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Full-Text Articles in Occupational Therapy

Primary Care: A Service-Learning Environment For Occupational Therapy Students, Brandi Andreae, Wen-Pin Chang, Thomas F. Fisher, Priya Bakshi Oct 2021

Primary Care: A Service-Learning Environment For Occupational Therapy Students, Brandi Andreae, Wen-Pin Chang, Thomas F. Fisher, Priya Bakshi

The Open Journal of Occupational Therapy

This research provides evidence on occupational therapy (OT) students in primary care (PC). OT demonstrates the skills and knowledge to address chronic medical conditions in PC with entry-level education. Limited evidence of occupational therapists in PC demonstrates a need to examine OT services in this setting. In this emerging area of practice and ever-changing reimbursement models, additional evidence is needed to define the value and continuation of OT services in PC. A mixed-methods study aimed to answer the primary research question: How are OT students used in the PC setting in fieldwork or capstone experiences? A two-phase process was involved. …


Promoting Social Participation For Adolescents With Burn Injury: A Guideline For Occupational Therapy Practice, Amanda M. Lange, Lenin Grajo Oct 2021

Promoting Social Participation For Adolescents With Burn Injury: A Guideline For Occupational Therapy Practice, Amanda M. Lange, Lenin Grajo

The Open Journal of Occupational Therapy

Adolescents with burn injury are vulnerable to psychosocial dysfunction because of the complex nature of their neurobiological, cognitive, and interpersonal changes that occur during this developmental stage. Physical differences in appearance also make these adolescents prone to peer bullying and at further risk for social functioning challenges. These social functioning challenges may involve underlying difficulties with cognitive functions needed to support adaptive social functioning and can present as social isolation, inappropriate social behaviors, or social anxiety. Promoting social participation is a recognized intervention to support positive mental health and is necessary for identity formation during transition into adulthood. This guideline …


Bridge To The Future: A Career Exploration Frame Of Reference For Students With Disabilities, Chia-Yang Chiang, Tsu-Hsin Howe Oct 2021

Bridge To The Future: A Career Exploration Frame Of Reference For Students With Disabilities, Chia-Yang Chiang, Tsu-Hsin Howe

The Open Journal of Occupational Therapy

Exploring and facilitating the transition process from school to employment for young adults with intellectual and developmental disabilities (IDD), especially those still in the school system, has now become an important concern for researchers, educators, and service providers working in this area. The Bridge to the Future (BTTF) Frame of Reference offers a new approach to facilitate the school-to-work transition for secondary school students with IDD in a self-contained classroom setting by adopting the Social Cognitive Career Theory and Self-Determination Theory as its main theoretical foundation. The BTTF Frame of Reference was developed for use by the team of transdisciplinary …


Development Of The Dynamic Model Of Occupation-Based Practice, Sarah M. Psillas, Wendy B. Stav Oct 2021

Development Of The Dynamic Model Of Occupation-Based Practice, Sarah M. Psillas, Wendy B. Stav

The Open Journal of Occupational Therapy

Background: Occupation-based practice is unique to occupational therapy, supported as effective in the literature, and promotes health and well-being for clients. There is no framework describing what occupation-based practice looks like, making the goal of infusing occupation into practice difficult. This research study aimed to develop a model of occupation-based practice, providing a framework with constructs, facilitators, and barriers for using occupation in practice.

Method: A grounded theory study was completed with interviews and a focus group. Charmaz’s approach to grounded theory was used to analyze data and allow a model to emerge.

Results: The dynamic model …


Occupational Therapy And Allied Health Interventions To Promote And Support Client Self-Advocacy: A Systematic Review Of The Literature, Theresa Guzaldo, Abraham Kim, Kimberly Lieberman, Erin Thrasher, Laura H. Vanpuymbrouck Oct 2021

Occupational Therapy And Allied Health Interventions To Promote And Support Client Self-Advocacy: A Systematic Review Of The Literature, Theresa Guzaldo, Abraham Kim, Kimberly Lieberman, Erin Thrasher, Laura H. Vanpuymbrouck

The Open Journal of Occupational Therapy

Background: Despite occupational therapy’s focus on optimizing participation in society for individuals with disability, self-advocacy has only recently (2008) become an official client factor in the Occupational Therapy Practice Framework (OTPF).

