Abstract Human language enables the exchange of complex information and precise instructions for collaborative planning and action. It rapidly evolves through social learning, generating diverse cultural communication signals used not only with other humans, but also with domesticated animals bred or trained to respond. More rarely, humans communicate with untrained, wild animals to coordinate joint actions, yet little is known about how or why these human‐to‐wildlife signals diversify. Human‐wildlife cooperation allows us to investigate whether human signals directed at untrained, wild animals exhibit regional variation, akin to dialects in human language. We investigated regional variation in human signals used to cooperate with greater honeyguides ( Indicator indicator ): wild birds that guide people to bees' nests in exchange for access to beeswax. Across 13 villages in northern Mozambique, we tested whether human honey‐hunting calls varied with spatial distance, as expected if regional dialects had emerged, or with measures of the physical environment affecting sound propagation, as expected if calls were shaped by habitat acoustics. Our analyses showed that trills, grunts, whoops, and whistles used while cooperating with honeyguides (i) consistently varied with spatial distance between villages, (ii) varied irrespective of the local habitat, and (iii) appeared to be adopted by immigrant honey‐hunters to match local calls. These findings suggest that regional variation in human‐to‐wildlife signals is shaped primarily by human social factors, forming a landscape of interspecific signal diversity similar to human language dialects. Honeyguides cooperate effectively with honey‐hunters throughout this landscape, suggesting that they accommodate (and likely reinforce) cultural differences by learning the local interspecies dialect. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Plant defence phenotypes commonly integrate physical and chemical traits that may act synergistically against herbivores, but empirical evidence for synergy as a defence strategy remains limited. We experimentally tested the separate and combined effects of two common plant defences, non‐glandular trichomes and leaf metabolites, on the feeding, behaviour and performance of a generalist herbivore. We conducted choice and no‐choice assays that exposed beet armyworm caterpillars ( Spodoptera exigua , Noctuidae) to desert stingbush ( Eucnide urens , Loasaceae) leaves with manipulated trichome cover and raised caterpillars on a diet containing factorial combinations of E. urens trichomes and leaf extracts. We assessed differences in caterpillar behaviour, performance, and survival across treatments. We found a significant interactive effect of trichomes and leaf metabolites that markedly decreased caterpillar growth, providing evidence for a defence synergism. Both defences also reduced caterpillar performance individually. Leaf extracts contained a high proportion of putatively defensive compounds, including iridoid glycosides, which were associated with reduced caterpillar growth and high mortality before pupation. Barbed trichomes impeded caterpillar movement and, when consumed, caused mandible damage and reduced eclosion rates compared to controls. Our results indicate that two commonly co‐expressed plant defences can synergistically reduce herbivore performance. These findings provide a rare example of trait synergy as a defence strategy and represent a step forward in the effort to study plant defence holistically, as suites or syndromes of defences, rather than isolated traits. Read the free Plain Language Summary for this article on the Journal blog.

Fibroblast growth factor-2 (FGF-2) is a novel agent utilized in periodontal regeneration therapy. However, its clinical efficacy compared with autologous bone graft (ABG), a long-established treatment, remains unclear. This study aimed to compare the clinical outcomes of FGF-2 and ABG and to assess the impact of patient background factors on outcomes when using FGF-2. We collected the subjects from January 2013 to September 2023. Clinical outcomes included the vertical bone defect improvement rate (VBDIR) and the probing pocket depth improvement (PPDI). Clinical outcomes between the two groups were compared using analysis of covariance (ANCOVA), adjusting for age, sex, smoking history, and hypertension. Additionally, a multilevel linear analysis was performed to assess factors influencing outcomes in FGF-2. A total of 180 sites from 141 patients (FGF-2: 150 sites; ABG: 30 sites) were evaluated. Both VBDIR and PPDI significantly improved postoperatively in both groups. There were no significant differences in clinical outcomes between FGF-2 and ABG. In FGF-2, smoking history was positively associated, while the preoperative bone defect angle (BDA) was negatively associated with clinical outcomes. FGF-2 might exhibit clinical outcomes comparable to those of ABG, suggesting it is a clinically viable alternative for vertical bone defects. When using FGF-2, patient-specific factors such as smoking history and preoperative BDA should be considered carefully. A survey of clinical practice and evaluation of treatment outcomes of periodontal regenerative therapy using REGROTH at Okayama University Hospital PLAIN LANGUAGE SUMMARY: This retrospective study compared the clinical outcomes of fibroblast growth factor-2 (FGF-2), a novel therapeutic agent, with autologous bone graft (ABG), a long-established treatment. A total of 180 sites from 141 patients (150 FGF-2 sites, 30 ABG sites) were evaluated based on the vertical bone defect improvement rate (VBDIR) and the probing pocket depth improvement (PPDI). Using analysis of covariance (ANCOVA), adjusted for patient background factors such as age, sex, smoking history, and hypertension, no significant differences in clinical outcomes were observed between the two treatment groups. Further multilevel linear analysis focusing on the FGF-2 group revealed that smoking history was positively associated, while preoperative bone defect angle (BDA) was negatively associated with clinical outcomes. These findings suggest that FGF-2 may offer clinical benefits comparable to ABG in treating vertical bone defects while having the added advantage of being less invasive. However, when using FGF-2, dentists should consider individual patient factors such as smoking habits and defect morphology, as these may influence treatment outcomes.

