Occupational Therapy Assessment Research Articles

Occupational therapy in the rehabilitation management of obesity in adults

Obesity is a global human problem due to its high prevalence and negative consequences for health, life duration and quality of life of the population. This situation makes it necessary to pay more attention to effective rehabilitation of overweight and obese persons. The article considers approaches to the application of occupational therapy measures in the rehabilitation management of obesity: the impact of the disease on occupation is described, the methods of occupational therapy assessment and the goals of occupational therapy interventions are defined, the role of occupational therapy measures is substantiated, an overview of the main occupational therapy strategies that have confirmed their effectiveness in the treatment of obesity in the adult population is provided. A client-centered approach to occupational therapy has been found to be particularly valuable in the treatment of chronic relapsing obesity. Using analysis of occupation performance and understanding the client's performance skills helps occupational therapists implement meaningful and effective interventions that promote the client's active participation in changing the daily life habits, roles, and patterns that underlie the development of obesity. Prospects for further research are practical testing and research of the effectiveness of occupational therapy programs for people with obesity in the context of the Ukrainian health care system.

Occupational therapy assessment and interventions for young autistic children in South Africa.

Occupational Therapy is among the top interventions for autistic children, hence the need for equitable and effective services in the public and private health and education sectors. Ongoing research into the therapies for autism spectrum disorders in different contexts is also required. To explore and describe occupational therapists' assessment and intervention for autistic children in South Africa. A descriptive qualitative research design using semi-structured interviews to gather data from purposively recruited OTs (n=20). Data were audio-recorded, transcribed and analysed thematically, and compared across three sectors public health, special needs schools and private practice. South African practice across all three sectors was similar to international patterns of informal play-based assessment, sensory processing and Ayres Sensory Integration (ASI®) treatment. Developmental frameworks guided specific approaches. Strong team collaboration was present across sectors, with some transdisciplinary teamwork and co-treatment. Undergraduate and postgraduate training opportunities were, however limited. Occupational therapy assessments had diagnostic value. Informal tools such as developmental checklists were found to have clinical utility, whilst standardised tools were most commonly used to assess sensory processing and visual perception. Recommendations included incorporating ASI® into undergraduate curricula and postgraduate training opportunities with multidisciplinary input to develop ASD professionals in South Africa. It is imperative to advocate for services in under-resourced rural areas and marginalised communities that lack financial and social resources. Occupational therapists need to find new ways of working collaboratively across sectors to ensure effective and comprehensive services in public health and special schools.

Preliminary Rasch Construct and Reliability Validation of TeleWrite: A Telehealth-Based Handwriting Assessment.

Telehealth is rapidly expanding, and telehealth-based occupational therapy assessments must be developed and validated to keep pace with this transition. TeleWrite aims to bridge this gap. To analyze the tool's initial psychometric properties using Rasch methods. Internal construct validity and test reliability were analyzed using data from 148 children from first to third grade. Rasch analysis helped to identify that TeleWrite is composed of three separate constructs for rate, accuracy, and fluency. All Infit/Outfit mean square (MNSQ) values fell within acceptable ranges of 0.5 to 1.7 logits. Separation analysis indicated lower but acceptable person separation values for rate (0.68-0.76) and fluency (0.61-0.73), but accuracy scales were in the poor-fair range (0.20-0.60), given sample limitations. TeleWrite is comprised of three separate constructs, showed a good fit with the Rasch model, indicated strong construct and internal validity, and moderate ability to reliably separate abilities of students in terms of handwriting skills.

