Occupational Therapy Assessment Research Articles

Development of a Cerebral Palsy Follow‐up Registry in Jordan (CPUP‐Jordan)

This study aims to describe the development of a Cerebral Palsy Follow-up Registry in Jordan (CPUP-Jordan) and to provide a baseline child and parent demographic information, birth history of the child participants, and distribution of the participants based on topographical distribution of cerebral palsy (CP) and functional classification systems. The CPUP-Jordan was developed using a similar framework of a follow-up surveillance programme for persons with CP in Sweden (CPUP). Standard assessment forms were utilized to collect data related to child and family demographics, child birth history, and functional classifications and physiotherapy and occupational therapy assessments and interventions. Research assistants were trained to conduct the assessments. A secured web-based system was developed to store data and disseminate knowledge maintained in the registry. Children with CP were included in the registry if they have confirmed diagnosis of CP. The ascertainment age of inclusion and the minimum age of survival required are 4years. One hundred sixty-seven children were registered between 2013 and 2015 (mean age is 3.6±3.0years). Forty-two percent were born premature, and 48% were less than the normal birthweight. Perinatal causes were reported for 54% of the participants. The most common type of CP based on tone disturbance was spastic type, and the most common topographical distributions of motor dysfunction were quadriplegia followed by diplegia. Fifty-six percent of the participants had severe limitation in ambulation; 48% had restricted manual abilities, and 47% had limited communication abilities even with familiar family members and partners. The development of CPUP-Jordan registry for children with CP proved to be both feasible and informative. The registry baseline descriptive data were similar to those reported in previous research in Jordan supporting validity of the data. The implementation of CPUP-Jordan at national level is expected to have a positive impact on children with CP, clinicians, policymakers, and researchers.

Anatomy education in occupational therapy curricula: Perspectives of practitioners in the United States.

The study of human anatomy is an integral component in the education of future occupational therapists, yet there is a paucity of research that explores the anatomy needs of students and new practitioners. As a follow up from a pilot study that surveyed a small cohort of practicing therapists, this article aimed to determine occupational therapy (OT) practitioners' views on anatomy course structure and content deemed important to include in OT curricula, entry level practitioners' anatomy knowledge, and application of anatomy in current practice. A Likert scale and free text questionnaire was distributed to practicing occupational therapists across the United States. Fifty-four percent of the participants in this cohort favored a standalone course, as compared to 94% in the pilot study group. Anatomy course content areas were comparable across groups. Systems identified as essential to cover in an OT anatomy course included skeletal, muscular, and nervous. Regions included the upper limb, thorax/trunk, head and neck, and lower limb. Seventy percent of participants in both groups felt that entry-level practitioners had adequate anatomy knowledge; 30% did not. Practice areas requiring anatomy knowledge included assessment of joint movement, muscle strength, pain, and functional mobility. Qualitative analysis of free text response data revealed the importance of anatomy knowledge in OT assessment and intervention strategies, determining the impact of injury or disease on occupational performance, client safety, and communication with other health care professionals and families. Anat Sci Educ 11: 243-253. © 2017 American Association of Anatomists.

Continuing competence assessment and maintenance in occupational therapy: Scoping review with stakeholder consultation.

Continuing competence activities hold the promise of improving health-care service quality, especially given concerns about system inefficiencies and fragmentation. The aim of this scoping review was to describe the assessment and maintenance of occupational therapists' continuing competence and identify knowledge gaps for future research. A secondary aim was comparing scoping review findings with those from other health-care fields and considering possible impact of varying international regulations. A series of database searches retrieved peer-reviewed and grey literature on assessment and maintenance of occupational therapy continuing competence from 1995 to 2015. Themes were developed and findings shared with stakeholders, whose comments drove a second phase: searching for reviews related to continuing competence from allied health, medicine, and nursing, and reviewing websites and documents concerning regulatory requirements for occupational therapy continuing competence in seven English-speaking nations. Twenty-seven sources from the scoping review search met inclusion criteria. Stakeholder consultation validated the themes and preliminary knowledge gaps. Research into other health-care specialties corresponded to findings from the scoping review. The website/document review of occupational therapy regulatory requirements revealed wide variation on both the state/province and national levels. This scoping review highlights gaps in research on effective methods and assessment of occupational therapy continuing competence. Findings suggest a need for research on approaches to continuing competence that incorporate the translation of evidence to practice and address the influence of external factors. Regulatory agencies may address the quality of occupational therapy services by incorporating a variety of professional development options into requirements.

