The Effect of Video-Based Games on Hand Functions and Cognitive Functions in Cerebral Palsy.

Objective: The purpose of this study is to investigate the effect of Leap Motion Based Exergame Therapy (LMBET) on upper limb gross grip strength (GGS), pinch forces, hand functions, gross motor function, and cognitive functions in patients with cerebral palsy (CP). Materials and Methods: Twenty patients with CP (11 hemiplegia and 9 diplegia) were included in the study. Structured Neurodevelopmental Therapy-based hand rehabilitation (SNDTBHR) (first treatment period) was applied a total of 12 sessions, 2 sessions per week (total 6 weeks), and then LMBET (second treatment period) was applied a total of 12 sessions, 2 sessions per week (total 6 weeks). GGS was evaluated by "dynamometer," pinch strengths were evaluated by "pinch meter," hand skills were evaluated by "Manual Ability Classification System (MACS)" and "Jebsen-Taylor Hand Function Test (JHFT)," the gross motor level was evaluated by "Gross Motor Function Classification System (GMFCS)," and cognitive functions were evaluated by "Wisconsin Card Sorting Test (WCST)." Results: Significant difference was found between LMBET and SNDTBHR on GGF, pinch forces, JHFT, and WCST in favor of LMBET (P < 0.017). There was no significant difference between both MACS and GMFCS measurements (P > 0.05). Conclusion: Positive effects of both SNDTBHR and LMBET have been found. However, measurements after LMBET are statistically more significant. Future research should take into account higher patient allocation. Including additional leap motion training to conventional physiotherapy is feasible and might be promising to train cognitive function in children with CP.

Clinical utility of the Danish version of the Canadian Occupational Performance Measure.

BACKGROUND: The Canadian Occupational Performance Measure (COPM) is intended to help clients identify and evaluate their occupational performance issues. As it enhances client-centred practice (CCP), more frequent use of the COPM might fulfill the political agenda of patient involvement in Denmark. However, in a study translating the COPM into Danish, challenges were found highlighting the need to study its clinical utility. AIM: To examine the clinical utility of the Danish version of the COPM (COPM-DK) and help determine whether to recommend a more routinely use. METHODS: Data gathered during qualitative interviews with 16 occupational therapists (OTs) from various settings were subjected to a qualitative content analysis. RESULTS: The COPM-DK appeared to have clinical utility, especially regarding the meaning and relevance of the information obtained, and seemed to facilitate an occupational lens and CCP. The OTs' difficulties and concerns when using the COPM and their personal and environmental commitment to the COPM seemed associated with how they performed the COPM. Thus, training was recommended to facilitate a valid and reliable use. CONCLUSION: Given the benefits and the perceived utility of the COPM-DK, a more routinely use, to place OTs and CCP in the center of Danish healthcare system, is recommended.Key MessagesThe utility of the Danish version of the Canadian Occupational Performance Measure is supported, according to Danish occupational therapists in various rehabilitation settings and hospitals.Using the Canadian Occupational Performance Measure seems to enhance a client-centred practice with collaborative goals and helps to establish partnership, being of value to the interdisciplinary team, too.The utility and acceptability of the Canadian Occupational Performance Measure seemed to be linked to the occupational therapists' experience and understanding of the Canadian Occupational Performance Measure's content and form, thus an introduction course is recommended to avoid a use that affects the assessment's validity and reliability.

Occupational therapists' competencies utilised in Danish job centres.

