Notes

Your medical value of modest well-defined spikes: A retrospective research associated with 909 sufferers within epilepsy keeping track of product.
In this article, we propose a knowledge distillation approach with two teachers for facial age estimation. Due to the nonstationary patterns of the facial-aging process, the relative order of age labels provides more reliable information than exact age values for facial age estimation. Thus, the first teacher is a novel ranking method capturing the ordinal relation among age labels. Especially, it formulates the ordinal relation learning as a task of recovering the original ordered sequences from shuffled ones. The second teacher adopts the same model as the student that treats facial age estimation as a multiclass classification task. The proposed method leverages the intermediate representations learned by the first teacher and the softened outputs of the second teacher as supervisory signals to improve the training procedure and final performance of the compact student for facial age estimation. Hence, the proposed knowledge distillation approach is capable of distilling the ordinal knowledge from the ranking model and the dark knowledge from the multiclass classification model into a compact student, which facilitates the implementation of facial age estimation on platforms with limited memory and computation resources, such as mobile and embedded devices. Extensive experiments involving several famous data sets for age estimation have demonstrated the superior performance of our proposed method over several existing state-of-the-art methods.We present RealWalk, a pair of haptic shoes for HMD-based VR, designed to create realistic sensations of ground surface deformation and texture using Magnetorheological fluid (MR fluid). RealWalk offers a novel interaction scheme through the physical interaction between the shoes and the ground surfaces while walking in VR. Each shoe consists of two MR fluid actuators, an insole pressure sensor, and a foot position tracker. The MR fluid actuators are designed in the form of multi-stacked disc structure with a long flow path to maximize the flow resistance. With changing the magnetic field intensity in MR fluid actuators based on the ground material in the virtual scene, the viscosity of MR fluid is changed accordingly. When a user steps on the ground with the shoes, the two MR fluid actuators are pressed down, creating a variety of ground material deformation such as snow, mud, and dry sand. We built an interactive VR application and compared RealWalk with vibrotactile-based haptic shoes in four different VR scenes grass, sand, mud, and snow. We report that, compared to vibrotactile-haptic shoes, RealWalk provides higher ratings in all scenes for discrimination, realism, and satisfaction. We also report qualitative user feedback for their experiences.Smart healthcare has been applied in many fields such as disease surveillance and telemedicine, etc. However, there are some challenges for device deployment, data collection and guarantee of stainability in regional disease surveillance. First, it is difficult to deploy sensors and adjust the sensor network in unknown region for dynamic disease surveillance. Second, the limited life-cycle of sensor network may cause the loss of surveillance data. Thus, it is important to provide a sustainable and robust regional disease surveillance system. Given a set of Disease surveillance Area (DsA)s and Point of disease Surveillance (PoS)s, some sensors are deployed to monitor these PoSs, and a drone collect data from the sensors as well as charge the sensors to extend their life-cycles. The drone replenish its energy by relying on the bus network. We first formulate the drone assisted regional disease surveillance problem under the constraints of life-cycle of sensors and energy of drone, and propose an approximation algorithm to find a feasible cycle of drone to minimize the traveling time cost of drone. To satisfy the diversity requirements and dynamic scalability of regional disease surveillance, we deploy one robot in each DsA instead of sensors. We further formulate the learning transferable driven regional disease surveillance problem, and propose a joint schedule algorithm of drone and robots. The results of both theoretical analysis and extensive simulations show that the proposed algorithms can reduce the total time cost by 39.71 and 48.74 percent, average waiting time by 42.00 and 50.14 percent, and increase the average accessing ratio of PoSs by 15.53 and 22.30 percent, through the assistance of bus network and learning transferable features.Functional electrical stimulation (FES) induced cycling is a common rehabilitative technique for people with neuromuscular disorders. A challenge for closed-loop FES control is that there exists a potentially destabilizing time-varying input delay, termed electromechanical delay (EMD), between the application of the electric field and the corresponding muscle contraction. In this article, the FES-induced torque production and EMD are quantified on an FES-cycle for the quadriceps femoris and gluteal muscle groups. Experiments were performed on five able-bodied individuals and five individuals with neurological conditions. Closed-loop FES-cycling was applied to induce fatigue and torque and EMD measurements were made during isometric conditions before and after each minute of cycling to quantify the effect of fatigue on EMD and torque production. A multiple linear regression and other descriptive statistics were performed to establish a range of expected EMD values and bounds on the rate of change of the EMD across a diverse population. The results from these experiments can be used to assist in the development of closed-loop controllers for FES-cycling that are robust to time-varying EMD and changes in torque production.Previous studies have shown the superior performance of hybrid electroencephalography (EEG)/ near-infrared spectroscopy (NIRS) brain-computer interfaces (BCIs). However, it has been veiled whether the use of a hybrid EEG/NIRS modality can provide better performance for a brain switch that can detect the onset of the intention to turn on a BCI. In this study, we developed such a hybrid EEG/NIRS brain switch and compared its performance with single modality EEG- and NIRS-based brain switch respectively, in terms of true positive rate (TPR), false positive rate (FPR), onset detection time (ODT), and information transfer rate (ITR). In an offline analysis, the performance of a hybrid EEG/NIRS brain switch was significantly improved over that of EEG- and NIRS-based brain switches in general, and in particular a significantly lower FPR was observed for the hybrid EEG/NIRS brain switch. A pseudo-online analysis was additionally performed to confirm the feasibility of implementing an online BCI system with our hybrid EEG/NIRS brain switch. The overall trend of pseudo-online analysis results generally coincided with that of the offline analysis results. No significant difference in all performance measures was also found between offline and pseudo online