Patricia Rigby

The Person-Environment-Occupation Model: A Transactive Approach to Occupational Performance.

Occupational therapy theory, practice and research has increasingly emphasized the transactional relationship between person, environment and occupation. Occupational performance results from the dynamic relationship between people, their occupations and roles, and the environments in which they live, work and play. There have, however, been few models of practice in the occupational therapy literature which discuss the theoretical and clinical applications of person-environment interaction. This paper proposes a Person-Environment-Occupation Model of occupational performance which builds on concepts from the Occupational Therapy Guidelines for Client Centered Practice and from environment-behaviour theories. The model describes interactions between person, occupation and environment, outlines major concepts and assumptions, and is applied to a practice situation.

The Impact of Adaptive Seating Devices on the Lives of Young Children With Cerebral Palsy and Their Families

OBJECTIVE To determine the parent-perceived effect of adaptive seating devices on the lives of young children with cerebral palsy (CP) (aged 2-7y) and their families. DESIGN Baseline-intervention-baseline study. SETTING Homes of participating families. PARTICIPANTS Thirty parents and their children with Gross Motor Function Classification System level III or IV CP. INTERVENTIONS Two special-purpose seating devices: 1 for sitting support on the floor or on a chair and the other for postural control on a toilet. MAIN OUTCOME MEASURES Family Impact of Assistive Technology Scale (FIATS) and Impact on Family Scale (IFS). RESULTS Thirty parents (29 mothers, 1 father) and their children with CP participated. Repeated-measures analysis of variance detected significant mean differences among the FIATS scores (F(1.4,40.6)=19.25, P<.001). Post hoc testing confirmed significant mean differences in overall FIATS scores between baseline and intervention and intervention and postintervention phases. The test of within-subject effects did not detect a significant change among IFS mean scores. CONCLUSIONS The introduction of adaptive seating devices for young children who need support to sit had a meaningful, positive impact on child and family life. Removal of the study devices showed a concomitant negative impact on key aspects of child and family life. Environmental resources, such as seating and other assistive technology devices, may have an important role to play in the lives of young children with physical disabilities and their families.

Effect of adaptive seating devices on the activity performance of children with cerebral palsy.

OBJECTIVE To evaluate the short-term impact of 2 adaptive seating devices on the activity performance and satisfaction with performance of children with cerebral palsy (CP), as observed by their parents. DESIGN Baseline-intervention-baseline study. SETTING Homes of participating families. PARTICIPANTS Parents and their children (N=30), mean age of 4 years 6 months, with Gross Motor Function Classification System levels III and IV CP participated. INTERVENTIONS Two special purpose seating devices: one for sitting support on the floor or on a chair, the other for postural control on a toilet. MAIN OUTCOME MEASURES Changes in activity performance and satisfaction were measured through parent ratings on the Canadian Occupational Performance Measure. We interviewed parents biweekly using the Home Activity Log to describe and explain their childs activity performance during the 3 study phases. RESULTS Parents identified 139 activity performance issues (4.6 a child): 58.3% in self-care, 34.5% in play, and 7.2% in socialization and quiet recreation. We used paired t tests to demonstrate significantly improved performance and satisfaction with self-care and play activities when the children used the adaptive seating devices during the 6-week intervention phase. Three themes arose from the analysis of comments made by parents during Home Activity Log interviews: adaptive seating can have an enabling influence on the child, caregivers and family find adaptive seating useful, and the adaptive seating devices did not meet every familys needs. CONCLUSIONS Parents reported that their young children with CP were more able to engage in self-care and play activities when using specific adaptive seating devices in their home. Parents indicated that their childs activity performance decreased after the seating devices were removed from their homes.

Stability of Playfulness Across Environmental Settings: A Pilot Study

The Test of Playfulness (ToP) was used in this pilot study to examine the stability of playfulness of 16 children with cerebral palsy (CP), aged 4–8 years, across three environmental settings: home, community, and school. Each videotaped play segment was scored using the ToP. The ANOVA statistic demonstrated a significant variance (p < 0.05) in the playfulness of the children across the 3 settings. The children were most playful at home and least playful at school (p < 0.05)The variability in playfulness across settings suggests that playful behaviors are influenced by factors external to the child. Eleven children were playful (achieving a positive ToP score) in at least one environment, which demonstrates that they had the capacity to be playful. Their play was supported in some settings and not in others. However, there was a lack of playfulness in 65% of the play segments suggesting that these children experience many barriers to their participation in play. Future research is needed to identify factors that help and hinder the playfulness of children with CP.

Electronic aids to daily living and quality of life for persons with tetraplegia

Purpose. To compare the satisfaction with quality of life (QOL) of adults with tetraplegia from spinal cord injury (SCI) who use and do not use electronic aids to daily living (EADLs). Method. This study used a cross-sectional design. Thirty-six persons with spinal cord injuries or conditions at or above C5/6 level participated. Fifteen participants used EADL at home and 21 formed the comparison group of non-users of EADL; all were living in the community. We used the Quality of Life Profile-Physical Disabilities (QOLP-PD) to examine participants QOL. Results. Both groups rated the levels of importance of all aspects of QOL equally. The EADL users rated their satisfaction with QOL significantly higher for total QOLP-PD scores and for four of the nine domains, including all three domains of belonging. The groups did not differ in age, FIM scores, level of education, and hours of paid attendant care. The EADL user group had significantly more males than females, and had higher levels of SCI. Conclusions. EADLs appear to contribute to the experience of greater subjective QOL for persons with severe physical disability from high SCI. Prospective cohort studies designs that employ methods and analytic plans to study the causal effect of EADLs on QOL are recommended. The QOLP-PD was found to be a valid measure of QOL for this population.

