School of Occupational Therapy
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Item Multimodal rehabilitation for postural orthostatic tachycardia syndrome (POTS)(2024-08) Rich, Emily M. 1992-; Vas, Asha; Goodman, Brent; Evetts, Cynthia L.; Sullivan, AnneObjectives: To examine (a) feasibility characteristics of the multimodal training program, (b) outcomes of the program, (c) participants’ integration of treatment for long-term outcomes, and (d) align the findings with occupational adaptation (OA) to refine the program. Design: A retrospective analysis to determine feasibility, baseline function, and progress following treatment. Focus group analysis to determine themes for long-term outcomes and alignment with OA concepts. Setting: Outpatient clinic Subjects: Nineteen female participants, ages 18 - 53 (M = 28.63) completed the multimodal training program. Six out of 19 participated in the focus group. Intervention: A 50-minute weekly training program across eight weeks using a multimodal approach including education, movement, and mindful self-compassion. Outcome Measures: Participants completed demographic and medical history and assessment for baseline orthostatic intolerance. At pre-training, post-training, and follow-up testing participants completed the Modified Fatigue Impact Scale, Lower Extremity Functional Scale, Rand 36-Item Health Survey 1.0, Trail Making Test (A and B), Center for Epidemiologic Studies Depression Scale – Revised, 10 Meter Walk Test, and grip strength testing. Results: At baseline, participants were significantly below norms in the areas of daily function (p < 0.001), grip strength (p ≤ 0.001) gait speed (p < 0.001), fatigue (p < 0.001), and quality of life (p < 0.001). Between pre-training and three-month follow-up, participants showed significant improvement across function in daily life tasks (p < 0.01); grip strength in the dominant (p < 0.01) and non-dominant (p < 0.01) hands; gait speed (p < 0.05); levels of fatigue (p < 0.05); cognitive performance (p < 0.05); and quality of life (p < 0.05). Focus group themes revealed many successful outcomes and several areas of ongoing need, specifically around the themes of information, community, growth, and advocacy. The EnRich Life Model was created, utilizing the POTSabilities Method as informed by OA to demonstrate the adaptation process in POTS. Conclusions: Individuals with POTS face functional challenges that can be significantly improved through multimodal rehabilitation. Specifically, the EnRich Life Model using the POTSabilities method demonstrates a process by which adaptation occurs to increase relative mastery. Opportunities for advocacy could optimize care and quality of life for patients with POTS.Item Diversity meets equitable and inclusive fieldwork: A qualitative phenomenological study(2024-08) Ammon, Alondra Maria 11/14/1981-; Evetts, Cynthia L.; Myers, Aimee; Martin, Jennifer; Shierk, AngelaOccupational therapy students who identify as Black Indigenous or Persons of Color (BIPOC) have intersecting identities that influence their experience within academia and Level II fieldwork—the occupational therapy profession advocates for increased diversity within the profession and equitable and inclusive practices. Recognizing diverse student backgrounds' needs is important to support learning outcomes within a supportive environment. An area for further exploration should be considered during Level II fieldwork, where students have reported barriers and challenges to learning due to fieldwork environments and educators. BIPOC student perspectives are seldom represented in occupational therapy literature. For a profession to truly embrace diversity, exploring diverse perspectives to inform inclusive practices is essential. The purpose of this study is to explore two questions: 1) What are the perceptions of equity and inclusion during Level II fieldwork from BIPOC students? and 2) How does one’s perception of equity and inclusion during Level II fieldwork influence relative mastery? A qualitative phenomenological study design incorporating a reflexive thematic analysis approach was utilized. The following data analysis generated three themes and eight sub-themes in response to participant’s perception of equity and inclusion: 1) Reflecting on the environment (subthemes: representation, workplace civility, and cultural celebration); 2) Resources for navigation (subthemes: therapeutic use of self; and the student becomes the teacher); and 3) Response to demands (subthemes: grit; adaptability; and true authentic self). The themes and subthemes do not work in isolation of each other as they are interrelated and not mutually exclusive. The second research question explored participants' perceptions of relative mastery. Irrespective of their experience of equity and inclusion during fieldwork, many participants shared similar sentiments toward their relative mastery, feeling satisfied with their overall performance