Principles Of Occupational Therapy Research Articles

Occupational therapy in the space of artificial intelligence: Ethical considerations and human-centered efforts

Background Artificial intelligence (AI) technology is constantly and rapidly evolving and has the potential to benefit occupational therapy (OT) and OT clients. However, AI developments also pose risks and challenges, for example in relation to the ethical principles of OT. One way to support future AI technology aligned with OT ethical principles may be through human-centered AI (HCAI), an emerging branch within AI research and developments with a notable overlap of OT values and beliefs. Objective To explore the risks and challenges of AI technology, and how the combined expertise, skills, and knowledge of OT and HCAI can contribute to harnessing its potential and shaping its future, from the perspective of OT’s ethical values and beliefs. Results Opportunities for OT and HCAI collaboration related to future AI technology include ensuring a focus on 1) occupational performance and participation, while taking client-centeredness into account; 2) occupational justice and respect for diversity, and 3) transparency and respect for the privacy of occupational performance and participation data. Conclusion and Significance There is need for OTs to engage and ensure that AI is applied in a way that serves OT and OT clients in a meaningful and ethical way through the use of HCAI.

Interoception and its application to paediatric occupational therapy: A scoping review.

Paediatric occupational therapists assess and provide intervention for children presenting with sensory processing challenges that impact their daily occupational performance. Interoception, the ability to sense internal body signals, is an emerging practice area, yet it remains unclear how and why paediatric clinicians are applying interoception and related concepts in practice. A scoping review was conducted to report on the current body of published literature related to interoception and its application to paediatric occupational therapy practice. A comprehensive search of 10 electronic databases and related grey literature was conducted. Title and abstract screening were completed prior to full-text review of evidence. The PRISMA-ScR Checklist and the Crowe Critical Appraisal Tool were used to support a systematic scoping review process and increase robust extraction and appraisal of data. Narrative synthesis was used to analyse and synthesise data. No consumer and community involvement. A total of 18 articles were included in this review, including original research articles (n= 8), published books (n= 4), theses/dissertations (n= 3), opinion pieces (n= 2), and one government document. Narrative synthesis analysis identified six themes: (1) occupational therapy principles relevant to interoception, (2) what is interoception?, (3) assessment of interoception, (4) clinical application of interoception, (5) clinical populations receiving interoception-based intervention, and (6) relationships between interoception and other performance components. Findings indicated that paediatric occupational therapists are integrating interoception concepts alongside occupational therapy principles to inform assessment and intervention processes. Several assessments and interventions are utilised to support children; however, evidence to strengthen use is lacking. Further, there are limited occupation-based assessments and intervention programs to address interoception deficits in children. Findings from this scoping review contribute to the emerging body of empirical evidence related to interoception and paediatric occupational therapy practice. These findings provide an informed basis for practice and research by occupational therapists in this area. Interoception allows us to feel what is going on inside our body and helps us to notice how our body might be feeling (e.g. if our stomach grumbles, we might feel hungry; if our heart is beating very fast, we might feel scared; if we are sweating, our body is feeling overheated). Some children may present with problems recognising interoceptive feelings in their bodies. Therefore, occupational therapists can help children learn about their own interoception related to their bodies. This is a new topic for therapists, and they need to know more about it so that they best help children and their families. There is not a lot of information about how to use interoception in occupational therapy practice, and we wanted to know what information already exists about interoception and occupational therapy. This review provides a summary of the current knowledge that is available and summarises it. Some information about interoception and how it relates to occupational therapy services with children was found, but more research knowledge about this topic is needed.

Preventing Surgeon Work-Related Musculoskeletal Disorders: A Pilot Study of the Comprehensive Operating Room Ergonomics (CORE) Program.

Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy-oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors. To design, implement, and assess the potential of the Comprehensive Operating Room Ergonomics (CORE) program for surgeons, a holistic evidence-based ergonomics and wellness intervention grounded in occupational therapy principles. Mixed-methods pilot study with the quantitative strand embedded in the qualitative strand. University-affiliated hospital. Six laparoscopic surgeons. CORE program outcomes were assessed using qualitative and quantitative data to indicate changes in posture, physical discomfort, sense of wellness, and operating room (OR) ergonomic performance. The Rapid Upper Limb Assessment (RULA) was used to quantify surgeons' WMSD risk level before and after intervention. There were 12 baseline observations (two for each participant), and two or three post-CORE implementation observations. A statistically significant difference, F(1, 6) = 8.57, p = .03, was found between pre- and post-occupational therapy intervention RULA scores. Thematic analysis of surgeon feedback, which was overwhelmingly positive, identified five themes: postural alignment, areas of commonly reported physical pain or discomfort, setup of the OR environment, surgical ergonomics training, and ergonomics in everyday life. The CORE program effectively decreased ergonomic risk factors to optimize surgeons' occupational performance in the OR. This study demonstrates a potential solution to how occupational therapists can holistically support surgeons and health care providers who are at risk for WMSDs. Plain-Language Summary: By 2025, a surgeon shortage is expected, partly because of the increase in surgeons' work-related musculoskeletal disorders, which affect their health and job continuity. This pilot study shows that the Comprehensive Operating Room Ergonomics program effectively addresses these problems. The study also serves as a framework for occupational therapy professionals to work with health care providers on ergonomics, benefiting population health. Results suggest that this approach could enhance surgeons' work conditions, supporting the American Occupational Therapy Association's Vision 2025 to improve health and quality of life.

Acceptability and usability of assistive equipment and technology by individuals with multiple sclerosis: A qualitative study with occupational therapists

Introduction: Assistive equipment and technology (AE&T) is often part of occupational therapy practice for individuals with multiple sclerosis (MS). We aim to explore the acceptability and usability of AE&T by people with MS from the perspective of occupational therapists. Methods: Our study applied a qualitative descriptive design, using semi-structured interviews conducted with five qualified occupational therapists with at least 6 months of experience in providing occupational therapy to adults with MS. Reflexive thematic analysis was used for data analysis. Findings: Three developed themes describe the occupational therapists’ experiences: ‘The cognitive impact of the illness rather than the physical’, ‘There’s a drive to not let the MS win’ and ‘They have to experience it by doing’. Therapists perceive cognitive changes, the meaning of technology and a person-centred approach as elements influencing the acceptability and usability of AE&T. Conclusion: Our findings highlight the importance of using core occupational therapy principles and approaches to best support people with MS in using AE&T effectively.

Collaboration within a curriculum of support in the classroom: occupational therapists' and educators' perceptions and experiences

Introduction: According to South Africa's key education policies, all children can learn and need support, necessitating collaboration between occupational therapists and educators. Collaboration between occupational therapists and educators within the classroom is however a relatively new practice in South Africa and there is a dearth of literature that report on studies in this regard. The aim of this study was thus to explore occupational therapists' and educators' experiences in adopting a classroom approach in three primary mainstream schools in the Metro North education district in the Western Cape. Methodology: A qualitative research approach andexploratory descriptive design was utilised. Data collection included semi-structured interviews and focus groups with educators and occupational therapists who participated in the curriculum of support in the classroom programme. Thematic data analysis was conducted. Findings: Three themes highlighting the meaning and value the participants assigned to classroom collaboration, andfactors that facilitate or limit the implementation of the curriculum of support emerged from the analysis. Conclusion: The study is useful in expanding the understanding of the changing role of occupational therapists within the context of inclusive education and contributes to the development of educator support strategies utilising the whole classroom approach. This approach entails the educator and occupational therapist working together in implementing activities in the classroom to all learners. These learning activities are based on curriculum themes and occupational therapy principles and components. IMPLICATIONS FOR PRACTICE Occupational therapists' roles in the education practice context are expanding from traditionally working in special school settings to providing support to educators within public mainstream schools. The role of the occupational therapist within public mainstream schools is evolving from a consultative role and providing input into the individual support of learners to providing hands-on support to educators and collaborating with them within the classroom.

