Spring 2022 Virtual OTD Capstone Symposium

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  Individuals with Intellectual & Developmental Disabilities and Meaningful Employment

  Bethanie Hernandez, Angela Labrie Blackwell, and Evan Edward Dean

  Individuals with disabilities tend to face poverty at a higher rate compared to those without disabilities (Kelley, 2016). Individuals with intellectual and developmental disabilities (IDD) benefit from a variety of supports to work in their communities. Not providing services to address these needs can cause increased unemployment rates and dependence on others. Currently, there is a lack of attention by OTP on supporting individuals with IDD (14-26 years) when acquiring meaningful employment. Increasing OTP’s awareness about the relationship between self-determination and employment can promote more services. Self-Determination is about acting or causing things to happen in your life as you work toward your goals (Shogren et al., 2015), and has been linked to enhanced employment outcomes and higher quality of life (Mumbardo-Adam et al., 2020). Advocating for the use of the Self-Determined Career Design Model (SDCDM) by occupational therapy practitioners (OTP) when working with individuals with IDD will help provide employment opportunity, equality, and life-fulfillment to those searching for meaningful employment.

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  Entrepreneurship and OT

  Alex Heumann and Susan Macdermott

  The purpose of this project was to discover the perceived and actual barriers to business ownership through research with current OT businesses and create a deliverable supporting OTs entering business ownership.

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  Teen Driving and Community Mobility Educational Module for OT Students

  Celeste Johns, Angela Blackwell, and Melissa "Missy" Bell

  Teens with disabilities require increased support in driving and community mobility (D&CM) due to increased complexity resulting from the combination of typical teen characteristics (physiological changes and developing cognitive skills), and limitations posed by physical, cognitive, or visual impairments (Interactive Autism Network, 2011; Monahan, 2012). Due to lack of training, decreased awareness, low confidence, decreased competence, billing, and productivity concerns OT practice is limited in addressing D&CM (Dickerson et al., 2011). There is a need for more targeted information regarding teen driving and community mobility within OT education to increase competence (knowledge, skills, attitudes), and prepare them to be generalists (American Occupational Therapy Association [AOTA], n.d.). The existing teen driving module in the pediatric course at USAHS is not adequate to comprehensively educate OT students on the role of OT in teen D&CM and introduction of a certified driving rehabilitation specialist (CDRS). Occupational therapy (OT) students display limited competency in teen driving and community mobility. An educational module with unique features was created to promote novice level competency in OT students.

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  Occupational Therapy Return to Work Program For Individuals Following a Traumatic Brain Injury

  Kalynn R. Johnson and Lisa Griggs-Stapleton

  Individuals with a traumatic brain injury (TBI) often experience difficulty returning to the workforce and lack the necessary resources to facilitate a successful return to work. This capstone project focuses on developing a resource that equips occupational therapists with tools and resources to provide valuable and effective return to work services for this population.

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  Exploration of the Transference of Cognitive Skills Gained from a Movement-Based Program Incorporating Modified Dance to Occupational Performance for Individuals with Parkinson’s Disease

  Alyssa Kronstadt-Trapasso

  A movement-based program incorporating modified dance was used with individuals with Parkinson’s disease (PD) to assess changes in cognition as it relates to occupational performance. This qualitative research study provided 1-hour dance sessions 3 days per week over the course of 16 weeks with 6 participants who have mild-moderate PD. Various dance styles were used including salsa, tango, waltz, line dancing, and others. Cognition and occupational performance were assessed using the Montreal Cognitive Assessment (MOCA), the Canadian Occupational Performance Measure (COPM), and surveys. Findings indicated improvements in perceived occupational performance via the COPM and surveys, while MoCA results indicated improvements in the areas of visuospatial/executive function, attention, and memory recall. Further research is warranted to address limitations of this research study and explore the possible benefits of dance as a movement-based intervention to address cognitive deficits within the Parkinson’s population.

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  Qualitative Evaluation of Occupational Therapy Assessments in Treating Veterans with PTSD Who are Transitioning into Civilian Life

  Natalia Marquez-Sterling

  Presentation on the capstone paper Qualitative Evaluation of Occupational Therapy Assessments in Treating Veterans with PTSD Who are Transitioning into Civilian Life. Explores the strengths and limitations of an OT assessment toolkit as well as the role of OTs in treating veterans with PTSD transitioning into civilian life.

