Application of the Person-Environment-Occupation-Performance Model: A Scoping Review

The Person-Environment-Occupation-Performance (PEOP) Model is one of several occupation-based models in occupational therapy. The model describes the transactional nature of person, environment, and occupation factors that support performance (doing), participation (engagement), and well-being (health and quality of life). The purpose of this study was to explore the extent and nature of evidence on the PEOP Model. We used a scoping review to identify and analyze journal articles that used the PEOP Model as a framework for study. The PRISMA extension for scoping reviews (PRISMA-ScR) criteria were used to develop the research methods. We found 109 articles that adopted the PEOP Model as an organizing framework. The studies reviewed represent the breadth of occupational therapy practice and the transactional nature of person, environment, occupation, and performance in the PEOP Model. The PEOP Model is a useful international framework for research and practice across populations, conditions, life circumstances, settings, and areas of practice.

The Parietal Lobe in Alzheimer’s Disease and Blindness

The progressive aging of the population will notably increase the burden of those diseases which leads to a disabling situation, such as Alzheimer’s disease (AD) and ophthalmological diseases that cause a visual impairment (VI). Eye diseases that cause a VI raise neuroplastic processes in the parietal lobe. Meanwhile, the aforementioned lobe suffers a severe decline throughout AD. From this perspective, diving deeper into the particularities of the parietal lobe is of paramount importance. In this article, we discuss the functions of the parietal lobe, review the parietal anatomical and pathophysiological peculiarities in AD, and also describe some of the changes in the parietal region that occur after VI. Although the alterations in the hippocampus and the temporal lobe have been well documented in AD, the alterations of the parietal lobe have been less thoroughly explored. Recent neuroimaging studies have revealed that some metabolic and perfusion impairments along with a reduction of the white and grey matter could take place in the parietal lobe during AD. Conversely, it has been speculated that blinding ocular diseases induce a remodeling of the parietal region which is observable through the improvement of the integration of multimodal stimuli and in the increase of the volume of this cortical region. Based on current findings concerning the parietal lobe in both pathologies, we hypothesize that the increased activity of the parietal lobe in people with VI may diminish the neurodegeneration of this brain region in those who are visually impaired by oculardiseases.

iPad Use Among Older Women with Low Vision: Follow-Up Focus Group Findings

Technology can enable efficient, effective, and independent performance of daily occupations and enhance social and leisure participation. This paper describes the findings of a qualitative study exploring iPad use during daily activities among adults with low vision. Five women who previously participated in a group iPad intervention participated in the study. Thematic analysis revealed 5 main themes: integration of the iPad into daily routine, benefits and barriers of the iPad, psychosocial factors, preferences regarding iPad use, and group instruction in individual iPad use. Group instruction may be a viable intervention option in low vision rehabilitation to improve occupational participation.

The environmental factors that influence technology adoption for older adults with age-related vision loss

Introduction

With the increasing proportion of older adults aging with vision loss, low-vision assistive devices can help to support occupational engagement; however, such devices are grossly underused among this population. The overarching purpose of this project was to examine the environmental factors that influence technology adoption for older adults with age-related vision loss.

Methods

A one-day workshop, which utilized a variety of hands-on methods including Show & Tell, Technology Interaction, and an “App” Assessment activity, was conducted. A total of 19 participants attended the workshop, including 10 older adults with age-related vision loss, six caregivers, one healthcare provider, and two technology industry professionals.

Results

A total of four themes emerged, including: (1) making life harder; (2) relying on support networks; (3) factoring in the pragmatics; and (4) not me, not yet. These themes illustrate the various ways that environmental factors, including physical, social, cultural, and institutional/political factors, influence decision-making regarding technology adoption by older adults with age-related vision loss.

Conclusion

This paper demonstrates several environmental factors that influence low-vision assistive device adoption among older adults with age-related vision loss. With their holistic view of clients, including an appreciation for environmental influences, occupational therapists are well positioned to help identify those environmental barriers limiting low-vision assistive device adoption and use.

The benefits and barriers to technology acquisition: Understanding the decision-making processes of older adults with age-related vision loss (ARVL)

Introduction

While research has investigated the factors influencing acquisition and use of technologies/assistive devices by older adults, few studies have addressed the decision-making processes regarding technology adoption of older adults with age-related vision loss.

Method

This critical ethnography engaged 10 older adults with age-related vision loss in narrative interviews, participant observation sessions, and semi-structured in-depth interviews to understand their decision-making processes related to the acquisition and use of low vision assistive devices to support occupational engagement.

Findings

Study findings focused on the benefits and barriers to technology acquisition and use. Benefits of technology acquisition included: enhanced occupational engagement; independence; safety; insurance; and validation of the disability, while the barriers to technology acquisition included: cost; training; usability; lack of awareness of low vision rehabilitation services; fear of being taken advantage of; and desire to preserve a preferred self-image.

