Rehabilitation and Therapy Commons^™

Exploring The Connections Between The Presence Of Developmental Trauma And Clinical Reasoning: The Lived Experience Of Pediatric Occupational Therapists, Gwendolyn R. Blake, Briar E. Plantinga, Julie Shafer

Pediatrics

Background: Developmental trauma is a current issue facing the nation. It adversely affects participation in occupations across the lifespan. This paper examines how the clinical reasoning of practicing pediatric occupational therapists changes when treating clients who have experienced developmental trauma.

Methods: A phenomenological approach was applied using multiple cases. Four individuals, who identified as working with clients with developmental trauma, were interviewed using a series of semi-structured and open-ended questions on their experience treating these clients.

Results: Narrative transcripts were reviewed by the authors and organized into themes of performance patterns of the therapist and the context of developmental trauma …

Long-Dose Intensive Therapy Is Necessary For Strong, Clinically Significant, Upper Limb Functional Gains And Retained Gains In Severe/Moderate Chronic Stroke, Janis J. Daly, Jessica P. Mccabe, John P. Holcomb, Michelle Monkiewicz, Jennifer Gansen, Svetlana Pundik

Mathematics and Statistics Faculty Publications

Background. Effective treatment methods are needed for moderate/severely impairment chronic stroke. Objective. The questions were the following: (1) Is there need for long-dose therapy or is there a mid-treatment plateau? (2) Are the observed gains from the prior-studied protocol retained after treatment? Methods. Single-blind, stratified/randomized design, with 3 applied technology treatment groups, combined with motor learning, for long-duration treatment (300 hours of treatment). Measures were Arm Motor Ability Test time and coordination-function (AMAT-T, AMAT-F, respectively), acquired pre-/posttreatment and 3-month follow-up (3moF/U); Fugl-Meyer (FM), acquired similarly with addition of mid-treatment. Findings. There was no group difference in …

Racial And Ethnic Disparities In Stroke Outcomes: A Scoping Review Of Post-Stroke Disability Assessment Tools, Suzanne Perea Burns, Brandi M. White, Gayenell Magwood, Charles Ellis, Ayaba Logan, Joy N. Jones Buie, Robert J. Adams

Health and Clinical Sciences Faculty Publications

Purpose: To identify how post-stroke disability outcomes are assessed in studies that examine racial/ethnic disparities and to map the identified assessment content to the International Classification of Functioning, Disability, and Health (ICF) across the time course of stroke recovery.

Methods: We conducted a scoping review of the literature. Articles published between January 2001 and July 2017 were identified through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion and exclusion criteria.

Results: We identified 1791 articles through database and hand-searching strategies. Of the articles, 194 met inclusion criteria for full-text review, and 41 met inclusion criteria for study inclusion. The …

Transforming Trauma: Resilience And Healing Through Our Connections With Animals, Philip Teseschi, Molly Anne Jenkins

Purdue University Press Book Previews

Have you ever looked deep into the eyes of an animal and felt entirely known? Often, the connections we share with non-human animals represent our safest and most reliable relationships, offering unique and profound opportunities for healing in periods of hardship. This book focuses on research developments, models, and practical applications of human-animal connection and animal-assisted intervention for diverse populations who have experienced trauma. Physiological and psychological trauma are explored across three broad and interconnected domains: 1) child maltreatment and family violence; 2) acute and post-traumatic stress, including military service, war, and developmental trauma; and 3) times of crisis, such …

The Quality Of Transdisciplinary Team Assessment Practices For Mobile Technology As Augmentative And Alternative Communication, Laura Jeanne Mansfield

Doctoral Dissertations and Projects

While research acknowledges the impact the rapid growth in mobile technology is having on the field of augmentative and alternative communication (AAC), little has been done to investigate the impact this development has had on assessment practices for matching an individual with the appropriate technology. The purpose of this descriptive and causal-comparative research study was to gather demographic and descriptive data on mobile technology as AAC and to investigate the quality of transdisciplinary teamwork assessment practices as evaluated by speech-language pathologists (SLPs) for the provision of mobile technologies as AAC devices across SLP practice settings. A random sample of 60 …

