Rehabilitation and Therapy Commons^™

Interventions For Sleep Problems In Pediatrics, Chelsea Rogers, Marie Trevisan, Maureen Traxler

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Julie Anderson, DrOT, OTR/L, will be conducting screenings and providing treatment for children with sleep problems in the Puyallup School District of Washington. To assist her in this emerging practice area, a systematic search and critical appraisal of research published between 2000 and January, 2017 was completed to address the question, “What is the current evidence regarding sleep intervention effectiveness in school-aged children?” The majority of research has investigated the use of behavioral interventions for improving child sleep. These studies included children with developmental disabilities (DD), attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), oppositional defiant disorder (ODD), sensory …

Cognitive And Occupationally-Based Assessments In Acute Care: For Individuals With Acquired Brain Injury, Jillian Harrison, Stephanie Lenk, Brooke Logan

School of Occupational Therapy Master's Capstone Projects (2016-2021)

The student researchers collaborated with Marcy Boschee, OTR/L, an occupational therapist practicing in the acute care unit at St. Joseph's Medical Center in Tacoma, WA to investigate two clinical questions: [1] “What evidence is there for the effectiveness of the Montreal Cognitive Assessment (MoCA) in predicting functional cognitive impairment of patients 18-years-old and older in acute care who have sustained an ABI?” and [2] “Which occupationally-based cognitive assessments, feasible to use in the acute care setting, are most effective at predicting functional impairment in patients 18-years-old and older with mild to severe ABI?” A systematic review was conducted and 29 …

Rate And Duration Of Adaptive Equipment Use Post-Discharge And Factors Affecting Use Post-Discharge, Elizabeth Goodwin, Elizabeth Siska, Jamie Theuer

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Patients in in-patient rehabilitation are often discharged with adaptive equipment in order to be safe and independent in their homes, as is the case for patients at ManorCare, a skilled nursing facility in Tacoma, Washington. However, if adaptive equipment that is functionally necessary is not being used by the patient, it can lead to reduced independence and safety, potentially resulting in incidents that result in injury and re-admittance. Therefore, Rehabilitation Director Joette Jindra, OTR/L requested research to understand the factors that contribute to continued use or non-use after discharge to assist therapists in their clinical decision-making when making equipment provisions …

Impact Of Trauma On Brain Morphology & Maladaptive School Behaviors, Brandon Escobar, Sharlene Lavaris, Teresa Le

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Wendi Trummert, DrOT, OTR/L, the collaborating clinician for this project, works with students in a self-contained program. Wendi wanted to know how childhood trauma affects brain structure and morphology and how it is linked to behaviors seen in children affected by trauma. A synthesis of all articles looking at the brain reveals differences in both structure and function in the brains of individuals exposed to childhood trauma versus those not exposed (e.g. Daniels, Lamke, Gaebler, Walter, & Scheel, 2013; McGowan et al., 2009; Saleh et al., 2017). A synthesis of articles looking at maladaptive behaviors finds that those often seen …

Lymphedema Assessments, Jessica Enyeart, Cullyn Foxlee, Divina Ramolete, Connie Colleen Wyatt

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Heidi Shaffer, a MultiCare occupational therapist specializing in lymphedema (LE) management, proposed the research question of whether bioimpedance spectroscopy (BIS) via the L-Dex (U400 Impedimed) is the most reliable, valid, cost-effective and time-efficient assessment tool on the market for measuring LE in comparison to circumferential measurements (CM). Shaffer currently uses the L-Dex in practice and hoped to substantiate its psychometrics from the literature to promote its clinical usage and potentially obtain consistent insurance coverage. A critical appraisal of the literature revealed a strong correlation between BIS and CM, suggesting that both can be used reliably and validly in clinical practice. …

School-Based Tier Ii And Iii Rti Interventions For Children Affected By Trauma, Sarah Ladderud, Maria Randall, April Crabtree

School of Occupational Therapy Master's Capstone Projects (2016-2021)

