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Development, refinement, and testing of occupational therapy interventions require a systematic approach. The authors explain the four phases for clinical trials used in pharmaceutical research and apply them to the development and testing of occupational therapy interventions. The challenges faced by occupational therapy researchers in designing clinical trials include difficulties in specifying the intervention, blinding subjects, therapists, and evaluators, and identifying objective but client-centered measures of primary outcomes. Examples are provided of researchers who have developed and tested occupational therapy interventions in phases. [ABSTRACT FROM AUTHOR]

The project was a master's level graduate program that prepares occupational therapists, physical therapists, speech and language pathologists, nurses and special educators for early intervention practice. The purpose of this descriptive report is to explain the conceptual framework for the graduate program and to identify themes in students' learning from the portion of the program focused on professional-family relationships-the family practicum. In the family practicum, each student spent 50 hours over 6 months with one family who had a young child with significant disabilities. The students wrote reflective journals during the practicum that revealed how they interpreted their experiences for application to their own practices. Through qualitative analysis of the students' journals, four themes emerged: (1) Acknowledge that parenting a child with a disability is a 24/7 job; (2) Recognize that internal and external resources are essential to family adaptation; (3) Respect parents as the experts on their child; and (4) Accept the family's values. These themes were validated by the families' evaluation of the practicum and provide evidence that students grew in their appreciation of and competence in relationship-centered early intervention. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of this study is to assess whether recent graduates of the Ohio State University's Occupational Therapy division are applying information-seeking skills they learned as undergraduates, and to seek their advice on ways to improve information-literacy instruction for current and future occupational therapy students. METHOD: A survey was sent to a sample of graduates from 1995-2000. The results were entered into an SPSS database, and descriptive and inferential results were calculated to determine the information-seeking patterns of these recent graduates. RESULTS: A majority of the occupational therapy graduates who responded to the survey prefer to use information resources that are readily available to them, such as advice from their colleagues or supervisors (79%) and the Internet (69%), rather than the evidence available in the journal literature. Twenty-six percent (26%) of the graduates have searched MEDLINE or CINAHL at least once since they graduated. Formal library instruction sessions were considered useful by 42% of the graduates, and 22% of the graduates found informal contacts with librarians to be useful. CONCLUSIONS: Librarians and occupational therapy faculty must intensify their efforts to convey the importance of applying research information to patient care and inform students of ways to access this information after they graduate. In addition to teaching searching skills for MEDLINE and CINAHL, they must provide instruction on how to assess the quality of information they find on the Internet. Other findings suggest that occupational therapy practitioners need access to information systems in the clinical setting that synthesize the research in a way that is readily applicable to patient-care issues. [ABSTRACT FROM AUTHOR]

Feeding is multi-sensory, highly stimulating experience for infants and young children. Feeding interactions with children who have oral sensory processing deficits may be therapeutic and pleasurable or may be stressful and disorganizing. Specific oral motor and feeding problems in hyposensitive/hypotonic children and hypersensitive/hypertonic children are described. Occupational therapy intervention that emphasizes sensory stimulation related to the environment, handling before and during feeding, and the sensory qualities of food is explained. [ABSTRACT FROM AUTHOR]

This study analyzed the differences in posture and fine motor control between at-risk preterm and full-term infants. On a qualitative measure with a sample of 65 full-term and 25 preterm infants, the full-term infants scored significantly higher in all aspects of posture and fine motor control than the preterm infants of the same adjusted ages. When the preterm infants were further categorized by number of medical risk factors, the postural differences existed only in preterm infants with high risk factors. All preterm infants (those with high and low risk factors) demonstrated less fine motor control when compared to full-term. These results have implications regarding the qualitative differences that may be observed in preterm infants during the first months of life. [ABSTRACT FROM AUTHOR]

