Managing the move from assisted to independent living: an inclusive qualitative study among adults with cerebral palsy.

PURPOSE: To understand aspects important to adults with severe cerebral palsy (CP) as they prepare to move from assisted to independent living and to create an appropriate intervention. MATERIALS AND METHODS: An inclusive qualitative study was conducted together with adults with severe CP (Gross Motor Function Classification Scale 4-5) preparing to move to independent living. It included semi-structured interviews which were recorded, transcribed, and analyzed by two occupational therapists to create themes. The themes were reviewed and adjusted by the partners in a group context. RESULTS: Seven partners aged 23-47 years (median= 35 years, standard deviation = 10; 4 female) participated. Four themes arose with sub-themes: (1) house management (finances, meals, maintenance, and housework), (2) interactions and boundaries (with a caregiver, family, friends, and romantic partners), (3) schedules (work, leisure, volunteering, education, and health management), and (4) "my way" (autonomy, independence, and self-advocacy; emotions and group power). These themes expressed the concerns of the partners and formed the basis of a group intervention before their move from assisted to independent living. CONCLUSIONS: The inclusive research revealed themes the partners raised that expressed their concerns; these became the basis for a group intervention to prepare for their move from assisted to independent living.

People with severe cerebral palsy raise many concerns regarding living independently.The theme most often discussed illuminated the desire for control over the process.Inclusive research allows participants to co-create a tailor-built intervention.

Participation Patterns of Israeli Children with and without Autism, and the Impact of Environment.

AIMS: Participation is vital to children's quality of life, yet it is often limited for those with autism spectrum disorder (ASD). An improved understanding of the factors that may support or hinder their participation is important. This study aims to explore the participation patterns of children with and without ASD in the home, school, and community settings, as well as to explore the impact of environmental factors on the participation of children with ASD. METHODS: 78 parents of children aged 6-12, attending mainstream educational settings (30 with ASD; 48 without ASD) completed the Participation and Environment Measure for Children and Youth and a demographic questionnaire. RESULTS: Children with ASD were rated significantly lower than children without ASD in participation, and their parents expressed a greater desire to change their participation while reporting lower overall environmental support. Among the ASD group, significant differences in participation were found across the three settings, with the highest participation scores at home. Environmental factors that support or limit children's participation were identified. CONCLUSIONS: The results highlight the importance of environmental factors in children's participation. It is essential to evaluate different environmental settings; identifying the supportive and limiting environmental factors will enhance interventions for children with ASD.

Participation of Children With Autism During COVID-19: The Role of Maternal Participation.

BACKGROUND: Little is known about participation during adverse times. OBJECTIVES: This study described participation of children with autism aged 6 to 13 during COVID-19 pandemic and examined the extent to which child factors, mother's own participation, and environmental barriers/supports explain child participation in home and community. METHOD: A total of 130 mothers completed the Participation and Environment Measure for Children and Youth, the Health Promoting Activities Scale, functional issues checklist, and sociodemographic questionnaire. RESULTS: Children's participation frequency and involvement were significantly higher at home than in the community. In both settings, mothers desired change in 71% of activities. Multiple regression models indicated that child's age and mother's participation frequency significantly explained child's home involvement (R2 = 21%), where mother's participation (frequency) had a unique contribution (ΔR2 = 10.4%) at home but not in the community. CONCLUSION: Findings imply the importance of maternal participation to child's participation at home and suggest redirecting attention for enhancing family participation as a whole.

The Pictorial Interview of Children's Metacognition and Executive Functions (PIC-ME): Cultural Adaptation for Ultra-Orthodox Jewish Populations.

