Occupational Science & Occupational Therapy - Journal articles
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Item Evidence for implementing tiered approaches in elementary schools in school-based occupational therapy: a scoping review(American Occupational Therapy Association, 2023) Lynch, Helen; Moore, Alice; O'Connor, Deirdre; Boyle, BryanImportance: Internationally, it is suggested that school-based occupational therapy (SBOT) has an important role in supporting inclusion in educational settings. In SBOT, multitiered service delivery models are identified as a way forward to maximize school inclusion. Therefore, identifying evidence for the implementation of tiered interventions in SBOT is vital. Objective: To identify and map evidence in the occupational therapy literature relating to SBOT interventions delivered in elementary schools for all children, for those at risk, and for those with identified diagnoses. Data Sources: Peer-reviewed literature published in 14 occupational therapy journals between 1990 and 2020, indexed in the EBSCOhost database. Study Selection and Data Collection: Included studies were those within the scope of SBOT that reported on school occupations and focused on elementary school–age children (excluding kindergarteners or preschoolers). Findings: Forty studies met the criteria. Individual-tier intervention studies (n = 22) primarily reported direct interventions with children at risk or with identified diagnoses (Tier 2 or Tier 3), focusing mostly on remedial approaches. None adopted a whole-school approach. Despite handwriting and self-regulation being dominant areas of concern, these studies were not explicitly related to inclusion outcomes. Evidence for implementing multitiered models primarily used indirect, collaborative consultation, embedded in the school context (n = 18). These studies identified positive school staff and child outcomes when collaboration was timely, consistent, and authentic. Conclusions and Relevance: More rigorous individual-tier intervention studies are required to inform the design and implementation of multitiered interventions in SBOT and to support participation and inclusion in schools. What This Article Adds: This scoping review provides evidence to support occupational therapists’ professional reasoning in developing evidence-based, contextual, educationally relevant multitiered models of intervention in SBOT.Item Family life and autistic children with sensory processing differences: A qualitative evidence synthesis of occupational participation(Frontiers Media S.A., 2022-10-20) Daly, Gina; Jackson, Jeanne; Lynch, Helen; Sensory Integration Network Limited, UK and IrelandAutistic children with sensory processing differences successfully navigate and engage in meaningful family daily occupations within home and community environments through the support of their family. To date however, much of the research on autistic children with sensory processing differences, has primarily been deficit focused, while much of the caregiver research has focused on issues of distress, burden, effort, and emotional trauma in coping with their child's diagnosis. This study aimed to conduct a qualitative evidence synthesis, using a meta-ethnographic approach to explore the gap identified in understanding successful occupational experiences of family participation and daily family routines when supporting an autistic child with sensory processing differences and to offer an alternative strengths-based perspective. Inclusion criteria were studies which were peer-reviewed qualitative design, published from 2000 to 2021, and that concerned parents/caregivers' perspectives of family occupations of children diagnosed with autism spectrum disorder. Studies were electronically searched in eight databases from October to December 2021 and 23 studies were identified which met the inclusion criteria. Noblit and Hare's seven step approach for conducting analysis in meta-ethnography was used, and three themes identified: (1) sensory processing differences in daily life, (2) what is hard about hard, and (3) orchestrating family life. Results identified the centrality of sensory experiences in understanding family life. Living with unpredictability while orchestrating certainty through routines was core to successful participation. This review provides insights into how parents negotiate the complexities of constructing family life when living with an autistic child. The results can inform the design of future interventions that specifically address the relationship between meaningful participation in family occupations and daily routines and sensory processing in autistic children.Item Can universal design support outdoor play, social participation, and inclusion in public playgrounds? A scoping review(Taylor & Francis, 2020-12-10) Moore, Alice; Lynch, Helen; Boyle, Bryan; Irish Research CouncilPurpose: To synthesize evidence regarding the physical design features and non-physical aspects of public playgrounds that facilitate/hinder outdoor play, social participation, and inclusion; identify design recommendations; and explore the current discourses and concepts around designing for outdoor play, social participation, and inclusion in public playgrounds in the context of Universal Design (UD). Methods: Published studies addressing public playgrounds, inclusion, and design, were identified via a systematic search of eleven databases from health, science, education, and humanities. Results: Fifteen documents met the inclusion criteria. Three main themes were identified concerning physical design features and non-physical aspects of public playgrounds that facilitate/hinder outdoor play, social participation, and inclusion, with associated design recommendations. Although UD is recognized to have the potential to support the design of public playgrounds, no studies examined UD solutions for playgrounds