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Thesis Abstracts 2014

Thesis abstracts class of 2014

Fall Risk Evaluation Tool for Acquired Brain Injury: A Validation of a Multifactorial Assessment by Tanya Orgill, Amanda Woods & Josue Zamora
Faculty Advisor:  Dr. Kitsum Li, OTD, OTR/L
Company/Collaborator:  Brain Injury Network of the Bay Area

Abstract: 
Objective: The purpose of this study examined the reliability and validity of FRET to predict falls in community-dwelling individuals with acquired brain injuries (ABI). Method: The target population was English speaking, community-dwelling individuals 18 years or older who have sustained an ABI. Individuals were excluded if they had neurodegenerative diseases, used a wheelchair for more than 25% of the day, or were classified as globally confused. Global confusion was assessed using the first three-questions on the Saint Louis University Mental Examination (SLUMS). A total of 12 participants were recruited for the study, two were excluded and there was one attrition. After the Fall Risk Evaluation Tool (FRET) was administered, participants were instructed to record whenever they had a fall in the following three months in the provided fall journal. Researchers made telephone calls every two weeks to remind the participants to record falls. At the end of the three months, each participant returned the fall journal by mail in a self-addressed envelope. Results: A Spearman’s Rank correlation was used to analyze the data to detect any correlation between the risk rank as determined by FRET and the fall rank determined by the number of times a participant fell. There was a positive relationship between the risk rank and the fall rank. Conclusion: The FRET was developed to assess fall risk in individuals with ABI. Although we had a small sample size, our pilot study returned significant data that FRET may be a valid and reliable multifactorial tool for assessing individuals with ABI who are at risk for falling.

The Impact of Fibromyalgia and Sensory Processing on Participation of Daily Activities by Florina Mendoza-Battle, Regina Okun, Ashlee Sand Faculty
Advisor:  Dr. Julia Wilbarger, Ph.D., OTR/L
Company/Collaborator's Name: University of Wisconsin-Madison

Abstract:
Fibromyalgia (FM) is a pain disorder that involves a variety of symptoms including painful joints, fatigue, muscle stiffness, and sleep disturbances. Cognitive symptoms are also a hallmark of FM, which result in difficulties with thought articulation, concentration, and mental fatigue. There is a gap in research substantiating increased levels of sensory defensiveness symptoms in individuals with FM and the effects in daily life.  Currently, only one study has provided evidence of increased sensory sensitivity across multiple modalities in individuals with FM.  The purpose of this research was to determine whether women with FM had increased levels of sensory defensiveness in daily life when compared to pain free age matched women. This research also examined whether women with FM had decreased quality of life (QOL) and participation in daily occupations.  Lastly, this study investigated if there was a relationship between sensory defensiveness, participation in typical patterns of daily activities, and QOL.  This study was a quantitative, multi-group, quasi-experimental comparison design.  Participants were recruited from South Central Wisconsin and Northern California.  A total of 20 women participated in the study, 11 in the control group and 9 in the FM group. The data was collected through the following three distinct questionnaires and one activity: Medical Outcome Survey-Short Form 36 (SF-36), Adult/Adolescent Sensory Profile (AASP), Fibromyalgia Impact Questionnaire (FIQ), and the Activity Card Sort (ACS).  Data was analyzed using two-tailed t-Test and Pearson's r Correlations.  Women in the FM group reported significantly more symptoms for sensory defensiveness and participation in fewer daily activities than the control group.  Women with FM reported decreased QOL when compared to the control group.  Symptoms of sensory defensiveness were moderately, but not significantly, correlated with participation in daily activities.  Increased symptoms of sensory defensiveness were strongly correlated with reports of poorer mental health scores in women with FM.