Community mobility: psychosocial experiences of stroke survivors who use wheelchairs in Worcester, South Africa

BACKGROUND: Despite policies promoting transport inclusivity, persons with disabilities in South Africa experience difficulties when accessing public transport. Poor community mobility hampers community integration and participation in occupations outside the home. This article describes the psychosocial community mobility experiences, of stroke survivors using wheelchairs in a town in the Western Cape province of South Africa METHOD: The study used a descriptive qualitative design. The study population were community dwelling stroke survivors, from Worcester, using wheelchairs. Data was collected from eight participants through semi-structured telephonic interviews. Inductive thematic analysis was used FINDINGS: The four themes derived from the data were: Freedom of movement (My power chair, my Ferrari'), Social anxiety (People stare at you like they do not have a heart), Dependency (I must dance along to his fiddle), and Social isolation (You feel done in, dejected). Participants identified wheelchairs, private vehicles, and mini-bus taxis as modes of community mobility CONCLUSION: When transport barriers prevent dignified, spontaneous community integration negative psychosocial consequences (social anxiety, dependency, and social isolation) followed. Community mobility barriers hampered participants' ability to participate in meaningful occupations and left them isolated. Occupational therapists should take cognisance of the community mobility challenges wheelchair users might experience and implement intervention strategies to mediate these Implications for practice • Community mobility is essential to perform occupations outside the residential setting and must be included in occupational therapy assessment and intervention strategies. • Occupational therapists can empower individuals with mobility impairments with the life skills to manage psychological challenges caused by accessing public transport and decreased community mobility. • Occupational therapy intervention for wheelchair users accessing public transport should include effective, appropriate transfer strategies to embark and disembark from minibus taxis. • In certain circumstances the occupational therapist should consider the possibility of a motorised wheeled mobility device to facilitate community integration.

The clinical profile of amyotrophic lateral sclerosis patients presenting to the National Hospital of Sri Lanka

OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a devastating neurodegenerative disease. Published data on ALS in Sri Lanka is scarce. The aim of this study was to describe the clinical profile of ALS patients presenting to the National Hospital of Sri Lanka(NHSL). METHODS A descriptive cross-sectional study was carried out in 33 consecutive patients with “clinically definite ALS” according to revised El-Escorial and Awaji criteria, who presented from May 2018-May 2020 to two neurology units at NHSL. RESULTS The mean age was 59.7 (±12.3) years while 57.6%(n=19) were males. The average duration for diagnosis was 15.48 (±12.4) months. The commonest first symptom was upper limb weakness 39.4%(n=13) followed by lower limb weakness 33.3%(n=11) and bulbar symptoms 27.3%(n=9). According to King’s Staging System, 18.2%(n=6) were in stage 1, 39.4%(n=13) were in stage 2, 36.4%(n=12) were in stage 3 and 3%(n=1) each were in stage 4A and 4B at the time of diagnosis. None had a family history of ALS. Four were treated with Riluzole. Out of all, 45%(n=15), 24.2%(n=8) and 6.1%(n=2) were referred for physiotherapy, occupational therapy and psychiatry assessment respectively. Seventy five percent (18/24) patients with bulbar symptoms, were referred to speech therapists and one had gastrostomy. Advance directives were not discussed with any of the patients. CONCLUSION The ALS patients presenting to the NHSL had a mean age of 59.7yrs with a slight male preponderance. The average duration taken for diagnosis was 15.5months while the commonest first presentation was upper limb weakness. Most present in King’s stage 2 or 3 and only a few were treated with disease modifying agents. Multidisciplinary care provided and management of disease related complications were suboptimal. Discussing about advance directives with ALS patients, is yet not part of Sri Lankan practice. This emphasizes the need to enhance standards of care for ALS patients to improve their quality of life.

CURRENT PRACTICE PATTERNS IN HOME HEALTH OCCUPATIONAL THERAPY

Abstract Occupational therapy practitioners are essential members of the home health rehabilitation team to support patients transitioning from acute care to home. However, home health occupational therapy services have been underutilized, in part, due to limited understanding of services that the profession provides. Improving this understanding is necessary to help patients receive timely services. The purpose of the study was to describe the current practice patterns in home health occupational therapy. Fifty home health occupational therapy practitioners from 27 states completed an electronic survey between May and June 2021. The survey consisted of questions about assessment and treatment, communication with physical therapy colleagues, and the impact of the Patient-Driven Grouping Model and the coronavirus disease 2019 pandemic on service delivery. Results showed that occupational therapy assessments focused on personal care activities, mobility and balance, and cognition. The treatment content usually included training in activities of daily living, functional mobility, the application of compensatory strategies (e.g., home adaptations), and fall prevention strategies. Most respondents communicated with their physical therapy colleagues at least once a week on topics related to scheduling, changes in a patient’s condition, and falls and safety concerns. Seventy percent of respondents experienced a reduction of home visits during the recent Medicare payment reform and the pandemic. These practitioners felt that some patients might be discharged prematurely because of this reduction. The survey results highlight the pertinence of occupational therapy services to support patients’ independence and safety at home and the need to increase these services for home health patients.

