Paediatric Occupational Therapy Practice Research Articles

Profile of paediatric occupational therapy practice in Eastern Mediterranean countries

Background Paediatric occupational therapy (OT) is considered the largest practice area in OT in several regions, including the Eastern Mediterranean (EM) countries. Aims/objectives This study aimed to establish a profile of paediatric occupational therapists in EM countries to identify theoretical models, assessments and interventions employed. It also investigated the therapists’ usage of evidence-based practice in their practice. Material and methods We conducted a cross-sectional survey using a questionnaire which was distributed electronically to occupational therapists working with children. Results The participants included 118 therapists. Majority of the participants were working at rehabilitation centres. The primary client groups were pre- and school-age children with autism spectrum disorder and cerebral palsy. The most frequently used assessments were sensory-related tools. Activities of daily living and play were the most often targeted interventional area. Participants highlighted some of the challenges faced in implementing evidence in their practice. Conclusion Paediatric occupational therapists are usually exposed to specific age groups and conditions. However, a lack of knowledge practice in some areas and challenges in others exist. Significance Within the EM region, knowledge regarding therapists’ practices is lacking. Actions should be taken to improve current practice and meet the current needs of clients, and utilise evidence-based practices.

Assessing physical literacy with school-aged children in occupational therapy practice: An exploratory qualitative study

Introduction: Physical literacy (the physical, psychological, social and cognitive capacities needed for movement and physical activity) is arguably important to occupational therapy yet is not explicit within current practice. This study aimed to understand how occupational therapists can engage with the physical literacy concept. Method: Eight paediatric occupational therapists were recruited by purposive sampling. Participants completed up to three semi-structured interviews to understand perspectives on physical literacy, introduce a novel pictorial assessment and to seek feedback on the assessment after trialling. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Results: Sixteen interviews were conducted. Four themes were identified: ‘Foreign tongue’ (occupational therapists have an understanding of physical literacy but used different terminology); ‘Sounds very OT oriented’ (illustrating the connection between physical literacy and occupational therapy); ‘We need the child’s voice’ (measure highlights the child’s perspective); and ‘Contemporary, useful BUT not for all’ (measure had utility for some children but was dependant on child’s condition). Conclusion: Occupational therapists can apply the physical literacy construct to traditional models and core concepts. The assessment can be used in paediatric occupational therapy practice supported by clinical reasoning, although future tool iterations may need to accommodate some children with disability.

Interocepção e prática da terapia ocupacional pediátrica: um protocolo para uma revisão de escopo

Abstract Introduction Interoception is relatively new within pediatric occupational therapy practice. Interoception allows us to feel and interpret internal body sensations and is related to our ability to regulate emotions and behavior. It is associated with other functions including sensory processing, self-regulation and executive functioning, making it important for everyday participation in life activities. Pediatric occupational therapists are considering interoception as part of intervention but there is limited research to understand how and why occupational therapists use interoception in clinical practice. Objectives The aim of this protocol is to describe the methodology and analyses to be used to undertake a scoping review. Method This paper presents the protocol for a scoping review. A search of literature from ten electronic databases (Ovid Medline, Ovid Embase, Ovid PsycINFO, ERIC, Scopus, CINAHL, ProQuest Dissertations & Theses Global, AMED, OTDBASE and Google Scholar), grey literature and article reference searching was conducted. Title and abstract screening was completed before full-text review. Selected articles met stringent inclusion criteria. The PRISMA-ScR Checklist was used alongside the Crowe Critical Appraisal Tool to ensure robust data extraction and synthesis from selected studies. Results A total of 2449 articles were retrieved. Eighteen articles were included in the review. A narrative synthesis approach will be used to synthesise data. Conclusion Findings from this scoping review will inform future research related to interoception and pediatric occupational therapy practice to support clinicians to consider evidence to underpin practice.

