Occupational therapy gender imbalance; revisiting a lingering issue

BACKGROUND

Recently, it has been suggested that gender disparity in Occupational Therapy has to do with segregated gendered job norms that position female dominated professions as a 'step down' for many males. Interestingly, this suggestion was not underpinned by experiences of males in the profession.

AIMS AND METHODS

Thirteen male Occupational Therapists with a variety of backgrounds were invited to this Round Table research, focussing on the broader issue of the existing gender imbalance in Occupational Therapy.

RESULTS

Two themes emerged: 'The core values of the profession', and 'Broadening the scope of the profession'; none of them suggesting that male/female imbalance was necessarily the most pressing issue.

CONCLUSIONS

A gender-unrelated approach to everyday problem-solving was put forward to achieve increased diversity in Occupational Therapists' backgrounds, better reflecting the people they serve. By broadening the scope and the way the profession is presented, and encouraging innovative and more entrepreneurially driven approaches, diversity in the workforce could be further facilitated. These findings are discussed within the context of 'The mutual constitution of cultures and selves' model.

SIGNIFICANCE

Diversity in the Occupational therapy workforce could be further facilitated with a shift in focus away from the male/female perspective to an intersectional approach.

Experiences of Parents of Specialist Peer Mentored Autistic University Students

ABSTRCTBackground: Parents continue to support to autistic university students, and consequently, experience considerable stress.Aim: To explore the experiences of parents of specialist peer mentored university students and to examine these using the ICF as a theoretical framework.Method: Thirteen semi-structured interviews were completed and analyzed using thematic analysis. Directive content analysis linked the data to the ICF core set for autism spectrum disorders (ASD).Results: Five interrelated themes emerged: The mentoring relationship is a facilitator, Developing skills for university, Mentoring changes lives, Mentoring is not a substitute for other supports, and University is an emotional rollercoaster. Specialist peer mentoring was linked to Activity and Participation (44%) and Environmental factors (32%) of the ICF core set for ASD.Conclusion: These results add to the specialist peer mentoring evidence-base, and indicate perceived benefits for autistic university students and their parents. An unintended consequence was that parents broadened their participation in activities.

Do hand therapists have a role in workplace-based education to manage tennis elbow? Beliefs about effective treatments among Australian hand therapists and medical practitioners

BACKGROUND

Lateral elbow tendinopathy (LET), commonly known as tennis elbow, is a prevalent work-related upper extremity musculoskeletal disorder. Medical practitioners and hand therapists manage LET with commonly available clinic-based treatments, despite no sound evidence to suggest long-term relief and functional restoration for workers with LET. Workplace-based rehabilitation is effective for injured workers with other health conditions, but no studies have investigated this rehabilitation approach in the management of LET.

OBJECTIVES

(i) Identify, compare, and contrast Australian hand therapists' and medical practitioners' perceptions about the effectiveness of common treatments for LET, and (ii) obtain their views towards a hand therapist delivered workplace-based education approach.

METHODS

In this cross-sectional study, 38 medical practitioners from Western Australia and 104 hand therapists around Australia completed online surveys. Independent t-tests were used to identify between-group differences in responses.

RESULTS

Despite some between-group differences regarding the perceived effectiveness of common LET treatments, both groups believed education about LET pathology, activity modification, postures, and workplace recommendations were most effective. Most medical practitioners (81%) and hand therapists (71%) believed workplace-based education delivered by a hand therapist would be beneficial for patients with acute and chronic LET.

CONCLUSION

Australian hand therapists and medical practitioners believed educational approaches were the most important component in the management of LET, and supported workplace-based educational interventions provided by hand therapists in the management of LET.

Investigating On-Road Lane Maintenance and Speed Regulation in Post-Stroke Driving: A Pilot Case-Control Study

Stroke can adversely affect the coordination and judgement of drivers due to executive dysfunction, which is relatively common in the post-stroke population but often undetected. Quantitatively examining vehicle control performance in post-stroke driving becomes essential to inspect whether and where post-stroke older drivers are risky. To date, it is unclear as to which indicators, such as lane keeping or speed control, can differentiate the driving performance of post-stroke older drivers from that of normal (neurotypical) older drivers. By employing a case-control design using advanced vehicle movement tracking and analysis technology, this pilot study aimed to compare the variations in driving trajectory, lane keeping and speed control between the two groups of older drivers using spatial and statistical techniques. The results showed that the mean standard deviation of lane deviation (SDLD) in post-stroke participants was higher than that of normal participants in complex driving tasks (U-turn and left turn) but almost the same in simple driving tasks (straight line sections). No statistically significant differences were found in the speed control performance. The findings indicate that, although older drivers can still drive as they need to after a stroke, the decline in cognitive abilities still imposes a higher cognitive workload and more effort for post-stroke older drivers. Future studies can investigate post-stroke adults' driving behaviour at more challenging driving scenarios or design driving intervention programs to improve their executive function in driving.

Kinematic and perceptual responses in heavy lifting and pulling: Are there differences between males and females?

This study investigated kinematic and perceptual differences between the sexes in a heavy lifting and pulling task. A 20 kg box was lifted from floor to chest height, and a 70 kg mannequin pulled across 20m. The effect of height, mass and average grip strength on kinematics and perceived workload was examined in 42 (19 females, 23 males) healthy individuals. A univariate linear regression analysis found females lifted with greater lumbar extension compared to males (p < 0.001), and adopted more hip (p = 0.006) and knee flexion (p = 0.036) in the pulling task. Females reported a greater perceived workload in both tasks (p < 0.001). After the multivariable analysis, only grip strength remained significant for perceived workload in the lift (p = 0.04), and height for knee flexion in the pull (p = 0.009). This highlights that height and strength are important factors driving kinematics and perceived workload. Clinicians may consider these factors in heavy manual tasks, more so than sex.

