The coronavirus disease 2019 (COVID-19) pandemic has presented unique challenges for occupational therapy practitioners working in acute and critical care settings. Using the best available evidence, this case report overviews a prototypical COVID-19 disease course and discusses key aspects of clinical reasoning for practitioners working with this novel population. Following a single patient admitted to a tertiary academic medical center, the authors review the occupational profile and medical history, common impairments, the intervention plan, and strategies to align the occupational therapy and medical goals of care.

Older adults living in skilled nursing facilities (SNFs) and long-term care facilities are particularly susceptible to the coronavirus disease 2019 virus and face unique challenges during their rehabilitation process. This case report highlights the disease and rehabilitation course of an older adult who received all of his medical and rehabilitative treatment while residing in a SNF. The occupational therapy evaluation and intervention processes, as well as the client’s response to intervention, are described. The client’s positive outcomes are linked directly to occupational therapy’s ability to incorporate medical, physical, and psychosocial aspects into part of the interdisciplinary model of care in a SNF.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The Mobility Assistance for People with Cognitive Disabilities (MAPCD) program, including the WayFinder 3 assistive smartphone navigation app and training program, addresses barriers to community mobility and provides supports to both individuals with cognitive deficits and their caregivers. We describe the MAPCD program and examine strategies that facilitated the adoption of the WayFinder 3 app designed to optimize independent community mobility. Primary Author and Speaker: Sarah E. Anderson Additional Authors and Speakers: Lisa Juckett Contributing Authors: Carmen DiGiovine, Sandra A. Metzler, Ashley Stojkov, Bethany Frick, Kaetlyn E. Culter, and Elizabeth Mance

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This mixed-methods case study examines use of a harness system in a community garden for persons poststroke.No studies exist on this topic. Two persons participated.Multiple pretest–posttest measures, observations, and poststudy interviews were conducted. Both showed improvement in balance and mobility, and Person 2's spirituality improved. Persons described enhanced confidence in functional mobility, ability to problem solve, and use of the hemiplegic upper extremity. Research in natural environments is needed. Primary Author and Speaker: Beth Ekelman Contributing Authors: Kelly Bishop, Erica Hughes, Allison Kienzle, Alicia Loreta, Marissa Melaragno, Shay Smallman, Jason Uth, Morgan Vaughn, and Jessica Zdanowicz

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study describes the interrater reliability of a novel goniometric technique to measure scapular protraction and retraction. Measurements obtained by two experienced OTs demonstrated a standard error of measure of less than 4 degrees using this technique on a healthy sample of adults (N = 80). This technique may offer a more reliable method to assess scapular mobility as an essential motor component of occupational performance. Primary Author and Speaker: Nathan Short Additional Authors and Speakers: Michelle Mays, Abigail Baist, Anthony Clifton, Adam Horty, Micaela Kosty, Courtney Olson, and Riddhi Patel Contributing Authors: Thomas Almonreoder

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This cross-sectional study provides a deeper understanding of how the experience of homelessness affects occupational engagement and quality of life. Health-related disparities among persons experiencing homelessness and their implications for functioning in daily life were analyzed through the World Health Organization Disability Assessment Schedule 2.0. Results indicate that the emotional burden of health conditions had the greatest impact on daily functioning. Highly affected domains included participation, mobility, and life activities. Primary Author and Speaker: John V. Rider Additional Authors and Speakers: Justina Selim, Alexys Garcia

Date Presented 04/23/21 Currently, there is limited information available to therapists to help them in advising parents about possibilities for very early powered mobility use in infants and very young children. Presenters will discuss the results of a pilot study that examined the progression of joystick driving skills in typically developing children from ages 12 to 24 months. Possible implications of the findings from this study for evidence-based practice will be considered. Primary Author and Speaker: Jennifer Iglthaler Contributing Authors: Erika Dalida, Caitlin Maclang, Eunice Cho, Hekanne Simbolon, and Marielle Santiago

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Power Fun, a therapeutic powered mobility summer camp, provides a pragmatic solution to promote mobility for children with severe cerebral palsy. This session presents the Power Fun protocol and the results of a repeated-measures mixed-methods validation study (N = 24). These showed significant improvement in powered mobility skills, attainment of most functional goals, and social change after participation, making it an evidence-based intervention for children with severe disabilities. Primary Author and Speaker: Lori Rosenberg Additional Authors and Speakers: Yafit Gilboa Contributing Authors: Adina Maeir

