Latino-American Mothers' Perspectives on Feeding Their Young Children: A Qualitative Study.

OBJECTIVE: We explored the cultural beliefs that influence Latino-American mothers' feeding practices with their young children and the sources they referenced in making food choices for their children. METHOD: We conducted semistructured interviews with 12 Latino-American mothers focusing on their experiences of feeding their young children. Data analysis, based in grounded theory, consisted of interview transcription, content analysis, coding, and theme development. RESULTS: We identified four themes summarizing the mothers' feeding practices: (1) "Grandma knows best," (2) "I want my child(ren) to be healthy," (3) "always soup and always rice," and (4) "mealtime is family time." CONCLUSION: Occupational therapy practitioners need to obtain accurate information from families about feeding practices and to understand and interpret those practices in broader cultural contexts to design and implement targeted feeding intervention strategies that avoid stereotyping or misinterpreted information. To promote family-centered, meaningful interventions, practitioners must understand the cultural influences on feeding practices and be sensitive to mothers' needs.

Randomized Controlled Trial to Improve Self-Efficacy in People With Multiple Sclerosis: The Community Reintegration for Socially Isolated Patients (CRISP) Program.

OBJECTIVE: We examined the efficacy of a 12-wk educational socialization program, Community Reintegration for Socially Isolated Patients (CRISP), in improving self-efficacy for people with multiple sclerosis (MS). We also examined whether participants in the experimental group with increased self-efficacy experienced reduced loneliness and depression. METHOD: This randomized controlled group design included 91 participants with MS (experimental group, n = 51; control group, n = 40). Participants were between ages 20 and 68 yr, and the majority experienced a relapsing-remitting MS course (86%) and mild to moderate disability. Participants completed baseline and posttreatment assessments, including questionnaires assessing self-efficacy, loneliness, and depression. RESULTS: Experimental group participants significantly improved in self-efficacy compared with control group participants. Experimental group participants who demonstrated improved self-efficacy reported reduced perceptions of loneliness but not depressive symptoms. CONCLUSION: CRISP is a promising intervention to improve self-efficacy for people with MS. However, results need to be treated with caution given the study's limitations.

Teaching Theory in Occupational Therapy Using a Cooperative Learning: A Mixed-Methods Study.

Cooperative learning provides an important vehicle for active learning, as knowledge is socially constructed through interaction with others. This study investigated the effect of cooperative learning on occupational therapy (OT) theory knowledge attainment in professional-level OT students in a classroom environment. Using a pre- and post-test group design, 24 first-year, entry-level OT students participated while taking a theory course in their second semester of the program. Cooperative learning methods were implemented via in-class group assignments. The students were asked to complete two questionnaires regarding their attitudes toward group environments and their perception toward group learning before and after the semester. MANCOVA was used to examine changes in attitudes and perceived learning among groups. Students' summary sheets for each in-class assignment and course evaluations were collected for content analysis. Results indicated significant changes in students' attitude toward working in small groups regardless of their prior group experience.

Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke.

OBJECTIVE: To compare the long-term effects of external focus (EF) and internal focus (IF) of attention after 4 weeks of arm training. DESIGN: Randomized, repeated-measures, mixed analysis of variance. SETTING: Outpatient clinic. PARTICIPANTS: Individuals with stroke and moderate-to-severe arm impairment living in the community (N=33; withdrawals: n=3). INTERVENTIONS: Four-week arm training protocol on a robotic device (12 sessions). MAIN OUTCOME MEASURES: Joint independence, Fugl-Meyer Assessment, and Wolf Motor Function Test measured at baseline, discharge, and 4-week follow-up. RESULTS: There were no between-group effects for attentional focus. Participants in both groups improved significantly on all outcome measures from baseline to discharge and maintained those changes at 4-week follow-up regardless of group assignment (joint independence EF condition: F1.6,45.4=17.74; P<.0005; partial η2=.39; joint independence IF condition: F2,56=18.66; P<.0005; partial η2=.40; Fugl-Meyer Assessment: F2,56=27.83; P<.0005; partial η2=.50; Wolf Motor Function Test: F2,56=14.05; P<.0005; partial η2=.35). CONCLUSIONS: There were no differences in retention of motor skills between EF and IF participants 4 weeks after arm training, suggesting that individuals with moderate-to-severe arm impairment may not experience the advantages of an EF found in healthy individuals. Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment, whereas dosage and intensity of practice appear to be pivotal. Future studies should investigate the long-term effects of attentional focus for individuals with mild arm impairment.

The evidence-based paradox.

Many occupational therapy practitioners consider evidence-based practice (EBP) to be the means by which occupational therapy can prove the validity of its services and thus support the legitimacy of our profession. The unquestioned acceptance of EBP as the way to establish credibility concerns me; unchallenged acceptance of any idea concerns me. Do practitioners accept EBP as the paradigm for guiding occupational therapy practice and research solely because it is presented as what we must do? I believe that practitioners must examine the implications for our profession of accepting EBP without question. In this article, I review EBP, present criticisms and concerns voiced by other professions and, finally, examine the implications of adopting an EBP perspective that replaces theory-directed practice.