Abstract Host competence—the ability to acquire, harbour and transmit infections—drives pathogen spread and persistence in multi‐host communities. Evaluating species‐specific competence is critical for predicting transmission, particularly for generalist fungal pathogens like Batrachochytrium dendrobatidis (Bd). Despite its central role in disease dynamics, we lack an epidemiologically grounded competence metric that rigorously accounts for how infection intensity affects a host's competence. This knowledge gap limits our ability to compare mechanisms across species and assess their roles in pathogen persistence. To address these challenges, we developed a novel, load‐dependent competence metric using host–pathogen Integral Projection Models (IPMs) that integrates variation in susceptibility, within‐host pathogen growth and pathogen shedding dynamics. We applied this metric to laboratory‐based challenge experiments with three common North American amphibians ( Notophthalmus viridescens , Rana clamitans and Rana catesbeianus ) that persist endemically with Bd. Using dose–response assays and repeated pathogen shedding measurements across species, we asked: (i) is there a consistent, non‐linear relationship between infection intensity and pathogen shedding across species? and (ii) which load‐based traits best predict host competence? We quantified four of five components of host competence—susceptibility, pathogen growth, pathogen survival and load‐dependent shedding—and used these to parameterize species‐specific IPMs, integrating competence into a single relative metric across species. We found that Bd shedding increased non‐linearly with infection intensity, contradicting the standard assumption that Bd shedding is linearly related to infection intensity. Notophthalmus viridescens and R. catesbeianus were the most competent hosts but through distinct pathways: high susceptibility in N. viridescens and elevated shedding rates in R. catesbeianus . In contrast, density‐dependent reductions in pathogen growth and shedding limited R. clamitans competence. Thus, species‐level competence is not determined by a single trait, but emerges from interactions among multiple load‐based processes. Our results demonstrate that variation in competence emerges from distinct, species‐specific processes across multiple dimensions of competence. By linking individual infection dynamics to population‐level transmission potential, our integrative framework provides a more mechanistic approach to predicting host contributions to community‐level pathogen persistence. Read the free Plain Language Summary for this article on the Journal blog.

ABSTRACT Background Mental health services for adolescents in mainland China are typically limited due to available resources and challenged by how adapting services from other countries fail to account for cultural values related to identity development. Context This practice-based report describes a structured mindfulness-informed art therapy program for adolescents in a psychiatric hospital. Approach Art therapy was offered in an in-patient setting in a group format of nine sessions over two weeks for around 14 adolescent patients (with attendance varying by session), who primarily were diagnosed with mood disorders. Outcomes Based on the observations, artwork, interviews, and evaluations, the program had several benefits, which included: emotional improvement, self-expression, and relationship building. Conclusions The outcomes seemed to be based on how the program promoted self-regulation and coping skills while honouring collectivist values. Implications for Research To continue expanding the field of art therapy for Chinese adolescents, future research could investigate more on the effectiveness of incorporating art therapy and mindfulness in treatment as well as exploring context-sensitive adaptations of traditional art materials. Plain-language summary This practice-based report describes a structured mindfulness-informed art therapy program for adolescents in a psychiatric hospital in China. The purpose is to expand how art therapy is used and adapted with attention to cultural values. Over two weeks, approximately 14 patients diagnosed primarily with mood disorders participated in nine sessions of art therapy. Based on observations and patient feedback, the benefits of the program included improved emotions, enhanced self-expression, and strengthened peer relationships. These successes seemed to be based on how the program encouraged self-regulation and reinforced coping skills that were steeped in Chinese cultural expectations.

