As awareness and diagnoses of FASD grow in Canada, there is increased need to support these individuals across their lifespan. One study suggested the prevalence of FASD may be as high as 10 per 1000 births (May & Gossage, 2001). The impact to society is growing as well, since this population requires support across their lifespan due to cognitive and sometimes physical impairments. It was estimated that the annual cost to Canadians was $53 billion (in 2007 dollar value) to support individuals aged 0-53 years (Stade et al., 2009). There is mounting evidence identifying the cognitive and physical impairments that these individuals have, particularly in children. Studies have also described the adaptive functioning of children with FASD, and their ability to cope in daily life. There is little information on youth and adults regarding their daily lives, and the factors that contribute to success in daily life. The purpose of this study was to identify predictive factors that contribute to success in occupational performance in youth and adults with FASD. Using the Canadian Model of Occupational Performance and Engagement (CMOP-E), the study explored variables reflecting the person, environment, and activity that promoted engagement and participation. The study also investigated the value of using self-report or performance-based assessment with the FASD youth and adult population. Due to memory, cognitive, and executive functioning deficits, the individual with FASD may not be able to accurately self-report. Results from the study suggest an individual’s living situation, involvement with foster care, and family involvement play a role in successful occupational performance. Formal assessments of cognitive, academic and memory abilities did not appear to play a role in the individual’s school completion and daily life. Interestingly, the characteristics of this FASD sample depicted a group of youth and adults, who, in general, lived with family, had completed some schooling at the grade 10-12 level, had limited employment, were not involved with the judicial system, and were just as likely to be Caucasian as Aboriginal. The concept of occupational performance proved complex, and future study on the factors contributing to occupational performance would benefit from additional variables related to environment and activity than were available in the current data set.

MSc, Occupational Therapy, Faculty of Health Sciences, University of the Witwatersrand, 2008 / Purpose of this study was to develop an appropriate and valid hand function assessment: the Steinmann-Obermeyer questionnaire (SOQ) for clients attending the Rheumatology Clinic at Kalafong Hospital. To achieve this • the construct validity of the SOQ had to be examined by assessing the face and content validity. • the criterion –related validity of the SOQ was assessed using convergent, concurrent and discriminative validity compared to pain, severity of deformity and disease severity. • the criterion –related validity of the SOQ was further assessed using the predictive validity by assessing normal subjects with the SOQ. Objective: The objective of this study was to test the following null hypotheses: 1.4.1 The SOQ is not a valid method of evaluating the functional ability of rheumatology clients treated at Kalafong hospital out patient clinic. 1.4.2 There is no correlation between the severity of the rheumatic disease and the score obtained by the SOQ. 1.4.3 There is no correlation between the disease activity and the score obtained by the SOQ. 1.4.4 There is no correlation between the client’s assessment of their level of pain and the score obtained by the SOQ. Method. The SOQ consisted of 48 questions, was translated into Sotho and Zulu and was administered and analysed on 96 arthritic clients between 18 and 69 years of age. An occupational therapy assistant (OTA), who spoke both the tribal languages fluently, completed the questionnaire with each client. An interviewer-administered format was used because many of the clients were illiterate. Results. After the analyses were completed, three questions were excluded and the final questionnaire consisted of 45 questions. This questionnaire was found to be a valid method of evaluating the functional ability of rheumatology clients treated at Kalafong hospital. Clients with severe functional limitations scored high on the questionnaire and those with minimal functional difficulty scored low on the questionnaire. The questionnaire scores correlated significantly with the pain levels experienced by the clients and their disease activity. The statistical analyses also showed that there is no correlation between the questionnaire score and the deformities of the clients. Inter-rater reliability was established. Conclusion. The 45-question occupational performance evaluation was developed, analysed and proven to be valid and sensitive for use with rheumatology clients with hand function difficulties at the Kalafong rheumatology clinic.

The manual wheelchair (MWC) and power wheelchair (PWC) each present advantages and disadvantages to participation and occupational performance. Consequently, some individuals choose to use both devices, depending upon the activity. A pushrim-activated, power-assisted wheelchair (PPW) may provide an alternative to the PWC for these users. This study utilized a two-phase, mixed methods design, comparing the performance and satisfaction of wheelchair users carrying out self-selected activities with their current PWC and with a PPW. There was no statistically significant difference in outcome measures between the PWC and PPW; however, many participants reported a preference for the PWC. Less accessible environments, particularly when transporting a wheelchair, were identified as opportunities for PPW use. Rather than replacing the PWC for all of their identified activities, participants indicated the PPW improved upon the MWC. As a result, participants expressed a willingness to try more (and new) activities, including some previously performed with the PWC. / October 2006

The manual wheelchair (MWC) and power wheelchair (PWC) each present advantages and disadvantages to participation and occupational performance. Consequently, some individuals choose to use both devices, depending upon the activity. A pushrim-activated, power-assisted wheelchair (PPW) may provide an alternative to the PWC for these users. This study utilized a two-phase, mixed methods design, comparing the performance and satisfaction of wheelchair users carrying out self-selected activities with their current PWC and with a PPW. There was no statistically significant difference in outcome measures between the PWC and PPW; however, many participants reported a preference for the PWC. Less accessible environments, particularly when transporting a wheelchair, were identified as opportunities for PPW use. Rather than replacing the PWC for all of their identified activities, participants indicated the PPW improved upon the MWC. As a result, participants expressed a willingness to try more (and new) activities, including some previously performed with the PWC.

