OBJECTIVE:The purpose of this study was to investigate whether occupational therapy intervention that focused on teaching children to use word processing, either alone or with word prediction, was effective in improving the written communication skills of children with learning disabilities and handwriting problems. METHOD:A single-subject alternating treatments design was replicated across three children in grades 4 and 5. During the baseline phase the children wrote stories by hand; during the intervention phase, the children wrote stories, alternating among handwriting, word processing, and word processing with word prediction. Dependent variables focused on percentages of legible words, percentages of correctly spelled words, total amount written, and rate of writing. Data were analyzed by visual inspection. RESULTS:Results were variable. Two children had clear improvements in legibility when using either word processing alone or with word prediction. These same children demonstrated clear improvements in spelling when using word prediction. Though rate of writing was best for two children when using handwriting, relative to total amount produced, one method was not clearly preferable to another. CONCLUSION:Occupational therapy intervention involving word processing with word prediction improves the legibility and spelling of written assignments completed by some children with learning disabilities and handwriting difficulties. It is important to evaluate each child individually and provide training and ongoing support for technology use.

Application of the seven principles of universal design of instruction in occupational therapy education is intended to meet the diverse learning needs of students and provide full access to educational experiences without disadvantaging some students (Bowe, 2000; Burgstahler, 2001; McGuire & Scott, 2002). The intended outcome is success for all students. Further, universal design of instruction is congruent with the occupational therapy core value of mutual respect, whereby... We treat people fairly and equitably. We acknowledge and support others regardless of differences. We appreciate their qualities, capabilities and contributions (American Occupational Therapy Association, 2003). While the benefits of universal design of instruction in occupational therapy curricula appear to be extensive, a caveat must be included. Use of any instructional design tool is legitimized when grounded in research. Though literature in multiple disciplines is expanding related to universal design of instruction, we need research specific to occupational therapy education.

OBJECTIVE. The purpose of this study was to explore the effects of a powered mobility riding toy on the participation behaviors of young children with complex developmental delays.METHOD. A single-subject withdrawal design was used to study the effects of powered mobility on child-initiated movement occurrences, initiation of contact with others, and affect, The participants were two young children with complex developmental delays, including spastic quadriplegia, The intervention consisted of having the children use a powered mobility riding toy in their school settings during gym class and outdoor recess.RESULTS. Primary findings were that use of the powered mobility riding toy (a) increased the number of self-initiated movement occurrences; (b) appeared to have some effect on initiation of contacts with adults and, for one child, negative adult initiations and positive peer initiations; and (c) did not have a clear impact on the amount of positive affect.CONCLUSION. For some young children with severe motor impairments and developmental delay, use of a powered mobility device may increase self-initiated movement occurrences during free play.

OBJECTIVES:The purpose of this study was to describe the sensory-based behaviors of young children with autism as reported by their parents on the Sensory Profile. Factor scores of children with autism were compared with those of children without autism. METHOD:The Sensory Profile questionnaire was completed by parents of 40 children with autism 3 through 6 years of age and parents of 40 children without autism 3 through 6 years of age. RESULTS:The performance of children with autism was significantly different from that of children without autism on 8 of 10 factors. Factors where differences were found included Sensory Seeking, Emotionally Reactive, Low Endurance/Tone, Oral Sensitivity, Inattention/Distractibility, Poor Registration, Fine Motor/Perceptual, and Other. CONCLUSION:Findings from the study suggest that young children with autism have deficits in a variety of sensory processing abilities as measured by the Sensory Profile. Further research is needed to replicate these findings, to examine the possibility of subgroups on the basis of sensory processing, and to contrast the sensory processing abilities of children with other disabilities to those of children with autism.

OBJECTIVE:This study was designed to compare measures of pain when children with burn injuries were engaged in a purposeful activity, specifically a play activity, versus rote exercise. METHOD:Two 6-year-old children participated in a study using a single-subject, randomized multiple treatment design to compare two conditions: purposeful activity and rote exercise. Data were gathered for each session on four dependent measures: number of repetitions of therapeutic exercise completed, number and type of overt distress behaviors displayed, scores on self-report scales of pain intensity, and overall enjoyment of the activity. RESULTS:Visual inspection of the graphed data suggested that, early in the rehabilitation process, the use of a play activity in comparison to rote exercise yielded better outcomes in terms of all four dependent measures. Additionally, the data implied that there may be a point later in the rehabilitation of a child with a burn injury when rote exercise may be as effective as play activities in meeting therapeutic goals. CONCLUSION:This study supports the belief that purposeful activity can yield results equal to or better than those achieved using rote exercise. Replication of this study is warranted, and the development is indicated of a measure of overt behavioral distress that is more appropriate than those currently available for children with burn injuries.