Method: This study examined the current evidence in allied health professions addressing self-advocacy skills through exploring the quality, characteristics, and effectiveness of interventions designed to promote client self-advocacy. Multiple electronic databases were used for the literature search, including: PubMed, Ebscohost, PsycINFO, Google Scholar, and Sagepub. Select professional journals were also searched. Key words used in literature review were: self-advocacy, self-determination, occupational therapy, advocacy, empowerment, interventions, allied health, …


Enriched Tai Chi (Etc) Program Enhances Quality Of Life For Older Adults In Assisted Living Facility: Feasibility Study, Pooja Ghai, Amanda J. Mohler, Mary Tracy Morrison Oct 2021

Enriched Tai Chi (Etc) Program Enhances Quality Of Life For Older Adults In Assisted Living Facility: Feasibility Study, Pooja Ghai, Amanda J. Mohler, Mary Tracy Morrison

The Open Journal of Occupational Therapy

Background: Older adults living in assisted living facilities (ALFs) are at risk for physical and mental health decline that precipitates nursing home placement. There is a need for an exercise program that improves the quality of life (QOL) for older adults living in the ALFs. This study’s primary purpose was to investigate the feasibility of an Enriched tai chi (ETC) intervention program on improving the QOL of older adults living in an ALF.

Method: A convenience sample of six older adults living in the same ALF attended the ETC program for 16 consecutive sessions two times per …


Determining The Initial Content Validity Of The Clinical Competency Assessment Tool (Cat) For Occupational Therapists Treating Patients With Neurodegenerative Disease, Scott G. Rushanan, Dawn M. Nilsen, Lenin Grajo Oct 2021

Determining The Initial Content Validity Of The Clinical Competency Assessment Tool (Cat) For Occupational Therapists Treating Patients With Neurodegenerative Disease, Scott G. Rushanan, Dawn M. Nilsen, Lenin Grajo

The Open Journal of Occupational Therapy

The provision of occupational therapy (OT) interventions for people with neurodegenerative disorder (NDD) requires advanced clinical competency; therefore, a means to evaluate that competency is needed. The Clinical Competency Assessment Tool for Occupational Therapists Treating Patients with Neurodegenerative Disease (CAT) was recently developed as a self-report assessment that aims to identify gaps in clinical competence and measure outcomes of professional development programs specific to occupational therapists treating patients with NDD. The purpose of this study is to explore preliminary content validity of the CAT. Classical test theory was used to test for content validity. A panel of 10 expert occupational …


Health Literacy In Occupational Therapy Research: A Scoping Review, Erin Attard, Andraya Musallam, Kirsten Vaas, Taylar Chaney, Jennifer K. Fortuna, Betsy Williams Oct 2021

Health Literacy In Occupational Therapy Research: A Scoping Review, Erin Attard, Andraya Musallam, Kirsten Vaas, Taylar Chaney, Jennifer K. Fortuna, Betsy Williams

The Open Journal of Occupational Therapy

Background: Low health literacy is a significant problem in the United States. Patient education is a key component of occupational therapy intervention. Occupational therapists have the skills to develop patient education materials (PEMs) all patients can understand. Few studies on health literacy exist in occupational therapy research. The purpose of this scoping review was to summarize the breadth of literature on health literacy in occupational therapy research and to identify knowledge gaps.

Method: A scoping review methodological framework (Arksey and O’Malley, 2005; Levac et al., 2010) was used to search five databases. A descriptive numerical summary and qualitative …


A Scoping Review Of Occupational Therapy Approaches To Enable Occupations For People Living With Behavioral Disturbance As A Result Of Acquired Brain Injury, Anahita Brown, Tamara Tse Dr, Tracy Fortune, Susan Petrie Oct 2021

A Scoping Review Of Occupational Therapy Approaches To Enable Occupations For People Living With Behavioral Disturbance As A Result Of Acquired Brain Injury, Anahita Brown, Tamara Tse Dr, Tracy Fortune, Susan Petrie

The Open Journal of Occupational Therapy

Background: Behavioral disturbance impacts almost 50% of people living with acquired brain injury (ABI) and severely impedes occupational participation. Occupational therapists are appropriately qualified and well placed to address behavioral disturbance. This scoping review analyzes the literature to ascertain approaches used by occupational therapists to treat behavioral disturbance.

