School of Occupational Therapy

Permanent URI for this collectionhttps://hdl.handle.net/11274/8848

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    Examining an application of occupation-based theoretical models to population-based occupational therapy practice: A Foucauldian critical discourse analysis
    (2024-05) Whittaker, Jennifer K. 1979-; Evetts, Cynthia L.; Vas, Asha; Grettano, Teresa
    Since the mid-1980s, occupational therapy scholars and practitioners have used occupation-based theoretical models to guide best practice and explain the relationship between the person, the environment, and occupation. Theoretical models and the language used to describe their use create a body of professional knowledge, or discourse, that shapes what occupational therapy is and influences how occupational therapy practitioners think about, understand, and do therapy. Theoretical discourse has far-reaching influence and exerts power over members of the profession, clients, and other stakeholders. These theoretical models were developed primarily from a Western cultural perspective focusing on individuals as clients which may not support practice with all cultures and communities. Recently, occupational therapy scholars interested in reducing health inequities have promoted practice with whole populations, focused on prevention and action on the social determinants of health. There is a call for critical analysis of occupation-based theoretical models to ensure they equitably meet the needs of populations today, allow for collaboration with interdisciplinary population health teams, and share power with clients. Health inequities, highlighted and exacerbated by the COVID-19 pandemic, make the need to work with populations urgent, yet little instruction exists on how to use occupational therapy models with populations. This study aimed to help students, educators, and clinicians understand and be able to apply models to population-based practice. This study’s methodology included 1) principles of culturally responsive focus group research, 2) scholarship of application by engaging three occupational therapy theory content experts to each apply one model a population-based case study, and 3) Foucauldian critical discourse analysis to examine how this emerging discourse constructs what population-based occupational therapy is and can be and to explore the implicit power relationships involved. The study determined that the ecology of human performance model, the model of human occupation, and theory of occupational adaptation can all be applied to a case study population with modification to support population-based practice and occupational justice. Further studies are warranted to examine their application beyond a simulation, to study additional occupation-based models, and to better understand how occupational justice and population health concepts can be explicitly incorporated into model discourse.
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    Social participation and quality of life for geriatric stroke survivors: A retrospective study
    (2024-05) King, Brooke E 1993-; Hay, Catherine Cooper; Mitchell, Katy; Chang, Pei-Fen; Baxter, Mary F
    The purpose of this dissertation was to explore the intersection of social determinants of health and post-stroke quality of life using a retrospective, cross-sectional analysis of data from the Health and Retirement Study (HRS). Despite evidence linking social participation to well-being, there is limited research exploring how this correlation varies across subsets of the population. The purpose of this study was to fill a gap in the literature with an investigation into the factors that influenced social participation and exploration of the moderating effect of social determinants on the relationship between social participation and quality of life. Two objectives guided this research: first, to describe the relationship between social participation and income, race, and functional ability for older adults with stroke; second, to investigate whether socioeconomic, sociodemographic, and health-related variables moderated the relationship between social participation and quality of life for older adults with stroke. Correlational analysis was employed for the first aim, with interpretations based on pre-established criteria and significance set at p < .05. For the second aim, moderation analysis and hierarchical linear regression were used to explore relationships within the data. Frequency and variety of participation were explored using measures piloted in this study. Quality of life was measured by the Satisfaction with Life Scale. Key findings revealed that informal social activities like spending time with family or engaging in phone calls were the most popular activities among geriatric stroke survivors. This study identified patterns in social participation related to income, sex, functional ability, and education. Additionally, functional ability emerged as a significant moderator of the relationship between social participation and quality of life in older adult stroke survivors. Findings from this study support the idea that the HRS is a valuable tool for occupational therapy research. The Social Participation Frequency Scale and the Social Participation Variety Scale were two measures developed for this dissertation. They proved instrumental in investigating occupational participation within the HRS. The collective findings contribute to a deeper understanding of the interactions between social participation, socioeconomic factors, and quality of life among geriatric stroke survivors, with implications for occupational therapy practitioners and researchers.
