Building back better: Imagining an occupational therapy for a post-COVID-19 world.

INTRODUCTION: The COVID-19 pandemic, which has disrupted occupations and lives of people around the world, has simultaneously exposed deeply rooted social inequities and structural injustices that have negated the facile claim that "we're all in this together." But the pandemic has also opened up opportunities to imagine other ways of living and doing in the future. This paper imagines some possibilities for shaping occupational therapy's future practices and seeks to illustrate why it is both timely and necessary to re-imagine occupational therapy in 2021. METHODS: Drawing from epidemiological research, the paper explores the inequitable impacts of COVID-19, environmental degradation, and multiple social determinants on people's real opportunities for health, wellbeing, and occupational engagement. FINDINGS: Evidence presented in this paper challenges occupational therapy's individualised approach towards wellbeing and contests the limited parameters of occupations "that matter" that are prioritised and promoted within the profession. In response, the paper seeks to expose the specific, political, economic, and ableist ideology that has effectively shaped the occupational therapy profession's assumptions, models, theories, and the practices these inform. CONCLUSION: Drawing from the "Build back better" approach to post-disaster recovery-with its dual attentions to wellbeing, equity, and inclusivity and to physical, social, cultural, economic, and environmental vulnerabilities-this paper imagines an occupational therapy for a post-COVID-19 world; an occupational therapy that takes seriously the premise that occupations and people are inseparable from their environments; a profession that no longer colludes in individualising problems that are inherently social or in depoliticising the systemic social and economic inequalities that create stress and illness; an occupational therapy that no longer promotes the values of neoliberal ableism; and an occupational therapy dedicated to expanding people's just and equitable opportunities to engage in meaningful occupations that contribute positively to their own wellbeing and the wellbeing of their communities.

Impact of COVID-19 pandemic lockdown on occupational therapy practice and use of telerehabilitation - A cross sectional study.

OBJECTIVE: COVID-19 has become a global public health emergency affecting 223 countries and territories, and it drastically changed the life of public and health care delivery systems. Although many guidelines have been proposed to avoid infection from COVID-19 and to promote the use of telerehabilitation, there is still no clear answer for the current scenario and strategies of therapists' practice during the COVID-19 pandemic lockdown. This study aimed to explore the impact of COVID-19 lockdown on Occupational Therapists' (OTs) practice, the use of telerehabilitation strategies by OTs, and their employment and mental health. Also, this study aimed to explore the OTs perspective on the role of telerehabilitation during this pandemic lockdown. MATERIALS AND METHODS: Online cross-sectional survey was conducted between April 2020 and May 2020. RESULTS: 114 OTs completed the survey. The results of this study showed that 52.8% of therapists had stress and anxiety due to COVID-19 lockdown. We found that 60.7% of OTs (n=65) used telerehabilitation, versus 36.1% (n=39) before the lockdown. Telerehabilitation approaches were mostly implemented during this lockdown for children with autistic problems (66.6%), stroke (12.9%), cerebral palsy (6.4%), learning disabilities (9.6%), Parkinson's diseases (1.6%), and other medical conditions (2.8%). 10% of therapists reported that they lost their job, and 76% reported that this lockdown affected their income negatively. Overall, 87.8% of therapists reported that mobile technology was very useful to overcome the stress due to COVID-19 related lockdown, social isolation, and social distancing. CONCLUSIONS: The COVID-19 pandemic lockdown experiences made us rethink the current approach of therapy services into alternative method (mixed mode) delivery of occupational therapy practice, which is including the combined method of video-based (telerehabilitation) consultation and face to face intervention.

Stimulating Research to Advance Evidence-Based Applications of Telehealth in Occupational Therapy.