Practical Guidance For Engaging Patients In Health Research, Treatment Guidelines And Regulatory Processes: Results Of An Expert Group Meeting Organized By The World Health Organization (Who) And The European Society For Clinical And Economic Aspects Of Osteoporosis, Osteoarthritis And Musculoskeletal Diseases (Esceo), Maarten De Wit, Cyrus Cooper, Peter Tugwell, Nathalie Bere, John Kirwan, Philip G. Conaghan, Charlotte Roberts, Isabelle Aujoulat, Nasser Al-Daghri, Islene Arajujo De Carvalho, Mary Barker, Nicola Bedlington, Maria Luisa Brandi, Olivier Bruyère, Nansa Burlett, Philippe Halbout, Mickaël Hiligsmann, Famida Jiwa, John A. Kanis, Andrea Laslop, Wendy Lawrence, Daniel Pinto, Concepción Prieto Yerro, Véronique Rabenda, René Rizzoli, Marieke Scholte-Voshaar, Mila Vlaskovska, Jean-Yves Reginster

Physical Therapy Faculty Research and Publications

There is increasing emphasis on patient-centred research to support the development, approval and reimbursement of health interventions that best meet patients’ needs. However, there is currently little guidance on how meaningful patient engagement may be achieved. An expert working group, representing a wide range of stakeholders and disciplines, was convened by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the World Health Organization (WHO). Through a structured, collaborative process the group generated practical guidance to facilitate optimal patient engagement in clinical development and regulatory decisions. Patient engagement is a relational process. The …

Practical Guidance For Engaging Patients In Health Research, Treatment Guidelines And Regulatory Processes: Results Of An Expert Group Meeting Organized By The World Health Organization (Who) And The European Society For Clinical And Economic Aspects Of Osteoporosis, Osteoarthritis And Musculoskeletal Diseases (Esceo), Maarten De Wit, Cyrus Cooper, Peter Tugwell, Nathalie Bere, John Kirwan, Philip G. Conaghan, Charlotte Roberts, Isabelle Aujoulat, Nasser Al-Daghri, Islene Arajujo De Carvalho, Mary Barker, Nicola Bedlington, Maria Luisa Brandi, Olivier Bruyère, Nansa Burlett, Philippe Halbout, Mickaël Hiligsmann, Famida Jiwa, John A. Kanis, Andrea Laslop, Wendy Lawrence, Daniel Pinto, Concepción Prieto Yerro, Véronique Rabenda, René Rizzoli, Marieke Scholte-Voshaar, Mila Vlaskovska, Jean-Yves Reginster

Physical Therapy Faculty Research and Publications

There is increasing emphasis on patient-centred research to support the development, approval and reimbursement of health interventions that best meet patients’ needs. However, there is currently little guidance on how meaningful patient engagement may be achieved. An expert working group, representing a wide range of stakeholders and disciplines, was convened by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the World Health Organization (WHO). Through a structured, collaborative process the group generated practical guidance to facilitate optimal patient engagement in clinical development and regulatory decisions. Patient engagement is a relational process. The …

Differential Effects Of Aging And Physical Activity On Corticospinal Excitability Of Upper And Lower Limb Muscles, Vianney Rozand, Jonathon William Senefeld, Christopher W. Sundberg, Ashleigh E. Smith, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Corticospinal tract excitability can be altered by age, physical activity (PA), and possibly sex, but whether these effects differ between upper and lower limb muscles is unknown. We determined the influence of age, PA, and sex on corticospinal excitability of an upper limb and a lower limb muscle during submaximal contractions by comparing stimulus-response curves of motor evoked potentials (MEPs). Transcranial magnetic stimulation (TMS) was used to evoke stimulus-response curves in active muscles by incrementally increasing the stimulator intensity from below the active motor threshold (AMT) until a plateau in MEP amplitudes was achieved. Stimulus-response curves were analyzed from the …

Use Of Online Educational Modules To Improve Occupational Therapy Students’ Knowledge And Perceptions Of Their Emotional Intelligence Skills: An Evidence-Based Pilot Study, Jennifer Calabrese, Jennifer E. Lape, Theresa Delbert

Journal of Occupational Therapy Education

Many current students studying in health care professions lack skills in communication, socialization, and decision-making that can lead to an inability to recognize and manage emotions, indicating a need for emotional intelligence training in university health field curricula. This article presents an evidence-based study that used a new approach to education using online emotional intelligence modules within a graduate occupational therapy program to supplement the program’s curriculum. The study was completed over six and one-half weeks and included 28 second-year graduate occupational therapy students. A pre/post-survey design was used to determine participants’ knowledge and their perceptions of their own emotional …