The Development of a Therapeutic Listening Instrument: A Pilot Study by Linda Roybal, Suzanne Schwind, Elizabeth Szoboszlay, Brittnee Witham
Faculty Advisor:  Dr. Janis Davis, PhD, OTR/L
Company/Collaborator:  N/A

Abstract:  
A therapeutic listening instrument for occupational therapy students was developed, piloted and evaluated to determine if a paper-based listening instrument could evaluate the listening skills of occupational therapy clinicians and students.  The instrument evaluated establishing rapport, organizing information, and non-verbal immediacy. Respondents in the study consisted of nine occupational therapy listening experts in the mental health area of practice, fourteen occupational therapy clinicians, and seventy-five occupational therapy students in Northern California. Findings indicated that internal consistency of the items did not hold, and the instrument was not sensitive enough to reliably evaluate listening skills. No correlation between the listening knowledge and listening skills was found.  The results from this study provide information for future research, suggesting that paper-based instruments may not be the most reliable to assess listening skills.

Developing a Website of Occupation Based Resources for Healthy Aging at Dominican University of California byDavid Aizpuru, Kevin Brown, Beverly DeGuzman & Cortney McIntosh
Advisor: Ruth Ramsey Ed. D, OTR/L, Chair, Thesis Advisor
Company/Collaborator: Dominican University of California, Department of Occupational Therapy 

Abstract:
The purpose of this project was to create a website to promote healthy aging at Dominican University of California.  The website contains relevant information to promote healthy aging and publicizes Dominican University of California’s activities and programs centered around healthy aging.  The design of this thesis is a virtual context project that focuses on occupation based resources for healthy aging and highlights the role of occupational therapy in health aging. The healthy aging website is currently located on the homepage of the Occupational Therapy Department of Dominican University of California website.  The need for a Dominican University of California healthy aging website was driven by the lack of a virtual context that provides healthy aging information in one area.  Dominican University of California has long been providing services of interest for older adults and healthy aging through community based programs in the occupational therapy and nursing departments, but did not have a website that promoted healthy aging.  The Dominican University of California healthy aging website provides evidence-based, occupation centered resources that highlight the role and influence occupational therapy has in healthy aging.  It is within the scope of Occupational Therapy to be advocates and educators in the prevention of disease and disability, and the promotion of healthy aging.  The goal of this thesis project was to provide older adults, Dominican University of California health professions students, and the general public with access to the internet with a credible resource on all aspects of healthy aging.   

The Preschool Kitchen Task Assessment (PKTA): A Pilot Study Exploring Executive Functioning in Children Ages 3 to 6 Years byAnnette Yuson, Mallory Engelhardt, Fanny Dizon
Faculty Advisor:  Julia Wilbarger, PhD, OTR/L
Company/Collaborator:  N/A

Abstract:
Background and purpose:  The Preschool Kitchen Task Assessment (PKTA) is a newly developed assessment tool based on the principles of the Kitchen Task Assessment (KTA) and may be a valuable tool for assessing executive function (EF). There is a lack of age-appropriate assessments for EF in occupational therapy. The purpose of this study was to examine the use of the PKTA as a new assessment and determine if it is a valid measure of EF in preschool children. Subjects. The total sample consisted of 11 willing preschool-aged children and their parents, with a female to male ratio of 8:3 and a mean age of 4.5 years. Methods: A non-experimental exploratory design was utilized to examine the relationship between the PKTA and other neuropsychological assessments. A series Pearson’s correlation coefficients were calculated to examine the relationship between the PKTA and two other neuropsychological tests: BRIEF-P and a modified Digit Span Backward. Results: A low, non significant correlation between PKTA total score and BRIEF-P GEC score (r = .12). A moderate to good correlation between the PKTA time and BRIEF-P GEC score (r = .68). Little to fair correlations between PKTA total score and the BRIEF-P clinical scales with a range of .17 to .41. A correlation could not be found between PKTA and Digit Span Backward. A moderate, negative correlation found between age in months and PKTA total scores (r = .74). Through qualitative observations, the PKTA was found to be ecologically valid. Discussion and conclusion: Results revealed weak support that the PKTA is a valid measure in assessing EF in preschoolers. The PKTA is developmentally sensitive to age with support that it is an ecologically valid assessment. The PKTA may be a beneficial tool in order to gain a complete understanding of a child’s needs.

