Spring 04

Abstract: Background and Purpose: Cerebrovascular accidents (CVA) are the leading cause of long-term disability secondary to a substantial loss of motor recovery. Constraint-induced movement therapy (CIMT) is a new approach to treating a person who has experienced a CVA in order to regain motor function. Based on the theory of learned nonuse, CIMT applies a physical constraint to the patient’s unaffected extremity in order to force the patient to focus on using their affected extremity in daily life activities. The purpose of this study is to determine the effectiveness of CIMT in improving occupational performance for patients following a CVA. In addition, to determine the effectiveness of CIMT in the more acute stage, less than one year post-CVA, verses the more chronic stages following a CVA. Methods: A critical review of the published literature between the years 1980-2004 was performed including all qualitative and quantitative studies. Studies included the implementation of CIMT with participants aged 40 years and older who have experienced a CVA. Participants received treatment in in-patient, out-patient, and home-based settings and focused on the use of the affected upper extremity during daily life activities. Four authors reviewed each study and completed the McMaster University Critical Review forms, compiled matrices, and graded the studies using the levels of evidence and grades of recommendation.
Results: Authors identified 15 studies for review. Most studies utilized similar assessments, which included the Motor Activity Log (MAL), the Wolf Motor Function Test (WMFT), the Fugl-Meyer Assessment (FMA), and the Action Research Arm Test (ARA) to determine functional upper extremity use. Interventions varied by study, however all included restricted movement of the unaffected upper extremity for a period of time, while emphasizing use of the affected upper extremity. Each study was graded and given a level of recommendation, which proved the quality of evidence to support the use of CIMT in practice.
Conclusion/Recommendations: The systematic review provided strong evidence that supports the effectiveness of CIMT in improving occupational performance and function for people who have sustained a CVA. Additionally, CIMT was as effective when implemented during a more acute phase of at least one-year post-CVA when compared to the implementation of CIMT greater than one-year post-CVA.

Abstract:
Purpose: This study examined the relationship between sensory processing and self-concept in typically developing young children.
Method: Forty-nine typically developing children between the ages of 7 and 10 completed the Piers-Harris Children’s Self-Concept Scale-2 (Piers & Herzberg, 2000) while a parent completed a Sensory Profile Caregiver Questionnaire (Dunn, 1999). This quantitative study analyzed data using a multiple linear regression.
Results: A significant correlation between the Sensory Processing subtest (r = .517, p = .000) and the Modulation subtest (r = .385, p = .003) of the Sensory Profile with the Piers-Harris 2. The multiple linear regression of these two areas was significantly related to the Piers-Harris 2 scores measuring self-concept (F (2,46) = 8.811, p< .001). Where as the Sensory Processing subtest was significant in predicting the criterion variable of self-concept, the Modulation subtest was not. Conclusion: These results support the assumption that sensory processing influences the development of self-concept in young children. To plan effective intervention when treating a child with low self-esteem, an OT practitioner needs to consider the child’s ability to modulate sensory input.

Abstract: In our study we explored which objects were brought with the person to a nursing home, how this process occurred, which objects reflected an affective bond between person and object (i.e., attachment), what is the nature of this bond (i.e., meaning), and how the objects reflected past and present occupational roles of the person. We also explored how the objects reflect the nature of each person as an occupational being. Fourteen participants age 65 and older took part in this study. A phenomenological design was used with semi-structured interviews in order to explore the individuals’ objects. Interviews were transcribed and coded using the five main research questions. Qualitative analysis resulted in nine overall categories that consistently appeared within the interviews, which include a) decorative items, b) pictures, c) electronics, d) religious objects, e) stuffed animals/dolls, f) items one can wear, g) plants/flowers, h) linens, and i ) leisure items. All but one participant identified at least one item that held significant value and importance regarding occupational performance in 1) past work roles, 2) social participation, in particular, role as a family member and 3) leisure participation. This study explored how objects in one’s environment reflected the person as an occupational being this information can be useful within assessment and intervention planning in occupational therapy.

