December 2007" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Max A. Ito The Individuals With Disabilities Education Act of 2004 requires individualized education program (IEP) teams to consider the intervention of assistive technology (AT); however, the Act allows IEP teams to provide or forego AT, without direction for implementation. Little evidence exists regarding the effectiveness of AT in a public school setting. This study investigated the effect of AT provided by a multidisciplinary AT team in a public school setting. Thirteen participant units each consisted of a special education case manager and student who had recently received AT to address unmet IEP goals and objectives. The students ranged from preschool to 8th grade, had varying special education classifications, and used AT for oral or written communication or computer or curriculum access. In a quasi-experimental pretest, posttest repeated-measures design, this study used the Student Performance Profile (SPP) and the School Function Assessment with the AT supplement (SFA-AT) to assess the effect of AT on performance and participation. Case managers completed both assessments soon after students received their AT and again 4 months later. The results of the SPP, which measures changes in ability on AT-relevant IEP goal-and-objectives, indicated significant improvement in performance, t(12) = 5.54, p = .00. The results of SFA-AT Part III (Activity Performance) were not significant for performance or participation over time, t(12) = 0.82, p = .21, and t(12) = 0.70, p = .50, respectively. AT provided by a multidisciplinary team may help students improve school performance in the form of improvement on goals and objectives; however, participation did not appear to be positively affected. Further study is needed for measuring performance and participation of larger populations of students who use AT and for improvement in instrumentation.

"May 2015" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Max A. Ito Participation in social roles and daily activities is considered a primary outcome for children with cerebral palsy (CP) and thus is an important focus of pediatric therapy. The purpose of this study was to describe the participation patterns of children ages 2 to 6 years with CP, investigate how gross motor impairment affects participation, and identify those family and environmental factors that may influence participation in daily activities and social roles. A convenience sample of 51 children with CP between the ages of 2 and 6 years and their parents completed this study. Parents completed four standardized instruments: the Assessment of Life Habits (LIFE-H), the Impact on Family Scale, The Child and Adolescent Scale of Environment, and the Child Health Conditions Questionnaire, which measured participation, family burden, the environment, and associated conditions respectively. Hierarchical multiple regression analysis was used to determine the extent to which family and environmental factors explained participation in daily activities and social roles while controlling for gross motor impairment (GMFCS), associated conditions and age. The findings of this study suggest that very young children with CP experience substantial restrictions across 10 of 11 domains of participation. Parents report greater environmental barriers, associated health conditions and impact on family as GMFCS levels increase. Gross motor impairment, associated health conditions, and age accounted for 65% of the variance in participation. The environment and family factors did not contribute significantly to the model. For the children in this study, intrinsic factors accounted for most of the variance in participation.

With age, more light is needed in order to function, but the effect of lighting on occupational performance has received little attention in occupational therapy. The purpose of the study was to determine if lighting affects older adults’ ability to perform selected occupational tasks, which require near vision and if lighting levels affects their perceived effort while performing selected occupational tasks. A quasi-experimental, repeated measures design was used with a convenience sample recruited from a retirement community. Thirty participants met the inclusion criteria, which included visual and cognitive screening. The mean age of the 30 participants was 83 years, and most (80%) were female. Participants completed three occupational tasks (reading a prescription label, sorting pills, and sorting dark colored socks) under three different lighting levels (low, M = 103; medium, M = 127; and high, M = 397 footcandles [fc]) presented in random order. Participants were placed in three groups based on order of lighting presentation and completed each set of tasks four times: a trial session, followed by three timed sessions. Participants were asked to rate their perceived effort under each lighting level using a self-report scale. Descriptive statistics were used to examine completion times, groups, and lighting levels. In general, participants required longer to complete occupational tasks and reported more effort when utilizing medium light levels (M = 127 fc) provided by ambient lighting and a floor lamp and performed best under high lighting levels (M = 397 fc) provided by ambient lighting as well as a floor lamp and task lamp. The results suggest lighting may have affected performance and perceived effort of older adults while completing the visually challenging tasks.