Factors that Influence Career Choice in South African Township High School Students by Emily Dodge and Martha Welderufael
Faculty Advisor: Janis Davis, Ph.D., OTR/L
Company/Collaborator's Name: Nelson Mandela Metropolitan University 

Abstract:
Keywords:  South Africa, Occupational Deprivation, Career Choice. Background: The legacy of apartheid is apparent in the lack of educational resources for Black South African high school students and the occupational deprivation they experience. Objectives of Study: To collect data on students’ perceptions of career choice in township high schools, barriers prohibiting students from engaging in a career of choice, students’ learning and listening strategies and their general hopefulness. Methods: Non-experimental, descriptive study using both quantitative and qualitative data collection and analysis strategies. Findings: A significant difference was found based on gender in relation to having career options and with regard to how knowledge about careers is gained. Despite occupational deprivation, students are hopeful about the future. Relevance to Clinical Practice: Occupational deprivation is a risk factor for South African youth living in disadvantaged communities.Limitations: Results are from two township high schools in the Eastern Cape of South Africa. English as a second language may have influenced data analysis. Other limitations identified were the participants’ lack of exposure with likert scales and time constraints to complete surveys. Recommendations for Further Research: Explore culturally sound career assessments, further listening and learning research, and evaluate the effectiveness of a mentorship program. 

A Randomized Controlled Trial Comparing Contrast Baths to Cryotherapy in Patients with a Wrist Fracture by Elizabeth Brown & Brittany Phipps
Faculty Advisor:  Dr. Kitsum Li, OTD, OTR/L
Company/Collaborator: Mills Peninsula Health Services

Abstract:  
Cryotherapy and contrast baths are common modalities used to treat edema. Despite the fact that many hand therapists report using contrast baths with their patients, there is still little evidence on the effectiveness of them. A Randomized Controlled Trial-Repeated Measures Design was employed to compare the effectiveness of contrast baths to cryotherapy. Participants were recruited after a period of post-fracture immobilization. Blind assessors attained measurements in range of motion, pain, and edema in the 1st, 2nd, and 4th weeks. Participants were randomly assigned to either use cryotherapy or contrast baths at home during the 4-week study period. The participants in this study were asked to keep a home program log to record the number of times that they were able to complete their assigned modality. Also, at the final measurement appointment, the participants were asked to complete a survey indicating their satisfaction with their assigned home program. The results from the ANOVA indicated that there was statistical significance for all the measurements (p < .05) except for palm circumferential and volumeter. The results from the home program logs indicated that the adherence for contrast baths had a mean of 2.03 (SD = 0.76) times per day and the cryotherapy group had a mean of 1.75 (SD = 0.98) times per day. The researchers also noted a trend that the contrast baths group may have a larger effect in the first two weeks of treatment, while the cryotherapy group may have more gradual improvements throughout the four weeks. The results of this study found that adherence for contrast baths and cryotherapy had similar home program adherence and that the participants had similar experiences.

Effect of Therapeutic Listening® Quickshift on Bilateral Coordination in Healthy Adults by Madeleine Haas & Amy Sequeira Boeschen
Faculty Advisor: Dr. Julia Wilbarger, Ph.D., OTR/L
Company/Collaborator:  N/A

Abstract:
The purpose of this research study was to examine the influence of Therapeutic Listening® Quickshift on the bilateral coordination of healthy adults with no history of developmental or motor delays.  Additional studies that demonstrate the effectiveness of the Therapeutic Listening® modality using measurable outcomes are necessary as many therapists currently use this program, even though few studies prove its effectiveness.  This study recruited 14 freshman and sophomore students aged 18-21 years.  Seven participants received Therapeutic Listening® Quickshift intervention one time for 20 minutes and seven received no intervention, but instead listened to white noise for the same duration.  The participants received the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) bilateral coordination subsection before and after either the white noise or Therapeutic Listening® Quickshift protocol.  Results demonstrated a slightly greater increase in scores for those who received the Therapeutic Listening® Quickshift intervention, however this difference was not statistically significant.  Additionally, many participants received the maximum score on the pre-test and had no room for improvement on the post-test.  This study was likely underpowered and the BOT-2 bilateral coordination subsection was not sensitive enough to measure change in a healthy, adult population.  More sensitive assessment tools are needed to support future research in order to prove effectiveness of interventions through measurable outcomes that further evidence based practice in occupational therapy. 