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This paper explores the everyday practices of scooter users as they construct and manage their identities. The qualitative semistructured interviews with 22 scooter users revealed the following themes: (1) being invisible, (2) from invisibility to hypervisibility, and (3) changing self-image (facing disability and invisibility). The study highlights scooter users’ ambivalent status and the literal and metaphorical ways in which their social and physical visibility and invisibility are manifested. Primary Author and Speaker: W. Ben Mortenson Contributing Authors: Alfiya Battalova, Laura Hurd, Lee Kirby, Sandra Hobson, and Richelle Emery

Date Presented 04/9/21 This study is the first to compare total and change scores of Section GG to the FIM® for patients with stroke receiving care at inpatient rehabilitation facilities (IRFs). The study’s findings show Section GG has relatively similar response patterns in self-care and mobility as the FIM. Our findings help OTs better understand Section GG and associated regional variations for patients with stroke and potential implications in IRF practice. Primary Author and Speaker: Chih-Ying Li Additional Authors and Speakers: Nicole Gerhardt, Madelyn Adams, Bernadette Alpajora, Taylor T. Sivori, and Mary Jane Mulcahey

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: Missing from the recent literature is information about specific categories of assistive technology (AT) education provided in entry-level occupational therapy curricula. Objective: To examine occupational therapists’ perceptions of the AT education received in occupational therapy entry-level programs, specifically the AT categories in which therapists received training. Design: Quantitative survey study with Likert-scale, multiple-choice, or ordinal ranking-scale questions and three open-response questions. Format was a web-based Qualtrics survey tool; participants had approximately 2 mo to respond. Participants: Occupational therapists certified as Assistive Technology Professionals (ATPs) were recruited through the Rehabilitation and Engineering Society of North America email database (response rate of 21%; N = 148). Outcomes and Measures: Outcomes may contribute to determining what categories of AT are missing from occupational therapy entry-level curricula and what further education is needed to develop competency. Results: Occupational therapists with ATP certification did not perceive their entry-level curricula as having adequately prepared them in the AT categories of technology for learning disabilities (67%), computer access (57%), augmentative and alternative communication (57%), and accessible transportation (52%). Conclusions and Relevance: This study supports the need for occupational therapy entry-level programs to reexamine the categories and amount of AT training they currently provide. Future research with a larger and more generalized sample could provide more detailed evidence of which AT categories should be provided. What This Article Adds: This article provides evidence that to use AT in intervention, entry-level occupational therapists require increased training in specific AT categories.

Importance: The findings support the use of occupation- and activity-based interventions to improve the occupational participation of children and youth with disabilities. Objective: To examine the effectiveness of occupation- and activity-based interventions to improve participation and performance in activities of daily living (ADLs), play, and leisure in children and youth. Data Sources: MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane Database of Systematic Reviews; reference lists of retrieved articles; and tables of contents of selected journals were searched to identify peer-reviewed studies published between 2000 and 2017. Study Selection and Data Collection: Studies addressing occupation- and activity-based interventions and outcomes for children ages 5 to 21 were selected and appraised using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines, evaluated for risk of bias, and synthesized to develop practice recommendations. Findings: Fifteen Level I (meta-analyses, systematic reviews, and randomized controlled trials), 5 Level II (two groups, nonrandomized), and 3 Level III (one group, pretest–posttest, retrospective) studies were examined and categorized by type of intervention and outcome. Each study used occupation- or activity-based interventions and reported ADL, play, or leisure outcomes. Intervention themes identified include supporting engagement in occupations, supporting participation with cognitive supports, and using technology to support occupational participation and performance. Conclusions and Relevance: Strong evidence indicates that engagement in occupations and activities, practice within and across environments, and coaching and feedback improve participation and performance in ADLs and functional mobility. Moderate evidence supports the use of collaborative goal setting, modeling, and guided participation in play and leisure. Moderate evidence also supports technological interventions for ADL, play, and leisure performance. What This Article Adds: Engaging children and youth in occupations and activities; providing guidance in goal direction, planning, and feedback to enhance their participation; coaching caregivers in effective carryover; and providing technology-based intervention can improve the occupational participation and performance of children and youth.

Evidence Connection articles provide clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of an older adult who was referred to outpatient occupational therapy services due to chronic back pain from herniated discs. Findings from the systematic review of occupational therapy for community-dwelling older adults were published in the July/August 2018 issue of the American Journal of Occupational Therapy ( Berger et al., 2018 ; Elliott & Leland, 2018 ; Hunter & Kearney, 2018 ; Liu et al., 2018 ; Smallfield & Lucas Molitor, 2018a , 2018b ) and in the American Occupational Therapy Association’s Occupational Therapy Practice Guidelines for Productive Aging for Community-Dwelling Older Adults. Each article in the Evidence Connection series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.

