Professor Shelly Lane

While the national economy remains uncertain, the field of occupational therapy continues to expand, creating a wealth of opportunities for innovative and exciting clinical programs. Occupational therapy practitioners must seek new ways to make their ideas for improved client services a reality. Grant writing is one way of obtaining funding for the types of projects and programs that can lead the profession in reaching its Centennial Vision. Occupational therapy practitioners can enhance their own grant writing abilities by working with mentors, attending workshops, and enrolling in continuing education courses.

The Centennial Vision makes it clear that the profession of occupational therapy is facing challenges that require members to move beyond clinical excellence toward larger health care initiatives (American Occupational Therapy Association, 2007). Accomplishing this goal requires the development of professionals with leadership skills. The focus of the doctorate in occupational therapy at Virginia Commonwealth University (VCU) hits this mark. In this paper, we describe the development process of a postprofessional occupational therapy doctorate focused on building leaders. To exemplify putting the Centennial Vision in action through education, we describe courses and content, and offer examples of the capstone leadership project and data describing students' experiences with becoming leaders. © 2010 Informa Healthcare USA, Inc.

Understanding sensory processing and sensory processing disorders such as sensory modulation disorder (SMD) is crucial for occupational therapy practitioners. SMD is increasingly identified by families, teachers, special educators, and professionals in other health related fields as an issue for children with a variety of conditions. In a recent issue of the American Journal of Occupational Therapy (AJOT), guest editors Schaaf and Davies (2010) enthusiastically asserted a "perfect storm" has arrived, and we must seize this opportunity to emerge as the leaders in the evolution of the theory of sensory integration and the treatment of people who experience participation limitations related to problems in processing and integrating sensory information. Our terminology must be clear, our role must be clearly delineated, our expertise must be defined, and our interventions must be evidence based (p. 363). It is with this declaration that we define, examine, and anticipate future research on the topic of sensory modulation from both a physiological and behavioral perspective. Here we define and organize the term SMD, including patterns of the clinical presentation of disorders that fall under it. Neuroscience foundations relative to modulation and modulation dysfunction are considered, and tentative links between neuroscience and behavior are presented. Finally, we look at concepts of intervention for disorders of sensory modulation.

Deficits in sensory modulation have been linked clinically with impaired attention, arousal, and impulsivity for years, but a clear understanding of the relationship between sensory modulation disorders and attention deficit hyperactivity disorder (ADHD) has proven elusive. Our preliminary work suggested that patterns of salivary cortisol and electrodermal responsivity to sensation may be linked to different groups of children with ADHD; those with and without sensory overresponsivity (SOR). Additionally, SOR has been linked to anxiety, and anxiety has been linked to ADHD. A clearer understanding of the relationship between anxiety, SOR, and ADHD may support a better understanding of ADHD diagnostic subtypes. We examined neuroendocrine, electrodermal and behavioral characteristics and sought to predict group membership among 6-to 12-year-old children with ADHD and SOR (ADHDs), ADHD and no SOR (ADHDt), and typicals (TYP). Behavioral questionnaires were completed to document SOR and anxiety. Lab testing used a Sensory Challenge Protocol (SCP) with concurrent electrodermal measurement and the collection of cortisol prior to and following the SCP. Results substantiated links between SOR and anxiety, in both TYP and ADHD children. Results suggests that ADHD should be considered in conjunction with anxiety and sensory responsivity; both may be related to bottom-up processing differences, and deficits in prefrontal cortex/hippocampal synaptic gating. © 2010 Lane, Reynolds and Thacker.