Occupational therapy focuses on therapeutic means to address participation in meaningful everyday tasks across the lifespan. No single setting is more conducive to this pursuit than individuals' authentic contexts. Occupational therapists are therefore uniquely suited to lead the charge toward stimulating research and advancing evidence-based application of telehealth. To this end, the American Occupational Therapy Foundation digitally convened their 2020 Planning Grant Collective to focus on the topic of Telehealth. Participants of the interdisciplinary collective collaboratively identified four themes: (1) Using technology to assess and intervene in the everyday context, (2) Partnerships with caregivers, (3) Telehealth delivery, and (4) Uniform data collection. Subgroups explored potential research and funding opportunities in their specialty area while also addressing the centralizing concepts of equity and diversity of telehealth delivery and COVID-19. Here, we provide a summary of the key concepts and recommendations from the 3 days of collaboration.

Can occupational therapy manpower be replaced with social robots in a singing group during COVID-19?

BACKGROUND: Prior to the COVID-19 global health emergency, reducing direct contacts between therapists and patients is an important issue, and could be achieved by using robots to perform certain caring activities. OBJECTIVE: This study compares therapeutic factors of singing group activities directed by social robots and by occupational therapists at elderly care centers during this COVID-19 outbreak. METHODS: This project has a quasi-experimental research design, based on a pilot study of 14 subjects aged above 65 years. They received eight sessions of singing group therapy given by a social robot or an occupational therapist. Completed copies of a therapeutic-factor questionnaire were then collected. RESULTS: At the 4th week, the scores for 8 therapeutic factors were higher in sessions with the occupational therapist than the robot-directed sessions, reaching a statistically significant level; at the 8th week, the scores for 3 therapeutic factors, including imparting of information, were higher in sessions with the occupational therapist than in sessions with the robot. The top scoring therapeutic factor in the robot sessions was group cohesiveness. CONCLUSIONS: Social robots may be good companion tools for elderly care during this COVID-19 outbreak, but group therapy sessions supervised by real-person therapists still have higher therapeutic factor scores than those conducted by robots. The number of subjects needs to be increased to enhance the validity of future study results.

Systematic Review of Disparities and Differences in the Access and Use of Allied Health Services Amongst Children with Autism Spectrum Disorders.

Individuals with autism spectrum disorder (ASD) often benefit from allied health services such as occupational therapy, speech and language pathology, and applied behavioral analysis. While there is consistent evidence of disparities in access and use of medical services (e.g. dentistry), no such systematic review has examined disparities and differences in allied health use amongst children with ASD. In this systematic review, we examine disparities and differences in service access and use for children with ASD. Our findings suggest that children who are older, have less severe ASD symptoms, are from minority groups, and those from particular geographic regions are less likely to receive allied health services. Limitations and future directions are discussed.

Short-term and sustained effects of a three-week neuro-developmental treatment intensive: A case series report.

BACKGROUND: Neuro-Developmental Treatment (NDT) currently embraces evidence-based concepts of motor control, motor learning and neuroplasticity. However, most research has been performed on outdated models of NDT. OBJECTIVE: This case series examines the short- and long-term outcomes of a three-week intensive using contemporary NDT interventions. METHODS: Six children, 2-10 years old with neurologic disorders and Gross Motor Function Classification System (GMFCS) levels I-III participated in the intervention. The three-week intensive included 60 minutes of physical, occupational and speech therapy 3-5 times weekly. RESULTS: All children demonstrated Gross Motor Function Measure-66 gains of medium to large effect sizes. These gains were maintained or improved upon 3 months' post conclusion of the intensive intervention. CONCLUSIONS: This study supports emerging research regarding the effectiveness of intensive intervention and further study of current NDT interventions.

