Occupational Therapy Clinic Research Articles

Getting Everyone in the Same Room: The Combined Therapist Approach to Teaching Independence in Clean Intermittent Catheterization

Introduction Most pediatric patients with neurogenic bladder require clean intermittent catheterization (CIC), several times daily, for maintenance of continence and health. CIC is performed by the caregiver until the child is developmentally ready to learn self-CIC. Children with associated mobility, dexterity, and cognitive deficits tend to take much longer to learn self-CIC. We piloted a combined pediatric urotherapy and occupational therapy clinic to address this problem. Methods Five children (6–14 years old) and their parents attended combined therapist sessions for 6 months. Explanation of self-CIC was done using show-and-tell method followed by doll play and/or supervised practice. Patients' mastery difficulties were identified by demonstration and collaborative discussion. Specific tasks and activities were recommended for home practice after task assessment and analysis. Reasons for slow progress in learning self-CIC were documented. Results All five children had motor and cognitive difficulties. Previously, caregivers regularly overassisted, which prevented patient practice and exposure. Task assessment, analysis, and recommendation had been suboptimal because patients' different combinations of disabilities caused unique difficulties with self-CIC that were unrecognized when attending individual therapist sessions. After the combined clinic, patients increased participation in the preparatory phase of self-CIC, functional mobility and dressing tasks. Discussion Despite longer session duration and scheduling constraints, the combined therapist approach was more efficient and effective for this category of patients, with fewer return sessions needed to achieve the desired outcome. We recommend early identification and referral of appropriate patients for a combined therapy clinic.

Return-to-Work Barriers Among Manual Workers After Hand Injuries: 1-Year Follow-up Cohort Study

ObjectiveTo determine time of return to work (TRTW) in relation to multivariable predictors among male manual workers after hand injury (HI) over a 12-month follow-up. DesignA cohort study with baseline medical information, functional evaluation, and 3-, 6-, 9-, and 12-month follow-up telephone interviews. SettingSeven physical rehabilitation community occupational therapy clinics. ParticipantsParticipants (N=178) with acute HI aged 22-65. Two participants were lost to follow-up. InterventionNot applicable. Main Outcome MeasureThe dependent variable was TRTW. The independent variables originated from 4 domains: personal factors, environmental factors, body function and structure, and activity limitation and participation restriction. The proportion of return to work (RTW) at each time point was calculated. Multiple Cox regressions established a predictive model for TRTW. ResultsAt the end of the study, 75.3% participants returned to work. The median TRTW was 94 days. In the final model, only compensation factors and education contributed significantly to overall RTW, but when separate analyses were performed, decreased level of self-efficacy, higher workplace demands, level of pain, level of emotional response to trauma, reduced physical capability of the hand, and higher level of disability were significantly associated with delayed TRTW. ConclusionsTRTW was determined by the physical capability of the hand, pain, and psychosocial factors, but it was also affected by legal factors. Participants who did not return to work during the first 9 months are at risk for long-term disability. Developing treatment programs for those who are at risk for not returning to work, taking into consideration these factors, is recommended.

Evaluation of pelvis postural systems in spinal cord injury patients: Outcome research

ObjectivesCompare three commercially available postural systems to determine the best for treatment of patients suffering from spinal cord injury lesion below the cervical spine.DesignOutcome Research.SettingAmbulatory.ParticipantsThirteen patients were recruited for this study between March 2016 and July 2016 from the Occupational Therapy clinic of “Policlinico Umberto I” hospital in Rome and Occupational Therapy of “CPO” hospital in Ostia. The patient samples consisted of eleven men (84.6%) and two women (15.4%). All the patient are suffering by SCI with a lesion below the cervical spine.InterventionWe evaluate postural systems customized by three different companies. Patients tried each pelvis device for a duration of one week, after which they have been asked to fill in questionnaire concerning static stability, temperature, movement adaptability, transfers and dynamical stability during the activities of every-day life. The impact on the health status has been evaluated by means of a further questionnaire (Health Status Scale SF-12) submitted to the patients.Outcome MeasuresQuality of life and daily life activities.ResultsThe analysis of the data from the questionnaire, along with those of objective nature associated with the mapping of the pressure due to weight distribution, has allowed the selection of the most appropriate clinical solution.ConclusionThis study has allowed two significant conclusions: the central role of the interplay between the patient and occupational therapist in the decision role and the clear evidence that patients with spinal cord injury felt definite differences between cushion stability and were able to indicate a specific typology providing the best satisfaction.

