Occupational therapy

Fellowship Grant. I would like to thank my thesis advisor, Dr. Patrice Wunch, for her support and direction with the project. I would also like to thank Dr. Carrico for always going out of her ways to help me with the research. My sincere appreciation also goes to Dr. Carole Ivey, who has provided me with the tools and knowledge to expand my understanding of the study topic. I graciously thank Dr. Berry, Program Director and Research Committee for supporting my research and accommodating clinic schedule for the research time. Last but not least, I would like to show my gratitude to my family for their endless support, dedication and love. I would not have made it to where I am today if it were not for them. iii Acknowledgement .

Praxis is the ability of the brain to develop an idea for action and plan, organize, and execute unfamiliar motor actions. It enables purposeful interaction with people and things in the environment. Ideation is central to praxis but has been little researched. This study investigated the reliability of the Test of Ideational Praxis (TIP) and examined ideational praxis in typical preschoolers. TIP performance for 78 preschoolers ages 3, 4, and 5 yr was videotaped and scored by two trained raters. The TIP has strong interrater reliability, supporting earlier findings. Further, we documented test–retest stability over 2 wk. As a group, preschoolers identified 10.6 affordances (ideas) for action on the TIP; no age differences were found. Training is required for accurate scoring of the TIP; following training, clinicians and researchers may find the TIP a useful tool to screen motor ideational abilities in young children.

This study established interrater reliability and preliminary developmental score guidelines for preschool children (ages 3–5 yr) on the Motor Planning Maze Assessment (MPMA). We administered the MPMA to 80 typically developing preschoolers and found age effects for Time, Error, and Total scores for each of three mazes. Five-year-olds obtained lower (better) scores than 4-yr-olds, who scored lower than 3-yr-olds. Older children completed the mazes with significantly fewer errors in significantly less time than younger children. Interrater reliability was excellent on the total MPMA score (intraclass correlation coefficient = 0.96) and individual maze scores (0.90–0.98). Results of this study provide evidence that the MPMA can serve as a reliable, objective screening of a preschooler’s ability to plan and execute motor movements. A larger reference population is needed to increase generalizability.

Occupational therapy faculty currently face enormous challenges in meeting teaching load expectations, while also under pressure to participate in scholarly projects and to make administrative and service contributions. Community engagement projects may provide opportunities for faculty to effectively and efficiently meet the goals in each of these areas while imparting benefits to students and community partners as well. Faculty at the Department of Occupational Therapy (OT) at Virginia Commonwealth University (VCU) embraced this idea as consistent with the university's mission and strategic plan, and recognized its benefits in assisting faculty to meet workload demands. Four community partnerships reflecting the range and diversity of populations currently involved are highlighted: the Children's Museum of Richmond, Rebuilding Together-Richmond, the William Nelson Bland Literacy Center, and Gateway Homes of Richmond. The developmental process and resulting benefits are described for each of these partnerships, and the paper concludes with lessons learned from these collaborative efforts. From these examples, it appears important to be proactive about developing community partnerships and realistic about the challenges of collaboration, but also to be aware of the role community engagement plays in creatively blending the potentially conflicting demands on faculty time.

INTERDISCIPLINARY TEAMWORK PEDAGOGY By Carole Kennedy Ivey A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University, Richmond, Virginia. Virginia Commonwealth University, 2011 Dissertation Chair: Evelyn Reed, Ph.D., Department Chair, Special Education and Disability Policy, School of Education The purpose of this study was to describe the interdisciplinary teamwork pedagogy of the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) training programs, specifically the content focus, instructional methods, and assessment practices. LEND programs are a national network providing long-term, graduate interdisciplinary training through federal funds from Health Resources and Service's Administration's Maternal Child Health Bureau. This study used a mixed method approach to describe the interdisciplinary teamwork pedagogy of LEND training programs. The study occurred in thre...

Leaders at VCU were interviewed to gather their lessons learned, their triumphs, and their challenges in regards to COVID-19. More than ten interviews were completed with leaders across both VCU campuses and at varying positions at the university. Their responses, gathered in a multi-media case study of “lessons learned,” were collected to serve as inspirations for learning about leadership through success in a crisis

Date Presented 4/17/2015 Children with autism spectrum disorder (ASD) are significantly more likely to have an unmet need for therapy than children with attention-deficit/hyperactivity disorder (ADHD), but they are similar in unmet needs compared with children with cerebral palsy (CP). We identify barriers to appropriate care in children with special health care needs and areas for future inquiry.

Although interdisciplinary teamwork is a recommended practice and important for coordinated interdisciplinary programming in special education, there is limited research on pedagogical practices to prepare professionals to work together effectively. This study examined the effectiveness of a graduate interdisciplinary teamwork course taught through two distinct learning formats (week-long face-to-face and hybrid) on graduate students' teamwork knowledge, skills, and dispositions. Using the How People Learn framework (National Research Council, 2000), further analysis was conducted to consider the relationship of students' prior teamwork experiences to their entry-level knowledge and satisfaction with course features. Results indicated that students in both learning formats reported improvements in teamwork knowledge and skills; however, differences in learners' prior experiences and their satisfaction with the course, course structure, assignments, and activities was found. Further examination of pedagogy is needed to characterize how professionals are prepared with knowledge, skills, and dispositions for effective teamwork.

