needs. Data from 15 participants in Hawaiʻi were collected over five sessions through a virtual Photovoice process and analyzed using the framework method and thematic analysis. Findings illustrate how occupation-centered approaches supported higher-level growth needs during a period of collective crisis and uncertainty. This underscores the value of coupling occupation-centered approaches, such as Clubhouse, with those that meet basic needs to support belonging, identity, and purpose among people with mental illness.

Keywords. Clubhouse, mental illness, Photovoice, hierarchy of needs, COVID-19 pandemic

In people, the experiencing, remembering, and believing selves are distinct modes of being that co-exist, though at any particular moment one mode can be dominant. While qualitative methods are effective for querying the remembering and believing selves, Ecological Momentary Assessment (EMA) methods may be better suited to capture the perspective of the experiencing self. Using EMA to investigate occupation allows participants to engage in their regular occupations in their natural environments, pausing to record information about experiences that occurred seconds or minutes prior. To demonstrate the use of EMA to capture the experiencing self (the ‘I’ in the present moment not occupied with memories or beliefs), we examined associations between working, recovering, and various aspects of being (e.g., mood) in secondary analyses using EMA data from workers with type one diabetes (T1D, n = 92). Densely repeated sampling of workers’ experiences through EMA allowed for a correspondingly comprehensive representation of how both working and recovering were associated with various aspects of being, yielding insights relevant to the clinical needs of workers with T1D and to understanding their experiencing self’s view of work and recovery generally. The potential benefits of EMA for occupational science include allowing a more comprehensive understanding of the immediate experience of occupation, enabling investigation of the experiencing self at different timescales (e.g., experience of work in the moment, versus average experience of work over a day), and providing additional means through which to inform occupation centered interventions in populations with chronic conditions.

Keywords. Occupational science, ecological momentary assessment, experience sampling method, work, recovery from work, experiencing self, diabetes

Objective. To examine associations among the time and content of rehabilitation treatment with self-care and mobility functional gain rate for adults with acquired brain injury.

Design. Retrospective cohort study using electronic health record and administrative billing data.

Setting. Inpatient rehabilitation unit at a large, academic medical center.

Participants. Adults with primary diagnosis of stroke, traumatic brain injury, or nontraumatic brain injury admitted to the inpatient rehabilitation unit between 2012 and 2017 (N=799).

Interventions. Not applicable.

Main Outcome Measures. Gain rate in self-care and mobility function, using the Functional Independence Measure. Hierarchical regression models were used to identify the contributions of baseline characteristics, units, and content of occupational therapy, physical therapy, and speech-language pathology treatment to functional gain rates.

Results. Median length of rehabilitation stay was 10 days (interquartile range, 8-13d). Patients received an mean of 10.62 units of therapy (SD, 2.05) daily. For self-care care gain rate, the best-fitting model accounted for 32% of the variance. Occupational therapy activities of daily living units were positively associated with gain rate. For mobility gain rate, the best-fitting model accounted for 37% of the variance. Higher amounts of physical therapy bed mobility training were inversely associated with mobility gain rate.

Conclusions. More activities of daily living in occupational therapy is associated with faster improvement on self-care function for adults with acquired brain injury, whereas more bed mobility in physical therapy was associated with slower improvement. A potential challenge with value-based payments is the alignment between clinically appropriate therapy activities and the metrics by which patient improvement are evaluated. There is a risk that therapists and facilities will prioritize activities that drive improvement on metrics and deemphasize other patient-centered goals.

Keywords. Brain injuries; Electronic health records; Recovery of function; Rehabilitation; Stroke

Objectives. Stiff shoulder, including primary and secondary types, poses diagnostic challenges due to vague definitions and criteria. This study evaluates the diagnostic potential of ultrasound-measured axillary recess (AR) thickness in shoulder stiffness.

Designs. In this cross-sectional study, 35 patients with unilateral shoulder stiffness were assessed. AR thickness was measured using high-resolution ultrasound. Parameters like passive range of motion (PROM), Numerical Rating Scale (NRS), and Constant-Murley (CM) score were evaluated to find correlations with AR thickness.

Results. The average age was 50.7 years, and mean BMI was 22.7. AR thickness in stiff shoulders (average 3.19 mm) was significantly higher than in unaffected shoulders (average 1.93 mm, p < 0.001). A cutoff of 3.0 mm for AR thickness yielded 73.3% sensitivity and 84.6% specificity for primary stiffness; 2.6 mm cutoff resulted in 57.9% sensitivity and 88.2% specificity for secondary stiffness. Significant correlations were found between AR thickness and PROM, especially in shoulder external rotation and extension.

Conclusion. AR thickness measured by ultrasound might serve as a valuable diagnostic and evaluation parameter in shoulder stiffness.

Objective. To describe the state of W&I occupational therapy practice and to identify challenges and opportunities in this specialty practice area.

Design. Cross-sectional survey conducted June 12 to July 17, 2020.

Setting. Online survey distributed through direct email invitations and online platforms (i.e., CommunOT, LinkedIn).

Participants. One hundred twenty occupational therapy practitioners who had worked in W&I within the most recent 5 yr.

Outcomes and Measures. We used 30 multiple-choice, Likert-scale, and free-response questions across three topics: (1) training, resources, and research; (2) challenges and barriers; and (3) opportunities.

Results. Most respondents were occupational therapy practitioners working in clinical settings with >5 yr of experience; 29.2% identified as male. The most frequently provided services were ergonomic consultation and worksite evaluation; clinic-based W&I services were less frequently provided. Workplace injury prevention, management of psychosocial issues, and employee wellness programs were ranked as the top opportunities for occupational therapy in W&I. A shortage of accessible training and resources to support W&I practice was found, particularly mentoring and occupational therapy–focused research evidence. Maintaining referrals, competition from other professions, and limited support from professional organizations were key challenges.

Conclusions and Relevance. This study illustrates the evolution of W&I occupational therapy practice and highlights an urgent need for increased professional recognition and educational support to maintain occupational therapy’s presence in this practice area.

Background. One criterion for infant NICU discharge is the ability to meet all nutritional needs by mouth, therefore, it is important to understand interventions that can improve the trajectory to full oral feeding. While many oral motor and feeding interventions are used in clinical practice, it remains unclear which are supported by the literature.

Aim. The aim of this integrative review was to identify and understand what oral motor interventions are defined in the literature to support positive outcomes for preterm infants and their parents.

Methods. An integrative review of studies published from 2002 to 2022 focusing on applied oral motor interventions and their impact on feeding-related outcomes was completed. The systematic search used databases including PubMed, Cochrane, CINAHL, Scopus, and Google Scholar. Studies were included if they used a study population of preterm infants born

Results. Forty articles met inclusion criteria with four different interventions (or a combination of them) identified: nonnutritive sucking, oral motor stimulation [Fucile's protocol, Premature Infant Oral Motor Intervention (PIOMI)], NTrainer, and swallowing exercises.