Introduction: The Children with Hemiparesis Arm and Movement Project (CHAMP) addresses two pressing issues concerning paediatric constraint-induced movement therapy (CIMT): effects of two dosages and two types of constraint on functional outcomes. Systematic reviews conclude that CIMT is one of the most efficacious treatments, but wide variations in treatment protocols, outcome measures and patient characteristics have prevented conclusions about potential effects of dosage levels and constraint methods., Methods and Analysis: CHAMP is a multisite comparative efficacy randomised controlled trial of 135 children (2-8 years) with hemiparetic cerebral palsy. The 2×2 factorial design tests two dosage levels-60 hours (3.0 hours/day, 5 days/week × 4 weeks) and 30 hours (2.5 hours/day, 3 days/week × 4 weeks) and two constraint conditions-full-arm, full-time cast and part-time splint, plus usual and customary (UCT) controls, yielding five groups: (1) 60 hours CIMT+full-time cast, (2) 60 hours CIMT+part-time splint, (3) 30 hours CIMT+full-time cast, (4) 30 hours CIMT+part-time splint and (5) UCT. Trained therapists deliver the standardised ACQUIREc protocol for CIMT. Blinded assessments at baseline, end of treatment, and 6 and 12 months post treatment include the Assisting Hand Assessment, and subscales from the Peabody Developmental Motor Scales-2 and modified Quality of Upper Extremity Skills Test. Parents complete the Pediatric Motor Activity Log and Pediatric Evaluation of Disability Inventory. A new Fidelity of Implementation Rehabilitation Measure monitors treatment delivery. Data analyses involve repeated-measures multivariate analysis of co-variance controlling for selected baseline variables., Ethics and Dissemination: Ethics boards at site universities approved the study protocol. To promote equipoise, parents of UCT controls are offered ACQUIREc after 6 months. A Data Safety and Monitoring Committee reviews results regularly, including measures of child and family stress. We will disseminate CHAMP results via peer-reviewed publications and presentations to professional and advocacy organisations., Trial Registration Number: NCT01895660; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Selective eating is common in children with autism spectrum disorder (ASD), but it is not yet well understood. The objectives of this study were to examine a new definition of selective eating, compare behavioral measures between children with ASD and selective eating and those without selective eating, and determine relationships among behavioral measures and measures of selective eating. Participants were assigned to groups on the basis of number of foods eaten compared with a population-based sample. Results of one-way multivariate analysis of variance indicated no overall effect of group for challenging behaviors, sensory reactivity, or repetitive behaviors. Between-participant tests indicated that scores for compulsive behaviors were significantly lower (p = .036) for the selective eating group. Correlations were moderately strong among variables relating to food intake and behavioral variables, but were not significant between selective eating and behavioral variables. Further research is needed to validate the definition of selective eating and to identify targets for intervention., (Copyright © 2015 by the American Occupational Therapy Association, Inc.)

Children with autism spectrum disorders often exhibit co-occurring sensory processing problems and receive interventions that target self-regulation. In current practice, sensory interventions apply different theoretic constructs, focus on different goals, use a variety of sensory modalities, and involve markedly disparate procedures. Previous reviews examined the effects of sensory interventions without acknowledging these inconsistencies. This systematic review examined the research evidence (2000-2012) of two forms of sensory interventions, sensory integration therapy and sensory-based intervention, for children with autism spectrum disorders and concurrent sensory processing problems. A total of 19 studies were reviewed: 5 examined the effects of sensory integration therapy and 14 sensory-based intervention. The studies defined sensory integration therapies as clinic-based interventions that use sensory-rich, child-directed activities to improve a child's adaptive responses to sensory experiences. Two randomized controlled trials found positive effects for sensory integration therapy on child performance using Goal Attainment Scaling (effect sizes ranging from .72 to 1.62); other studies (Levels III-IV) found positive effects on reducing behaviors linked to sensory problems. Sensory-based interventions are characterized as classroom-based interventions that use single-sensory strategies, for example, weighted vests or therapy balls, to influence a child's state of arousal. Few positive effects were found in sensory-based intervention studies. Studies of sensory-based interventions suggest that they may not be effective; however, they did not follow recommended protocols or target sensory processing problems. Although small randomized controlled trials resulted in positive effects for sensory integration therapies, additional rigorous trials using manualized protocols for sensory integration therapy are needed to evaluate effects for children with autism spectrum disorders and sensory processing problems., (© The Author(s) 2014.)

This study examined the effectiveness of Write Start, a handwriting and writing program cotaught by teachers and occupational therapists for first-grade children. Four classrooms (n = 80) received the Write Start program, and four (n = 58) received standard handwriting and writing instruction. Two teachers and an occupational therapist implemented the 24-session manualized program, which included station teaching and individualized supports. The program emphasized practice in small groups in which the coteaching team provided students with frequent feedback, encouraged self-evaluation, and facilitated peer modeling and peer evaluation. Students who completed the Write Start program improved more in handwriting legibility and speed than the group receiving standard instruction. Writing fluency and written composition were no different between groups at posttest; however, writing fluency was significantly higher for Write Start students at 6-mo follow-up. Write Start students with low legibility at baseline made significant improvements, suggesting that the program may benefit students at risk for handwriting and writing problems., (Copyright © 2014 by the American Occupational Therapy Association, Inc.)