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  Qualitative Evaluation of Occupational Therapy Assessments in Treating Veterans with PTSD Who are Transitioning into Civilian Life

  Natalia Marquez-Sterling, Pam Kasyan-Howe, Kristin Domville, and Lisa Schubert

  The purpose of this qualitative research type capstone project was to explore the strengths and limitations of an occupational therapist assessment toolkit for use with the population of veterans with PTSD who are transitioning into civilian life. OTs lack consistent assessment tools for use with this population, resulting in a lack of inclusion of occupational therapy as a consistent member of the multidisciplinary team (Kerr et al., 2020). Kerr et al. (2020) found that while OT assessments may be mentioned in research regarding veterans with PTSD who are transitioning into civilian life, there was limited or no discussion of the strengths or limitations of the assessments. This qualitative research project involved virtual interviews with six OTs that worked with veterans with PTSD. The results were organized into themes to answer the research questions. Overall themes supporting the strengths of the assessment toolkit were a lack of familiarity with the tools, the client-centered nature of the toolkit, the identification of roles and interests, as well as its ability to be used as a 'foot-in-the-door' with clients. Themes found as a limitation of the toolkit were a preference for informal or semi-structured assessments, the length of time of the assessments, and a lack of assessment of communication skills or depression. The therapists found the role of OT in treating veterans with PTSD who are transitioning into civilian life to be the education on PTSD, promote an understanding of triggers, development of social-emotional wellbeing, and to collaborate with a multidisciplinary team.

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  Analysis of Role Changes for Women with Breast Cancer Related Lymphedema to Return to Work

  Soraya Martinez, Pam Kasyan-Howe, Kristin Domville, and Lisa Schubert

  Breast Cancer survivors diagnosed with secondary lymphedema have decreased quality of life and experience greater challenges when attempting to return to work compared to survivors who do not have secondary lymphedema. Limited research is available in understanding the impact breast cancer-related lymphedema has on survivors transitioning from traditional medical care to return to work. Occupational therapists specializing in Lymphedema therapy have the unique training skills and knowledge to address the challenges this population faces, as well as the tools needed to educate patients and their family members on how to manage returning to work, and make any adaptations to their work environment in order to achieve overall satisfaction and quality of life. A quantitative study was done to identify the impact BCRL has had on the role changes survivors with secondary lymphedema experience, as well as satisfaction with work. Results collected from the study were indicative of decreased overall satisfaction with return to work secondary to diagnosis, significant role changes with decreased independence and difficulties from employers, as well as little to no therapeutic services addressing return to work during this survivorship phase. Future recommendations include developing a program addressing return to work and successful techniques manage lymphedema symptoms of the affected limb within the work environment.

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  Foundational Curriculum to Engage Students in the Occupation of Cooking

  Brooke Mehus and Karen Park

  The reason for this project is that adolescents are not being provided with the knowledge surrounding cooking and meal preparation from their household, secondary schooling systems, and/or a lack of culinary programs resulting in a decrease in independence and life skills. Therefore, an additional program needs to be implemented in order to address these barriers.

  The purpose of this project was to develop a program to enhance participation of adolescents in the occupation of cooking emphasizing life skills, safety, confidence, and knowledge within the kitchen. The program was completed at The Winston School which had an existing culinary arts program; therefore, enhancements and additions were made to that program. This program worked with students from grades 9-12 and who were 14-18 years of age. After participating in this 3-week program students reported an increase in at least one of the six statements on their outcome measure survey. These results indicate that an occupation-based approach and inclusion of contextual factors is essential to the success of high school culinary arts programs.

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  Wellness Promotion Through Leisure Activity Among Community-Dwelling Older Adults

  Gabriela Morrell-Zucker

  The purpose of this capstone project is to analyze the outcomes of an occupation-based wellness program which aims to address the problem of a lack of wellness promotion programs for community-dwelling older adults. Through structured programming older-adults demonstrated increased participation in leisure activities contributing to positive health and wellness. As the older adult population continues to grow, there is a need to engage community-dwelling older adult populations in wellness promotion through leisure activities. For this purpose, a quantitative approach examines the outcomes of program development from older adults' perspectives through a the CHAMPS Older Adult Physical Activity Questionnaire.

