Occupational Therapy Outcome Measures in Preschool Children With Autism Spectrum Disorders: A Scoping Review.

With the rising prevalence of autism spectrum disorder (ASD), early assessment of preschool children is vital for occupational therapists. This scoping review aimed to provide detailed information about outcome measures used in occupational therapy interventions in preschool children with ASD and map the focus of the outcome measures based on the International Classification of Functioning, Disability, and Health (ICF) components. A thorough search from 2000 to 2022 was conducted that employed ICF linking rules to categorize the outcome measures. Seventy-four outcome measures were identified. They predominantly targeted body function and activity/participation, with less emphasis on environmental factors, and none assessed body structure. The most common measures were Vineland Adaptive Behavior Scale (VABS-2), Canadian Occupational Performance Measure (COPM), and Parenting Stress Index-Short Form (PSI-SF). This study offers a diverse array of outcome measures and underscores the potential of the ICF framework in enhancing evaluations, particularly concerning broader environmental components as one of the primary facilitating/hindering factors in the participation of children with ASD.

METHOD: We did a scoping review following steps by Arksey and O'Malley. Scoping reviews help us to find important information. We wanted to see what works in occupational therapy for young children with ASD, using the ICF. We looked at studies from 2000 to 2022 and also checked different sources for studies. We made a summary of what we found. RESULTS: We found 802 articles but only used 46 after checking. Most kids in the studies were 4 years or older. We found 74 different tools to see whether treatments worked. The most common tools were COPM, Vineland-II, and PSI-SF. These tools looked at how children move, do things, and feel. Some ways looked at how children play, talk, and connect with others. Others focused on how parents feel. Two ways, Pediatric Evaluation of Disability Inventory (PEDI) and Functional Emotional Assessment Scale (FEAS), looked at everything. Some general ways were used too. Over time, people looked more at how the environment affects children with ASD. CONCLUSION: We gathered many ways to see whether treatments work for children with ASD. The most common ones were COPM, Vineland-II, and PSI-SF. Each tool looked at different parts of how children do things. We did not see big changes in how people looked at treatments over time. Children with ASD need better ways to see whether treatments help them. We should look more at how the environment affects children.

Mapping the Available Tools for Occupational Therapy Effectiveness in Young Children With ASD Based on the ICF StructureIntroduction: Autism spectrum disorders (ASD) affect how people communicate and behave, with about one in 44 children having it. Early help for ASD, such as occupational therapy, is really important. Occupational therapy helps with everyday skills and makes life better. Not many studies use good ways and tools to see whether occupational therapy works for young children with ASD. The International Classification of Functioning, Disability, and Health (ICF) is a reference that helps to see how well treatments work.

Online occupational therapy in the caregivers of people with Multiple sclerosis: a randomized control trial.

PURPOSE: Caregivers of people with Multiple sclerosis (MS) face various challenges in the occupations of daily lives. We investigated the effect of an online occupational therapy program on the mastery and performance in caregivers of people with MS. METHOD: In a single-blind randomized controlled trial twenty-four eligible caregivers of people with MS participated in the control and an occupational therapy group program. Caregivers completed The Canadian Occupational Performance Measure (COPM) and the Relative Mastery Scale (RMS) before and after the intervention and one-month later. FINDINGS: The level of performance, satisfaction and mastery were significantly improved in the intervention group after the intervention (p<.001) and there were significant differences in performance and satisfaction scores between the groups (p<.001). IMPLICATIONS: Online Occupational therapy shows promising results in facilitating the adaptation process and improving caregivers' performance and satisfaction levels.IMPLICATIONS FOR REHABILITATIONCaregivers of people with multiple sclerosis face various challenges when engaging in their daily occupations.Managing the challenges faced by caregivers as essential members of the treatment team contributes to improving their performance level in daily occupations and can finally enhance the quality of treatment interventions for patients.Online delivery can overcome caregivers' time constraints for attendance in the treatment centers for training.Online occupational therapy can enhance mastery, occupational performance level, and satisfaction, and is recommended for caregivers of people with multiple sclerosis.