Discussion. All interventions were associated with positive outcomes and began between 29- and 30-weeks PMA. Detailed information on adverse events (both physiologic and behavioral) in future research could allow for better risk-benefit analysis. The methodology and quality of the studies differed too much to allow for quantitative analysis; however, there does not appear to be compelling evidence that more stimulatory interventions are superior to less stimulatory interventions – a key consideration when working with preterm infants.

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.

Carpal tunnel syndrome (CTS) is highly prevalent, resulting in decreased function and increased need for costly healthcare services. External wrist ratio (depth/width >0.70) is a strong predictor of the development of CTS and has been suggested to be a proxy for internal carpal tunnel (CT) shape. Conversely, sonography can more directly evaluate CT shape. The purpose of our study was to explore the relationship between wrist ratio and sonographic CT measurements to (1) evaluate the reliability of sonographic CT measurements and (2) explore how external wrist measures relate to anthropometric features of the CT. We used sonographic imaging on a sample of healthy participants (n = 226) to measure CT cross-sectional area, depth, width, and depth/width ratio. We conducted exploratory correlation and regression analyses to identify relationships of these measures with external wrist ratio. Reliability for dominant and nondominant sonographic CT measures ranged from good to excellent (0.79–0.95). Despite a moderate correlation between CT width and depth and their external wrist counterparts (0.33–0.41, p < 0.001), wrist ratio and CT ratio demonstrated weak to no correlation (dominant: r = 0.12, p = 0.053; nondominant: r = 0.20, p = 0.002) and the mean CT ratio was far lower than the mean wrist ratio (0.45 vs. 0.71 bilaterally). Supporting this, we observed several key differences in the relationship between external wrist measures compared to corresponding CT measures. Additionally, regression analyses combining participant factors and CT measurements produced models accounting for less than 15% of the variability in external wrist ratio (linear models) or correctly predicting less than 68% of wrist ratio-based risk categorization (logistic models). Overall, among healthy young adults, wrist shape is not an adequate proxy for CT shape.

Objective. Burnout in sonographers is a prevalent and complex professional hazard associated with poorer quality of work life, productivity, and patient outcomes. This study aimed to understand the prevalence of and work systems factors associated with burnout among a large sample of sonographers.

Materials and Methods. Research study registry participants (n = 3659) were invited to complete a follow-up survey about personal and work environment factors, including work hours, break time, coworker and supervisor support, and job satisfaction, overall health, and sleep quality. The Copenhagen Burnout Inventory assessed personal, work-related, and client burnout. Simple and multiple linear regressions were used to identify work systems factors associated with burnout.

Results. Of 1389 respondents, over half reported moderate-to-severe personal and work-related burnout, while one-quarter reported moderate-to-severe client burnout. Higher work-related burnout was associated with younger age, working in the Western United States, working full-time, taking fewer weekly break hours, poorer overall health and sleep quality, and lower supervisor support and job satisfaction. Client burnout was associated with poorer sleep quality and lower job satisfaction.

Conclusion. Burnout was prevalent in a large sample of sonographers. Multilevel work systems factors are associated with burnout, suggesting collaboration among sonographers, administrators, and organizations is needed to address burnout.

Occupational therapy literature contains little evidence of the added value of clinical doctorate education, the professional identity of a Doctor of Occupational Therapy, or distinctions between master’s-prepared and doctorate-prepared occupational therapists. This study is intended to add to the literature base through the systematic and in-depth exploration of the experiences of graduates from a post-professional clinical doctorate program in occupational therapy. The goal of this study was to examine the professional identity transformation experienced by occupational therapists completing a doctorate degree, and to better understand the Doctor of Occupational Therapy identity. The study followed a qualitative descriptive design, including participant focus group interviews and document review. Participants included sixteen recent graduates, two male and fourteen female, of a post-professional doctorate program in occupational therapy. Data analysis revealed recent graduates’ perceptions of the leadership characteristics and capacities they developed throughout their learning experiences in the program and contributing to their professional identities as Doctors of Occupational Therapy. Results may have implications for the capacity for leadership within the profession. Further study is warranted to examine the impact of occupational therapy doctoral education on professional identity and capacities.

Exposure to repetitive head impacts in contact sports is associated with neurodegenerative disorders including chronic traumatic encephalopathy (CTE), which currently can be diagnosed only at post-mortem. American football players are at higher risk of developing CTE given their exposure to repetitive head impacts. One promising approach for diagnosing CTE in vivo is to explore known neuropathological abnormalities at post-mortem in living individuals using structural MRI.

MRI brain morphometry was evaluated in 170 male former American football players ages 45–74 years (n = 114 professional; n = 56 college) and 54 same-age unexposed asymptomatic male controls (n = 54, age range 45–74). Cortical thickness and volume of regions of interest were selected based on established CTE pathology findings and were assessed using FreeSurfer. Group differences and interactions with age and exposure factors were evaluated using a generalized least squares model. A separate logistic regression and independent multinomial model were performed to predict each traumatic encephalopathy syndrome (TES) diagnosis, core clinical features and provisional level of certainty for CTE pathology using brain regions of interest.

Former college and professional American football players (combined) showed significant cortical thickness and/or volume reductions compared to unexposed asymptomatic controls in the hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, insula, temporal pole and superior frontal gyrus. Post hoc analyses identified group-level differences between former professional players and unexposed asymptomatic controls in the hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, insula and superior frontal gyrus. Former college players showed significant volume reductions in the hippocampus, amygdala and superior frontal gyrus compared to the unexposed asymptomatic controls. We did not observe Age × Group interactions for brain morphometric measures. Interactions between morphometry and exposure measures were limited to a single significant positive association between the age of first exposure to organized tackle football and right insular volume. We found no significant relationship between brain morphometric measures and the TES diagnosis core clinical features and provisional level of certainty for CTE pathology outcomes.

These findings suggested that MRI morphometrics detect abnormalities in individuals with a history of repetitive head impact exposure that resemble the anatomic distribution of pathological findings from post-mortem CTE studies. The lack of findings associating MRI measures with exposure metrics (except for one significant relationship) or TES diagnosis and core clinical features suggested that brain morphometry must be complemented by other types of measures to characterize individuals with repetitive head impacts.

Keywords. neuroimaging, structural MRI, sports-related head injury, repetitive head impact, former American football players

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.

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.

Objectives. The study examined the mediating role of fall-related self-efficacy in the association between falls and mental health among older Korean Americans living in subsidized senior housing in the greater Los Angeles area. We focused on serious fall incidents (i.e. multiple falls or any fall with a fracture) and used symptoms of depression and anxiety as indicators of mental health.

Method. Survey data from 315 participants (M age = 79.4 years) were used to examine the direct effects of serious fall incidents on mental health symptoms, as well as indirect effects through fall-related self-efficacy.

