Sensory processing challenges in adults are associated with life experiences, such as anxiety, depression and decreased quality of sleep (Engel-Yeger & Dunn, 2011; Engel-Yeger & Shocat, 2012; Kinnealey & Fuiek, 1999). These life experiences may impact perceptions of Life Balance related to patterns of daily activities to support health, relationships, challenges and identity (Matuska, 2012b). Researchers have reported that life imbalance is associate with decreased well-being and dissatisfaction with life (Eakman, 2015). Literature that connects the sensory integration literature with the life balance literature is just evolving. The aim of this doctoral project was to better understand the potential relationship between sensory processing challenges and life balance and to identify evidence-based interventions to best address the problem of life imbalance for adults with sensory processing challenges. Making Sense of Life Balance, an 8-week intervention program, was developed using the results of the literature review. The intervention incorporates four key components: an interview that focuses on the participant’s sensory needs as well as current coping strategies, goal-setting with development of an action plan, co-active coaching for problem solving, as well as use of journal for tracking strategies and reflecting on life balance. The intervention is designed to facilitate reflection and problem solving to identify effective coping strategies, increase use of effective coping strategies, increase self-efficacy regarding self-management of sensory needs, and, ultimately increase perception of life balance.

Stroke is a leading cause of long-term disability (Benjamin et al., 2017) and patients with this diagnosis have been found to have higher incidences of inappropriately long hospital lengths of stay (McDonagh, Smith, & Goddard, 2000). Generalist training in occupational therapy curriculum coupled with variable research utilization (Dysart & Tomlin, 2002; McKenna et al., 2005) leads to inconsistent methods of evaluation and decreased communication between providers across settings. Furthermore, there are currently no standardized discharge planning models or guidelines for clinicians to follow when evaluating patients or making recommendations (Ilett, Brock, Graven, & Cotton, 2010). An evidence-informed discharge planning model was created to address these issues. This model utilizes a multidisciplinary approach, with guidelines for selecting and administering evaluations to quantify a patient’s functional status. Assessments are clustered into four domains: activities of daily living, balance and mobility, cognition, and other (i.e. visual inattention, motor control and spasticity). These assessments supplement a basic patient evaluation, and results are used to guide clinical decision making regarding recommendations for the next level of care. Stroke rehabilitation and care cannot be standardized, but the methods used to select measures and make discharge recommendations should have distinct guidelines. By choosing from a core set of measures, clinicians can use a common “language” to describe patient function and measure progress across settings over time. This will ensure patients are discharged to the appropriate level of rehabilitation to optimize their recovery, and it will also help prevent excessively long hospital admissions.

Social and political movements over the past few decades have contributed to the need for more occupational therapy (OT) services in the community for mental health, wellness, recovery from substance use disorder, and homelessness. There has been a sharp increase in the number of OT educational programs since the 1970s, as well as a paradigm shift from a medical model to a socio-political or community service model that is more in keeping with the original principles of OT. Yet only 2% of occupational therapists currently work in the community. All of these factors have contributed to a severe shortage of fieldwork (FW) sites, especially in the community. To address the need for more FW sites to train students for practice in the community, a best practice model for community-based Level II FW was created. The goals of the Level II FW program are to support the development of a student’s unique professional identity and to prepare students for entry-level practice. Because there will be limited supervision by a fieldwork educator (FWEd) on-site, the model is based on the principles of Adult Learning Theory including self-directed learning (SDL), collaborative learning, and experiential learning with self-reflection. The components of the program include an online, interactive wiki-based website that will be accessible to the FWEd and students both on- and off-site. The website will include manuals for both the students and FWEd as well as training modules, site-specific objectives, and student self-assessments. Reflective sessions and journals will also be included in the FW experience. A student’s readiness for SDL will be determined prior to the beginning of FW by using the Self-Directed Learning Readiness Scale for Nursing Education. Goal Attainment Scaling will be used to encourage SDL and to provide a structured progression of goal competency attainment for entry-level practice. Students will also complete a pre- and post-fieldwork survey. Dissemination of this model to administrators of potential FW sites will hopefully increase the number of FW programs that can offer students an experience focused not only on the health and well-being of individuals, but of communities and populations.

