Outpatient Occupational Therapy Research Articles

Effects of home-based virtual reality upper extremity rehabilitation in persons with chronic stroke: a randomized controlled trial

BackgroundUpper extremity rehabilitation in persons with stroke should be dose-dependent and task-oriented. Virtual reality (VR) has the potential to be used safely and effectively in home-based rehabilitation. This study aimed to investigate the effects of home-based virtual reality upper extremity rehabilitation in persons with chronic stroke.MethodsThis was a single-blind, randomized, controlled trial conducted at two centers. The subjects were 14 outpatients with chronic stroke more than 6 months after the onset of the stroke. The participants were randomly divided into two groups. The intervention group (n = 7) performed a home rehabilitation program for the paretic hand (30 min/day, five days/week) using a VR device (RAPAEL Smart Glove™; NEOFECT Co., Yung-in, Korea) for four weeks. The control group (n = 7) participated in a conventional home rehabilitation program at the same frequency. All participants received outpatient occupational therapy once a week during the study period. The outcome measures included the Fugl-Meyer Assessment of upper extremity motor function (FMA-UE), Motor Activity Log-14 (MAL), Jebsen-Taylor Hand Function Test (JTT), and Box and Block Test (BBT) scores.ResultsAll 14 participants completed the study. Compared to the control group, the intervention group showed more significant improvements in FMA-UE (p = 0.027), MAL (p = 0.014), JTT (p = 0.002), and BBT (p = 0.014). No adverse events were observed during or after the intervention.ConclusionCompared to a conventional home program, combining a task-oriented virtual reality home program and outpatient occupational therapy might lead to greater improvements in upper extremity function and the frequency of use of the paretic hand.Trial registration: This study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trial Registry in Japan (Unique Identifier: UMIN000038469) on November 1, 2019; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043836.

A case series on combining repetitive transcranial magnetic stimulation with conventional rehabilitation therapies for upper limb motor-function restoration

This case series reports the integration of repetitive transcranial magnetic stimulation (rTMS) with conventional rehabilitation therapies in three early subacute ischemic stroke patients with upper limb motor impairment. In Malaysia, data on the combination of rTMS with intensive rehabilitation for stroke patients remains limited. The three patients with completely paretic upper limb, began therapy on post-stroke day 20, 16, and 15, respectively. They received rTMS sessions with inhibitory protocols targeting the contralesional primary motor area (M1) at 1 Hz, 5 days per week for 2 weeks (10 sessions). Each session included 1800 pulses at 120% resting motor threshold for 40 minutes, followed by 60 minutes of upper limb motor-function training. Outpatient occupational therapy was then continued for 3 months. All patients showed neurological and functional recovery as measured by the Medical Research Council scale and Fugl-Meyer Assessment-Upper Extremity Motor. The gains were observed immediately after the 10 rTMS sessions and persisted at 3 months post-stroke. Furthermore, all patients also achieved total independence in daily activities, with Modified Barthel Index scores of 99-100. No serious adverse events were reported. This case series suggests that combining rTMS with conventional rehabilitation therapies during the early subacute phase may enhance upper limb motor function recovery in stroke patients.

Examining outpatient occupational therapy utilization among children and youth with special health care needs in South Carolina: A structural equation model of individual- and community-level factors

BackgroundChildren and youth with special health care needs (CYSHCN) comprise 23 % of the pediatric population in South Carolina (SC), compared to state prevalences of 13.6 %–24 % nationwide. While occupational therapy (OT) is critical to maximizing CYSHCN's participation in daily activities, there are significant disparities in rehabilitation access in the Southeast region. ObjectiveThis study examines associations between patient-and community-level factors and outpatient OT utilization. MethodsThis study analyzes OT utilization data among CYSHCN (N = 1913) in a health system in SC from 07/01/2022-06/31/2023, merged with Child Opportunity Index 2.0 zip-code level social drivers of health (SDOH) data. SDOH are non-medical factors that affect individual's long-term health, with estimates ranging from “very low” to “very high” opportunity. Structural equation modeling was conducted to understand complex associations between observed and latent variables in a real-world context. ResultsCYSHCN were diagnosed with congenital (40.77 %), developmental (37.87 %), and neurological/neuromuscular conditions (21.36 %). CYSHCN who were non-Hispanic Black or Hispanic and were hospitalized were associated with living in lower opportunity areas. CYSHCN with private or military/other insurance/self-pay were associated with living in higher opportunity areas than Medicaid-insured CYSHCN. CYSHCN who were female and ≥12 years demonstrated lower OT utilization. CYSHCN who participated in speech and/or physical therapy demonstrated higher OT utilization. OT utilization increased with each increase in SDOH. ConclusionWith these findings, healthcare providers may consider accessibility barriers, including transportation, when referring CYSHCN to OT services. Further research is needed to examine the impact of household-level SDOH on OT access across SC.

