Category Archives: Research Projects 2017

Justin Turner & Darren Wiebe

Perceptions of Custom Wheelchair Seating Clinicians on Current Practices and New Technologies

Authors: Justin Turner, Darren Wiebe, Dr. William Miller, & Emma Smith

Background. The development and clinical implementation of custom wheelchair seating technologies have improved the lives of many wheelchair users worldwide (Requejo, Furumasu, & Mulroy, 2015). Nonetheless, many such technologies (e.g., 3-D scanning, digital fabrication, CNC Milling, 3-D printing, telerehabilitation) remain underutilized by clinicians who, instead, employ low-tech custom seating practices that may be more time-consuming, more expensive, less accurate and often inaccessible to individuals in remote communities (Kim, Kim, & Schmeler, 2012; Tasker, Shapcott, & Holland, 2011). Method. Using semi-structured interviews in this qualitative study, we explore what wheelchair seating specialists think about current custom wheelchair seating practices.  Furthermore, we garner the specialists’ opinions on the potential to introduce new technologies in their practice as well as the suspected impact of such change.  In this study we included Occupational Therapists, Physiotherapists, Custom Wheelchair Technicians and Rehabilitation Technologists that practice in custom wheelchair seating, where standard off-the-shelf seating does not meet the client’s needs. Analysis. After interviewing five participants, we developed themes through constant comparative analysis and compared the themes to ensure intercoder agreement and interrater reliability.  The identified themes provide insight into practicing clinicians’ perceptions of currently practiced and alternative, technology-enhanced custom wheelchair seating systems. Significance. To our knowledge, this is the first study to examine wheelchair seating specialists’ thoughts about new technologies and why or why not they are currently utilized. These data can be used by various healthcare stakeholders (including: clinicians, engineers, funders, program managers and custom wheelchair companies) to develop superior, more accessible products and adapt practice to better serve wheelchair users.

After attending this presentation, session participants will:

  1.              Understand study participants’ perceptions of the current custom wheelchair seating systems
  2.              Describe three factors which influence the use of new technologies in clinical practice
  3.              Describe three ways new technologies could be integrated into their current clinical practice

References

Kim, K. Y., Kim, Y. S., & Schmeler, M. R. (2012). Remote decision support for wheeled mobility devices. Expert Systems with Applications, 39(2012), 7345-7354.doi:10.1016/j.eswa.2012.01.083

Requejo, P. S., Furumasu, J., & Mulroy, S. J. (2015). Evidence-based strategies for preserving mobility for elderly and aging manual wheelchair users. Topics in Geriatric Rehabilitation, 31(1), 26-41. doi:10.1097/TGR.0000000000000042

Tasker, L. H., Shapcott, N. G., & Holland, P. M. (2011). The use and validation of a laser scanner for computer aided design and manufacturing of wheelchair seating. Journal of Medical Engineering & Technology, 35(6-7), 377-385. doi:10.3109/03091902.2011.601783

Melanie Tait & Kendall Miller

Road to Recovery: The Influence of Mindfulness on Occupations for People with Mental Health Conditions and/or Substance Use

Authors: Melanie Tait, Kendall Miller, Tom Heah, Kathy Wong, Katie Lee Bunting, Jaisa Sulit, Noa Cohen, & Dr. Tal Jarus

Introduction. One in four people will have a mental health and/or substance-use condition within their lifespan. Such conditions can negatively impact functioning in everyday life and overall participation in occupations. Mindfulness is one approach taught by Occupational Therapists (OTs) to promote recovery. Research suggests that mindfulness reduces symptomology and increases awareness of present moment experiences.  There is minimal research on how mindfulness influences participation in occupations. Objectives. To explore how an eight-week mindfulness program influences participation in occupations for individuals who have a mental health and/or substance-use condition. Methods. This exploratory research used a mixed-methods approach. A convenience sample (N=27) was recruited from four eight-week, mindfulness programs run by OTs in the community. Participation (Subjective Assessment of Participation), mindfulness (Freiburg Mindfulness Questionnaire) and symptomatology (anxiety and depression scales) were measured pre and post intervention (N=15). Ten participants took part in a semi-structured interview after program completion. Results. The themes “Doing,” “Being,” “Belonging,” and “Becoming” are described, wherein participants describe how doing the mindfulness group results in an improved sense of occupational balance on their road to recovery. Quantitative changes in participation are expected to increase with improved mindfulness skills. Conclusions. Through exploring the lived experience of people with mental health conditions participating in mindfulness interventions, this research examines related changes in occupational engagement. It also speaks to the value of integrating emerging therapeutic tools such as mindfulness into OT practice to broaden and enhance occupational therapy’s future potential.

Alan Osiovich & Jeannise Nichols

Test-Retest Reliability of the Wheelchair Outcome Measure for Young People

Authors: Jeannise Nichols, Alan Osiovich, Dr. Debra Field, & Dr. William Miller

Introduction. Children with mobility limitations often have several participation restrictions. Power and/or manual wheelchairs can help to reduce participation restrictions in a child’s life. The Wheelchair Outcome Measure for Young People (WhOM-YP) is a paediatric adaptation of the Wheelchair Outcome Measure, a client-centred semi-structured interview outcome tool. The WhOM-YP captures participation outcomes considered important for children who use manual or power wheelchairs, either as a self-report or administered by parent proxy (dependent on age or abilities of the child). Objective. This study estimated the WhOM-YP’s test-retest reliability when administered to parents providing a proxy response. Methods. In this study, the WhOM-YP was administered on two occasions two weeks apart to 18  parents of children under 19 years of age who use manual or power wheelchairs for mobility. A volunteer  sample of parents were identified by their treating occupational or physical therapist. Exclusion criteria ensured that there were no acute medical and/or equipment changes between sessions. Results. An intra-class correlation (ICC 2,1 ) with 95% confidence intervals was calculated in order to estimate the WhOM-YP test-retest reliability coefficient. We hypothesize that there will be an acceptable test-retest reliability (ICC > 0.70), based on previously published WhOM test-retest reliability estimates. Conclusions. Estimates within the acceptable range of test-retest reliability will give therapists greater confidence in using the WhOM-YP with parents to evaluate the impact of wheeled mobility interventions on their child’s participation.

