Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. We developed a mobile app to facilitate self-management behaviour among individuals with spinal cord injury (SCI) to help them improve their management of secondary conditions. The purpose of this study was to explore user expectations of the mobile app intervention to inform its adoption. This presentation will inform practitioners about a technology-based approach to promoting self-care and the unique mobile self-management app expectations and needs of people living with SCI. Primary Author and Speaker: W. Ben Mortenson Contributing Authors: Gurkaran Singh, Ethan Simpson, Megan McGillivray, Jared Adams, and Bonita Sawatzky

Date Presented 04/21/21 Most spinal cord injury (SCI) clinical trial measures do not have the capability to accurately measure recovery of movement, which creates serious problems for SCI clinical trials that have motor recovery or repair as an endpoint. Work is underway to develop a clinical trial outcome measure that is intended to evaluate recovery of neurotypical movement within the context of function. This poster presents the iterative development process of the fine motor item pool for this outcome measure. Primary Author and Speaker: Rachel Kim Additional Authors and Speakers: William Conrad, Dianna Lunsford, Kristin Valdes

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study at EmpowerSCI exhibits the importance of community-level rehabilitation, including OT, and its effects on the quality of life (QoL) of individuals with spinal cord injury (SCI). Community programs such as EmpowerSCI offer a promising new sector for OTs to offer effective client-centered care to the SCI patient population. Also, the study shows how volunteering at EmpowerSCI influences the values and motivations of rehabilitation students, including future OTs. Primary Author and Speaker: Gillian Hopkins Additional Authors and Speakers: Saumya George, Jenna Schunke, and Brittany Zouzias

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Transcutaneous spinal cord stimulation (TSCS) is a novel mechanism to excite spinal neural circuits and unmask latent voluntary function. This research presentation will discuss outcomes associated with an 8-week trial combining TSCS with therapy. Participants improved in walking function, bowel and bladder function, and sensation with commensurate improvements in quality of life. TSCS is a feasible, meaningful intervention for patients with incomplete spinal cord injury. Primary Author and Speaker: Rebecca Martin

Date Presented 04/13/21 Informal caregivers are at risk for experiencing stress, anxiety, and other concerns that influence quality of life and that have a direct effect on the care recipient. Preliminary evidence suggests that Health Coaching in Context may help address the needs of mothers who are caring for a child with spinal cord injury. Using this client-centered and solution-focused approach, OTs develop a partnership that is connected by authenticity and trust through the use of skillful, constructive dialogue. Primary Author and Speaker: Bernadette Alpajora Additional Authors and Speakers: Rochelle Mendonca

Importance: Falls have a considerable physical and psychological impact on people with spinal cord injury (SCI). Occupational therapy practitioners require evidence to support the timely development of occupation-based programs that can be applied to fall prevention in daily life. Objective: To determine what is known about falls after SCI, including wheelchair users and people who are ambulatory, and to understand elements of fall prevention to be addressed by occupational therapy practitioners. We applied the Canadian Measure of Occupational Performance and Engagement to understand elements to be addressed in fall education and prevention with this population. Data Sources: We searched eight databases using the key words falls and spinal cord injury with no limit set on dates. Study Selection and Data Collection: Studies were included that reported on falls among adults with SCI and measured one or more of the following: incidence of falls, consequences of falls, contributing factors for falls, the person’s experience of falls, and strategies to prevent falls. Findings: Thirty-five articles were included. The majority of the articles included information on the incidence (n = 20), consequences (n = 26), and contributing factors (n = 30) of falls. Two articles analyzed the person’s experience of falls, and 1 study reviewed a fall prevention program for people with SCI specifically. Conclusions and Relevance: Research on participants’ experience of falls and fall prevention programs used in spinal cord rehabilitation is extremely limited. Future research on the lived experience of falls for people with SCI is warranted. What This Article Adds: This review of evidence on falls after SCI highlights gaps in the current available evidence.

Importance: This study lays the groundwork for a self-management program run by occupational therapy practitioners for parents with spinal cord injury or disease (SCI/D). Objective: To develop and implement the Parenting Self-Management Program with people with SCI/D and evaluate the potential impact on knowledge, self-efficacy, and participation. Design: A mixed-methods approach was used to develop (Phase 1) and implement and evaluate (Phase 2) a pilot group intervention for parents with SCI/D. Setting: Community-based occupational therapy settings. Participants: Phase 1 participants were professionals working in the field of disability and SCI/D (n = 11) and experienced parents with SCI/D (n = 9). Phase 2 participants were people with SCI/D who were newly injured or inexperienced in parenting (n = 10). All participants were paid volunteers. Intervention: The 4-wk Parenting Self-Management Program was piloted with 10 parents with SCI/D. Participants attended a weekly program with other parents with SCI/D led by occupational therapists in which they received parenting resources and presentations and set weekly goals. Outcomes and Measures: The General Self-Efficacy Scale, a modified version of the Participation Survey/Mobility, and open-ended questions regarding parents’ participation in parenting tasks were administered during Phase 2. Results: Significant increases (p < .05) in perceived knowledge were found for the topics of emergency preparedness, home modifications, adapted equipment, fatigue management, pain management, and community resources among Phase 2 participants. Conclusions and Relevance: A self-management approach combined with pertinent resources for parents with SCI/D yielded positive outcomes. What This Article Adds: This research demonstrates that a self-management structure for a specific population (people with SCI/D) in combination with a targeted occupation (parenting) and delivered through group occupational therapy services, improved client outcomes.

