Differences in social participation between individuals who do and do not attend brain injury drop-in centres: a preliminary study.

OBJECTIVE: To compare social participation for individuals with traumatic brain injury (TBI) ≥1 year post-injury who attend brain injury drop-in centres (BIDCs) with individuals who do not attend but were identified as potentially benefitting from attending. RESEARCH DESIGN: Cross-sectional study with 23 individuals attending BIDCs and a comparison group of 19 individuals not attending. KEY OUTCOME MEASURES: Community Integration Questionnaire, Social Provisions Scale and Adult Subjective Assessment of Participation. MAIN RESULTS: The comparison group was found to consist of 12 participants who stated that they would attend a BIDC ('Yes sub-group') and seven participants who stated that maybe they would attend a BIDC but for the most part were too busy ('Maybe sub-group'). The BIDC group was found to have statistically significantly higher levels of social participation than the comparison group and particularly the 'Yes sub-group'. CONCLUSIONS: Findings provide support that attendance at BIDCs may benefit social participation. Future directions for research are suggested.

Perceived environmental restrictions for the participation of children with mild developmental disabilities.

AIM: In light of the International Classification of Functioning, and Health (ICF) model, to assess whether parents of children with mild developmental disabilities perceived various environmental factors as barriers to their child's participation, and whether these factors have a unique contribution to the total explained variance of participation, beyond personal factors. METHODS: Seventy-nine kindergarten children (mean age 5.20 ± 0.52 years old) with mild developmental disabilities and their parents participated in the study. Three questionnaires measuring the child's participation, performance skills and environmental factors were completed by the parents. RESULTS: Parents perceived environmental factors as slightly restricting to their child's participation. Associations were found between home and education factors and the dimensions of child participation - independence, enjoyment and parental satisfaction. Although parents perceived human environmental factors as more restricting than physical factors at home, regression analysis revealed that the latter was found to affect the child participation dimension of independence beyond the contribution of personal factors. INTERPRETATION: These findings are the first, to our knowledge, to support the contribution of environmental factors to the participation of young children with mild developmental disabilities. The results show that environmental factors have significant slight contribution to child's independence in participation beyond other predictors (i.e. personal factors). Therefore, it is recommended to include environmental restrictions measurement in the child evaluation process to facilitate effective intervention programs.

Personal and environmental pathways to participation in young children with and without mild motor disabilities.

OBJECTIVE: Participation in everyday activities has a positive influence upon health and well-being and is considered as an outcome measure. According to recent models child participation is the product of the dynamic interaction between health states and both individual and environmental factors. Children with mild developmental disabilities often present decreased participation in everyday activities. The purpose of this study was to explore the extent to which individual and environmental factors explain the participation of young children, with and without mild motor disabilities. METHODS: The study population included 58 kindergarten children together with their parents (29 children with mild motor disabilities who were referred to occupational therapy and 29 children without motor disabilities). Both groups of children were matched for: age; gender; age of parents; and socio-economic status (SES). We assessed participation using the Child Participation Questionnaire (intensity, diversity, independence, child enjoyment and parental satisfaction) and we assessed children's self-efficacy and motor abilities for individual factors. Parental self-efficacy and SES were collected by questionnaires. RESULTS: Participation diversity (number of activities) was predicted by child and mother self-efficacy and by SES. Child independence and enjoyment as well as parental satisfaction were predicted by child motor ability but mainly by maternal self-efficacy. Results suggest that the total explained variance is more than double when the environmental variables (parental self-efficacy and SES) are inserted to the participation model. CONCLUSIONS: Maternal self-efficacy and SES serve as facilitators to increased participation and well-being of children with mild motor disabilities.

Can personal and environmental factors explain dimensions of child participation?