Results. The mediating effect of fall-related self-efficacy was found to be significant in both models for depressive symptoms (B [SE] = 0.15 [0.07], bias-corrected 95% CI = [0.03, 0.31]) and anxiety symptoms (B [SE] = 0.11 [0.05], bias-corrected 95% CI = [0.02, 0.23]).

Conclusion. The mental health impact of serious fall incidents was shaped by older individuals’ perceived concerns about falls and confidence in performance. The findings highlight the importance of addressing fall-related psychological responses in preventing falls and promoting mental health among senior housing residents.

Keywords. Falls, fall-related self-efficacy, mental health, older immigrants, senior housing

This lecture explores the topic of uncertainty — defined from a Deweyan perspective as a quality of experience — and its relationship to understandings about occupation. Part I traces the evolution of a focus on uncertainty in my research and scholarship as an occupational scientist. Part II describes an initial descriptive literature review that aimed to survey the extent to which uncertainty has featured in theorizations of occupation in published occupational science literature. Part III charts future directions for both exploring uncertainty in extant occupational science work and bringing uncertainty more centrally into theorizations of occupation and occupational participation.

Keywords. Occupational science; transactional perspective; theory; conditions of association; precarity

With the exponential rise in the prevalence of automation, trust in such technology has become more critical than ever before. Trust is confidence in a particular entity, especially in regard to the consequences they can have for the trustor, and calibrated trust is the extent to which the judgments of trust are accurate. The focus of this paper is to reevaluate the general understanding of calibrating trust in automation, update this understanding, and apply it to worker’s trust in automation in the workplace. Seminal models of trust in automation were designed for automation that was already common in workforces, where the machine’s “intelligence” (i.e., capacity for decision making, cognition, and/or understanding) was limited. Now, burgeoning automation with more human-like intelligence is intended to be more interactive with workers, serving in roles such as decision aid, assistant, or collaborative coworker. Thus, we revise “calibrated trust in automation” to include more intelligent automated systems.

Keywords. trust, automation, calibrated trust, workers

This study examines adaptations, successes, and persistent challenges engaging members in virtual or hybrid community-based psychosocial rehabilitation centers called Clubhouses. Methods: Fifteen members and staff from five Clubhouses across two Hawaiian Islands participated in a virtual Photovoice process.

Results. Results illustrated several unexpected positive outcomes from the transition to hybrid or virtual formats including opportunities for growth, learning new technology, cross-Clubhouse collaborations, deepened relationships, and better access to some hard-to-reach members. Persistent challenges included members reporting “something missing” in the socioemotional quality of virtual engagement and losing members who had low digital literacy or who preferred in-person engagement.

Conclusions and Implications for Practice. Overall, participants described that virtual Clubhouse supported their wellness by fostering a sense of purpose, companionship, and potential, despite sustained uncertainty from the COVID-19 pandemic. However, they also made clear that virtual and hybrid formats should be a complement to, not a replacement for, in-person Clubhouse services.

Keywords. community mental health; virtual mental health services; COVID-19 pandemic; Photovoice; participatory research

People with serious mental illness (PWSMI) experience dramatic disparities in health, quality of life, and longevity. Mental health Clubhouses are a community-based treatment model that can positively affect health and quality of life among PWSMI. However, few studies investigate the processes within Clubhouses and what factors are related to the improvement of health and quality of life among members. To address this gap, this research offers a conceptual model of how Clubhouses contribute to health and quality of life.

Method. This conceptual model was created using participatory qualitative methods, combining Photovoice and grounded theory. Forty-two participants (37 Clubhouse members and six staff) from four Clubhouses in Hawai’i were engaged in 22 sessions over the course of 2 years.

Results. The conceptual model begins with quality of participation in Clubhouse activities, which refers not only to being present in the Clubhouse but being actively and meaningfully engaged in Clubhouse activities. Engagement in Clubhouse activities and working side-by-side with members and staff led to reciprocal social support. As members were supported and supported others, they gained a sense that they mattered, and they perceived themselves as more capable, more efficacious, and less stigmatized over time. They became a contributing member of a community, which supported health and quality of life directly and indirectly.

Conclusions and Implications for Practice. This work offers a novel conceptual framework of Clubhouse processes that highlights the importance and potential of empowering psychosocial treatment models.

We open this article by asking you to consider that the magnitude of racism present in clinical spaces is much larger and more in depth than we can ever begin to cover. In this spirit, we are going to provide you with some context to think about the problem of racism and mental health and disability and ways to deconstruct the problem through the lens of structural violence and structural racism. We offer you a brief discussion on and a definition of structural violence and structural racism and then tie them to two case studies to help contextualize how racism currently exists within the medical field. We hope that the language and framework of structural violence and structural racism will help you think anew about racism and your own interactions with it. Although the difficulties with racial and structural violence are much too pervasive and will take collective action to dismantle, we do think that giving a framework to think and talk about racism may help the ways that you choose to interact with your patients, engage in clinical assessments, diagnosis, treatment, and navigate systems from your current role within the medical field.

Stress experiences can have dire consequences for worker performance and well-being, and the social environment of the workplace is a key contributor to worker experience. This study investigated the relationship between hybrid workers’ self-ratings of productivity, mood, and stress with perceptions of positive (eustress) and negative (distress) stress states. We hypothesized that self-ratings would vary across combinations of eustress and distress experiences and that these differences would differ based on the social context. Ecological momentary assessments (EMA) were used to obtain ecologically valid data at four data points each workday across a 4-month study period in a cohort of seven office workers. Findings aligned with the Yerkes–Dodson law, such that higher states of arousal were associated with greater self-perceived productivity, and higher stress magnitudes were found when distress existed. Compared to other states, eustress was associated with higher productivity in work-related activities and better mood across all activity types.

Importance. Occupational therapy practitioners play an important role in addressing the impairments, occupational performance, and participation needs of adults living with and beyond cancer.

Objective. These Practice Guidelines aim to assist occupational therapy practitioners, educators, and researchers in applying evidence and expert opinion to occupational therapy practice across the cancer continuum of care, including identifying gaps in care. Key focus areas include psychosocial function, fatigue, cognition, pain, sleep, and physical activity. These guidelines can serve as a reference for policymakers, health care professionals, health care managers, regulators, third-party payers, and managed care organizations to manage, reimburse, and set policy.

Method. We examined, synthesized, and integrated the results of systematic reviews, supporting literature, and expert opinion to develop and provide clinical recommendations for practice in the care of adults living with and beyond cancer.

Results. Sixteen systematic reviews with moderate to strong strength of evidence published between 2019 and 2022 served as the foundation for these Practice Guidelines.

