Exploring the nexus between health promotion and occupational therapy: synergies and similarities.

BACKGROUND: The similarities between health promotion and occupational therapy have been recognized. Both are based on perspectives that share a goal of enabling individuals and populations to improve control over their health. Consequently, it is logical that the principles of health promotion complement the practice of occupational therapy. PURPOSE: This paper highlights the affinity between occupational therapy and health promotion, and discusses ways in which health promotion principles can be incorporated into occupational therapy practice. KEY ISSUES: Some Canadian occupational therapists may be unaware of the current discourse in health promotion and, thus, may not be incorporating its principles into practice. Steps are warranted to expand the current knowledge and practice of therapists to include health promotion, with specific attention to providing services for the population. IMPLICATIONS: Incorporating health promotion principles into occupational therapy perspectives will facilitate the implementation of the domains of practice within the occupational therapy profile. This paper highlights how the principles of health promotion can impact practice at the individual and community level.

Exploring the use of cognitive intervention for children with acquired brain injury.

INTRODUCTION: Children with acquired brain injury (ABI) often experience cognitive, motor, and psychosocial deficits that affect participation in everyday activities. Cognitive Orientation to Daily Occupational Performance (CO-OP) is an individualized treatment that teaches cognitive strategies necessary to support successful performance. OBJECTIVE: This study explores the use of CO-OP with children with ABI. METHOD: Children with ABI, experiencing school and self-care difficulties, were identified from a previous study. Six children, aged 6-15 years, completed 10 weekly intervention sessions with occupational therapists. Children and parents rated the child's performance of challenging everyday tasks and their satisfaction with this performance. Task performance was also evaluated objectively through videotape analysis. RESULTS: Participants showed significant improvement in their ability to perform child-chosen tasks and maintained this performance 4 months later. However, they had difficulty applying the executive problem-solving strategy and discovering cognitive strategies on their own. Issues related to the use of CO-OP with this population are discussed.

Revisiting therapy assumptions in children's rehabilitation: clinical and research implications.

PURPOSE: This commentary draws on a recent workshop hosted by the Canadian Children's Rehabilitation Research Network that brought together stakeholders to critically examine assumptions embedded in children's rehabilitation in order to advance current debates and suggest areas for further inquiry. METHOD: Six issues are discussed: (1) the wisdom of dichotomising 'fix' versus 'function'; (2) the ethics of it might help and it won't hurt' therapy approaches; (3) the emphasis on early intervention rather than a lifespan approach; (4) the challenges of providing care for new rehabilitation populations; (5) discrepancies between performance outcomes and patient satisfaction; and (6) innovative partnerships to support care transitions of adolescents and their families. RESULTS: Issues identified include: finding the right balance between therapies that focus on 'fixing' children versus enhancing function, judicious design of therapy programs as to not overburden children and families, adopting lifespan approaches to meet the needs of multiple 'paediatric' populations, cautious interpretation of measures and approaches that link well-being with physical performance, and the benefits of including parent and youth facilitators on children's rehabilitation teams. CONCLUSIONS: Ongoing debate, discussion and research are needed in each of these areas to ensure that rehabilitation services are enhancing the well-being of children and families.

Exploring a cognitive intervention for children with pervasive developmental disorder.

BACKGROUND: Pervasive developmental disorders (PDD) affect approximately 3-4% of the childhood population. PDD pervades every aspect of a child's life, having significant adverse effects on occupational performance. PURPOSE: This study investigates a new treatment approach to treating children with PDD, the Cognitive Orientation to Occupational Performance (CO-OP). CO-OP emphasizes problem-solving strategies and guided discovery of child- and task-specific strategies. METHOD: Three goals were established in collaboration with the parents and the child. Pre- and post-measures of parents'perceptions of child performance were identified using the Canadian Occupational Performance Measure (COPM). Repeated measures were taken using clinical observations, video analysis, and the Performance Quality Rating Scale (PORS). FINDINGS: Improved COPM ratings of performance and satisfaction were observed, and these results were paralleled by improved PQRS scores. PRACTICE IMPLICATIONS: Self-report and observer report together provide preliminary evidence of the effectiveness of the CO-OP approach with children who have PDD supporting the use of CO-OP and suggesting further investigation.

School-based occupational therapy for children with fine motor difficulties: evaluating functional outcomes and fidelity of services.