Use of AI in Pediatric Occupational Therapy: A Review

The utilization of artificial intelligence (AI) in pediatric occupational therapy (OT) has emerged as a promising avenue for enhancing assessment, intervention, and outcomes for children with diverse developmental needs. This paper provides a comprehensive review of the current state of AI applications in pediatric OT, highlighting key findings, benefits, challenges, and future directions. AI technologies, including machine learning algorithms, computer vision systems, and wearable sensors, offer innovative approaches to assess children’s motor skills, sensory responses, and cognitive functions objectively and efficiently. AI-driven intervention strategies, such as personalized treatment planning, adaptive task selection, virtual reality environments, and gamified activities, promote engagement, motivation, and skill acquisition among pediatric patients. Additionally, AI-powered telehealth platforms enable remote delivery of OT services, real-time monitoring of patient progress, and access to care for underserved populations. However, challenges related to data privacy, ethical decision-making, disparities in access, and therapist education must be addressed to ensure the ethical, effective, and equitable integration of AI into pediatric OT practice. By embracing ongoing research, collaboration, and innovation, pediatric OT practitioners can harness the transformative potential of AI to improve outcomes and quality of life for children and families worldwide.

Profile of Assessments in Pediatric Occupational Therapy Practice.

Occupational therapy practice is intended to reflect the core construct of occupation throughout all aspects of service delivery. In pediatric occupational therapy, the evidence examining regularly selected assessment tools and the occupational constructs of those assessment tools is insufficient. To examine the assessment tools regularly selected by practicing pediatric occupational therapists and the therapists' classification of assessment tools as occupation-based. A cross-sectional quantitative design through the dissemination of an anonymous, close-ended assessment tool inventory with completion of descriptive statistics. Pediatric occupational therapist practice specific to the assessments used. There were 337 pediatric occupational therapists recruited through targeted sampling via social media. The participants were included if they had provided direct client care to individuals ages of 0 to 21 yr during their career. The assessment tools most commonly used by pediatric occupational therapists are the Sensory Profile (86.4%) and the Beery-Buktenica Developmental Test of Visual-Motor Integration (85.2%). The primary assessment tools selected by pediatric occupational therapists were skill-based regardless of years of practice or practice setting. Therapists were unable to correctly classify assessment tools as occupation-based. The limited use of occupation-based assessments in conjunction with decreased recognition of the occupational nature of assessment tools hinders the integration of occupation-based assessment tools across pediatric clinical practice. Pediatric occupational therapists' integration of occupation-based assessment tools is needed to promote the occupational constructs of the profession. What This Article Adds: This article identifies the common assessment tools utilized by pediatric occupational therapists. Additionally, this article brings awareness to the inconsistent identification and integration of occupation-based assessment tools within pediatric clinical practice.

Occupation-Based Assessments in Pediatric Occupational Therapy Practice.

In pediatric occupational therapy, there is insufficient evidence examining assessment tool selection by occupational therapists and how assessment tools contribute to occupation-based practice. To examine the perceptions of occupation-based assessment tool selection by pediatric occupational therapists, a phenomenological research study was conducted with six pediatric occupational therapy practitioners. Three themes emerged from participants' perspectives: the centrality of occupation, selecting the just right tool, and practice implications. Participants recognized the need to integrate occupation-based assessments into practice but reported decreased opportunities secondary to training, available supplies, lack of awareness of foundational constructs, and organizational expectations. The use of occupation-based assessments positively enhances pediatric occupational therapists' clinical practice by upholding the core occupational beliefs of the profession throughout all phases of service delivery.