Examining Occupation-Based Outcome Measure Use in a Neurologic Outpatient Occupational Therapy Setting: A Knowledge Translation Initiative

Examining Occupation-Based Outcome Measure Use in a Neurologic Outpatient Occupational Therapy Setting: A Knowledge Translation Initiative

Characterizing Occupational Therapy Intervention for Children on the Autism Spectrum.

Occupational therapy is one of the most used interventions for children on the autism spectrum. There is a critical need to develop an operationalized list of key treatment components of usual-care occupational therapy practice for children on the autism spectrum. To identify and develop consensus on definitions and examples of key treatment components of usual-care occupational therapy for children on the autism spectrum, ages 6 to 13 yr. We conducted a Delphi study to obtain feedback from a panel of experts. Electronic survey. 17 occupational therapy panelists with expertise in autism intervention. Panelists rated the definition and example of each treatment component and provided feedback through multiple rounds of survey. On the basis of the panelists' feedback on Delphi Round 1, the criteria rating form was revised to include four questions for the definition and example of each treatment component. Through four Delphi rounds of consensus building, we developed an operationalized list of 20 treatment components with definitions and examples that incorporated elements of usual-care occupational therapy intervention for children on the autism spectrum. This operationalized list of treatment components serves as a foundational framework to improve education, practice, and research of occupational therapy intervention for children on the autism spectrum. Plain-Language Summary: This study identified and developed consensus on definitions and examples of key treatment components used in usual-care outpatient occupational therapy for children on the autism spectrum. Through four rounds of consensus building with 17 occupational therapy experts in autism, we identified 20 key treatment components central to occupational therapy practice. Our results have the potential to serve as a framework to improve education, practice, and clinical research in autism.

Diagnosis of spatial neglect and rehabilitation access for stroke survivors.

Spatial neglect in stroke survivors is associated with a decrease in quality of life. This disorder occurs in 20-80% of stroke survivors and up to 1/3 of stroke survivors will continue to experience chronic impairment. Occupational therapists are uniquely qualified to treat stroke survivors with spatial neglect due to their holistic approach but access to therapy is limited. Diagnostic coding is used to help determine appropriate reimbursement and continuation of care including rehabilitation services. The objectives of this study were to 1) identify the prevalence of diagnostic coding for spatial neglect in stroke survivors, and 2) identify the prevalence and types of rehabilitation for patients with diagnostic coding for spatial neglect. We completed a retrospective cohort analysis using 2018 and 2019 5% Medicare Limited Data Sets from the Centers for Medicare and Medicaid Services. We extracted all ischemic stroke survivors and stratified them by the presence of a secondary diagnostic code indicating spatial neglect. Rehabilitation Current Procedural Terminology codes were used to identify stroke survivors who received rehabilitation. Despite recommendations from clinical practice, only 4.9% had a diagnostic code for spatial neglect. Of those formally diagnosed, only 2.3% received outpatient occupational therapy after being discharged from acute care.