Introduction: Executive functions (EFs) are strongly linked to attention deficit hyperactivity disorder (ADHD). The pictorial interview of children's metacognition and executive functions (PIC-ME) assesses children's self-perceptions regarding their EF. This study is aimed at describing the cultural adaptation of the PIC-ME to the ultra-Orthodox (UO) Jewish population in Israel. Method: In the first of three stages, 30 occupational therapists, who were experienced in working with children with ADHD from the UO population, completed a questionnaire about the suitability of PIC-ME for the UO community. In the second stage, six therapists participated in a focus group to discuss the recommendations and the adaptations made following the first stage. In the third stage, 20 UO children aged 5-10 participated in the tool validation process. Results: First stage: most of the items of the original tool were found to be appropriate in representing the EFs of UO children and did not need to be adapted. No significant differences were found between the boys' and girls' versions regarding the tool's adaptability. However, most of the therapists suggested that the pictures in both versions needed adaptations. Second stage: additional recommendations led to the development of a final adapted version. Third stage: over 70 percent agreement was found among UO children regarding the clarity of the adapted pictures. No significant differences were found between boys and girls or between age groups. Conclusions: This study presented wide agreement on the necessity for cultural adaptation of the PIC-ME to the UO population and described the adaptation process. Based on its face validity, the UO version may be a useful tool to assess the self-perception of EF among UO children. Further studies are needed to assess its psychometric properties and its usefulness as an outcome measure. The study findings may contribute to the cultural adaptation of other tools for culturally distinct populations.

Improving Participation among Youth with Disabilities within Their Unique Socio-Cultural Context during COVID-19 Pandemic: Initial Evaluation.

BACKGROUND: Participation in meaningful activities is important for quality of life among youth with disabilities; yet participation is often restricted during adverse times. This study aimed to explore the effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention among ultra-Orthodox Jewish Israeli youth with disabilities during the COVID-19 pandemic. METHODS: A 20-week single-subject research design with multiple baselines measuring participation goals/activities was employed with two youths (15 and 19 years old) combining quantitative and qualitative descriptive data. Changes in participation levels were measured biweekly using the Canadian Occupational Performance Measure; COPM; participation patterns were measured using the Participation and Environment Measure-Children and Youth; PEM-CY pre- and post-intervention; parents' satisfaction was measured using the Client Satisfaction Questionnaire, CSQ-8. Semi-structured interviews were conducted post-intervention. RESULTS: Both participants significantly improved participation in all selected goals and participation patterns, and were highly satisfied with the intervention. The interviews revealed additional information on personal and environmental barriers, factors supporting intervention, and intervention effects. CONCLUSIONS: The results indicated that an environment-centered and family-centered approach can potentially improve the participation of youths with disabilities within their unique socio-cultural context, during adverse times. Flexibility, creativity, and collaboration with others also contributed to intervention success.

The Relationship between Young Children's Graphomotor Skills and Their Environment: A Cross-Sectional Study.

The current study aimed to examine the unique contribution of personal and environmental factors to explain graphomotor skills in typically developing preschoolers and first-year elementary school students. A convenience sample of 136 Israeli children aged three−seven years was recruited. Graphomotor skills were assessed using the Gilboa Functional Test (GIFT); personal and environmental factors were assessed using a demographic questionnaire and the Home Literacy Experiences Questionnaire (HLEQ). A hierarchical multiple linear regression analysis revealed that home literacy and educational approach accounted for 43.1% of the variance of graphomotor skills (R2 = 40.4, p < 0.000), each providing a unique contribution to the explained variance after controlling for age, gender, and spoken language. Generally, our results supported the bioecological model, with proximal factors (home literacy and educational approach) having a greater influence on child graphomotor skills than distal factors (parental socioeconomic and immigration status). By highlighting the role of environmental factors in graphomotor development, these results can be used as a conceptual framework for developing early intervention programs.

Participation in preschool activities of children with autistic spectrum disorder and comparison to typically developing children.