This article presents a rationale for the development of professional occupational therapy doctorate (OTD) programs. As more universities transition to the entry-level OTD degree, opportunities are becoming available to advance the profession and increase benefits to clients. We analyzed the current health care environment and developed the following proposed outcomes for doctoral-trained practitioners: (1) Demonstrate advanced clinical skills; (2) attain proficiency in outcomes measurement and analysis and synthesis of outcomes data; (3) routinely use standardized evidence-based practice clinical guidelines that translate research into practice; (4) develop, implement, and lead health promotion services; and (5) excel as partners in interprofessional teams., (Copyright © 2014 by the American Occupational Therapy Association, Inc.)

The evidence for Constraint-Induced Movement Therapy (CIMT) effectiveness for infants and toddlers with unilateral cerebral palsy is minimal. We performed a pilot study of CIMT using one-month usual care, one-month intervention, and one-month maintenance (return to usual care) phases on five infants (7- to 18-month old). For the CIMT phase, the infants received 2 hr of occupational therapy and 1 hr of parent-implemented home program for five days/week. The infants were casted for the first 23 days, and bimanual therapy was provided for the last three days. Fine motor skills for the more affected arm and gross motor skills improved significantly during the CIMT; these gains were maintained at one-month follow-up. Individual infant data show mixed effects. This pilot study provides initial evidence that CIMT is feasible for infants with unilateral cerebral palsy, and presents preliminary data for CIMT on fine and gross motor performance.

Our study examined the effects of Write Start, a classroom-embedded handwriting/writing program on handwriting and writing fluency for first grade students, co-taught by occupational therapists and teachers. Two first grade classrooms received the Write Start and two received standard handwriting instruction. This co-taught program included specific feedback during handwriting practice, small group activities, student self-evaluation, and peer supports. The students were evaluated on handwriting legibility, fluency, and written expression at baseline, immediately after the program, and 6 months later. When performance was compared between the two groups, the students in the Write Start program improved significantly more in legibility (d = .57) and fluency (d = .75) than students who received standard instruction. Gains in handwriting speed (d = .18), average legibility (d = .26), and written expression (d = .25) did not differ significantly between the two groups. A co-taught, inclusive handwriting/writing program can promote first grade students' achievement of lower case legibility and writing fluency.

This systematic review synthesized the research on interventions used by occupational therapy practitioners to promote social-emotional development in young children (birth-5 yr) with or at risk for disabilities. After a comprehensive search of the research literature, 23 studies were reviewed and then synthesized into five themes: (1) touch-based interventions to enhance calming and parent-infant bonding, (2) relationship-based interventions to promote positive caregiver-child interactions, (3) joint attention interventions, (4) naturalistic preschool interventions to promote peer-to-peer engagement, and (5) instruction-based interventions to teach children appropriate social behaviors. The interventions for infants primarily involved coaching parents in specific strategies to promote positive interactions; interventions for preschool-age children typically involved encouraging peer support, instructing children, and applying naturalistic behavioral techniques to develop higher-level social competence. The studies demonstrated low to moderate positive effects for interventions used by occupational therapy practitioners to improve social-emotional development across ages, diagnoses, and settings., (Copyright © 2013 by the American Occupational Therapy Association, Inc.)

We examined the research evidence for interventions used in occupational therapy to promote the motor performance of young children ages 0-5 yr. We identified 24 trials, Levels I-III, that met our review criteria. The studies fell into three categories: (1) developmental interventions for infants (ages 0-3 yr), (2) interventions for young children with or at risk for cerebral palsy (CP), and (3) visual-motor interventions for preschool children (ages 3-5 yr). Developmental interventions showed low positive short-term effects with limited evidence for long-term effects, and findings on the benefits of neurodevelopmental treatment were inconclusive. Interventions using specific protocols for children with CP resulted in positive effects. Visual-motor interventions for children with developmental delays (ages 3-5 yr) resulted in short-term effects on children's visual-motor performance. Of the intervention approaches used in occupational therapy, those that embed behavioral and learning principles appear to show positive effects., (Copyright © 2013 by the American Occupational Therapy Association, Inc.)

