Medicine and Health Sciences Commons^™

Discordance Between Balance Ability And Perception Is Associated With Falls In Parkinson’S Disease: A Coordinated Analysis, Jason K. Longhurst, Andrew Hooyman, Merrill R. Landers, Martina Mancini, Erika Franzén, Breiffni Leavy, Hanna Johansson, Daniel Peterson

Physical Therapy Faculty Articles and Research

Background: The congruence or discordance between actual and perceived balance ability has been proposed to be linked to functional outcomes such as falls. However, gaps remain in our ability to quantify discordance, and its relationship to relevant outcomes.

Objective: To investigate a novel quantification of concordance/discordance between balance performance and perception and determine the relationship to falls among people with Parkinson’s disease (PwPD).

Methods: Data from 244 PwPD were aggregated from 5 previously conducted studies. Variables extracted included age, sex, Activities-Specific Balance Confidence scale (ABC; perceived balance), Timed Up and Go (TUG; balance performance), Movement Disorder Society Unified Parkinson Disease …

Advance Care Planning In Rehabilitation: Training Nurses And Social Workers To Facilitate Discussions, Celeste Christiansen

Student Scholarly Projects

Practice Problem: Patients and healthcare workers fail to hold advance care planning (ACP) discussions. Social workers perceive a lack of time and feel unprepared to hold ACP conversations.

PICOT: The PICOT question that guided this project was: Do patients in acute inpatient rehabilitation (P) who receive education and resources about ACP from trained nurses and social workers (I) accept and participate in ACP (O) compared to prior standards of care (C) while on the rehabilitation unit (T)?

Evidence: The public and healthcare workers have limited knowledge of ACPs and their role in these discussions. People are more likely to hold …

Evaluating The Superiority Of Multimodal Analgesia Over Opioid-Based Analgesia In Postoperative Pain Management For Total Knee Arthroplasty: A Comprehensive Integrative Review, Janna Smith, Mahdi Mofazali, Nya-Qien Smith

Master's Projects

With total knee arthroplasty (TKA), postoperative pain management is so important for optimal recovery and patient outcomes. This integrative review evaluates the effectiveness of multimodal analgesia (MMA) compared to traditional opioid-based analgesia in reducing pain and opioid consumption post-TKA. Research shows that MMA is very effective at providing adequate pain relief, reducing side effects, and also decreasing opioid use. MMA also addresses both the specific needs of individual patients and the broader public health issue of opioid dependence. However, a significant barrier to widespread adoption is the absence of standardized protocols. This review sets forth the importance of coming up …

The Effect Of A Virtual Covid-19 Interprofessional Educational Module On Knowledge, Confidence, Attitude, And Practice Among Health And Allied Health Professions Students, Tsu-Yin Wu, Jenni L. Hoffman, Grigoris Argeros, Sarah Lally, Andrea Gossett Zakrajsek, Jillian Graves, Alice Jo Rainville, Olivia Ford, Angela Lukomski, Renuka Roche, John Sonnega, Joan E. Cowdery Phd

Journal of Interprofessional Practice and Collaboration

Purpose: The purpose of this research study was to examine the effect of an innovative, online COVID-19 interprofessional educational module among health and allied health professions students.

Methods: This study utilized a pre- and posttest design with quantitative and qualitative data collected winter 2023 and spring/summer 2023 semesters, and consisted of health and allied health professions students (N=143) from three Midwestern, urban, public universities. Participants completed a pretest, then an IPE module on COVID-19, and a posttest immediately after the educational intervention, and another (the same) posttest one month later. Quantitative and qualitative data were subject to statistical …

Efficacy Of High-Definition Transcranial Alternating Current Stimulation (Hd-Tacs) At The M1 Hotspot Versus C3 Site In Modulating Corticospinal Tract Excitability, Hao Meng, Michael Houston, Nicholas Dias, Chen Guo, Gerard Francisco, Yingchun Zhang, Sheng Li

