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. This poster describes how the Medical Research Council’s process evaluation guidelines were applied in a clinical trial undertaken to evaluate a complex intervention designed to reduce falls among full-time wheelchair or scooter users with multiple sclerosis. Preliminary process evaluation findings relevant to implementation and mechanisms of impact based on postintervention survey and interview data from both participants and interventionists will be presented. Primary Author and Speaker: Toni Van Denend Additional Authors and Speakers: Elizabeth Walker Peterson, Laura Rice Contributing Authors: Jonghun Sung

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: Although an essential component of best practice, wheelchair skills training is often inadequate; occupational therapy practitioners’ professional preparation is a contributing factor. Objective: To assess the effectiveness of a boot camp on capacity and self-efficacy in wheelchair skills and self-efficacy in clinical practice, retention of improvements, and effective boot-camp attributes. Design: Concurrent, embedded, mixed-methods cohort design that used blinded, repeated-measures quantitative evaluation with 4-mo follow-up and directed content analysis of a qualitative questionnaire. Setting: University entry-to-practice program. Participants: Convenience sample (N = 42) of final-year students. Intervention: A 4-hr boot camp with demonstration and supervised practice. Content incorporated skill performance, training and motor-learning strategies, and safe supervision. Outcomes and Measures: Skill performance capacity (Wheelchair Skills Test–Questionnaire), self-efficacy with manual wheelchair use (Wheelchair Use Confidence Scale), confidence in provision of manual wheelchair training services (Self-Efficacy in Assessing, Training, and Spotting test), and a boot-camp experience questionnaire. Results: Within-subjects analysis of variance revealed significant improvements on all measures (p < .001) with large effect sizes (η_p² = .68–.88). All measures except skill capacity demonstrated retention; skill capacity decreased 5.3% (95% confidence interval [2.0, 8.5]) but was significantly higher than baseline. Three themes influenced practice confidence: knowledge acquisition, experiential learning, and client empathy. Conclusions and Relevance: Results confirm improved wheelchair self-efficacy, capacity, and self-efficacy with clinical intervention skills. Retention of outcomes suggests the potential impact on future practice. Experiential learning supports performance component acquisition and imparts empathy of client experience, which may improve occupational therapy practitioners’ perceptions of client potential. What This Article Adds: A 4-hr experiential boot camp can increase students’ capacity and confidence to deliver wheelchair skills training to future clients. Experiential learning increased students’ appreciation for clients’ experience and expectation of client potential.

Date Presented 04/04/19 This survey of patient members of an online health community who use power wheelchairs suggests that OTs may better meet patient functional and social needs during power wheelchair assessment by discussing power wheelchair features that are available but may not be covered by insurance, as well as recommendations for avoiding complications. While most respondents felt their medical needs were assessed, few patients felt their social needs are being discussed in assessments. Primary Author and Speaker: Sherry Xiao Additional Authors and Speakers: Helene Svahn, Karin Leire, Angela Regier Contributing Authors: Kristina Simacek, Paul Wicks, Elizabeth Lawler, Christopher Curran, Jamie Granskie

Date Presented 04/05/19 Primary Author and Speaker: Mary Hill Additional Authors and Speakers: Ben Salatin

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. Homelessness prematurely ages people. A large subgroup of formerly homeless adults between ages 40 and 64 yr have health conditions similar to or worse than people categorized as elderly. Little is known about the impact of this group’s chronic health conditions on their ability to safely function in supportive housing. METHOD. Home safety visits were carried out with 25 formerly homeless adults, ages 40–64 yr, now residing in supportive housing. RESULTS. Participants had physical, cognitive, and mental health problems that significantly interfered with their ability to perform daily life skills, safely function in an apartment, and manage chronic health conditions. Home safety hazards included cluttered walking paths, the presence of steps, and the lack of grab bars and nonskid flooring. CONCLUSION. The homeless population would benefit from aging specialists, such as occupational therapists, who could help people to maintain and function more safely in their homes. Without such services, this population may be at risk for home safety events leading to hospitalization and mortality.