Processes of Care and Associated Factors in Patients With Stroke by Immigration Status.

Receiving evidence-based stroke care processes is associated with good clinical outcome. However, data on early stroke care among immigrants are scarce. We investigated whether guideline-recommended acute stroke care and associated factors differ between immigrants and Danish-born residents. Patients admitted with ischemic and hemorrhagic stroke diagnoses (n=129,724) between 2005 and 2018 were identified from the Danish Stroke Registry. We included 123,928 Danish-born residents and 5796 immigrants with stroke. Compared with Danish-born residents, immigrants were less likely to be admitted to a stroke unit within 24 hours after stroke onset (81.5% vs. 83.9%, P <0.001) and had lower odds of early stroke care including dysphagia screening, physiotherapy, occupational therapy, and nutritional assessment. After adjustment for age, sex, clinical, and sociodemographic factors, immigrants had lower odds of early stroke unit admission (odds ratio [OR]: 0.97; 95% CI, 0.94-0.99), early dysphagia screening (OR: 0.96; 95% CI, 0.93-0.98), early physiotherapy (OR: 0.96; 95% CI, 0.94-0.99), and early occupational therapy (OR: 0.96; 95% CI, 0.93-0.98) than Danish-born residents. Small absolute differences in overall quality of stroke care were found when comparing immigrants and Danish-born residents. Significant factors associated with greater likelihood of stroke care included high income, high education, and cohabitation. Immigrants had lower chances of early stroke unit admission and received fewer individual early stroke care processes such as dysphagia screening, physiotherapy and occupational therapy than Danish-born residents. However, the absolute disparities were in general minor and largely influenced by socioeconomic status and cohabitation.

Quality improvement project to improve the standardisation and efficiency of occupational therapy initial contact and assessment within a mental health inpatient service

Timely contact and assessment between occupational therapists (OTs) and patients are vital to understanding their needs and creating person-centred interventions. Any delays in completing contact and assessment will likely impact...

215 WHAT VALUE DOES OCCUPATIONAL THERAPY ADD TO THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE?

Abstract Background The EDITH team has provided an alternative care pathway for older adults with emergency care that takes place in the persons’ home. The EDITH service provides both medical and Occupational Therapy assessment and intervention in the home environment with onward referrals to appropriate agencies as indicated, thus negating the need for an emergency department presentation. Methods To assess consistency in OT practice and assessment, an audit was completed of OT logbooks and electronic patient data. Paper count method was used. Data gathered with regards to OT process and assessment. Results 100% of patients had at least 1 type of OT assessment (e.g functional, home environment, falls prevention, cognitive etc), 80% had at least 2 and 43% had 3 or more types of OT assessments. 100% of patients had Clinical Frailty Scores completed, 100% had their living situation and level of care supports assessed and documented. 43% of patients received onwards referrals to community supports, day hospital, voluntary supports etc. Conclusion The OTs complete a thorough and multifactorial assessment of the older adult within the context of their home environment. This holistic assessment approach adds significant value to the overall EDITH assessment and service. It also ensures appropriate and relevant onwards referrals are completed. It is imperative to ensure value for money with regards to health care services. In line with the HSE “Value Improvement Programme” it is timely to review OT services and ensure they are delivering consistent, high quality and high value services for our stakeholders.