BACKGROUND: Participation is essential to children's development and is a major focus of intervention. This study aimed to describe the participation patterns of children with ASD, in comparison to typically developing (TD) children. METHODS: 70 preschoolers participated: 33 children with ASD, attending non-inclusive-education settings; and 37 TD children, attending mainstream educational settings. Two occupational therapists assessed their participation through structured observations in self-care activities, play, learning, and social participation areas; demographic and environmental questionnaires were also completed. RESULTS: In the ASD group, frequency of participation was found to be significantly higher in ADL and learning than in other areas; level of performance was found to be significantly lower in social participation than in other areas. The TD group scored significantly higher than did the ASD group in most areas and scales. Initial findings tentatively showed that a structured educational environment for children with ASD may increase participation frequency. CONCLUSIONS: The findings are consistent with recognized disabilities in play and social participation among children with ASD, and their limitations in participation, compared to their TD peers in most areas. Further studies are needed to evaluate additional psychometric properties of the different scales, and the impact of educational environments on participation.

The Structured Preschool Participation Observation (SPO) for Children with ASD: Adaptation, Initial Psychometric Properties, and Children's Participation.

Aims: Due to the lack of tools evaluating participation of children with ASD in the educational setting, this study aimed to adapt the Structured Preschool Participation Observation (SPO), which assess the participation of preschool children attending mainstream-educational settings to children with ASD attending non-inclusive special education (content validity), to measure its initial psychometric properties (internal reliability, inter-rater reliability), and to describe children's participation characteristics, creating an effective tool to fill this gap.Methods: Content validity was evaluated by 21 experts using questionnaires. Thirty-five children with ASD were observed in their educational setting using the adapted tool (SPO-ASD).Results: Content validity was satisfactory regarding the items and their classification into occupational areas. Moderate to excellent internal consistency (α = .73-.92) and inter-rater reliability (ICC = .61-.95, p<.05) were found for all scales and most areas. Children's participation frequency was high in learning and activities of daily living (ADL), low in play and social participation. Performance level was low in social participation. Enjoyment level was low, and needed assistance in ADL was high.Conclusions: Based on our initial evaluation, the SPO-ASD may be suitable for assessing participation of children with ASD attending special education preschools. Additional studies are needed to more securely establish its psychometric properties.

Clinicians' Views on the Need for Cultural Adaptation of Intervention for Children with ADHD from the Ultraorthodox Community.

Culture is a core context within occupational therapy, with a recent literature emphasizing the importance of cultural competence, as well as culturally sensitive assessment and intervention. The recent literature has indicated the efficacy of the Cognitive-Functional intervention (Cog-Fun) for children with ADHD among the general Israeli population, yet no studies to date have examined the necessity of cultural adaptations for minority groups. The current study examines the necessity of adapting the intervention protocol and process to the Ultraorthodox (UO) population, as perceived by occupational therapists. The study included 28 occupational therapists certified to use the Cog-Fun intervention, who reported using this approach with UO children. Participants responded to an online questionnaire developed for this study, regarding characteristics of the UO population and necessary adaptions to the Cog-Fun intervention process and protocol. Findings were analyzed using descriptive statistics and qualitative content analysis. Results of the study point to the necessity of addressing various features of the UO community, including daily routines and habits, cultural values, knowledge regarding ADHD, and accessibility of information. Participants also reported a need to adapt the graphic content of the intervention materials. The qualitative data expanded on the perceptions of the participants through four main themes: (a) knowledge regarding ADHD diagnosis and intervention; (b) perceptions and attitudes regarding ADHD diagnosis and medication; (c) factors affecting communication between the OT, parents, and teachers; and (d) adapting the intervention protocol to habits, routines, and lifestyle of UO families. This study has direct implications for therapists utilizing the Cog-Fun with UO children and may also provide insights relevant to occupational therapists using other treatment approaches with children from this culture, as well as other minority or traditional groups. Furthermore, this study may serve as an important addition to the limited literature describing cultural adaptations of evidence-based interventions.

Participation Profile of Children and Youth, Aged 6-14, with and without ADHD, and the Impact of Environmental Factors.

