Feasibility of Addressing the Spiritual Well-Being of Persons With Multiple Sclerosis: A Mixed-Methods Program Evaluation.

IMPORTANCE: Spiritual well-being is an important aspect of health-related quality of life for persons with chronic illnesses such as multiple sclerosis (MS), yet research on interventions remains limited. OBJECTIVE: To assess the feasibility of an occupational therapy intervention addressing the spiritual well-being of people with MS. DESIGN: Mixed-methods program evaluation using theoretical thematic analysis of qualitative data. SETTING: Community center serving people with MS in a midwestern U.S. city. PARTICIPANTS: A total of 42 participants attended at least one session; 22 participants provided qualitative data. Ten met the inclusion criteria for quantitative analysis, including completion of pretest and posttest measures and attendance of at least half of the sessions. INTERVENTION: Making Meaning, a group intervention based on the Model of Occupational Wholeness, was conducted over eight weekly 45-min sessions. The focus was on exploring and integrating spiritual practices into daily life. OUTCOMES AND MEASURES: Participants completed the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12-Item Scale (FACIT-Sp-12) to measure spiritual well-being and answered open-ended questions. Attendance was recorded and the facilitator and observers provided qualitative observations. RESULTS: Pretest-posttest comparisons of FACIT-Sp-12 scores indicated a moderate improvement in spiritual well-being (d = 0.41). Attendance and qualitative data supported the intervention's feasibility and suggested areas for refinement. CONCLUSIONS AND RELEVANCE: Making Meaning is a feasible intervention, showing promise for promoting spiritual well-being for people with MS. Further research is warranted. Plain-Language Summary: This study introduces a practical and acceptable occupational therapy group intervention, Making Meaning, which shows promising potential for improving the spiritual well-being of people with multiple sclerosis.

Loading-induced bone formation is mediated by Wnt1 induction in osteoblast-lineage cells.

Mechanical loading on the skeleton stimulates bone formation. Although the exact mechanism underlying this process remains unknown, a growing body of evidence indicates that the Wnt signaling pathway is necessary for the skeletal response to loading. Recently, we showed that Wnts produced by osteoblast lineage cells mediate the osteo-anabolic response to tibial loading in adult mice. Here, we report that Wnt1 specifically plays a crucial role in mediating the mechano-adaptive response to loading. Independent of loading, short-term loss of Wnt1 in the Osx-lineage resulted in a decreased cortical bone area in the tibias of 5-month-old mice. In females, strain-matched loading enhanced periosteal bone formation in Wnt1F/F controls, but not in Wnt1F/F; OsxCreERT2 knockouts. In males, strain-matched loading increased periosteal bone formation in both control and knockout mice; however, the periosteal relative bone formation rate was 65% lower in Wnt1 knockouts versus controls. Together, these findings show that Wnt1 supports adult bone homeostasis and mediates the bone anabolic response to mechanical loading.

Relationship Between Sensory Processing and Participation in Daily Occupations for Children With Autism Spectrum Disorder: A Systematic Review of Studies That Used Dunn's Sensory Processing Framework.

Research measuring sensory processing in children with autism spectrum disorder (ASD) has shown variability in terms of measures used and participant ages, contributing to difficulty in interpreting and summarizing the findings of these studies. In an attempt to clarify the status of the literature, we conducted a systematic review of studies that focused on participation in daily occupations and evaluated sensory processing in children with ASD aged 5-13 yr using Dunn's sensory processing framework. Evidence from 7 studies shows that sensory processing has a significant impact on participation in daily life of children with ASD. Included studies demonstrated medium and low levels of evidence. Additional research using more robust scientific methods is needed.

Sensory Patterns, Obesity, and Physical Activity Participation of Children With Autism Spectrum Disorder.

Obesity is a public health concern for the population in general and for children with autism spectrum disorder (ASD) specifically. The purpose of this study was to understand relationships between sensory patterns, obesity, and physical activity engagement of children with ASD (N = 77) sampled from a specialized community-based swimming program. This retrospective correlational study analyzed program data. Results show that almost half (42.2%) of the children were overweight or obese, and sensory avoiding behaviors were related to higher body mass index (BMI). Children participated in few formal and informal physically active recreation activities. Sensory seeking behaviors were associated with increased participation in informal activities, and higher BMI was associated with less participation in both formal and informal activities. Practitioners should consider sensory processing patterns and BMI when developing community-based programs to promote physical activity of children with ASD.

Mindfulness-based interventions with social workers and the potential for enhanced patient-centered care: A systematic review of the literature.