188 A REVIEW OF THE REABLEMENT PROGRAM WHICH INCLUDES THERAPY ASSISTANTS WITHIN THE AMBULATORY HUB

Abstract Background The Ambulatory Hub for the older person commenced in May 2021 in line with the Enhanced Community Care Implementation Guidance documents. From a client and carer perspective, the hub provides a single point of access and a co-ordinated approach to the client's care needs with a focus on frailty. The Reablement service is provided alongside the Hub team providing a specialist Occupational Therapy and Physiotherapy geriatric assessment. Depending on the outcome of the assessment and needs identified, the client can avail of the Reablement program. Each patient will have an individualised therapy program which is carried out by the therapy assistants in the client’s home. The Reablement program aims to provide care in line with the “Right Care, Right Place, Right Team, Right Time” ethos. Methods The charts of 20 clients who completed the Reablement program were reviewed. The data collected included the number of visits by the Occupational Therapist, Physiotherapist and therapy assistants. Feedback from the client and their family was sought and documented. Results The results showed that clients received on average 4 Occupational Therapy and 4 Physiotherapy sessions each. The therapy assistants provided on average 15 visits per client to support the implementation of specialist programs developed by the therapy team. The feedback from clients and family was very positive and the following feedback was received “A program like this is a great initiative”, “ It Improved my confidence”, “I’m able to cook my meals for myself again” Conclusion The Reablement program with the support of therapy assistants has led to a patient centred service and co-ordinated approach to the care of the client with increased client compliance. A similar service was not available in the community previously. The Reablement program has reduced the need for inpatient reablement beds which was previously the pathway of care for these clients in the community.

228 LONG TERM OUTCOMES FOR FALLS PATIENTS WHO WERE TREATED BY THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE

Abstract Background The EDITH service provides an alternative to an ED attendance for the older adult. Medical treatment and Occupational Therapy (OT) assessment take place within the patient’s home. Patients who experience an explained fall are routinely treated by the EDITH service, these patients receive OT falls prevention and home environment assessment as standard. It is imperative to assess the long-term outcomes for these patients in order to inform future service provision. Methods A total of 40 patients, who were referred following an explained fall to the EDITH service and remained at home following assessment, were selected for audit. These patients were seen over a 2-month period in 2021. Data were gathered with regards to ED presentations via healthcare records and mortality rates were captured via RIP.ie Results At 3 months, 4 patients had re-presented to ED with a fall and 3 required admission. At 6 months, 6 patients re-presented to ED with a fall with 5 requiring admission. At 9 months, 4 patients re-presented to ED with a fall and 3 required admission. 100% of patients had an OT home environment assessment and received advice regarding falls prevention. The average age of patient was 84 years. At 1 year, the mortality rate for this patient group was 10%. Conclusion Patients with explained falls that were treated by the EDITH service appear to have a reasonably low ED re-attendance rate at 3, 6 and 9 months for explained falls. This may be as a result of the tailored falls prevention education/home environment assessment that took place within the patient’s home by the OT. However further audit and a larger population group would be required to suggest a definite correlation between same.

98 PREPARING FOR THE COMMENCEMENT OF THE DECISION MAKING “CAPACITY” ACT (2015): REVIEWING CURRENT PRACTICE WITHIN AN OCCUPATIONAL THERAPY DEPARTMENT

Abstract Background The Decision Making ‘Capacity’ Act (2015) will commence in 2022. This will have significant implications for health care professionals. Occupational therapists undertake a wide range of assessments of cognitive, physical and functional ability. There is a need to streamline the recording of comprehensive and holistic assessment outcomes for easier access and interpretation during the interdisciplinary assessment of Decision Making Capacity (DMC) for independent living. A working group was established to review current practices and formulate a document to support the assessment. Methods The model for improvement was employed, which incorporates the plan, do, study, act methodology. Current practice of the occupational therapy team was reviewed in relation to assessments used, the format of recording and the knowledge of the DMC act. A working document was formulated and reviewed with medical staff. Team education on the DMC act was provided. A qualitative questionnaire was circulated among the occupational therapy staff to ascertain the educational needs of the department. Perceptions of current practice in DMC assessment of independent living were gathered. Results 100% of questionnaire respondents identified need for further training and education on the DMC Act 2015. No respondents agreed that the relevant assessment outcomes were easily accessible. 67% of respondents were unsatisfied with the current process in place for DMC assessment of independent living. 45% of respondents do not feel confident in completing assessments contributing to DMC assessment of independent living. There was no consistency in the format of recording assessment outcomes. Conclusion The group developed a clinical document to improve easy and consistent interpretation of occupational therapy assessment in relation the DMC assessment of independent living. This ensures person centred, comprehensive assessment to enhance the patient journey. The team are better prepared for the commencement of the DMC act and have identified future training needs.