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  Sexuality Based Content in an Entry- Level Occupational Therapy Curriculum: A Content Analysis

  Victoria E. Ontiberos, Steven M. Gerardi, and Elizabeth DeLuca

  Sexuality is multifaceted and is developed across the lifespan. Researchers report little advancement, consistency, and knowledge regarding incorporation of sexuality into occupational therapy (OT) curricula, which supports the need for research. The purpose of this capstone project was two-fold: a) to conduct a content analysis of an entry-level OT curriculum to identify content gaps regarding addressing sexuality in practice; and b) to develop sexuality-based educational materials as a resource for the faculty for potential inclusion in future courses. The Model of Human Occupation (MOHO) is an evidenced-based model that was used in this project, in conjunction with notional sexuality educational standards, to frame the content analysis and develop sexuality-based materials. A curricular matrix was created to chart the extracted data based on the notional sexuality educational standards and constructs of MOHO. Results of this curricular analysis identified educational gaps within the OT curriculum. Of the 30 courses reviewed, 16 (53.33%) mentioned sexuality within online units, required readings, or assignments. However, 13 (43.3%) addressed sexuality only in passing, with no link to occupation. Required readings were noted as the most frequently used teaching method for sexuality content and the MOHO construct most frequently focused on was performance capacity. This indicates that although sexuality is mentioned throughout the OT curriculum, in most instances, it was not presented in depth. Based on analysis of findings, sexuality-based materials were created and implemented.

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  Improving Belonging Through Occupation in Individuals Within the Substance Use Disorder Population

  Michelle Perkins and Susan MacDermott

  This capstone project focused on improving belonging through occupation in individuals within the substance use disorder population. Based on site-based needs assessment findings and informed by the Recovery Model and the Doing, Being, Belonging, and Becoming framework, the Elevate 4-week pilot program was created. The Elevate program successfully demonstrated the feasibility of improving belonging through occupations, as evidenced by changes in pre and post-program client questionnaire scores. The client’s self-report scores in sense of belonging, satisfaction of belonging, and connection to housemates and staff demonstrated noticeable improvement. While the Elevate program demonstrated noticeable improvement in participants’ sense of belonging, satisfaction with belonging, and feelings of connection to house members and staff, it should be noted that this was a pilot program that occurred at one facility with a limited number of participants, and as this was not a research study, information gathered cannot be generalized on a population level. While these limitations existed in this program, there is still value in further research on improving belonging in individuals within the SUD population and in the continued implementation of this program.

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  Translating Neurobiological Knowledge into Trauma-Informed Occupational Therapy

  Kimberley Pierce, Jessica De Brun, and Karen Park

  There is a growing need for an expanded understanding of the experience of trauma in light of many socio-political and cultural events of the previous years. Occupational therapy literature mentions a growing understanding of neuroscience that is leading to trauma-informed protocol reform, however, consistently concludes with the acknowledgment that more information is needed. The purpose of this project was to advocate for occupation as a significant tool in addressing traumatic stress. This project included a scoping review of non-peer-reviewed and peer-reviewed literature and manuscripts as well as a phenomenological qualitative research study interviewing occupational therapy practitioners who work with individuals who have experienced trauma. Preliminary results revealed four major themes, first, the significance of occupation for individuals who have experienced trauma is currently underrepresented/underexplored. Second, therapists and staff members often make judgments during interventions that reveal an incomplete understanding of how to identify a trauma response. Third, there is a need for a universal approach to all therapeutic interactions that acknowledge the ubiquitousness and pervasiveness of trauma. Finally, the neurobiology of trauma is a central component of occupational engagement. Results reveal that understanding how neurobiological mechanisms are involved in the therapeutic process will inform better trauma-informed practice for occupational therapists.

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  Improving Mental Health After SCI: An Occupation-Based Program

  Kerston Ring

  The purpose of this project was to assess the effectiveness of occupational therapy in promoting positive mental health in those with SCI. Formal conversations related to mental health as well as various leisure activities took place throughout the program. The leisure activities were determined prior to initiating the program during the needs assessment. These were activities that the participants were either familiar with or novel. The activities were client-centered and modified as necessary to meet the client’s needs for full participation. The objectives of this capstone were to conduct a needs assessment to understand what factors could be changed to improve mental health. Other objectives were to develop and implement a health promotion program that supports mental health and wellbeing through leisure activities, as well as to identify how occupational therapy can address and help people with SCI to overcome barriers that would lead to depression and anxiety. Lastly, a post-program survey was used to gather feedback from the participants.