Effects of a wheelchair-mounted rigid pelvic stabilizer on caregiver assistance for children with cerebral palsy.

A within-subjects repeated measures (A1, B, A2) design was used to study the impact of a rigid pelvic stabilizer (RPS) compared with a traditional lap belt on the caregiver assistance requirements of six children with cerebral palsy as they completed functional tasks from their wheelchair seating system. Study participants wore a lap belt during the 3-week baseline phases (A1 and A2). The RPS was used during the 5-week intervention phase (B). At baseline, each child and parent identified five bimanual or reaching tasks with which the child had difficulty. Using a six-point scale, each parent (caregiver) rated the degree of assistance the child required to do each task. Parents also maintained a log, recording how many times the child was repositioned daily. The RPS appeared to impact directly on reducing caregiver assistance for 30% of the tasks, as the need for assistance was less during phase B when the RPS was used and was greater during phases Al and A2 when the lap belt was worn. Five children required repositioning less often during phase B than during the A phases. The RPS reduced the childs need for caregiver assistance for some bimanual and reaching tasks as well as for repositioning.

Functional Outcomes Associated With Adaptive Seating Interventions in Children and Youth With Wheeled Mobility Needs

OBJECTIVE To determine the parent-reported functional outcomes associated with adaptive seating devices for wheeled mobility devices used by young people aged 1 to 17 years. DESIGN Longitudinal case series. SETTING Homes of participating parents. PARTICIPANTS Parents (N=70, 63 mothers, 6 fathers, 1 grandmother) who had children with adaptive seating needs. INTERVENTION Adaptive seating system for wheeled mobility devices. MAIN OUTCOME MEASURE Family Impact of Assistive Technology Scale for Adaptive Seating (FIATS-AS). RESULTS All parents completed the FIATS-AS 4 times-2 times before and 2 times after their child received a new adaptive seating system. Mixed-design analysis of variance did not detect significant mean differences among the FIATS-AS scores measured at baseline and 2 and 8 months after receiving the seating system (F2,134=.22, P=.81). However, the FIATS-AS detected a significant interaction between age cohort and interview time (F4,134=4.5, P<.001, partial η(2)=.16). Post hoc testing confirmed that 8 months after receiving the seating system was associated with a large improvement in child and family functioning for children <4 years, maintenance of functioning for children between 4 and 12 years, and a moderate decline in functioning for youth between 13 and 17 years. CONCLUSIONS Adaptive seating interventions for wheeled mobility devices are associated with functional changes in the lives of children and their families that interact inversely with age. Future controlled longitudinal studies could provide further empirical evidence of functional changes in the lives of children and their families after the introduction and long-term use of specific adaptive seating interventions.

Person-Environment Relations

The interaction that occurs between individuals and their environment is central to all work and rehabilitation practice. In the past, rehabilitation has focused more on facilitating personal adaptation and less on understanding the influence of the environment on behavior. Eight person-environment models, developed by other disciplines but of relevance to rehabilitation, are presented and discussed. The way in which each of these models views the person, the environment, the person-environment relationship, and adaptation is compared and contrasted to views inherent in rehabilitation practice. The literature suggests that rehabilitation is gradually moving from an interactive perspective of person-environment fit toward a transaction view that more accurately acknowledges the complexity and the entwined nature of these issues.

Randomised controlled trial comparing two school furniture configurations in the printing performance of young children with cerebral palsy

AIM This randomised controlled trial compared the same-session effects of two different school furniture configurations on printing legibility. METHODS A total of 30 school-age children with ambulatory cerebral palsy participated in this study. Each child provided one near-point printing sample of up to 34 letters while positioned on Mandal-type specialty school furniture and on standard school furniture. An assessor who was unaware of the intervention assignment scored printing errors. RESULTS No significant difference in legibility score mean values between the interventions was detected and the effect size was small. CONCLUSIONS Compared with standard school furniture, the use of specialty school furniture did not lead to immediate gains in printing legibility and other printing performance areas for children with cerebral palsy. Further study of the influence of functional abilities, other contextual factors and the longer-term use of school furniture on handwriting performance is recommended.

Community-Based Performance of a Pelvic Stabilization Device for Children With Spasticity

We developed a new type of pelvic stabilization device designed to help children be better positioned in their wheelchairs. The device replaces a wheelchair lap belt by providing firm anterior pelvic support for the seated user. We developed, tested, and evaluated instructions for installing, fitting, and using the device to study its performance in “typical” community settings in Toronto, Canada. Each of four therapists worked with a local rehabilitation technology supplier to install and fit the device onto an adaptive wheelchair seating system for a young child between 5 and 10 years of age. Therapists assessed the systems positioning effects, and children used the system for 12–14 days. Following the trials, therapists, parents, and children reported their levels of satisfaction with the performance of the device as compared with the childrens existing lap belts. Participating therapists confirmed that the device provided better anterior pelvic stability for their clients. Parents felt that their children were generally better positioned in their seats and thought that the device was easy to use. Children had similar perspectives. Suppliers were confident that they could readily install the devices following the instructions provided. Based on the opinions of participants and our inspection of the installed devices, we proposed that minor modifications be made to the product design and instructions for installation, fitting, and use.