Consultative occupational therapy services are becoming widely used in the school environment. However, few studies have evaluated the utility of and the process by which these services are delivered. This study examined whether the written communication and fine motor skills of 23 children with fine motor difficulties improved after receiving school-based occupational therapy from a program whose mandate was to deliver services according to a consultation model of service delivery. In addition, the study assessed the process of service delivery, including treatment fidelity, or the extent to which consultation services were implemented as intended. Statistically significant and practically meaningful improvement was found in written communication on the Vineland Adaptive Behavior Scales-Classroom Edition (VABS-C) and School Functional Assessment-Version 3.0 (SFA), and in fine motor skills on the SFA, but not on the VABS-C. An examination of the service delivery process revealed that therapists deviated from a purely consultative model, with 86% providing some direct therapy to children. Parents were mostly satisfied with services received, whereas teachers were indifferent or somewhat dissatisfied. Treatment fidelity is taken into consideration when discussing study findings. Recommendations to enhance school-based occupational therapy services delivered according to a primarily consultative model, and suggestions for future research, are provided.

Cognitive strategy generation in children with developmental coordination disorder.

BACKGROUND: Developmental coordination disorder (DCD) is a condition of impaired quality of movement and occupational performance. It has been hypothesized that the difficulties experienced by children with DCD may in part be due to an impaired ability to use cognitive strategies to solve occupational performance problems. Cognitive Orientation to daily Occupational Performance (CO-OP) is a verbally-based approach to helping children remediate this difficulty. The current pilot study investigated the use of cognitive strategies in children with DCD to determine whether cognitive strategy use is improved by CO-OP. METHODS: Observations of video-recorded sessions of 18 school-aged children were scored for frequency and type of cognitive strategies used. RESULTS: Differences within and between groups revealed changes in the types and frequency of cognitive strategies. CLINICAL IMPLICATIONS: The results of the present study support the use of a cognitively-based approach such as CO-OP in assisting children with DCD in developing cognitive strategies when solving occupational performance problems. However, further research using a larger sample is necessary to fully explore the impact of CO-OP on the strategy use of children with DCD.

Children with developmental coordination disorder (DCD) and their ability to disengage ongoing attentional focus: more on inhibitory function.

Children with developmental coordination disorder (DCD), along with their Control counterparts, completed two endogenous, spatial precue tasks. When the precue arrow was informative (.80) with respect to target location, the spatial precue effect results demonstrated that children with DCD take significantly longer than Control individuals to volitionally disengage (inhibit) attention from an endogenously cued location (i.e., a disengagement inhibition deficit). When the precue was uninformative (.25), we found, contrary to a common assumption, that the precue arrow automatically moved attention in the direction of the arrow, and, in addition, that DCD children may also be less able to inhibit the precued-induced urge to move attention (i.e., an initiation inhibition deficit). This type of inhibitory difficulty was also indicated for manual response inclinations produced on catch trials. Overall, DCD children appeared to have an elevated difficulty suppressing the initiation of incorrect, stimulus-provoked movement urges, be they manual or attention in nature.

On the ability of children with developmental coordination disorder (DCD) to inhibit response initiation: the simon effect.

The ability of children with developmental coordination disorder (DCD) to inhibit the initiation of an incorrect manual response urge was examined using a typical Simon task. While the size of the Simon effect was the same for both DCD (N = 20) and Control (N = 20) groups of children, showing no difference with respect to the time needed to complete the inhibition an unwanted response, children with DCD produced significantly more errors of the type which reflected a reduced ability to successfully effect the inhibition operation when it was required. This result is consistent with some earlier findings pointing to an inhibitory deficit for children with DCD (Wilson & Maruff, 1999).

Stigma and its management: a pilot study of parental perceptions of the experiences of children with developmental coordination disorder.

The findings of a small qualitative interview study with 8 parents of 6 children with developmental coordination disorder are reported. The parents discussed the social consequences of their children's motor difficulties. The new International Classification of Functioning, Disability and Health was used as a framework for the analysis of the interview transcripts. The analysis revealed that the parents believed that their children's impairments restrict their participation in society. The interactions between impairment and participation are interpreted in the context of stigma and its management. The significance of occupational therapy interventions in the area of physical activity play to children's social life is discussed.