The Role Of Movement Pattern In Relation To Running Related Injuries Risk Factors, Marwan Mahmoud A Aljohani

Dissertations (1934 -)

About 52.3 million American run on a regular basis. Up to 79% of runners get injured every year and the rate of injury has not declined over the past decades. Females have twice the risk of developing a running related injury (RRI). Rate of loading (ROL), tibial impact shock (TIS), and low movement variability may contribute to the development of RRI. Not much is known, however, about the relationships between impact kinetics (i.e. ROL, TIS) and movement variability. In addition, there is a lack of understanding about the effects of sex and speed on the aforementioned RRI risk factors. Therefore, …

Bringing Upstairs Care Downstairs; Integration Of Rehabilitation Medicine, Care Management, And The Hospital Elder Life Program (Help) Into An Emergency Department., Robert Anderson, Molly Anderson, Rhonda Babine, Farid Feghali, Elizabeth Dunstan, Matthew Glazer, Susan Horton, Stephanie O'Brien, Elizabeth Pontius, David Smith, Megan Viens, Heather Williams

Journal of Maine Medical Center

Introduction: Services such as physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), social work (SW), care management, and elder life specialists have long been an established part of care for patients admitted to Maine Medical Center (MMC) but not for patients in the Emergency Department (ED). Methods and Results: Driven in part by changes in Medicare reimbursement models, care management established a presence in the Emergency Department (ED) in 2003 with a focus on care planning and cost avoidance. In recent years PT, OT, SLP, SW, and the Hospital Elder Life Program (HELP) have increased their ED involvement substantially. …

Dance As A Protective Measure Against The Cognitive And Physical Declines Associated With Aging: A Proposed Study, Sarah M. Schwanz, Jeffrey Holmes, Jessica Grahn

Western Research Forum

Background:

Dance is considered a multimodal activity in that it requires both physical and cognitive engagement. Combining physical activity with music may have a synergistic effect, enabling dance to enhance physical and cognitive functions more than music and physical activity alone. The positive changes attributed to dance training such as improved visuospatial and motor ability, high coordination, greater balance, and increased cognitive ability may also benefit individuals as they age.

Methods:

This proposed study will examine whether dance training has the potential to protect against age-related cognitive and physical decline by assessing the cognitive and physical domains that show decline …

Interpreting Patient Reported Outcomes In Orthopaedic Surgery: A Systematic Review, Shgufta Docter, Zina Fathalla, Michael Lukacs, Michaela Khan, Morgan Jennings, Shu-Hsuan Liu, Dong Zi, Dianne Bryant

Western Research Forum

Background: Reporting methods of patient reported outcome measures (PROMs) vary in orthopaedic surgery literature. While most studies report statistical significance, the interpretation of results would be improved if authors reported confidence intervals (CIs), the minimally clinically important difference (MCID), and number needed to treat (NNT).

Objective: To assess the quality and interpretability of reporting the results of PROMs. To evaluate reporting, we will assess the proportion of studies that reported (1) 95% CIs, (2) MCID, and (3) NNT. To evaluate interpretation, we will assess the proportion of studies that discussed results using the MCID or the effect sizes and how …

Does Improved Physical Function Following A Nustep® Seated All Extremity Exercise Intervention Reduce The Fear Of Falling And Improve Quality Of Life In Older Adults With Fear Of Falling Living In Community Care Homes?, Navjot Gill, Denise Connelly

Western Research Forum

Background:

Decreased physical activity associated with fear of falling invokes a dangerous cycle of more fear, reduced activity and falls. NuStep is a seated all-extremity recumbent cross trainer which provides safe and efficient exercise training.

