Professor Shelly Lane

Introduction: As the rate of post-traumatic stress disorder (PTSD) among military personnel and military veterans continues to rise, occupational therapists are increasingly concerned with the impact of this disorder on health, occupational performance, and quality of life. However, the literature on occupational therapy for military personnel and military veterans with PTSD has not been summarised. Method: The objective was to identify what is known from the published, peer-reviewed literature, about the services provided by occupational therapists to military personnel and military veterans experiencing PTSD. Arksey and O¿Malley's five steps for scoping reviews were utilised. A search of three databases identified 27 articles. Results: Of the 27 papers reviewed, 13 papers discussed military personnel, 13 for military veterans, and 1 reported on both populations. Of these 27, 9 research papers provided data to support the efficacy of interventions, whereas 2 papers reported occupational performance issues. Eight opinion and eight service description papers were included. The most commonly mentioned interventions across the reviewed papers were stress and anger, or coping skills (n¿=¿11), returning to duty (n¿=¿9), physical training (n¿=¿7), and sleep hygiene (n¿=¿6). Conclusion: Occupational therapists provide services to military personnel who are vulnerable to PTSD from combat and operational stress. Rarely did publications address intervention efficacy for military personnel. Additionally, there is a paucity of literature that addresses occupational therapy interventions following transition from military service for veterans with PTSD specific to facilitating reintegration to civilian life. Despite this, occupational therapists are well suited to enable military veterans to build upon their existing strengths, skills, and professional identities to minimise the impact of PTSD on daily life and to reach their full potential.

Introduction: Preliminary reports support the hypothesis that sensory issues may be related to atypical defecation habits in children. Clinical practice in this area is limited by the lack of validated measures. The toileting habit profile questionnaire was designed to address this gap. Methods: This study included two phases of validity testing. In phase 1, we used Rasch analysis of existing data to assess item structural validity, directed content analysis of recent literature to determine the extent to which items capture clinical concerns, and expert review to validate the toileting habit profile questionnaire. Based on phase 1 outcomes, we made adjustments to toileting habit profile questionnaire items. In phase 2, we examined the item structural validity of the revised toileting habit profile questionnaire. Results: Phase 1 resulted in a 17-item questionnaire: 15 items designed to identify habits linked to sensory over-reactivity and two designed to identify sensory under-reactivity and/or poor perception items. The analysis carried out in phase 2 supported the use of the sensory over-reactivity items. Remaining items can be used as clinical observations. Conclusion: Caregiver report of behaviour using the revised toileting habit profile questionnaire appears to adequately capture challenging defecation behaviours related to sensory over-reactivity. Identifying challenging behaviours related to sensory under-reactivity and/or perception issues using exclusively the revised toileting habit profile questionnaire is not recommended.

Sensory over-reactivity may be related to atypical defecation habits in children with constipation. The Toileting Habit Profile Questionnaire-Revised (THPQ-R) is designed to identify defecation-related sensory issues. This study examined the discriminative and concurrent validity of the THPQ-R. Differentiating between children with and without constipation was used to establish discriminative validity. The relationship between scores on the THPQ-R and on the defecation scale of the Virginia Encopresis-Constipation Apperception Test (VECAT-S) was examined to establish concurrent validity. The difference in THPQ-R scores was statistically significant. There was a strong positive correlation between the over-reactivity section of the THPQ-R and VECAT-S scores. Results support using the THPQ-R to identify atypical defecation behaviors.

Aim: This study examined cross-sectional population-based rates in reported need and unmet need for occupational, physical, and speech therapy services in children with autism spectrum disorder (ASD) compared with children with attention-deficit¿hyperactivity disorder (ADHD) and cerebral palsy (CP). Method: The 2005¿2006 and 2009¿2010 (USA) National Survey of Children with Special Health Care data sets were used to compare therapy need and unmet need among children younger than 18 years with ASD (n=5178), ADHD (n=20 566), and CP (n=1183). Bivariate approaches and multivariate logistic regression using imputed data were used to identify associations between child and family characteristics, and access to therapy services. Results: After adjusting for other variables, children with ASD had a significantly greater likelihood of having an unmet therapy need compared with children with ADHD (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.36¿2.03), but a similar unmet need as children with CP (OR 1.30, 95% CI 0.97¿1.74). Factors associated with unmet need included survey year, younger child age, no health insurance, and increased functional and behavioral difficulties. Interpretation: Children in our sample had greater unmet therapy needs in 2009 than in 2005. Caregiver-reported reasons for unmet need included cost and school resources. Research examining future trends in therapy access are warranted for children with ASD and CP. What this paper adds: Children with complex diagnoses of autism spectrum disorder and cerebral palsy had reported unmet need for therapy services. High costs of therapy were the primary reported reason contributing to reduced access among children.

