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

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

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

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

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

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

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

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

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

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

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

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

Becoming innovators in an era of hyperchange.

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

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

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

Interrater reliability and discriminant validity of the deductive reasoning test.

OBJECTIVE: The purpose of this study was to determine the interrater reliability and discriminant validity of Toglia's Deductive Reasoning test for individuals with brain injuries. METHOD: Forty-two individuals with brain injuries and 51 participants without disabilities ranging in age from 18 to 84 years were given the Deductive Reasoning test three consecutive times. A between groups repeated measure design was used to examine differences between the two groups in performance of the Deductive Reasoning test across the three trials. RESULTS: An interclass correlation coefficient (ICC) was statistically significant, indicating good interrater reliability for participants without disabilities. A repeated measures analysis of variance (ANOVA) comparing performance across trials and between groups revealed a significant group main effect, F(1,91) = 52.68, p < .001, thus, participants with brain injuries performed significantly lower on the test than participants without disabilities. This analysis also revealed a significant increase in all participants' scores across trials, F(1.63, 148.67) = 35.094, p < .001. CONCLUSION: Findings confirm acceptable interrater reliability of the Deductive Reasoning test. Further, comparison of the performance of the two groups supports the discriminant validity of the Deductive Reasoning test for individuals with brain injuries. Thus, the Deductive Reasoning test was found to be an appropriate, valid, and reliable assessment tool for occupational therapists to assess deductive reasoning skills in individuals with brain injuries. Additional research is needed to continue to investigate the psychometric value of the Deductive Reasoning test so that clinicians and researchers can use it appropriately.

Categorization and deductive reasoning: predictors of instrumental activities of daily living performance in adults with brain injury.

OBJECTIVE: The purpose of this study was to examine the predictive relationship of categorization and deductive reasoning abilities to performance of instrumental activities of daily living (IADL) among adults with brain injury. METHOD: A correlational research design was used to examine the performance of 19 patients from a neurosurgery acute care unit on Toglia's Category Assessment (TCA), the Deductive Reasoning test (DR), and the Observed Tasks of Daily Living-Revised. RESULTS: Multiple regression analysis indicated that categorization and deductive reasoning accounted for a significant proportion of the variance in IADL performance scores, with deductive reasoning making the greater contribution. Demographic characteristics such as age and education reduced the power of the previous variables, especially of the categorization. CONCLUSION: The results of this study indicate that assessments of categorization and deductive reasoning abilities of persons with brain injury may be good predictors of IADL functional performance. Results support the use of the TCA and DR as quick measures of a person's cognitive and functional abilities. Furthermore, this study provides preliminary results to support that categorization and deductive reasoning abilities are fundamental for the performance of IADL skills.

Improving quality of life for persons with Alzheimer's disease and their family caregivers: brief occupational therapy intervention.

OBJECTIVE: This study examined the extent to which adherence to occupational therapy recommendations would increase the quality of life of persons with Alzheimer's disease living in the community and decrease the burden felt by family members caring for them. METHOD: Using a pretest-posttest control group design, the Assessment of Instrumental Function (AIF) was administered to two groups of persons with Alzheimer's disease in their own homes (n= 40). Caregivers completed measures of their feelings of burden and the quality of life, including level of function of the persons with Alzheimer's disease. RESULTS: A significant (MANCOVA) main effect was obtained for caregiver burden and three components of quality of life, positive affect, activity frequency and self-care status, by the treatment group, F(4, 31) = 7.34, p < .001. CONCLUSIONS: Individualized occupational therapy intervention based on the person-environment fit model appears effective for both caregivers and clients. This is especially important in light of a recent directive for more favorable reimbursement for occupational therapy services for persons with dementia.

Shifts in parent-therapist partnerships: twelve years of change.

OBJECTIVE: A national survey was conducted to identify occupational therapists' current attitudes and values in their working relationships with parents of preschool children with developmental disabilities. This study replicated a 1987 national survey that examined therapists' relationships with parents of preschool children with cerebral palsy. METHOD: Surveys were sent to a random sample of 400 therapists, with 199 returned from respondents who identified themselves as working with preschool children with developmental disabilities. After calculating descriptive statistics for each item in the survey, a one-way analysis of variance was performed to test for differences based on four demographic variables. RESULTS: Respondents reported that working with parents, more than any other aspect of intervention, had the greatest impact on the progress of a child with disabilities. Consistent with the 1987 survey, respondents believed that parents focus on their own adjustment to their child's disability as well as on their child's progress more than any other issues. Therapists continue to report satisfaction when generating positive change for child and parent through education and use of clinical knowledge and skill. CONCLUSION: Results suggest that efforts to foster family-centered intervention in occupational therapy educational programs are increasing therapists' confidence and skills in working with parents of children with disabilities. Implications for occupational therapy practice and education include a need for therapists to expand their knowledge and expertise in working effectively with vulnerable families. Educators need to focus on teaching strategies not only to refine the role of occupational therapy as a direct treatment provider, but also to incorporate creative ways to deal with the psychosocial issues of parents and families.

The evidence-based paradox.

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

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

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

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

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