Importance: Motor vehicle accidents are the leading cause of unintentional deaths of children ages 1 and older, particularly children with health care needs. Objective: To explore family caregivers’ experiences and current practices while transporting children diagnosed with autism spectrum disorder (ASD). Design: A concurrent nested mixed-methods approach was used to gain insight into caregiver experiences. Setting: Participants completed an online Qualtrics survey. Participants: A convenience sample of 54 caregivers of children with ASD from 17 U.S. states. Results: Themes that emerged include sensory behaviors of children, education related to child passenger safety, and participation in the community. Statistically significant findings suggest a correlation between caregivers (n = 39) being less likely to participate in activities away from home if the child had attempted to elope (p = .013), displayed aggressive behaviors (p = .005), or demonstrated self-injurious behaviors (p = .001). Conclusions and Relevance: The findings suggest a correlation between caregivers limiting the distance traveled during vehicular transportation and behavioral safety concerns. If caregivers must limit travel, they may refrain from accessing the community and engaging in leisure pursuits. What This Article Adds: The findings suggest that therapists who treat children with ASD should be familiar with child passenger safety restraints, particularly for elopement.

Importance: Informal caregivers often receive limited training and support, especially in providing assistance with toileting, a physically and emotionally demanding activity of daily living. This increases caregivers’ risk for physical injury and burnout and jeopardizes older adults’ ability to age in place. Objective: To assess the feasibility, acceptability, and preliminary efficacy of a toileting intervention using an automated bidet to reduce the amount of physical assistance required from caregivers. Design: Randomized wait-list control feasibility study. Setting: Caregiver’s home. Participants: Ten informal caregivers. Intervention: An occupational therapy intervention to educate and train caregiving dyads to use an automated bidet system. Outcomes and Measures: Feasibility was measured in terms of recruitment and retention, bidet installation, ability to operate the bidet, acceptability (a process evaluation), preliminary efficacy (physical barriers and impact on caregiver outcomes of performance, satisfaction, and self-efficacy), and adverse events. Results: All bidets were installed successfully. All caregivers reported that the intervention made toileting easier and increased their confidence. Physical barriers decreased for the treatment group. The bidet had a large effect on self-efficacy for the treatment group. Conclusions and Relevance: The results suggest that the automated bidet intervention is feasible and acceptable and can have a positive impact on caregiver outcomes when assisting with toileting. What This Article Adds: A toileting intervention using an automated bidet is feasible and acceptable for caregivers of older adults and can reduce the amount of physical assistance required from caregivers.

OBJECTIVE. We sought to understand how functional status, impairment level, and use of assistive devices change over 3 years for older adults with depressive symptoms. We further explored factors that predict change in severity of depressive symptoms. METHOD. This study used data from the Rehabilitation Engineering Research Center on Aging Consumer Assessment Study, a longitudinal study of coping strategies of elders with disabilities. Seventy-three participants with depressive symptoms were interviewed at baseline and 3 years later. RESULTS. During 3 years, participants experienced increased physical disability (p = .001), a decline in severity of depressive symptoms (p = .03), and an increase in the total number of assistive devices owned. CONCLUSION. A significant number of older adults will experience a decrease in depressive symptoms over 3 years, despite an increase in physical disability. They also will obtain more assistive devices as they age.

OBJECTIVE. Cognitive impairment is a common symptom for people with multiple sclerosis (MS). This study evaluated the effects of an occupational therapy training protocol using personal digital assistants (PDAs) as assistive technology for people with cognitive impairment related to MS. METHODS. Twenty participants were trained to use PDAs by an occupational therapist. Assessments of functional performance were taken at the start of an 8-week pretreatment period, at the beginning and end of training, and 8 weeks after the conclusion of training. RESULTS. Participants demonstrated the ability to learn how to use basic PDA functions and retain learning for at least 8 weeks. Functional performance increased significantly with PDA use, and this gain was maintained at 8-week follow-up. CONCLUSION. This study provides evidence of an association between an intervention providing training in the use of a PDA and improvements in the everyday function of people with cognitive impairment related to MS.

OBJECTIVE. This article describes the effect of a robotic device combined with repetitive-task practice (RTP) on upper-extremity function in a patient with chronic stroke. METHOD. The client was a 32-year-old woman, 11 months after stroke, with minimal wrist and finger movement. She received approximately 48 hr of intervention split evenly between a robotic device (Hand Mentor) and RTP during 3 weeks. RESULTS. Favorable scores in the Wolf Motor Function Test were observed from pre-to postevaluation. Active range of motion, from pre-to postintervention, increased by 35° in the shoulder, 65° in the wrist, and 70° in the thumb. Kinetic analysis of a bimanual dexterity task indicated improved specification of grasping forces for both limbs. CONCLUSION. Improvements in upper-extremity motor functioning and functional performance in daily tasks followed this client's engagement in distal initiation of movement during an RTP exercise regimen that was robotically reinforced.