Process evaluation of an autism-specific workplace tool for employers

BACKGROUND

Limited studies exist exploring employers' capacity in hiring and supporting employees on the autism spectrum, and even fewer have considered interventions targeting employers' skills and knowledge in enhancing employment opportunities. In response to this need, the Integrated Employment Success Tool (IEST^TM) was developed and its effectiveness established in a randomized controlled trial (RCT). Furthermore, a process evaluation was conducted to determine the usability and implementation of the IEST^TM.

AIMS/OBJECTIVES

The process evaluation was conducted to determine employers' perceived usability, implementation, and perceived barriers and facilitators in using the IEST^TM.

MATERIAL AND METHODS

Employers (N = 29) provided their feedback via an online questionnaire. Of these, 11 participants were interviewed, further exploring their experiences. Data were analysed via descriptive statistics and thematic analysis.

RESULTS

While employers' frequency and usage of the IEST^TM varied across workplaces, it was predominantly used to increase employers' knowledge of autism and implement workplace strategies. A major barrier was the paper-based format of the intervention, with more than 60% of employers indicating the need for an online version.

CONCLUSIONS AND SIGNIFICANCE

The process evaluation was a critical step in understanding why the IEST^TM was effective, and how it could be further optimized for prospective employers.

In-the-moment experiences of mothers of children with autism spectrum disorder: a comparison by household status and region of residence

Purpose: This study compared the in-the-moment experiences among mothers of children with Autism Spectrum Disorders (ASD) by their household status (i.e., single versus coupled) and region of residence (i.e., regional versus major city area).Methods: An experience sampling method was employed to collect data, and a total of 40 mothers used an iOS device to record activity types and in-the-moment experiences for one week during school term. Mann-Whitney U test and multilevel analysis were conducted to compare the experiences of these mothers.Results: The analyses found the following results: 1) mothers spent most time in childcare and least time in self-care activities; 2) coupled mothers were more likely to feel supported; 3) coupled mothers were less likely to feel supported in domestic tasks; 4) mothers from major city were more likely to feel challenged in self-care activities; and 5) mothers from major city were more likely to feel supported in productivity tasks.Conclusion: Limited but significant differences between single and coupled mothers, as well as mothers from regional and major city areas, were found. Future research direction and service provisions were suggested.Implications for rehabilitationThis study shows that all mothers spent the most time on childcare and the least amount of time on self-care activities.In-the-moment experiences between single and coupled mothers, as well as mothers from major cities and mothers from regional areas, differ somewhat; however, this study builds evidence to support that these mothers' experiences are similar.The result of the study indicates that single mothers require extra support as they carry similar levels of responsibilities as coupled mothers, but without the support of a partner.Promoting a sense of control may assist all mothers to fully engage in parenting activities.

"I don't want to be a patient": Peer mentoring partnership fosters communication for autistic university students

Background: Despite recognition of the benefits of post-school education in improving life outcomes for autistic adults their university completion rates remain low.Aim: To explore the experiences of undergraduate autistic university students participating in specialist peer mentoring (SPM) to identify active ingredients in the peer mentoring process and to examine the impact of SPM on social communication.Material and method: A total of 30 (8 female; M age = 22.3; SD = 6.7) undergraduate autistic university students engaged in SPM participated in this study. A quantitative pre-test post-test design examined changes in autistic traits. In parallel, the experiences of participating in SPM were explored through semi-structured interviews.Results: Improvements were noted at post-test on the Social Responsiveness Scale-2 total score p = 0.02), and its Social Communication, (p = 0.03) and Social Motivation (p = 0.03) sub-scales. Four themes emerged from the interviews: Developing Partnership and Understanding, Modelling and Practising Communication, Psychological Support and Grading and Planning Skills.Conclusions: These results indicated that the mentor-mentee partnership was a crucial active ingredient of SPM. This partnership appeared to modify social cognition and motivation for autistic university students through modelling and practising communication.Significance: These results demonstrate that SPM can support participation at university for autistic university students.

Effect of Visual Information on Postural Control in Adults with Autism Spectrum Disorder

Sensory processing difficulties affect the development of sensorimotor skills in individuals with autism spectrum disorder (ASD). However, the effect of sensory information on postural control is unclear in the ASD adult population. The present study examined the effect of visual information on postural control as well as the attentional demands associated with postural control in fourteen adults with ASD and seventeen typically developed adults. The results showed that postural sway and attention demands of postural control were larger in adults with ASD than in typically developed adults. These findings indicate that visual processing used for postural control may be different in adults with ASD. Further research in visual field processing and visual motion processing may elucidate these sensorimotor differences.

Effect of Visual Information on Postural Control in Children with Autism Spectrum Disorder

Visual information is crucial for postural control. Visual processing in children with autism spectrum disorder (ASD) was hypothesized to be less efficient and thus they would display a less stable standing posture than typically developing children. The present study compared the static standing responses and attentional demands of 15 children with ASD and 18 control participants in conditions of eyes open and eyes closed. The results showed that postural responses and attention invested in standing were similar between the participant groups in the two visual conditions. Both groups displayed a more stable posture when their eyes were open in comparison to eyes closed. The finding suggests that normal postural control development could occur in children with ASD.

Process Evaluation of the BOOST-A™ Transition Planning Program for Adolescents on the Autism Spectrum: A Strengths-Based Approach

A process evaluation was conducted to determine the effectiveness, usability, and barriers and facilitators related to the Better OutcOmes & Successful Transitions for Autism (BOOST-A™), an online transition planning program. Adolescents on the autism spectrum (n = 33) and their parents (n = 39) provided feedback via an online questionnaire. Of these, 13 participants were interviewed to gain in-depth information about their experiences. Data were analyzed using descriptive statistics and thematic analysis. Four themes were identified: (i) taking action to overcome inertia, (ii) new insights that led to clear plans for the future, (iii) adolescent empowerment through strengths focus, and (iv) having a champion to guide the way. The process evaluation revealed why BOOST-A™ was beneficial to some participants more than others. Trial registration #ACTRN12615000119594.

