Review of occupational therapy intervention research in the practice area of children and youth 2009-2013

Profile of Assessments in Pediatric Occupational Therapy Practice

IMPORTANCE

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.

OBJECTIVE

To examine the assessment tools regularly selected by practicing pediatric occupational therapists and the therapists' classification of assessment tools as occupation-based.

DESIGN

A cross-sectional quantitative design through the dissemination of an anonymous, close-ended assessment tool inventory with completion of descriptive statistics.

SETTING

Pediatric occupational therapist practice specific to the assessments used.

PARTICIPANTS

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.

RESULTS

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.

CONCLUSIONS AND RELEVANCE

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.

[Description of a Pilot Project for Pediatric Occupational Therapy in Daycare and Community Settings]

Background. Occupational therapy interventions that promote and prevent children's health and well-being aim to reduce health inequalities and foster protective factors. The purpose of this study is to describe a pilot community-based occupational therapy project for preschoolers in partnership with community organizations and childcare services. Method. A participatory action research approach was implemented with support from an advisory committee. An occupational therapist provided community-based occupational therapy services in a tiered organization model over one year. Findings. Services were offered in three tiers: 7 awareness workshops for parents and caregivers (Tier 1), 57 visits and 27 consultations in 8 community agencies (Tier 2), and 23 individual follow-ups (Tier 3). Implications. There is an opportunity to implement with community agencies and daycare settings an occupational therapy service based on community-based rehabilitation for children under 5 years of age.

Case study research: Building the occupational therapy evidence base one case at a time

BACKGROUND

There is growing recognition in healthcare that evidence from randomised controlled trials may not be appropriate to answer the full spectrum of practice-based questions and a more pluralistic approach is needed.

AIM

To consider the use of case study research in contributing to the occupational therapy evidence base.

MATERIAL AND METHODS

A critical discussion of the current state of evidence-based practice in occupational therapy and exploration of a viable approach to case study research is used.

RESULTS

Case study research can capture the context and complexity of occupational therapy practice. Cases can then be pooled to make a substantial contribution to the evidence base.

CONCLUSIONS

Occupational therapists should consider the use of case study research to produce practice related, meaningful research. Journal editorial boards need to be mindful of the value of high-quality case study research when considering publication priorities in occupational therapy literature.

SIGNIFICANCE

Highlights a changing landscape in the literature about how best to conduct research in health and social care, particularly for complex interventions and describes a pragmatic approach to case study research for occupational therapy.

Effect of occupational therapy on self-determination skills of adolescents at risk of emotional and behavioral disorders: A randomized controlled trial

Background: Self-determination skills enable to support an individual’s needs and make decisions to function independently. Improvement of self-determination skills has had a positive result for adolescents at risk of Emotional and Behavioral Disorders (EBD). The aim of this study was to investigate the effect of occupational therapy interventions on the self-determination skills of adolescent girls at risk of emotional-behavioral disorders.

Methods: In this single-blind control trial study, 14-16-years-old girl students (n=54) at risk of EBD were recruited by cluster sampling from secondary high schools of Tehran, Iran. Youth self-report Questionnaire (YSR) was used to include adolescents at risk of EBD in the study and were randomized into the intervention (n=27) and control group (n=27) by block randomization. The Student Self-Determination Scale (SDSS) and the Self-determination Parent Perception Scale (SDPPS) were used to collect data. Students in the intervention group participated in 8 – once a week- sessions of occupational therapy and the control group received no training. Data were analyzed by repeated-measures analysis of variance (RMANOVA), Bonferroni test and SPSS 16.0 version. The significance level was set at 0.05.

Results: The score of self-determinations (SDSS) increased significantly in the intervention group after the intervention (p<0.001). Although the mean scores of self-determination at follow-up have increased in the intervention group compared to the post-test. No significant differences were found (p>0.05); also, the score of parents' perception of student self-determination (SDPPS) increased but there were not significantly different (p=0.064).

Conclusion: The findings indicated self-determination skills could be taught to adolescents at risk of EBD in OT sessions. Since self-determination has been identified as the necessary skills for adolescents at-risk to transition into adulthood, occupational therapists have an important role in promoting self-determination skills in adolescents at risk of EBD.

Efficacy of an Intervention to Teach Zippering: A Two-Group Control Study

IMPORTANCE

Engaging and pulling up a zipper is a functional skill needed by young children.

OBJECTIVE

To compare the efficacy of a standard zippering teaching vest presented with general verbal prompts to a modified zippering teaching vest presented with a related story and vocabulary among typically developing preschoolers.

DESIGN

An experimental, two-group, pre-post design.

SETTING

A local preschool.

PARTICIPANTS

Fifty preschoolers ages 3 yr, 6 mo to 4 yr, 11 mo were recruited.

INTERVENTION

Eligible children received three zippering practice sessions from occupational therapy and speech-language pathology graduate students supervised by faculty; either a standard (control group) or modified (comparison group) zippering teaching vest was used.

OUTCOMES AND MEASURES

Individual sessions were video recorded. We coded data using a score of 2, 1, or 0, indicating degree of success through seven zippering steps. Using IBM SPSS Statistics (Version 26) for analysis, we conducted independent t tests to compare measures between the two groups.

