Importance: Occupational therapists are the primary clinicians tasked with management of the more affected upper extremity (UE) after stroke. However, there is a paucity of efficacious, easy-to-use, inexpensive interventions to increase poststroke UE function. Objective: To compare the effect of a multimodal mental practice (MMMP) regimen with a repetitive task practice (RTP)–only regimen on paretic UE functional limitation. Design: Secondary analysis of randomized controlled pilot study data. Setting: Outpatient clinical rehabilitation laboratory. Participants: Eighteen chronic stroke survivors exhibiting moderate, stable UE impairment. Intervention: Participants administered RTP only participated in 45-min, one-on-one occupational therapy sessions 3 times per week for 10 wk; participants administered MMMP completed time-matched UE training sessions consisting of action observation, RTP, and mental practice, delivered in 15-min increments. Outcomes and Measures: The Action Research Arm Test, the UE section of the Fugl-Meyer Scale, and the Hand subscale of the Stroke Impact Scale (Version 3.0) were administered 1 wk before and 1 wk after intervention. Results: The MMMP group exhibited significantly larger (p < .01) increases on all three outcome measures compared with the RTP group and surpassed minimal clinically important difference standards for all three UE outcome measures. Conclusions and Relevance: Because of the time-matched duration of MMMP and RTP, findings suggest that MMMP may be just as feasible as RTP to implement in clinical settings. Efforts to replicate results of this study in a large-scale trial are warranted. What This Article Adds: This study shows the efficacy of an easy-to-use protocol that significantly increased affected arm function even years after stroke.

Importance: Virtual reality in head-mounted displays (HMD-VR) may be a valuable tool in occupational therapy to address anxiety. Findings from the virtual reality exposure therapy (VRET) literature may facilitate translation of HMD-VR to occupational therapy psychosocial practice. Objective: To explore how HMD-VR has been used to treat anxiety through VRET and could be translated to occupational therapy. Data Sources: We searched seven electronic databases for articles published between 2000 and 2020: CINAHL, Cochrane Library, Embase, ERIC, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms included HMD-VR constructs, products, and therapy concepts. Study Selection and Data Collection: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to report studies implementing VRET to treat anxiety. At least two reviewers assessed each citation, and a third resolved disagreements. Articles were included if they were in English, reported experimental data, and used HMD-VR. Letters, commentaries, book chapters, technical descriptions, theoretical papers, conference proceedings (≤4 pages), and reviews were excluded. Findings: Twenty-eight studies used HMD-VR to treat posttraumatic stress disorder (n = 3), specific phobias (n = 19), and performance-based social anxiety (n = 6); protocols and levels of evidence varied (randomized controlled trials, n = 11; controlled trials without randomization, n = 6; case–control or cohort studies, n = 11). Qualitative examination indicates HMD-VR is an effective treatment tool. Conclusions and Relevance: HMD-VR can be a valuable tool for occupational therapy to simulate environments where clients with anxiety disorders participate. Eliciting presence through multisensory features and body representation may enhance outcomes. What This Article Adds: Drawing from the VRET literature, this scoping review suggests that HMD-VR can be used by occupational therapy practitioners to simulate ecologically valid environments, evaluate client responses to fearful stimuli, and remediate anxiety though immersion in virtual tasks when participation in natural contexts is unfeasible. Having ecologically valid environments is particularly important for people with anxiety disorders because they need support to cope when they encounter triggers in everyday life environments.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Health professionals treat a growing multiethnic population. The results of this mixed-methods research showed the positive effect of a short-term Costa Rica study-abroad experience on interprofessional and cultural competencies, teamwork, and collaboration of OT and nursing students. OT educators can use these methods as a guide in their own programs to strive for collaborative mutual enrichment and to broaden learning opportunities focused on OT in a globally connected world. Primary Author and Speaker: Brittany N. Saviers Contributing Authors: Lavona S. Traywick, Julie Meaux

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study examined how adults treated with cancer rated their confidence in and difficulty performing activities of daily living (ADLs) and how that was related to receiving OT services. Participants who attended OT had statistically significantly higher confidence in ADLs compared to those who did not attend. Nearly 75% of participants reported experiencing difficulty completing ADLs after cancer diagnosis. OTs can advocate for referrals to OT and target function in treatment. Primary Author and Speaker: Brittany A. Boyer Additional Authors and Speakers: Katherine McVey, Leah Gossard Contributing Authors: Anna M. Quigg, Stacy Buckingham-Howes

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This mixed-methods study explored the perspectives of current OT students from under-represented groups and OT faculty and staff. Surveys and interviews were used to gather data on OT students' experiences during the OT admissions process within their OT program and OT faculty and staff perspectives on inclusion in their OT program. Results highlight supports and barriers to inclusion and support various efforts to increase representation of students from under-represented groups within OT education. Primary Author and Speaker: Arielle Ramirez Contributing Authors: Anne Kiraly-Alvarez