Evidence consistently reveals that taking part in an inclusion classroom does not guarantee that children with disabilities will be accepted, valued, or included (Lindsay & Edwards, 2012; Rillota & Nettelbeck, 2007; Ison et al., 2010). Children with disabilities have been reported to have significantly less friendships and overall social participation within the school environment (Ison et al., 2010). With the growing number of youth with disabilities in the United States and the important push for education in the least restrictive environment (Currie & Kahn, 2012), it is concerning that so many of these children are still feeling devalued among their typically developing peers. Since the 1980s, disability awareness programs have incorporated activities to increase knowledge and understanding of disabilities as a means to improve attitudes toward and acceptance of the growing number of children being mainstreamed (Lindsay & Edwards, 2012). However, these programs are often disjointed from the general education teachers and the general curriculum, and rarely extend the length of an entire academic year; this is a potential cause of their short-lived impact (Lindsay & Edwards, 2012; Rillota & Nettelbeck, 2007; Ison et al., 2010; de Boer, Pijl, Minnaert & Post, 2014; Hurst et al., 2012; Hunt & Hunt, 2004; Favazza, Phillipsen & Kumar, 2000; Freeman 2000). This doctoral project, Inclusion through Infusion: Disability Awareness Training for Elementary Educators, seeks to develop an evidence-based solution to the challenges outlined above. This teacher training program strives to provide education, support and structure for implementation of disability modules within the general curriculum of a New York State first grade inclusion classroom. The program modules aim to eliminate barriers to implementation, such as lack of academic time, knowledge, and confidence in educators, with the greater goal of improving typically developing children’s attitude towards and acceptance of their peers with disabilities.

As a result of increased academic rigor and limited movement opportunities during the school day, students may have more limited focus and difficulty in maintaining attention in the classroom (McMurrer, 2007; Stark, Rentner, & Kober 2014; Common Core State Standards 2014). As students have more difficulty maintaining attention, their learning can be affected and impaired. As the trend for increased academic rigor continues, teachers need strategies to help students maintain attention, such as movement breaks, classroom environmental modifications, and alternative seating suggestions that can be incorporated throughout the day and that do not impede on time spent on academic curriculum guidelines. The research is clear that occupational therapists should focus on best practice including multi-faceted approaches that meet the needs of the children and incorporate self-regulation and sensory integration strategies (Schaaf & Davies, 2010; Cohn, Kramer, Schub, & May-Benson 2014; Reynolds, Glennon, Ausderau, Bendixen, Kuhaneck, Pfeiffer, Watling, Wilkinson, & Bodison, 2017). Interventions in the proposed program will focus on three sensory integration strategies including the use of alternative seating in the classroom by students, modifying the classroom environment through consultation and strategies with the teacher and classroom staff to increase student focus and limit distractions and using classroom-based movement and physical activities. These specific approaches offer a variety of supports in the classroom setting to all children, as well as those with disabilities to help them obtain and maintain optimal attention for learning. The Moving to Learn program will take place for 12 weeks, unless additional consultation time is needed on an individual basis. The program starts with a two-hour in-service and training for regular education and special education teachers during their extended day time. During phase two, the occupational therapist will meet with teachers in small groups, preferably by grade level, in a consultation format in order give them the opportunity to ask questions and discuss the students in need of specific intervention. The occupational therapist will observe specific students in the classroom, following up to see and address the teachers’ concerns. Moving to Learn will be offered first during the Fall Semester of the school year in the school at which that I currently work, but will be offered both in the winter and spring semesters as well to other schools within the Springfield Public School District. Following the implementation of this program in a target elementary school building, teachers will participate in scoring satisfaction surveys. As Moving to Learn is offered in new parts of the school district, more teachers will share to continue the excitement of this important program.