Conclusion

Considering the low uptake of vision rehabilitation services, the study findings are important to occupational therapy. A better understanding of the perceived benefits and barriers to technology adoption from the perspective of older adults will help occupational therapists maximize treatment planning designed to enhance the occupational engagement of older adults aging with vision loss.

Screening for sensory impairment in older adults: Training and practice of occupational therapists in Quebec

BACKGROUND

The goal of occupational therapy education is to train generalists who can refine their knowledge after graduation according to the requirements of the professional environment. However, it is currently unclear to what extent sensory screening should be included in the educational curricula.

PURPOSE

The purpose of this study was to examine the sensory screening education for and practice by occupational therapists working with older adults.

METHOD

A cross-sectional survey was used to collect data from members of the Quebec Order of Occupational Therapists. Descriptive statistics were used in the analysis.

FINDINGS

Data from 102 respondents indicated that training on sensory impairment-related topics was minimal and in stark contrast to the proportion who reported serving clients with a visual (92%), hearing (84%), or combined impairment (53%).

IMPLICATIONS

Occupational therapy considers numerous aspects of physical, cognitive, and emotional well-being. The question remains as to what extent vision and hearing health should take their place among these priorities.

Critical success factors in awareness of and choice towards low vision rehabilitation

PURPOSE

The goal of the current study was to examine the critical factors indicative of an individual's choice to access low vision rehabilitation services.

METHODS

Seven hundred and forty-nine visually impaired individuals, from the Montreal Barriers Study, completed a structured interview and questionnaires (on visual function, coping, depression, satisfaction with life). Seventy-five factors from the interview and questionnaires were entered into a data-driven Classification and Regression Tree Analysis in order to determine the best predictors of awareness group: positive personal choice (I knew and I went), negative personal choice (I knew and did not go), and lack of information (Nobody told me, and I did not know).

RESULTS

Having a response of moderate to no difficulty on item 6 (reading signs) of the Visual Function Index 14 (VF-14) indicated that the person had made a positive personal choice to seek rehabilitation, whereas reporting a great deal of difficulty on this item was associated with a lack of information on low vision rehabilitation. In addition to this factor, symptom duration of under nine years, moderate difficulty or less on item 5 (seeing steps or curbs) of the VF-14, and an indication of little difficulty or less on item 3 (reading large print) of the VF-14 further identified those who were more likely to have made a positive personal choice. Individuals in the lack of information group also reported greater difficulty on items 3 and 5 of the VF-14 and were more likely to be male.

CONCLUSIONS

The duration-of-symptoms factor suggests that, even in the positive choice group, it may be best to offer rehabilitation services early. Being male and responding moderate difficulty or greater to the VF-14 questions about far, medium-distance and near situations involving vision was associated with individuals that lack information. Consequently, these individuals may need additional education about the benefits of low vision services in order to make a positive personal choice.

Evaluating Barten image metric for predicting character recognition in people with low vision

Electronic devices with small visual displays (SVDs) are often inaccessible to the millions of Americans with vision loss. The Barten square root integral (SQRI) is an image quality metric that has been shown to predict whether people with normal vision can see images on a cathode ray tube monitor. The present proof-of-concept study begins to explore whether the same metric could predict the ability of users with low vision to see images on SVDs. In a sample population of 33 adults with low vision, the Barten SQRI was the best predictor of the ability to recognize low-contrast single digits on a screen (r(2) = 0.80, p < 0.01), followed by the Pelli-Robson Contrast Sensitivity Chart (r(2) = 0.69, p < 0.01). Visual acuity was not significantly predictive of the ability to read low-contrast characters on a display. Further work will explore whether the Barten SQRI remains predictive of the ability of people with low vision to use actual devices that have SVDs.

Broadening the Vision: The Education and Training Needs of Occupational Therapists Working with People with Sight Loss

This study aimed to identify the continuing professional development needs of occupational therapists in the area of sight loss and to identify the ways in which these needs could be met through pre-registration and post-registration education. A two-stage survey was carried out: an online survey was used to explore the education experience of occupational therapists who were members of two of the College of Occupational Therapists Specialist Sections – Older People and Housing, and a telephone survey was used to gather information from higher education institutions involved in the pre-registration education of occupational therapists regarding the current content of the curriculum relating to sight loss. The results of the study revealed low confidence levels among therapists in assessing and giving advice to people with sight loss, along with a varied approach to the inclusion of sight loss in pre-registration occupational therapy curricula.

A need for the development of appropriate education and training for working with people with sight loss was identified for occupational therapists at both pre-registration and post-registration stages, in order to enable the profession to seize the opportunity for prioritising this area of emerging practice and to make a more significant contribution to improving outcomes for people with sight loss.