Importance: Psychometrically sound instruments are needed to evaluate executive functioning in the population of people with cancer. Objective: To develop and evaluate the reliability and validity of the Executive Function Performance Test–Enhanced (EFPT–E) in women after being treated for breast cancer. Design: Cross-sectional. Setting: University research laboratory. Participants: Women treated for breast cancer who had cognitive impairment (n = 12) and community control participants (n = 13). Outcomes and Measures: Evaluators (n = 8) independently scored a recorded administration of the EFPT–E to evaluate interrater reliability. An assessment battery, including the EFPT–E, was administered to evaluate the EFPT–E’s known-groups validity and concurrent validity. Results: Excellent interrater reliability was observed for the EFPT–E total score and each subtask score (intraclass correlation coefficient = .90–.98). Moderate effect sizes were noted for the EFPT–E total score (Cohen’s d = 0.5) and the total number of cues (d = 0.4) between the breast cancer group and the control group, with the breast cancer group demonstrating poorer performance. A limited correlation was found between the EFPT–E and the other cognitive measures. Conclusions and Relevance: The results support the EFPT–E’s interrater reliability and warrant continued investigation to further establish its reliability and validity. What This Article Adds: Assessments are needed to quantify the impact of cognitive processes within functional tasks. The EFPT–E has been developed to assess the functional impact of mild cognitive impairment; initial testing with women with cancer showed excellent agreement between raters and promising results for validity.

The American Occupational Therapy Association’s (AOTA’s) Vision 2025 conveys a strong commitment to diversity, equity, and inclusion ( AOTA, 2019 ). AOTA affirms the inalienable right of every individual to feel welcomed, valued, a sense of belonging, and respected while accessing and participating in society, regardless of the internal or external factors that make every individual unique. This statement supports efforts to increase diversity, equity, and inclusion within all aspects of occupational therapy, including practice, education, and research, as well as policy development and advocacy.

Date Presented 04/04/19 Adolescents with mental-health trauma (MHT) history face many challenges, and increasing OT providers’ knowledge and confidence in MHT treatment may improve both advocacy for OT role in MHT and program efficacy. The current study examined feasibility and effectiveness of using a brief informational infographic to increase the confidence, knowledge, and willingness of OT providers in working with adolescents with MHT history. Primary Author and Speaker: Jamelle Brownlee Additional Authors and Speakers: Michelle Jackson, Anna Quigg Contributing Authors: Joanna Cruz, Katherina Zumalt, Stacy Buckingham-Howes

OBJECTIVE. We examined the effectiveness of modified constraint-induced movement therapy (mCIMT) in treating infants with hemiplegic cerebral palsy and compared therapy outcomes with a nonconstraining bimanual therapy (BIM) of equal intensity. METHOD. In a single-blinded randomized controlled trial, 33 infants with hemiplegia (mean corrected age = 11.1 mo, standard deviation = 2.2) received either mCIMT (n = 17) or BIM (n = 16). Both interventions included home programs encouraging the use of the affected hand during daily 1-hr play sessions for 8 wk. Outcome measures were administered pre- and posttreatment and included the Mini-Assisting Hand Assessment for babies and the Functional Inventory. At baseline, parents also filled out the Dimensions of Mastery Questionnaire. RESULTS. Both groups demonstrated a significantly large and equal improvement in hand and gross motor function posttreatment (p < .001) and high treatment compliance. CONCLUSION. mCIMT and BIM are equally effective methods for treating infants with hemiplegia.

Despite the inevitable loss of function seen in people with progressive dementias, interventions for reversing or minimizing functional loss are understudied. Research supports task-oriented training, but practical gaps in how to best evaluate clients for this training and how to implement it in clinical settings may be thwarting translation to occupational therapy practice. We structured an intervention model called STOMP (Skill-building through Task-Oriented Motor Practice) using a unique blend of task-oriented training and motor-learning principles. In this article, we describe through a case study the process and outcome of using STOMP to improve functional skills in a woman with moderate dementia with Lewy bodies. Our findings suggest that STOMP has the potential to serve as a structure for the evaluation and treatment of occupational performance deficits in people with dementia and that this model warrants further investigation.

Historical inquiry enriches occupational therapy practice by identifying enduring values and inspiring future excellence. This study presents for the first time the pioneering life and work of Philip King Brown, a San Francisco physician who used occupation to treat the physical, mental, and social effects of tuberculosis (TB) at Arequipa Sanatorium, the institution he founded in 1911. Through textual analysis of the Arequipa Sanatorium Records, this article evaluates and defends Brown’s assertion that his institution was medically and socially experimental. The Arequipa Sanatorium promoted occupational therapy by demonstrating its viability in the treatment of TB, the era’s most critical health threat. It also put into practice the ideals of holism, humanism, and occupational justice that resonate within the profession today. Finally, Arequipa provided an example of how an occupation program can change the public perception of disability.