Metaphors of mindfulness in pediatric occupational therapy practice

Introduction: Metaphors are commonly used linguistic devices that can encourage deep reflection and offer new insight. Metaphors have been used within the both the occupational therapy and mindfulness literature to describe complex phenomena. The aim of this phenomenological study was to identify, analyze, and interpret metaphors used by pediatric occupational therapists to describe mindfulness in their clinical practices with children and youth. Method: Eight North American Occupational Therapists participated in semi-structured interviews which were transcribed verbatim. Transcripts were read to identify idiographic or naturally occurring metaphors used by participants. Metaphors of mindfulness were also elicited from participants as an interview question. Findings: Three themes were identified within participants’ idiographic metaphors of mindfulness: mindfulness as a tool, mindfulness as exploration, and mindfulness as a support. Two additional themes were identified within participants’ idiographic metaphors of themselves as facilitators of mindfulness: therapist as a guide, and therapist as a gardener. Elicited metaphors generally aligned with the themes identified for idiographic metaphors while some offered additional unique insights. Conclusion: The findings open conversations about therapists’ framing of the use of mindfulness within the context of pediatric occupational therapy.

The Relationship Between School-Age Children’s Self-Reported Perceptions of Their Interoceptive Awareness and Emotional Regulation: An Exploratory Study

ABSTRACT Interoceptive awareness (IA) refers to one’s ability to perceive and recognize internal bodily signals. Our behavioral and emotional responses to interoceptive signals are determined by self-regulation. Therefore, IA and self-regulation have considerable impacts on children’s daily occupational engagement and performance. Nonetheless, the relationship between IA and self-regulation relevant to pediatric occupational therapy practice continues to lack empirical evidence. This study explores the association between school-age children’s self-reported IA, emotional regulation, and academic self-regulation. Twenty-five children completed the Cognitive Emotion Regulation Questionnaire for children (CERQ-k), the Multidimensional Assessment of Interoceptive Awareness – Youth adapted version (MAIA-y), and the Academic Self-Regulation Scale; parents/caregivers completed a demographics questionnaire (n = 25). Data were analyzed using Spearman’s rho (ρ) correlation and linear regression analyses with bootstrapping. Nineteen significant correlations were identified between MAIA-y and CERQ-k subscales (ρ = −.724 to .700, p < .05) and 14 between MAIA-y and ASRS subscales (ρ = .448 to .687, p < .05). Two MAIA-y subscales (“not-distracting” and “self-regulation”) were predictive of cognitive emotional regulatory strategies (total variance = 33%, 74.1%; p < .05); one MAIA-y subscale (“trusting”) was predictive of children’s autonomous academic self-regulation (total variance = 64.1%; p = .005). The result demonstrates significant correlations in children’s self-reported IA, emotional regulation, and academic self-regulation. Therapists should consider assessing children’s IA to inform self-regulation goal setting and treatment planning.

Mindfulness in paediatric occupational therapy practice: a phenomenological inquiry

Purpose While research into mindfulness practices is on the rise across populations, there is evidence to suggest that clinical practice has outpaced the literature with regard to mindfulness in pediatric rehabilitation. The aim of this study was to explore the perceptions of occupational therapists who opt to incorporate mindfulness into their clinical practices with children and youth. Methods Hermeneutic phenomenology was the methodology of the study. The theoretical framework employed a Heideggerian-informed phenomenology of practice. Eight occupational therapists practicing in Canada and the United States participated in 90–120 min semi-structured interviews that elicited first-hand accounts of mindfulness in pediatric occupational therapy practice. Interviews were transcribed verbatim and analyzed using Finlay’s four-step approach. Results Six salient themes were identified in the data: drawing from personal practice, enhancing participation, fostering healthy habits, adapting for children, keeping it playful, and doing with. Conclusion The findings of this study offer insights for therapists who are considering incorporating mindfulness into their practices with children and youth. Further, this research highlights a number of research priorities that require further inquiry.

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.

