An Evaluation of a Clinic-Based Low Vision Device Lending Library.

As the efficacy of low vision service provision is facilitated by clients' access to and proper use of low vision devices, the objective of this study was to evaluate an outpatient clinic-based low vision device lending library program and the functional and psychosocial impact that device use had upon clients. Twenty individuals borrowed portable video magnifiers during the study period. Line items from the Revised-Self-Report Assessment of Functional Visual Performance and the Reading Behavior Inventory were analyzed before and after device loan at two months. The Psychosocial Impact of Assistive Devices Scale-10 and a semi-structured interview were also completed at two months. Reported improvements in reading performance and satisfaction levels on the Reading Behavior Inventory were significant (p<.001). The Revised-Self-Report Assessment of Functional Visual Performance indicated improved independence in reading medications, bills and labels. Higher scores in happiness, independence, sense of control and adaptability on the Psychosocial Impact of Assistive Devices Scale-10 indicated device retention at two months. Qualitative themes included improved independence, time needed to acclimate to the device, personal appraisal impacting motivation and challenges specific to low vision. This article provides occupational therapists a model to facilitate access, person-device fit and successful use of low vision devices to promote therapy outcomes.

Physical Activity Self-Efficacy in Older Adults with Vision Loss: A Grounded Theory Study.

The purpose of this study was to develop a model describing the process of how older adults with age-related macular degeneration develop physical activity self-efficacy. The primary aim of this research was to determine how adults with age-related macular degeneration living in a southeastern metropolitan area develop physical activity self-efficacy. Sixteen older adults with age-related macular degeneration participated in face-to-face interviews and observations of their regular physical activity. Grounded theory approach was used to identify emerging themes and a model describing the development of physical activity self-efficacy in this cohort. Five themes related to the development of physical activity self-efficacy emerged: 1) physical activity engagement, 2) self-management behaviors, 3) physical activity determinants, 4) strategies, and 5) self-perceived benefits. These themes were analyzed to produce a preliminary model describing the development of physical activity self-efficacy in older adults with age-related macular degeneration. Findings provide a preliminary model, which practitioners can use to facilitate self-efficacy and participation in physical activity in older adults with age-related macular degeneration.

Evaluation of a Magic Camp for Children with Hemiparesis: A Pilot Study.

This single-group open trial was designed to evaluate the effectiveness of a two-week magic camp as a means of hand-arm motor skills training to improve upper limb motor function (unilateral and bilateral) in children with hemiparesis. Seven children with hemiparesis participated in a magic camp program which met 3 days a week, 4 hours each day, for two consecutive weeks for a total of 24 hours. Participants completed three assessments at the beginning of the camp, post-camp, and at a three-month follow-up: the Jebsen Hand Function Test (JHFT), Children's Hand Experience Questionnaire (CHEQ), and a box opening task that required coordination of both upper limbs. A Wilcoxon signed-rank test revealed significant improvement in JHFT composite scores of the affected limb at post-camp (p = .04) and three-month follow-up (p = .04). In addition, a significant improvement in the number of activities performed using two hands from baseline to three-month follow-up was observed (p = .03). This pattern of improvement was also observed in the speed of completion for the box opening task. The improvement in motor function seems related to the participants' continuing performing daily activities with the affected hand and two hands after the magic camp.

Factors Associated with Comfort Level of School-Based Occupational Therapists in Providing Low-Vision Services.

This study identified factors associated with the comfort level of school-based occupational therapists in providing services to children with visual impairments. Sixty-one school-based occupational therapists completed an on-line survey. Fifty-four percent of respondents were comfortable or somewhat comfortable when choosing assessments and 84% were comfortable or somewhat comfortable in providing occupational therapy services for children with visual impairments. Multivariable linear regression analyses indicated years of professional experience, history of a caseload of children with visual impairments, and training received in treating children with visual impairments from continuing education were uniquely and significantly associated with the respondents' comfort level. Though not included in the final model, collaboration with other low vision service providers (e.g., teachers, optometrists, ophthalmologists, and orientation/mobility specialists) was also significantly associated with respondents' comfort level in the univariate analysis. Findings provide an initial direction and strategies to improve occupational therapists' comfort level in providing services to children with visual impairments in school settings.

