Occupational Therapy

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  • ItemOpen Access
    Linking People and Activities through Community Mobility: An International Comparison of the Mobility Patterns of Older Drivers and Non-Drivers
    (2022) Dickerson, Anne Elizabeth; Unsworth, Carolyn; Gélinas, Isabelle; Harries, Priscilla; Margot-Cattin, Isabel; Mazer, Barbara; Stapleton, Tadhg; Swanepoel, Lizette; Timmer, Amanda; Van Niekerk, Lana; Vrkljan, Brenda
  • ItemRestricted
    Using Eye Tracking Technology To Compare Hazard Detection On Road Versus Driving Simulator At Night Across Two Age Groups
    (2021-05-01) Leonardo, Juliette; Dickerson, Anne Elizabeth; Occupational Therapy
    Rationale: Though previous literature exists that demonstrates the validity of using driving simulation compared to on-road driving, few studies have examined hazard detection between two driving conditions. Even fewer studies have specifically examined hazard detection at night. Results of current research regarding age differences in driving is inconclusive, and night driving is an under-researched area. Purpose: This study sought to analyze the visual components of night driving for older adults. Eye tracking technology and driving simulation were combined to analyze on-road scanning behavior, visual attention, glance patterns, and hazard detection. Research questions sought to determine if there were significant differences in hazard detection between: 1) on-road and simulated drives, 2) older adults and younger adults, or any interaction effect. Design: This quasi-experimental study used a 2x2 repeated-measures factorial design and examined comparisons between two age groups (older adults v. younger adults) and across two driving situations (on-road v. simulated). Driving conditions were counterbalanced. Participants: Participants included 16 older drivers (65+ years) and 17 younger drivers (20-40 yeras). All participants were healthy, community-living adults obtained through convenience sampling. Methods: Instruments included wearable Tobii Pro eye tracking glasses which tracked and recorded pupil glances, a STISIM driving simulator, and each participant’s personal vehicle. In both the on-road and simulated conditions, a pedestrian “hazard” stood at three locations. Pedestrians stared at their cell phone and appeared to cross the street, though they did not actually walk. Outcomes examined from the eye tracking recordings in the Tobii Pro Analysis software included total fixation duration, fixation count, and time to first fixation. Analysis: The majority of findings indicate that night hazard detection behavior was similar across the driving conditions with the exception of time to first fixation. Time to detect the hazards was generally quicker on the road in both age groups. Comparison of the eye tracking measures indicated few statistically significant differences between older and younger adults’ hazard detection behavior. Though, older adults did take slightly longer to initially see hazards. Discussion: Findings indicated that, despite age-related visual decline, older adults detected hazards similarly to younger adults, especially when assessing on-road performance. However, they may take slightly longer to see hazards at night which should be considered in self-regulation. Results also support the use of driving simulators as a safe mechanism to observe driving habits, behaviors, and mistakes without risk to the driver, evaluator, or environment. Though, fitness to drive assessment should also include on-road observation due to limitations in absolute validity of simulation. Future research should place emphasis on analysis on time to first fixation, as it may offer the most driving-safety related information. Occupational therapists have a vital role in determining/addressing fitness to drive, reducing risk of crashes, and researching ways to address occupational needs.
