Occupational Therapy Outcome Measures in Preschool Children With Autism Spectrum Disorders: A Scoping Review

With the rising prevalence of autism spectrum disorder (ASD), early assessment of preschool children is vital for occupational therapists. This scoping review aimed to provide detailed information about outcome measures used in occupational therapy interventions in preschool children with ASD and map the focus of the outcome measures based on the International Classification of Functioning, Disability, and Health (ICF) components. A thorough search from 2000 to 2022 was conducted that employed ICF linking rules to categorize the outcome measures. Seventy-four outcome measures were identified. They predominantly targeted body function and activity/participation, with less emphasis on environmental factors, and none assessed body structure. The most common measures were Vineland Adaptive Behavior Scale (VABS-2), Canadian Occupational Performance Measure (COPM), and Parenting Stress Index-Short Form (PSI-SF). This study offers a diverse array of outcome measures and underscores the potential of the ICF framework in enhancing evaluations, particularly concerning broader environmental components as one of the primary facilitating/hindering factors in the participation of children with ASD.

The Effect of ICF-Core Set-Based Occupational Therapy Interventions on the Function and Satisfaction of Individuals with Chronic Stroke: A Randomized Clinical Trial

Stroke can affect all aspects of a person's health and functioning. Therefore, it is important occupational therapists, have a comprehensive understanding of various levels of function and the factors affecting function. The ICF (International Classification of Functioning, Disability, and Health) and the selections of ICF categories or Core Sets relevant for people with a specific health condition, offer a model for intervention. This study aimed to investigate the effect of ICF-CS-based occupational therapy interventions on the function and satisfaction of individuals with chronic stroke. This study was designed as a randomized, single-blind, parallel-group clinical trial. Twenty-five patients with stroke were randomly assigned to the control group (which received traditional occupational therapy) or the treatment group (Stroke ICF-CS based occupational therapy). Patients were evaluated before and after the intervention (two months, three sessions per week, 45 minutes each session), as well as two weeks after the end of the intervention, using Fugl-Meyer and COPM (Canadian Occupational Performance Measure) tools. The independent T-test, Chi-square, and ANOVA with repeated measures were used to analyze the data. The results showed that the interaction effect of time and group was not significant in none of the Fugl-Meyer test sections (p > 0. 05), but it was significant in the performance and satisfaction of COPM (p < 0.05). The results suggest that ICF-CS-based occupational therapy interventions may assist persons with chronic stroke improve their functional level and satisfaction.

Online occupational therapy in the caregivers of people with Multiple sclerosis: a randomized control trial

PURPOSE

Caregivers of people with Multiple sclerosis (MS) face various challenges in the occupations of daily lives. We investigated the effect of an online occupational therapy program on the mastery and performance in caregivers of people with MS.

METHOD

In a single-blind randomized controlled trial twenty-four eligible caregivers of people with MS participated in the control and an occupational therapy group program. Caregivers completed The Canadian Occupational Performance Measure (COPM) and the Relative Mastery Scale (RMS) before and after the intervention and one-month later.

FINDINGS

The level of performance, satisfaction and mastery were significantly improved in the intervention group after the intervention (p<.001) and there were significant differences in performance and satisfaction scores between the groups (p<.001).

IMPLICATIONS

Online Occupational therapy shows promising results in facilitating the adaptation process and improving caregivers' performance and satisfaction levels.IMPLICATIONS FOR REHABILITATIONCaregivers of people with multiple sclerosis face various challenges when engaging in their daily occupations.Managing the challenges faced by caregivers as essential members of the treatment team contributes to improving their performance level in daily occupations and can finally enhance the quality of treatment interventions for patients.Online delivery can overcome caregivers' time constraints for attendance in the treatment centers for training.Online occupational therapy can enhance mastery, occupational performance level, and satisfaction, and is recommended for caregivers of people with multiple sclerosis.

A randomized controlled trial for evaluating an occupational therapy self management intervention in adults with type 2 diabetes

This study evaluated the efficacy of the Occupational Therapy Diabetes Self-Management intervention (OTDSM) to enhance glycemic stability and self-management skills in people with diabetes type-2. Based on this single-blind randomized trial, 30 subjects with diabetes type-2 were assigned to two groups of intervention and control. The intervention group received a 10-week program, consisting of four group visits and six individualized sessions. The control group received an individual session and three weekly phone calls. The primary study outcome, blood hemoglobin A1C, was measured before and three months after the study. The secondary outcome was assessed in terms of the participants' self-management behaviors, self-efficacy, diabetes distress, depressive symptoms, and performance and satisfaction with daily activities. These outcomes were evaluated three times: before, one month into, and three months after the study. The study findings demonstrated significant differences between the two groups in the hemoglobin A1C levels, self-management behaviors, self-efficacy, and performance and satisfaction with daily routines after the intervention (P < 0.05). No significant differences existed between the groups for the extent of diabetes distress and depressive symptoms. Inclusion of occupational therapy protocol into the plan of care for people with diabetes can improve health outcomes by promoting their routine participation in self-management activities.

Translation, reliability and validity of Persian version of Adolescent/Adult Sensory Profile in dementia

Our study aimed at the reliability and validity of the Persian version of the Adolescent/Adult Sensory Profile (AASP). This study was conducted on 130 people with dementia as well as 77 healthy elderlies. After translating the AASP into Persian, its content validity was determined based on 9 experts working in the same field. Cronbach's alpha and the Intraclass correlation coefficient (ICC) were calculated to assess the internal consistency and test-retest reliability of the Persian version of AASP. The two groups of people with dementia and healthy elderlies were compared in terms of scores in the four quadrants by performing an Independent t-test. All items in the Content Validity Ratio (CVR) and Content Validity Index (CVI) received an acceptable score. The Cronbach's alpha score for different parts of AASP was also calculated (α between 0.894 and 0.916; p < 0.001). The test-retest reliability of sub-tests of AASP was excellent (ICC between 0.885 and 0.948; p < 0.001). There was a statistically significant difference between the healthy Elderlies and dementia persons for low registration, sensory avoiding quadrants (p < 0.05). The Persian version of the AASP questionnaire is a reliable and valid questionnaire for people with dementia in Iran.