analysis schemes when the amount of training data was same, with one exception for the ITRs of an EEG brain switch. These offline and pseudo-online results demonstrate that a hybrid EEG/NIRS brain switch can be used to provide a better onset detection performance than that of a single neuroimaging modality.Chronic stroke survivors often suffer from gait impairment resistant to intervention. Recent rehabilitation strategies based on gait training with powered exoskeletons appear promising, but whether chronic survivors may benefit from them remains controversial. We evaluated the potential of exoskeletal gait training in restoring normal motor outputs in chronic survivors (N = 10) by recording electromyographic signals (EMGs, 28 muscles both legs) as they adapted to exoskeletal perturbations, and examined whether any EMG alterations after adaptation were underpinned by closer-to-normal muscle synergies. A unilateral ankle-foot orthosis that produced dorsiflexor torque on the paretic leg during swing was tested. Over a single session, subjects walked overground without exoskeleton (FREE), then with the unpowered exoskeleton (OFF), and finally with the powered exoskeleton (ON). Muscle synergies were identified from EMGs using non-negative matrix factorization. During adaptation to OFF, some paretic-side synergies became more dissimilar to their nonparetic-side counterparts. During adaptation to ON, in half of the subjects some paretic-side synergies became closer to their nonparetic references relative to their similarity at FREE as these paretic-side synergies became sparser in muscle components. Across subjects, level of inter-side similarity increase correlated negatively with the degree of gait temporal asymmetry at FREE. Our results demonstrate the possibility that for some survivors, exoskeletal training may promote closer-to-normal muscle synergies. But to fully achieve this, the active force must trigger adaptive processes that offset any undesired synergy changes arising from adaptation to the device's mechanical properties while also fostering the reemergence of the normal synergies.As improvements in medicine lower infant mortality rates, more infants with neuromotor challenges survive past birth. The motor, social, and cognitive development of these infants are closely interrelated, and challenges in any of these areas can lead to developmental differences. Thus, analyzing one of these domains - the motion of young infants - can yield insights on developmental progress to help identify individuals who would benefit most from early interventions. In the presented data collection, we gathered day-long inertial motion recordings from N = 12 typically developing (TD) infants and N = 24 infants who were classified as at risk for developmental delays (AR) due to complications at or before birth. As a first research step, we used simple machine learning methods (decision trees, k-nearest neighbors, and support vector machines) to classify infants as TD or AR based on their movement recordings and demographic data. Our next aim was to predict future outcomes for the AR infants using the same simple classifiers trained from the same movement recordings and demographic data. We achieved a 94.4% overall accuracy in classifying infants as TD or AR, and an 89.5% overall accuracy predicting future outcomes for the AR infants. The addition of inertial data was much more important to producing accurate future predictions than identification of current status. This work is an important step toward helping stakeholders to monitor the developmental progress of AR infants and identify infants who may be at the greatest risk for ongoing developmental challenges.While natural movements result from fluid coordination of multiple joints, commercial upper-limb prostheses are still limited to sequential control of multiple degrees of freedom (DoFs), or constrained to move along predefined patterns. To control multiple DoFs simultaneously, a probability-weighted regression (PWR) method has been proposed and has previously shown good performance with intramuscular electromyographic (EMG) sensors. This study aims to evaluate the PWR method for the simultaneous and proportional control of multiple DoFs using surface EMG sensors and compare the performance with a classical direct control strategy. To extract the maximum number of DoFs manageable by a user, a first analysis was conducted in a virtually simulated environment with eight able-bodied and four amputee subjects. Results show that, while using surface EMG degraded the PWR performance for the 3-DoFs control, the algorithm demonstrated excellent achievements in the 2-DoFs case. Finally, the two methods were compared on a physical experiment with amputee subjects using a hand-wrist prosthesis composed of the SoftHand Pro and the RIC Wrist Flexor. Results show comparable outcomes between the two controllers but a significantly higher wrist activation time for the PWR method, suggesting this novel method as a viable direction towards a more natural control of multi-DoFs.This article presents an imaging scheme capable of estimating the full 3-D velocity vector field in a volume using row-column addressed arrays (RCAs) at a high volume rate. A 62 + 62 RCA array is employed with an interleaved synthetic aperture sequence. It contains repeated emissions with rows and columns interleaved with B-mode emissions. The sequence contains 80 emissions in total and can provide continuous volumetric data at a volume rate above 125 Hz. A transverse oscillation cross correlation estimator determines all three velocity components. The approach is investigated using Field II simulations and measurements using a specially built 3-MHz 62 + 62 RCA array connected to the SARUS experimental scanner. Both the B-mode and flow sequences have a penetration depth of 14 cm when measured on a tissue-mimicking phantom (0.5-dB/[ [Formula see text]] attenuation). Simulations of a parabolic flow in a 12-mm-diameter vessel at a depth of 30 mm, beam-to-flow angle of 90°, and xy-rotation of 45° gave a standard he volume, allowing for retrospective analysis of the flow. Moreover, B-mode planes can be selected retrospectively anywhere in the volume. This shows that tensor velocity imaging (full 3-D volumetric vector flow imaging) can be estimated in 4-D ( x, y, z, and t ) using only 62 channels in receive, making 4-D volumetric imaging implementable on current scanner hardware.High-intensity focused ultrasound (HIFU) has been used in different medical applications in the last years. In this work, we present for the first time the use of HIFU in the field of cryopreservation, the preservation of biological material at low temperatures. An HIFU system has been designed with the objective of achieving a fast and uniform rewarming in organs, key to overcome the critical problem of devitrification. The finite-element simulations have been carried out using COMSOL Multiphysics software. An array of 26 ultrasonic transducers was simulated, achieving an HIFU focal area in the order of magnitude of a model organ (ovary). A parametric study of the warming