A Comparison of Child-Reported and Parent-Reported Interoceptive Awareness in Typically Developing School-Aged Children

ABSTRACT Interoceptive awareness refers to the way in which we perceive and interpret our body signals. It has links to sensory processing and how we understand and respond to emotion. Current research lacks evidence as to whether gender influences interoceptive awareness in children. In occupational therapy practice, clinicians use a family-centered approach to understand both child and parent perspectives to support participation, yet there is a gap in the literature that speaks to any differences in child- and parent-reports of child interoceptive awareness. This exploratory study investigated comparisons of gender and child- and parent-reported child interoceptive awareness. Twenty-seven pairs of typically developing school-aged Australian children, and one of their parents participated in the study by completing the Multidimensional Assessment of Interoceptive Awareness – Youth (MAIA-y). Independent-samples t-tests revealed no statistically significant differences in child interoceptive awareness between boys and girls. Comparing child-report (M = 3.837, SD = 0.509) and parent-report (M = 3.326, SD = 0.785) of child interoceptive awareness elicited one statistically significant difference on the MAIA-y Emotional Awareness subscale (t(52) = −2.840, p = 0.006). This exploratory study provides preliminary evidence relating to gender differences regarding interoceptive awareness in children and for using both a child- and family-centered practice approach in pediatric occupational therapy practice.

The experience and role of mentorship for paediatric occupational therapists.

Within Australia, the introduction of the National Disability Insurance Scheme has led to a growth in paediatric occupational therapists working in community settings. This growth has increased the demand for support from more senior paediatric occupational therapists to novice clinicians. Mentoring has long been valued by occupational therapists as a means to provide this support. Despite its apparent benefit, there is limited research on the contribution of mentoring as distinct from supervision, and its impact on mentees' skills and confidence in providing care. This study examined the contribution of mentorship to the development of professional capability in paediatric occupational therapy practice from the perspective of mentors and mentees. Interpretive description methodology was used. In-depth interviews were conducted with nine mentors and eight mentees from three Australian states. Data were analysed inductively and thematically. All participants reflected on the challenges presented by the complexity of practice, requiring a knowledge base that mentees perceived they did not possess. The essential nature of non-judgemental, emotional support allowed mentees to feel safe to discuss their concerns when they were often overwhelmed by practice. Mentorship was viewed as capacity building, building competence by scaffolding clinical reasoning and supporting theory to practice translation while developing resilience to cope with complexity. Study participants reported that successful mentorship assisted novice practitioners to integrate knowledge and skills required for complex clinical and professional reasoning. The emotional support provided through the relationship supported novice therapists to build their confidence and resilience while promoting professional identity and socialisation into the profession. The study raised questions related to how the profession best supports novice paediatric therapists in the current employment contexts, and the need to review how bodies of knowledge relevant to paediatrics are brought together to be used by both novice clinicians and senior therapists, who support them, for translation to effective practice.

Profile of Pediatric Occupational Therapy Practice in Kuwait: A Qualitative Study

Pediatrics specialty is the most occupational therapy practice in Kuwait. Therefore, the purpose of this survey is to establish a profile of pediatric occupational therapy practice in Kuwait. Moreover, it aims to recognize the most common diagnoses that are referred to the pediatrics occupational therapy in Kuwait as well as identify the most common assessments, frame of reference, and intervention techniques that are used in the area of practice. In addition, there are also many studies conducted about pediatric occupational therapy profiles in Australia, Canada, and United States, However, there are no studies about pediatric occupational therapy profiles in Kuwait (Australian Occupational Therapy Journal, 2005). Therefore, the importance of this research is to follow a successful role model similar to Canada, Australia, and the United States. The Methodology was is ex post facto survey that is adapted to conduct the data. The sample is all pediatric occupational therapists working in both Ministry of Health and the privet educational sector in Kuwait receive the survey. The sample size was 260 therapists but the responding participants were 217 therapists. The result showed that the most commonly used assessments were the Developmental Test of Visual Motor Integration, Peabody Developmental Motor Scales, Bruininks-Oseretsky Test of Motor Proficiency, and the Sensory Profile.

Developing the Occupational Therapy-Specific Mini-Clinical Evaluation Exercise (Mini-CEX) for Evaluating Interns' Clinical Skills and Attitudes in Pediatric Occupational Therapy.

