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Full-Text Articles in Rehabilitation and Therapy

Assessing Information Literacy Skills And Library Anxiety Of First-Year Occupational Therapy Graduate Students, Christine Moghimi, Mary C. Rickelman Jan 2021

Assessing Information Literacy Skills And Library Anxiety Of First-Year Occupational Therapy Graduate Students, Christine Moghimi, Mary C. Rickelman

Journal of Occupational Therapy Education

In today’s academic environment, students equipped with self-regulated learning and information literacy (IL) skills have an excellent opportunity for professional success given the current information-based practices in health care. Purposefully providing IL instruction to students early in their coursework will help them develop competent research skills applicable to their remaining studies and scholarly projects. Along with IL challenges, students can experience “library anxiety,” which the literature identifies as a contributing factor to poor academic performance. This study explored components of library anxiety in Master of Occupational Therapy (MOT) students and identified opportunities for IL training that could help students become …


Collaborating With A Transitional Care Unit To Provide Student Hands-On Time: A Win-Win For Hospital And Academic Institution, Emily Grattan, Amanda K. Giles Jan 2021

Collaborating With A Transitional Care Unit To Provide Student Hands-On Time: A Win-Win For Hospital And Academic Institution, Emily Grattan, Amanda K. Giles

Journal of Occupational Therapy Education

Occupational therapy students crave hands-on learning experiences that take place in authentic environments. This study describes an innovative experiential learning activity involving collaboration between an academic institution and an inpatient transitional care unit (TCU). Three cohorts of second year occupational therapy students (N=138) participated in the TCU learning activity, which involved reviewing the electronic medical record, planning and delivering a treatment, documenting the therapy session, and intentionally reflecting on the experience. Based on an optional, anonymous survey, one hundred percent of students reported that “this learning experience was valuable” and “provided opportunity to practice clinical reasoning.” Ninety-nine percent of students …


Needs Assessment, Program Development, And Pilot Testing: Training For Occupational Therapy Students Working With Survivors Of Gun Violence, Lea Fang, Aisha Mohammed, Vicki Kaskutas Jan 2021

Needs Assessment, Program Development, And Pilot Testing: Training For Occupational Therapy Students Working With Survivors Of Gun Violence, Lea Fang, Aisha Mohammed, Vicki Kaskutas

Journal of Occupational Therapy Education

After the first year of operation, members of a student-staffed occupational therapy (OT) clinic found that 36% of their patients’ injuries were violence-related, mostly due to gun violence. The purposes of this project were to identify unmet needs of survivors of violence seen in a clinic setting, identify treating professionals’ preparedness to meet these needs, and develop and pilot test a program within the scope of OT to address these needs. A literature review and key informant interviews, surveys, and focus groups identified potential solutions to address gaps between patients’ needs and professionals’ preparedness to meet those needs. The need …


Effects Of Textured Mat On Lower Limb Muscle Activities And Body Sway In Individuals With Chronic Ankle Instability, Nanthiphak Konphet Jan 2021

Effects Of Textured Mat On Lower Limb Muscle Activities And Body Sway In Individuals With Chronic Ankle Instability, Nanthiphak Konphet

Chulalongkorn University Theses and Dissertations (Chula ETD)

A textured mat with flexible nubs is a novel type of unstable surface offering more texture variety than a conventional unstable surface. A textured mat may be utilized to improve balance and muscular activation in individuals with chronic ankle instability (CAI). The purpose of this study was to compare the effects of a textured mat versus a regular foam surface and a firm surface on lower limb muscle activity and postural control in individuals with CAI. This repeated measurements within subject study recruited 28 participants with CAI. A triaxial accelerometer and electromyograph were used to monitor the 10 muscles of …


Diagnostic Accuracy Of The Timed Up-And-Go Test With Different Types Of Cognitive Tasks For Mild Cognitive Impairment In Older Adults, Kanyakon Chanabangkaew Jan 2021

Diagnostic Accuracy Of The Timed Up-And-Go Test With Different Types Of Cognitive Tasks For Mild Cognitive Impairment In Older Adults, Kanyakon Chanabangkaew

Chulalongkorn University Theses and Dissertations (Chula ETD)

