OTJR: Occupational Therapy Journal of Research

Polytrauma, including mild traumatic brain injury, posttraumatic stress disorder, and orthopedic conditions, is common among combat veterans (CVs) from Operations Enduring Freedom and Iraqi Freedom. Medical conditions, coupled with deployment-related training, may affect CVs' fitness to drive and contribute to post-deployment crash and injury risks. However, empirical interventions are lacking. Therefore, the study purpose was to examine the efficacy of an occupational therapy driving intervention (OT-DI) with pre and post testing of CVs. Using a DriveSafety 250 simulator, Occupational Therapy-Driver Rehabilitation Specialists recorded driving errors. Eight CVs (mean age = 39.83, SD = 7.80) received three OT-DI sessions, which incorporated strategies to address driving errors and visual search retraining. We determined baseline driving errors (mean = 31.63, SD = 8.96) were double the number of posttest errors (mean = 15.38, SD = 9.71). At posttesting, a significant (p < 0.05) decrease was noted for total errors and lane maintenance. Despite study constraints, preliminary data support the efficacy of the OT-DI.

The objective was to assess effectiveness of apraxia treatments using a systematic review. In contrast to previous reviews, each study was rated as to its applicability to occupational therapy practice and its focus on occupational performance using the FAME rating system (defined by four categories: Feasibility, Appropriateness, Meaningfulness, Effectiveness). This systematic review included eight studies: four randomized controlled trials (level 1 evidence) and four pre-post designs (level 3 evidence). Three treatment approaches were reported: errorless learning with training of details; gesture training; and strategy training. FAME scores ranged from A to C. All studies reported significant treatment effects, but only one demonstrated an impact on observed occupational performance that transferred from clinic to home.

The purpose of this article is to examine a father feeding his daughter who is diagnosed with cerebral palsy in order to identify the contexts that make this occupation significant. The analysis of direct observation and interviews demonstrates significant moments where two individuals make intersubjective connections. Themes that are presented are the Intensity of Mealtime, Connections Between Participants, and Adapted Forms of Communication. Both the difficulties and rewards of mealtime are illustrated within these themes. This analysis reveals the structure and importance of doing together in influencing and determining occupations. From a clinical perspective, the meaningfulness of fathering occupations highlights the importance of including fathers in family-centered care.

Guided cues facilitate discovery of problems and strategies. Directed cues are instructional statements and commands. Both types of cues are used by therapists to promote learning; yet, little is known about the frequency and effects of these cues in clinical practice. We developed a standardized coding scheme for characterizing training cues. We recorded 27 sessions among 10 participants engaged in inpatient rehabilitation after stroke. Two raters coded type and number of cues on 33% of sessions. We resolved discrepancies between raters and refined the standardized coding scheme, achieving excellent inter-rater reliability (ICC = 0.950, guided cues; ICC = 0.995, directed cues). We applied the final coding scheme to all 27 sessions (10 participants). Average cues per minute ranged from 1 to 13. Guided cues were less frequent than directed cues. This study sets the stage for future, larger studies designed to examine the significance of the number and types of cues in usual practice.

Implementation into real-world practice of interventions previously studied in randomized controlled trials is an ongoing challenge. In this article, we describe the methodology we used for the first phase of a project for the implementation and outcomes assessment of an occupational therapy pressure ulcer prevention intervention for people with spinal cord injury in the Veterans Health Administration. This first phase of the project was guided by practice-based evidence research methodology and resulted in an intervention manual tailored to meet the needs of Veterans and the establishment of a system for documenting and monitoring care processes, patient characteristics, and intervention outcomes. This system, in turn, will provide the data-gathering template for the next phase in which the beneficial effects of the intervention will be assessed. We conclude by recommending that clinicians explore the utility of this approach for the implementation of other novel interventions.