Measuring the Outcomes of Therapeutic Listening® in Children With Learning and Developmental Disabilities
Donielle Hair, Phoebe Taasan, Hannah Tashjian, and Julia L. Wilbarger
A practice-based evidence (PBE) approach was used to explore the outcomes of the Therapeutic Listening® technique. PBE examines how effective clinical practice is within the actual clinical context. PBE capitalizes on using customary procedures and measures to establish clinical outcomes. (Horn & Gassaway, 2010; Swisher, 2010).
Therapeutic Listening® (TL®) is a sound-based intervention broadly used by pediatric OTs as a complement to sensory integration interventions for children with sensory processing disorders.
Brooke Czuleger, Emily Garnica, Jessica Phung, and Maciej Rzepka
In the past decade, the prevalence of Autism Spectrum Disorder (ASD) and Intellectual Disabilities (ID), has increased. Sensory processing is an area of need for individuals with ASD and ID that requires specialized interventions. In best practices, these services are delivered by an interdisciplinary team, often consisting of an occupational therapist, speech language pathologist, behaviorist and special education teacher. Yet, to date there has been limited research examining interdisciplinary collaboration with the many professionals on the team. The purpose of this study was to empirically examine the interdisciplinary team practices at a special education center in Northern California. This research employed interview methods and qualitative analysis. Results informed a conceptual practice model for collaboration as a highly intentional practice. The model depicts sensory needs of individual students and thusly sensorimotor programming for the classroom as a priority for the interdisciplinary team. Final themes from the analysis as essential to collaboration were: taking action, communicating, addressing barriers, reinforcing team values and understanding interdisciplinary roles. Implications for practice include advocating for the scope of OT, active engagement in the collaborative process at the IEP level, taking leadership roles, creating opportunities for collaboration, engagement in dialogue with administration and formal inservice training.
Age-Related Changes in Visual Processing Speed: A Pilot Study Using the Motor-Free Visual Perception Test- 4 (MVPT-4)
Lauren Gollnick, Kassidy Ha, Stephanie Pawek, Zoe Studer, and Amber Zadravecz
Evidence reveals that visual processing speed decreases with age. The Motor-Free Visual Perception Test- Third Edition (MVPT-3) has an age-normed Response Time Index that measures visual processing speed. In 2015, a new version, Motor-Free Visual Perception Test- Fourth Edition (MVPT-4), was published. The new MVPT-4 does not yet demonstrate its utility in measuring visual processing speed. The purpose of this study was to explore if differences in visual processing speed between younger adults ages 20-35 years and older adults ages 70 years and older could be detected using the new MVPT-4. Results revealed a significant difference between older and younger adults’ time to complete the MVPT-4 (p <.05). This pilot study demonstrated that the MVPT-4 may be able to detect age-related changes in visual processing speed and therefore, a possible clinical tool for occupational therapists.
Evelyn Tang, Blanka Pentek, Laura Greiss Hess, and Katherine Sadoff
Professional collaboration in special education is essential for student success (Barnes & Turner, 2000). However, IDEA legislation does not guide how such collaboration should take place (Pub. L. 108–446). The Conceptual Model for Collaboration (CMC) created by Czuleger and colleagues (2016) described professional collaborative practices of a transdisciplinary team at a special education center. The purpose of this study was to examine the CMC in a broader context.
Michelle DAmato, Sophie E. Miller, April Perez, Carmen Joaquin, and Louiza Alexandria Villarina
Approximately 50% of US nursing home residents have a diagnosis of dementia. Abilities Care Approach® was created by occupational therapists (OTs) to promote quality dementia care for residents in skilled nursing facilities (SNFs). Certified nursing assistants (CNAs) are often the primary caregiver for residents with dementia. To ensure carryover of ACA principles, ACE dementia training was targeted towards CNAs. The purpose of this study was to evaluate Abilities Care Experts®(ACE) training program which provides CNAs with an occupation-based dementia care approach by focusing on the importance of occupational engagement and knowledge of dementia stages. Results indicated that ACE trained CNAs (N=13) had significantly higher levels of self-efficacy, knowledge of dementia care approaches, and perceived knowledge of dementia compared to non ACE trained CNAs (N=16). Findings demonstrate the importance of caregiver training focused on strategies to facilitate occupational engagement at each stage of dementia. OT expertise in providing stage-specific dementia care training can improve caregiving educational outcomes. Further empirical research may help to further understand the optimal use of ACA-focused dementia training programs to improve quality of care.