ABBREVIATIONS ASD Autism spectrum disorder CSHCN Children with special healthcare needs NS-CSHCN National Survey of Children with Special Health Care Needs AIM This study examined cross-sectional population-based rates in reported need and unmet need for occupational, physical, and speech therapy services in children with autism spectrum disorder (ASD) compared with children with attention-deficit-hyperactivity disorder (ADHD) and cerebral palsy (CP).

Children with secondary dystonia due to cerebral palsy (CP) often exhibit excess variability in their movements. To investigate the relationship between excess variability and single-joint control in these children, we compared their force variations during single-joint isometric tasks to age-matched controls. Subjects performed isometric biceps contractions at six target force levels scaled to their maximum voluntary contraction. Similar studies in healthy adults have shown that movement variability exhibits characteristics of signal-dependent noise (SDN). We look for the first time at whether variability in single-joint force contractions in healthy children and children with CP exhibit similar characteristics of SDN. Results showed that compared to controls, patients exhibited increased variability (standard deviation about the mean), increased force error bias (difference between the mean and target), and increased dependence of force error bias on target force level. Signal-dependence of the noise was significant only in healthy subjects due to the higher overall variability in the patients. A control experiment using filtered visual feedback confirmed that overcorrection for perceived error was not the cause of the observed variability. These results contribute to a better understanding of movement variability in childhood dystonia and have potential use in therapeutic interventions designed to increase force production reliability.

Successful reaching requires that we plan movements to compensate for variability in motor output. Previous studies have shown that healthy adults optimally incorporate estimates of motor variability when planning a pointing task. Children with dystonia have increased variability compared with healthy children. It is not known whether they are able to compensate appropriately for the increased variability and whether this compensation leads to changes in reaching behavior. We examined healthy children and those with increased motor variability due to secondary dystonia. Using a simple virtual display, children performed a motor task where the variability of their movements was manipulated. Results showed that both subject groups changed their movement strategies in response to changes in the level of perceived motor variability. Both groups changed their strategy in a way that improved performance relative to the perceived motor variability. Importantly, dystonic children faced with decreased motor variability adapted their movement strategy to perform better and more similarly to healthy children. These findings show that both healthy and dystonic children are able to respond to changes in motor variability and alter their movement strategies. motor control; variability; children; dystonia A NUMBER OF EXPERIMENTS on perception have shown that humans take uncertainty into account when interpreting and responding to sensory information (

Successful reaching requires that we plan movements to compensate for variability in motor output. Previous studies have shown that healthy adults optimally incorporate estimates of motor variability when planning a pointing task. Children with dystonia have increased variability compared with healthy children. It is not known whether they are able to compensate appropriately for the increased variability and whether this compensation leads to changes in reaching behavior. We examined healthy children and those with increased motor variability due to secondary dystonia. Using a simple virtual display, children performed a motor task where the variability of their movements was manipulated. Results showed that both subject groups changed their movement strategies in response to changes in the level of perceived motor variability. Both groups changed their strategy in a way that improved performance relative to the perceived motor variability. Importantly, dystonic children faced with...

Practice of movement in virtual-reality and other artificially altered environments has been proposed as a method for rehabilitation following neurological injury and for training new skills in healthy humans. For such training to be useful, there must be transfer of learning from the artificial environment to the performance of desired skills in the natural environment. Therefore an important assumption of such methods is that practice in the altered environment engages the same learning and plasticity mechanisms that are required for skill performance in the natural environment. We test the hypothesis that transfer of learning may fail because the learning and plasticity mechanism that adapts to the altered environment is different from the learning mechanism required for improvement of motor skill. In this paper, we propose that a model that separates skill learning and environmental adaptation is necessary to explain the learning and aftereffects that are observed in virtual reality experiments. In particular, we studied the condition where practice in the altered environment should lead to correct skill performance in the original environment. Our 2-mechanism model predicts that aftereffects will still be observed when returning to the original environment, indicating a lack of skill transfer from the artificial environment to the original environment. To illustrate the model prediction, we tested 10 healthy participants on the interaction between a simple overlearned motor skill (straight hand movements to targets in different directions) and an artificially altered visuomotor environment (rotation of visual feedback of the results of movement). As predicted by the models, participants show adaptation to the altered environment and after-effects on return to the baseline environment even when practice in the altered environment should have led to correct skill performance. The presence of aftereffect under all conditions that involved changes in environment demonstrates separation of environmental adaptation and skill learning. Our results support the existence of two distinct learning modules with different adaptation properties. Therefore we suggest that adaptation to an altered environment may not be useful for training new skills.