The overall goal of this study was to determine if parasympathetic nervous system (PsNS) activity is a significant biomarker of sensory processing difficulties in children. Several studies have demonstrated that PsNS activity is an important regulator of reactivity in children, and thus, it is of interest to study whether PsNS activity is related to sensory reactivity in children who have a type of condition associated with sensory processing disorders termed sensory modulation dysfunction (SMD). If so, this will have important implications for understanding the mechanisms underlying sensory processing problems of children and for developing intervention strategies to address them. The primary aims of this project were: (1) to evaluate PsNS activity in children with SMD compared to typically developing (TYP) children, and (2) to determine if PsNS activity is a significant predictor of sensory behaviors and adaptive functions among children with SMD. We examine PsNS activity during the Sensory Challenge Protocol; which includes baseline, the administration of eight sequential stimuli in five sensory domains, recovery, and also evaluate response to a prolonged auditory stimulus. As a secondary aim we examined whether subgroups of children with specific physiological and behavioral sensory reactivity profiles can be identified. Results indicate that as a total group the children with severe SMD demonstrated a trend for low baseline PsNS activity, compared to TYP children, suggesting this may be a biomarker for SMD. In addition, children with SMD as a total group demonstrated significantly poorer adaptive behavior in the communication and daily living subdomains and in the overall Adaptive Behavior Composite of the Vineland than TYP children. Using latent class analysis, the subjects were grouped by severity and the severe SMD group had significantly lower PsNS activity at baseline, tones and prolonged auditory. These results provide preliminary evidence that children who demonstrate severe SMD may have physiological activity that is different from children without SMD, and that these physiological and behavioral manifestations of SMD may affect a child's ability to engage in everyday social, communication, and daily living skills. © 2010 Schaaf, Benevides, Blanche, Brett-Green, Burke, Cohn, Koomar, Lane, Miller, May-Benson, Parham, Reynolds and Schoen.

This study examined the prevalence of sensory modulation disorders (SMD) in a population of minority children enrolled in an urban Head Start program. Parents of 105 children attending Head Start were surveyed using the Short Sensory Profile. Results indicated that 17% to 35% of children could be classified as having SMD, with 43% of children exhibiting extreme under-responsive/sensory-seeking behaviors. Rates of SMD in these children were approximately three times higher than those reported in other populations of young children. Potential reasons for these higher prevalence rates are discussed along with the role of occupational therapists in Head Start settings. © 2008 by The Haworth Press.

Through The Rehabilitation Act, the Technology Related Assistance for Individuals with Disabilities Act (The Tech Act), the Individuals with Disabilities Education Act (IDEA), and the Americans with Disabilities Act (ADA) of 1990, the federal government broadened the states' roles in increasing awareness and accessibility of assistive technology (AT) devices and services to children with disabilities. As a member of the AT team, the occupational therapy practitioner plays an integral role in selecting the most appropriate device, and working with parents and other professionals to integrate the device into a child's daily routines. This literature review presents a summary of available information on AT materials and strategies that assist infants, toddlers, and school-aged children with disabilities. We begin with a brief look at legislation affecting the provision of AT. Issues concerning the use of Electronic Aides of Daily Living (EADL), and strategies for successful manipulation are presented; followed by a discussion of play and leisure, mobility, and communication devices. Finally, we conclude with a discussion concerning the importance of measuring the effectiveness of AT devices and services. © 2002 by The Haworth Press, Inc. All rights reserved.

To examine the perceptions of parent education and support of feeding in the neonatal intensive care unit (NICU), a survey was conducted with occupational therapists (OTs) and parents of infants in the NICU. Data were collected from 32 OTs and 11 parents. The results showed that OTs used a variety of teaching methods to convey information about feeding to parents, that parents felt ¿very confident¿ and OTs felt ¿confident¿ in the parents' understanding of the material, and that different types of equipment and follow-up services were offered to parents following their child'S discharge from the NICU. © 2000, Informa UK Ltd All rights reserved: reproduction in whole or part not permitted. All rights reserved.

Play forms an important foundation for the development of skills in all children. Unfortunately, for infants and children with disabilities, real play may be absent or diminished, replaced by therapies and/or special instruction. Infants and young children with disabilities experience barriers to play that are created by the nature of their disability. Parents of these children may feel they do not have time to play, given the demands of intervention and education. Alternatively, they may not know how to facilitate play with a child with a disability. Assistive technology has the potential to open up play options to children with disabilities and their parents, if our "definition" of assistive technology is broadened. This article examiness "low-tech" assistive technology options addressing positioning, communication, learning, mobility, and self-care barriers. A discussion of the combination of low-tech assistive technology with high-tech assistive technology is presented with a case example. Finally, policy issues that interfere with the ability to include low- and high-tech assistive technology in early intervention are addressed, and recommendations for overcoming these barriers are considered.