Allison Hunt, Morganne Peterson, and Emily White
The purpose of this study was to fill the gap in literature and further examine the use of sensory diets in the field of occupational therapy. This study investigated the use of sensory diets among California occupational therapy practitioners. A mixed-methods design was used to collect data through a SurveyMonkey survey. The survey was sent out to members of the Occupational Therapy Association of California (OTAC) and received 98 respondents within one month. Participants worked among various clinical settings and implemented sensory diets with various client populations. Practitioners reported using terms such as “sensory strategies,” “sensory tools,” and “sensory supports” which indicates an overall misunderstanding associated with the term “sensory diet.” An alternative name that is more easily understandable and used universally would help decrease confusion among clinicians and clients. Further research is needed to better understand the effectiveness of sensory diets and how they are implemented.
Kayla Comer, Tiffany Huang, Kelly Schmidt, and Matthew Tong
As the population and longevity of older adults’ increases, the prevalence of falls is becoming an ever-growing issue. One in three adults aged 65 years and older experience a fall each year. Falls in older adults may lead to sedentary behavior, decreased independence, and lower quality of life. Evidence has shown that traditional exercise programs emphasizing strength and balance exercises can decrease the fall risk in older adults, but may be difficult to sustain over time. Emerging evidence suggests that exercises that are integrated into daily life may have a more lasting effect in reducing fall risk in older adults. This study explored the effectiveness of an integrated exercise program, the modified-LiFE program, in decreasing fall risk in community-dwelling older adults. Results supported integrative exercise programs may decrease fall risk in community-dwelling older adults with previous history of falls. Therefore, integrating exercises into daily life offers occupational therapists an effective occupation-based intervention that promotes safety, independence, and quality of life for older adults.
Samantha L. Alexander, Noelani M. Brisbane, Rebecca M. Schira, and Kaitlyn M. Williams
Fragile X Syndrome (FXS) is the most common form of inherited Intellectual Developmental Disorder and a genetic model for Autism Spectrum Disorder. Those living with FXS face emotional, social, intellectual, and physical challenges that impact engagement in occupations, yet to date, there has been limited qualitative research examining family occupations in FXS. In this research, twelve interviews were transcribed, coded, and analyzed for common themes anchored in the Person, Environment, Occupation (PEO) model. Results indicated that while children with FXS exhibit strengths, there are certain occupations that families find difficult to engage in. A new model was created for consideration of family occupations and FXS. This model depicts family occupations as a complex and ever changing, dynamic interaction between the child and family engaging in varying environments, and activities. This model can further inform clinical reasoning when designing a comprehensive child and family-centered approach supporting participation in occupations.
Raechel Jacala, Holly Snyder, Amanda Lee, and Katelyn Harden
Fragile X Syndrome (FXS) is the most common form of inherited intellectual and developmental disability (IDD), and is a genetic model for autism spectrum disorder (ASD). According to the National Fragile X Foundation (NFXF, 2012), the disorder affects people of all ethnic backgrounds, with an estimate of 1 in 3,600 to 4,000 males and 1 in 4,000 to 6,000 females. A majority of males with FXS have an intellectual disability and up to 50-75% of males with FXS meet the diagnostic criteria for ASD (Roberts, 2016). According to the CDC, a national parent survey found that 46 percent of males and 16 percent of females with FXS have been diagnosed or treated for ASD (Bailey et al., 2008). Additionally, about 10 percent of children with ASD have another genetic and chromosomal disorder, such as FXS (Hall, Lightbody, & Reiss, 2008). Individuals living with FXS experience difficulties with social interaction, communication, sensory processing, and behavioral excesses across their lifespan (Brady et al., 2006). The purpose of our qualitative research is to examine the lived experiences of families who have been touched by FXS through an occupational therapy lens. The research seeks to understand families’ perspectives and occupations via their own voice, through semi-structured, recorded interviews. By analyzing parent routines, behaviors, thoughts, interactions, and contexts, occupational therapists can create individualized interventions and promote research to further the recognition of family values and goals they have for their child.