  • ItemOpen Access
    (East Carolina University, 2020-06-22) Baran, Tara Jean; Dickerson, Anne Elizabeth
    Rationale: Driving is an important developmental milestone for all adolescents as it increases their independence and ability to participate in vehicle-dependent activities. However, adolescents with high functioning autism spectrum disorder (HFASD) are less likely to obtain licenses and drive independently due to characteristics related to their diagnosis. Although current research exists exploring the efficacy of driving simulator training for adolescent drivers with HFASD and eye tracking, there is a gap in the literature related to training on the simulator and its effects on overall driving performance and hazard perception and response in this population. Purpose: This pilot study utilized a training protocol on the simulator that included hazard perception to determine its effect on overall driving performance. Eye tracking technology was used to determine if there was a change in hazard perception and response to non-social and social hazards after training. Design: This study was a one group, pretest-posttest intervention design. Methods: There were 17 participants between the ages of 15 and 22 with a self-reported diagnosis of ASD and a desire to learn to drive independently. Each participant completed a pre-test and post-test on the driving simulator while wearing eye tracking technology. Each participant completed a protocol of 30 learning modules with scenarios related to driving skills and hazard detection and response in one-to-one training. Analysis: Driving performance was measured by a quantitative score from a standardized observational tool for driving. Eye tracking measures including fixation duration, fixation count, and time to first fixation were analyzed using a Wilcoxon Signed Rank Test. Results: Participants significantly increased their overall driving performance scores pre-test to post-test. Results of hazard perception using eye tracking technology tended towards improvement overall, but specific hazard results were inconsistent and varied for both non-social and social hazards in terms of fixation duration, fixation count, and time to first fixation. Discussion: Findings from this study indicate driving simulator training related to hazard perception was effective in improving overall driving simulator performance in adolescents with HFASD. Additionally, findings indicate hazard perception and response differs for this population after hazard perception training, but specific eye tracking measures may increase or decrease, and results may not be specific to non-social or social hazards.
  • ItemRestricted
    (East Carolina University, 2019-12-10) McDonald, Mary-Grace K; Dickerson, Anne Elizabeth; Occupational Therapy
    Rationale: Although current research exists regarding the validity of using a driving simulator compared to on-road driving for evaluation, there is a lack of evidence regarding hazard detection between the two driving conditions. Additionally, there is no clear consensus on whether old and young adults detect hazards differently. Purpose: This study utilized eye- tracking technologies to assess the validity of using a driving simulator compared to on-road driving for evaluation of hazard detection. The study also explored age differences in hazard detection across these two driving conditions. Design: This study was a 2x2 factorial design with repeated measures to determine if hazard detection is similar during on-road driving and simulated driving across two age groups. In addition, secondary analyses were completed to determine if hazard detection is similar between (1) on-road and simulated drives for younger drivers, (2) on-road and simulated drives for older drivers, (3) older adults and younger adults for on-road driving and (4) older and younger adults for simulated driving. Participants: Participants were 18 younger adults (ages 22-39) and 16 older adults (ages 65+). Methods: Each participant completed a simulated drive and on-road drive in their personal vehicle while wearing the eye-tracking glasses. Standardized pedestrians served as potential hazards and were placed throughout each driving condition in similar locations (three-way stop sign, pedestrian by the car, four-way stop light). Eye tracking metric including total fixation duration, fixation count, total visit duration, and visit count were analyzed. These metrics were compared between driving conditions and age groups. Results: Repeated measures ANOVAs were completed to compare simulated and on-road performance for all participants. Results showed significant differences between driving conditions for fixation count (F(1, 20), p=0.045) at the four-way stoplight and for total fixation duration (F(1, 20)=13.669, p=0.001), total visitation duration (F(1, 20)=12.876, p=0.002), and visit count (F(1, 20)=9.547, p=0.006) at the three-way stop sign hazard. Repeated measures ANOVAs compared performance between older and younger adults for both driving conditions with no significant differences found. For the secondary analysis using paired samples t-test, results within the older adults indicated there was a statistically significant difference between driving conditions for fixation duration (t(10)=3.491, p=0.006) and visit duration (t(10)=3.406, p=0.007) at the pedestrian by the car and for fixation duration (t(9)=3.833, p=0.004), visit duration (t(9)=3.841, p=0.004), and visit count (t(9)=2.751, p=0.022) at the three-way stop sign. No significant differences were found with younger adult performance. Two sample t-test compared older and younger adults’ performance on the on-road driving condition with no significant differences found. Two sample t-test compared older and younger adults’ performance on the simulated drive. Statistically significance difference between older and younger drivers included fixation duration (t(20)= 3.255, p= 0.030) and visit duration (t(20)= 3.236, p= 0.034) at the four-way stoplight. There were no significant differences between age groups for the simulated drive at the three-way stop sign and pedestrian by the car. Discussion: The results of this study indicated that hazard detection behavior was similar across the driving conditions, with a few exceptions. Therefore, supporting the use of driving simulators as a safe mechanism to observe driving habits, behaviors, and mistakes without risk to the driver, evaluator, or environment. Additionally, these findings indicate that, despite age-related visual decline, older adults detect hazards similarly to younger adults, especially when assessing on-road performance.