and effectively utilizing resources. The results of this study may inform how the profession moves forward with fieldwork educator training to support competence, including workshops, mandated training, or readily accessible resources (Karp et al., 2022). The emphasis of this study is to ensure work towards equitable and inclusive Level II fieldwork practices support entry-level practitioners ready to serve diverse populations and confidently represent the profession.Item Carpal tunnel syndrome: influencing factors affecting post surgical recovery rates for functional hand recovery(1998-05) Schreiber, Teresa; Reid, Cynthia; Harnish, SherrillCarpal Tunnel Syndrome is one of the most prevalent cumulative trauma disorders among assembly line workers and computer operators employed in highly repetitive jobs. The treatment options available have included the following: conservative course of therapy, job changes, steroid injections, splinting, and/or surgical intervention. The purpose of this study was to determine the following: Of the people that acquire Carpal Tunnel Syndrome and seek surgical intervention, does the time elapsed between initial experiencing of the symptomatology to the actual surgical intervention play a role in their actual recovery rates from the syndrome? A retrospective study was undertaken to review data collected from an out-patient Occupational Therapy setting. Data taken from a 6 year period was analyzed to determine if days of median nerve compression affected post-surgical grip strength recovery rates. In conclusion, less than 10% of the sample recovered 75% or more of normal grip strength after surgery. There was no statistical significance found between post-surgical grip strength recovery and days of median nerve compression.Item Computers and Allied Health Science education: A comparison of faculty attitudes(1984-12) Shirali, ShubhaItem 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, TeresaSince 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.Item 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 FThe 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.Item 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 anastasiaOccupational 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.Item 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; IllegibleAs 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.Item Defining functional performance in an educational environment(1991-05) Orr, Catherine; Schkade, Janette; Schultz, Sally; Zucker, RhondaThe Model of Student Role Adaptation, developed to guide occupational therapy practice in the public schools, states that the demands of an educational environment affect the tasks required for a student to effectively benefit from instruction. This study examines the relationship between tasks identified by teachers as required for classroom participation and tasks addressed by occupational therapy treatment goals for evidence that therapists in public schools respond to needs created by environmental demands. A written survey consisting of school related tasks was sent to teachers and occupational therapists serving students in similar classrooms. The results indicated that occupational therapy treatment goals overall were significantly distributed among tasks designated as required by teachers. Analysis of the tasks by category, however, revealed a discrepancy. Teachers rated a high proportion of human interaction tasks as required yet occupational therapists appeared less responsive to these needs than to tasks related to motor skills.Item Occupational therapy intervention and aids: developing a beginning research base and functional perspective(1990-05) Puccetti, DiannaItem Professional esteem of United States occupational therapists(1989-08) Fader, PatriciaItem A survey of the occupational therapist's perceived role in mental health programs of the 1970s(1978-05) Raffen, EleanorItem 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.Item The effectiveness of activities of daily living training in the stroke patient(1974-05) Wallace, Bertha; Griffin, Nancy; Currie, Catherine; Long, Dorn; Mattie, CruzNo abstract availableItem An electromyographic study of the effects of overflow and cutaneous stimulation(1974-08) Arrington, Jo Ann; Currie, Catherine; Keele, Marjorie; Mattei, CruzNo abstract availableItem An observation on stereognosis in preschool cerebral palsied children(1972-05) Chen, Mei-jinNo abstract availableItem 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, GeraldineEarly 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.Item The effects of carpometacarpal thumb orthosis on pinch strength, self-reported activitries of daily living and pain in osteoarthritis(1991-05) Kraenzle, Joyce; Spencer, JeanThis 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.Item 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, NicoleObjective: 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.