Hypotheses/Objectives:

The objectives of this study are to:

i. improve physical function and mobility of older adults living with a fear of falling with a NuStep;

ii. assess change in self-reported fear of falling and quality of life before and after the exercise intervention; and

iii. determine whether there is a relationship between exercise-related improved physical function/mobility with change in fear of falling and/or quality …

Developing Interactive Curricular Elements With Teams Of Faculty, Staff And Students, Betsy J. Becker, Sara Bills, Robert H. Fuchs, Kellie Gossman, Tessa Wells, Peggy Moore

Posters and Presentations: Physical Therapy

Students are continually searching for new resources to augment their learning. Online resources have become highly favored, especially by the millennial age group, for convenience, self-paced content, and versatility across learning styles. It has been reported that e-learning platforms are as effective as traditional face-to-face instruction, but may be best utilized when used as an adjunctive resource for teaching psychomotor skills.1,2 In a study about student confidence, results showed an increase in self-efficacy following the use of online learning materials.3 Blended learning, the next generation of web-based education, mixes advances in technology with creative faculty to fuse effective delivery methods …

Neural Foundations Of Ayres Sensory Integration, Shelly J. Lane, Zoe Mailloux, Sarah Schoen, Anita Bundy, Teresa A. May-Benson, L. Diane Parham, Susanne Smith Roley, Roseann C. Schaaf

Department of Occupational Therapy Faculty Papers

Sensory integration, now trademarked as Ayres Sensory Integration^® or ASI, is based on principles of neuroscience and provides a framework for understanding the contributions of the sensory and motor foundations of human behavior. The theory and practice of ASI continues to evolve as greater understanding of the neurobiology of human behavior emerges. In this paper we examine core constructs of ASI identified in the seminal work of Dr. Jean Ayres, and present current neuroscience research that underlies the main patterns of sensory integration function and dysfunction. We consider how current research verifies and clarifies Ayres’ propositions by describing functions …

Psychometric Properties Of Standardized Balance Confidence, Fear Of Falling, And Falls-Efficacy Measures In People With Lower Limb Amputations, Jack Y. Wang, Susan W. Hunter, Ricardo Viana, Jeffrey D. Holmes, Michael Payne

Western Research Forum

Background:

In Canada, >50% of community-dwelling lower limb amputees (LLA) fall at least once each year, a rate that is almost twice that of community-dwelling older adults. While the physical consequences of falls may be readily apparent, psychological sequelae that follow may be just as, if not more, detrimental than an actual fall itself. Current measures of balance confidence show no change in LLA following discharge from rehabilitation. The limited detectable change may be due to content validity challenges of the measures as they were not developed for the unique challenges faced by LLA.

Objectives:

1) Review items from standardized …

Depression Affects Recovery Following Distal Radius Fracture: A Latent Class Analysis, Shirin Modarresi, David M. Walton, Joy C. Macdermid

Western Research Forum

Background: Most people recover within six months following distal radius fractures (DRFs) but some experience pain and disability for one year or longer. Therefore, it is important to understand the factors that can help predict recovery. According to the biopsychosocial model of pain, psychological aspects of a condition can play important roles in explaining recovery.

Objectives: To identify the recovery trajectories of patients with DRFs and to determine the degree to which depression affects these trajectories.

Methods: Recovery was assessed in 318 patients using the Patient-Rated Wrist Evaluation scale at baseline, three, six, and 12 months. Demographic information was collected …

Ethnic And Gender Disparities In The Uptake Of Transcatheter Aortic Valve Replacement In The United States, Ayman Elbadawi, Syed Yaseen Naqvi, Islam Y. Elgendy, Mohamed F. Almahmoud, Mohamed Hamed, Hesham Abowali, Gbolahan O. Ogunbayo, Hani Jneid, Khaled M. Ziada

Internal Medicine Faculty Publications

Introduction: Little is known about ethnic and gender disparities for transcatheter aortic valve replacement (TAVR) procedures in the United States.

Methods: We queried the Nationwide Inpatient Sample (NIS) database (2011–2014) to identify patients who underwent TAVR. We described the temporal trends in the uptake of TAVR procedures among various ethnicities and genders.

