A Qualitative Study to Explore Ways to Observe Results of Engaging Activities in Clients with Dementia

BACKGROUND

Many occupational therapists face the challenge of helping clients with dementia to select and perform meaningful occupations, which may be difficult due to cognitive impairment. Understanding tacit knowledge of well-experienced occupational therapists could positively affect occupational therapy practice for clients with dementia.

OBJECTIVES OF STUDY

To explore the observations of experienced occupational therapists when evaluating the effects of activities in clients with dementia.

METHODS

Ten occupational therapists with over 10 years of clinical experience participated in this qualitative study. In-depth interviews were conducted to ask the question, "What do you observe in clients with dementia when you assess the effectiveness of activities among these clients?" Findings. From 47 cases, we found five major themes and 18 subthemes. Main themes were "engaging activity," "emotional expression during activity," "verbal expression during activity," "social interaction through activity," and "something obtained as outcome of activity." Relevance to Clinical Practice. The 18 subthemes could be used as viewpoints to observe engagements of activity in clients with dementia.

LIMITATIONS AND RECOMMENDATIONS FOR FURTHER RESEARCH

Future studies could examine which viewpoints were utilized for each type of activity and/or severity of dementia as this was not investigated in the current study.

Factors Influencing Occupational Therapists' Decision to Supervise Fieldwork Students

The purpose of this study was to identify factors that influence the decision to supervise a Level II occupational therapy fieldwork student. A survey was sent to occupational therapists identified from licensure boards and alumni rosters, including those who have and have not supervised students (n = 548). The results identified both positive and negative influences along with predictive factors of supervising a student. While positive factors included continuing education units, education on fieldwork expectations, their own fieldwork experiences, shared supervision, and access to educational resources, negative influences consisted of: job responsibilities, caseload, productivity standards, working part-time, and fear of failing a student. The discussion focuses on how to address the needs of the clinician and facilitate fieldwork placement.

Structured Evaluation of Glioma Patients by an Occupational Therapist-Is Our Clinical Examination Enough?

BACKGROUND

Preservation of neurologic function is mandatory when offering a surgical intervention to patients with low-grade gliomas (LGGs), given that the goal of any treatment is the patient's return to their normal everyday life.

OBJECTIVE

To determine whether a structured evaluation by an occupational therapist can reveal deficits that might be overseen in routine clinical examination of patients with a surgically treated LGG.

METHODS

A total of 20 patients with radiographically suspected LGG were examined in a standardized fashion at 3 stages: preoperatively, postoperatively, and 3 months thereafter. Results were analyzed descriptively.

RESULTS

A total of 19 patients (95%) showed no postoperative motor deficit; one suffered from akinesia due to supplementary motor area involvement and demonstrated a transient deficit with manifestation on the first postoperative day. Patients with eloquent LGGs, involving speech (n = 6, 30%), exhibited different transient speech disturbances according to the location of the lesion. Structured testing revealed a postoperative worsening of movement mirroring (upper extremity) and finger discrimination (sensory) in 5 of 20 patients (25%). Force meter evaluation of the upper extremity was decreased significantly postoperatively for the affected hemisphere, even though motor deficits were absent in most patients. The action research arm test detected deterioration in more than one half of the patients postoperatively. Patients recovered from these deficits within the first 3 months.

CONCLUSIONS

Routine clinical examination and neuropsychological evaluation fail to detect mild deficits in sensory function, reactivity, and apraxia, which may have a serious impact on patients' ability to return to their normal lives and work.

Inconsistent staffing and its impact on service delivery in ASD early-intervention

BACKGROUND

Inconsistent staffing (high turnover, casual workforce) is problematic in organisations, with the potential to impact both staff and services provided. Research has primarily focused on the impacts of inconsistent staffing in child welfare and community services with little evidence surrounding their ability to impact the outcomes for children with Autism Spectrum Disorders attending early-intervention services.

AIM

The aim of this study was to explore staff views regarding the impact of staff turnover on the delivery of group based early intervention for children with ASD.

METHODS AND PROCEDURES

We conducted five focus groups involving 29 professional (e.g. teachers, behaviour therapists), para-professional (e.g. child care workers), and managerial staff to explore their views. Audio recordings were transcribed verbatim for use in thematic analysis.

OUTCOMES AND RESULTS

Two central themes, comprising five categories emerged to encompass participants' views. "Impacts on Staff" accounted for the challenges existing staff felt when working with new and untrained staff in the centre. Participants also expressed concerns for the "Impacts on Service Delivery" that resulted from dynamic staffing, affecting fidelity of interventions and the program itself.

CONCLUSIONS AND IMPLICATIONS

The findings suggest that lacking a consistent staffing structure is problematic when attempting to provide high quality early intervention services to children with ASD and suggest that future research should investigate the extent of inconsistent staffing, impacts of inconsistent staffing on providing intervention, and develop a range of tools to help measure these effects.

