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Articles 1 - 30 of 402
Full-Text Articles in Medicine and Health Sciences
Perspectives Of Occupational Therapy Practitioners On Benefits And Barriers On Providing Occupational Therapy Services Via Telehealth, Taylor Corey
Student Capstone Papers
The purpose of this project is to gain a better understanding of the provider’s perspectives about the strengths and barriers of occupational therapy (OT) services provided via telehealth. Based on the evidence that will be collected through surveys and interviews, this research can help determine specific factors on whether or not therapist choose to provide services through telehealth. Centered around those perspectives of telehealth, the results can help explore more in depth on the issues and concerns therapists have regarding telehealth as a service delivery model.
Caregiver Perspectives On Telehealth: A Service Delivery For Occupational Therapy, Rebecca Johnston
Caregiver Perspectives On Telehealth: A Service Delivery For Occupational Therapy, Rebecca Johnston
Student Capstone Papers
Telehealth; also known as telerehabilitation, telecare, telemedicine, teletherapy, and telepractice; is an emerging healthcare service that is utilized in various healthcare facilities with a span of ages, conditions, and locations (World Federation of Occupational Therapy [WFOT], 2014). Telehealth utilizes information and communication technologies to deliver services to a patient when the healthcare provider is not in the same location (WFOT, 2014). Telehealth can provide an online platform for evaluations, consultations, monitoring, supervision, and intervention with patients and other professionals (WFOT, 2014).
Telehealth is an emerging method of delivering occupational therapy (OT) services to various populations, including: children and youth; productive …
Wheelchair Propulsion For Everyday Manual Wheelchair Users: Repetition Training And Machine Learning-Based Monitoring, Pin-Wei Chen
Wheelchair Propulsion For Everyday Manual Wheelchair Users: Repetition Training And Machine Learning-Based Monitoring, Pin-Wei Chen
Arts & Sciences Electronic Theses and Dissertations
Upper limb pain and injuries are prevalent among manual wheelchair users and can restrict their participation and daily activities. Due to the high repetition and force in wheelchair propulsion, chronic wheelchair propulsion has been linked to the risk of upper limb pain and injury. Prevention of upper limb pain and injury is a high priority in wheelchair-related research. Decades of research in wheelchair propulsion biomechanics have led to clinical practice guidelines (CPG). Unfortunately, a decade after the publication of the CPG, CPG-recommended propulsion is still uncommon. Hence, for the first aim, a randomized controlled trial pilot study with two groups …
Caregiver Perspectives On Telehealth: A Service Delivery For Occupational Therapy, Rebecca Johnston, Becki Cohill, Susan Macdermott
Caregiver Perspectives On Telehealth: A Service Delivery For Occupational Therapy, Rebecca Johnston, Becki Cohill, Susan Macdermott
San Marcos, Fall 2019
Telehealth; also known as telerehabilitation, telecare, telemedicine, teletherapy, and telepractice; is an emerging healthcare service that is utilized in various healthcare facilities with a span of ages, conditions, and locations (World Federation of Occupational Therapy [WFOT], 2014). Telehealth utilizes information and communication technologies to deliver services to a patient when the healthcare provider is not in the same location (WFOT, 2014). Telehealth can provide an online platform for evaluations, consultations, monitoring, supervision, and intervention with patients and other professionals (WFOT, 2014).
Telehealth is an emerging method of delivering occupational therapy (OT) services to various populations, including: children and youth; productive …
Perspectives Of Occupational Therapists On Telehealth, Taylor Corey, Becki Cohill, Susan Macdermott
Perspectives Of Occupational Therapists On Telehealth, Taylor Corey, Becki Cohill, Susan Macdermott
San Marcos, Fall 2019
The purpose of this project is to gain a better understanding of the provider’s perspectives about the strengths and barriers of OT services provided via telehealth. Based on the evidence that will be collected through surveys and interviews, it can help determine specific factors on whether or not therapist choose to provide services through telehealth. Centered around those perspectives of telehealth, the results can help explore more in depth on the issues and concerns therapists have when it comes to telehealth as a service delivery model.