Winni Chou & Kiarndeep Bains

Telephone Coaching for Caregivers of Children with Type 1 Diabetes

Authors: Kiarndeep Bains and Winni Chou,  Dr. Liisa Holsti, & Sandy Tatla

Introduction. Type 1 diabetes (T1D) is a common lifelong condition in children. Caregivers are involved in diabetes management of children that are diagnosed at a young age; however, caregivers need support as they are supporting their child’s diabetes management. Data from telephone coaching conversations with caregivers will provide insight into the common challenges that arise for caregivers supporting their child with diabetes. Objective. The aim of this qualitative study is to explore the experiences of telephone coaching for caregivers of children with T1D as they support their children in their diabetes management as well as the feasibility of telephone coaching. The qualitative findings of this study will supplement the larger quantitative study. Method. Participants meeting the eligibility criteria of the following: eight-14 years-old, have had T1D for at least one year and have a caregiver or guardian willing to participate, will be introduced to this study during clinic visits and contacted by a member of the research team who will invite participants to join the study. Healthcare professionals who attended a coaching skills development program will complete telephone calls to caregivers bi-weekly for six months to discuss diabetes management and family relationships. Analysis. Researchers will utilize thematic analysis to report meaningful patterns within the data. Implications. The findings will reflect caregiver experiences in supporting their child with diabetes management and provide information about the feasibility of coaching in the context of diabetes care for children and families.

Meaghan Schaefer & Sarah Wex

Seeing Blindness: Exploring Perception of Blindness and Partial Blindness

Authors: Sarah Wex, Meaghan Schaefer, Laura Bulk, & Dr. Tal Jarus

Introduction.  People who are blind/partially blind face occupational injustices rooted in ocularcentrism, a societal perspective whereby vision is considered to be of higher value than other senses, privileging those with full vision while disadvantaging those with visual impairments. The social model of disability posits that, while an individual may experience impairments, it is the social environment that is inherently disabling. Examining social perceptions can help identify stigma and misconceptions that contribute to occupational injustices such as unemployment, social isolation, and poverty. Objective. To explore societal perceptions of occupational participation and the capabilities of people who are blind/partially blind. Method.  The researchers conducted quantitative and qualitative research using a cross-sectional survey. Questions were developed in collaboration with an advisory committee, comprised of experts in the field of visual impairment, the majority of whom have lived experience. Survey data was collected from 368 participants and analyzed using quantitative software. Thematic analysis of qualitative survey data was conducted by the research team. Practice Implications. Examining societal perceptions of blindness/partial blindness is a critical first step in seeking to increase participation in meaningful occupation for people who are blind/partially blind. Conclusion. This study identifies societal perceptions of blindness/partial blindness to address misconceptions and facilitate greater opportunities for occupational participation This study contributes to a body of research providing opportunities for future efforts to reshape societal perceptions of blindness/partial blindness, enabling more full and inclusive participation.

Serena Hurvitz & Negah Mortazavi

Teaching Practices and University Student Well-being: An Outcome Evaluation

Authors: Serena Hurvitz, Negah Mortazavi, Dr. Tal Jarus & Michael Lee

Introduction. Student mental health is an increasing concern on university campuses in Canada, which can greatly impact the occupation of learning. Different teaching practices can result in various learning outcomes. However, there is a gap in literature regarding the impact of teaching practices on student well-being. Our previous studies identified teaching strategies that promote student well-being by surveying thousands of UBC students in 2015-2016. Using the data collected from these students, we designed knowledge translation events on specific teaching practices that promote student mental health and well-being. These events were shared with UBC instructors in the form of symposiums, workshops, and poster presentations. Objective. This quantitative study will describe how increasing awareness on teaching practices that promote university student well-being among the teaching community are the seeds of change for enhancing wellness and learning outcomes. Method. Five student wellness promotion knowledge translation events were presented to UBC instructors from various faculties. This project evaluated the effectiveness of these events by asking instructors to report before and after on their perceptions of their own knowledge, skills, and sense of responsibility around supporting student well-being. Conclusions. The findings of this study suggest that instructors’ awareness regarding teaching practices that enhance student wellbeing is improved after participation in a KT event. This project will help promote student well-being through raising awareness on teaching practices that facilitate learning as an enriching occupation.

