Objective. The purpose of the study was to determine if there were significant relationships between dysfunction in sensory modulation, affective disorders, and adaptive behaviors in children and adolescents between the ages of 6 and 17. There were four main hypotheses: (a) there will be a positive relationship between sensory defensiveness and anxiety, (b) there will be a positive relationship between sensory hyposensitivity and depression, (c) there will be a negative relationship between the levels of anxiety and depression and overall adaptive behaviors, and (d) there will be a negative relationship between levels of hyper and hyposensitivity and overall adaptive behavioral functioning. Method. Parents of 46 children and adolescents between the ages of 6 and 17 diagnosed with Asperger Syndrome based on the DSM-IV-TM criteria completed the (a) Sensory Profile for children ages 6 to 10 or the Adolescent/Adult Sensory Profile for adolescents ages 11 to 17; (b) the Adaptive Behavior Assessment System: Parent Version; (c) Revised Children's Manifest Anxiety Scale Adapted Parent's Version; and (d) the Children's Depression Inventory Adapted Parent's Version. Descriptive statistics and the Pearson product-moment coefficient of correlation calculations were used for data analysis. Results. There were statistically significant positive correlations between anxiety and sensory defensiveness (r = .270, p = .035) in the total group and depression and sensory hyposensitivity in only the older group (r = .461, p =.024). There was an inverse significant relationship between depression and the total adaptive behaviors score (r = −.256, p = .043) and specific inverse relationships with the adaptive behaviors of functional academics, leisure and social skills. The relationship between anxiety and adaptive behaviors was not significant (r = −.121, p = .212) although there was a significant inverse relationship between sensory defensiveness and adaptive behaviors (r = −.254, p = .044). The relationship between hyposensitivity and adaptive behaviors approached significance (r = −.214, p = .077). Conclusion. The data supports relationships between anxiety and sensory defensiveness in all age ranges and the relationship between depression and hyposensitivity in older children. A temporal relationship between anxiety and depression may explain the developmental nature of the results. Depression and sensory defensiveness demonstrated significant inverse relationships with overall adaptive behavior functioning. Occupational therapy evaluations and interventions need to address these relationships when treating children with Asperger Syndrome.

"Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, in the Occupational Therapy Department College of Allied Health and Nursing Nova Southeastern University December 2004."

"Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Occupational Therapy Department, College of Allied Health and Nursing, Nova Southeastern University." The author explored the current state of practice and the essential elements in the wheelchair assessment and procurement process. Obtaining the correct wheelchair is a complex process, involving the client, family, practitioners, suppliers, manufacturers, policy makers and insurers. This study utilized a qualitative research approach using Participatory Action Research (PAR) and a Delphi consensus approach to garner input from 155 individuals who have experience in the field of wheelchair assessments. While wheelchair users account for 1% of the United States population over the age of 6, they experience oppression, unemployment, and activity limitations. The findings of this study suggest that the wheelchair assessment process be theoretically based on empowerment and reflect a client-centered process.

July 2010. "Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Occupational Therapy, Occupational Therapy Department, College of Allied Health and Nursing, Nova Southeastern University, Fort Lauderdale, Florida" Objective. The following research questions were posed: (1) Does participatory ergonomic education and programming influence occupational performance among cosmetologists? (2) Does ergonomic education and programming influence quality of life among cosmetologists? (3) Does ergonomic education and programming influence pain among cosmetologists? (4) Does ergonomic education and programming influence numbness and tingling in the upper extremities of cosmetologists? The purpose of this study was to: (1) implement a participatory ergonomic program for cosmetologists and (2) to examine the effectiveness of the implemented program in decreasing signs and symptoms associated with work-related musculoskeletal disorders. Method. A multiple baseline, single subject design was used. Data were collected from seven subjects for a total of 12 weeks. The intervention was introduced to subjects at different times throughout the study and consisted of general ergonomic education, a participatory ergonomic interview session, and basic range of motion stretches. Outcome measures included the QuickDASH, a 10-point pain scale, and a 10-point numbness and tingling scale. Data were analyzed using visual analysis techniques including the two-standard deviation band method and the binomial test method. Data trends were assessed to further support the results. Results. The results of this study indicate that ergonomic programming improved occupational performance, improved quality of life, decreased upper extremity pain, and decreased upper extremity numbness and tingling for several of the participants. The results of this study also produced statistically significant changes in QuickDASH scores indicating improved quality of life and improved occupational performance. Statistically significant change in pain scores and numbness/tingling scores indicated that several participants experienced decreased pain, numbness, and tingling in the upper extremity. Conclusion. The results of this study support the assumption that cosmetologists experience symptoms consistent with work-related musculoskeletal disorders and respond to participatory ergonomic programming similar to other working groups. The results of this study support the main principles of the participatory ergonomic approach which focus on involvement of the worker. The participatory ergonomic approach used in this study aligns with the client-centered principles found in the practice of occupational therapy and therefore provides evidence of effective occupational therapy intervention.

"Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Occupational Therapy, Occupational Therapy Department, College of Allied Health and Nursing, Nova Southeastern University."Obesity is a global public health issue, yet interventions to create change have been largely ineffective. Few researchers have considered obesity from the perspective of the person experiencing it, and even fewer have explored the effects obesity has on the Mexican-American population. This dissertation explored the lived experiences of Mexican-American women with obesity living along the El Paso/Mexico border. The study used occupational therapy's Lifestyle Performance Model as the orienting framework. Theoretical concepts from psychology and sociology also clarified contexts of social construction and outcomes of negative stereotyping. Using a phenomenological, qualitative design, this study answered the following research question: What are the lived experiences of Mexican-American women with obesity living along the El Paso/Mexico border? Eight women participated in the study, ranging in age from 25-45 years. The women were recruited though posted flyers and snowball sampling methods. Individual, in-depth interviewing resulted in emergent themes and subthemes that articulated the core essence of their lived experiences. The dominant themes of the study portrayed obesity as a: (a) pervasive entity, (b) disruption to a harmonious self, (c) social negotiation, (d) disconnection from self and others, and (e) product of cultural patterning. Through the voices of the participants, results showed that obesity affects physical and emotional health, which alters lifestyle performance and overall quality of life. Cultural and environmental factors also significantly influence active engagement in meaningful occupation. The data suggest a need for clinician training, student education, and advocacy skills for individuals who live with obesity. Further topics for future research and detailed recommendations regarding treatment interventions are also discussed.

March 2011. "Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Occupational Therapy Department, College of Allied Health and Nursing, Nova Southeastern University." This phenomenological study was designed to understand the lived experience of adolescents being treating for cancer and the impact of their lived experience on engagement in occupations and social participation. Participants in this study included four young adolescents 17-19 years of ages attending school on a part-time basis. They were on active treatment protocols for cancer and enjoyed participating in sports or other activities with friends. In-depth structured interviews with questions to illuminate the impact of cancer treatment on social participation were completed and audio recorded. Data analysis was completed utilizing a phenomenological reduction method to determine emerging themes and significant statements. A description of the experience and its meaning were then developed from themes emerging from the perspective of the participants. The four major themes and sub themes resulting from this study were: 1. Change of Lifestyle a) Physical & Emotional Pain of Living b) School Re-entry--A Saving Grace; 2. Exploring New Occupations a) Adapting Occupations b) Awakening or Confirming Beliefs; 3. Reconnecting with Family a) Importance of Support b) A Kid Again. 4. Living with Cancer Isn't Easy a) Isolation b) Hidden Disability. The findings revealed lifestyle changes, which these adolescents needed to deal with in order to maintain a sense of routine and engagement in occupation. Changes in appearance, physical strength, and overall endurance impacted the participants' ability to engage in occupation(s) which often led to isolation among their peers. In spite of this, participants discovered new occupations that were less physically demanding but still fostered social participation with peers. The study of social participation for adolescents with cancer has implications for and can assist in developing client-centered interventions and simultaneously increase occupational therapy's understanding of these individuals during a transitional period of their lives.

"Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Occupational Therapy Department, College of Health Care Sciences, Nova Southeastern University." Attachment and sensory modulation are two processes that co-occur in early development and that have an impact on the future development of the child. Attachment difficulties occur when the child cannot, for whatever reason, use the primary caregiver as a secure base from which to experience the world. Sensory modulation disorder (SMD) is characterized by maladaptive responses to sensory input. Although the literature and current research in the separate areas of attachment and sensory modulation have some parallels with regard to behavioral sequelae, relation to stress, and impact on participation, the relation of the two processes has not been the focus of published research. This research examined the relation between attachment and sensory modulation in 68 children ages 3 to 6. Two assessments were administered during the course of a home visit with each participant and primary caregiver: the Attachment Q-Set (3rd edition; AQS) and the Short Sensory Profile (SSP). There were significant correlations between the AQS security criterion (AQS-S) and the SSP as well as the AQS dependency criterion (AQS-D) and the SSP providing evidence for a relation between attachment and sensory modulation. Significance was found in simple linear regression with the SSP total score and SSP section scores for tactile sensitivity and visual/auditory sensitivity predicting AQS-D scores. Multiple regression calculations were significant for AQS-S and AQS-D predicting SSP as well as SSP section scores predicting AQS-D. These findings support the view of a dynamic model of interaction between attachment and sensory modulation development as well as among the child, the caregiver, the child-caregiver dyad, and the environment.