Although occupation-centered curricula are highly promoted, the teaching processes that convey such designs remain unclear. This case study elucidated occupation-centered teaching practices. Interview and observational data were collected over 8 weeks, and analysis involved coding transcriptions, data matrices, concept maps, journaling, and writing. Participants augmented active learning strategies with strategies that linked course topics to the subject of occupation. The use of linking strategies suggested that: (a) course content was treated as two-tiered; (b) neither content nor instructional processes were inherently occupation-centered; and (c) subject-centered education strengthens social learning theories. Although curricula may appear occupation-centered based on a curriculum description and course content, ultimately “linking opportunities” in the classroom constitute an essential feature that demarcates a program as occupation-centered.

This article provides a meta-analysis of the current best evidence for the use of occupational therapy with clients with multiple sclerosis (MS). A review of the literature identified 23 articles that examined the effectiveness of occupational therapy–related treatments on clients with MS. Meta-analytic analysis suggests that occupational therapy–related treatments were effective in treating the deficits associated with MS (r = .52), particularly for outcomes in the capacity and ability (r = .52; e.g., muscle strength, range of motion, mood) and task and activity (r = .57; e.g., dressing, bathing, ambulation) levels. A review of the research designs used to study MS suggests that more rigorous research is necessary to fully understand treatment effectiveness. Further, more research must be done to establish the effectiveness of occupational therapy treatment at the life role level.

Objectives. This article describes the relationship of mothers’ orchestration of daily occupations, the specialized maternal work of parenting a child with a disability, and the mother’s subjective well-being. Method. Mothers’ daily occupations and subjective well-being were studied using multiple in-depth interviews, participant observation of a day’s round of occupations, and scales of well-being. Data were treated to a recursive analysis, which included theoretical notes generated during transcriptions that identified important themes and additional points of inquiry, line-by-line coding of transcripts, and theoretical sorting of codes and regrouping, recoding. To account for patterns in the data, a relational analysis was conducted that included the generation of metaphors. Results. Emergent findings of this analysis identified the mothers’ guiding occupational motif and eight processes of orchestration in their daily routines. The occupational motif, the embrace of paradox, directed the mother’s orchestration of daily occupations. The orchestration processes included planning, organizing, balancing, anticipating, interpreting, forecasting, perspective shifting, and meaning making. Examples illustrate the maternally driven and child-sensitive nature of these processes. Conclusion. In their daily rounds, the mothers studied were attentive to the manner and method with which they interacted with their children to produce child-contingent occupations commensurate with their values of being a good mother. Using these orchestration processes, mothers made sense of their past, designed their present, and planned for their future within their daily occupational rounds for themselves and family members.

Objectives. Single-case reports indicate that behavioral methods can assist persons with brain injury to redevelop self-care skills. However, the proportion of patients who could benefit from these interventions is unknown. The present study used a specific retraining protocol to treat all patients admitted to a single facility over a 3-year period who were unable to wash and dress independently. Method. Four patients out of 48 met the study criteria and were treated with the washing and dressing protocol. Three had traumatic brain injury, and one had brain injury after cerebral bleed. The training program involved behavioral observation, task analysis, consistent practice, and cue fading. The Adaptive Behavior Scale was used to measure behavior change. Results. Three subjects achieved rapid independence in washing and dressing (20 days, 37 days, and 11 days of treatment), and one did not show significant clinical improvement. Conclusion. All patients admitted to the facility during a 3-year period who required washing and dressing retraining were treated with the same protocol. The consecutive series design prevented researchers from selecting patients who they believed were good treatment candidates; therefore, the findings support the general applicability of the training program.

Family-centered occupational therapy services are based on a collaborative relationship that does not always come easily. Role performance in parenting a child with special needs and being a consumer of occupational therapy services can be partially understood in terms of environmental context. Although occupational therapists recognize the need to adjust services to the cultural and economic backgrounds of families, most of the available literature has examined the contribution of ethnic differences. A particular challenge for occupational therapists may be treating clients and their families who live in chronic poverty. This article examines chronic poverty as it shapes parenting the child with special needs and subsequently the caregiver’s participation in occupational therapy services. A framework for understanding cultural differences is used to suggest constrasting value orientations between families who live with persistent poverty and occupational therapists. A family-centered approach challenges the professional to understand varied influences on caregiving. Suggestions are offered to enhance communication between therapists and caregivers.

The treatment of self-injurious behavior in adults with mental retardation is a major challenge. A critical review of the literature compares sensory-based treatment studies by behavioral psychologists with sensory integrative treatment studies by occupational therapist. In general, therapists have used direct intervention in concentrated daily sessions. This report includes a single subject study that (a) demonstrates the clinical reasoning involved in the assessment and treatment planning process, (b) documents the efficacy of multiple short treatment sessions spread throughout the day, and (c) presents an alternative model of service provision in which direct care staff provide sensory and adaptive activities under the supervision of an occupational therapist. The use of sensory integration with adults with profound handicaps is presented as a valid application of a theory and treatment that was originally developed from work with higher functioning children with learning disabilities.