h i g h l i g h t s A new method of measuring lower extremity dynamic load perception during gait is developed. Load perception impairments in stroke survivors not detected by static tests were significant in our dynamic load perception test. Impairments in dynamic load perception correlated with gait asymmetry in stroke survivors. a b s t r a c t Objective: This study aimed to improve our understanding of static and dynamic lower extremity sensory perception and the impact of sensory impairments on the control of walking in stroke survivors. Methods: Using a custom, real-time unloading system, we tested load perception at heel strike, mid stance and push off in 10 stroke survivors and compared their performance to 10 age-matched and 5 young adult control subjects. Dynamic load perception was based on a judgment of which leg was bearing more load, which was altered on a step by step basis. We also examined lower extremity static load perception, coordination, proprioception, balance, and gait symmetry. Results: The stroke survivors performed significantly worse than the control subjects in dynamic load perception, coordination, proprioception, balance and gait symmetry. Gait symmetry correlated with static and dynamic load perception measures but not with age, proprioception, coordination, and balance. Conclusions: Sensory deficits related to load detection in the impaired limb could result in an increased uncertainty of limb load and a gait strategy in which stroke survivors minimize loading of the impaired limb. Significance: This new method of measuring lower extremity dynamic load perception provides a framework for understanding gait-related sensory impairments in stroke survivors.

This study aimed to improve our understanding of static and dynamic lower extremity sensory perception and the impact of sensory impairments on the control of walking in stroke survivors. Using a custom, real-time unloading system, we tested load perception at heel strike, mid stance and push off in 10 stroke survivors and compared their performance to 10 age-matched and 5 young adult control subjects. Dynamic load perception was based on a judgment of which leg was bearing more load, which was altered on a step by step basis. We also examined lower extremity static load perception, coordination, proprioception, balance, and gait symmetry. The stroke survivors performed significantly worse than the control subjects in dynamic load perception, coordination, proprioception, balance and gait symmetry. Gait symmetry correlated with static and dynamic load perception measures but not with age, proprioception, coordination, and balance. Sensory deficits related to load detection in the im...

As reflected by the comments of Kumar et al. (2015), there is an increasing interest in developing quantitative measurements of complex sensorimotor behaviors in people with neurologic injury or disease. In concept, our manuscript "Perception of lower extremity loads in stroke survivors" addresses one of these behaviors, which is likely to be important to gait function in stroke survivors (Chu et al., 2015). While we believe that impairment in load perception plays an

Children with dystonia are characterized by highly variable and seemingly uncontrolled movements. An important question for any rehabilitative effort is whether these children can learn and improve their performance. This study compared children with dystonia due to cerebral palsy, typically developing children, and healthy adults in their ability to acquire a novel sensorimotor skill. Using a virtual setup, subjects threw a virtual ball tethered to a post to hit a virtual target. Multiple combinations of release angle and velocity of the arm at ball release could achieve a target hit-the task was redundant and afforded solutions with different sensitivity to variability. Subjects performed 200 trials for two target locations that presented different types of redundancy. We hypothesized that children with dystonia develop strategies that are tolerant to their high variability. Estimating this variability highlighted the insufficiency of traditional outcome measures. Therefore, additional analyses of data distributions and of ball release timing were applied. Results showed that: 1) children with dystonia reduced their performance error despite their high variability; 2) this improvement was brought about by finding error-tolerant solutions; and 3) they generated arm trajectories that created time windows for ball release that were tolerant to timing variability. While reduced in magnitude, the performance improvements in children with dystonia paralleled those in healthy children and adults. These findings demonstrate that children with dystonia are able to adapt their behavior to their high variability, an important basis for any rehabilitative intervention.

Proprioception is the subconscious and conscious awareness of the spatial and mechanical status of the musculoskeletal framework. When working with children with motor delays and sensory integrative dysfunction, occupational therapists routinely assess the client's proprioceptive system. However, currently available assessments for occupational therapists are primarily observer-based and concerns have been raised about the reliability of observer-based assessments of sensation. The author's purpose was to review measures of proprioception currently available to occupational therapists and explore direct measures of proprioception from neuroscience and rehabilitation that can be adapted for pediatric clinical use. Observer-based and direct measurements of proprioception assessments complement each other in meeting clinical needs. A better understanding of both types of evaluation will improve proprioceptive evaluation.

Balance deterioration is a major risk factor for falling, particularly among the elderly. Early detection of emerging balance problems can allow behavioral and medical interventions to reduce the impact and severity of balance-related incidents. The iBalance technology presents a small, mobile platform that integrates hardware and software engineering for balance monitoring at a low cost for use in the home, physical therapy office, or other point of care setting. The hardware solution has the form factor of a bathroom scale and takes the standard approach of a force plate with four load cells arranged in the corners beneath the platform. The load cells output 12-bit data to a computing device running the accompanying software. There is less scientific consensus about the most effective software solution for performing analysis on balance data. A survey of the literature reveals 16 commonly used metrics of balance derived from force plate data. Using principal component analysis, we identify three underlying clusters of metrics from which a representative metric for each cluster may be chosen to construct an exogenous balance score. Finally, we have developed a graphical user interface for the iBalance that allows researchers to collect raw and/or processed data and view analytic visualizations of the data, with ease of extensibility for further research and analysis.