Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Current evidence on robot-assisted therapy to improve use of the paretic upper extremity during everyday activities is limited. Semistructured interviews and thematic analysis investigated participants' experiences with a novel cognitive-strategy-based protocol for individuals who had a stroke in order to gain a better understanding of how motor skills trained during robot-assisted therapy transferred to paretic upper extremity use during daily occupations. Primary Author and Speaker: Madison R. Costa Contributing Authors: Susan E. Fasoli

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.

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.

Bathroom assistive devices are used to improve safety during bathing transfers, but biomechanical evidence to support clinical recommendations is lacking. This study evaluated the effectiveness of common bathroom aids in promoting balance control during bathing transfers. Twenty-six healthy adults (12 young, 14 older) stepped into and out of a slippery bathtub while using a vertical grab bar on the side wall, a horizontal grab bar on the back wall, a bath mat, a side wall touch, or no assistance. Balance control was characterized using center of pressure measures and showed greater instability for older adults. The vertical grab bar and wall touch resulted in the safest (best controlled) transfers. The bath mat provided improved balance control in the axis parallel to the bathtub rim but was equivalent to no assistance perpendicular to the rim, in the direction of obstacle crossing. These results can support clinical recommendations for safe bathing transfers.

This Evidence Connection describes a case report of a woman with an exacerbation of multiple sclerosis (MS), applying the evidence for intervention from the systematic reviews on MS that were conducted in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. The occupational therapy assessment and treatment processes for an inpatient rehabilitation setting are described. Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the AOTA’s Evidence-Based Practice Project.

OBJECTIVE. We evaluated the effects of transfer training—after training in the classroom and in the high-technology simulation laboratory (WISER Center)—on students’ perceptions of their self-efficacy for knowledge, skill, and safety in executing dependent transfers. METHOD. After classroom training, occupational therapy students were randomized to three teaching groups on the basis of the amount of participation and observation opportunities provided at the WISER Center—observation dominant, participation dominant, and participation only. RESULTS. The participation-dominant group reported an increase in knowledge self-efficacy over time compared with the observation-dominant and participation-only groups. Over time, self-efficacy ratings increased for all students, regardless of group. CONCLUSION. Simulation scenarios implemented at the WISER Center provided a useful adjunct to classroom training in transfer skills. Both participatory and observational experiences contributed to the development of students’ perceptions of their ability to manage acutely ill and medically complex patients.

OBJECTIVE. We describe an educational intervention that involved simulation scenarios of medically complex patients to teach transfer training and promote clinical reasoning. METHOD. Scenarios were developed with practitioner input that described (1) a patient who was acutely ill, (2) a critical medical management event that occurred during a bed-to-wheelchair transfer of the patient, and (3) an occupational need. Transfer training, using the scenarios, occurred in a high-technology laboratory with SimMan^® and a mock hospital suite. Evaluation was based on student performance and perceptions of simulation effectiveness. RESULTS. On average, students completed 66%–88% of the transfer items correctly. Student performance suggested that the simulation scenarios were more difficult than practitioners rated them. Students rated the simulation scenarios as effective teaching tools. CONCLUSION. Scenario use in simulations for transfer training makes a positive curricular contribution to teaching procedural skills and clinical reasoning simultaneously.

OBJECTIVE. Classroom teachers teach handwriting, but when problems arise, students are referred to occupational therapy for remediation. This study, conducted by occupational therapists, reviews handwriting instruction by classroom teachers in one school district. METHOD. Teachers from kindergarten through grade 6 were asked to complete an open-ended questionnaire regarding handwriting instruction. RESULTS. Teachers differed in their methods of instruction, including in the programs and paper used, and practice provided. Teachers of grades 5 and 6 had to continue to review handwriting instruction, because all students could not fluently use handwriting as a tool of expression. CONCLUSION. Elementary students need structured instruction to develop the motor skill of writing. School-based occupational therapists can support effective handwriting instruction by interpreting information from motor learning theory pertaining to instruction and practice, which supports acquisition, transfer, and retention of handwriting skills. They also need to be cognizant of prior handwriting instruction when addressing handwriting difficulties.

