School of Occupational Therapy

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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
    No abstract available
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    An electromyographic study of the effects of overflow and cutaneous stimulation
    (1974-08) Arrington, Jo Ann
    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.
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    The process to expertise: A constructivist grounded theory study with caregivers of hospitalized infants with critical congenital heart disease
    (May 2023) Rogers, Stefanie Casey 03/04/1976-; Pickens, Noralyn D; Poskey, Gail; Evans, Stephanie; Roberts, Heather
    Caregivers of hospitalized infants with critical congenital heart disease (CCHD) experience stress, emotions, and contextual challenges with staff and unit culture during their infant's stay in critical care units, especially if the stay is lengthy. These compounding adverse conditions impact a caregiver's ability to learn to care for their infant. The purpose of this constructivist grounded theory study was to construct an explanatory theory, based on the analysis of the caregivers' perspectives, to uncover the process caregivers of hospitalized infants with CCHD go through to become experts of their infant's care in the critical care setting. Fifteen mothers and one father participated in intensive, semi-structured interviews. Data collection, data analysis, and theory formation transpired through an iterative process of constant comparison within and amongst data cases, theoretical sampling, memos, and participant feedback. The result was a co-constructed overarching framework, the Process Model to Caregiver Expertise, showing how caregiver confidence develops over time and through active participation in caregiving tasks. Findings also indicate that caregivers need prompt peer and mentorship connections and early active participation in caregiving tasks to hasten their transformation into independent, expert caregivers. Knowing this process may empower caregivers to understand their journey and guide education, support, and tool development for healthcare providers. Additional research is needed to understand the paternal caregiver role, healthcare professionals' perceptions of this process, and how the model develops as the child ages.
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    Experience of transition from active duty to civilian life for post 9/11 combat veterans
    (May 2023) Haines, Christine E; Chang, Pei-Fen; Baxter, Mary F; Littles, Sabrenda
    BACKGROUND: The suicide rate for veterans who served after 9/11 is 21% greater than that of the general United States population. Most of them commit suicide within the first three years of transition from active duty. Combat veterans report more difficult transitions from the military than non-combat veterans. High levels of stress during transition from the military has been associated with decreased well-being, occupational dysfunction, and suicidal ideation. The purpose of this study was to provide an understanding of the experience of transition from active duty to civilian life for combat veterans who served after 9/11. METHOD: A phenomenological research method was chosen to describe the lived experience of transition from active duty to civilian life for combat veterans who served after 9/11. In-depth interviews were recorded and used to collect data virtually via Zoom or in a location convenient to the participant. The transcripts were coded line by line until data saturation was met and themes developed. RESULTS: Five main themes and nine subthemes emerged from the data that illustrate these combat veterans’ experience of transition from active duty life to the civilian world. Main themes include: 1) Having Expectations; 2) Confronting Barriers; 3) Crisis of Identity; (4) Employing Coping Mechanisms; and (5) Filling a Void. CONCLUSION: Findings from this study add depth to the understanding of occupational identity as it relates to social and psychosocial identity and the important interaction roles, context, and meaningful occupations have on a veteran’s occupational adaptation in the civilian context.
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    Advancing the sock test for sitting balance: A comparison with the Barthel Index of activities of daily living in older adults
    (December 2022) Broussard, Kim Celeste 1958-; Mary Francis Baxter; Mitchell, Katy; Pei-Fen, Chang
    The objective of this study was to determine whether a correlation existed between scores on the Sock Test for Sitting Balance (STSB) and items on the Barthel Index (BI) for activities of daily living. The STSB and BI scores of older adults from independent living and assisted living communities were compared. No difference in STSB scores emerged between the independent living and assisted living communities. Results showed a significant relationship between the STSB score and the following BI scores: self-feeding (p < .05) and bathing, dressing, urinary incontinence, and stair mobility (p < .01). The results indicated that the STSB did not differentiate between the independent living and assisted living communities. However, a significant correlation emerged between the STSB score and the BI items of self-feeding, bathing, dressing, urinary incontinence, and stair mobility in older adults living in independent living and assisted living communities.
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    Evaluation of interrater reliability between Occupational therapists scoring portions of the fieldwork evaluation
    (1991-05) Isaacson, Mary
    Evaluation of the occupational therapy student's clinical performance has been an essential part of the occupational therapy education program. This evaluation must be objective, reliable, and valid. This study evaluated interrater reliability between occupational therapists scoring ten items in the Fieldwork Evaluation after reading a case study. A case study about an occupational therapy student completing her fieldwork, the Fieldwork Evaluation with the ten items to be scored highlighted, a letter of instruction, and an individual questionnaire were sent to therapists. Thirty-three were returned. Intraclass correlation was determined in three areas, performance, judgement, and attitude. None of the areas demonstrated a high degree of interrater reliability. Many factors may have.
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    The effect of pretesting on mastery of course material
    (1974-08) Kimmel, Judy; Griffin, Nancy; Rosentswieg, Joel; Currie, Catherine
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    A caregiver perspective: adaptation after stroke
    (2006-08) Coutinho, Franzina
    Three studies were designed to explore the question, "What physical, social and psychological factors contribute to adaptation in the caregiver's life following the stroke of a spouse?" Studies focused on the psychosocial, sociocultural and environmental dimensions of adaptation among the spousal caregivers of stroke survivors. The first study in this dissertation was a critical literature review of information in the form of articles and editorials related to occupational therapy. Concepts that have evolved within occupational therapy related to informal caregiving were discussed and a comparison was made with literature available in the other fields like nursing and the social sciences. Both qualitative and quantitative studies were considered from peer reviewed journals. Articles from MEDLINE and Cumulative Index to Nursing and Allied Health Literature were selected for review for the period of 1982-2005. Keywords used were: informal caregiving, occupational therapy, environment, occupation, motivation, meaning, and spouse. In the second study, "A Caregiver Journey: The Process of Recovery after Stroke", the participants were interviewed at five time points over a year in which the caregiving experience of spousal caregivers of stroke survivors was described. Eight participants (pseudonyms used) were selected to illustrate the adaptation process over time. For the purpose of this mixed design study interview data from caregivers were analyzed, along with scores from the Caregiver Preparedness Scale. The third study was a qualitative design and included the same caregivers from Study 2. The third study, "Occupations Lost and Gained: A Caregiver Perspective", demonstrated the changes in the occupational lives of the caregivers. A core tenet of occupational therapy is the belief that health is reflected and maintained through participation in occupations: work, play or leisure and self care. The research from these three studies attempted to be thorough by identifying the process involved in adaptation and caregiving and by filling the gaps that currently exist in the profession on this topic. The holistic view of adaptation was a significant component of this dissertation with a focus on the dyad as a unit viewed together in treatment consideration to achieve more effective outcomes.
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    Interrater reliability of the Balcones Sensory Integration Screening Test-Revised
    (1986-08) Kleuser, Mary; Gilkeson, Grace; Gench, Barbara; McEwen, Molly
    No abstract available