Conclusions and Recommendations. To support symptom management for adults living with and beyond cancer, occupational therapy practitioners can consider using psychosocial interventions for anxiety, depression, posttraumatic growth, and overall psychological distress. Practitioners can consider using physical activity interventions for cancer-related fatigue, cognitive performance, and sleep. Practitioners could also consider using interventions for cognition, pain management, and self-management for the improvement of cancer-related symptoms.

AOTA Taxonomy. adults, cancer, client factors, evidence-based practice/knowledge translation, functional cognition deficits, groups and populations, habilitation and rehabilitation, home and community settings, hospitals, intervention approaches, intervention types, long-term care, occupations and everyday activity, older adults, outcomes, outpatient clinics, quality and value-based care, sleep deficits, telehealth and virtual services

Keywords. adult, cancer, occupational therapists, practice guidelines, fatigue, systematic reviews

The purpose of this study was to differentiate clinically meaningful improvement or deterioration from normal fluctuations in patients with disorders of consciousness (DoC) following severe brain injury. We computed indices of responsiveness for the Coma Recovery Scale-Revised (CRS-R) using data from a clinical trial of 180 participants with DoC. We used CRS-R scores from baseline (enrollment in a clinical trial) and a four-week follow-up assessment period for these calculations. To improve precision, we transformed ordinal CRS-R total scores (0 to 23 points) to equal-interval measures on a 0-to-100-unit scale using Rasch Measurement theory. Using the 0-to-100 unit total Rasch measures, we calculated distribution-based 0.5 standard deviation (SD) minimal clinically important difference, minimal detectable change using 95% confidence intervals, and conditional minimal detectable change using 95% confidence intervals. The distribution-based minimal clinically important difference evaluates group-level changes, whereas the minimal detectable change values evaluate individual-level changes. The minimal clinically important difference and minimal detectable change are derived using the overall variability across total measures at baseline and four weeks. The conditional minimal detectable change is generated for each possible pair of CRS-R Rasch person measures and accounts for variation in standard error across the scale. We applied these indices to determine the proportions of participants who made a change beyond measurement error within each of the two sub-groups, based on treatment arm (amantadine hydrochloride or placebo) or categorization of baseline Rasch person measure to states of consciousness (i.e., unresponsive wakefulness syndrome and minimally conscious state). We compared the proportion of participants in each treatment arm who made a change according to the minimal detectable change and determined whether they also changed to another state of consciousness. CRS-R indices of responsiveness (using the 0-100 transformed scale) were as follows: 0.5SD minimal clinically important difference = 9 units, minimal detectable change = 11 units, and the conditional minimal detectable change ranged from 11 to 42 units. For the amantadine and placebo groups, 67% and 58% of participants showed change beyond measurement error using the minimal detectable change, respectively. For the unresponsive wakefulness syndrome and minimally conscious state groups, 52% and 67% of participants changed beyond measurement error using the minimal detectable change, respectively. Among 115 participants (64% of the total sample) who made a change beyond measurement error, 29 participants (25%) did not change state of consciousness. CRS-R indices of responsiveness can support clinicians and researchers in discerning when behavioral changes in patients with DoC exceed measurement error. Notably, the minimal detectable change can support the detection of patients who make a ‘true’ change within or across states of consciousness. Our findings highlight that continued use of ordinal scores may result in incorrect inferences about the degree and relevance of a change score.

Committed to the necessity of international dialogues in occupational therapy and occupational science, we have developed a proposal for alliance between social occupational therapy and critical occupational science based on a series of theoretical dialogues between Brazilian and Canadian researchers. Through these dialogues, we have aimed to understand and propose contributions that articulate the shared intent of social transformation enhancing social justice of these disciplines. While acknowledging points of difference, we propose an alliance based on points of convergence, including emergence from concerns related to justice and equity; development coming from the ‘margins’; mobilization of critical social theory to orient knowledge production and question power relations within and outside the discipline and the profession; and an intent to work towards social justice, especially with marginalized groups. Our key arguments are informed by theoretical concepts from three authors: Judith Butler’s conceptualizations of vulnerability, precarity, and alliance; Nancy Fraser’s propositions regarding social justice; and Paulo Freire’s concept of dialogue. Through dialogue that recognizes and respects different knowledges and practices, an alliance is produced toward social justice, one that aims to realize more complex theoretical and practical resources for critical thinking about social reality. In turn, possibilities for apprehending how different oppressions impact and influence the possibilities of living can be expanded, informing approaches to building inhabitable worlds and proposing practices of freedom with persons and communities facing oppression.

Keywords. Occupational science; Occupational therapy; Social justice; Dialogue; Critical thinking; Coalition

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.

While a growing body of interprofessional education (IPE) literature demonstrates a positive impact on learner knowledge, there is limited data on its long-term impact on collaborative practice (CP). With the growth of the aging population globally, understanding both the long-term impact on CP and sustainability of community-based geriatric experiential IPE programs are imperative. This study explores the impact of the Interprofessional Geriatric Curriculum (IPGC), a community-based geriatric IPE program, on post-graduate clinical practice among seven health professions. This study utilized a cross-sectional descriptive design, where both qualitative and quantitative data were collected in the same online survey of health professionals’ to measure their perceptions of the impact IPGC has had on their respective clinical practice 1–3 years post-graduation. Forty-six per cent of health profession graduates provided clinical care for people 65 years of age or older; 81% worked in interprofessional teams; 80% reported the IPGC experience significantly impacted their practice (N = 137), and all used validated assessment tools taught in the IPGC program in their practice. Eight themes emerged from the list of what health professionals learned from IPGC that they use regularly in their clinical practice: four themes were interprofessional in nature (i.e. teamwork and team-based care, interprofessional communication, roles/responsibilities, and personal/professional) and four themes related to geriatrics (i.e. aging, screening and assessment, medications, and didactic content). This study is one of the first to describe the sustained influence of a community-based IPE program across multiple health professional disciplines on clinical geriatric practice.

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.

This qualitative study examined participants’ experiences of transitioning to telehealth-delivered pediatric occupational therapy for autistic children during the COVID-19 pandemic. We interviewed three clinic administrators, four occupational therapists, and six parents of autistic children (n=13) from three Los Angeles area clinics over a 7-month period. Our narrative and thematic analyses yielded three overarching themes: Transformative Experiences, Reimagining Therapy, and Going Forward. Overall, we found that the transition to telehealth shifted participants’ preconceptions about themselves, their relationships, and the nature of occupational therapy. Many deepened their relationships; adapted interventions; uncovered surprising capabilities; and challenged the occupational therapy status quo to advocate for ongoing virtual delivery. Our findings bear relevance to the body of current literature debating the post-pandemic viability of telehealth-delivered occupational therapy.

Keywords. Autism, COVID-19, Occupational therapy, Pandemic, Telehealth, Telerehabilitation

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

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

Design. Cross-sectional survey study.