  • ItemRestricted
    (East Carolina University, 2018-11-27) Branson, Sydney; Donica, Denise; Occupational Therapy
    The purpose of this study was to investigate the two-year impact of using the Keyboarding Without Tears[trademark] instruction program compared to a mixed method instruction approach on students' net typing words per minute (WPM) and technique. In the current technological era, it is becoming increasingly important for students to possess keyboarding skills so that they are successful in education, social activities, and future work. Although the Common Core State Standards (National Governors Association & Council of Chief School Officers, 2010) emphasize the use of technology, including keyboarding, across grades, there has been no systematic implementation of keyboarding in schools (Poole & Preciado, 2016). This is largely due to the fact that there is not enough research identifying how the effectiveness of keyboarding interventions would balance the cost of implementing these interventions. This study utilized a pre-test post-test design over a two-year intervention period to measure the effectiveness of the two different instruction programs. Results revealed that students in the Keyboarding Without Tears group had significant improvements in their keyboarding speed in second and third grade and their keyboarding technique in all grades as compared to students in the mixed methods group. Results also indicated that both forms of keyboarding curriculum are effective at significantly improving students' keyboarding speed and technique. Occupational therapists and teachers can utilize this information to support the implementation of a keyboarding curriculum in schools and improve the keyboarding skills of students that need improvement with this skill.
  • ItemOpen Access
    Effects of Music on the Driving Performance of Young Drivers With and Without Autism Spectrum Disorder
    (East Carolina University, 2018-08-02) Goehmann, Brittany; Dickerson, Anne Elizabeth; Occupational Therapy
    Purpose: Driving is an important step in attaining independence for teens and young adults as it allows for an independent mode of transportation for the development of social relationships and expansion of employment opportunities. Music and background chatter are common auditory stimulators that may improve or hinder driving performance. This pilot study investigated the effects of background music on the driving performance of individuals with Autism Spectrum Disorder (ASD) as compared with neurotypical individuals to identify how the environment can best be modulated to facilitate safe driving. Design: A quasi-experimental 2 (ASD/not ASD) X 3 (music condition: no music, light classical, and self-selected) factorial design was used. Method: Participants consisted of 33 adolescents and young adults; one group with ASD (n=18) and a control group of neurotypical individuals (n=15). All the participants were observed under the three conditions driving similar 15-minute scenarios with critical events on a driving simulator route. The dependent variable was driving performance, measured by a quantitative score from a standardized observational tool for driving, the Performance Analysis of Driving Ability (P-Drive). The learning curve was considered a covariate. Results: Repeated measures ANOVA showed no difference in driving performance among young drivers with ASD when compared across music conditions (p=0.275). While it is a small sample using a simulator, the results suggest that background music will not assist or impair with driving performance. Additionally, there was no difference overall between the two groups of drivers, ASD and neurotypical (p=.292). There was a significant effect of order and driving experience level, so these were controlled for throughout the analysis. Conclusion: While there was no difference in driving performance overall between the three music conditions, there are still key implications for practice. It may suggest background music playing may not hinder driving performance providing contesting evidence against the common assumption that music is a distraction while driving.