BACKGROUND: Twenty-nine out of 94 Danish job centres employ occupational therapists (OTs) and numbers are increasing. Occupational therapy (OT) vocational rehabilitations are diverse, and a more specific description of OT practice within this field is lacking. AIMS: To explore how OTs employed at Danish job centres describe their own competencies and what they perceive that their colleagues from other professions request from them. MATERIAL AND METHODS: Firstly, working diaries were obtained from 16 OTs working in job centres and analysed using content analysis. Secondly, semi-structured interviews were performed and analysed using systematic text condensation. RESULTS: The 16 OTs described four areas of competencies to their profession's practice within job centres; client-centeredness; a holistic approach; work ability assessments and ergonomics and adaptation. The OTs perceived that their colleagues requested their work ability assessment skills and their competencies as health professionals. CONCLUSION: The OTs had a client-centered and holistic focus on the citizens' whole life situation and used their health professional education and knowledge of ergonomics and adaptation to strengthen their work ability assessments. SIGNIFICANCE: The OTs perceived that they had competencies that supplemented the competencies of the interdisciplinary team. The results therefore support the inclusion of OTs within job centres.

Danish translation, cultural adaptation and initial validation of the Self-Assessment of modes questionnaire (D-SAMQ).

BACKGROUND: The Self-Assessment of Modes Questionnaire (SAMQ) was developed for occupational therapists (OTs) to identify their therapeutic style when interacting with clients. To provide Danish Occupational Therapists (OTs) with access to the SAMQ, a rigorous translation, cultural adaptation and validation are required. AIM: To describe the process of translating and culturally adapting the SAMQ into Danish (D-SAMQ) and examining initial validation of the SAMQ in terms of relevance and comprehensiveness in a Danish context. MATERIAL AND METHODS: A 10-step process for translation and cultural adaptation was followed: (1) Preparation, (2) Forward translation, (3) Reconciliation, (4) Back translation, (5) Back-translation review, (6) Harmonization, (7) Cognitive debriefing, (8) Review of cognitive debriefing results and finalization, (9) Proofreading and (10) Final report. The cognitive debriefing also involved validation. RESULTS: Seven OTs and one OT student were included in the cognitive debriefing. Adaptations were made in eight of twenty cases, and modifications regarding the choice of words, sentence structure, and rephrasing were performed. The participants suggested more contextual details in the case descriptions. CONCLUSION: The SAMQ was translated into Danish (D-SAMQ) and adapted and validated by Danish OTs. The D-SAMQ may enable OTs to identify their therapeutic style, and thereby improve the client-therapist relationship.

Construct validity of the Child-Initiated Pretend Play Assessment-For 3-year-old Brazilian children.

INTRODUCTION: Play is an indication of children's development and how they function. In occupational therapy it is regarded as an important occupation of childhood. Assessment of a child's play should be included in the test batteries of occupational therapists, who understand the construct validity of the assessment they have chosen. Our aim was to provide evidence of reliability, internal consistency and hypotheses testing of the construct validity of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment. METHODS: Two hundred typically developing Brazilian children aged 3 years were evaluated individually using the Child-Initiated Pretend Play Assessment. RESULTS: The internal consistency showed a Cronbach's alpha coefficient to Percentage of Pretend Play Actions (PEPA) of 0.86 and NOS of 0.81. There were significant differences between the younger children (aged 36-41 months) and the older children (aged 42-47 months) for elaborate play across both conventional-imaginative play (p = .002), symbolic play (p = .012), and the combined score (p = .005). There were significant differences between younger and older girls for elaborate play with symbolic play materials (p = .009) and elaborate play overall (p = .039). There were significant differences between young and older boys for elaborate play with conventional toys (p = .006) and elaborate play overall (p = .025). There were no significant differences for object substitution or imitated actions. CONCLUSION: The measurement properties of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment for 3-year-old Brazilian children identified evidence for response processes, internal structure, with discussion of consequences of testing for 3-year-old Brazilian children.

Neoliberalism: Unpacking Limited Employment Success for Persons with SMI.

BACKGROUND.: A mixed-methods case study exploring access to competitive employment for persons with serious mental illness (SMI) revealed limited access to work and low employment success across two northern communities. PURPOSE.: To explore possible explanations for why low employment rates persist despite existing employment services and supports. METHODS.: A total of 46 individual or group interviews were conducted with persons with SMI, vocational providers, and decision-makers regarding access to competitive employment in the case communities. Data were systematically analysed for dominant ideas, interests and institutions using a neo-institutional framework. FINDINGS.: Participants described access to employment to be constrained by provider competition, limited supports, and a lack of consideration of difference-ideas and interests associated with neoliberal influences within provincial employment supports policy. IMPLICATIONS.: Enabling participation in meaningful employment for people with SMI will require occupational therapists to appreciate and contest the oppressive nature of neoliberal policies on local programs and services.