Eudemonic Care: A Future Path for Occupational Therapy?

The core tenets of occupational therapy date to ancient Greece. Philosophers and physicians alike promulgated that quality of life, or “eudemonia,” is at the center of both ethical and medical concern and can be attained through healthful engagement in meaningful occupation. In more recent times, there has been a strong call to return to the powerful implementation of the eudemonic moral philosophy in health care practice, especially in occupational therapy. Searches of recent occupational therapy research show that integration of wellness initiatives into rehabilitative treatment sessions can have a profound impact on the physical and emotional healthfulness of people with a wide variety of ailments. Accordingly, we put forth three self-reflection questions and 10 client-centered questions to use in occupational therapy assessment to promote eudemonic care.

Bangladesh Norms for a Gender-Specific Functional Fine Dexterity Test (FFDT)

Background: Good psychometrics and cultural relevance are needed for evidence-based practice. Occupational therapy (OT) assessment tools in Bangladesh have been developed outside of Bangladesh and have not been validated or normed for Bangladeshis. This normative and psychometric study was to provide culturally relevant norms for in Bangladesh for bilateral fine motor. Method: The Functional Fine Dexterity Test (FFDT) consists of two functional/self-care gender-specific task instruments: a shirt with five buttons for males and a pinning board for females. Raters were trained in timing these tasks. Results: Intra-Class Correlation (ICC) scores were > .85 for all rater teams. Participants were timed three times while they completed the task. Convergent validity was examined using a Pearson’s Product-Moment correlation to compare the average of three trials of the FFDT and three trials of the Nine Hole Peg Test (NHPT). Male and female norms were developed for the FFDT using descriptive statistics. The sample included 180 Bangladesh participants. Convergent validity, when compared to the NHPT, ranged from r = .4 to .67 for males (ages 18-29 and 40-49), p < .05; and r = .53 to .76 for females (aged 18-39), p < .05. FFDT norms were developed for gender and age categories. Conclusion: The FFDT is a valid test to use for evaluating fine motor dexterity in Bangladesh. This is the first OT instrument to be studied for culturally relevancy.

Development and validation of the Vellore Occupational Therapy Evaluation Scale to assess functioning in people with mental illness.

Available occupational therapy assessment scales focus on specific areas of functioning. There is a need for comprehensive evaluation of diverse aspects of functioning in people with mental illness. To develop a comprehensive assessment scale to evaluate diverse aspects of functioning among people with mental illness and to assess its validity and reliability. Available instruments, which evaluate diverse aspects of functioning in people with mental illness, were retrieved. Relevant items, which evaluate specific functions, were selected by a committee of mental health experts and combined to form a comprehensive instrument. Face and content validity and feasibility were assessed and the new instrument was piloted among 60 patients with mental illness. The final version of the instrument was employed in 151 consecutive clients, between 18 and 60 years of age, who were also assessed using Global Assessment of Functioning (GAF), Occupational Therapy Task Observation Scale (OTTOS), Social Functioning Questionnaire (SFQ), Rosenberg Self Esteem Scale (RSES) and Pai and Kapur Family Burden Interview Schedule (FBIS) by two therapists. The inter-rater reliability and test-retest reliability of the new instrument (Vellore Occupational Therapy Evaluation Scale (VOTES)) were also evaluated. The new scale had good internal consistency (Cronbach's alpha = .817), inter-rater reliability .928 (.877-.958) and test-retest reliability .928 (.868-.961). The correlation between the general behaviour domain (Pearson's Correlation Coefficient [PCC] = -.763, p = .000), task behaviour (PCC = -.829, p = .000), social skills (PCC = -.351, p = .000), intrapersonal skills (PCC = -.208, p = .010), instrumental activities of daily living (IADL) (PCC = -.329, p = .038) and leisure activities (PCC = -.433, p = .005) scores of VOTES with the corresponding domains in the scales used for comparison was statistically significant. The correlation between the total score of VOTES and the total scores of OTTOS, SFQ and RSES was also statistically significant suggesting convergent validity. The correlation between the total score of VOTES with the total score of FBI is not statistically significant, implying good divergent validity. VOTES seems to be a promising tool to assess overall functioning of people with mental illness.