Talia Budlovsky & Rhiannon Evans

Estimating Reliability of the Power Mobility Program with School-Aged Children

Authors: Talia Budlovsky, Rhiannon Evans, Dr. Debra Fields, & Dr. William Miller

Introduction. Power mobility facilitates developmental growth by providing children with mobility limitations opportunity for independence and participation in meaningful activities. The Power Mobility Program (PMP) developed by Furumasu and colleagues, evaluates children’s power mobility driving skills and guides therapists’ goal-setting when considering power mobility. Although the PMP has been used in several research studies, there is limited reliability evidence of its use with school-aged children. Objectives. To estimate inter- and intra-rater reliability (reliability, hereafter) of the PMP from video recordings of children aged 5-17 years who use power mobility along with 95% confidence intervals for reliability coefficients. We hypothesize that the intraclass correlation coefficients (ICCs) will be >0.75. Methods. This methodological study will recruit a convenience sample of seven participants who are English-speaking, and either registered occupational therapists or (final year) occupational therapy students residing in British Columbia. Participants’ will score the PMP, while viewing video recordings of ten children performing power mobility driving skills, on two occasions, three weeks apart. Quantitative data will be analyzed using descriptive and inferential statistics. ICCs ≥ .75 will be interpreted as excellent, > .40 as good to moderate, and < .40 as poor reliability. Practice Implications. Acceptable reliability evidence can improve confidence when interpreting PMP scores as therapists’ evaluate children’s power mobility skills. This will promote use of the PMP in research and evidence-based practice. Conclusions. The scores obtained from occupational therapists and occupational therapy students were analyzed and found to have an inter-rater ICC of 0.702 suggesting “good to moderate” reliability. There was considerable variability in the intra-rater reliability score, ranging from 0.373 to 0.961, suggesting poor intrarater reliability. Qualitative feedback obtained from participants was consistent with this finding; participants emphasized the difficulty in scoring discrete ability of skills using the Mobility Rating Scale due to its focus on determining amount of verbal cueing and hands-on assistance provided by the instructor rather than the performance of the child.

Nicole Heron & Mikkayla Johnson

A Pilot Study to Explore How People Who Use Manual Wheelchairs Choose to Navigate in Community-Based Settings

Authors: Nicole Heron, Mikkayla Johnson, Dr. Ben Mortenson, Mike Prescott, & Dr. Jaimie Borisoff

Introduction. The environment often poses barriers and burden (the cumulative effects of environmental factors) to mobility in the community for manual wheelchair users. Together, barriers and burden can make destinations disconnected and unreachable if they exceed an individual’s abilities. Objective. To learn more about community navigation from the perspective of different manual wheelchair users. Methods. Mixed-methods. Qualitative data was collected by asking participants to provide a running commentary while travelling a community route. Quantitative data about the physical environment was collected using GIS. Quantitative data was also collected from the Wheelchair Skills Test questionnaire, Borg Scale of Perceived Exertion, and cognitive fatigue scale. Results. It is anticipated that there will be variation among participants’ physical abilities and perceptions. It is expected that there will be significant environmental barriers and burden for manual wheelchair users navigating the community course. Implications. Findings will help identify common rules of thumb used by manual wheelchair users in community travel, and provide information for future studies on improving community accessibility. Findings could also provide evidence for the need of an intervention that helps reduce the burden of moving about the community for manual wheelchair users.

Kristy Inouye & Chelsey Gowan

Inflammatory Arthritis Care Teams: Re-examining Notions of Client-Centred Practice

Authors: Kristy Inouye, Chelsey Gowan, Dr. Melinda Suto, & Dr. Laura Nimmon

Introduction. Team approaches are common in inflammatory arthritis (IA) care. Following diagnosis, clients face learning to manage their care in the context of multiple new healthcare relationships. Little is known regarding how different team members providing care to the same newly-diagnosed client negotiate this shared responsibility. This knowledge is required to inform client-centred care, a foundational concept of occupational therapy. Objective. To examine how power is perceived and negotiated amongst IA healthcare teams. Methods. This analysis drew on data from a large-scale three-year ethnographic study that used a sociological power lens to explore how IA client care is negotiated amongst team members. Researchers conducted individual semi-structured interviews with all team members and wrote ethnographic field notes. Data were drawn from two men with IA and their care teams, including healthcare professionals and one family member. Researchers used thematic analysis to identify patterns of relationships in the data to illuminate insights into our research question. Results. Our analysis highlighted opportunities and challenges in team communication, and subsequent impacts on client care. An overarching analytic lens of knowledge as power framed two main themes revealing how teams negotiate power by 1) seeking and sharing information and 2) striving to coordinate unified care. Conclusions. Preliminary findings emphasize the importance of team communication dynamics beyond the dyadic relationship of client and care provider. We suggest that communication and power negotiation can be improved through interprofessional educational initiatives.

Greg Halliday & Matthew Dixon

How do People Use Their Wheelchairs, with and without the SmartDrive? Exploring Bout Mobility Patterns Among Canadians

Authors: Greg Halliday, Matthew Dixon, Dr. Ben Mortenson, & Dr. Bonita Sawatzky

Introduction. Wheeled mobility devices enable independence in social and work engagements and facilitate increased access to one’s community. Not all individuals who rely upon wheeled mobility have the physical capacity necessary to operate a manual wheelchair and must therefore rely upon external assistance to mobilize. The SmartDrive MX+ (SD) is one example of a power assist mobility device designed to bridge the gap between power and manual wheelchair mobility. This device is lightweight and attaches to the rear of a manual wheelchair. To date, little research has been done to explore the mobility patterns and experiences of manual wheelchair users while using the SD device. Objectives. The primary objective of this study is to explore bout mobility patterns of manual wheelchair users pre and post provision of the SD. Additionally this study aims to explore the experiences of manual wheelchair users while using the SD device. Methods. Researchers recruited six participants to take part in a one week study that explored the use of the SD. Participants were experienced wheelchair users with a range of diagnoses. The wheelchair was instrumented with an accelerometer, seat sensor pad/data logger, a global positioning system, and the SD. The participants were trained on use of the smart drive.  After one week of use the participants returned to the research facility and underwent a semi-structured interview aimed at exploring each user’s personal experience with using the SD. A Prompted Recall Interview (PRI) was also administered to help identify location and level of participation in their community. Results. One of the emerging themes of our study is that the SD was both a blessing and a curse. Some participants reported that the device enabled greater access to their communities and requested an extension to their study, while others found difficult to manage and returned the equipment after only a few days.