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    Occupational stress, well-being, and pediatric occupational therapists: A mixed-methods study
    (2024-05) Goffredo, Christopher Adam 1982-; Bowyer, Patricia; Fletcher, Tina; Roberts, Heather; miller anastasia
    Occupational stress is a risk factor for the sustainability of occupational therapy. This mixed methods study aimed to investigate the self-reported stress levels of pediatric occupational therapists. A qualitative descriptive approach followed a quantitative descriptive correlational study. The results indicated that a third of pediatric occupational therapists surveyed for this study scored severe to dangerous levels of workplace stress, with another third falling into the moderate range of workplace stress. The mean stress score of this study compared to the mean score of the validating sample of the Workplace Stress Scale (WSS) indicated that there were significantly higher stress levels of the participants in this study compared to the validating sample with a large effect size. The WSS and the Work Environment Impact Scale-Self Report (WEIS-SR) demonstrated a significant positive relationship. WSS and the WEIS-SR significantly negatively correlated with the Scales of General Wellbeing-clinical tool. Being married is the only significant predictor of increased occupational stress and decreased well-being. The significant well-being predictors of occupational stress were calmness, connection, autonomy, awareness, optimism, and development. The interplay of positive and negative work experiences of occupational stress shaped the participant's work functioning and well-being. It provided detailed descriptions to understand further the dynamic interaction between occupational stress, general well-being, and work functioning. All three are needed for pediatric occupational therapists' health, employee retention, and professional sustainability.
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    Care givers' perceptions of the role of the home care therapist in non-oral feeding intervention in failure to thrive patients
    (1995-08) Bell, Audrey; Baxter, Mary; Illegible
    As the nation tries to curtail spending in the health care industry, more physicians are using home health care to provide intervention for their patients. Infants who are deprived of oral feeding for prolonged periods experience great difficulty establishing oral feeding while they are recovering from medical problems. The purpose of this naturalistic inquiry study is to investigate care givers' perceptions of the home care therapist role in feeding intervention. Interviews using open-ended questions were completed with five care givers of Failure to Thrive children. Data was transcribed in narrative form. Results indicate that care givers valued the intervention that they received from home care therapist and they would recommend home care to other families when appropriate.
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    An interpretative phenomenological analysis of school-based occupational therapists' experiences with moral distress
    (December 2023) Rupp, Teri Kaye 1968-; Fletcher, Tina; Fette, Claudette; Toms, Robin; Evetts, Cynthia L.
    Workplace stress in healthcare can impact patient safety and staff well-being. Moral distress, which refers to the suffering experienced by healthcare professionals when external pressures prevent them from acting, has gained public recognition due to the COVID-19 pandemic. Healthcare professionals who experience moral distress are more vulnerable to developing burnout and leaving their positions, making it a critical challenge for healthcare providers. Using a qualitative research approach and interpretative phenomenological analysis (IPA), this study explored the meanings and experiences of eight occupational therapists with moral distress in school-based occupational therapy in kindergarten through 12th grade public schools in the northwestern United States. IPA as a research design is well suited for investigating complicated, emotional, and nuanced topics that require in-depth understanding of participants’ perspectives. Data were gathered through participant-centered in-depth interviews, with a decontextualized photo-elicitation component, and a demographic questionnaire. Analysis included the six steps of IPA to generate personal experiential themes, resulting in group experiential themes across all participants. Participants attributed their moral distress to three overarching themes: (a) professional ethos versus educational culture, (b) professional identity versus educational identity, and (c) professional autonomy versus perceived compliance. The meaning of these themes to the participants included a lack of value for occupational therapy services and knowledge among stakeholders, a lack of shared decision-making and unequal power in school-based practice, and the value of moral distress as a catalyst for action. These findings contribute to the understanding and meaning of moral distress in school-based occupational therapy as issues of incongruence of professional values, diminished professional identity, and compromised professional autonomy in school-based practice that lead to disillusionment and loss of meaning in their profession and school positions. Proposed future practices for addressing moral distress in this group include implementing peer mentoring programs, establishing community of practice groups, advocating for a broader scope of practice, and setting up multitiered systems of support. This study proposed the need for further investigation to effectively identify and define moral distress, explore the impact of moral distress on occupational therapy practitioners and consumers, and subsequently design targeted interventions to foster adaptive capacity and resilience.