Faculty, Staff and Student Publications

Previous studies have shown that beta-band transcranial alternating current stimulation (tACS) applied at the M1 hotspot can modulate corticospinal excitability. However, it remains controversial whether tACS can influence motor unit activities at the spinal cord level. This study aims to compare the efficacy of applying tACS over the hotspot versus the conventional C3 site on motor unit activities and subsequent behavioral changes. This study used a randomized crossover trial design, where fifteen healthy participants performed a paced ball-squeezing exercise while receiving high-definition tACS (HD-tACS) at 21 Hz and 2 mA for 20 min. HD-tACS targeted either the flexor digitorum superficialis …

Consumers', Family Members', And Health Practitioners' Perspectives On Increasing Activity Engagement Of Older Patients Admitted To Geriatric Hospital Units, Yvonne Y.K. Mak-Yuen, Farnaz Khoshmanesh, Tamara Tse

Patient Experience Journal

The aim of this study was to explore the perspective of consumers, family members, and health practitioners on increasing patient activity engagement in a Geriatric Evaluation and Management (GEM) Unit. This study followed a qualitative phenomenology approach. Semi-structured interviews were conducted, audio-recorded and transcribed verbatim with consenting patients (n = 12), family members (n = 3), and health practitioners (n = 5) admitted to the GEM Unit of a tertiary metropolitan hospital in Melbourne, Victoria, Australia between August 2017 and March 2018. Data were analysed using spiral content analysis. From the 20 interviews, three themes emerged: 1. What can I …

Patient, Family, And Health Professional Perspectives Of How Families Are Involved In Adult Inpatient Traumatic Brain Injury Rehabilitation, Kaylee Eady, Katherine A. Moreau, Shawn Marshall, Mary Egan

Patient Experience Journal

Objective: We aimed to answer the following research question: From the perspectives of patients, family members, and health professionals, how are families involved in the rehabilitation of adult patients with Traumatic Brain Injury at an inpatient Acquired Brain Injury service within an adult rehabilitation centre? Methods: We used an interpretive qualitative approach, from a constructivist view. This approach allowed us to understand and describe family involvement from the perspectives of patients with Traumatic Brain Injury, family members, and health professionals. We conducted one-on-one interviews with patients, family members, and health professionals. We used a three-step analysis method: data …

Exploring Consumer And Clinician Attitudes Towards Patient Reported Outcome Measures (Proms) In An Australian Inpatient Musculoskeletal Rehabilitation Unit: A Qualitative Pilot Study, Rehana Di Rico, Louisa Ng, Jacquelin T. Capell

Patient Experience Journal

Objective: This pilot qualitative study explores consumers' and clinicians' perspectives about the relevance and utility of patient reported outcome measures (PROMs) in an Australian inpatient rehabilitation unit. Methods: Two focus groups, were recruited via convenience sampling, comprising English speaking rehabilitation clinicians (n = 5) and consumers (n = 6) who had recent experience of inpatient musculoskeletal rehabilitation in a large, privately funded, rehabilitation hospital in Melbourne Australia, in 2020. The focus groups were conducted via videoconference, moderated by two experienced rehabilitation clinician-researchers, following semi-structured interview guides. Focus group recordings were professionally transcribed for coding and thematic analysis by …

Early Mobility And Delirium Prevention For Intensive Care Unit Patients At Kingman Regional Medical Center, Lyndsey R. Lehman Ms, Otr/L

Masters Projects

Over five million patients are admitted to the intensive care unit (ICU) annually in the United States, with 50-70% of those developing debilitating physical, cognitive, and mental health issues. Occupational therapy (OT) is a holistic profession that provides evidence-based interventions to improve ICU patients’ function and participation in daily occupations by addressing early mobility and delirium. A needs assessment performed for the Kingman Regional Medical Center (KRMC) ICU revealed a lack of knowledge about early mobility and delirium prevention among nursing staff, underutilization and limited understanding of OT services, and KRMC-specific barriers impacting patient care. This author designed and implemented …

Effects Of High-Intensity Interval Training Combined With Resistance Training On Functional Capacity And Clinical Risk Factors In Patients With Cardiovascular Disease, Philip Matthew Wilson

Doctoral Dissertations and Projects

Moderate-intensity continuous training (MICT), resistance training (RT), MICT combined with RT, and high-intensity interval training (HIIT) have all been proven to provide clinical benefits for individuals with cardiovascular disease (CVD). However, the effects of HIIT combined with RT on functional capacity outcomes and clinical risk factors outcomes in patients with CVD are not well investigated. Therefore, the purpose of this retrospective cohort study is to investigate the synergistic effects of HIIT combined with RT on functional capacity outcomes including six-minute walk distance (6MWD), peak oxygen uptake (VO2peak), and metabolic equivalent of tasks (METs) and clinical risk factors outcomes including systolic …