Alyssa Ledingham & Kristin Mow

Validating Socio-Emotional Scenarios for a Virtual Reality Autism Intervention

Authors: Alyssa Ledingham, Kristin Mow, Parisa Ghanouni, & Dr. Tal Jarus

Introduction. Children with autism spectrum disorder (ASD) often have difficulty developing socio-emotional skills that are essential for participation in school, play, and community settings. Virtual reality (VR) environments can help improve socio-emotional skills in an interactive and customizable way. Involving stakeholders in the development of these programs will ensure end users’ needs are met. Despite the importance of socio-emotional skills in ASD and the value of stakeholders’ perspectives, there are no VR programs incorporating stakeholders’ ideas. Objectives. To involve stakeholders in developing and validating the content of a VR intervention, which includes socio-emotional scenarios that children with ASD may find difficult to understand. Method. We used the Delphi method, a structured and iterative process of group judgments. Approximately 40 stakeholders in the field of ASD (experienced clinicians and parents of children with ASD) completed two rounds of online questionnaires to refine and validate the VR scenarios and corresponding emotions. Scenarios that reached a 75% agreement level were accepted. Implications. Validated scenarios can help occupational therapists and parents identify certain skills requiring further attention. Stakeholders can use these scenarios with children to practice real life interactions. Using these scenarios in a VR program will decrease costs and keep children motivated while engaged in occupational therapy services. Conclusion. This project used a client-centred approach to incorporate stakeholders’ ideas in developing a novel VR program for children with ASD, which will facilitate their participation in daily activities and interpersonal communications.

Abilee Kellett & Rhaya Howich

Construction Reliability of a Locally-Sourced Pressure-Reducing Wheelchair Cushion for Less-Resourced Settings

Authors: Abilee Kellett, Rhaya Howich, Emma Smith, & Dr. William Miller.

Background. In developing countries, 80% of people with spinal cord injuries die from pressure ulcer complications. Appropriately prescribed and constructed wheelchair cushions help to mitigate the occurrence of pressure ulcers. The Tuball cushion, constructed using inexpensive and locally-sourced materials, has been shown to have similar pressure-reducing properties as the ROHO cushion, providing an accessible option for low-income wheelchair users in less-resourced settings. The ecological validity of the Tuball cushion depends on the consistency of its construction, which until now, had not been explored. Aim. The purpose of this study is to assess the reliability of pressure-reducing properties across multiple Tuball cushions when independently constructed by different individuals, given equivalent materials and instructions. Mental workload demands of cushion construction will also be assessed. Method. Eleven participants were included in this study, and randomly assigned to one of two groups. In the first group, six occupational therapy (OT) students independently constructed a Tuball cushion, using equivalent instructions and materials. Following cushion construction, the six OT students each completed the NASA Task Load Index for subjective workload assessment. Each of the five OT  students in the second group sat on all six Tuball cushions, and Force Sensing Array (FSA) pressure mapping values were obtained and compared. FSA data were analysed for a primary outcome measure, dispersion index, and three secondary outcome measures, peak pressure index, contact area-quartile, and seat pressure index. Intraclass correlation coefficients (ICC’s) and 95% confidence intervals were calculated for each outcome measure. Practice Implications. The provision of a reduced-cost, locally-sourced wheelchair cushion has potential to address a critical gap in health care for wheelchair users in less-resourced areas. This study contributes to seating and mobility literature by expanding our understanding of the pressure-reducing qualities of a wheelchair cushion created from inexpensive and accessible materials. Further research is warranted to ensure Tuball cushions can be safely and effectively constructed in less-resourced settings.

Leigh Dueck & Kelly Sutton

Neurodevelopmental Outcomes of Children with Congenital Diaphragmatic Hernia

Authors: Kelly Sutton, Leigh Dueck, Margot Mackay, Dr. Julie Petrie, Anne Synnes, & Dr. Jill Zwicker

Rationale. Congenital diaphragmatic hernia (CDH) is a rare birth defect resulting in incomplete diaphragm formation during fetal development; abdominal organs herniate into the chest cavity and hinder lung development. Respiratory deficiencies at birth contribute to poor neonatal outcomes, but few studies have extensively examined neurodevelopmental outcomes of children with CDH. Objectives. The aims of this study are to describe the motor and global cognitive outcomes of children born with CDH and determine whether severity of CDH is associated with poorer neurodevelopmental outcomes. Children classified as high risk are defined as having had patch repair, extracorporeal membrane oxygenation, and/or respiratory support ≥ 30 days. Methods. Neurodevelopment of 66 children with CDH at 4.5 years was assessed at a neonatal follow-up program at a tertiary care hospital. Motor development was assessed using the Movement Assessment Battery for Children and the Peabody Developmental Motor Scales. Global cognitive development was assessed using the Wechsler Preschool and Primary Scale of Intelligence. Frequencies and descriptive statistics were used to describe our cohort’s motor and cognitive performance. Chi squared analyses were used to compare the proportion of high vs. low risk children who scored within a low or average range. Results. The majority of children scored within an average range on both motor and global cognitive outcome measures at 4.5 years. A high risk classification was not significantly associated with poorer neurodevelopmental outcomes at 4.5 years. Conclusion. Further studies are needed to identify guidelines for neurodevelopmental screening for children with CDH.