OBJECTIVE:To relate grant funding activities of the National Center for Medical Rehabilitation Research (NCMRR) with the Center's mission, priorities, and terminology for disability classification. STUDY DESIGN:Retrospective review by the National Advisory Board on Medical Rehabilitation Research (NABMRR). DATA:Abstracts of 153 research proposals and one contract funded by the NCMRR from 1992 through 1996. METHOD:A six-member research group participated in the development of a rating form and related instructions used to evaluate each abstract. The form was piloted and revised, and interrater agreement was monitored. RESULTS:Funded proposals reflected each of the NCMRR priorities evaluated, with the highest proportion in the areas of assistive technology and whole body system, and the lowest in the area of behavioral adaptation. Although some proposals were funded in each of the domains of the disability classification system, proportionately fewer addressed the domains of disability and societal limitations. Findings also indicated that few funded proposals addressed more than one domain in the disability classification system and that most abstracts did not address consumers' perspectives on quality of life. RECOMMENDATIONS:The NABMRR recommended that the NCMRR (1) encourage more research in the areas of disability and societal limitations and in behavioral adaptation, (2) examine funded proposals in light of a recent Institute of Medicine report, and (3) explore quality-of-life measurements. Further, members of the rehabilitation community are encouraged to e-mail their responses to this review to NCMRR staff at (1q2n@nih.govA) and to suggest areas of research emphasis.

OBJECTIVE:The purpose of this study was to examine the current practice patterns of occupational therapists experienced in working with children with autism spectrum disorders. METHOD:Occupational therapists experienced in providing services to 2-year-old to 12-year-old children with autism completed a mail questionnaire describing practice patterns, theoretical approaches, intervention techniques, and preferred methods of preparation for work with children with autism. RESULTS:Of those contacted, 72 occupational therapists met the study criteria and returned completed questionnaires. Practice patterns included frequent collaboration with other professionals during assessment and intervention. Intervention services were typically provided in a one-to-one format with the most common techniques being sensory integration (99%) and positive reinforcement (93%). Theoretical approaches included sensory integration (99%), developmental (88%), and behavioral (73%). Evaluations relied heavily on nonstandardized tools and clinical observations. Educational methods identified as most helpful were weekend workshops (56%) and on-the-job training (52%). CONCLUSION:This study clarified the nature of current occupational therapy practice patterns for 2-year-old to 12-year-old children with autism. Additional studies are needed to examine the efficacy of current evaluation and intervention methods, as well as to explore the relevance of available standardized assessments for this population.

OBJECTIVE:Functional written communication, an important goal in the rehabilitation of persons with tetraplegia, frequently is met through the use of personal computers and alternative computer access systems. To make informed decisions about alternative access systems, the therapist needs information on the efficacy of the available choices. The purpose of this study was to investigate the effectiveness of two commercially available systems for text entry, the traditional mouthstick and the Prentke Romich HeadMaster. METHOD:Participants were a 25-year-old man and 76-year-old woman who both functioned at a C5 neurological level. Neither participant had previous experience with either system for text entry. A single-subject research design was used whereby Participant 1 experienced six phases of treatment (i.e., CBCBCB, where C = mouthstick and B = HeadMaster), and Participant 2 experienced four phases of treatment (i.e., BCBC). RESULTS:Participant 1 achieved a maximum rate of text entry of 5.85 wpm with both the HeadMaster and the mouthstick, whereas Participant 2 achieved a maximum rate of 7.15 wpm with the mouthstick and 4.85 wpm with the HeadMaster. Results from this study were similar to the results from previous comparison studies of persons with severe disabilities who had no experience with alternative computer access systems. CONCLUSION:Both participants were able to use both systems successfully; however, their respective rates of text entry were too slow to be functional in most employment situations.

OBJECTIVE:This study examined the test-retest reliability of the legibility portion of the Evaluation Tool of Children's Handwriting-Manuscript (ETCH-M). METHOD:The sample consisted of 31 first-grade and second-grade students with handwriting dysfunction. The ETCH-M was administered two times, 1 week apart, to participants. The primary investigator acted as sole rater and followed standard scoring procedures. RESULTS:The reliability coefficients were .63 for total numeral legibility .77 for total letter legibility, and .71 for total word legibility. Individual task reliability coefficients were generally lower and ranged from .20 (near-point copy) to .76 (alphabet uppercase). CONCLUSION:Total letter, total word, and uppercase letter legibility were more stable than total numeral legibility scores and other individual tasks scores. When evaluating handwriting for a child, it is important to consider ETCH legibility scores as only one aspect of a comprehensive evaluation.

OBJECTIVEThe purpose of this study was to determine whether switch control site (hand vs. head) affects the age at which children can successfully activate a computer to play a cause-and-effect game.METHODThe sample consisted of 72 participants randomly divided into two groups (head switch and hand switch), with stratification for gender and age (9-11 months, 12-14 months, 15-17 months). All participants were typically developing. After a maximum of 5 min of training, each participant was given five opportunities to activate a Jelly Bean switch to play a computer game. Competency was defined as four to five successful switch activations.RESULTSMost participants in the 9-month to 11-month age group could successfully use a hand switch to activate a computer, and for the 15-month to 17-month age group, 100% of the participants met with success. By contrast, in the head switch condition, approximately one third of the participants in each of the three age ranges were successful in activating the computer to play a cause-and-effect game.CONCLUSIONThe findings from this study provide developmental guidelines for using switches (head vs. hand) to activate computers to play cause-and-effect games and suggest that the clinician may consider introducing basic computer and switch skills to children as young as 9 months of age. However, the clinician is cautioned that the head switch may be more difficult to master than the hand switch and that additional research involving children with motor impairments is needed.