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    The effectiveness of activities of daily living training in the stroke patient
    (1974-05) Wallace, Bertha; Griffin, Nancy; Currie, Catherine; Long, Dorn; Mattie, Cruz
    No abstract available
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    An electromyographic study of the effects of overflow and cutaneous stimulation
    (1974-08) Arrington, Jo Ann; Currie, Catherine; Keele, Marjorie; Mattei, Cruz
    No abstract available
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    An observation on stereognosis in preschool cerebral palsied children
    (1972-05) Chen, Mei-jin
    No abstract available
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    An examination of life-style factors that influence parental support of oral-motor/feeding skill development of the child with down's syndrome
    (1991-05) Mueller, Geraldine
    Early intervention is a growing area of employment for occupational therapists. Inherent in the federal guidelines for programs is a family approach. Many occupational therapists in early intervention are involved in assisting families with determining the developmental level of oral-motor/feeding skills in their children with Down's syndrome. It is the purpose of this paper to examine the parent(s)' perceptions concerning their child's oral motor/feeding skills and how recommendations for oral-motor/feeding skill acquisition were implemented in five families with different life-styles. Interviews were completed with the five families. As a complement to the interviews, a stress index was completed. Data were discussed in narrative for the interviews and the stress index. Results indicated that life-style factors influenced the care parents provided and, therefore, should be considered by occupational therapists when giving recommendations.
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    The effects of carpometacarpal thumb orthosis on pinch strength, self-reported activitries of daily living and pain in osteoarthritis
    (1991-05) Kraenzle, Joyce; Spencer, Jean
    This project investigates the effects of splint intervention on pinch strength, activities of daily living (ADL) and pain in persons with osteoarthritis at the thumb carpometacarpal (CMC) joint. Eight female subjects were evaluated for dominant hand involvement. Using a small-n design, baseline levels across variables were obtained using objective measures and self-report questionnaires. A thumb orthosis was fabricated to support the CMG joint while allowing hand function. Pinch strength, ADL performance and pain were reassessed at one, two and six week post-intervention intervals to determine the effects of treatment. Subject graphs, summary tables, repeated measures MOVA and correlations were computed to analyze data. Results revealed significant effects upon lateral pinch strength, ADL performance and pain at six weeks post-intervention. No correlation was found among variables of percentage time splints were worn and its beneficial effects which suggests changes in splint wearing protocols prescribed by therapists.