Factors Associated With the Use of Standardized Power Mobility Skills Assessments Among Assistive Technology Practitioners.

This study investigated self-reported prevalence of and factors affecting clinicians' use of standardized assessments when evaluating clients for power mobility devices (PMDs), and explored assessments clinicians typically use when carrying out PMD evaluation. An e-mail survey was sent to assistive technology professionals listed in the Rehabilitation Engineering and Assistive Technology Society of North America directory. Three hundred fifty-four respondents, qualified to conduct formal power mobility skills assessments, completed the online survey. Of those, 122 (34.5%) respondents reported that they were aware of the presence of standardized performance-based power mobility skills assessments, but only 28 (7.9%) used these assessments in their practice. Multivariate analysis revealed that the odds of the respondents who use the standardized assessments were 18 times higher for those who were aware of the presence of these assessments than those who were not (adjusted odds ratio [OR] OR = 17.85, P < 0.0001). The odds of using the standardized assessment for respondents who did not identify themselves as occupational or physical therapists were five times higher than those who were therapists (adjusted OR = 0.20, P < 0.0001). This survey revealed that the assistive technology practitioners who recommend PMDs mainly use non-standardized mobility skills assessments.

Clinical application of low vision rehabilitation strategies after completion of a computer-based training module.

This study evaluated changes in occupational therapists' practice behaviors after completion of an online continuing education (CE) program delivered over a hospital Intranet system. The setting was a large rural medical system covering parts of two southeastern states. A convenience sample of 28 occupational therapists and occupational therapy assistants was recruited from the facility therapy staff. A CE module on low vision assessment and treatment was delivered using the hospital Intranet and a follow-up survey assessing practice change was carried out 8 weeks later. Most participants reported an increase in their comfort level when treating clients with low vision after course completion. Fifty percent of participants reported screening for vision impairments, increased use of environmental modifications, and more referrals to other vision specialists. Outcomes suggest that Internet-delivered CE programs can improve knowledge and affect practice.

Visual concerns that interfere with daily activities in patients on rehabilitation units: a descriptive study.

The purpose of this study was to estimate the prevalence of patients with visual concerns that interfere with their activities of daily living (ADL) performance in physical rehabilitation units through occupational therapy assessment. Over the two-month study period, 215 adult inpatients from a physical rehabilitation hospital were evaluated using the Brief Vision Screen (BVS) through ADL. The BVS assessed four areas of visual concerns, namely left visual field, focusing, and near- and low-contrast acuity, while patients engaged in ADL. The occupational therapists identified 33% of patients who had at least one area of visual concern, with the largest proportion diagnosed with stroke (55%), followed by pulmonary disease (40%) and joint replacement (35%). When comparing the four areas of visual concerns in the BVS between the two major diagnostic groups (acquired brain injury, ABI and non-acquired brain injury, non-ABI), a significantly higher proportion of patients with ABI were identified as having left hemianopsia concerns compared to patients with non-ABI. No significant difference was observed in other areas of visual concern between the two groups. Findings indicated that visual concerns that interfere with ADL performance among older patients in rehabilitation units are common. The high proportion of patients with pulmonary disease identified as having visual concerns warranted further confirmation and investigation. Preliminary evidence to support the psychometric properties of the BVS for identifying visual concerns in patients on rehabilitation units was established.

Perspectives on home safety: do home safety assessments address the concerns of clients with vision loss?

PURPOSE: We explored the occupational performance and home safety perspectives of older adults with vision loss. Our study focused on the person-environment interaction to ascertain whether participants' concerns are addressed by three commonly used home safety assessments. METHOD: Twenty-two older adults with vision loss participated in face-to-face interviews regarding their perspectives on home safety. We compared categories generated from a content analysis of the data with the contents of three standardized home safety assessments. RESULTS: Five categories of home safety emerged from the analysis: (1) lighting, (2) contrast, (3) visual distractions, (4) glare, and (5) compensation strategies. Comparisons of content in the three home safety assessments with emerged categories revealed that study participants had specific concerns about home safety that were not thoroughly addressed in the selected assessments. CONCLUSION: The findings provide preliminary content areas that should be included in the development of a home assessment specific to the low vision population.

Perspectives of diabetes educators and dental hygienists regarding strategies to improve oral health for people with diabetes.