  The gap in research remains regarding how participation in occupations, such as leisure, may positively affect mental health. Accessibility to more mental health programs will decrease the prevalence of depression and anxiety among individuals with SCI. The goal was to instill a safe atmosphere and to provide an optimistic outlook for the transition to a new way of life.

  This project collected information about the SCI experience and the struggles of mental health from individuals to allow for further exploration of occupational performance.

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  Black Occupational Therapists’ Experiences on the Occupational Impacts of Racism

  Kenzie Saleh and Susan MacDermott

  Research indicates that there is a correlation between racism and impact on occupations (Beagan & Etowa, 2009; Gershenson et al., 2016; Lavalley & Johnson, 2020). The purpose of this study was to expand on the existing research of occupational impacts of racism on the Black community and discover any differences or new themes that have occurred in the past decade. Additionally, this research project investigated specific examples and experiences that lead to these occupational impacts. The student researcher used surveys and in-depth qualitative interviews to gather data focused on the occupational needs and engagement of this population. The research question of this study was: What are the occupational impacts of racism from the perspectives and experiences of Black occupational therapists? The purpose of recruiting Black individuals within the realm of occupational therapy is due to the assumption that they have a true understanding of occupation, and have more insight on the impact racism has on occupations, drawn from their own personal experiences. This student researcher hypothesized that there were undiscovered impacts on occupational engagement and impacts on performance patterns (habits, routines, roles, and rituals) within this population, which became evident through this research study. The study has proven that there are many other occupations impacted by racism such as, but not limited to, social participation, dressing, eating, safety and emergency maintenance, driving and community mobility, shopping, and physical activity. Overall, the study found that anticipatory stress and the fear of affirming stereotypes leads to Black individuals avoiding and adapting occupations. In addition, while engaging in certain occupations, many Black individuals feel as though they cannot fully enjoy themselves, therefore decreasing the quality of engagement. This information is important to the profession of occupational therapy and will open up a broader conversation regarding systemic racism and the profession’s role in supporting the Black community and promoting occupational justice for all people.

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  The Intersection of Breastfeeding Dyads and the Impact on Perinatal Mental Health

  Faith Saunders, Heather Truog, and Lisa Griggs-Stapleton

  As the mother transitions from the prenatal period to the postpartum period, the new occupational role of motherhood emerges. In this perspective, infant feeding is considered a co-occupation when discussing maternal functioning. The emergence into this new chapter requires adaptation and adjustment to the mothers’ occupational roles, routines, and identity. Occupational therapy practitioners (OTPs) are equipped to provide holistic, client-centered interventions to address occupational dysfunctions during this maternal role transition (Slootjes et al., 2016). However, there are significant gaps in the literature of the OT profession that discusses the role of OTPs within in interdisciplinary healthcare team for perinatal care with a specific lack of research relevant to the interplay as a co-occupation. There is a need for the OT profession to further examine how the foundation of OT practice would be an optimal fit for addressing how the interplay of breastfeeding as a co-occupation impacts perinatal mental health, molding the maternal role transition and identity among postpartum women.

  The purpose of this capstone project was the explore the emerging role of occupational therapy within the breastfeeding dyad population and how this co-occupation impacts perinatal mental health. The focus of this descriptive pilot study was to understand the confidence levels, opinions, and perceptions in practice of occupational therapy practitioners specializing in perinatal/postpartum care. This preliminary descriptive pilot study consisted of a 27-question survey. The researchers will continue to collect data following the completion of this capstone project.

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  Inclusive Employment Opportunities for Adults with Down Syndrome

  Valerie Schlieder and Susan MacDermott

  Adults with Down syndrome (DS) face several barriers to inclusive and community-based employment opportunities, including the DS phenotype, volition, and disability stigma. The purpose of this project was to create a strengths-based occupational therapy (OT) group program to address these barriers. Using information from the needs assessment as well as the Ecology of Human Performance model, the Model of Human Occupation, and the Social Model of Disability, the EmployAble program was created. EmployAble took place twice a week for five weeks and included six adults with DS, ages 19-32. The group focused on employment readiness skills such as interpersonal skills, professional communication, and self-advocacy through various client-centered activities.