OBJECTIVE:The purpose of this study was to determine the effectiveness of oral support on feeding efficiency in preterm infants who were identified by the medical team as poor feeders. METHOD:Thirteen premature infants between 34 and 40 weeks' postconceptional age were selected from a group of infants at Children's Hospital and Medical Center in Seattle, Washington. They were fed twice within a 26-hr period, once with oral support and once without. The order of occurrence of these two conditions was randomly selected without replacement to assure that an equal number of both conditions occurred during the first feed. Only the first 2 min of the feed were used in data analysis. RESULTS:A statistically significant difference (z = -2.62, p < .01, two-tailed) in volume intake occurred between the oral support condition (M = 10.9 cc) and the no oral support condition (M = 4.8 cc). CONCLUSION:This study validates the use of oral support as an effective treatment technique to enhance sucking efficiency in preterm infants.

Traumatic brain injury can result in persistent impairments of motor performance that interfere with functional activities. This study compared the gross and fine motor performance of 14 traumatically brain-injured children (five to 15 years old, with loss of consciousness for at least 24 hours) to 14 normal children group matched for age and sex. All subjects had normal intelligence and no prior history of cognitive or motor delays. Subjects were assessed with the Bruininks-Oseretsky Test of Motor Proficiency at least 16 months after injury. Results were compared using the Wilcoxon rank sum test. Highly significant differences were found between groups on the Gross Motor Composite. Although no significant differences were found on the Fine Motor Composite, a highly significant difference also was found on one of the fine motor sub-tests, Upper-Limb Speed and Dexterity. Subtest analysis revealed that when speed was a component of either fine or gross motor tasks, a pattern of significant differences was found. This is consistent with previous research in neuropsychology, which has demonstrated problems in speeded motor performance of children with brain injuries. These findings provide direction for further research, clinical assessment, and treatment of this at-risk population.

Computer access was studied with children between the ages of 6 months and 18 months with no known handicapping conditions. The research focused on determining at what age young children can access a computer using a single-switch system to run a simple cause-and-effect program. The sample consisted of 80 children divided into four groups (6 to 8 months, 9 to 11 months, 12 to 14 months, and 15 to 17 months). Results demonstrated that some children as young as 6 months of age could control a computer-based, cause-and-effect program using a single-switch access system. Therefore, professionals who work with children with disabilities may consider introducing computers to children at this age or to children who are functioning near this cognitive developmental level.

The purpose of this study was to compare the performance of four power wheelchairs when used by children to perform a variety of indoor activities. Eight boys and eight girls performed a series of 11 functional tasks when positioned in each of four different power wheelchairs reflecting different design classes. There were no significant differences for many of the dependent variables. However, the Everaid Turbo was significantly better for functional positioning at a standard kitchen table and at school desks and for accessing objects at different heights. By contrast the Invacare Jaguar was better for straight-line driving speed. Other findings include children's subjective impressions of the four power wheelchairs.

Spasticity commonly occurs after a spinal cord injury and is characterized by increased resistance to passive movement of peripheral joints. This study examined the effect of an antispasticity medication on stiffness from the myotatic reflex response generated by passive sinusoidal ankle motion. A repeated measures, multiple base-line, single-subject, double-blind design was employed. The independent variable was spasticity medication treatment, where the levels were 40 mg/day and 80 mg/day of baclofen v placebo treatment. Viscous and elastic stiffness measurements were taken at the ankle joint during a placebo base-line phase and during treatment with baclofen for five adult males with traumatic spinal cord injuries. Ankle sinusoidal oscillation frequencies were from 3 to 12 Hz during test sessions. Mean viscous and elastic stiffness scores for all frequencies were calculated for each phase of the study. Randomization tests of mean changes in stiffness measurements between each treatment phase of the study failed to provide any convincing evidence of a significant treatment effect for reduction of spasticity in the traumatic spinal cord injured subjects studied. Further testing is needed to exclude potential confounding factors before this conclusion can be confirmed. The results suggest that baclofen is not a universal treatment of choice for all individuals with spasticity resulting from traumatic spinal cord injury.

The purpose of this research project was to provide occupational therapists with preliminary descriptive data on the spherical grip strength of 3- to 5 1/2-year-old children using the Martin Vigorimeter. Three hundred and eighty boys and girls were tested. Standardized positioning and instructions were followed. The mean of three trials was used as the grip strength score for each hand. The right and left hands were alternated during testing to allow a 20-second rest between trials. A repeated measures design multiple analysis of variance was used to analyze the data. The findings indicated that the mean grip strength scores increased linearly with an increase in age (p less than .001) and that the right grip strength score was greater than the left (p less than .001). The descriptive data were reported separately for the right and left hands by age increments of 6 months. Two tables of mean grip strength scores and their standard deviations were generated for clinical use.