Assessing handwriting intervention effectiveness in elementary school students: a two-group controlled study.

This study examined the effectiveness of two approaches used in elementary schools to improve children's handwriting. Participants were 72 New York City public school students from the first and second grades. A nonequivalent pretest-posttest group design was used in which students engaged in handwriting activities using two approaches: intensive handwriting practice and visual-perceptual-motor activities. Handwriting speed, legibility, and visual-motor skills were examined after a 12-wk Handwriting Club using multivariate analysis of variance. The results showed that students in the intensive handwriting practice group demonstrated significant improvements in handwriting legibility compared with students in the visual-perceptual-motor activity group. No significant effects in handwriting speed and visual-motor skills were found between the students in intensive handwriting practice group and the students in visual-perceptual-motor activities group. The Handwriting Club model is a natural intervention that fits easily into existing school curriculums and can be an effective short-term intervention (response to intervention Tier II).

Personal strategic plan development: getting ready for changes in our professional and personal lives.

Daily challenges for occupational therapists and occupational therapy assistants are changing work environments and the desire to address the needs of their clients. This article highlights the need for occupational therapy practitioners to create personal strategic plans to prepare for their rapidly changing futures. Although AOTA's Centennial Vision responds to the profession's future, practitioners must focus on their personal and professional roles and responsibilities. They also must engage in individual strategic planning. Sound individual strategic planning provides a means for practitioners to merge their fantasized views of occupational therapy with the reality of today's practice.

Relationship between postural control and fine motor skills in preterm infants at 6 and 12 months adjusted age.

We examined the relationship between postural control and fine motor skills of preterm infants at 6 and 12 mo adjusted age. The Alberta Infant Motor Scale was used to measure postural control, and the Peabody Developmental Motor Scales II was used to measure fine motor skills. The data analyzed were taken from 105 medical records from a preterm infant follow-up clinic at an urban academic medical center in south Taiwan. Using multiple regression analyses, we found that the development of postural control is related to the development of fine motor skills, especially in the group of preterm infants with delayed postural control. This finding supports the theoretical assumption of proximal-distal development used by many occupational therapists to guide intervention. Further research is suggested to corroborate findings.

Professional and organizational commitment in paediatric occupational therapists: the influence of practice setting.

The professional and organizational commitment of paediatric occupational therapists working in two distinct practice settings, schools and medically based settings, was investigated. A web-based survey program was used to administer a questionnaire to occupational therapists employed in New York, New Jersey and Connecticut. The study employed social identity theory as a guiding perspective in understanding therapists' professional and organizational commitment. One hundred and fifty-seven paediatric therapists responded to the Professional Commitment Questionnaire and the Organizational Commitment Questionnaire to gauge their commitment to both the profession and their employing organizations. Results indicated that paediatric therapists, regardless of employment setting, have high professional commitment. Paediatric occupational therapists employed in medically based settings indicated statistically significant higher organizational commitment than their school-based counterparts. For therapists that work in school settings, the presence of a professional cohort did not influence professional commitment scores. As the study employed a web-based survey methodology, only individuals who were members of associations and had access to a computer and the Internet were able to participate. Further study might include widening the participant pool as well as adding additional instruments to explore both professional and organizational commitment on a more national scale.

Postural control of pre-term infants at 6 and 12 months corrected age.

BACKGROUND: Pre-term infants are at high risk for motor disabilities. Postural control, the basis for motor development, develops rapidly during the first year of life. An early start to extra-uterine life with an immature motor system may influence a pre-term infant's postural control. AIMS: To identify important prognostic factors and determine the difference in postural control between full-term and pre-term infants. METHOD: Medical records of 93 pre-term infants with birth weight of less than 1501g (mean birth weight=1136.03+/-243.86g; mean gestational age=29.14+/-2.78 weeks) were reviewed. Data was collected from the preemie clinical follow-up program at the National Cheng Kung University, Taiwan. RESULTS: Results demonstrated that pre-term infants had poorer postural control than full-term infants both at 6 and 12 months adjusted age, and that medical complication as measured by the Neonatal Medical Index was the best predictor of postural control in pre-term infants in the first year of life. In addition, our findings confirmed that the development of postural control at 6 months adjusted age predicts the development of postural control at 12 months adjusted age after controlling for prognostic factors. CONCLUSIONS: Both biological and social environmental factors appeared to be associated with pre-term infants' postural control at 6 and 12 months adjusted age. The development of postural control at 6 months adjusted age predicted the development of postural control at 12 months adjusted age. This suggested the value of early follow-up examinations at 6 months adjusted age.

The transition experience to pre-school for six families with children with disabilities.