A Qualitative Study of the Experiences of First-Generation Peer Mentors by Cindelle Leyson, Jessica Taylor, Tiffany Torres
Advisors: Stacy Frauwirth, PhD (cand), OTR/L, Ruth Ramsey, EdD, OTR/L
Company/Collaborator: Dominican University of California, Academic Advising and Achievement Center 

Abstract:
While there are numerous studies reporting on the benefits that mentees receive from peer mentoring, there is limited research on the benefits to mentors, particularly first-generation students (FGS).  The purpose of this study was to examine the experience of mentoring from the FGS mentors’ point of view.  In this qualitative, exploratory design, four FGS mentors were interviewed about their experiences with a peer-mentoring program at their university.  The participants believed they developed skills in the areas of time management, communication, and setting boundaries.  The participants learned about themselves and gained an understanding of how the skills they developed while mentoring will help with the transition out of college and transfer into the workforce. The transition out of college can be just as challenging for FGS as the transition into college. It is important FGS leave college with a skill set that will help them be successful in the workforce. While the participants were mentoring, they were able to develop skills that are essential in the workforce, helping the participants be better prepared to succeed at work. 

An Inventory of Evidence-Based Health and Wellness Assessments for Community-Dwelling Older Adults by Elliott Brent & Matthew Carlson
Faculty Advisor:  Dr. Kitsum Li, OTD, OTR/L
Company/Collaborator: N/A

Abstract:  
It is estimated that by 2020 older adults will makeup one fifth of California's population. Many of these older adults are living in the community and are maintaining their independence. In order to help the older adults to maintain their independence, occupational therapists are turning to the newly emerged wellness promotion model to guide their practice. The wellness promotion model is a holistic model that addresses six domains of wellness (intellectual, spiritual, physical, social, emotional, and vocational). One of the concerns in using this model to guide the emerging practice area in occupational therapy is that there is little information on health and wellness assessments. The purpose of this project was to create an inventory of evidence-based Health and Wellness Assessments for use with the community-dwelling older adult population.

Developing a Data Compilation for the Marin Autism Collaborative by Sarah Jane Calub, Nicole Hofeditz, and Caitlin McIntyre
Faculty Advisors: Stacy Frauwirth, MS, OTR/L and Julia Wilbarger, PhD, MS, OTR/L
Company/Collaborator:  N/A

Abstract:
There is a documented need for better services for those with autism spectrum disorders.  Various barriers, such as availability and accessibility of services and financial barriers, prevent those who need services from obtaining them.  According to the literature, using data, particularly population level data, leads to improved services.  Understanding the effectiveness and ineffectiveness of services helps healthcare providers identify areas for improvement and/or capitalize on past successful methods.  The purpose of this project was to provide a data compilation containing autism statistics including but not limited to prevalence, trend data, service use, and needs for the Marin Autism Collaborative (MAC).  The compilation is meant to aid the various organizations that comprise MAC in improving existing supports for the autism community to better meet this population’s needs.  The presented data compilation follows the trend in data-driven service development, while taking an occupational justice perspective on the various trends in autism data at the county, state, and national levels.  In addition, it highlights the gaps in current autism statistics.  A survey including a Likert scale and open-ended questions was sent to MAC agencies to evaluate the data compilation, the results of which were overall positive.

