Occupational Therapy

In recent decades, policy changes in many countries have significantly affected the treatment of people with mental illness (MI), particularly in reducing the length of hospitalization in acute psychiatric departments. Occupational therapists, as key mental health professionals, must consider the impact of these shifts in mental health care delivery and focus on evidence-based interventions suited to the acute psychiatric setting. This review aims to examine existing studies to assess the scope and nature of research on occupational therapy interventions for acute psychiatric inpatients through a scoping review.

The scoping review followed the PRISMA Extension for Scoping Reviews guidelines. The study comprised three stages: pre-search, search, and post-search, following the scoping review methodology. A structured search was performed using Web of Science, PubMed, and Scopus for items published up to April 5, 2023. Two independent reviewers evaluated the selected literature in two rounds of review.

Articles meeting the inclusion criteria (n=13) were incorporated into the analysis. Most publications originated from Japan, followed by the United States and Germany. For the initial days of an acute inpatient stay, especially given the unpredictability of behavior, tolerance, and unstable symptoms, short individual sessions of 20 minutes or less were generally recommended. Treatment sessions in the selected studies typically ranged from three to five days per week, with each session lasting approximately 45 minutes to 2 hours. Flexible, one-on-one intervention structures appeared beneficial in the early hospitalization phase. Four main elements of occupational therapy interventions in acute mental health were identified: individual assessment and intervention, group therapy, and discharge planning. Interventions were compared with control groups who did not participate in these activities, revealing statistically significant Personal and Social Performance Scale improvements. Using weighted blankets in sensory rooms significantly reduced distress and disruptive behaviors. Studies on MetaCognitive Training (MCT), Cognitive Remediation, and Occupational Connections (OC) demonstrated significant differences in outcomes between intervention and control groups.

Occupational therapy interventions in acute psychiatric inpatient settings appear effective. Further studies are warranted to develop and refine these intervention methods for acute psychiatric inpatients.

Context: 

Some researchers proved new and persistent symptoms lasting for weeks and even months after COVID that is named “long-COVID” or “post-COVID syndrome.” It appears that occupational therapists (OTs) have a significant role in managing the symptoms of long COVID, with the aim of enhancing patients' ability to perform daily activities and improving their overall well-being. The objective of this study was to conduct a scoping review study of reputable databases to identify the various ways in which OTs can manage long COVID from the onset of symptoms.

Evidence Acquisition: 

To identify relevant documents, the following databases and search engine were searched from 2019 to 2023 in the English language: PubMed, Scopus, ISI, and Google Scholar. Keywords used for search include (("occupational therapy") AND (("post-COVID") OR ("long-COVID"))) AND ((intervention) OR (exercise)), of which 45 articles were found, and a total of 22 were chosen according to the predetermined criteria.

A diverse array of interventions in OT can be useful for the management of post-COVID symptoms, as mentioned in the 22 studies found as the search result, including energy management education, pulmonary rehabilitation, sleep hygiene, stress and fatigue management, and work simplification.

Occupational Therapist offers a distinctive viewpoint on health conditions that arise in human life, and its interventions can be utilized to enhance health, self-management, and quality of life (QOL).

There is uncertainty in identifying which aspects of functioning should be prioritized in the clinical brief assessment of children with cerebral palsy (CP). Brief ICF category sets specify the essential aspects of functioning that should be addressed in such assessments.

This study aimed to develop five brief ICF category sets based on the functional limitations of children with CP, as viewed by Iranian occupational therapists (OTs).

This cross-sectional, multi-method study was conducted from January to May 2022 in Iran. Nineteen OTs were recruited through purposive sampling for a Delphi process, and ten OTs through snowball sampling for an expert panel, all experienced in CP and ICF. The Delphi involved two rounds of electronic surveys, where participants identified categories that should be minimally addressed in brief assessments of children aged 6 - 12 with CP based on their functional limitations. The content validity of these sets was then quantitatively evaluated by the expert panel.

Most confirmed categories in the gross and fine motor brief sets pertained to body structure and function, while those in the eating-and-drinking and communication-function brief sets related to cognition and motor reflexes. Categories in the visual function brief set mostly pertained to activity, participation, and environmental factors. Content validity ratio (CVR) and item-content validity indexes (I-CVI) ranged from 0.80 to 1 across all categories/brief sets, with scale-content validity index/Average (S-CVI/Ave) ranging from 0.95 to 0.98.