The Role Of Occupational Therapy For Survivors Of Human Trafficking, Margaux Mariano, Becki Cohill, Susan Macdermott
The Role Of Occupational Therapy For Survivors Of Human Trafficking, Margaux Mariano, Becki Cohill, Susan Macdermott
San Marcos, Fall 2019
Human trafficking involves sex trafficking, labor trafficking, and trafficking of children. The needs of survivors of human trafficking are widespread due to the traumatic experiences they face. Concerns that may arise include decreased participation in meaningful activities in an individual's life, possibly due to anxiety, depression, suicidal ideation, memory loss, posttraumatic stress disorder, and social isolation. Individuals who have been subjected to human trafficking often experience occupational deprivation and occupational therapy has yet to establish its role in the recovery process for survivors. This poster presents a capstone project consisting of the process towards the development of an occupation-based, trauma-informed, …
Occupational Therapy's Role In Maternal Mental Health Within Transition From Nicu To Home, Victoria Briltz, Becki Cohill, Susan Macdermott
Occupational Therapy's Role In Maternal Mental Health Within Transition From Nicu To Home, Victoria Briltz, Becki Cohill, Susan Macdermott
San Marcos, Fall 2019
The purpose of this capstone project is to identify OT’s role in maternal mental health following the transition home from a NICU setting. This capstone project focused on mothers’ roles, routines, and environment during the transition from the NICU to home. Mothers may feel unprepared for the discharge home when their babies are ready to leave the NICU (Boykova, 2016). Occupational therapists address occupational performance through skilled interventions for women during the perinatal period; however, there is a lack of evidence guiding occupational therapy for providing services for maternal wellness (Slootjes, 2016). This capstone project will help share information, ideas, …
Developing Financial Literacy Skills For A Secondary Transition Program For Students With Learning Differences, Rose Marie Borillo, Becki Cohill, Susan Macdermott
Developing Financial Literacy Skills For A Secondary Transition Program For Students With Learning Differences, Rose Marie Borillo, Becki Cohill, Susan Macdermott
San Marcos, Fall 2019
Under the Individuals with Disabilities Education Act (IDEA), schools are required to provide transition planning for students with disabilities and mental illness by age 16 (Eismann et al, 2017). Occupational therapists have been underutilized in secondary transition planning, despite their expertise in targeting functional abilities, comprehension, and health using activity analysis to promote skill attainment and achieve independence (Mankey 2012; Eismann et al, 2017).
At the Winston School, there was no formal transition program aside from the individual college counseling provided by a staff member. A coordinated transition program was indicated to prepare students for life after high school to …
Weight-Bearing Interventions To Decrease Spasticity And Improve Gait In Stroke Patients: A Case Report, Melin Nguyen, Shelby Peterson, Jessika Sun, Irene Taing, Faris Alshammari
Weight-Bearing Interventions To Decrease Spasticity And Improve Gait In Stroke Patients: A Case Report, Melin Nguyen, Shelby Peterson, Jessika Sun, Irene Taing, Faris Alshammari
San Marcos, Fall 2019
The purpose of this case report was to determine the success of weight-bearing interventions on spasticity reduction and improved gait patterns in a 61 year-old-male patient recovering from a chronic left hemorrhagic CVA. The patient’s primary impairments included right upper and lower extremity spasticity, circumduction gait, weakness and decreased range of motion of right extremities.
