PURPOSE: Surface electromyography (sEMG) provides an alternative method for individuals with severe motor impairments to use the voluntary contractions of sparred musculature as inputs into an alternative and augmentative communication (AAC) device. Current research suggests that individuals with typical motor control prefer a sEMG-based click mechanism over a dwell-based click mechanism to operate an on-screen cursor. However, there is no existing data on the effects of cursor click modality on language production in AAC users with motor impairments. The goal of this study was to evaluate the communicative abilities of individuals with neuromuscular disorders when using an AAC device with two different cursor click modalities. METHOD: Twelve individuals with neuromuscular disorders produced synthetic language samples via an on-screen keyboard using an sEMG/accelerometer system with two different click modalities: dwell-based clicking and sEMG-based clicking. A third language sample via natural speech was also recorded. Language sample analysis was used to evaluate language complexity at syntactic, semantic, and ideational levels. To analyze syntactic complexity, language samples were examined for clausal density, conjunction usage, phrase expansions (noun phrase, verb phrase, and prepositional phrase), and mean length of utterance. Semantic complexity was analyzed using measures of moving-average type token ratio, abstract noun usage, metacognitive verb usage, and usage of morphologically complex words. Ideational complexity was analyzed in terms of the extent to which the responses conveyed the participant’s ideas. A questionnaire was used to measure the participants’ perceptions of usefulness for each modality. RESULTS: Mean length of utterance was shorter in the dwell-based click modality than in the sEMG-based click and natural speech modalities. In the sEMG-based click modality the majority of sentences were complex sentences, whereas simple sentences made up the majority in the dwell-based click modality. Morphologically complex word usage was used more frequently in the natural speech modality than in the sEMG-based click modality and used most frequently in the dwell-based click modality. There were no modality-specific trends for ideational complexity. Measures from the questionnaire showed that participants ranked natural speech as being more useful than either of the cursor-click modalities, but all three modalities were rated as at least somewhat useful (5 out of 7 on a rating scale of usefulness). CONCLUSION: This study is the first to evaluate the effects of cursor-click modality on the communicative abilities of individuals with neuromuscular disorders. Despite differences in language complexity on some measures, participants were able to use all three modalities to accurately respond to the language prompt with similar ideational scores. These results support both sEMG and dwell as alternative access methods for controlling a cursor-click system for individuals with neuromuscular disorders in future AAC applications.

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Background: There is a high worldwide prevalence of cerebral palsy, a neurological condition which impacts most areas of life of children and their families. Evidence shows that occupational therapy is effective in enhancing the child's function, participation and quality of life, especially when provided at a young age and with high intensity. Literature provides additional recommendations for occupational therapy to follow a holistic and family-centred approach, considering participation in context, rather than an individual medical focus. These notions place pressure on the strained South African healthcare system, where human and physical resources, as well as contextually-relevant evidence for practice, are limited. The aim of this research was, therefore, to obtain a baseline description of the occupational therapy services being provided to children with severe cerebral palsy, across all government healthcare facilities of the Western Cape province. Methods: A quantitative, cross-sectional descriptive study was conducted, using a selfdesigned questionnaire. The questionnaire was developed using recognised survey principles in order to maintain research rigour, reliability and validity of results, and guidelines from previousstudies of a similar nature. The questionnaire was available to participants in duplicate online and hard copy formats. The anonymous, self-report questionnaire obtained profiles of the participating occupational therapists and their departments, descriptions of current service provision (assessments, goal-setting and interventions), perceived factors influencing service selection, and an understanding of services therapists felt they should be providing more of. No sampling took place and responses were invited from all occupational therapists employed by the provincial health department. All recruitment and correspondence took place via email or telephone. Recruitment and data collection took place over a period of 16 weeks, with each participant having a maximum of two weeks to submit their responses, after which a maximum of three reminders were sent. Numerical data were analysed using non-parametric descriptive statistics and categorical data were presented in terms of frequencies and percentages. Ethical principles adhered to included respect, confidentiality, anonymity, beneficence, non-maleficence and justice. Results: There was a response rate of 53%, with all provincial health districts and levels of care represented amongst participants. Assessments frequently involved observations of the child in activities(85%) and interviews with their caregiver (98%). Goals formulated, with some input of caregivers, related to occupational performance components (91%) more often than occupational performance (77%), and largely aimed to maintain the child's condition (68%), rather than improve development or functional participation (47%). A range of interventions were provided, but appointments were infrequent (median: 1 per month), mainly took place in clinical environments (100%), and waiting periods for assistive devices and orthotics were common. Opportunities for direct therapy and interventions in the child's daily context were limited, and home programmes and caregiver education were heavily relied upon indirect intervention methods, frequently implemented by 100% and 91% of participants respectively. Key factors influencing the selection of services included resource availability (62%), therapists' training (62%) and the level of care at which they worked (59%). Therapists felt they were meeting some of the children's needs, and required the support of the multidisciplinary team to meet more of their needs effectively. Conclusion: This study provides insight into occupational therapists' roles in the government healthcare sector in the Western Cape province, and highlights the degree of alignment of services with policy and elements of best practice. Some merits are clear, in terms of the combination of direct and indirect services provided and the involvement of families in therapy processes. However, there remains a shortfall in terms of effective holistic, evidence-based, family-centred, and early and intensive approaches. This study, therefore prompts revision of strategies to implement existing policies promoting quality services for people with disabilities and align occupational therapists' training with evidence-based practice and holistic frameworks and approaches. Further research is recommended, particularly a qualitative consideration of the contextual factors influencing service provision, in order to better understand and address the barriers to meaningful and effective services for this population within the context of Primary Healthcare. With these recommendations, quality service provision, leading to participation and quality of life outcomes for children with severe cerebral palsy and their families, may be enhanced.