The Timed Up-and-Go test (TUG) test with cognitive tasks was a motor and cognitive dual-task approach used to evaluate the level of cognitive ability in older adults. Moreover, the different types of cognitive tasks challenge different aspects of cognition and impact performance differently. To our knowledge, the accuracy of the TUG test with different types of cognitive tasks still lacks information regarding which cognitive tasks and test outcomes are optimal to use. This study aimed to evaluate and compare the accuracy of the TUG test with different types of cognitive tasks to detect older adults with mild cognitive impairment (MCI). …


Comparing The Effectiveness Of Lumbar Rotation To Central Posteroanterior Mobilization In The Treatment Of Individuals With Bilateral Non-Specific Low Back Pain, Nalinee Eitssayeam Jan 2021

Comparing The Effectiveness Of Lumbar Rotation To Central Posteroanterior Mobilization In The Treatment Of Individuals With Bilateral Non-Specific Low Back Pain, Nalinee Eitssayeam

Chulalongkorn University Theses and Dissertations (Chula ETD)

To compare the effectiveness of lumbar rotation mobilization and central posteroanterior (central PA) mobilization on the intensity of low back pain (LBP), lumbar range of motion (LROM), functional rating index (FRI), and global perceived effect (GPE) in individuals with bilateral non-specific low back pain (NSLBP). Seventy bilateral NSLBP individuals were recruited (19 men and 51 females). The participants were randomly assigned into two groups using concealed opaque envelopes: central PA or rotation. Both groups got a placebo treatment with detuned shortwave diathermy before receiving intervention according to their group assignment. The outcomes were measured at four points: baseline, after placebo …


Cognitive-Motor Interactions In Gait And Postural Control And Cortical Network Neurocorrelates, Nathan Morelli Jan 2021

Cognitive-Motor Interactions In Gait And Postural Control And Cortical Network Neurocorrelates, Nathan Morelli

Theses and Dissertations--Rehabilitation Sciences

The ability to mitigate performance decrements during the concurrent completion of cognitive and motor tasks (i.e., dual task (DT)) deteriorates in patients with mild Traumatic Brain Injury (mTBI). It is theorized that the long-term sequelae of mTBI are due to the return to full activity prior to neurophysiologic healing. To mitigate the negative outcomes associated with mTBIs, translational clinical research of neurophysiologic recovery is of paramount importance for both athletic and non-athletic populations. Despite the well-known health consequences, clinical decisions regarding neurophysiologic recovery and return to activity remain problematic for clinicians. Return to activity decisions are currently based on normalization …


Evaluation Of The Effectiveness Of A Pain Neuroscience Education Curriculum For Patients Who Experience Chronic Musculoskeletal Pain With Concurrent Opioid Dependence, Nicole D. Windsor Jan 2021

Evaluation Of The Effectiveness Of A Pain Neuroscience Education Curriculum For Patients Who Experience Chronic Musculoskeletal Pain With Concurrent Opioid Dependence, Nicole D. Windsor

Theses and Dissertations--Rehabilitation Sciences

Background: Chronic musculoskeletal pain (CMP) is estimated to affect over 100 million adults annually and is targeted as an instigator of opioid dependence (OpD). Opioid medications are often the first response for patients suffering from CMP, but over 10 million people annually admit to misusing opioids. With the opioid epidemic, the healthcare system now has a population of patients who experience CMP with concurrent OpD. This persistent problem creates a perfect storm of fear of movement, low self-efficacy, and physical dysfunction. A critical component to chronic pain management is understanding how patients view their pain experience. Education may be one …


Beyond The Treatment Protocol: Active Ingredients For Precision Voice Rehabilitation, Maria H. Bane Jan 2021

Beyond The Treatment Protocol: Active Ingredients For Precision Voice Rehabilitation, Maria H. Bane

Theses and Dissertations--Rehabilitation Sciences

Despite the growing body of research demonstrating voice therapy efficacy, only 12 of 100 people referred to a speech-language pathologist (SLP) for a voice evaluation will successfully complete therapy. One possible reason for this discrepancy is that clinical laboratory and clinical outcomes studies have focused on if voice therapy works while failing to explain how voice therapy works. While the if question is important, the yes or no response this question generates is of limited utility when those referred for voice therapy fail to complete. Consequently, the how question, which concentrates on the mechanisms and processes underlying effective voice therapy, …