Toward Facilitating The Collection And Utilization Of Patient-Reported Outcomes In The Military Health System: Lessons Learned From A Pragmatic Clinical Trial On Physical Therapy Management For Low Back Pain, Emma H. Beisheim-Ryan, Brad D. Hendershot, Timothy C. Mauntel, Sara R. Gorczynski, Ryan W. Smith, Andrea Crunkhorn, Shawn Farrokhi, Christopher L. Dearth

Physical Therapy Faculty Articles and Research

"In pursuit of delivering 'the right care to the right patient at the right time,' the Military Health System (MHS) advocates for collecting and using patient-reported outcomes (PROs) to help demonstrate value-based care.1 PROs identify patients’ perceptions of their health, function, and well-being, which can enhance patient-centered communication and guide data-driven healthcare. 2 The MHS recognizes the value of incorporating PRO data into clinical decision-making and has established a number of platforms for PRO collection across health conditions (eg, behavioral health, traumatic brain injury, musculoskeletal injuries). The Military Orthopedics Tracking Injuries and Outcomes Network (MOTION)3 was started as a research …

Enhancing Data Standards To Advance Translation In Spinal Cord Injury, Vanessa K. Noonan, Suzanne Humphreys, Fin Biering-Sørensen, Susan Charlifue, Yuying Chen, James D. Guest, Linda A. T. Jones, Jennifer French, Eva Widerström-Noga, Vance P. Lemmon, Allen W. Heinemann, Jan M. Schwab, Aaron A. Phillips, Marzieh M. Rizi, John L. K. Kramer, Catherine R. Jutzeler, Abel Torres-Espin

Department of Physical Therapy Faculty Papers

Data standards are available for spinal cord injury (SCI). The International SCI Data Sets were created in 2002 and there are currently 27 freely available. In 2014 the National Institute of Neurological Disorders and Stroke developed clinical common data elements to promote clinical data sharing in SCI. The objective of this paper is to provide an overview of SCI data standards, describe learnings from the traumatic brain injury (TBI) field using data to enhance research and care, and discuss future opportunities in SCI. Given the complexity of SCI, frameworks such as a systems medicine approach and Big Data perspective have …

Position- And Sex-Related Differences In Sagittal And Frontal Plane Concentric Isokinetic Hip Muscle Peak Torques And Agonist-Antagonist Ratios, Lisa T. Hoglund, Matthew C. Schiffino, James E. Freels, Isabella G. Romano

Department of Physical Therapy Faculty Papers

BACKGROUND: Hip muscle weakness is associated with many musculoskeletal conditions and athletic injuries. Isokinetic testing is often performed to measure a patient's strength or to assess treatment response. Patient sex and positioning during isokinetic strength testing may influence peak torque production and the agonist-antagonist peak torque ratios. However, different test positions are used clinically and in research to measure hip muscle strength. It is unknown how patient test position or sex impacts test results.

HYPOTHESIS/PURPOSE: The purpose of this study was to determine whether concentric isokinetic peak torques of sagittal and frontal plane hip muscles differ when tested in recumbent …

Harmful Or Helpful? A Content Analysis Of Online ‘Yoga For Low Back Pain’ Videos, Travis Pollen, Jenni Rawlings, Lindsey Burns, Dylan Lloyd, Natalie Pifer, Sheri Silfies

Department of Exercise Science Posters

INTRODUCTION

• Low back pain (LBP) is one of the most prevalent musculoskeletal conditions worldwide (Walker, 2000).
• To self-manage LBP, yoga is often used.
• One convenient and common way to access yoga practices specifically dedicated to LBP is through the internet.
• However, the informational quality of online yoga for LBP videos has not been investigated.

PURPOSE

• To determine the prevalence and nature of potentially problematic narratives in popular online yoga for LBP videos.