The Effect of Occupation-Based Modified Constraint-Induced Movement Therapy on the Participation of Children with Cerebral Palsy: A Single-Blind Randomized Controlled Trial

Objective

This study investigates the impact of modified constraint-induced movement therapy (m-CIMT), accompanied by occupation-based and activity analysis, on the participation of children with hemiplegia.

Materials & Methods

Twenty-three participants were randomly assigned to the intervention and control groups. The intervention group received occupation-based m-CIMT (m-CIMT along with occupation-based and activity analysis), while the control group received m-CIMT without occupation-based and activity analysis. The intervention was conducted one hour per day, three days a week, for four weeks.

Results

The primary outcomes revealed no significant differences between groups in promoting the participation of children with hemiplegia in the activities of daily living (ADL). However, scores were higher in the intervention group with a medium to large effect size (Canadian occupational performance measure: F(1,19)=2.14, P=0.160, η2P=0.101, Canadian occupational performance measure-satisfaction: F(1,19)=1.53, P=0.231, η2P=0.075, Goal attainment scaling: F(1,19)=5.55, P=0.029, η2P=0.226). This effect remained during the follow-up period. The secondary outcomes indicated no significant differences between groups in improving the manual ability of the children. However, scores were higher in the intervention group with a medium to large effect size (ABILHAND-Kids: F(1,19)=0.64, P=0.434, η2P=0.033, pediatric motor activity log- how long: F(1,19)=3.53, P=0.076, η2P=0.157, pediatric motor activity log- how well: F(1,19)=2.59, P=0.124, η2P=0.120). This effect was sustainable during the follow-up period.

Conclusion

m-CIMT accompanied by occupation-based and activity analysis and the client-centered paradigm substantially enhances the manual ability of children with hemiplegia and their participation in the ADL.

Development and Validation of Occupation Based Practice Measure (OBPM)

Background. Occupation based practice (OBP) is the central core of occupational therapy. Therefore, measuring its usage and influencing factors seems necessary. Purpose. To develop and validate the occupation based practice measure (OBPM). Method. OBPM was developed in two phases: (I) following a qualitative study, a literature review was conducted. The item pool was revised by expert panel; (II) The face, content, construct validity, internal consistency, and test-retest reliability were assessed. Findings. The 142 items derived through the qualitative study were integrated with the 42 items derived from the literature review. The item pool was reduced by expert panel to 78 items and finalized to 37 items through face, content, and construct validity. Cronbach's alpha was greater than 0.70 and intra-class correlation coefficient showed good to excellent reliability. Implications. OBPM is a valid and reliable questionnaire that evaluates the occupational therapists' knowledge, attitudes, interest, usage, and contextual factors influencing the OBP.

Strategies to Promote the Quality of Occupational Therapy Fieldwork Education: A Qualitative Study

Background: Clinical education is a bridge between theory and practice. The purpose of this study was to develop strategies to promote the quality of occupational therapy fieldwork education.

Methods: The qualitative content analysis was used to identify the promoting strategies of fieldwork quality in occupational therapy from students' and fieldwork educators’ perspectives during the 2019–2020 academic sessions. Participants were 12 fieldwork educators (mean age=39.33 yr, Male=5, female 7) and 14 students (mean age=23.28 yr, Male=7, female 7) in the code extraction phase and 16 fieldwork educators (12 of them were in code extraction phase too) in actions of strategies scoring phase.

Results: Following the content analysis of the data, the prompting strategies categorized into 4 major categories and 10 subcategories: factors related to Fieldwork educators (Improving clinical teaching skills, Enhancing fieldwork management skills, Motivating fieldwork educators, and Fostering coordination between fieldwork educators), related to Educational Planning (Modifying clinical fieldwork planning, Revising curriculums), related to Students (Empowering students, Motivating students) and related to Fieldwork settings ( Improving the social environment, Improving physical environment ). Based on the qualitative content analysis and 3 expert panels. Finally, the 23 promoting actions were identified.

Conclusion: Improving the quality of fieldwork education in occupational therapy needs a systematic collaboration between educators, students, and educational planners. Doing the promoting actions on fieldwork education process in occupational therapy may improve the quality of fieldwork education process.

Effectiveness of Self-Action Observation Therapy as a Novel Method on Paretic Upper Limb and Cortical Excitability Post-Stroke: A Single-Subject Study

Background: Action Observation Therapy (AOT) is a top-down approach that has been recently introduced in the rehabilitation of neurological disorders mainly after stroke. The main goal of this study was to investigate the effects and feasibility of a new technique in AOT procedure (called self-AOT) following periods of no treatment and routine AOT intervention on upper limb motor function, occupational performance and neurophysiological changes in a stroke patient.

Methods: A single-subject A-B-A-C design was used and a 58-year-old woman with a 3-year history of left hemiplegia poststroke participated in this study. In the baseline (A1, A2) phases, the patient received no treatment. In the first intervention (B phase), she received a 4-week AOT, and in the second intervention (C phase), a 4 week of Self-AOT was practiced. In all phases, upper limb motor recovery as a target outcome was evaluated on 4 occasions using the Fugl-Meyer assessment. Upper limb function, dexterity and spasticity were assessed using Action Research Arm Test, Box-Block Test and Modified Modified Ashworth Scale respectively. Occupational Performance/Satisfaction was assessed with Canadian Occupational Performance Measure and to assess neuroplasticity, Motor Evoked Potential was recorded by Transcranial Magnetic Stimulation. Visual analysis, slope, and percentage of non-overlapping data were used for assessing the changes between phases.

