Importance: The recovery model in mental health involves person-driven care and informed decision making to enhance engagement in meaningful activities and inclusion in society. To facilitate the recovery process, occupational therapy practitioners must support their clients in understanding how their participation in meaningful occupation is intimately related to their health and well-being. Objective: To explore whether engaging in an occupational reflection intervention on an inpatient psychiatric unit can support the recovery of adults living with serious mental illness (SMI). Design: Using a phenomenological design, we conducted semistructured interviews to assess whether participation in an occupational reflection intervention supported recovery. Setting: An inpatient psychiatric unit at a university medical center. Participants: We recruited 10 adults living with SMI using purposive sampling. Intervention: Participants engaged in a structured occupational reflection intervention using the Occupational Experience Profile (OEP). The OEP is a time-use diary that captures respondents’ subjective experiences of pleasure, productivity, restoration, and connection in relation to their participation in occupations over 24 hr. Study participants engaged in collaborative analyses regarding their OEP results to explore their subjective experiences in relation to their occupational participation. Outcomes and Measures: Participant self-report during interviews. Results: Engaging in structured reflection affected participants’ experiences of recovery by promoting insight into and awareness of how occupations affect mental health, encouraging positive reframing of occupational experience, and facilitating identification of strategies to support recovery and meaningful participation after discharge. Conclusions and Relevance: Occupational reflection can promote the recovery of adults living with SMI. What This Article Adds: A structured occupational reflection intervention can help adults living with SMI in inpatient psychiatric units to understand the close relationship between their participation in occupations and their health. This process provides valuable insight to clients regarding how to support their recovery through engagement in meaningful occupation.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Hospital discharge readiness is an important yet often elusive matter for pediatric patients, families, and health care providers. Caregiver readiness for discharge should be assessed both at admission and before discharge to allow for timely education and training. The Pediatric Readiness for Hospital Discharge Scale is recommended for use by OTs in an acute rehabilitation setting because they harness the unique ability to address both physical and psychosocial aspects of the child and family encompassed by the measure. Primary Author and Speaker: Lori B. Ragni Additional Authors and Speakers: Camille Velasco, Teresa Fitzsimons, and Katie Shniderman

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The study objective was to examine the implementation barriers and facilitators after a year of training and use of a task-specific training manual in inpatient rehabilitation. The Consolidated Framework for Implementation Research provided structure for the survey of OTs. Stakeholders reported confidence in evidence incorporation, and the barriers related to ease of selection and use of this intervention need to be addressed. Primary Author and Speaker: Eron Bozec Additional Authors and Speakers: Namrata Grampurohit Contributing Authors: Namrata Grampurohit, Jaime Gorska

Date Presented 04/22/21 This study was a retrospective cohort design that used data from the U.S. Uniform Data System for Medical Rehabilitation. We examined the improvement of swallowing status between patients with primary dysphagia diagnosis and those with poststroke dysphagia upon discharge from inpatient rehabilitation facilities. A main finding includes that patients with a primary dysphagia diagnosis demonstrated substantially worse swallowing status compared to those with poststroke dysphagia. Primary Author and Speaker: Kimberly Hreha Additional Authors and Speakers: Bailee Cloutier, Zana A. McNeil, Erin Pyles, and Breanna Trueblood Contributing Authors: Sharon Cosper

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Cancer-related cognitive decline (CRCD) is not well understood in the oncology population, and evaluation for cognitive dysfunction while inpatient is not routine. The aims of this project are to (1) identify the prevalence of CRCD in an inpatient hospital, utilizing the Trail Making Test Part B, and (2) identify differences between individuals experiencing CRCD and those scoring within normal limits. Primary Author and Speaker: Erika Dobson Additional Authors and Speakers: Malarie Chant

Date Presented 04/22/21 The Occupational Adaptation Practice Guide (OAPG) is an instrument used to operationalize the theory of occupational adaptation and promote client-centered care. This study assessed the usability and reliability of the OAPG in an inpatient rehabilitation setting. The results indicate a high percentage of agreement for the person and environment sections of the instrument. All respondents agreed that the OAPG promotes client-centered care, but results regarding its efficiency were mixed . Primary Author and Speaker: Jackie Green Additional Authors and Speakers: Ashley Marks, Jamison Hogan, Brett Campbell, and Dustin Cox

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The Menu Task Assessment is a brief, reliable, and valid functional cognitive assessment designed for use by OTs in both the acute- and the postacute-care environment. This poster describes the feasibility of its use in an inpatient heart failure population, as well as the prevalence of cognitive dysfunction and association between Menu Task Assessment score and discharge disposition. Primary Author and Speaker: Malachy James Clancy Additional Authors and Speakers: Megan Drollinger

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This systematic review examined interventions for anxiety and depressive symptoms among inpatient physical rehabilitation patients. Results were framed by intervention type, context, and concentration of current literature among patient groups. Setting specific analyses does not seem to be common, because patient groups are often considered regardless of therapeutic setting and therefore regardless of recovery stage. Setting-specific information can aid resource development and literature navigation. Primary Author and Speaker: Janell Pisegna Additional Authors and Speakers: Sarah E. Anderson Contributing Authors: Jessica L. Krok-Schoen

This case report describes the distinct value of occupational therapy services in the treatment of a pediatric patient with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children in an acute care setting. Practice-based evidence was used to design the treatment plan for this patient throughout the course of his hospital stay. Interventions addressed range of motion, strength, functional endurance, activities of daily living (ADLs), instrumental activities of daily living (IADLs), and functional cognition. Occupational therapy goals focused on the progression toward return to baseline functioning and participation in ADLs and IADLs.