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

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

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

As the occupational therapy profession is rooted in Western ideals, it may encounter complexities in culturally traditional settings like Palestine, especially for adults. This study reveals the challenges faced by occupational therapists in Palestine. A phenomenological qualitative approach was used, interviewing six experienced female therapists using semi-structured interviews. Purposive sampling ensured a diverse participant selection. Thematic analysis revealed several key themes, such as the continuous adaptation to Western practices to fit the Palestinian context, the value of interdependence, and the unique life balance. Results show that cultural and gender norms significantly shape occupational therapy practices in Palestine. The discussion emphasizes the theoretical necessity for cultural sensitivity in occupational therapy, advocating alignment with local values and addressing resource limitations for effective service delivery.

Keywords. Adult settings; cultural characteristics; gender; occupational therapy; palestine; therapists

Objective. This systematic review aims to determine the extent, scope, and nature of research using the sonographic measurement of intraneural blood flow within the median nerve and to identify, characterize, and compare image acquisition and analysis protocols that have been reported as potential candidate techniques for standardizing research and clinical applications.

Materials and Methods. This systematic review summarizes image acquisition protocols and analysis methodologies from 52 current research studies using Doppler ultrasound to examine median nerve intraneural blood flow.

Results. Four types of Doppler technologies were identified: power Doppler, color Doppler, spectral Doppler, and Superb Microvascular Imaging, but there were inconsistencies in how images were acquired and analyzed. Intraneural blood flow measurements were categorized into four types based on a combination of measurement level (e.g., binary, ordinal, continuous) and type of flow indicator (e.g., pixel count, intensity, velocity).

Conclusion. Standardized imaging protocols and reporting guidelines are needed to improve consistency. Future studies should evaluate the accuracy and reliability of different image acquisition methods and analysis measurements.

Objectives. Investigate relationships between aEEG in the first 72 h in extremely preterm infants with 1) infant, medical, and environmental factors, and 2) infant feeding and neurobehavioral outcomes at term and school-age.

Methods.. Sixty-four preterm infants (≤28 weeks gestation) were enrolled within the first 24-hours of life and had two-channel aEEG until 72 h of life. Standardized neurobehavioral and feeding assessments were conducted at term, and parent-reported outcomes were documented at 5–7 years.

Results. Lower aEEG Burdjalov scores (adjusted for gestational age) were related to vaginal delivery (p = 0.04), cerebral injury (p = 0.01), Black race (p < 0.01) and having unmarried parents (p = 0.02). Lower Burdjalov scores related to less NICU Network Neurobehavioral Scale arousal (p = 0.002) at term and poorer BRIEF global executive function (p = 0.004), inhibition (p = 0.007), working memory (p = 0.02), material organization (p = 0.0008), metacognition (p = 0.01), and behavioral regulation (p = 0.02) at 5–7 years. We did not observe relationships of early aEEG to feeding outcomes or sensory processing measures.

Conclusion. Early aEEG within the first 72 h of life was related to medical and sociodemographic factors as well as cognitive outcome at 5–7 years.

The COVID-19 pandemic necessitated a transition to telehealth. Research supports the use of telehealth; however, there is a paucity of literature on the ethical considerations of this shift. This study explored ethics through narratives of practitioners’ lived experiences of transitioning to telehealth. Semi-structured interviews were conducted virtually with 10 pediatric health care professionals. Transcripts were analyzed from a narrative phenomenological perspective. Discussed themes include responding to the rapid redirection, collaborating with colleagues and caregivers, applying therapeutic use of self, and evolving pragmatic clinical reasoning. Transitioning to telehealth resulted in ethical dilemmas pertaining to clients and practitioners. The need for additional support was salient to ensure clients received beneficial services that would not cause harm (non-maleficence). Communities of practice formed organically as forums to explore strategies for sharing comprehensive and equitable information (veracity and justice). Knowledge generated through providers’ experiences may inform future guidelines on service delivery transitions.

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

In the professional education of mental health practitioners, including occupational therapists, there has been a lack of meaningful inclusion of people labeled with mental illness into curricula, beyond guest speaker panels and presentations. This study explored the experiences of students, faculty, and 'Experts by Experience' within a mental health occupational therapy course that incorporated Experts with lived experience as co-facilitators of weekly fieldwork debriefs. The study utilized focus groups and interviews to understand the experiences of students, mental health faculty, and 'Experts by Experience'. Key themes that emerged from the qualitative data analysis were organized under three broad categories: 1) Students experienced powerful insights, 2) Experts conveyed the complexity of the work, and 3) Faculty grew from co-creating learning experiences with the Experts. This research makes a significant contribution to occupational therapy education by shifting the Expert's role beyond traditional speaker panels or storytelling. This broader responsibility elevated experiential knowledge into the realm of practice in clinical reasoning by shifting the context of the knowledge from storytelling to support practice reasoning. While this created significant learning opportunities for the students, it also did appear to cause emotional risk for the 'Experts by Experience'. It is important that efforts to include 'Experts by Experience' in curriculum also include sources of support and financial remuneration.

Parental language input influences child language outcomes but may vary based on certain characteristics. This research examined how parental language differs during two contexts for toddlers at varying likelihood of autism based on their developmental skills. Parental language (quantity, quality, and pragmatic functions) was analyzed during dyadic play and mealtime interactions as a secondary data analysis of observational data from a study of toddlers at elevated and lower likelihood of autism. Child developmental skills and sensory processing were also assessed. Parents used more words per minute, directives, and verbs during play and more adjectives, descriptions, and questions during mealtime. Parental language differed based on child fine motor skills, receptive language, and levels of sensory hyporesponsiveness but not autism likelihood. Overall, this study found that parental language varies based on context and child developmental skills. Future research examining parental language should include pragmatic functions and context across developmental trajectories.

Keywords. autism; parental language; early intervention; play; mealtime

Background. Fatigue is the subjective experience of insufficient energy that interferes with daily life participation. Fatigue is experienced by 75% to 90% of individuals with multiple sclerosis (MS), and 60% identify fatigue as their most difficult symptom to manage. Evidence proposes fatigue management interventions should be individualized, comprehensive, and systematic, and they should address the priorities of the individual, with behavior change interventions recommended as a frontline intervention. Fatigue management interventions delivered by occupational therapy practitioners (OTPs) facilitate learning strategies, techniques, and skills that reduce the impact of MS-related fatigue on daily activities. Lifestyle Redesign® (LR) is an intervention framework utilized by OTPs to address the needs of individuals living with chronic conditions through the promotion of awareness between occupational engagement and health and participation in occupations, habits, and routines to improve health and well-being. It involves the use of core techniques, including education, occupational self-analysis, autonomy-enhancing communication, and occupational orchestration and engagement. LR has been applied in a group format with people with MS with beneficial effects on occupational participation, quality of life, and fatigue.

Objectives. Describe the 1-to-1 delivery of fatigue management interventions through the LR intervention framework in patients with MS and provide a case study with clinical outcomes to demonstrate how these interventions can be integrated into an occupational therapy (OT) plan of care.

