Digital Commons Network^™

A Scoping Review Of Non-Instrumental Dysphagia Screening Tools: Building Flowcharts To Guide Tool Selection, Yu-Chun Chang, Ming-Jhuan Wang, Shu-Fen Siao, Yu-Juan Xu, Meng-Shan Wu, Tyng-Guey Wang, Cheryl Chia-Hui Chen

Rehabilitation Practice and Science

Selecting an appropriate non-instrumental dysphagia screening tool is a complex process. This scoping review aimed to identify dysphagia screening tools with established reliability and validity, and to develop administrator-based flowcharts to guide tool selection across different clinical populations. A scoping review was conducted using studies identified in CINAHL, Embase, PsycINFO, PubMed, and Web of Science. Our search was guided by five keywords: “dysphagia,” “deglutition,” “screening,” “test,” and “measure.” Original studies about the development and validation of non-instrumental dysphagia screening tools were selected. Six reviewers were involved in the review process, and at least two reviewers independently completed each step of …

Senescent Fibroblasts In Aging And Pulmonary Fibrosis, Sara B. Palega, Aiwei Y. Borengasser, Yan Y. Sanders

Microbiology & Molecular Cell Biology Faculty Publications

Aging is a major risk factor for many chronic lung diseases, including Idiopathic Pulmonary Fibrosis (IPF), a fatal and incurable disease characterized by progressive fibrotic remodeling. Age-associated structural alterations, impaired regenerative capacity, and dysregulated cellular signaling collectively create a pro-fibrotic microenvironment. A central driver of this pathological shift is the accumulation of senescent cells, which undergo irreversible growth arrest and develop a robust pro-inflammatory senescence-associated secretory phenotype (SASP). Emerging evidence identifies senescent lung fibroblasts as critical mediators of IPF pathogenesis. These cells promote excessive extracellular matrix deposition, myofibroblast differentiation, and tissue stiffening, while simultaneously impairing epithelial regeneration. Together, these effects …

Rock On Technology: Perspectives Of People With Neurological Conditions On Robot-Assisted Lower Limb And Gait Neurorehabilitation, Rachel G. Buckingham, Saran Chamberlain, Amanda Timler, Matthew K. Bagg, Nikki E. Bakhtazad, Taya Hamilton, Patricia Martinet, Bianca Haagman, Stuart I. Hodgetts, Barbara Singer, Ann Maree Vallence, Jodie Marquez, Eric Gaitho, Emma Gee, Jessica Nolan

Research outputs 2022 to 2026

Purpose: Explore perspectives of people living with neurological conditions in Western Australia (WA) on robot-assisted lower limb neurorehabilitation (RALLR), and implementation requirements. Materials and methods: This co-designed, qualitative descriptive study included people living with neurological conditions. In-person semi-structured focus groups (FGs) were facilitated by a person with lived experience of stroke. FGs were recorded, data were transcribed, and thematically analysed using a reflexive approach. Results: Five FGs included 24 participants (54.2% women, median age 50 years). Of these, thirteen participants had RALLR experience. Primary neurological conditions represented among participants comprised spinal cord injury (n = 11), stroke (n = 3), …

Reimagining Occupational Justice Beyond Anthropocentrism: A Humane Education Approach To Occupational Therapy Education, Macy Sutton

Antioch University Dissertations & Theses

Occupational therapy positions itself as a holistic, justice-oriented profession, yet many of its theories, practices, and educational standards reflect Eurocentric values and assumptions. Even occupational justice, the disciplinary concept specifically concerned with advancing a more just world, is steeped in coloniality. Critical scholars have increasingly critiqued particular oppressive structures embedded in the field, such as ableism and white supremacy; however, anthropocentrism remains largely unchallenged. In the occupational justice literature, anthropocentrism operates primarily through omission; that is, animals are absent from most scholarly works. This gap is significant because anthropocentrism contributes to prejudice, oppression, and discrimination not only toward animals and …

Addressing Professional Tensions Through Intellectual Candour And Stewardship, Thoughtful Dialoguing As A Duoethnographic Collaborative Exploration, Sarah Barradell, Narelle Lemon