Objective. The purpose of this study was to investigate whether practicing a complex self-care occupation in a contextually relevant environment would enhance the learning and transfer of skill. Method. The design consisted of an acquisition phase, a rest period, and a transfer phase. Fifty-six women were recruited for this study and randomly assigned to one of three groups: (a) a contextually relevant (CR) group that practiced tying a necktie knot onto a mannequin, (b) a non-contextually relevant (NCR) group that practiced tying the same type of knot with a rope onto a wooden pole, and (c) a control group that did not practice at all during the acquisition phase. Participants in all three groups tied a necktie onto themselves during the transfer phase. Dependent variables were movement time, movement units, and the quality of the necktie knot. Results. No difference in the rate of performance change was found during the acquisition phase between the CR and NCR groups. The difference among the CR, NCR, and control groups’ initial transfer phase performance was near significance for movement time and movement units. A significant difference in the rate of performance change was found among the three groups in movement time and movement units during the transfer phase but not in the quality of necktie knot measures. Conclusion. The degree of similarity during the acquisition of a dressing skill may influence the rate of performance improvement in a similar dressing skill during a transfer phase. Until further research has been established, generalization of these results to special populations should be done conservatively.

Objective. Cross-transfer effects were investigated during an occupationally embedded task that involved learning a fine motor skill. Cross-transfer is a phenomenon that occurs when an untrained limb receives some of the same benefits in performance from unilateral training that the contralateral limb received. It was hypothesized that cross-transfer would occur after a unilateral training regime using an occupationally embedded task. Method. Forty-eight participants (mean age = 24.4 years) volunteered for this repeated-measures study. Participants were randomly assigned to a training or control group and were asked to complete a toy maze with their right and left hands for the pretest and posttest. Whereas participants in the control group did not train, participants in the training group completed a toy maze three times a day for 7 days with their left hands. All participants returned in 1 week to complete the posttest portion of the experiment. Dependent variables included movement time, movement units, force oscillations, and average force. Results. Significant decreases in movement time and force oscillations were found for the untrained limbs (p < .0125) in the training group. No significant differences were found in movement units or average force. The improved movement time and force oscillations in the untrained limb provides evidence suggesting that cross-transfer occurred. Conclusion. This study indicates that with a population without impairments, cross-transfer can occur during an occupationally embedded task. This phenomenon may prove useful to the field of occupational therapy to rehabilitate immobilized extremities. Further research is needed to test this phenomenon with special populations.

Objective. A major concern of occupational therapy is the identification of context characteristics that optimize performance. The purpose of this study was to examine the effect of context on skill acquisition and transfer. Method. Forty college students without disabilities (12 men, 28 women) were randomly assigned to the task of learning to use chopsticks in either a natural or a simulated context. Each participant practiced 60 trials in an acquisition phase on 1 day and was tested on a transfer task 24 hr after the acquisition phase. Their performances in the acquisition and transfer phases were measured with the variables of success rate and reaching kinematics. Results. The natural context elicited significantly larger improvement of success rate in the acquisition phase and a significantly higher success rate in the transfer phase than the simulated context. No major difference was found in kinematic variables between the two contexts. Conclusion. These results suggested the use of natural contexts to facilitate the outcome of motor skill learning.

Objective. Numerous studies in the occupational therapy literature have investigated the effects of added-purpose (multidimensional, goal-oriented) occupation on performance. Motor learning research has demonstrated that factors that enhance performance measures do not necessarily enhance motor learning. This study examined the effects of both added-purpose and meaningful occupation on motor learning. Method. Twenty subjects (university students) were randomly assigned to either an added-purpose or rote exercise condition. After a skill acquisition phase, retention and transfer scores were obtained, and subjects were asked to rate the meaningfulness of the occupation on a visual analog scale. Results. A two-way analysis of variance indicated that only the added-purpose occupation resulted in significantly greater motor learning. Additionally, the added-purpose scores were not influenced by the level of meaning assigned to the occupation. Conclusion. This study is the first to demonstrate how added-purpose can enhance a more permanent aspect of performance: motor learning. Further research is necessary to determine whether occupations that both are meaningful and have added-purpose are the most effective in enhancing motor learning.