Conceptual Model of Effective Parenting Strategies for Mother with Children Who Experience Developmental Disorders

Aim Prior studies on Japanese parents raising children with developmental disorders have predominantly emphasized negative psychological aspects like parenting conflicts and challenges. Purpose of this study was to construct a conceptual model to aid mothers in parenting children with developmental disorders by identifying effective parenting strategies. Methods In this qualitative study, participants were mothers who engaged in a home program through individual outpatient occupational therapy. Therapy sessions occurred biweekly, totaling 12 sessions, each lasting 40 min. Data collection involved semi-structured interviews, and the data were analyzed through the Modified Grounded Theory Approach. Results Analysis of mothers’ narratives revealed heightened physical burden, psychological distress, severe stress, and social isolation. Our findings highlight those mothers who engaged in the home program navigated the intricate parenting landscape through problem-solving, including managing negative emotions, their demanding schedules, and societal norms. Conclusion This study offers insights into the perceptions, experiences, and behaviors of families in supporting the development of parenting strategies within the family. Occupational therapy should prioritize evaluating a mother’s parenting context and her interactions with her environment. Furthermore, it is crucial to provide support for her to independently formulate suitable parenting strategies that resonate with the specific circumstances of her family.

OTs Should Be Using Video Modeling to Teach Self-Care to Children with NDDs

ABSTRACT An evidence-based project aimed at finding whether utilizing video modeling as an occupational therapy (OT) intervention increased basic self-care skills in school-aged children with neurodevelopmental disorders (NDDs). A total of 11 pediatric outpatient OT clients, 6–12 years old, with one or more NDDs, participated in this project. Pre- and post-intervention surveys completed by their parents garnered information regarding parental views on their children’s self-care skills, parental stress, and quality of life. Real-time data gathered during the intervention revealed the efficacy of video modeling, showing an overall increase in the completion of basic self-care skills from 16.1% at baseline to 96.4%. Meaningful gains were achieved in all eight self-care skills addressed and with all participants, elucidating a combined mean percentage of 79.3% improvement using video modeling. Post-intervention, qualitative data showed resultant perspectives of less parental stress, improved quality of life for the children and their parents, and improved independence with basic self-care skills. Considering the increasing diagnosis of NDDs, the call for evidence-based interventions from both payers and NDD-related organizations, and the future socioeconomic ramifications of not addressing basic self-care skills, this project reveals the efficacy of video modeling as a viable, accessible, cost-effective intervention which can be utilized across environments to address these concerns.

A Cognitive Behavioral Approach to Improving Performance and Satisfaction in Meaningful Occupations in the Outpatient Mental Health Occupational Therapy Setting

This retrospective study explored the efficacy of integrating a cognitive behavioral frame of reference into outpatient occupational therapy treatment to improve performance and satisfaction in meaningful occupations in patients living with a mental health condition. Forty-eight medical records of patients aged eight to 78 years old were included in the study. The records included first and second administrations of the Canadian Occupational Performance Measure (COPM). This study strongly demonstrates that the incorporation of a cognitive behavioral approach into treatment for those living with a mental health condition creates positive, clinically significant change over time.

Differences in rehabilitation evaluation access for rural and socially disadvantaged stroke survivors

ABSTRACT Background Most stroke survivors have ongoing deficits and report unmet needs. Despite evidence that rehabilitation improves stroke survivors’ function, access to occupational and physical therapy is limited. Describing access to care for disadvantaged communities for different levels of stroke severity will provide proportions used to create Markov economic models to demonstrate the value of rehabilitation. Objectives The objective of this study was to explore differences in the frequency of rehabilitation evaluations via outpatient therapy and home health for Medicare Part B ischemic stroke survivors in rural and socially disadvantaged locations. Methods We completed a retrospective, descriptive cohort analysis using the 2018 and 2019 5% Medicare Limited Data Sets (LDS) from the Centers for Medicare and Medicaid Services using STROBE guidelines for observational studies. We extracted rehabilitation Current Procedural Terminology (CPT) codes for those who received occupational or physical therapy to examine differences in therapy evaluations for rural and socially disadvantaged populations. Results Of the 9,076 stroke survivors in this cohort, 44.2% did not receive any home health or outpatient therapy. Of these, 64.7% had a moderate or severe stroke, indicating an unmet need for therapy. Only 2.0% of stroke survivors received outpatient occupational therapy within the first year Rural and socially disadvantaged communities accessed rehabilitation evaluations at lower rates than general stroke survivors. Conclusions These findings describe the poor access to home health and outpatient rehabilitation for stroke survivors, particularly in traditionally underserved populations. These results will influence future economic evaluations of interventions aimed at improving access to care.