Plain Language Summary What is this summary about? Alzheimer’s dementia is a disorder of the brain. People living with Alzheimer’s dementia have a slow decline of their thinking, memory, and behavior. Agitation is common among people living with Alzheimer’s dementia, and can show in different ways such as restlessness, repetitive questions, wandering, shouting, swearing, and kicking. Brexpiprazole is a medicine used to treat agitation in people living with Alzheimer’s dementia. Many types of medicine can cause harmful side effects when they are used by older people living with dementia. Therefore, researchers decided to have a detailed look at the side effects of brexpiprazole over 3 months and 6 months of use. Researchers combined information from four previous clinical studies of brexpiprazole in people with agitation in Alzheimer’s dementia. What are the key takeaways? Side effects were reported by roughly 1 in 2 people (around 50%) treated with brexpiprazole, over 3 months and over 6 months. This was slightly higher than in people taking placebo (a pretend medicine) over 3 months. The number of people with side effects like stroke, heart problems, movement-related (extrapyramidal) symptoms, sleepiness, infections, dizziness, and falls were generally similar between brexpiprazole and placebo. What are the main conclusions reported by the researchers? No new or unexpected safety problems were found in people with agitation in Alzheimer’s dementia who were taking brexpiprazole, even when it was taken for up to 6 months. These results, combined with previous results showing that brexpiprazole can improve agitation, suggest that brexpiprazole may be a helpful treatment for people with agitation in Alzheimer’s dementia. How to say (download PDF and double click sound icon to play sound)… Agitation: a-juh-TAY-shun Alzheimer’s: ALTS-hy-mers Antipsychotic: an-tee-sy-KOH-tick Brexpiprazole: brex-PIP-ruh-zohl Dementia: dih-MEN-shuh Placebo: pluh-SEE-bo Side effect: A new or worsening health issue that a person has during a clinical study. Clinical study: A study to evaluate the effects of potential new treatments in people. Extrapyramidal: Side effects to do with movement, such as shaking, stiffness, or muscle contractions. Safety: The risks associated with taking a treatment, such as its side effects. This is an abstract of the Plain Language Summary of Publication article. View the full Plain Language Summary PDF of this article to read the full-text Link to original article here Trial registration: ClinicalTrials.gov identifier: NCT01862640; NCT01922258; NCT03548584; NCT03594123.

ABSTRACT Background Art therapy is an emerging, evidence-supported mental health care service for children and adolescents, with a growing practice in education settings. However, the scope and nature of its implementation in Singapore remain uncertain. Aims This study seeks to map the current art therapy practices and uncover the challenges faced by art therapists in Singapore's formal school system. Methods Mixed methods, including an online survey and an in-depth focus group, were used. Results Results suggest that school-based art therapy services in Singapore are still at an early developmental stage and not yet well-supported. Art therapists raised fundamental challenges including inappropriate physical space, poor scheduling, unsuitable group sizes, misaligned expectations with co-facilitators, insufficient ethical safeguard and complex relationships with other school stakeholders. Conclusion Art therapy in Singapore's schools is in its early stage and considerable work is needed to advance theory, research, practice and policy. Implications for practice and policy We offer actionable insights and call for urgent policy action to formally integrate art therapists into Singapore's education ecosystem and safeguard the mental health needs of our younger generation. Plain-language summary Art therapy can be a powerful tool to help children and youths thrive socially, emotionally and creatively. While schools worldwide are increasingly using art therapy, many students in Singapore are missing out. This study offers insights into how art therapy is currently delivered in Singapore's schools. It demonstrates that school-based art therapy is still in its early stage of development and faces several barriers that make it difficult to deliver safe and effective programs. These challenges include unsuitable physical spaces, disrupted schedules, overly large group sizes, unclear roles between co-facilitators, limited ethical safeguards, and strained relationships between art therapists and school staff. Although there is growing appreciation for the potential of art therapy, the lack of institutional support and clear policies continue to limit its reach and impact. The study calls for policy action to formally integrate art therapy into Singapore's education system, ensure ethical and professional standards, and provide proper training and resources. With these steps, art therapy can become a sustainable and valuable support for students’ emotional, social and creative well-being in schools across Singapore.