The Influence Of Physical Health, Emotional Health, And Socioeconomic Factors On The Musculoskeletal Pain Experience In Patients Attending A Pro Bono Physical Therapy Clinic, Garrett Naze Jan 2021

The Influence Of Physical Health, Emotional Health, And Socioeconomic Factors On The Musculoskeletal Pain Experience In Patients Attending A Pro Bono Physical Therapy Clinic, Garrett Naze

Theses and Dissertations--Rehabilitation Sciences

Non-communicable, chronic diseases are highly prevalent in the United States, reducing the quality of life for those affected and contributing to the majority of the nation’s healthcare expenditure. These conditions include, among others, cardiovascular disease, diabetes, and musculoskeletal disease. Musculoskeletal disease is particularly of interest for the field of physical therapy as the vast majority of patients seeking care in the outpatient setting present with musculoskeletal pain complaints, resulting in limitations in function, participation, and quality of life for the patient.

The factors influencing health outcomes are diverse and include a person’s physical environment, social and economic factors, access to …


Development Of A Field Expedient Screening Tool For The Coach To Identify Musculoskeletal Risk Factors In Baseball Players, Kyle Andrew Matsel Jan 2021

Development Of A Field Expedient Screening Tool For The Coach To Identify Musculoskeletal Risk Factors In Baseball Players, Kyle Andrew Matsel

Theses and Dissertations--Rehabilitation Sciences

Identification of musculoskeletal (MSK) injury risk factors in baseball players can be challenging particularly for youth and high school coaches. Many baseball coaches lack a sports medicine and/or strength and conditioning staff to assist with injury prevention initiatives. Given the extensive responsibilities in managing the team and preparing the players for athletic competition, little time remains to focus on injury prevention and arm care programs. Furthermore, assessment, diagnosis, and management of MSK impairments is outside the scope of practice and expertise of baseball coaches. However, educating and empowering the coach to efficiently screen their players for potentially injury producing MSK …


Changing The Perspective In Management Of A Progressive Neurological Disorder: Developing Interventions To Target Multifactorial Components Of Parkinson’S Disease With Emphasis On Improving Clinical Meaningful Outcomes, Jordana Christine Lockwich Jan 2021

Changing The Perspective In Management Of A Progressive Neurological Disorder: Developing Interventions To Target Multifactorial Components Of Parkinson’S Disease With Emphasis On Improving Clinical Meaningful Outcomes, Jordana Christine Lockwich

Theses and Dissertations--Rehabilitation Sciences

Neurological disorders are currently the leading source of disability in the United States with Parkinson’s disease (PD) having the fastest growing incidence rate (Abate et al., 2017). PD is the second most common degenerative disease in older adults above 60 years old (Tysnes & Storstein, 2017) and epidemiology reports predict that the number of PD cases has doubled to 6 million since 1990 (Dorsey, Sherer, et al., 2018) It is estimated that PD prevalence will continue to rise with a projected 60,000 new cases in the United States by 2030 (Dorsey, Elbaz, et al., 2018) and has the potential to …


Broadening The Role Of Occupational Therapists Within The Icu Setting: An Occupation-Based Toolkit, Roxana Chirinos, Carly Derouin Jan 2021

Broadening The Role Of Occupational Therapists Within The Icu Setting: An Occupation-Based Toolkit, Roxana Chirinos, Carly Derouin

Occupational Therapy Capstones

Purpose: The purpose of this project was to create a quick intervention toolkit for occupational therapists treating clients in the intensive care unit (ICU) in order to increase occupation-based services, quality of care, and improve client outcomes. Additionally, this project hopes to enlighten occupational therapists who may experience burnout while providing services within such an intensive setting.


Increasing Quality Of Life And Occupational Performance: A Treatment Protocol For Military Burn Patients And Their Families, Emma Chafin, Jessica Lambert Jan 2021

Increasing Quality Of Life And Occupational Performance: A Treatment Protocol For Military Burn Patients And Their Families, Emma Chafin, Jessica Lambert

Occupational Therapy Capstones

Purpose: The purpose of this scholarly project was to develop a treatment protocol to address the challenges that can affect quality of life and occupational performance of military burn patients and their families. Occupational therapy can offer skilled treatment to help facilitate a successful transition back into civilian life after sustaining a lifealtering combat wound.