METHODS

• A deductive content analysis was conducted on the 30 most-viewed yoga for LBP videos on a popular online video platform.
• The themes of interest were the purported …

Ancds Diversity Writing Group Discussion: The Evidence Base For Neuro-Rehabilitation Of Acquired And Degenerative Communication Disorders In Diverse Populations: What Is Available, What Is Needed, And Reasons Why, Gloriajean Wallace, Ivan Portillo, Latoya Roberts, Whitney Postman, Gerald Imaezue, Anthony Pak-Hin Kong, Taryn Malcolm

Library Presentations, Posters, and Audiovisual Materials

This presentation will discuss evidence-based practice (EBP), with a focus on available research that supports the neurorehabilitation care of people with neurogenic disorders, including the increasingly large number of people from culturally and linguistically diverse communities.  Presenters will provide the audience with preliminary findings of the ANCDS Diversity Writing group.  Presenters will then provide the audience with thoughts about topics related to neurorehabilitation care of people from diverse communities, including topics relating to academic and clinical training, professional training, current practices, and conversation focused on cultural and linguistic considerations including the use of interpreters and translators.  The presentation will pinnacle …

Dance Inclusivity For People With Low Vision, Emma Winckler

Honors Theses

The primary concentration of my project was providing education to promote inclusivity in dance for people with low vision. My objectives for this project were to create a literature review relating to my project, create an educational infographic for how to best support those with low vision in a dance class, and share the infographic I created with the WMU dance department and at the Barbra Rider Colloquium.

Dance has been an integral part of my life and in my experience, I’ve never seen dance opportunities provided to people with low vision. After looking more into dance with low vision …

Bridging The Gap Between Occupational Therapy And Therapeutic Horseback Riding: An Interdisciplinary Approach To Further Engagement In Childhood Occupations, Veronica Smith

Honors Theses

My name is Veronica Smith and I have been a CTRI (certified therapeutic riding instructor) since 2022. I began volunteering at a therapeutic riding program center in elementary school and have accumulated 5000+ hours of experiences that instilled this passion in me. With these experiences, I recognized a gap and developed my thesis project with a clear vision.

With a passion for occupational therapy, and a special interest in equines, I focused my undergrad honors thesis project that also served as my baccalaureate project for the occupational therapy assistant program around these values. I created an activity book that can …

A 7-Item Tampa Scale For Kinesiophobia In People With Femoroacetabular Impingement Syndrome: Evaluation Of Structural Validity, Hypothesis Testing, Internal Consistency And Minimally Important Change, Myles C. Murphy, Ebonie K. Rio, Mark J. Scholes, Denise M. Jones, Marcella Pazzinatto, Richie Tj Johnston, Sally L. Coburn, Joanne L. Kemp

Research outputs 2022 to 2026

Background: The 17-item Tampa Scale for Kinesiophobia (TSK) is a commonly used patient-reported outcome measure (PROM) to assess kinesiophobia, but the measurement properties of the TSK in people with femoroacetabular impingement syndrome (FAIS) are unknown. Objectives: 1) Revise the existing TSK by removing items, as needed, with inadequate functioning to optimise the TSK for people with FAIS, and 2) evaluate construct validity (both structural validity and hypothesis testing), internal consistency, and minimal important change. Methods: Cross-sectional cohort study including 153 young adults with FAIS. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate structural validity and …

A Geriatric Interprofessional Education Workshop: A Mixed Method Study, Patricia Watford, Meghan Hall, Colleen Hergott, Wanda Jirau-Rosaly, Shilpa Brown, Elena Wood, Nicole Rockich-Winston

Journal of Applied Disciplines

Interprofessional healthcare teams are essential for meeting the needs of our older population. To prepare for interprofessional collaboration, educational programs should offer opportunities for interprofessional education. We created a four-hour geriatric interprofessional workshop addressing cognition, macular degeneration, dysphagia, home safety, fall risk, and pharmacotherapy to examine student perceptions of working in interprofessional teams and their attitudes toward geriatric patients. Participants included 189 second-year medical (MD) students, 41 first-year occupational therapy (OT) students, and 36 second-year physical therapy (PT) students. We utilized a sequential explanatory mixed-method approach. Data analysis comprised descriptive statistics, paired t-tests for the pre/post surveys, and inductive content …