Significant data exist for the personal, environmental, and occupational risk factors for carpal tunnel syndrome. Few data, however, explain the interrelationship of tissue morphology to these factors among patients with clinical presentation of median nerve pathology. Therefore, our primary objective was to examine the relationship of various risk factors that may be predictive of subjective reports of symptoms or functional deficits accounting for median nerve morphology. Using diagnostic ultrasonography, we observed real-time median nerve morphology among 88 participants with varying reports of symptoms or functional limitations resulting from median nerve pathology. Body mass index, educational level, and nerve morphology were the primary predictive factors. Monitoring median nerve morphology with ultrasonography may provide valuable information for clinicians treating patients with symptoms of median nerve pathology. Sonographic measurements may be a useful clinical tool for improving treatment planning and provision, documenting patient status, or measuring clinical outcomes of prevention and rehabilitation interventions., (Copyright © 2013 by the American Occupational Therapy Association, Inc.)

Purpose: This systematic review examined the efficacy of hippotherapy or therapeutic horseback riding (THR) on motor outcomes in children with cerebral palsy (CP)., Methods: Databases were searched for clinical trials of hippotherapy or THR for children with CP., Results: Nine articles were included in this review. Although the current level of evidence is weak, our synthesis found that children with spastic CP, Gross Motor Function Classification System (GMFCS) levels I-III, aged 4 years and above are likely to have significant improvements on gross motor function as a result of hippotherapy and THR. Evidence indicates that 45-min sessions, once weekly for 8-10 weeks, result in significant effects., Conclusions: The current literature on hippotherapy and THR is limited. Large randomized controlled trials using specified protocols are needed to more conclusively determine the effects on children with CP. From the current evidence, it appears that hippotherapy and THR have positive effects on gross motor function in children with CP.

We examined the effects of a cotaught handwriting and writing program on first-grade students grouped by low, average, and high baseline legibility. The program's aim was to increase legibility, handwriting speed, writing fluency, and written expression in students with diverse learning needs. Thirty-six first-grade students in two classrooms participated in a 12-wk handwriting and writing program cotaught by teachers and an occupational therapist. Students were assessed at pretest, posttest, and 6-mo follow-up using the Evaluation Tool of Children's Handwriting-Manuscript (ETCH-M) and the Woodcock-Johnson Writing Fluency and Writing Samples tests. Students made large gains in ETCH-M legibility (η² = .74), speed (η²s = .52-.65), Writing Fluency (η² = .58), and Writing Samples (η² = .59). Students with initially low legibility improved most in legibility; progress on the other tests was similar across low-, average-, and high-performing groups. This program appeared to benefit first-grade students with diverse learning needs and to increase handwriting legibility and speed and writing fluency., (Copyright © 2012 by the American Occupational Therapy Association, Inc.)

Objective: To compare effects of 2 dosage levels of constraint-induced movement therapy (CIMT) for children with hemiplegic cerebral palsy (CP). We hypothesized that high-dosage CIMT would produce larger benefits than moderate-dosage., Methods: Three sites enrolled a total of 18 children (6 children per site from 3-6 years) with unilateral CP. Children were randomly assigned to CIMT for 21 days for either 6 hours/day (high-dosage=126 hours) or 3 hours/day (moderate-dosage=63 hours); both groups wore a long-arm cast. Evaluators (blind to dosage) assessed children 1-week prior, then 1-week and 1-month after treatment with the Assisting Hand Assessment (AHA), The Quality of Upper Extremity Skills Test (QUEST) Dissociated Movement and Grasp sections, the Shriners Hospital Upper Extremity Evaluation (SHUEE), and the Pediatric Motor Activity Log (PMAL)., Results: All children responded well to casting and received the full intended dosage. Both groups showed statistically significant gains on the AHA, QUEST, SHUEE, and PMAL. Effect sizes ranged from 0.36-0.79. Overall, both groups showed comparable improvements at 1-week and 1-month post-treatment., Conclusions: Pediatric CIMT at both moderate and high dosages produced positive effects across multiple reliable, valid outcome measures. The findings refuted the hypothesis of differential dosage benefits. Future research should address long-term effects, enroll larger and more diverse samples, and assess lower dosages to ascertain a minimal-efficacy threshold.