OBJECTIVE: One of the main goals of paediatric occupational therapists and other health professionals is to enhance child participation in age-related activities within their communities. According to theoretical models, the act of participation has numerous dimensions, affected by personal and environmental factors. However, there have been relatively few studies undertaken to validate this theory. The purpose of this study was to explore the extent to which personal and environmental factors explain each of five distinct dimensions of child participation, which are: diversity, intensity, independence, enjoyment and subsequent parental satisfaction. METHOD: A convenient sample of 70 kindergarten children without developmental disabilities together with their parents participated in the study. Data were collected using standardized assessments for personal factors and questionnaires for environmental factors. RESULTS: The findings confirmed our hypothesis and revealed that with typical children, motor and cognitive abilities affect participation diversity. Moreover, performance skills and self-perceptions of competence affect their independence levels, while environmental factors contribute to frequency of participation and parental satisfaction. However, these factors on their own do not fully explain the degree of enjoyment experienced by children. CONCLUSIONS: The findings highlight the importance of measuring the full range of participation dimensions, and provide empirical evidence about the nature of child participation. Further studies are warranted to validate this approach for children with developmental difficulties.

Locus of control and the spontaneous use of mnemonic strategies in a motor memory task.

A test was developed which enabled isolating the effects of locus of control over specific parts of the learning process, while studying its effect on the spontaneous use of mnemonic strategies. Fifty-six adults with mild or moderate mental retardation were randomly assigned to four groups that differed by both internal versus external control, and empty versus filled interval. Recall after an empty interval was significantly better than that following a filled one, suggesting the spontaneous use of mnemonic strategies. No effect was found for the locus of control variable. A longer "warm up decrement" in this population is suggested.

Motor learning and occupational therapy: the organization of practice.

This article addresses implications for the practice of occupational therapy when that therapy is guided by theories of motor learning. In occupational therapy, clients must learn or relearn motor skills through the use of activities. The occupational therapist must present activities in a manner that elicits the retention and transfer of the desired skills for use in functional settings. Therefore, the therapist should strive for acquisition conditions that facilitate retention and transfer of the learned skills. The processes that underlie motor learning should guide therapy. Three major factors that affect motor learning are environmental conditions, cognitive processes, and movement organization. Examination of the clinical implications of these factors, however, results in contradictory predictions regarding optimal practice conditions for motor skills. This article explores the successful integration of these factors and its application in occupational therapy practice. It is suggested that increasing the difficulty of the learning context during practice is beneficial for retention.

Hand function evaluation: a factor analysis study.

The purpose of this study was to investigate hand function evaluations. Factor analysis with varimax rotation was used to assess the fundamental characteristics of the items included in the Jebsen Hand Function Test and the Smith Hand Function Evaluation. The study sample consisted of 144 subjects without disabilities and 22 subjects with Colles fracture. Results suggest a four factor solution: Factor I--pinch movement; Factor II--grasp; Factor III--target accuracy; and Factor IV--activities of daily living. These categories differentiated the subjects without Colles fracture from the subjects with Colles fracture. A hand function evaluation consisting of these four factors would be useful. Such an evaluation that can be used for current clinical purposes is provided.

Construct-related validity of the Toglia Category Assessment and the Deductive Reasoning test with children who are typically developing.

OBJECTIVE: Both classification and deductive reasoning are essential cognitive components underlying any learning process and, therefore, are important to assess in children with developmental or learning disabilities. The aim of this study was to establish construct-related validity of the Toglia Category Assessment (TCA) and the Deductive Reasoning test, which were originally developed to evaluate adults with brain injury. This study represents the first step in validating and adapting the two tests for children who are typically developing. METHOD: The study population consisted of 235 children without disabilities in 6 different age groups (from 5-11 years of age). Both the TCA and the Deductive Reasoning test were administered to all participants. RESULTS: The results of the study indicate significant differences in the average performance of children in several age groups on both the TCA and the Deductive Reasoning test, but they do not show differences among all the groups. Children could not predict their ability in either test, but most were able to estimate their ability after actual performance of the TCA. A significant correlation was found only for the 5-year-olds and 7-year-olds between the Deductive Reasoning test final score and the children's estimation of their performance. CONCLUSION: The findings of this study support the suitability of the TCA and the Deductive Reasoning test for use with children who are typically developing. We recommend that both tools be studied further to amplify their validity.

From hand twister to mind twister: computer-aided treatment in traumatic wrist fracture.