A central concern being addressed in this project is the acknowledged gap between reductionist Western and holistic Eastern approaches to healthcare and the growing global movement aimed at narrowing this gap. In contrast to biomedicine, where the body is understood in terms of the operation of its constituent parts, Eastern medicine is based on recognition of the interconnection of bodily systems and the environment. The Global Holistic Occupational Therapy (GH-OT) course is an intensive program designed for occupational therapy practitioners in India that are interested in expanding their current biomedical based clinical methods by incorporating Eastern medical philosophies and practices. It is comprised of three instructional modules delivered over six days. The teachings of yoga and Ayurveda brought forth by the Bhrigu Yoga BCP Trust, which offers a non-religious method for enhancing human potential, provide the basis for instruction designed to prepare participants to make appropriate use of the ancient wisdom and to integrate an expanded Eastern holistic and inner vision perspective with the customary logical and analytical mindset of clinical reasoning in a way that upholds the theoretical foundations of OT practice. The educational activities include experiential practice of yoga exercises, examination of the current healthcare system and exploration of emerging world trends for promoting health and wellness. The GH-OT course is the beginning of an effort to achieve a transformation in OT education that will be applicable in the future to other regions such as Israel and the United States.

Youth with disabilities, including those with autism spectrum disorder (ASD) and intellectual disability (ID), have difficulty forming and maintaining peer relationships (Carter & Hughes, 2005; Guralnick, 1999; Meyer & Ostrosky, 2014; Petrina, Carter, & Stephenson, 2014; Shattuck, Orsmond, Wagner, & Cooper, 2011; Wagner, Newman, Cameto, Garza, & Levine, 2005). This is of concern considering that early friendships are important to positive social, cognitive, and emotional development, and contribute to future success and wellbeing (Carter & Hughes, 2005; Meyer & Ostrosky, 2014; Petrina et al., 2014; Wagner et al, 2005). Of all youth with disabilities, those diagnosed with ASD and/or ID (ASD/ID) who have greater cognitive and communication challenges may present with the most severe social impairments (de Bildt et al., 2005; Matson et al., 2009; Wilkins & Matson, 2009). However, effective interventions for adolescents with ASD/ID who have limited cognitive and communication skills are limited by gaps in the social intervention literature. In general, the social intervention literature focuses on: (1) younger children (Carter, Sisco, Chung, & Stanton-Chapman, 2010; Hughes et al., 2012), (2) children with ASD/ID who have stronger cognitive and communication skills (Walton & Ingersoll, 2013), (3) only immediate outcomes in the contrived intervention context (Gresham et al., 2001; Hughes et al. 2012; Sheridan, Hungelmann, & Maughan, 1999), and (4) discrete social skills outcomes rather than friendship-based outcomes (Finke, 2016). A program to address these gaps is needed. Class Videos of Important People (Class VIP) is a theory- and evidence-driven school-based social intervention for adolescents with ASD/ID who have limited cognitive and communication skills. The 20-week program will include: (1) video self-modeling, (2) positive self-review, (3) peer disability awareness education, (4) peer training, and (5) teacher training. Goals of the program will be to improve quality of social interactions, increase self-efficacy, and increase friendship formation among students with ASD/ID. The proposed evaluation plan will explore feasibility of program implementation and preliminary outcomes. Potential funding of the program and dissemination activities will also be discussed.

Improving the Care Partner Experience: An Occupational Therapy Intervention proposes a clinic or telehealth based occupational therapy (OT) treatment intervention to teach care partners how to maximize the occupational engagement of care recipients diagnosed with Alzheimer’s disease and related dementias and decrease caregiver burden. Caregiver burden contributes to care partner illness and care recipient institutionalization. The intervention consists of a protocol that is both client-centered and designed to foster self-efficacy of the care partner in providing care. A sense of self-efficacy will decrease caregiving burden and improve quality of life for both partners as described in the evidence supporting the project. The first chapter provides an overview of the intent and genesis of the intervention. It includes a description of the author’s work environment, the problem as it was identified and how the intervention fits within the OT practice framework. The next chapter explores factors contributing to the problem including the rural nature of New Hampshire, barriers to accessing adequate treatment and the theoretical basis grounded in Self-efficacy theory and the Model of Human Occupation. The second half of the chapter explores current best practice that exists in the literature. Several programs and interventions are identified and their efficacy is discussed. Based on the findings in chapter two, the intervention itself is outlined in chapter three, with examples of templates and a case scenario available in the appendices. The intervention, administered in the clinic or via telehealth, is based on the evidence of effective treatment in the home, translated into a clinic or telehealth based model. Administration of the program is fully described and reproducible from this document. Finally, a plan for program evaluation along with a budget and dissemination plan are included in the final chapter. The result is an evidenced based, client-centered occupational therapy treatment that can be administered in a consistent manner and contribute to lower caregiver burden and increased quality of life.