Results: Our analysis identified 39,253 records; 20,497 (52.2%) were men and 18,756 (47.8%) were women. Among all TAVRs, 87.2% were Caucasians, 3.9% were African Americans (AA), 3.7% were Hispanics, and 5.2% were of other ethnicities. We found a significant rise in the trend of TAVRs in all groups: …

A Method To Concatenate Multiple Short Time Series For Evaluating Dynamic Behaviour During Walking, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Gait variability is a sensitive metric for assessing functional deficits in individuals with mobility impairments. To correctly represent the temporal evolution of gait kinematics, nonlinear measures require extended and uninterrupted time series. In this study, we present and validate a novel algorithm for concatenating multiple time-series in order to allow the nonlinear analysis of gait data from standard and unrestricted overground walking protocols. The fullbody gait patterns of twenty healthy subjects were captured during five walking trials (at least 5 minutes) on a treadmill under different weight perturbation conditions. The collected time series were cut into multiple shorter time series …

Do Patient Sociodemographic Factors Impact The Promis Scores Meeting The Patient-Acceptable Symptom State At The Initial Point Of Care In Orthopaedic Foot And Ankle Patients?, David N. Bernstein, Kiah Mayo, Judith F. Baumhauer, Chris Dasilva, Kathleen Fear, Jeff Houck

Faculty Publications - College of Physical Therapy

Background

Patient-reported outcome measures such as the Patient-Reported Outcomes Measurement Information System (PROMIS) allow surgeons to evaluate the most important outcomes to patients, including function, pain, and mental well-being. However, PROMIS does not provide surgeons with insight into whether patients are able to successfully cope with their level of physical and/or mental health limitations in day-to-day life; such understanding can be garnered using the Patient-acceptable Symptom State (PASS). It remains unclear whether or not the PASS status for a given patient and his or her health, as evaluated by PROMIS scores, differs based on sociodemographic factors; if it does, that …

Risk Factors For The Elevation Of Psychosocial Barriers In The Recovery Of Lumbar Pathology, Christopher Keating, Cameron Hui, Gerard Smith, Tingting Zhan

Department of Physical Therapy Faculty Papers

Background/Purpose: The prevalence of low back pain (LBP) continues to rise and an appreciation for a biopsychosocial approach, which takes in multiple facets of a patient presentation, may significantly impact this increase. To the best our knowledge, there are no studies evaluating the relationship between the STarTBack Screening Tool (SBT) and the access point the patient enters the health system. Our hypothesis is that patients that access care through the medical model will exhibit greater psychosocial risk.

Methods: A retrospective analysis of 1404 cases of LBP utilizing past medical history, demographic information, and SBT data. A linear regression model to …

An Innovative Interprofessional Team To Enhance Refugee Resettlement Into U.S. Daily Life, Stephen Kern, Phd, Otr/L, Faota, Christina Kubica, Msw

Department of Occupational Therapy Posters and Presentations

The world continues to see dramatic increases in the numbers of refugees as new humanitarian crises emerge. Once approved by a host nation, the resettlement process begins. To facilitate successful resettlement, a collaborative partnership between a refugee resettlement agency and a university occupational therapy program has continued to successfully serve the needs of the partnership’s three key stakeholders; the organization; the individual refugee or family; and the clinical training of occupational therapy students. Through ongoing program development and enhancements, an innovative interprofessional team approach to resettlement has emerged.

Together, with the individuals and families served, a clientcentered, interprofessional approach was …

Taking Advantage Of External Mechanical Work To Reduce Metabolic Cost: The Mechanics And Energetics Of Split-Belt Treadmill Walking, Natalia Sánchez, Surabhi N. Simha, J. Maxwell Donelan, James M. Finley

Physical Therapy Faculty Articles and Research

No abstract provided.

Amputee Perspectives Of Virtual Patient Education, Sandra L. Winkler, Michelle Schlesinger, Krueger Alice, Ann Ludwig

The Qualitative Report

Amputees have expressed the need for more information on the recovery path that follows amputation. Inclusion of education in the amputation rehabilitation process empowers amputees to make decisions about their options and form realistic expectations. Virtual worlds are effective as healthcare support communities because they provide both synchronous and asynchrous communication, voice enabled technology, file sharing and more, enhanced by immersion in a visually stimulating and interactive 3-D environment. The objective of this research was to discover how a virtual world could be used to address amputees’ educational needs. A focus group of three lower limb amputees ages ranging from …

The Validity, Reliability, Measurement Error, And Minimum Detectable Change Of The 30‐Second Fast‐Paced Walk Test In Persons With Knee Osteoarthritis: A Novel Test Of Short‐Distance Walking Ability, Lisa T. Hoglund, Phd, Erik Folkins, Dpt, Laura Pontiggia, Phd, Michael W. Knapp, Dpt

Department of Physical Therapy Faculty Papers

Objective

To develop and establish the reliability, validity, measurement error, and minimum detectable change of a novel 30‐second fast‐paced walk test (30SFW) in persons with knee osteoarthritis (OA) that is easy to administer and can quantify walking performance in persons of all abilities.