Karen Huang, Ashley Cook, and Ajay Pala
These pilot case studies investigated the effectiveness of the Functional Cognitive Activities for Adults with Brain Injury: A Sequential Approach (FCA) in generalizing functional cognitive skills across meaningful occupations for adults with traumatic brain injury (TBI). This quasi-experimental pretest-posttest design consisted of two participants with TBI. Both participants received occupation-based intervention sessions twice a week and equaled a total of 14 sessions each. For pretest, the two participants were given three assessments to track changes with aspects of functional cognition and engagement in occupations: the Canadian Occupational Performance Measure (COPM), Kohlman Evaluation of Living Skills (KELS), and Goal Attainment Scale (GAS). After completing the treatment sessions, the participants completed the COPM, KELS, and GAS as posttest measures. Four months later, the COPM and the GAS were administered along with a brief phone interview to determine if generalization of strategies to overcome cognitive deficits has occurred. Findings from this study provide preliminary evidence supporting the effectiveness of the FCA approach in improving functional cognitive skills and generalizability of skills to novel tasks in individuals with TBI.
Haley Caruthers, Samantha Talavera, Stephanie Vera, and Jackeline Ulloa
Older adults (OAs) over the age of 65 are the fastest growing age group in the United States. They are also the fastest growing population of Internet users as they use the Internet to access health information related to optimizing independence, productivity, and social engagement. Although there is an abundant amount of information available that is devoted to healthy aging, the validity of the information can be questionable and the information may be confusing.
Dominican University of California’s (DUC) Healthy Aging website contains relevant and evidence-based research, including activities and local community based programs that promote healthy aging. To expand the website, a literature-based needs assessment was conducted, which indicated, the value of health promotion materials that foster of emotional and physical wellness and encourage a safe and active lifestyle in and outside of the home. Specifically, new topics such as “Living Safely Inside and Outside of Home,” “Local Events,” “Emotional Wellness,” “At Your Fingertips,” “Apps You Can Use,” and “ Position, Movement, & Ergonomics” have been added to enhance the DUC Healthy Aging website. The DUC Healthy Aging website is very beneficial to both OAs and health profession majors because it is highly accessible and provides resources and information regarding health promotion and prevention behaviors to live a productive lifestyle.
Implementing Multifactorial Education Modules with Older Adults: Individualized and Interactive Fall Prevention Education
Salvador Chavez, Jocelle Flores, and Rachelle Yambao
Falls are a significant concern for community-dwelling older adults (OAs), with one in four OAs reporting a fall every year. Occupational therapy students collaborated with first responders of the Novato Fire District to identify gaps in fall prevention community outreach programs and found that many interventions lack an interactive or individualized approach. Based on the gap analysis and current literature, seven education modules were developed to address key risk factors including home modifications, polypharmacy, fear of falling, and balance exercises. Thirty community-dwelling OAs participated in the education modules and were implemented at two senior community sites in Marin County. Participants were screened via Functional Reach Test (FRT) and completed a survey to determine their personal risk factors for falling, which guided their personalized fall prevention education. Of the participants, 90% rated their experience with the education modules as “very good” or “excellent,” and a majority rated the balance exercises as most important. The interactive 1:1 education modules are an effective and innovative method for fall prevention education and highlight the importance of client-centered treatment.
