Play behavior and occupational therapy.

The effectiveness of treatment methods on a person\u27s ability to carry out occupational roles competently is of interest to occupational therapists. This case study demonstrated how play, as an occupational role of childhood and as a measure of competence, can be used to evaluate the effectiveness of occupational therapy that uses a sensory integrative approach. The positive changes in C.C.\u27s play behavior support the basic philosophy of sensory integration, which states that an increase in sensory integrative functions will improve competence (in this study, competence is defined as play), that is, that a person will have the ability to carry out occupational roles in an adaptive and competent manner. In addition, improvements in other areas, such as the organization and execution of self-care skills and improvements in gross and fine motor skills, provide further support to sensory integrative philosophy. Further exploration of these concepts would add to a growing body of knowledge aimed at the documentation of the effectiveness and efficacy of occupational therapy interventions

The frequency of vestibular disorders in developmentally delayed preschoolers with otitis media.

This study investigated the frequency of vestibular disorders in developmentally disabled preschoolers who did and who did not have a history of otitis media. Fifteen children with a history of otitis media and fifteen children with no history of otitis media were given two tests for vestibular functioning: the Southern California Postrotary Nystagmus Test (SCPNT) and the Lateral Labyrinthine Righting Reaction (LLRR), acting on the head. The scores on these tests were dichotomized, and a correlation between these two tests as measures of vestibular function was obtained. Because this correlation did not reach a satisfactory level, two a satisfactory level, two separate chi-square analyses were performed to examine the frequency of vestibular disorders with otitis media. Both tests showed a statistically significant difference in the incidence of vestibular disorders between the two groups of children; the group having otitis media demonstrated more vestibular disorders. The SCPNT demonstrated more striking results than did LLRR. This finding is related to the two tests measuring different aspects of vestibular functioning; the separate chi-square analyses were performed to examine the frequency of vestibular disorders with otitis media. Both tests showed a statistically significant difference in the incidence of vestibular disorders between the two groups of children; the group having otitis media demonstrated more vestibular disorders. The SCPNT demonstrated more striking results than did LLRR. This finding is related to the two tests measuring different aspects of vestibular functioning; the SCPNT reflects semicircular canal functioning, and the LLRR reflects utricular and saccular functioning. The criteria used for LLRR (four seconds) also may have influenced the results obtained using this test

Occupational therapy using a sensory integrative approach: a case study of effectiveness.

OBJECTIVE: This article presents a case report of a child with poor sensory processing and describes the disorders impact on the child\u27s occupational behavior and the changes in occupational performance during 10 months of occupational therapy using a sensory integrative approach (OT-SI). METHOD: Retrospective chart review of assessment data and analysis of parent interview data are reviewed. Progress toward goals and objectives is measured using goal attainment scaling. Themes from parent interview regarding past and present occupational challenges are presented. RESULTS: Notable improvements in occupational performance are noted on goal attainment scales, and these are consistent with improvements in behavior. Parent interview data indicate noteworthy progress in the child\u27s ability to participate in home, school, and family activities. CONCLUSION: This case report demonstrates a model for OT-SI. The findings support the theoretical underpinnings of sensory integration theory: that improvement in the ability to process and integrate sensory input will influence adaptive behavior and occupational performance. Although these findings cannot be generalized, they provide preliminary evidence supporting the theory and the effectiveness of this approach

Examining the neuroscience evidence for sensory-driven neuroplasticity: implications for sensory-based occupational therapy for children and adolescents.

When Ayres first presented the theory of sensory integration (SI), she grounded it in the neuroscience literature. Neuroplasticity was then, and is today, considered to be at the heart of this theory. This evidence-based review sought to critically examine the basic science literature to specifically identify evidence for the assumptions and tenets of Ayres\u27 theory of SI. We reviewed literature between 1964 and 2005, within psychological, physiological, and biomedical areas, addressing neuroplasticity. The review focused on sensorimotor-based neuroplasticity; explored the data that addressed the links among sensory input, brain function, and behavior; and evaluated its relevance in terms of supporting or refuting the theoretical premise of occupational therapy using an SI framework (OT/SI) to treatment. Although direct application from basic science to OT/SI is not feasible, we concluded that there was a basis for the assumptions of Ayes\u27 SI theory

Occupational therapy in early intervention: a family-centered approach.