In today’s health care environment of quick discharges and shortened hospital stays discharge planning has become increasingly important in acute care occupational therapy practice. Discharge planning is a complex process and an important aspect of patient care as poor discharge planning has been associated with poor patient outcomes and increased risk of adverse events and readmission. This study addressed the following research questions: (a) How do acute care occupational therapists describe their role in the discharge planning process? (b) What guides acute care occupational therapists discharge decisions and recommendations? (c) How do acute care occupational therapists define optimal discharge planning? and (d) What actions can acute care occupational therapists take to optimize the effectiveness of their discharge planning skills within the current health care system? Using an action research methodology, two groups of five occupational therapists met online to discuss acute care occupational therapy discharge planning practices, and actions that could be taken to strengthen their practice. Action plans generated, implemented, and evaluated focused on improving communication with discharge planners, language used in documentation, and incorporating the use of standardized assessments to assist with discharge planning. Schell’s ecological model of professional reasoning as the theoretical model underlying this study was used to examine factors that influence occupational therapy discharge decision making. Data were collected from audio chat transcripts, survey responses, and researcher notes, and analyzed using Stringer’s action research sequential data analysis and interpretation methodology. Five themes emerged including (a) the role of occupational therapy, (b) the complexity of discharge planning, (c) pragmatics of practice, (d) why don’t they pay attention, and (e) the importance of stakeholder communication. Participants felt that discharge planners were not reading occupational therapy documentation, occupational therapy consults were late so that occupational therapy discharge recommendations were just a formality, and physical therapy discharge recommendations had more weight than occupational therapy recommendations. Participants felt that if patients were discharged without benefit of occupational therapy recommendations they could be at increased risk for an adverse event and compromised safety. Good communication among stakeholders was seen as essential for optimal discharge planning.

Background: Chinese immigrants (CIs) with non-insulin dependent diabetes mellitus (NIDDM) generally have poor control in their diet regimen. Due to the variation in body mass, physiology, and cultural differences as compare with the general American population, special attention must be conducted in treating diabetes in Cis, emphasizing culturally sensitive care and nutrition therapy that acknowledge the differences. Purpose: The purpose of this project was to assess cultural challenges in self-management for CIs living with non-insulin dependent diabetes mellitus and evaluate the effectiveness of a diabetic nutritional self-management guide tailored to this population. Theoretical Framework: Havelock’s theory of change is a model emphasized for understanding and intervening of the possibility that people might be resistant to behavior changes. Methods: Thirty-five foreign-born CIs were selected. The project was comprised of two phases to include pretest and posttest self-assessment questionnaires in addition to pretest and posttest A1C levels to evaluate the effectiveness of a custom meal plan. Results: Result findings were non-significant. However, female CIs were noted to have superiority for diet management as compared with male CIs. The two groups had no significant difference in age and cultural characteristics. Conclusion: The goal of the implementation of this project was to improve self-care for Chinese diabetic patients through behavior training and change in policy making. Social and cultural norms were identified that had great influence on an individual’s overall health knowledge. Increasing health care providers’ overall cultural competency was expected to promote better health outcome and ease the complexity of the acculturation process. However, the management of the diet did not have a significant change for the improvement of A1c. Future recommendations include the exploration of the immensity of change in cultural diet and acculturation.

Background: Effective testing in pre-licensure nursing programs is a challenge in nursing education. Implementing evidence-based test development is essential to successful assessment of students’ competence and preparation for licensure. Purpose: Identifying the beliefs, attitudes and values of nursing faculty will contribute to the use of best practices in student assessments, ultimately contributing to increased retention of competent students and increasing the workforce within the healthcare industry. Theoretical Framework: This study is based on Rokeach’s theory of beliefs, attitudes and values. Methods: A quantitative descriptive research methodology was used in this study using survey data collection. A purposive, non-probability, convenience sample was the sampling strategy. The instrument utilized was developed and validated in a previous study and additional researcher-developed items were added. These additional items were field tested for readability and structure by current nursing educators. Results: The results revealed that nursing faculty are not consistent with utilizing evidence-based test development practices within their nursing programs. The beliefs and attitudes identified from the data indicate a concern with the understanding and confidence towards evidence-based practices. Several challenges were identified in implementing test development practices such as addressing linguistic and cultural biases, faculty time constraints, and utilization of test banks. Conclusions: Identifying faculty beliefs, attitudes, and values of evidence-based test development practices offers insight into the challenges facing nursing faculty, nursing programs and nursing students. These challenges affect and influence the retention and persistence of nursing students in prelicensure programs which ultimately affects diversity in the nursing workforce.