The interventions included in this patient’s treatment program included standing calf stretches, toe raises, ankle range of motion and gait training for 1 hour once a week for 4 weeks. This case report supports the application of weight-bearing through the paretic limb, which has been …
Lifestyle Management For Individuals With Vestibular Disorders, Michelle Pock, Becki Cohill, Susan Macdermott
Lifestyle Management For Individuals With Vestibular Disorders, Michelle Pock, Becki Cohill, Susan Macdermott
San Marcos, Fall 2019
Individuals with vestibular disorders have concerns that impact lifestyle including limiting activities of daily living, limiting participation in social events, difficulty driving, and difficulty working (Cohen, 2014). Occupational therapists are able to help individuals with vestibular disorders by task analyzing symptom provoking activities, assessing the impact of symptoms on occupations, providing adaptations, and providing ways to modify environments (Gronski, Neville, Kannenberg, & Cohen, 2017). While occupational therapists are qualified to provide services to sustain and improve the occupational performance of individuals with vestibular disorders, occupational therapy is not well represented in this area particularly in addressing lifestyle components for vestibular …
Application Of Occupation-Based Models To Edward Of Edward Scissorhands: Oa And Ehp Models, Amy Griswold, Kelsey Harris, Whitney Marwick, Whitney Wilbanks, Courtney Wild
Application Of Occupation-Based Models To Edward Of Edward Scissorhands: Oa And Ehp Models, Amy Griswold, Kelsey Harris, Whitney Marwick, Whitney Wilbanks, Courtney Wild
San Marcos, Fall 2019
This presentation examines the character Edward Scissorhands, a young adult with hand deformities and poor social skills, through the lens of the Ecological Human Performance (EHP) Model. We propose occupational therapy interventions based off of the EHP model. Through the use of establishing social skills training, as well as adapting and modifying Edward’s hands with tips and attachments, Edward’s life could be immensely improved
Case Study: Efficacy Of Physical Therapy On A Patient With Cva In Normalizing Gait And Shoulder Mechanics, Jane Mongkolvipakul, Amanda Orr, Queenie Lim, Rajbir Basati, Faris Alshammari
Case Study: Efficacy Of Physical Therapy On A Patient With Cva In Normalizing Gait And Shoulder Mechanics, Jane Mongkolvipakul, Amanda Orr, Queenie Lim, Rajbir Basati, Faris Alshammari
San Marcos, Fall 2019
Background & Purpose: Cerebrovascular Accident (CVA) is known as Stroke. It is a damage to the brain due to an interruption of blood supply. Two main types of stroke are ischemic stroke and hemorrhagic stroke. Ischemic stroke, the most common type of stroke, is due to a blocked artery and a hemorrhagic stroke is due to a leak or burst of a blood vessel. Signs and symptoms of stroke are presented contralaterally. The purpose of this case report is to demonstrate the use of PT interventions to improve shoulder function and gait mechanics in a post CVA patient.
Case …
Correlation Between Proprioceptive Processing And Self-Concept In Children Ages Nine To Twelve Years From The Pacific Northwest, Jaclyn Brown Otr/L
Correlation Between Proprioceptive Processing And Self-Concept In Children Ages Nine To Twelve Years From The Pacific Northwest, Jaclyn Brown Otr/L
School of Occupational Therapy Post-Professional Doctoral Theses
Objective: The correlation between proprioceptive processing and self-concept in children ages nine to twelve years of age was investigated.
Method: A descriptive research design was used to examine the results of 40 participants ages 9 to 12 years using the Comprehensive Observations of Proprioception (COP) and the Piers-Harris Self-Concept Scale: 3rd Edition (Piers Harris 3). Participants were recruited through convenience sampling and snowballing strategies. Pearson product moment correlation (r) analyses were used to examine the correlation between variables.
Results: The study sample consisted of 40 participants with 16 females and 24 males. Significant correlations at p = .05 were noted …
Trauma-Informed Care (Tic) Interventions: An Evidence-Based Practice Project, Ryan Anderson, Jenalyn Bigasin, Amal Hassan, Kendra Mertes, Rebekah Muilenburg, Christine Simon, Julia Trnka, Lucy Zeihen, Julie D. Bass
Trauma-Informed Care (Tic) Interventions: An Evidence-Based Practice Project, Ryan Anderson, Jenalyn Bigasin, Amal Hassan, Kendra Mertes, Rebekah Muilenburg, Christine Simon, Julia Trnka, Lucy Zeihen, Julie D. Bass
Graduate Occupational Therapy Research and Projects
This Evidence-Based Practice (EBP) project examined the following question: What are the characteristics and effectiveness of trauma-informed care (TIC) approaches on health and participation (well-being, quality of life) outcomes for populations who have experienced trauma?
Trauma And Health Outcomes: An Evidence-Based Practice Project, Kelly Breuer, Christina Cink, Shawna Geisler, Hannah Hillstrom, Cerena Ice, Olivia Kreuser, Ladislava Mazurkevicz, Hallie Schommer, Jullie D. Bass
Trauma And Health Outcomes: An Evidence-Based Practice Project, Kelly Breuer, Christina Cink, Shawna Geisler, Hannah Hillstrom, Cerena Ice, Olivia Kreuser, Ladislava Mazurkevicz, Hallie Schommer, Jullie D. Bass
Graduate Occupational Therapy Research and Projects
This Evidence-Based Practice (EBP) project examined the following questions: EBP Question What is the relationship between trauma (ACE or traumatic events) and child and adult performance, participation, health and disability outcomes for general and specific populations? What additional person or environment characteristics predict positive or negative outcomes from trauma?