Background: Antiretroviral treatment (ART) has reduced the mortality rate of HIV-positive children significantly, and is known to prevent the development and progression of HIV encephalopathy. However, even with ART, perinatal HIV infection places HIV-infected children at increased risk for encephalopathy and associated developmental delays. Research is lacking in the extent of developmental delay on children established on ART, along with evidence-based occupational therapy interventions to treat these developmental delays. A play-informed, caregiver-implemented, home-based group occupational therapy intervention (PICIHBI) presents one possible service delivery option to be explored. Aim: To determine whether children attending an experimental group (PICIHBI) versus children attending a control group (conventional, individual occupational therapy intervention) would present similar results in their total developmental quotient – on the Griffiths Mental Developmental Scales (GMDS) and Paediatric Functional Independence Measure (WeeFIM). Methods: A randomised control trial, which was pragmatic in nature and single-blinded, was used. The research population was all HIV-positive children, pre-formal school-going aged (6 months – 5 years), on ART attending the Groote Schuur Hospital paediatric HIV clinic at the time of the study. Caregiver and child dyads were randomly assigned to either the experimental or control group, and attended a monthly occupational therapy session. Differences in the GMDS and WeeFIM scores of each child after 5 and 10 months' intervention were compared. Results: Inter-rater reliability was established among the five researchers performing the GMDS before baseline assessments. Forty-two participants were recruited from a possible population of 72 participants and 39 participated in the baseline assessment. Twenty-eight participants completed mid and post assessments, 15 in the experimental PICIHBI group and 13 in the control group (90% power). Baseline averages on the GMDS showed the participants scoring at a borderline mental retardation level, with better performance in the locomotor and personal-social subscales, before interventions. Both groups had an average attendance of 5 sessions. Post-interventions, average total GMDS and WeeFIM scores between the two groups revealed similar scores within the predetermined non-inferiority margin and no significant differences at any time point. Conclusion: In conclusion, the low baseline scores confirm the need for occupational therapy intervention in pre-formal school-going HIV-positive children on ART. The PICIHBI intervention demonstrates a non-inferior impact in child development in this group compared to conventional, individual occupational therapy intervention. PICIHBI thus has potential for impacting occupational therapy practice in this field by providing an alternative equivalent treatment with increased reach.

PURPOSE: The purpose of this study was to evaluate change in mean fundamental frequency (fo) and estimated vocal tract length (VTL) after laryngeal manual therapy and laryngeal reposturing with voicing in a group of transmasculine speakers, a group for which current research is lacking. METHOD: Fifteen transmasculine individuals were recruited for this study. Participants were recorded at baseline (timepoint 1), again after 15 minutes of laryngeal manual therapy (timepoint 2), and again after 15 minutes of laryngeal reposturing with voicing (timepoint 3). Recordings consisted of the following: 1) elongated productions of “pot, seed, coop, cat, hut” to isolate the vowel sounds /ɑ, i, u, æ, ʌ/; 2) a 30–60 second spontaneous speech sample. Mean fo was calculated from the speech samples and VTL was estimated using an average of the third and fourth formants calculated from the middle of the vowel /ʌ/ in “hut.” Two separate repeated measures analyses of variance were completed for mean fo and estimated VTL with main effects of timepoint, followed by post hoc t tests. RESULTS: The repeated measures analyses of variance showed a statistically significant effect of timepoint on fundamental frequency and on estimated VTL. Tukey simultaneous tests for differences of mean fo across timepoints found significance between timepoints 3 and 2. Tukey simultaneous tests for differences of estimated VTL across timepoints found significance between timepoints 3 and 1. CONCLUSION: Laryngeal reposturing with voicing and laryngeal manual therapy together led to a significant increase in estimated vocal tract length, and laryngeal reposturing with voicing led to a significant decrease in mean fo. Individual outcomes varied, but overall results showed effectiveness for the use of these intervention techniques in the treatment of transmasculine individuals seeking gender-affirming voice care.

