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.

This case report examines the role of occupational therapy in the recovery of a client who became critically ill with severe acute respiratory syndrome coronavirus 2. In it, we describe evaluation and treatment methods, functional impairments, and special considerations when working with a client with severe coronavirus disease 2019 infection. The client was a 43-yr-old Hispanic man treated in a long-term acute-care hospital. Client-centered treatment sessions focused on activities of daily living (ADLs), self-feeding, medication management, and leisure and were implemented in 30- to 45-min sessions 3 times per week for 5 wk. The Activity Measure for Post Acute Care Daily Activities Short Form was used to measure basic mobility, daily activities, and applied cognition in the acute setting. A manual dynamometer was used to measure grip strength, and the Nine-Hole Peg Test was used to measure digit dexterity. Both were used in the context of occupational engagement. Data were collected at evaluation, every 2 wk, and at discharge. The client achieved his goals and demonstrated marked improvement in independence with basic ADLs, leisure activities, bilateral grip strength, and manual dexterity.

This special issue of the American Journal of Occupational Therapy highlights the contribution of occupational therapy practitioners to the care of clients during the coronavirus disease 2019 (COVID-19) pandemic. The case studies and articles exemplify the resilience of practitioners and the importance of occupational therapy interventions in addressing the physical, cognitive, psychological, and social needs of clients, their families, and care providers. We encourage practitioners to be inventive, to be collaborative, and to contribute to research regarding the benefits of occupational therapy for this population.

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.

This case report describes occupational therapy services provided in consultation with a primary care practice for a community-dwelling older adult dyad with mild coronavirus disease 2019. The occupational therapy evaluation included administration of the Canadian Occupational Performance Measure through telehealth to identify priority areas for intervention; the clients selected participation during activities of daily living and mealtime, fall prevention, cooking together, and leisure participation. The intervention process focused on addressing the dyad’s identified priorities as well as managing caregiver stress and preventing hospitalization. Positive outcomes were achieved while adhering to social distancing guidelines set forth by state and national agencies.

Prolonged symptoms from the novel coronavirus disease 2019 (COVID-19), otherwise known as long COVID, postacute sequelae of COVID-19 (PASC), or post-COVID syndrome, are affecting an increasingly high number of patients after severe, moderate, and mild acute COVID-19 infections. Using evidence-based practice strategies, this case report describes occupational therapy evaluation and treatment approaches, plan of care, and associated outcomes for one client experiencing long COVID symptoms in the outpatient setting.

The neurodiversity movement presents a significant opportunity for occupational therapy practitioners to meet the needs of neurodivergent people across the life course The term neurodiverse includes autistic people and people with intellectual disabilities, attention deficit hyperactivity disorder, obsessive–compulsive disorder, and several other mental health conditions. Research shows that neurodivergent people continue to need occupational therapy beyond the end of high school, when most supports and services end for them. Despite research showing that the needs of neurodiverse populations continue throughout the life course, research also shows that services for this population seem to taper as they progress through the public school system. The studies in this issue add to the body of literature supporting the role of occupational therapy practitioners in meeting the needs of neurodiverse people for services and supports through all stages of life.

Importance: Parents play an essential role in the transition to adulthood for autistic youth, yet often feel they do not have adequate training and resources. Objective: To evaluate data on the preliminary efficacy of and collect participant feedback about the Maximizing Adolescent Post-Secondary Success (MAPSS) intervention. Design: Single-group, pretest–posttest pilot study. Setting: Clinic. Participants: Twenty-two families of autistic youth (ages 13–19 yr, 72.7% male). Intervention: MAPSS is a group intervention for parent–youth dyads that is designed to guide parents in facilitating the development of independent skills for adulthood. Outcomes and Measures: Measures included the Transition Preparation Activities Measure (T-PAM), Family Empowerment Scale (FES), 10-item Perceived Stress Scale (PSS–10), Adulthood Expectations Questionnaire (AEQ), Adaptive Behavior Assessment System–Third Edition (ABAS–3), and a study-specific participant feedback survey. Results: Frequency of transition preparation activities (T-PAM) significantly increased from before to after the intervention, and although the frequency of preparation activities decreased by 1-mo follow-up, it remained significantly higher than at baseline. Parent self-efficacy (FES), parent expectations (AEQ), and parent sense of control over outcomes (AEQ) also significantly increased from preintervention to follow-up; however, parent coping (PSS–10) was unchanged. Youth self-care skills (ABAS–3) demonstrated improvements 6 mo after the completion of the intervention, although other areas of adaptive behavior did not significantly change. Feedback from parents suggested they had positive experiences and felt the intervention was beneficial. Conclusions and Relevance: Our data suggest that the MAPSS intervention is an appropriate candidate for larger, controlled clinical trials. What This Article Adds: With additional evidence, this intervention can offer guidelines for occupational therapists to work with autistic youth and their parents to prepare for adulthood.