Road vehicle transportation of children with physical and behavioral disabilities: A literature review

Background: A literature review in 2001 found that children with disabilities were frequently transported in unsafe conditions and further research was required to investigate the gap between regulations, standards and actual transportation practices.Objectives: To synthesize available evidence on the transportation of children with disabilities in road vehicles.Methods: Four databases were systematically searched: CINAHL; Medline; National Transport Library Catalogue (Sweden); and Transport Research International Documentation.Results: Nineteen studies ranging in methodological quality from poor to excellent were included in the review. The findings are presented under the following six major themes: child safety restraints, wheelchairs, vehicles, travel habits, parental and professional knowledge. The results are mapped onto two groups of children, those with behavioral problems and those with physical disabilities.Conclusion: The literature reflected little change across the six major themes since the previous review. Children with disabilities continue to be inappropriately restrained in vehicles, constituting an ongoing road safety problem. There is a strong need to increase parent knowledge, upskill health professionals and provide families with financial assistance to enable them to ensure the safe transportation of children with disabilities to minimize the risk of injury and fatalities on the road, and enhance their participation in the community.

Effect of Optic Flow on Postural Control in Children and Adults with Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) have been associated with sensorimotor difficulties, commonly presented by poor postural control. Postural control is necessary for all motor behaviors. However, findings concerning the effect of visual motion on postural control and the age progression of postural control in individuals with ASD are inconsistent. The aims of the present study were to examine postural responses to optic flow in children and adults with and without ASD, postural responses to optic flow in the central and peripheral visual fields, and the changes in postural responses between the child and adult groups. Thirty-three children (8-12 years old) and 33 adults (18-50 years old) with and without ASD were assessed on quiet standing for 60 seconds under conditions of varying optic flow illusions, consisting of different combinations of optic flow directions and visual field display. The results showed that postural responses to most optic flow conditions were comparable between children with and without ASD and between adults with and without ASD. However, adults with ASD appeared more responsive to forward-moving optic flow in the peripheral visual field compared with typically developed adults. The findings suggest that children and adults with ASD may not display maladaptive postural responses all the time. In addition, adults in the ASD group may have difficulties prioritizing visual information in the central visual field over visual information in the peripheral visual field when in unfamiliar environments, which may have implications in understanding their motor behaviors in new surroundings.

Factors associated with stress in families of children with autism spectrum disorder

PURPOSE

The purpose of this study was to identify key factors associated with severe stress in families raising a child with autism spectrum disorder (ASD).

METHODS

Questionnaires were mailed to families with one or more children with a diagnosis of ASD. Data from 543 surveys were analyzed using univariate and multivariate logistic regression.

RESULTS

Forty-four percent (n = 241) of the caregivers reported severe family stress related to raising a child with ASD. Severe family stress was associated with (1) reduced ability to socialize; (2) not having accessed individual therapy; (3) negative co-parent relationships; and (4) high out of pockets costs due to the child's ASD. The specific ASD diagnosis, comorbid conditions, socio-demographic variables, and social support were not associated with severe family stress.

CONCLUSION

The findings of the current study highlight the importance of a systemic approach to family stress, whereby individual, family, and ecological factors are investigated.

Towards unpacking older drivers' visual-motor coordination: A gaze-based integrated driving assessment

Visual information for a driver is predominant during driving. Linking drivers' visual search patterns with motor behaviour helps understand how drivers perceived spatial and hazardous information to regulate their physical movements. Visual-motor coordination performance can be a sensitive indicator for driver competency assessment. Due to age-related cognitive decline, older drivers are likely inefficient in visual-motor coordination. While poor visual-motor coordination can cause risky behaviour behind the wheel, it is yet challenging to examine it owing to the complexity of driving behaviour. By reviewing how vision guides driving, we proposed a gaze-based integrated driving assessment approach. The empirical data were from 38 older drivers aged 60 to 81 years, who completed an on-road driving assessment recorded by eye tracking and vehicle movement tracking. Their visual search attributes were extracted from eye tracking video frames and linked to vehicle positions. Driving data, drivers' cognitive condition and driving section were encapsulated into an integrated database, allowing interrogating multi-faceted driver-vehicle-environment interactions. Exploratory analysis results show that older drivers' performed different visual search patterns at roundabout and intersection manoeuvres. Older drivers with better executive function skills performed more frequent eye fixations on the curves and inside vehicle features. The investigation of visual-motor coordination performance demonstrated the feasibility and effectiveness of using the integrated approach in assessing older drivers' performance.

To be understood: Transitioning to adult life for people with Autism Spectrum Disorder

Introduction

The purpose of this study was to explore the viewpoints of parents of young people with Autism Spectrum Disorder (ASD) in relation to their child’s transition to adulthood.

Methods

Data were collected during four structured focus groups with 19 parents of young people with ASD with average to high intellectual capacities. Condensed meaning units were identified and checked during focus groups, and were subsequently linked to the International Classification of Functioning, Disability and Health (ICF).

Results

Three major themes emerged: to be understood, to understand the world and to succeed. The ICF domains of activity and participation and environmental factors emerged as having the greatest potential to influence transition outcomes.

Conclusions

Policies and services should focus on strengths to maximise participation in higher education, employment and independent living amongst young people with ASD. Interventions targeting environmental factors could be effective in improving participation in adult life. Person-centred and individualised approaches could further complement this approach supporting the transition to adulthood for people with ASD, ultimately improving outcomes in adulthood.

Eye gaze performance for children with severe physical impairments using gaze-based assistive technology-A longitudinal study

Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with a before and after design was conducted on 10 children (aged 1–15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9–11 months, and after 15–20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15–20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

Hazard perception skills of young drivers with Attention Deficit Hyperactivity Disorder (ADHD) can be improved with computer based driver training: An exploratory randomised controlled trial

BACKGROUND

Young drivers with Attention Deficit Hyperactivity Disorder (ADHD) are at higher risk of road traffic injuries than their peers. Increased risk correlates with poor hazard perception skill. Few studies have investigated hazard perception training using computer technology with this group of drivers.