The COMPACT: A New OT Assessment—A Mixed-Methods Study

Abstract Date Presented 4/9/2016 A mixed-methods study was conducted on a new occupational therapy (OT) assessment designed to promote occupation-based and client-centered OT practice ideals. Results from OT practitioner focus groups and client data provide evidence to support initial content validity and clinical utility of this assessment. Primary Author and Speaker: Jan Stube Additional Author and Speaker: Debra Hanson

Longitudinal Evaluation of Injurious Falls and Fall Prevention Strategy Use Among People With Multiple Sclerosis

Abstract Date Presented 4/7/2016 This paper describes a study of the prevalence of self-reported injurious falls and trends in fall prevention strategy use among people with multiple sclerosis (MS). Findings and associated implications for occupational therapy assessment and intervention targeting people with MS are highlighted. Primary Author and Speaker: Elizabeth Peterson Contributing Authors: Miho Asano, Michelle Cameron, Marcia Finlayson

Fast Track Recovery Program After Endoscopic and Awake Intraparenchymal Brain Tumor Surgery

There is an increasing drive to deliver a more efficient, cost-effective service leading to shorter stays in hospital. The advent of endoscopic and awake tumor surgery has reduced the morbidity associated with brain tumor resection, allowing patients to mobilize and be discharged earlier. Here, we present the outcomes from a single neurosurgical center in the United Kingdom on a fast track recovery program. All consecutive patients undergoing elective endoscopic (n= 65) or awake (n= 10) tumor resection over a 3-year period between 1 December 2011 and 31 January 2015, under a single surgeon, were recruited. Data regarding their length of stay and outcomes were prospectively collated and analyzed. 66.7% of patients could be discharged safely within 1 postoperative day. Of the patients who stayed longer, 76% had a prolonged stay because of either social reasons or failing occupational therapy assessments. Only 6 cases (24%) of prolonged hospital admission were for medical reasons. Patients discharged within 1 day were no more likely to develop postoperative complications compared with those staying for longer (18% vs. 28%; odds ratio, 0.56; 95% confidence interval, 0.18-1.75; P= 0.21). The readmission rates were identical in both groups (16%). The only factor significantly affecting length of stay was World Health Organization performance score, both pre- and postoperative. An early discharge after endoscopic and awake craniotomy tumor resection is both safe and feasible for most patients and is not associated with increased postoperative morbidity. We recommend that all patients who have good baseline function be offered short stay surgery.

Identifying the brain regions associated with acute spasticity in patients diagnosed with an ischemic stroke

Spasticity is a common impairment found in patients that have been diagnosed with a stroke. Little is known about the pathophysiology of spasticity at the level of the brain. This retrospective study was performed to identify an association between the area of the brain affected by an ischemic stroke and the presence of acute spasticity. Physical and occupational therapy assessments from all patients (n = 441) that had suffered a stroke and were admitted into a local hospital over a 4-year period were screened for inclusion in this study. Subjects that fit the inclusion criteria were grouped according to the presence (n = 42) or absence (n = 129) of acute spasticity by the Modified Ashworth Scale score given during the hospital admission assessment. Magnetic resonance images from 20 subjects in the spasticity group and 52 from the control group were then compared using lesion density plots and voxel-based lesion–symptom mapping. An association of acute spasticity with the gray matter regions of the insula, basal ganglia, and thalamus was found in this study. White matter tracts including the pontine crossing tract, corticospinal tract, internal capsule, corona radiata, external capsule, and the superior fronto-occipital fasciculus were also found to be significantly associated with acute spasticity. This is the first study to describe an association between a region of the brain affected by an infarct and the presence of acute spasticity. Understanding the regions associated with acute spasticity will aid in understanding the pathophysiology of this musculoskeletal impairment at the level of the brain.

Occupational Therapy Interventions for Adults With Multiple Sclerosis

This Evidence Connection describes a case report of a woman with an exacerbation of multiple sclerosis (MS), applying the evidence for intervention from the systematic reviews on MS that were conducted in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. The occupational therapy assessment and treatment processes for an inpatient rehabilitation setting are described. Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the AOTA's Evidence-Based Practice Project.