Importance: Occupational therapy practitioners use a range of habilitative and compensatory approaches to teach new skills or modify tasks and environments to address occupational performance among adults with intellectual disability (ID); therefore, they must identify and use available evidence to guide intervention planning. Objective: To summarize the scope of evidence that can inform occupational therapy intervention with adults with primary or comorbid ID. Data Sources: Articles published in peer-reviewed journals between January 2002 and January 2018 and indexed in PubMed, CINAHL, PsycINFO, and Scopus. Study Selection and Data Collection: A total of 159 articles met inclusion criteria and contained information on occupational therapy intervention with adults ages 18 yr or older with primary or coexisting ID. Findings: Fifty-seven of the 159 articles focused on intervention to address occupational performance outcomes (i.e., employment, self-care, leisure and social interaction, community participation). Conclusions and Relevance: A wide range of literature is available to support occupational therapy intervention with adults with ID. Occupational therapy practitioners may be less knowledgeable about this evidence because much of it is located in non–occupational therapy or international journals. What This Article Adds: This scoping review provides occupational therapy practitioners with evidence to support high-quality occupational therapy intervention with adults with ID.

Importance: Understanding occupational therapy practice patterns for adolescents who have autism spectrum disorder (ASD) provides a baseline to determine areas of need and effective interventions. Objective: To identify puberty-related challenges addressed and interventions used by occupational therapy practitioners with adolescents ages 8–16 yr with ASD. Design: A nonexperimental survey design with a stratified random sample was used. Setting: The Occupational Therapy–Autism and Puberty Survey was distributed in the United States online through the Qualtrics platform (available October 2017–January 2018). Participants: Occupational therapists (89%) or occupational therapy assistants with experience with adolescents who have ASD were included. The 71 eligible respondents were primarily White women with an average 16 yr of experience. Outcomes and Measures: Nine key challenges and 11 interventions regarding puberty and ASD were identified. Hypotheses were generated before data collection. Results: More practitioners (>47%) addressed emotional regulation and personal hygiene, and fewer (<26%) addressed menstruation, safety, and masturbation. Nearly all practitioners (>92%) reported using social learning approaches and behavioral strategies, and most (>80%) reporting having received education in these interventions. Significant differences were found between reported education and use of behavioral skills training incorporating applied behavioral analysis (p < .001), parent training (p = .002), and technology (p = .003). Conclusions and Relevance: Practitioners are neglecting to address puberty-specific challenges with adolescents who have ASD. Opportunities exist to expand the interventions used and challenges addressed by occupational therapy practitioners for adolescents with ASD. What This Article Adds: This article expands occupational therapy literature by giving a baseline understanding of the puberty-related challenges that practitioners are addressing with adolescents who have ASD. This information can assist the profession in developing effective interventions and educational opportunities to allow practitioners to successfully address puberty-specific challenges.

