Handwriting of eight year old children with and without autistic spectrum disorder

Anecdotally it was found that Queensland occupational therapists reported a surprisingly high referral rate for handwriting problems amongst school aged children with Autistic Spectrum Disorder (ASD). A subsequent review of the literature revealed a number of anecdotal reports of disordered handwriting in this population but limited research in the area. This thesis presents a descriptive and exploratory study of the nature of handwriting in eight year old children with and without ASD. Issues of handwriting development and motor learning are canvassed followed by an examination of concepts of motor control. Next follows a review of current handwriting models. The Systems Model of Handwriting was proposed as a response to the evidence for both dynamic and motor programme aspects of handwriting. Using this model as an organizing structure, the literature on ASD and handwriting was then examined which led to the framing of three research questions: 1. Is the handwriting speed of children with ASD significantly different from that of children without ASD? 2. Is the handwriting legibility of children with ASD significantly different from that of children without ASD? 3. At what stage/s of the Sequential Handwriting Process, is the handwriting of children with ASD different from that of children without ASD? Twenty-eight eight year old children with ASD and a matched control group of twentyeight comparison children were recruited from state primary schools in Brisbane and surrounding areas. These fifty-six children were assessed on thirteen handwriting process variables and two handwriting outcome variables in order to answer the research questions. Data produced were analyzed primarily with t-tests for between group differences and by examination of correlations between process and outcome variables. Small but measurable differences were found in both speed and legibility between the two groups, with the handwriting of the children with ASD being both less legible (t=- 2.47, df=54, p=0.02) and slower (t=-2.47, df=54, p=0.02). Accuracy of letter formation was also found to be significantly worse for the children with ASD compared to children in the control group (t=3.53, df=54, p=0.001). Further, the two groups were found to differ in some aspects of the Sequential Handwriting Process. Specifically, the children with ASD showed significant correlations between legibility and Perceiving, Conceptualizing and Planning stages, while the comparison children showed significant correlations between legibility and Interpreting, Conceptualizing, Planning and Activating stages. Only one process variable (consistency of letter formation) showed a moderate correlation with handwriting speed all other variables were of only slight to fair strength. Finally, the implications of the research findings are discussed, limitations described and directions for future research canvassed. As a result of the present study, a revised Systems Model of Handwriting is proposed. Several recommendations for occupational therapy intervention in handwriting practices in the classroom are made, notably: clear and focussed initial tuition of letter formation and secondly, the development of automaticity of the handwriting skill

Helping children with autism spectrum disorders and families: Are we losing our occupation-centred focus?

A great number of organic compounds, commonly used, could become instable if stored under poor conditions or for over-long periods in contact with air. Indeed, they can react with molecular oxygen, also at room temperature, in a process of autoxidation (peroxidation), which is self-propagating and based on free radical reactions. The products of this process are peroxidized compounds (hydroperoxide or alkyl peroxides), thermodynamically instable and well-known to be the cause of many laboratory accidents. A full characterization of such a process is very difficult at experimental level, due also to the presence of short-living radicals and many possible reaction pathways. The aim of this thesis, carried out within the RIPER (for "study of RIsk linked to the PERoxidation of chemical products") research project of INERIS, is the mechanistic study of the autoxidation of ethers, using a molecular modeling approach, in order to share some lights on the principal causes of accidental risks arising from the used of ethers, notably from storage in standard (normal) conditions. Firstly a detailed mechanistic study on diethyl ether (DEE) oxidation has been carried out, using both molecular (DFT) and kinetic modeling. The identified reaction mechanism and the developed kinetic model show that accidental risk of the process of oxidation is directly linked to the accumulation of some peroxidized compounds produced during the process (hydroperoxides in particular). The main reactions identified and characterized for the DEE oxidation process have been then studied (always at DFT level) for 13 aliphatic ethers and a common behavior in the oxidation mechanism has been found. This mechanistic generalization relieves of a detailed study of whole oxidation process for each single molecule, allowing for the energy evaluations only of the identified key steps. Finally, the inhibition mechanism of DEE oxidation has also been investigated by a DFT study considering the effect of 12 potential effective antioxidants. Preliminary results show that phenolic antioxidants are the best performing ones for the process of inhibition and, in particular, the efficacy of butylated hydroxytoluene (BHT), an additive already commonly used in DEE storage.De nombreux produits chimiques organiques usuels sont susceptibles de devenir instables lorsqu'ils sont stockés de manière inadéquate ou durant de longues périodes au contact de l'air. Ils peuvent réagir avec l'oxygène moléculaire, y compris { température ambiante, par un processus d'autoxydation (peroxydation), qui se déroule selon un mécanisme radicalaire de réactions en chaine. Ce processus mène { la formation d'espèces chimiques peroxydées, thermodynamiquement instables et reconnus responsables de nombreux accidents de laboratoire. La présence d'espèces radicalaires, de plusieurs chemins réactionnels et le fait que les produits de réaction soient souvent des mélanges de composés, rendent la caractérisation expérimentale du processus de peroxydation très difficile. L'objectif de cette thèse, qui s'intègre dans le cadre du programme de recherche RIPER (étude des RIsques liés { la PERoxydation des produits chimiques) de l'INERIS, a été l'étude, par des méthodes de modélisation moléculaire, du processus d'autoxydation d'une famille d'espèces facilement peroxydables, les éthers, afin d'identifier les risques accidentels liés { leur utilisation, notamment dans des conditions normales de stockage. Dans ce but, une étude mécanistique détaillée a été menée sur l'oxydation de l'éther diéthylique (DEE) en utilisant une double approche de modélisation moléculaire (DFT) et cinétique. Le mécanisme réactionnel identifié pour le processus ainsi que le modèle cinétique détaillé développé, démontrent que, la compétition entre la voie réactionnelle de décomposition du radical alkyle issu de l'étape d'initiation et celle d'isomérisation des radicaux peroxyde est au coeur du processus d'oxydation du DEE est et que, la prépondérance d'un chemin par rapport { l'autre, dépend de la concentration d'oxygène dissous dans le solvant. Ces deux approches complémentaires indiquent aussi que le risque accidentel lié à cet éther est dû { l'accumulation de certaines espèces peroxydées produites (hydroperoxydes notamment). Les voies réactionnelles principales caractérisées pour le processus d'oxydation du DEE ont ensuite été étudiées pour treize autres éthers aliphatiques. Les résultats ont mis en évidence un comportement commun des éthers vis-à-vis de leur oxydation et cela a permis d'évaluer les énergies en jeu dans les étapes clefs du processus pour toutes les espèces considérées en s'affranchissant d'une étude détaillée. Enfin, le mécanisme d'inhibition de l'oxydation du DEE par ajout d'espèces chimiques antioxydantes a également été examiné par modélisation moléculaire. Les résultats préliminaires démontrent que les antioxydants phénoliques sont les plus efficaces pour l'inhibition du processus et confirment que le BHT (hydroxytoluène butylé), qui est déj{ l'antioxydant le plus utilisé pour la stabilisation du DEE, est l'inhibiteur le plus performant parmi les 12 étudiés