Method: A literature search of three databases revealed 379 papers for consideration, five of which met inclusion criteria. The Critical Appraisal Skills Programme (CASP) checklists were used for the analysis. This paper employs the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework.

Results: Sensory modulation interventions, community-based …


Older Adults In An Lgbt Residential Community: Impact Of A Safe Space On Occupation And Well-Being, Daniel P. Swiatek, Sheryl Ryan, Terry Peralta-Catipon Oct 2021

Older Adults In An Lgbt Residential Community: Impact Of A Safe Space On Occupation And Well-Being, Daniel P. Swiatek, Sheryl Ryan, Terry Peralta-Catipon

The Open Journal of Occupational Therapy

Background: LGBT seniors have suffered a lifetime of societal and institutional discrimination and health care inequalities. The number of LGBT people 50 years of age and older will surpass five million in the coming decades. LGBT seniors are at greater risk of disability, isolation, physical and mental health issues, and substance abuse. Supportive social environments and networks are correlated with higher quality of life. The purpose of this study was to better understand how living in a safe and secure apartment community specifically for low-income LGBT older adults impacted the residents’ daily life and well-being.

Method: This study …


Compassion: Importance And Implications For The Profession Of Occupational Therapy, Diane Powers Dirette Oct 2021

Compassion: Importance And Implications For The Profession Of Occupational Therapy, Diane Powers Dirette

The Open Journal of Occupational Therapy

No abstract provided.


Ikebana: An Ancient Tradition Of Contemporary Healing And Artful Practice, Jennifer K. Fortuna Phd, Otr/L Jul 2021

Ikebana: An Ancient Tradition Of Contemporary Healing And Artful Practice, Jennifer K. Fortuna Phd, Otr/L

The Open Journal of Occupational Therapy

Dr. Ricardo Carrásco, PhD, OTR/L, FAOTA, is an occupational therapy professor and ikebana artist. He provided the cover art for the Summer 2021 edition of The Open Journal of Occupational Therapy (OJOT). Ikebana is the ancient Japanese art of arranging flowers. “Kanta of the Wind, Sun and Moon” is an ikebana design made from blue and white Phalaenopsis orchids, chrysanthemum, bear grass, and heirloom driftwood. This gendaika, or freestyle design, is a haiku tribute to the wind, sun, and moon. Dr. Carrásco has been practicing occupational therapy and ikebana for more than 5 decades. As an occupational scientist and …


The Potential Of Virtual Reality In Social Skills Training For Autism: Bridging The Gap Between Research And Adoption Of Virtual Reality In Occupational Therapy Practice, Vineeta Pandey, Lori Vaughn Jul 2021

The Potential Of Virtual Reality In Social Skills Training For Autism: Bridging The Gap Between Research And Adoption Of Virtual Reality In Occupational Therapy Practice, Vineeta Pandey, Lori Vaughn

The Open Journal of Occupational Therapy

Impairments in social functioning greatly hinder children and youth with autism spectrum disorder (ASD) from responding appropriately and adapting to various social situations. As a result, individuals with ASD get fewer opportunities for social inclusion, physical well-being, and forming interpersonal relationships. Virtual reality (VR) has been studied extensively in this area, where a large body of evidence shows that VR is a promising tool for social skills training (SST) in individuals with ASD. With the flexibility and projected effectiveness that VR offers, it can provide more opportunities to learn and practice strategies for recognizing daily challenges that involve forming social …


Cognitive Orientation To Daily Occupational Performance (Co-Op): 1-Week Group Intervention With Children Referred For Motor Coordination Difficulties, Rose Martini, Jacinthe Savard Jul 2021

Cognitive Orientation To Daily Occupational Performance (Co-Op): 1-Week Group Intervention With Children Referred For Motor Coordination Difficulties, Rose Martini, Jacinthe Savard

The Open Journal of Occupational Therapy

Background: The aim of this study was to explore the effectiveness of a Cognitive Orientation to daily Occupational Performance (CO-OP) intervention delivered in a group format in a 1-week summer day camp program for children referred for motor coordination difficulties. Transfer of learned skills to self-selected tasks not addressed in the group intervention was also explored.

Method: A quasi-experimental one group pretest-posttest design with a 1-month follow-up was used. Changes in nine children’s self-selected occupational performance goals, as well as their sense of self-efficacy for these goals, were determined using nonparametric statistics.