Research outputs 2022 to 2026

Using duoethnography, we explore our experiences of physiotherapy practice and education and argue that the profession’s desire for credibility is at the expense of vulnerability, risk and intellectual candour–of imagining the profession and education of its graduates differently. We identified key themes around: alignment/misalignment, reflection/reflexivity and professional scope. This methodology models risk and questioning through the juxtaposition of different perspectives. Through our contrasting narratives, we remain open to new forms of learning, modelling what intellectual candour demands from us: facing the problems of the past so that we might learn from our history and change our future. This can be …

Association Of Alcohol Use With Helmet Use In Cyclists: Analysis Of The National Trauma Data Bank, Daniel C Brock, Gaibo Yan, Chad T Wilson, Emanuel Narcis Husu

Faculty, Staff and Students Publications

Background: Helmet use significantly reduces the risk of traumatic brain injury among cyclists; however, the influence of alcohol use on helmet-wearing adherence remains understudied in large national data sets. The goal of this study was to investigate the relationship between alcohol use and helmet use in injured cyclists.

Methods: This study is a retrospective cross-sectional analysis of 155 766 cyclists with traumatic injuries from the National Trauma Data Bank spanning 8 years (2017-2023). Cyclists were categorized by blood alcohol concentration (BAC) as follows: not screened, sober (BAC < 0.02), impaired (BAC 0.02-0.08), intoxicated (BAC ≥0.08), and multidrug intoxicated (BAC ≥0.08 plus ≥1 positive drug screen). The primary outcome was helmet usage. Secondary outcomes included mortality, hospital and intensive care unit length of stay, Injury Severity Score, and adverse events. Comorbid substance use disorders were considered as covariates.

Results: Alcohol use was associated with a dose-response decrease in helmet use. Helmet …

Exploring The Role Of Occupational Therapy In A Pediatric Specialty Care Office, Sierra Leigh Hays

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: The role of OT in primary and specialty care clinics is a rising area of interest in the field. There are also many multidisciplinary clinics that OTs can be or are apart of. This study aims to evaluate the consulting role of OT in primary and specialty care clinics, as well as to evaluate data collected by an OT in a pediatric brachial plexus and peripheral nerve clinic. Methods: The first objective was focused on analyzing functional outcomes, using the Active Movement Scale (AMS), of children following neurosurgery or onabotulinum toxin A injections. This was a retrospective study with …

Caring For The Caregiver: Implementing An Occupational Therapy-Tailored Educational Program To Alleviate Caregiver Burden, Lura Elizabeth Simons

Graduate Theses, Dissertations, and Problem Reports (ETD)

Caregivers of traumatic brain injury (TBI) survivors experience caregiver burden, which is a prevalent issue. The most significant concern is for symptoms of burden affecting mental health and sleep quality. This doctoral capstone project addressed the knowledge gap regarding programs that alleviate these signs and symptoms through evidence-based interventions. The objective was to create an educational program with modules that demonstrated improvement in satisfaction and content understanding through in-person sessions and individualized interviews with staff members. This project aimed to reduce perceived burden by conducting in-person sessions to implement interventions through an occupational therapy (OT) lens and by using educational …

Enhancing Occupational Engagement And Wellness In Middle-Aged And Retired Adults Through Movement And Mindfulness Program Development, Erin J. Harvey

Graduate Theses, Dissertations, and Problem Reports (ETD)

Occupational imbalance and a diminished sense of purpose are common challenges faced during middle age and the transition into retirement. These issues can contribute to increased burnout, decreased participation in meaningful activities, and an overall decline in health and well-being. Occupational therapy is well-equipped to address these concerns through comprehensive and holistic, occupation-based wellness programs that promote healthy routines and engagement in meaningful roles. This doctoral capstone project involved developing and implementing two community-based wellness programs tailored to different populations. The first program included self-paced wellness modules for middle-aged adults, aiming to encourage healthy lifestyle habits, enhance coping skills, and …

Healthcare Provider Perspectives On A Clinical Decision Tool To Support Individualized Exercise Prescriptions And Discussions For Breast Cancer Survivors, Jinani Jayasekera, Oliver W. A. Wilson, Kaitlyn M. Wojcik, Eleanor M. Kerr, Rachelle Brick, David Berrigan, Jennifer Yeong-Shin Sheng, Takeo Fujii, Kathleen Thomas, Henri K. Parson, Padma Sheila Rajagopal, Richard L. Street Jr.