Observers Have Similar Improvements In Student Learning Outcomes As Participants In Athletic Training Simulation Education: A Pilot Study., Alma R. Mattocks Phd, Atc, Chse, Sara E. Mahoney Phd, Facsm, Rachele E. Vogelpohl Phd, Atc, Kim Hawkins Phd, Aprn, Fnp-C

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Introduction: The use of standardized patient (SP) encounters in athletic training education programs have become more common; however, due to time and space constraints, it is possible that not all athletic training students will be able to participate and some must be observers. The objective of this study was to determine if observers experience similar improvements in student learning outcomes as participants for SP encounters. Methods: A pretest/posttest, non-randomized controlled trial was utilized. Nine athletic training students volunteered to participate in the research study. All participants completed a pretest survey including a knowledge assessment and confidence rating scale, followed by …

Relationship Between Posterior Tibial Artery Blood Flow And Lower Leg Flexibility Among Collegiate Runners, Jeffrey Williams, Megan Battles, Rachel Bowden, Cameron Greene, Arbin Thapaliya, Justin Stanek

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Purpose: Understanding relationships between blood flow and muscle inflexibility in the lower leg can support improved healthcare competency. Sports medicine practitioners might use the reference ranges and knowledge of relationships among these variables to support effective health screenings among their competitive runners. These variables have been linked in other areas of the body where inflexibility in the pectoralis minor and scalene muscles have been associated with diminished blood flow to the upper limb. No studies, however, have examined the relationship between vascular and mobility characteristics in the lower legs of runners. Therefore, the purpose of this study was to examine …

Bidirectional Nature Of Work Family Conflict: Family Interfering With Work Conflict Among Athletic Trainers In The Collegiate Setting, Stephanie M. Singe, Milana Adaspour, Alexandrya Cairns, William Pitney

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Introduction: Work-family conflict is bidirectional, yet research has largely only investigated the extent to which work interferes with family conflict (WIFC) and not whether family interferes with work conflict (FIWC). Objective: Investigate FIWC among collegiate athletic trainers. Specifically, we were focused on relationships between gender, marital status, employment status of the athletic trainer’s spouse, and number of children. Methods: Data were collected via a cross-sectional, online survey (Qualtrics). Descriptive statistics were calculated for demographic information; Mann Whitney U analyses were utilized to discover differences between gender, marital status, employment status of spouse, and number of children.

Results: 984 (605 women, …

Athletic Trainer Emergency Management Skill Assessment Via Low Fidelity Simulation, Jaclyn B. Arduini, Jennifer L. Volberding

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Introduction: Athletic training education requires the inclusion of emergency management (EM) best practices, however the Board of Certification (BOC) does not mandate any continuing education (CE) past Emergency Cardiac Care (ECC). With EM best practices continuing to change there is potential for a large knowledge gap to develop in practicing athletic trainers (ATs) who do not chose to engage in EM CE. The purpose of this study was to identify knowledge gaps in practicing ATs’ EM skills via low fidelity simulation. Methods: A cross-sectional study was conducted in an educational laboratory setting involving twenty-two ATs (age 36.7±10.8 years; 13 males, …

Telehealth Education In Athletic Training, W. David Carr, Mccall E. Christian, Jennifer L. Volberding, Zachary K. Winkelmann

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Context: Within the broad telehealth education literature, there are numerous case studies and position statements from various associations of model practices. Little is known about how athletic training is addressing telehealth education. Objective: To determine how athletic training education programs teach, assess, and structure telehealth content. Design: Cross-sectional study Setting: Online survey instrument Patients or Other Participants: An institutional athletic training faculty member from 82 athletic training programs in the United States. Data Collection and Analysis: The survey contained the validated Telehealth Evaluative Content in Higher Education (TECHE) instrument, which consisted of descriptive items focused on how education programs teach, …

Athletic Training Students’ Experiences And Perceptions Of Exertional Heat Stroke Simulated Encounters: A Qualitative Analysis, Hannah L. Stedge, Malissa Martin, Beth L. Kinslow, Valerie Herzog, Christine Reyes