The use of mindfulness-based interventions (MBIs) is well documented in the mental health, medical, and education literature. There is minimal research on the use of mindfulness with social workers. As demonstrated in other professional and helping fields, mindfulness may enhance clinical skills, reduce burnout, and increase job satisfaction among social workers. In the health care field mindfulness appears integral to patient and family relationships and personal resilience. The evolving and expanding role of hospital social workers may lead to increased work stress and greater demands from both the medical system and patients and families. Research with medical providers, such as physicians and nurses, suggests mindfulness may help in reducing stress, enhancing relationships, and fostering the self-reflection required to provide patient-centered care. We systematically reviewed the existing literature to begin understanding both mindfulness qualities and practices and the effectiveness of MBIs among social workers as well as the relationship of mindfulness to patient-centered care.

Notochord to Nucleus Pulposus Transition.

A tissue that commonly deteriorates in older vertebrates is the intervertebral disc, which is located between the vertebrae. Age-related changes in the intervertebral discs are thought to cause most cases of back pain. Back pain affects more than half of people over the age of 65, and the treatment of back pain costs 50-100 billion dollars per year in the USA. The normal intervertebral disc is composed of three distinct regions: a thick outer ring of fibrous cartilage called the annulus fibrosus, a gel-like material that is surrounded by the annulus fibrosus called the nucleus pulposus, and superior and inferior cartilaginous end plates. The nucleus pulposus has been shown to be critical for disc health and function. Damage to this structure often leads to disc disease. Recent reports have demonstrated that the embryonic notochord, a rod-like structure present in the midline of vertebrate embryos, gives rise to all cell types found in adult nuclei pulposi. The mechanism responsible for the transformation of the notochord into nuclei pulposi is unknown. In this review, we discuss potential molecular and physical mechanisms that may be responsible for the notochord to nuclei pulposi transition.

The relationship between children's sensory processing patterns and their leisure preferences and participation patterns.

BACKGROUND: Sensory processing patterns may be associated with children's preferences for different activities; however, knowledge about how different sensory processing patterns may relate to children's participation in leisure activities is scarce. PURPOSE: This study investigated in what leisure activities children with extreme sensory processing patterns participate and if relationships exist between children's sensory processing patterns and their leisure preferences and participation patterns. METHOD: This correlational study analyzed data from children's Sensory Profiles and reported play and leisure preferences. All 91 children in the sample completed the Children's Assessment for Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC). Parents of children ages 6 to 10 years completed the Sensory Profile, and children ages 11 to 14 years completed the Adolescent/Adult Sensory Profile. FINDINGS: Children with different sensory processing patterns preferred both similar and distinct leisure activities. Low-registration quadrant summary z scores negatively correlated with CAPE overall diversity scores (rs=-.23, p=.03), sensitivity quadrant summary z scores negatively correlated with preferences for social activities (rs=-.23, p=.03) and preferences for skill-based activities (rs=-.22, p=.04), and avoiding quadrant summary z scores negatively correlated with preferences for social activities (rs=-.26, p=.01). IMPLICATIONS: Children's sensory preferences are related to leisure preferences and participation.

Families with children with medical complexity and self-management of care: a systematic review of the literature.

This review analyzes the quantitative literature on children with medical complexity (CMC). Using the Pediatric Self-Management Model, evidence is summarized into facilitators and barriers to self-management. Current quantitative research focuses on the caregiver burden in families with CMC. A model for social work with families with CMC was introduced in response to these findings. A re-envisioned model allows the child with medical complexity to be seen as whole rather than focusing on typically deficit-based areas of medical specialty or service provision.

Exploring Play Interactions of Children With Autism Spectrum Disorders and Their Pets.

The purpose of this secondary qualitative analysis was to explore the play interactions of children with autism (n = 10) and their pets in the home environment. Researchers coded 115 minutes of video of children playing with their pets at home and transcripts from eight caregiver interviews. Thematic analysis revealed six codes which represented three themes, including children with ASD play with pets in a variety of ways, playing with pets supports child development, and playing with pets yields benefits for children with ASD. Findings suggest playing with pets may be beneficial for developing responsibility and social skills of children with ASD, particularly in how they interact with animals. Future research should examine perspectives of families who do not own or who have relinquished pets and perspectives of adults with ASD to better understand positive and negative aspects of pet play.

Coaching mothers of children with autism: a qualitative study for occupational therapy practice.