Patients ¹ are experts on their own lives and the ways in which an illness, injury, or disability affects their health, activity, and quality of life. With its longstanding foundations in participatory action research, patient engagement has been gaining momentum across health care and related research. This momentum is supported by investments from several key research and federal policy–related organizations, including the Patient-Centered Outcomes Research Institute, National Institutes of Health, and Agency for Healthcare Research and Quality. Occupational therapy practitioners are uniquely positioned to champion patient collaborations. In this article, we discuss ways in which patient perspectives can be embraced in occupational therapy research, and we share insights from a research planning collaborative with adolescents and young adults that was led by occupational therapy researchers.

OBJECTIVE. Our objective was to examine demographic, cognitive, emotional, and physical factors that predict return to paid employment for people after neurological injury. METHOD. Four hundred eighty adults with stroke (n = 149), traumatic brain injury (n = 155), and spinal cord injury (n = 176) completed an occupational outcome questionnaire and physical, emotional, and cognitive assessments at three rehabilitation facilities. RESULTS. Odds of employment were predicted by being married or partnered, having more education, requiring fewer prompts for task sequencing, and having higher inhibitory control (but were not predicted by specific type of injury). Participants who returned to work within 3 mo were more likely to work with the same employer and to take a full-time position than those who returned later. CONCLUSION. Executive functioning, in particular sequencing and inhibitory control, strongly predicts employment and highlights the importance of cognitive strategy training during occupational therapy with people who have sustained neurological injuries.

OBJECTIVE. Our objective was to evaluate interunit agreement and construct validity of two activity monitors (Actiwatch Score and PRO-Diary) in people with and without spinal cord injury. METHOD. Thirty-eight participants (19 with spinal cord injury; 19 age- and sex-matched controls; mean age = 49 yr) wore both monitors and completed tasks during one visit ranging in physical intensity. To compare activity by group and monitor, we conducted t tests. We assessed interunit agreement using intraclass correlations and Bland–Altman plots. RESULTS. Both monitors demonstrated significantly different increasing physical activity levels with higher intensity tasks. Participants with spinal cord injury had similar activity counts within tasks compared with controls except for walking–wheeling. Agreement was high between monitors across tasks (interclass correlation coefficients = .78–.97). CONCLUSION. Both monitors demonstrated good construct validity for measuring physical activity across activities and high agreement. Either monitor is appropriate to examine physical activity patterns in people with spinal cord injury.

OBJECTIVE. A bibliometric analysis was completed of highly cited occupational therapy literature and authors published from 1991 to 2014 and accessible in the Science Citation Index Expanded (SCI–Expanded) and Social Sciences Citation Index (SSCI) databases. METHOD. Data were obtained from the SCI–Expanded and SSCI. Articles referenced >100 times were categorized as highly cited articles (HCA). RESULTS. Of 6,486 articles found, 31 were categorized as HCA. The American Journal of Occupational Therapy published the largest number of HCA (n = 8; 26%). The 31 HCA were distributed across seven countries: United States (20 articles), Canada (3), United Kingdom (3), Australia (2), the Netherlands (1), New Zealand (1), and Sweden (1). The three authors with the highest Y-index were S. J. Page, F. Clark, and W. Dunn. CONCLUSION. A latency period of 4 to 5 yr post-publication appears to be needed for a journal article to gain citations.

This study identifies the meaning of context in recapturing self-care after a stroke or spinal cord injury (SCI). Recapturing denotes the process of engaging in self-care to regain the ability to participate in self-care activities. Five people who had had a stroke and 6 people with SCI were interviewed 1–3 months after onset. The interviews were open ended and transcribed verbatim. They were analyzed by using the empirical, phenomenological, psychological method, which identified 6 main characteristics describing the role of context in recapturing self-care: (1) support from others, (2) an air of expectation, (3) extended time, (4) new daily structure, (5) therapeutic relationship as enabling possibility, and (6) gradual change in challenge. These findings showed that rehabilitation professionals play an important role in creating a context that contributes to recapturing self-care by allowing extended time, enabling patients to see possibilities, and creating expectations for them to do things on their own.