Approach to chronic low back pain in a Rural Mission Hospital: An audit report

Background: Challenging psychological and ergonomic burden demands a streamlined approach to Chronic low back pain (LBP) in rural population. Methodology: All patients with chronic LBP managed in the outpatient physiotherapy and occupational therapy clinic at the rural mission hospital from July 2015 to June 2016 were included in a retrospective chart audit. Patients' demographic data and diagnosis were statistically analyzed with t-test. Results: One hundred and fifty five patients were included in the study. 65 patients (42%) had mechanical LBP, 46 patients (30%) had chronic LBP with lumbar radiculopathy, 22 patients (14%) had discogenic chronic LBP, 15 patients (10%) had chronic LBP due to osteoporosis, 5 patients (3%) had chronic infective spondylitis and 2 patients (1%) had post-traumatic chronic LBP. 25 patients (16%) were less than 30 years old, 106 patients (68%) were between 30 and 60 years and 24 patients (16%) were older than 60 years. Higher incidence of mechanical chronic LBP was noted in younger group (t [129] = 1.36, P = 0.17) and higher incidence of chronic LBP with lumbar radiculopathy (t [129] =1.181, P = 0.239) was noted in middle aged patients, respectively. Gender prevalence of osteoporosis was statistically significant (t [153] =2.188, P = 0.03). Conclusion: Chronic LBP constituted 23% of all patients managed at the PT/OT outpatient clinic and mechanical chronic LBP was the most common diagnosis. Highest incidence of chronic LBP was noted in the middle aged 'working class' group of patients. Higher proportion of osteoporosis was detected among the female patients.

On-Campus Occupational Therapy Clinic Enhances Student Professional Development and Understanding

On-Campus Occupational Therapy Clinic Enhances Student Professional Development and Understanding

Auditing Access to Outpatient Rehabilitation Services for Children With Traumatic Brain Injury and Public Insurance in Washington State

ObjectiveTo identify insurance-based disparities in access to outpatient pediatric neurorehabilitation services. DesignAudit study with paired calls, where callers posed as a mother seeking services for a simulated child with history of severe traumatic brain injury and public or private insurance. SettingOutpatient rehabilitation clinics. ParticipantsSample of rehabilitation clinics (N=287): 195 physical therapy (PT) clinics, 109 occupational therapy (OT) clinics, 102 speech therapy (ST) clinics, and 11 rehabilitation medicine clinics. InterventionsNot applicable. Main Outcome MeasuresAcceptance of public insurance and the number of business days until the next available appointment. ResultsTherapy clinics were more likely to accept private insurance than public insurance (relative risk [RR] for PT clinics, 1.33; 95% confidence interval [CI], 1.22–1.44; RR for OT clinics, 1.40; 95% CI, 1.24–1.57; and RR for ST clinics, 1.42; 95% CI, 1.25–1.62), with no significant difference for rehabilitation medicine clinics (RR, 1.10; 95% CI, 0.90–1.34). The difference in median wait time between clinics that accepted public insurance and those accepting only private insurance was 4 business days for PT clinics and 15 days for ST clinics (P≤.001), but the median wait time was not significantly different for OT clinics or rehabilitation medicine clinics. When adjusting for urban and multidisciplinary clinic statuses, the wait time at clinics accepting public insurance was 59% longer for PT (95% CI, 39%–81%), 18% longer for OT (95% CI, 7%–30%), and 107% longer for ST (95% CI, 87%–130%) than that at clinics accepting only private insurance. Distance to clinics varied by discipline and area within the state. ConclusionsTherapy clinics were less likely to accept public insurance than private insurance. Therapy clinics accepting public insurance had longer wait times than did clinics that accepted only private insurance. Rehabilitation professionals should attempt to implement policy and practice changes to promote equitable access to care.