  • ItemOpen Access
    The Effectiveness of Visual Scanning Training to Improve Functional Performance Poststroke: A Case Study in Eastern North Carolina
    (East Carolina University, 2018-06-18) Gartz, Rachel; Dickerson, Anne Elizabeth; Occupational Therapy
    Rationale: Although an abundance of research exists regarding overall rehabilitation interventions poststroke, there is a lack of evidence for treatment of visual deficits. Additionally, eye tracking glasses may be used to further understand the effects of visual field deficits poststroke, though no studies have yet used eye tracking in the context of daily occupations. Purpose: This study evaluated the effectiveness of component-based, occupation-based, and combined occupational therapy treatment for visual scanning training on improving occupational performance in instrumental activities of daily living. The second portion of the study described the differences in visual scanning tendencies during cooking and driving, between an individual with a visual field deficit poststroke and a healthy control of similar age and gender. Design: This study used a case study design with a health control for the eye tracking portion. Participant: The participant was a 55-year-old female who had a stroke 7 years prior. Methods: One participant with a visual field deficit poststroke underwent three visual scanning treatments - component-based, occupation-based, and combined. The researchers administered the Assessment of Motor and Process Skills (AMPS) and took standardized measures on the Vision Coach (full field, 60 dots, all red, speed 0, fixator off) at pretest, after the component-based intervention, after the occupation-based intervention, and after the combined intervention to determine the change in occupational performance - measured by motor skills and process skills - after each intervention. After the interventions were complete, the participant completed a cooking tasks and a task on the driving simulator, while wearing the Tobii Glasses Pro 2 eye tracking glasses. Analysis: Data from the AMPS was compared between times and to the AMPS standardization sample to determine observable improvements. Vision Coach data was also compared between times. The participant's eye tracking data - duration of first fixation, total visit duration, and heat maps - were compared to a healthy control of the same age and gender. Results: With regards to the AMPS and in order of time, the participant scores of motor skills were 1.4 (mild to moderate increased physical effort), 1.8 (questionable to mild increased physical effort), 2.0 (questionable increased physical effort), and 1.8 (questionable to mild increased physical effort). Her scores of process skills were 0.8 (questionable to mild inefficiency), 1.0 (questionable inefficiency), 0.8 (questionable to mild inefficiency), 1.2 (questionable inefficiency). As per the AMPS standardization sample, an observable difference is one of 0.30 logits or more. Comparison of the eye tracking measures and heat maps revealed differences between time spent viewing areas of the visual field, including during two crashes on the driving simulator. Discussion: Overall, visual scanning training as a compensatory method was effective for this participant and could therefore be considered by occupational therapists when treating clients with chronic visual field deficits poststroke, with the combined training being most effective. This study also supports the use of eye tracking glasses during occupations to understand visual scanning tendencies between individuals with and without visual deficits.
  • ItemOpen Access
    Comparing the Effectiveness of Video Training Alone Versus Hands-on Training for Older Adults Using GPS Technology
    (East Carolina University, 2018-07-05) Coleman, Michael Chandler; Dickerson, Anne Elizabeth; Occupational Therapy
    Rationale: The number of older drivers is expected to grow substantially in the coming years, making research regarding older adult mobility critical. Research related to enhancement of driver safety is imperative, as older adults have a much greater risk of injury and fatality when in a crash. One of the options is to use advanced technology to improve safety; however, training older adults to use technology requires different learning strategies than younger adults. In a recent study, it was demonstrated that older adults performed better after receiving video tutorial training on how to program and use a GPS compared to a control group. Purpose: The purpose of this study was to examine whether one-to-one, hands-on training is more effective in training older adults to program a GPS device as compared to video training alone and to no training. Design: A posttest only design that included three groups: two interventions (video-only training and one-to-one, hands-on training), and a control group was used. Participants: Participants were 60 adults over the age of 60, and all unfamiliar with GPS technology. Method: The two intervention groups used the same videos with the one-to-one, intervention providing opportunities for a hands-on/interactive experience. The video tutorials provided information on how to set up and drive with a GPS unit. The control group watched unrelated videos. Participants in all three groups completed nine destination entry tasks on the GPS unit without any assistance. Analysis: Outcomes were compared between the three groups. A one-way ANOVA was used to compare total time on each of the nine destination entry tasks between the groups and chi-square tests were used to determine the accuracy of entry method. Results: There were significant differences among the groups on the outcome measure of time for four of the nine destination entry tasks; the one-to-one, hands-on group had significantly lower times on three of those tasks while the video-only group had significantly lower times on one. Considering the mean time spent on tasks among groups, the one-to-one, hands-on group had lower average times on all but one destination entry tasks. Regarding accuracy of entry method, although results did not show the expected significance for the one-to-one, hands-on group as compared to the other groups, the one-to-one group had a higher percentage of correct entry method used than the other groups on seven of the nine tasks. Additionally, the one-to-one, hands-on group had a lower percentage of incorrect entry method used on all tasks. Discussion: Compared to the control group, training, both in the video-only and one-to-one, hands-on format, was an effective method for increasing performance. In addition, the one-to-one, hands-on training was an effective method for decreasing the amount of time spent on the destination entry tasks compared to the video only and control groups. Although accuracy varied between groups, the one-to-one, hands-on group showed improved performance on many tasks compared to the other groups. These results support the use of a one-to-one, hands-on training method when educating older adults to use technology systems such as GPS. The use of a training method which meets the unique needs of older adult learners may increase performance and confidence when using in-vehicle technologies, and therefore may promote on-road safety and allow older adults to remain driving for longer.