These functional-based ICF brief sets are the first developed for children with CP in this age group and provide occupational therapists with tools to address crucial aspects of functioning, tailored to specific functional limitations. However, cultural biases and the generalizability of these brief sets remain limitations.

Assessment tools are essential in occupational therapy for providing client-centered care, clinical decision-making, evidence-based documentation, and defining expected outcomes. This study investigated available occupational therapy assessment tools for children and adolescents in Iran.

A comprehensive search was conducted in MEDLINE, PubMed Central, Web of Science, Embase, Scopus, SID, Magiran, and Google Scholar from their inception until May 24, 2022. Two reviewers screened records and applied inclusion criteria focused on peer-reviewed articles in English or Persian, covering children and adolescents aged 0-18 years old in Iran. The methodological quality of each study and the evidence quality of each measurement tool was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias Checklist, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

A review of 66 articles published between 2010 and 2021, identified 51 assessment tools. The majority of tools (70.7%) targeted typically developing children and those with cerebral palsy, with limited options for adolescents (n=5) and infants (n=1). These tools primarily focused on assessing body functions (47.06%), particularly sensory-motor functions. While numerous tools demonstrated good reliability (66.67%) and significant content validity (31.37%), there was a paucity of high-quality evidence supporting other psychometric properties.

This study identified 51 occupational therapy assessment tools for Iranian children and adolescents. However, the present research identified some concerning trends, such as lack of tools available for specific populations, an overreliance on translated tools, and a predominant focus on body functions. Moreover, there were concerns about the methodological quality of studies using these tools.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms that can impact daily activities.

Activity-based interventions, particularly when combined with motivational strategies, may enhance upper extremity function and participation in people with PD.

This study will include forty-five patients with PD aged 35 to 85 years, categorized as stages I to III according to the Hoehn and Yahr Scale. Patients will be recruited from neurological and rehabilitation centers and randomly assigned to one of three intervention groups: Activity-based interventions with motivational strategy, activity-based interventions without motivational strategy, and conventional interventions. All participants will undergo a 24-session intervention, three times a week. The study will assess various outcomes at multiple time points, including baseline, session 10, session 18, post-intervention (week 9), and follow-up (week 17). Primary outcome measures will focus on motor control of the upper extremity and participation, while secondary outcome measures will include cognitive function and quality of life.

This proposed randomized controlled trial (RCT) aims to investigate the potential beneficial effects of activity-based interventions, combined with motivational strategies, on upper extremity function and participation in activities of daily living (ADLs) for individuals with PD.

The expected outcome of this study is to provide valuable insights that can assist occupational therapists in making informed decisions regarding intervention plans for people with PD.

New developments in artificial intelligence (AI) provide bright prospects to transform therapy approaches and enhance results for people with a range of abilities. Therefore, the aim of this systematic review was to investigate the applications of AI in occupational therapy (OT).

We looked for literature on February 18, 2024, using the databases from PubMed, Embase, Scopus, and Web of Science. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting on the evidence from the studies that were a part of this systematic review. English-language studies that investigated the use of AI in OT were included in this study.

Totally, 6 eligible studies were included in this review. AI approaches used in studies include artificial neural networks, multi-core learning models, deep learning models, machine learning models, and classification and regression trees. All the studies had promising results from the use of AI in evaluating and predicting return to work, relief of symptoms, recovery of social function, reduction of disease recurrence, improvement of re-employment rate, and overall health level of patients.

This study provided an overview of AI applications in OT. The evidence from this review showed that potential of using AI models to predict patients' return to work and problems. One of the most common problems with these models was their low accuracy and the possibility of mistakes. Therefore, it is suggested that future studies investigate barriers and facilitators to improve the prediction accuracy of AI models in OT.

Kleefstra Syndrome is a rare genetic neurodevelopmental disorder caused by a microdeletion in chromosomal region 9q34.3 or a mutation in the EHTM1 gene. Patients with KS show a range of clinical symptoms, including delay in motor and speech development, intellectual disability, autistic-like features, childhood hypotonia, and distinctive facial dysmorphic features. The patient is a 4-year-old girl who was initially diagnosed with developmental motor delay by a pediatric neurologist and referred to an occupational therapy clinic at 6 months of age. The initial assessment showed hypotonia and difficulties with rolling. Occupational therapy intervention was based on principles of neurodevelopmental treatment and sensory integration with cognitive integration and activities of daily living training. With continuous occupational therapy services over more than 3 years, she overcame many disabilities and improved in occupational performance skills such as gross and fine motor skills as well as cognitive abilities, although her verbal communication skill is not effective. The patient's progress was as follows: she began rolling over at 7 months, achieved independent sitting at 10 months, crawled at 18 months, stood with support at 20 months, and took her first steps at 26 months. The predominant problem was speech delay which was noticeable in this syndrome. When a patient is being referred because of Kleefstra syndrome, occupational therapy, and speech therapy assessments should be accurately implemented.