Cost analysis of outpatient services for major external structural birth defects: an ingredient approach in selected hospitals in Kiambu County, Kenya.

major external structural birth defects (MESBDs) are known to exert an enormous economic burden on individuals and health services; however, they have been vastly underprioritized as a public health problem in settings where cost analyses are limited. This study aimed at conducting a cost analysis of outpatient services for MESBDs in selected hospitals in Kiambu County, Kenya. a cross-sectional descriptive survey was conducted in four hospitals selected for providing outpatient corrective and rehabilitative services to the under-fives. An ingredient approach was used to gather data retrospectively on the cost drivers for castings, bracings, and tendonectomies from healthcare providers' perspectives for a one-year time horizon from January 1st, 2018, to December 31st, 2018. Prevalence-based morbidity data were extracted from outpatient occupational therapy clinic registers, whereas staff time was gathered through face-to-face inquiries. Associated cost drivers of 349 cases were quantified, valued using prevailing market prices, and categorized as recurrent costs. The unit economic costs were calculated as average costs, expressed in U.S. dollars, and inflated to the U.S. dollar Consumer Price Index from January 2018 to December 2018. the unit economic cost of all the cases was estimated at $1,139.73; $1,143.51 for neural tube defects (NTDs), $1,143.05 for congenital talipes equinovarus (CTEV), and $1,109.81 for congenital pes planus. the highest economic burden of MESBDs was associated with NTDs, and CTEV, respectively. We recommend further research to estimate the economic costs of MESBDs among school-going pupils to inform the equitable allocation of resources for health and childhood developmental programs.

Feasibility and efficacy of an early sensory-motor rehabilitation program on hand function in patients with stroke: a pilot, single-subject experimental design.

Hand and upper limb functional impairments following stroke lead to limitations in performing activities of daily living. We aimed to investigate feasibility and efficacy of an early sensory-motor rehabilitation program on hand and upper limb function in patients with acute stroke. A pilot, single-subject experimental, A-B-A study. Stroke unit of an educational hospital and an outpatient occupational therapy clinic. A convenience sample including five people with acute stroke. Participants received 3h of an intensive hand and upper limb sensory and motor rehabilitation program, 5days per week for 3months (15-min mental imagery, 15-min action observation, 30-min mirror therapy, 1.5-h constraint-induced movement therapy, and 30-min bilateral arm training). Activities were chosen based on the task-oriented occupational therapy approach. An assessor blinded to intervention program measured sensory and motor functions using action research arm test, box and block test, Semmes-Weinstein monofilaments, and upper extremity section of Fugl-Meyer assessment. Assessment data points in intervention and follow-up phases compared to baseline were in higher levels, sloped upwardly, and increased significantly for all participants in all outcome measures. The present pilot study showed that a package of nowadays evidence-based rehabilitation methods including mental imagery, action observation, mirror therapy, modified constraint-induced movement therapy, bilateral arm training, and task-oriented occupational therapy approach is able to improve sensory and motor functions of the hand and upper limb in patients with acute stroke.

Occupational Therapy Practice: Time From Stroke Onset to Outpatient Upper Limb Rehabilitation.

Upper limb stroke rehabilitation has been understudied in usual occupational therapy. The study's purpose was to describe the timing and amount of usual occupational therapy in the stroke population for hospital-based outpatient upper limb rehabilitation. A multi-site study of timing and amount of occupational therapy was calculated for mild and moderate upper limb stroke impairments using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE). Mild stroke participants (n = 58) had a mean of 164.25 days, and the moderate stroke participants (n = 64) had a mean of 106.75 days from the date of stroke onset to first treatment which was significantly different (p = .047). There were no significant differences in the amount of therapy between mild or moderate stroke patients. Mild stroke patients experience a longer delay in receiving outpatient occupational therapy compared with moderate impairments which may be attributed to the subtlety of the impairments that impact participation in daily activities.