ABSTRACT The purpose of this study was to understand the perceptions of mothers of children with autism spectrum disorder (ASD) who participated in 10 one-hour coaching sessions. Coaching occurred between an occupational therapist and mother and consisted of information sharing, action, and reflection. Researchers asked 10 mothers six open-ended questions with follow-up probes related to their experiences with coaching. Themes were identified, labeled, and categorized. Themes emerged related to relationships, analysis, reflection, mindfulness, and self-efficacy. Findings indicate that parents perceive the therapist-parent relationship, along with analysis and reflection, as core features that facilitate increased mindfulness and self-efficacy. The findings suggest that how an intervention is provided can lead to positive outcomes, including increased mindfulness and self-efficacy.

Evidence-based practice models and frameworks in the healthcare setting: a scoping review.

OBJECTIVES: The aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with the original model of (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change, along with patient values and preferences and clinical skills. DESIGN: A Scoping review. INCLUDED SOURCES AND ARTICLES: Published articles were identified through searches within electronic databases (MEDLINE, EMBASE, Scopus) from January 1990 to April 2022. The English language EBP models and frameworks included in the review all included the five main steps of EBP. Excluded were models and frameworks focused on one domain or strategy (eg, frameworks focused on applying findings). RESULTS: Of the 20 097 articles found by our search, 19 models and frameworks met our inclusion criteria. The results showed a diverse collection of models and frameworks. Many models and frameworks were well developed and widely used, with supporting validation and updates. Some models and frameworks provided many tools and contextual instruction, while others provided only general process instruction. The models and frameworks reviewed demonstrated that the user must possess EBP expertise and knowledge for the step of assessing evidence. The models and frameworks varied greatly in the level of instruction to assess the evidence. Only seven models and frameworks integrated patient values and preferences into their processes. CONCLUSION: Many EBP models and frameworks currently exist that provide diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models and frameworks. Also, the issues of EBP expertise and knowledge to assess evidence must be considered when choosing a model or framework.

The Hsp90 kinase co-chaperone Cdc37 regulates tau stability and phosphorylation dynamics.

The microtubule-associated protein tau, which becomes hyperphosphorylated and pathologically aggregates in a number of these diseases, is extremely sensitive to manipulations of chaperone signaling. For example, Hsp90 inhibitors can reduce the levels of tau in transgenic mouse models of tauopathy. Because of this, we hypothesized that a number of Hsp90 accessory proteins, termed co-chaperones, could also affect tau stability. Perhaps by identifying these co-chaperones, new therapeutics could be designed to specifically target these proteins and facilitate tau clearance. Here, we report that the co-chaperone Cdc37 can regulate aspects of tau pathogenesis. We found that suppression of Cdc37 destabilized tau, leading to its clearance, whereas Cdc37 overexpression preserved tau. Cdc37 was found to co-localize with tau in neuronal cells and to physically interact with tau from human brain. Moreover, Cdc37 levels significantly increased with age. Cdc37 knockdown altered the phosphorylation profile of tau, an effect that was due in part to reduced tau kinase stability, specifically Cdk5 and Akt. Conversely, GSK3ß and Mark2 were unaffected by Cdc37 modulation. Cdc37 overexpression prevented whereas Cdc37 suppression potentiated tau clearance following Hsp90 inhibition. Thus, Cdc37 can regulate tau in two ways: by directly stabilizing it via Hsp90 and by regulating the stability of distinct tau kinases. We propose that changes in the neuronal levels or activity of Cdc37 could dramatically alter the kinome, leading to profound changes in the tau phosphorylation signature, altering its proteotoxicity and stability.

Exploring Effects of Sensory Garments on Participation of Children on the Autism Spectrum: A Pretest-Posttest Repeated Measure Design.

Objective: Autistic children experience sensory challenges that interfere with participation and increase parent stress. Sensory-based interventions are used to address children's behaviors affected by sensory processing difficulties, but research is limited regarding use of sensory garments to support participation of autistic children. This study explored sensory garment effects on participation, parental competence, and perceived stress of autistic children and their parents. Method: Twenty-one children were recruited and 17 males with ASD and atypical sensory processing patterns completed the 14-week study. The Canadian Occupational Performance (COPM) and Goal Attainment Scaling (GAS) were used to set and monitor participation goals. After a baseline period, children wore sensory garment(s) for 8 weeks. The COPM, GAS, Parent Stress Index-Short Form (PSI-SF), and Parent Sense of Competence Scale (PSOC) were administered four times (prebaseline, before and after the intervention, and three weeks postintervention). Results: There were moderate to large significant differences in both COPM and GAS scores after the intervention and from the beginning to the end of the study indicating sensory garments may improve participation of autistic children. There were no significant differences in PSI or PSOC at any timepoint. Two children rejected the garments. Conclusions: Parent- or child-selected sensory garments may improve participation in individually meaningful activities for children who can tolerate wearing them. Children's improvement in participation did not improve parent stress or competence, possibly due to the passive nature of the intervention. More research is needed explore the influence of heterogeneous sensory patterns on response to intervention.

