Development of an Objective Structured Clinical Examination Station for Pediatric Occupational Therapy and an Evaluation of Its Quality.

IMPORTANCE: The Objective Structured Clinical Examination (OSCE) is a highly valued measure of students' clinical competencies in medical education. However, few studies have reported on the administration of the OSCE in pediatric occupational therapy education. OBJECTIVE: To describe the development of a pediatric occupational therapy OSCE station to evaluate students' use of a standardized assessment and examine its standard setting, failure rates, and psychometric properties. DESIGN: Prospective, cross-sectional, observational study design. SETTING: Three OSCE stations in a university clinical skills center. PARTICIPANTS: Five experienced occupational therapists, 60 examinees, 44 child standardized patients, 44 chaperones, and 15 examiners. MEASURES: The sum of the rating scale and the global performance scores were used. The rating scale measured the examinee's clinical competences in administering a standardized assessment. The 5-point global performance score was used to evaluate the examinee's whole performance. RESULTS: The OCSE station's expert validity was acceptable (item-level content validity index [CVI] = 0.8-1.0; scale-level CVI = 0.98). Passing scores according to the Angoff method (passing score = 14) and the contrasting-groups M-SD method (passing score = 13) were similar. Failure rates were high (61.7%-73.3%). Internal consistency was acceptable (Cronbach's α = .78). No significant examiner effect was found (p = .554), and interexaminer reliability was acceptable (item score = 0.58-1.00; sum of the rating scale score = 0.97; global performance score = 0.79). CONCLUSIONS AND RELEVANCE: The OSCE station for using a standardized assessment is a reliable and valid measure of students' interpersonal communication skills and assessment skills. What This Article Adds: The OSCE for education in pediatric occupational therapy is both effective and rigorous.

Customized designs of short thumb orthoses using 3D hand parametric models.

This research achieved its purposes of producing a 3D hand parametric hand model in a functional position, using the 3D hand parametric model as a template to generate an individualized approximate 3D hand model, constructing a 3D printed short thumb orthosis with a seamless structural design and ductile materials based on the individualized approximate 3D hand model, and reporting a case study on the usability. In experiment one, 3D hand parametric models were generated using anthropometric data collected with a scanning device from 120 Taiwanese adults. Experiment two examined the feasibility of constructing 3D-printed orthoses from the 3D hand parametric models through a case report on one client. The 19 values of the parameters measured from the client were imported into the 3D hand parametric models. An individual 3D hand mesh model approximating the client's hand was synthesized. The orthosis was precisely sketched and then printed. In usability testing, scores on the Quebec User Evaluation of Satisfaction with Assistive Technology were mostly high. The orthosis provided greater flexibility of hand movement and stronger support than the traditional, manually-formed orthosis. The results indicated the feasibility of using a hand parametric model to optimize the reverse engineering of a short thumb orthosis.

Test-retest reliability and minimal detectable change of the Contextual Memory Test in older adults with and without mild cognitive impairment.

BACKGROUND: The ability to detect one's own memory capacity and develop strategies based on daily contexts is important for daily activities. The Contextual Memory Test (CMT) assesses self-awareness, self-efficacy, self-perception/evaluation of performance, recall, and strategy use that are associated with daily contexts, and could be a potentially suitable measurement for assessing memory and meta-memory in older adults with and without cognitive impairment. Nevertheless, the test-retest reliability and minimal detectable change (MDC) remain unknown in these individuals. OBJECTIVE: The purpose of this study was to examine test-retest reliability and calculate MDC of the CMT in healthy older adults and those with mild cognitive impairment (MCI). METHODS: Eighty-three participants completed the CMT twice with a one-month interval. Test-retest reliability was examined using intraclass correlation coefficient (ICC) in all seven domains of the CMT and the recognition subtest. The standard error of measurement (SEM) and MDC were calculated. The Bland-Altman analysis was performed to evaluate the degree of agreement between measurements. RESULTS: The ICC of five domains (self-awareness, self-perception/evaluation of performance, immediate/delayed/total recall) and the recognition subtest were good to excellent (ICC = 0.63-0.94) in healthy and MCI participants and the MDC% were less than 30% The ICC of the other two domains (self-efficacy and total strategy use, TSS) were low (ICC = 0.07-0.59) and the MDC% exceeded 30%. The Bland-Altman analysis showed generally better performance in the 2nd than the 1st measurement in most CMT domains. CONCLUSIONS: Our results revealed sufficient test-retest reliability and acceptable MDC in most CMT domains in healthy and MCI participants. Only the self-efficacy and TSS domains demonstrated low ICC and large MDC. Possible practice effects were found between repeated measurements. Clinicians should be cautious when evaluating self-efficacy and strategy use using the CMT in older adults. Further improvements are needed for these two domains.