The Mini-Clinical Evaluation Exercise (Mini-CEX) is highly recommended for assessing interns' performance. To develop a pediatric occupational therapy-specific Mini-CEX and examine its psychometrics. Stage 1 had a retrospective design; Stage 2 had a prospective design. Pediatric occupational therapy unit in a hospital in Taiwan. Thirty-four occupational therapy interns were evaluated with the Mini-CEX (physician version), and 57 were evaluated with the occupational therapy-specific Mini-CEX. The occupational therapy-specific Mini-CEX was developed with seven items on a 9-point scale categorized into three levels (unsatisfactory, satisfactory, highly satisfactory). In Stage 1, the frequency of Mini-CEX (physician version) items receiving a rating of not applicable ranged from 1.9% to 88.1%. In Stage 2, the frequency of occupational therapy-specific Mini-CEX items receiving a rating of not applicable ranged from 3.5% to 31.6%. With the theme of evaluation taken into consideration, the frequency of not-applicable ratings was 0% to 8.8%. For the occupational therapy-specific Mini-CEX, content validity (item-level content validity index = 1, scale-level content validity index = 1) and internal consistency (Cronbach's α = .93) were excellent. The interns' scores on the second evaluation were significantly higher than those on their first evaluation, indicating good discriminant validity. The occupational therapy-specific Mini-CEX appears to be reliable and valid, and it is appropriate for evaluating interns' skills and attitudes in pediatric occupational therapy practice. What This Article Adds: The results support the development of the occupational therapy-specific Mini-CEX and its application in pediatric internship training.

Utility of the occupation-centered intervention assessment in pediatric occupational therapy practice

ABSTRACT Best practice supports the use of occupation as a therapeutic agent of change for pediatric occupational therapy practice. However, limited tools to promote the development of and implementation of occupation-centered practice exist. This study explored the clinical utility of the Occupation Centered Intervention Assessment (OCIA) as a tool to facilitate occupation-centered practice in outpatient and school-based pediatric settings. The OCIA allows practitioners to reflect on their own practice by scoring interventions on personal, contextual, and occupational relevance. This qualitative, descriptive study utilized semi-structured interviews (n = 12) with practitioners in outpatient and school settings to glean information regarding tool utility. A six-step thematic analysis process guided the coding process. Four themes emerged from the data related to clinical utility of the OCIA: reflection on practice habits, practice settings influence therapy service delivery, translation of theoretical knowledge into practice technique, and the distinct value of occupation. Preliminary evidence supports the use of the OCIA in outpatient and school pediatric settings to promote reflection on occupation-centered practice for students and novice practitioners, although some setting are more conducive to use of an occupation-centered approach than others.

Telehealth in paediatric occupational therapy: a scoping review

Background/Aims This study reviewed the use of telehealth in paediatric occupational therapy practice and its clinical outcomes over the past 20 years. Methods A scoping review following Arksey and O'Malley's five stages was undertaken using six databases and Google Scholar. The scoping review covered articles from January 2000 to April 2020. Results A total of 22 articles were reviewed. Most studies indicated positive outcomes of using telehealth in paediatric occupational therapy practice. Although there is insufficient evidence, the results indicated that telehealth can be more effective than face-to-face interventions when there are mobility or travel challenges for children. Conclusions The use of telehealth in paediatric occupational therapy is an alternative service delivery model, facilitating access for children and their families to the rehabilitation services. Further research is needed to address the difficulties and potential solutions to expand the use of telehealth services to help children with disadvantages alongside their families.

Occupational Therapy Services in School-Based Practice: A Pediatric Occupational Therapy Perspective from Ireland.