Carrie Payne and Lauren Kufer
This critically appraised topic explores the functional task performance of adults with low vision utilizing tactile vision substitution systems, specifically tongue display units (TDUs). TDUs are a novel assistive device that functions to provide artificial vision to those with low vision. TDUs pixelate images captured on a camera the person wears and the images are translated via electronic stimulation on the tongue to paint a picture. Two studies that measured functional task performance utilizing a TDU with adults with low vision were explored. Examples of functional tasks measured include word recognition, object recognition, and orientation and mobility tasks. The studies concluded that with skilled training, the TDU may significantly improve functional task performance in tasks previously impossible for the participants. Use of technology such as a TDU can improve functional task performance to enhance overall quality of life for adults with low vision of light perception or less. The results indicate the need for skilled training by professionals such as occupational therapists to best utilize a TDU.
Kaylee E. Gothelf, Ty Duong, Ana Baldinger, and Theresa Chase
The purpose of this study was to evaluate the use of semi-structured interviews as an outcome measure in a clinical trial for children with fragile X syndrome (FXS) ages 2-6. This qualitative approach was used to analyze twenty-five interviews of parents with children in a double-blind medication trial - sertraline or placebo. The aim was to assess occupational improvements in their child that may not have been detected with the use quantitative outcome measures alone. Results showed greater improvements in the sertraline group in areas of behavior, social participation, sensory-related behaviors, receptive language, education, family impact and therapeutic strategies. Our findings support the use of semi-structured interviews as an additional outcome measure in a medication trial to account for the voice and context of family experiences through an occupation centered lens.
May Anne Gamueda, Janie Grant, America Ortega, and Jordan Song
OBJECTIVE: The purpose of this study was to investigate whether a mobile health application (mHealth app) will result in a decrease in fatigue and an increase in adherence to energy conservation techniques for adults with multiple sclerosis (MS).
METHOD: Using a quantitative, exploratory, pretest and post-test design, we examined the use of the mHealth app, Pace My Day (PMD), by seven participants during one chosen task while incorporating energy conservation strategies for two weeks. Main outcome measures included Modified Fatigue Impact Scale (MFIS) and Canadian Occupational Performance Measure (COPM).
RESULTS: There was a significant decrease in the MFIS scores indicating a decrease in fatigue over the two-week period t(6)=5.75, p=0.001.
CONCLUSION: Use of mHealth apps and energy conservation strategies were found to significantly reduce levels of fatigue and increase self-perceived performance and satisfaction of task execution.
Hannah Tashjian, Phoebe Taasan, and Donielle Hair
This study examines a structured protocol to measure the effects of daily individualized use of Therapeutic Listening - Quickshifts (TL-Q) used to improve occupational performance in children with learning and developmental disabilities. The study identifies a standardized practice-based evidence procedure to measure the outcomes of implementing TL-Q within traditional OT practice. OTs worldwide are using sound-based therapies (SBTs) despite limited supporting evidence available regarding the productivity of these interventions. Even fewer studies have been published on the effects of Therapeutic Listening (TL), a novel intervention shown to increase personal and interpersonal skills including sensory processing skills, visual motor integration, and emotional regulation (Frick & Hacker, 2001). TL-Q is used to modify distressing effects of sensory dysregulation and learning disabilities through an individualized listening program of modified musical patterns that the child listens to through headphones for a set amount of time each day. The music program is implemented at home for a more intensive intervention designed to stimulate neuroplasticity across hemispheres eliciting behavioral changes and improved neurological responses (Wink, McKeown, & Casey, 2017).
Michelle Chan, Kelsie Colombini, Kristen M. Henderson, and Courtney Malachowski
In recent years, the number of inpatient cardiovascular surgeries has significantly increased in hospitals around America. Occupational therapists in the intensive care unit (ICU) at Mills-Peninsula Medical Center (Burlingame, California) currently lack a standard protocol for addressing physical, cognitive, and psychosocial factors in patients post cardiac surgery. Furthermore, interventions are frequently guided by professional experience and clinical reasoning instead of current evidence. The American Occupational Therapy Association’s Centennial Vision encourages occupational therapists to pursue science-driven practices and provide evidence-based interventions. In response to this vision, an extensive review of current literature was conducted and applied to develop an evidence-based clinical pathway for the occupational therapists at Mills-Peninsula Medical Center. The proposed clinical pathway includes intervention guidelines for physical recovery, early detection of cognitive impairment, and psychosocial health for patients post cardiac surgery recovering in the ICU. The clinical pathway would establish a standard of care and facilitate patients’ return to their highest level of function during post-cardiac surgery rehabilitation.