Investigating the optimal handle diameters and thumb orthoses for individuals with chronic de Quervain's tenosynovitis - a pilot study.

Aims: The aims of this study were to compare the differences in forearm muscle activities between two types of thumb orthoses and the optimal handle diameter when the orthosis is worn during a power grasp for individuals with chronic de Quervain's Tenosynovitis.Methods: A 2 × 3 (Group × orthosis) and a 2 × 2 × 3 (Group × orthosis × diameter) repeated factorial design were used. Grip strength and muscle load were measured. A 2 × 3 mixed repeated measures ANOVA was conducted, and the Least Significant Difference (LSD) test was used for post hoc analysis. Cohen's d was used to calculate the effect size between groups and handle diameters.Results: Grip strength was significantly lower (in long/short/no-orthosis conditions) and muscle load was higher in 12 participants with chronic de Quervain's Tenosynovitis than in 16 healthy participants (p < 0.001). No differences in muscle activities were found when the two different orthoses were worn. The muscle activities were higher during grasping of the 33 mm handle diameter.Conclusion: Individuals with chronic de Quervain's Tenosynovitis require greater muscle loads than healthy controls to produce the same power grasp, and when one of the two orthoses is worn, the optimal handle diameters for performing a power grasp are relatively larger (45 and 55 mm).Implications for RehabilitationBoth the long and short thumb orthoses can be worn by individuals with de Quervain's Tenosynovitis during daily activities because wearing both orthoses requires the same exertion of muscle load.When performing a power grasp, individuals with de Quervain's Tenosynovitis tend to exert greater muscle loads than healthy controls to produce the same power grasp.We suggest that patients with de Quervain's Tenosynovitis use utensils with larger handle diameters, such as 45 mm and 55 mm.

Using children as standardized patients in OSCE in pediatric occupational therapy.

BACKGROUND: Objective structured clinical examinations (OSCEs) have been administered in physical and psychiatric occupational therapy (OT) education, but not in pediatric OT education. The objectives were to examine the satisfaction and the influences of OSCE in pediatric OT on all participants. METHODS: The OSCE contained evaluation, intervention, and parent education stations. Sixty examinees, 44 child standardized patients (SPs), 44 chaperones, three playroom managers, 14 OSCE assistants, and 15 examiners participated in the OSCE. An OSCE video and three playrooms were prepared for child SPs. RESULTS: Ninety percent of the child SPs liked taking part in the OSCE and 75-85% expressed interest in participating in an OSCE the following year. Their parents appreciated the chaperones accompanying their children and giving them a memorable day. 88.3% of the examinees thought that the OSCE was helpful for their upcoming clinical training. 73.3% preferred the OSCE over the written exam. 60-93.4% considered the implementation appropriate. Most of the examiners thought that the content (80-100%) and the implementation (93.3-100%) were appropriate. Many chaperones reported having valuable experiences. CONCLUSIONS: It is practical using child SPs in OSCE in pediatric OT. The OSCE was beneficial to all participants. It is recommended that OSCEs be included in pediatric OT education.

Optimal Grasp Distance and Muscle Loads for People With Rheumatoid Arthritis Using Carpometacarpal and Metacarpophalangeal Immobilization Orthoses.

OBJECTIVES: The objectives of this study were to investigate whether people with rheumatoid arthritis (RA) require greater muscle loads to equal the grip strength of healthy adults and to find the optimal grip distance for people with RA using carpometacarpal and metacarpophalangeal immobilization orthoses as measured by electromyography of the forearm muscles. METHOD: A 2 × 2 (Group × Orthosis) experiment and a 2 × 3 (Orthosis × Grasp Distance) factorial were conducted. Grip strength and muscle load were measured. RESULTS: Grip strength was significantly lower, and muscle load was greater, in 18 participants with RA than in 18 healthy adults. No effect of orthosis use on grip strength and muscle load was found. Muscle load was lower for the 42.25-mm diameter dynamometer handle than for handles with larger diameters. CONCLUSION: People with RA require more muscle load than healthy adults to produce the same exertion, and 42.25 mm is recommended for people with RA as the optimal grasp distance.

Exploration of the associations of touch-screen tablet computer usage and musculoskeletal discomfort.