Importance: Assessments that evaluate health care providers’ communication in acute rehabilitation settings remain scarce; this article contributes to the knowledge base. Objective: To assess the reliability and validity of the Clinical Assessment of Modes–Therapist version (CAM–T) from the provider’s perspective. Design: Cross-sectional, psychometric study. Setting: Acute care and acute inpatient rehabilitation. Participants: Ninety-six clients and 32 providers (occupational therapy, physical therapy, and nursing). Measures: The CAM–T was psychometrically evaluated using classical test theory and Rasch analytic approaches. Results: The findings offer strong evidence for the CAM–T’s reliability and validity for evaluating overall communication and adequate evidence for evaluating individual communication modes. Conclusion and Relevance: The CAM–T may be used by providers as a self-assessment of communication in occupational therapy and in associated rehabilitation professions. What This Article Adds: This article offers evidence in support of the CAM–T’s reliability and validity for evaluating health care providers’ communication with clients in acute rehabilitation settings. The CAM–T may be used to evaluate providers’ overall communication and individual mode use as described in the Intentional Relationship Model.

OBJECTIVE. This pilot study is the first to examine the effects of an occupational therapist–led African drumming group on mental well-being among adult psychiatric inpatients with mood disorders. METHOD. We used a quasi-experimental, uncontrolled, one-group, pretest–posttest design. We collected data for six different drumming groups (N = 13) using the Stellenbosch Mood Scale, the Primary Health Questionnaire–9, the Generalized Anxiety Disorder–7 scale, and the Enjoyment of Interaction Scale. RESULTS. Participants significantly improved on all six domains of the Stellenbosch Mood Scale, with a large clinical effect. Participants with higher self-reported anxiety and depression benefited the most. According to the Enjoyment of Interaction Scale results, all the participants enjoyed the drumming “a great deal.” CONCLUSION. Our positive findings suggest that drumming may be an effective intervention for adults with acute mood disorders. We recommend further research that uses a control intervention.

OBJECTIVE. Poor self-awareness co-occurs with cognitive impairments after stroke and may influence independence in daily activities. Strategy training promotes independence after stroke, but poor awareness may attenuate treatment response. We examined the degree to which awareness status affected changes in independence attributed to strategy training. METHOD. We conducted a secondary analysis of 30 participants with cognitive impairments after acute stroke randomized to strategy training or attention control in addition to typical inpatient rehabilitation. We measured awareness with the Self-Awareness of Deficits Interview and independence with the FIM™. Data were analyzed using general linear models. RESULTS. Poor awareness attenuated improvements in independence over time, F(3, 55) = 3.04, p = .038. Strategy training promoted greater improvements in independence over time relative to attention control, F(3, 55) = 5.93, p = .002. However, the interaction between awareness and intervention was not significant, F(1, 19) = 0.025, p = .877. CONCLUSION. Awareness status may not affect the response to strategy training, indicating that strategy training may benefit people with poor awareness.

OBJECTIVE. We investigated the feasibility of delivering an individualized, progressive, high-repetition upper-extremity (UE) task-specific training protocol for people with stroke in the inpatient rehabilitation setting. METHOD. Fifteen patients with UE paresis participated in this study. Task-specific UE training was scheduled for 60 min/day, 4 days/wk, during occupational therapy for the duration of a participant’s inpatient stay. During each session, participants were challenged to complete ≥300 repetitions of various tasks. RESULTS. Participants averaged 289 repetitions/session, spending 47 of 60 min in active training. Participants improved on impairment and activity level outcome measures. CONCLUSION. People with stroke in an inpatient setting can achieve hundreds of repetitions of task-specific training in 1-hr sessions. As expected, all participants improved on functional outcome measures. Future studies are needed to determine whether this high-repetition training program results in better outcomes than current UE interventions.

OBJECTIVE. We investigated the specific type of occupational therapy intervention used by occupational therapists during inpatient stroke rehabilitation in one midwestern U.S. hospital to determine the frequency of prefunctional versus functional activity use. METHOD. A retrospective chart analysis was conducted of clients who received inpatient stroke rehabilitation between January 2003 and June 2004. Type of intervention, intervention strategies, and adaptive equipment use were recorded for each session provided. RESULTS. The majority of sessions (65.77%, n = 1,022) consisted of activities that were prefunctional in nature compared with 48.26% (n = 750) that focused on activities of daily living. Musculoskeletal intervention strategies were used in more than half (52.25%) of the sessions. CONCLUSION. More sessions were spent on prefunctional than on functional activities, and musculoskeletal intervention strategies were most common. Future research studies are warranted to determine the most effective intervention for this client population.

