Janice P. Burke

The Tailored Activity Program to Reduce Behavioral Symptoms in Individuals With Dementia: Feasibility, Acceptability, and Replication Potential

PURPOSE The Tailored Activity Program (TAP) is a home-based occupational therapy intervention shown to reduce behavioral symptoms and caregiver burden in a randomized trial. This article describes TAP, its assessments, acceptability, and replication potential. DESIGN AND METHODS TAP involves 8 sessions for a period of 4 months. Interventionists identify preserved capabilities, previous roles, habits, and interests of individuals with dementia; develop activities customized to individual profiles; and train families in activity use. Interventionists documented time spent and ease conducting assessments, and observed receptivity of TAP. For each implemented prescribed activity, caregivers reported the amount of time their relative spent in activity and perceived benefits. RESULTS The TAP assessment, a combination of neuropsychological tests, standardized performance-based observations, and clinical interviewing, yielded information on capabilities from which to identify and tailor activities. Assessments were easy to administer, taking an average of two 1-hr sessions. Of 170 prescribed activities, 81.5% were used, for an average of 4 times for 23 min by families between treatment sessions for a period of months. Caregivers reported high confidence in using activities, being less upset with behavioral symptoms (86%), and enhanced skills (93%) and personal control (95%). Interventionists observed enhanced engagement (100%) and pleasure (98%) in individuals with dementia during sessions. IMPLICATIONS TAP offers families knowledge of their relatives capabilities and easy-to-use activities. The program was well received by caregivers. Prescribed activities appeared to be pleasurable and engaging to individuals with dementia. TAP merits further evaluation to establish efficacy with larger more diverse populations and consideration as a nonpharmacological approach to manage behavioral symptoms.

Parasympathetic Functions in Children with Sensory Processing Disorder

The overall goal of this study was to determine if parasympathetic nervous system (PsNS) activity is a significant biomarker of sensory processing difficulties in children. Several studies have demonstrated that PsNS activity is an important regulator of reactivity in children, and thus, it is of interest to study whether PsNS activity is related to sensory reactivity in children who have a type of condition associated with sensory processing disorders termed sensory modulation dysfunction (SMD). If so, this will have important implications for understanding the mechanisms underlying sensory processing problems of children and for developing intervention strategies to address them. The primary aims of this project were: (1) to evaluate PsNS activity in children with SMD compared to typically developing (TYP) children, and (2) to determine if PsNS activity is a significant predictor of sensory behaviors and adaptive functions among children with SMD. We examine PsNS activity during the Sensory Challenge Protocol; which includes baseline, the administration of eight sequential stimuli in five sensory domains, recovery, and also evaluate response to a prolonged auditory stimulus. As a secondary aim we examined whether subgroups of children with specific physiological and behavioral sensory reactivity profiles can be identified. Results indicate that as a total group the children with severe SMD demonstrated a trend for low baseline PsNS activity, compared to TYP children, suggesting this may be a biomarker for SMD. In addition, children with SMD as a total group demonstrated significantly poorer adaptive behavior in the communication and daily living subdomains and in the overall Adaptive Behavior Composite of the Vineland than TYP children. Using latent class analysis, the subjects were grouped by severity and the severe SMD group had significantly lower PsNS activity at baseline, tones and prolonged auditory. These results provide preliminary evidence that children who demonstrate severe SMD may have physiological activity that is different from children without SMD, and that these physiological and behavioral manifestations of SMD may affect a childs ability to engage in everyday social, communication, and daily living skills.

How Do We Change Practice When We Have the Evidence

Translating research findings into practice includes myriad pragmatic realities, including understanding the suitability of the data to a particular patient group, writing new guidelines for occupational therapy practitioners, facilitating adoption of the guidelines, and instituting new patterns of care for patients. The process is more than a matter of disseminating the information to practitioners and expecting immediate change in patient treatment. Indeed, the field of implementation science is devoted to the identification of the numerous barriers and supports that constrain or expedite practice change in response to research. Moving forward and adopting evidence-based findings will require a focused understanding of the particular setting where change is warranted. Among the issues to address are the health system levels involved in change (professional, legislative, administrative, practitioner, and patient and family members), the values and beliefs of the participants, and knowledge of the communication channels that exist in the setting and how information and new ideas make their way through the setting.