RESULTS

Each cohort consisted of 14 preschoolers (N = 28); 252 separate zippering trials were analyzed. Pretrial zippering ability demonstrated no initial differences. Results indicate that both groups advanced their skills with added practice; however, the comparison group performed statistically significantly better than the control group, beginning with the second set of interventions.

CONCLUSIONS AND RELEVANCE

Beginning with a second exposure to a novel instructional method, preschoolers increased their success by completing more of the seven identified steps of zippering than those receiving traditional input. This study demonstrates the ability of occupational therapy-speech-language pathology partnerships to create innovative treatments that facilitate occupationally based skill acquisition.

WHAT THIS ARTICLE ADDS

This article adds evidence supporting the use of a modified practice zippering vest with added visual and language cues to teach zippering skills to occupational therapy clients.

Occupation- and Activity-Based Interventions to Improve Performance of Activities of Daily Living, Play, and Leisure for Children and Youth Ages 5 to 21: A Systematic Review

IMPORTANCE

The findings support the use of occupation- and activity-based interventions to improve the occupational participation of children and youth with disabilities.

OBJECTIVE

To examine the effectiveness of occupation- and activity-based interventions to improve participation and performance in activities of daily living (ADLs), play, and leisure in children and youth.

DATA SOURCES

MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane Database of Systematic Reviews; reference lists of retrieved articles; and tables of contents of selected journals were searched to identify peer-reviewed studies published between 2000 and 2017.

STUDY SELECTION AND DATA COLLECTION

Studies addressing occupation- and activity-based interventions and outcomes for children ages 5 to 21 were selected and appraised using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines, evaluated for risk of bias, and synthesized to develop practice recommendations.

FINDINGS

Fifteen Level I (meta-analyses, systematic reviews, and randomized controlled trials), 5 Level II (two groups, nonrandomized), and 3 Level III (one group, pretest-posttest, retrospective) studies were examined and categorized by type of intervention and outcome. Each study used occupation- or activity-based interventions and reported ADL, play, or leisure outcomes. Intervention themes identified include supporting engagement in occupations, supporting participation with cognitive supports, and using technology to support occupational participation and performance.

CONCLUSIONS AND RELEVANCE

Strong evidence indicates that engagement in occupations and activities, practice within and across environments, and coaching and feedback improve participation and performance in ADLs and functional mobility. Moderate evidence supports the use of collaborative goal setting, modeling, and guided participation in play and leisure. Moderate evidence also supports technological interventions for ADL, play, and leisure performance.

WHAT THIS ARTICLE ADDS

Engaging children and youth in occupations and activities; providing guidance in goal direction, planning, and feedback to enhance their participation; coaching caregivers in effective carryover; and providing technology-based intervention can improve the occupational participation and performance of children and youth.

Prescribing Physical, Occupational, and Speech Therapy Services for Children With Disabilities

Pediatric health care providers are frequently responsible for prescribing physical, occupational, and speech therapies and monitoring therapeutic progress for children with temporary or permanent disabilities in their practices. This clinical report will provide pediatricians and other pediatric health care providers with information about how best to manage the therapeutic needs of their patients in the medical home by reviewing the International Classification of Functioning, Disability and Health; describing the general goals of habilitative and rehabilitative therapies; delineating the types, locations, and benefits of therapy services; and detailing how to write a therapy prescription and include therapists in the medical home neighborhood.

The Contribution of Sensory Sensitivity to Emotional Lability in Children with ADHD Symptoms

Emotional lability and sensory sensitivity have been shown to contribute to the overall clinical picture in children with attention deficit hyperactivity disorder (ADHD; Dunn & Bennett, 2002; Sobanski et al., 2010). Further, both of these characteristics have been individually demonstrated to contribute to poorer quality of life, increased functional impairment, and poorer treatment response (Anastopoulos et al., 2010; Boterberg & Warreyn, 2016). However, to date, no study has evaluated the relationship among all three of these factors. The current study hypothesized that increased sensory sensitivity would moderate the relationship between hyperactive/impulsive symptoms of ADHD and emotional lability in youth. Results indicate that heightened sensory sensitivity strengthens the relationship between hyperactive/impulsive symptoms of ADHD and emotional lability in children with three or more clinically impairing ADHD symptoms. This dimensional approach was taken in accordance with growing evidence that even children with sub-threshold ADHD experience significant functional impairment and high rates of sensory sensitivity (Hong et al., 2014). These findings suggest that clinicians treating children with ADHD symptoms and emotional lability should consider assessing for sensory sensitivity as integration of multi-sensory techniques or referral to concurrent occupational therapy may significantly improve treatment outcomes and quality of life for these children and their families.

Mixed-Method Exploration of Social Network Links to Participation

The people who regularly interact with an adolescent form that youth's social network (SN), which may impact participation. We investigated the relationship of SNs to participation using personal network analysis and individual interviews. The sample included 36 youth, aged 11 to 16 years. Nineteen had diagnoses of learning disability, attention disorder, or high-functioning autism, and 17 were typically developing. Network analysis yielded 10 network variables, of which 8 measured network composition and 2 measured network structure, with significant links to at least I measure of participation using the Children's Assessment of Participation and Enjoyment (CAPE). Interviews from youth in the clinical group yielded description of strategies used to negotiate social interactions, as well as processes and reasoning used to remain engaged within SNs. Findings contribute to understanding the ways SNs are linked to youth participation and suggest the potential of SN factors for predicting rehabilitation outcomes.