Michelle Beckwith, Brina Nguyen, Jennifer Sik, Kenneth Yu, and Laura Greiss Hess
Fragile X Syndrome (FXS) is the most common form of inherited intellectual and developmental disability, and a known genetic cause of autism. Individuals with FXS present with deficits in cognition, social skills, behavior, language and sensory processing skills; all of which are commonly assessed through standardized and norm-referenced assessments. However, these outcome measures are sometimes not sensitive to contextually based changes in daily life. Further, there is limited research employing qualitative methods in the FXS literature. The purpose of this research was to examine family perspectives collected via semi-structured interviews as part of a randomized controlled medication trial of sertraline (Zoloft®) on children two to six years old diagnosed with FXS. The constant comparison method was used to analyze differences in family expressions of their child’s improvements over the course of the 6-month clinical trial. Twelve interviews were analyzed, six-treatment, six-placebo, and all coding was done blind to group assignment. Results indicated greater improvements in the treatment group when compared to the placebo group in: anxiety, receptive / expressive communication, maladaptive behaviors and some sensory issues. These preliminary findings warrant a need for further research with a larger sample.
Jeffrey Kou, Yvonne Lam, Patricia Lyons, and Susan Nguyen
Low vision is an age-related condition that affects many older adults, and may create challenges in everyday activities in older adults. Guide dogs have been shown to be an effective assistive device that can help older adults within their community. Despite vast research on dog companionship, there is limited research on the facilitators and barriers of owning a guide dog among older adults with low vision. The purpose of this qualitative phenomenological study is to explore the facilitators and barriers of owning a guide dog as experienced by older adults with low vision participating in Guide Dogs for the Blind (GDB) organization. Seven first time guide dog owners, ages 55 and older, were interviewed using semi-structured questions. Through constant comparison methods, five major themes emerged: changes in habits and routines, being a dog guide owner, increase in community integration, human-dog guide bonding, and dog guide enhances autonomy. Study results provide implications for occupational therapists (OT) of how guide dogs affect the daily living patterns of older adults. Additionally, study results provide insight for GDB and OTs into improving support and training processes.
Sarah L. Yoder, Jason Ichimaru, Emily Lu, and Nghi Tran
As the number of individuals with autism spectrum disorder (ASD) entering adulthood grows, it is crucial to identify interventions that can help this population acquire adaptive behaviors necessary for independent living and employment. This study aimed to identify how Autisty Studio’s project-based therapy impacts this population’s engagement in adaptive behaviors.The study utilized the Brief Adaptive Behavior Scale (BABS), a quantitative assessment informed by the BRIEF-2 and the Vineland-II, to measure improvements in adaptive behaviors in 11 participants at Autistry Studios. Specifically, the BABS measured frequency (Frq), highest level of assistance (LoAHigh) required, and lowest level of assistance (LoALow) required to engage in adaptive behaviors over the course of nine sessions. Domains of Frq, LoAHigh and LoALow scores included executive functioning (EF), socialization (SOC), and self-regulation (SR). Analysis using a Repeated Measures ANOVAs and paired-sample T-test found significant differences and trends toward significance of the LoAHigh and LoALow scores in the domains of EF and SOC , indicating that Autistry’s pre-vocational, project-based therapy program is effective in improving adaptive behavior skills in adults with ASD, as measured by the BABS.
Pilot Study: Assistive Technology as a Vocational Support for Individuals with Autism Spectrum Disorder
Erin Chaffee, Christina Ho, and Kevin Ng
The purpose of this pilot study was to determine the effectiveness of video-based instruction (VBI) to support completion of vocational tasks. A mixed-method approach was utilized to explore the use of VBI on a personal digital assistant with adults with autism spectrum disorder. Using two assembling cooking tasks, researchers investigated the level of independence with task completion through written instruction versus VBI. The results indicated a small non-significant increase in the level of independence with task completion during the intervention task independent of intelligence quotient (IQ) levels. Participant’s feedback of VBI was also noted as positive to help learn other tasks. This study presents evidence for the use of assistive technology to support task completion in the area of vocation.