Aims: This study aims to explore the opinions of dental hygienists and diabetes educators on improving oral health for people with diabetes. Methods: Registered dental hygienists (RDHs) and certified diabetes educators (CDEs) who provided written responses to the same open-ended question from two state-wide mailing surveys (one for RDHs and the other for CDEs) "what more can you tell us to help improve oral health for people with diabetes?" were included in this study. The surveys were sent to all RDHs (n=2237) and CDEs (n=250) in the state of South Carolina, United States. Results: Of the 1125 valid returned questionnaires from both surveys, 474 provided written responses to this question. Qualitative analysis revealed three main themes from participants' written responses which were: Education (3 subthemes: resources for patients, educate the public, and professional practice resources), interprofessional collaborative care (3 subthemes: role of medical and dental professionals in oral health promotion for people with diabetes, and role of dental and diabetes professional organizations, and companies in the oral healthcare industry), and dental insurance. Conclusions: The three themes that emerged are interrelated indicating that strategies to improve oral health for people with diabetes are multi-faceted.

The 'magic' of magic camp from the perspective of children with hemiparesis.

Previous studies have examined the quantitative results of using an organized approach of teaching and learning magic tricks-a therapeutic magic camp-but set aside the qualitative aspect. The purpose of this qualitative study is to explore the interpretation of the lived experience of children with hemiparesis after they have participated in a therapeutic magic camp. Six children, aged between 11 and 14 years old, with hemiparesis who completed the magic camp program 3 months prior were invited to participate in an in-person individual semistructured interview. The interviews were audio-recorded and transcribed verbatim for content analysis. Results from the initial qualitative analysis yielded categories of enjoyment, positive social and learning experience from participation in the camp, increased confidence, and self-motivation to use the affected upper limb. These categories were grouped into two themes: "having fun with others while learning" and "helping my arm perform." Having fun with others while learning was an amalgamation of fun, and positive social and learning experience. Helping my arm perform reflected a sense of increased competence and self-belief, and a willingness and motivation of the children to attempt challenging daily activities. The lived experiences of children with hemiplegia who participated in an organized delivery of learning to perform magic tricks yield-ed positive outcomes. These themes are consistent with the limited literature that is available suggesting that further research is needed to confirm the efficacy of the therapeutic magic camp intervention.

Pain in adults with cerebral palsy: A systematic review and meta-analysis of individual participant data.

BACKGROUND: There is little focus on adults with cerebral palsy (CP) in research and health care and insufficient knowledge on how to identify and manage pain in this population. OBJECTIVES: This systematic review and meta-analysis aimed to determine whether pain prevalence in adults with CP is high and to explore variations in pain prevalence of subgroups, pain locations, pain severity and pain interference. METHODS: Potential datasets were identified by experts in the field and literature searches in Embase, MEDLINE, and Cochrane, from January 2000 to October 2016. Included studies had a representative sample of ≥25 adults with CP and ≥1 pain outcomes. Methodological quality assessment, pain prevalence estimates and logistic regression models for subgroup effects on pain prevalence were conducted. RESULTS: In total, 17 eligible studies were identified from 4584 publications. A meta-analysis was performed with individual participant data from 15 studies totalling 1243 participants (mean [SD] age 34.3 [12.6] years). Overall mean pain prevalence was 70% (95% CI 62-78). Women were more likely to have pain than men (P<0.001). The odds of pain was increased in adults with gross motor function level II (odds ratio [OR] 1.92, 95% CI 1.22-3.12) and IV (OR 1.77, 95% CI 1.03-4.29). Participants with pain reported pain predominantly in the legs (76%, 95% CI 66-84), and mean pain severity was 3.7/10 (95% CI 2.7-4.7) and pain interference 3.5/10 (95% CI 2.5-4.5). CONCLUSIONS: This meta-analysis provides the first reliable pain prevalence estimate in a large international sample of adults with CP. The high prevalence of pain, 70%, suggests that adults with CP should be routinely screened for pain and treated accordingly. The range of measurement instruments used by the included studies emphasizes using common outcome measures specific to pain internationally.

Pain in adults with cerebral palsy: impact and solutions.