Constelações afetivas: cotidiano, atividades humanas, relações sociais e Terapia Ocupacional entrelaçados à cosmovisão Krenak / Affective constellations: the everyday, human activities, social relations and occupational therapy interwoven with Krenak's cosmovision / Constelaciones afectivas: cotidiano, actividades humanas, relaciones sociales y terapia ocupacional entrelazados con la cosmovisión Krenak

Dado o contexto pandêmico, terapeutas ocupacionais refletem sobre atividades humanas, cotidianos e relações sociais em uma construção contra-hegemônica em diálogo com Ailton Krenak e sua cosmovisão. Problematizando perspectivas que dissociam seres/natureza/cultura/vida e não consideram os impactos dos modos de vida; inspiram-se nessa perspectiva para potencializar experiências e renovar o compromisso ético-político-cultural com a coletividade. Identificamos afinidades propositivas: pessoas-coletivas; a ressignificação da humanidade e da vida em sua interdependência em constelações de seres; o acolhimento dos encontros intensificando alianças afetivas; a presença na experiência pois o que existe é o agora; e o deslocamento urgente dos modos de vida modernos pela criatividade e poesia da resistência com reinvenção e criação de mundos possíveis mobilizados pelo cantar, dançar, suspender o céu e construir paraquedas coloridos. (AU)

In the context of a pandemic, occupational therapists reflect on human activities, the everyday, and social relations, in a contra>-hegemonic construction that intersects with Ailton Krenak's cosmovision. Problematizing perspectives that dissociate beings/nature/culture/life and disregard the impacts of modes of living, this study draws on this perspective to potentiate experiences and renew the ethical-political-cultural commitment to the collective. We identified propositive affinities: people-collectives; the resignification of humanity and life in its interdependence in constellations of beings; the receptiveness of encounters intensifying affective alliances; the presence in experience because all that exists is now; the urgent shift in modern modes of living and poetry of resistance, with the reinvention and creation of possible worlds mobilized by singing, dancing, suspending the sky, and building colorful parachutes. (AU)

Considerando el contexto pandémico, terapeutas ocupacionales reflexionan sobre actividades humanas, cotidianos y relaciones sociales en una construcción contra-hegemónica en diálogo con Ailton Krenak y su cosmovisión. Problematizando perspectivas que disocian seres/naturaleza/cultura/vida y no consideran los impactos de los modos de vida, se inspira en esa perspectiva para potencializar experiencias y renovar el compromiso ético- político-cultural con la colectividad. Identificamos afinidades propositivas: personas-colectivas; la resignificación de la humanidad y de la vida en su interdependencia en constelaciones de seres; la acogida de los encuentros intensificando alianzas afectivas; la presencia en la experiencia, puesto que lo que existe es el ahora; y el desplazamiento urgente de los modos de vida modernos por la creatividad y poesía de resistencia con reinvención y creación de mundos posibles movilizados por el cantar, bailar, suspender el cielo y construir paracaídas de colores. (AU)

The experiences of work: Retirees' perspectives and the relationship to the role of occupational therapy in the work-to-retirement transition process.

BACKGROUND: Work experiences have the potential to influence retirement. Occupational therapists' understanding of the importance of engagement in occupation for active healthy ageing places them in a position to facilitate the work-to-retirement transition. OBJECTIVE: To describe the experience of work from retirees' perspectives to understand the influence of work on retirement and to discuss the role of occupational therapy in the work-to-retirement transition. METHODS: Semi-structured interviews with retirees were utilised. Thematic analysis identified themes and categories in relation to the experience of work. Categories were related to the Model of Human Occupation (MOHO). RESULTS: Eleven retirees were interviewed. Twelve categories relating to the experience of work were identified and were captured under three over-arching themes: Varied experiences and motivators; Intersection of work and life; and Impact of context. Categories collectively covered all MOHO concepts. Questions to guide therapeutic reasoning were developed to assist putting MOHO theory in to practice. CONCLUSIONS: Working experiences can be an influencing factor on retirement life. Occupational therapy could enable active healthy ageing through understanding the experience of work and how this can assist older workers to remain in the workforce, find a balance between work and other areas of life, and to choose retirement activities.

Insights into cognitive work hardening for return-to-work following depression: Qualitative findings from an intervention study.