Methods. The case study participant completed 13 OT sessions. Traditional fatigue management interventions (ie, fatigue management psychoeducation, and primary and secondary fatigue management training) were used in conjunction with the LR intervention framework to target daily habits and routines to improve occupational engagement. The Canadian Occupational Performance Measure (COPM) was administered before and after the intervention to capture perceived performance and satisfaction in areas of occupational performance deficit, including fatigue management.

Results. Clinically significant improvement occurred in the COPM performance (+5.0) and satisfaction (+4.0) scores for the fatigue management occupational performance domain. Additionally, the participant had clinically significant improvement in aggregate scores, with a 5.0-point increase in performance and a 5.6-point increase in satisfaction.

Conclusions. The results of this case study highlight the benefit of combining fatigue management interventions and the LR intervention framework delivered by OTPs. The study contributes to the literature supporting the need for and benefits of the use of fatigue self-management interventions in adults with MS.

Keywords. Management of activities of daily living in MS, Self-management

Introduction. Patients recovering from cardiothoracic surgery in acute care experience physical and psychosocial challenges impacting participation in activities of daily living. Occupational therapists are well positioned to address these needs; however, there is little evidence exploring occupational therapy’s role in this area.

Method. This retrospective study of electronic medical records examined changes in activities of daily living participation for adult patients (n = 37) who received occupational therapy in acute care while recovering from cardiothoracic surgery via median sternotomy. Wilcoxon signed-rank tests and paired t-tests compared patients’ scores on the Functional Independence Measure (FIM) and Activity Measure for Post-Acute Care “6-Clicks” Daily Activity Inpatient Short Form at occupational therapy evaluation and discharge from their inpatient stay.

Results. Patients showed statistically significant improvements on both assessments in activities of daily living participation while receiving occupational therapy services following cardiothoracic surgery. Lower body dressing, toileting, and bed mobility showed the greatest increases in the FIM categories.

Conclusion. Occupational therapists are valuable in addressing the complex needs of patients recovering from cardiothoracic surgery in acute care. Continued research is needed to provide further evidence supporting occupational therapy’s unique role in this setting.

Camouflaging, the masking of neurodivergent traits to blend in with the dominant neurotypical society, is reported among autistic women. At the core of camouflaging, however, is the desire to belong, which is yet to be explored in the literature despite its costly impacts on one's quality of life. Occupational science, a discipline concerned with human doing and belonging is uniquely situated to address camouflaging. Yet, camouflaging has not been explored from an occupational science lens. Therefore, in this conceptual article, we first explore the unique perspective that occupational science contributes to camouflaging scholarship. Given the dearth of camouflaging research and scholarship on autistic women with intersecting identities (e.g., Black autistic women), we draw from Bailey and Mobley's Black Feminist Disability Framework. Second, analyzing existing qualitative narratives in camouflaging research, we illuminate “occupational disruptions,” or potential risk factors of camouflaging, focusing on the work environment, educational settings, and interpersonal and intimate relationships. We highlight the importance of understanding Black autistic women's unique experiences of occupational disruptions. Third, we consider how unmasking is a privilege not granted to those beyond the margins. Finally, we conclude with implications and future directions for interdisciplinary research and scholarship, including a critique of our discipline's paradoxical relationship between belonging theory and camouflaging, therapeutic considerations (masking vs. unmasking safely), and a call to action for scholars, practitioners, and allies to challenge the need for camouflaging to belong, thereby mitigating existing occupational disruptions.

What was the purpose of this article? We (the authors) are concerned about the negative outcomes that autistic women experience related to camouflaging. Camouflaging, sometimes called “masking” or “passing as neurotypical,” is something that neurodivergent people might do to hide their neurodivergent traits so that they are accepted by other people, or to be safe in a neurotypical society. In this article, we discuss camouflaging from an occupational science perspective. Occupational science is an academic discipline that is related to occupational therapy that focuses on human doing and belonging.

Why is this article important? This article is important for several reasons. First, camouflaging impacts the quality of life of autistic people, and we believe that it is closely associated with the deep human need for belonging. In this article, we use occupational science concepts to add a new perspective to current discussions among autistic people and researchers about camouflaging. Recognizing that Black autistic women are almost entirely ignored by researchers and that they might be marginalized based on their race, gender, and neurotype, we also use a Black Feminist Disability Framework to highlight the unique experiences of people with intersecting marginalized identities. Finally, the authors, both neurodivergent and allistic (nonautistic), from various racial and ethnic backgrounds, bring a richness of perspectives based on our diverse life experiences and areas of expertise.

What did the authors do? We applied our unique occupational science perspective to camouflaging. First, we discussed camouflaging in relation to the occupational science concept of belonging and described a Black Feminist Disability Framework. Second, we analyzed the lived experiences of autistic women, using quotes from academic articles. We brought the readers' attention to the lack of diversity within camouflaging literature, which has amplified the voices of White autistic women, while marginalizing women of color. Third, we showed how unmasking is a privilege for White autistic women, but not for autistic women with intersecting identities.

What did the authors conclude? We concluded that camouflaging disrupts various occupations, or important activities people want to do. We also provided a call to action for occupational scientists, occupational therapists, the broader research community, and allies to make environments more inclusive and safer for diverse autistic people.

How does this information help autistic adults? We hope our analysis provides autistic women with the words to describe their experiences, including how camouflaging may have caused occupational disruptions in their lives. We also hope that our call to action contributes to making spaces safer for autistic women.

The articles in this Special Issue on Recovery of Function After Neurological Injury include an impressive range of clinical diagnoses, scientific approaches, and theoretical frameworks that demonstrate the breadth and depth of occupational therapy in the restoration of function after neurological injury. An emerging theme throughout is the need for the profession of occupational therapy to identify and use more efficient methods for diagnosing and treating people with neurological injuries to improve their quality of life and the impact of care.

Aim. To identify relationships between early medical factors and preterm infant feeding behaviors at term-equivalent age.

Methods. Forty-three very preterm infants born ≤32 weeks gestation had standardized feeding assessments using the Neonatal Eating Outcome Assessment at term-equivalent age (36–42 weeks postmenstrual age). Medical factors were collected and analyses were run to determine if associations between different medical factors and feeding performance exist.

Results. Lower Neonatal Eating Outcome Assessment scores at term-equivalent age were associated with lower estimated gestational age (p < .01), lower birthweight (p < .01), older postmenstrual age at discharge (p < .01), longer length of stay in the neonatal intensive care unit (p < .01), chronic lung disease (p = .03), as well as more days on total parenteral nutrition (p = .03), endotracheal intubation (p < .01), and noninvasive mechanical ventilation (p < .01).

Conclusion. More feeding problems are observed in infants born earlier, with longer hospital stays, and with complex medical courses. Knowledge of the association between these medical factors and feeding difficulties allows for identification of infants who may benefit from early, targeted interventions to optimize the feeding process.