We partnered with Wendi Trummert, DrOT, OTR/L, an occupational therapist in a school district in Puyallup, Washington. We collaborated to examine what school-based Tier II & Tier III Response to Intervention (RTI) interventions can be used by occupational therapists, teachers, and paraeducators to improve school participation in children aged 3-13 who have experienced trauma. It was found that various forms of Cognitive Behavioral Therapy (CBT) interventions may reduce post-traumatic stress disorder (PTSD) symptoms, depression, and anxiety in children age birth - 13 who have experienced trauma. CBT was the most effective intervention based on the current literature. Additionally, there is …

Strategies For Effective Collaboration Among Multidisciplinary Teams: Integration Of An Aba Professional, Elizabeth Schroeder, Kalene Lynch, Allison Turgeon

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Our collaborating practitioner (CP), Kari Tanta, PhD, OTR/L, FAOTA, manages Valley Medical Center which is a multidisciplinary pediatric outpatient therapy clinic. Dr. Tanta was seeking research to support incorporating an applied behavior analysis (ABA) professional into VMC’s practice. The focused question became, “What are strategies to promote successful collaboration when integrating a Board Certified Behavior Analyst (BCBA) into an established multidisciplinary pediatric clinic to promote best practice for clients?” From September 2016 - January 2017, 26 articles were analyzed using a critically appraised topic (CAT) table. The literature indicated effective health care team collaboration yields positive patient outcomes, provided strategies …

Determining The Efficacy Of The Use Of Instrument Assisted Soft Tissue Mobilization In Hand Therapy, Kaitlin Chaput, Sarah Clue, Yoseph Kim, Evan Kimpton

School of Occupational Therapy Master's Capstone Projects (2016-2021)

In collaboration with Brian Chase, CHT, OTR/L of NW Sports Physical Therapy in

Tacoma, WA, our research group addressed his question of whether instrument assisted soft tissue mobilization (IASTM) is effective for clients and if so, are certain brands such as Graston Technique (GT) or Astym more effective. Through our careful review of the literature, summarized in a critically appraised topic format, we found that the majority of studies (case reports and experimental studies) found that IASTM treatments improved scores on outcome measures including return to occupation, range of motion, pain, and grip and pinch strength over baseline measurements. However, …

A Review Of Health Related Quality Of Life Assessments For Patients With Lymphedema, Bonnie C. Blair, Gina M. Dellino, Jennifer E. Thomas

School of Occupational Therapy Master's Capstone Projects (2016-2021)

In collaboration with Heidi Shaffer, one of the occupational therapists on staff at the MultiCare lymphedema clinic in Gig Harbor, Washington, we sought to answer the question “Which patient-reported outcome assessments are most valid and reliable in measuring health-related quality of life (HRQoL) in patients with lymphedema?” We conducted a systematic literature review to answer this question. In reviewing selected databases, 19 articles were chosen to appraise the evidence supporting psychometric properties and clinical utility of 10 HRQoL assessments used for patients with lymphedema. The Disability of the Arm, Shoulder and Hand (DASH) and Lymphedema Life Impact Scale (LLIS) assessments …

Social Skills Interventions For Adolescents With Asd, Adhd, And Other Comorbidities, Margaret Batson, Sarah Elliott, Gary Lam, Nora Seimears

School of Occupational Therapy Master's Capstone Projects (2016-2021)

This project was part of a research initiative to collaborate with Kristin Brubaker, MSOT, OTR/L, practicing pediatric occupational therapist at the Center for Therapeutic Intervention (CTI). CTI is an outpatient, private pediatric occupational therapy clinic in Gig Harbor, WA. The purpose of our project was to determine existing and effective interventions to improve social skills in adolescents, ages 11 to 18 years, with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), sensory processing disorder (SPD) and other sensory processing issues. Our search of the literature yielded a total of 22 research studies, with the majority representing group-based interventions. Limited …

Episodic Versus Continuous Care In Outpatient Pediatric Clinics, Rebecca Newman, Kimberly Mcgarvey, Laura Hoppe

School of Occupational Therapy Master's Capstone Projects (2016-2021)