308 A Geriatric Emergency Medicine Assessment Team Reduces Hospital Length of Stay through Faster Discharge to Subacute Rehabilitation

308 A Geriatric Emergency Medicine Assessment Team Reduces Hospital Length of Stay through Faster Discharge to Subacute Rehabilitation

Domains of Frailty Predict Loss of Independence in Older Adults After Noncardiac Surgery.

Preoperative frailty has been consistently associated with death, severe complications, and loss of independence (LOI) after surgery. LOI is an important patient-centered outcome, but it is unclear which domains of frailty are most strongly associated with LOI. Such information would be important to target individual geriatric domains for optimization. To assess whether impairment in individual domains of the Edmonton Frail Scale (EFS) can predict LOI in older adults after noncardiac surgery. Retrospective Cohort Study. One Academic Hospital. Patients aged 65 or older who were living independently and evaluated with the EFS during a preoperative visit to the Center for Preoperative Optimization at the Johns Hopkins Hospital between June 2018 and January 2020. LOI defined as discharge to increased level of care outside of the home with new mobility deficit or functional dependence. New mobility deficit and functional dependence were extracted from chart review of the standardized occupational therapy and physical therapy assessment performed before discharge. A total of 3497 patients were analyzed. Age (mean±SD) was 73.4±6.2 years, and 1579 (45.2%) were female. The median total EFS score was 3 (range 0-16), and 725/3497 (27%) were considered frail (EFS≥6). The frequencies of impairment in each EFS domain were functional performance (33.5% moderately impaired, 11% severely impaired), history of hospital readmission (42%), poor self-described health status (37%), and abnormal cognition (17.1% moderately impaired, 13.8% severely impaired). Overall, 235/3497 (6.7%) patients experienced LOI. Total EFS score was associated with LOI (odds ratio: 1.37, 95% CI, 1.30-1.45, P <0.001) in a model adjusted for age, sex, body mass index, American Society of Anesthesiologists rating, congestive heart failure, valvular heart disease, hypertension diagnosis, chronic lung disease, diabetes, renal failure, liver disease, weight loss, anemia, and depression. Using a nested log likelihood approach, the domains of functional performance, functional dependence, social support, health status, and urinary incontinence improved the base multivariable model. In cross-validation, total EFS improved the prediction of LOI with the final model achieving an area under the curve of 0.840. Functional performance was the single domain that most improved outcome prediction, but together with functional dependence, social support, and urinary incontinence, the model resulted in an area under the curve of 0.838. Among domains measured by the EFS before a wide range of noncardiac surgeries in older adults, functional performance, functional dependence, social support, and urinary incontinence were independently associated with and improved the prediction of LOI. Clinical initiatives to mitigate LOI may consider screening with the EFS and targeting abnormalities within these domains.

Ayres Sensory Integration ® Implementation in Malaysian Occupational Therapists: Challenges and Limitations

One of the most popular interventions provided by occupational therapists for pediatric clients is Ayres Sensory Integration® (ASI). Strict fidelity measures consisting of procedural and structural elements must be adhered to when using it. These fidelity measures distinguish Ayres Sensory Integration® from other sensory-based interventions. This study involved the development of a survey instrument and outlined the challenges that Malaysian occupational therapists face when using Ayres sensory integration® (ASI). The questionnaire development involved the processes of assessing its validity and reliability. A total of 161 occupational therapists working in various healthcare settings responded to the survey by answering a self-administered questionnaire. The results identified eight themes or issues: (1) Inadequate Training, (2) Resource Issues, (3) Physical Constraints, (4) Time Constraints, (5) Limited Information/ Support Provided By Family, (6) Limited Support From Management, (7) Limited Information/Support Provided By Suppliers, and (8) Issues in Implementing Evidence-Based Practice. Identifying the challenges of implementing ASI is an important aspect of improving occupational therapy assessments and interventions, which would establish the effectiveness of the interventions provided. Keywords: Ayres sensory integration; occupational therapy intervention; fidelity measures; sensory processing issues