rate and temperature gradients, as a function of the frequency and power of ultrasonic waves, was performed. An optimal value for these parameters was found. The results validate the appropriateness of the technique, which is of utmost importance for the future creation of cryopreserved organ banks.The discovery of the theory of compressed sensing brought the realisation that many inverse problems can be solved even when measurements are "incomplete". This is particularly interesting in magnetic resonance imaging (MRI), where long acquisition times can limit its use. In this work, we consider the problem of learning a sparse sampling pattern that can be used to optimally balance acquisition time versus quality of the reconstructed image. We use a supervised learning approach, making the assumption that our training data is representative enough of new data acquisitions. We demonstrate that this is indeed the case, even if the training data consists of just 7 training pairs of measurements and ground-truth images; with a training set of brain images of size 192 by 192, for instance, one of the learned patterns samples only 35% of k-space, however results in reconstructions with mean SSIM 0.914 on a test set of similar images. The proposed framework is general enough to learn arbitrary sampling patterns, including common patterns such as Cartesian, spiral and radial sampling.Quantification of coronary artery stenosis on X-ray angiography (XRA) images is of great importance during the intraoperative treatment of coronary artery disease. It serves to quantify the coronary artery stenosis by estimating the clinical morphological indices, which are essential in clinical decision making. However, stenosis quantification is still a challenging task due to the overlapping, diversity and small-size region of the stenosis in the XRA images. While efforts have been devoted to stenosis quantification through low-level features, these methods have difficulty in learning the real mapping from these features to the stenosis indices. These methods are still cumbersome and unreliable for the intraoperative procedures due to their two-phase quantification, which depends on the results of segmentation or reconstruction of the coronary artery. In this work, we are proposing a hierarchical attentive multi-view learning model (HEAL) to achieve a direct quantification of coronary artery stenosis, withcoronary artery disease.Non-invasive quantification of functional parameters of the cardiovascular system, in particular the heart, remains very challenging with current imaging techniques. This aspect is mainly due to the fact, that the spatio-temporal resolution of current imaging methods, such as Magnetic Resonance Imaging (MRI) or Positron Emission Tomography (PET), does not offer the desired data repetition rates in the context of real-time data acquisition and thus, can cause artifacts and misinterpretations in accelerated data acquisition approaches. We present a fast non-invasive and quantitative dual-modal in situ cardiovascular assessment using a hybrid imaging system which combines the new imaging modality Magnetic Particle Imaging (MPI) and MRI. This pre-clinical hybrid imaging system provides either a 0.5 T homogeneous B0 field for MRI or a 2.2 T/m gradient field featuring a Field-Free-Point for MPI. A comprehensive coil system allows in both imaging modes for spatial encoding, signal excitation and reception. In this wnical applications.Knee osteoarthritis (OA) is one of the highest disability factors in the world. This musculoskeletal disorder is assessed from clinical symptoms, and typically confirmed via radiographic assessment. This visual assessment done by a radiologist requires experience, and suffers from moderate to high inter-observer variability. The recent literature has shown that deep learning methods can reliably perform the OA severity assessment according to the gold standard Kellgren-Lawrence (KL) grading system. However, these methods require large amounts of labeled data, which are costly to obtain. In this study, we propose the Semixup algorithm, a semi-supervised learning (SSL) approach to leverage unlabeled data. Semixup relies on consistency regularization using in- and out-of-manifold samples, together with interpolated consistency. On an independent test set, our method significantly outperformed other state-of-the-art SSL methods in most cases. Finally, when compared to a well-tuned fully supervised baseline that yielded a balanced accuracy (BA) of 70.9 ± 0.8% on the test set, Semixup had comparable performance - BA of 71 ± 0.8% ( p=0.368 ) while requiring 6 times less labeled data. These results show that our proposed SSL method allows building fully automatic OA severity assessment tools with datasets that are available outside research settings.The title refers to the conceptual quality of being similar, as a kind of resemblance between both procedures.Students take engineering courses to learn techniques for solving problems. Thus, most engineering courses taken by undergraduate students are highly technical in nature. But, there are many additional techniques and skills that can be learned along the way. Other types of knowledge can also be incorporated into engineering science courses without diminishing the value of the engineering techniques being taught. These other skills, of an ancillary nature, can improve the value of a course to future engineers. This writing is a description of collateral learning that took place in my Transport Design course and, to a lesser extent, my Introduction to Electronic Design course.After initial assertions that the wearing of face masks was an unnecessary public health tool in the prevention of the spread of Covid-19, the advice coming out of the Centers for Disease Control (CDC) suddenly changed. In early April, the CDC issued new guidelines advising people to wear face coverings in public settings where social distancing is difficult.The human body is miraculous in its capacity to heal but it can always use a little help. Wound care traditionally consists of little more than a protective barrier, possibly with an antibacterial agent, to cover the damage while the body works its magic. Now, a new technology has opened up a more active approach to encouraging healing.Qualitative interpretation is a good thing when it comes to reading lung images in the fight against coronavirus 2019 disease (COVID-19), but quantitative analysis makes radiology reporting much more comprehensive. To that end, several research groups have begun looking to artificial intelligence (AI) as a tool for reading and analyzing X-rays and computed tomography (CT) scans, and helping to diagnose and monitor COVID-19.
Tympanic membrane perforations might have a negative impact on the patient's quality of life, especially in the pediatric population. Surgery is therefore often required. The most adequate age for surgery remains unclear and is debated in the current literature. The aim of this study was to investigate outcomes of type I tympanoplasty in children and examine the impact of age on surgical outcome.