Objective: Pediatric constraint-induced movement therapy (CIMT) is a promising intervention for children with unilateral cerebral palsy (CP). This multisite randomized controlled trial (RCT) tested the hypothesis that 6 hr versus 3 hr per day for 21 days would produce larger maintenance of gains 6 mo posttreatment., Method: Three sites recruited 18 children (6 per site) ages 3-6 yr with unilateral CP. Children were randomly assigned 3 to 6 hr/day of CIMT for 21 days and wore a cast on the unaffected extremity the first 18 days. Occupational therapists applied a standardized pediatric CIMT protocol. Evaluators blinded to condition administered the ASsisted Hand Assessment and the Quality of Upper Extremity Skills Test, and parents completed the Pediatric Motor Activity Log pre- and posttreatment (1 wk, 1 mo, and 6 mo)., Results: Both CIMT dosage groups showed significant gains on all five assessments with no significant group differences at 6 mo follow-up. Effect sizes (n = 15) comparing preintervention to postintervention measures (partial η2) ranged from .33 to .80., Conclusion: The first multisite RCT of pediatric CIMT confirmed the maintenance of positive effects at 6 mo follow-up across multiple functional performance measures. The hypothesis that maintenance of effects would differ for children who received 6 versus 3 hr/day of CIMT (126 vs. 63 total hr) was not supported.

Objective: To identify the perceived level of competence in teaching and assessing critical thinking skills and the difficulties facing radiologic science program directors in implementing student-centered teaching methods., Methods: A total of 692 program directors received an invitation to complete an electronic survey soliciting information regarding the importance of critical thinking skills, their confidence in applying teaching methods and assessing student performance, and perceived obstacles. Statistical analysis included descriptive data, correlation coefficients, and ANOVA., Results: Responses were received from 317 participants indicating program directors perceive critical thinking to be an essential element in the education of the student; however, they identified several areas for improvement. A high correlation was identified between the program directors' perceived level of skill and their confidence in critical thinking, and between their perceived level of skill and ability to assess the students' critical thinking. Key barriers to implementing critical thinking teaching strategies were identified., Conclusion: Program directors value the importance of implementing critical thinking teaching methods and perceive a need for professional development in critical thinking educational methods. Regardless of the type of educational institution in which the academic program is located, the level of education held by the program director was a significant factor regarding perceived confidence in the ability to model critical thinking skills and the ability to assess student critical thinking skills.

We developed and piloted a program for first-grade students to promote development of legible handwriting and writing fluency. The Write Start program uses a coteaching model in which occupational therapists and teachers collaborate to develop and implement a handwriting-writing program. The small-group format with embedded individualized supports allows the therapist to guide and monitor student performance and provide immediate feedback. The 12-wk program was implemented with 1 class of 19 students. We administered the Evaluation of Children's Handwriting Test, Minnesota Handwriting Assessment, and Woodcock-Johnson Fluency and Writing Samples test at baseline, immediately after the Write Start program, and at the end of the school year. Students made large, significant gains in handwriting legibility and speed and in writing fluency that were maintained at 6-mo follow-up. The Write Start program appears to promote handwriting and writing skills in first-grade students and is ready for further study in controlled trials.

A plethora of research investigates sonography vs. electrodiagnostic testing (EDX) for diagnosis of carpal tunnel syndrome (CTS). Through database searches, hand searches and communication with authors, 582 abstracts published from 1999 to 2009 were identified. A comprehensive systematic review process resulted in inclusion of 23 studies. Significant methodologic discrepancies among the studies limited the ability to complete a meta-analysis to identify specific diagnostic thresholds. Instead, the data were reviewed to provide implications for clinical utility of sonography as a screening tool as a compliment to EDX and to suggest continued and future research. The largest cross-sectional area of the median nerve within the carpal tunnel region has high potential for clinical screening, especially in individuals with severe CTS. Identifying swelling of the nerve through comparative measurements, qualitative analysis and Doppler techniques all require further investigation. Screening protocols may be enhanced through exploration of sonography in patients with mild CTS and false-negative EDX., (Copyright © 2011 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Are Master of Occupational Therapy (MOT) graduates more successful than BS graduates in accessing and analyzing research literature? This retrospective cohort study used a survey sent to Ohio State University MOT graduates, asking why they need information for their practice, what types of information they seek, and how they search for and use it. Results suggest that the MOT program has fostered higher-level skills than did the BS program in independent writing, a greater focus on evidence-based practice, and the use of bibliographic databases. The MOT graduates report high confidence in their ability to apply research to practice and high satisfaction with the lifelong learning skills they learned. The survey findings support the importance of collaboration between Occupational Therapy faculty and medical librarians in developing MOT educational programs.