Results: Findings indicate a significant …


A Comparison Of Two Keyboarding Instruction Methods Over 2 Years For Elementary Students, Denise K. Donica, Peter Giroux, Young Joo Kim, Sydney Branson Jul 2021

A Comparison Of Two Keyboarding Instruction Methods Over 2 Years For Elementary Students, Denise K. Donica, Peter Giroux, Young Joo Kim, Sydney Branson

The Open Journal of Occupational Therapy

Background: As computer and digital device use continues to grow in prevalence for school and work tasks, it is important for elementary-aged students to develop efficient keyboarding skills to support future academic and vocational success.

Method: A quasi-experimental pre-test and post-test study design was used to compare the effect of two different keyboarding instructional approaches on elementary students over a consecutive 2-year period. One group used Keyboarding Without Tears (KWT; N = 592) both years while the other group used free web-based activities the first year and Keyboarding Without Tears the second year (mixed methods; N = 714). …


A Comparison Of Activity Participation Between Children With And Without Asthma, Jacqueline R. Jezioro, Sharon A. Gutman, Stephanie Lovinsky-Desir, Virginia Rauh, Frederica P. Perera, Rachel L. Miller Jul 2021

A Comparison Of Activity Participation Between Children With And Without Asthma, Jacqueline R. Jezioro, Sharon A. Gutman, Stephanie Lovinsky-Desir, Virginia Rauh, Frederica P. Perera, Rachel L. Miller

The Open Journal of Occupational Therapy

Background: Asthma affects approximately 6 million children in the United States and can greatly impact quality of life and occupational engagement. Although occupational therapists are well-equipped to address participation limitations, insufficient evidence exists to support the role of occupational therapists in asthma treatment.

Method: The purpose of this study was to further understand the occupational limitations experienced by children with asthma. We also explored a dual diagnosis of asthma and obesity. The participants included children with (n = 84) and without (n = 63) asthma living in New York City. The Child Behavior Checklist, Youth Self Report, Brief …


Promoting Population Health In Local Communities: Parental Perceptions Of An Embedded Movement And Physical Activity Program For A Preschool Population, Jennifer Hight, Shirley P. O'Brien, Colleen M. Schneck Jul 2021

Promoting Population Health In Local Communities: Parental Perceptions Of An Embedded Movement And Physical Activity Program For A Preschool Population, Jennifer Hight, Shirley P. O'Brien, Colleen M. Schneck

The Open Journal of Occupational Therapy

Background: Many children reach kindergarten lacking age-appropriate motor skills because of a lack of access to early intervention services or a lack of continued early intervention beyond 3 years of age. Research suggests sedentary children become sedentary adults, which contributes to a growing population of unhealthy Americans with chronic health conditions, such as high blood pressure, diabetes, heart disease, and psychosocial difficulties. Parents often are not aware of the benefits of engaging in physical activity or possess a lack of awareness of their local resources. A community based preschool movement program was created to foster physical activity and promote …


Preliminary Measurement Properties Of The Early Childhood Occupational Profile (Ecope), Cary C. Moore Jul 2021

Preliminary Measurement Properties Of The Early Childhood Occupational Profile (Ecope), Cary C. Moore

The Open Journal of Occupational Therapy

Background: This study established the preliminary psychometric properties of the Early Childhood Occupational Profile (ECOPE; Moore & Bowyer, 2018) and investigated the perspectives of occupational therapists on the clinical utility of the tool.

Method: An embedded mixed methods research design was used to support the use of different research questions and unique sets of data. National and international occupational therapists administered the ECOPE on video case studies and on children from their caseload. These data were analyzed using the Rasch goodness of fit statistics to evaluate the validity and reliability of the ECOPE. The participating occupational therapists also …


Plagiocephaly Perception And Prevention: A Need To Intervene Early To Educate Parents, Sonja Burmeister, Allison N. Kayne, Ali R. Yazdanyar, J. Nathan Hagstrom, David B. Burmeister Jul 2021

Plagiocephaly Perception And Prevention: A Need To Intervene Early To Educate Parents, Sonja Burmeister, Allison N. Kayne, Ali R. Yazdanyar, J. Nathan Hagstrom, David B. Burmeister

The Open Journal of Occupational Therapy

Background: Plagiocephaly is a condition where the cranium has been malformed because of external forces or premature cranial suture fusion. This study’s objective was to gather and examine data regarding parent and caregiver awareness of plagiocephaly and its potential impact on development as well as to determine their rate of concern for positional flattening.

