Thesis (D.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / This two year cohort study involved 248 workers within the automotive industry and explored the effects of two workplace factors, e.g. overtime and assembly-line work, on behavior and cognitive performance as measured by neurobehavioral tests. Review of the occupational epidemiology literature did not reveal any studies of the effects of cumulative fatigue, as a result of long work days due to overtime, on cognitive abilities or job performance. Overtime, defined as number of hours worked greater than 8 hours per day and/or greater than 5 days per week, was calculated from company payroll records. Subjects were categorized as working a machine-paced, assembly line job based on review of their work histories and characterization of their job codes. Cross-sectional analysis of Year 1 data by multiple linear regression demonstrated that overtime worked the week before testing was significantly associated with increased response times on tasks involving simple and complex attention and executive function and an attention-requiring task of basic verbal abilities. The findings from Year 1 support the hypothesis that overtime per week results in cumulative fatigue which affects cognitive performance in the specific functional domains of attention and executive function. Machine-paced work was significantly associated with impaired performance in the areas of attention and executive function, however no significant mood changes were observed. An increased number of errors on a task of complex attention and executive function, poorer performance on a visual memory task involving attention and new learning skills, and reduced percent correct on a computerized task of attention and motor skills and on an attention-requiring task of basic verbal abilities were observed. Machine-paced work did not significantly affect the observed effects of overtime. The results suggest a different response to the strain produced by machine-paced work than that observed with overtime. Machine-paced work was predictive of a faster response time with increased errors, whereas the fatigue effects of overtime resulted in a slower time to complete a task without a decrease in accuracy. Neither overtime nor machine-paced work was associated with performance on any test in Year 2. It was suspected that fewer subjects working increased overtime hours, loss-to-follow-up, and that two of the tests associated with overtime in Year 1 were not repeated in the Year 2 battery, contributed to the difference in the findings between the two years. Further study is recommended to evaluate the proposed hypotheses regarding the effects of overtime and machine-paced work on cognitive function and to investigate the strategic response difference between overtime and machine-paced work. / 2031-01-01

Knowledge translation includes the steps of researching and establishing best practices, communicating those findings to stakeholders and consumers, and then using that information effectively in practice (Straus, Tetroe, & Graham, 2009). Knowledge translation usually takes the form of conducting research, creating systematic reviews and other research articles, and publishing in academic journals, all of which are not enough to guarantee that knowledge will actually be used in clinical practice (Straus et al., 2009). Therefore, there needs to be a more explicit process for improving knowledge translation to increase the use of evidence-based interventions in clinical practice (Straus et al., 2009). This doctoral project will focus on improving knowledge translation as it applies to occupational therapy researchers disseminating research knowledge to school-based professionals and will further explore the barriers both occupational therapy researchers and school professionals face with knowledge translation. The proposed solution is an online course titled Closing the Gap: A Knowledge Translation Course Designed to Improve Evidence-Based Clinical Practice for School Professionals. This course will be developed in order to address the current gap between knowledge translation and clinical practice; and to improve research utilization in occupational therapy in school settings in particular. This six-week course utilizes an online learning environment through teachable.com in order to increase accessibility of information to course participants and to allow for weekly self-paced learning to promote participant success. The course will include multiple professional development activities, such as small discussion work through an online discussion board, case studies, and problem-based learning as these are proven methods to effectively promote confidence with integrating research into clinical practice (Anaby, Korner-Bitensky, Law, & Cormier, 2015; Cahill, Egan, Wallingford, Huber-Lee, and Dess-McGuire, 2015). The online course described above aims to improve evidence clinical practice in school settings by increasing direct communication between the school professionals and researchers, by having school professionals practice applying research to relevant clinical cases, and by having researchers practice communicating research findings to other professionals. This online course is critically needed in order to make knowledge translation more intentional, to improve evidence-based clinical practice, and to achieve AOTA’s 2025 Vision of being an effective and evidence-based profession.