OBJECTIVES

*Determine the presence and magnitude of the between-group and within- subject change in hazard perception skills in young drivers with ADHD who receive Drive Smart training. *Determine whether training-facilitated change in hazard perception is maintained over time.

METHODS

This was a feasibility study, randomised control trial conducted in Australia. The design included a delayed treatment for the control group. Twenty-five drivers with a diagnosis of ADHD were randomised to the Immediate Intervention or Delayed Intervention group.The Immediate Intervention group received a training session using a computer application entitled Drive Smart. The Delayed Intervention group watched a documentary video initially (control condition), followed by the Drive Smart computer training session. The participant's hazard perception skill was measured using the Hazard Perception Test (HPT).

FINDINGS

After adjusting for baseline scores, there was a significant betweengroup difference in post-intervention HPT change scores in favour of the Immediate Intervention group. The magnitude of the effect was large. There was no significant within-group delayed intervention effect. A significant maintenance effect was found at 6-week follow-up for the Immediate Intervention group.

CONCLUSIONS

The hazard perception skills of participants improved following training with large effect size and some maintenance of gain. A multimodal approach to training is indicated to facilitate maintenance. A full-scale trial is feasible.

A comparison of families of children with autism spectrum disorders in family daily routines, service usage, and stress levels by regionality

PURPOSE

To explore whether family routines, service usage, and stress levels in families of children with autism spectrum disorder differ as a function of regionality.

METHODS

Secondary analysis of data was undertaken from 535 surveys. Univariate and multivariate analyses were performed to investigate differences between families living in densely populated (DP) areas and less densely populated (LDP) areas.

RESULTS

Families living in LDP areas were found to: (1) have reduced employment hours (a two-parent household: Exp (B) = 3.48, p < .001, a single-parent household: Exp (B) = 3.32, p = .011); (2) travel greater distance to access medical facilities (Exp (B) = 1.27, p = .006); and (3) report less severe stress levels (Exp (B) = 0.22, p = .014).

CONCLUSIONS

There were no differences in family routines; however, flexible employment opportunities and travel distance to medical services need to be considered in families living in LDP areas.

Investigating cognitive ability and self-reported driving performance of post-stroke adults in a driving simulator

Background Safe driving is a complex activity that requires calibration. This means the driver can accurately assess the level of task demand required for task completion and can accurately evaluate their driving capability. There is much debate on the calibration ability of post-stroke drivers. Objectives The aim of this study was to assess the cognition, self-rated performance, and estimation of task demand in a driving simulator with post-stroke drivers and controls. Methods A between-groups study design was employed, which included a post-stroke driver group and a group of similarly aged older control drivers. Both groups were observed driving in two simulator-based driving scenarios and asked to complete the NASA Task Load Index (TLX) to assess their perceived task demand and self-rate their driving performance. Participants also completed a battery of psychometric tasks to assess attention and executive function, which was used to determine whether post-stroke cognitive impairment impacted on calibration. Results There was no difference in the amount of perceived task demand required to complete the driving task. Despite impairments in cognition, the post-stroke drivers were not more likely to over-estimate their driving abilities than controls. On average, the post-stroke drivers self-rated themselves more poorly than the controls and this rating was related to cognitive ability. Conclusion This study suggests that post-stroke drivers may be aware of their deficits and adjust their driving behavior. Furthermore, using self-performance measures alongside a driving simulator and cognitive assessments may provide complementary fitness-to-drive assessments, as well as rehabilitation tools during post-stroke recovery.

Investigating the driving performance of drivers with and without autism spectrum disorders under complex driving conditions

PURPOSE

The aim of this study was to investigate the driving performance of drivers with autism spectrum disorders under complex driving conditions.

METHOD

Seventeen drivers with autism spectrum disorders and 18 typically developed drivers participated in a driving simulator trial. Prior to the assessment, participants completed the Driving Behaviour Questionnaire and measurements of cognitive and visual-motor ability. The driving simulation involved driving in an urban area with dense traffic and unpredictable events.

RESULTS

In comparison with the typically developed group, drivers with autism spectrum disorders reported significantly more lapses in driving, committed more mistakes on the driving simulator, and were slower to react in challenging situations, such as driving through intersections with abrupt changes in traffic lights. However, they were also less likely to tailgate other vehicles, as measured by time-to-collision between vehicles, on the driving simulator.

CONCLUSIONS

The performances of licensed drivers with autism spectrum disorders appeared to be safer in respect to car-following distance but were poorer in their response to challenging traffic situations. Driver education for individuals with autism spectrum disorders should focus on quick identification of hazards, prompt execution of responses, and effective allocation of attention to reduce lapses in driving. Implications for rehabilitation Drivers with autism spectrum disorders reported significantly more lapses during driving. Drivers with autism spectrum disorders were observed to be poorer in traffic scenarios requiring critical response. Driver education for individuals with autism spectrum disorders should focus on managing anxiety and effective attention allocation while driving. Driving simulators can be used as a safe means for training critical response to challenging traffic scenarios.

Pilot of the BOOST-A™: An online transition planning program for adolescents with autism

BACKGROUND

Many adolescents with autism face difficulties with the transition from high school into post-school activities. The Better OutcOmes & Successful Transitions for Autism (BOOST-A™) is an online transition planning program which supports adolescents on the autism spectrum to prepare for leaving school. This study describes the development of the BOOST-A™ and aimed to determine the feasibility and viability of the program.

METHODS

Two pilot studies were conducted. In Pilot A, the BOOST-A™ was trialled by six adolescents on the autism spectrum, their parents, and the professionals who worked with them, to determine its feasibility. In Pilot B, 88 allied health professionals (occupational therapists, speech pathologists, and psychologists) reviewed the BOOST-A™ to determine its viability.