Results: Percentage of non-overlapping data and slopes indicated that motor recovery had clinically relevant improvements after both interventions compared to baselines. Other outcomes also showed improvements except for spasticity of wrist/elbow flexors and Motor Evoked Potential of opponens indicis.

Conclusion: Self-AOT may be as effective as other procedures of AOT for improving upper limb motor function, occupational performance/satisfaction, and cortical excitability post-stroke.

The effect of play-based occupational therapy on symptoms and participation in daily life activities in children with cancer: A randomized controlled trial

Introduction

This study aimed to investigate the effect of play-based occupational therapy on symptoms and participation in daily life activities in hospitalized children with cancer undergoing chemotherapy.

Method

A total of 25 children (mean age = 9.28 ± 0.95 years, range = 7–12 years) with cancer undergoing chemotherapy were enrolled and randomly assigned to a play-based occupational therapy group ( n = 12) or control group ( n = 13). The intervention group received eight 1-hour play-based occupational therapy sessions, and the control group received traditional occupational therapy services. Participation in daily life activities, therapy-related symptoms, pain, anxiety, and fatigue were evaluated.

Results

Total mean scores of participation in daily life activities in the intervention group in the diversity of activities ( p = 0.001, d = 1.39), intensity of participation ( p = 0.001, d = 1.86), with whom done ( p = 0.005, d = 1.22), enjoyment ( p = 0.003, d = 1.33), and parents’ satisfaction ( p = 0.003, d = 1.33) were significantly higher than the control group. Symptoms decreased in both groups; however, this trend had a significant difference in the intervention group for the therapy-related symptom checklist ( p = 0.001, d = 1.68), pain ( p = 0.001, d = 1.61), anxiety ( p = 0.001, d = 1.58), and fatigue ( p = 0.002, d = 1.39) scores.

Conclusion

A 2-week course of inpatient play-based occupational therapy is an effective approach in the reduction of cancer symptoms, therapy-related symptoms, and the participation facilitation, of children with cancer in daily life activities.

Barriers to Occupational Therapy Fieldwork Education in Iran: The Perspectives of Fieldwork Educators and Students

Background

Clinical education is a vital factor in the process of learning in medical sciences universities. The aim of the present study was to explore the perspectives of fieldwork educators and students concerning barriers to occupational therapy fieldwork education in Iran.

Materials and Methods

A qualitative research was conducted from May 2019 to April 2020 to address the study objectives. The data analysis was performed using conventional content analysis based on Graneheim and Lundman's approach. Purposive sampling was used to enroll 12 educators and 14 students of various backgrounds (physical disabilities-adult, physical disabilities-pediatrics, psychosocial-adult, and psychosocial-pediatrics) in the study.

Results

The findings indicated that the main themes were related to fieldwork educators, fieldwork settings, educational planning, students, and educational regulation.

Conclusions

It can be concluded that the perspectives of students and occupational therapy educators regarding the field of clinical education are not only important but also useful for the attainment of effective clinical education and the development of knowledge related to rehabilitation nursing education. Therefore, educational planners should develop effective programs based on these themes.

Development and psychometric evaluation of performance-based upper extremity motor control test (PB-UE-MCT) for people with cerebral palsy

Abstract Introduction Upper extremity disorders limits the performance in the activities of daily living, especially, in bilateral (two-handed) activities. Objective This study was designed to develop a performance-based upper extremity motor control test (PB-UE-MCT) and to measure its psychometric properties (including, convergent validity, intrarater reliability, and interrater reliability) for people with cerebral palsy (CP). Method The PB-UE-MCT was developed in three phases, including planning, construction, and psychometric evaluation. The participants included 50 people with CP with an age range of 6 to 18 years. To measure internal consistency, Cronbach's alpha was run (n=50). Intrarater and interrater reliability was measured for 25 participants. To assess convergent validity, the correlations of the PB-UE-MCT with the Manual Ability Classification System (MACS) and with the Selective Control Upper Extremity Scale (SCUES) were calculated. Results The values obtained for Cronbach's alpha (.90 to .96) indicated the excellent internal consistency of the PB-UE-MCT. The ICC values for intrarater reliability and interrater reliability were between .84 and .99 and between .89 and .99, respectively. The correlation coefficients obtained for the items of the PB-UE-MCT and those of the MACS were between .51 and .73. The correlation coefficients of the items of the PB-UE-MCT with those of the SCUES were in the range of .67 to .98, which proves the PB-UE-MCT's good to excellent levels of convergent validity. Conclusion The results confirm that the PB-UE-MCT is a valid and reliable tool for evaluating the upper extremity performance of people with CP through task analysis.

A Qualitative Exploration of Occupational Adaptation in Caregivers of People with Multiple Sclerosis

Due to the unpredictable and progressive nature of multiple sclerosis, the burden of care is placed on the primary caregivers. This study aimed to explore occupational adaptation strategies implemented by primary caregivers to adapt to occupational challenges of caregiving. Seventeen primary caregivers of people with MS were interviewed using purposive sampling techniques. Data were analyzed using content analysis method. Two main categories of strategies were determined: (a) Strategies to alleviate intrapersonal challenges of occupational adaptation; and (b) Strategies to alleviate environmental challenges of occupational adaptation. These included various skills and solutions that aided primary caregivers' adaptation toward occupational challenges. Based on the results of this study, occupational adaptation is a means of achieving mastery in alleviating occupational challenges to cope with adverse circumstances. The results of this study can be used to help therapists design appropriate caregiver-focused interventions, ultimately improving caregiver performance.

Occupational balance in people with type-2 diabetes: A comparative cross-sectional study

Introduction

Diabetes mellitus may negatively impact individuals’ occupational balance. This study seeks to compare occupational balance in people with and without diabetes and also explore the biological and psychological factors associated with occupational balance in people with diabetes.