  • ItemOpen Access
    Vision Coach: Effects of Standing Versus Sitting on Visual Reaction Times
    (East Carolina University, 2017-05-03) Miller, Megan E; Dickerson, Anne Elizabeth; Occupational Therapy
    Assessment and intervention tools for occupational therapy practice must be evidence-based for appropriate use and include normative data with healthy adults. The overall goal of this research was to collect normative data on healthy adults' visual reaction time when completing the full field 60 light task on a novel device, the Vision Coach. The specific research question in this study was to determine if a change in body positioning in regards to person's base of support will affect a person's reaction time. We hypothesized that reaction times would be significantly different in the positions of standing versus sitting. Reaction times from 121 healthy adults, ages ranging from 21-79 years, were collected. Participants completed eight trials total, four trials in a standing position, and four trials in a sitting position. There were no significant differences on the factors of body position, gender, height, and wingspan on the averaged visual reaction times. The implication is that clients can be standing or sitting for use of the tool and therapists have normative data available for usage. This research also provides foundational data for further studies on the Vision Coach apparatus as well baseline criteria for the process of standardization of the Vision Coach. Future studies will need to address the limitation of learning to determine the number of practice trials required in both positions.
  • ItemOpen Access
    Effects of the Interactive Metronome® on older adults : does use improve cognitive and motor abilities?
    (East Carolina University, 2016-12-15) Christy, Lauren S; Trujillo, Leonard; Occupational Therapy
    The purpose of this pre-test, post-test, quasi-experimental study was to examine the relationship between the Interactive Metronome[registered] (IM) protocol and cognitive plasticity, cognitive retention, and motor skills of older adults in southeastern North Carolina. The IM protocol was carried out in various settings with an occupational therapist and/or graduate occupational therapy students present for motivation and guidance. All participants underwent pre- and post-test assessments in order to track cognitive and motor function as they moved through the protocol. Cognitive assessments included the Woodcock-Johnson III (WJ III) and the d2 Test of Attention (d2). Motor assessments included the Four Step Square Test (FSST) and the Nine Hole Peg Test (NHPT). The participants' scoring and progress within the IM program was also tracked and examined for trends and indicators. This pre-test, post-test, quasi-experimental design was used to compare the differences between the assessment scores before and after intervention with the IM protocol. In all, a relationship was delineated between positive percentage of change on IM performance and positive percentage of change on the cognitive and motor assessments.
  • ItemOpen Access
    The Effectiveness of Interactive Metronome® as a Tool to Improve Cognition and Motor Performance in Healthy Older Adults in Eastern North Carolina
    (East Carolina University, 2016-12-15) Reilly, Rebekah; Trujillo, Leonard; Occupational Therapy
    The purpose of this study was to measure the effectiveness of the Interactive Metronome (IM) in improving cognitive and motor performance in healthy older adults. As the aging adult population continues to rise, it is important to explore tools which can support this population to live as independently as possible, for as long as possible. Literature indicates there is a natural decline in cognition with aging, and that cognitive decline may be related to decline in functional performance. 13 healthy older adults completed 18 sessions of IM protocol and researchers gathered data from IM assessments, d2 Test of Attention, and Nine Hole Peg Test across four points of measure. Results indicated a significant increase in percentage of change from the baseline measure to the final point of measure on each of the four assessments. Researchers concluded the participants' improved scores on cognitive and fine motor measures may indicate IM could be beneficial in preventatively treating this population. Future research should explore if increased performance on assessment scores might contribute to increased functional performance.