BACKGROUND: Tablet users may be at high risk of developing physical discomfort because of their usage behaviors and tablet design. OBJECTIVE: Investigate the usage of tablets, variations in head and neck posture associated with different tablet tilt angles, and the association of tablet use with users' musculoskeletal discomfort. METHODS: A survey of users' subjective perceptions conducted by questionnaire and measurements of users' postures by a 3D Motion analysis system was used to explore the effects of tablet use. RESULTS: The questionnaire results indicated that over half of the participants reported physical discomfort after using tablets, with the most prevalent discomfort in the neck and shoulders, and more intensity of discomfort for the back although only few participants experienced it. Chi-squared tests indicated that significantly more participants who tended to use tablet computers to play games reported having musculoskeletal discomfort after using a tablet. In addition, preferences for tablet tilt angles varied across tasks (reading and game playing). The results from the 3D motion analysis revealed that head and neck flexion angles were significantly reduced when the tablets were positioned at relatively steep tilt angles. Neck flexion angle was significantly higher in game playing. CONCLUSIONS: These data add information regarding to the usage of tablet and its associations with physical discomfort (significantly more participants who tended to use tablet computers to play games reported having musculoskeletal discomfort after using a tablet). Steep tilt angles (such as 60°) may cause tablet users to decrease their head and neck flexion angles, which could lead to a more neutral, effortless, and ergonomically correct posture. Maintaining proper neck posture during active activities such as game playing is recommended to avoid neck discomfort.

Influence of background music on work attention in clients with chronic schizophrenia.

BACKGROUND: Work attention in persons with chronic schizophrenia is an important issue in vocational rehabilitation. Some of the research literature indicates that background music may influence visual attention performance. OBJECTIVES: Based on the theory of occupational therapy, environmental sounds, colors and decorations may affect individual performance, this study thus examined the influence of music on work attention in persons with schizophrenia. PARTICIPANTS: Participants were recruited from a halfway house in Taipei. Forty-nine (49) patients with chronic schizophrenia volunteered. They had been accepted into vocational rehabilitation and a work-seeking program. The sample included 20 females and 29 males. The participant ages ranged between 29 and 63 years old, and their average age was 47 years old. METHODS: Using a randomized controlled trial (RCT) study, the participants were assigned to one of three conditions: quiet environment as the control group (n= 16), classical light music as background music (n= 16), and popular music as background music (n= 17). RESULTS: For Group 1 (control group/quiet environment), there was no significant variance (sig = 0.172). For Group 2 (Classical light music), the intervention revealed significant variance (sig = 0.071*). For Group 3 (popular music), the intervention had significant variance (sig = 0.048**). CONCLUSIONS: The introduction of background music tended to increase attention test scores of persons with schizophrenia. Moreover, the increase in test attention scores was statistically significant when popular music was played in the background. This result suggested that background music may improve attention performance of persons with chronic schizophrenia. Future research is required with a larger sample size to support the study results.

The compensatory motion of wrist immobilization on thumb and index finger performance--kinematic analysis and clinical implications.

BACKGROUND: Based on the high prevalence of people with problems in the wrist and hand simultaneously, it is of its importance to clarify whether hand joints exert extra motion to compensate for wrist motion while immobilized. OBJECTIVE: This study aimed to measure the compensatory movement of the thumb and index finger when people perform daily activities with an immobilized wrist. METHODS: Thirty healthy volunteers were recruited in this study. A wrist splint, the Jebsen-Taylor Hand Function Test, and the OptoTrak Certus motion tracking system were used. Seven inter-digit mean joint angles of the index finger and thumb were calculated. Paired sample t-test was used. RESULTS: (1) The compensatory motions were noted in the Metacarpophalangeal and Carpometacarpal joints of the thumb, and the proximal interphalangeal joints of the index finger; (2) The manifestation of compensatory motion was related to type of activity performed except when picking up light and heavy cans. CONCLUSIONS: The compensatory motions appeared while the wrist was immobilized and were found to be disadvantageous to the progression of disease. In the future, studies need to be done to understand how to select products with correct ergonomic design to enable people to reap greater benefits from wearing wrist splints.

Ergonomic design of a computer mouse for clients with wrist splints.

OBJECTIVE: We explored effects of cutaneous feedback and hump position on efficiency and comfort in mouse use with a splint. We also analyzed the relationship between anthropometric measurements (width of hand and length of hand, palm, and index) and the task performance. METHOD: Thirty participants performed a computer task with two forms of mice (front hump and rear hump) and two kinds of wrist splints (dorsal and volar). Movement time and satisfaction scores were recorded. RESULTS: No interaction effect (Hump Position × Splint Type) was found on movement time. Movement time was shorter for rear-hump mouse users than for front-hump mouse users. Movement time was also shorter for wearers of dorsal wrist splints than for wearers of volar wrist splints. Limited differences existed in the satisfaction scores. Participants with a longer index finger had shorter movement time. CONCLUSION: Both dorsal wrist splints and rear-hump mice are recommended. Length of index finger positively correlated with task performance.

Surveying the comfort perception of the ergonomic design of bluetooth earphones.