Understanding and Preventing Falls: Perspectives of First Responders and Older Adults by Monica Fernandez, Anita Hin, Chelsea Prado
Faculty Advisor:  Ruth Ramsey
Company/Collaborator:  Novato Fire Department

Abstract:
Objective: The objectives of this study were to identify characteristics of older adult fallers in a local community in Marin County, California, examine the perceptions of older adults who contacted a local fire district after a fall, examine the perceptions of first responders from a local fire district regarding falls and fall prevention, explore the degree of depression in older adult fallers, and identify strategies to prevent falls in older adults. Methods: This research study was an exploratory and retrospective descriptive study that utilized a mixed-method design.  The researchers coded narratives from Patient Care Report (PCRs) provided by the fire district and also quantitatively analyzed PCRs to identify characteristics of older adult fallers. Researchers also qualitatively analyzed data gathered from focus groups with older adults and first responders and from phone interviews with community-dwelling older adults to understand their experiences regarding falls and fall prevention. Results: Findings revealed that the majority of fallers were female, at an average age of 81 years old, living at home and alone during the fall.  Older adult participants associated falls with negative emotions and expressed a strong desire to maintain their independence despite experiencing falls and fall injuries.  First responder participants experienced challenges when communicating with older adult fallers due to cognitive and psychosocial factors.  The lack of coordination of services with care facility staff also posed a challenge for first responder participants. Conclusion: As the older adult population increases, more older adults will fall and require emergency care from first responders.  A collaboration between first responders and occupational therapists to develop and implement effective fall prevention programs for the community can potentially reduce falls and fall-related injuries and costs and improve the health and well-being of older adults.

Exploring Occupational Adaptation in First Year College Students by LaShelle Rullan, Jovita Vazquez, and Julia Wong    
Faculty Advisors: Stacy Frauwirth, MS, OTR/L and Ruth Ramsey, Ed.D, OTR/L 
Company/Collaborator:  Dominican University of California, Department of Occupational Therapy 

Abstract:
Objective:  To evaluate the effectiveness of peer mentoring in helping first year, first-generation college students at Dominican University of California (DUC) adapt to university life and navigate the occupational challenges experienced during the first year of college. Method:  Sixty-seven students voluntarily completed an online survey, First Year College Experience (FYCE) Survey: Adaptation to University Life.  Quantitative research determined the influence of peer mentoring on the students’ adaptation and occupational performance in their transition to college.  Effectiveness was determined by: 1) sense of belonging, 2) developed academic and social skills, 3) adaptive responses and strategies used, and 4) overall satisfaction with the college experience. Results:  FGS experienced a greater sense of belonging compared to non-FGS (p = 0.012).  Mentored students gained more skill over time academically than students who did not use peer mentoring (p = 0.003).  There was no statistical difference between FGS and non-FGS in the use of adaptive strategies (p = 0.902).  There was a statistical difference in use of adaptive strategies between students who were mentored and non-mentored.  Mentored students self-reported having more problem solving strategies when confronted with a challenge compared to non-mentored students (p=0.025).  Conclusion:  The results suggest that peer mentoring is effective in helping students develop adaptive strategies, academic skills, and increasing overall college satisfaction.  Implications of this study suggest that peer mentoring designed specifically for FGS in their first year of college may help FGS develop adaptive skills and flexibility in their problem-solving strategies that enhance their occupational performance as college students. 

Skill Generalization Following Computer-Based Cognitive Retraining Among Individuals with Acquired Brain Injury by Jonathan Alonso, Nisha Chadha & Jennifer Pulido(Academic Scholars 2013-2014)
Faculty Advisor:  Dr. Kitsum Li, OTD, OTR/L
Company/Collaborator:  Brain Injury Network of the Bay Area

Abstract:  
Individuals with acquired brain injury (ABI) often experience cognitive deficits. This creates many challenges in learning or relearning skills and generalizing skills among different contexts and task demands. Computer-Based Cognitive Retraining (CBCR) is a common intervention utilized by occupational therapists to help remediate cognitive deficits in individuals with ABI. Although research has shown that CBCR programs are effective at improving cognitive domains, there is limited evidence to support generalization of these skills to functional daily living tasks. Therefore, the primary purpose of this study was to assess the occurrence of generalizing gained skills in overall cognition, attention, and memory from a CBCR program to a medication-box task in individuals with ABI. This study utilized the Parrot Software for the CBCR intervention and 
evaluated changes in overall cognition, attention, and memory skills with the Montreal Cognitive Assessment (MoCA©), and generalization of those skills utilizing a performance-based medication-box task. The results indicated that the Parrot Software CBCR was effective at improving overall cognition, but not significantly in any particular cognitive domain. In addition, the gains in overall cognition failed to generalize to improved performance in the medication-box task. Extraneous variables did not affect the changes in cognition. However, participants without previous CBCR experience improved significantly when compared to participants with previous CBCR experience. Future areas of research should include interventions that can bridge the gap between CBCR and performance in daily living tasks.  