Department of Medicine Faculty Publications

Purpose: We evaluated healthcare providers' current knowledge, practices, and perspectives on a novel clinical decision tool (beta-version) to facilitate individualized exercise prescriptions and discussions in clinical settings.

Methods: We recruited healthcare providers who had treated or provided care to breast cancer survivors aged >= 35-years in the past 12 months. The participants were presented with a tool to provide individualized exercise recommendations considering women's individual, clinical, and contextual characteristics. Validated and reliable pre-existing instruments were used to survey providers' current knowledge, practices regarding exercise discussions, and perspectives on the beta-version (paper-draft) of the novel tool.

Results: The sample consisted of …

Acute Lower Leg Transcutaneous Electrical Nerve Stimulation Increases Leg Blood Flow And Exercise Capacity In Patients With Peripheral Arterial Disease, Thomas K. Pellinger, Catherine B. Neighbors, Joshua C. Hefta, Patrick H. Luo, Carl B. Suarez, Erotokritos T. Varlas, Grant H. Simmons, Brett J. Wong

EVMS School of Health Professions Faculty Publications

We tested the hypothesis that two different durations of lower leg transcutaneous electrical nerve stimulation (TENS) increase post-TENS popliteal artery blood flow (PABF), popliteal vascular conductance (PVC), and 6-min walk distance (6MWD) in patients with peripheral artery disease (PAD). Seven subjects (5 male, 2 female) with PAD (67.9 ± 7.4 years; claudication: ankle-brachial index (ABI) < 0.90) participated in three randomized treatment sessions: control or bilateral TENS (3.0 Hz burst mode, 250 µs) for either 15 or 45 min. PABF (Doppler ultrasound) was measured before and after treatment. 6MWD and time/distance to claudication onset were measured 25 min post-treatment during each session. PABF, PVC and 6MWD increased after both 15 and 45 min of TENS (P < 0.05, post-TENS vs. pre-TENS baseline/control). Our preliminary results suggest that as little as 15 min of lower leg TENS increases leg blood flow and exercise capacity in individuals with PAD.

Strategic Transition Planning And Post-Graduation Preparedness For Students In Secondary School, Kelsey Renae Armentrout

Graduate Theses, Dissertations, and Problem Reports (ETD)

The transition period between high school and post-graduation life can be a challenging time for many students. Young adults may follow different paths, including going into the workforce or attending post-secondary education, as well as learning how to navigate life skills such as paying bills, buying a house or a car, applying for jobs, obtaining insurance, and occupations within the adult life stage. While young adults may learn about these things throughout their high school career, it is likely that the feelings of unpreparedness are continuously relevant. The purpose of this DCE is to develop and implement learning modules for …

Bridging The Sensory Gap With Occupational Therapy: Program Development For Sensory Integration In Inpatient Rehabilitation For Adults With Central Nervous System Injuries, Callie Marie Honaker

Graduate Theses, Dissertations, and Problem Reports (ETD)

Objectives: This project aimed to identify sensory processing deficits in adults with central nervous system injuries and to inform the development of sensory-informed program components in an inpatient rehabilitation setting. Participants: A total of 76 adults admitted with diagnoses including cerebrovascular accident, brain injury, and spinal cord injury were included. Methods: A structured sensory screening and mental health questionnaire were administered and compared to prescreening admission documentation and PHQ-9 scores. Descriptive statistics and inferential analyses were conducted. Results: Sensory impairments were highly prevalent, with participants demonstrating an average of three impairments across the sensory domains. Proprioceptive, tactile, and visual deficits …

Multisystem Predictors Of Dynamic Gait Stability Across Fall Risk In Older Adults, Ashwini Kulkarni, Neda Moghim, Ross Gore, Soumya Banerjee, Christopher K. Rhea, Brittany Samulski