Design and Use of a 3D-Printed Dynamic Upper Extremity Orthosis for Children With Cerebral Palsy and Severe Upper Extremity Involvement: A Pilot Study.

Children with cerebral palsy (CP) and severe hand impairment have limited options for upper extremity (UE) orthoses. To (1) design and fabricate a customized low-cost, functional, three-dimensional (3D) printed dynamic upper extremity orthosis (DUEO) and (2) examine, using a comprehensive evaluation, the effect of the orthosis on the UE function of children with unilateral UE CP, Manual Ability Classification System (MACS) Levels III to V. Pilot study. Assessments were performed pretreatment and immediately posttreatment. Hospital-based outpatient occupational therapy department. Five patients, ages 13 to 17 yr, with CP and unilateral UE involvement MACS Levels III to V. Custom forearm thumb opponens orthosis and the DUEO were designed and fabricated by a multidisciplinary team for use during eight 1-hr occupational therapy sessions targeting bimanual UE training. Pretreatment and posttreatment assessments included the Assisting Hand Assessment (AHA), Melbourne Assessment 2 (MA-2), Pediatric Motor Activity Log-Revised (PMAL-R), and the Pediatric Quality of Life Inventory: CP Module (PedsQL:CP). All participants had higher posttreatment scores on at least one measure. Four had minimal clinically important differences (MCID) on the AHA. Three met MCID criteria on MA-2 subtests (one negative change). Four demonstrated improvement on the PMAL-R (one participant achieved an MCID score), and three reported improvements in more than one PedsQL:CP domain. This novel 3D-printed device, in combination with occupational therapy, shows promising evidence that children who score in lower MACS levels can show gains in UE function. What This Article Adds: This study demonstrates that a customized, 3D-printed dynamic orthosis, in combination with occupational therapy intervention, can facilitate UE function in children with severe hand impairment.

Unmet Need for Outpatient Occupational Therapy Services Among Veterans With Mild Traumatic Brain Injury in the Veterans Health Administration: The Role of Facility Characteristics

ObjectiveTo investigate whether participation restrictions, an indicator of need for occupational therapy (OT), was associated with outpatient OT utilization in the Veterans Health Administration (VHA) among Veterans with mild traumatic brain injury (mTBI), and whether this relation differs by facility characteristics. DesignIn a secondary analysis of national VHA data, we used modified Poisson regression to model OT utilization (yes/no) as a function of participation restrictions (Mayo-Portland Adaptability Inventory Participation Index [M2PI]), facility characteristics, and covariates. Facility characteristics included complexity, geographic region, and self-reported access to specialty care. Covariates included prior OT utilization, sociodemographic factors, injury characteristics, and spatial access (eg, drive time). Interactions estimated whether the relation between participation restrictions and OT utilization differed across facility characteristics. SettingOutpatient setting in the VHA. Participants8684 Veterans with a clinician-confirmed mTBI who received outpatient VHA care between 2012 and 2020 (N=8684). InterventionsNone. Main Outcome Measure(s)OT utilization was measured within a year of M2PI administration using VHA administrative data. ResultsMany Veterans who did not receive OT reported participation limitations, indicating unmet need for OT (eg, 67% with leisure restrictions). Participation restrictions were associated with increased likelihood of receiving OT (risk ratio [RR]=1.01; 95% confidence interval [CI]=1.006-1.019), suggesting a tendency for Veterans’ OT-related needs to be satisfied. However, interactions indicated that this was not the case among Veterans receiving care in lower complexity facilities, and those in the South. Veterans with longer drive times were less likely to receive OT (RR=0.82; 95% CI=0.744-0.904). ConclusionsParticipation restrictions were associated with OT utilization, yet many Veterans with mTBI who may have benefited did not receive such care. Specific barriers to accessing OT (eg, OT practitioner supply) should be investigated. Novel care models can ensure access to OT services among Veterans seeking care at less-resourced and/or geographically distant VHA facilities.