UW Medicine Valley Medical Center, Children’s Therapy (VMC-CT) has experienced difficulties with consistent service delivery schedules for their clients. Long waitlists, absences, and scheduling and insurance constraints have impeded client ability to receive standard, continuous therapy. Thus, this critically appraised topic (CAT) paper addresses a research question developed in conjunction with Kari Tanta, PhD, OTR/L, FAOTA, the Rehabilitation Manager at VMC-CT, to understand the most effective methods of service delivery: episodic therapy (i.e. high frequency over a short duration) or continuous therapy (i.e., low frequency over a longer duration). The following research question was developed: Is episodic pediatric care as …

Anxiety In Children: Intervention Strategies, Nina Handojo, Christine Hsu-Nazzal, Nadia Kabbani

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Three occupational therapy graduate students at the University of Puget Sound partnered with a practicing pediatric occupational therapist to investigate effective interventions for anxiety in children in the literature. A Critically-Appraised-Topic (CAT) was performed on the research question: Which interventions geared towards school-aged children between 5 and 18 with anxiety and related disorders are effective in reducing symptoms and increasing participation in school and meaningful occupations as compared to no intervention?

Cognitive Behavioral Therapy (CBT) was found to have the strongest research base and the strongest positive outcomes. Gains were maintained following CBT even 10-26 weeks post-treatment. Other promising interventions …

Identifying And Implementing Assessments Of Upper Extremity Motor Control For Patients With Stroke Or Parkinson’S Disease, Julia Albright, Kayla Karelsen, Allison Lucas

School of Occupational Therapy Master's Capstone Projects (2016-2021)

The authors collaborated with a team of clinicians at a skilled nursing facility (SNF) in Gig Harbor, WA to identify the need for measures of UE functional use that are most appropriate to utilize with the two largest client populations at their facility, stroke and Parkinson’s disease (PD). In order to meet the clinical utility characteristics identified as important by the clinicians, the authors searched two databases that contain overviews of assessments. This search identified five stroke assessments and two PD assessments that met the clinical utility parameters outlined by the clinicians. The authors then conducted a systematic literature search …

Seeing Relief: Mirror Box Therapy As A Treatment For Chronic Regional Pain Syndrome, Danielle Watson, Mel Velsher

School of Occupational Therapy Master's Capstone Projects (2016-2021)

In collaboration with an occupational therapist who works in a physical therapy private practice as a hand therapist, the following clinical questions were identified: Is mirror box therapy (MT) effective in reducing pain for patients with complex regional pain syndrome (CRPS); secondary to orthopedic injury or peripheral nerve damage in the upper extremity (UE)? What protocols and dosages are the most effective? A structured review of the literature identified 18 studies that focus on the use of MT for CRPS of the UE: one meta-analysis of systematic reviews, five systematic reviews (SR) and 12 individual studies of which four are …

Four Effective And Feasible Interventions For Hemi-Inattention Post Cva: Systematic Review And Collaboration For Knowledge Translation In An Inpatient Rehab Setting., Elizabeth Armbrust, Domonique Herrin, Christi Lewallen, Karin Van Duzer

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Purpose: To locate, evaluate, and summarize the evidence for effective and feasible interventions to treat hemi-inattention in inpatient rehabilitation settings and ensure knowledge translation with a collaborating clinician Timothy Rich, OTR/L and his team at Harborview Medical Center. Design: Systematic literature review, participatory active research with a collaborating clinician, and knowledge translation. Methods: Included studies that tested effectiveness of mirror therapy (MT), transcutaneous electric nerve stimulation (TENS), limb activation therapy (LAT), and visual scanning therapy (VST). 11 databases were searched to yield 31 articles included in a critically appraised topic (CAT) table. A concise protocol for each …

Comparison Of Four Cognitive Screening Tools: Clinical Utility In A Skilled Nursing Setting And Relationship To Discharge Location, Liliya Bachinskaya, Alina Muller

School of Occupational Therapy Master's Capstone Projects (2016-2021)

A systematic review of 34 articles was conducted to answer the following clinical questions posed by Joette Jindra, the Director of Rehabilitation, at ManorCare of Tacoma: “Which cognitive screen, out of the four we are currently using, most accurately measures a patient's functional cognitive performance?” and “How well do cognitive tools and measures predict a client’s discharge setting from a skilled nursing facility (SNF)?”. Results indicate the Montreal Cognitive Assessment (MoCA) to be the most clinically useful tool for detecting mild cognitive impairment (MCI) as it demonstrated the greatest sensitivity across studies and diagnoses. The evidence did not support the …