BACKGROUND: Workplace mental health disability claims are rising with concomitant challenges to return-to-work (RTW) success. Cognitive work hardening (CWH) addresses work re-entry issues including fatigue, coping skills, and reduced cognitive abilities which are relevant for people returning to work following an episode of depression. OBJECTIVE: To gain insight into underlying factors contributing to CWH's effectiveness in RTW preparation following depression. METHODS: Twenty-one individuals on paid disability leave due to depression completed a four week CWH treatment intervention prior to returning to work. At program completion and at three months follow up, participants provided qualitative information regarding their experience of the intervention in the form of written questionnaires and interviews. Data were analyzed using a directed approach to content analysis. RESULTS: Intervention elements perceived by participants as helpful included structure, work simulations, and simulated work environment. Main treatment gains reported by participants related to routine, self-confidence, stamina, and cognitive abilities. Personal agency, empowerment, and skill development emerged as important consequences of interventions for RTW following depression. CONCLUSIONS: Study findings enhance understanding of CWH with relevance to clinical practice. Key intervention elements deemed important for RTW are discussed and may provide guidance for other work-re-entry programs.

Occupational therapy practice in oncology care: Results from a survey.

The everyday landscape of occupational therapy (OT) in oncology is underexplored, hindering targeted improvements. The purpose of the present study was to identify the OT interventions commonly provided and reimbursed in oncology. A survey utilizing snowball sampling was disseminated online to OT working in oncology care; 167 surveys were received from 21 states in the United States. Results found that over 90% of therapists reported focusing on physical impairment, weakness, fatigue, and activities of daily living. Interventions for emotional/social support, self-advocacy, quality of life, lifestyle management, and cognitive impairment were not directly billed. More than 90% of therapists reported that, in the absence of barriers, they would address quality of life, emotional difficulties, lifestyle management, and home safety. Overall, the findings suggested that OT in the United States primarily provide physical interventions for oncology patients. However, they also provide psychosocial services and client/caregiver education, but often do not bill directly for this care. Reimbursement structures should be modified to allow for the direct billing of mental/psychosocial and educational interventions in OT for cancer care.

Be Bold: A Call to Action for Occupational Therapy.

Surrounded by changes and opportunities, the profession of occupational therapy finds itself at a tipping point. We all have the power to make a difference. What bold action can you take to create meaningful change?

Development of preventive behavior at work: Description of occupational therapists' practice.

BACKGROUND: Integrating more prevention interventions into different workplace settings as a component of the role of occupational therapists has a significant relevance recognized by the occupational therapy professional community. Even if some studies suggested that occupational therapists already provide prevention interventions, and that other studies showed the efficacy of such interventions, the literature does not offer a comprehensive understanding of the specific practice of occupational therapists engaging in prevention in workplace settings. OBJECTIVE: The aim of the study was to describe the practice of occupational therapists toward the development of preventive behaviour at work among their clients. METHOD: Semi-structured interviews were conducted with 13 occupational therapists. Phenomenological analysis was used to examine the content of the interviews. RESULTS: Results suggest that occupational therapists form representations of preventive behavior that are consistent with theory, but those are limited and do not take into account the complexity of the concept. Results of the interviews found eight different interventions provided by occupational therapists toward the development of their clients' preventive behavior at work. CONCLUSION: Occupational therapists recognize their role in supporting their clients' development of preventive behavior at work. However, they appear to lack a conceptual understanding and resources to help them in their practice toward prevention.

Conference Report: 6th Annual International Symposium on Regenerative Rehabilitation.

The 6th International Symposium on Regenerative Rehabilitation, hosted by the Alliance for Regenerative Rehabilitation Research and Training (AR3T), included a preconference meeting of institutional representatives of the International Consortium of Regenerative Rehabilitation, keynote talks from distinguished scientists, platform and poster presentations from experts and trainees, panel discussions and postconference workshops. The following priorities were identified: increasing rigor in basic, preclinical and clinical studies, especially the use of better controls; developing better outcome measures for preclinical and clinical trials; focusing on developing more tissue-based interventions versus cell-based interventions; including regenerative rehabilitation in curricula of professional programs like occupational and physical therapy; and developing better instruments to quantify rehabilitative interventions.

Evolution of upper limb kinematics four years after subacute robot-assisted rehabilitation in stroke patients.