How do allied health professionals evaluate new models of care? What are we measuring and why?

The aim of this study was to identify what outcome measures or quality indicators are being used to evaluate advanced and new roles in nine allied health professions and whether the measures are evaluating outcomes of interest to the patient, the clinician, or the healthcare provider. A systematic search strategy was used. Medical and allied health databases were searched and relevant articles extracted. Relevant studies with at least 1 outcome measure were evaluated. A total of 106 articles were identified that described advanced roles, however, only 23 of these described an outcome measure in sufficient detail to be included for review. The majority of the reported measures fit into the economic and process categories. The most reported outcome related to patients was satisfaction surveys. Measures of patient health outcomes were infrequently reported. It is unclear from the studies evaluated whether new models of allied healthcare can be shown to be as safe and effective as traditional care for a given procedure. Outcome measures chosen to evaluate these services often reflect organizational need and not patient outcomes. Organizations need to ensure that high-quality performance measures are chosen to evaluate the success of new health service innovations. There needs to be a move away from in-house type surveys that add little or no valid evidence as to the effect of a new innovation. More importance needs to be placed on patient outcomes as a measure of the quality of allied health interventions

Improving transfer of learning: an innovative comentoring program to enhance workplace implementation after an occupational therapy course on autism spectrum disorders

Introduction: Research suggests that learning gained through training is infrequently implemented in the workplace. A shortterm postcourse comentoring program was developed with the aim of facilitating workplace implementation of learning after a 3-day course for occupational therapists. The program was evaluated for usefulness, successes, challenges, recommended improvements, and associations with changes in self-rated knowledge and confidence. Method: Two months after the course, 42 participants completed an evaluation of the comentoring program with closed-and open-ended questions addressing usefulness, successes, challenges, pairing preferences, and recommendations. They also completed a record on whether or not they had worked on goals nominated in their comentoring contract. Before and 2 months after the course, they completed a self-rated questionnaire on knowledge and confidence. Results: The comentoring program was recommended by 80% of participants. Benefits included opportunities for information and resource sharing, debriefing, problem solving, reassurance, and implementation of ideas. Ninety-five percent of participants worked on some or all their comentoring goals. Although there were significant improvements in knowledge (P < 0.001) and confidence (P < 0.001), the total comentoring evaluation score was not significantly associated with these changes. It is therefore possible that these improvements related to the course itself rather than the comentoring program. Challenges related to time, scheduling, distance, and pairing of comentors. Conclusion: Reported benefits of the program included enhanced psychosocial support and prompting to trial newly learned strategies. Effectiveness may be improved by setting aside time for comentoring in the workplace and better matching of comentors

Using staffing ratios for workforce planning: evidence on nine allied health professions

Background: Modern healthcare managers are faced with pressure to deliver effective, efficient services within the context of fixed budget constraints. This requires decisions regarding the skill mix of the workforce particularly when staffing new services. One measure used to identify numbers and mix of staff in healthcare settings is workforce ratio. The aim of this study was to identify workforce ratios in nine allied health professions and to identify whether these measures are useful for planning allied health workforce requirements. Method: A systematic literature search using relevant MeSH headings of business, medical and allied health databases and relevant grey literature for the period 2000-2008 was undertaken. Results: Twelve articles were identified which described the use of workforce ratios in allied health services. Only one of these was a staffing ratio linked to clinical outcomes. The most comprehensive measures were identified in rehabilitation medicine. Conclusions: The evidence for use of staffing ratios for allied health practitioners is scarce and lags behind the fields of nursing and medicine

The unrealized promise of infant statistical word–referent learning

Recent theory and experiments offer a new solution regarding how infant learners may break into word learning by using cross-situational statistics to find the underlying word–referent mappings. Computational models demonstrate the in-principle plausibility of this statistical learning solution and experimental evidence shows that infants can aggregate and make statistically appropriate decisions from word–referent co-occurrence data. We review these contributions and then identify the gaps in current knowledge that prevent a confident conclusion about whether cross-situational learning is the mechanism through which infants break into word learning. We propose an agenda to address that gap that focuses on detailing the statistics in the learning environment and the cognitive processes that make use of those statistics