Retrospective cohort study. All patients under the age of 18 undergoing type I tympanoplasty at Regional Hospital West Jutland, Denmark, from 1/1-2013 to 31/12-2017 had their medical files reviewed. The primary endpoint of interest was tympanic membrane closure rate six months following surgery, i.e. surgical success. Secondary outcomes were air-bone-gap reduction and the correlation between age and surgical success.

A total of 180 patients undergoing 197 procedures met the predefined criteria. Age at the time of surgery ranged between five and 17 years. Mean age at the time of surgery was 10.1 years (95% CI 9.1-11.2). Surgical success was achieved in 91,3% of the cases. No correlation between age and surgical success was found. Mean air-bone gap was reduced from 19.8dB (95% CI 18.5-21.0) preoperatively, to 6.9dB (95% CI 6.1-7.7) at follow-up, p<0.05. Air-bone gaps ≤10dBat follow-up were achieved in 155 of the cases (78.6%). Postoperative infection seemed to increase the risk of surgical failure, RR 2.80 ((95% CI 1.06-7.38), p=0.037).

Type 1 tympanoplasty in children is an effective treatment in terms of achieving an intact tympanic membrane and improved hearing. No correlation could be found between age and surgical success. Postoperative infection influences surgical outcome negatively.
Type 1 tympanoplasty in children is an effective treatment in terms of achieving an intact tympanic membrane and improved hearing. No correlation could be found between age and surgical success. Postoperative infection influences surgical outcome negatively.Nuclear RNAi provides a highly tractable system to study RNA-mediated chromatin changes and epigenetic inheritance. Recent studies have indicated that the regulation and function of nuclear RNAi-mediated heterochromatin are highly complex. Our knowledge of histone modifications and the corresponding histonemodifying enzymes involved in the system remains limited. In this study, we show that the heterochromatin mark, H3K23me3, is induced by nuclear RNAi at both exogenous and endogenous targets in C. elegans. In addition, dsRNA-induced H3K23me3 can persist for multiple generations after the dsRNA exposure has stopped. We demonstrate that the histone methyltransferase SET-32, methylates H3K23 in vitro. Both set-32 and the germline nuclear RNAi Argonaute, hrde-1, are required for nuclear RNAi-induced H3K23me3 in vivo. Our data poise H3K23me3 as an additional chromatin modification in the nuclear RNAi pathway and provides the field with a new target for uncovering the role of heterochromatin in transgenerational epigenetic silencing.Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice Project. This article presents a case example of a young child with autism spectrum disorder who receives occupational therapy evaluation and intervention in natural environments (home and child care center). Systematic review findings supporting enhancement of key life occupations through interventions to develop cognitive, motor, social-emotional, and self-care skills for young children were published in AOTA's Occupational Therapy Practice Guidelines for Early Childhood Birth-5 Years (Frolek Clark & Kingsley, 2020) and the March/April 2020 issue of the American Journal of Occupational Therapy (Gronski & Doherty, 2020; Kingsley et al., 2020; Tanner et al., 2020). Each article in the Evidence Connection series applies evidence from the published reviews on a topic to a related case. These articles are designed to promote application of the evidence to practice.Occupational therapy practitioners provide interventions to promote activity engagement to multiple clinical populations. They help clients develop restorative, adaptive, and compensatory skills to improve their performance in daily activities. The issue addressed in this article is that current clinical frameworks lack translation of learned skills to consistent everyday performance. There is a gap between what clients can do and what clients actually do in everyday life. Behavioral activation provides an explicit, structured, and practical approach that can translate capacity into long-term engagement. This article presents behavioral activation as a transdiagnostic approach that targets populations experiencing chronic illness to bridge the gap between what the client can do in therapy and what the client could do in everyday life.
People with chronic illness have difficulty translating the skills learned in traditional practice settings to everyday life. Behavioral activation offers occupational therapy practitioners a practical structure to promote the translation of learned skills.
People with chronic illness have difficulty translating the skills learned in traditional practice settings to everyday life. Behavioral activation offers occupational therapy practitioners a practical structure to promote the translation of learned skills.
Given the importance of proprioception in motor coordination, the identification of sensory deficits contributing to motor challenges is crucial for appropriate intervention; however, objective proprioceptive tests are not currently available in pediatric clinical practice.