Exploring the Personal Reality of Disability and Recovery: A Tool for Empowering the Rehabilitation Process

People experiencing disability and chronic disease often feel powerless, relinquishing medical control to “more knowledgeable” professionals. This article presents qualitative and quantitative results from three individual patients experiencing an emerging procedure called Recovery Preference Exploration (RPE). To inspire greater patient involvement, self-direction, and individual choice, we instructed participants to create an imagined recovery path, exposing recovery preferences while learning about clinical rehabilitation concepts. Results uncovered important values and feelings about disability, providing a richer context for patient evaluation and treatment goal modification. Applying mixed methods, RPE is presented as an explanatory process for quantifying recovery preferences in a way that stimulates rich narrative of how people see different types of disabilities. RPE shows promise for increasing depth of discussions among patients, family, and clinicians. RPE may promote greater quality of life through patient empowerment by directed learning, increased communication, and enhanced self-knowledge.

Linking Sensory Factors to Participation: Establishing Intervention Goals With Parents for Children With Autism Spectrum Disorder

Parents often focus on independence in activities of daily living and social participation when setting goals for their children with autism spectrum disorders. Occupational therapy practitioners use clinical reasoning to translate these goals to define occupation-based outcomes. This article describes an exploratory analysis of 160 parent-identified goals for children with autism. We identified sensory integrative factors hypothesized to influence each goal and then categorized the goals using the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health (ICF). Most goals were at the ICF participation and activity levels. Activities of daily living were the most common area of occupation identified, followed by social participation and play. Sensory reactivity and somatopraxis were the most frequently occurring sensory integrative factors. The value of addressing parent goals using a systematic reasoning process to identify factors affecting participation and the importance of measuring participation outcomes are discussed.

Context and culture: African-American elders’ experiences of depression

The word “depression” is used in many forums, such as clinically or colloquially. Our study explored how the word is used culturally and experientially in a particular group of individuals. In this article, we examine the meaning of depression to a sample of 60 African-American men and women with varying levels of health and functional status. We presented the word depression in our interview questionnaire but did not pre-define the word, nor did anyone in the sample ask us to define it. A key finding of this article is that the way in which persons construct an experience of depression, their expression of it, and their perception of an appropriate resolution emerges from their belief system. Our data offered a window into the internal world of elders, particularly the cultural and religious beliefs and traditions that shaped their processes of defining, interpreting, and resolving depression. For this group, resolving depression meshed with the spiritual adaptive strategies, such as reliance on God, community, self, and others, that they used throughout life to deal with negative circumstances.

Maternal Role Preparation

The Maternal Role Preparation (MRP) project demonstrates an innovative occupational therapy approach to increasing maternal competence in first time mothers. This four session program provided women with discussion, demonstration, practice and written materials covering topics concerning their infants (attachment, sensory systems, developmental abilities) and themselves (acquiring a new role as mother). Theoretical constructs from Behavioral Pediatrics, Sensory Integration and Occupational Behavior were evaluated for their compattbility and combined under the unifying framework of Occupational Behavior. The program represents an opportunity for occupational therapists to combine sensory integration theory and practice with other compatible treatment perspectives and approaches.

State of Measurement in Occupational Therapy Using Sensory Integration

This article presents the current state of measurement in the area of sensory integration within the field of occupational therapy in three areas: (1) phenotypic characterization, (2) intervention adherence and dosage, and (3) outcome measurement. The need for additional measurement tools in all three areas is addressed. In regard to outcome measurement of occupational therapy using sensory integration, the use of both qualitative and quantitative methods to obtain outcome data is recommended. Further, a strategy is recommended for obtaining outcome data from direct report from the child or other stakeholder.

Evolution of a Revolution in Occupational Therapy Education.

This issue of the American Journal of Occupational Therapy reflects an increase in the quantity and quality of scholarly projects submitted for publication in this special issue. The positive response to the call for papers is evidence of the focused interest that faculty, both academic and clinical, and practitioners have brought to their work of educating and preparing the next generation of occupational therapists. This article discusses educational issues from academic, student, and fieldwork points of view, further validating the pervasive commitment that is being made to further understanding of how occupational therapists are educated. The articles cover topics including the critical issues of curriculum, value and timing of fieldwork and simulation experiences, and documentation of strategies to measure the effects of comparative educational experiences.

A collaborative approach to meeting the need for quality personnel training in early intervention.

No abstract available for this article.