OBJECTIVE: The use of computers as a treatment modality in the occupational therapy hand clinic is, as yet, not common practice. A computer interface for wrist movements was developed, and a study to justify the application of such a device is presented. METHOD: Forty-seven patients in a day hand clinic who had traumatic fracture of one hand with limitation of wrist mobility participated in the study. Participants were divided into two treatment groups: computer-aided treatment (high technology) and traditional brush machine treatment (low technology). A device was developed based on the brush machine in which the brush machine's mechanism was converted into a medial-lateral joystick. Right-to-left movements were digitally transformed for the use of a computer game. Participants were treated for 5 weeks, and outcome measures included range of motion (ROM), grip strength, edema, and level of interest. RESULTS: Results showed significant improvement in ROM, grip strength, and edema across 5 weeks for all participants. Although no significant differences were found between the two groups in ROM, grip strength, and edema, the computer-aided group showed significantly more interest in treatment than did the brush machine group. Finally, the interaction between treatment group and the attitude toward computers was not significant. CONCLUSIONS: These results indicate the potential for more interesting motor treatment and rehabilitation of the wrist through the use of computer games. The efficacy of using computers in occupational therapy clinics needs further investigation.

Effects of contextual interference and age on acquisition, retention, and transfer of motor skill.

This experiment was designed to investigate the varying conditions of contextual interference within three age groups. 40 5-yr.-olds, 40 7-yr.-olds, and 40 11-yr.-olds practiced the task of throwing beanbags under either low contextual interference (blocked practice), high contextual interference (random practice), or medium contextual interference (combined practice). All subjects performed 30 acquisition trials, 12 retention trials and 6 transfer trials. Analysis indicated that only the 7-yr.-old subjects differed in their performance in the various practice groups. As hypothesized and suggested by developmental theories, the combined and blocked practice groups acquired the task better. On the other hand, the 5- and 11-yr.-olds did not differ in performance in the different practice groups. Whether this is associated with difficulty of the task or the length of practice can be assessed in further study. Contextual interference in different age groups needs further investigation.

Effects of contextual interference and conditions of movement task on acquisition, retention, and transfer of motor skills by women.

This experiment was designed to investigate varying conditions of contextual interference within two different conditions of movement tasks during acquisition on the acquisition and retention of a computerized task and transfer to a functional skill. Performance of head movements was conducted under open- or closed-task conditions and with random or blocked schedules of practice. Analysis indicated that learning under the open-task condition resulted in better retention and transfer than the closed-task condition. It is suggested that increasing the within-trial variability in the open-task condition produced a contextual interference effect. In this regard, support for Battig's predictions is provided by the current findings in that the high variability present during the open-task condition was more beneficial for retention and transfer than the low variability present during the closed-task condition. Differences between random and blocked schedules of practice on the retention and transfer data were not statistically significant.

Reported level of pain of upper extremities related to multi-factorial workloads among office workers during and after work hours.

OBJECTIVES: This research compared the level of reported pain between women workers with high workload (main work involved typing) and women workers with low workload (various office work where typing was not the main task). The research examined the relationship between reported pain of upper extremities (UE) and the following variables: physical strain exerted during typing on a computer keyboard, extra-work strain on UE, bio-demographic variables, psychosocial variables, and ergonomic variables. STUDY DESIGN: Participants were 60 women who worked in offices, divided into two groups. The index group included women whose main work involved typing (high workload: M=6.16 h of typing per day), and the control group did various office work where typing was not the main task (low workload: M=3.23 h of typing per day). The level of pain, physical strain, and data concerning bio-demographic variables, psychosocial variables and ergonomic variables was assessed by a self-reported questionnaire. RESULTS: The results suggested that there was a significant difference between workers with high and low typing workloads. Workers with higher typing load reported higher levels of pain. There was a significant positive correlation between level of reports of pain and levels of physical overload at work, and extra-work strain on UE both among workers with high and low workloads. It was also found that levels of pain correlated significantly with bio-demographic variables (age and number of children) and psychosocial variables (managerial responsibilities) among low workload workers only. CONCLUSIONS: The research on pain of UE indicates that pain may be affected by a multi-factorial nature of a work-related environment which includes physical strain exerted during typing on a computer keyboard, extra-work strain on UE, bio-demographic variables and psychosocial variables.