The emotional impact of surviving a stroke has not received the same attention as physical aspects. This is particularly true regarding how stroke survivors cope during inpatient rehabilitation. This study examined the coping strategies used by stroke survivors undergoing inpatient rehabilitation and the relationships between demographic or clinical variables and coping behaviors. This case series examined 16 acute stroke survivors via standardized assessments and a medical records review completed during the first week of inpatient rehabilitation. Stroke survivors used combinations of multiple coping strategies. All stroke survivors used a higher number and frequency of adaptive rather than maladaptive strategies. Women used a higher number of adaptive strategies. Stroke survivors with depression used maladaptive coping strategies more frequently, whereas those presenting with a greater number and severity of comorbidities used adaptive coping strategies more frequently. Stroke survivors with higher levels of coping self-efficacy used the strategies of active coping and positive reframing more frequently. Based on these results, it is recommended direct-care providers place greater emphasis on objectifying the emotional consequences of stroke. Further research is recommended regarding understanding the relationship between coping and outcomes.

Objective. The purpose of this study was to investigate the relationship between cognitive disability and performance of daily living skills and stability of cognitive level after discharge in a sample of adult psychiatric inpatients (N = 40). Method. The Allen Cognitive Level Test-90 (ACL-90) was administered at time of discharge (Time I) and at 21 days to 28 days after discharge (Time II). The self-report version of the revised Routine Task Inventory (RTI-2) was also administered at Time II. Results. No significant correlation was found between the ACL-90 at Time I and the RTI-2 scores; however, significant correlations were found between the ACL-90 scores at both times and between the ACL-90 score at Time II and the RTI-2 scores. Conclusion. The findings suggest that cognitive level remains relatively stable over a 1-month period in the postacute stage of a psychiatric illness. Cognitive level and performance of daily living skills are related, but the relationship is sensitive to time. Implications for occupational therapy assessment include recognizing the temporal constraints of functional assessments and refining instruments to be more sensitive to performance of familiar tasks, taking into consideration client adaptation to exigencies.

Objective. This study examined the relationship of the Allen Cognitive Level Test (ACL) to demographics, diagnosis, and disposition after hospitalization among persons with psychiatric disorders. Method. Data were retrospectively collected from medical records, including initial occupational therapy evaluation notes, on 62 female and 38 male patients consecutively admitted to an urban, acute psychiatric inpatient unit. Collected was information on demographics, diagnosis, mental and physical health history, initial ACL scores, role involvement, and discharge living situation (DLS). Results. Patients with higher initial ACL scores were more likely to be younger, to have lived independently before admission, to have been given nonpsychotic diagnoses, and to have been suicidal before admission. Although DLS was most strongly correlated with Living situation before admission, ACL scores showed the second strongest correlation to DLS. Patients with higher ACL scores were significantly more likely to be discharged to independent living than were patients with Lower ACL scores. Conclusions. These results provide evidence that patients’ cognitive Level, as measured by the ACL, may be a useful predictor of community functioning. However, further research is needed to validate the Cognitive Disabilities Model.

Objective. The purpose of this study was to evaluate the effects of pet therapy on geriatric psychiatry inpatients. A demonstrable impact could lead to more Widespread or targeted use of animal companionship programs for hospitalized older persons. Method. The study design was a randomized, parallel-group control treatment trial with pretreatment and posttreatment measures. Fifty-eight subjects with chronic age-related disabilities who were patients of the Wills Eye Hospital Geriatric Psychiatry Unit were assigned to a pet therapy intervention group or an exercise control group for 1 hr a day for 5 consecutive days. Every subject was blindly evaluated with the Multidimensional Observation Scale for Elderly Subjects (MOSES) before and after the intervention week. Results. No Significant differences in MOSES scores were found between or within groups before and after the interventions. There was a nonsignificant tendency for subjects who received the pet intervention to have less irritable behavior after treatment. However, women with dementia who received either pet therapy or exercise intervention had improved irritable behavior scores after treatment. Conclusion. This pilot study demonstrates the need for further research on animal-assisted interventions with hospitalized elderly persons. Differential improvement in women with dementia also requires further investigation.

Objectives. Dementia is the disease most frequently leading to admission in long-term care institutions, primarily because persons with this disease exhibit several behavioral problems. The objective of this study was to measure the efficacy of the sensory integration program developed by Ross and Burdick in improving the functioning of persons with dementia. Method. Forty subjects with dementia (28 women, 12 men, mean age of 78.4 years) in three different institutional settings in Quebec City, Canada, were randomly assigned to the study (n = 22) or control (n = 18) group. Subjects in the study group participated in three 45-min sessions of a sensory integration program per week for 10 weeks. Outcomes were measured using the Revised Memory and Behavior Problems Checklist and the Psychogeriatric Scale of Basic Activities of Daily Living. Results. The sensory integration program had no significant effect on the behaviors of the study group. Conclusion. Before this type of program is labeled inefficacious, other studies are necessary to determine whether modifying the frequency of sessions, the number of subjects, and the measuring instruments would lead to similar results.