Introduction: Barth syndrome is a rare X-linked genetic disorder caused by a mutation or deletion of the tafazzin gene. Approximately 50¿70% of affected males have family-reported feeding issues that affect eating habits and/or restrict dietary intake. Research to date suggests that these feeding problems may be related to differences in responsivity to taste and smell stimuli. The purpose of this study was to use indices of chemosensory function to study differences in food-related sensation and anatomy in males with and without Barth syndrome. Methodology: A cross-sectional two-group comparison design was used. Participants included 34 males with Barth syndrome between 5 and 34¿years of age and 34 age-matched controls. Measures included the number of fungiform papillae on the anterior dorsal surface of the tongue and scores on the Sniffin¿ Sticks olfactory threshold test. Results: Fungiform papilla counts did not differ significantly between males with and without Barth syndrome, suggesting that altered oral anatomy does not contribute to reported taste and feeding problems in this population. Olfactory thresholds significantly differed between groups; the Barth syndrome sample had a lower threshold for odor detection, indicating greater olfactory sensitivity. These objective measures match self-report data from the Barth syndrome population indicating that they perceive themselves as having a heighted sense of smell compared to others. Conclusions: This study supports previous behavioral research indicating that olfactory sensitivity is heightened in the Barth syndrome population. Although differences in oral anatomy did not occur, previous research suggests that specific oral sensory cues (e.g., bitterness, texture) may be especially salient in Barth syndrome. Implications: Since this is the first study to identify differences in odor threshold in the Barth syndrome population, findings should be corroborated with future research. These efforts should include odor, taste, and tactile cues at both threshold and suprathreshold concentrations. Results suggest, however, that interventions to address feeding and dietary needs of the Barth syndrome population should consider how food-related stimuli can be modified in order to facilitate appetite and reduce food refusal.

Introduction: Preterm infants admitted to the Neonatal Intensive Care Unit are at higher risk of poor neurodevelopmental and sensory outcomes. There is interest in establishing whether elements of the Neonatal Intensive Care Unit sensory environment may influence the sensory and overall development of these infants. Method: The purpose of this scoping review was to provide a comprehensive overview of relevant research regarding the sensory elements of the Neonatal Intensive Care Unit, and their short- and long-term influence on preterm infants. This scoping review is underpinned by the six-stage framework by Arksey and O¿Malley. Results: There are few studies that have directly examined the influence of the Neonatal Intensive Care Unit environment upon the sensory and developmental outcomes of infants born preterm, in infancy. The findings of the studies included in this review suggest that the Neonatal Intensive Care Unit sensory environment may alter developmental trajectories of preterm infants. However, low-quality evidence exists in this field, with much of the literature being preliminary. Conclusion: Further experimental studies are required that combine multiple methods of assessment to more rigorously understand the sensory characteristics of the Neonatal Intensive Care Unit, and their relationship with developmental outcomes across early childhood.

Current neurodevelopmental research suggests that chronic and highly stressful environments and experiences, occurring during early development, have a strong negative impact on the neural architecture and overall brain development in young children. Evidence based practice suggests interventions which provide safe, relational, playful, regulatory directed, and repetitive sensory/motor qualities, geared to the developmental age of the child, will best meet child and family needs. Optimally meeting the needs of these children and their caregivers with a neurobiologically based approach requires a multidisciplinary team approach. Here we describe our multidisciplinary practice model and present the case of a "graduate" of our program. Our model is based on Perry's neurosequential model of therapeutics approach to clinical reasoning, and emphasizes the healing power of safe relationships and the use of regulatory activities designed to activate specific brain regions. We also incorporate trauma informed play therapy to support relationship building and self-regulation, strengths-based and trauma informed early childhood education, occupational therapy emphasizing sensory integration for self-regulation, and caregiver therapy. We suggest that this multidisciplinary, multifaceted model of intervention for preschoolers with serious emotional disorders related to the developmental trauma is healing to both the child and caregiver and assists the child to reenter the educational system with more adaptive selfregulation tools and social emotional tools.

This study examined the face and preliminary content validity of the Toileting Habit Profile Questionnaire, a tool designed to screen for sensory-based defecation difficulties in children. A panel of experts reviewed a pilot version of the questionnaire and responded to probe questions. Two reviewers conducted direct content analysis of responses; 100% agreement was reached. Experts demonstrated a high degree of agreement and their input was useful in establishing this tool for initial research and clinical use. The Toileting Habit Profile Questionnaire appears to capture behaviors that are consistent with problematic toileting behaviors, particularly as they relate to sensory overreactivity.

Evidence-based occupational therapy practice is informed during the evaluation by using assessments that characterize clients¿ strengths, abilities, and participation challenges; guide recommendations for intervention; and allow identification of meaningful and desired outcomes. Patterns of sensory integration (SI) function and dysfunction, originally identified by Ayres (Ayres, 1979/2005; Mailloux et al., 2011; Parham & Mailloux, 2015), through numerous factor and cluster analyses of test scores in a variety of populations, have been further characterized over time. Originating with theoretical links between SI functions and occupational performance, Ayres conducted studies that showed data-based patterns that were consistent, even as specific evaluation tools evolved and developed. Research on these identified patterns of function and dysfunction informed further theory development and elucidated our understanding of the various constructs that serve to support the validity of SI theory and practice. In this article, we review the identified patterns of SI function and dysfunction based on historic and current analyses; examine the links between certain patterns of SI dysfunction in various diagnostic and clinical groups, including children with conditions such as attention deficit hyperactivity disorder, autism spectrum disorder, and hearing loss addressed through cochlear implants; and review the way in which theoretical models informed by this theory and research allow further examination through research and in practice.

This article builds on the work of Case-Smith and colleagues and proposes a roadmap to guide future research in occupational therapy. To foster best practice in the application of principles and practices of sensory integration (SI), the pillars of practice, advocacy, and education are identified as elements that provide the foundation for research. Each pillar ensures that SI research is conducted in a rigorous and relevant manner. To this end, achievements to date are discussed, with proposed goals presented for each pillar. Finally, the roadmap builds on the pillars and outlines implications for occupational therapy with the overarching theme that a wide array of scientists, educators, therapists, and service recipients will be needed to ensure that those who may benefit most have access to intervention that is evidence based, theory driven, and provided within the highest standards of service delivery.