Purpose School is a primary setting for pediatric occupational therapy practice, yet little is known about the provision of school-based occupational therapy in many countries internationally. The purpose of this study was to explore current school-based occupational therapy practice for the first time in Ireland to gain insight into current and potential service provision and to identify new directions and potential pathways for development. Methods This descriptive quantitative study utilized a cross-sectional online survey to gain the perspectives of the population of pediatric occupational therapists working regularly in schools across Ireland. Respondents were recruited through convenience and snowball sampling. Data were analysed through qualitative content analysis and descriptive statistics. Results The survey elicited 35 responses, yielding a 21.2% estimated response rate. Findings demonstrated that respondents provided therapy services in schools most commonly on a weekly (28.6%) or monthly (34.3%) basis, with only 5.0% working in the same school on a weekly or fortnightly basis. The majority of respondents (54.3%) used a direct therapy approach with a child, rather than coaching or modelling, to primarily address sensory, hand function, or daily living needs. None used a whole class or whole school (universal or tiered) approach. While respondents (54.3%) generally viewed collaborative practice as a strength of school-based practice, they also identified barriers to collaboration in schools. A core barrier is related to how services are constructed across health and education, with differing philosophies of service provision. The majority of respondents (75.0%) reported that they had not received any training to deliver evidence-based practice in therapy provision specific to school-based practice. Implications for Practice. This study indicates that therapists require continual education on evidence-based school practice as it applies in an Irish context. Furthermore, clarification of school therapy roles and service delivery models are required in order to determine how they contrast with traditional clinic roles. This will enable therapists to strengthen the coordination of service delivery between health and educational services to maximize the outcomes of school-based practice.

Instrumental Activities of Daily Living in Pediatric Occupational Therapy Practice: A Survey of Current Practice Patterns and Perceived Importance

Aims We investigated how instrumental activities of daily living (IADLs) are addressed and perceived, in comparison to activities of daily living (ADLs), across preschool (3–5 years), middle childhood (6–11 years), early adolescence (12–15 years), and older adolescence (16–21 years) age groups by pediatric occupational therapy (OT) practitioners. Method 247 OT practitioners with at least 2 years of pediatric work experience in the U.S. completed an electronic survey assessing (a) type of IADLs most frequently addressed and (b) type of IADLs perceived as most important across the age groups. Results With increasing age of children and adolescents with disabilities, frequency and perceived importance of addressing IADLs increased in comparison to ADLs; there was a statistically significant relationship between the frequency and the perceived importance of addressing IADLs for all 12 activities across the age groups. Conclusion The decision-making process in addressing IADLs in pediatric OT practice was significantly influenced by the practitioners’ perceived importance of IADLs.

A Call to Action: Addressing Maternal Mental Health in Pediatric Occupational Therapy Practice

A Call to Action: Addressing Maternal Mental Health in Pediatric Occupational Therapy Practice

A qualitative study of Irish parents’ views on hippotherapy, including its influence on their children’s home-based occupations

Purpose Hippotherapy is an emerging area of paediatric occupational therapy practice in Ireland. It is a treatment strategy used by specially trained occupational therapy practitioners, physical therapists and speech language pathologists as part of the intervention programme to facilitate functional gains. This paper aims to explore parents’ perspectives on children’s participation in home-based occupations following hippotherapy treatment. Design/methodology/approach Qualitative, semi-structured interviews were conducted with eight participants. Interviews were audio-recorded and transcribed verbatim. In accordance with thematic analysis, line-by-line coding was completed to identify codes. Codes were organised into categories, which were grouped to develop themes. Findings Three core themes were identified: lack of knowledge regarding hippotherapy as an occupational therapy intervention; children’s increased participation in home-based occupations secondary to improved physical, psychological, communication and social skills; and the unique hippotherapy environment as a motivating factor for children to engage in occupational therapy intervention. Originality/value Findings from this study support the growing body of evidence that hippotherapy is an effective means of intervention for increasing physical, psychological, social and communication skills. The participants report positive effects following hippotherapy on their children’s participation in home-based occupations. It highlights a link between the unique hippotherapy environment and children’s increased engagement in occupational therapy. Given that no published hippotherapy-specific literature related to occupational therapy exists in the Irish context, and given that hippotherapy is an emerging area of practice in Ireland, this paper contributes to the knowledge base.