In the present study both the Fagan Test of Infant Intelligence (FTII) and the Motor Assessment of Infants (MAI) were administered to 36 full term infants previously exposed to cocaine in utero. The infants were participating in a program at the PACT (Parents And Children Together) clinic operated by Children's Hospital of Buffalo, New York. The FTII was administered at 69 weeks post-conceptional age and the MAI was administered 8 months from birth. It was hypothesized that significant relationships existed between the mean novelty preference scores on the FTII at 69 weeks and the risk scores on the subsections of the 8-month MAI. Moderate, but statistically significant, negative correlations were found between the FTII and both the automatic reactions and the primitive reflexes subsections of the MAI. The implications of these results are discussed in the context of a homeostatic model of functioning, under which the infants are viewed as having difficulties with internal regulation and motor control, leading to higher risk scores on the MAI and to lower novelty preference scores on the FTII.

The dramatic rise in cocaine use in the 1980s has prompted increased concern on the part of clinicians for both the user and, if the user is a woman of child-bearing age, for the developing fetus. The impact of prenatal cocaine exposure on the newborn has been repeatedly documented, 1-6 and plans for intervention are beginning to be developed for these newborns and their caregivers which may be of some help in getting through initial crises. 7 The long-term impact is presently poorly articulated. Although anecdotal reports of developmental concerns in prenatally exposed children at preschool and school age are available, and expectations for developmental deviations exist, research reports are not available to support these contentions. Understanding the actions of cocaine, and the implications of cocaine use, may assist parents and professionals in being realistic in both predictions and expectations. This article provides a summary of these issues. © 1996, Informa UK Ltd All rights reserved: reproduction in whole or part not permitted. All rights reserved.

The major purpose of this article is to review literature relating to the risk factors for low birth weight (LBW), and the subsequent impact LBW will have on the child. Since children with dificits related to LBW may be referred to occupational and physical therapist, this overview should assist them in knowing what to expect from this population. In addition, suggestions for assessment of the child of LBW throughout infancy and early childhood is presented along with a brief discussion of appropriate program planning recommendations. In reviewing the literature on this subject, an attempt has been made to include literature which differentiates between LBW alone, and LBW complicated by prematurity. In some instances this was not feasible, but the information warranted inclusion. In these cases the possible confound of prematurity on the developmental impact of LBW has been noted. © 1993 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

Scientific knowledge has expanded concerning the adverse effects of low-level lead exposure. In spite of this expansion, many professionals working with infants and children are unaware of the prevalence of this problem and the developmental consequences associated with it. This article reviews the etiology and impact of low-level lead exposure based on current research. Particular attention is given to developmental issues in the prenatal, infancy, and preschool years. A family-focused intervention model is suggested to deal with this complex issue. © 1993 Aspen Publishers, Inc.

This study of the maturation of prestimulation-induced modulation of startle in 3 to 8 year old children and adults demonstrated significant effects of age on both startle magnitude and onset latency. Startle was evoked by 104dB(SPL) 50-ms bursts of white noise, and the amplitude and onset latency of the blink reflex were measured after integration of the obicularis oculi EMG. Prestimulation with 75dB 1000 Hz tones resulted in severe inhibition of both amplitude and latency in adults when 20-ms tones preceded the startling stimuli by 120 ms or 250 ms. Following sustained prestimulation for 2000 ms, the adults showed modest nonsignificant response facilitation. Eight-year-old children showed mature inhibitory and facilitatory startle amplitude modulation, but significantly less inhibition and more facilitation of onset latency compared to adults. Preschool children showed significantly less amplitude and latency inhibition and more facilitation than 8-year-olds and adults. In response to prestimulation 120 ms before startling stimuli, the preschool children actually showed latency facilitation. Modulation of startle by prestimulation is mediated by brainstem neuronal networks. These findings suggest that brainstem mechanisms which mediate startle response modulation undergo development during early childhood and do not mature until about 8 years of age. Copyright © 1986, Wiley Blackwell. All rights reserved