Method

This comparative cross-sectional study was conducted using simple non-probability sampling. Participants’ occupational balance was evaluated by the Life Balance Inventory. Blood samples were taken from those with diabetes and analyzed. Psychological distress was also evaluated in the people with diabetes using the Diabetes Distress Scale.

Results

A total of 160 individuals, including 80 people with diabetes and 80 people without diabetes, participated in this study. The mean occupational balance scores for people with and without diabetes were 2.56 and 2.61, respectively. There was no significant difference between the groups in occupational balance. Distress was the only significant factor related to occupational balance in people with diabetes ( p < 0.05).

Conclusion

Distress was the only bio-psychological factor associated with occupational balance in people with diabetes. A higher level of distress is associated with lower occupational balance and also poor glycemic control in this population.

Which models can be used as a clinical education model in occupational therapy? Introduction of the models: A scoping review study

Background: Clinical education is a vital part of occupational therapy education process. High clinical education quality in fieldwork settings leads to higher clinical competency and occupational proficiency. One of the most effective clinical education methods in equalizing the conditions of clinical education to students is the correct use of educational models related to each field of medical sciences. In the field of clinical education, various models have been designed with a specific subject. However, limited research has been done on the introduction of the usability of these models in occupational therapy settings. This study was conducted to determine which models have the potential to be used as clinical education models in occupational therapy. Methods: A scoping review was conducted and studies published in English between 2000 and 2018 that examined clinical education models were selected. Results: A total of 8 articles were entered in the review, and a central theme of implementing clinical education models in occupational therapy was determined by thematic analysis. This central theme consisted of 3 categories: (1) evaluative models, (2) acting models, and (3) evaluative/acting models. Conclusion: Occupational therapists, especially who work as educators should be aware of the different types of clinical education models and try to use these models in clinical education process and minimize the variation of teaching methods in fieldwork settings to promote the clinical education quality. However, more research should be done to improve evidence-based occupational therapy practice in clinical education.

Fatigue in Children with Cancer: Reliability and Validity of the Persian Version of Child, Parent, and Staff Fatigue Scale

CONTEXT

The fatigue is reported as the most common and annoying symptom in patients with cancer, timely diagnosis, and treatment can significantly influence the treatment and rehabilitation. It is crucial to have an appropriate tool to accurately assess fatigue status.

OBJECTIVES

Our purpose was to assess psychometric properties of the Persian versions of fatigue scale by Original Scales from the viewpoint of children with cancer (Child Fatigue Scale [CFS]-24 h), their parents (Parent Fatigue Scale [PFS]-24 h), and staff (Staff Fatigue Scale FSF-24 h).

METHODS

Convenience sampling of the participants was conducted 100, including children with cancer within the age range of 7-12 years, their parents, and caregivers in medical staff. Test-retest reliability and internal consistency were evaluated using intraclass correlation (ICC) and Cronbach's alpha coefficient. Dimensionality was determined by factor analysis. The patients' fatigue was also assessed through visual analog scale-fatigue (VAS-F).

RESULTS

Test-retest (ICCCFS = 0.71, ICCPSF = 0.82, and ICCSFS = 0.78) was acceptable with a high level of internal consistency (αCFS = 0.80, αPFS = 0.83, and αSFS = 0.84). Factor analysis identified three, five, and two components for the CFS, PFS, and Staff Fatigue Scale (SFS), respectively. There was moderate correlation between CFS and VAS-F.

CONCLUSIONS

Results of the current study indicated that CFS in children with cancer, PFS in their parents, and SFS in medical staff were valid and reliable instruments to assess fatigue from the viewpoint of children with cancer along with their parents and medical staff.

Participation in Peer-Play Activities Among Children With Specific Learning Disability: A Randomized Controlled Trial

OBJECTIVE

Children with a specific learning disability (SLD) have deficits in social and academic competence and executive function (EF). In this study, we used the Model of Human Occupation to investigate the effect of peer-play activities on occupational values and competence as well as EF skills (i.e., behavior regulation and metacognition) in children with SLD.

METHOD

Forty-nine children ages 7-11 yr with SLD were randomly assigned to the peer-play and control groups. Outcome measures were the Behavior Rating Inventory of Executive Function and the Child Occupational Self-Assessment (COSA).

RESULTS

Data analysis showed that the effects of the intervention on EF skills were medium to large. The occupational values and competence did not change according to the COSA.

CONCLUSION

Occupational therapy practitioners can use peer-play activities to enhance EF in children with SLD; however, perceived occupational values and competence may not show any changes with the peer-play intervention using a self-assessment instrument.

Assessment priorities in cerebral palsy using ICF core set by Iranian occupational therapists

BACKGROUND.

International Classification of Functioning, Disability and Health (ICF) core set for cerebral palsy allows for the description of the levels of functioning in cerebral palsy. It is not exactly clear which of these levels is more important for evaluation from the perspective of occupational therapists in Iran. By identifying these priorities, we can establish a better plan for intervention.

PURPOSE.

This study defines assessment priorities in children with cerebral palsy (<6 years).

METHOD.

Sixty-two Iranian occupational therapists studied the priorities of assessment based on the Iranian ICF core set. The therapists were asked to rate the code categories from 1 to 3. The results are presented as mean values.

FINDINGS.

Occupational therapists first focus on body functions assessment, then activities/participation, and ultimately, environmental factors.

IMPLICATIONS.

Occupational therapists in Iran have a bottom-up approach toward clients with cerebral palsy. It may be necessary to revise the educational curriculum, prepare a training course, and provide more supervision for practising occupational therapists.

Reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version for children with physical disabilities

INTRODUCTION

Occupational therapy supports individuals to participate in meaningful activities. Participation in activities should be assessed with appropriate tools. The aim of the present study was to establish the reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version (CPAS-P) for children with physical disabilities.

METHODS

The participants were 304 parents of 6- to 12-year-old children with physical disabilities. Confirmatory factor analysis (CFA), internal consistency, convergent validity of the CPAS-P with the Vineland Adaptive Behavior Scale (VABS), and test-retest reliability were measured.