This article describes a framework for occupational therapy service provision in early intervention settings and presents pilot data aimed at examining the framework\u27s effectiveness. The Family-Centered Framework for Early Intervention is a synthesis of concepts from the Model of Human Occupation (Kielhofner & Burke, 1980) and from the literature on play. It encompasses a systematic, holistic approach that considers the child and the family within the context of their life environments. In this framework, play is used both as an evaluative tool and as an intervention modality that addresses the volition, habituation, and performance of the child and family as well as the strengths and weaknesses of the environment. Play is also used as a primary measure of competence and change. This framework may be useful in defining occupational therapy roles for the early intervention population

Outcomes of an Evidence-Based, Data Driven-Model Fieldwork Experience for Occupational Therapy Students

Over the past decade, there has been an increased emphasis on evidence-based practice (EBP) and the use of outcome measurement in clinical practice, however, the implementation of evidence into practice remains challenging and irregular. During fieldwork, students often experience a disconnect between the emphasis on EBP in the classroom and lack of use in the clinic. Recognizing the need to develop high-quality, evidence-based and data-driven models of practice for student training, we partnered with local fieldwork educators to develop an innovative program that guides students and simultaneously trains fieldwork educators (FWE) in the use of a systematic data driven decision making (DDDM) process to infuse evidence into practice. Using a pre-post quasi-experimental design, we evaluated the impact of this program on students’ perceived knowledge and skills in use of EBP and DDDM. A focus group with participating fieldwork educators captured their knowledge and attitudes in the use of EBP and DDDM in their clinical sites. Eleven FWEs and twenty four students participated. Results revealed significant change in students’ knowledge and skill in use of EBP and DDDM. FWEs reported the program clarified the role of occupational therapy, enhanced communication, and validated the value of occupational therapy in their clinical site. This program serves as a model for training students to implement evidence and data driven approaches in clinical practice, thus bridging the gap between classroom and clinic

Use of robotics in spinal cord injury: a case report.

OBJECTIVE: We examined the use of robotics to treat upper-extremity (UE) dysfunction in tetraplegic patients with spinal cord injury (SCI). METHOD: a 51-yr-old man with incomplete SCI participated in an occupational therapy program that combined traditional occupational therapy with Reo Go®, a comprehensive therapy platform that includes a robotic guide featuring a telescopic arm to enable high repetitions of functionally relevant UE exercises. RESULTS: The participant demonstrated measurable improvements in active range of motion, muscle strength as measured through manual muscle testing, perceived right UE function, and self-care performance as measured by the FIM™. CONCLUSION: The findings from this case are promising and demonstrate the Reo Go\u27s utility in combination with traditional occupational therapy. However, more research and specific protocols that are easily reproducible with robots such as the Reo Go are needed to validate this evolving treatment area

A curriculum based on systems theory.

This paper describes an entry-level curriculum based on systems theory that was designed to promote integrated thinking and a shared image of practice among all of the members of an educational community that included students, faculty, and clinicians. Initiated in 1983, the program integrates occupational therapy theory, critical thinking, and knowledge about person-environmental transactions with traditional medical, biological, psychological, and sociological course work to create a unique educational experience. The curriculum model is based on a spiral learning process that encourages integrated thinking. Furthermore, all concepts are systematically tied to the occupation core, the central theme of the program. Fieldwork is used to reinforce ideas presented in the classroom and features discrete learning experiences where students demonstrate their integration of knowledge and skills. In an evaluation of the program, responses from 78 clinician, 51 alumni, and 132 student questionnaires; feedback from 132 fieldwork supervisors; and longitudinal data from 33 alumni confirmed that graduates are critical thinkers who appreciate the diverse needs of clients while demonstrating an appreciation for the curative effect of meaningful, goal-directed activities