Studies of health in adults with cerebral palsy (CP) have identified pain as a significant concern. Investigations regarding incidence, intensity, and location in adults with CP found that increasing age and inactivity appeared to be related to pain. Activity and participation in adults with CP seem to be only moderately affected by presence of pain. Various sources of pain have been identified in adults with CP but have not been well studied. These include orthopedic issues, poor bone mineral density and related fractures, dental and jaw problems, and nutrition-related pain. Limited healthcare utilization studies suggest that adults with CP use healthcare services, especially preventative and rehabilitative services less, and do not consult physicians regarding pain. Medication solutions for chronic pain are not well studied. Botulinum toxin and intrathecal baclofen have been demonstrated to minimize pain; however, the impact of other medications needs further investigation. Other interventions for pain include small studies examining the use of biofeedback and exercise. Larger studies are needed to establish effectiveness. In order to prevent future generations of adults with CP from experiencing high levels of pain, environmental sources of pain need more specific study, as do interventions that are affordable and easily accessed.

Search performance of healthy adults on cancellation tests.

Cancellation tests are used extensively to identify visual search deficiencies in people with neurologic conditions, but little is known about how healthy adults perform on these tests. This study described the performance and types of search strategies used by healthy adults to complete cancellation tests from the Brain Injury Visual Assessment Battery for Adults. Study participants predominantly used structured left-to-right and top-to-bottom linear search patterns regardless of the configuration of the visual array. Other search qualities included (1) use of the same pattern throughout the search of an array, (2) symmetrical search of the array, and (3) rechecking performance on complex arrays. Older adult participants took more time to complete the tests than younger adults did. Knowing the strategies healthy adults use on cancellation tests enables therapists to identify visual search deficiencies in clients and design interventions to reestablish normal search strategies in daily occupations.

Using an Education Intervention to Increase Preparedness Among Pet Owners: Results of a Pilot Study.

OBJECTIVES: Households with pets are considered a high-risk population, presenting many challenges to response and recovery efforts. Research indicates that households with pets are less likely to evacuate during disasters, and pets left behind pose a health risk to relief workers and the general public. This pilot study explores a brief education intervention targeting households with pets as a method of increasing general household preparedness, with the purpose of facilitating evacuation and protective behaviors in this population. METHODS: A convenience sample of households with pets was recruited to participate in a one-group pre- and post-survey design evaluating the impact of a brief education intervention on increasing pet-specific and general household preparedness levels. RESULTS: Results suggest that the sample population was below national estimates in basic household preparedness before the intervention. Post-survey results indicate an increase in completion of some preparedness tasks after the intervention. There was a statistically significant increase in overall pet preparedness at the P=0.10 level; however, that difference did not translate into general household preparedness. CONCLUSION: The findings from this study are consistent with those from previous literature suggesting that persons often place the needs of their pets above their own; however, the use of a brief education intervention may be successful in increasing pet-specific preparedness levels, which may be useful in successful evacuation and pet well-being. (Disaster Med Public Health Preparedness. 2018;12:441-445).

Methodological quality of service learning studies in rehabilitation professions: A systematic review.

BACKGROUND: Service-learning (SL) has been widely implemented and grown as a pedagogy in the rehabilitation professions. However, assessment on the quality of evidence for the effectiveness of SL related to student learning outcomes and the scope of SL activities related to the occupation of work in the rehabilitation professions is not available. OBJECTIVE: This systematic review was to evaluate the rigor of the methodological quality of SL studies and the scope of SL activities related to the occupation of work in the rehabilitation professions. METHODS: We performed a systematic on-line electronic literature search of nine bibliographic databases available through the university library system to identify peer-reviewed journal articles on SL provided by the tri-alliance of rehabilitation professional students, with the primary or secondary outcome on the evaluation of student SL experiences. Twenty-two SL articles using experimental design between 1995 and 2016 were extracted as they qualified for the methodological appraisal. Appraisal of each article was performed independently by four investigators using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. RESULTS: In six of the 22 SL studies (27%), service provided by the rehabilitation professional students was related to the occupation of work (i.e., assessment, prevention of illness, injury, and disability, and intervention). There was a significant increase in the number (and percent) of SL studies related to the occupation of work compared to that of a previous systematic review (0%, P = 0.03, Fisher's exact test). Results from the evaluation of the methodological quality of these 22 reviewed articles revealed that all received a global rating score of weak. The low methodological quality rating of the reviewed articles was mainly attributed to not controlling for confounders (22 articles), non-blinding (21), and using outcome measures which did not have evidence to support their validity (14). Inability to control for confounders was related to weak research design as more than 77% of the reviewed articles used quasi-experimental designs without a control group. Non-blinding was related to the self-report nature of the outcome measures. CONCLUSIONS: A significant increase in the number of SL studies related to the occupation of work was found, which may provide an indirect indication on an increase in the capacity to provide (work) rehabilitation services. However, selected studies demonstrated high risk of bias which limited firm conclusions to be drawn on reported findings from SL in the tri-alliance of rehabilitation professions curricula.