Does Parent Report Gross Motor Function Level of Cerebral Palsy Children Impact on the Quality of Life in these Children?

The aim of this study was to assess the effect of parent report gross motor function level of cerebral palsy (CP) children on the parent report quality of life of CP children. Sampling of this cross-sectional study was done in occupational therapy clinics and CP children's schools in 2016 in Zanjan, Iran. Samples size was 60 CP children aged 6-12 yr and for sampling method, a non-probability convenience was used. For assessing the quality of life of CP children the cerebral palsy quality of life (CP QOL) questionnaire and for assessing the level of gross motor function of CP children the Gross Motor Function Classification System Family Report Questionnaire (GMFCSFRQ) were used. The average age of children (22 males and 30 females) was 8.92 yr old (minimum 6 yr and maximum 12 yr). The relationship between the level of gross motor function and participation and physical health was direct and significant (r=0.65). The relationship between functioning, access to services and family health with the level of gross motor function was direct but was not significant (P>0.05) and the relationship between pain and impact of disability and emotional well-being with the level of gross motor function was significant (P<0.05). There was no strong correlation between the level of gross motor function and quality of life of children with cerebral palsy. It means that the level of gross motor function cannot be used as a predictor of quality of life for children with cerebral palsy alone.

Bilateral robotic priming before task-oriented approach in subacute stroke rehabilitation: a pilot randomized controlled trial

Objectives: To investigate the treatment effects of bilateral robotic priming combined with the task-oriented approach on motor impairment, disability, daily function, and quality of life in patients with subacute stroke. Design: A randomized controlled trial. Setting: Occupational therapy clinics in medical centers. Subjects: Thirty-one subacute stroke patients were recruited. Interventions: Participants were randomly assigned to receive bilateral priming combined with the task-oriented approach (i.e., primed group) or to the task-oriented approach alone (i.e., unprimed group) for 90 minutes/day, 5 days/week for 4 weeks. The primed group began with the bilateral priming technique by using a bimanual robot-aided device. Main measures: Motor impairments were assessed by the Fugal-Meyer Assessment, grip strength, and the Box and Block Test. Disability and daily function were measured by the modified Rankin Scale, the Functional Independence Measure, and actigraphy. Quality of life was examined by the Stroke Impact Scale. Results: The primed and unprimed groups improved significantly on most outcomes over time. The primed group demonstrated significantly better improvement on the Stroke Impact Scale strength subscale (p = 0.012) and a trend for greater improvement on the modified Rankin Scale (p = 0.065) than the unprimed group. Conclusion: Bilateral priming combined with the task-oriented approach elicited more improvements in self-reported strength and disability degrees than the task-oriented approach by itself. Further large-scale research with at least 31 participants in each intervention group is suggested to confirm the study findings.

Factors Associated with Quality of Life in Mothers of Children with Cerebral Palsy in Iran

Objective/Background Children with cerebral palsy (CP) need more attention and care, especially from their mothers. This can affect the mothers’ quality of life (QOL) adversely. This study aimed to assess the QOL of Iranian mothers who have a child with CP, compared with mothers with a healthy child, focusing on some individual and social underlying factors. Methods Using a cluster-sampling approach, two groups of eligible mothers having children aged 4–12 years, with and without CP, from Tehran's randomly selected clinics, were chosen in a convenient way and enrolled in a cross-sectional study. A group of mothers with healthy children whose demographics closely matched with the group of mothers having children with CP were selected and recruited in the study. The group with mothers with children with CP was selected randomly from a convenience sample in 14 rehabilitation and occupational therapy clinics in Tehran, Iran. To collect data on characteristics of interest, mothers were interviewed, and the SF-36 Questionnaire was used to measure their QOL. The relationship between each characteristic and the mothers’ level of QOL was assessed, and the crude odds ratios (ORs) and adjusted ORs were measured by logistic regression. Results Sixty mothers with CP children, and 60 mothers with healthy children participated in this study. Their mean (±standard deviation) age was 33.79 (±6.02) years, and their children's mean age was 7.11 (±2.71). The two groups were significantly different in QOL mean score (57.35 ± 18.39 vs. 71.7 ± 13.58; p ≤ .001). It was shown that having a child with CP with intellectual disability is significantly related to a worse level of QOL of mothers (adjusted OR = 5.4, p ≤ .001), whereas having full-time jobs is reversely associated with it (adjusted OR = 0.2, p = .02). Conclusion Two important factors that lead to a worse QOL of mothers with a CP child are the unemployment of mothers and having a CP child with concurrent intellectual disabilities. To diminish the adverse effects of having a CP child on QOL of mothers, unemployed women who have a CP child with concurrent intellectual disabilities need more psychological support and help.