RESULTS

Participants rated the BOOST-A™ as a feasible tool for transition planning. The majority of allied health professionals agreed that it was a viable program. Based on participant feedback, the BOOST-A™ was modified to improve usability and feasibility.

CONCLUSION

The BOOST-A™ is a viable and feasible program that has the potential to assist adolescents with autism in preparing for transitioning out of high school. Future research will determine the effectiveness of the BOOST-A™ with adolescents across Australia.

Employers' perception of the costs and the benefits of hiring individuals with autism spectrum disorder in open employment in Australia

Research has examined the benefits and costs of employing adults with autism spectrum disorder (ASD) from the perspective of the employee, taxpayer and society, but few studies have considered the employer perspective. This study examines the benefits and costs of employing adults with ASD, from the perspective of employers. Fifty-nine employers employing adults with ASD in open employment were asked to complete an online survey comparing employees with and without ASD on the basis of job similarity. The findings suggest that employing an adult with ASD provides benefits to employers and their organisations without incurring additional costs.

Gaze-based assistive technology in daily activities in children with severe physical impairments-An intervention study

OBJECTIVE

To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents' satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention.

METHODS

Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1-15 years) participated in gaze-based AT intervention for 9-10 months, during which period the gaze-based AT was implemented in daily activities.

RESULTS

Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents' satisfaction with the AT and with services was high.

DISCUSSION

The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.

Experiences of facilitators or barriers in driving education from learner and novice drivers with ADHD or ASD and their driving instructors

BACKGROUND

Little is known about whether individuals with autism spectrum disorder (ASD) or attention deficit hyperactive disorder (ADHD) experience any specific facilitators or barriers to driving education.

OBJECTIVE

To explore the facilitators or barriers to driving education experienced by individuals with ASD or ADHD who obtained a learner's permit, from the perspective of the learner drivers and their driving instructors.

METHODS

Data were collected from 33 participants with ASD or ADHD, and nine of their driving instructors.

RESULTS

Participants with ASD required twice as many driving lessons and more on-road tests than those with ADHD. Participants with ADHD repeated the written tests more than those with ASD. Driving license theory was more challenging for individuals with ADHD, whilst individuals with ASD found translating theory into practice and adjusting to "unfamiliar" driving situations to be the greatest challenges.

CONCLUSION

Obtaining a driving license was associated with stressful training experience.

Factors associated with negative co-parenting experiences in families of a child with autism spectrum disorder

PURPOSE

The purpose of this study was to identify key factors associated with negative co-parenting experiences in parents raising a child with autism spectrum disorder.

METHODS

Questionnaires were sent to families with one or more children with a diagnosis of autism spectrum disorder. Parents of 142 children with autism spectrum disorder indicated that the diagnosis had a very negative impact on their co-parent relationship. A multivariate logistic regression model was run to analyze the association of these experiences with various demographic, family and community factors.

RESULTS

Three factors were associated with negative co-parenting relationships: (1) family stress due to the child's diagnosis, (2) effects of the diagnosis on parents' relationship with their other children and (3) distance travelled to the nearest medical facility.

CONCLUSIONS

Findings highlight the need to further explore family dynamics, particularly the relationships between the co-parenting alliance, other family members and the extra-familial environment.

'Like the worst toothache you've had' - How people with rheumatoid arthritis describe and manage pain

BACKGROUND

Rheumatoid arthritis (RA) is a chronic inflammatory disease often associated with disability. Despite new treatments, pain and activity limitations are still present.

OBJECTIVES

To describe how persons with RA experience and manage pain in their daily life.

METHODS

Seven semi-structured focus groups (FGs) were conducted and analyzed using content analysis.

RESULTS

The analysis revealed four categories: 1) Pain expresses itself in different ways referred to pain as overwhelming, aching or as a feeling of stiffness. 2) Mitigating pain referred to the use of heat, cold, medications and activities as distractions from the pain. 3) Adapting to pain referred to strategies employed as coping mechanisms for the pain, e.g. planning and adjustment of daily activities, and use of assistive devices. 4) Pain in a social context referred to the participants' social environment as being both supportive and uncomprehending, the latter causing patients to hide their pain.

CONCLUSIONS

Pain in RA is experienced in different ways. This emphasizes the multi-professional team to address this spectrum of experiences and to find pain management directed to the individual experience that also include the person's social environment.

Participation in extracurricular activities for children with and without siblings with autism spectrum disorder

OBJECTIVE

To compare the number, frequency, enjoyment and performance in extracurricular activities of siblings of children with autism spectrum disorders (ASD) to their typically developing (TD) peers, and to identify differences between actual and desired participation.

METHODS

A case-control study with 30 siblings of children with ASD and 30 siblings of TD children was conducted using the Paediatric Interest Profiles and a questionnaire.

RESULTS

Siblings of children with ASD participated in fewer extracurricular activities than those with TD siblings. ASD symptoms were significantly associated with the sibling participating in fewer extracurricular activities. Children with TD siblings had higher enjoyment scores in relaxation activities than children with siblings with ASD.

CONCLUSION

While results were mainly positive, some differences indicated that having a sibling with ASD may impact participation in extracurricular activities. Assessments of participation barriers, as well as support to minimise participation restrictions among siblings of children with ASD are required.

Does somatosensation change with age in children and adolescents? A systematic review

BACKGROUND

Somatosensory modalities, such as touch, proprioception and haptic ability, greatly influence the achievement of developmental milestones for children. Describing somatosensory impairment, natural variability and typical or expected developmental changes across age groups will help establish frameworks for intervention in clinical populations. This systematic review aimed to determine how different somatosensory modalities develop across childhood into adolescence to use as a point of reference for children at risk of somatosensory impairment.

METHODS

Searches of five electronic databases were undertaken through EBSCO-host (MEDLINE, CINAHL, PsycINFO, SPORTDiscus and ERIC) for studies measuring at least one somatosensory modality in typically developing individuals between birth and 18 years and analysed by age. Characteristics of studies were collected including country of origin, sample size, demographics and outcome measure used. Quality assessment and data extraction were performed by two independent reviewers.