Abstract Community‐led restoration operates at the intersection of ecological feasibility and social acceptability. In the marine realm, restoration is challenging due to gaps in ecological knowledge on how and where to restore lost ecosystems and limited public engagement that provides social licence for restoration. The restoration of lost oyster reefs provides a prime example because these ecosystems have been degraded to functional extinction on many coastlines, resulting in limited knowledge on their restoration potential and generational amnesia among communities that these ecosystems ever existed. To generate an evidence‐base and social licence for future restoration work, we engaged high school students and coastal residents in research on where to restore lost oyster reefs in South Australia's iconic Coffin Bay. Using a mixed methods approach, we aimed to understand (1) the motivation of high school students to participate in restoration research, (2) to quantify ecological responses to habitat provision (oyster and biodiversity recruitment) to identify appropriate restoration sites, and (3) to assess the response of local residents' to the ecological outcomes, including their willingness to support future restoration efforts. The high school students anticipated benefits that were personal (e.g. new experiences, career development), environmental (e.g. nature connection) and benefited local community (e.g. recreational activities). Students received SCUBA diving certification that enabled them to deploy 28 restoration units (shell baskets) at eight sites throughout Coffin Bay. This experiment was retrieved after 3 months to reveal high density recruitment of oysters and biodiversity at all sites; key environmental indicators for identifying suitable sites for restoration. Most residents engaged with the results expressed surprise in the ecological outcomes (the density of native oyster recruitment and associated diversity of marine life) and were very supportive of more oyster restoration occurring (91% of respondents). This study demonstrates that ecological feasibility and social licence are not sequential hurdles to be overcome independently, but mutually reinforcing processes that can be co‐generated through community‐based research. These results show that when restoration is designed as a socio‐ecological learning system, rather than a technical intervention alone, it can unlock local stewardship, political momentum and generate restoration‐ready knowledge. Read the free Plain Language Summary for this article on the Journal blog.

Core GRADE unpacked: a summary of recent innovations in complementary GRADE methodology.

Oral motor interventions are used in the neonatal intensive care unit (NICU) to support the development of oral feeding skills in preterm infants. Literature regarding which oral motor interventions are used, when they are implemented, and how parents are involved is lacking. To benchmark evidence of oral motor interventions in the literature against reported use in NICU practice, understand the type and timing of oral motor interventions used, and understand perspectives about implementation of oral motor interventions and family involvement in these interventions. Qualitative study. Virtual, recorded focus groups and interviews on Zoom. Convenience sampling was used to recruit neonatal therapists with at least 2 yr experience in the NICU who were currently implementing oral motor interventions. Duringsemistructured focus groups and interviews, we specifically probed the type of oral motor interventions that clinicians use in the NICU to benchmark them against the interventions found in the literature. Recordings were transcribed and uploaded to NVivo for descriptive analysis. Twelve neonatal therapists participated in focus groups or interviews. Applied oral motor stimulation, nonnutritive sucking, NTrainer®intervention, swallowing exercises, and milk drops were reported to be used in practice and most often were started as early as 29 wk postmenstrual age. Parents were primarily involved in facilitating nonnutritive sucking and providing milk drops. Oral motor interventions reported to be used in NICU clinical practice mirror those available in the evidence. This supports ongoing implementation of evidence-based practice for neonatal therapists. Plain-Language Summary: A recent integrative review was completed to understand oral motor interventions used to support the development of feeding skills in preterm infants. The interventions identified in the scientific literature were nonnutritive sucking, applied oral motor stimulation, swallowing exercises, and use of a pacifier that elicits a sensory pulse to stimulate sucking called the NTrainer. However, there was no published information regarding which (if any) of these interventions are actually used in clinical practice and how parents may be involved in their implementation at the neonatal intensive care unit bedside. Therefore, this qualitative study sought to understand oral motor interventions used in clinical practice. All of the interventions identified in the scientific literature were identified as being used in practice, although at varying rates. An additional intervention, milk drops, was also identified. Nonnutritive sucking and milk drops were most commonly used by the study participants and were most commonly taught to parents to implement with their infants. These findings support neonatal therapists' implementation of evidence-based practice in the clinical setting.

Sensory integration (SI) typically follows a normal sequence of development. Its evaluation is crucial for evidence-based interventions. To examine the relationship between age and performance on the Evaluation in Ayres Sensory Integration (EASI) vestibular and proprioceptive tests and to compare linear and nonlinear models. Normative data from the EASI tests were collected and used for model-building to characterize age effects on SI abilities. Laboratory in Taiwan. Children (N = 209) ages 3-12 yr. Occupational therapists (N = 23) from various regions of Taiwan collected data from typically developing children. Linear and nonlinear (quadratic and hyperbolic) models were used to examine the relationship between age and test performance. Linear models accounted for 36%-43% of the variance in vestibular and proprioceptive test performance. Nonlinear models performed slightly better, explaining 42%-48% of the variance. The sum of squared errors was lower for nonlinear models (2,943-3,832) than for linear models (3,944-4,223). The hyperbolic model generally showed the highest R2 (explained variance) and the lowest root-mean-square error of approximation, except for the Joint Position test, where it did not outperform the other models. We developed a clinically applicable system for assessing vestibular and proprioceptive functions. The results showed marked developmental improvements, especially between ages 7 and 9 yr. The findings suggest that occupational therapists can use a hyperbolic model with EASI vestibular and proprioceptive tests to better identify SI challenges, which supports the development of evidence-based intervention plans. Plain-Language Summary: Sensory integration plays a vital role in children's typical development and tends to follow a predictable pattern as they grow. The Evaluation in Ayres Sensory Integration (EASI) is a tool that is used to assess children's sensory, motor, and motor planning skills. This study focused specifically on the vestibular and proprioceptive tests. The vestibular system in the inner ear maintains balance, posture, head position, and keeps our eyes stable during movement. Proprioception lets us sense limb position without seeing them. We assessed 209 children between the ages 3 and 12 years to explore how performance on these tests changes with age. We compared two types of models: (1) a linear model (which assumes steady, constant growth) and (2) a nonlinear model (which allows for more complex growth patterns). The results showed that the nonlinear hyperbolic model better captured how children's vestibular and proprioceptive abilities develop over time. One key finding was that these skills improved most noticeably between the ages of 7 and 9 years. We developed a clinical decision support system using the EASI vestibular and proprioceptive tests. For occupational therapists, this means that applying a hyperbolic model to interpret test results may lead to more accurate identification of sensory integration difficulties. This enhanced approach can guide the development of evidence-based intervention plans.