Purpose: This article presents a rationale for specialized services personnel to use fluid models of service delivery and explains how specialized services personnel make decisions about the blend of service delivery methods that will best serve a child., Method: The literature on occupational therapy, physical therapy, and speech-language pathology service delivery in early childhood programs is reviewed, synthesized, and applied to current practice. The literature explains that direct and consultative services provide unique benefits to children and should be flexibly scheduled based on each child's current priorities. Flexible service delivery models allow therapists to meet the evolving needs of children within dynamic environments., Conclusion: To establish fluid service delivery models, therapists need to (a) plan collaboratively with teachers so that the model selected meets the teacher's preferences, (b) design flexible scheduling systems that emphasize inclusive practice, and (c) maintain precise documentation about when and how services are provided.

Occupational therapy practitioners are among the professionals who provide services to children and adults with autism spectrum disorder (ASD), embracing both leadership and supportive roles in service delivery. The study's primary aims were as follows: (1) to identify, evaluate, and synthesize the research literature on interventions for ASD of relevance to occupational therapy and (2) to interpret and apply the research literature to occupational therapy. A total of 49 articles met the authors' criteria and were included in the review. Six categories of research topics were identified, the first 3 of which are most closely related to occupational therapy: (1) sensory integration and sensory-based interventions; (2) relationship-based, interactive interventions; (3) developmental skill-based programs; (4) social cognitive skill training; (5) parent-directed or parent-mediated approaches; and (6) intensive behavioral intervention. Under each category, themes supported by research evidence and applicable to occupational therapy were defined. The findings have implications for intervention methods, communication regarding efficacious practices to professionals and consumers, and future occupational therapy research.

The Test of In-Hand Manipulation (TIHM; Case-Smith, 2000) is a five-task test that uses a 9-hole pegboard to examine 2 key components of in-hand manipulation: rotation and translation with stabilization. The authors used Rasch modeling to examine the TIHM's construct validity, interrater reliability, and test-retest reliability in 45 typically developing children ages 5.5 years to 6.5 years. A version of the test, revised using Rasch modeling, was found to have evidence for adequate construct validity and excellent interrater reliability. However, test-retest reliability over a 2-week retest period was not supported. The TIHM demonstrates potential as a clinically useful assessment of in-hand manipulation. The test does not examine all aspects of in-hand manipulation, however, and it may have limited sensitivity to the performance of finger-to-palm and palm-to-finger translation. Further validation of the test is needed before the TIHM can confidently be used in occupational therapy practice.

One method to determine trends in occupational therapy research is to survey the literature published in occupational therapy journals. This study describes the types and topics of articles published in five prominent occupational therapy journals over a 5-year span. Feature articles published between 2001 and 2005 were analyzed to determine the types of articles and research and subject areas. The percentage of research articles published between 2001 and 2005 increased from 65% to 78% of all articles published and is higher than previous reports. More than 70% of the research articles used designs that substantially contribute to the evidence base for occupational therapy (defined by Kielhofner, Hammel, Finlayson, Helfrich, & Taylor [2004] as correlational-comparison, experimental, qualitative, and meta-analysis). Of the research articles, 60% addressed pediatric, physical disability, and rehabilitation topics. The 5-year period showed a trend of increasing frequency of geriatric and pediatric topics in research reports. Scholars should emphasize research designs that build the evidence for occupational therapy approaches and practices and focus on research topics of highest value to society.

This study investigated the effects of a sensory diet and therapeutic listening intervention program, directed by an occupational therapist and implemented by parents, on children with sensory processing disorders (SPD) and visual-motor delays. A convenience sample was used of 10 participants, ages 5 to 11 years, with SPD and visual-motor delays. In the first phase, each participant completed a 4-week sensory diet program, then an 8-week therapeutic-listening and sensory diet program. The Sensory Profile was completed by the participants' parents before and after both study phases. The Draw-A-Person test, Developmental Test of Visual Motor Integration (VMI), and Evaluation Tool of Children's Handwriting (ETCH) were administered before and after each phase. Over 12 weeks, the participants exhibited significant improvement on the Sensory Profile, increasing a mean of 71 points. Parents reported improvements in their children's behaviors related to sensory processing. Scores on the VMI visual and ETCH legibility scales also improved more during the therapeutic listening phase. Therapeutic listening combined with a sensory diet appears effective in improving behaviors related to sensory processing in children with SPD and visual-motor impairments.