Objectives. Health care workers who have patient transfer duties are at risk for back injury. Transferring patients between beds and gurneys is a rigorous pulling task that requires back, leg, and arm strength. This study analyzed the efficiency of commercially available transfer devices, namely a patient roller, patient shifter, and draw sheet. Method. With the use of one or two force scales attached to each transfer device, the amount of force needed to transfer 15 participants, weighing from 101 lb to 240 lb, back and forth between a bed and a gurney was measured. Ten transfers per device per participant were performed. Results. The patient roller was superior to the patient shifter and draw sheet in reducing transfer forces. Additionally, gurney-to-bed transfers tended to be more demanding for all transfer devices and for heavier participants. Conclusions. The patient roller was the most efficient transfer device in moving participants compared with the draw sheet and patient shifter. Transfer forces can be estimated with the use of linear equations, with patient weight, direction of transfer and transfer device as the independent variables. These estimated forces can assist occupational therapists in the returning their injured health care coworkers to patient transfer duties. The results further indicated that high forces are required to transfer patients; therefore, patient-transfer personnel should obtain assistance when moving patients.

Objectives. A retrospective study was conducted to investigate differences in the functional outcome between patients with left cerebrovascular accident (left CVA) and right cerebrovascular accident (right CVA) in wheelchair transfer performance. It was hypothesized that the level of improvement in left CVA and right CVA groups of patients would not be the same, due to the different constellation of neurological impairments. Method. Data were obtained from the admission and discharge scores on the Functional Independence Measure of 100 male patients, 50 with left CVA and 50 with right CVA. Results. Both groups demonstrated a statistically significant improvement between admission and discharge for wheelchair to bed, wheelchair to toilet, and wheelchair to tub or shower transfer (p < .001). However, there were no statistically significant differences between the two groups at admission or discharge for any of the three transfer, even after statistical removal of the effects of age, number of days from onset at stroke to rehabilitation, and number of days in rehabilitation. Conclusion. The lack of difference between the groups at time of discharge may have obscured a difference in the rate of transfer learning during the course of rehabilitation.

Objectives. Treatment protocols derived from research literature can help therapists provide more rigorous treatment and more systematic assessment of client progress. Method. This study applied research findings about the influence of task, subject, and feedback parameters on adult performance with block designs to an occupational therapy treatment protocol for parquetry block assembly – an activity occupational therapists use to remediate constructional deficits. Task parameter research suggests that parquetry tasks can be graded according to the features of the design cards, with cards having all block boundaries drawn in being easier than those with some block boundaries omitted. Results. Subject parameter findings suggest that clients’ lesions and initial constructional competence can influence their approaches to parquetry tasks. Conclusion. Feedback parameter research suggests that a combination of perceptual and planning cues is most effective for parquetry tasks. Methods to help clients transfer constructional skills from parquetry to functional tasks are also discussed.

A two-part longitudinal study of occupational therapy patients at the University of Illinois was conducted to assess the quality of treatment they received. The first part measures psychosocial objectives and changes on 7 activities of daily living items achieved by 534 patients between admission and discharge. The second part, a follow-up study, measures the same factors between discharge and follow-up on 86 of these patients who met certain criteria. This follow-up study also included measurements of health and life satisfaction. Significant changes were shown toward independence on all activities of daily living items between admission and discharge. Only three items—dressing, toileting, and self-transfer—changed significantly between discharge and follow-up. Measurements of self-perception of health showed a positive relationship to life satisfaction. Implications for occupational therapy stressed that new methods of delivering service be considered.