Optimizing participation of children with autism spectrum disorder experiencing sensory challenges: a clinical reasoning framework.

BACKGROUND: Remedial sensory interventions currently lack supportive evidence and can be challenging to implement for families and clinicians. It may be timely to shift the focus to optimizing participation of children with autism spectrum disorders (ASD) through accommodation and self-regulation of their sensory differences. PURPOSE: A framework to guide practitioners in selecting strategies is proposed based on clinical reasoning considerations, including (a) research evidence, (b) client- and family-centredness, (c) practice contexts, (d) occupation-centredness, and (e) risks. KEY ISSUES: Information-sharing with families and coaching constitute the basis for intervention. Specific strategies are identified where sensory aversions or seeking behaviours, challenges with modulation of arousal, or sensory-related behaviours interfere with participation. Self-regulatory strategies are advocated. The application of universal design principles to shared environments is also recommended. IMPLICATIONS: The implications of this framework for future research, education, and practice are discussed. The clinical utility of the framework now needs to be tested.

Comment on: 'An intervention for sensory difficulties in children with autism: a randomized trial' by Schaaf et al. (2013).

The purpose of this letter to the editor is to comment on a recently published paper in the Journal of Autism and Developmental Disorders, 'An Intervention for Sensory Difficulties in Children with Autism: A Randomized Trial' by Schaaf et al. (2013). The authors are commended for undertaking a randomised clinical trial (RCT) examining the efficacy of occupational therapy using sensory integration (OT/SI). The study complies with many of the recommended standards of RCT's including: (a) detailed eligibility criteria, (b) well-matched experimental and control groups, (c) use of gold-standard instruments to measure the symptoms of autism spectrum disorder, (d) the use of functionally relevant outcome measures, (e) fidelity checking, and (f) manualization of the intervention. Additional aspects of rigour that could be considered in subsequent research include: (a) independent blinded measure of observational outcomes, (b) treatment and control interventions of equivalent dose, (c) public access to the manualized treatment guidelines, and (d) the use of a comparison occupational therapy intervention to address the same goals as the OT/SI intervention.

Anatomy of cognitive strategies: a therapist's primer for enabling occupational performance.

BACKGROUND: Promoting effective strategy use is an integral part of enabling occupational performance; however, there are variations in how strategies are defined, discussed, used, and applied in occupational therapy practice. PURPOSE: Focusing on cognitive strategies, in this paper, we define and describe strategies and their types and divide the concept of strategies into two dimensions: strategy attributes and strategy use. A comprehensive framework for each dimension (attribute and use) is proposed as a clinical reasoning guide as well as a foundation for future research. The frameworks are designed to reduce ambiguity, deepen understanding, and serve as clinical reasoning guides assisting therapists in specifying, describing, and observing cognitive strategies during occupational performance. KEY ISSUES: We argue that there is a need for therapists to use consistent terminology and to be able to systematically select cognitive strategies and evaluate their use. IMPLICATIONS: The proposed strategy frameworks provide clinical guides for systematic analysis and selection of cognitive strategies as well as for observing components of strategy use during clients' occupational performance. We suggest the need for greater specification and description of strategies during intervention and highlight directions for future research.

Facilitating student occupational therapists' mastery of occupation-centred approaches for working with children.

BACKGROUND: Student occupational therapists experience particular challenges in the learning and practicing of occupation-centred practice (OCP) techniques with children. PURPOSE: This study aimed to identify factors that facilitate mastery of OCP from both students' and practice educators' perspectives. METHODS: Nine student occupational therapists and two practice educators participated in three interviews at intervals across the students' fieldwork experiences. Observation and document review assisted data triangulation. FINDINGS: Students experienced distinct turning points in their understanding and use of OCP after encountering challenges and then experiencing success. Factors that assisted students' mastery of OCP included modelling and practice opportunities; individualised, performance-specific debriefing; specific learning and teaching styles; and structured learning tools for observation and reporting. IMPLICATIONS: Key quality teaching and learning practices can be used by practice educators and universities to promote mastery of OCP approaches. Further opportunities for practice and guided reflection on OCP are needed.

Occupational therapy students' experiences in learning occupation-centred approaches to working with children.

BACKGROUND: The increasing emphasis on performance outcomes and the use of occupation-centred approaches has implications for practice education. PURPOSE: This study aimed to describe students' experiences of learning to use occupation-centred approaches when working with children within a university clinic. METHODS: Nine occupational therapy students and two clinical educators completed three indepth interviews at intervals across the students' fieldwork experiences. Therapy observations, review of therapy documentation, and tutorial group e-mails informed data triangulation. Thematic analysis was used to identify key themes. FINDINGS: Students described needing to make a theoretical shift in thinking to focus on occupational performance and identified a number of challenges relating to learning complex techniques and strategies. IMPLICATIONS: Teaching methods that assist in making occupation-centred assessment and intervention techniques more explicit and learner-friendly for new users are required. These findings provide valuable new insights in guiding this process.

Consumer-identified barriers and strategies for optimizing technology use in the workplace.

PURPOSE: This article explores the experiences of 26 assistive technology (AT) users having a range of physical impairments as they optimized their use of technology in the workplace. METHOD: A qualitative research design was employed using in-depth, open-ended interviews and observations of AT users in the workplace. RESULTS: Participants identified many factors that limited their use of technology such as discomfort and pain, limited knowledge of the technology's features, and the complexity of the technology. The amount of time required for training, limited work time available for mastery, cost of training and limitations of the training provided, resulted in an over-reliance on trial and error and informal support networks and a sense of isolation. AT users enhanced their use of technology by addressing the ergonomics of the workstation and customizing the technology to address individual needs and strategies. Other key strategies included tailored training and learning support as well as opportunities to practice using the technology and explore its features away from work demands. CONCLUSIONS: This research identified structures important for effective AT use in the workplace which need to be put in place to ensure that AT users are able to master and optimize their use of technology.

Effective health care teams: a model of six characteristics developed from shared perceptions.

This study into understanding health care teams began with listening to participants' teamwork experiences. It unfolded through a dialectic of iterations, analyses and critique towards a simplified model comprising six key characteristics of effective teams. Using the complementary theoretical perspectives of personal construct theory and inductive theory building, three research methods were used to collect a range of participant perspectives. A purposive sample of 39 strategic informants participated in repertory grid interviews and clarification questionnaires. A further 202 health care practitioners completed a purpose designed Teamwork in Healthcare Inventory. All responses were transformed through three iterations of interactive data collection, analysis, reflection and interpretation. Unstructured participant perspectives were qualitatively categorised and analysed into hierarchies to determine comparative contributions to effective teamwork. Complex inter-relationships between conceptual categories were investigated to identify four interdependent emerging themes. Finally, a dynamic model of teamwork in health care organisations emerged that has functional utility for health care practitioners. This Healthy Teams Model can be utilised in conjunction with a Reflective Analysis and Team Building Guide to facilitate team members to critically evaluate and enhance their team functioning.