Using occupational therapy principles and practice to support independent message generation by individuals using AAC instead of facilitated communication

Facilitated communication (FC) has been a heavily debated and documented topic across multiple disciplines, including sociology, education, psychology, pediatrics, speech-language pathology, and disability studies. Although many professionals from various disciplines and advocates have offered opinions, suggestions, and research on the topic, there has been minimal input from the occupational therapy (OT) profession. The lack of OT input is noteworthy as OTs are experts in enabling upper extremity performance and independence through a variety of training, adaptation and modification strategies, and use of external supports. Because of their professional code of ethics and a specific knowledge base, OTs are uniquely positioned to provide a host of ethical and evidence-based strategies that enable independent access to communication technology. The consideration of multiple access options is contrary to the typical facilitated encounter where facilitators exclusively choose to manipulate an upper extremity in order for letters to be selected on a display or keyboard. The purpose of this paper is threefold: (a) To offer insight into the standard of care by OTs including their ethical standards; (b) to identify varied accommodations that enable access using a feature-matching standard of care that eliminates the need for a facilitator; and (c) to highlight how to increase independent assistive technology/augmentative and alternative communication access, thus dissuading the need or use of facilitated access to letters.

Cultural competence in occupational therapy to reduce health disparities: a systematic literature review

Background/Aims Despite agreement about the relationship between cultural competence and health equality, there is a lack of clear guidance within occupational therapy about what it means to be culturally competent and how it can be achieved. This literature review aims to critically appraise qualitative research to explore occupational therapists' experience of working cross culturally. By comparing these experiences, this review aims to identify ways in which occupational therapists individually, and occupational therapy as a profession, can increase the efficacy of the interventions they provide within cross-cultural situations, so all clients can be supported to achieve equal health outcomes. Methods The following databases were searched between 2010 and 2020: ASSIA (Applied Social Science Index), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, Embase, Medline Pubmed. The resultant papers were appraised using the Critical Appraisal Skills Programme checklist and thematic analysis was used to identify three themes. Results The six papers included in this review present the experiences of occupational therapists and occupational therapy students working in cross-cultural situations in the UK, Canada, South Africa, USA, Australia and Ireland. Three major themes emerged that explore the relationship between client-centred practice and cultural competence, theory–practice links, and strategies and barriers to working in a culturally competent way. Conclusions Cultural competence is strongly aligned with some of the core principles of occupational therapy: occupational justice and occupational identity. However, theoretical knowledge and confidence among occupational therapists in this area is lacking, implying that their impact could be greater if there was a more concrete definition of cultural competence and standardised guidelines for practice. Further research is needed to build on the strategies and overcome barriers, so that occupational therapists can fulfil the professional obligation they have to work effectively with all populations.

Doing, being and becoming – the synergetic relationship of occupational therapy principles and employability

Doing, being and becoming – the synergetic relationship of occupational therapy principles and employability

Occupational Therapy Department's Engagement in the Organizational Management of Coronavirus Disease-2019 Pandemic in an Acute Care Setup

Background: Coronavirus disease-2019 (COVID-19) pandemic came as a big challenge to the medical fraternity. The novelty of its manifestation made it clear that occupational therapy (OT) professionals would require to adapt to the ever-changing scenario of the pandemic and engage in newer roles to combat the pandemic. Objective: The objective of the study was to provide descriptive narration of the process of engagement of the OT department in handling the COVID-19 pandemic at an acute care setup. Study Design: A perspective from a clinical experience and a narrative review. Methods: Narrative account of the initiatives, challenges, preparations, and outcomes of the measures taken by the King Edward VII Memorial Hospital's (KEMH) OT Department's professionals as part of a multidisciplinary team member in combating the COVID-19 pandemic is reported. The occupational therapist at KEMH used core OT principles and teachings in treatment sessions and managerial functions to aid patients and the organization during the pandemic. Results: The measures taken by the OT department professionals at KEMH helped facilitate the management of the COVID-19 pandemic at the hospital. Being well-versed with the organization's style of functioning and philosophy enabled the OT department to work as part of a multidisciplinary team. The active participation of occupational therapists underlined their role in acute respiratory conditions. It helped OT be a part of the critical management of COVID-19 patients admitted in the hospital and at the Jumbo care centers developed by the hospital team of experts. Conclusion: The COVID-19 pandemic allowed OT professionals to create new processes and enhance service delivery through innovative actions in an acute care setup.

Changing Perspectives of Local Therapists Eight Years after the Implementation of an Occupational Therapy Service in a Unique Himalayan Cross-Cultural Setting.