Front Desk Duty Multitasking Test After Mild Stroke: Preliminary Reliability and Validity.

BACKGROUND.: Performance-based multitasking assessments may be more sensitive than cognitive screens to detect executive dysfunction after a mild stroke. PURPOSE.: This cross-sectional study examined inter-rater reliability and preliminary convergent and discriminant validity of the Front Desk Duty Test (FDDT). METHOD.: Adults with mild stroke (n = 35) and community controls (n = 33) were administered the FDDT and other measures of executive functions. FINDINGS.: Inter-rater reliability of the FDDT subscores were high (ICC 0.971-0.999). There were weak but statistically significant correlations between participants' scores on some of the executive function tests and some FDDT subscores. Participants with mild stroke and community controls had statistically significant different FDDT scores (performance accuracy p = .006; performance time, p = .033), with rank order FDDT score patterns across community controls, participants with mild stroke who passed the executive function screen, and participants with mild stroke who failed the executive function screen. IMPLICATIONS.: Preliminary validation results suggest that the FDDT warrants further study.

Crosscultural Validation of the Community Integration Questionnaire-Revised in an Italian Population.

OBJECTIVE: The aims of this study are the translation, cultural adaptation, and validation of the Community Integration Questionnaire-Revised (CIQ-R) in Italian in a group of individuals with no clinical evidence of disability. METHODS: The test's internal consistency and validity were assessed by following international guidelines. The test's internal consistency was examined using Cronbach's alpha (α) coefficient. Pearson's correlation coefficient was calculated to assess the test's concurrent validity compared with the Short Form-12 (SF-12) health survey. RESULTS: The CIQ-R was administrated to 400 people with no clinical evidence of disease, impairment, or disability, aged between 18 and 64. Cronbach's α reported a value of 0.82 in the home integration subscale. The test also showed a good test-retest reliability, with an Intraclass Correlation Coefficient of 0.78, and a significant correlation between the total score of the CIQ-R and the Physical Component Summary (PCS) of the SF-12 (r = 0.118), between the "social integration" subscale's score and PCS12 (r = 0.121) and between the "Electronic Social Networking integration" subscale's score and PCS12 (r = 0.184), with p < 0.05. CONCLUSION: This is the first study to report the results of the translation and validation of the CIQ-R in Italian. The CIQ-R is an important tool for Italian professionals and can be useful in both clinical practice and research for measuring the level of community integration among the healthy population.

Linking the effect of psoriatic arthritis-related foot involvement to the Leeds Foot Impact Scale using the International Classification for Functioning, Disability and Health: a study to assess content validity.

BACKGROUND: Previous research to describe the impact of foot involvement in psoriatic arthritis has used the Leeds Foot Impact Scale in Rheumatoid Arthritis (LFIS-RA) in the current absence of any psoriatic arthritis foot-specific tools. However, the LFIS-RA is a rheumatoid arthritis disease-specific outcome measure and its content validity for evaluating the experiences of people with psoriatic arthritis-related foot involvement is unknown. The study objective was to determine the content validity of the LFIS-RA for assessing people with psoriatic arthritis, using the International Classification of Functioning, Disability and Health (ICF) as the frame of reference. METHOD: Concepts within each item of the LFIS-RA were linked to the best-matched ICF categories using established linking rules, which enable a systematic and standardised linking process. All concepts were independently linked to the ICF by 2 investigators with different professional backgrounds, which included occupational therapy and podiatry. The list of ICF categories derived from previous research that pertained to the foot in psoriatic arthritis was then compared with the ICF categories linked to the LFIS-RA. The comparison was undertaken in order to determine the extent to which concepts important and relevant to people with psoriatic arthritis-related foot involvement were addressed. RESULTS: Thirty-five distinct ICF categories were linked to the LFIS-RA, which related to body functions (44%), activities and participation (35%), environmental factors (16%) and body structure (5%). In comparison with the ICF categories derived from concepts of the foot in psoriatic arthritis previously defined, the LFIS-RA provided coverage of key constructs including pain, functioning, daily activities, footwear restrictions and psychological impact. Other concepts of importance in psoriatic arthritis such as skin and toenail involvement, self-management and paid employment were not addressed in the LFIS-RA. CONCLUSION: Content validity of the LFIS-RA to determine the impact of foot functional impairments and disability in people with psoriatic arthritis was not supported by the results of this study. Future work should consider the development of a psoriatic arthritis foot-specific patient reported outcome measure, using the LFIS-RA as an important foundation.