Patients with Duchenne muscular dystrophy in their second decade of life present with decreased upper extremity strength and active range of motion (AROM) that limit activities of daily living (ADLs). We evaluated the ability of the Wilmington Robotic Exoskeleton (WREX) to improve AROM and independence with ADLs. A retrospective chart review of 9 patients who trialed the WREX was performed. Patients were classified on the basis of the Brooke Upper Extremity Scale. AROM, strength, and independence with ADLs were assessed before and after a WREX trial. Patients demonstrated increased shoulder flexion and abduction (25°–100°, median = 55°) and elbow flexion (10°–110°, median = 60°). Increased independence with self-feeding, item retrieval, use of phones and tablets, and facial grooming were noted. The WREX allowed for gravity-reduced movement via elastic bands to unweight the upper extremity, enabling increased upper extremity active movement that supported increased independence with ADLs.

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.

We describe the results of a systematic review of the literature on occupational therapy–related interventions for people with amyotrophic lateral sclerosis (ALS). The review included 14 studies. We found limited to moderate evidence that people involved in multidisciplinary programs have longer survival than those in general care and limited evidence that those in multidisciplinary programs have a higher percentage of appropriate assistive devices and higher quality of life in social functioning and mental health. Limited evidence indicates that people with ALS are satisfied with the comfort and ease of use of their power wheelchairs (PWCs). In addition, limited evidence is available that PWCs allow people to have increased interaction in the community. Evidence also is limited that some assistive devices are more helpful than others. Moderate evidence indicates that a home exercise program of daily stretching and resistance exercise results in improved function. The implications for practice, education, and research are discussed.

OBJECTIVE. This case study describes an occupational therapy intervention to increase the self-mobility and social participation of a nursing home resident with dementia using a power wheelchair equipped with a collision-prevention system. METHOD. We used an exploratory case study design. Data sources included the medical record, standardized assessments, interviews, observations of daily activities, and a driving log. RESULTS. During driving sessions, changes in affect such as smiling and attempts to socialize were noted. The resident required ongoing prompting to operate the modified power wheelchair. CONCLUSION. The resident was unable to achieve self-mobility with an intervention involving a modified power wheelchair. However, this study demonstrates that even supervised mobility can have a positive impact on affect and social participation. Observations from this study are being applied to the design and testing of the next generation of power wheelchairs intended for use by nursing home residents with dementia.

Assistive technology (AT) devices enable people with disabilities to function in multiple contexts and activities. The usability of such devices is fundamentally indicative of the user’s level of participation in multiple roles and occupations. Seventy people who used power wheelchairs were interviewed using a novel tool, the Usability Scale for Assistive Technology (USAT). The USAT uses a human factors science framework to investigate the wheelchair user’s perceived independence in mobility-related activities within home, workplace, community, and outdoors in accordance with the characteristics of the wheelchair, environmental factors, and abilities and skills of the user to operate the wheelchair. Descriptive analysis of the data revealed usability issues with the use of power wheelchairs in all contexts. Users confronted far more significant issues within the community and outdoor environment compared with those at home and in the workplace. These issues have been elucidated and applied to an intervention framework with relevance to a multitude of AT stakeholders.

OBJECTIVE. The primary aim of this pilot study was to develop a testing protocol for gathering shoulder muscle surface electromyography (EMG) data during a sustained submaximal isometric wheelchair-propulsion effort. Of special interest was analysis of the median frequency of the surface EMG signal power spectrum; a negative median frequency shift during a sustained effort is an indicator of muscle fatigue. The long-term goal is to improve our understanding of how fatigue and muscle imbalance might play a role in the development of a broad array of upper-extremity overuse syndromes. METHOD. Participants were a convenience sample of seven male manual-wheelchair users with spinal cord injury and 14 able-bodied males. Surface EMG in six right-side shoulder muscles was recorded while subjects resisted a static force equal to 60% of their maximum wheelchair-propulsion strength until fatigued. Percent of maximum voluntary contraction and the median frequency shift for each muscle were analyzed. RESULTS. The able-bodied group used a higher percent of maximum than the manual-wheelchair group (p < .05), and a more pronounced negative median frequency shift was evident in the able-bodied group (p < .10). CONCLUSION. Patterns that emerged suggest that spectral analysis of the surface electromyographhic signal has promise as a clinically useful tool to authenticate muscle fatigue in the upper extremities during occupational performance. Such data in the future could be used to justify the need for and benefits of adapted performance techniques and assistive technology.

