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Person Environment Occupational Performance model [keywords]
- Collaborative approach in the development of high-performance brain-computer interfaces for a neuroprosthetic arm: translation from animal models to human control. [Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.]
- Clin Transl Sci 2014 Feb; 7(1):52-9.
Our research group recently demonstrated that a person with tetraplegia could use a brain-computer interface (BCI) to control a sophisticated anthropomorphic robotic arm with skill and speed approaching that of an able-bodied person. This multiyear study exemplifies important principles in translating research from foundational theory and animal experiments into a clinical study. We present a roadmap that may serve as an example for other areas of clinical device research as well as an update on study results. Prior to conducting a multiyear clinical trial, years of animal research preceded BCI testing in an epilepsy monitoring unit, and then in a short-term (28 days) clinical investigation. Scientists and engineers developed the necessary robotic and surgical hardware, software environment, data analysis techniques, and training paradigms. Coordination among researchers, funding institutes, and regulatory bodies ensured that the study would provide valuable scientific information in a safe environment for the study participant. Finally, clinicians from neurosurgery, anesthesiology, physiatry, psychology, and occupational therapy all worked in a multidisciplinary team along with the other researchers to conduct a multiyear BCI clinical study. This teamwork and coordination can be used as a model for others attempting to translate basic science into real-world clinical situations.
- Occupational performance and self-determination: the role of the occupational therapist as volunteer in two mountain communities. [Journal Article]
- Aust Occup Ther J 2014 Feb; 61(1):6-12.
Occupational therapists involved in volunteer programmes do so as either a volunteer or as a professional working with volunteers. This study outlines two such programmes: one in regional Queensland, with refugees settling into a life in Australia, and one in Bhutan, with an organisation assisting families of children with disabilities. In both instances, the author has been involved as a volunteer, drawing on her occupational therapy skills, the Person-Environment-Occupation Model and self-determination theory as theoretical frameworks.This report offers an insight into two geographically and culturally different volunteer programmes, and outlines the potential for occupational therapists to be involved in cross-cultural experiences, within Australia and abroad. In the Australian setting the author is working with newly arrived refugees from Africa, Iran and Iraq in a local community group the Toowoomba Refugee and Migrant Service. Within the Bhutanese setting the author is working with the Ability Bhutan Society, an organisation established by a group of local parents with the initial aim of sharing experiences and information relating to their children with disabilities.The descriptions of each volunteering experience outline the opportunities for facilitating the development of independence, self-determination and acquisition of new roles in two cross-cultural communities by an occupational therapist working as a volunteer.An occupational therapist's ability to assess the interaction between a person or organisation's skills, the environment in which that person or organisation is functioning, and the desired occupational outcomes of that person or organisation, enables a unique and valuable contribution as a volunteer.
- Circadian time organization of professional firemen: desynchronization-tau differing from 24.0 hours-documented by longitudinal self-assessment of 16 variables. [Comparative Study, Journal Article, Research Support, Non-U.S. Gov't]
- Chronobiol Int 2013 Oct; 30(8):1050-65.
We investigated the circadian synchronization/desynchronization (by field-study assessment of differences in period, τ, of 16 coexisting and well-documented rhythms) of 30 healthy firemen (FM) exposed to irregular, difficult, and stressful nocturnal work hours who demonstrated excellent clinical tolerance (allochronism). Three groups of FM were studied (A = 12 FM on 24-h duty at the fire station; B = 9 FM on 24-h duty at the emergency call center; C = 9 day-shift administrative FM) of mostly comparable average age, body mass index, career duration, chronotype-morningness/eveningness, and trait of field dependence/independence. The self-assessed 16 circadian rhythms were (i) physiological ones of sleep-wake (sleep log), activity-rest (actography), body temperature (internal transmitter pill probe), right- and left-hand grip strength (hand dynamometer), systolic and diastolic blood pressure (BP) plus heart rate (ambulatory BP monitoring device); (ii) psychological ones (visual analog self-rating scales) of sleepiness, fatigue, fitness for work, and capacity to cope with aggressive social behavior; and (iii) cognitive ones of eye-hand skill and letter cancellation, entailing performance speed (tasks completed/unit time) and accuracy (errors). Data (4-6 time points/24 h; 2 591 480 values in total) were gathered continuously throughout two 8-d spans, one in winter 2010-2011 and one in summer 2011. Each of the resulting 938 unequal-interval time series was analyzed by a special power spectrum analysis to objectively determine the prominent τ. The desynchronization ratio (DR: number of study variables with τ = 24.0 h/number of study variables × 100) served to ascertain the strength/weakness of each rhythm per individual, group, and season. The field study confirmed, independent of group and season, coexistence of rather strong and weak circadian oscillators. Interindividual differences in DR were detected between groups and seasons (χ(2), correlation tests, analysis of variance [ANOVA]). Moreover, in each group, both in winter and summer, a normal distribution was observed in the number of FM with rhythms with τ = 24.0 h, e.g., ranging from 5/16 (large desynchronization) to 16/16 (no desynchronization). Such a normal distribution with intraindividual stability over time (i.e., seasons) is consistent with the hypothesis of an inherited origin of a differential propensity to circadian desynchronization and which is supported by the distribution of τs in winter and summer following the Dian-Circadian Genetic Model, i.e., with τ = 24.0 h, τ = 24.0 h + n(0.8 h), and τ = 24.0 h - n(0.8 h).