Mara Salter & Kay Chan

Supporting Future Professionals: Accessibility Module for University Students with Disabilities

Authors: Mara Salter, Kay Chan, Dr. Tal Jarus, & Michael Lee

Introduction. Students with disabilities, enrolled in health and human service (HHS) programs encounter a variety of barriers when engaging in their occupations as students and future professionals in both academic and clinical contexts. The DREAM (Disclosure, Rights & Responsibilities, Advocacy, and Accommodations Module) is a blended learning series comprised of an online module and face-to-face workshops, guided by gaps identified by students with disabilities. Evaluations from the pilot version of the DREAM demonstrated relevance to students’ needs and potential for widespread impact. Objectives. The purpose of this project is to evaluate the usability and efficacy of the modified DREAM in developing students’ knowledge and skills to enhance successful participation in the educational context, and on building a sense of community. Accessibility of the module will also be evaluated. Methods. Students with and without disabilities from all HHS programs will be recruited. Acquisition of knowledge and skills will be measured through the use of surveys, interviews and focus groups, before and after completing the online and in-person workshops. Results. We anticipate that the DREAM will be effective in providing knowledge and skills that will help students with disabilities in HHS programs successfully participate in their educational experience in both academic and clinical contexts. Conclusion. Adapting the environment for individuals to successfully participate in meaningful occupations is a core and historical principle of occupational therapy. Therefore, the DREAM learning series can potentially enable occupational therapy education to be more inclusive in the future.

Sacha Trivett & Robbie Bezati

Professionalism & Disability: The Client’s Perspective

Authors: Roberta Bezati, Sacha Trivett, Dr. Tal Jarus, Michael Lee, Laura Bulk, & Jennifer Gagnon

Introduction. Individuals with disabilities are significantly underrepresented in healthcare professions. Literature suggests that professional competencies are established from an ableist viewpoint, forming institutional barriers for clinicians with disabilities.  Often ‘the safety of the client’ is raised when discrediting the competencies of clinicians with disabilities. However, the client’s perspective on the professional competency of clinicians with disabilities has yet to be investigated. Objectives. This research sought to investigate the client’s perspective of the professional behaviours of clinicians with disabilities. Method. To develop a better understanding of the client perspective, focus groups and interviews were conducted with twenty-seven adults, twenty of whom identify as having a disability or chronic health condition and are receiving services from clinicians. Participants were asked about their expectations and perceptions of professionalism from clinicians with a disability. Themes were developed through a thematic analysis of the qualitative data. Implications for Practice. Exploring the client perspective of professionalism as displayed by clinicians with disabilities may have several implications for occupational therapy practice. The client perspective may enable the participation of clinicians with disabilities in occupational therapy by shifting the definition of professionalism, thereby ending their marginalization from the profession. Conclusion. This research may assist in decreasing the stigma towards clinicians with disabilities within occupational therapy. Future occupational therapy practice may be challenged to adopt a non-ableist viewpoint of clinicians with disabilities and professional competencies.

Danita Morin & Heather Karras

Quality of Life of Children with Developmental Coordination Disorder

Authors: Heather Karras, Danita Morin, & Dr. Jill Zwicker

Introduction. Developmental Coordination Disorder (DCD) is primarily a motor disorder, which affects a child’s ability to perform daily activities. Consequently, the child’s emotional and psychosocial functioning may be significantly impacted. Evidence suggests that children with DCD may experience lower quality of life than typically developing peers, but this has not been explicitly examined. Objectives. The purpose of this study is to examine the domains of health-related quality of life (HRQOL) that are most affected in 8-12 year old children with DCD. Differences in HRQOL of children with and without DCD and differences between parent and child reports were explored. Methods. In this cross-sectional study, quantitative data were collected from 50 children with DCD [Mean (SD) age: 9.8 (1.2) years] and their parents using the Kidscreen-52 and the Strength and Difficulties Questionnaire. Analysis of data included descriptive statistics and one-way ANOVAs with correction for multiple comparisons to determine significant differences between children with DCD compared to published data on typically-developing children, and between parent and child reports. Linear regression analyses were used to determine if motor scores, comorbidities, and family demographics are associated with HRQOL. Results. Children with DCD report significantly lower HRQOL scores than the reference population samples. In all domains except Financial Resources, caregivers of children with DCD report significantly lower HRQOL scores than the norms. In many areas of HRQOL, caregivers of children with DCD have a significantly lower perception of their child’s HRQOL than the self-report perspective of the children. Parents of children with DCD report significantly more emotional and behavioral disturbances than the normative sample. Conclusion. This research aims to contribute to shaping the body of knowledge surrounding the effect of DCD on HRQOL. Findings inform targets of occupational therapy for children with DCD, beyond motor skill intervention.

Salome Emmanuel & Alex Mulhern

Managing Daily Life with Cognitive Challenges for Persons with Multiple Sclerosis: Protocol Development

Authors: Alex Mulhern, Salome Emmanuel, Dr. Susan Forwell, Denise Kendrick & Nancy Forseth

Background. Approximately half of all persons with multiple sclerosis (MS) experience cognitive challenges. Despite growing evidence about the impact on daily life, there are few cognitive interventions leaving individuals with MS with limited options. To date, there is no individualized intervention manual for the treatment of cognitive dysfunction in persons with MS that targets education, specific cognitive domains impairments, and challenges in daily function. Objectives. (1) To develop an individualized intervention manual for cognitive dysfunction in MS. (2) To test the clinical utility of the individualized cognitive intervention manual with a group of experienced clinicians. Method. The development phase involved an extensive literature review from which interventions were selected and included in the program. Interventions to support challenges with daily function emerged from grey literature and clinical experience. These results were compiled into an easy to use manual for both persons with MS and clinicians. The preliminary testing phase of the manual and program involved occupational therapists with experience working with persons with MS to review the manual and respond to a questionnaire regarding the clinical utility. Interviews were conducted to provide additional feedback on the manual usefulness and feasibility. Results. An individualized cognitive intervention manual for persons with MS was created that addresses both specific cognitive impairments and challenges in daily function. Feedback from participants was used to refine the manual prior to pilot testing the manual. It is expected that the intervention will be clinically useful for the treatment of cognitive dysfunction in persons with MS. Conclusion. A individualized cognitive intervention manual should lead to an increase in knowledge and strategies to manage cognitive challenges in daily life and lead to satisfaction in daily function and quality of life for persons with MS.