BACKGROUND: Children and youth with attention deficit hyperactivity disorder (ADHD) may experience difficulties in participation, but few studies examine their participation and the environmental factors affecting participation. This study explored the participation and the environmental factors of children and youth, with and without attention deficit hyperactivity disorder (ADHD), in the following three settings: home, school, and community. MATERIALS AND METHODS: Parents of 65 participants aged 6-14 (M = 9.91, SD = 1.87) with and without ADHD completed the Participation and Environment Measure for Children and Youth (PEM-CY) questionnaire, which evaluates participation and environmental factors, along with demographic and screening questionnaires. RESULTS: The ADHD group (n = 31) scored significantly lower than the non-ADHD group (n = 34) in "frequency" at home, "involvement", and overall environmental support in all settings, with parents expressing a greater desire to change their child's home and community participation. For the ADHD group, a relationship was found between environmental support and involvement in all three settings. CONCLUSIONS: The findings demonstrated differences in the participation of children and youth with ADHD across different settings, compared to those without ADHD, and confirmed the effect of environmental factors on participation, especially involvement. It is essential to consider participation measures and environmental factors when designing interventions for children and youth with ADHD.

The Psychometric Properties of the Structured Preschool Participation Observation (SPO).

AIMS: To evaluate the validity and reliability of the Structured Preschool Participation Observation (SPO), based on the COnsensus-based-Standards for the selection of health Measurement INstruments. The SPO development was based on biopsychosocial and ecological models to evaluate children's participation in play, learning and social occupational areas. METHODS: Following the establishment of content validity, construct validity using factor analysis and reliability were examined among 250 preschool children with typical development (TD). The known-groups procedure was used, comparing 88 children with developmental disabilities (DD), who attended special educational settings with the TD children. RESULTS: Three factors accounted for 68% of the variance. High internal consistency (alpha>.812) was found, as well as a significant moderate-to-high inter-rater reliability in most areas. Children with TD scored significantly higher than children with DD with small to large effect sizes. CONCLUSIONS: The SPO appears to be a suitable measure for assessing children's participation in preschool activities through structured observation. Further studies are needed to further establish its psychometric properties, along with using additional scales of enjoyment and/or involvement and self-care activities. The SPO may assist in generating intervention goals for children with limitations in participation and may complement information gathered from parents.

"Perceptions, expectations and satisfaction levels of occupational therapy students prior to and after practice placement and comparison of practice placement models".

BACKGROUND: Practice placements in occupational therapy are fundamental components in developing a student's professional identity. Various models of placements are available to expose and expand students' participation in various community-based services. The purpose of this study was to compare occupational therapy students' perceptions and expectations prior to placements with their perceptions and satisfaction levels upon completion of placements, and to compare clinical placement models (role-established and role-emerging). METHODS: The study included 155 undergraduate occupational therapy students, who completed questionnaires prior to and upon completion of their placements. The questionnaire included items that were divided into categories of placement setting and supervision, personal skills, professional skills, and community. Paired t-tests and two-way repeated measures analyses of variance (ANOVA) were used in order to examine the change in scores over time, and a-parametric tests were used in order to compare the two models. RESULTS: For all students a significant decrease in scores was found from pre- to post-placement regarding setting and supervision (t[df] = 3.96[154], p < .001), and a significant increase in scores was found from pre- to post-placement regarding personal and professional skills (t[df] = 7.82[154], p < .001; t[df] = 14.24[154], p < .001, respectively). Comparison between placement models indicated nonsignificant differences regarding personal and professional skills. However, role-established post-scores were significantly higher than role-emerging scores regarding setting and supervision, but significantly lower regarding the contribution of services to the community. CONCLUSIONS: Practice placements promote a student's personal and professional skills. Students were less satisfied with the setting and supervision in comparison to their pre-placement expectations. Both models may contribute to students' professional development. Role-established model had an advantage in students' satisfaction with settings and supervision, while role-emerging models had an advantage in students' perceptions regarding contribution to the community. Role-emerging model may contribute to developing and expanding areas of practice in the community.

Responsiveness and discriminant validity of the Child and Adolescent Scale of Participation across three years for children and youth with traumatic brain injury.