Effects of cognitive processes and task complexity on acquisition, retention, and transfer of motor skills.

This experiment was designed to investigate the effect of cognitive problem-solving operations (termed contextual interference) and complexity of tasks on the acquisition retention and transfer of motor skills. Ninety-six children, ages 7.5-9.5 practiced the task of throwing beanbags under either low contextual interference (blocked practice), high contextual interference (random practice) or medium contextual interference (combined practice). Half of the participants acquired a complex task and the other half a simple task. All participants performed 30 acquisition trials, 9 retention trials and 4 transfer trials. Results indicated that participants who practiced in the blocked practice group did not differ in their performance whether they acquired complex or simple tasks. On the other hand, participants from the random and combined practice groups who acquired simple tasks performed better than those who acquired complex tasks. These findings support the hypothesis that there is a limit to the interference during practice that will benefit retention and transfer, thus creating the contextual interference effect. It seems that the complex-task condition combined with random or combined practice schedule increased the difficulty of acquisition, possibly impeding the cognitive processing during acquisition, thus impairing the learning process.

The validity and reliability of the modified version of the Role Checklist (M-RCL).

BACKGROUND: The Role Checklist assesses the number of roles a person performs, and the values ascribed to those roles. In this study, a modified version of the Role Checklist was created, which also measures role load. OBJECTIVE: The purpose of this study is to examine the discriminant validity and test-retest reliability of the modified version. METHOD: 30 healthy women were divided into two groups: Mothers and women with no children. The original Role Checklist (RCL) and the modified version (M-RCL) were administered and compared. The modified questionnaire was administered again after two weeks. RESULTS: Test-retest reliability was found for all but two roles, and ranged between 0.268-0.709; 0.248-0.629; and 0.336-0.648 for the past, present, and future respectively. VALIDITY: The modified version and the original version showed strong correlation. Pearson correlations were high for the past (r = 0.923, p = 0.001), present (r = 0.1, p = 0.001), and future (r = 0.841, p = 0.001). In addition, significant statistical differences between mothers and non-mothers were found. CONCLUSION: The modified version of the RCL exhibits initial reliability and validity. Occupational therapists can use the M-RCL to learn about the individual's occupational roles and role load.

Sony PlayStation EyeToy elicits higher levels of movement than the Nintendo Wii: implications for stroke rehabilitation.

BACKGROUND: Virtual reality (VR) is an emerging trend in stroke rehabilitation. VR gaming consoles in stroke intervention have been shown to increase motivation and enjoyment during exercise. The amount and intensity of movements elicited using these consoles are unknown. AIMS: The aims of this study were: (1) to quantify the amount and intensity of movement elicited from both hands of two groups of individuals ([chronic stroke and without a disability [healthy]); (2) to determine the effect of console (Wii/EyeToy) and group (stroke/healthy) on the amount and intensity of upper extremity movement; (3) to determine the effect of console (Wii/EyeToy) and group (stroke/healthy) on the usability and VR experience. DESIGN: A cross-sectional design was taken. SETTING: Outpatient rehabilitation setting and healthy participant's homes. POPULATION: Participants included ten adults with stroke and ten adults without a disability. METHODS: Participants experienced two games from each console. Amount and intensity of movement was measured using accelerometers on both wrists, while the virtual experience and usability was determined with questionnaires. RESULTS: No significant differences were found between the consoles usability and experience. EyeToy elicited significantly greater activity count than Wii among the healthy participants (P=0.028) and significantly greater movement intensity in both the stroke (P=0.005) and healthy (P=0.005) groups. CONCLUSION: Both consoles rated high for usability, enjoyment and satisfaction highlighting their suitability for a range of individuals in stroke rehabilitation. EyeToy provides increased movement and movement intensity. CLINICAL REHABILITATION IMPACT: Both consoles are suitable for use in stroke rehabilitation however this information can be helpful to clinicians while selecting a gaming console according to the type and intensity of movements that he/she aims to encourage during therapy.

How do young children with DCD participate and enjoy daily activities?

