Thumb Proprioception in Hypermobile and Non-Hypermobile Adults: An Observational Study

Aims and Background Hypermobility is a common presentation in the community and is reported related to higher rates of injury and musculoskeletal pain, however the mechanism underpinning this relationship remains unclear. Poor proprioception in hypermobile joints has been proposed as a potential mechanism. This study aims to determine if there is a difference in proprioceptive acuity, as measured by joint position reproduction, in adults with generalised joint hypermobility. Design and methods A convenience sample of 26 university students and staff (mean age 29.23 years, range 18-47) were recruited, of which 12 participants displayed generalised joint hypermobility, and 14 did not. A laser light, mounted to the dominant thumb, was used to test joint position reproduction sense by pointing to targets using a unilateral active-active position reproduction protocol. Results/Findings Test reliability across a range of targets was poor to good (intraclass correlation coefficients ranged from 0.1163 to 0.7256), indicating significant variability between participants. No significant differences was found in absolute angle of error between generalised joint hypermobility and non-generalised joint hypermobility participants. For direction of error in relation to the proprioceptive targets, only 30° thumb extension above horizontal was found to be significantly different between the hypermobile and non-hypermobile groups, with hypermobile participants tending to underestimate distance to target. Age and sex were not correlated to thumb proprioception. Application and Conclusion The difference found in direction of error and tendency to underestimate angular distance may be protective against straying into possibly injurious end-ranges; however, larger studies are recommended to confirm this.

A Narrative Thematic Study of the Impact of International Placement Experience on Graduate Occupational Therapy Practice

Aim and Background: Globally, there is movement towards the internationalisation of allied health care. Many universities across the globe are offering international student placements as part of the movement to create therapists equipped to participate in a dynamic, borderless environment. This narrative study sought to contribute to the developing body of knowledge exploring these longer-term impacts. Design and Methods: Seven occupational therapy graduates who completed an international placement as part of their studies were recruited. Narrative data were gathered via in-depth semi-structured interviews, and thematically analysed by coding and grouping similar concepts to develop themes. Results: The overarching themes were the influence of international placement on participants’ paths and practice as therapists. Sub-themes included developing relationships, representing occupational therapy, working with interpreters, cultural sensitivity and empathy, reflective practice, resourcefulness and autonomy. Conclusion: The study identifies ongoing impact of international student placement on occupational therapy practice. Participants gained a rangeof experiences during their time overseas that has influenced their practice as therapists. Future studies would provide further knowledge to inform universities and students of the benefits of undertaking international student placements. Keywords: international educational exchange, professional practice, professional competence

Occupational Therapy Interventions for Adolescents: A Scoping Review

Aim and Background: Occupations are everyday activities that help occupy our time and provide us with a sense of purpose in life. Adolescence is a unique stage of life when individuals experience occupational change that assists with preparation for adulthood. Participation in occupations is linked to health and wellbeing. Existing literature on occupational participation appears to combine adolescents’ and children’s experiences. Due to the unique nature of adolescence and an increased focus on service development and re-design for all age groups in Australia since the implementation of the National Disability Insurance Scheme, this scoping review sought to explore Occupational Therapy interventions that promote adolescents’ participation in everyday occupations. Design and Methods: A systematic search of eight databases for peer reviewed papers published between 2008 and 2018 was conducted. The PRISMA guidelines were used to guide the review processes. Study selection criteria focussed on Occupational Therapy interventions promoting participation in everyday occupations for adolescents (between 10 to 19 years of age). The data was charted and synthesised to identify key features of the interventions. Results: The 26 included studies revealed various intervention types and adolescent groups. The majority of the interventions targeted adolescents with physical disabilities and autism spectrum disorder. Many studies focussed on promoting functional independence in work, personal care, social participation and health management. Features of interventions include collaborative (with the adolescent and family) intervention goal setting and evaluation processes, as well as the use of technology. The majority of the papers reported positive outcomes, however mixed results were also identified. The findings provide guidance for adolescent service development and re-design by identifying the areas of occupation and features of programs, documented in Occupational Therapy-specific literature. Future reviews can extend our understanding further by incorporating by including publications that focus on assessment and other roles of Occupational Therapists. Keywords: participation, occupation, Occupational Therapy, adolescents

Transition from hospital to home during COVID-19: A case report from an Australian transitional care program