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

Occupational therapy is a profession with origins rooted in Western values. As culture plays an important role in shaping theory and practice, the curriculum design of academic programs that train future rehabilitation professionals should reflect the local context. As part of an international partnership, a dual-degree graduate program in occupational therapy was established between a Chinese and an American university. A team composed of members from both institutions collaborated on culturally adapting an entry-level master’s program in occupational therapy for China, based on a U.S. program, which welcomed its first cohort in September 2019. This article details the timeline and process of program design and adaptation from conception, through implementation to evaluation and revision, with the aim of offering a framework for curriculum adaptation of other academic programs in the U.S. and internationally. The adapted curriculum includes the program mission, vision, and philosophy; the curriculum model with program outcomes and threads; the program scope and sequence; materials and resources; and course-specific objectives, learning activities, and assessments. The authors also share lessons learned through this experience of international collaboration as well as next steps for program evaluation and sustainability. The detailed overview of this international collaboration offers suggestions for individuals and institutions seeking to develop global partnerships and adapt curricula across cultural contexts.

Youth diagnosed with autism spectrum disorder (ASD) and those with developmental coordination disorder (DCD) are at heightened risk for co-occurring mental health diagnoses, especially anxiety and attention-deficit/hyperactivity disorder (ADHD). However, caregiver-child agreement on presence of related symptoms in populations with neurodevelopmental conditions is not well understood. Here, we examine the extent to which 37 ASD, 26 DCD, and 40 typically developing children and their caregivers agree on the degree of the child's symptoms of anxiety and ADHD. All caregiver-child dyads completed the Screen for Child Anxiety Related Emotional Disorders and Conners 3 ADHD Index. Across groups, intraclass correlations indicated generally poor agreement on anxiety and ADHD symptomatology. Although youth generally reported greater internalizing symptoms (i.e., anxiety), caregivers tended to report more observable externalizing behaviors (i.e., ADHD). Together, the results of this study support the need for a multi-informant approach in assessments of anxiety and ADHD in youth with neurodevelopmental disorders.

Objective. Work-related injuries have a major effect on worker health and well-being. This is particularly true in sonography, where work-related musculoskeletal disorders (WRMSDs) are common. In response to the current challenge of understanding strategy implementation across social and organizational dimensions, this research captured sonographers’, echocardiographers’, and vascular technologists’ perceptions of critical administrative, organizational, and general health and training challenges, and potential solutions for improving worker health and well-being.

Materials and Methods. A survey invitation was sent to the WRMSD Grand Challenge longitudinal study registry participants. Open-ended questions on the online questionnaire allowed respondents to share comments, ideas, or potential solutions to improve worker health and well-being regarding the administrative and organizational environment or through training and general health interventions. There were 377 free-text responses that were qualitatively analyzed using a grounded theory approach to generate overarching themes and identify emerging theory, supported by initial coding, focused coding, and reflexive memoing. A member check was conducted by interviewing four participants to refine and confirm the findings.

Results. Five themes were identified: “Limits and Guidelines,” “Injury Education,” “Ergonomics Training Constraints,” “Resources and Equipment,” and “Individual Habits.” Participant suggestions within these themes were categorized and mapped onto a sociotechnical systems model that was developed previously to study the healthcare system(s) in which sonography users work. This conceptual mapping revealed how these solutions were situated to impact different levels of the work environment. The themes and mapping supported an emerging grounded theory: Risk Reduction Relies on Proper Employee Representation.

Conclusion. These qualitative findings align with contemporary guidelines and recommendations for mitigating injuries in sonographers, illuminating challenges and solutions targeting levels of influence beyond the staff sonographers’ scope. The need for representation of sonographers at higher-level administrative levels has not heretofore been addressed by WRMSD guidelines.

Importance. Complex telehealth interventions can facilitate remote occupational therapy services and improve access for people living with chronic neurological conditions. Understanding the factors that influence the uptake of these technologies is important.

Objective. To explore the fit between electromyography (EMG) biofeedback and telerehabilitation for stroke survivors, optimize EMG biofeedback interventions, and, more broadly, support other efforts to develop complex telerehabilitation interventions.

Design. Pre-implementation mixed-methods analysis of usability and acceptability data collected during a pilot and feasibility study.

Setting. Community.

Participants. Adult stroke survivors with hemiparesis (N = 11; M age = 54 yr).

Intervention. Game-based EMG biofeedback system for arm sensorimotor rehabilitation, delivered via telehealth.

Outcomes and Measures. Post-Study System Usability Questionnaire, an extended Unified Theory of Acceptance and Use of Technology model questionnaire, and semistructured interview. We coded the interview data using questionnaire constructs.

Results.. Participants used an EMG biofeedback intervention at home. Quantitative measures show high levels of perceived usability and acceptability, supported by qualitative findings describing specific facilitators and barriers.

Conclusions and Relevance. Pre-implementation studies can improve the design and relevance of complex telehealth interventions. One major conclusion from this study is the influence of therapy providers on acceptability and usability of complex telehealth interventions.

Plain-Language Summary. This study contributes to an emerging body of literature that examines the use of complex telehealth interventions with survivors of neurological injury. The findings highlight the value and support the development and use of complex telehealth interventions, which have the potential to improve remote access to occupational therapy for clients living with chronic neurological conditions. Complex telehealth interventions can open doors for survivors of neurological injury who face barriers to accessing occupational therapy and would benefit from technology-enabled therapy at home.

Rarely do individuals seek, obtain, and understand health information in a solitary void. Nevertheless, most research treats health literacy as an individual-level construct. Individual conceptualization and measurement of health literacy can limit health literacy interventions and theory by ignoring how social contexts define, shape and influence how health information is accessed and understood. We aim to address this research gap by examining the multifaceted ways in which social contexts influence health literacy. We link cutting-edge research on social contexts and health literacy with extant literature by summarizing eleven articles for the special issue, using research traditions identified in this area. Author teams represented seven countries and examined social influences on health literacy in diverse contexts including heath care settings, community-based mental health centers (Clubhouses), sheltered workshops, universities, libraries, digital spaces, and others. In addition to diversity in geography and setting, these 11 articles consider unique social factors influencing health literacy for various populations including university students, children, individuals with intellectual disabilities, individuals with mental illness, among others. We conclude with recommendations for health professionals and researchers. These recommendations revolve around four main themes: (1) the need for a comprehensive, multi-level intervention framework to guide practice and research; (2) strategies to leverage natural social contexts and resources to enhance health and health literacy in vulnerable populations; (3) the increasing necessity to focus on digital interaction spaces and online communication (both true and false information) to address health literacy gaps; and (4) bidirectional influences between improving community health and health literacy.