Exploring the Utility of the Children’s Kitchen Task Assessment for Use with Six-Year-Olds by Vanessa Carzon, Charisa Kelly, and Alexandra Rodriguez  
Faculty Advisor: Julia Wilbarger Ph.D., OTR/L
Company/Collaborator:  N/A

Abstract:
Background:  The Children’s Kitchen Task Assessment (CKTA) is an ecologically valid assessment that assesses executive functioning in children ages 7-10.  Purpose.  To explore the utility of the CKTA for use with six-year-olds.  Methods:  This study used an exploratory, qualitative, case study design and used quantitative data to make qualitative inferences about the results.  Participants included two typically developing female participants, six years of age.  Participants were given the CKTA and the WISC-IV Digit Span while parents completed a background questionnaire and Parent BRIEF.  Children’s performance on the CKTA was observed, recorded, and compared to their performance on the neuropsychological tests. Results:  Patterns of advantages and disadvantages emerged in using the CKTA with six-year-olds.  The advantages included physical ability to perform the task, the task was motivational for participants, and the participants were able to problem solve by using the pictures in the recipe book. Disadvantages included difficulties with reading, fractions, and the sand timer.  Researchers found that scores on the neuropsychological tests administered to participants did not correspond with their performance scores on the CKTA.  Conclusion:  The study found that although the CKTA is a feasible assessment to test executive function in children, it poses some challenges for six-year-olds.  Based on the results obtained from this study, researchers suggest several ways to modify the current CKTA assessment in order for it to be better suited for use with six-year-olds.  The Researchers’ ideas for modifications would not take away from the authenticity of this assessment.

Employment Exchange Opportunities for Young Adults with Autism and Asperger Syndrome by Rafael Garcia, Kisa Geiger, and Alex Shragg
Faculty Advisors: Stacy Frauwirth, OTR/L, Ph.D. (Cand.) and Julia Wilbarger, Ph.D., OTR/L
Company/Collaborators: Marin Autism Collaborative; Janet Lawson

Abstract:
In the United States 1 in 88 children are diagnosed with an autism spectrum disorder (ASD) and approximately one in every 150 people are living with an ASD diagnosis (Center for Disease Control and Prevention [CDC], 2010). Adults with Asperger syndrome (AS) and ASD have a particular set of challenges which contribute to a lack of vocational participation.  Factors limiting employment are the inability to acclimate to a new job routine, difficulty with the social and communication aspects of the interview process, determining the amount of detail needed for filling out an application, and determining what information to put on a resume (Muller, Schuler, Burton, & Yates, 2003). Specific types of vocational rehabilitation have been identified by the consumer to improve employment skills and social skills, supported employment, transition training, and various forms of vocational support services have been effective in improving vocational experiences amongst individuals with AS and autism (Bennette, Brady, Scott, Dukes, & Frain, 2010; Hillier, Fish, Siegel, & Beversdorf, 2011; Taylor et al., 2012). The purpose of this project is to create a resource guide which includes information about the steps an individual with autism or Asperger syndrome must take with the Department of Rehabilitation to gain vocational support services within Marin County. The resource guide also includes information about the variety of services available to support individuals with autism and Asperger syndrome, both from the DOR and from private agencies. The effectiveness of the resource guide is of significance as there are many young adults with autism or AS in Marin County who are transitioning from school to employment. Additionally, the guide is a valuable resource to potential employers as it introduces vocation related attributes of a young adult with AS or ASD and highlights the benefits of employing a young adult with ASD or AS.


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