Aim and Background: With the ongoing COVID-19 global pandemic, consideration for vulnerable groups, including our ageing population has been of great concern. Social isolation has been recommended to protect older adults with chronic diseases and reduce the spread of the virus, as well as to prevent healthcare services becoming overwhelmed. Yet social isolation presents its own health risks. Methods: In this paper, we provide commentary on the lived experience of returning home from hospital during the COVID-19 pandemic. This case report details the experience of an 83-year-old female, who was living and mobilising independently in her own home, prior to hospital admission following a fall and resultant head injury. Results: The participant returned home during the COVID-19 pandemic with a community transition care program which included assistance with cleaning tasks, shopping, and physiotherapy over a 45-day period. Conclusions: COVID-19 has illuminated the issue of social isolation and increased awareness of its negative health effects at a global level. As society eases restrictions and returns to a new ‘normal’, many older adults will remain socially isolated. Ongoing allied health intervention is required to ensure quality of life through the latter years and to support older adults through periods of social distancing. Keywords: transition care; COVID-19, social isolation, community participation

Communication strategies used by specialised preschool teachers for children with Autism Spectrum Disorder in South Africa.

Aim and Background: The study aimed at expanding our understanding of the communication strategies used by teachers of pre-schoolers with Autism Spectrum Disorders (ASD) in Johannesburg, South Africa. By describing the use of current practices, our study aimed to provide recommendations for the development of support in the classroom, including Allied Health services. Methods: Through homogeneous purpose sampling, five qualified teachers were recruited from public and private pre-schools in Johannesburg. The data were gathered through semi-structured qualitative interviews, combined with observations from the classroom. A qualitative descriptive design, with the combination of both data sets and thematic analysis were used. Results: One overarching theme emerged from the data: Diversity. With three sub-themes: range of communication strategies, communication difficulties, and feelings and perceptions related to interacting with children with ASD. Diversity was prominently displayed in the children’s communication and needs, in the successful use of multi-modal communication strategies used by teachers and in the teachers’ feelings and perceptions related to the children. Teachers’ skills and comfort level in communicating with children with diverse needs, is foundational to successful communication and learning. Allied Health support for teachers in classrooms and workforce strategies for teachers will assist in supporting teachers of young children in classrooms. Key Words: autism spectrum disorder, communication strategies, teachers, pre-schoolers

The value placed on roles and attributes of clinical educators: An international comparison of Indian, South African and Australian undergraduate physiotherapy students.

Aim and Background: Clinical Education opportunities for undergraduate Physiotherapy students are now increasingly occurring internationally. The clinical educator (CE) plays a significant role in the clinical education process particularly when a student undertakes a clinical placement in a different country as the CE often takes on a surrogate caretaker role. This study explores the self-reported perceptions of Physiotherapy students from three countries representing different global society clusters – South Africa (Sub-Saharan Africa), India (Southern Asia) and Australia (Anglo), regarding the roles and attributes of a CE that they value in the clinical education process. Method: Data was collected from undergraduate Physiotherapy students in a university in India (n=23) and Australia (n=154) and compared with data from a similar student cohort in South Africa (n=70). Students were asked roles and attributes of a clinical educator were of most value in the clinical education setting. Results: The relative values placed on CE roles/attributes across the three cohorts was similar, however specific differences between cohorts suggest that clinical educators should be aware of differences when supervising international students.

Weekly versus fortnightly Allied Health early intervention for children with diagnosed/suspected developmental delay

Aim and background: Reviewing service provision is prudent for early childhood development teams to ensure efficient and high quality service delivery. The context of this study is an outpatient, clinic-based, Allied Health Early Intervention service, for children, aged 1-4years with diagnosed/suspected developmental delay and their families, which is currently provided fortnightly over 10-weeks. This study aimed to compare the impact on carer and clinician preferences, client outcomes and efficiencies such as attendance rates, of weekly versus fortnightly clinics. Methods: A prospective multi-informant, group comparison design was conducted comparing fortnightly interventions over 10-weeks and weekly interventions over 5-weeks. Intervention outcome data (Canadian Occupational Performance Measure), attendance rates and questionnaire data completed by clinicians and carers, were compared between the two frequency periods. Results: No statistically significant difference was found between both models for overall attendance rates or outcome measures (n=25 fortnightly, n=29 weekly). Carers’ (n=97) and clinicians’ (n=36) perceptions showed a variety of preferences. Carers suggested weekly was preferable for children who function well with routine, have shorter term goals and homework and for rapport building. Concerns for vulnerable families regarding a shorter contact period of 5-weeks with the weekly service, compared to 10-weeks (for fortnightly service), were identified by clinicians. Consistent feedback from carers was weekly over 10-weeks as the best option. Clinician themes included perception of increased workload with weekly and additional time needed to observe change for some children. Carers for both models articulated practical attendance barriers. Conclusions: A flexible model of service frequency is recommended, to suit the needs of children and carers, aligning with clinicians’ clinical reasoning. Decision making considerations should include condition, type of therapy (need for intensity/longer period/routine/relationship building), family practicalities, family vulnerability and benefits of service contact time.