Cognitive functioning over 3 years in community dwelling older adults with chronic partial epilepsy.

Little is known about cognitive functioning of older adults with chronic partial epilepsy. We examined cognitive performance of this epilepsy patient group over 2-3 years. Seventeen older adults with epilepsy and 17 healthy older adults were administered measures of overall cognition and verbal memory at baseline and 2-3 years later. At baseline, older adults with epilepsy performed below controls on overall cognition and verbal memory (p's<0.001). These deficits generally remained stable at follow-up, although executive control appeared to decline (p<0.05). Older adults with epilepsy showed a failure to benefit from practice on a verbal memory measure (p=0.017). Older adults with epilepsy demonstrated cognitive deficits that generally are not progressive. A failure to benefit from repeat exposure to a Delayed Recall task could indicate learning deficits. These patients may also progressively lose executive control, possibly as a result of accelerated aging.

A comparison of physicians' attitudes and beliefs regarding driving for persons with epilepsy.

OBJECTIVE: The purpose of this survey was to compare attitudes and opinions regarding driving restrictions for persons with epilepsy (PWE) between internal medicine and general practice physicians and neurologists. METHOD: A questionnaire aimed at eliciting physicians' perspectives related to driving with epilepsy was developed that focused on physicians' experiences and opinions with respect to driving issues for PWE. Three groups of physician subspecialties were targeted based on the likelihood of persons with epilepsy in their practice: neurologists, family practice physicians, and internal medicine practitioners. Questions asked about driving with controlled and uncontrolled seizures, predictable auras, nocturnal seizures, seizures without loss of consciousness, patient reporting, seizure-related accidents, and patient justifications for driving. RESULTS: Error rates were high with respect to knowledge of state reporting practices, especially among family practitioners and internal medicine physicians. Family practitioners and internists were less likely than neurologists to support driving for people with uncontrolled seizures under specific conditions and more likely to support a minimum seizure-free period before issuing a driver's license and mandatory reporting of seizure information. Physicians who thought they were from states with mandatory reporting were more supportive of mandatory reporting of seizure information and setting a minimum seizure-free period before a driver's license is issued. Physicians having fewer patients with epilepsy were more likely to oppose driving in persons with intractable seizures. CONCLUSION: Nonneurologists have more restrictive beliefs regarding driving for PWE, who are in fact allowed to drive in many states. Nonneurologists, in particular, demonstrated poor knowledge of state reporting requirements for PWE. The data from this study support a significant effort to promote education of all physicians regarding state regulations and aspects of epilepsy related to driving.

Falls prevention interventions for older adults with low vision: A scoping review: Étude de portée sur les interventions visant à prévenir les chutes chez les aînés ayant une basse vision.

BACKGROUND: Older adults with low vision are especially vulnerable to falls. There are no comprehensive reviews of fall prevention interventions for older adults with vision loss who live in the community. PURPOSE: The aim of this study was to review the evidence regarding community-based falls prevention interventions that appear inclusive of and/or accessible to individuals with low vision. METHOD: A scoping review was completed using the framework developed by Arksey and O'Malley, and the charted data were analyzed using sums and percentages and qualitative content analysis. FINDINGS: Seventeen publications were selected for this review. The analysis allowed for a thorough description of the types of falls prevention interventions (multiple components, home safety/modification, tai chi, the Alexander Technique, improvement of vision through vision assessment and referral, vision/agility training, and yoga), how each intervention addresses vision impairment, and the relation of results to falls risk. IMPLICATIONS: Falls prevention research targeting individuals with visual impairment is limited, and the intervention approaches available may not be effective for older adults with permanent vision loss.