The purpose of this qualitative study was to gain understanding of the lived experience of senior stroke survivors who used prescribed wheelchairs in their homes and communities. The study involved semistructured, in-depth interviews that were conducted with 10 participants, ages 70 to 80 years old, who had used a wheelchair for a mean of 5.6 years. A constant comparative inductive method of analysis was performed. Three different categories of acceptance of wheelchair use were identified; reluctant acceptance, grateful acceptance, and internal acceptance. Increased mobility, varied social response, and loss of some valued roles were common to all three wheelchair acceptance categories. Aspects of level of burden, freedom, and spontaneity varied in degree among the three acceptance categories. As the wheelchair provided opportunity for increased continuity in the lives of these stroke survivors, it appeared to be accepted more fully and viewed more positively. Prestroke lifestyle and values need to be carefully considered in order to maximize acceptance of wheelchair use among senior stroke survivors.

Analysis of the case studies of two preschool children with profound cognitive disabilities indicates that training in a powered wheelchair can increase wakefulness and alertness, stimulate a limited use of the arms and hands, and promote the understanding of very simple cause-and-effect relationships. The enhanced activity level had a positive influence on the children’s ability to react to external stimuli and invitations to interact. These effects in turn promoted the development of initiative and exploratory behavior. Because of their profound cognitive disabilities, neither of the children was able to reach the normative training goal—to be able to drive purposefully and safely. In this paper the target group is defined according to criteria for the prescription of powered wheelchairs and the resulting new concept of “driving to learn” is described and discussed from different aspects.

This paper examines the experiences of mothers who are wheelchair users in their roles of homemaking and parenting. A qualitative study using in-depth, focused interviews was conducted with a purposeful sample of 11 women with various physical disabilities. Three major themes were uncovered in the data: (a) lived space restricting personal autonomy, (b) advocacy strategies to secure appropriate housing, and (c) my wheelchair, my liberator, my sense of comfort. Findings from this study showed that women did not have the freedom or economic resources to seek out new living arrangements or make modifications to existing environments. Lack of space, stairs, difficult-to-reach spaces, poor transportation, and limited community access were barriers that women experienced. The study also points to the importance of recognizing that the women used many strategies to regain control over aspects of their environment to enable greater autonomy and participation for themselves. Sensitivity to the meaning of home and the relationship between the body and the environmental features that surround it may be a significant contribution of the clinician as he or she seeks to assist women wheelchair users.

This case report summarizes the evaluation and treatment used to provide occupational therapy services to a man living with multiple sclerosis. Primary impairments included ataxia, paraparesis, and decreased endurance. The focus of this case study was on improving the client’s ability to use powered mobility to access the community despite severe ataxia. A task-oriented approach was used as a frame of reference to guide the evaluation and intervention process. The primary goals of intervention were to control the degrees of freedom required for task participation and simultaneously increase postural stability, resulting in independent control of a power wheelchair. A combination of occupational therapy interventions is illustrated, including assistive technology, positioning, orthotic prescription, and adaptation of movement patterns.

Objective. The purpose of this study was to establish test–retest reliability values for the newly designed grip and wrist attachments of the BTE Primus^® and to determine criterion-related validity of the new grip attachment against the Jamar dynamometer. An additional purpose was to explore the differences in grip and wrist flexion strength between wheelchair users and control participants without disabilities and to examine the effect of body position on strength in persons without disabilities. Method. Wheelchair users and matched controls (13 per group) were tested for grip and wrist flexion strength on the BTE Primus and for grip on the Jamar dynamometer. Results. The BTE Primus grip attachment was found to be valid and reliable. No significant differences were found in static and dynamic grip or wrist flexion strength between the two groups or in the sitting versus standing position for the control group. Conclusion. The findings suggest that the BTE Primus may be used to assess grip and wrist flexion strength validly and reliably for both wheelchair users and persons without disabilities.