  The outcome measures and evaluations demonstrated the effectiveness of the program. 66% of the group improved in the following domains: appropriate greetings, asking for help when needed, offering help if needed, taking responsibility for mistakes. Parents of group members reported unanimous satisfaction with the program. The EmployAble program, as well as relevant information about inclusive employment, was disseminated across a variety of platforms. It is recommended that OT practitioners continue to facilitate inclusive employment opportunities for adults with DS.

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  Occupational Therapy for Sleep Dysfunction: An Education Course for Students and Occupational Therapy Practitioners

  Hayley Shank, Mary Smith, and Emily Frank

  Sleep disorders are the second most frequent complaint, after pain, in individuals with chronic illness; the healthcare field is considering this an epidemic. Research suggests there is an insufficient amount of awareness and education regarding treating sleep dysfunction among occupational therapy students and practitioners. The purpose of this capstone project was to create an OT education course for OT students and practitioners to utilize when addressing sleep dysfunction with their clients and caregivers. Results of my course support the capstone problem statement; that there is an insufficient amount of awareness and education regarding the treatment and management of sleep dysfunction among occupational therapy students and practitioners.

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  Occupational Therapy's Role in Upper Extremity Posture, Ergonomics, and Injury Prevention in Esports

  Braden W. Singleton

  Electronic sports, also known as esports, is organized competitive gaming. Esports athletes routinely sustain injury to the upper extremity (UE) and are forced into early retirement due to pain and limitation. Employing ergonomic principles through education has a significant impact in assisting with pain reduction and prevention of disability. This program sought to decrease the prevalence of upper extremity injury seen in the esports athlete population, and decrease the intensity of pain if it was already present. Twelve total participants were included in the program, as determined by the inclusion and exclusion criteria. Data was gathered through the use of pain scales, the Rapid Upper Limb Assessment (RULA), and surveys so inclusion and exclusion criteria could be upheld and the program could be improved for future use. The program was implemented through five informative presentations regarding instruction of anatomy and ergonomic strategy implementation, and six surveys monitoring pain levels and feedback from participants. The program was determined to be somewhat effective at maintaining and reducing pain levels in athletes whose pain was already present, and also reducing ergonomic risk exhibited by participants.

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  How Occupational Therapists Address Chronic Pain and Sex/Intimacy

  Millie Szeto and Susan MacDermott

  Sexual activity is 1 out of the 9 activities of daily living (ADLs) and is considered to be fundamental for a person's life, yet it is one of the least discussed topics that occupational therapists address in client care settings, academia, and/or professional development.

  The aim for this project was to explore how occupational therapists addressed sex/intimacy with the chronic pain population in order to provide more insight and encouragement for other occupational therapists to incorporate discussion of sex/intimacy in their practice.

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  Exploring a Role for Occupational Therapists in Adult Eating Disorder Treatment

  Felicia Titus and Karen Park

  Background: Occupational therapists working in eating disorder (ED) treatment in the United States is an emerging practice area. The main objective of this study was to seek an understanding of the perceived gaps in current adult ED treatment in the United States, from both the perspectives of ED treatment providers and individuals with an ED to discover if there is a role for occupational therapists.

  Methods: The design of this study was a convergent mixed methods in which the data was collected through online surveys and recorded semi-structured interviews of ED treatment providers (N = 15) and individuals diagnosed with an ED (N = 40). Braun & Clarke (2006) thematic analysis was used to analyze open-ended survey data and all interview data, while numeric coding was used to analyze close ended survey data.

  Results: Both provider and client participants of both the survey and interviews expressed similar barriers to adult ED treatment. There was high interested in potential occupational therapy (OT) services by client participants and high interested in referring clients to OT services by provider participants.

  Conclusion: Provider and client participants in the survey and interviews expressed overall dissatisfaction with the current structure of adult ED treatment. There is potential for occupational therapists to make meaningful contributions to adult eating disorder treatment according to both survey and interview data collected from bot client and provider participants.