Inter-Rater Reliability of the Pizzi Health and Wellness Assessment (PHWA)

The objective of this study is to determine the inter-rater reliability of the Pizzi Health and Wellness Assessment (PHWA) by comparing the consistency in scores between clients and their caregivers in the following areas of participation: social, physical, family, occupational, mental/emotional, and spiritual. A retrospective inter-rater correlational design was used to analyze the agreement of scores from a convenience sample consisting of two groups: clients with disabilities (n = 19) and their healthy caregivers (n = 19). Inter-rater reliability was calculated using correlations for the PHWA as a whole, and for the current level of participation and wishing to improve participation subsections. Inter-rater reliability as calculated by an Intraclass Correlation Coefficient, and either the Pearson or Spearman rho correlation and found to be reliable between clients and caregivers (rICC = .636, p < .001; rho = .642, p < .001). More specifically, current level of participation demonstrated acceptable reliability (rICC = .513, p < .001; r = .521, p < .001) as did wishing to improve participation (rICC = .689, p < .001; r = .725, p < .001). This supports the PHWA as a clinically relevant health and wellness occupational therapy assessment.

Physical Activity Behavior of Patients at a Skilled Nursing Facility: Longitudinal Cohort Study.

BackgroundOn-body wearable sensors have been used to predict adverse outcomes such as hospitalizations or fall, thereby enabling clinicians to develop better intervention guidelines and personalized models of care to prevent harmful outcomes. In our previous work, we introduced a generic remote patient monitoring framework (Sensing At-Risk Population) that draws on the classification of human movements using a 3-axial accelerometer and the extraction of indoor localization using Bluetooth low energy beacons, in concert. Using the same framework, this paper addresses the longitudinal analyses of a group of patients in a skilled nursing facility. We try to investigate if the metrics derived from a remote patient monitoring system comprised of physical activity and indoor localization sensors, as well as their association with therapist assessments, provide additional insight into the recovery process of patients receiving rehabilitation.ObjectiveThe aim of this paper is twofold: (1) to observe longitudinal changes of sensor-based physical activity and indoor localization features of patients receiving rehabilitation at a skilled nursing facility and (2) to investigate if the sensor-based longitudinal changes can complement patients’ changes captured by therapist assessments over the course of rehabilitation in the skilled nursing facility.MethodsFrom June 2016 to November 2017, patients were recruited after admission to a subacute rehabilitation center in Los Angeles, CA. Longitudinal cohort study of patients at a skilled nursing facility was followed over the course of 21 days. At the time of discharge from the skilled nursing facility, the patients were either readmitted to the hospital for continued care or discharged to a community setting. A longitudinal study of the physical therapy, occupational therapy, and sensor-based data assessments was performed. A generalized linear mixed model was used to find associations between functional measures with sensor-based features. Occupational therapy and physical therapy assessments were performed at the time of admission and once a week during the skilled nursing facility admission.ResultsOf the 110 individuals in the analytic sample with mean age of 79.4 (SD 5.9) years, 79 (72%) were female and 31 (28%) were male participants. The energy intensity of an individual while in the therapy area was positively associated with transfer activities (β=.22; SE 0.08; P=.02). Sitting energy intensity showed positive association with transfer activities (β=.16; SE 0.07; P=.02). Lying down energy intensity was negatively associated with hygiene activities (β=–.27; SE 0.14; P=.04). The interaction of sitting energy intensity with time (β=–.13; SE 0.06; P=.04) was associated with toileting activities.ConclusionsThis study demonstrates that a combination of indoor localization and physical activity tracking produces a series of features, a subset of which can provide crucial information to the story line of daily and longitudinal activity patterns of patients receiving rehabilitation at a skilled nursing facility. The findings suggest that detecting physical activity changes within locations may offer some insight into better characterizing patients’ progress or decline.