Abstract: Relationships with friends, family, and health care providers play a major role in the aging process (Hummert & Nussbaum, 1992). There is a drastic decline in communication in the latter years that is commonly identified as a ‘generation gap’ (Strom & Strom, 1993). Computer usage may help reduce the decline in communication between generations and help fill in the gap. The purpose of this study was to examine the influence that an educational internet communication group had on the type and frequency of social communication for ten individuals residing in an assisted living center. Mean age of the participants was 91 years for the males (n=5) and 83 years for the female (n=5) participants. Participants completed the SF-36 Health Survey both before and after the educational internet communication group, and maintained a daily log of communication throughout the four week program. Results indicated that the most notable increases in the subscales of the SF-36 were Role-Physical and Role-Emotional. These increases were not statistically significant. Communication log summaries indicated that a majority of the communication took place during mealtime or in scheduled groups. E-mail usage outside of the scheduled sessions was quite infrequent during the first two weeks of the program, but did increase to two – five times a week during the final stage of the program. Further exploration of this topic is relevant to occupational therapy since our goals are to increase life satisfaction, quality of life, and a sense of autonomy through daily life occupations. Research considering the physical, emotional, as well as psychosocial aspects at various points in the life span may provide a holistic picture of computer usage and its multiple benefits.

Title: Correlation of Length of Stay in the Neonatal Intensive Care Unit with Scores on the Pediatric Evaluation of Disability Inventory and the Sensory Profile
Authors: Melinda Aeppli, Andrea M. Ahmie, Naomi Epe, Julia Fritz, Kristen Steiner

Abstract: A correlational study was done to examine the association between neonatal intensive care unit (NICU) length of stay (LOS), sensory processing and functional performance. Using the Pediatric Evaluation of Disability Inventory (PEDI) and the Sensory Profile (SP), the researchers interviewed thirteen caregivers of children 24-36 months of age who had a stay in the NICU. The researchers hypothesized a significant inverse correlation between LOS and scores on both the PEDI and SP; however upon analyzing data, no significant correlation was found except for one aspect of sensory processing. The correlation found was between LOS and sensory sensitivity within the SP with a statistical significance level of p=.035. This result may indicate children with increased sensory sensitivity may tend to over attend to irrelevant stimuli, which may lead to distractibility and hyperactivity. Further research should explore if the relationship identified in this study may be a causal one.

Year: 2004
Chair: Lalit Shah, Ed.D, OTR/L
Reader: Ellen M. Mclaughlin, Ed.D., OTR/L

Title: Functional Performance and Satisfaction of Individuals with a Lower Limb Prosthesis
Authors: Allison Bush, Jeff Edmonston, Elizabeth Fiorilla, Chris Hindson

Abstract: Forty lower limb amputees responded to a detailed questionnaire asking how satisfied the individual was with their performance while using the prosthesis. Seventy-seven and a half percent reported being overall satisfied with their participation in their ADLs. Forty-two and a half percent reported being employed. Twenty-five percent reported wearing their prosthesis more than 8 hours a day. Eighty-seven and a half reported being overall satisfied with their performance in the area of leisure. This study found that the prosthetic user who wore their prosthesis for more than 8 hours a day were more satisfied with their performance in ADLs, work and productive activities, and leisure activities compared to those prosthetic users who only wore their prosthesis less than 8 hours a day.

Chair: Lalit Shah, Ed.D., OTR/L
Reader: Molly Mika, M.S., OTR/L

Title: A Test of the Effectiveness of Simultaneous Presentation of Visual and Auditory Information in Children with Learning Disabilities
Authors: Christine Breslin, Samantha Conzo, Stacey Sterner, Stephanie Viola, and Wendy Warner

Abstract: The purpose of this pilot study was to test a protocol of assessing the effectiveness of bimodal reading programs. A protocol for testing the ability of children to retain information presented using a bimodal approach of vision, hearing, or both was developed and tested. The pilot study utilized the computer program, WYNN, to present each mode by controlling which of the sensory channels was available to the subject. The story was presented in one of three formats: print only, voice only, or the combination of print and voice. The participants were randomly assigned to one of these three groups. At the end of each reading, the participants were asked a series of nine multiple choice questions. In order to test delayed recall of the reading material, the participants were asked the second series of multiple choice questions one week later without review of the reading material. The pilot study demonstrated that the research protocol was able to present information at a consistent rate across the three delivery methods, and to assess both short term and delayed recall of the information presented. In addition, the pilot study indicated that there may be differences in delayed recall that are not in agreement with accepted practice. Based upon this information, the protocol allows for future research to determine the most effective method of teaching for children with learning disabilities. The weakness of the protocol was in recruitment, which may have been influenced by concerns about new federal legislation, and the enforcement of confidentiality within the school systems.