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Introduction: Athletic trainers are trained to recognize exertional heat stroke (EHS), which is critical to implementing lifesaving measures. Rectal thermometry is the best practice for recognizing EHS, and the Commission on Accreditation of Athletic Training Education (CAATE) requires students to learn rectal thermometry. Rooted in transformative learning theory, this study explored the perceptions and experiences of athletic training students following simulated EHS encounters with either high-fidelity (HF) simulators or standardized patients (SPs). Methods: This was a qualitative study using phenomenological theory. Through semi-structured qualitative interviews, we explored participants' personal experiences and perceptions following their simulation interventions. Participants included sixteen first-year …

Utility Of The Vestibular/Ocular Motor Screening In Military Medicine: A Systematic Review, Carrie W. Hoppes, Tomas Garcia De La Huerta, Stefanie Faull, Margaret Weightman, Margaret Stojak, Leland E. Dibble, Ryan Pelo, Peter C. Fino, Holly Richard, Mark E. Lester, Laurie A. King

Physical Therapy Faculty Publications

Introduction

The Vestibular/Ocular Motor Screening (VOMS) was created as a brief clinical screening tool for identifying vestibular and ocular motor symptoms and impairments post-concussion. It was found to have predictive validity in correctly identifying concussed athletes from healthy controls. In 2018, the Military Acute Concussion Evaluation 2 (MACE2) replaced the original Military Acute Concussion Evaluation (MACE); the most prominent change between the MACE and MACE2 was the addition of the VOMS. Despite its adoption into military medicine, it is not known if the addition of the VOMS to the MACE2 is acutely helpful, and if it provides additional information for …

Exploring The Perceived Effects Of Integrating Unloader Braces And Exercise Therapy Interventions In Orthopedics And Sports Medicine: An Investigation Among Athletes With Knee Osteoarthritis, Lerome D. Pratt

Doctoral Dissertations and Projects

The purpose of this doctoral applied research project was to examine the perceived effects of integrating unloader braces and exercise therapy interventions within orthopedics and sports medicine, specifically focusing on athletes diagnosed with knee osteoarthritis (OA). The problem addressed by this study is the limited understanding of how combined treatment modalities can enhance functional abilities, alleviate pain, and improve overall well-being in this population. This research was driven by the rationale that existing conventional treatments often provide limited efficacy, necessitating a more comprehensive and personalized approach. The central research question explored how athletes with knee OA perceive the impact of …

Art As An Intervention For Healing And Empowerment, Erin Barrus

The Open Journal of Occupational Therapy

Komal Patel, an occupational therapist and artist residing in New Jersey, USA, provided the cover art for the Fall 2024 issue of the Open Journal of Occupational Therapy (OJOT). “Emotions” is a piece made from acrylic on canvas that depicts the emotional complexities the human mind goes through during a person’s experience or stage of life. The inspiration comes from her personal journey of moving to the United States from India and the emotional turbulence, both negative and positive, she experienced. Art has become part of the healing story for herself and others. She shares how incorporating this intervention leads …

Preventing Musculoskeletal Disorders In Navajo Weavers, Ramona F. Yazzie, Kimberly Masker, Kristin Biggins

The Open Journal of Occupational Therapy

The Navajo Nation is one of the many reservations that lack access to health care services, leading to increasing chronic health conditions. Navajo rug weaving is a common creative occupation on the reservation. Navajo rug weaving involves multiple steps in creating a beautiful rug. The multiple steps include repetitive gripping, pinching, reaching, pulling, and prolonged sitting. Therefore, weavers are at risk for developing musculoskeletal disorders (MSDs), preventing individuals from participating in meaningful occupations. Occupational therapists have the skills to provide appropriate education through active listening, visual handouts, and family members. However, occupational therapists must demonstrate and understand cultural sensitivity to …

Social And Environmental Determinants Of Occupation And The Need For An Intersectional Approach To Culturally Meaningful Practice, Diane Smith

The Open Journal of Occupational Therapy

To provide culturally-centered care to clients and develop interventions that meet the client’s holistic needs, occupational therapists need to consider social and physical environments affecting participation in culturally meaningful occupations. Using a case study, this paper describes the use of the concept of social and environmental determinants of occupation (SEDO) as a necessary strategy to incorporate in clinical practice to determine how SEDO intersect, resulting in occupational justices/injustices that influence access to participation. SEDO are defined as broad (and intersecting) social and environmental factors that increase or limit an individual, community, or population’s ability to participate in culturally meaningful occupations …