RESULTS

Twenty three cross-sectional studies were included from a total of 188 articles retrieved: 8 examined aspects of touch, 5 proprioception and 10 haptic ability. Variability of study designs and variation in assessment tools precluded any formal meta-analysis.

CONCLUSIONS

Somatosensation matures through childhood into adolescence; however, the present review found the pattern of somatosensory development varied depending on the assessment tool used and the aspect of somatosensation being measured, making it difficult to describe typical performance. There is a need for comprehensive assessment batteries to measure the somatosensation, including touch, proprioception and haptic ability, of children at risk of somatosensory impairment to aid in the development of effective interventions.

Single-trial event-related potential extraction through one-unit ICA-with-reference

OBJECTIVE

In recent years, ICA has been one of the more popular methods for extracting event-related potential (ERP) at the single-trial level. It is a blind source separation technique that allows the extraction of an ERP without making strong assumptions on the temporal and spatial characteristics of an ERP. However, the problem with traditional ICA is that the extraction is not direct and is time-consuming due to the need for source selection processing. In this paper, the application of an one-unit ICA-with-Reference (ICA-R), a constrained ICA method, is proposed.

APPROACH

In cases where the time-region of the desired ERP is known a priori, this time information is utilized to generate a reference signal, which is then used for guiding the one-unit ICA-R to extract the source signal of the desired ERP directly.

MAIN RESULTS

Our results showed that, as compared to traditional ICA, ICA-R is a more effective method for analysing ERP because it avoids manual source selection and it requires less computation thus resulting in faster ERP extraction.

SIGNIFICANCE

In addition to that, since the method is automated, it reduces the risks of any subjective bias in the ERP analysis. It is also a potential tool for extracting the ERP in online application.

Gaze and visual search strategies of children with Asperger syndrome/high functioning autism viewing a magic trick

OBJECTIVE

To examine visual search patterns and strategies used by children with and without Asperger syndrome/high functioning autism (AS/HFA) while watching a magic trick. Limited responsivity to gaze cues is hypothesised to contribute to social deficits in children with AS/HFA.

METHODS

Twenty-one children with AS/HFA and 31 matched peers viewed a video of a gaze-cued magic trick twice. Between the viewings, they were informed about how the trick was performed. Participants' eye movements were recorded using a head-mounted eye-tracker.

RESULTS

Children with AS/HFA looked less frequently and had shorter fixation on the magician's direct and averted gazes during both viewings and more frequently at not gaze-cued objects and on areas outside the magician's face. After being informed of how the trick was conducted, both groups made fewer fixations on gaze-cued objects and direct gaze.

CONCLUSIONS

Information may enhance effective visual strategies in children with and without AS/HFA.

Investigating the Spatial Pattern of Older Drivers’ Eye Fixation Behaviour and Associations with Their Visual Capacity

Visual capacity generally declines as people age, yet its impact on visual search patterns along different road sections of actual driving still remains undocumented. In this on-road driving study, we simultaneously recorded 30 older drivers’ eye movement and precise vehicle movement trajectories. The vehicle positions were linked to every eye fixation of individual drivers so that we know the locations of a driver's gaze origin in geospatial coordinates. Spatial distribution pattern of drivers’ eye fixations (duration and frequency) were then analysed. We further investigated the associations between older drivers’ visual capacity (processing speed, divided and selective attention) and their eye fixation patterns in various driving manoeuvres. The results indicate that driving scenarios have significant impact on older drivers’ visual patterns. Older drivers performed more frequent eye fixations when manoeuvreing through roundabouts, while they tended to fixate on certain objects much longer during straight road driving. The key findings show that the processing speed and divided attention of older drivers were associated with their eye fixations at complex right-turns; drivers with a lower capacity for selective attention performed less frequent eye fixations at roundabout manoeuvres. This study has also demonstrated that visualisation and spatial statistics are effective and intuitive approaches in eye movement analysis.

Can you see it too? Observed and self-rated participation in mainstream schools in students with and without autism spectrum disorders

OBJECTIVES

To examine the degree to which observations can capture perception of participation, observed and self-rated levels of interactions for students with and without autism spectrum disorders (ASD) were explored.

METHODS

Frequencies and levels of involvement in interactions with classmates were observed and compared in 22 students with ASD and 84 of their classmates in mainstream schools, using a standardized protocol. Self-reported participation measurements regarding interactions with classmates and teachers from five questionnaire items were correlated with the observations. In total, 51,516 data points were coded and entered into the analyses, and correlated with 530 questionnaire ratings.

RESULTS

Only one weak correlation was found in each group. Compared with classmates, students with ASD participated less frequently, but were not less involved when they actually did.

CONCLUSIONS

Observations alone do not capture the individuals' perception of participation and are not sufficient if the subjective aspect of participation is to be measured.

Attitudes of Primary Care Physicians Toward Older Drivers: A Finnish-Swedish Comparison

Finnish and Swedish general practitioners'(GPs) activities, knowledge, and attitudes related to aging and driving were compared using a mail survey to evaluate the effects of the two countries' different driver licensing policies. The hypothesis was that the existence of an obligatory medical screening system in Finland would make the Finnish GPs more active or knowledgeable concerning aging and driving than their Swedish colleagues with no experience of such a system. The survey was sent to a random sample of registered GPs who worked in primary health care centers in Sweden ( n = 1,500) and in Finland ( n = 1,527); 1,682 respondents completed the form and were included in final analysis. The results did not support the hypothesis: The Swedish GPs reported more activities than did their Finnish colleagues. The level of knowledge was similar in both countries, but the Finnish GPs had higher confidence in their diagnostic competence and more restrictive attitudes than did the Swedish GPs. The existence of an obligatory medical screening system hence did not make the Finnish GPs more active or knowledgeable concerning aging and driving compared to their Swedish colleagues. In contrast, it may contribute to the Finnish GPs' unrealistic confidence in their own assessment skills and in the adequacy of the present screening system in Finland.

Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis

OBJECTIVE

To study whether personal factors (self-efficacy and pain acceptance) mediate the relationship between pain and performance of valued life activities in persons with rheumatoid arthritis.

METHODS

Persons with rheumatoid arthritis for at least four years ( n = 737; 73% women) answered a questionnaire measuring self-efficacy, pain acceptance, performance of valued life activities, and self-rated pain. Relationships among these constructs were explored using univariate and multivariate analyses. Structural equation modelling was then used to examine the mediational role of personal factors on the relationship between pain and performance of valued life activities.

RESULTS

A direct negative association between pain and performance of valued life activities was identified ( Beta = .34, P < .001). This suggests that people with rheumatoid arthritis who had higher levels of pain has increased difficulties in performing valued life activities. Self-efficacy and activity engagement component of pain acceptance mediated the relationship between pain and performance of valued life activities, however the pain willingness component of pain acceptance did not influence participation in valued life activities.

CONCLUSION

These findings highlight the importance of considering personal factors, such as pain acceptance and self-efficacy, in facilitating participation in valued life activities.

A comprehensive conceptual framework for road safety strategies

Road safety strategies (generally called Strategic Highway Safety Plans in the USA) provide essential guidance for actions to improve road safety, but often lack a conceptual framework that is comprehensive, systems theory based, and underpinned by evidence from research and practice. This paper aims to incorporate all components, policy tools by which they are changed, and the general interactions between them. A framework of nine mutually interacting components that contribute to crashes and ten generic policy tools which can be applied to reduce the outcomes of these crashes was developed and used to assess 58 road safety strategies from 22 countries across 15 years. The work identifies the policy tools that are most and least widely applied to components, highlighting the potential for improvements to any individual road safety strategy, and the potential strengths and weaknesses of road safety strategies in general. The framework also provides guidance for the development of new road safety strategies, identifying potential consequences of policy tool based measures with regard to exposure and risk, useful for both mobility and safety objectives.

Managing children's postural risk when using mobile technology at home: Challenges and strategies

Maintaining the musculoskeletal health of children using mobile information and communication technologies (ICT) at home presents a challenge. The physical environment influences postures during ICT use and can contribute to musculoskeletal complaints. Few studies have assessed postures of children using ICT in home environments. The present study investigated the Rapid Upper Limb Assessment (RULA) scores determined by 16 novice and 16 experienced raters. Each rater viewed 11 videotaped scenarios of a child using two types of mobile ICT at home. The Grand Scores and Action Levels determined by study participants were compared to those of an ergonomist experienced in postural assessment. All postures assessed were rated with an Action Level of 2 or above; representing a postural risk that required further investigation and/or intervention. The sensitivity of RULA to assess some of the unconventional postures adopted by children in the home is questioned.

Viewpoints on Factors for Successful Employment for Adults with Autism Spectrum Disorder

This article explores the key factors for successful employment from the viewpoints of adults with autism spectrum disorder (ASD) and employers. Two groups of individuals participated in this study, 40 adults with ASD and 35 employers. Q method was used to understand and contrast the viewpoints of the two groups. Data were analysed using by-person varimax rotation factor analysis. Results showed that although both groups appear committed to the employment process, the difference in their understanding regarding the type of workplace support required, job expectations and productivity requirements continues to hinder successful employment. These results highlight the need to facilitate communication between employees and employers to ensure a clear understanding of the needs of both groups are met. The use of an ASD-specific workplace tool may assist in facilitating the necessary communication between these two groups.

Belongingness in Early Secondary School: Key Factors that Primary and Secondary Schools Need to Consider

It is unknown if, and how, students redefine their sense of school belongingness after negotiating the transition to secondary school. The current study used longitudinal data from 266 students with, and without, disabilities who negotiated the transition from 52 primary schools to 152 secondary schools. The study presents the 13 most significant personal student and contextual factors associated with belongingness in the first year of secondary school. Student perception of school belongingness was found to be stable across the transition. No variability in school belongingness due to gender, disability or household-socio-economic status (SES) was noted. Primary school belongingness accounted for 22% of the variability in secondary school belongingness. Several personal student factors (competence, coping skills) and school factors (low-level classroom task-goal orientation), which influenced belongingness in primary school, continued to influence belongingness in secondary school. In secondary school, effort-goal orientation of the student and perception of their school's tolerance to disability were each associated with perception of school belongingness. Family factors did not influence belongingness in secondary school. Findings of the current study highlight the need for primary schools to foster belongingness among their students at an early age, and transfer students' belongingness profiles as part of the hand-over documentation. Most of the factors that influenced school belongingness before and after the transition to secondary are amenable to change.

Differences in the use of vision and proprioception for postural control in autism spectrum disorder

BACKGROUND

People with autism spectrum disorders (ASDs) also have poorer fundamental motor skills. The development of postural control underlies both social and motor skills. All three elements are facilitated by the active use of visual information. This study compares how adults with ASD and typically developed adults (TDAs) respond to a postural illusion induced using neck vibration. Adults with ASD unlike the TDA, were not expected to correct the illusion using vision.

METHODS

The study used intermittent (15off, 5on) posterior neck vibration during 200 s of quiet stance to induce a postural illusion. In TDAs and only in the absence of vision this protocol induces a forward body lean. Participants (12 ASD, 20 TDA) undertook four conditions combining vibration and visual occlusion.

RESULTS

As predicted, TDA were only affected by the postural illusion when vision was occluded (vibration condition: vision occluded (n=1) p=0.0001; vision available (n=3) p>0.2466). Adults with ASD were affected by the postural illusion regardless of the availability of vision (all conditions p<0.0007).