Learning encompasses lasting alterations in behavior stemming from experience. The sensory system receives and interprets information gathered from individual experiences, priming it for integration with other neuro-psychological facets of learning. The processes and modalities of learning, juxtaposed with sensory processing, may or may not exhibit interrelation akin to gears within a learning clock mechanism. The objective is to explore the potential correlation between the stages and styles of learning outlined by Kolb and the sensory processing patterns delineated in Dunn's model.

This correlational study involved undergraduate Occupational Therapy students from the Rehabilitation Faculty at Shiraz University of Medical Sciences (SUMS) in Iran. In 2018, all students were invited to participate and were asked to complete two questionnaires: The Kolb Learning Styles Inventory and the Adolescent/Adult Sensory Profile. Out of 83 distributed questionnaires, responses from 62 participants were included in the analysis. The collected data underwent descriptive and analytical statistical analyses using SPSS23 software.

Findings revealed no significant correlation between Kolb's Learning Steps and Learning Styles and Dunn's Sensory Processing Patterns among Iranian Occupational Therapy students (p-value>0.05). However, there was a correlation between low registration and preferred learning steps among female students (p-value=0.003).

 The findings suggest no correlation between learning steps and learning styles with sensory processing patterns overall. However, gender-based analysis indicates a potential correlation among participants exhibiting low registration sensory patterns.

This study investigated the efficacy of telerehabilitation (TR) in school-based Occupational Therapy (OT) for children with Specific Learning Disorder (SLD), focusing on occupational competence and parental satisfaction, aiming to contribute empirical insights to the discourse on the educational well-being of this population.

The study adopted a Randomized Controlled Trial (RCT) design involving 31 children diagnosed with SLD, implementing TR and in-person interventions alongside a control group. Outcome measures included the School Self-Concept Inventory, Child Occupational Self-Assessment (COSA), and Canadian Occupational Performance Measurement (COMP), analyzed using descriptive and inferential statistics (ANOVA, post hoc tests).

Both TR and in-person interventions exhibited significant enhancements in academic self-efficacy (F=23.96, p<0.001, Partial ȵ²=0.461), occupational competence (F=70.59, p<0.001, Partial ȵ²=0.716), and parent satisfaction (F=17.03, p<0.001, Partial ȵ²=0.378) compared to the control group. Notably, no significant differences emerged between the TR and in-person groups, emphasizing their comparable effectiveness in improving outcomes.

In conclusion, the study demonstrated the efficacy of TR and in-person interventions in school-based OT for children with SLD. The cohesive outcomes in academic self-efficacy, occupational competence, and parental satisfaction highlight TR as a versatile modality. This research, grounded in robust methodology, encourages further exploration of TR’s transformative role in enhancing the holistic well-being of children with SLDs.

Short child occupational profile (SCOPE) screening tool is used to assess different factors of functional abilities and record the progress levels of individuals in occupational therapy interventions. This study aimed to validate a Persian version of the SCOPE test. 

This methodological research was conducted in two stages, including translation and psychometric properties. A total of 182 people aged 3-21 years were recruited using the convenience sampling method for the second stage.

The results of the content validity of the questionnaire were in acceptable ranges. The total intra-class correlation coefficient and total Cronbach's α were 0.97 and 0.93, respectively. The results of the discriminant validity between the normal and disabled groups showed significant differences between the normal and disabled groups in all items of the questionnaire.

The findings demonstrated that the Persian version of the SCOPE questionnaire could be used as a valid and reliable tool.

Since cerebral palsy (CP) is a corollary to brain damage, persistent treatment should accompany an alteration in brain functional activity in line with clinical improvements. In this regard, the corpus callosum (CC), as a connecting bridge between the two hemispheres, plays an essential role.

This study aimed to investigate the therapeutic effects of occupational therapy (OT) on CC functional activity and walking capacity in children with cerebral palsy.