To pilot test methods for assessing proprioception in children. Children with somatodyspraxia were predicted to have reduced proprioceptive awareness compared with age-matched control children.

Observational study.

Individual clinic.

Ten children identified as having somatodyspraxia and 10 typically developing children, ages 6-8 yr.

Spatial awareness and force perception were assessed by having the children match arm positions and grip and pinch forces using electronic dynamometers.

All children were able to complete the proprioceptive assessments. Of those identified as having somatodyspraxia, 90% showed deficits in at least one area of proprioception. Children with somatodyspraxia performed more poorly on spatial awareness and force perception tests than typically developing children (p < .05).

Children with dyspraxia have difficulties with spatial awareness and force perception, confirming a somatosensory contribution to dyspraxia.

This article presents a framework and methods to measure proprioception in children. These methods will allow occupational therapy practitioners to quantify the proprioceptive deficits common in children with dyspraxia.
This article presents a framework and methods to measure proprioception in children. These methods will allow occupational therapy practitioners to quantify the proprioceptive deficits common in children with dyspraxia.
Autistic adults face decreased community participation for employment, education, and social activities plus barriers to driving and transportation. However, little is known about their experiences of moving around community environments.

To explore contextual issues and experiences of independent community mobility and driving for autistic adults and to determine the modes of community mobility, regions studied, and methodologies used.

Seven databases were searched from 2000 to 2019. All empirical research relating to autism, community mobility, and driving for people older than age 5 yr was mapped. Studies examining experiences of community mobility and driving were selected for scoping review.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews methodology was used. Thirteen studies reporting specifically on autistic adults' experiences with public transportation, driving, and pedestrian navigation of community environments were included. These studies wtion, anxiety, social skills, communication, and occupational performance desires. Environmental factors such as parental concerns, community safety, pedestrian environments, traffic volume, and public transportation design are important. Further research partnering with autistic adults could better inform future occupational therapy interventions for community mobility and driving.
Occupational therapy interventions should address community mobility and driving skills before school transition. Autistic adults' skill development may be affected by person factors such as motivation, anxiety, social skills, communication, and occupational performance desires. Environmental factors such as parental concerns, community safety, pedestrian environments, traffic volume, and public transportation design are important. Further research partnering with autistic adults could better inform future occupational therapy interventions for community mobility and driving.
The Intentional Relationship Model (IRM) guides learning about therapeutic use of self. The observer version of the Clinical Assessment of Modes (CAM-Observer) may be used to evaluate students' therapeutic communication as the process is defined in the IRM.

To assess the structural validity of the CAM-Observer.

Cross-sectional, psychometric study.

Master's in occupational therapy program.

One hundred thirty-four entry-level students.

The overall CAM-Observer and the individual subscales (Advocating, Collaborating, Empathizing, Encouraging, Instructing, Problem-Solving) were used to assess students' communication from the instructor's perspective.

The overall CAM-Observer and six subscales demonstrated appropriate rating scale functioning and dimensionality. The Advocating subscale demonstrated poor item fit, floor effects, and low person separation. One Collaborating item demonstrated poor fit to the overall CAM-Observer and the Collaborating subscale, requiring revision. Instructing and Encourase of self.
Designing, implementing, and measuring the effectiveness of sustainable Internationalization at Home programs will support the development of cultural competence among occupational therapy students.

To explore potential sustainable, effective methods for enhancing cultural competence in occupational therapy students through cross-cultural online collaborations.

Pretest-posttest, parallel mixed-methods design.

An online collaboration using video conferencing technology and classrooms at the European University Cyprus and the University of St. Augustine for Health Sciences.

Bachelor of science and master of occupational therapy students at the European University Cyprus and the University of St. Augustine for Health Sciences, respectively.

Online video conferencing collaboration between occupational therapy students in which students discussed their perspectives and experiences regarding social injustice and occupational therapy's role in working with vulnerable populations.