Background: The concept of client-centred practice (CCP) was first developed and implemented by occupational therapists in Canada during the early 1980s and subsequently transferred into the Tanzanian occupational therapy curriculum by international volunteer educators. Currently, the occupational therapy curriculum at the Kilimanjaro Christian Medical University College (KCMUCo) in Moshi, Tanzania covers CCP using assessment tools and models developed by the Canadian Association of Occupational Therapy. To date, no occupational therapy research has been conducted to investigate the relevance of CCP for Tanzania, or to document the perspectives of therapists in applying the principles of CCP. This study was indicated to inform the occupational therapy curriculum at the KCMUCo and the Tanzania Occupational Therapy Association (TOTA) about occupational therapy practice realities related to the implementation of CCP in Tanzania and to guide the alignment of the occupational therapy curriculum towards a local understanding of CCP or an alternative (non-Western) perspective. This study, therefore, aimed to determine the understanding and use of CCP by occupational therapists in Tanzania. Methodology: The study used a descriptive cross-sectional design. All qualified occupational therapists working in different regions in Tanzania were approached to participate in the study (N=80). A questionnaire, the Professional Questionnaire for Assessing CCP (PQACCP) was adapted for the study. The questionnaire consisted of five sections: 1) demographic and practice information; 2) an adaptation of an existing checklist on understanding CCP (Parker, 2006); 3) potential barriers to CCP; 4) enablers of CCP; and, 5) therapist opinions on the relevance of CCP for the Tanzanian context. The checklist of potential barriers and enablers was adapted from Sumsion & Smyth, (2000). Data were analysed using the SSPS software program (version 20.0). Numerical variables were checked for normality and the appropriate measures of central tendency and dispersion calculated. Frequencies and proportions were determined for categorical items. The Chi-square test of association was done to determine whether there were any observed associations between demographic variables and barriers/enablers.

The present intervention study explores the immediate and delayed word learning in 14 children with cochlear implants. Capitalizing on the multimedia options available in electronic storybooks, the intervention incorporates elements such as videos and illustrations to support a vocabulary intervention that includes evidence-based teaching strategies. The extent of the children's word learning was assessed using three assessment tasks that required an increasing level of word understanding; receptive pointing, expressively labeling and word defining. Children demonstrated greater immediate word learning gains for words taught in the treatment condition compared to those in the comparison condition, across the expressive labeling task. The children's performance on delayed post-test vocabulary assessments did not indicate better retention across receptive and expressive vocabulary tasks for words taught within the treatment condition compared to the comparison condition. Findings suggest that children with cochlear implants can benefit from an oral only multimedia enhanced intensive vocabulary instruction. / A Dissertation submitted to the Department of Communication Science and Disorders in partial fulfillment of the Doctor of Philosophy. / Spring Semester, 2015. / February 27, 2015. / cochlear implants, electronic storybooks, intervention, vocabulary / Includes bibliographical references. / Carla Wood, Professor Directing Dissertation; Michael Kaschak, University Representative; Ramonda Horton, Committee Member; Beth Phillips, Committee Member.

Perceptual adaptation to a talker allows listeners to efficiently resolve inherent ambiguities present in the speech signal introduced by the lack of a one-to-one mapping between acoustic signals and intended phonemic categories across talkers. In ideal listening environments, preceding speech context has been found to enhance perceptual adaptation to a talker. However, little is known regarding how perceptual adaptation to speech occurs in more realistic listening environments with background noise. The current investigation explored how talker variability and preceding speech context affect identification of phonetically-confusable words in adverse listening conditions. Our results showed that listeners were less accurate and slower in identifying mixed-talker speech compared to single-talker speech when target words were presented in multi-talker babble, and that preceding speech context enhanced word identification performance under noise both in single- and mixed talker conditions. These results extend previous findings of perceptual adaptation to talker-specific speech in quiet environments, suggesting that the same underlying mechanisms may serve to perceptually adapt to speech both in quiet and in noise. Both cognitive and attentional mechanisms were proposed to jointly underlie perceptual adaptation to speech, including an active control process that preallocates cognitive resources to processing talker variability and auditory streaming processes that support successful feedforward allocation of attention to salient talker-specific features.