CONCLUSIONS

Our findings indicated the adults with ASD did not use visual information to control standing posture. In light of existing evidence that vision-for-perception is processed typically in ASD, our findings support a specific deficit in vision-for-action. These findings may explain why individuals with ASD experience difficulties with both social and motor skills since both require vision-for-action. Further research needs to investigate the division of these visual learning pathways in order to provide more specific intervention opportunities in ASD.

Face Recognition and Visual Search Strategies in Autism Spectrum Disorders: Amending and Extending a Recent Review by Weigelt et al

The purpose of this review was to build upon a recent review by Weigelt et al. which examined visual search strategies and face identification between individuals with autism spectrum disorders (ASD) and typically developing peers. Seven databases, CINAHL Plus, EMBASE, ERIC, Medline, Proquest, PsychInfo and PubMed were used to locate published scientific studies matching our inclusion criteria. A total of 28 articles not included in Weigelt et al. met criteria for inclusion into this systematic review. Of these 28 studies, 16 were available and met criteria at the time of the previous review, but were mistakenly excluded; and twelve were recently published. Weigelt et al. found quantitative, but not qualitative, differences in face identification in individuals with ASD. In contrast, the current systematic review found both qualitative and quantitative differences in face identification between individuals with and without ASD. There is a large inconsistency in findings across the eye tracking and neurobiological studies reviewed. Recommendations for future research in face recognition in ASD were discussed.

Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project

OBJECTIVES

To study differences regarding pain and activity limitations during the 3 years following diagnosis in women and men with contemporary treated early RA compared with their counterparts who were diagnosed 10 years earlier.

METHOD

This study was based on patients recruited to the Early Intervention in RA (TIRA) project. In the first cohort (TIRA-1) 320 patients were included in time for diagnosis during 1996-1998 and 463 patients were included in the second cohort (TIRA-2) during 2006-2009. Disease activity, pain intensity (Visual Analogue Scale, VAS), bodily pain (BP) in the 36-item Short Form Health Survey (SF-36), activity limitations (Health Assessment Questionnaire, HAQ), and medication were reported at inclusion and at follow-up after 1, 2, and 3 years.

RESULTS

Disease activity, pain, and activity limitations were pronounced at inclusion across both genders and in both cohorts, with some improvement observed during the first year after diagnosis. Disease activity did not differ between cohorts at inclusion but was significantly lower at the follow-ups in the TIRA-2 cohort, in which the patients were prescribed traditional disease-modifying anti-rheumatic drugs (DMARDs) and biological agents more frequently. In TIRA-2, patients reported significantly lower pain and activity limitations at all follow-ups, with men reporting lower pain than women. Women reported significantly higher activity limitations at all time points in TIRA-2.

CONCLUSIONS

Pain and activity limitations were still pronounced in the contemporary treated early RA cohort compared with their counterparts diagnosed 10 years earlier and both of these factors need to be addressed in clinical settings.

Viewpoints on driving of individuals with and without autism spectrum disorder

OBJECTIVE

Understanding the viewpoints of drivers with autism spectrum disorder (ASD) is crucial in the development of mobility support and driver training that is responsive to their needs.

METHODS

Fifty young adults with ASD and fifty seven typically developed adults participated in the study to form a contrasting group. Q-methodology was used to understand viewpoints on driving as a main mode of transportation. Data were analysed using a PQ by-person varimax rotation factor analysis.

RESULTS

Although some ASD participants perceived themselves as confident and independent drivers, others preferred other modes of transportation such as public transport and walking. Anxiety was also found to be a barrier to driving. The contrast group revealed consistent viewpoints on their driving ability. They preferred driving as their main mode of transportation and believed that they were competent, safe and independent drivers.

CONCLUSION

These results are important in the planning of transport policies and driver training for individuals with ASD. Driver training manuals can be developed to address anxiety issues, hazard perception and navigation problems in the ASD population. Their use of public transport could be further facilitated through more inclusive transport policies.

Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis

This study aimed to examine the difficulties with performing valued life activities in relation to pain intensity in women and men with rheumatoid arthritis (RA). In total, 737 persons with RA (73 % women) from three rheumatology units in Sweden responded to a questionnaire measuring performance of 33 valued life activities and self-rated pain. The relationships between performance of valued life activities (VLAs) and pain (measured by visual analogue scale (VAS)) were analysed based on gender. Multiple linear regression analyses were conducted with the total VLA score as dependent variable. Women reported more pain and difficulties in performing valued life activities than men. Across genders, 85 % reported at least one valued life activity affected by RA. Significantly more women than men encountered difficulties in performing some activities such as cooking, gardening and meeting new people. Women reported higher pain intensity (35 mm) than men (31 mm). Almost all 33 difficulty ratings for valued life activities were higher among persons with high pain (>40 mm) than persons with lower pain. Difficulty ratings for valued life activities correlated positively with pain in persons with lower pain, but not among those with high pain. The results highlight the importance of addressing pain, especially among women with RA, as they reported pain to impact on their valued life activities. Interestingly, this was evident also in women with lower levels of pain.

A review of models relevant to road safety

It is estimated that more than 1.2 million people die worldwide as a result of road traffic crashes and some 50 million are injured per annum. At present some Western countries' road safety strategies and countermeasures claim to have developed into 'Safe Systems' models to address the effects of road related crashes. Well-constructed models encourage effective strategies to improve road safety. This review aimed to identify and summarise concise descriptions, or 'models' of safety. The review covers information from a wide variety of fields and contexts including transport, occupational safety, food industry, education, construction and health. The information from 2620 candidate references were selected and summarised in 121 examples of different types of model and contents. The language of safety models and systems was found to be inconsistent. Each model provided additional information regarding style, purpose, complexity and diversity. In total, seven types of models were identified. The categorisation of models was done on a high level with a variation of details in each group and without a complete, simple and rational description. The models identified in this review are likely to be adaptable to road safety and some of them have previously been used. None of systems theory, safety management systems, the risk management approach, or safety culture was commonly or thoroughly applied to road safety. It is concluded that these approaches have the potential to reduce road trauma.