Occupational Therapy For Pregnant Women: An Ergonomics Program For First-Time Mothers, Kaitlyn Berglund, Brianna Peterman Jan 2021

Occupational Therapy For Pregnant Women: An Ergonomics Program For First-Time Mothers, Kaitlyn Berglund, Brianna Peterman

Occupational Therapy Capstones

This scholarly project, Occupational Therapy for Pregnant Women: An Ergonomics Program for First-Time Mothers, provides occupational therapy practitioners with a 3-session group protocol to address ergonomic concerns of pregnancy and new motherhood with pregnant women who are becoming mothers for the first time. These ergonomic concerns are addressed as they specifically relate to the occupations of the clients. Through an extensive literature review, it was found that there is limited research and programming specific to occupational therapy’s role in providing services to pregnant women and new mothers. Ergonomic programming for pregnant women that was previously available did not address occupations …


Recovering From The Loss Of A Loved One: A Group Protocol For Remaining Active In Valued Occupations While Coping With The Loss Of A Loved One, Hailey Axtell, Ty Berg Jan 2021

Recovering From The Loss Of A Loved One: A Group Protocol For Remaining Active In Valued Occupations While Coping With The Loss Of A Loved One, Hailey Axtell, Ty Berg

Occupational Therapy Capstones

Purpose: The purpose of this scholarly project is to develop a manualized intervention program utilizing the CMOP-E to better understand grief and coping while promoting occupational engagement for older adults who have recently lost a partner. A group protocol was created to address spirituality, the survivor, participation in desired occupations, and the environment to help with the process of grieving and promote occupational performance.


Addressing Sexual Intimacy Post-Spinal Cord Injury With Clients And Their Significant Other, Michelle Arnhalt, Taylor Beatty Jan 2021

Addressing Sexual Intimacy Post-Spinal Cord Injury With Clients And Their Significant Other, Michelle Arnhalt, Taylor Beatty

Occupational Therapy Capstones

Discussing sexual participation with a client who has experienced a spinal cord injury (SCI) can be a critical component to addressing their overall occupational needs during the rehabilitation process. Literature has shown that education on sexual intimacy following their injury is often neglected during therapy due to the sensitive nature of the topic (Federici, Artegianai, Pigliautile, Antonelli, Diotallevi, Ritacco, & Maschke, 2019; Hess & Hough, 2012; Walker, Otte, LeMond, Hess, Kaizer, Faulkner, & Christy, 2020). Overlooking the topic of sexual intimacy during the client’s rehabilitation process can impact the client psychologically by decreasing their self-esteem and confidence, their desire to …


A Group-Protocol: Returning To Life Post Breast Cancer Treatment, Janice Finley, Ashley Timm Jan 2021

A Group-Protocol: Returning To Life Post Breast Cancer Treatment, Janice Finley, Ashley Timm

Occupational Therapy Capstones

The purpose of this project was to design a group protocol to assist breast cancer survivors living in the community to address unmet physical, cognitive, and psychosocial needs. There are more than 3.5 million breast cancer survivors within the United States today (American Cancer Society, n.d.). A cancer survivor's performance in meaningful occupations and roles need to be addressed as they learn to live with the long-term physical and psychosocial effects of treatments such as self-confidence and pain management (Burg et al., 2015; Kim, Kim, & Han, 2020). There is a lack of occupational therapy services for individuals diagnosed with …


Prevention Of Work-Related Musculoskeletal Disorders Among Individuals Utilizing A Home Computer Workstation, Dalton Fetsch, Jonah Kratochvil Jan 2021

Prevention Of Work-Related Musculoskeletal Disorders Among Individuals Utilizing A Home Computer Workstation, Dalton Fetsch, Jonah Kratochvil

Occupational Therapy Capstones

Purpose: The purpose of this project was to develop a comprehensive educational guide for office workers and students who utilize a home computer workstation for a majority of their day utilizing current evidence. This guide is intended to help prevent the onset of MSDs that often occur due to improper ergonomic positioning and limited resources when utilizing home computer workstations


Creating Sense Of It: An In-Service To Address Military Students Experiencing Sensory Deficits, Danielle Cox, Katelyn Jennings Jan 2021

Creating Sense Of It: An In-Service To Address Military Students Experiencing Sensory Deficits, Danielle Cox, Katelyn Jennings

Occupational Therapy Capstones

Purpose: Life for military children is challenging as they are exposed to various experiences that may have adverse effects. There is an unprecedented need for additional resources regarding sensory deficits in military children to provide more insight into the challenges faced by this population as well as to increase awareness and support for the demands placed upon children in military families. The purpose of this project is to provide information to educators regarding added sensory challenges faced by military students as well as to increase awareness and support for the demands placed upon these children.