Differences in children's sensory reactivity (SR) may contribute to increased parental stress levels. To examine the association between SR differences and parental stress among parents of children ages 3 to 7 yr. Cross-sectional. Population-based study. A total of 466 parents and their typically developing school-age children from 21 randomly selected schools in Alicante, Spain. Parental stress was assessed using the short version of the Parental Stress Scale, a 12-item Likert-scale questionnaire (1 = strongly disagree, 5 = strongly agree) on which higher scores indicate higher stress levels. SR was measured using the Short Sensory Profile, classifying children as showing or not showing SR differences using established cutoffs. Multiple linear regression models adjusted for potential confounders were used to explore the associations. Global SR differences were associated with increased parental stress in both fathers (β = 2.71, 95% confidence interval [CI] [1.40, 4.03]) and mothers (β = 2.74, 95% CI [1.47, 4.00]). Associations were also observed for mothers and fathers, respectively, in several sensory domains: Tactile Sensitivity (β = 2.20, 95% CI [0.43, 3.97]; β = 1.84, 95% CI [0.02, 3.66]), Underresponsive/Seeks Sensation (β = 1.84, 95% CI [0.71, 2.97]; β = 1. 74, 95% CI [0.58; 2.90]), Auditory Filtering (β = 2.61, 95% CI [1.49, 3.72]; β = 2.18, 95% CI [1.02, 3.34]), Low Energy/Weak (β = 2.09, 95% CI [0.40, 3.78]; β = 1.94, 95% CI [0.19, 3.68]), and Visual/Auditory sensitivity (β = 1.61, 95% CI [0.33, 2.90]; β = 2.59, 95% CI [1.27, 3.90]). SR differences among children are associated with increased stress levels for both parents, underscoring the need for family-centered support. Plain-Language Summary: Children respond to sensory experiences-such as touch, sound, or movement-differently. Some children may be more sensitive to certain stimuli, less responsive, or seek out intense sensations. This study explored whether differences in how children react to sensory input are linked to higher stress levels in their parents. Researchers surveyed 466 parents of children ages 3 to 7 yr and found that both mothers and fathers reported more stress when their children showed noticeable differences in sensory reactivity. Specific sensory challenges-such as tactile sensitivity, reduced responsiveness, and difficulty processing sounds-were particularly associated with increased parental stress. These findings highlight the importance of family-centered support to help parents manage sensory-related challenges. Occupational therapy practitioners can play a key role in providing guidance and strategies to reduce parental stress and improve family well-being.

Understanding the diverse vocational functioning profiles of individuals with disabilities is crucial for effective, person-centered practice in vocational rehabilitation. To identify latent profiles of vocational functioning on the basis of Work Rehabilitation Questionnaire (WORQ) scores of individuals with disabilities in Turkey and to investigate demographic predictors of profile membership. Cross-sectional study using online survey methods. Online data collection. A total of 522 adults (67.8% male), ages 18-64 yr, literate, and possessing a health report confirming a disability rating of more than 40% were recruited. Latent profile analysis was used to identify distinct vocational functioning profiles. Multinomial logistic regression examined predictors of profile membership. Latent profiles were derived from participant scores on the WORQ subdomains: Emotion, Cognition, Dexterity, and Mobility. Predictors included gender, education, and work experience. Three distinct latent profiles were identified: Class 1 (n = 199), with the lowest scores across all subdomains; Class 2 (n = 83), with higher Emotion and Cognition scores but lower Dexterity and Mobility scores; and Class 3 (n = 240), with higher Dexterity and Mobility scores but lower Emotion and Cognition scores. Prior work experience significantly predicted membership likelihood between profiles (p = .031). Individuals with disabilities exhibit distinct vocational functioning profiles, highlighting significant heterogeneity beyond diagnostic labels. These findings underscore the need for individualized assessment and intervention in vocational rehabilitation, tailoring approaches to profile characteristics. The profiles can guide goal setting and intervention planning, although further research is needed to explore links with specific diagnoses and employment outcomes. Plain-Language Summary: Understanding the different work-related strengths and challenges people with disabilities face is important to help them succeed in employment. This study identified three common patterns, or profiles, of individuals with disabilities on the basis of their self-reported emotional, thinking, physical movement, and fine motor skills related to work. One group had lower scores overall, another had stronger emotional and thinking skills but weaker physical skills, and the third had stronger physical skills but weaker emotional and thinking skills. Knowing these profiles can help occupational therapists tailor vocational rehabilitation programs to better meet each person's specific needs, focusing on the areas in which they need the most support to find and keep meaningful work.