  • ItemOpen Access
    (East Carolina University, 2016-12-15) Forrest, Lauren S; Donica, Denise; Occupational Therapy
    Health and long-term outcomes of neonates hospitalized directly after birth are affected by the work of medical professionals and by parental involvement in care (Vergara, et al., 2006). Research shows that parental involvement in infant care during hospitalization in the Neonatal Intensive Care Unit (NICU) has positive effects on neurocognitive development (Reynolds, et al., 2013), parent-infant attachment (Mehler, et al., 2011), and feeding outcomes (Meyer, Coll, Lester, Boukydis, McDonough, and Oh, 1994). Occupational therapists working with infants in NICUs must consider family situations, priorities, and cultural beliefs in order to facilitate parental visitation and involvement in care (Vergara, et al., 2006). This study examined, primary barriers that hinder parental visitation and facilitators that promote visitation at the NICU and Special Care Nursery (SCN) in a Level 1 trauma hospital in rural eastern North Carolina. Additionally, parental involvement approaches in infant care during hospitalization were identified. Parent surveys were conducted at the infant's discharge from the NICU or SCN with consenting parents. Results indicated that the primary barriers to visitation were related to parental factors unrelated to the hospital environment or infant health. Parents reported that living far away, having other children at home, and household responsibilities, and work responsibilities were the most influential barriers. Positive relationships with staff were the primary facilitators to visitation. Overall, parent involvement was more passive in nature, as parents participated in observing the infant, talking or singing to the infant, engaging in eye contact with the infant, and touching or stroking the infant most frequently. Diaper changes, feeding, assisting the staff with procedures and holding was engaged in less often by parents. Overall, the results indicate that of occupational therapists and other medical professionals must provide support to parents when visiting to promote active participate in infant care. Staff were seen as a facilitator of presence so it is vital that NICU and SCN staff are providing proper education during interactions with parents and inviting parents to participate in direct infant care.
  • ItemOpen Access
    (East Carolina University, 2016-12-15) Ozment, Danielle K.; Dickerson, Anne Elizabeth; Occupational Therapy
    Purpose: The purpose of this study was to determine the effectiveness of the interactive driving simulator as an intervention tool for teens and young adults with Autism Spectrum Disorder. Method: A pretest/post-test design was used on an assessment drive on the interactive driving simulator which took place within the context of a Driving Bootcamp. Eight participants with self-reported Autism Spectrum Disorder completed pretesting on the interactive driving simulator on day two of the camp. This was followed by the intervention periods on the interactive driving simulator including: three consecutive days of 30 minutes and six weeks of follow-up sessions two times a week for 30 minutes. Individualized intervention sessions were used to target client-centered driving deficits. Post-testing was completed on the last day of the follow-up sessions. Drives were scored using both the performance measures from the simulator output data and a standardized observational assessment tool (P-Drive). Results: Simulator output data revealed a significant difference between pre and post testing on one measure, total collisions. No significant differences were found between pre and post testing on measures related to: object collisions, pedestrian collisions, sign tickets, times over speed, percentage of time out of lane, and percentage of pedal reaction time. P-Drive average raw scores and calibrated scores demonstrated significant differences between pre and post testing among the participants and had very good interrater reliable between four trained raters. Conclusions: With limited significant differences, simulator output data may not be an effective measure of overall driving performance, although it may be due to the low number of participants. Significant differences on the P-Drive average raw score and calibrated scores suggests the interactive driving simulator to be an effective intervention tool for teens and young adults with Autism Spectrum Disorder. Further, the P-Drive proved to be a useful observational assessment tool to use when examining performance on the interactive driving simulator.