Gelareh Ghafooripoor & Nikki Ryan

Participation of Children with Developmental Coordination Disorder

Authors: Gelareh Ghafooripoor, Nikki Ryan, & Dr. Jill Zwicker

Introduction. Children with developmental coordination disorder (DCD) participate less frequently and in less diverse activities compared to typically-developing children (Jarus et al., 2011). Participation restrictions have been attributed to poor motor skills, but no studies have examined the influence of the environment on participation of children with DCD. Objectives: This study examined participation in children with DCD at home, school and in the community, considering both personal and environmental factors. Methods. 81 parents of 4- to 12-year-old children with DCD (M=8.3, SD=2.1) completed the Participation and Environment Measure-Child and Youth (PEM-CY). The PEM-CY identifies personal and environmental factors that influence a child’s participation in home, community, and school settings. Descriptive analyses (means, SD) were derived for responses in each setting and compared to previously published data on typically-developing children. Results. Children with DCD participated less frequently than typically developing children in school and community settings and had less overall environmental support in all three settings. Conclusions. Children with DCD would benefit most from motor interventions with a focus on increasing participation and not the underlying motor deficits, as well as adaptations in the environment to support participation of children with DCD in home, school, and community settings.

References

Jarus, T., Lourie-Gelberg, Y., Enger-Yeger, B., & Bart, O. (2011). Participation patterns of school-aged children with and without DCD. Research in Developmental Disabilities, 32, 1323-1331

Joel Helland & Leah Kasinsky

Life Transitions From An Occupational Perspective

Authors: Joel Helland, Leah Kasinsky, Dr. Susan Forwell, & Katie Lee Bunting

Introduction. Life transitions have been well researched in occupation studies in the last twenty-years [1]. Despite this, only recently has a definition and model of predictable life transition (Predictable Transitions from an Occupational Perspective or P-TOP) been developed that captures occupational implications [2]. Purpose. To form an occupational understanding of the lived experiences of professional entry-level Master of Occupational Therapy students transitioning to practitioners. To use this sample population as a means to prospectively test the P-TOP. Methods. Participants from 2015, 2016, and 2017 graduating classes participated in cohort specific ninety-minute focus groups. Employing interpretive description,  the data was coded according to thematic and interaction analysis. Themes gleaned from the data were systematically compared to the P-TOP to assess fit. Results. Findings offer novel insights into the occupational experience of students transitioning to practitioners; such findings will verify the core components of the P-TOP. Conclusion. This study adds to the breadth of research on life transitions from an occupational perspective, and substantiates the P-TOP as a theoretical framework to understand predictable life transitions unrelated to health within the occupation literature.

References

  1. Crider, C., Calder, R., Lee Bunting, K., & Forwell, S.J. (2014). An Occupational Perspective of Transition: An Integrative Review. Journal of Occupational Science, 21(3), 1-16. doi:10.1080/14427591.2014.922913
  2. Romanyk, J., Young, T., Lee Bunting, K., & Forwell, S.J. (2016, October). Transition from an occupational perspective: Defining and presenting a model of life transition unrelated to health. CSOS–SSO:USA 3rd joint conference. Portland, Maine, USA. (paper)

Caitlin Hanna & Montana Bahen

Isn’t It Swell? Stakeholders Experiences’ With An Adaptive Sailing Program

Authors: Caitlin Hanna, Montana Bahen, Dr. Ben Mortenson, Dr. Jaimie Borisoff, Johanne Mattie & Dr. Delphine Labbe

Introduction. Participation in leisure is associated with increased subjective well-being, social connectedness, and positive emotional experiences (Brajša-Žganec,  Merkaš, & Šverko, 2011). However, people with disabilities may have limited access to leisure activities, especially those taking place in natural settings (Perrier, Smith, Strachan, & Latimer-Cheung, 2013). Adaptive sailing is a leisure activity that exists worldwide; however, few studies have explored participants’ experiences. There are anecdotal claims, by sailing clubs and websites, that it is the most inclusive activity for all levels of disability or diagnoses. Objectives. To explore the experiences of sailors, staff, and volunteers involved in an adaptive sailing summer program. Methods. Data was collected using an ethnographic approach including participant observations and semi-structured interviews.  Participants were recruited through a local adaptive sailing program, and GoPro footage was collected to capture sailing excursions and various adaptations. Thematic analysis was completed by the research team on an ongoing basis throughout the study. Results. Twenty days of observational data were collected at the sailing site and 18 qualitative interviews were completed. Analysis of the data identified three main themes: 1) “Anchors away: reasons for setting sail” describes the benefits of being in nature, and the freedom and independence adaptive sailing offers. 2) “Running ashore: challenges with program delivery” acknowledges the various difficulties that sailors and staff face in accessing or participating in adaptive sailing. 3) “All hands on deck: daily logistics and future directions” explores the management of daily operations and identifies directions for the future of the program. Conclusions. This is one of the first studies to examine the impact of adapted sailing and the experiences for all stakeholders, including sailors, staff, and volunteers.  Findings will be conveyed to the adaptive sailing program to develop strategies to improve user experiences, mitigate barriers to participation, enhance programming, and lobby for additional funding.

References

Brajša-Žganec, A., Merkaš, M., & Šverko, I. (2011). Quality of life and leisure activities: How do leisure activities contribute to subjective well-being?.Social Indicators Research, 102(1), 81-91.