Cognitive assessment and intervention in occupational therapy for Thai older adults with neurocognitive disorders

Background: Occupational therapists (OTs) have a significant role in maintaining clients' well-being. Understanding the current occupational therapy (OT) practice for the elderly with neurocognitive disorders (NCDs) brings effective service. Objectives: This study aimed to explore current OT practice for cognitive assessment and intervention for the elderly with NCDs in Thailand. Materials and methods: This study explored OT practices via questionnaire. Questionnaires were distributed to one hundred and ninety-one OTs throughout Thailand. Results: One hundred and fifty-two occupational therapists (79.87%) responded to the survey. Most worked full-time (94.08%), and 74.34% worked at general hospitals. Participants were more likely to employ standardized cognitive tests (45.33%) than non-standardized assessments (38.00%). Typical standardized tests were screening tests rather than comprehensive tests. The most reported cognitive problem was basic cognition (77.63% to 98.08%). The main cognitive intervention focused on basic cognition (80.92% to 94.74%). Typical interventions were caregiver education (83.89%), physical activity (73.15%), and perceptual retaining (68.46%). Challenges to OT intervention were therapists had poor evaluation skills, unclear intervention guidelines, and an insufficient number of therapists. Conclusion: OTs should participate in further education and develop a guideline and appropriate comprehensive cognitive assessment tools.

Practice Guidelines: Addressing Vestibular and Visual Problems in the Neurologically Impaired Adult

The visual and vestibular problems experienced by adults post brain injury (concussion, traumatic brain injury, cerebral vascular accident, tumor removal, etc.) must be evaluated and treated in conjunction with each other for best outcomes. The American Occupational Therapy Association’s (AOTA) Practice Framework categorizes both the visual and vestibular sensory systems as client factors (body functions) that are a part of the scope of practice of occupational therapy (AOTA, 2020). AOTA’s statement on vestibular impairment, vestibular rehabilitation, and occupational performance emphasizes the importance of occupational therapists addressing this critical client factor. The skills of entry-level and advanced-level occupational therapists are outlined in that document (AOTA, 2017). The objective of this article is to provide practical guidance to support advanced-level occupational therapists in more careful analysis of vestibulo-ocular skills that are needed for safe and efficient occupational performance. Literature and conceptual models from 1986 to 2021 from the fields of occupational therapy, physical therapy, ophthalmology, optometry, audiology, neurology, and otolaryngology that address the visual and vestibular problems experienced by adults with traumatic brain injury were reviewed and compared. Two models are presented to provide a framework to guide occupational therapy assessment and intervention of clients with neurological disorders who have vestibulo-ocular deficits that interfere with occupational performance.

Working with clients of higher weight in Australia: Findings from a national survey exploring occupational therapy practice.

Occupational therapists are key members of the multidisciplinary team and regularly work with people of higher weight across age groups and practice settings. There is limited existing research regarding the occupational therapy role with this client group. The aim of this study was to explore occupational therapy practice and barriers to service provision for Australian occupational therapists working with clients of higher weight. A cross-sectional study design using a self-administered online survey was distributed to members of the national occupational therapy professional association. The survey was designed to identify common assessments and interventions used with clients of higher weight and explore occupational therapists' perspectives on their knowledge and confidence and the barriers to service delivery. Descriptive statistics were used to summarise rating scales, and open-ended responses were analysed using thematic analysis. Eighty Australian occupational therapists working in a range of settings and with varied experience levels participated in the study. Participants described the most common areas of occupational therapy assessment and intervention when working with clients of higher weight to be self-care, equipment prescription, home modifications and pressure care. Respondents were least confident in interventions related to psychosocial, leisure and employment interventions. Barriers to service delivery included accessibility and cost of equipment, lack of training and weight stigma. Occupational therapy practice promotes and enables participation in everyday occupations with people of higher weight. This study highlights not only the occupational therapy skills and unique approach to the person, their environment and occupations but also the challenges faced by occupational therapists when working with people of higher weight. Occupational therapists could consider utilising the weight-inclusive paradigm to broaden their contribution from self-care to other important aspects of participation and well-being.