Effects of Sensory Garments on Sleep of Children with Autism Spectrum Disorder.

OBJECTIVE: The purpose of this study is to assess the effectiveness of the use of sensory garments for improving sleep in children with autism spectrum disorder. METHOD: Using a single-subject ABAB reversal design, the researchers evaluated the effectiveness of a sensory garment on sleep duration, sleep latency, and parental stress related to a child's sleep. Four children aged 4-10 participated. We measured sleep duration and sleep latency using the Garmin watches and parent-report sleep logs, parent stress using the Parenting Stress Index Short Form, and sleep behaviors using the Children's Sleep Habits Questionnaire. Results/Discussion. Data showed variable effects on sleep duration and latency across children. The oldest child with the hyposensitive sensory patterns experienced the greatest sleep improvements. All parents experienced stress from daily life, and some reported increased stress due to study participation. Future research is recommended to further investigate the effectiveness of sensory garments on sleep for children with ASD. Therapists are encouraged to evaluate children's development and sensory preferences prior to recommending sensory garments for sleep.

Osteoblast-Specific Wnt Secretion Is Required for Skeletal Homeostasis and Loading-Induced Bone Formation in Adult Mice.

Wnt signaling is critical to many aspects of skeletal regulation, but the importance of Wnt ligands in the bone anabolic response to mechanical loading is not well established. Recent transcriptome profiling studies by our laboratory and others show that mechanical loading potently induces genes encoding Wnt ligands, including Wnt1 and Wnt7b. Based on these findings, we hypothesized that mechanical loading stimulates adult bone formation by inducing Wnt ligand expression. To test this hypothesis, we inhibited Wnt ligand secretion in adult (5 months old) mice using a systemic (drug) and a bone-targeted (conditional gene knockout) approach, and subjected them to axial tibial loading to induce lamellar bone formation. Mice treated with the Wnt secretion inhibitor WNT974 exhibited a decrease in bone formation in non-loaded bones as well as a 54% decline in the periosteal bone formation response to tibial loading. Next, osteoblast-specific Wnt secretion was inhibited by dosing 5-month-old Osx-CreERT2; WlsF/F mice with tamoxifen. Within 1 to 2 weeks of Wls deletion, skeletal homeostasis was altered with decreased bone formation and increased resorption, and the anabolic response to loading was reduced 65% compared to control (WlsF/F ). Together, these findings show that Wnt ligand secretion is required for adult bone homeostasis, and furthermore establish a role for osteoblast-derived Wnts in mediating the bone anabolic response to tibial loading. © 2021 American Society for Bone and Mineral Research (ASBMR).

Phosphorylation dynamics regulate Hsp27-mediated rescue of neuronal plasticity deficits in tau transgenic mice.

Molecular chaperones regulate the aggregation of a number of proteins that pathologically misfold and accumulate in neurodegenerative diseases. Identifying ways to manipulate these proteins in disease models is an area of intense investigation; however, the translation of these results to the mammalian brain has progressed more slowly. In this study, we investigated the ability of one of these chaperones, heat shock protein 27 (Hsp27), to modulate tau dynamics. Recombinant wild-type Hsp27 and a genetically altered version of Hsp27 that is perpetually pseudo-phosphorylated (3×S/D) were generated. Both Hsp27 variants interacted with tau, and atomic force microscopy and dynamic light scattering showed that both variants also prevented tau filament formation. However, extrinsic genetic delivery of these two Hsp27 variants to tau transgenic mice using adeno-associated viral particles showed that wild-type Hsp27 reduced neuronal tau levels, whereas 3×S/D Hsp27 was associated with increased tau levels. Moreover, rapid decay in hippocampal long-term potentiation (LTP) intrinsic to this tau transgenic model was rescued by wild-type Hsp27 overexpression but not by 3×S/D Hsp27. Because the 3×S/D Hsp27 mutant cannot cycle between phosphorylated and dephosphorylated states, we can conclude that Hsp27 must be functionally dynamic to facilitate tau clearance from the brain and rescue LTP; however, when this property is compromised, Hsp27 may actually facilitate accumulation of soluble tau intermediates.