Perrier, M. J., Smith, B., Strachan, S. M., & Latimer-Cheung, A. E. (2014). Narratives of athletic identity after acquiring a permanent physical disability. Adapted Physical Activity Quarterly, 31(2), 106-124.

Kathryn Reimer & Rebecca Leja

Pilot Project: Does the Use of a Petrie Abduction Splint Post Hip Containment Surgery Maintain ROM and Hip Location in Children with Cerebral Palsy GMFCS Levels IV and V?

Authors: Kathryn Reimer, Rebecca Leja, Daphne O’Young, Sonja Magnuson, & Dr. Jill Zwicker

Background. Children with cerebral palsy and similar conditions are at risk for hip joint subluxation or dislocation, which often leads to pain and restricted participation in meaningful occupations. Treatment involves hip containment surgery, followed by application of a Petrie hip abduction splint to maintain hip position. Although the Petrie hip abduction splint is standard of care, there is currently no evidence to show its effectiveness. Aim. To provide preliminary evidence to support or refute the effectiveness of the Petrie hip abduction splint in maintaining hip position after hip containment surgery. Methods. This two-year pilot study used a single-subject research design to assess three outcomes: (1) range of motion as measured by goniometry; (2) hip migration percentage as identified on x-rays; and (3) quality of life using the CPCHILD questionnaire. Data were gathered through six pre- and post-intervention data points over a one-year period. Further, self/caregiver reported wear time of the splint was collected over the one year period to be compared with each subject’s own outcome measures. Lastly, demographic information, the type of hip containment surgery, and participants’ physical description were collected for future analysis. Preliminary Results. Based on two participants and preliminary data, results  indicated that the Petrie hip abduction splint may be associated with maintenance of  hip migration percentage; however, the range of motion results were inconclusive.  Longer-term data and quality of life results were not available at the time of publication. Future Implications. This pilot study is ongoing. Findings will determine if the Petrie hip abduction splint is effective for long-term hip positioning.  The results will inform future studies regarding timing of splint implementation, the impact of GMFCS level and individual demographic factors/ physical presentation on splint efficacy.

Carrie Hunt & Anna La Lau

The Step-Wise Approach for Treating Intention Tremor 2 (SWAT-IT2): The Community Application

Authors: Carrie Hunt, Anna La Lau, Denise Kendrick & Dr. Susan Forwell

Background. The Step-Wise Approach for Treating Intention Tremor 2 (SWAT-IT2) is a revised version of the original SWAT-IT that has been developed for broader application. This study aims to test the feasibility and clinical utility of the SWAT-IT2 in the community and to determine if the SWAT-IT2 impacts people living with multiple sclerosis (MS) satisfaction of function, and self-efficacy. Methods. Using the SWAT-IT2 protocol, one-on-one sessions were conducted with seven participants with MS-related IT. The protocol was applied to the daily functional activities. Data was collected using a demographic questionnaire (DQ), medical status questionnaire (MSQ), the new generalized self-efficacy scale (NGSE), the Multi-Dimensional Assessment of Tremor (MAT), Expanded Disability Status Scale (EDSS), Symbol Digits Modalities Test (SDMT), Tremor Treatment Techniques Visual Analog Scales (T3-VAS), and the Daily Tremor Evaluation Form (DTEval). Analysis included descriptive statistics to characterize the population and nonparametric statistics to analyze the pre-post intervention trends for client perceived function, satisfaction of function, and self-efficacy in the SWAT-IT2. Results. Nine participants were recruited to participate in the study, but two did not display IT at their visit and consequently did not receive the SWAT-IT2 protocol. Most participants found the techniques easy to use and incorporate into their daily lives. After a month of using SWAT-IT2 techniques, the majority of participants reported less tremor interference in their daily lives and some participants reported improved self-efficacy. Conclusion. This study adds to the literature surrounding non-pharmacological, non-invasive interventions for MS-related IT by providing a feasible and effective intervention protocol addressing functional activities.

Erin Harmuth & Emy Silletta

Towards a Model of Employment Support for Adults with Autism Spectrum Disorder

Authors: Erin Harmuth, Emy Silletta, Dr. Anthony Bailey, Charlotte Beck & Dr. Skye Barbic

Introduction. Adults with Autism Spectrum Disorder (ASD) have a range of cognitive difficulties and behaviors that impair participation in meaningful activities. In particular, unemployment rates for adults with ASD are very high (Scott, Falkmer, Girdler, & Falkmer, 2015), which has negative consequences for mental and physical health. Information about the facilitators and barriers to employment for this population is scarce. Objectives. To (a) identify employment barriers and facilitators for adults with ASD in the existing literature, and (b) use these data to inform the creation of an intake questionnaire for supportive employment services. Methods. A scoping review of the literature was conducted that followed Arskey and O’Malley’s framework and spanned 7 databases: ABI/Inform, CINAHL, Cochrane Review, EMBASE, MEDLINE, PubMed, and PsycINFO (searched 08/22/16 to 08/25/16). A thematic analysis of the collected data informed the creation of an intake questionnaire to help support adults with ASD to find successful employment. The questionnaire will then be critiqued by several patient research partners (community-based adults living with ASD who have performed employment-related activities). Results. The scoping review identified the breadth and gaps in current ASD and employment literature, while the data analysis provided rich data about existing themes. When patient research partner input is added, the questionnaire will reflect both current research and first-person perceptions. Conclusions. The data from this study will inform the public of barriers and facilitators to employment for adults with ASD, and the questionnaire will enable Occupational Therapists, among other stakeholders, to play a key role in supporting engagement and access to meaningful employment opportunities for this population.