Descriptive Characteristics And Risk Factors For Trauma: An Evidence-Based Practice Project, Hawo Jama, Hibak Jama, Molly Kreutter, Jill Olson Moser, Glory Pierre, Sora Samejima, Naomi Teetzel, Julie D. Bass
Descriptive Characteristics And Risk Factors For Trauma: An Evidence-Based Practice Project, Hawo Jama, Hibak Jama, Molly Kreutter, Jill Olson Moser, Glory Pierre, Sora Samejima, Naomi Teetzel, Julie D. Bass
Graduate Occupational Therapy Research and Projects
This Evidence-Based Practice (EBP) project examined the following question: What are the perspectives, experiences, and self-reports of adult individuals, groups, or populations who have MCI or report problems with Functional Cognition (and / or their caregivers)?
Fragile X Syndrome And Family Occupations: Sertraline Treatment Via Case Studies, Decerie Mendoza, Tracy P. Ye, Martina C. Dualan, Elena A. Javier
Fragile X Syndrome And Family Occupations: Sertraline Treatment Via Case Studies, Decerie Mendoza, Tracy P. Ye, Martina C. Dualan, Elena A. Javier
Student Research Posters
Current research on children with Fragile X Syndrome (FXS) lacks inclusion of qualitative outcomes on the child’s daily occupational performance. Standardized measurements are frequently utilized and provide useful information, however, can be less sensitive to change (Berry Kravis et al., 2013) and miss capturing family perspectives and improvements within meaningful occupations. This research incorporates family perspectives via semi-structured interviews to promote an in-depth understanding about FXS and its impact on child and family occupations in addition to standardized assessment scores through in-depth case study analysis. This study used a mixed method research design examining four male participants who were given …
Training In Trauma-Informed Care (Tic): An Evidence-Based Practice Project, Erin Bugajski, Danielle Erler, Ashley Fosness, Diamond Hill, Jon Lindahl, Lindsay Purcell, Amber Ramirez-Acosta, Joy Smith, Michelle Vacinek, Julie D. Bass
Training In Trauma-Informed Care (Tic): An Evidence-Based Practice Project, Erin Bugajski, Danielle Erler, Ashley Fosness, Diamond Hill, Jon Lindahl, Lindsay Purcell, Amber Ramirez-Acosta, Joy Smith, Michelle Vacinek, Julie D. Bass
Graduate Occupational Therapy Research and Projects
This Evidence-Based Practice (EBP) project examined the following question: What are the characteristics and effectiveness of trauma-informed care (TIC) training on the performance of health professionals and organizations who provide services to populations who have experienced trauma (traumatic events or ACE)?
Trauma Experiences And Perspectives: An Evidence-Based Practice Project, Libby Blattner, Melanie Homan, Ellie Leabch, Jennifer Malwitz, Faye Mcguire, Rachel Mcpherson, Julia Rupp, Maria Tonn, Hannah Zenisek, Julie D. Bass
Trauma Experiences And Perspectives: An Evidence-Based Practice Project, Libby Blattner, Melanie Homan, Ellie Leabch, Jennifer Malwitz, Faye Mcguire, Rachel Mcpherson, Julia Rupp, Maria Tonn, Hannah Zenisek, Julie D. Bass
Graduate Occupational Therapy Research and Projects
This Evidence-Based Practice (EBP) project examined the following questions:
- How do individuals who have experienced trauma or adverse childhood experiences describe their experiences and the impact trauma has had on their life?
- How do healthcare professionals describe their experiences of working with individuals who have experienced trauma or adverse childhood experiences and their perspectives on trauma-informed training and approaches?
Screening And Assessment In Trauma-Informed Care: An Evidence-Based Practice Project, Megan Bender, Beka Bickel, Ashley Hoffmann, Emily Howard, Mykayla Laurie, Yer Lee, Rachael Nelson, Ciara Nervick, Julie D. Bass
Screening And Assessment In Trauma-Informed Care: An Evidence-Based Practice Project, Megan Bender, Beka Bickel, Ashley Hoffmann, Emily Howard, Mykayla Laurie, Yer Lee, Rachael Nelson, Ciara Nervick, Julie D. Bass
Graduate Occupational Therapy Research and Projects
This Evidence-Based Practice (EBP) project examined the following question: What interprofessional and occupational therapy screening and assessment measures are used in trauma-informed care and what are their psychometric characteristics?