- Cross-border contributions to obesity research and interventions: a review of canadian and american occupational therapy contributions. [Journal Article]
- Occup Ther Health Care 2013 Apr; 27(2):129-41.
This paper identifies the contributions of Canadian and American occupational therapists to the empirical discourse on obesity. This scoping study includes an independent review of the published literature followed by a series of meetings during which key themes and contributions were categorized. The Person, Environment, Occupation, and Performance Model (Baum & Christiansen, 2005) was used to organize the themes reported in the literature. Although occupational therapists contribute to knowledge about body systems and functions as well as activity limitations and participation restrictions for persons with obesity, the majority of work has a focus on the environment and the person, with limited attention to occupation. Occupational therapy practitioners and researchers are contributing in areas valued in obesity research and practice but can do more to promote consideration of the interaction of personal, environmental, and occupational factors which may cause obesity or contribute to the participation in everyday living for persons with obesity.
- A conceptual-practice model for occupational therapy to facilitate return to work in breast cancer patients. [Journal Article]
- J Occup Rehabil 2013 Dec; 23(4):516-26.
Improved therapies and early detection have significantly increased the number of breast cancers survivors, leading to increasing needs regarding return to work (RTW). Occupational therapy (OT) interventions provide successful RTW assistance for other conditions, but are not validated in breast cancer. This paper aims to identify a theoretical framework for OT intervention by questioning how OT models can be used in OT interventions in RTW of breast cancer patients; criteria to be used to select these models and adaptations that would be necessary to match the OT model(s) to breast cancer patients' needs?Using research specific criteria derived from OT literature (conceptual OT-model, multidisciplinary, referring to the International Classification of functioning (ICF), RTW in breast cancer) a search in 9 electronic databases was conducted to select articles that describe conceptual OT models. A content analysis of those models complying to at least two of the selection criteria was realised. Checking for breast cancer specific issues, results were matched with literature of care-models regarding RTW in breast cancer.From the nine models initially identified, three [Canadian Model of Occupational Performance, Model of Human Occupation (MOHO), Person-Environment-Occupation-Performance model] were selected based on the selection criteria. The MOHO had the highest compliance rate with the criteria. To enhance usability in breast cancer, some adaptations are needed.No OT model to facilitate RTW in breast cancer could be identified, indicating a need to fill this gap. Individual and societal needs of breast cancer patients can be answered by using a MOHO-based OT model, extended with indications for better treatment, work-outcomes and longitudinal process factors.
- Innovative system for real-time ergonomic feedback in industrial manufacturing. [Journal Article, Research Support, Non-U.S. Gov't]
- Appl Ergon 2013 Jul; 44(4):566-74.
This work presents a system that permits a real-time ergonomic assessment of manual tasks in an industrial environment. First, a biomechanical model of the upper body has been developed by using inertial sensors placed at different locations on the upper body. Based on this model, a computerized RULA ergonomic assessment was implemented to permit a global risk assessment of musculoskeletal disorders in real-time. Furthermore, local scores were calculated per segment, e.g. the neck region, and gave information on the local risks for musculoskeletal disorders. Visual information was fed back to the user by using a see-through head mounted display. Additional visual highlighting and auditory warnings were provided when some predefined thresholds were exceeded. In a user study (N = 12 participants) a group with the RULA feedback was compared to a control group. Results demonstrate that the real-time ergonomic feedback significantly decreased the outcome of both globally as well as locally hazardous RULA values that are associated with increased risk for musculoskeletal disorders. Task execution time did not differ between groups. The real-time ergonomic tool introduced in this study has the potential to considerably reduce the risk of musculoskeletal disorders in industrial settings. Implications for ergonomics in manufacturing and user feedback modalities are further discussed.
- Lumbar-load analysis of manual patient-handling activities for biomechanical overload prevention among healthcare workers. [Journal Article, Research Support, Non-U.S. Gov't]
- Ann Occup Hyg 2013 May; 57(4):528-44.
Manual patient handling commonly induces high mechanical load on the lower back of healthcare workers. A long-term research project, the 'Third Dortmund Lumbar Load Study' (DOLLY 3), was conducted to investigate the lumbar load of caregivers during handling activities that are considered 'definitely endangering' in the context of worker's compensation procedures. Nine types of handling activities in or at a bed or chair were analysed. Measurement of action forces via specifically developed devices and posture recording by means of optoelectronic marker capturing and video recordings in order to quantify several lumbar-load indicators was previously described in detail. This paper provides the results of laboratory examinations and subsequent biomechanical model calculations focused on lumbar load and the potentials of load reduction by applying biomechanically 'optimized' transfer modes instead of a 'conventional' technique and, for a subgroup of tasks, the supplementary usage of small aids such as a sliding mat or a glide board. Lumbosacral-disc compressive force may vary considerably with respect to the performed task, the mode of execution, and individual performance. For any activity type, highest values were found for conventional performance, lower ones for the improved transfer mode, and the lowest compressive-force values were gathered when small aids were applied. Statistical significance was verified for 13 of these 17 comparisons. Analysing indicators for asymmetric loading shows that lateral-bending and torsional moments of force at the lumbosacral disc may reach high values, which can be reduced considerably by implementing an improved handling mode. When evaluating biomechanical loads with respect to age- and gender-specific work-design limits, none of the analysed tasks, despite execution mode, resulted in an acceptable load range. Therefore, applying a biomechanically adequate handling mode combined with small aids to lower the friction between patient and surfaces is highly recommended, especially to prevent overload in older caregivers.