Each campus participatational therapy students' cultural competence. Recommendations to further enhance Internationalization at Home experiences provide opportunities for increased cultural collaboration.
Documenting the benefits and barriers of implementing Internationalization at Home experiences will allow academic institutions to create sustainable methods for enhancing occupational therapy students' cultural competence. Recommendations to further enhance Internationalization at Home experiences provide opportunities for increased cultural collaboration.
A reliable observational measure is necessary to measure clients' behaviors as they participate in activities. The Comprehensive Occupational Therapy Evaluation Scale (COTES) is designed to measure strengths and difficulties in various behaviors that support occupational performance.

To examine the test-retest reliability of the COTES (overall score and scores on the General Behavior, Social Behavior, and Work Behavior subscales) and calculate the minimal detectable change (MDC) for people with schizophrenia.

Prospective, observational study.

A psychiatric center.

COTES data for 118 people with schizophrenia were collected from occupational therapy records. Data from the initial and second COTES measurements were chosen for analysis.

Test-retest reliability of the overall scale and three subscales was evaluated using the intraclass correlation coefficient (ICC). The MDC was calculated on the basis of the standard error of measurement.

ICCs for the overall scale and three subscales ranged from .91 to .97. The MDC values (MDC%) were 6.5 (10.5%) for the overall scale, 3.4 (13.5%) for the General Behavior subscale, 2.3 (15.2%) for the Social Behavior subscale, and 2.4 (11.0%) for the Work Behavior subscale.

The COTES has good test-retest reliability. Clinicians and researchers can use the MDC values provided in this study to explain the implications of change scores for behaviors that affect occupational performance for people with schizophrenia.

The COTES has sound reliability and support for its use in determining whether people with schizophrenia make real improvements in behavior that affects occupational performance over time.
The COTES has sound reliability and support for its use in determining whether people with schizophrenia make real improvements in behavior that affects occupational performance over time.
Constraint-induced movement therapy (CIMT) is a common treatment for children with unilateral cerebral palsy (CP). Although clinic-based assessments have demonstrated improvements in arm function after CIMT, whether these changes are translated and sustained outside of a clinic setting remains unclear.

Accelerometers were used to quantify arm movement for children with CP 1 wk before, during, and 4 wk or more after CIMT; measurements were compared with those from typically developing (TD) peers.

Observational.

Tertiary hospital and community.

Seven children with CP (5 boys, 2 girls; average [AVE] age ± standard deviation [SD] = 7.4 ± 1.2 yr) and 7 TD peers (2 boys, 5 girls; AVE age ± SD = 7.0 ± 2.3 yr).

30-hr CIMT protocol.

Use ratio, magnitude ratio, and bilateral magnitude were calculated from the accelerometer data. Clinical measures were administered before and after CIMT, and parent surveys assessed parent and child perceptions of wearing accelerometers.

During CIMT, the frequency and magnitude of paretic arm use among children with CP increased in the clinic and in daily life. After CIMT, although clinical scores showed sustained improvement, the children's accelerometry data reverted to baseline values. Children and parents in both cohorts had positive perceptions of accelerometer use.

The lack of sustained improvement in accelerometry metrics after CIMT suggests that therapy gains did not translate to increased movement outside the clinic. Additional therapy may be needed to help transfer gains outside the clinic.

Accelerometer measurements were effective at monitoring arm movement outside of the clinic during CIMT and suggested that additional interventions may be needed after CIMT to sustain benefits.
Accelerometer measurements were effective at monitoring arm movement outside of the clinic during CIMT and suggested that additional interventions may be needed after CIMT to sustain benefits.
Practitioners working in school settings have a variety of job-related responsibilities in addition to direct service provision. Models of best practice indicate that a workload approach to service delivery allows practitioners to provide effective and productive interventions in the school setting; however, current information related to service delivery by school-based practitioners in the United States is lacking.

To explore current caseloads, service delivery models, implementation of workload models, knowledge of state and local policies, and job satisfaction of school-based occupational therapy practitioners and how they relate to best practice.

Web-based survey.

School-based practice.

Three hundred seventy-one school-based practitioners from across the United States completed the study.

Investigator-developed survey with both closed- and open-ended questions.

School-based practitioners recruited via social media platforms and snowball sampling completed an online survey. Results indicate guidelines and implementation, service delivery models, and methods of advocacy and negotiation skills are needed to support practitioners as they advocate for changes in their practice.
Few predictive models for later handwriting difficulties have been developed for kindergarteners.

To develop a nomogram for the purpose of detecting the risk of later poor Chinese handwriting among Taiwanese kindergarteners.

One-year prospective longitudinal, observational study.

Kindergarten and elementary school.

One hundred fifty-six kindergarteners were included. In first grade, they were grouped into the normal and poor handwriting groups on the basis of handwriting performance in first grade.

Participants received fine motor (FM), visual-perceptual (VP), and visual-motor integration tests in kindergarten and handwriting assessments in first grade.

Logistic regression results indicated that younger age at school entry and lower scores on measures of FM and VP in kindergarten increased the risk for later poor handwriting. The area under the receiver operating characteristic curve in the nomogram built with these risk factors was .75, indicating that the nomogram had acceptable diagnostic value.