Hsc70 rapidly engages tau after microtubule destabilization.

The microtubule-associated protein Tau plays a crucial role in regulating the dynamic stability of microtubules during neuronal development and synaptic transmission. In a group of neurodegenerative diseases, such as Alzheimer disease and other tauopathies, conformational changes in Tau are associated with the initial stages of disease pathology. Folding of Tau into the MC1 conformation, where the amino acids at residues 7-9 interact with residues 312-342, is one of the earliest pathological alterations of Tau in Alzheimer disease. The mechanism of this conformational change in Tau and the subsequent effect on function and association to microtubules is largely unknown. Recent work by our group and others suggests that members of the Hsp70 family play a significant role in Tau regulation. Our new findings suggest that heat shock cognate (Hsc) 70 facilitates Tau-mediated microtubule polymerization. The association of Hsc70 with Tau was rapidly enhanced following treatment with microtubule-destabilizing agents. The fate of Tau released from the microtubule was found to be dependent on ATPase activity of Hsc70. Microtubule destabilization also rapidly increased the MC1 folded conformation of Tau. An in vitro assay suggests that Hsc70 facilitates formation of MC1 Tau. However, in a hyperphosphorylating environment, the formation of MC1 was abrogated, but Hsc70 binding to Tau was enhanced. Thus, under normal circumstances, MC1 formation may be a protective conformation facilitated by Hsc70. However, in a diseased environment, Hsc70 may preserve Tau in a more unstructured state, perhaps facilitating its pathogenicity.

A Qualitative Study of Stroke Survivors' Experience of Sensory Changes.

BACKGROUND.: Previous literature examined tactile and proprioceptive changes after stroke; however, the lived experience of changes in all sensory systems is still a gap in the literature. PURPOSE.: To gain understanding of stroke survivors' experience of sensory changes and how sensory changes impact participation in daily life activities. METHOD.: This study utilized a qualitative description method. Researchers used semi-structured interviews with probing questions. Inductive content analysis approach was used to analyze the data. Researchers recruited 13 stroke survivors ≤75 years old who participated in a community-based stroke program. FINDINGS.: Emerging themes included daily life impact of sensory function changes, and experience and timing of sensory changes. Participants experienced changes in various sensory systems including touch and proprioception, visual, auditory, and taste. Survivors also reported sensitivity to environmental stimuli. Sensory changes affect survivors' participation in different aspects of daily life activities. Most participants experienced sensory changes right after their stroke. IMPLICATIONS.: Results from this study inform health care providers about stroke survivors' sensory needs to help them design interventions that match their needs.

A Qualitative Investigation of Swimming Experiences of Children With Autism Spectrum Disorders and Their Families.

OBJECTIVE: To understand the swimming experience from the perspective of children with autism spectrum disorder (ASD) and their families. METHODS: We interviewed 12 diverse families using a semi-structured interview with follow-up probing questions related to their swimming experiences. Interviews were transcribed verbatim and coded by researchers. RESULTS: Themes included family water activities, safety, characteristics of ASD, instructional methods, swim skills, swimming preferences, barriers/challenges, and benefits of swimming. Findings indicate positive experiences and skill acquisition were prevalent when instructional methods matched a child's unique needs. Parents revealed they were more confident in safety as their children's swimming competence improved. Individualized instructional methods and unique characteristics of ASD may influence perceived safety.

Use of Virtual Reality to Distract From Pain and Anxiety.

OBJECTIVES: To determine the effects of a virtual reality intervention on pain and anxiety in patients undergoing a bone marrow aspiration and biopsy procedure. SAMPLE & SETTING: 97 adults in an outpatient cancer center in the midwestern United States. METHODS & VARIABLES: In this quasiexperimental study, participants were assigned to either the experimental group (use of virtual reality goggles) or the control group (standard treatment). Vital signs, pain, and anxiety were measured before and after the procedure. T tests and chi-square tests were used to compare the two groups based on demographic data, pain, anxiety, and total amount of medication used during the procedure. RESULTS: Participants who wore virtual reality goggles during a bone marrow aspiration and biopsy procedure did not experience a statistically significant decrease in pain and anxiety. However, the experimental and control groups showed a decrease in pain and anxiety levels from pre- to postprocedure. IMPLICATIONS FOR NURSING: Virtual reality goggles may be a feasible, noninvasive alternative to traditional pharmacologic treatment. The cost of any intervention would need to be considered. Virtual reality should be researched and adapted to benefit patients in appropriate settings.