Comparison of Sensory Profile scores of young children with and without autism spectrum disorders.

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.

Therapeutic efficacy of GAR-936, a novel glycylcycline, in a rat model of experimental endocarditis.

GAR-936, a novel glycylcycline, was investigated with a rat model of experimental endocarditis. It was compared with vancomycin against both vancomycin-susceptible and -resistant Enterococcus faecalis and methicillin-resistant Staphylococcus aureus. GAR-936 exhibited the lowest MICs (2 log(10) CFU, compared to those in untreated controls, for both vancomycin-susceptible and -resistant (VanA and VanB) E. faecalis strains and >4 log(10) CFU for a methicillin-resistant S. aureus isolate. The glycylcycline was more efficacious at a lower administered dose in the rat model of endocarditis than was vancomycin. The efficacy of GAR-936 in this model was apparently not enhanced by a factor in rat serum, as was observed for vancomycin with a time-kill curve. The results of this study demonstrate the therapeutic potential of GAR-936 for the treatment of enterococcal and staphylococcal infections and warrant further investigation.

Children with burn injuries: purposeful activity versus rote exercise.

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.

Current practice of occupational therapy for children with autism.

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.

The grant portfolio of the National Center for Medical Rehabilitation Research: the first five years.

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.

A comparison of two computer access systems for functional text entry.

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.

Test-retest reliability of the evaluation tool of children's handwriting-manuscript.

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.

The role of play in pediatric occupational therapy.

OBJECTIVE: This study examined the roles that play occupies within current occupational therapy practice with preschoolers. METHOD: Two hundred twenty-four pediatric occupational therapists completed mail questionnaires designed to ascertain how they use play in their practice, their knowledge and use of play assessments, and potential constraints on their use of play. RESULTS: Although respondents indicated that play was important in motivating children and frequently used play as a treatment modality or reinforcer, they less frequently assessed play behaviors or wrote treatment goals and objectives related to play. Differences were found between school-based and non-school-based respondents regarding the discipline or model that addresses play in the work setting, the use of play assessments, and constraints that limit the use of play in the work setting. CONCLUSION: The results suggest a need for increasing the emphasis on play in entry-level curricula and continuing education, improving clinician access to valid and reliable play assessments, and completing studies designed to examine the use and efficacy of play in occupational therapy intervention.

The Test of Sensory Functions in Infants: test-retest reliability for infants with developmental delays.

OBJECTIVE: The Test of Sensory Functions in Infants (TSFI) is one tool that occupational therapists use to identify sensory processing disorders among infants. However, data on the reliability of TSFI scores with infants with developmental delays are lacking. METHOD: Test-retest reliabilities for TSFI total test and subtest scores were determined with a sample of 26 infants with developmental delays. All infants were between 10 months and 18 months of age. The test-retest interval ranged from 5 days to 10 days. Magnitudes of difference between test and retest scores and percentages of agreement among the TSFI classification categories (i.e., normal, at-risk, deficient) also were determined to examine relationships between test scores. RESULTS: Reliability for the total test score was borderline, with an intraclass correlation coefficient of .78. Reliability coefficients for the five subtests ranged from .54 to .74. Percentage of agreement for the total test classification categories between test and retest was adequate (81%). Percentages of agreement for subtest classification categories were low, ranging from 58% to 68%. CONCLUSION: TSFI scores should be interpreted cautiously and used only in conjunction with findings from additional developmental assessments and clinical observations for infants with developmental delays.

The effect of switch control site on computer skills of infants and toddlers.

OBJECTIVE: The 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. METHOD: The 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. RESULTS: Most 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. CONCLUSION: The 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.

The effect of oral support on sucking efficiency in preterm infants.

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.

Single-switch computer access for infants and toddlers.

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.

Test-retest reliability of the test of visual perceptual skills with children with learning disabilities.

This study examined the test-retest reliability of the Test of Visual Perceptual Skills (nonmotor) (TVPS). The sample consisted of 30 first- and second-grade children (aged 6 years through 8 years) with identified learning disabilities. The TVPS was administered on two separate occasions that were 1 to 2 weeks apart. The intraclass correlation coefficient for the total test standard scores was .81. The intraclass correlation coefficients for the subtests ranged from .33 (Sequential Memory) to .78 (Form Constancy). The primary finding from this study is that TVPS scores on the total test show adequate test-retest reliability for use in clinical settings. The scores on the subtests, however, should be used with extreme caution, as the test-retest reliability estimates were low.

Test-retest reliability of two tiltboard tests in children.

BACKGROUND AND PURPOSE: Most clinical evaluations of postural control in children are relatively subjective and have not been tested for reliability of scoring. The purpose of this study was to investigate the test-retest reliability of measurements obtained with two tiltboard tests. SUBJECTS: Subjects were 18 children, aged 53 to 81 months (mean = 64.4, SD = 8.3), who were typically developing (TD group) and 18 children, aged 50 to 79 months (mean = 63.3, SD = 8.4), with developmental delays (DD group). METHODS: Each child was tested using the two tilt-board tests and was then retested using the same tests approximately 1 week later. The maximum angle of tiltboard tilt prior to any postural adjustment by the child was recorded. RESULTS: Intraclass correlation coefficients for test-retest reliability (two-way, random-effects, repeated-measures model) ranged from .49 to .54 for the TD group and from .52 to .82 for the DD group. Angles were higher for both groups for the second test. CONCLUSION AND DISCUSSION: The results suggest that these tiltboard tests do not give stable and reliable measurements across test sessions. Before these tests can be used to document change in postural control abilities across time, further research is warranted.