RESULTS

Confirmatory factor analysis showed acceptable values for all indices of fit, namely goodness of fit index (GFI), adjusted GFI, normal fix index, comparative fit index, incremental fit index (i.e., greater than 0.90), and the value of root mean square error of approximation was 0.07, which was acceptable. High Cronbach's alpha coefficients (above 0.9) were reported for the total score of each scale (diversity = 0.94, frequency = 0.94, with whom = 0.92, enjoyment = 0.95, and parent satisfaction = 0.95). The convergent validity of the CPAS-P with the VABS was moderate to good and the test-retest reliability (ICC) for the total scores ranged from 0.90 to 0.96.

CONCLUSION

The CPAS-P had good psychometric properties for parents reporting the activities of their 6- to 12-year-old children with physical disabilities and can be utilized in clinical practice.

Psychometric Properties of the Iranian-Children Participation Questionnaire (I-CPQ) When Used with Parents of Preschool Children with Cerebral Palsy

The purpose of the study was to establish the psychometric properties of the Iranian-Children Participation Questionnaire (I-CPQ) among parents (n = 120) of preschool children with cerebral palsy. The mean age of the preschool children was 5.1 years old. The confirmatory factor analysis was conducted in two stages, and the values of all goodness of fit tests reached an acceptable level (greater than 0.9), and achieved an acceptable root mean square error of approximation model fit value of 0.05. The results of convergent validity with the Vineland Adaptive Behavior Scale for all subtests were significant. Internal consistency was acceptable to excellent (α: 0.66-0.85), and test-retest reliability was excellent (ICC: 0.92-0.98). We concluded that the I-CPQ demonstrated good psychometric properties and utility for assessing participation of Iranian preschool children with cerebral palsy.

Effect of Play-based Therapy on Meta-cognitive and Behavioral Aspects of Executive Function: A Randomized, Controlled, Clinical Trial on the Students With Learning Disabilities

Introduction:

Although the effect of educational methods on executive function (EF) is well known, training this function by a playful method is debatable. The current study aimed at investigating if a play-based intervention is effective on metacognitive and behavioral skills of EF in students with specific learning disabilities.

Methods:

In the current randomized, clinical trial, 49 subjects within the age range of 7 to 11 years with specific learning disabilities were randomly assigned into the intervention (25 subjects; mean age 8.5±1.33 years) and control (24 subjects; mean age 8.7±1.03 years) groups. Subjects in the intervention group received EF group training based on playing activities; subjects in the control group received no intervention. The behavior rating inventory of executive function (BRIEF) was administered to evaluate the behavioral and cognitive aspects of EF. The duration of the intervention was 6 hours per week for 9 weeks. Multivariate analysis of covariance was used to compare mean changes (before and after) in the BRIEF scores between the groups.

Results:

The assumptions of multivariate analysis of covariance were examined. After controlling pre-test conditions, the intervention and control groups scored significantly differently on both the metacognition (P=0.002; effect size=0.20) and behavior regulation indices (P=0.01; effect size=0.12) of BRIEF.

Conclusion:

Play-based therapy is effective on the metacognitive and behavioral aspects of EF in students with specific learning disabilities. Professionals can use play-based therapy rather than educational approaches in clinical practice to enhance EF skills.

Factor Structure and Construct Validity of Children Participation Assessment Scale in Activities Outside of School-Parent Version (CPAS-P)

The aim of this study was assess the factor structure, reliability and construct validity of the Children Participation Assessment Scale in Activities Outside of School-Parent Version (CPAS-P). The participants of this study were 700 parents of children aged 6-12 years. For data analysis, the confirmatory factor analysis, internal consistency, and test-retest reliability were conducted. Convergent validity was calculated by correlation with the Vineland Adaptive Behaviour Scale. The results indicated the CPAS-P has good internal reliability. Overall, Cronbach's alpha for the participation measures ranged between 0.87 and 0.91, indicating good homogeneity, and Spearman correlations for convergent validity was acceptable. The temporal stability of the CPAS-P was supported with Intra-Class Correlations ranging from 0.79 to 0.94. Therefore, the CPAS-P, which evaluates all eight areas of occupation (i.e., activities of daily living, instrumental activities of daily living, play, leisure, social participation, education, work, and sleep/rest) has demonstrated good psychometric properties; and can be used as a reliable and valid measure to assess children's participation at the age of 6-12 years.

The Effect of Group-Based Occupational Therapy on Performance and Satisfaction of Stroke Survivors: Pilot Trail, Neuro-Occupational View

Introduction:

Stroke imposes limitations on performing activities of daily living (ADL) and their level. Different therapeutic approaches are used for improving the level of performance after a stroke. This study was performed with the aim of evaluating the effect of group-based occupational therapy on improving the performance of ADL and satisfaction of its performance in patients with chronic strokes.

Methods:

Fourteen chronic stroke patients with the mean age of 52 years participated in the study. The participants were assigned into two groups (control and treatment). The level of performance of ADL, level of stroke disability, and participation were respectively evaluated by Barthel index (BI), modified Rankin scale (MRS), and Canadian Occupational Performance Measure (COPM). Six sessions of group therapy tasks were scheduled with an emphasis on three main activities, including mobility exercises, craft, and cooking.

Results:

The COPM changes in the ‘performance’ and ‘satisfaction’ scores in the treatment group and the ‘performance’ scores in the control group were significant. The MRS scale in the two groups revealed no change in the level of stroke disability. However, the changes in the ADL performance in BI were significant.

Conclusion:

The current study indicated that doing daily, craft, and mobility activities in the groups can affect the ‘performance’ and ‘satisfaction’ levels in stroke patients.

