Noralyn Davel Pickens

Co‐occupation: Extending the dialogue

Co‐occupation is a concept not thoroughly studied or understood. A new definition of co‐occupation is proposed which postulates that the nature of engagement in co‐occupation involves aspects of shared physicality, shared emotionality, and shared intentionality, embedded in shared meaning. Each of the aspects is explored through vignettes and reflections on previous literature. Three propositions are presented to advance the understanding of co‐occupation: 1) a spectrum of co‐occupations exists and each type of co‐occupation is characterized by unique aspects; 2) the nature of co‐occupation may be understood through quantitative and/or qualitative means and; 3) impairment or disability across the lifespan may influence how the co‐occupation is manifested and this has implications for research and practice. As the title suggests we put forth these ideas to open a dialogue to enhance knowledge and understanding about co‐occupation.

Loss, Gain, and the Reframing of Perspectives in Long-Term Stroke Survivors: A Dynamic Experience of Quality of Life

Abstract Purpose: Little is known about stroke survivors’ subjective quality of life experience. The purpose of this study was to understand the lived experience of quality of life in 6 long-term stroke survivors. Method: Using a phenomenological design, we interviewed participants (who were 21 months to 11 years post stroke) twice and gave them journals to write in between interviews. Data were evaluated using thematic analysis. Results: The main theme, “It makes me feel like a human again,” integrates 2 subthemes – activity loss: “That’s what I miss” and awakening: “Reality comes to your world.” The main theme describes quality of life as a constantly changing experience, and the subthemes elaborate on the process of change. Conclusion: Themes described quality of life as a dynamic experience that changed as activities of value were lost or gained and as participants experienced changes in their perspectives, beliefs, values, and behaviors. The discussion examines these themes through the lens of the Model of Human Occupation and the Shifting Perspectives Model of Chronic Illness. Clinical implications of the results are also discussed.

Home Modification Assessments: Clinical Utility and Treatment Context

ABSTRACT Occupational therapists need effective assessments to help evaluate the physical, social, and psychological aspects of the home environment when planning home modification interventions. Assessment tools need to have a client-centered focus, emphasis on occupation or occupational performance, comprehensive evaluation of the environment, strong psychometric properties, and clinical utility. When selecting an assessment tool, occupational therapists also need to take into an account the type of home modification interventions that they will be able to complete in a given treatment context. Because of the unique needs of each home modification intervention, there is no one-fits-all assessment; the best tool will depend on the context of care. This paper details six assessment tools for use in three different contexts of care.

Becoming "At Home" in Home Modifications: Professional Reasoning Across the Expertise Continuum.

ABSTRACT Professional reasoning used by occupational therapists in home modifications as they develop from novice to expert was explored in this grounded theory study. Eight occupational therapists participated in multiple interviews and member checks about home modifications training and practice. Formal academic and experiential learning provided the foundation for reasoning systems and habits of practice. As therapists gained expertise, they were able to shift their primary focus from systematic reasoning steps to focus on the comprehensive, client-centered, and contextual picture. Creative educational strategies support confidence in engaging in home modifications practice.

Heart rate variability of activity and occupation during solitary and social engagement

Objective: This study is part of a larger project to investigate psychological, behavioral, and physiological aspects of engagement in activity and occupation. It examined physiological response to social challenges when individuals were bouncing a ball (activity) and playing a game of Yahtzee (occupation). Method: Twelve healthy college students aged 19–24 years participated in four test conditions (solitary ball bouncing, socially engaged ball bouncing, solitary Yahtzee, and socially engaged Yahtzee). Physiological responses were indexed through measures of heart rate variability using ambulatory holter recorders. Repeated measures ANOVA determined differences across conditions. Results: Statistically significant differences were found in measures of heart rate variability across the ball bouncing and Yahtzee conditions. The type of performance (ball bouncing vs. Yahtzee) accounted for 63% of the within‐subjects variance. There were no statistically significant differences found between solitary or social engagement conditions. Conclusion: High frequency heart rate variability may be a more useful measure for examining metabolic cost associated with performance of activity and occupation than it is for determining differences in solitary and social engagement.

Embedding technology into inter-professional best practices in home safety evaluation.