The perceived meaning of occupations among children: correlations with children's socio-emotional characteristics and executive functions.

INTRODUCTION: Participation in meaningful occupations within our everyday environments contributes to health and wellbeing. Therefore, it is important to study perceived meaning and its inter-related factors. The perceived meaning of occupations is the emotional and cognitive qualities people attach to their occupations. However, research on the perceived meaning of occupations among children is limited. The meaning of occupations may be related to personal factors concerning the child. Hence, this study aimed to assess the correlations between socio-emotional characteristics and executive functions of typically developing children and their perceived meaning of occupations-value, challenge, and sense of time and autonomy. METHODS: A cross-sectional study comprising 80 children (6-13 years old) and their parents was conducted. The parents completed the Strengths and Difficulties Questionnaire (SDQ) and the Behaviour Rating Inventory of Executive Function. The children completed the Perceived Meaning of Occupation Questionnaire and the Verbal Working Memory test. RESULTS: Children with higher scores on the SDQ-internalised behaviours and lower working memory-perceived their everyday activities as more challenging (r = .300, r = -.244, p < .05, respectively). Children with higher scores on the SDQ-prosocial behaviours-attached higher value to their everyday activities (r = .23, p < .05). However, increases in executive function difficulties were found to decrease the perceived value (r = .24, p < .05) and to alter the perceived sense of time (r = . 27, p < .05). CONCLUSIONS: The meaning children attach to their everyday activities changes when they experience socio-emotional and executive difficulties. Therefore, to inspire positive meaning of occupations among children, practitioners should consider the child's socio-emotional and cognitive strengths and difficulties.

Changes in older adults' impairment, activity, participation and wellbeing as measured by the AusTOMs following participation in a Transition Care Program.

INTRODUCTION: Maintaining a continuum of care is vital to ensure adequate health among older adults, particularly during periods of care transitions, when they are vulnerable and at risk of poor health outcomes. The Transition Care Program in Australia is designed to support older adults following the conclusion of a hospital episode. Using the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT), this study aimed to understand how the Transition Care Program impacts an older adult's occupational performance during care transitions. METHODS: Data were collected as a part of usual occupational therapy care from March 2016 to August 2017 from clients admitted to a Gold Coast Health Transition Care Program. Data from 110 clients were analysed on 5 AusTOMs-OT scales: functional walking and mobility, upper limb use, self care, domestic life-home, and community life/recreation/leisure/play. Change data from these scales were analysed using the Wilcoxon Signed Ranks Test. RESULTS: Clients in the Transition Care Program experienced statistically and clinically significant improvements in all AusTOMs-OT scales analysed as well as in each domain of impairment, activity limitation, participation restriction and distress/wellbeing. CONCLUSION: These results are meaningful for clients, occupational therapists and Australian Transition Care Programs. Clients demonstrated progress towards their goals, indicating maintenance or improvements in their occupational performance, confirming for occupational therapists that the provision of services is promoting goal achievement and leading to improved occupational performance. The study also highlighted the benefits for the use of outcome measures such as the AusTOMs-OT to quantify and validate client change.