The Effect of Occupation-Based Modified Constraint-Induced Movement Therapy on the Participation of Children with Cerebral Palsy: A Single-Blind Randomized Controlled Trial.

Objective: This study investigates the impact of modified constraint-induced movement therapy (m-CIMT), accompanied by occupation-based and activity analysis, on the participation of children with hemiplegia. Materials & Methods: Twenty-three participants were randomly assigned to the intervention and control groups. The intervention group received occupation-based m-CIMT (m-CIMT along with occupation-based and activity analysis), while the control group received m-CIMT without occupation-based and activity analysis. The intervention was conducted one hour per day, three days a week, for four weeks. Results: The primary outcomes revealed no significant differences between groups in promoting the participation of children with hemiplegia in the activities of daily living (ADL). However, scores were higher in the intervention group with a medium to large effect size (Canadian occupational performance measure: F(1,19)=2.14, P=0.160, η2P=0.101, Canadian occupational performance measure-satisfaction: F(1,19)=1.53, P=0.231, η2P=0.075, Goal attainment scaling: F(1,19)=5.55, P=0.029, η2P=0.226). This effect remained during the follow-up period. The secondary outcomes indicated no significant differences between groups in improving the manual ability of the children. However, scores were higher in the intervention group with a medium to large effect size (ABILHAND-Kids: F(1,19)=0.64, P=0.434, η2P=0.033, pediatric motor activity log- how long: F(1,19)=3.53, P=0.076, η2P=0.157, pediatric motor activity log- how well: F(1,19)=2.59, P=0.124, η2P=0.120). This effect was sustainable during the follow-up period. Conclusion: m-CIMT accompanied by occupation-based and activity analysis and the client-centered paradigm substantially enhances the manual ability of children with hemiplegia and their participation in the ADL.

Translation, reliability and validity of Persian version of Adolescent/Adult Sensory Profile in dementia.

Our study aimed at the reliability and validity of the Persian version of the Adolescent/Adult Sensory Profile (AASP). This study was conducted on 130 people with dementia as well as 77 healthy elderlies. After translating the AASP into Persian, its content validity was determined based on 9 experts working in the same field. Cronbach's alpha and the Intraclass correlation coefficient (ICC) were calculated to assess the internal consistency and test-retest reliability of the Persian version of AASP. The two groups of people with dementia and healthy elderlies were compared in terms of scores in the four quadrants by performing an Independent t-test. All items in the Content Validity Ratio (CVR) and Content Validity Index (CVI) received an acceptable score. The Cronbach's alpha score for different parts of AASP was also calculated (α between 0.894 and 0.916; p < 0.001). The test-retest reliability of sub-tests of AASP was excellent (ICC between 0.885 and 0.948; p < 0.001). There was a statistically significant difference between the healthy Elderlies and dementia persons for low registration, sensory avoiding quadrants (p < 0.05). The Persian version of the AASP questionnaire is a reliable and valid questionnaire for people with dementia in Iran.

Effects of Meaningful Action Observation Therapy on Occupational Performance, Upper Limb Function, and Corticospinal Excitability Poststroke: A Double-Blind Randomized Control Trial.

Introduction: Action observation therapy (AOT) is a mirror neuron-based approach that has been recently used in poststroke rehabilitation. The main goal of this study was to investigate the effectiveness of AOT of occupations and tasks that are meaningful for chronic stroke patients on occupational performance, upper-extremity function, and corticospinal changes. Method: A randomized control trial was designed to compare between experimental (n = 13) and control groups (n = 14). In both groups, the execution of meaningful tasks was practiced, but the videos of those tasks were just shown to the experiment group. Instead, patients in the control group watched nature videos as a placebo. Clinical outcomes were evaluated using the Canadian Occupational Performance Measure (COPM), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box-Block Test (BBT) on 3 occasions: baseline, post (at 4 weeks), and follow-up (at 8 weeks). The assessments of central motor conduction time (CMCT) for abductor policis brevis (APB) and extensor indicis (EI) were only recorded at baseline and posttreatment. Both assessors of clinical and neurophysiological outcomes were blinded to the allocation of subjects. Result: Finally, the results of outcomes in 24 patients who completed the study were analyzed. In both groups, significant improvements after treatment were seen for most outcomes (p ≤ 0.05). These changes were persistent until follow-up. There were significant differences in COPM performance (p = 0.03) and satisfaction (p = 0.001) between the experimental and control groups. In contrast, other clinical assessments such as FMA, ARAT, and BBT did not show significant differences between the two treatments (p ≥ 0.05). The results of CMCT related to APB showed a more significant change in the experiment group compared to the control group (p = 0.022). There was no difference in change detected between the two groups for CMCT related to EI after treatments. Conclusion: Observation and execution of meaningful activities can enhance the effects of simply practicing those activities on occupational performance/satisfaction and corticospinal excitability poststroke.