Building blocks system for a prosthesis training of a child with congenital amputee

Our objective is to provide a novel habilitation experience using play to children with special needs, in particular to those with congenital defects of the upper limbs. Our concept is a device-assisted motivational training session using tangible building block devices. In order to verify the feasibility of our concept with used bioToys in a clinical training session with occupational therapists. Our participant was a one-year-old girl with congenital amputation of the right upper limb. We verified that bioToys could be used in clinical training for a prosthesis, and could assist with both playful training and quantitative therapeutic evaluation.

The conduct and process of mental capacity assessments in home health care settings

The assessment of capacity to consent to treatment is key to shared practitioner-patient decision-making. It is the responsibility of the person closest to the decision being made to carry out the assessment. The aim was to examine the factors that influence mental capacity assessments in home health care settings and identify the facilitators and inhibitors to the conduct and process of assessments as perceived and experienced by non-medical health practitioners providing generalist community services. Semi-structured interviews with a purposive sample of community nurses, community physiotherapists and community occupational therapists in one NHS Trust in London. Data were analysed thematically. The main themes were issues relating to: intrinsic patient factors and behaviours; recognising, managing and utilising the influence of the family; practitioner motivation and competence; working together as a team to optimise shared decision making, and; the importance of place. While some issues appear germane to both hospital and home health care settings, others are unique to - or manifest very differently in - home health care settings. The findings suggest that the influence of family members, long-term practitioner-patient relationships and physical distance from co-workers make the conduct and process of mental capacity assessments in home health care settings an inherently complex endeavour.

Physiotherapists working in clinics have increased risk for new-onset spine disorders: a 12-year population-based study

Health care professionals are known to have a high risk for work-related musculoskeletal disorders. However, the information on the risk of new-onset spine-related musculoskeletal disorders (SRMDs) in health care professionals is insufficient. This study aimed to investigate new-onset spine disorder associations among physical, occupational, and pharmacy health care professionals working in different workplaces.Taiwan's National Health Insurance Research Database for registered medical personnel claims from 2000 to 2011 was analyzed. An age- and sex-matched longitudinal cohort study of 7448 subjects (1682 physiotherapists, 1682 occupational therapists [OTs], and 3724 pharmacists) with or without new-onset spine disorders was conducted. The hazard ratios for the development of new-onset spine disorders were estimated among these 3 groups.The overall percentage of new-onset SRMD for physiotherapists is 32.12. The median time from obtaining a registered license to developing SRMD is 1.94 years. The log-rank test showed that physiotherapists have the least possibility of having a SRMD-free rate (P < 0.0001). The Cox model showed that physiotherapists have a higher risk of new-onset SRMD (hazard ratio: 1.65, 95% confidence interval: 1.48-1.84, P < 0.0001) compared with OTs and pharmacists. Physiotherapists working in clinics have a 2.40-fold increased risk of developing SRMD (95% confidence interval: 1.97-2.92, P < 0.0001) relative to OTs and pharmacists.This may be the first study regarding new-onset SRMD in physiotherapists based on a powerful nationwide population-based database. We conclude that working in clinics is a potential risk for new-onset SRMD in physiotherapists. Therefore, we suggest that physiotherapists should pay more attention to this issue to prevent the development of spine disorders.

Professionalism in Physician Assistant, Physical Therapist, Occupational Therapist, Clinical Psychology, and Biomedical Sciences Students

Interprofessional collaboration for healthcare requires a better understanding of the commonalities and differences in student perceptions of professionalism.

METHODS

217 students in five programs (PA 71, PT 46, OT 29, CP 12, and BMS 59) completed a 22-item survey (response rate 79.5%). A Likert scale grading from 1 (hardly ever) to 5 (always) was used to assess professional attitudes and behaviors.

RESULTS

A mixed-model MANOVA, supplemented with post-hoc analyses, showed significant group by time interactions for 5 items. Sensitivity to differences and diversity of other people increased for BMS students, but decreased for PT students. Timeliness increased for BMS students, but did not change for PA students. Seeking out new learning experiences increased for BMS students, but did not change for PA or PT students. Taking a group leadership role increased for BMS students, decreased for PT students, while PA and OT students showed no change. Volunteering time to serve others decreased for OT and PA students, while BMS and BM students showed no change.

CONCLUSION

It is plausible that these findings emerge from differences in program curricula and specific training objectives. The findings provide initial insight to educators on ways that attitudes and behaviors pertaining to professionalism sometimes vary among students in different health science programs.

The Environmental Impact on Occupational Therapy Interventions

The purpose of this study was to investigate how the environment influenced the intervention choices occupational therapists made for patients recovering from a stroke in an inpatient rehabilitation hospital. Three occupational therapists were observed providing intervention for six patients over a 16-month period. Treatment spaces included a therapy gym, gym with kitchen combination, and a home-like space. Furniture was added to the therapy gym to be more home-like midway through the study. Observations included therapist selection of treatment location and interventions, and observational data of the environment and interactions among therapists and patients. This study found that inpatient rehabilitation environments did influence interventions. The occupational therapists provided therapy in the standard therapy gym environment most often, whether it was enhanced to be more home-like or not, and predominately used preparatory methods.