Importance: Occupational therapy practitioners should use evidence-based practices, such as video modeling, to address work occupations supporting people with autism spectrum disorder, including those with co-occurring intellectual and developmental disabilities. Objective: To examine the evidence and relevance of video modeling supporting engagement in work occupations for people with autism and to translate these findings to occupational therapy practice. Data Sources: Cochrane Collection Plus, CINAHL, PubMed, ERIC, ProQuest, and peer-reviewed occupational therapy literature from 2008 to 2018. Study Selection and Data Collection: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study selection and data collection focused on occupational therapy scope of practice, autism spectrum disorder, co-occurring intellectual and developmental disabilities, video modeling, and work occupations for people age 16 yr and older. Findings: A total of 464 articles were screened. Six articles met inclusion criteria. Results indicated moderate evidence for video modeling to support work occupations for people with autism, specifically employment seeking and acquisition and specific job-performance skills. Samples were limited to people younger than age 28 yr and represented varied intellectual abilities, indicating potential for benefits across the spectrum of cognitive functioning. Conclusions and Relevance: This systematic review highlights the promising potential of video modeling to address work occupations for people with autism. However, more rigorous effectiveness research is needed, including studies by occupational therapy practitioners. What This Article Adds: Occupational therapy expertise paired with video modeling, as a strengths-based, client-centered, customizable, socially acceptable intervention, can provide meaningful support for work occupations.

Importance: The occupational goal intervention (OGI) method has been proven effective in improving executive function (EF) in people with schizophrenia, but it has not yet been tested with those with treatment-resistant schizophrenia (TRS). Objective: To test the efficacy of the OGI in people with TRS. Design: Single-blind randomized controlled trial. Setting: The Schizophrenia Program, Institute of Psychiatry, University of São Paulo General Hospital, Brazil. Participants: People with TRS according to Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria, ages 18 to 55. Outcomes and Measures: Primary outcome: improvement in EF as measured by the Behavioural Assessment of the Dysexecutive Syndrome (BADS). Secondary outcomes: improvement of functionality, as measured by the Direct Assessment of Functional Status–Revised (DAFS–BR), and improvement in autonomy in activities of daily living (ADLs), as measured by the Independent Living Skills Survey (ILSS–BR), administered to caregivers. The outcomes were measured at baseline, posttreatment, and follow-up. Intervention: Participants were divided into two groups: OGI and craft activities (control). Each group participated in 30 sessions during 15 wk, with follow-up at 6 mo postintervention. Results: The OGI group improved significantly compared with the control group, with medium to large effect sizes in posttreatment scores on the BADS and DAFS–BR. The ILSS–BR showed the highest effect sizes at posttreatment and follow-up. Conclusions and Relevance: The OGI method is effective for improving EF, occupational performance and ADLs in people with TRS. What This Article Adds: The OGI method is an important therapeutic tool for use in the occupational therapy clinic.

Importance: Quality of life (QoL) is a core outcome of occupational therapy, but it is decreased among autistic adolescents and adults. This is the first review of QoL from an occupational therapy standpoint. Objective: To identify self-reported QoL differences between autistic and nonautistic samples; investigate sex differences in QoL among autistic people; examine consistency in QoL among autistic people across age, intellectual disability (ID), and self- versus proxy-report method; and appraise occupational therapy–related interventions addressing QoL among autistic people. Data Sources: Articles published in peer-reviewed journals between 2010 and 2020, located through Academic Search Ultimate, PubMed, and OTseeker, along with the American Journal of Occupational Therapy, British Journal of Occupational Therapy, Canadian Journal of Occupational Therapy, and Australian Occupational Therapy Journal. Study Selection and Data Collection: Article samples consisted of at least 20% autistic females and used self-reported QoL measures. Qualitative research was excluded, as well as studies with participants younger than age 13 yr. Twenty-seven articles qualified (3 Level 1B, 13 Level 3B, and 11 Level 4). Findings: Autistic adolescents and adults demonstrated decreased self-reported QoL compared with nonautistic peers across age and ID presence. One article compared sex differences in QoL among autistic people. Interventions improved QoL among autistic people. Conclusions and Relevance: Autistic adolescents and adults demonstrate decreased QoL in comparison with nonautistic peers. Questions remain related to sex differences in QoL among autistic people, an area for future research. Multiple evidence-based approaches to improve QoL in the autistic population are relevant to occupational therapy practice. What This Article Adds: Self-reported QoL among autistic adolescents and adults is clearly lower than among their nonautistic counterparts. This article provides information on multiple interventions related to occupational therapy to improve QoL among autistic people.