Paulo Freire’s work is important to support the praxis of Social Occupational Therapy. The purpose of this study is to expand the scope and deepen the character of the academic presence of Paulo Freire in Social Occupational Therapy. A scoping review was carried out as a methodological approach, including studies published in four Brazilian journals and three international databases. The searches were conducted only in Portuguese; no year parameters were stipulated. The review considered articles published at any time up to February 2023. A total of 18 studies with Freire’s works in their references were included; “Pedagogy of the Oppressed” and “Education, the Practice of Freedom” are the works that mostly appeared in the articles included. The refinement of the Freirean categories was carried out, and 42 categories were verified: conscientization, eleven times, transformation/transformative action, and praxis/ action-reflection, both ten times. With the data obtained in the study, it was possible to verify the increase in the number of publications in Social Occupational Therapy that use Freire’s theoretical framework. The author’s work has contributed significantly to the construction of a problematizing and emancipating Social Occupational Therapy.

Keywords. social change, occupational therapy, education

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.

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

Previous studies have primarily focused on predicting stress arousal, encompassing physiological, behavioral, and psychological responses to stressors, while neglecting the examination of stress appraisal. Stress appraisal involves the cognitive evaluation of a situation as stressful or non-stressful, and as a threat/pressure or a challenge/opportunity. In this study, we investigated several research questions related to the association between states of stress appraisal (i.e., boredom, eustress, coexisting eustress-distress, distress) and various factors such as stress levels, mood, productivity, physiological and behavioral responses, as well as the most effective ML algorithms and data signals for predicting stress appraisal. The results support the Yerkes-Dodson law, showing that a moderate stress level is associated with increased productivity and positive mood, while low and high levels of stress are related to decreased productivity and negative mood, with distress overpowering eustress when they coexist. Changes in stress appraisal relative to physiological and behavioral features were examined through the lenses of stress arousal, activity engagement, and performance. An XGBOOST model achieved the best prediction accuracies of stress appraisal, reaching 82.78% when combining physiological and behavioral features and 79.55% using only the physiological dataset. The small accuracy difference of 3% indicates that physiological data alone may be adequate to accurately predict stress appraisal, and the feature importance results identified electrodermal activity, skin temperature, and blood volume pulse as the most useful physiologic features. Implementing these models within work environments can serve as a foundation for designing workplace policies, practices, and stress management strategies that prioritize the promotion of eustress while reducing distress and boredom. Such efforts can foster a supportive work environment to enhance employee well-being and productivity.

Introduction. Older adults experiencing subjective cognitive decline (SCD) have a higher risk of dementia. Reducing this risk through behavioral interventions, which can increase emotional well-being (mindfulness and compassion) and physical activity, is crucial in SCD.

Methods. SCD-Well is a multicenter, observer-blind, randomized, controlled, superiority trial. Three hundred forty-seven participants (mean [standard deviation] age: 72.7 [6.9] years; 64.6% women) were recruited from memory clinics in four European sites to assess the impact of an 8-week caring mindfulness-based approach for seniors (CMBAS) and a health self-management program (HSMP) on mindfulness, self-compassion, and physical activity.

Results. CMBAS showed a significant within-group increase in self-compassion from baseline to post-intervention and both a within- and between-group increase to follow-up visit (24 weeks). HSMP showed a significant within- and between-group increase in physical activity from baseline to post-intervention and to follow-up visit.

Discussion. Non-pharmacological interventions can differentially promote modifiable factors linked to healthy aging in older adults with SCD.

Although occupational therapy has its roots in mental health practice, the profession has not been able to adequately and consistently address mental health issues that face society today. As we continue to experience both the protracted coronavirus disease 2019 pandemic and political and social unrest, occupational therapy professionals must take action at individual, state, and national levels to assist in mitigating the current mental health tsunami and improving a fractured mental health care system. In this column, we define and explore issues facing the mental health care system and the different roles and perspectives that are relevant to occupational therapy professionals. Recommendations for the future are provided: actions that can be facilitated at the individual level, in practice, education, and research; at the state level, through state organizations and strategic partnerships; and at the national level, through the American Occupational Therapy Association and other means of advocacy. We want to honor Mary Reilly’s vision that occupational therapy become one of the greatest ideas of our time.

Importance. The Supporting and Enhancing NICU Sensory Experiences (SENSE) program is an evidence-based intervention that promotes daily, positive sensory exposures for infants in the neonatal intensive care unit (NICU). Understanding program implementation across sites may aid in optimizing strategies for uptake of the program and subsequently improve outcomes for infants and families.

Objective. To investigate health care professionals’ perceptions of implementing the SENSE program.

Design. The SENSE Program Implementation Survey was developed using Proctor et al.’s model and the BARRIERS scale to probe organizational practices across sites worldwide.

Setting. Survey distributed to 211 hospitals with a SENSE program license obtained before March 2020.

Participants. One hundred fourteen NICU personnel (response rate = 54%).

Outcomes and Measures. The survey sought to understand barriers and facilitators, adaptations during implementation, and associated costs.

Results. Of the 53% (n = 57 of 107) of respondents who had implemented the SENSE program, many (n = 14; 31%) experienced quick timing (<1 mo) to use, including spread to nearly all infants in their NICU within 6 mo (n = 18; 35%). Most reported the program was used to educate families ≤3 days of birth (n = 20/59; 34%). Most of the sensory interventions in the program were performed by parents (n = 38; 67%) and therapists (n = 44; 77%). Barriers and facilitators at the organizational and individual levels were identified. No additional staff were hired to implement the program.

Conclusions and Relevance. Given perceived successes and challenges, strategic enhancement of implementation can inform future administrations of the SENSE program.

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.

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.

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

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

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

Purpose/Objective. Brain injuries are often “invisible” injuries that can have lifelong consequences including changes in identity, functional independence, relationships, and reduced participation in daily activities. Survivors of brain injury experience stigma and challenges related to the misattribution of symptoms to other causes that are significant barriers to recovery and adjustment. Changes in policy and other large-scale interventions are cited as an underexplored, yet critical path to reducing the impact of brain injury. The present study sought to comprehensively characterize the impact of one such initiative—Brain Injury Identification Cards—among survivors to further refine the resource.

Research Method/Design. In this cross-sectional qualitative focus group study, we recruited 16 individuals with a history of brain injury via email listservs of individuals who registered for a Brain Injury Identification Card. We used rapid data analysis with a hybrid of deductive and inductive analytic strategies to identify themes within a priori domains.

Results. We extracted themes within four domains: (a) process and reasons for obtaining cards; (b) overall impressions of the cards; (c) uses of the cards; and (d) feedback and proposed changes. Participants described the process of obtaining cards as straightforward and shared wide-ranging benefits across domains, including improving survivors’ sense of safety, self-advocacy, and ability to participate in daily activities.

Conclusions/Implications. Findings highlight the utility of Brain Injury Identification Cards for improving community understanding of brain injury symptoms and how injury-related challenges may manifest in daily life.