Inter-rater reliability of theAction Research arm test & Upper limb related fugel meyer test in Adult with CVA from qazvin

Introduction : Stroke is one of the most common life-threatening neurologic disorders and is among the most important causes of disability in adult life.Unilateral upper limb motor impairment is one of the main causes of dependence in activity of daily living. Action Research arm test &Upper limb related fugel meyer test evaluates upper limb motor performance of a hemiplegic patient. The aim of this study was to demonstrate inter-rater reliability of the tests. Materials and methods : In this analytic and reliability study, 20 patients with CVA aged from 40 to 65, selected form occupational therapy clinics& rehabilitation center in Qazvin based on convenience sampling were tested by two occupational therapists in one session. SPSS 18 and ICC test was used for data analysis (α=0.05). Result s : the ICC test was calculated and equalled to 0/972(ARAT),0/977(FMT) (p<0.05 ) Conclusion :ARAT &fugel meyer test inter-rater reliability is acceptable to be used for CVA patients

A possible correlation between vestibular stimulation and auditory comprehension in children with attention-deficit/hyperactivity disorder.

Twenty children, aged 10 to 12 years with attention-deficit/hyperactivity disorder (ADHD), were selected to study the effect of vestibular stimulation on auditory perception and sensitivity using the Integrated Visual and Auditory Continuous Performance Test (IVA CPT; a neuropsychological test that is applied in occupational therapy clinics). The present study examined children based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. After obtaining guardian and parental consent, the children were enrolled in the study and randomly matched according to age across intervention and control groups. The IVA CPT was applied as a pre-test. The children in the intervention group then received vestibular stimulation during therapy sessions twice per week for 10 weeks. The IVA CPT assessment (post-test) was then applied in both groups. The mean pre- and post-test scores were compared across groups. The statistical analyses revealed a significant difference in improvement in auditory comprehension. In conclusion, the present findings suggest that vestibular training is a reliable and powerful treatment option for ADHD, especially when combined with other training. Stimulating the sense of balance highlights the important interaction between inhibition and cognition.

Birth and developmental correlates of birth weight in a sample of children with potential sensory processing disorder

BackgroundMost research examining birth history (i.e. related birth complications) and developmental milestone achievement follow outcomes for infants at-risk with very specific birth weight categories and gestational age classifications. The purpose of this study was to examine how birth weight relates to infants’ birth histories and developmental milestone achievement when they fall into a variety of birth weight and gestational age categories.MethodsIn the current study, we examined birth histories and onset ages for developmental milestones by analyzing a convenience sample of anonymous existing data from 663 developmental histories completed by parents at the time of an initial evaluation at a pediatric outpatient occupational therapy clinic. Infants fell into 3 birth weight categories; low birth weight (LBW), normal birth weight (NBW), and high birth weight (HBW) and 3 gestational age classifications considered with birth weight; small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA).ResultsNBW, AGA, and SGA infants with related birth complications had lower birth weights than infants without birth complications. Larger birth weights were associated with earlier ages for independent sitting for HBW infants, earlier ages for eating solids for NBW infants, and earlier walking onsets for LBW and NBW infants. Higher birth weights were also linked with rolling at a younger age for LGA infants, earlier walking and speaking words for AGA infants, and sooner independent sitting for SGA and AGA infants.ConclusionsOur findings suggest that birth weight and gestational age categories provide unique insights into infants’ birth history and developmental milestone achievement.