Home Environmental Assessment Protocol-Revised Initial Psychometrics: A Pilot Study.

Efficient home assessments are needed for persons with dementia and their caregivers. Pilot studies to establish a content validity index (CVI), measure concurrent criterion validity, and examine test-retest reliability of the Home Environment Assessment Protocol-Revised (HEAP-R). Six experts reviewed the tool and scored content validity items. Twenty-one caregiver/person with dementia dyads engaged with HEAP and HEAP-R to examine concurrent criterion validity. Seventeen occupational therapists viewed 10 videos of home environments to examine reliability. The CVI score was .980. Concurrent criterion validity for domains: hazards (r =.792), adaptations (r = .742), clutter (r = .843), and comfort (r = .958). Test-retest reliability: hazards (r = .820), adaptations (r = .887), visual cues (r = .487), and clutter (r = .696). Pilot data suggest the HEAP-R has preliminary content and concurrent criterion validity and test-retest reliability. Robust psychometric analysis is needed prior to use in clinical practice.

Occupational Therapy Roles in an Indigenous Context: An Integrative Review.

BACKGROUND.: Indigenous peoples experience health inequities linked in part to lack of access to culturally-relevant health care. The Truth and Reconciliation Commission of Canada (TRC) calls on all health professionals, including occupational therapists, to reduce health inequities through improved work with Indigenous communities. PURPOSE.: This integrative review of the literature explores how occupational therapists can improve their work with Indigenous peoples. KEY ISSUES.: Communication and building relationships are central to effective work with Indigenous communities, along with reciprocity regarding knowledge exchange. Issues surrounding service provision are a significant concern, yet improvements are unlikely to be effective unless therapists can critically examine the (mainstream) Western cultural assumptions that infuse the profession and their own practices. IMPLICATIONS.: Though nascent, there are identified directions for occupational therapists to meet the TRC's calls for more competent health care. Researchers should explore best ways for therapists to critically interrogate taken-for-granted professional assumptions mired in Western colonialism.

The Validity of the Danish Version of the Canadian Occupational Performance Measure.

PURPOSE: To establish the construct validity of the Danish version of the Canadian Occupational Performance Measure (COPM). METHODS: A cross-sectional study was performed in two settings, a regional hospital and a rehabilitation centre in a community. Including adult clients with a variety of diagnoses, we assessed construct validity by correlating the COPM to the Occupational Self-Assessment (OSA), the five-item World Health Organization Well-Being Index (WHO-5), and the EuroQol-five domain-five level questionnaire (EQ-5D-5L). Further examination of the comparability of the OSA and the COPM was performed in two ways. First, an interrater agreement of the theoretical correlation of the 21 OSA items and the three areas of the COPM was conducted. Secondly, we examined the compliance between the prioritized occupational performance issues (OPIs) and items of the OSA prioritized for change. RESULTS: The study included a total sample of 112 participants with more than half of the participants (56%) recruited from the hospital. 109 participants had measurements for both COPM and OSA (44% males) with a mean age of 64.7 years (range 16-96 years). All correlations, between the COPM and the OSA, the WHO-5, and the EQ-5D-5L, were low or negligible (r < 0.50). Manual examination confirmed a difference in the constructs of the OSA and the COPM. This was demonstrated by a negligible interrater agreement between the items of the OSA and the areas of the COPM, and differences in the prioritized OPIs and OSA items, even if there were some resemblances, were found. CONCLUSIONS: This study suggests that the construct of the COPM provides data different to those obtained with the standardized measurements included for comparison. The present study supports the assumption that the COPM can detect unique OPIs that clients want to do, need to do, must do, or are not satisfied with the way they do.

Clinical Relevance and Psychometric Properties of the Swedish Version of the Cultural Competence Assessment Instrument.