Assistive technology (AT) is any item, piece of equipment or product system whether acquired commercially off the shelf, modified, or customized that is used to increase, maintain or improve functional capabilities of individuals with disabilities" (21st Century Assistive Technology Act of 2019, p.9–10). Students with multiple disabilities in the US have insufficient access to the AT and related services that they need to develop their maximum skills and participate meaningfully in school (Schaefer & Andzik, 2016). Lack of training and resources is repeatedly found to compromise classroom AT access for students with complex needs (Egilson, 2009; Machalicek et al., 2010; Okolo and Dietrich, 2014; Rogers and Johnson, 2018). Recent literature reflects a variety of positive outcomes for students with multiple disabilities when they do have access to assistive technology (Talber, 2019; Stasolla, et al., 2015; Stasolla, et al., 2019; Desai, 2014; Mumford & Chau, 2016; Lancioni et al., 2014). It could be argued, if more school staff, in particular occupational therapy practitioners (OTPs), had the confidence and competence to routinely support student AT needs across least restrictive education settings, more students with multiple disabilities could be served in these environments. For OTPs to expand their familiarity and knowledge of AT and its application, vehicles to grow assistive technology competencies for current practicing therapists need to be available. Creating a program, such as Switching on Engagement (SOE!), that emphasizes using and applying assistive technologies, would be effective in promoting greater capacity. By focusing on the service delivery process of AT, OTPs will develop clinical reasoning in which integration of assistive technology use is inherent to the overarching student goal of increased participation (Griffiths & Price, 2011). School-based occupational therapy practitioners (OTPs) are an untapped resource to support classroom access through assistive technology service delivery. Participating in SOE! can help develop this resource. In his 2017 Eleanor Clark Slagle lecture, Dr. Roger Smith proclaimed “technology has a role in occupational therapy so fundamental, it must be considered an essential building block of occupation” and thus mandates technology’s daily presence in the future of our profession (Smith, 2017, p. 1). AOTA’s Vision 2025 charges OTPs to practice with intentional inclusivity (AOTA, 2019). SOE!, in aligning with the growth in scope and vision of the occupational therapy profession, seeks to expand the OTP’s capacity to provide AT service delivery to facilitate greater authentic participation by students with multiple disabilities in accessible school settings they justly deserve.

Entry-level occupational therapy (OT) students are required to complete level I and level II clinical fieldwork placements as part of their training program. Level II fieldwork experiences take place at the end of an OT academic program and have the purpose of transitioning students into competent entry-level practitioners. Many entry-level OT students complete their level II fieldwork experience at an inpatient rehabilitation facility; however, students typically learn information relevant to inpatient rehabilitation during the first year of a two- or three-year OT program. In this study, a review of eight OT program curriculums revealed that only one out of eight programs provide a fieldwork preparation course for students and few reviewed students’ clinical skills prior to their level II fieldwork placement. Inadequate preparation for fieldwork can decrease students’ readiness for the fast-paced environment in an inpatient rehabilitation facility setting and their learning experiences while on placement. To address this issue, an online educational module, Rehab Read-e, was designed to increase the level of preparedness for level II OT students completing their placement, at an inpatient rehabilitation facility. Using Bandura’s (1977) theory of self-efficacy, Rehab Read-e incorporates psychological changes achieved through different modes of intervention. Having previous experience will likely boost confidence in an individual’s perceived abilities to perform in similar situations as well as in different situations (Bandura, 1977). Rehab Read-e incorporates different learning styles and preferences that are enjoyable and beneficial for students completing online modules (Doyle & Jacobs, 2013). The module reviews important information including basic anatomy, vital signs, common diagnosis, formal assessments and patient handling. This module will assist OT programs and OT fieldwork supervisors with preparing students for their placement in an inpatient rehabilitation setting.

Data in the literature consistently shows most of specialty care is provided at large metropolitan, academic medical centers where there is a great enough volume of patients to support specialty providers (The Robert Wood Johnson Foundation, 2016). America occupies over 3.8 million square miles with 72% of the country classified as rural territory by the Department of Agriculture in 2017 with 20% of Americans living where healthcare provider shortages exist (Nationmaster, 2017). Poor maternal health combined with barriers in accessing quality prenatal care, place infants at greater risk for sustaining a Brachial Plexus Birth Injury (BPBI) during the delivery process. BPBI has an incidence of 1/1000 births with the potential for nerve damage to be permanent in 10-18% of cases (Chauhan, S. et al., 2014; Frade et al., 2019). Restriction on the use of telehealth results in reduced access to specialty care. To mitigate the inequities in healthcare, this author applied key concepts found in the literature on effective educational collaborations between specialty providers and community providers to develop an online educational series (Ashburner et al., 2016; Bywood et al., 2013; Careau et al., 2008; Day et al., 2012; González-Espada et al., 2009; Mahnke et al., 2011; Shivji et al., 2011; Ray et al., 2015), for community occupational and physical therapists in gaining important knowledge and competence for caring for children with BPBI in their own communities. This program integrates the positive benefits of building community networks for formal and informal mentoring to decrease provider isolation, to improve efficiency and effectiveness of healthcare for children with BPBIs in rural areas.