Personalised Assessment and Rapid Intervention in Frail Patients With Lung Cancer: The Impact of an Outpatient Occupational Therapy Service

IntroductionLung cancer and its treatments cause or accelerate frailty, detrimentally affecting function and quality of life. Occupational therapists (OTs) provide global assessments and interventions, but services are often available for inpatients. The impact of holistic assessment and early intervention in the outpatient setting is unknown. Materials and MethodsA tertiary cancer center in North East England piloted a Lung Cancer Outpatient OT Service for patients with thoracic malignancy and a Clinical Frailty Scale Score (CFS) ≥ 5. Service effectiveness was evaluated through calculation of admission avoidance, hospital length-of-stay reduction, completion/impact of advance care planning and patient/family feedback. Demographics, frailty level, required interventions, and onward referrals were recorded. ResultsA total of 153 patients (median age of 71 (range 46-90) received OT assessment and intervention. 48% were in the lowest socioeconomic quintile. Median CFS score was 5 (mildly frail (range: 4-7)) at initial assessment. Total of 918 interventions were delivered (median: 5, IQR: 3-7, Range 0-22). 48% of patients engaged in future planning (national average: 10%-15% P < .0001) and 78.5% achieved preferred place of death (national average 30%). An estimated 37 hospital admissions were avoided. In admitted patients, average inpatient stay when known to the service was 6.5 days less than other frail lung cancer patients in our unit (95% CI 4-9.1 days P < .0001). Higher CFS was associated with poor survival (P < .05). ConclusionOutpatient OT services can avoid and shorten hospital admissions through advance care planning, management of functional disruption, onward referral to other allied health professionals and palliative care. A comprehensive multidisciplinary outpatient service may benefit patients further and should be the focus of future research.

Pediatric Outpatient Occupational Therapy: Transitioning From In-Person Services to Telehealth.

The COVID-19 pandemic necessitated rapid adoption of telehealth for outpatient pediatric occupational therapy practice. The dose of therapy may have varied across diagnostic and geographical groups despite efforts to ensure access for all patients. The objective of the study was to describe the visit length of outpatient pediatric occupational therapy practice for three diagnostic groups at one institution both during and prior to the COVID-19 pandemic. Retrospective review of electronic health records for two time periods using both practitioner-entered and telecommunications data. Data were analyzed using descriptive statistics and generalized linear mixed model. Prior to the pandemic, average treatment length did not vary by primary diagnosis. During the pandemic, average visit length varied by primary diagnosis, with feeding disorder (FD) visits significantly shorter than cerebral palsy (CP) and autism spectrum disorder (ASD) visits. During the pandemic, visit length was associated with rurality for the whole sample and for patients with ASD and CP, but not FD. Patients with FD may have been seen for shorter durations during telehealth visits. The technology gap may affect services for patients living in rural communities.

Ayres Sensory Integration® for Addressing Play in Autistic Children: A Multiple-Baseline Examination

Play is an area of difficulty for autistic children, and occupational therapy practitioners need evidence to guide interventions to improve play for this population. Ayres Sensory Integration® (ASI) intervention has not yet been studied for its impact on play outcomes. To examine the impact of ASI intervention on play types in autistic children. Nonconcurrent, multiple-baseline design across subjects. Outpatient occupational therapy clinic in New England. Three autistic children, ages 5, 6, and 6 yr. Twenty-four ASI sessions. Frequency of play type was coded using partial interval coding. Progress monitoring used Goal Attainment Scaling. All three participants demonstrated changes in the frequency of specific types of play, but changes varied among them. Findings suggest that ASI intervention may alter a child's patterns of play. What This Article Adds: This study is the first to examine the impact of ASI on play and the third that documents the feasibility of single-subject research for studying ASI. If confirmed in future studies, ASI could become an evidence-based intervention for improving play, an important outcome for autistic children and the profession of occupational therapy. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel etal., 2021; Kenny etal., 2016).