Exploring Wheelchair Service Delivery In A Dedicated Seating Department, Cara E. Masselink
Exploring Wheelchair Service Delivery In A Dedicated Seating Department, Cara E. Masselink
Dissertations
This study is a series of three studies aimed at exploring wheelchair service delivery in a department of physical and occupational therapists dedicated to wheelchair seating. The three studies utilized a retrospective analysis to investigate the clinical documentation written by the practicing clinicians between 2007 and 2017. The first study aimed to describe the wheelchair and accessory recommendations made in the 11-year period, in relationship to age and gender. The majority of recommendations in the dedicated seating department were for complex wheelchairs. The results indicated the ratio between standard and complex power mobility devices and four complexities of cushions changed, …
Developing An Ignatian Pedagogy For Occupational Therapy Education In China: The Lived Experience Of The First Two Entry Level Otd, Jesuit Trained Clinicians, Angela Patterson, Alfred G. Bracciano
Developing An Ignatian Pedagogy For Occupational Therapy Education In China: The Lived Experience Of The First Two Entry Level Otd, Jesuit Trained Clinicians, Angela Patterson, Alfred G. Bracciano
Jesuit Higher Education: A Journal
This paper explores the lived experience of the initial two Chinese professionals, competitively selected by a Traditional Chinese Medicine University, to attend and graduate from the Creighton University entry-level Doctor of Occupational Therapy (OTD) program. The process and challenges facing implementation of an international collaborative relationship between a Jesuit university and a public higher education institution in China is considered along with the challenges facing international students immersed in Jesuit health care education. Highlights of differences between Eastern and Western higher education are suggested in the discussion. A review of Jesuit education in China provides the historical background and context …
Exploring The Impact Of An Occupation-Based Group On Self-Esteem And Self-Concept, Christie E B Briskey, Elyse Marie Powderly
Exploring The Impact Of An Occupation-Based Group On Self-Esteem And Self-Concept, Christie E B Briskey, Elyse Marie Powderly
Showcase of Graduate Student Scholarship and Creative Activities
Due to the need for an occupation-focused intervention for childhood cancer survivors, we will be conducting a five week group occupation-based program to explore its impact on self-concept and self-esteem in childhood cancer survivors through occupational exploration and participation. The purpose of our study is to determine the efficacy of a group occupation-based intervention on enhancing areas of psychological well-being such as self-esteem and self-concept in childhood cancer survivors in order to support their transition from childhood to adolescence. Each week we will guide the participants through various activities with creative and self-expressive components such as poetry writing, creative movement, …
The Effect Of Parent-Infant Swim Classes On Maternal Parenting Competence, Emotional Availability, And Aquatic Handling, Hope Sadowski, Chanele Molano
The Effect Of Parent-Infant Swim Classes On Maternal Parenting Competence, Emotional Availability, And Aquatic Handling, Hope Sadowski, Chanele Molano
Showcase of Graduate Student Scholarship and Creative Activities
Low parenting competence and limited emotional availability decrease the quality of the parent-infant relationship (Young, 2011; Sturge-Apple et al., 2012). However, co-occupations, or reciprocal relationships where the occupations of two or more individuals are interactively shaping each other, have been associated with strengthening parent-infant relationships (Pierce, 2009; Price & Stephenson, 2009). Parent-infant swim classes are co-occupation based interventions that facilitate close bodily contact and teach parents handling skills that can generalize into the home. Numerous websites allude to the benefits of these classes; however, there are currently no evidence-based claims supported by the occupational therapy literature. The researchers hypothesized that …
A Participatory Filmmaking Process With Children With Disabilities In Rural India: Working Towards Inclusive Research, Colleen E. Mcgrath
A Participatory Filmmaking Process With Children With Disabilities In Rural India: Working Towards Inclusive Research, Colleen E. Mcgrath
Occupational Therapy Publications
Children with disabilities often experience exclusion within their communities, and this exclusion can extend into research processes. The United Nations Convention on the Rights of the Child, however, emphasizes that children of all abilities need to be involved as decision makers in matters affecting them. This article provides an in-depth description of the process of a participatory action research project carried out with children with disabilities from a rural village in India. It argues for the utility of participatory filmmaking as a research methodology that supports inclusion of children with disabilities as co-researchers in research and action processes. The …