  • ItemRestricted
    (East Carolina University, 2016-12-15) Case, Rebecca; Dickerson, Anne Elizabeth; Occupational Therapy
    This study was designed to determine the perceived effectiveness of a driving and community mobility Bootcamp for young adults with high functioning autism spectrum disorder (HFASD). Seven participants and their parents completed surveys prior to and after the completion of the Bootcamp. They were asked a variety of questions about skills, knowledge, and functional abilities of the participant to perform driving and community mobility skills in both a likert scale and open-ended format. The results showed both parents and participants' perceived significant increases in the participant's abilities, knowledge and confidence. The participants and their parents also provided positive open-ended responses, comments, and opinions adding to the Bootcamp's success. Although only a survey on perceived changes, combined with objective data from other study elements, results suggest the Bootcamp was an effective intervention for increasing driving and community mobility skills for young adults with HFASD.
  • ItemRestricted
    (East Carolina University, 2016-12-15) Register, Joshua; Dickerson, Anne Elizabeth; Occupational Therapy
    This study examined the effects of gender and age on reaction time during visual-motor tasks on a dynamic light board, Vision Coach[trademark], which is a prospective tool to be used for occupational therapy evaluation and/or intervention. As part of the study, normative data was gathered and established for the Vision Coach tool, specifically for the Full Field 60 task (i.e., reacting to 60 red dots as fast as possible), as normative data has yet to be published for clinical use. A cross over design was used to compare the relationship of age and gender as it relates to reaction time performance on the Vision Coach. One hundred twenty-one younger and older adults from the university and the surrounding community participated in the study. Data analysis revealed significant differences (p[less than or equal to]0.001) between reaction time of younger and older adults. The average trial time difference between the two age groups was 17±1.08 seconds. While data analysis revealed differences in reaction time between genders, this difference was non-significant. Due to the integration of complex skills related to driving that are also needed to engage in this task, it was discussed as it related to the skills needed for scanning and reacting to the driving environment. These results suggest that the Vision Coach may serve as a beneficial screening or intervention tool for drivers undergoing driving assessments.
  • ItemOpen Access
    The Impact of Mild Stroke on Participation in Physical Fitness Activities
    (2012) Hildebrand, Mary; Brewer, Megan; Wolf, Timothy
    Objective. To compare participation in moderate to high intensity physical activities in persons before and after a mild stroke. Methods. We used data from the Cognitive Rehabilitation and Research Group to examine changes in moderate to high intensity physical activity participation in persons who had a mild stroke as defined by an NIH Stroke Scale score of less than 6 (). Using the Activity Card Sort, we compared the participants' high-demand leisure activity (leisure activities that are moderate to high intensity physical activities) participation at 6-months after stroke with their prestroke level. Results. We found a significant decrease in numbers of high-demand leisure activities in all participants and in each demographic group after mild stroke. Conclusion. These results suggest that persons after mild stroke are not retaining the high-demand leisure activities they were doing prior to their stroke. Health professionals must promote participation in high-demand leisure activities in patients with mild stroke as a tool to enhance health and fitness.
  • ItemOpen Access
    Handwriting in Young Adults in an Era of Technological Advancements
    (East Carolina University, 2015-12-10) Spencer, Courtney N.; Donica, Denise; Occupational Therapy
    The purpose of this study was to investigate handwriting and technology as methods for note-taking in the post-secondary classroom, handwriting in daily life, and perceptions of handwriting instruction, both print and cursive, in young adult post-secondary students. Based on the current use of handwriting for note-taking and personal tasks in young adults, is handwriting an important skill which should continue to be taught in the primary classroom? The study utilized a web-based survey given to current students at East Carolina University. Question formats included Likert scale, sorting, multiple choice and open ended. The survey was distributed to a random sample of 1800 East Carolina University students, 106 young adult responses were analyzed. Results revealed handwriting is the most common note-taking method, used by 72.7% of students for 75-100% of the classroom experience. Furthermore, participants reported handwriting instruction is an important component of the primary education. Statistical chi square analysis revealed no statistically significant correlations between groups of post-secondary students based on gender and handwriting grasps. Occupational therapists and teachers can utilize this information to consider the importance of continuing to support handwriting instruction and making it a greater priority in the primary classroom as handwriting was found to have educational and personal relevance while achieving a post-secondary education.