Prevention, Positioning, Participation: Wheelchair Education And Promotion Of Occupational Engagement For Caregivers In Snfs, Sarah Lovelace, Brandon Steffen Jan 2021

Prevention, Positioning, Participation: Wheelchair Education And Promotion Of Occupational Engagement For Caregivers In Snfs, Sarah Lovelace, Brandon Steffen

Occupational Therapy Capstones

Purpose: Certified nursing assistants are considered the principal caregivers within long-term care / skilled nursing facilities (Bureau of Labor Statistics, U.S. Department of Labor, 2019), and spend the most time interacting and caring for residents. Although CNAs provide approximately 60-90% of the care to elderly residents in nursing homes, they are provided with the least amount of education of the direct-care employees (Lerner, Resnick, Galik, Russ, 2010). The purpose of this scholarly project is to provide caregivers in skilled nursing facilities with adequate education and resources to increase certified nursing assistants’ knowledge of pressure injury prevention, correct positioning for increased …


The Role Of Occupational Therapy In Promoting Employment Outcomes With Individuals Diagnosed With A Serious Mental Illness, Lexie Coalwell, Allison Moran Jan 2021

The Role Of Occupational Therapy In Promoting Employment Outcomes With Individuals Diagnosed With A Serious Mental Illness, Lexie Coalwell, Allison Moran

Occupational Therapy Capstones

Purpose: The purpose of this scholarly project is to enhance occupational therapy (OT) practitioners’ and other healthcare professionals’ knowledge on the essential role OT plays in promoting employment outcomes among individuals diagnosed with a serious mental illness (SMI).


Parental Caregiver Guide For An Adolescent With Down Syndrome: Transitioning Out Of High School, Kalindi Rachey, Hailey Johnson Jan 2021

Parental Caregiver Guide For An Adolescent With Down Syndrome: Transitioning Out Of High School, Kalindi Rachey, Hailey Johnson

Occupational Therapy Capstones

Purpose: The current literature revealed a need to address the establishment, organization, and application of primary health care as well as support programs for parental caregivers of adolescents with Down syndrome, especially during the transition period out of high school (Barros, Barros, Barros, & Santos, 2017). Providing information, resources, and support to parental caregivers of adolescents with Down syndrome and health care professionals, such as occupational therapists, can help alleviate caregiver burden and promote the parents’ quality of life. Occupational therapists can play an important role during the post-secondary transition period for adolescents with Down syndrome by assisting them in …


Occupational Therapy’S Role In Developing Social Skills For Adolescents With Complex Post-Traumatic Stress Disorder, Rachel Grubb, Amira Ragab Jan 2021

Occupational Therapy’S Role In Developing Social Skills For Adolescents With Complex Post-Traumatic Stress Disorder, Rachel Grubb, Amira Ragab

Occupational Therapy Capstones

The purpose of this scholarly project was to create a group protocol for occupational therapy practitioners to provide skilled mental health services to adolescents experiencing complex post-traumatic stress disorder (C-PTSD) due to domestic violence.


Occupational Therapy And Primary Care: The Tools For Referral, Alexandra Grosser, Kelsey Tadman Jan 2021

Occupational Therapy And Primary Care: The Tools For Referral, Alexandra Grosser, Kelsey Tadman

Occupational Therapy Capstones

Individuals with chronic conditions receive the most primary care services and account for the highest annual healthcare spending with the poorest outcomes (Leland, Fogelberg, Halle, & Mroz, 2017). Primary care providers (PCP) often address acute symptom management due to inadequate time to explore underlying problems related to diagnoses due to time limitations and a shortage of PCPs. (Dahl-Popolizio, Manson, Muir & Rogers, 2016). It has been recommended that other disciplines are incorporated into primary care to increase holistic, client-centered care and to improve health outcomes. Occupational therapy has been identified as one discipline that is well suited to contribute to …


The Occupational Therapy Guide For Enabling Meaningful Social Participation Post-Tbi, Vanessa Johnson, Hope Nelson Jan 2021

The Occupational Therapy Guide For Enabling Meaningful Social Participation Post-Tbi, Vanessa Johnson, Hope Nelson

Occupational Therapy Capstones

Introduction: The purpose of this scholarly project was to create a guide for occupational therapists to enable meaningful social participation throughout the rehabilitation phases with adults who have sustained a moderate or severe traumatic brain injury (TBI). The Guide discusses and presents assessments and interventions recommended for each phase of the rehabilitation process.