VALIDITY AND RELIABILITY OF ACTIVITIES SCALE FOR KIDS (ASK) IN CHILDREN WITH CEREBRAL PALSY

Background: The aim of this study was to translate Scale for Kids (ASK) into Farsi and to determine its validity in children with cerebral palsy. Materials & Methods: In a methodological study, ASK was first translated into Farsi and then its validity and reliability was determined through a four-stage procedure. The first two phases of this four-stage procedure included cloudy translation into Farsi and back translation into English. In the third phase of this study, the validity of this test was determined through conducting a pilot study in which a group of professionals and also parents with children diagnosed as having CP rated the test. Finally, it was provided to two groups of parents (a group with children with CP and another group with children without any problems). Children with CP were recruited from the affiliated occupational therapy clinics of The University of Social Welfare and Rehabilitation Science and normal children were sampled from general population via a snowball procedure. 73 children with cerebral palsy and 69 normal children (5-15 years old) were participated in the study. Reliability (internal consistency and test-retest within a 2-week interval) and validity (content on basis of Lawasche's method, concurrent with GMFCS-E&R and discriminate) of ASK were analyzed using SPSS 13 software. Results: Content validity index demonstrated a high content validity (0.79 for university professors and 0.86 for parents). ASK and GMFCS- E&R (-0.901) strongly negatively correlated as it was shown by Spearman's correlation coefficiency. Internal consistency was assessed by Cronbakh's alpha and the result was 0.997. Line regression in CP and normal groups demonstrated significant statistic variation and this indicated a sophisticated discriminate validity of Farsi version of ASK. Test-retest reliability of ASK was 0.998. Conclusion: Farsi version of ASK has acceptable validity and reliability rates and it may be used for clinical as well as research purposes. Key word: Validity, Reliability, Activity of Daily Living, Activities Scale For Kids, Children

The Longer Term Functional Impact of a Traumatic Hand Injury on People Living in a Regional Metropolitan Australian Location

Aims: This article describes a study exploring the longer term functional impact of a traumatic hand injury on people residing in a regional metropolitan Australian location. Methods: A descriptive cross sectional retrospective survey was sent to adult patients who received treatment for a traumatic hand injury from the occupational therapy clinic at a regional Australian hospital, 1-4 years post injury (n=498). The Upper Extremity Functional Index was included in the survey. Findings: Over 90% of respondents reported having ongoing residual difficulties. Participants indicated that the most affected areas were work and leisure. Almost half the respondents agreed or strongly agreed that the exercises ‘hurt too much to do’ (46%) and that they ‘did not have enough time’ to do exercises (34.5%). Conclusions: This study emphasized notable longer term impact of a traumatic hand injury on people residing in a metropolitan Australian location; especially in the areas of work and leisure. Findings indicate the need for some change in the delivery of rehabilitation programmes in an Australian regional metropolitan context. Holistic consideration of factors which may influence outcomes will improve rehabilitation programmes and, in turn, overall quality of life for individuals who sustain a traumatic hand injury.

IMPROVING COMMUNICATION SKILLS OF PSYCHIATRIC PATIENTS: A GROUP IN OCCUPATIONAL THERAPY

This paper reports on a group conducted by two occupational therapists at Brentwood VA Psychiatric Hospital. This group met weekly in the occupational therapy clinic after patients had pursued individual activities during regular clinic hours. The goal of this group was to discuss feelings and interactions which had occurred in the clinic. Thus, this group was a verbal interaction group aimed at improving communication skills of patients. It is our feeling that discussion groups of this type are of definite value for psychiatric patients. At one point during this group, the two occupational therapists requested supervision. Occupational therapists may need some additional education in group dynamics and the process of individual supervision of group facilitators can be beneficial.