The manual wheelchair (MWC) and power wheelchair (PWC) each present advantages and disadvantages to participation and occupational performance. Consequently, some individuals choose to use both devices, depending upon the activity. A pushrim-activated, power-assisted wheelchair (PPW) may provide an alternative to the PWC for these users. This study utilized a two-phase, mixed methods design, comparing the performance and satisfaction of wheelchair users carrying out self-selected activities with their current PWC and with a PPW. There was no statistically significant difference in outcome measures between the PWC and PPW; however, many participants reported a preference for the PWC. Less accessible environments, particularly when transporting a wheelchair, were identified as opportunities for PPW use. Rather than replacing the PWC for all of their identified activities, participants indicated the PPW improved upon the MWC. As a result, participants expressed a willingness to try more (and new) activities, including some previously performed with the PWC.

Anxiety disorders are among the most prevalent mental health disorders in adolescents. This cross-sectional study examined the relationship between anxiety symptoms and occupational performance in adolescents; no prior literature on this topic has been found. Adolescents ages 13 to 17 (N = 30) referred to anxiety services in a hospital setting were assessed. The five self-reported variables investigated included: (a) perception of occupational performance, (b) satisfaction with occupational performance, (c) levels of anxiety symptoms, (d) levels of depressive symptoms, and (e) stress levels. Occupational performance issues were identified using the Canadian Occupational Performance Measure. Significant positive correlations were found between perceptions of, and satisfaction with, occupational performance and anxiety symptoms in younger adolescents (ages 13.0 to 15.3), but not older adolescents (ages 15.4 to 17.9). The relationships between anxiety symptoms and occupational performance and satisfaction are complex and may be different for younger adolescents versus older adolescents and adults.

Anxiety disorders are among the most prevalent mental health disorders in adolescents. This cross-sectional study examined the relationship between anxiety symptoms and occupational performance in adolescents; no prior literature on this topic has been found. Adolescents ages 13 to 17 (N = 30) referred to anxiety services in a hospital setting were assessed. The five self-reported variables investigated included: (a) perception of occupational performance, (b) satisfaction with occupational performance, (c) levels of anxiety symptoms, (d) levels of depressive symptoms, and (e) stress levels. Occupational performance issues were identified using the Canadian Occupational Performance Measure. Significant positive correlations were found between perceptions of, and satisfaction with, occupational performance and anxiety symptoms in younger adolescents (ages 13.0 to 15.3), but not older adolescents (ages 15.4 to 17.9). The relationships between anxiety symptoms and occupational performance and satisfaction are complex and may be different for younger adolescents versus older adolescents and adults.

The overall aim of the present thesis was three-fold. The first was to study occupational performance in individuals with severe mental disorders and their experiences of occupational therapy, the second to study experienced burden of family caregivers and the third to test the validity and the homogeneity of assessment tools in this area. The samples consisted of individuals with severe mental disorders participating in organised occupations (n= 112), occupational therapy records (n=64), occupational therapists working in mental health care (n=7) and family caregivers of individuals with severe mental disorders (n=256). Data were collected by questionnaires, structured and narrative interviews, observations and occupational therapy records. Individuals with severe mental disorders reported problems related to leisure and work activities and the occupational therapists recorded problems concerning how to organise and structure occupational performance. Individuals functioning on a high cognitive level experienced problems related to work and productive activities. Participation in occupational therapy strengthened their confidence in their own ability. The “Experience of Occupational Performance Questionnaire” (EOPQ) was developed from data on the experiences of women participating in occupational therapy. A principal component analysis gave seven factors with acceptable homogeneity. There is a need for assessment tools to evaluate occupational therapy. The EOPQ represents an attempt to fulfil this need. Family caregivers experienced limitations of daily activities as a burden. The ability to perform daily activities was studied from three perspectives, the individuals’, the occupational therapists’, and the experienced burden of the family caregivers. These perspectives are complementary and thus necessary for planning and implementation of individually adapted occupational therapy as well as for the evaluation of outcomes.

Occupational therapists theorize that behavioral responses to sensory stimuli are reflective of a child’s underlying ability to process sensory information in a manner that allows the child to engage in childhood occupations meaningfully. If a child’s ability to process sensory information is compromised, then occupational performance is compromised. Similarly if coping skills are less than adequate, successful engagement in occupations is limited. What is less clear is how sensory modulation and coping interact to influence occupational performance. This study examined the interplay between sensory modulation, coping, and occupational performance in a sample of children referred for sensory processing difficulties. Two hundred sixty children, ages 4 – 9 years of age, referred to Occupational Therapy Associates at The Koomar Center in Watertown, MA, for sensory processing concerns were examined for Sensory Modulation Disorder (SMD), coping abilities, and occupational performance. Results indicate that while sensory modulation is a strong predictor of occupational performance, it only accounts for approximately 20% of the variance in this model. As such, there are additional factors that contribute to occupational performance; these were not identified in the current study. Children with SMD appear to have mild coping deficits, and the interaction between the two, SMD and coping, remains unclear. Additional exploratory analyses revealed significant overlap between subtypes of SMD. Findings from this study laid the foundation for an emerging model reflecting the coping process of children with SMD. Testing the model in future studies will help elucidate these relationships.

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