Jessica McClain, Caroline Lee, and Katelyn Gullatt
We sought to investigate whether three protective factors, (physical health, social support, and self-efficacy) predict resilience in Marin County older adults to promote successful aging in place. Fifty-eight Marin County participants aged 62 years and older participated in an exploratory cross-sectional quantitative study. Recruited from senior community programs and personal contacts, participants completed four self-report questionnaires. Descriptive and multivariate analyses using SPSS were conducted to investigate the relationship between the key variables. Of the three protective factors, self-efficacy is the most important predictor of resilience. Physical health and social support are important predictors of self-efficacy. In conclusion, three protective factors influence resilience, especially self-efficacy, and should be incorporated into occupational therapy interventions to build resilience in older adults.
Sarah Button, Emily Minor, and Kristen Christensen
Objective: Sensory processing issues can have a large negative impact on the ability to participate in daily occupations such as ADLs, access to work, school and leisure environments, and social interactions (Dunn, 2001). The evidence documenting sensory processing issues in adults is sparse. Physiological information can be used as objective evidence to support the claim that those with over-responsivity to sensations are experiencing their environment differently than the typical population. Understanding more about sensory processing in adults may lead to increased recognition of the problem and more opportunities for intervention to increase occupational participation. The purpose of this quantitative study compared the physiological responses to sensation in people who self-report as high in sensory sensitivity compared to people who self-report as low in sensory sensitivity.
Method: Using a quasi-experimental design, physiological responses to sensation in typical adults was measured. The use of the Sensory Profile assessment as a behavioral self-reported measure was used as a pretest and the Sensory Challenge Protocol was used as our physiological outcome measure to quantify participants’ physiological responses to sensation.
Results: No significant differences were shown between experimental and control groups in EDR responses to stimuli. Based on the sensory profile, participants’ in the experimental group who identified as sensory sensitive had higher EDR responses to more the intense sensations, such as mower (1.3), feather (1.8), and camphor (1.7). There is a significant correlation between low registration and sensory sensitive (.678), sensory avoidant (.847) and sensory defensive (.817) for the experimental group’s self-reported scores on the Sensory Profile supporting the idea that people who have sensory sensitivities may also suppress responses to sensation.
Conclusion: There are differential, meaningful patterns observed in how people with sensory sensitivities are responding to sensations. There is high variability in individuals’ personal understanding of their own sensory sensitivities and what sensory stimuli they are responding to. Therefore, it is important to know and understand what certain people in the general population do because overtime it can lead to maladaptive behaviors in daily functioning.
Savannah Hancock, Jacqueline Bloom, Charlotte Sally, and Rhianna Wallace
College students in particular have chronically restricted sleep patterns and experience more daytime sleepiness, and physical and mental health issues than their same-aged peers who are not students. Sleep is an emerging area of research and intervention for occupational therapists. The purpose of this study was to identify and investigate how college student’s beliefs about sleep affect their quality of sleep. This study asked: how do beliefs and attitudes about sleep affect sleep quality and participation in valued occupations in college students? Four college students were interviewed regarding their sleep beliefs and attitudes. They also completed a two-week sleep diary to determine their general sleep beliefs and attitudes and daily behavior. The interviews were coded for themes and four emerging themes were identified: a) beliefs about sleep patterns related to temporal structure of sleep, b) the impact of stress on sleep, c) occupational performance in terms of performance in the occupation of sleep and performance in all other occupations (daytime performance), and d) conflicting beliefs about sleep. Sleep diary data revealed that participants’ idealized sleep beliefs are not consistent with actual behavior. From these themes researchers concluded that college students do not have well defined beliefs and attitudes about sleep or consistent, routine sleep schedules, leading to fair sleep quality and performance of daily occupations.
Research is a cornerstone of graduate education in Department of Occupational Therapy at Dominican University of California. Posters in this collection showcase some of the student work presented at conferences.
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