- Work capacity assessment and return to work: a scoping review. [Journal Article, Review]
- Work 2013 Jan 1; 44(1):37-55.
This review sought to synthesize existing evidence on work capacity assessments and to identify the knowledge supporting their use in return to work practice and future research.A scoping review was conducted identifying studies examining assessments used in return to work. Studies published before 1986 and studies not written in English were excluded. A five point relevancy criteria was used to establish the fit of articles with the research question. Articles were thematically analyzed into components of the PEO Model, proposed future research, and areas of vested interest.Forty four articles met the criteria for inclusion. For over twenty five years, work capacity assessment literature has remained focused on the individual's physical work performance capacities. Gaps were identified in the lack of qualitative research and incorporation of person, occupation, and environmental dimensions in evaluation of work capacity. Future research recommendations emphasize the need for knowledge generation on work modification and investigation of psychosocial factors that impact work capacity and return to work yet only minimal progression is evident in these areas in the literature reviewed.The limited consideration of the occupation and environmental dimensions in returning to work and the global interest in work capacity assessment highlight the need for the development of contextually based assessment tools. Assessment needs to move toward the incorporation of environmental and occupational aspects in addition to the person dimension in a culturally transcendent manner.
- Support and process in individual placement and support: a multiple case study. [Journal Article, Research Support, Non-U.S. Gov't]
- Work 2013; 44(4):435-48.
This multiple case study investigated support and process in the Individual Placement and Support (IPS) approach from individual client, longitudinal, and Person-Environment-Occupation (PEO) model perspectives.Five IPS-participants, or cases, with severe mental illness (SMI) who worked a minimum of 4 hours a week entered the study.A multiple data collection method was used over a period of 12 months and included IPS-vocational profiles and plans as well as various instruments and questionnaires concerning socio-demographics, work performance, limitations, and accommodations. Both within- and across-case analyses were performed.The IPS-process concerned job search support, job-matches (PEO-match), and adjustment of the PEO-match by providing accommodations by on- and off-worksite support. All participants had limitations concerning social interactions and handling symptoms/tolerating stress. Several accommodations were made for the same limitations, mostly directed towards the social environment. Prior work experience, disclosure, and not being in an acute phase of illness seemed important to the support provided.This study has visualised the support and process in IPS and provided a theoretical framework, the PEO-model, to detect limitations and provide IPS-support. The organization of IPS-support and methods of providing it to individuals may be important for job tenure and employment success.
- Real-time fit of a respirator during simulated health care tasks. [Evaluation Studies, Journal Article, Research Support, Non-U.S. Gov't]
- J Occup Environ Hyg 2012; 9(10):563-71.
Fit is an important but difficult-to-predict feature of respirator performance. This study examined a new approach to measuring respirator performance using two continuous direct-reading particle-counting instruments in a simulated health care workplace. A pilot test was conducted with eight experienced health care professionals who passed a traditional quantitative fit test before performing three randomized 10-min health care scenarios (patient assessment [PA], IV treatment [IV], and wound care [WC]). Two TSI Portacount Plus (Model 8020) with N95 Companion (Model 8095) instruments were used to continuously measure 1-sec ambient particle concentrations inside and outside the respirator facepiece. A simulated workplace protection factor (SWPF) was calculated by dividing outside by inside concentrations. Data were log transformed and examined using analysis of variance (ANOVA) between subjects, scenario types, and scenario order. The GM SWPF for the eight subjects, three scenarios per subject, ranged from 172 to 1073 (GSD 1.7 to 3.5) and was significantly different for each subject. A multi-way analysis of variance showed no difference between the three scenario types (PA, IV, WC). There were differences by the order in which scenarios were performed: the third scenario SWPF was significantly different and higher than that of the first and second scenarios. All subjects passed the initial quantitative fit test with a fit factor of at least 100. Five subjects had fit factors greater than 200 and GM scenario SWPFs greater than 400. Three participants with initial fit factors less than 200 had GM scenario SWPFs ranging from 132 to 326. This pilot test demonstrates that it is possible to evaluate instantaneous respirator fit using two quantitative fit test instruments in a simulated health care environment. Results suggest that an initial fit test may be predictive of fit during simulated tasks and that one scenario may be adequate for measuring a simulated workplace protection factor. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a video for subject D activities overlaid with simulated workplace protection factor data.].