Rehabilitation Sciences Faculty Publications

Gait stability arises from interactions between physiological, cognitive, and psychological systems, yet these domains are often assessed in isolation. This study examined multisystem predictors of anteroposterior margin of stability during walking (MoSAP) in community-dwelling older adults. Of 340 participants, 143 were retained after data quality screening (105 females; age: 70.8 ± 7.8 years). Participants completed the Physiological Profile Assessment (PPA), cognitive testing using Montreal Cognitive Assessment (MoCA), fear-of-falling evaluations using Modified Falls Efficacy Scale (MFES) and a biomechanical gait assessment during preferred and fast speeds. Participants were stratified into four PPA-based fall-risk groups: low, mild, moderate, and high risk. MoSAP …

Preoperative Patient Sentiment Is Associated With Postoperative Outcomes In Adult Spinal Deformity Surgery, Ross J. Gore, David Mazur-Hart, Mohan K. Sunkara, Aaqib Ali, Qizar Ali, Christopher J. Lynch

Center for Secure and Intelligent Critical Systems (CSICS) Publications

Study Design:

Prospective observational pilot study of adult spinal deformity surgery patients.

Objective:

To determine whether preoperative patient sentiment, quantified using a 21-class valence scale extending the CARP paradigm implemented through an offline Large Language Model, predicts postoperative outcomes.

Summary of Background Data:

Predicting adult spinal deformity surgery outcomes remains challenging with traditional clinical and radiographic parameters alone. Although patient psychological factors and expectations significantly influence postoperative satisfaction and quality of life, systematic approaches to capture these factors are underdeveloped. Offline Large Language Models offer scalable, privacy-preserving psychological risk stratification.

Materials and Methods:

We prospectively enrolled 18 patients undergoing adult …

Optimizing Healthy Aging: A Preventative Approach To Support Community-Dwelling Older Adults, Jada Welke

Occupational Therapy Capstones

Introduction: Healthy aging is a complex and multidimensional process influenced by physical, cognitive, psychosocial, environmental, and lifestyle factors across the lifespan. Increasing evidence from researchers suggests that many health care systems continue to rely on reactive models that address decline only after functional limitations emerge. Preventive interventions initiated in midlife have the potential to significantly influence long-term health outcomes, independence, well-being, and quality of life. As a result, there is growing recognition that multidimensional, proactive screening and intervention should begin earlier, before age-related conditions become clinically significant.

Purpose: The purpose of this scholarly project was to address this need through …

From Play To Pressure: Understanding Early Sports Specialization Through An Occupational Lens, Kiley Jade Washnieski

Occupational Therapy Capstones

Background: Youth sport participation plays a significant role in the daily lives of children ages 6-12 (Lee et al., 2018). Participation in organized sports can offer numerous benefits; however, the expectations surrounding youth sports have evolved over time. Increased emphasis on early specialization has intensified training demands and performance pressures placed on youth athletes during critical developmental years (Brenner et al., 2019). Although occupational therapy is well positioned to address both the physical and psychosocial demands of youth sport participation, the profession’s role within this context remains underexplored (Bulan et al., 2025).

Purpose: The purpose of this scholarly project was …

Family-Centered Programming For A Rural Midwest Emergency Shelter: An Occupational Lens, Ariel Kathryn Tix

Occupational Therapy Capstones

Introduction: After a period of decline in homelessness, a startling trend reversal occurred between 2023 and 2024; there was a 39% increase in families experiencing homelessness in the United States (de Sousa & Henry, 2024). Rural homelessness is less visible and often looks different from urban homelessness, which presents challenges that require a different approach (Brott et al., 2019). Individuals experiencing homelessness have challenges in every area of occupation and could benefit from novel strategies and resources. Challenges include parenting, accessing medical care, obtaining permanent housing, community mobility, and meaningful routine development (American Occupational Therapy Association, 2020; Brott et al., …

Expanding Access To Hand Therapy In Rural Wyoming Through Telehealth, Cheyenne Rose Thompson