The Effect of ICF-Core Set-Based Occupational Therapy Interventions on the Function and Satisfaction of Individuals with Chronic Stroke: A Randomized Clinical Trial.

Stroke can affect all aspects of a person's health and functioning. Therefore, it is important occupational therapists, have a comprehensive understanding of various levels of function and the factors affecting function. The ICF (International Classification of Functioning, Disability, and Health) and the selections of ICF categories or Core Sets relevant for people with a specific health condition, offer a model for intervention. This study aimed to investigate the effect of ICF-CS-based occupational therapy interventions on the function and satisfaction of individuals with chronic stroke. This study was designed as a randomized, single-blind, parallel-group clinical trial. Twenty-five patients with stroke were randomly assigned to the control group (which received traditional occupational therapy) or the treatment group (Stroke ICF-CS based occupational therapy). Patients were evaluated before and after the intervention (two months, three sessions per week, 45 minutes each session), as well as two weeks after the end of the intervention, using Fugl-Meyer and COPM (Canadian Occupational Performance Measure) tools. The independent T-test, Chi-square, and ANOVA with repeated measures were used to analyze the data. The results showed that the interaction effect of time and group was not significant in none of the Fugl-Meyer test sections (p > 0. 05), but it was significant in the performance and satisfaction of COPM (p < 0.05). The results suggest that ICF-CS-based occupational therapy interventions may assist persons with chronic stroke improve their functional level and satisfaction.

Strategies to Promote the Quality of Occupational Therapy Fieldwork Education: A Qualitative Study.

Background: Clinical education is a bridge between theory and practice. The purpose of this study was to develop strategies to promote the quality of occupational therapy fieldwork education. Methods: The qualitative content analysis was used to identify the promoting strategies of fieldwork quality in occupational therapy from students' and fieldwork educators' perspectives during the 2019-2020 academic sessions. Participants were 12 fieldwork educators (mean age=39.33 yr, Male=5, female 7) and 14 students (mean age=23.28 yr, Male=7, female 7) in the code extraction phase and 16 fieldwork educators (12 of them were in code extraction phase too) in actions of strategies scoring phase. Results: Following the content analysis of the data, the prompting strategies categorized into 4 major categories and 10 subcategories: factors related to Fieldwork educators (Improving clinical teaching skills, Enhancing fieldwork management skills, Motivating fieldwork educators, and Fostering coordination between fieldwork educators), related to Educational Planning (Modifying clinical fieldwork planning, Revising curriculums), related to Students (Empowering students, Motivating students) and related to Fieldwork settings ( Improving the social environment, Improving physical environment ). Based on the qualitative content analysis and 3 expert panels. Finally, the 23 promoting actions were identified. Conclusion: Improving the quality of fieldwork education in occupational therapy needs a systematic collaboration between educators, students, and educational planners. Doing the promoting actions on fieldwork education process in occupational therapy may improve the quality of fieldwork education process.

Development and Validation of Occupation Based Practice Measure (OBPM).