Background. Whether concepts and principles of Occupational Therapy (OT) can successfully be applied to non-Western and cross-cultural settings is being intensively discussed. Aims/Objectives. We explored the changing perspectives of local occupational therapists (OTs) eight years after the implementation of an OT service in a Himalayan cross-cultural setting in terms of (1) treatment applied, (2) professional identity, and (3) cross-cultural interactions. Material and Methods. A qualitative study design was chosen, and semistructured interviews were conducted in all employed practitioners (a) during implementation and (b) eight years later (n = 7). Questions were carefully formulated in order to narrow down the intended issues but respecting crosscultural differences. The framework method was implemented for data analysis. Findings. Long-term empowering local OTs resulted in the successful development of a sustainable OT department in a unique Himalayan cross-cultural setting. Practitioners became aware of their therapeutic potentials, a clear sense of professional identity was developed, and it was recognised that sensitive cross-cultural practice is only achieved by an ongoing and intentional cultural learning process. Conclusions and Significance. Our findings suggest that OT can be applied to non-Western cross-cultural settings.

The role of Occupational Therapy in Africa: A scoping review

Objectiv e: This scoping review explores the role of occupational therapy in African countries including major practice areas, specific activities within practice areas, and potential considerations unique to the African context. Method : Two authors independently reviewed articles from online database searches and manual searches of reference lists and specific Occupational Therapy journals using a combination of keywords related to ‘Occupational Therapy’, ‘Africa’, and ‘role’. Articles were included based on pre-determined eligibility criteria (i.e., peer-reviewed, English articles that describe occupational therapists’ tasks/ activities) and discussion to reach consensus. The authors charted data through content analysis of the articles based on the review’s objectives prior to drawing out common themes relevant to the African context. Results : Thirty-two articles were included covering twelve African countries, though predominantly focused on South Africa. Findings demonstrate that, despite having tasks specific to practice areas, the overarching role of occupational therapy is facilitating engagement in meaningful occupation. Additionally, the findings highlight a vital role for African therapists in community-based services and the need to consider the unique cultural context in practice. Conclusion : Congruent with universal occupational therapy principles, Occupational Therapy in Africa aims to facilitate engagement in meaningful occupation, but therapists should consider their unique cultural context to ensure meaningful and sustainable outcomes whilst maintaining a valuable universal identityObjective: This scoping review explores the role of occupational therapy in African countries including major practice areas, specific activities within practice areas, and potential considerations unique to the African context. Key words : Occupational Therapy, Occupational Therapists, Africa, role, culture, community-based

The Supporting Older Americans Act of 2020: How Policy Connects With Occupational Therapy Principles and Practice.

The U.S. population is aging at an unprecedented rate, creating both opportunities and challenges for the overall health of the nation. Occupational therapy practitioners can inform important health policies by developing an understanding of the basis for relevant laws and programs and how occupational therapy principles relate to policy goals. This column discusses the Older Americans Act of 1965 (reauthorized as the Supporting Older Americans Act of 2020) and describes ways in which the objectives of this legislation align with the principles and practice of occupational therapy. Recommendations are provided for how the field of occupational therapy can enhance current policy development and debate, thus leading to expanded opportunities for the profession.

The role and scope of occupational therapy in Africa

Purpose Occupational therapy (OT) is a global health profession that promotes participation in meaningful occupations to enhance well-being, particularly for persons with disabilities. Occupational therapy is relatively new in many African countries and there is limited research regarding the role of OT in this region. Thus, this study aims to understand the role and scope of OT in Africa by exploring its unique contribution to healthcare and cultural considerations for practicing OT in various African contexts. Methods We conducted an exploratory qualitative descriptive study involving semi-structured interviews with 15 occupational therapists from 11 African countries. Interview questions focused on participants’ work activities, rewards and challenges of their work, and perceived contribution to healthcare. We audio-recorded and transcribed interviews followed by inductive thematic analysis. Results All participants described maintaining multiple roles. Four main themes (with sub-themes) emerged: advocacy (clients and the profession), collaboration (multi-disciplinary team, professional support, and internationally), maintaining core OT principles (occupation, function, participation, empowerment, and holistic practice), and contextual considerations (community-based services, practice approaches, sustainability, cultural norms, and spirituality). Conclusions Occupational therapists working in African contexts have a unique and challenging role involving advocacy and collaboration. They need to maintain core OT values whilst addressing contextual considerations to ensure culturally relevant practice. Implications for Rehabilitation Occupational therapists have an important role in promoting health and well-being; however, practice is influenced by the cultural context. Occupational therapists in Africa maintain multiple roles, including advocacy for their clients and the profession, and collaboration within a multidisciplinary team, for professional support and internationally. African occupational therapists need to be rooted in core OT principles whilst considering their unique context to ensure culturally relevant practice.