As populations age, promoting health span has become a public health priority. Occupational therapy is well positioned to contribute through health promotion and primary prevention, yet its effectiveness remains underexplored. To examine the effectiveness of occupational therapy interventions in health promotion and primary prevention for adults, as measured by health-related outcomes such as occupational performance, quality of life (QoL), well-being, and participation. The PubMed, CINAHL, Cochrane Library, ProQuest, and Wiley Online Library databases were searched in February 2025. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines, eligible studies were randomized controlled trials (RCTs) of interventions led by or aligned with occupational therapy in adult health promotion or primary prevention. Risk of bias was assessed using the Joanna Briggs Institute (2024) checklist. Data were narratively synthesized because of heterogeneity. Twelve RCTs (2020-2024) were included, covering diverse populations and settings. Interventions included workplace health promotion, home modifications, telerehabilitation, exergaming, and environmental or behavioral strategies. Positive effects were noted in fall reduction, coping, physical performance, and health-related QoL. Interventions rooted in occupational frameworks and delivered by trained occupational therapy practitioners showed greater effectiveness. Variability in intensity and delivery limited comparability. Occupational therapy interventions can support adult health promotion and disease prevention when contextual, person-centered, and occupation-based. Further research should address younger adults, leisure occupations, and intervention intensity. These findings support integrating occupational therapy into public health strategies to enhance health span and reduce reliance on reactive care. Plain-Language Summary: This review looked at how occupational therapy can help adults stay healthier longer through health promotion and disease prevention. We found 12 studies showing that occupational therapy programs-such as those focused on workplace wellness, home safety, or digital health-can improve things such as quality of life and physical ability. Programs led by trained occupational therapists and tailored to people's everyday lives worked better. More research is needed to learn how to reach younger adults and to understand what features make programs most effective. These findings show that occupational therapy can play a key role in public health and help people live healthier lives longer.

Constraint-induced movement therapy (CIMT) is an intervention for hemiplegic cerebral palsy (CP) that has a strong evidence base. CIMT has been shown to be effective in improving functional use of the more impaired upper extremity, yet has not become standard practice. Toolkits have been effectively used in various settings to increase intervention implementation; however, no guide currently exists to support clinical decision-making related to CIMT. To provide an overview of the development of a practical guide for pediatric CIMT (pCIMT) that will aid therapists, other health care professionals, and families with children who may be eligible for pCIMT. Model development research. Virtual communication secured in accordance with the Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191). Content experts (N = 12) with expertise related to pCIMT, hemiplegic CP, and occupational therapy who were recruited via purposive sampling to develop the practical guide. Development of the practical guide followed a toolkit developmental model. Field notes were used to record all verbal and written feedback provided by content experts. The participants provided recommendations to include in the guide during the developmental phase. In two rounds of the expert review phase, they recommended revisions related to readability, content, and visuals. The final practical guide included six sections. A practical guide was developed to support occupational therapists, health care professionals, and caregivers in making an informed decision about whether pCIMT is the right intervention for a particular child. Plain-Language Summary: Hemiplegic cerebral palsy is the most common motor disability that affects children, and it often causes difficulty moving one side of the body. Pediatric constraint-induced movement therapy (pCIMT) is an evidence-based intervention to help children use their more affected side. However, pCIMT is not widely available. With guidance from key informants, we designed a practical guide to support health care professionals and families in determining whether pCIMT could be an appropriate intervention. A three-phase toolkit development model was followed to design the practical guide. In this article, we report on Stages 1 and 2 (the development and expert review phases). Twelve experts and caregivers informed the development of the six sections of the practical guide. Future research should proceed to Stage 3 (the evaluation phase) to evaluate the effectiveness of the practical guide and identify implementation strategies for the guide to support pCIMT usage.