Background. Occupation based practice (OBP) is the central core of occupational therapy. Therefore, measuring its usage and influencing factors seems necessary. Purpose. To develop and validate the occupation based practice measure (OBPM). Method. OBPM was developed in two phases: (I) following a qualitative study, a literature review was conducted. The item pool was revised by expert panel; (II) The face, content, construct validity, internal consistency, and test-retest reliability were assessed. Findings. The 142 items derived through the qualitative study were integrated with the 42 items derived from the literature review. The item pool was reduced by expert panel to 78 items and finalized to 37 items through face, content, and construct validity. Cronbach's alpha was greater than 0.70 and intra-class correlation coefficient showed good to excellent reliability. Implications. OBPM is a valid and reliable questionnaire that evaluates the occupational therapists' knowledge, attitudes, interest, usage, and contextual factors influencing the OBP.

Effectiveness of Self-Action Observation Therapy as a Novel Method on Paretic Upper Limb and Cortical Excitability Post-Stroke: A Single-Subject Study.

Background: Action Observation Therapy (AOT) is a top-down approach that has been recently introduced in the rehabilitation of neurological disorders mainly after stroke. The main goal of this study was to investigate the effects and feasibility of a new technique in AOT procedure (called self-AOT) following periods of no treatment and routine AOT intervention on upper limb motor function, occupational performance and neurophysiological changes in a stroke patient. Methods: A single-subject A-B-A-C design was used and a 58-year-old woman with a 3-year history of left hemiplegia poststroke participated in this study. In the baseline (A1, A2) phases, the patient received no treatment. In the first intervention (B phase), she received a 4-week AOT, and in the second intervention (C phase), a 4 week of Self-AOT was practiced. In all phases, upper limb motor recovery as a target outcome was evaluated on 4 occasions using the Fugl-Meyer assessment. Upper limb function, dexterity and spasticity were assessed using Action Research Arm Test, Box-Block Test and Modified Modified Ashworth Scale respectively. Occupational Performance/Satisfaction was assessed with Canadian Occupational Performance Measure and to assess neuroplasticity, Motor Evoked Potential was recorded by Transcranial Magnetic Stimulation. Visual analysis, slope, and percentage of non-overlapping data were used for assessing the changes between phases. Results: Percentage of non-overlapping data and slopes indicated that motor recovery had clinically relevant improvements after both interventions compared to baselines. Other outcomes also showed improvements except for spasticity of wrist/elbow flexors and Motor Evoked Potential of opponens indicis. Conclusion: Self-AOT may be as effective as other procedures of AOT for improving upper limb motor function, occupational performance/satisfaction, and cortical excitability post-stroke.

A Qualitative Exploration of Occupational Adaptation in Caregivers of People with Multiple Sclerosis.

Due to the unpredictable and progressive nature of multiple sclerosis, the burden of care is placed on the primary caregivers. This study aimed to explore occupational adaptation strategies implemented by primary caregivers to adapt to occupational challenges of caregiving. Seventeen primary caregivers of people with MS were interviewed using purposive sampling techniques. Data were analyzed using content analysis method. Two main categories of strategies were determined: (a) Strategies to alleviate intrapersonal challenges of occupational adaptation; and (b) Strategies to alleviate environmental challenges of occupational adaptation. These included various skills and solutions that aided primary caregivers' adaptation toward occupational challenges. Based on the results of this study, occupational adaptation is a means of achieving mastery in alleviating occupational challenges to cope with adverse circumstances. The results of this study can be used to help therapists design appropriate caregiver-focused interventions, ultimately improving caregiver performance.

Which models can be used as a clinical education model in occupational therapy? Introduction of the models: A scoping review study.

Background: Clinical education is a vital part of occupational therapy education process. High clinical education quality in fieldwork settings leads to higher clinical competency and occupational proficiency. One of the most effective clinical education methods in equalizing the conditions of clinical education to students is the correct use of educational models related to each field of medical sciences. In the field of clinical education, various models have been designed with a specific subject. However, limited research has been done on the introduction of the usability of these models in occupational therapy settings. This study was conducted to determine which models have the potential to be used as clinical education models in occupational therapy. Methods: A scoping review was conducted and studies published in English between 2000 and 2018 that examined clinical education models were selected. Results: A total of 8 articles were entered in the review, and a central theme of implementing clinical education models in occupational therapy was determined by thematic analysis. This central theme consisted of 3 categories: (1) evaluative models, (2) acting models, and (3) evaluative/acting models. Conclusion: Occupational therapists, especially who work as educators should be aware of the different types of clinical education models and try to use these models in clinical education process and minimize the variation of teaching methods in fieldwork settings to promote the clinical education quality. However, more research should be done to improve evidence-based occupational therapy practice in clinical education.

Reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version for children with physical disabilities.

INTRODUCTION: Occupational therapy supports individuals to participate in meaningful activities. Participation in activities should be assessed with appropriate tools. The aim of the present study was to establish the reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version (CPAS-P) for children with physical disabilities. METHODS: The participants were 304 parents of 6- to 12-year-old children with physical disabilities. Confirmatory factor analysis (CFA), internal consistency, convergent validity of the CPAS-P with the Vineland Adaptive Behavior Scale (VABS), and test-retest reliability were measured. RESULTS: Confirmatory factor analysis showed acceptable values for all indices of fit, namely goodness of fit index (GFI), adjusted GFI, normal fix index, comparative fit index, incremental fit index (i.e., greater than 0.90), and the value of root mean square error of approximation was 0.07, which was acceptable. High Cronbach's alpha coefficients (above 0.9) were reported for the total score of each scale (diversity = 0.94, frequency = 0.94, with whom = 0.92, enjoyment = 0.95, and parent satisfaction = 0.95). The convergent validity of the CPAS-P with the VABS was moderate to good and the test-retest reliability (ICC) for the total scores ranged from 0.90 to 0.96. CONCLUSION: The CPAS-P had good psychometric properties for parents reporting the activities of their 6- to 12-year-old children with physical disabilities and can be utilized in clinical practice.

Content Validity of the Comprehensive ICF Core Set for Children with Cerebral Palsy Aged 0-6 Years: Iranian Occupational Therapists Perspective.

OBJECTIVES: Comprehensive ICF Core Set of cerebral palsy (CP) includes a set of functions of children with CP has been created recently. This study determined the content validity of this version based on Iranian Occupational Therapists' perspectives to explore whether the ICF Core Sets for CP include the areas of function of CP in Occupational Therapy practice. MATERIALS & METHODS: This qualitative study conducted from Feb 2015 to Apr 2016 in Tehran, Iran. Experts were the academic staffs selected through convenience sampling. Content validity of comprehensive ICF-Core Set of CP with 135 ICF categories was done by them. Delphi survey was used for generating consensus on the final version. Participants were 50 clinical Occupational Therapists invited via email from across Iran. An agreement of 75% was considered as the cut-off for inclusion of each code-category. RESULTS: About 60% of the code-categories of comprehensive version of ICF Core Set of CP were approved by Occupational Therapists. In the final version, 82 code-categories were listed that included 21 code-categories for Body Functions, 40 for Activity/Participation, and 21 for Environmental Factors. CONCLUSION: The validity of the Iranian ICF Core Set for children with CP aged 0-6 yr was supported by Iranian Occupational Therapists. It could be the basis for evaluation of this population in Occupational Therapy.

Psychometric Properties of the Iranian-Children Participation Questionnaire (I-CPQ) When Used with Parents of Preschool Children with Cerebral Palsy.

The purpose of the study was to establish the psychometric properties of the Iranian-Children Participation Questionnaire (I-CPQ) among parents (n = 120) of preschool children with cerebral palsy. The mean age of the preschool children was 5.1 years old. The confirmatory factor analysis was conducted in two stages, and the values of all goodness of fit tests reached an acceptable level (greater than 0.9), and achieved an acceptable root mean square error of approximation model fit value of 0.05. The results of convergent validity with the Vineland Adaptive Behavior Scale for all subtests were significant. Internal consistency was acceptable to excellent (α: 0.66-0.85), and test-retest reliability was excellent (ICC: 0.92-0.98). We concluded that the I-CPQ demonstrated good psychometric properties and utility for assessing participation of Iranian preschool children with cerebral palsy.