Importance: Occupational therapy practitioners use structured assessment tools to gather information from adults with intellectual disability (ID) in order to develop the occupational profile, guide occupational therapy intervention, and assess change over time. Objective: To identify occupational therapy–related tools in the peer-reviewed literature for use in practice with adults with ID. Data Sources: Peer-reviewed literature published between January 2002 and January 2018 included in CINAHL, PsycINFO, PubMed, and Scopus. Study Selection and Data Collection: The review included articles that had information on occupational therapy–related assessment with adults 18 yr or older who had primary or co-occurring ID. Findings: Fifty-eight articles identified 73 occupational therapy–related assessment tools. Conclusions and Relevance: This scoping review identified a broad range of assessment tools in the occupational therapy domain that are appropriate for adults with ID, some of which may be unfamiliar to occupational therapy practitioners. What This Article Adds: This scoping review provides occupational therapy practitioners with a summary of occupational therapy–related assessment tools for adults with ID and an assessment reference guide.

Importance: The number of adults with intellectual and developmental disabilities (IDD) seeking treatment in non–IDD-specific health care settings is growing. Little is known about how adults with IDD use health care services in specialty settings, including occupational therapy services. Objective: To describe adults with IDD in hospitals and identify differences in utilization patterns compared with patients without IDD. Design: Descriptive and correlational designs were used. Participants: Data were obtained from Vizient (Clinical Data Base/Resource Manager™), a national database of administrative discharge abstracts for adults admitted to hospitals for an orthopedic procedure. From this sample, subsamples of (1) patients diagnosed with IDD and (2) an age- and gender-matched sample of patients without IDD were identified. Results: The study cohort with IDD experienced longer lengths of stay, t(2821.5) = −14.2, p < .001; were more likely to have Medicare coverage, χ²(3, N = 8,472) = 1,170.38, p < .001; and were more commonly discharged to subacute or skilled nursing facilities, χ²(5, N = 8,472) = 1,033.60, p < .001. Differences in occupational therapy services were also noted. Conclusions and Relevance: Despite similarities in orthopedic procedures, participants with IDD had different use patterns than those without IDD. Differences may be attributed to varying client factors and contexts. The results also indicate that practitioners in non–IDD-specific settings should expect to encounter clients with IDD. Occupational therapy practitioners have an opportunity to be leaders in adapting treatment protocols and providing education to caregivers and health care providers on behalf of people with IDD. What This Article Adds: This article provides novel information about a population that is known to experience disparities in health outcomes. It offers a basis on which future research can build to improve health care delivery and occupational therapy interventions to improve outcomes.

Importance: People with intellectual and developmental disabilities (IDD) express a clear interest in intimate relationships but face many barriers to receiving sex education (SE) that would support their engagement in these relationships. Objective: To understand barriers to, the context of, and recommendations for SE for people with IDD. Design: Qualitative study design with interviews and focus groups with four key stakeholder groups. Data were analyzed using a constant comparative approach. Participants: Participants were 8 youths with IDD, 9 parents, 12 health care providers, and 8 educators. Results: Four barriers to SE were identified: (1) values and cultural issues, (2) parental attitudes toward their child’s sexuality, (3) a lack of organizational policies and standards, and (4) limited professional education or societal biases. These barriers contribute to a SE context primarily initiated by people with IDD or provided reactively. The participants recommended proactive, formal SE provided by multiple stakeholders throughout adulthood. Conclusions and Relevance: Stakeholders should advocate for policies, standards, and additional training for parents, educators, and health care providers to support SE for people with IDD throughout adulthood. What This Article Adds: Barriers to SE contribute to the current context in which SE is shared with people with IDD. Stakeholders can advocate for policies, standards, and training to overcome these barriers and support recommendations for proactive, formal SE provided by multiple stakeholders through adulthood.