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    The feasibility of a mental practice protocol for severe upper extremity hemiparesis
    (August 2023) Green, Teresa M 1982-; Vas, Asha; Neville, Marsha; Hay, Catherine Cooper; Fromm, Nicole
    Objective: To increase the efficacy of mental practice (MP) with severe upper extremity (UE) hemiparesis following a stroke and examine the feasibility of following a MP protocol in the acute inpatient rehabilitation setting. Design: single-group, pretest-posttest Setting: acute inpatient rehabilitation Subjects: 11 patients, less than 1-month post-stroke with severe UE hemiparesis and 17 occupational therapists working in acute inpatient rehabilitation Intervention: Patients completed a MP protocol of MP 5 days/week for 2 weeks of wiping a table and picking up a cup. Outcome Measures: Wolf Motor Function Test (WMFT) and Fugl Meyer Assessment-UE (FMA-UE) assessed UE functional abilities and impairments. The Acceptability of Intervention Measure (AIM), the Intervention Appropriateness Measure (IAM), and the Feasibility of Intervention Measure (FIM) measured perceptions of MP. Results: Wilcoxon signed-rank test demonstrated completing MP showed a statistically significant difference in FMA-UE scores from pretest (Mdn = 7.00, M = 8.36, SD =5.46) to posttest (Mdn = 13.00, M = 16.27, SD =11.11), n = 11, Z= 2.70, p= .007, r = .57. There was no statistically significant change in WMFT time scores from pretest (Mdn = 120.00, M = 114.48, SD = 18.32) to posttest (Mdn = 120; M = 81.25, SD = 54.72), Z = 1.82, p =.068, r = .39. There was a statistically significant change in WMFT-FAS from pretest (Mdn = 1.00, M = .91, SD = .831) to posttest (Mdn = 1.00, M = 1.55, SD = 1.29), Z = 2.07, p =.041, r = .44. MP improved UE impairments with less effect on UE functional abilities. Mean AIM scores demonstrated 72.7% of patient responses and 70.6% of therapist responses were agreeable to the acceptability of MP as a treatment. Mean IAM and FIM scores for therapists and patients demonstrate >80% of patient responses were agreeable to MP as an appropriate and feasible intervention. Conclusions: Although there is less acceptability of patients and therapist toward MP as an intervention, MP is a feasible and effective treatment for acute UE hemiparesis following a stroke.
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    Transition to adulthood: Executive functions and independent living skills in autism spectrum disorder
    (August 2023) Sullivan, Anne 1975-; Vas, Asha; Johnson, Wendi L.; Neville, Marsha
    The transition to adulthood is particularly challenging for young adults with autism spectrum disorder (ASD). These challenges exhibit themselves with poor outcomes in independent living, employment, education, and community participation. Broad executive functioning deficits have been indicated as a key factor in the development of independent living skills for young adults with ASD. This study aims to expand the understanding of the impact of executive functions on independent living skills in young adults with ASD and examine (1) differences in independent living and executive functioning skills between young adults with ASD and neurotypical peers and (2) the contribution of executive functions to independent living skills for young adults with ASD. This study utilizes a novel performance-based assessment of executive function, utilizing an everyday activity that challenges the integration of cognitive skills, the Weekly Calendar Planning Activity (WCPA). Eighty-four age-matched participants (52 in the ASD group and 32 neurotypical peers) completed a battery of assessments of independent living and executive functioning skills. These included the Montreal Cognitive Assessment (MoCA), Adaptive Behavior Assessment System (ABAS-3), Daily Living Questionnaire (DLQ), Behavior Rating Inventory of Executive Function (BRIEF-A), and the WCPA. Independent living skills in young adults with ASD, as measured by ABAS-3, were significantly lower than their neurotypical peers (p < .001) and fell 2 standard deviations below the mean. Executive functioning skills, as measured by the BRIEF-A and WCPA were all significantly lower in young adults with ASD. WCPA was able to significantly differentiate young adults with ASD and neurotypical peers; as demonstrated by following fewer rules, utilizing fewer strategies, performing with less accuracy, and stating lower self-awareness of performance than their neurotypical peers. Executive functioning skills as measured by BRIEF-A robustly correlated with independent living skills (ABAS-3 and DLQ). However, WCPA scores did not significantly correlate with independent living skill measures, highlighting the heterogeneity of executive dysfunction within ASD. Though no significant relationships were found between WCPA scores and independent living, WCPA shows promise at providing a window into how the integration of multiple executive functions impact challenges with everyday living.