Based on the increasing diversity of Swedish society, health professionals, like occupational therapists, find it challenging to provide culturally competent services to international clients. Consequently, cultural competence among professionals needs to be measured and improved using psychometrically tested instruments. This study examines the clinical relevance, construct validity, and reliability of the Swedish version of the Cultural Competence Assessment Instrument among Swedish occupational therapists. Material and Methods. A randomised sample of 312 Swedish occupational therapists answered a survey based on the Swedish version of the Cultural Competence Assessment Instrument with supplementary questions on the clinical relevance of the instrument. Descriptive statistics were used to examine the clinical relevance of the Swedish version of the Cultural Competence Assessment Instrument. Factor analyses, both exploratory and confirmatory, were run to examine the factor structure. Cronbach's alpha was performed to assess the internal consistency of the instrument. Results. The participants reported that the 24 items had high clinical relevance. The validation yielded a three-factor model: openness and awareness, workplace support, and interaction skills. All three of these factors showed high loadings. Conclusions. The study results indicated positive clinical relevance and psychometric properties for the Swedish version of the Cultural Competence Assessment Instrument and strong support to be utilised in Sweden. The implications of this study are important given the rapid growth in migration over the last few decades. A self-rating instrument measuring cultural competence could support occupational therapists' professional knowledge and development when they interact with international clients. As the tool was originally developed in English in the United States, the feedback from the Swedish version could potentially be useful for the instrument in modified form and for use by occupational therapists in English-speaking countries.

Occupational Therapy Practice Guidelines for Early Childhood: Birth-5 Years.

IMPORTANCE: This Practice Guideline provides stakeholders with a condensed summary of a large number of effectiveness studies. It is a valuable tool for facilitating decision making related to occupational therapy interventions for children ages birth-5 yr. OBJECTIVE: Early childhood (birth-5 yr) is a critical period in which the foundation of key life occupations is developed (e.g., eating, dressing, play, learning, social participation, rest and sleep, and chores). The development of cognitive, motor, social-emotional, and self-care skills is important to support these occupations. This Practice Guideline synthesizes recent systematic reviews (SRs) on these areas of development to promote decision making for and high-quality interventions with this population. METHOD: Four SRs related to cognition, mental health, motor function, and ADLs analyzed studies published from 2010 to 2017 retrieved from six electronic databases (MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane). RESULTS: A total of 196 articles were included in the SRs, which served as a guide to final clinical recommendations. Case studies describe translation and application to practice. CONCLUSION: and Recommendations: A variety of interventions within the domain of occupational therapy were found to support the development of cognitive, social-emotional, motor, and self-care skills. Although some of these interventions are typically implemented by occupational therapy practitioners, others can be implemented by parents after training or by teams working in preschool settings. These findings should be used to inform evidence-based practice provided by occupational therapy practitioners working in various early childhood settings. WHAT THIS ARTICLE ADDS: This Practice Guideline gives occupational therapy practitioners clear information about which interventions will be effective for specific outcomes. Better intervention choices mean better outcomes for young children and their families.

Occupational therapy return to work interventions for persons with trauma and stress-related mental health conditions: A scoping review.

BACKGROUND: Trauma and stress-related mental health conditions can impact a person's ability to participate in work and can cause disruptions in employment. Best practice guidelines for occupational therapy return to work interventions with these populations are limited. OBJECTIVE: To identify and describe occupational therapy return to work interventions for trauma and stress-related mental health conditions. METHODS: Using a scoping review methodology, research databases were searched for papers relating to occupational therapy, return to work interventions, and trauma and stress-related mental health conditions. Three reviewers independently applied selection criteria and systematically extracted information. Data were extracted and synthesized in a narrative format. RESULTS: The search produced 18 relevant papers. The interventions described were more often person-focused versus environment- and occupation-focused, and many were carried out by multidisciplinary teams, making it difficult to identify best practices for occupational therapists in this area. CONCLUSION: Emerging practices include the Swedish "ReDO" intervention, support for active military members to manage operational stress to remain at work, and multidisciplinary team treatment. Further research, including studies with direct focus on the implications of occupational therapy interventions for return to work with trauma and stress-related mental health conditions, is required.