Abstract Purpose: To explore inter-professional home evaluators’ perspectives and needs for building useful and acceptable decision-support tools for the field of home modifications. Method: Twenty semi-structured interviews were conducted with a range of home modification professionals from different regions of the United States. The interview transcripts were analyzed with a qualitative, descriptive, perspective approach. Results: Technology supports current best practice and has potential to inform decision making through features that could enhance home evaluation processes, quality, efficiency and inter-professional communication. Conclusions: Technological advances with app design have created numerous opportunities for the field of home modifications. Integrating technology and inter-professional best practices will improve home safety evaluation and intervention development to meet client-centred and societal needs. Implications for rehabilitation Understanding home evaluators technology needs for home safety evaluations contributes to the development of app-based assessments. Integrating inter-professional perspectives of best practice and technological needs in an app for home assessments improves processes. Novice and expert home evaluators would benefit from decision support systems embedded in app-based assessments. Adoption of app-based assessment would improve efficiency while remaining client-centred.

Home Modifications for People With Alzheimer's Disease: A Scoping Review.

OBJECTIVE The purpose of this review was twofold: (1) to gain insight into what is known from the literature about home modifications for people with Alzheimers disease (AD) and (2) to identify gaps in the literature that could lead to opportunities for research. METHOD A systematic scoping review of peer-reviewed articles published from 1994 through 2014 explored home modifications and AD. RESULTS Seventeen articles met the inclusion criteria. The three major findings pertain to (1) the caregiver role and caregiver training, (2) a client-centered collaborative approach to assessment and intervention, and (3) modifications for safety and function. Home modifications involved the physical and social environments as well as cognitive strategies at the task level. CONCLUSION Opportunities exist for the development of assessment procedures, the exploration of home modifications in the later stages of AD, and the study of home modification needs of people with dementia who live alone.

Reliability of the Participation and Sensory Environment Questionnaire: Teacher Version

The Participation and Sensory Environment Questionnaire—Teacher Version (PSEQ-TV) is a teacher-report questionnaire to assess the impact of the sensory environment on participation of preschool children with autism spectrum disorder (ASD). Many children with ASD have sensory processing differences, although these differences are frequently examined from the standpoint of the person. The PSEQ-TV provides a single assessment to examine both participation and the sensory environment for preschool aged children with ASD. This study established the reliability of the PSEQ-TV including internal consistency of 0.98 and test-rest reliability of 0.70. The results indicate initial reliability of PSEQ-TV as an instrument that can be used to identify sensory environmental barriers within the preschool setting to target during interventions to increase participation.

An Exploration into Occupation-Centered Practice in Skilled Nursing Facilities

ABSTRACT Aims: The aims of this pilot study were to identify occupational therapy interventions provided to short-term rehabilitation clients at skilled nursing facilities and to determine if therapists engaged clients in interventions with an occupation-centered approach. Methods: This study utilized a prospective mixed methods design with in-depth observations of two occupational therapists and three clients. Field notes, schematic drawings, and the Occupation-Centered Intervention Assessment documented and captured 57 interventions. Results: Provision of interventions occurred primarily in the clinic (36/57), with exercise and rote practice as the most common intervention approach (26/57), and interventions that utilized occupation were rated higher on the OCIA indicating a more occupation-centered approach. Conclusions: More than half of the interventions did not involve the use or focus on occupation, indicating a gap between theoretical frameworks and interventions taught in professional school and what actually occurs in practice.

How Patient Educators Teach Students: “Giving a Face to a Story”

Patient Educators are persons with specific pathologies that have participated in an education program in which they learn how to instruct students on physical examinations. The aim of this study was to explore the impact of graduate student experiences with Patient Educators during coursework on occupational therapy clinical internships. A phenomenological design was used to explore the lived experiences of students through a qualitative interview. As participants described their experiences with the Patient Educators, three primary themes emerged: (a) self-awareness, (b) confidence, and (c) empathy. The quotes from the transcriptions were organized into four sequential plot categories: (a) Before the Interaction, (b) During the Interaction, (c) Immediate Change, and (d) Impact on Clinical Internship. The results reveal a narrative of the learning process experienced by students from before the Patient Educators lab through clinical internships. These results suggest that incorporating Patient Educators in the classroom could be a critical component in preparing students for clinical internship and future clinical practice.