Method: A cross-sectional survey study was conducted. Categorical variables were described by frequency and proportions. The study was conducted across eight outpatient pediatric sites. Approximately 1,100 parents and caregivers were targeted. Inclusion criteria required participants to be willing to answer the questionnaire, to be …


Use Of A Caregiver Coaching Model For Implementation Of Intensive Motor Training For Hemiplegic Cerebral Palsy: A Case Study, Sheryl Eckberg Zylstra, Aimee Sidhu Jul 2021

Use Of A Caregiver Coaching Model For Implementation Of Intensive Motor Training For Hemiplegic Cerebral Palsy: A Case Study, Sheryl Eckberg Zylstra, Aimee Sidhu

The Open Journal of Occupational Therapy

Background: There is extensive literature to support the efficacy of both pediatric constraint-induced movement therapy (pCIMT) and hand-arm bimanual intensive therapy (HABIT) for children with hemiplegic cerebral palsy. In addition, there is increasing evidence to support the training of caregivers (parents and other care providers) to carry out therapy interventions in the home. The Family Activity Adaptation Model (FAAM) presents guidelines for parent and caregiver coaching for intensive therapies used in occupational therapy practice.

Method: In this descriptive case study the FAAM was used to frame caregiver training to answer the question: Is a coaching model, using a …


Observing And Promoting Normative Developmental Outcomes: Reciprocity Is Key, Nicki L. Aubuchon-Endsley, Bryan M. Gee, Heather L. Ramsdell, Nancy Devine, Hillary E. Swann-Thomsen, Nicholas Burgett, Leah R. Kollmeyer, Michele R. Brumley Jul 2021

Observing And Promoting Normative Developmental Outcomes: Reciprocity Is Key, Nicki L. Aubuchon-Endsley, Bryan M. Gee, Heather L. Ramsdell, Nancy Devine, Hillary E. Swann-Thomsen, Nicholas Burgett, Leah R. Kollmeyer, Michele R. Brumley

The Open Journal of Occupational Therapy

Background: Occupational therapists focus on caregiver-infant reciprocity, which is influenced by a host of biopsychosocial factors and is predictive of developmental outcomes across domains. It is important for early intervention professions to understand how different forms of reciprocity may predict infant development in salient domains (i.e., language, mobility, and co-occupation). Therefore, the purpose of this study was to investigate associations among related measures of development in and across age, while also exploring how reciprocity influences the acquisition of developmental milestones.

Method: We examined these important areas of development in relation to novel caregiver-infant co-occupational constructs in addition to …


Occupational Therapists’ Perceptions Of Intraprofessional Collaboration When Working With Young Children Aged Birth To 3 Years, Christine Rocchio Mueller, Mindy Garfinkel Jul 2021

Occupational Therapists’ Perceptions Of Intraprofessional Collaboration When Working With Young Children Aged Birth To 3 Years, Christine Rocchio Mueller, Mindy Garfinkel

The Open Journal of Occupational Therapy

Background: Birth to 3 years of age is a critical period in a child’s development, and occupational therapy intervention during this period can serve many purposes. While pediatric occupational therapists may be working in different settings with different specialties, the foundational knowledge all occupational therapists possess provides a common lens through which they approach treatment. Intraprofessional collaboration is considered best practice, as it is not uncommon for young children to receive occupational therapy services by more than one therapist, and in more than one practice setting at the same time.

Method: This study used a qualitative, phenomenological approach. …


Adaptations To Early Intervention Service Delivery During Covid-19, Lauren Little, Ashley Stoffel Jul 2021

Adaptations To Early Intervention Service Delivery During Covid-19, Lauren Little, Ashley Stoffel

The Open Journal of Occupational Therapy

Background: Early Intervention (EI) systems made a rapid shift to telehealth during the COVID-19 pandemic. Given the limited preparation of EI providers in the telehealth service delivery model, it is unclear how providers implemented adaptations. The purpose of this study was to evaluate the factor structure of the Service Delivery Adaptations Questionnaire and examine the influence of provider type, years of EI experience, and willingness to return to in-person services on the questionnaire’s subscales.