This nomogram could be used as a screening tool to detect kindergarteners at risk of poor Chinese handwriting in first grade.

This study is the first to establish a nomogram constructed with significant predictors in kindergarten of a child's probability of poor handwriting later in first grade. This predictive nomogram may help occupational therapists, educators, and parents identify at-risk kindergarteners early for the purpose of early interventions to prevent later poor Chinese handwriting.
This study is the first to establish a nomogram constructed with significant predictors in kindergarten of a child's probability of poor handwriting later in first grade. This predictive nomogram may help occupational therapists, educators, and parents identify at-risk kindergarteners early for the purpose of early interventions to prevent later poor Chinese handwriting.
Resuming driving after a change in functional ability is challenging for patients with a neurological condition. Although a combination of assessment tools has been suggested for use in driving evaluation, resources and availability of tools have been a problem.

To examine the predictive ability of two commonly used tools, the Motor-Free Visual Perception Test (MVPT) and the Trail Making Test, Parts A and B (TMTA and TMTB), on on-road driving performance.

Retrospective chart review of 82 patient charts between 2015 and 2016.

Local rehabilitation hospital.

Eighty-two patients with a primary neurological diagnosis (general neurological condition, n = 13; spinal cord injury, n = 11; stroke, n = 58).

MVPT, TMTA, and TMTB.

Among the patients, 36 passed and 46 failed the on-road evaluation. The TMTA and TMTB scores were significantly different between those who passed or failed the on-road evaluation. Logistic regression analyses revealed that the TMTB completion time was the only significant predictor of on-road driving performance (for the all-patient model, 66% prediction accuracy, -2 log-likelihood [LL] = 93.47, exp β = 0.98; for the stroke-only model, 76% prediction accuracy, -2LL = 59.61, exp β = 0.97).

Our findings suggest that the TMTB is a better predictor of on-road driving performance for patients with a neurological condition than the MVPT. The findings shed light on the importance of selecting proper tools when assessing driving performance. Future prospective studies with a wider array of predictive variables are recommended to support the present findings.

Occupational therapists should revisit the use of the MVPT in driving assessment and consider multiple assessment tools when evaluating and predicting driving performance.
Occupational therapists should revisit the use of the MVPT in driving assessment and consider multiple assessment tools when evaluating and predicting driving performance.
Head-mounted displays for virtual reality (HMD-VR) may be used as a therapeutic medium in physical rehabilitation because of their ability to immerse patients in safe, controlled, and engaging virtual worlds.

To explore how HMD-VR has been used in adult physical rehabilitation.

A systematic search of MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, and ERIC produced 11,453 abstracts, of which 777 underwent full-text review.

This scoping review includes 21 experimental studies that reported an assessment or intervention using HMD-VR in a physical rehabilitation context and within the scope of occupational therapy practice.

HMD-VR was used for assessment and intervention for patients with a range of disorders, including stroke, multiple sclerosis, spinal cord injury, and Parkinson's disease.

HMD-VR is an emerging technology with many uses in adult physical rehabilitation. Higher quality clinical implementation studies are needed to examine effects on patient outcomes.

We review existing research on how immersive virtual reality (e.g., using head-mounted displays) has been used for different clinical populations in adult physical rehabilitation and highlight emerging opportunities in this field for occupational therapists.
We review existing research on how immersive virtual reality (e.g., using head-mounted displays) has been used for different clinical populations in adult physical rehabilitation and highlight emerging opportunities in this field for occupational therapists.
Spasticity is one of the most common and disabling motor impairments after stroke.

To examine the evidence for the effectiveness of stretching interventions, including splinting, on reducing upper extremity spasticity, increasing hand function, and improving functional tasks for adults with poststroke spasticity.

Databases searched were MEDLINE, CINAHL, OTseeker, AgeLine, and the Cochrane Library; results were limited to studies published from 2004 to January 2017.

Following PRISMA guidelines, we included articles describing Level I-III studies with participants who were adults with upper extremity spasticity and received a stretching intervention.

Eleven articles describing 6 Level I and 5 Level III studies met inclusion criteria.

For reducing upper extremity spasticity, low strength of evidence was found to support the use of static splinting, strong strength of evidence was found for the use of stretching devices, and low strength of evidence was found to support the use of dynamic splinting; no evidence was found for manual stretching to address spasticity. For increasing hand function, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. For improving functional tasks, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices.

This updated synthesis summarizes the current literature regarding the effectiveness of stretching interventions to improve poststroke spasticity, hand function, and functional tasks.
This updated synthesis summarizes the current literature regarding the effectiveness of stretching interventions to improve poststroke spasticity, hand function, and functional tasks.
The Low Vision Independence Measure (LVIM) was designed to measure the effectiveness of occupational therapy to improve visual ability in low vision rehabilitation.

To validate the Revised LVIM (LVIM-R) as an outcome measure by determining its sensitivity to visual ability changes after occupational therapy.