Importance: In the transition to adulthood, driving supports independence. For autistic adolescents, training provided by specialized driving instructors, including occupational therapists, may establish fitness to drive and continued independence. Objective: To examine specialized driving instructors’ experiences providing behind-the-wheel instruction to autistic adolescents. Design: We recruited participants through purposive and snowball sampling of members of ADED, the Association for Driver Rehabilitation Specialists. Interviews investigated experiences providing instruction, autistic students’ strengths and challenges, strategies used, and recommendations to improve the learning-to-drive process. We coded transcripts using a directed content analysis approach. Setting: Telephone interviews. Participants: Specialized driving instructors (N = 17) trained as occupational therapists, driver rehabilitation specialists, or licensed driving instructors with recent experience providing behind-the-wheel training for autistic adolescents participated. Results: Behind-the-wheel challenges included mental inflexibility, distractibility, and difficulties with social cues and motor coordination. Instructors acknowledged students’ strengths, including adherence to rules of the road, limited risk taking, and careful observations. Instructors scaffolded learning to help students develop skills. Although licensure and driving outcomes were sometimes unknown to instructors, students who became licensed frequently drove with supervision or restrictions. Conclusions and Relevance: Licensure is possible for autistic adolescents, although developing fitness to drive requires individualization and rigorous specialized instruction, which may culminate in delayed or restricted driving. What This Article Adds: This article highlights challenges and strengths encountered by specialized driving instructors teaching autistic adolescents. Despite requiring prolonged training, autistic adolescents can achieve licensure when supported by specialized instruction that is individualized to their needs and strengths.

Importance: Occupational therapy practitioners should understand the barriers faced by young adults with intellectual and developmental disabilities (IDD) who are attempting a successful transition to postsecondary work, higher education, community and social activities, and living opportunities so they can better advocate for them and tailor their involvement in the transition process. Objective: To explore the lived experience of parents of adolescents with IDD participating in the transition process. Design: Phenomenological design. Setting: Community-based setting with interviews occurring face-to-face in the participants’ home or via telephone. Participants: Eleven parents of adolescents and young adults (ages 16–22 yr) with IDD. Outcomes and Measures: Semistructured interviews focusing on parent and family experiences with the transition process. Results: Seven themes emerged from the data representing parent perceptions related to the use or lack of person-centered practices, needing more communication from the team, frustration with being the driving force of progress, feelings of defeat, gaps between programming options, positive team collaboration, and planning for the future. Conclusions and Relevance: Parents identified person-centered planning, guidance from school staff, and resource sharing as desired practices in the transition planning process. The outcomes indicate that some aspects of the transition process have not changed in several decades. What This Article Adds: Occupational therapy practitioners are optimally positioned to remediate transition issues; therefore, it is essential that they assert their integral role in the transition planning process to increase self-determination and quality of life for all adolescents and young adults with IDD.

Importance: Practitioners seek evidence from intervention effectiveness studies to provide best-practice services for children. Objective: To examine the effectiveness of occupation- and activity-based interventions to improve instrumental activities of daily living (IADLs) and sleep outcomes for children and youth ages 5–21 yr. Data Sources: MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane Database of Systematic Reviews. Study Selection and Data Collection: The American Occupational Therapy Association research methodologist conducted the first review of literature published from 2000 to 2017. The results were exported, and we completed the subsequent stages of review. Only peer-reviewed Level I, II, and III evidence was reviewed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane risk-of-bias guidelines were used to compile evidence and risk-of-bias tables. Findings: We reviewed 96 articles; 28 studies met the inclusion criteria for IADL and rest–sleep outcomes. Analysis resulted in several themes: rest–sleep, health management (nutrition–dietary, physical activity–fitness, wellness), and the IADLs of driving, communication management, and safety. Strong evidence exists for interventions embedded in school programming to improve physical activity and fitness and for sleep preparation activities to maximize quality of rest and sleep. Moderate-strength evidence exists for interactive education and skills training interventions to improve health routines, dietary behaviors, and IADL participation and performance. Conclusions and Relevance: Use of skills-focused training in activity- and occupation-based interventions was supported. Service provision in the context of natural environments, including school settings and with parental or caregiver participation, is recommended for children and youth ages 5–21 yr with varied abilities and diagnoses. What This Article Adds: Occupational therapy practitioners can confidently examine their current practices and choose activity- and occupation-based interventions and methods of service delivery that are supported by evidence.