  • ItemRestricted
    Driving Performance While Wayfinding On-Road & in an Interactive Driving Simulator
    (East Carolina University, 2015-12-10) Cochran, Lauren Marchman; Dickerson, Anne Elizabeth; Occupational Therapy
    Rationale: Driving is a fundamental instrumental activity of daily living (IADL) and occupational therapists need practical, effective tools to evaluate clients’ fitness to drive. To be proficient at driving, one needs competency on the operational (manipulating pedals, steering wheel), tactical (negotiating obstacles), and strategic (navigation) levels. Few studies explore the strategic level. It is beneficial to determine if the strategic level of driving can be evaluated without an expensive, lengthy on-road test. Purpose: This study compared on-road driving performance during wayfinding using paper directions compared to GPS. A second question compared performance between on-road driving and driving in an interactive driving simulator (IDS). Typical clinical assessments tools, specifically the Trail Making Test B, Assessment of Motor & Process Skills (AMPS), and Useful Field of View (UFOV ®) were also compared with driving outcomes. Design: Counterbalancing testing order of simulated driving and on-road driving of two unfamiliar routes yielded eight conditions. Participants: Participants were 24 volunteer drivers, ages 18-45 years. Methods: Each participant was assessed by the clinical assessments, navigated via printed directions on the driving simulator, and drove two routes on the road using either GPS guidance and printed directions. Driving performance was measured by the same evaluator using the same measuring tool. Analysis: Driving performance were compared with box plots, scatter plots, and a paired t-test with a 95% confidence interval. Clinical assessment scores were compared to driving scores on the simulator and on-road assessments using scatter plots. The two independent sample t-tests comparing groups defined by order was not statistically significant (p=.734; p=.805; p=.690). Results: The means of scores of participants wayfinding on road with GPS were significantly better than when using printed directions (p = .024; 95% CI = 1.58-20.7 points). Nineteen of 24 participants had better driving performance scores when using GPS. For participants using printed directions, the difference in mean scores for those driving in the simulator compared to on-road was not statistically significant (p=0.058). Outcomes of the clinical assessments did not have a strong relationship with any driving performance. Discussion: Performance using a GPS for wayfinding results in improved driving performance over printed directions. Overall, driving performance during wayfinding on an interactive driving simulator was similar to on-road driving performance, although there was individual variation. Limitations included a homogenous group of healthy participants and the driving simulator wayfinding was not a duplication of the on road route. This study suggests that wayfinding can be evaluated on an interactive driving simulator, offering opportunity for assessment of multiple client factors in a controlled environment and potentially reduce the number of individuals who need to proceed to an on road evaluation. It also supports that concept of using technology to support wayfinding for unfamiliar areas.
  • ItemOpen Access
    Impact of the Alert Program on School Function for At Risk Cohorts in the Kindergarten Classroom: A Four Year Review of the Data
    (East Carolina University, 2015-12-09) LaBelle, Leslie; Lust, Carol; Occupational Therapy
    A child’s ability to process, organize, and respond to incoming sensory information and to self-regulate often impacts his or her school performance. The Alert Program, was established with the goal of teaching students the skills needed for self-regulation and therefore, has the potential to yield school function outcomes. This study examined the impact of a classroom approach to the Alert Program on school function for identified at risk students. Retrospective in nature, subjects for this study included 104 kindergarten students at an independent private school in eastern North Carolina between the years 2010-2014. Program implementation consisted of 40-60 minute weekly sessions over 5 months; sessions were led by three to four East Carolina University Occupational Therapy students. Data was collected using the Sensory Processing Measure: Main Classroom (SPM-C) and the School Function Assessment–Part III Activity Performance: Cognitive/Behavioral tasks (SFA). A master panel comprised of early elementary teaching faculty provided input as to what areas of school function are addressed, expected, and most developmentally appropriate at the kindergarten level; feedback revealed that the areas most relevant include: following social conventions, personal care awareness, behavior regulation, task/behavior completion, and positive interaction. Data analysis of student performance on the SFA in each of these pre-identified categories showed significant improvement (p < .05) for identified at risk students after participation in the Alert Program. Results suggest the Alert Program, a sensory-based approach to teaching self-regulation, produces end outcomes in areas of school function, particularly for at risk students. However, while the classroom approach was successful for the majority of students, some students may likely benefit more from an individualized approach.