In this clinical trial study, 4 children with CP (8.25±1.71 years) received 45 min OT sessions 3 times weekly for 8 weeks. Functional magnetic resonance imaging (fMRI) was acquired while conducting passive motor tasks to quantify CC activation. The pre-post activation changes in CC following therapy were quantified in terms of activated voxels. Walking capacity was evaluated using the timed-up-and-go (TUG), 6-minute walk test (6 MWT), and 10-meter walk test (10 MWT) in pre-and post-treatment.

The number of activated voxels in CC indicated significant improvement in participants. Post-treatment activated voxels substantially exceeded pre-treatment active voxels. Clinical measures, including TUG, 6 MWT, and 10 MWT are improved by 11.9%, 12.6%, and 25.4%, respectively.  

Passive task-based fMRI can detect the effects of OT on CC functional activity in children with CP. According to the results, OT improves CC functional activity in addition to gait and balance performance.

Identifying the currently-used outcome measures for clients with cerebral palsy (CP) in the Iranian occupational therapy (OT) research can declare the new trend of such researchers and identify the more focused domains regarding such individuals. Accordingly, this integrative review aims to define the utilized outcome measures for school-age children with CP in the Iranian OT research.

We conducted an integrated review of online Persian and English databases, namely PubMed, Web of Science, Otseeker, Cochrane, Medline, Embase, CINAHL, PsycInfo, OVID Medline, Magiran, ISC, SID, IranMEDEX, Irandoc, and IRCT, along with the Google Scholar search engine from January 2000 to March 2021.

Out of 605 potentially relevant articles that were initially retrieved, 51 articles met the inclusion criteria, and their used outcome measure(s) was identified. A total of 42 identified outcome measure(s) were not diagnosis-specific and or child-report. A maximum of 15 tools, which assessed the motor components of CP children based on a biomedical bottom-up approach, was commonly used by the majority of studies.

Most Iranian OT studies utilized bottom-up outcome measures. Iranian OT researchers were suggested to highlight the current paradigm of OT in their research regarding school-age children with CP to comprehensively address their multiple challenges and needs according to a top-down client-centered approach.

 The evaluation of educational environments is the key to achieving a student-centered and qualified curriculum.

 This study was conducted to evaluate the educational environment in the School of Rehabilitation Sciences at Shiraz University of Medical Sciences (SUMS), Shiraz, Iran, focused on occupational therapy (OT) students, using the Dundee Ready Educational Environment Measure (DREEM) questionnaire for incoming students of 8 years (2013-2020).

 This cross-sectional, descriptive-analytical, and applied study was carried out on two occasions in 2017 and 2021. The students' perspectives of the 4incomings between 2013 to 2016 (group 1) and another four incomings between 2017 to 2020 (group 2) were evaluated. SPSS software (version 23) was utilized for data analysis.

 The average total score of the educational environment questionnaire for all 136 students was 102.301 ± 20.607. There was a statistically significant difference in the perception of students in these two groups. The results showed better quality in the total score of the educational environment and all subdomains of this questionnaire in group 2 with a P-value of < 0.05.

 It seems that OT students’ perception shows a semi-favorable to favorable circumstance regarding the educational environment in SUMS. The incoming OT students from 2017 to 2020 in SUMS have reported more favorable conditions in all aspects of the educational environment than the incoming students from 2013 to 2016. Students' perspectives were more negative after passing their years of studying at the university. Serious reforms in the educational environment of OT at SUMS are needed.

Due to the limited access of clients in non-urban areas to rehabilitation and the difficulty of specialized counseling in such conditions, the need for telehealth services has increased. The purpose of this study is to evaluate the effectiveness of Tele occupational therapy in common disorders of children and adolescents.  

In this systematic review study, a research method published from 2010 to 2022 focusing on the effectiveness of tele-rehabilitation and its impact on children and adolescents with different physical disabilities was done in Google Scholar, PubMed, Scopus and EMBASE databases. 467 articles were obtained in the review, and finally, 18 articles were reviewed. 

In children with CP, Tele occupational therapy will be effective on gross motor function and balance skills, but the impact on the executive function needs more studies. In children with ASD, it will be effective on behavioral problems, but the effect on pro-social behavior needs further studies. In children and adolescents with other movement disorders, it will have an impact on the progress of their physical activity and in children and adolescents with Traumatic Brain Injury (TBI), it will be effective, but the effectiveness of MitiiTM programs needs further studies.  

The findings of this study showed that tele-occupational therapy could be performed in line with face-to-face occupational therapy, and it can lead to the satisfaction of families, but there is still a need to assess the effectiveness of various interventions and tools on different disorders, outcomes and settings.