The purpose of this qualitative study was to gain an understanding of how families receiving related therapy services experience the transition from early intervention to pre-school special education. Participants were six families with a child who received early intervention services and became eligible for pre-school special education services. Data was collected using in-depth interviews over 3 months. Grounded theory lead to theoretical insights and supported the development of three themes and a metatheme. 'Transition is scary', describes the families' feelings about the transition itself and their own perspectives of how their families fared. 'Therapy is central to progress, but not to transition', reflects how therapy remained central to their children's progress, but did not help families acclimate to the pre-school environment. 'Communication is key to comfort', expresses the importance of communication with all relevant parties. The metatheme 'The Outsiders' describes how the transition represents a significant status change for the family in terms of their involvement in their children's education, but also highlights the ways in which families continue to meet the needs of their children outside of the pre-school milieu. Findings suggest that families perceive the transition as difficult despite the presence of policies designed to make it easier for them. A deeper examination of policy and its influence on everyday practice related to the transition must occur to help reconcile the reasons for this difference.

Reported experiences from occupational therapists interacting with teachers in inclusive early childhood classrooms.

This grounded theory study described the perspectives of school-based occupational therapists working in inclusive early childhood classrooms emphasizing interactions with teaching staff. Six therapists were interviewed multiple times over several months. The participants viewed their interactions with teaching staff as challenging but potentially rewarding experiences. Viewing collaboration as valuable, their descriptions nonetheless generally omitted many collaborative features, with therapists often assigned the role of "expert." Data analysis revealed four major themes: (1) "It's Not Like I Don't Value Collaboration" (the benefits of collaboration); (2) "Collaboration--I Can't Do It Alone" (the challenges of interactions); (3) "My Opinion, Please Ask for It" (attachment to the expert status), and (4) "Is This Collaboration?" (interactions in practice). The results of this study suggest that current recommendations for collaboration for inclusion in school-based occupational therapy are not optimally implemented in all practice settings.

Multiple factors related to bottle-feeding performance in preterm infants.

BACKGROUND: A great deal of attention has focused on understanding preterm infant feeding behaviors and on strategies to support the preterm infant during this period; however, comprehensive descriptions of the feeding behavior of preterm infants that incorporate an examination of multiple subsystem levels are lacking. OBJECTIVE: To examine various physical indicators related to preterm infants' bottle-feeding performance. METHODS: This was a retrospective, descriptive, exploratory study using a convenience sample. Medical records of 116 preterm infants were reviewed from the initiation of bottle-feeding until discharge from the neonatal intensive care unit. This study examined bottle-feeding performance (volume intake in milliliters per minute) as well as postmenstrual age, weight at each observed feed, oral motor skills, signs of distress, feeding techniques, feeding experience, gender, and Apgar scores at 5 minutes. Oral motor skills were measured by the Neonatal Oral Motor Assessment Scale. RESULTS: Linear mixed-effects models were used to examine the relationship between bottle-feeding performance and the remaining variables. Postmenstrual age, weight at each observed feed, oral motor skills, feeding experience, and feeding techniques were found to be significant predictors of feeding performance at the .05 level. CONCLUSIONS: Multiple factors, both intrinsic and extrinsic, play a role in determining an infant's bottle-feeding performance. In addition to age and weight, the presently employed conventional criteria, oral motor skills, feeding practice, and feeding techniques also contribute to infants' feeding performance. Arbitrary age (34 weeks gestational age) and weight criteria (1,500 g) should not be the only indicators for oral feeding.

Becoming innovators in an era of hyperchange.

We live in a time of hyperchange--rapid, dramatic, complex, and unpredictable change occurring in today's society, which creates unprecedented challenges. High-speed advances in technology and knowledge and changes in society require that we shift our paradigms. We must become innovators of change. This lecture examines how occupational therapy is reacting to hyperchange as a profession. How is hyperchange influencing the roles and responsibilities of practitioners? How is hyperchange affecting education? And, in accepting hyperchange, what can we do as occupational therapy practitioners, educators, and scholars to shape our own future?

The activity setting of homework: an analysis of three cases and implications for occupational therapy.

An important goal of occupational therapy is to foster clients' participation in daily life. The daily lives of children occur mainly within their homes and schools. Homework is an occupation whose performance affects children's participation in both home and school. A qualitative study of parental self-reports of the strategies they use to foster their children's successful engagement in homework was conducted. In this paper, we examine three cases from this study using the activity setting concept from the ecocultural theory of family accommodation. The three cases were chosen based on their diversity: ethnic and religious background, socioeconomic status, presence of a stay-at-home mother, and presence of children with special needs. The analysis of these cases illustrates that strategies used by parents to foster their children's engagement in homework reflect their values and priorities, their expectations of their children, and their perceptions of their children's strengths and limitations. The concept of activity setting can be useful for occupational therapists to analyze family situations when they are developing home treatment programs.