Occupational Therapy Capstones

Individuals living in rural Wyoming experience significant barriers to accessing specialized hand therapy services, including geographic isolation, limited availability of certified hand therapists, and inconsistent healthcare infrastructure, resulting in delayed rehabilitation and reduced functional outcomes (Hirth et al., 2022; Rural Health Information Hub, 2025). Although telehealth has emerged as a potential solution to improve access, challenges related to clinician training, safety, and adaptation of interventions to virtual environments persist (Feldhacker et al., 2022; Morris, 2024). The purpose of this scholarly project was to develop an evidence-based telehealth hand therapy program to improve access to upper extremity rehabilitation services in rural …

The Lens Of Farmers: Understanding Culture To Improve Occupational Therapy Care, Allison Marie Stephani

Occupational Therapy Capstones

Introduction: Accessible healthcare is essential for farmers due to their limited available time and hazardous job duties (Hildebrand et al., 2019; Hopkins et al., 2023; Salmon et al., 2025; U.S. Department of Agriculture, 2023). Due to the high incidence of injuries that occur within the profession, it is crucial that farmers seek appropriate healthcare services to address these concerns. However, a significant barrier for seeking healthcare assistance is the limited cultural competence among healthcare professionals in understanding the unique needs within farming communities (Gordon et al., 2024; Hildebrand et al., 2019; Hopkins et al., 2023; Purc-Stephenson et al., 2024). The …

Occupational Therapy In Rural North Dakota Schools To Enhance Transition Planning, Kyra M. Schwartz

Occupational Therapy Capstones

Background: Access to services does not guarantee participation. Youth with disabilities, particularly in rural communities, continue to experience disparities in postsecondary outcomes related to employment, education, and independent living. While transition services are available, barriers related to awareness, coordination, and usability limit effective engagement. These challenges highlight a gap between service availability and access within rural systems and contribute to reduced participation outcomes.

Purpose: The purpose of this scholarly project was to develop an occupational therapy– informed, advocacy-driven approach to improve access to and navigation of transition services for youth with disabilities in rural communities.

Methodology: A multi-method, iterative approach …

Swimming With Confidence From An Occupational Therapy Perspective, Emma M. Schultz

Occupational Therapy Capstones

Background: Autism Spectrum Disorder (ASD) is a neurological disorder that impacts thousands of people and their families. Those with an ASD diagnosis demonstrate difficulty with safety awareness are at an increased risk to die due to drowning. Those with autism are often drawn to water for a multitude of reasons especially after an elopement attempt. There has been an increased awareness and development in aquatic therapy to reduce the drowning risks for those with ASD. Occupational therapists have begun to develop interventions that targets basic swimming and water safety. During these interventions, occupational therapists use their skills of activity analysis, …

The Effect Of Sensory Processing And Integration On Engagement In Occupations For Children With Sensory Processing Disorders, Ashley Schindele

Occupational Therapy Capstones

Background: Sensory Processing Disorder (SPD) is a condition where the person is unable to process and respond to sensory information (Guardado & Sergeant, 2023). Children who are lacking sensory integration skills may have more behavior problems due to their inability to regulate their responses (Guardado & Sergeant, 2023; Pfeiffer et al., 2013). Children with SPD may have abnormal sensitivities in any or all the sensory systems which may cause the child to not participate in their occupations (Guardado & Sergeant, 2023; Parham & Mailloux, 2020).

Purpose: The purpose of this scholarly project was to provide parents/caregivers a handout that thoroughly …

Harvesting Health: Cultivating Skills For Wellness In Agricultural Workers, Katie Renee Quinley

Occupational Therapy Capstones

Purpose: The nature of agricultural work is physically demanding and associated with an increased risk of musculoskeletal injury due to repetitive movements, heavy lifting, awkward postures, and prolonged physical labor. Despite the importance of agriculture as a meaningful occupation and major contributor to the workforce, limited resources address the unique physical demands of agricultural labor. The purpose of this scholarly project was to develop a video-based educational resource to promote safety and continued occupational participation in agricultural workers. Additionally, the project aims to assist therapy professionals in implementing ergonomic and task modifications through an accompanying resource guide.