Sudden onset of Cotard&amp;#8217;s syndrome as a clinical sign of brain tumor

We report the clinical case where the sudden onset of a Cotard syndrome in a 69 year old lady lead to the discovery of a multifocal glioblastoma in the right temporo-parietal lobe. Cotard’s syndrome is a rare psychiatric disorder in which the afflicted patient believes he or she is dead. These nihilistic thoughts are the expression of a rare syndrome first described by Jules Cotard in late XIX century. The Cotard’s syndrome has been studied and it seems that its psychopathology can be ascribed to the temporoparietal cortex. Although the Cotard’s syndrome is not part of the DSM-V it is common in psychiatric literature and is included in ICD-10-CM within code F22. It has been described associated with organic lesions and atrophy of the non-dominant temporo-parietal cortex, in pathologies like bipolar disorder, schizophrenia1, subdural hemorrhage2, multiple sclerosis, brain atrophy3 and cerebral infarction4 among others5-7. We observed the case of a female patient, 69 years old, with no relevant past medical history, that was admitted to the John Radcliffe Hospital in Oxford (UK) with an episode of numbness in the left hand and an episode of dizziness whilst at home, duration of symptoms was of 15 minutes and then resolved entirely. She had no history of head trauma. Neurological exam was unremarkable and the stroke team felt a CT scan was not required, however she failed occupational therapy assessment and was not sent home. During the night she developed the delusion of being dead. When being interviewed, in the next day early in the afternoon, she stated: – “I think I’m dead (...) it started during the night, like it was some kind of a dream, but this remain until now” (...) – “Do you rationally think you are dead?” – “I do. It may not make much sense since I realize I have blood pressure when they measure it but I rationally think I am dead.”

In the Groove: An Evaluation to Explore a Joint Music Therapy and Occupational Therapy Intervention for Children with Acquired Brain Injury

An acquired brain injury in children disrupts brain development and neural pathways, which may have serious implications on occupational role performance. Assessment and management of children with neurological disorders is complex and treatment requires the engagement of a multidisciplinary team. Increasing evidence indicates that both occupational therapists and music therapists work effectively towards similar goals with children with acquired brain injury. This evaluation investigated the effectiveness of a joint music therapy and occupational therapy group in promoting the development of self-regulation skills in children with an acquired brain injury or neurological condition, as part of a pilot project at a regional paediatric hospital in Australia. Six participants, aged five and half to ten years, were recruited through the acquired brain injury and neurology outpatient service at a regional paediatric hospital. Children underwent occupational therapy assessment and were identified to have sensory processing difficulties that negatively impacted on the child’s occupational roles of "friend" and "student." The intervention group, In the Groove, received seven, weekly, one-hour sessions, held for one hour on a weekly basis. Each session involved a variety of joint music therapy and occupational therapy activities, specifically planned to achieve intervention goals. A range of standardised occupational therapy and music therapy outcome measures were used, as well as non-standardised measures. All children received positive outcomes following intervention for at least one outcome measure. The findings indicate that joint music therapy and occupational therapy intervention may provide children with acquired brain injury and neurological impairment opportunities to develop self-regulation skills.

Methods of Handwriting Assessment in Occupational Therapy: A Quick Reference

Handwriting constitutes one of the main means of communicating ideas in written form. The prevalence of handwriting problems in typically developing children has been estimated to range from 5% to 25%. Difficulty in handwriting may interfere with academic performance and may lead to many consequences as discussed below. A proper intervention in this regard requires a proper assessment of the handwriting skills. This article attempts to provide quick guidelines for occupational therapy assessment in handwriting.

The development of the modified blaylock tool for occupational therapy referral (MBTOTR): a preliminary evaluation of its utility in acute care

Purpose: Acute hospitals are facing more complex admissions with older people at increased risk of functional decline. This study aimed to create and trial the feasibility of a new screening tool designed to identify patients at risk of functional decline who need an occupational therapy referral within acute care. Method: Ten screening tools were reviewed and the Modified Blaylock Tool for Occupational Therapy Referral (MBTOTR) was developed. The MBTOTR was applied in a retrospective chart review of 50 patients over the age of 65 years who were admitted to five acute wards. Data on patients identified at risk of functional decline were compared to patients who were referred to occupational therapy. Results: Occupational therapy referrals were made by ward staff for 14 out of the 50 patients reviewed (32.5%). Only 14% (n = 7) of patients did not require a referral. The MBTOTR identified no irrelevant occupational therapy referrals. However, 66.5% of patients identified as needing an occupational therapy referral did not get one. Conclusion: The MBTOTR identified high risk acute patients requiring an occupational therapy referral who were not referred to occupational therapy. Use of the MBTOTR would facilitate early occupational therapy referrals for complex patients, and potentially better discharge outcomes.Implications for rehabilitationThe MBTOTR can be used in acute care settings to facilitate relevant occupational therapy referrals.Without a screening tool, many older people who should have an occupational therapy assessment may not receive a referral for occupational therapy.Nursing and medical staff need to use this tool to identify older people in their care who may benefit from occupational therapy assessment and intervention.If occupational therapy referrals can be made early, this may contribute to reducing delays to discharge plans for complex patients.