Methods

Twenty females with symptomatic knee OA (mean age [SD] 58.30 [8.05] years) and 20 age‐ and sex‐matched asymptomatic controls (57.25 [8.71] years) participated in the study. Participants completed questionnaires of demographic and clinical data, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the 36‐item Short Form Health Survey (SF‐36) followed by 30SFW performance. Participants returned …

Client Centered Simulation: Practicing Interprofessional Teamwork With Standardized Patients, E. Adel Herge, Otd, Otr/L, Faota, Sarah Libros, Ba, Courtney Newsome, Ba, Richard Hass, Phd, Caitlin Cadematori, Ots, Abegale Nelson, Bs, Neal Geosits, Ba

Department of Occupational Therapy Posters and Presentations

Background

Interprofessional education (IPE) prepares students to work in collaborative teams (Burin et al., 2009). Educators use a variety of methods to develop and enhance teamwork skills (Fox et al., 2018).

Standardized patient (SP) simulations allow students to practice skills in safe environments (Herge et al., 2013) and respond to situations as they would under natural conditions (McGaghie, 1999). As an active learning experience, SP simulations help students break through the “illusion of understanding” (Syinicki & McKeachie, 2001 p. 190).

Kirkpatrick posits a hierarchy of changes as a result of training/education (Kirkpatric, 1979). At the highest level is transfer of …

Alterations In Cortical Activation Among Individuals With Chronic Ankle Instability During Single-Limb Postural Control, Adam B. Rosen, Jennifer M. Yentes, Melanie L. Mcgrath, Arthur C. Maerlender, Sara A. Myers, Mukul Mukherjee

Center for Brain, Biology, and Behavior: Faculty Publications

Context: Chronic ankle instability (CAI) is characterized by repetitive ankle sprains and perceived instability. Whereas the underlying cause of CAI is disputed, alterations in cortical motor functioning may contribute to the perceived dysfunction.

Objective: To assess differences in cortical activity during single-limb stance among control, coper, and CAI groups.

Design: Cross-sectional study.

Setting: Biomechanics laboratory.

Patients or Other Participants: A total of 31 individuals (10 men, 21 women; age = 22.3 ± 2.4 years, height = 169.6 ± 9.7 cm, mass = 70.6 ± 11.6 kg), who were classified into control (n = 13), coper (n = 7), and CAI …

Use Of Clinical Test Clusters Versus Advanced Imaging Studies In The Management Of Patients With A Suspected Slap Tear, Richard C. Clark, Chasiti C. Chandler, Andrew C. Fuqua, Kelly N. Glymph, Grayson C. Lambert, Katherine J. Rigney

Physical Therapy Faculty Research

Background and Purpose

The Magnetic Resonance Arthrogram (MRA) has served as the gold standard for identifying patients with possible Superior Labrum Anterior-Posterior (SLAP) lesions and are often required by orthopaedic surgeons prior to clinical evaluation. However, as the literature shows MRA sensitivity as 0.65-0.98, and specificity between 0.80-1.00, there is still room for misinterpretation of the imaging study, and potential mismanagement of a patient who may or may not exhibit a true SLAP lesion. It is proposed that by grouping a series of clinical special tests it may be possible to develop greater sensitivity in identifying a SLAP lesion, resulting …

Implementing School-Based Education Programs To Combat Lack Of Access To Psychiatric Facilities In The United States, Marisa L. Sparbanie

Kentucky Journal of Undergraduate Scholarship

One in five Americans are diagnosed with a mental illness, yet only 41% of adults received healthcare services in the past year. Due to barriers in accessing care, services are costly, wait times are long, and appointment times are inconvenient. Lack of access to quality, affordable care disproportionately affects those in rural areas and individuals with low socioeconomic status. School-based mental health education programs should be developed as a beginning step to combat increasing mental health conditions and limited access to healthcare facilities. Lack of access to care may lead to occupational injustices such as: occupational alienation, deprivation, and imbalance. …