Effect of Play-based Therapy on Meta-cognitive and Behavioral Aspects of Executive Function: A Randomized, Controlled, Clinical Trial on the Students With Learning Disabilities.

INTRODUCTION: Although the effect of educational methods on executive function (EF) is well known, training this function by a playful method is debatable. The current study aimed at investigating if a play-based intervention is effective on metacognitive and behavioral skills of EF in students with specific learning disabilities. METHODS: In the current randomized, clinical trial, 49 subjects within the age range of 7 to 11 years with specific learning disabilities were randomly assigned into the intervention (25 subjects; mean age 8.5±1.33 years) and control (24 subjects; mean age 8.7±1.03 years) groups. Subjects in the intervention group received EF group training based on playing activities; subjects in the control group received no intervention. The behavior rating inventory of executive function (BRIEF) was administered to evaluate the behavioral and cognitive aspects of EF. The duration of the intervention was 6 hours per week for 9 weeks. Multivariate analysis of covariance was used to compare mean changes (before and after) in the BRIEF scores between the groups. RESULTS: The assumptions of multivariate analysis of covariance were examined. After controlling pre-test conditions, the intervention and control groups scored significantly differently on both the metacognition (P=0.002; effect size=0.20) and behavior regulation indices (P=0.01; effect size=0.12) of BRIEF. CONCLUSION: Play-based therapy is effective on the metacognitive and behavioral aspects of EF in students with specific learning disabilities. Professionals can use play-based therapy rather than educational approaches in clinical practice to enhance EF skills.

The Effect of Group-Based Occupational Therapy on Performance and Satisfaction of Stroke Survivors: Pilot Trail, Neuro-Occupational View.

INTRODUCTION: Stroke imposes limitations on performing activities of daily living (ADL) and their level. Different therapeutic approaches are used for improving the level of performance after a stroke. This study was performed with the aim of evaluating the effect of group-based occupational therapy on improving the performance of ADL and satisfaction of its performance in patients with chronic strokes. METHODS: Fourteen chronic stroke patients with the mean age of 52 years participated in the study. The participants were assigned into two groups (control and treatment). The level of performance of ADL, level of stroke disability, and participation were respectively evaluated by Barthel index (BI), modified Rankin scale (MRS), and Canadian Occupational Performance Measure (COPM). Six sessions of group therapy tasks were scheduled with an emphasis on three main activities, including mobility exercises, craft, and cooking. RESULTS: The COPM changes in the 'performance' and 'satisfaction' scores in the treatment group and the 'performance' scores in the control group were significant. The MRS scale in the two groups revealed no change in the level of stroke disability. However, the changes in the ADL performance in BI were significant. CONCLUSION: The current study indicated that doing daily, craft, and mobility activities in the groups can affect the 'performance' and 'satisfaction' levels in stroke patients.

Participation of Iranian Cerebral Palsy Children in Life Areas: A Systematic Review Article.

OBJECTIVE: Cerebral palsy (CP) is the most common cause of chronic disability that restricts participation in areas of occupations for children. The main aim of rehabilitation is enhancement of their clients for participation in occupations. The aim of this study was to overview of the factors influencing the participations of children with CP in Iran. MATERIALS & METHODS: A systematic, evidence-based process (Duffy 2005) was used. For data gathering electronic databases including Google scholar and Iranian and foreigner famous journals in the fields of pediatrics, were used. The main key words for search were Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL), play, leisure, work, rest/sleep, social participation, and education. All the papers of this study were about the factors influencing the participation of Iranian CP children during 2000-2016. Totally, 156 articles were found eligible as for Iranian CP children study, of which 100 articles were discarded. Because of repetitive and duplicability of some articles, 17 articles were removed as well. RESULTS: The most studies about Iranian CP children participations in life areas were in the ADL area of participation (N=12), and the lowest articles were in the area in the field of: Work (N=2), play (N=2), and sleep/rest (N=2). Most of the occupational therapists do not focus on the all life areas. CONCLUSION: In Iran, many researchers do not pay attention to the participation of CP children. Many articles just paid attention to the sensory, motor or cognitive components of their clients.