Method: We used exploratory factor analysis (EFA) to examine the structure of the Service Delivery Adaptations Questionnaire among n = 704 EI providers. We …


Occupational Therapists’ Perspectives On Family-Centered Practices In Early Intervention, Irma J. Pereira, Francine M. Seruya Jul 2021

Occupational Therapists’ Perspectives On Family-Centered Practices In Early Intervention, Irma J. Pereira, Francine M. Seruya

The Open Journal of Occupational Therapy

Background: Early intervention (EI) requires service provision in natural settings while incorporating interventions based on family-centered practice (FCP). This study sought to understand (a) how occupational therapists define and implement FCP in their daily interventions and (b) therapists’ perspectives on using this model of practice in EI.

Method: This study used a qualitative, phenomenological approach. Nine licensed occupational therapists from six states with a minimum of 3 years of working experience in the area of EI participated. Semi-structured interviews were recorded, transcribed, and subsequently coded and analyzed for emergent themes.

Results: The therapists had an average of …


They Said: Preparing Future Ei Providers Across Disciplines Through An Academic Partnership, Beth K. Elenko Jul 2021

They Said: Preparing Future Ei Providers Across Disciplines Through An Academic Partnership, Beth K. Elenko

The Open Journal of Occupational Therapy

No abstract provided.


They Said: Coaching Alongside Families In Early Intervention, Beth K. Elenko Jul 2021

They Said: Coaching Alongside Families In Early Intervention, Beth K. Elenko

The Open Journal of Occupational Therapy

No abstract provided.


Bringing The Family To The Center Of Early Intervention Practice In Occupational Therapy, Beth K. Elenko Jul 2021

Bringing The Family To The Center Of Early Intervention Practice In Occupational Therapy, Beth K. Elenko

The Open Journal of Occupational Therapy

No abstract provided.


Examining Complementary Health Approaches And Integrative Health (Chaih) Practices Among Occupational Therapists In The United States: A Mixed Methods Approach, Sarah M. Renner Jun 2021

Examining Complementary Health Approaches And Integrative Health (Chaih) Practices Among Occupational Therapists In The United States: A Mixed Methods Approach, Sarah M. Renner

Dissertations

The use of complementary health approaches and integrative health (CHAIH) is increasing among adults and children in the United States and continues to grow within various health care settings. With Health and Wellness identified as a key practice area for occupational therapists and the American Occupational Therapy Association supporting the use of CHAIH in occupational therapy (OT) practice, practitioners must offer safe, research-driven treatments supporting this movement. Research around CHAIH continues to grow; yet the gaps in the literature make it difficult to determine how CHAIH is being used in OT practice as well as the practitioner’s perspectives on the …


The Impacts Of Occupational Therapy And Assistive Technology In The Lives Of Alzheimer's Patients, Hannah Wilson Apr 2021

The Impacts Of Occupational Therapy And Assistive Technology In The Lives Of Alzheimer's Patients, Hannah Wilson

Honors Theses

Occupational therapy and the assistive devices that are recommended provide an outlet to a better quality of life for individuals with Alzheimer’s as well as increases safety and independence in the individual. Alzheimer’s disease is a progressive neurodegenerative disorder that affects an individual’s memory, physical functioning, safety, and cognition. As the disease progresses, it decreases an individual’s level of independence in their environment and often calls for outside care to successfully complete the daily skills and activities needed to age successfully. The practitioners that work with individuals who have Alzheimer’s aim to improve the completion of activities of daily living …


Life Repurposed: Finding A New Calling Through Meaningful Occupation, Jennifer K. Fortuna Apr 2021

Life Repurposed: Finding A New Calling Through Meaningful Occupation, Jennifer K. Fortuna

The Open Journal of Occupational Therapy

Kelly Allen, an occupational therapist and artist based in Grand Rapids, MI, provided the cover art for the Spring 2021 edition of the Open Journal of Occupational Therapy (OJOT). “Follow” is a 16” x 20” painting made from oil on panel. The painting, which features a coati from Central America, is from Kelly’s Animal Totem series. After more than 2 decades as a fine artist and educator, she began searching for a career change. Kelly’s background in fine art and her desire to help others prepared her for a career in occupational therapy. Certain events in Kelly’s life aligned not …