For some older adults in hospice, confronting end-of-life issues is frightening. It can also be alarming for loved ones and family members. Gerontologists recommend that people who are confronting death tell stories about their lives to reveal and create meanings for themselves. Hospice team members encourage individuals to express their thoughts and feelings to enhance and solidify meaning in one's life. This qualitative study utilizes reminiscing and creativity as a way for older adults in hospice to confront end-of-life issues, strengthen relationships and solidify meaning in life. The encompassing research question asks "How does art therapy help older adults in hospice express the physical, emotional and spiritual aspects of one's life?" Two other questions are asked, "In the context of hospice, what is the nature and meaning communicated by dying individuals, their loved ones and family members using reminiscing and art-making?, and "In the context of hospice, what is the nature and meaning that the created art object(s) has to the older adult, their loved ones and family members who participated in the art-making experience? Interviews were conducted with three family units. Each family unit consisted of an older adult in hospice and one of their loved ones. Interviews revealed stories about highlighted events, experiences and achievements, and an illustration was created to depict and symbolize that story. The final meeting consisted of a collaborative collage-making project depicting many of the highlighted stories, events and experiences of the older adult in hospice. The data was analyzed using grounded theory, which is also known as the constant comparative method. The results reinforce that older adults in hospice, as well as loved ones, benefited from reminiscing and creatively expressing expression, and hence it is a useful tool for individuals to solidify meaning and strengthen relationships as one confronts end-of-life issues. / A Dissertation Submitted to the Department of Art Education in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy. / Spring Semester, 2008. / March 5, 2008. / Aging, Creativity, Existentialism, Art, Death Education, Art Education, Art Therapy / Includes bibliographical references. / David Gussak, Professor Directing Dissertation; Linda Vinton, Outside Committee Member; Marcia Rosal, Committee Member; Penelope Orr, Committee Member.

Art-based assessment instruments are used by many art therapists to: determine a client's level of functioning; formulate treatment objectives; assess a client's strengths; gain a deeper understanding of a client's presenting problems; and evaluate client progress. To ensure the appropriate use of drawing tests, evaluation of instrument validity and reliability is imperative. Thirty-five published and unpublished quantitative studies related to art therapy assessments and rating instruments were systematically analyzed. The tools examined in the analysis are: A Favorite Kind of Day (AFKOD); the Bird's Nest Drawing (BND); the Bridge Drawing; the Diagnostic Drawing Series (DDS), the Child Diagnostic Drawing Series (CDDS); and the Person Picking an Apple from a Tree (PPAT). Rating instruments are also investigated, including the Descriptive Assessment of Psychiatric Art (DAPA), the DDS Rating Guide and Drawing Analysis Form (DAF), and the Formal Elements Art Therapy Scale (FEATS). Descriptive results and synthesis outcomes reveal that art therapists are still in a nascent stage of understanding assessments and rating instruments, that flaws in the art therapy assessment and rating instrument literature research are numerous, and that much work has yet to be done. The null hypothesis, that homogeneity exists among the study variables identified in art therapy assessment and rating instrument literature, was rejected. Variability of the concurrent validity and inter-rater reliability meta-analyses results indicates that the field of art therapy has not yet produced sufficient research in the area of assessments and rating instruments to determine whether art therapy assessments can provide enough information about clients or measure the process of change that a client may experience in therapy. Based on a review of the literature, it was determined that the most effective approach to assessment incorporates objective measures such as standardized assessment procedures (formalized assessment tools and rating manuals; portfolio evaluation; behavioral checklists), as well as subjective approaches such as the client's interpretation of his or her artwork. Due to the inconclusive results of the present study, it is recommended that researchers continue to explore both objective and subjective approaches to assessment. / A Dissertation Submitted to the Department of Art Education in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy. / Spring Semester, 2005. / April 11, 2005. / Meta-Analysis, Literature Review, Projectives, Projective Techniques, Projective Tests / Includes bibliographical references. / Marcia L. Rosal, Professor Directing Dissertation; Susan Carol Losh, Outside Committee Member; David E. Gussak, Committee Member; Penelope Orr, Committee Member.