Testing the effectiveness of a professional development program to support practitioners' ability to provide caregiver coaching for children younger than age 3 with sensory-based challenges is a professional responsibility. To evaluate the impact of the Sensory Approaches to Infant/Toddler Learning (SAIL) program on practitioners' knowledge of and confidence in caregiver coaching and its acceptability, appropriateness, and feasibility. Prospective cohort pilot study with data collected at three time points. Large midwestern pediatric hospital with established evidence-based practice, research, and professional development infrastructure. Occupational therapy practitioners with one or more children younger than age 3 on their caseload were eligible and invited via email. SAIL included five asynchronous webinars (sensory integration [SI] theory and intervention), 12 biweekly mentorship sessions over 6 mo, and 3 mo access to the Sensory Processing Measure-2 Sensory Professional Reasoning Kit to Promote Infant/Toddler Participation (SPM-2 SPARK). Practitioner knowledge of and confidence in SI and SI-based caregiver coaching were measured with an investigator-developed survey. Ratings of acceptability, appropriateness, and feasibility of SAIL components were completed using validated measures. Participants significantly improved in all knowledge and confidence domains from pretest to posttest and from pretest to follow-up; no significant change occurred from posttest to follow-up. Participants rated the webinar series and SPM-2 SPARK as highly acceptable, appropriate, and feasible. SAIL is a feasible and well-received approach to enhance capacity for SI-based caregiver coaching. Further research is needed with larger, diverse samples to confirm the results and assess long-term use. Plain-Language Summary: Sensory integration and processing challenges can disrupt infants' and toddlers' participation, yet the literature documents that occupational therapy practitioners feel underprepared to coach caregivers. Despite consensus on the need for postprofessional education and mentorship, evidence of effective approaches is limited. Some young children process and respond to sensory information differently. This includes what they see, feel, hear, taste, and smell, as well as their sense of movement and balance, their sense of body position, and how they use these senses together. Differences in processing and combining these senses can make daily activities such as eating, sleeping, or playing harder. Early intervention, which provides services for children from birth to age 3, often includes occupational therapy practitioners who work with caregivers to help children join in everyday routines. Yet there are reports that many practitioners do not feel confident coaching caregivers about sensory needs. This project tested the Sensory Approaches to Infant/Toddler Learning (SAIL) program, which included online training, mentoring, and practical resources. After the program, practitioners reported more knowledge and confidence in working with families. These results are a first step toward showing that SAIL is effective, but more research is needed.

Children with developmental delays face significant health challenges, including oral health problems, that disrupt dietary habits and contribute to food insufficiency. To examine the association between oral health problems and food insufficiency among children with developmental delays. Cross-sectional design using the 2022 National Survey of Children's Health database. National survey. Participants were 1,483 children ages 3-17 yr with developmental delays. Food insufficiency was rated on a 4-point scale and oral health problems as problem present versus no problem. The ordinal logistic regression models were adjusted for child, health, and socioeconomic variables. Among participants, 26.2% had oral health problems. Oral health problems were significantly associated with food insufficiency (adjusted odds ratio [AOR] = 1.72, 95% confidence interval [CI] [1.14, 2.60]). Poor maternal mental health (AOR = 4.14, 95% CI [2.24, 7.68]) and low-income households (AOR = 9.82, 95% CI [5.00, 19.36]) were strongly associated with food insufficiency. Findings demonstrate that oral health problems, maternal mental health, and socioeconomic disparities are interrelated determinants of food insufficiency among children with developmental delays. Occupational therapists can address these issues through caregiver training and advocacy to enhance access to oral health and nutritional resources. Plain-Language Summary: Children with developmental delays frequently experience oral health issues, such as cavities and chewing difficulties, which are linked with poor nutrition and food insufficiency. Using national survey data, this study examined associations among oral health problems, maternal mental health, and family income in relation to food insufficiency. Findings indicate that food insufficiency was more often reported when children had oral health problems, particularly among families with low income or mothers with poor mental health. These results highlight the need for accessible dental care, caregiver support, and food assistance programs. Occupational therapists can support families by promoting oral health strategies, stress management, and resource connections to strengthen food sufficiency and overall health.