In this observational study, LVIM-R scores were collected before and after customary low vision intervention.

Home health agency or outpatient facility.

Forty-four participants with a mean age of 80.2 yr (standard deviation = 11.2) and an average length of visual impairment of 6.2 yr. Twenty-three participants (52.3%) were treated in an outpatient setting, and 21 (47.7%) were treated in the home. The majority of participants were non-Hispanic White (92.8%) and had macular degeneration (54.5%).

Customary low vision intervention by occupational therapists.

LVIM-R scores were collected before and after intervention, and participants' pre- and posttest scores were anchored into Rasch-calibrated item parameters.

Paired t tests demonstrated significant increases in person measures with large effect sizes for both constructs of the LVIM-R, the visual field or scotoma (t[43] = 6.46, p < .0001; Cohen's d = 0.92) and visual acuity (t[43] = 9.08, p < .0001; Cohen's d = 1.14) constructs.

The LVIM-R is sensitive to changes in visual ability in clients who have good rehabilitation potential and can be used to examine the effectiveness of occupational therapy for low vision.

The LVIM-R is useful for measuring occupational therapy outcomes in low vision rehabilitation in the home or in outpatient settings.
The LVIM-R is useful for measuring occupational therapy outcomes in low vision rehabilitation in the home or in outpatient settings.
Occupational therapy can play a role in primary care management of chronic diseases among older adults.

To assess the feasibility of delivering a primary care occupation-focused intervention (Integrated PRimary care and Occupational therapy for Aging and Chronic disease Treatment to preserve Independence and Functioning, or i-PROACTIF) for older adults with chronic disease.

Feasibility study comparing i-PROACTIF with complex care management using a two-group randomized controlled trial design with data gathered at baseline and during and after the 8-wk intervention.

Family medicine clinic serving an urban, low-income, working-class community.

Feasibility indicators were recruitment, retention, utility of clinical assessments, and acceptability of interventions assessed through feedback surveys completed by patients and primary care providers (PCPs). Patient outcomes, including perspectives on chronic illness care, occupational performance, and overall well-being, were collected using standardized, vic conditions.
The results of this study can inform future occupational therapy interventions and clinical trials in primary care for older adults with chronic conditions.
There is a critical gap in the literature regarding the efficacy of occupational therapy interventions for pediatric hematopoietic cell transplantation (HCT) patients.

To demonstrate that occupational therapy 4-5×/wk during inpatient hospitalization positively affects strength, coordination, and independence in activities of daily living (ADLs) of pediatric patients during HCT.

Retrospective study.

Inpatient bone marrow transplant unit at a children's hospital.

Thirty-two pediatric patients admitted for HCT.

Patients were seen by an occupational therapist as part of an interdisciplinary program. Interventions included play and leisure engagement, upper extremity therapeutic exercises, fine motor activities, and ADL training. Strength, coordination, and daily living skills data were documented prospectively and analyzed retrospectively to compare differences between patients seen by occupational therapy at high versus low frequency.

For grip strength (dynamometer), fine motor dexterity (the 9-Holimportant part of the interdisciplinary team treating pediatric bone marrow transplant patients. It also demonstrates that occupational therapy interventions delivered at a high frequency can have a positive impact on upper extremity strength and independence in ADLs.
Occupational therapy practitioners can use therapeutic activity to promote veterans' well-being, but the mechanisms through which participation promotes well-being are poorly understood.

To examine whether coping ability, meaningful activity, and social support mediate the relationship between participation and two indicators of veterans' overall well-being life meaning (psychological well-being) and life satisfaction (subjective well-being).

Explanatory cross-sectional design. We used two multiple mediation models to test whether coping ability, meaningful activity, and social support explained the relationship between participation and both life meaning and life satisfaction. Models were adjusted for demographic characteristics and service-related health conditions (e.g., posttraumatic stress disorder).

Community.

Three hundred eighty-nine community-based veterans attending college.

None.

Measures of participation, coping ability, meaningful activity, social support, life meaning, life satisfaement in activities and their overall well-being. Results may inform treatment theories for activity-based interventions in the veteran population. For example, results indicate that occupational therapy interventions that facilitate engagement in meaningful and shared activities could be developed to promote veterans' well-being.
This is among the first studies to test mechanisms underlying the relationship between veterans' engagement in activities and their overall well-being. Results may inform treatment theories for activity-based interventions in the veteran population. For example, results indicate that occupational therapy interventions that facilitate engagement in meaningful and shared activities could be developed to promote veterans' well-being.The U.S. population is aging at an unprecedented rate, creating both opportunities and challenges for the overall health of the nation. Occupational therapy practitioners can inform important health policies by developing an understanding of the basis for relevant laws and programs and how occupational therapy principles relate to policy goals. This column discusses the Older Americans Act of 1965 (reauthorized as the Supporting Older Americans Act of 2020) and describes ways in which the objectives of this legislation align with the principles and practice of occupational therapy. Recommendations are provided for how the field of occupational therapy can enhance current policy development and debate, thus leading to expanded opportunities for the profession.
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