People with multiple physical impairments are not capable of using proper pointer devices, thus diminishing their opportunities to communicate and learn through computers. This research design used a replicated single-case experimental approach to compare the individual performance of two students with speech impairments and quadriplegic athetoid cerebral palsy in using four different computer-access solutions (the CameraMouse, the ASL Head Array mouse emulator, the CrossScanner, and the Quick Glance Eye Tracking System). The results demonstrate statistical significance in the correlation of movement time and accuracy to the level of comfort and satisfaction, which was used to guide the selection of computer-access solutions for clinical interventions. The WinFitts and Assessment of Comfort tests used in this study can be replicated for further clinical research into computer-access systems.

The training of providers working with children who need assistive technology devices or services has not kept pace with the explosion of new, more sophisticated assistive technology devices now available. This article reports on a national survey of 272 pediatric occupational therapists, who responded to questions about their training needs in the area of assistive technology and delivering assistive technology services. A sizable percentage of these therapists reported less-than-adequate training in policies governing assistive technology services and the organization and function of the service system. The therapists would like training that is accessible and affordable in the areas of funding of technology and services; collaborating with families and other service providers; and accessing reliable, knowledgeable vendors. These findings underscore the need to develop pre-service and in-service training in assistive technology for providers who work with children who have disabilities.

In 1995, seven men from Iraq had their right hands surgically amputated under the regime of Saddam Hussein. The men have lived with the shame, that is associated with missing a right hand in their culture, since that time. Recently, the media and a team of health care providers collaborated to bring these seven men to Houston, Texas, for surgical revisions, prosthetic hands, and occupational therapy services. The preprosthetic, interim-prosthetic, and postprosthetic interventions are discussed, as well as the typical time frames for each. This case report outlines the time restrictions that were placed on the health care team and demonstrates the continuous collaborative approach between occupational therapists, prosthetists, and other health care professionals, which contributed to the initial successful outcomes for these men.

PURPOSE. To develop an understanding of family members’ reactions to the acquisition of power mobility by persons with multiple sclerosis (MS) from the perspectives of the end users and their family members. METHODS. Data were obtained through semistructured interviews with seven persons with MS using or considering power mobility and four of their family members. RESULTS. Three major themes emerged from the data. Recognizing the Need for Power Mobility resulted from the interaction between multiple sclerosis progression and the participants’ desired performance. Family decision making and communication, insurance funding and approval, and the physical and social environment were just some of the factors affecting the process of Deciding and Obtaining the Power Mobility. Using Power Mobility resulted in positive, negative, and neutral outcomes. CONCLUSIONS. This study uncovered an overall lack of resources and some issues within the family environment, such as communication and decision making, both of which can negatively impact the acquisition and use of power mobility for persons with MS. Understanding these challenges may assist occupational therapists to facilitate this transition with their clients.

Occupational therapists who work with young children routinely evaluate self-care and consider it an important domain of practice. Little is known about what children perceive is important self-care or what they experience as self-care within a school context. Without knowledge about children’s perspectives of self-care, occupational therapists cannot know whether or not they are targeting areas that are central to children’s needs. The purpose of this naturalistic study was to explore 6-year-old children’s perceptions of self-care in their school day. Participant observation and group interviewing were used to elicit descriptive information from 24 Grade One children, attending an elementary school located in Sydney, Australia. A fishing game, drawing activity, and excerpts from a videotape of their day at school were used as stimuli to explore how the children described and attributed meaning to their self-care occupations. Findings showed that children described self-care at school two ways. First, they named specific self-care tasks that mirrored adult views of self-care and represented culturally shared views of the concept of self-care across ages. Second, children described highly individual views about self-care that were derived from their own experience of doing self-care at school. These views seemed to be based on their personal perceptions of salient factors in operation at the time of self-care performance such as social and physical contexts, perceived skill, and expectations of others. The findings suggest that occupational therapy assessment and intervention for self-care include sensitivity to experiential differences between adult views of self-care and those of children. This sensitivity should include an attempt to understand children’s experiences of self-care in specific contexts such as school.

OBJECTIVES. Using a taxonomy of object play, this study describes methodological issues in using retrospective video analysis and computer-based coding as a research tool for early identification of autism. METHOD. Home videos of 32 infants with autism (n = 11), developmental delay (n = 10), and typical development (n = 11) were edited and analyzed for duration and highest level of object play in four hierarchical categories (exploratory, relational, functional, symbolic) using The Observer 3.0. RESULTS. The three groups had similar levels of engagement with objects, and no statistically significant differences in duration of exploratory play. Higher levels of play were rarely evident at 9–12 months, however, the highest level achieved (functional play) was apparent only in the typical group. CONCLUSION. This study provides the first naturalistic investigation of object play skills in infants with autism ages 9–12 months. It also demonstrates feasibility for using computer-based coding technology within the context of retrospective video analysis methods. Duration of exploratory play was not a discriminating feature of autism at this early age.