Effect of Play-based Occupational Therapy on Symptoms of Hospitalized Children with Cancer: A Single-subject Study

OBJECTIVE

Cancer is one of the four leading causes of death in children. Its courses of diagnosis and treatment can cause physiologic symptoms and psychological distress that secondarily affect children's quality of life and participation in daily activities. The aim of this study was to investigate the effect of play-based occupational therapy on pain, anxiety, and fatigue in hospitalized children with cancer who were receiving chemotherapy.

METHODS

Two hospitalized children with acute lymphoblastic leukemia at least 4 months after diagnoses who received two courses of chemotherapy participated in this pilot study. Takata Play History and Iranian Children Participation Assessment Scale were used to develop intervention protocol. Nine, 30-45 min play-based occupational therapy sessions took place for each child. Children filled out the Faces Pain Scale, Visual Fatigue Scale, and Faces Anxiety Scale before and after each intervention session.

RESULTS

Pain, anxiety, and fatigue levels decreased in both participants. Furthermore, the results showed a relationship between pain, anxiety, and fatigue variables in these children.

CONCLUSIONS

Play-based occupational therapy can be effective in improving pain, anxiety, and fatigue levels in hospitalized children with cancer receiving chemotherapy.

Occupation-based intervention versus rote exercise in modified constraint-induced movement therapy for patients with median and ulnar nerve injuries: a randomized controlled trial

Objective:

To investigate effect of practice type during modified constraint-induced movement therapy on hand function in patients with chronic median and ulnar nerve injuries.

Design:

A prospective, single-blinded, randomized controlled clinical trial.

Setting:

Participants’ private home.

Subjects:

A convenience sample of 36 outpatient participants allocated randomly to three equal groups.

Interventions:

Intervention groups underwent 3-hour intensive training of affected hand each day, 3-day a week, 4-week in association with immobilisation of healthy hand: occupation-based group practiced meaningful occupations while rote exercise-based group performed rote exercises during constraint-induced movement therapy. Control group performed different activities with affected hand for 1.5-hour each day during 4-week without restriction of healthy hand.

Main measures:

A blinded assessor tested Canadian occupational performance measure, box and block, Static two-point discrimination, disabilities of arm, shoulder, hand questionnaire, and self-assessment manikin in a random order across sessions 3-time as baseline (pre-test), after 4-week intervention (post-test), and 1-month after intervention period (follow up).

Results:

Scores significantly changed in intervention groups compared to control. Despite significantly more improvement in occupation-based than rote exercise-based group in subjective measures at post-test and follow up (Canadian occupational performance measure: mean change 4.7 vs. 2.1 for performance, P< 0.001 and mean change 5.3 vs. 2.6 for satisfaction, P< 0.001), it was significant just at follow up for box and block and static two-point discrimination.

Conclusions:

Practice content of constraint-induced movement therapy is a critical part of its effectiveness on improving outcomes following peripheral nerve repair in favour of occupation-based intervention in present study.

The Comparison of Participation in School-Aged Cerebral Palsy Children and Normal Peers: A Preliminary Study

Background

Participation in daily activities during childhood is an important aspect for health and social development.

Objectives

This study was designed to investigate the participation of children with cerebral palsy aged 8 to 14 years, and their normal peers.

Patients and Methods

In this cross-sectional study, 30 children with cerebral palsy, and 30 normal children were selected via the non-probability convenience sampling. Their participation was evaluated with children’s assessment of participation and enjoyment (CAPE) through interviews.

Results

Significant differences were found between the means of the two groups regarding the diversity, intensity, overall participation (P = 0.000) and all types of the activities except the recreational activities. The children with cerebral palsy took part in the skill-based activities and overall activities individually compared to the normal peers. The children with cerebral palsy, in comparison with their normal peers, often performed most of the activities inside the house. The main effect of gender and the interaction between gender and groups were not statistically significant in any of the variables of the CAPE test.

Conclusions

Physical disability can influence the children’s daily activities and socialization. Understanding the participation of physically disabled children can help health care professionals in designing and introducing appropriate treatment according to their needs.

Development and validation of Iranian children's participation assessment scale

BACKGROUND

Participation is mostly cultural and familial based, and there is not any assessment scales for evaluating kids' participation in Iranian context, therefore the purpose of this study was developing children's participation assessment scale for Iranian children.

METHODS

Development of this scale occurred in two phases; phase I: planning: following reviewing the literature and adopting and compiling some items of available evaluation tools in the area (such as CAPE, CPQ, CLASS, Life-H) and receiving advice from two expert panels, the preliminary94- item questionnaire was prepared. Phase II: construct: the survey study was carried out on40 children and 21 of their parents to assess the popularity of the activity in Iran; thus, the items of the questionnaire reduced to 92 and after face and content validity, the final version prepared with 71 items.

RESULTS

The final 71-item questionnaire was developed in two parent-report and child-report versions. The 71 items based on the literature and expert panels' advice were categorized in 8 areas of occupation according to Occupational Therapy Practice Framework (ADL, IADL, Play, leisure, social participation, education, work, and sleep/rest).

CONCLUSION

Iranian children's participation assessment is a useful and culturally relevant tool to measure participation of Iranian children. It can be used in rigorous clinical and population-based research.

Can hand dexterity predict the disability status of patients with multiple sclerosis?

BACKGROUND

Multiple Sclerosis (MS) is the most common disabling neurological disease. Hand dysfunction is one of the main complaints of patients with MS. The present study aimed to compare hand dexterity of MS patients with low Expanded Disability Status Scale (EDSS) scores and healthy adults. It also sought to identify the predictors of disability status of patients with MS based on their manual dexterity and demographic characteristics.

METHODS

In this cross-sectional study, 60 (16 male/44 female) patients with MS and 60 (19 male/41 female) healthy people, who matched in terms of age and sex, were recruited. Their hand dexterity was evaluated by the Purdue Pegboard Test. The disability status of the MS group was determined by the Expanded Disability Status Scale. The data were analyzed using SPSS15.