A Practitioner's Guide: Using The Cognitive Performance Test To Increase Independent Living Skills For Individuals With Intellectual Disabilities, Alycia Peacock, Grace Spanos Jan 2021

A Practitioner's Guide: Using The Cognitive Performance Test To Increase Independent Living Skills For Individuals With Intellectual Disabilities, Alycia Peacock, Grace Spanos

Occupational Therapy Capstones

Problem: Individuals with intellectual disabilities (ID) have the desire to live as independently as possible (Gragoudas, 2014). There are a number of barriers that impact living independently including the ability to complete self-care tasks, money management, home management, and health management (Bond & Hurst, 2010). Other barriers reported for individuals with ID include relationships with caregivers, living alone, and vulnerability (Bond & Hurst, 2010). Research identifies that it is difficult to determine the amount of support needed to promote independence in individuals with ID (Francis & Reed, 2019). Occupational therapists (OTs) possess a unique skillset to assist clients with ID …


Occupational Therapy Joining Bariatric Care Teams: A Web-Based Resource, Annabelle Tarnowski, Rylee Skyberg Jan 2021

Occupational Therapy Joining Bariatric Care Teams: A Web-Based Resource, Annabelle Tarnowski, Rylee Skyberg

Occupational Therapy Capstones

Purpose

Despite the overall positive physical and mental health results patients obtain following bariatric surgery, some individuals still experience significant negative health challenges postoperatively. Researchers have asserted that the psychosocial concerns of patients that undergo bariatric surgery are not being properly addressed prior to surgery; therefore, patients are not appropriately equipped with strategies or follow-up care to promote continued weight loss and increase quality of life post-operatively (Kalarchian & Marcus, 2019). Patients who undergo bariatric surgery have experienced maladaptive eating, substance abuse, suicide and self-harm at an increased rate (Kalarchian & Marcus, 2019; Sarwer & Heinberg, 2020). Additionally, occupational therapy …


Increasing Participation In Meaningful Occupations For Disabled Veterans Through The Promotion Of Spirituality: An Intervention Resource Manual For Occupational Therapists., Tristen Smith, Audrya Tarango Jan 2021

Increasing Participation In Meaningful Occupations For Disabled Veterans Through The Promotion Of Spirituality: An Intervention Resource Manual For Occupational Therapists., Tristen Smith, Audrya Tarango

Occupational Therapy Capstones

Purpose: Veterans with psychological disorders may experience a combination of deficits that decrease their ability to engage in meaningful activities (Speicher, Walter, & Chard, 2014). Increasing the well-being and quality of life for veterans is an optimal opportunity for the OT profession to assert its distinct value in addressing the mental health needs of veterans through the enhancement of spirituality. The inclusion of spirituality in interventions are beneficial when alleviating symptoms of a physical and mental capacity, reestablishing beliefs, values, moral code, and relationships with self and the transcendent (Brémault-Phillips et al., 2019).


Empowering Grand-Families Through Occupation: An Occupational Therapy Intervention Program For Grandchildren And Custodial Grandparents, Macie Romsdal, Gabrielle Wavra Jan 2021

Empowering Grand-Families Through Occupation: An Occupational Therapy Intervention Program For Grandchildren And Custodial Grandparents, Macie Romsdal, Gabrielle Wavra

Occupational Therapy Capstones

The purpose of this scholarly project was to create a program for occupational therapists to use with custodial grandparents and their grandchildren. The number of grandparents becoming primary caregivers to grandchildren continues to increase, and more than 5.7 million grandchildren in the United States were living with and being provided for by grandparents in 2014 (U.S. Census Bureau, 2014). Although there are benefits to being placed in grandparent care, there are also challenges. Some of the challenges custodial grandparents face are health concerns, financial resources, and changes in social supports and occupational roles (Marken & Howard, 2014). Grandchildren may have …