Attending behavior: a descriptive study of children aged 18 through 23 months.

The purpose of this study was to provide descriptive data on the attending behavior of children aged 18 through 23 months. The method used was designed to be clinically feasible for occupational therapy practitioners. Forty-eight children between the ages of 18 and 24 months were studied through observation of a 15-min session of free play with a standard set of toys. The child's physical contact with objects was used as a guideline for timing. Four factors were examined: total time attending, total number of activities attended to, average attending time per activity, and longest time attending to one activity. The Mann Whitney U statistic revealed that there were no significant differences between boys and girls on any of the four factors. There were, however, statistically significant differences between children aged 18 through 20 months and children aged 21 through 23 months for all of the factors except longest time attending to one activity. The children in this study changed activities frequently (median of 10 activities in 15 min) and attended briefly (median attending time per activity of 81 sec). They were, however, capable of attending to one activity for much longer periods of time (median of 225 sec). With minimal adult intervention, the children spent an average of 12.5 min attending to the toys during a 15-min session. These results may augment other aspects of occupational therapy assessment by offering some insight into whether or not an individual child demonstrates age-appropriate attending behavior. Additionally, this standardized method of observation may offer occupational therapists a clinically feasible means of assessing attending behavior.

Gait parameters of children with spastic diplegia: a comparison of effects of posterior and anterior walkers.

The purpose of this study was to compare the effects of posterior and anterior walkers on the gait parameters of five children with spastic diplegic cerebral palsy. Computer-based kinematic analysis was used to investigate differences in gait. Gait laboratory data indicated that use of the posterior walker (1) facilitated more upright posture in these subjects, as seen in decreased trunk and hip flexion during stance phase; (2) decreased double stance time; and (3) increased walking velocity. According to parent report, both the parents and their children preferred the posterior walker. Most parents also reported that when using the posterior walker, their children walked more normally with increased stability and interacted more easily with other children.

Motor performance in children after traumatic brain injury.

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.

Performance of preschoolers on the Pediatric Clinical Test of Sensory Interaction for Balance.

The purposes of this study were to describe the performance of 40 children aged 4 and 5 years on the Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB) and to determine whether age- and gender-related differences were present. The P-CTSIB measures standing balance when sensory input is systematically altered. Kruskal-Wallis one-way analyses of variance by ranks (p less than or equal to .05) were used for comparisons by age and gender. When the 4-year-olds were compared with the 5-year-olds, significant duration differences were found in 4 of the 6 conditions in the heel-toe position of the P-CTSIB. The age-related differences on the remaining 2 heel-toe conditions, as well as on Condition 6 of the feet-together position, approached significance. Gender differences with 4-year-olds and 5-year-olds combined were statistically non-significant in all instances; however, girls performed better on 9 of the 12 conditions of the P-CTSIB. The results indicate that the feet-together position can discriminate between children without balance deficits and children with balance deficits. The heel-toe position is difficult for children aged 4 and 5 years without balance deficits and consequently has limited diagnostic value for this age group.

Self-psychological approach to posttraumatic stress disorder: neurobiological aspects of transmuting internalization.

This essay presents the case of a young man with severe posttraumatic stress disorder (PTSD) in order to demonstrate how a self-psychological orientation and psychotherapeutic approach enables acute symptoms to be relieved, while concomitantly addressing vulnerability in character structure. The self-psychological conceptualization of the psychodynamics of PTSD is discussed, along with a recently proposed neuropsychological theory of PTSD. After viewing the pertinent neurobiological research, an integration of the self-psychological concepts of transmuting internalization (a purported curative factor in psychotherapy) with neurobiological data and behavioral observations is presented.

Carpal tunnel syndrome: objective measures and splint use.

One hundred five adults with carpal tunnel syndrome (CTS) were studied to assess the efficacy of a neutral-angle wrist splint, and to identify criteria for splint referral. Ten observations before and after treatment were analyzed with descriptive and inferential statistics. After splint use, 67% of the subjects reported symptom relief. T-test comparison of sensory latency of values before and after treatment indicated improvement for the total group. Chi-square and t-tests failed to reveal significant differences between relief and no-relief groups for gender, affected hand, presence of concomitant conditions, duration of symptoms before treatment, age, length of time between pretreatment and posttreatment nerve conduction testing, initial nerve latency of motor and sensory fibers, or the difference between pretreatment and posttreatment sensory latencies. A significant difference was found for motor latency; the relief group improved and the no-relief group deteriorated. Data suggest that splinting is most effective if applied within three months of symptom onset. Those with damage to the wrist structures or median nerve were least responsive to splinting.