Who Benefits from An Intervention Program on Foundational Skills for Handwriting Addressed to Kindergarten Children and First Graders?

This study examined the effectiveness of a 10-wk intervention program based on occupational therapy principles on visual-motor integration skills and fine motor abilities in kindergartners and first graders. We recruited 55 students tested three times with the Visual-Motor Integration Test (VMI) and Movement Assessment Battery for Children-2 (MABC-2): before the intervention (T1), post-intervention (T2) and one month later (T3). Research findings: Significant improvements were found on VMI between T1 and T2, particularly for kindergartners. Neither group of children demonstrated changes on manual dexterity scores. The present study showed that the intervention program led to different changes in the at-risk of motor impairment group than in the not at-risk children. Results indicated that games and stimulation activities helped children below the 16th percentile over time in the manual dexterity domain. A gender effect was observed, with female children increasing their abilities over time more than male peers. Future research should concentrate on stimulating fine motor skills in hand manipulation and test how these abilities influence graphomotor skills and handwriting over time. Finally, more research is needed to determine the impact of activities and games carried out in educational settings.

Using systematic collaborative reflection to enhance consumer-led mental health research

IntroductionConsumer-led and collaborative research is consistent with occupational therapy principles of inclusion and client-centredness, and is increasingly valued in mental health. Our research...

Exploring the effectiveness of a screening measure to identify subtle cognitive and functional problems in a sample of acquired brain injury patients admitted to a neurological hospital in the UK: A feasibility study

Patients considered asymptomatic after acquired brain injury (ABI) may be exhibiting undetected cognitive deficits which can lead to problems with everyday tasks. Current screening tools focus on cognitive deficits and not functional impact. This cross-sectional feasibility study aimed to explore the use of a bedside screening tool: Cognitive Functional Performance Measure (CFPM). Drawing on occupational therapy theory and principles, the CFPM offers the multi-disciplinary team a unique tool to trigger referral to occupational therapy. A sample of patients with ABI (n = 34) were recruited and their CFPM scores were compared with scores on the Montreal Cognitive Assessment (MoCA) and the Kettle Test. Spearman’s rank and Chi-square were used to analyse the data. A moderate correlation was found between the MoCA and CFPM. There was no significant association between the type of ABI and performance on the CFPM. The unique design of the CFPM offers an alternative to existing screening tools, placing emphasis on the identification of cognitive impairment and functional deficits with the ultimate goal to develop a tool that is ecologically valid. Further studies exploring the feasibility and validity of the CFPM is recommended.

Experiences of participating in a client-centred ADL intervention after stroke

Background: This qualitative study was conducted in the context of a client-centred activities of daily living (CADL) intervention aiming to enable agency in daily activities and participation in everyday life after stroke. The intervention was based on the principles of client-centred occupational therapy and then further developed based on empirical research findings.Objective: To identify what from the clients’ perspective characterises the lived experience and meaning of participating in a CADL intervention after stroke.Methods: The study included 10 persons with stroke who received the intervention and who were able to communicate their experience of participating. Data were collected through two interviews, after the initiation and after the end of the intervention. The analysis was performed using an empirical phenomenological psychological method.Results: The overall characteristic of the meaning of participating in the intervention was transparency, which was expressed in the participants’ experiences of being able to see and follow their own rehabilitation process. An awareness and understanding of their own situation enabled the participants to be actively involved in their rehabilitation.Conclusion: The intervention contributed to transparency, which appeared to enable and support the client’s sense of ownership of daily activities and rehabilitation after stroke.Implications for rehabiliationA client-centred activities of daily living intervention seems to contribute to transparency, where persons with stroke can discover and understand their new ability and situation after stroke.A client-centred rehabilitation situation seems to enable clients to actively engage in their own rehabilitation process.Inviting clients to participate in goal-setting seems to be important in order to create the experience of transparency.Creating continuity in the therapeutic alliance seems to be important in order for the clients to feel trust and experience agency in everyday life.

Understanding the Mechanisms of Change in a Lifestyle Intervention for Older Adults.