or tested them for effectiveness. Conclusion: We cannot yet determine whether UD can support outdoor play, social participation, and inclusion in public playgrounds. Research to date has mostly focused on understanding usersâ perspectives; future research should continue to be informed by diverse usersâ perspectives to address gaps in knowledge concerning childrenâ s voice from migrants, lower socioeconomic communities, and intergenerational users with disabilities alongside researching design solutions for play. Implications for rehabilitation: Children, particularly children with disabilities and their families, continue to experience marginalization and exclusion in public playgrounds, despite a commitment to inclusion in international treaties. Universal design is recognized to have the potential to support the design of public playgrounds, however, the evidence is currently very sparse. While accessibility is an important consideration for playground design, it does not ensure that play occupations can take place. Extending knowledge on universal design as it applies explicitly to playgrounds and play occupation requires multi- and trans-disciplinary collaboration that includes a play-centered perspective.Item Consultations on driving in people with cognitive impairment in primary care: A scoping review of the evidence(PLoS, 2018-10-15) Sinnott, Carol; Foley, Tony; Forsyth, Justin; McLoughlin, Kathleen; Horgan, Linda; Bradley, Colin P.; Road Safety Authority Ireland; National Institute for Health Research; School for Primary Care Research (SPCR)Objectives: To review the empirical evidence on approaches used by Primary Care Physicians (PCPs) in fitness to drive (FtD) consultations with people living with cognitive impairment. Design: Scoping review of empirical literature focused on primary studies of any design. Setting: Primary care practice. Participants: PCPs or their equivalent and/ or individuals with cognitive impairment across the spectrum of mild cognitive impairment to dementia. Measurements: Systematic search of Medline, Cinahl, PsychINFO, Academic Search Complete, Psychological and Behavioural Sciences Collection, SocIndex and Social Sciences FT were conducted. Records screened by two reviewers against agreed inclusion criteria. Mixed studies (qualitative and quantitative) were synthesized within overarching themes. Results: Eighteen studies met our inclusion criteria. Synthesized data showed PCPs have mixed feelings on the appropriateness of their role in FtD assessments, with many feeling particularly uncomfortable and lacking confidence in the context of possible cognitive impairment. Reasons include lack of familiarity with legal requirements and local resources; fear of damaging the doctor-patient relationship; and impact on the patient’s quality of life. Patients voiced their desire to maintain agency in planning their driving cessation. Studies evaluating pragmatic educational programmes suggest these can improve physician confidence in FtD consultations. Conclusion: The increasing number of older people affected by cognitive impairment, for whom driving may be a concern, has implications for primary care practice. Addressing the reasons for PCPs lack of comfort in dealing with this issue is essential in order for them to better engage in, collaborative discussion with patients on plans and preferences for driving cessationItem Play and play occupation: a survey of paediatric occupational therapy practice in Ireland(Emerald Publishing Limited, 2018) Moore, Alice; Lynch, HelenPurpose: Play occupation has been identified as an essential part of children’s lives, and it subsequently features in paediatric occupational therapy. However, few studies address the current place of play and play occupation in occupational therapy practice. This study aims to address this gap in knowledge by exploring paediatric occupational therapists’ perspectives on the place of play and play occupation in occupational therapy practice in Ireland. Design/methodology/approach: A cross-sectional online survey was conducted to gather data about the current use of play in the occupational therapy for children under 12 years. Convenience sampling and snowball recruitment techniques were used to recruit paediatric occupational therapists. Data were analysed using descriptive statistics and qualitative content analysis. Findings: In total, 65 therapists responded to the survey (estimated response rate, 32%). Results are organised into four sections: demographics and practice context, play assessment practices, use of play in practice and perceived barriers to play-centred practice. Respondents reported that they valued play as a childhood occupation. However, the survey findings identified that the primary focus was on play as a means to an end. Lack of education on play (research, theory and interventions) and pressures in the workplace have been identified as barriers to play-centred practice. Research limitations/implications: Findings indicate that there is a mismatch between therapists valuing play as an occupation and how play is used in occupational therapy practice. Unless clarifications are made about play occupation as being different to skills acquisition in childhood, play occupation will continue to get overlooked as an authentic concern of occupation-centred practice. Thus, play as occupation deserves further attention from educators, researchers and practitioners as a means of strengthening occupation-centred practice, in particular play-centred practice in the paediatric context. Originality/value: Play has been described as an important occupation in childhood, and consequently, it features in paediatric occupational therapy. However, little is known about the current place of play in occupational therapy practice. This study addresses this gap by considering the current place of play in occupational therapy practice in Ireland.