Sensory Processing and Visual Motor Integration of Children with Autism

<h3>Research Objectives</h3> To investigate the visual motor integration performance and sensory processing of preschool aged children with autism spectrum disorder. <h3>Design</h3> Multiple linear regression was employed. Retrospective data on preschool aged children with autism who received six months of occupational therapy was collected from an outpatient clinic in Florida. Three research questions were analyzed using data from 36 children (32 males, 4 females) who met the inclusion criteria. <h3>Setting</h3> Data was retrieved from an outpatient rehabilitation clinic in Florida. <h3>Participants</h3> A non-probability purposive sampling strategy was employed for the study. Patient charts of children aged two to five years of age with diagnoses of ASD were reviewed. The data reviewed spanned from June 1, 2017 to March 13, 2020. Patient charts with pre and six-month-post SSP and Beery VMI scores who attended at least one therapy treatment session were included in the study. <h3>Interventions</h3> Children with ASD who attended at least one outpatient occupational therapy treatment session were included in the study. Pre SSP, post SSP, pre Beery VMI scores, and post Beery VMI scores were recorded with relevant demographic information (e.g., age and gender) based on attendance and participation in occupational evaluations. <h3>Main Outcome Measures</h3> Beery-Buktenica Developmental Test of Visual Motor Integration and the Short Sensory Profile 2 were utilized for pre and post scores. <h3>Results</h3> There was a statistically significant improvement in visual motor scores, with pre scores being highly predictive of post scores. There was no significant difference between pre and post sensory scores and they were not predictive of Visual Motor scores. <h3>Conclusions</h3> The findings showed significant improvements in VMI and non-significant improvements in SSP. The final predictive model for VMI can be utilized by clinicians to create realistic goals for therapy. Additionally, these findings suggest that VMI may improve regardless of a child's sensory processing difficulties. <h3>Author(s) Disclosures</h3> The authors declare no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in the information being presented.

Implementing Prism Adaptation Treatment for Spatial Neglect in the Outpatient Setting

<h3>Research Objectives</h3> To implement two evidence-based care tools for spatial neglect in outpatient rehabilitation facilities <h3>Design</h3> Retrospective observation. <h3>Setting</h3> Outpatient clinic. <h3>Participants</h3> Occupational therapists. <h3>Interventions</h3> Professional education and skill acquisition on spatial neglect assessment and treatment. <h3>Main Outcome Measures</h3> Number of neurological patients received the newly implemented care. <h3>Results</h3> We trained two therapists as the leads for the implementation of both the Kessler Foundation Neglect Assessment Process (KF-NAP) and Prism Adaptation Treatment (KF-PAT) in the outpatient occupational therapy care and the cognitive rehabilitation program affiliated with one rehabilitation care provider. The two lead therapists then trained 6 other therapists. From March 2017 to July 2019, when suspecting a patient of having spatial neglect, these 8 therapists assessed 45 individuals (27 men and 18 women; median age = 62) using the Catherine Bergego Scale (CBS) via the KF-NAP. Among those patients, 37 (82%) had stroke, 4 (9%) had traumatic brain injury, and 4 (9%) had other neurological conditions. The median days post neurological diagnosis was 210 (IQR = 123-710), and the median CBS score was 6.25 (IQR = 4-12.5) out of 30 (higher value = greater severity of neglect). 39 (87%) patients received prism adaptation treatment following the KF-PAT protocol, which recommends the treatment course being 10 once-daily sessions over two weeks. 23 (59%) of them received 10 sessions over 24 to 100 days, median = 38 days (IQR = 31-49). 21 (91%) were assessed for spatial neglect after treatment, and the median improvement was CBS change of 3.75 (IQR = 2-5.5). <h3>Conclusions</h3> Clinicians found the KF-NAP assessment tool useful and informative. The KF-PAT treatment, however, could not be delivered as recommended. Further work is needed to ensure the implementation of treatment to be completed within two weeks. <h3>Author(s) Disclosures</h3> KF-NAP and KF-PAT are registered trademarks owned by Kessler Foundation, which is the employer of three authors (Chen, Kaplan, and Masmela). None of the authors receive financial incentive related to the sales of the tools. Mauch and Chirdon have nothing to disclose.