A Critical Appraisal And Participatory Action Research Project On Effectiveness Of Weighed Vests For Early Elementary Children With Asd, Luna Blossom, Arielle Langworthy, Sarah Steckel

School of Occupational Therapy Master's Capstone Projects (2016-2021)

A Tacoma Public School clinician approached the University of Puget Sound with a research question regarding the effectiveness of weighted vests to increase on-task behaviors and decrease problem behaviors (such as self-injurious behaviors) of students ages 3-12 with ASD. A structured literature review produced eleven studies (six single subject experimental studies and five systematic reviews) published on or after 2005 and presented evidence ranging from no evidence of effectiveness, to inconclusive results, to some rare positive effect results with weighted vest usage related to increasing on-task and decreasing self-injurious behaviors within the target population. Of the six single subject experimental …

Clinical Utility Of The Weefim As A Mandated Outcome Measure: Navigating The Needs Of The Organization, Client And Clinician, Elise Brown, Andrea Hokanson, Tricia Turner

School of Occupational Therapy Master's Capstone Projects (2016-2021)

Local outpatient pediatric occupational therapists expressed a need for evidence to support the use of the Functional Independence Measure for Children (WeeFIM) as a universal measure for evaluations in their facility. We summarized the evidence addressing the psychometrics of the WeeFIM and a comparison instrument, the Pediatric Evaluation of Disability Inventory (PEDI). We ultimately made a recommendation for the PEDI based on its better evidence history for children with autism. The collaborating clinicians received an organizational mandate to implement use of the WeeFIM. We surveyed them to better understand their knowledge translation process. Themes from surveys were inserted into the …

Sensory Interventions In Schools: A Literature Review And Knowledge Translation Project, Cordelia Nwogu, Kelly Peterson

School of Occupational Therapy Master's Capstone Projects (2016-2021)

A literature review of sensory interventions that are possible in a school setting by occupational therapists was completed based on Jennifer Burke’s, a Franklin Pierce Public Schools occupational therapist, question. Her question was what sensory interventions have been shown to be effective for decreasing negative behaviors and/or increasing participation that could be used in a school setting. Most sensory based interventions (SBI) had only weak evidence in support. Sensory integration therapy (SIT) showed more promise for achieving individual goals. Because of the mix of evidence it was recommended that if a clinician chooses to use SBI or SIT they should …

Cognition In Clients With Acute Tetraplegia: Why Assessment Matters, Olivia Allen, Michael Dewilde, Jon-Erik Golob

School of Occupational Therapy Master's Capstone Projects (2016-2021)

The authors of this research project collaborated with Sarah Bicker, OTR/L, an acute care therapist working at Harborview Medical Center in Seattle, WA to investigate two clinical questions: [1] “What is the correlation between high-level (C1-C7) spinal cord injury (SCI) and cognitive impairment?” [2] “Which assessments are most effective for evaluating cognition in adult clients who have very limited motor and/or verbal abilities and could potentially be used with clients who have acute high-level spinal cord injuries?” A review of the research revealed that common comorbidities, including orthostatic hypotension, sleep apnea, and traumatic brain injury, often affect cognition in clients …

Impact Of Garden Spaces On Dementia Residents: Translating Evidence-Based Research Into Clinical Practice, Angela Ko, Jenna Williams

School of Occupational Therapy Master's Capstone Projects (2016-2021)

The research addressed the following focused question: “Do garden spaces decrease the incidence of behaviors such as combativeness and agitation, psychiatric medication use, depression, falls, cognitive decline, and sleep disturbance in clients with dementia in a residential facility?” The research team collaborated with staff at a skilled nursing facility in an urban area of the Pacific Northwest. Appraisal of existing research revealed multiple potential benefits of residents’ with dementia utilizing garden spaces for wandering and/or therapeutic activities. Based on these findings, the research team recommended implementation of an on-site garden. To support the implementation of these findings, the research team …