Factor Structure and Construct Validity of Children Participation Assessment Scale in Activities Outside of School-Parent Version (CPAS-P).

The aim of this study was assess the factor structure, reliability and construct validity of the Children Participation Assessment Scale in Activities Outside of School-Parent Version (CPAS-P). The participants of this study were 700 parents of children aged 6-12 years. For data analysis, the confirmatory factor analysis, internal consistency, and test-retest reliability were conducted. Convergent validity was calculated by correlation with the Vineland Adaptive Behaviour Scale. The results indicated the CPAS-P has good internal reliability. Overall, Cronbach's alpha for the participation measures ranged between 0.87 and 0.91, indicating good homogeneity, and Spearman correlations for convergent validity was acceptable. The temporal stability of the CPAS-P was supported with Intra-Class Correlations ranging from 0.79 to 0.94. Therefore, the CPAS-P, which evaluates all eight areas of occupation (i.e., activities of daily living, instrumental activities of daily living, play, leisure, social participation, education, work, and sleep/rest) has demonstrated good psychometric properties; and can be used as a reliable and valid measure to assess children's participation at the age of 6-12 years.

Occupation-based intervention versus rote exercise in modified constraint-induced movement therapy for patients with median and ulnar nerve injuries: a randomized controlled trial.

OBJECTIVE: To investigate effect of practice type during modified constraint-induced movement therapy on hand function in patients with chronic median and ulnar nerve injuries. DESIGN: A prospective, single-blinded, randomized controlled clinical trial. SETTING: Participants' private home. SUBJECTS: A convenience sample of 36 outpatient participants allocated randomly to three equal groups. INTERVENTIONS: Intervention groups underwent 3-hour intensive training of affected hand each day, 3-day a week, 4-week in association with immobilisation of healthy hand: occupation-based group practiced meaningful occupations while rote exercise-based group performed rote exercises during constraint-induced movement therapy. Control group performed different activities with affected hand for 1.5-hour each day during 4-week without restriction of healthy hand. MAIN MEASURES: A blinded assessor tested Canadian occupational performance measure, box and block, Static two-point discrimination, disabilities of arm, shoulder, hand questionnaire, and self-assessment manikin in a random order across sessions 3-time as baseline (pre-test), after 4-week intervention (post-test), and 1-month after intervention period (follow up). RESULTS: Scores significantly changed in intervention groups compared to control. Despite significantly more improvement in occupation-based than rote exercise-based group in subjective measures at post-test and follow up (Canadian occupational performance measure: mean change 4.7 vs. 2.1 for performance, P< 0.001 and mean change 5.3 vs. 2.6 for satisfaction, P< 0.001), it was significant just at follow up for box and block and static two-point discrimination. CONCLUSIONS: Practice content of constraint-induced movement therapy is a critical part of its effectiveness on improving outcomes following peripheral nerve repair in favour of occupation-based intervention in present study.

The Comparison of Participation in School-Aged Cerebral Palsy Children and Normal Peers: A Preliminary Study.

BACKGROUND: Participation in daily activities during childhood is an important aspect for health and social development. OBJECTIVES: This study was designed to investigate the participation of children with cerebral palsy aged 8 to 14 years, and their normal peers. PATIENTS AND METHODS: In this cross-sectional study, 30 children with cerebral palsy, and 30 normal children were selected via the non-probability convenience sampling. Their participation was evaluated with children's assessment of participation and enjoyment (CAPE) through interviews. RESULTS: Significant differences were found between the means of the two groups regarding the diversity, intensity, overall participation (P = 0.000) and all types of the activities except the recreational activities. The children with cerebral palsy took part in the skill-based activities and overall activities individually compared to the normal peers. The children with cerebral palsy, in comparison with their normal peers, often performed most of the activities inside the house. The main effect of gender and the interaction between gender and groups were not statistically significant in any of the variables of the CAPE test. CONCLUSIONS: Physical disability can influence the children's daily activities and socialization. Understanding the participation of physically disabled children can help health care professionals in designing and introducing appropriate treatment according to their needs.