BACKGROUND: Bluetooth earphones can facilitate communications among workers engaged in manual (e.g., professional driver)or visual tasks (e.g., security guard). If workers remove their Bluetooth earphones due to poor fit, then communication effectiveness will decline, especially during manual or visual tasks. OBJECTIVES: (1) To identify which design properties of Bluetooth earphones can contribute to user comfort, and (2) to identify if person characteristics (i.e., gender and ear shapes in this study) are related to differences in comfort perception during earphone use. METHODS: 198 participants were recruited for this study.Individuals used four models of Bluetooth earphones in randomized order while performing computer tasks and then completed questionnaires on comfort perception specifically designed for this study. The 2 × 3 × 4 mixed design analysis of variance (ANOVA) was conducted to investigate the effects of gender, ear shape, and model condition. RESULTS: The results indicated that there were significant differences in model on comfort perception. CONCLUSIONS: For earplugs, the shape of the earphone and the elasticity of material are important ergonomic concerns to improve the comfort perception. In addition, the adjustable tail length is an important ergonomic design property for the ear-hook. The information gained in this study should be useful in improving the ergonomic fitness of Bluetooth earphones.

Effect of assistive reading software on high school students with learning disabilities: a pilot study.

OBJECTIVE: This research project was designed to test the immediate effect of using assistive reading software - Kurzweil 3000 (K-3000) for high school students with learning disabilities (LD) to improve their English reading and other school performances. PARTICIPANTS: 29 Taiwanese high school students with LD were randomly assigned to one of two groups: (1) use of the K-3000 or (2) control group (using a pen and paper). METHODS: Both groups were asked to complete the standardized measurements using pen and paper a pre-test. Students in experiment group used the K-3000 to do the post-test after they were familiarized with the K-3000, while the students in the control group used pen and paper for the post-test. The differences between the pre-test and post-test of two groups were analyzed. RESULTS: The results suggested that the K-3000 had an immediate impact on students' English word recognition and pronunciation. However, the use of K-3000 did not have a significant influence on the students' general English proficiency, learning adjustment, and academic self-perception. CONCLUSIONS: The use of K-3000 had a positive effect on students' English word recognition. The reason why there was no significant change in students' other performances could be due to the length of the intervention.

Evaluation of the benefits of assistive reading software: perceptions of high school students with learning disabilities.

Using assistive reading software may be a cost-effective way to increase the opportunity for independent learning in students with learning disabilities. However, the effectiveness and perception of assistive reading software has seldom been explored in English-as-a-second language students with learning disabilities. This research was designed to explore the perception and effect of using assistive reading software in high school students with dyslexia (one subtype of learning disability) to improve their English reading and other school performance. The Kurzweil 3000 software was used as the intervention tool in this study. Fifteen students with learning disabilities were recruited, and instruction in the usage of the Kurzweil 3000 was given. Then after 2 weeks, when they were familiarized with the use of Kurzweil 3000, interviews were used to determine the perception and potential benefit of using the software. The results suggested that the Kurzweil 3000 had an immediate impact on students' English word recognition. The students reported that the software made reading, writing, spelling, and pronouncing easier. They also comprehended more during their English class. Further study is needed to determine under which conditions certain hardware/software might be helpful for individuals with special learning needs.

Essential needs and requirements of mobile phones for the deaf.

Despite their necessity for deaf people in daily life, mobile phones still lack features and functions required by those individuals. While assessing the daily needs of deaf mobile phone users is an important issue for closing this gap, this issue has seldom been addressed. Therefore, we adopted a qualitative research method to extract and construct needs from deaf mobile phone users and translate them into user requirements for mobile phone development. Semistructured interviews and task observations were performed to obtain information from 12 deaf mobile phone users. Context coding was used to code the collected data into needs. The coded needs were then sorted into six categories (social, communication, consumption, entertainment, transportation, and safety) and translated subjectively into three requirements (specific feature-function, general feature-function, and common). The requirements were compared with the functions of the mobile phones of the participants, and five feature-function gaps were identified.

Optimizing the usability of mobile phones for individuals who are deaf.

Mobile phones are employed as an assistive platform to improve the living quality of individuals who are deaf. However, deaf individuals experience difficulties using existing functions on mobile phones. This study identifies the functions that are inadequate and insufficient for deaf individuals using existing mobile phones. Analytical results were referenced by designers to optimize mobile phone functions for the deaf community. A simulated mobile phone interface, the PeacePHONE, was designed to evaluate functions. Functions were developed based on the conceptual design of a multifunction mobile phone. This conceptual design was based on the daily life requirements of individuals who are deaf. PeacePHONE usability was tested by 18 deaf individuals. Five factors were assessed: user experience profile, user perceived usability, functions on existing mobile phones that should be retained, new functions that should be added to existing mobile phones, and functions that are most useful to individuals who are deaf. Positive and negative feedback on the PeacePHONE is presented as well.