Developmental problems may decrease participation of children. The objective of this study was to evaluate multidimensional aspects of participation amongst preschool children with and without DCD. Participants included 63 children with mean age of 4.96 years (SD=0.62; range=4.02-6.35 years). Twenty one children were diagnosed with DCD, 21 children without DCD who were referred to OT due to mild developmental problems, and 21 children from mainstream public kindergartens whom did not require any developmental intervention. All three groups were matched for age, gender, and socioeconomic status. Children were administered the M-ABC2 and their parents completed the PSQ questionnaire. Results indicate significant differences in level of independence and subjective measures of participation (enjoyment and parents' satisfaction) between the DCD group and the two other groups. The results indicate that from a young age, and in comparison to their peers, the participation of children with DCD is compromised. The integration of the DSM diagnostic criteria and the ICF perception of health enables us to capture the full scope of DCD and its complexity.

Participation and Well-Being Among Older Adults Living with Chronic Conditions.

This study explored the unique contribution of participation (daily activities and social roles) in explaining well-being of older adults living with chronic conditions and examined which aspect of participation (accomplishment of participation or satisfaction with participation) was more important in describing their well-being. Two hundred older adults with chronic conditions completed the following assessments: Satisfaction with Life Scale to measure well-being; Assessment of Life Habits to evaluate two aspects of participation: (a) accomplishment of daily activities and social roles and (b) level of satisfaction with participation; Interpersonal Support Evaluation List to assess level of social support and Affect Balance scale to measure level of balance confidence. In addition, participants' level of mobility was assessed using the Timed Up and Go test. Regression analysis was performed. Results indicated that number of chronic conditions, social support and satisfaction with participation had a significant contribution to well-being and altogether explained 31% of its variance whereas accomplishment of participation did not play as significant role in the model. In conclusion, participation has a unique contribution to older adults' well-being where satisfaction with participation rather than the accomplishment of activities is of importance. Additional aspects of participation and level of disability are key factors identified for further inquiry.

Development and validation of the Documentation of Occupational Therapy Session during Intervention (D.O.T.S.I.).

OBJECTIVE: To developed and validate a form for Documentation of Occupational Therapy Session during Intervention (D.O.T.S.I) based on the OTPF. This form may fill the need for more consistent and detailed documentation of the intervention process. METHOD: Fifty five pediatric OT's documented 2-3 treatment sessions. A total of 120 treatment sessions were recorded. Construct validity was assessed through known-groups differences, once based on age groups and once based on context groups. RESULTS: Significant inter-rater reliability in most sub-categories was found with a good Cronbach alpha coefficient. Construct validity was established by significant differences between the two settings (educational and clinic) and the two age groups. CONCLUSION: The D.O.T.S.I. form as a reliable and valid measure enables to simply document intervention in a unified and professional method. The documentation method of the D.O.T.S.I. stimulates clinical reasoning by allowing the therapist to reflect on the process of intervention and plan future progress.

Effects of prone and supine positions on sleep state and stress responses in preterm infants.

AIM: The purpose of the study is to assess the influence of prone or supine position on sleep states and on withdrawal and approach reactions of preterm infants. METHODS: Thirty-two preterm infants from Meir Medical Center, Israel, mean post menstrual age 30.37±2.57, mean birth weight 1250g±313.86, participated in the study. Infants were studied during 48h. Positions (prone and supine) were alternated every 3-4h after feedings. Sleep states were assessed by Actigraph measurement and by two daily 30-min Naturalistic Observations of Newborn Behavior (NONB) to confirm sleep states and for recording the behavioral reactions (approach and withdrawal). RESULTS: In the prone position there were more approach reactions as compared to withdrawal reactions (p<.001) while in the supine position, the approach and withdrawal reactions were comparable. In the prone position more sleep patterns (deep sleep, light sleep, drowsy) were observed as opposed to more awake patterns (quiet awake, active awake and agitated fussy) that were seen in the supine position. CONCLUSIONS: Clinical implications encourage placing the preterm infant in the prone position while in the NICU. This enables important achievements such as longer periods of quality sleep, and production of adaptive self-regulatory reactions.