Leonard G. Trujillo

Fear of Falling and Its Relationship With Anxiety, Depression, and Activity Engagement Among Community-Dwelling Older Adults

OBJECTIVE This study examined (1) the relationship of fear of falling to depression, anxiety, activity level, and activity restriction and (2) whether depression or anxiety predicted fear of falling, activity level, activity restriction, or changes in activity level. METHOD We administered the Survey of Activities and Fear of Falling in the Elderly; the Geriatric Depression Scale-30; and the Hamilton Anxiety Scale, IVR Version, during a one-time visit to 99 community-dwelling adults ≥55 yr old. RESULTS We found significant relationships between (1) fear of falling and depression, anxiety, and activity level; (2) depression and anxiety; and (3) activity restriction and depression. Activity level was negatively correlated with activity restriction, fear of falling, depression, and anxiety. Anxiety predicted both fear of falling and activity level. Both anxiety and depression predicted activity restriction because of fear of falling and for other reasons. CONCLUSION Occupational therapy practitioners should consider screening their older adult clientele for fear of falling, anxiety, and depression because these states may lead to fall risk and activity restriction.

Using an IADL Assessment to Identify Older Adults Who Need a Behind-the-Wheel Driving Evaluation

Occupational therapists need to routinely assess driving ability in hospital and/or rehabilitation settings. The purpose of this study is to determine if the Assessment of Motor and Process Skills (AMPS), an observational tool of instrumental activities of daily living, could discriminate between older adult drivers who pass, pass with restrictions, or fail a behind-the-wheel (BTW) evaluation. Forty-six participants were evaluated with a BTW driving assessment and the AMPS. Two one-way ANOVAs found significant differences for both the motor and process scores suggesting the AMPS can be used as a screening tool for driving. Results also showed no significant difference in age between those participants who passed, failed, or needed restrictions supporting the concept that driving abilities are related more to function, not age. Exploration of minimum scores is discussed.

Distance Education Pedagogy and Instructional Design and Development for Occupational Therapy Educational Programs

Distance education in occupational therapy programs is increasingly becoming an instructional norm. Technological advances and the common expected use of the Internet and its multiple options to communicate and share information have made its use also commonplace for occupational therapy educators. As with any instructional modality, Web-based instruction can offer a vibrant learning environment created through different teaching strategies, activities, and technologies. This article briefly outlines educational models and instructional designs that can be part of every occupational therapy program as they incorporate distance education and Web-based learning into their programs. The primary focus is on the incorporation of the constructivist approach.

The Validation of the Interactive Metronome: A Pilot Study Prior to Implementation for Post Deployment Service Members

The purpose of this study was to validate the protocols created for the Interactive Metronome TM (IM) used in conjunction with the TRX® System for returning post deployment service members diagnosed with mild traumatic brain and/or Post-Traumatic Stress Disorder. This was done using a pilot population similar in age and physical status as active duty military, but within a college setting. The pre-established protocols were pilot tested on two male and two female participants. The data collected was from the IM Long Form, Nine Hole Peg Test, Canadian Occupational Performance Model and the Test of Everyday Attention. In a comparative analysis of pre- and post- status it was determined that the IM along with TRX® system would potentially benefit returning post deployment service members using this series of treatment interventions.

Creating a custom fabricated neoprene orthosis for optimal thumb positioning

Neoprene orthoses are used extensively in treating conditions of the hand when flexibility and support are sought. Devices such as these may be prefabricated from Neoprene alone or may include a thermoplastic or metal stay. Neoprene devices can also be custom fabricated by a practitioner in a time effective manner and at low cost. The custom fabricated orthosis described in this article is designed to support the thumb in a position of palmar abduction and opposition while maintaining CMC extension and an adequately open web space to prevent soft tissue contracture.

The Culture of Falls and Fear of Falling: A Phenomenological Study

Purpose: This phenomenological study explored and described the lived experiences of community-dwelling older adults regarding what falls and fear of falling meant to them, and how each entity influenced self-efficacy, functional performance, and degree of engagement in occupations. Methods: Thirty-one older adults, 58 to 94 years old, were interviewed one time at a senior center or continual care retirement community. All interviews were analyzed using QSR NUD*IST 6 software. Results: Three main themes emerged: 1) highly fearful, and having their lives affected by the fear of falling; 2) having fallen, but rationalized their fears and modified their lives accordingly; and, 3) felt they had not fallen by their definition and remained active in place. Conclusion: Findings suggest the importance for practitioners to listen and understand their clients’ stories and perceptions of how they are selectively engaging in life’s activities while maintaining a personal perception of living an active life style.

Crafts and Creative Media in Therapy

Within this book, the authors give examples of the benefits of crafts, describe how to document their use, and give suggestions for effective implementation. Given this is the 4th edition of the book, the authors present the case for the value of the use of crafts and other creative media in treatment intervention. The previous editions of the book did not include the OT Practice Framework, which the authors make an attempt to address through an introductory chapter. Most of the text is presented where a chapter introduces a craft or art media. Within the craft chapter, a significant portion of the chapter is spent introducing basic instruction on how to do that particular media or craft. Because of this format, the intention of the book is unclear. The therapeutic use of crafts as a treatment modality can be overshadowed by the “how-to” of specific craft media. If one is unfamiliar with craft media and wishing to learn for use for practice, then this book is an excellent resource. However, only one method of engaging in the media is presented and it is at an introductory level. This text is written under an initial assumption that crafts are activities, which are therefore occupations. While there is a new chapter that addresses the use of crafts as occupation, it seems to justify the use of crafts as treatment in contrast to exploring the possibility that craft media may be a viable occupation in which a person engages; thus, knowledge of the specific craft becomes valued in restoring a person’s ability to engage in a personal favorite past time. At first glance, one may feel the book is a quick redo of previous editions, but notable enhancements were made with the case studies by giving greater detail and information to more clearly illustrate the use of crafts in a therapeutic manner rather than just activity-based therapy. Photos and drawings have not been updated from previous versions and include a combination of line drawings and older black and white photos. They are basic and could have been updated to help make the book provide a newer insight to the use of crafts rather than a sense of “resurrecting archives from days past.” The book is well written and easy to read. The chapters that focus on a specific craft are laid out to include:

Driver rehabilitation and community mobility principles and practice.

The national AOTA office has identified driving evaluation and driving rehabilitation as an emerging and critical practice area for occupational therapists. The authors address this national focus with their well-written book. This text meets the needs of both the novice occupational therapist (OT) looking to enter the field, as well as providing an excellent consolidation of expert material for the more experienced therapist. There are 48 contributing authors who expertly present a broad range of content in a thorough and understandable manner. The text reads well and allows the reader to gain insight and knowledge into the complex venues of driving rehabilitation with ease. The chapters cover almost every topic that the OT seeking to specialize in driving evaluation and rehabilitation would need. These range from looking at driving from a historical perspective, evaluating and determining driving performance, rehabilitation and improving driving skills, and environmental factors that impact the driver and other community mobility issues. The progression of the chapters follows a very practical and clinically based approach, providing a logical building of the reader’s knowledge base. The text is complete and up to date in its content and methods discussed. The appendices provide a wealth of information that is a must to have, particularly if one is developing a driving evaluation program. A full complement of materials on the laws that the OT must be aware of are covered, as well as CPT codes and an introduction to the values of connecting with the Association for Driver Rehabilitation Specialists (ADED).