Affordable Care Act (ACA) was passed and implemented to expand insurance coverage, reduce health care cost, and improve the quality of care. The purpose of this dissertation study was to investigate whether the ACA insurance expansion correlates with the number of visits made to emergency departments (EDs). The quasi-experimental design interrupted time series was utilized in the analysis. The ED visits were compared using MANOVA to determine the relationship between ED visits and ACA and canonical correlation analysis to assess the strength of the relationship and the extent to which independent variables could predict the dependent variable. The hypothesis was that the ACA will reduce the uninsured, increase the insured, and reduce the ED visits. The relationship between number of ED visits and the ACA will present whether the uninsured patients contributed significantly to the ED overcrowding. Analysis of secondary data from four EDs (H1, H2, H3, and H4) in the Chicago area showed that 484,742 visits were made, and 2,801 were excluded due to unknown payer type. Medicaid patients recorded the largest number of visits (181,226) while the uninsured patients recorded the least number of visits (56,572). The ED visits decreased by 6% from 2012 to 2013 (pre-ACA) and increased by 4% from 2013 to 2105 (post-ACA). The ACA implementation increased the people with insurance who visited the EDs by 11%. The results demonstrated a strong relationship between ACA and ED visits. The correlation of the variables (hospital and year) and ED visits demonstrated that the hospital could explain 97% of the Medicaid visits and 87% of uninsured while the year could predict 82.6% of the uninsured visits and 52.5% of Medicaid visits.

Congenital and infant acute leukemia remain one of the most puzzling clinical issues in pediatric hematology-oncology. There is a paucity of studies focused on these rare, aggressive, acute leukemias; specifically, there is little study on the differences in disease in the youngest of infants less than 1 year of age unlike the numerous studies of the disease in older children. The United States National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) cancer population registry program has been integral for a plethora of clinical population and pathology research studies for numerous diseases in the last 40 years and has an excellent resource for investigation of the infant population. Laboratory medicine and pathology professionals must use pathology results not only to diagnose individuals after the disease has been discovered, but the information must be applied retrospectively to develop new testing strategies. By classifying the intense heterogeneity within these cancers, the distinct changes of the diseases within individuals can be established, ultimately reshaping diagnostic methodologies. Through the application of Integrative Molecular Pathological Epidemiology to a 325-infant case series from the SEER program from 2008 to 2014, this dissertation study was used to evolve the classification of these pediatric cancers with the application of scientific nosology. This dissertation study has documented characteristics of this population for application in further precision medicine investigations to influence laboratory medicine algorithms for diagnosis and management of patients guiding health policy that are aimed at improving outcomes in the youngest of children.

Objectives: This study compares wearing time for four months after receiving a new spectacle correction in subjects within Autism Spectrum Disorder (ASD) population to typically developing (TD) children and adolescents age 9 to 17 years old. Methods: Children and adolescents who were ASD or TD were enrolled from subjects recruited from another pilot study focused on eye examination testing for children and adolescents with ASD. A psychologist determined group status/ eligibility using American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) criteria after review of previous evaluations and parent report of symptomology on the Social Communication Questionnaire. Parents provided the subject's age, level of parent education, gender, race, ethnicity and urbanization level. Parents completed a telephone survey at 1, 2, 4, 8, 12, and 16 weeks after the child received their spectacles. The survey asked questions about wearing time, willingness to wear spectacles and amount of prompting required. Data was analyzed to determine if there were differences between the ASD and TD group. Results: 22 subjects were enrolled who met review criteria for ASD or TD group and needed refractive correction. No significant difference was found between ASD and TD wearing time (p > 0.05). Age, gender, ethnicity, level of parent education, urbanization level and grade in school did not demonstrate differences in adaptation between the TD and ASD groups. Conclusions: Parental reports of wearing time and resistant behavior demonstrate that children and adolescents with ASD adapt to spectacle wear for significant refractive error similarly to typical children and adolescents.

Occupational therapists need a means to efficiently and accurately screen a client’s medication management capacity, especially for clients post-stroke. Most therapists are not aware of, nor do they utilize specific assessments for medication management capacity, partly due to lack of thorough assessments. The purpose of this study was to compare the scores of the ManageMed Screen (MMS), the Screening for Self-Medication Safety Post Stroke (S5), and the Montreal Assessment of Cognition (MoCA) on a population of rehabilitation clients post-stroke to evaluate consistency of scores and determine their usefulness in clinical practice. All screens were designed for use in occupational therapy; the MMS was validated for the general adult population, the S5 for clients post-stroke, and the MoCA is a cognitive screen used with adult clients with a variety of diagnoses including stroke. The MoCA was used to explore the potential relationship between cognition and medication management capacity. Study participants included five clients post-stroke and three occupational therapists. Clients were screened by the occupational therapists with the MMS, S5, and MoCA, and clinicians also participated in a focus group to assess their perceived usefulness of the screens. Results demonstrated that the MMS was consistent with the S5 in identifying the clients who performed the poorest. The MoCA has no consistent relationship with either the MMS or S5. Additionally, through a focus group, clinicians deemed both the MMS and S5 as useful, but felt the MMS was a more useful screen for their clinical practice in regards to efficient and practical use with clients post-stroke in a rehabilitation setting