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    The ecology of change in outdoor therapy (ECO-Therapy) model: A preliminary theoretical framework for nature-based pediatric occupational therapy practice
    (May 2023) Figueroa, Laura Park 06/19/1976-; Poskey, Gail; Pickens, Noralyn D; Rose, Katherine K
    The vital childhood occupation of outdoor play in nature is on the decline in industrialized societies around the world. Ubiquitous technology use, sedentarism, over-protective parenting, and urbanization have caused a mass human migration to indoor lifestyles characterized by a lack of connection to the outdoors. This disconnection from nature has profound implications for children because contact with nature has myriad benefits for children’s physical health and emotional well-being throughout life. Re-connecting children to nature may support improved occupational participation and performance. Occupational therapy practitioners are beginning to take their work with children outdoors into nature, but a unifying model or theoretical framework incorporating nature does not yet exist in the field of occupational therapy. The purpose of this qualitative constructivist grounded theory study was to develop a theoretical model to illustrate the process of nature-based pediatric occupational therapy, based on analysis of the perspectives of occupational therapy practitioners currently engaging in nature-based pediatric practice with children ages 0–12 years. Twenty-seven photos and 23.5 hours of interview data were analyzed. The developed theory, the Ecology of Change in Outdoor Therapy (ECO-Therapy) Model, is a preliminary interpretive explanation of the causal conditions, contextual elements, and relationships between primary actors in the nature-based pediatric occupational therapy process. The ECO-Therapy Model proposes the core mechanism of change in nature-based occupational therapy intervention involves practitioners and children braving real-life challenges outdoors together as an impetus for growing adaptive capacity, leading to improved occupational participation and performance in daily life. As a constructivist grounded theory, the ECO-Therapy Model is an interpretive theoretical analysis representative only of this sample of participants in this socio-cultural context at this historical moment in time. Future research may test and refine the ECO-Therapy Model to assess applicability in other contexts, both within and outside of the field of occupational therapy.
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    Assessing the effectiveness of an intervention promoting occupational therapy student well-being
    (May 2023) Espiritu, Elena Wong; Evetts, Cynthia L.; Chang, Pei-Fen; Adams, Joshua
    Occupational therapy students experience decreased well-being during their educational experience. Extending self-compassion to oneself, engaging in meaningful occupations, and experiencing occupational balance are known to positively impact well-being in individuals. The purpose of this convergent mixed methods study was to determine the effectiveness of a newly developed and distinctively occupation-based intervention in promoting well-being in occupational therapy students. Quantitative data was collected via four standardized measures (14-Item Scales of General Well-Being, Self-Compassion Scale–Short Form, Engagement in Meaningful Activities Survey, Occupational Balance Questionnaire 11) at three timepoints (pre-intervention, immediate post-intervention, 6 weeks post-intervention) and analyzed using a repeated measures ANOVA. Reflections completed pre-intervention and immediately post-intervention comprised the qualitative data, which was analyzed using a multiple layer coding process resulting in four themes: current levels of well-being, obstacles and facilitators to well-being, strategies to promote well-being, and definitions and assumptions about well-being. Qualitative data was also analyzed through a theory of occupational adaptation lens, resulting in themes related to desire for mastery, press for mastery leading to occupational challenges, adaptive repertoire of strategies, and varying levels of relative mastery. The manualized intervention included six 45 min virtual synchronous sessions, which were delivered once per week and included a variety of activities (e.g., small and large group discussions, opportunities for exploration, reflection, and practice, mini teaching sessions). Results showed statistically significant differences in well-being (p = .024, ηp2 = .09), self-compassion (p = .006, ηp2 = .12), and engagement in meaningful occupations (p = .014, ηp2 = .10) between intervention and control group participants, suggesting that the intervention was effective. The results suggest that when the intervention study participants were self-compassionate and were intentional about promoting their well-being, they increased their participation in a variety of meaningful occupations moving them towards more occupational balance and improved well-being. This occupation-based intervention may serve as an alternative to current programming offered within higher education settings to promote graduate student well-being. Future studies are warranted to generalize results beyond this specific group of students and to determine the intervention’s effectiveness long term and with other populations.