Little is known about characteristics and driving patterns of drivers with physical disabilities who use vehicle modifications (VMs). We gathered information about, and from, drivers with disabilities who use VMs to better understand their needs and to inform current occupational therapy driver rehabilitation practice. A prospective descriptive cross-sectional analysis of 97 drivers with physical disabilities who used VMs identified that most participants were dependent on wheelchairs for personal mobility and that access to key destinations without independent driver mobility was difficult or impossible. Personal independence facilitated by VM use enhanced community participation, including access to health care and employment. Slightly more than half the surveyed drivers (51%) obtained occupational therapy services for driver assessment and VM evaluation. Participants reported VM safety and maintenance issues, including difficulties obtaining appropriate VMs. Study results highlight the potential value of occupational therapy driver assessments and the need for postimplementation review of VMs.

OBJECTIVE. We describe the development and content validation of the revised Self-Report Assessment of Functional Visual Performance (R–SRAFVP). METHOD. The content validation process consisted of three stages: (1) three occupational therapy experts in low vision rehabilitation revised items on the 38-item SRAFVP via written feedback and semistructured interview, (2) eight occupational therapy low vision experts evaluated items for relevance and provided feedback on the rating scale, and (3) five adults with low vision provided feedback on item clarity via cognitive interviewing. RESULTS. In Stage 1 review, 21 items were added, totaling 59 items. In Stage 2 evaluation, 9 items were eliminated, resulting in the 50-item R–SRAFVP with a 4-point scale. The scale content validity index of the R–SRAFVP was .9. Stage 3 cognitive interviewing provided no substantive changes in content. CONCLUSION. R–SRAFVP content was relevant to evaluate the ability of adults with low vision to complete vision-dependent daily tasks and was understandable by these participants.

OBJECTIVE. Our objective was to validate the construct of the Revised Self-Report Assessment of Functional Visual Performance (R–SRAFVP) for older adults with low vision resulting from age-related eye disease. METHOD. The 50-item draft of the R–SRAFVP was administered to 87 older adults with low vision. Construct validation included principal-components analysis and the known-groups method. RESULTS. Principal-components analysis revealed nine components (comprising 33 items): Personal Care, Oral Care, Meal/Laundry Preparation, Financial Management, Telephone Usage, Personal Preference Activities, Reading, Writing, and Functional Mobility. Cronbach’s α ranged from .72 to .84 for individual components and was .92 overall. Known-groups comparisons showed that participants with moderate to profound acuity loss or contrast sensitivity deficits reported significantly greater difficulty completing tasks on the R–SRAFVP than those with milder acuity loss or normal contrast sensitivity. CONCLUSION. The 33-item R–SRAFVP demonstrates adequate evidence of reliability and validity to evaluate the ability of older adults with low vision to complete vision-dependent activities of daily living.

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of a person who underwent a total knee replacement due to severe osteoarthritis of his left knee. The occupational therapy assessment and intervention process both before and after surgery in the home setting is described. Findings from the systematic review ( Dorsey & Bradshaw, 2017 ) on this topic were published in the January/February 2017 issue of the American Journal of Occupational Therapy and in AOTA’s Occupational Therapy Practice Guidelines for Adults With Musculoskeletal Conditions. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical reasoning.

As the health care system continues to evolve toward one based on quality not quantity, demonstrating the value of occupational therapy has never been more important. Providing high-quality services, achieving optimal outcomes, and identifying and promoting occupational therapy’s distinct value are the responsibilities of all practitioners. In relation to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 , the Centers for Medicare and Medicaid Services (CMS) is implementing new functional items and related outcome performance measures across postacute care (PAC) settings. Practitioners can demonstrate the role and value of occupational therapy services through their participation in data collection and the interpretation of the resulting performance measures. In this column, we review the objectives of the IMPACT Act, introduce the new self-care and mobility items and outcome performance measures being implemented in PAC settings, and describe ways to use these new data to advocate for occupational therapy. We also discuss American Occupational Therapy Association initiatives to provide materials and guidance for occupational therapy practitioners to contribute to PAC data collection.

The Centers for Medicare and Medicaid Services (CMS) has scrutinized the provision of rehabilitation services in skilled nursing facilities (SNFs) for some time. Little research guidance exists on appropriate dosage or rehabilitation intensity (RI) among SNF patients or patients in other postacute care (PAC) settings. CMS developed a PAC assessment, the Continuity Assessment Record and Evaluation (CARE) Tool, in response to questions about what issues drive placement in various PAC settings under Medicare. The ability to adequately assess functional outcomes and correlate them to the RI provided by using the CARE Tool is promising. However, further research, policy advocacy, and practice analysis must be undertaken to promote and protect adequate access to occupational therapy and physical therapy in SNFs and other PAC settings. Individual practitioners must participate in data gathering to ensure that the data for analysis are fully informed by the occupational therapy perspective.