OBJECTIVE. This study examined how community-dwelling adults with spinal cord injury (SCI) respond in real-life circumstances after detecting a low-grade (Stage 1 or Stage 2) pressure ulcer. METHOD. We performed a secondary analysis of personal information profiles obtained in a previous qualitative research study. Profiles were examined to explore how individualized lifestyle considerations affected pressure ulcer risk in 19 adults with SCI who responded to an early ulcer that later progressed to a medically serious level. RESULTS. On the basis of a total of 46 pressure ulcer events, we identified a typological framework that described eight primary response categories and seven subcategories. CONCLUSION. The findings have significant practice implications for occupational therapists who provide services for adults with SCI living in the community. The importance of combining an initial individualized preventive intervention with structured follow-up within a person’s unique everyday life setting is further explored.

This study sought to identify the characteristics of the lived experience of recapturing self-care after a stroke or a spinal cord injury (SCI). Five people who had had a stroke and six with SCI who were in the midst of recapturing self-care (1–3 months after onset) were interviewed. All interviews were analyzed using the Empirical, Phenomenological, and Psychological method. Four main characteristics were present among all of the participants’ lived experiences: (a) becoming familiar with the new body, (b) recapturing self-care through trying, (c) reclaiming control, and (d) feeling uncertainty in the continued recapturing process. The findings indicate that a prerequisite for recapturing self-care was to get experience from doing to become familiar with the new body, which makes explicit the importance of enabling self-care in the rehabilitation process after stroke or SCI. The findings can be used in clinical practice to improve the understanding of how to better plan individualized self-care intervention.

OBJECTIVE. This study explored how Greek men with spinal cord injury experience sexuality. METHODS. Six men with spinal cord injury acted as key informants and data collection consisted of in-depth unstructured interviews, field notes, and a reflective log. The transcribed interviews were analyzed thematically. RESULTS. The themes that emerged were: Barriers, Metamorphoses, and Enjoying. Sexuality was important in the life of the informants and they were engaged in various patterns of adaptation. Rather than impairment as such, certain social beliefs and values prevalent in Greek society were found to act upon the informants in compromising ways. CONCLUSION. The results suggest that the process of reclaiming one’s sexuality is a process of meaning-finding. The data support a conclusion that occupational therapists should respect the cultural nature of sexuality. Moreover, the topic of sexuality should be approached in a holistic manner, perceiving it as extending in a continuum, which may be positively or negatively affected as a result of an acquired impairment.

Objective. Previous studies have suggested that no single wheelchair pressure-relieving cushion material was optimal for all persons with spinal cord injury (SCI). The purpose of this study was to compare the effectiveness of the shortterm pressure-relieving ability of the three most commonly prescribed wheelchair cushions (Roho, Jay, Pindot) for a person with SCI. Method. The number of pressure sensors registering at the buttock–cushion interface during wheelchair sitting was measured by the Xsensor Pressure Mapping System after 5 min of sitting. An alternating treatments research design, with an initial baseline and a final treatment phase ending with the most effective cushion for relieving pressure, was used for the clinical evaluation. Measurements were compared using visual inspection and a Wilcoxon signed ranks test. Results. Data analyses indicated that the number of pressure sensors that registered potential harmful levels of pressure at the buttock–cushion interface for the Roho cushion was significantly less than those of the Jay and Pindot cushions. Conclusion. The Roho cushion was more effective in relieving pressure at the seating surface than the Jay and Pindot cushions.

Objective. The purpose of this study was to determine whether participation in sports by persons with spinal cord injuries (SCIs) affected level of community integration as defined by the World Health Organization and as measured by the Craig Handicap Assessment and Reporting Technique (CHART). Method. Forty-eight participants were recruited from a camp for persons with physical disabilities as well as from SCI support groups. Participants were divided into groups of athletes (n = 30) and nonathletes (n = 18) on the basis of their self-reported level of sports participation. Results. Athletes scored significantly higher on four of five subsections of the CHART (physical independence, mobility, occupation, social integration), indicating greater levels of community integration than nonathletes. Conclusion. These findings extend the literature outlining the physical and psychological benefits of sports. Occupational therapists have a unique opportunity to use the occupation of sports to integrate the roots of the profession with the cultural demands of society.

Objective. The purpose of this study was to examine educational participation and accommodations for children with spinal cord injury (SCI) or disease in primary, secondary, and postsecondary educational settings. Method. Written surveys were developed for students with SCI and their teachers. Fifty-three participants had SCI onset before age 18 years, were at least 4 years old and enrolled in a school program, and had residual motor disability without cognitive–behavioral impairments. Results. Nearly all participants were enrolled full time in regular education classrooms. Seventy-five percent of primary-level participants and 32% of secondary-level participants were qualified for special education and related services, receiving teacher aide assistance as well as occupational and physical therapy services. Most participants were graduating from high school and pursuing postsecondary education. Classroom performance and grades were reported as average or above average, but curriculum modifications were commonly made, and many participants required human assistance and assistive technology in functional and classroom tasks. Access barriers were often reported by participants using wheelchairs, and those using augmentative writing aids were not fluent with these devices. Conclusion. Accommodations in schools for students with SCI appear to support completion and advancement to higher levels of education, but these accommodations appear to be geared toward participation rather than levels of performance and productivity that may be realistic for work and other community settings.