The purpose of this work was to explore the physiological mechanisms of vocal effort, the acoustical manifestation of vocal effort, and the perceptual interpretation of vocal effort by speakers and listeners. The first study evaluated four proposed mechanisms of vocal effort specific to the larynx: intrinsic laryngeal tension, extrinsic laryngeal tension, supraglottal compression, and subglottal pressure. Twenty-six healthy adults produced modulations of vocal effort (mild, moderate, maximal) and rate (slow, typical, fast), followed by self-ratings of vocal effort on a visual analog scale. Ten physiological measures across the four hypothesized mechanisms were captured via high-speed flexible laryngoscopy, surface electromyography, and neck-surface accelerometry. A mixed-effects backward stepwise regression analysis revealed that estimated subglottal pressure, mediolateral supraglottal compression, and a normalized percent activation of extrinsic suprahyoid muscles significantly increased as ratings of vocal effort increased (R2 = .60). The second study had twenty inexperienced listeners rate vocal effort on the speech recordings from the first study (typical, mild, moderate, and maximal effort) via a visual sort-and-rate method. A set of acoustical measures were calculated, including amplitude-, time-, spectral-, and cepstral-based measures. Two separate mixed-effects regression models determined the relationship between the acoustical predictors and speaker and listener ratings. Results indicated that mean sound pressure level, low-to-high spectral ratio, and harmonic-to-noise ratio significantly predicted speaker and listener ratings. Mean fundamental frequency (measured as change in semitones from typical productions) and relative fundamental frequency offset cycle 10 were also significant predictors of listener ratings. The acoustical predictors accounted for 72% and 82% of the variance in speaker and listener ratings, respectively. Speaker and listener ratings were also highly correlated (average r = .86). From these two studies, we determined that vocal effort is a complex physiological process that is mediated by changes in laryngeal configuration and subglottal pressure. The self-perception of vocal effort is related to the acoustical properties underlying these physiological changes. Listeners appear to rely on the same acoustical manifestations as speakers, yet incorporate additional time-based acoustical cues during perceptual judgments. Future work should explore the physiological, acoustical, and perceptual measures identified here in speakers with voice disorders. / 2019-07-06T00:00:00Z

Within occupational therapy and the healthcare community there are calls to promote professionalism through self-awareness and emotional intelligence training (Andonian, 2017), as well as improve therapeutic rapport and performance during clinical fieldwork (Brown, Williams, & Etherington, 2016). Based on literature reviews, an effective way to incorporate training is through mobile applications (Kron, 2016). However, there is limited evidence within the occupational therapy literature to help occupational therapy programs develop self-awareness curriculum. This doctoral project (1) identifies a mobile phone application for occupational therapy students (2) investigates evidence and best practice in developing self-awareness training (3) develops an outline for development of a mobile phone application (4) identifies implementation strategies and (5) identifies evaluation plan. The project’s evaluation results will contribute to three areas within occupational therapy: addressing specific needs of self awareness training (Allen, Montgomery, Tubman, Frazier, & Escovar, 2003), providing more evidenced-based education (AOTA, 2017; Bakker, Kazantzis, Rickwood, & Rickard, 2016), and building self-awareness training into occupational therapy curriculum (Carvalho, et al., 2011; Andonian, 2017). / 2019-10-23T00:00:00Z