Using Participant Observation To Enable Critical Understandings Of Disability In Later Life: An Illustration Conducted With Older Adults With Low Vision, Colleen E. Mcgrath
Using Participant Observation To Enable Critical Understandings Of Disability In Later Life: An Illustration Conducted With Older Adults With Low Vision, Colleen E. Mcgrath
Occupational Therapy Publications
Research with older adults aging with vision loss has typically been informed by a biomedical theoretical framework. With a growing focus, however, on critical disability perspectives, which locates disability within the environment, new methods of data collection, such as participant observation, are needed. This article, which reports on the findings from a critical ethnographic study conducted with older adults with age-related vision loss (ARVL), aims to share those insights gained through participant observation and to demonstrate the utility of this method. Three insights were gained including the adaptive strategies tacitly employed to navigate the physical environment, a grounded understanding of …
What Can Be Achieved With An Interprofessional Class?, Kitsum Li, Olivia Catolico
What Can Be Achieved With An Interprofessional Class?, Kitsum Li, Olivia Catolico
Kitsum Li
Introduction Recently, educators advocated for interprofessional education to better prepare entry-level healthcare workers for efficient, effective, and respectful teamwork to lower the cost of healthcare and improve the delivery of collaborative quality patient care. This article describes the results of an educational program evaluation of an interprofessional class (IPC) taught over a five-year period between nursing and occupational therapy (OT) departments at a small private university.
Methods During the IPC sessions, a small group of nursing and OT students observed a simulated patient care scenario in which a nursing and an OT student provided care related to their respective discipline. …
What Can Be Achieved With An Interprofessional Class?, Kitsum Li, Olivia Catolico
What Can Be Achieved With An Interprofessional Class?, Kitsum Li, Olivia Catolico
Occupational Therapy | Faculty Scholarship
Introduction Recently, educators advocated for interprofessional education to better prepare entry-level healthcare workers for efficient, effective, and respectful teamwork to lower the cost of healthcare and improve the delivery of collaborative quality patient care. This article describes the results of an educational program evaluation of an interprofessional class (IPC) taught over a five-year period between nursing and occupational therapy (OT) departments at a small private university.
Methods During the IPC sessions, a small group of nursing and OT students observed a simulated patient care scenario in which a nursing and an OT student provided care related to their respective discipline. …
Understanding Participation In A Community-Based Art Program, Melody Taban, Otd, Otr, Gabrielle Kains, Otd, Otr/L, Lydia Navarro-Walker, Otd, Otr/L, Namrata Grampurohit, Phd, Otr/L
Understanding Participation In A Community-Based Art Program, Melody Taban, Otd, Otr, Gabrielle Kains, Otd, Otr/L, Lydia Navarro-Walker, Otd, Otr/L, Namrata Grampurohit, Phd, Otr/L
Department of Occupational Therapy Posters and Presentations
Objectives
- To understand the perceived benefits of occupational engagement with art for people with dementia and their informal caregivers
- To understand the art program’s influence on interpersonal relationships
Health Coaching In Context: A Descriptive Case Study, Caitlin Cadematori, Otd, Otr/L, Samantha Betz, Otd, Otr/L, Winnie Dunn, Phd, Otr/L, Faota, Mj Mulcahey, Phd, Otr/L
Health Coaching In Context: A Descriptive Case Study, Caitlin Cadematori, Otd, Otr/L, Samantha Betz, Otd, Otr/L, Winnie Dunn, Phd, Otr/L, Faota, Mj Mulcahey, Phd, Otr/L
Department of Occupational Therapy Posters and Presentations
Persons with spinal cord injury (SCI) often report challenges with accessing employment, reliable transportation and opportunities for social engagement, resulting in decreased independence and self-efficacy.1 When challenges with access are addressed, participation in valued activities is possible and supports social-emotional health, physical health, and quality of life.2,3
“Health Coaching in Context” is a skillful dialogue that adheres to coaching competencies and draws from the tenets of health coaching and positive psychology. “Health Coaching in Context” reflects authentic client centeredness, and develops problem solving skills that address solutions that lead to meaningful engagement in everyday living despite the presence …