This study investigated the mechanisms of change underlying an activity-based lifestyle intervention, an occupational therapy program aimed at promoting healthy habits, and routines in older adults. We examined two activity-relevant factors as potential mediators linking the intervention to reduced symptoms of depression: activity frequency and global perceptions of activity significance. Social connections and perceived control were assessed to understand how activity-related factors relate to reduced symptoms of depression. The sample consisted of 460 multiethnic community-dwelling older adults aged 60-95 years. Participants were randomly assigned to a 6-month lifestyle redesign intervention (n = 232) or a no-treatment control (n = 228) condition. After the 6-month period, 360 individuals completed post-testing. Latent change score models were used to represent changes from baseline over the experimental interval. Structural equation models were applied to examine the indirect effects of the intervention on reduced depressive symptoms. The results demonstrated significant indirect effects from intervention receipt to decreased depressive symptoms via increased activity frequency and activity significance. Higher activity frequency was linked to fewer depressive symptoms via heightened social connections, whereas increased activity significance was associated with fewer depressive symptoms via enhanced perceived control. The results support basic principles of occupational therapy by highlighting important mediating roles of activity frequency and activity significance in reducing depressive symptoms. Understanding of these change mechanisms can help optimize activity-centered interventions to reduce depressive symptoms.

Qualitative research is consonant with the espoused values of occupational therapy: A Review of Qualitative Research in Occupational Therapy

In her 2001 edited text, Qualitative Research in Occupational Therapy: Strategies and Experiences, Joanne Valiant Cook presents an approachable and informative introduction to qualitative research for occupational therapists. As the discipline of occupational therapy continues to develop its own base of knowledge, the need for research methods which capture the complexity of occupation has become evident. Through considering the similarity between the founding principles of occupational therapy and the world-view of qualitative research, Cook presents a theoretically-oriented research guide specific to the domain of concern of occupational therapy. Examples of qualitative studies and reflections of occupational therapy researchers will be helpful to occupational therapy practitioners and researchers embarking upon the journey of qualitative inquiry to contribute to the discipline’s body of knowledge.

Hand Impairment in Systemic Sclerosis: Various Manifestations and Currently Available Treatment.

Systemic sclerosis (SSc) is an autoimmune disease initially recognized by hand involvement due to characteristic Raynaud's phenomenon (RP), puffy hands, skin thickening, and contractures resembling claw deformities. SSc contributes to hand impairment through inflammatory arthritis, joint contractures, tendon friction rubs (TFRs), RP, digital ulcers (DU), puffy hands, skin sclerosis, acro-osteolysis, and calcinosis. These manifestations, which often co-exist, can contribute to difficulty with occupational activities and activities of daily living (ADL), which can result in impaired quality of life. However, despite this knowledge, most diagnostic and treatment principles in SSc are focused on visceral manifestations due to known associations with morbidity and mortality. Treatment of inflammatory arthritis is symptom based and involves corticosteroids ≤10mg daily, methotrexate, tumor necrosis factor inhibitors, tocilizumab, and abatacept. Small joint contractures are managed by principles of occupational hand therapy and rarely surgical procedures. TFRs may be treated similar to inflammatory arthritis with corticosteroids. All patients with RP and DU should keep digits covered and warm and avoid vasoconstrictive agents. Pharmacologic management of RP begins with use of calcium channel blockers, but additional agents that may be considered are fluoxetine and phosphodiesterase 5 (PDE5) inhibitors. DU management also involves vasodilators including calcium channel blockers and PDE5 inhibitors; bosentan has also been shown to prevent DU. In patients with severe RP and active DU, intravenous epoprostenol or iloprost can be used and surgical procedures, such as botulinum injections and digital sympathectomies, may be considered. For those with early diffuse cutaneous SSc needing immunosuppression for skin sclerosis, methotrexate or mycophenolate mofetil can be used, but the agent of choice depends on co-existing manifestations, such as inflammatory arthritis and/or lung involvement. Various pharmacologic agents for calcinosis have been considered but are generally ineffective; however, surgical options, including excision of areas of calcinosis, can be considered. Overall management of hand impairment for all patients with SSc should include occupational hand therapy techniques such as range of motion exercises, paraffin wax, and devices to assist in ADL. Thus, treatment options for the various manifestations contributing to hand impairment in SSc are limited and often modestly efficacious at best. Robust studies are needed to address the manifestations of SSc that contribute to hand impairment.