PURPOSE: To examine responsiveness and discriminant validity of the Child and Adolescent Scale of Participation (CASP) across three years. METHODS: Examined longitudinal data on 515 children and youth with TBI and arm injuries. Repeated measures analyses of variance were used to examine CASP scores (pre-injury; 3, 12, 24, 36 months post-injury). RESULTS: Scores decreased from pre-injury to 3 months, but significantly only for moderate and severe TBI groups. Scores gradually increased post-injury for all groups except severe TBI. Scores were consistently lowest for severe TBI, followed by moderate TBI, mild TBI, and arm injury across time. Severe TBI scores were significantly lower than scores for mild TBI and arm injury, but not moderate TBI. CONCLUSIONS: CASP scores were responsive to change over time at most measurements and differentiated between groups, particularly severe TBI. Further research is needed with a larger sample of children with moderate/severe TBI as they were underrepresented in this study.

Psychometric properties of the Child and Adolescent Scale of Participation (CASP) across a 3-year period for children and youth with traumatic brain injury.

BACKGROUND: Children with traumatic brain injury are often restricted in their participation due to impairments and environmental barriers. Reliable and valid instruments are essential for monitoring their participation over time. OBJECTIVE: To examine the construct validity and internal consistency of the Child and Adolescent Scale of Participation (CASP) across a 3-year period. METHODS: A longitudinal prospective cohort study (USA) that included 926 children (0-18 years) with TBI and arm injury. Three measures were administered at 3, 12, 24, and 36 months post-injury: The CASP, Pediatric Quality of Life Inventory (PedsQL), and Adaptive Behavior Assessment Scale II (ABAS). RESULTS: Associations between the CASP and PedsQL and ABAS were moderate-to-high at all time periods. Internal consistency of the CASP and its sub-sections was high, with a pattern of gradual increase over time. Factor analyses indicated a clearer four factor solution at 3, 12 and 24 months resembling the four CASP sub-sections. CONCUSIONS: Results provide evidence of convergent validity and internal consistency of the CASP and support its use for assessing participation of children with TBI over time. Prudence should be taken when considering use of factor scores due to differences in factor solutions found in this study and prior studies.

Efficacy of an early intervention program for at-risk preschool boys: a two-group control study.

OBJECTIVE: We report the results of a preschool-based multidisciplinary intervention program. METHOD: This study took place in two educational settings and included 81 preschool boys from unique cultural backgrounds and of low social economic status (SES). The settings were randomly assigned to an intervention or control group. In the intervention group, boys identified as at risk for or with developmental delays received 8 mo. of intervention through a monitoring model. Additionally, a collaborative consultation model was used with all participants. Performance skills (visual-motor integration, motor, and cognitive) and performance and participation in preschool activities were evaluated at pretest and posttest. RESULTS: At termination of intervention, all children in the intervention group scored significantly better than control children on most performance skills and more fully participated in preschool activities. CONCLUSION: A multidisciplinary preschool early intervention program appears to assist children of low SES with improving their performance skills, and participation in preschool activities.

The influence of environmental factors on the development of ultra-orthodox preschool boys in Israel.

The study objectives were: (a) to compare the prevalence of children at risk and/or with developmental delay (at risk/delayed) among the Ultra-Orthodox community with the prevalence reported in the literature and (b) to compare the performance of Ultra-Orthodox children in kindergarten versus that of children in preschool. To this end, motor, visual-motor integration and cognitive performance of 203 Ultra-Orthodox boys from low socio-economic status were assessed. We found a higher percentage of children who were at risk/delayed in gross motor and motor-cognitive skills as compared with the percentage reported in the literature. However, as opposed to expected, the results did not show that there was a higher percent of at-risk/delayed children among the kindergarten group as compared with those among the preschool group. Our findings are consistent with the research literature suggesting that children's cultural background and economic constraints can affect their motor and cognitive development. Thus, occupational therapists and other health professionals should be more culturally competent and more aware of the specific values and practices of families of children with whom they work, which can impact their development. However, in this study, it is difficult to distinguish between the influence of the cultural factors and the influence of socio-economic factors. Therefore, it is recommended to repeat this study among children from either low socio-economic status or other cultural backgrounds.