OBJECTIVE. The purpose of this study was to examine qualities of caregiver–child interactions during daily activities of healthy children born full-term and of children born prematurely and very low birth weight with and without white matter disorder. METHOD. Three groups of 12 caregiver–child dyads, representing three levels of child biological risk, were matched on birth history, maternal education, ethnicity, and child gender. Ten expert clinicians used videotapes to rate behaviors of caregivers and their 30-month-old children engaging in dressing and snack activities. Correlations between ratings of three qualities were examined: caregiver directiveness, caregiver engagement, and child engagement. RESULTS. There were no significant differences between groups for the average caregiver and child ratings. However, correlations between caregiver directiveness and caregiver engagement ranged across the three groups from greatest to least biological risk (i.e., r = .63, .35, –.67, respectively). In the full-term group, correlations between the caregiver qualities of directiveness and engagement and child engagement were r = .62 and –.69, respectively. In contrast, the correlations between the caregiver and child qualities were small in the two very-low-birth-weight groups. CONCLUSION. Results suggest patterns of caregiver interactions during daily activities may vary according to the child’s level of biological risk. Caregivers of children with the greatest risk (i.e., white matter disorder) were both engaging and directive of their children during the activities, whereas caregivers of full-term children were less engaging when directive. The findings suggest that caregivers may be adjusting the level of their social and emotional assistance during caregiver–child interactions to the level of their children’s abilities.

OBJECTIVE. The purpose of this study was to explore current conceptualizations of clinical reasoning in occupational therapy. METHOD. Using a head-mounted video camera and debriefing interviews following therapy sessions, clinical reasoning data were collected from 13 experienced occupational therapists working in physical rehabilitation. The data were collected and analyzed within a focused ethnographic framework. FINDINGS. Mattingly and Fleming's (1994) classification of clinical reasoning encompassed most of the thinking processes revealed in the therapists’ debriefing interviews. Therapists also used aspects of pragmatic reasoning (Schell & Cervero, 1993). Additionally, within the forms of procedural, interactive, conditional, and pragmatic reasoning, a new form of “generalization reasoning” is proposed in which therapists draw on past experience or knowledge to assist them in making sense of a current situation or client circumstance. CONCLUSION. This research builds upon previous classification systems to support the categories of narrative, procedural, interactive, conditional, pragmatic (practice context), and generalization reasoning to explain how occupational therapists think in action. Further research is required to explore this emerging description of clinical reasoning.

OBJECTIVE. Student academic performance (grades) has traditionally shown a weak correlation with clinical performance (supervisor ratings). A computer-based interactive video client evaluation program was created to determine whether the decision making of occupational therapy students on a client simulation explained variability in fieldwork supervisor ratings not accounted for by grades. METHOD. Two student cohorts (N = 43; N = 30) selected evaluation procedures for a client with a cerebrovascular accident from on-screen menus and recorded and interpreted client responses as shown on videodisc. Multiple regressions were calculated in which grades and simulation scores were used to predict fieldwork supervisor ratings. RESULTS. In cohort 1, grade in a physical disabilities course predicted 31% of the variance in supervisor ratings, whereas the simulation score for “completeness” accounted for an additional 12%, F(2, 39) = 16.75, p < .0001, adjusted R ² = .434. Students with better grades received higher ratings, whereas students who evaluated the simulated client less exhaustively received higher ratings. For cohort 2, fieldwork ratings were best predicted by a combination of several simulation efficiency scores (number of correct answers given per unit time), F(4, 21) = 6.17, p < .002, adjusted R ² = .453. Mostly, higher efficiency scores were associated with higher supervisor ratings. CONCLUSION. Video simulations of client encounters may measure decision-making skills not measured by grades, in particular, making correct decisions in a timely manner within a realistic context.

The ability to effectively communicate thoughts, feelings, and identity to others is an important aspect of occupational performance. The symptoms of Parkinson’s disease can impair a person’s ability to verbally and non-verbally communicate with others. In order to better understand issues of communication functioning for this population, research tools to describe expressive and communicative behavior during occupation and social interaction are needed. In this study, six persons with Parkinson’s disease participated in individual, videotaped interviews focused on problem solving during daily activities. Three trained graduate students viewed edited clips from the videotapes and completed a rating scale of expressive behavior designed by the authors. Data support the reliability and construct validity of the behavioral rating scale, suggesting that measures of expressive behavior of persons with Parkinson’s disease can be effectively derived using short segments of videotaped activity.