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  Exploration of Occupational Problems and Concerns in Individuals with Long-Covid (Post-Acute Sequelae of SARS-CoV-2)

  Velinda Utile, Pam Kasyan-Howe, Kristin Domville, and Lisa Schubert

  Long-Covid is a complex illness causing disruption in the lives of millions of individuals suffering from its symptoms resulting from Covid-19 infection. With over 65 million confirmed cases of Covid-19 and 10% of individuals expected to experience Long-Covid, knowledge in this area is important to support occupational therapy practice. The purpose of this qualitative research project is to provide knowledge on the reported occupational performance problems and concerns being experienced by individuals with Long-Covid to help fill this gap in research and provide some guidance for OT evaluation and intervention.

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  Supporting the Transition Out of the Family Caregiver Role: An Occupation-Centered Approach

  Whitney Wilbanks and Susan MacDermott

  Engagement in meaningful and valued occupations can be used as a means to help former family caregivers cope, heal, and grow following the loss of their loved one (Pickens, 2011). Occupational engagement can be used as a means to help former family caregivers reshape their personal identity, experience a sense of wholeness, and reestablish purpose and balance in their lives (Hocking, 2016). The purpose of this doctoral capstone project was to educate hospice care staff on ways to support individuals with transitioning out of the family caregiver role following the death of the care recipient. An educational resource was developed to inform hospice care staff on the use of occupation-centered interventions and activities to foster adaptation to shifts in roles, routines, habits, and rituals after caregiving ends.

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  Quality of Life for Pediatric Prosthetic Users

  Courtney Wild, Karen Park, and Susan MacDermott

  The population of children with limb loss fall into a category of children with chronic physical disability and are vulnerable to functional challenges resulting in adverse impacts on their participation and performance of life activities, known as occupational participation. A mixed method research study was aimed at answering the following research questions: (a) is there an impact on the engagement in meaningful everyday activities for children with prosthetic limbs, considering the functional, emotional, and social challenges they might encounter? (b) does their level of engagement in meaningful everyday activities have an impact on their quality of life (QoL) and (c) how does the care they receive influence their QoL?

  Assessment measures were administered, and interviews were completed. The inclusion criteria consisted of pediatric prosthetic users between the ages of 8 and 18 years with at least one prosthetic limb and their primary caregiver. A total of 8 families participated in this study.

  This study found areas of significant challenge to this population that impact their overall QoL. These include their communication and interactive skills impacting their psychosocial well-being, physical participation impacting their occupational participation, and systemic issues of healthcare and insurance coverage impacting their obtainment of necessary prosthetic limbs. This study confirmed that the skill set of occupational therapy (OT) is not being utilized to its fullest potential and that there is a general lack of understanding among the healthcare professionals who treat pediatric prosthetic users regarding each other's scope of practice and level of expertise. An increased awareness of the skill set that OT’s can provide to pediatric amputees regardless of their amputation level, is necessary so that their unmet needs can be better addressed.

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  Exploring the Occupational Impact of Pregnancy and the Role of Occupational Therapy During the Prenatal Period

  Monica Wutzke, Karen Park, and Susan MacDermott

  Background: Pregnancy is a major transitional period accompanied by different physiological changes that can impact performance and engagement in meaningful and needed daily occupations. There is currently limited research that examines the transition to parenthood during the prenatal period through an occupational therapy (OT) perspective.

  Objective: The purpose of this study was to explore the impact pregnancy has on an individual’s roles, routines, and daily occupations. This study aimed to investigate this through an OT lens in order to better identify how the needs of pregnant individuals fall within the scope of OT.

  Methods: Pregnant individuals participated in an online survey (n=42) and an optional one-time interview (n=8) to assess the occupational impact of pregnancy. Data collected was inclusive of changes in occupational participation, perceived barriers to engagement, and perceived shifts in daily routines.

  Results: Survey data illustrated an overall average decrease in participation in focus areas of rest and sleep, sexual activity, social participation, physical activity, nutrition management, work and education, and home management during pregnancy. Four common themes were derived from participants’ interviews including: change in occupational form, decrease in ability to participate in meaningful occupations, temporality impacting occupational engagement, and decrease in perceived quality of occupational engagement.

  Conclusion: The results of this study indicated daily occupations that are impacted during pregnancy and the various ways in which occupations, roles, and routines are impacted throughout the span of the prenatal period. These results help identify how the needs of the pregnant population fall within the scope of OT practice.