"October 2004" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. This study examined the relationship between university faculty attitudes toward academic accommodations and the provision of academic accommodations for students with disabilities. A pretest posttest design was used to examine the relationship between faculty attitudes (willingness, perceptions, and intentions) toward students with disabilities and whether the attitudes and the knowledge one posses about providing academic accommodations influences faculty teaching behaviors. According to the 2000 Census, one out of twelve children and teenagers (ages 520) living in the United States has a physical or mental disability (Cohen, 2002). This statistic indicates that the number of students requiring academic accommodations in post secondary education will continue to grow throughout the next decade. The literature suggests that faculty who are not well informed on how to provide reasonable accommodations for students with disabilities may develop negative attitudes that create additional barriers for these students. Therefore, in an effort to contribute to evidence-based occupational therapy practice, a faculty-training workshop was developed and conducted to evaluate whether training faculty about academic accommodations affected their willingness to provide academic accommodations to students with disabilities. Participants were faculty at Eastern Michigan University, Ypsilanti, Michigan who elected to participate in a four-hour training session on providing academic accommodations to students with disabilities. The results of the study suggest that both knowledge and attitudes (willingness, perceptions, and intentions) of faculty improved as a result of the intervention which in turn can have a positive impact on students enrolled in their courses. The researcher concluded that further qualitative research is needed to address if the training provided did in fact have an impact on the participants' long-term behavior and whether participating faculty are now more willing to provide academic accommodations to students with disabilities as a result of the workshop. Additionally inquiry is recommended with larger and diverse samples to determine the most effective training interventions.

"December 2005" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript (.pdf) Project Advisor : Ferol Menks Ludwig The purpose of this study was to determine if structured observations were associated with the Sensory Integration and Praxis Tests (SIPT). Structured observations have been utilized in sensory integration for many years to assist therapists in assessing children with sensory integration dysfunction. The sample for this study consisted of 21 children ages 5-8 treated with a sensory integration frame of reference in a treatment and training center in west Los Angeles. Sensory integration dysfunction was tested using the SIPT and a set of 10 different structured observations including the supine flexion postural test, prone extension, slow motions, postrotary nystagmus, diadochokinesis, finger-to-thumb opposition, finger-to-nose, the modified Schilder's arm extension test, and the heel-to-toe measure of balance. Results show a small degree of association and highlight the complementary role of both measures. Data reduction indicated that a few structured observations better described two profiles of the SIPT; the low average bilateral integration and sequencing and visuo-somatodyspraxia. Three factors best described the most common structured observations in the group of children with low average bilateral integration and sequencing disorder and included aspects of motor planning and bilateral sequencing; vestibulo-proprioceptive and cerebellar aspects of speed, acceleration, and trajectory. The forward linear regression analysis indicated that structured observations could only predict a small portion of the variability of the different measures of the SIPT.

"May 2007" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Max A. Ito Occupational therapy candidates face a challenging task on the path to becoming registered occupational therapists. Uncertainty surrounds the professional community as to why certain candidates, who otherwise perform soundly both academically and clinically, struggle to be successful on the certification exam. Literature suggests that factors such as stress and anxiety may be the root cause. There is a plethora of literature discussing the importance of clinical reasoning skills in occupational therapy practitioners and students. However, no literary sources to date have investigated the importance of clinical reasoning in certification exam performance. This research study investigated the correlation between clinical reasoning skills and performance on the NBCOT certification examination. Thirty-five candidates from across the U.S. completed the Health Sciences Reasoning Test (HSRT), which tests critical thinking skills in five key areas. Supporting demographic information was collected for further comparisons. The participants then sat for the NBCOT exam within 90 days of taking the HSRT. Pearson product-moment correlation and Spearman's rho analyses indicated significant relationships between certification exam performance and three sub-skills of reasoning: inductive reasoning (p = .032/rs = .011), deductive reasoning (p = .007/rs = .004), and analytical reasoning (p = .001/rs = .002). Total HSRT score was also a significant factor in exam performance (p = .001/rs = .003). In ANOVA analysis investigating the relationship between highest educational level and certification exam performance, students who earned only master's degrees in occupational therapy performed significantly better than those earning combined bachelor's/master's degrees (p = .000), scoring an average of 29.15 points higher on the certification exam. In additional analysis, multiple regression analysis indicated that only analytical reasoning was a predictor of certification exam score. Race, age, grade point average (GPA), geographic location, and fieldwork settings were not significant factors in certification exam performance. Application of these results to larger populations should be exercised with caution due to the limited sample size of this study. Results of this study can initiate a dialogue among occupational therapy practitioners and educators who hold a role in assisting students in developing clinical reasoning skills and preparation for the certification exam. Results are also beneficial for students who can incorporate clinical reasoning skills as part of a certification exam study regimen.