Methodology: A literature …

Enhancing Leisure Opportunities For People With Disabilities In Rural Communities, Joslyn Mary Nordmark

Occupational Therapy Capstones

Purpose. The purpose of this scholarly project was to promote access to leisure opportunities for people with disabilities in rural areas. The author addressed unmet needs among this population considering personal, occupational, environmental, cultural, and socioeconomic factors. The goal was to develop a product that provided opportunities regardless of abilities to promote leisure exploration and participation, social engagement, and life skill development for people with disabilities

Methods. The author conducted a needs assessment through a literature review following the Model of Human Occupation (MOHO), collaborations with site staff, and an on-site observation and environmental analysis. Data was examined to identify …

The Missing Link: Psychosocial Integration In Neuro Ot Care, Emily Nelson

Occupational Therapy Capstones

Introduction: Over 1 in 3 people are affected by neurological conditions, making it the leading cause of illness and disability worldwide (World Health Organization, 2024). Patients are often referred to inpatient rehabilitation to increase independence and functional recovery. There is a need to address psychosocial factors within this setting thus, The Missing Link: Integrating Psychosocial Factors into Neuro OT was created.

Methodology : The capstone is guided by the Model of Human Occupation (MOHO), which emphasizes the dynamic interaction between the person and their environment and its influence on psychosocial factors, personal identity, and competence. A comprehensive needs review was …

Cultivating Connections: Empowering Agricultural Community Members Through Collaborative Care, Kearyn E. Nelsen

Occupational Therapy Capstones

Background: Agriculture and mental health – two words not typically used in the same sentence; however, considering the rate of suicide among those working in the agriculture profession is significantly higher than the general population, the need for both awareness and action is critically important. Despite a lack of research specific to occupational therapy and the agricultural population, occupational therapists on an interprofessional healthcare team are uniquely positioned to serve this population. Interprofessional collaboration is essential when serving agricultural community members, whose needs involve a complexity of physical, mental, social, and environmental factors, each impacting the overall health and well-being …

Occupation-Based Transition Planning Guide For High School Students With Disabilites., Kelsey Milleson

Occupational Therapy Capstones

Background: The transition from high school to adulthood is a critical period influencing independence, employment, and community participation for students with disabilities (Carroll et al., 2025; Rosner et al., 2020). Despite mandates under the Individuals with Disabilities Education Act (IDEA), many students experience poor postsecondary outcomes, including limited employment and increased reliance on caregivers (Benson et al., 2021; U.S. Department of Education, 2020). Effective transition planning should begin early, be individualized, and emphasize real-world skill development such as daily living, vocational skills, and self-advocacy (Cleary & Persch, 2020). However, school-based programs often lack consistency, structure, and performance-based outcome measures, reducing …

Increasing Leisure Exploration In Older Adults As They Age, Jackie Middendorf

Occupational Therapy Capstones

Background: As individuals age, it is common for them to experience deficits that impact how and where they age (Dieuleveult et al., 2017; Nakahara & Yokoi, 2024; Park et al., 2021; Rimland et al., 2016; Szanton et al., 2016). These deficits commonly impact functional mobility and their ability to complete self-cares, leading to them having to leave their homes or receive services (Dieuleveult et al., 2017; Feller & Baker, 2022; Lindquist et al., 2021; Mayo et al., 2021; Spang et al., 2024). Along with deficits with functional mobility and self-cares, older adults experience decreases in their social engagement and leisure …

The Role Of Occupational Therapy In The Prevention Of Sudden Unexpected Infant Death (Suid), Natalie Ryan Mcfarren

Occupational Therapy Capstones

Background: Each year, 3,700 infants die from SUID; this equates to about ten infants per day. SUID is an umbrella term that covers three separate subcategories: suffocation and strangulation in bed, sudden infant death syndrome (SIDS), and unknown (Cribs for Kids, 2026). Suffocation and strangulation in bed is the only subcategory that is 100% preventable with safe sleep practices, while the risk of SIDS can be decreased by adhering to safe sleep guidelines. While the prevalence of SUID has decreased since the 1992 Back to Sleep campaign, current data indicate a plateau, if not a slight increase, in SUID cases …