“It Would Be a Shame to Lose Them”: A Critical Historical, Scoping, and Expert Review on the Use of Projective Assessments in Occupational Therapy, Part II

Projective assessments have a long history in occupational therapy, yet their relevance may be questioned. Part I of this article provided a critical history of their development and a scoping review of the evidence. This second article outlines an interview-based qualitative study of the clinical and academic perspectives of nine experts. Through this comprehensive two-part article, conceptual and methodological issues are articulated in order to suggest educational and clinical guidelines, and future research avenues. The place of projective assessments in occupational therapy is demonstrated as a salient specialty area of practice in the current evolving landscape of mental health.

Two-year assessment of the activity of an evaluation unit of fitness to drive

Driving is a complex and essential activity for patient autonomy. High Health Autority practice guidelines for the assessment of brain injury patient ability to drive are to be published in 2015 [1]. The main objective of this study is to analyze the activity of an evaluation unit of driving ability. The second one is to assess the compliance with clinical practice guidelines. Retrospective study concerning the relevance and the systematic nature of a medical assessment protocol ability to drive made by a PMR ward in tertiary university Hospital over a two year period. The protocol includes medical and ophthalmological evaluations, occupational therapy (OT) and neuropsychological assessment. Finally an on-road test with a suitable vehicle in the presence of a driving school instructor and an occupational therapist is made. A total of 77 patients were evaluated in our unit. We considered after evaluation that about half (23/52) of brain-damaged patients assessed in our unit were able to drive. Forty-two ophthalmologic assessments, 31 neuropsychological assessments and 25 reviews with OT coupled to a road test were performed. Practical analysis confirmed that the multidisciplinary assessment of visual, sensorimotor, cognitive and road test are consistent with the guidelines. However, the highlight of a neglect syndrome had not systematically dissuaded the driving capacity, that is not in line with the HAS guidelines. The assessment of ability to drive must be standardized, particularly concerning on-road test. Patient and family's information on the need to make such an assessment must be systematized and made as early as possible. It seems necessary to better estimate driving habits after evaluation of patient, whatever they were validated or not. It is also necessary to analyze post validation risk for accident [2]. Finally, these guidelines should be disseminated and shared by all stakeholders (evaluation unit, licensed physician, Committee on driving license).

“It Would Be a Shame to Lose Them”: A Critical Historical, Scoping, and Expert Review on the Use of Projective Assessments in Occupational Therapy, Part I

Projective assessments have a long history in occupational therapy, yet their relevance may be questioned. This first article reviews the clinical utility of projective assessments by providing a critical history of their development, followed by a scoping review of the current evidence. The second article outlines the opinions of nine experts in this field. Through this comprehensive process, conceptual and methodological issues are articulated in order to suggest educational and clinical guidelines, and future research avenues. The place of projective assessments in occupational therapy is demonstrated as a salient specialty area of practice in the current evolving landscape of mental health.

Exploring the Role and Scope of Clinical Assessment in Occupational Therapy

Exploring the Role and Scope of Clinical Assessment in Occupational Therapy

Spiritual Assessments in Occupational Therapy

Spirituality is recognized as an important concept in the study and practice of medicine, including occupational therapy. This aligns with occupational therapy’s core value of treating people holistically—mind, body, and spirit. Currently, the Joint Commission for the Accreditation of Hospital Organizations ( JCAHO) requires that a spiritual assessment be given to patients on admission. To conduct effective spiritual assessments, occupational therapists must distinguish between religion and spirituality. They also must be aware of their own spiritual beliefs and practices and how those might influence their clinical interactions. This article presents spiritual assessment tools that occupational therapists can use in clinical practice; they range from history taking, to questionnaires, to observation scales. Guidelines are presented for selecting among several spiritual assessments. A case study is presented in which a patient’s faith tradition is being challenged, which could affect the outcome of therapy. Finally, treatment and intervention planning and ethical considerations are discussed.