Developmental coordination disorder (DCD) is characterized by impaired motor coordination and co-occurring deficits in executive function that significantly affect daily participation. There is limited understanding of the participation of adolescents with DCD, in particular in the domains of household chores, community mobility and driving, education, and work. To explore the strengths and challenges experienced by adolescents with DCD in their participation across multiple occupational domains. Qualitative descriptive secondary analysis. Community. Adolescents with DCD (N = 11), ages 13-18 yr. Interviews were analyzed with a directed approach to elicit participation experiences in activities of daily living (ADLs), household chores and responsibilities, community mobility and driving, education, work, and leisure and social activities. The analysis revealed cross-domain participation patterns characterized by effortful performance and inefficiency, where significant effort often did not lead to successful outcomes. Challenges with motor coordination, organization, and spatial orientation affected performance in activities ranging from ADLs and education to household chores, team sports, and leisure pursuits. Despite these difficulties, participation in education emerged as a relative strength. The participants described adapting to challenges by gravitating toward leisure activities that aligned with their abilities and were enjoyable. They perceived their interpersonal and social performance as an area of strength. The findings provide an in-depth understanding of the daily participation experiences of adolescents with DCD, highlighting both challenges and strengths, and emphasize the need for support services for individuals with DCD during adolescence, which can be informed by using a strengths-based approach. Plain-Language Summary: We explored how teens with developmental coordination disorder take part in daily activities, such as those related to self-care, chores, school, work, and social life. Experiences varied: The participants said that movement and organization tasks felt difficult, but other activities brought joy. Some teens adapted by choosing activities that matched their strengths, leading to success and enjoyment. However, difficulties in activities also affected emotions, causing frustration when tasks were hard and boosting self-esteem when they did well. This study provides a better understanding of the daily experiences and feelings of teens with developmental coordination disorder.

Children with cerebral palsy (CP) and other neurodevelopmental conditions often face significant toileting challenges because of motor, sensory, cognitive, and behavioral impairments, as well as environmental factors such as limited caregiver awareness. These difficulties affect daily function and participation, yet they are often overlooked when documenting daily challenges in existing functional classification systems or care planning. To develop and validate the Toileting Function Classification System (TFCS) for children with cerebral palsy ages 6-18, enabling tailored interventions and resource allocation. A six-phase approach: initial conceptualization and drafting, preliminary refinement, expert consultation through interviews, stakeholder consensus building through nominal and focus groups, Delphi-based content validation, and reliability assessments similar to those of other functional classification systems. Various clinical and research environments involving experienced professionals, caregivers, and children with CP. One hundred eighty children with CP, 180 caregivers, and 24 professionals with expertise in CP and toileting. Reliability (interrater and test-retest consistency) was measured using weighted κ; consensus was evaluated through Delphi surveys. The Delphi survey achieved over 80% agreement on key TFCS components across two rounds. Reliability values ranged from .61 to 1.00, demonstrating substantial to almost perfect agreement. The system successfully classified toileting functions across five levels, supporting its clinical and research applications. The TFCS provides a reliable framework for documenting and addressing toileting challenges in children with CP. Its implementation enhances family-professional communication and guides rehabilitation programs, ultimately improving quality of life. Plain-Language Summary: Toileting is a complex part of daily life that can be especially challenging for many children with disabilities. Difficulties with toileting are often linked to a combination of physical, sensory, and cognitive factors and may be even greater when conditions such as cerebral palsy occur alongside intellectual or developmental disabilities. This study focused on children with cerebral palsy and the development of a new classification system to describe their toileting function in a structured way. This tool can help occupational therapists and families better understand a child's needs and plan appropriate supports, contributing to improved care and quality of life.

Sensory processing is a vital precursor for students to engage successfully in the school environment. Sensory activities, such as movement breaks, can be strategically scheduled into the school day by the educational team, including occupational therapy practitioners, to help students with self-regulation and academic demands. To synthesize the evidence regarding the impact of sensory activity schedules on school performance and behavior of students who have documented sensory processing differences. PubMed, CINAHL, ERIC, Embase, ProQuest Central, and Web of Science databases. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed to search for and select articles. Nine articles were found that met inclusion criteria: two Level 2b studies and seven Level 4 studies. The studies examined how a sensory activity schedule affects a student's school performance or behavior. The outcome measures were categorized as disruptive behavior, on-task behavior, cognitive strategy use, and task mastery. Although sensory activity schedules have the potential to benefit a student's school performance or behavior, the current strength of evidence is low. Occupational therapy practitioners may advocate incorporating sensory activities into a student's daily routine to improve school-related outcomes; however, with the current body of evidence, clinical reasoning and individualized progress monitoring are essential to track the intervention's efficacy. Additional research is needed to build more substantial evidence to support occupational therapy practitioners' use and promotion of sensory activity schedules with students. Plain-Language Summary: Students need to regulate their senses to fully participate in school activities. This systematic review looked at research on whether sensory activity schedules improve students' school performance and classroom behavior. Although sensory activity schedules may help students, the current research is limited. Occupational therapy practitioners can still recommend scheduled sensory activities but should carefully track each student's progress to see if the approach works. More high-quality research is needed to better understand the benefits of school sensory activity schedules.