Objective: To develop and establish the reliability and validity of a new quantitative functional measure of haptic perception in the hand, the Hand Active Sensation Test (HASTe)., Design: Reliability was assessed by test-retest sessions. Validity was assessed via discriminant analysis, concurrent validity with 2-point discrimination and wrist position test, and receiver operating characteristic (ROC) curve construction., Setting: Subject preference., Participants: Heterogeneous sample of 28 stroke survivors and 28 individually matched controls., Intervention: Subjects used 1 hand to manipulate HASTe objects that vary by weight or texture to complete 18 match-to-sample trials., Main Outcome Measures: Two-point discrimination threshold, Wrist Position Sense Test (WPST) average error, and HASTe accuracy score., Results: Test-retest reliability was strong (intraclass correlation coefficient model 3,1 = .77). The HASTe score significantly discriminated the groups (t = 8.3, P < .001) and correlated with 2-point discrimination (r = -.67, P < .001) and WPST (r = -.60, P < .001). ROC curve area was .94 for test 1 and .92 for the average of 2 tests., Conclusions: The HASTe is a reliable and valid functional measure of haptic perception, appears to detect impairment of haptic perception even in stroke survivors with no reported sensory deficits, and may provide valuable quantitative clinical data about complex sensory loss and hand function after stroke.

Purpose: Parents of children with chronic medical conditions and associated disabilities have substantial caregiving responsibilities different from those of typical children. This ethnographic study examined how parents manage these caregiving demands, how they maintain their social lives, and how they form their self identities., Method: Graduate students interviewed eight parents of children with chronic medical conditions and disabilities and participated in 60 hours of activities with them over a 6-month time period. The interview transcripts, students' field notes, and journals were analyzed for themes that related to caregiving, social activities, and self-identity., Results: Parents felt that they "always needed to be with their child," and most had changed their career plans to devote more time to caregiving. Parents also expressed anxiety about making difficult medical and educational decisions for their children. Activities outside the home required extensive planning and preparation and maintaining a social life was perceived as challenging because friends and relatives did not always understand the families' limitations in activity., Conclusions: Although the parents expressed stress related to coping with the caregiving load, they viewed having a child with chronic medical conditions as a positive experience that brought cohesion to their family. The parents explained that their experiences with their children helped them to appreciate life and develop more sensitivity to and tolerance of individual differences. The parents had become strong advocates for their children and other children with similar needs.

Objective: The purpose of this study was to measure functional outcomes after outpatient occupational therapy for clients who had upper-extremity injury and surgery or both., Methods: A sample of 33 clients referred to occupational therapy outpatient intervention was recruited from five clinics in Ohio. The Canadian Occupational Performance Measure (COPM) was used to guide the occupational therapy sessions and to measure outcomes. The Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Short Form 36 (SF-36) were also administered to the clients pre and post 6 to 8 weeks of hand rehabilitation services. Two to three months after discharge, the clients responded by the telephone to the Community Integration Questionnaire., Results: The clients received a mean of 13 hours of outpatient occupational therapy services and received no other rehabilitation service. Functional performance gains following 6 to 8 weeks of services were significant (COPM; t(32) = -11.5, p < .001; t(32) = -11.31, p < .001; DASH; t(32) = 9.22, p < .001; t(32) = -9.02, p < .001). Effect sizes on the COPM and DASH ranged between 1.43 and 2.52. Progress in the clients' goals was moderately correlated to progress in functional measures., Conclusion: Clients with upper-extremity injury or surgery made strong, positive gains in functional measures following client-centered occupational therapy services. The COPM was the most sensitive to client change, followed by the DASH, and then the SF-36.

Objective: This study investigated the effects of school-based occupational therapy services on students' handwriting., Method: Students 7 to 10 years of age with poor handwriting legibility who received direct occupational therapy services (n = 29) were compared with students who did not receive services (n = 9) on handwriting legibility and speed and associated performance components. Visual-motor, visual-perception, in-hand manipulation, and handwriting legibility and speed were measured at the beginning and end of the academic year. The intervention group received a mean of 16.4 sessions and 528 min of direct occupational therapy services during the school year. According to the therapists, visual-motor skills and handwriting practice were emphasized most in intervention., Results: Students in the intervention group showed significant increases in in-hand manipulation and position in space scores. They also improved more in handwriting legibility scores than the students in the comparison group. Fifteen students in the intervention group demonstrated greater than 90% legibility at the end of the school year. On average, legibility increased by 14.2% in the students who received services and by 5.8% in the students who did not receive services. Speed increased slightly more in the students who did not receive services., Conclusion: Students who received occupational therapy services demonstrated improved letter legibility, but speed and numeral legibility did not demonstrate positive intervention effects.