Year: Spring 2004
Chair/Reader: Denis Anson/Lalit Shah

Title: Does Voice Recognition Deserve Recognition? A Study Comparing the Efficacy of Voice Recognition vs. the Standard Keyboard
Authors: Luann Daveski, Patrick Chavannes, and Karen Shaughnessy

Abstract: Many claims have been made on behalf of speech recognition as a method input. However, little controlled research on the relative value of speech input for document processing is available. Consequently, clinicians are unable to provide to their clients optimal access to activities enabled by voice recognition input. Thus this study sought to compare the speed and accuracy of voice recognition Dragon Naturally Speaking Preferred Version 7 versus the standard keyboard. This study used a single subject, successive intervention design in which a sample of nine able-bodied individuals participated. Each participant was required to type a document which included prose, headings, and a table containing special characters on a laptop and was required to continue to type rearranged versions of the document until a plateau was achieved (i.e., three consecutive trials have entry times within 7% of each other). The 7% standard has been derived from past studies, in which it was found that many individuals have speed variations of greater than 5% in normal typing, while a 10% standard can be achieved while a participant continues to make significant gains in performance. Using a standard of 7% seems to balance these two difficulties. This same procedure was also replicated using voice recognition input. Results of the study indicate that, for complex, real-world documents, voice input takes approximately twice as long, with error rates approximately twice as high.

Year: Spring 2004
Chair/Reader: Denis Anson/Dawn Evans

Title: The Effects of Word Completion and Word Prediction on Typing Rates Using On-Screen Keyboards.
Authors: Penni M. Moist, Mary Przywara, Heather Wells, Heather Saylor, Hantz Maxime

Abstract: While often recommended by therapists as a means to improve typing speeds, current research of standard keyboard users have failed to show any improvements in typing speed provided by word completion and word prediction programs. One of the reasons that these programs are not considered to be helpful to touch typists is that the use of this software requires the user to look away from the source document from which the user is typing. For input methods that already require the typist to look away from the copy, this effect might be negated.
The focus of this research was to determine whether word completion or word prediction programs would increase typing speed when used with an input method (on-screen keyboard) that also requires looking away from the source document. Ten people, five males and five females with ages ranging from 20 to 38 years old, participated in this study. This study used a single-subject, successive intervention design to test typing speed and accuracy using an on-screen keyboard with integrated word prediction software. To make this analysis, the participants were tested using each of the following options: on-screen keyboard only, on-screen keyboard with word completion, and on-screen keyboard with word prediction. Seven participants had their fastest typing speed with word prediction. Two participants had their fastest typing speed with word completion. Only one participant demonstrated no improvement in speed when using these two programs. Overall, these results show that the use of word prediction and word completion may assist on-screen keyboard users to improve typing speed.

Year: Spring 2004
Chair/Reader: Denis Anson/Molly Mika

Title: The Relationship Between Visual Perception and Comprehension in Students with Learning Disabilities
Authors: Kessler Carrie, Susan Gouldson, Jill O’Conner, Yu-Yun Shih-Manis & Keri Stockton

Abstract: The purpose of this study was to examine the relationship between visual perception and both visual reading and listening comprehension in children with learning disabilities. Forty children between the ages of 7 and 16 (m = 10 yrs, 6 mo.) with learning disabilities were given the MVPT, a reading comprehension test and a listening comprehension test. It was hypothesized that there would be a significant correlation between visual perception and visual reading comprehension, but not listening comprehension. It was also hypothesized that for children with low scores on the MVPT, there would be decreased performance in reading comprehension as compared to listening comprehension.
Results indicated a correlation of r = .28 (p = .037) between scores of visual perception and reading comprehension, although these scores were not significant at the alpha adjusted for multiple comparisons (.025). The correlation between visual perception and listening comprehension was virtually the same (r = .285, p = .038). For the 14 participants whose MVPT scores demonstrated a significant delay, average reading scores were 53.46 %, and average listening scores were 57.79%, failing to support the hypothesis that there would be significantly higher listening scores. Implications of these results for occupational therapists and further research are discussed.

Year: Spring 2004
Chair/Reader: Ellen McLaughlin/Grace Fisher