Factors Influencing Satisfaction and Efficacy of Services at a Free-Standing Psychiatric Occupational Therapy Clinic

As the number of therapists in mental health settings continues to decline, research is needed to explore the scope, satisfaction, and efficacy of services. In this study, we used Patton's (1997) Utilization-Focused Program Evaluation to explore scope of services, therapist and client satisfaction, and perceived efficacy of services in a free-standing community-based mental health occupational therapy clinic. Surveys were administered to 36 clients and 9 therapists and followed up by qualitative interviews with 6 therapists. We identified characteristics unique to a free-standing psychiatric occupational therapy clinic, along with factors contributing to satisfaction and perceived efficacy of services. The importance of a supportive therapeutic environment and emphasis on the therapist-client relationship were cited as key factors influencing both satisfaction and effectiveness of service. Results are presented and compared with the existing literature.

Assessments Used in Occupational Therapy Practice: An Exploratory Study

ABSTRACTThe purpose of this study was to explore the assessments used in occupational therapy practice through identifying most commonly used assessments and the rationale for their use in different occupational therapy practice areas. The study utilized a nonprobability convenience sample of 260 occupational therapy practitioners attending the American Occupational Therapy Association's annual conference. A descriptive survey research design was used for conducting this study. The survey instrument addressed three major questions related to (a) the area of practice, (b) the specific assessments used, and (c) reasons for using the specific assessments. Descriptive statistics were utilized to analyze the results. Results indicated most of the assessments used in occupational therapy clinics target body structure and function. Assessments were used due to their convenient availability in clinics, clinical utility and standardization, client-centeredness, development by occupational therapists, being taught in school/fieldwork, and being satisfying to insurance companies. Implications for occupational therapy education, practice, and research are presented.

Visual Perception Abilities and Executive Functions in Children with School-Related Occupational Performance Difficulties

This study identified the relative pattern of performance on measures of visual perception and executive functions in children with school-related occupational performance difficulties. The participants were 46 children aged 5 to 10 years (M = 7.4, SD = 1.3) referred to an occupational therapy clinic for difficulty in performing tasks such as handwriting, and cutting with scissors. Children completed the Developmental Test of Visual Perception, 2nd edition (DTVP-2), and parents and teachers completed the Behavior Rating Inventory of Executive Function (BRIEF). Results on the DTVP-2 identified that approximately one-third of the sample displayed impairments in visual perception, and children were more likely to demonstrate difficulties in the area of metacognition than behavioral regulation on the BRIEF. There were minimal significant correlations between the subscales of the DTVP-2 and BRIEF. Classification of children's executive functions on the BRIEF differed according to parent and teacher ratings, thus highlighting the importance of contextual influences in this assessment. Findings are discussed in relation to tailoring both assessment and intervention practices.

A Review of 41 Upper Extremity War Injuries and the Protective Gear Worn during Operation Enduring Freedom and Operation Iraqi Freedom

Forty-one patients with upper extremity war injuries sustained during combat operations Operation Enduring Freedom and Operation Iraqi Freedom were reviewed to report on protective gear availability and usage at the time of injury. Participants treated at the Madigan Army Medical Center occupational therapy clinic from August 2004 until February 2005 completed a questionnaire regarding injuries sustained during deployment. Overall, 6 injuries were to upper extremity regions that were covered with issued protective gear; 21 injuries were to areas not covered with issued protective gear (i.e., participant was not wearing issued gear), and 22 injuries were to regions that were not covered because no protective gear was issued for that body area. Although this study is limited, future research would provide valuable insights about the efficacy of current body armor and the need for additional or modified gear.

Upper extremity splinting: Nerve injuries in the war casualty

Abstract: The Global War on Terrorism has generated an increased incidence of upper extremity nerve injuries in American service men and women compared with previous wars. The body armor and Kevlar helmets that soldiers wear during battle protect their core, but do little to protect the extremities. Soldiers suffering gunshot wounds to the upper extremity frequently endure nerve trauma as well. In addition, rocket-propelled grenades, mortar rounds, and other weaponry cause trauma to the extremities that, although not life-threatening, can be devastating to the extremities. Frequently, the nerve trauma is induced by humerus fractures. In the past two years, there have been at least 25 patients seen at the Walter Reed Army Medical Center and Womack Army Medical Center occupational therapy clinics for upper extremity nerve trauma. This presentation is designed to discuss war injuries to the upper extremity and demonstrate various splinting methods for traumatic radial nerve palsy and radial/median nerve combined palsy.