Objectives: This study examined the relationships between sixth-grade students' handwriting speed and legibility and their keyboarding speed and error rate. A second purpose was to examine how well handwriting performance discriminates students as slow or fast in computer keyboarding., Method: After participation in a school-required keyboarding class, 40 sixth-grade students were asked to copy a familiar poem using handwriting and keyboarding. Handwriting legibility and speed and keyboarding speed and errors were measured. Relationships among these variables were analyzed using Pearson product-moment correlations and discriminant analysis., Results: Keyboarding speed correlated with handwriting legibility (n = 38, r = .361, p = .026), suggesting that handwriting performance accounts for 12% to 13% of the variance in keyboarding performance. Handwriting speed and legibility together accurately categorized 71% of students as slow or fast in keyboarding. On average, students were able to keyboard faster than handwrite. Of the 20 slowest handwriters, 75% achieved more text production with keyboarding than with handwriting., Conclusion: Keyboarding performance demonstrated low to moderate correlation with handwriting performance, suggesting that these forms of written expression require distinctly different skills. Most students who were slow at handwriting or had poor legibility increased the quantity and overall legibility of text they produced with a keyboard. These results suggest that keyboarding has the potential to increase and improve a student's written output.

Purpose: This study examined how performance components and variables in intervention influenced fine motor and functional outcomes in preschool children., Method: In a sample of 44 preschool-aged children with fine motor delays who received occupational therapy services, eight fine motor and functional performance assessments were administered at the beginning and end of the academic year. Data on the format and intervention activities of each occupational therapy session were recorded for 8 months., Results: The children received a mean of 23 sessions, in both individual and group format. Most of the sessions (81%) used fine motor activities; 29% addressed peer interaction, and 16% addressed play skills. Visual motor outcomes were influenced by the number of intervention sessions and percent of sessions with play goals. Fine motor outcomes were most influenced by the therapists' emphasis on play and peer interaction goals; functional outcomes were influenced by number of sessions and percent of sessions that specifically addressed self-care goals., Conclusion: The influence of play on therapy outcomes suggests that a focus on play in intervention activities can enhance fine motor and visual motor performance.

Objective: Using single-subject research design, the effects of an occupational therapy intervention emphasizing sensory integration with five preschool children with autism were examined., Method: In the AB design, nonengagement, mastery play, and interaction were measured, using videotape clips of each child's free play in the preschool. Following a 3-week baseline, an occupational therapist provided one-on-one sessions and consultation to teachers for 10 weeks., Results: When baseline and intervention phases were compared, four children demonstrated decreased frequency of nonengaged behavior, and three demonstrated increased frequency of mastery (goal-directed) play. Improvements in frequency of interaction were minimal., Conclusion: The results support descriptions in the literature regarding the behavioral changes that children with autism can make when participating in intervention using a sensory integration approach.

Objective: Although the prevalence of children with pervasive developmental disorders (PDD) has increased, empirical data about the role and practices of occupational therapists have not been reported in the literature. This descriptive study investigated the practice of occupational therapists with children with PDD., Method: A survey was mailed to 500 occupational therapists in the Sensory Integration Special Interest Section or School System Special Interest Section of the American Occupational Therapy Association in eastern and midwestern United States. The valid return rate was 58% (292 respondents). The survey used Likert scale items to measure frequency of performance problems observed in children with PDD, performance areas addressed in intervention, perceived improvement in performance, and frequency of use of and competency in intervention approaches., Results: The respondents primarily worked in schools and reported that in the past 5 years they had served an increasing number of children with PDD. Most respondents provided direct services and appeared to use holistic approaches in which they addressed multiple performance domains. They applied sensory integration and environmental modification approaches most frequently and believed that they were most competent in using these approaches. Respondents who reported more frequent use of and more competence in sensory integration approaches perceived more improvement in children's sensory processing. Respondents who reported more frequent use of and more competence in child-centered play perceived more improvement in children's sensory integration and play skills.