References

Arksey, H. & O’Malley, L. (2005) Scoping studies: towards a methodological framework, International Journal of Social Research Methodology, 8(1), 19-32.

Scott, M., Falkmer, M., Girdler, S., & Falkmer, T. (2015). Viewpoints on factors for successful employment for adults with autism spectrum disorder. PLoS ONE [Electronic Resource], 10(10), e0139281. doi:http://dx.doi.org.ezproxy.library.ubc.ca/10.1371/journal.pone.0139281

Paige Lund & Caitlyn Moir

Establishing Reliability and Validity of the ScanCourse

Authors: Paige Lund, Caitlyn Moir, Dr. Ben Mortenson, & Lisa Kristalovich

Background. The ScanCourse, a component of the Brain Injury Visual Assessment Battery for Adults (biVABA), examines a client’s visual scanning ability while ambulating (Warren, 2006). The ScanCourse is commonly used in occupational therapy practice. However, the psychometric properties of this assessment have not been examined. Purpose. To assess the interrater reliability, test-retest reliability and construct validity of the ScanCourse for use with clients with neurological impairments. Methods. Approximately 40 patients with conditions such as stroke, Parkinson’s disease, or brain injury, who are able to mobilize independently, and communicate either verbally or through pointing will partake in the study. To assess test-retest reliability, the ScanCourse will be administered twice within a 2 week period. To assess interrater reliability, a second rater will be present on one of these sessions. To evaluate construct validity, the results of the ScanCourse will be compared to results of the Bells Test and Trails A & B. Findings. The ScanCourse was found to have excellent interrater and test-retest reliability, and to be significantly correlated to Trails A & B, therefore its use in practice with this population is supported. Implications. This study will inform future research on the predictive validity of the ScanCourse for driving capability.

References

Warren, M. (2006). Brain Injury Visual Assessment Battery for Adults Test Manual. Birmingham, AL: visAbilities Rehab Services.

Christl Bradley & Taryn Gmitroski

A Scoping Review Examining the Facilitators and Barriers for Emerging Adults with Mental Illness

Authors: Christl Bradley, Taryn Gmitroski, Kim Mueser, Steve Mathias, Sarah Irving, Stephanie Gillingham, Dan Huang-Taylor, & Dr. Skye P. Barbic

Introduction. Among young adults living in Canada, 20-25% experience mental health problems. At this stage, youth are typically completing school or career training, and laying the foundation for a their independent future. For young adults with mental illness, there is a gap in knowledge about youth-specific models of supported employment that enable youth to concurrently achieve their employment/education goals while successfully self-managing their illness. Objectives. (1) To outline the existing scope and breadth of knowledge currently available regarding supported employment programs for youth with mental illness. (2) Understand the barriers and facilitators to employment for youth with mental illness who have accessed a supported employment program. Approach. To meet the first objective, a scoping review of the literature will be conducted. To meet the second objective, we will conduct focus groups with youth who have participated in a local supported employment program tailored to their age range. We will use themes and information gathered from the focus groups to inform and support the findings of the scoping review. Practice implications. By understanding the barriers and facilitators to employment faced by youth, health care professionals and health services can be better equipped to meet the needs of young adults who want to gain employment. Results. Findings from both the scoping review and information gathered in the focus groups display that supported employment programs tailored to youth focusing on engagement in meaningful activity and employment result in higher quality of life, increased self-efficacy, and promote recovery from mental illness. The literature shows that the supported employment programs can be improved by incorporating a longer and consistent follow-up period to support youth throughout the development of their years of employment. Conclusions. The results will contribute to much needed evidence towards how best to improve the standard of care and securing/ maintaining employment for young adults who experience mental illness, in Canada and beyond.

References

Hoffman, H., Jäckel, D., Glauser, S., Mueser, K. T., Kupper, Z. (2014). Long-term Effectiveness of Supported EMployment: 5-year follow up of a randomized controlled trial. Am J Psychiatry 171:11, 1183-1190.

Nicole Pineau & Colleen Sanderson

Introducing Power Mobility In Early Childhood: Parents’ and Therapists’ Perspectives

Authors: Colleen Sanderson, Nicole Pineau, Roslyn Livingstone, Debbie Field, & Dr. Jill Zwicker

Introduction. Limited independent mobility reduces childhood participation in desired occupations and negatively influences child development. Power mobility use is linked to cognitive, physical, and social benefits through increased mobility and exploration. However, power mobility use by young children is limited, in part due to minimal availability of child-friendly devices. Objectives. This study explored families’ and therapists’ perspectives regarding their experience with an introductory power mobility session comparing four power mobility devices developed for young children. Methods. Researchers ran ‘Power Mobility Days’ at eight child development centres across British Columbia. Young children (under 6 years of age) with mobility limitations tried the Bugzi, WizzyBug, Tiger Cub, and motorized ride-on toy car in a 1-1½ hour session. Consenting parents and therapists who attended the session then participated at a later date in semi-structured phone interviews asking about their experience of the day and their impressions about power mobility for their children/clients. These interviews were audio recorded, transcribed, and thematically analyzed using a directed content analysis approach. Results. We completed 22 interviews with 11 parents and 11 therapists. Children ranged in age from 12 to 48 months and had a range of neuromotor disorders, with cerebral palsy being most prevalent. Four themes were identified: Change in perspective; Social integration of children and parents; Power Mobility Days as an acceptable way to introduce power mobility; Function and aesthetics as priorities for parents and therapists. Conclusion. Participation in Power Mobility Days exposed parents’ and therapists’ to the use of novel power mobility devices and their potential to improve functional outcomes for young children with mobility limitations. This experience expanded their understanding of early power mobility options, and increased desire to pursue early power mobility as an intervention.