The prevalence of regular video game use among populations of all ages, genders, geographic locations, and life experiences has grown exponentially in recent years (Entertainment Software Association, 2021). Gaming provides many players with an opportunity to engage in an immersive, engaging, and enjoyable activity that has the power to positively impact many facets of quality of life and well-being (Jones, 2021; Britnell & Goldberg, 2002). Despite monumental strides made in the gaming industry to ensure gaming controllers and software settings are accessible for players with disabilities, many players still face barriers to video game access following the onset of injury, illness, or an existing condition. The relationship between the occupational therapy profession and the prevalence of video game technologies is multifaceted. First, occupational therapists are tasked with adapting tasks or environments to facilitate access and independence in activities that a particular client finds meaningful. Additionally, occupational therapists ground the nature of their work in creating evaluation methods and intervention approaches that leverage a client’s established meaningful occupations in producing functional outcomes through therapeutic exercise and activity (AJOT, 2020). Given the large and growing population of clients who consider gaming a meaningful occupation, this project asserts that occupational therapists have the following responsibilities related to adequately serving the needs of their current and future clients: 1. Acquiring knowledge needed to successfully adapt gaming hardware and gameplay tasks through assistive technologies to facilitate access and independence in gameplay for leisure or social participation purposes 2. Acquiring knowledge needed to successfully embed game-based activities within occupational therapy interventions to ensure treatment sessions remain occupation based, meaningful, and engaging to applicable client populations. Despite these factors, gaming knowledge and adoption among occupational therapists remains relatively low due to a variety of factors discussed in further detail throughout this paper (Hills et al., 2016; Jones, 2021; Levac et al., 2017; Thomson et al., 2016). This project assessed the current body of evidence-based literature related to the therapeutic implications of gaming, the nature of current barriers contributing to low technology adoption rates, and established approaches deemed effective in mitigating these barriers in detail. This large body of data and evidence was used to create the Gaming and Occupational therapy Adoption Training Program (G.O.A.T.). This program leverages a multidimensional approach in providing a comprehensive intervention program for occupational therapists that ultimately seeks to increase the adoption of gaming technologies within the occupational therapy profession.

The American Occupational Therapy Association (AOTA) describes sexuality as a “core characteristic and formative factor for human beings” (AOTA, 2013, para 1). Despite this statement and the inclusion of sexuality activity as an occupation and activity of daily living (ADL) in the Occupational Therapy Practice Framework (OTPF), many occupational therapy practitioners (OTPs) are unwilling to address sexuality. Research has shown that the reasons for this neglect are limited knowledge regarding sexuality, limited awareness of OTPs’ role in sexuality, decreased comfort discussing sexuality, pre-existing values and beliefs regarding sexuality and institutional barriers. These causal factors which lead to the unwillingness to include sexuality within plan of care, negatively impacts individuals with disabilities who are faced with many questions and anxieties regarding their sexuality and who continue to communicate their desire to express their sexuality (Mc Grath & Sakellariou, 2016; Mohammed, 2017; Mona et al., 2017). The goal of this project is to increase the inclusion of sexuality intervention within occupational therapy (OT) and to advocate for the importance of sexuality within a client centered and holistic healthcare model. An elective college course will be used to increase OT students’ knowledge of sexuality, improve their awareness of OT’s unique role, improve their level of comfort, navigate potential institutional barriers, and reflect on their existing attitudes and beliefs. The Diffusion of Innovations (DOI) model is used to understand the problem of limited sexuality intervention within OT but also to create positive change within the field of OT. Utilizing a fifteen-week elective course, focusing on the most current evidence for populations who frequently report sexuality dysfunction and related questions, OT students will be more likely to integrate sexuality into their practice and diffuse this area of practice to both novice and seasoned OTPs within their practice setting. This project supports not only the advancement of the field of OT by increasing the frequency of referrals for this occupation, but also the quality of life and holistic care for individuals living with disabilities.

Loneliness is a pressing issue effecting affecting many older adults that has far reaching implications for health and wellness (Collins et al., 2020). A literature review by this author was conducted to determine if there are interventions that are effective for decreasing loneliness in retired older adults. This literature review provided mixed results. Some studies showed improvements in quality of life but not change in loneliness. Others showed efficacy at addressing social isolation but not in degree of loneliness. The most effective interventions used cognitive behavior therapy, involved groups, had an established theoretical foundation and included multiple components (Smallfield & Molitor, 2018; Gardiner et al., 2018). This paper will address the underlying factors that contribute to loneliness and the current research on effective interventions to address loneliness. It will go on to offer a new evidence-and-theory-based intervention to address loneliness for retired older adults within the community setting.

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No description available.