RESULTS

The hand dexterity in MS group even with low EDSS score (1.5 ± 1.07) was weaker than control group. Moreover, the dexterity of dominant hand and alternating two hands coordination subtests of the PPT was a good discriminator between two groups (p<0.001). The results of linear regression analysis suggested dominant hand dexterity and disease duration as predictors of disability status that predict 60.5 per cent of the variation in EDSS scores in patients with MS (p<0.001).

CONCLUSION

Reduced dominant hand dexterity in patients with MS is a disabling factor. Further research is recommended to determine if early hand rehabilitation can reduce the severity of disability in Patients with MS.

Undergraduate prosthetics and orthotics teaching methods: A baseline for international comparison

BACKGROUND

Education of Prosthetics and Orthotics is a relatively recent professional program. While there has been some work on various teaching methods and strategies in international medical education, limited publication exists within prosthetics and orthotics.

OBJECTIVES

To identify the teaching and learning methods that are used in Bachelor-level prosthetics and orthotics programs that are given highest priority by expert prosthetics and orthotics instructors from regions enjoying a range of economic development.

STUDY DESIGN

Mixed method.

METHODS

The study partly documented by this article utilized a mixed method approach (qualitative and quantitative methods) within which each phase provided data for other phases. It began with analysis of prosthetics and orthotics curricula documents, which was followed by a broad survey of instructors in this field and then a modified Delphi process.

RESULTS

The expert instructors who participated in this study gave high priority to student-centered, small group methods that encourage critical thinking and may lead to lifelong learning. Instructors from more developed nations placed higher priority on student's independent acquisition of prosthetics and orthotics knowledge, particularly in clinical training.

CONCLUSIONS

Application of student-centered approaches to prosthetics and orthotics programs may be preferred by many experts, but there appeared to be regional differences in the priority given to different teaching methods.

CLINICAL RELEVANCE

The results of this study identify the methods of teaching that are preferred by expert prosthetics and orthotics instructors from a variety of regions. This treatment of current instructional techniques may inform instructor choice of teaching methods that impact the quality of education and improve the professional skills of students.

A computer-based selective visual attention test for first-grade school children: design, development and psychometric properties

BACKGROUND

Visual attention is known as a critical base for learning. The purpose of the present study was to design, develop and evaluate the test-retest and internal consistency reliability as well as face, content and convergent validity of the computer- based selective visual attention test (SeVAT) for healthy first-grade school children.

METHODS

In the first phase of this study, the computer-based SeVAT was developed in two versions of original and parallel. Ten experts in occupational therapy helped to measure the content validity using the CVR and CVI methods. Face validity was measured through opinions collected from 10 first-grade children. The convergent validity of the test was examined using the Spearman correlation between the SeVAT and Stroop test. In addition, test-retest reliability was determined by measuring the intra-class correlation (ICC) between the original and parallel versions of the SeVAT in a single session. The internal consistency was calculated by Cronbach's alpha coefficients. Sixty first grade children (30 girls/30boys) participated in this study.

RESULTS

The developed test was found to have good content and face validity. The SeVAT showed an excellent test-retest reliability (ICC= 0.778, p<0.001) and internal consistency (Cronbach's Alpha of original and parallel tests were 0.857 and 0.831, respectively). SeVAT and Stroop test demonstrated a positive correlation upon the convergent validity testing.

CONCLUSION

Our results suggested an acceptable reliability and validity for the computer-based SeVAT in the assessment of selective attention in children. Further research may warrant the differential validity of such a test in other age groups and neuro-cognitively disordered populations.

Clinical assessment of fear of falling after stroke: validity, reliability and responsiveness of the Persian version of the Fall Efficacy Scale-International

BACKGROUND

Fear of falling may be related to falling during stroke onset. The Fall Efficacy ScaleInternational (FES-I) with excellent psychometric properties, is an instrument developed to assess patients' concerns about fallings. The aim of this study was to determine validation of this scale in Iranian patients with stroke.

METHODS

The "forward-backward" procedure was applied to translate the FES-I from English to Persian. One hundred-twenty patients who had suffered stroke, aged 40 to 80 years (55% male) completed the Persian FES-I, Geriatric Depression Scale-15 (GDS-15), General Health Questionnaire-28 (GHQ-28), Berg Balance Scale (BBS) and Timed up and Go (TUG) questionnaires. The interval time for the test-retest of the Persian scale was 7-14 days.

RESULTS

The test-retest and inter-rater reliabilities of the Persian FES-I were excellent (ICC2,1=0.98, p<0.001) and the internal consistency was high (Cronbach's alpha=0.78). Factor analysis of the 16 items in the Persian scale showed only one significant factor. The total Persian FES-I score had a significantly negative correlation (p<0.001) with the BBS, but it had significantly positive correlation with the TUG, GHQ-28, and GDS-15. The difference in responsiveness scores across fallers and non-fallers yielded a large effect size (0.46), which indicated a good discriminating validity.

CONCLUSION

The Persian FES-I proved to be an effective and valuable measurement tool to assess stroke patients' fear of falling in practice and research setting.

Factors affecting clinical reasoning of occupational therapists: a qualitative study

BACKGROUND

Clinical reasoning is generally defined as the numerous modes of thinking that guide clinical practice but little is known about the factors affecting how occupational therapists manage the decision-making process. The aim of this qualitative study was to explore the factors influencing the clinical reasoning of occupational therapists.

METHODS

Twelve occupational therapy practitioners working in mental and physical dysfunction fields participated in this study. The sampling method was purposeful and interviews were continued until data saturation. All the interviews were recorded and transcribed. The data were analyzed through a qualitative content analysis method.

RESULTS

There were three main themes. The first theme: socio-cultural conditions included three subthemes: 1- client beliefs; 2- therapist values and beliefs; 3- social attitude to disability. The second theme: individual attributions included two subthemes 1- client attributions; 2- therapist attributions. The final theme was the workplace environment with the three subthemes: 1- knowledge of the managers of rehabilitation services, 2- working in an inter-professional team; 3- limited clinical facilities and resources.