Purpose: To assess functional status and robot-based kinematic measures four years after subacute robot-assisted rehabilitation in hemiparesis. Materials and methods: Twenty-two patients with stroke-induced hemiparesis underwent a ≥3-month upper limb combined program of robot-assisted and occupational therapy from two months post-stroke, and received community-based therapy after discharge. Four years later, 19 (86%) participated in this follow-up study. Assessments 2, 5 and 54 months post-stroke included Fugl-Meyer (FM), Modified Frenchay Scale (MFS, at Month 54) and robot-based kinematic measures of targeting tasks in three directions, north, paretic and non-paretic: distance covered, velocity, accuracy (root mean square (RMS) error from straight line) and smoothness (number of velocity peaks; upward changes in accuracy and smoothness represent worsening). Analysis was stratified by FM score at two months: ≥17 (Group 1) or <17 (Group 2). Correlation between impairment (FM) and function (MFS) was explored at 54 months. Results: FM scores were stable from 5 to 54 months (+1[-2;4], median [1st; 3rd quartiles], ns). Kinematic changes (three directions pooled) were: distance -1[-17;2]% (ns); velocity, -8[-32;28]% (ns); accuracy, +6[-13;98]% (ns); smoothness, +44[-6;126]% (p < 0.05). Group 2 showed decline vs. Group 1 (p < 0.001) in FM (Group 1, +3[1;5], p < 0.01; Group 2, -7[-11;-1], ns) and accuracy (Group 1, -3[-27;38]%, ns; Group 2, +29[17;140]%, p < 0.001). At 54 months, FM and MFS were highly correlated (Pearson's rho = 0.89; p < 0.001). Conclusions: While impairment appeared stable four years after robot-assisted upper limb training during subacute post-stroke phase, movement kinematics deteriorated despite community-based therapy, especially in more severely impaired patients. Trial registration: EudraCT 2016-005121-36. Registration: 2016-12-20. Date of enrolment of the first participant to the trial: 2009-11-24.

An Interactive System for Fine Motor Rehabilitation.

PURPOSE: One of the most important aspects in neuromotor rehabilitation is the need of feedback for patients. The rehabilitation system's efficiency relies on the therapist's judgment; the therapist tells the patient whether he/she is performing the exercises correctly. This process may be quite subjective, because it depends on the therapist's personal opinion. On the other hand, recent studies have shown that vibrotactile biofeedback can improve the effectiveness of interaction as it is a very helpful tool in the physiological process of neuromotor rehabilitation. DESIGN: We designed an interactive system focused on rehabilitation of the upper limbs using active markers and image processing, which consists of drawing activities in both augment and virtual reality. METHODS: The system gives the user a correction through multimodal stimuli feedback (vibrotactile, visual, and sound stimulus) and force measurement to let the patients know if they are not achieving the tasks' goals. FINDINGS: The developed system could be used by nursing assistants to better help patients. The purpose of this system was assisting patients with injuries in shoulders, elbows, or wrists, providing an audio-vibrotactile feedback as a factor of correction in the movements of the patient. To examine our system, 11 participants were asked to participate in an experiment where they performed activities focused to strengthen their fine motor movements. CONCLUSIONS AND CLINICAL RELEVANCE: Results showed show that patients' fine motor skills improved 10% on average by comparing their error rates throughout the sessions.

Making information skills meaningful: a case study from occupational therapy.

The effective delivery of information literacy training can be a challenging process, and health library and information professionals are constantly innovating in this area. This article presents a case study of the BHSc (Hons) Occupational therapy degree programme at York St John University to demonstrate ways in which deep integration of information skills into the curriculum can be achieved. The article advises that in the delivery of health and social care related information skills, we should look more broadly at where relevant learning can happen. In particular, contexts of the health care environment are suggested as a consideration rather than the narrow scope of the academic, classroom-based environment. Examples are provided of specific teaching and learning activities used on the programme alongside CPD activity and curriculum design.