CONCLUSION

In this study, the influence of the attitudes and beliefs of client, therapist and society about illness, abilities and disabilities upon reasoning was different to previous studies. Understanding these factors, especially the socio-cultural beliefs basis can play a significant role in the quality of occupational therapy services. Accurate understanding of these influential factors requires more extensive qualitative and quantitative studies.

Identification and Incidence of Iris yellow spot virus, a New Pathogen in Onion and Leek in Greece

Iris yellow spot virus (IYSV; genus Tospovirus, family Bunyaviridae) is an emerging and serious pathogen affecting several Allium spp. worldwide (2). The virus causes straw-colored, chlorotic or necrotic lesions that coalesce, occasionally resulting in an extensive necrosis on onion (A. cepa L.) leaves. From February to June 2008, 530 onion and 439 leek (A. porum L.) leaf samples showing a variety of lesions were collected from different areas of Greece. All plants sampled were infested with Thrips tabaci Lindeman, the sole thrips species identified as the vector of this virus. Samples were analyzed by double-antibody sandwich (DAS)-ELISA using polyclonal antibodies against the N protein of IYSV (Laboratory of Virology, Wageningen Agricultural University). A higher percentage of onion samples than leek samples were infected, with IYSV detected in 36, 44, 23.7, 61.7, 10, 55, 15.3, and 9.4% of onion samples from the prefectures of Evros, Heraklion, Kavala, Magnissia, Pella, Rodopi, Thessaloniki, and Viotia, respectively, and in 5, 0, 0, 9.3, and 13% of leek samples from Evros, Heraklion, Magnissia, Pella, and Thessaloniki, respectively. No leek samples were tested from Kavala, Rodopi, and Viotia. Sap extracts from some positive samples were mechanically inoculated onto Nicotiana benthamiana leaves, and infected plants developed typical IYSV symptoms and were positive in DAS-ELISA, confirming transmission from the field samples. Viral RNA was extracted from ELISA-positive onion and leek samples and an ~800-bp amplicon was obtained from both hosts by reverse-transcription (RT)-PCR and N-gene primers derived from IYSV (IY1: 5'-CCCGAGGATCCATGGCTACCGTTAGGG-3' and IY2: 5'-CCCGAGGATCCAAATTAATTATATCTATCTTTCTTGG-3') (1). These amplicons were cloned and sequenced (GenBank Accession No. FJ785835) and nucleotide sequence comparisons showed a 98 to 99% identity with a Dutch isolate of IYSV (GenBank Accession No AF001387). The virus was transmitted among onion seedlings in the laboratory using a leek population of T. tabaci. Infected seedlings, as determined by DAS-ELISA, developed symptoms similar to those observed in the field samples. To our knowledge, this is the first report of IYSV in Greece; however, the virus seems already to be very well established. References: (1) I. Cortez et al. Phytopathology 88:1276, 1998. (2) D. Gent et al. Plant. Dis. 90:1468, 2006.

Occurrence of Impatiens necrotic spot virus in Ornamentals in Mahallat and Tehran Provinces in Iran

Impatiens necrotic spot virus (INSV) (genus Tospovirus, family Bunyaviridae) has been detected in commercial nurseries and field-grown ornamentals in Mahallat (Markazi) and Tehran provinces of Iran. INSV on ornamentals was first reported in 1990 (2). Ornamental plants with small necrotic spots, leaf yellowing, ring spots, necrotic vein clearing, wilting, and dwarf symptoms were collected. For mechanical inoculation on selected host species, leaf samples were triturated in chilled 0.01 phosphate buffer, pH 7.2, containing 0.02% sodium sulfite. Cowpea (cv. Mashad local), Chenopodium amaranticolor, Datura mete, Nicotiana rustica, N. tabacum (cv. White Burly), and Lycopersicon sp. produced local necrotic symptoms 5 days postinoculation. N. rustica, N. tabacum cv. White Burley, and D. metel also developed systemic mosaic symptoms that were followed by total wilting and death of the plant. The severity of the disease was higher in warm weather (July and August in greenhouses). Thrips tabaci and Frankliniella intonsa were often present at the site of INSV infection. Triple-antibody sandwich enzyme-linked immunosorbent assay (TAS-ELISA) was applied using a commerical polyclonal antibody kit (As-0115) in combination with monoclonal antibody 5E4 (As-0117) prepared against nucleoprotein of INSV isolate Pv-0280 (antibody kits and positive control were a gift from DSMZ, Braunschweig, Germany). Samples were tested for the presence of TSWV and INSV. The ornamental species found infected with INSV were Rosa sp., Gazania sp., Chrysanthemum sp., Leucanthemum sp., Matricaria camomila, Pelargonium roseum, Salvia sp., and Dianthus caryophyllus, which were collected from the Mahallat area; and Gazania sp. and Bougainvillea spectabilis collected from the Tehran Province. ELISA values of field-infected samples (OD⁴⁰⁵, read after 1h) diluted at 1:10 (wt/vol) were 0.317 (minimum) and 0.914 (maximum), and 0.312 for the positive control. None of the samples reacted in TAS-ELISA with Tomato spotted wilt virus (TSWV) (antibody kits, As-0105, As-0106, and As-01106, gift from DSMZ). A few samples of Chrysanthemum sp. and Leucanthemum sp. (collected from the Mahallat area) reacted in TAS-ELISA with TSWV, indicating they were doubly infected with TSWV and INSV. Within the genus Tospovirus the TSWV peanut isolate has been reported from Iran (1). To our knowledge, this is the first report of the occurrence of INSV on ornamentals in Iran. References: (1) A. R. Golnaraghi et al. Plant Dis. 85:1286, 2001 (2) M. D. Law and J. W. Moyer. J. Gen.Virol.71:933, 1990.