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  • ItemEmbargo
    Advancing clarity: exploring professional thinking skills in occupational therapy
    (Colorado State University. Libraries, 2023) Burke, Hannah K., author; Lane, Shelly J., advisor; Bundy, Anita C., committee member; Sample, Pat L., committee member; Hepburn, Susan, committee member; Spielmann, Virginia, committee member
    Background: Reasoning, reflection and evidence-based practice are three interrelated and essential skills for occupational therapy practice. As threshold concepts in the field, they contribute to development of a sense of professional identity. However, these skills are inconsistently defined and differentiated from one another, leading to difficulties in related communication, education, and research. In this dissertation I sought to advance the profession's understanding of consensus conceptualizations of these essential professional thinking skills and how they are taught. Methods: This dissertation comprises five articles reporting results of two broad studies. In the first study, a scoping review, I explored peer-reviewed occupational therapy literature that included a definition of a term related to reasoning and/or reflection. Along with my research team, I extracted data from each paper on definitions of relevant terms, relationships amongst relevant terms, references used to define relevant terms, and descriptive information about each article. In the second study, I used Delphi methodology to explore nine occupational therapy educators' consensus definitions of, conceptualizations of relationships between, and educational strategies for teaching clinical reasoning, professional reasoning, reflective practice, and evidence-based practice. I then conceptually integrated results of both studies to compare findings between the literature and educators. Findings: Both studies indicate that there is some agreement about main characteristics of each of these skills. They also both suggest that clinical/professional reasoning, reflective practice, and evidence-based practice are related to each other in complex, non-linear ways that warrant further exploration. Findings from the Delphi study additionally indicate that there are key educational strategies that may support development of multiple of these professional thinking skills. Conclusion: This dissertation adds to the body of literature clarifying conceptualizations of necessary professional thinking skills in occupational therapy. Continued explicit consideration of conceptualizations of reasoning, reflection, and evidence-based practice within occupational therapy literature and education will advance communication, measurement, and, ideally, uptake of these skills into practice to support an integrated sense of professional identity.
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    Acquiring stakeholder input on the clinical usefulness of measuring outcomes of therapeutic horseback riding
    (Colorado State University. Libraries, 2023) Brenneman, Moriah, author; Peters, Caiti, advisor; Schmid, Arlene, advisor; Stallones, Lorann, committee member
    Therapeutic riding (TR) is a recreational activity which provides mounted and ground-based horsemanship opportunities adapted to the abilities of the participants Click or tap here to enter text.. TR provides physical and psychological benefits to participants with diverse disabilities, including physical, developmental, cognitive, and age-related disabilities, promoting higher quality of life (QoL); however, certified therapeutic riding instructors (CTRIs) and centers are limited in their capacity to implement outcome assessments and report the benefits of their community-based TR programs to a broad audience due to credentialing requirements, time restraints, and limited financial resources. Therefore, the purpose of this study was to identify whether and how TR professionals are currently measuring participant outcomes; benefits and barriers to implementing standardized assessments in TR; and characteristics which would make TR assessments clinically useful in the community TR environment. To address this purpose, we conducted a computer-based survey among TR stakeholders. We identified that while TR professionals measure outcomes among their participants, they typically do not use standardized assessments. Benefits of implementing standardized assessments included bolstering the TR profession, acquiring funding, and communicating about TR services with a broad audience. Barriers to implementing standardized assessments included time, systemic, and expertise constraints. Respondents reported that standardized assessments should be relevant to all age groups and populations who receive TR services. Finally, our respondents reported that for standardized assessments to be clinically useful, they would need to be low-cost (free or $1 – 2 per use), require less than 20 minutes, and available in either paper or computer format. This study revealed that standardized assessments may be a strong support to the TR profession; however, assessments must meet the needs of TR providers in the community.
  • ItemEmbargo
    Occupational therapists' perspectives on their unique role in pelvic health
    (Colorado State University. Libraries, 2023) Fyhrie, Jennifer, author; Schmid, Arlene A., advisor; Weaver, Jennifer, committee member; Fruhauf, Christine A., committee member
    Introduction: Pelvic floor dysfunction (PFD) may present as urinary/fecal incontinence, pelvic organ prolapse, and/or pelvic pain. These symptoms have been shown to cause disruption to individuals' activities of daily living and decrease quality of life. Conservative estimates indicate 28 million women are affected by PFD worldwide. The core of occupational therapy (OT) is to mitigate barriers to engagement in occupations of one's choosing, yet there is a gap in the literature detailing occupational therapy practitioners' (OTP) perspectives on their unique contributions in pelvic health. Methods: This exploratory descriptive study utilized an online survey to purposively recruit OTPs and screen individuals for an interview. Inclusion criteria required that participants a) be a licensed or retired OTP, b) have at least one year experience as an OTP, and c) have any professional experience in pelvic health. One-on-one semi-structured interviews occurred on a virtual platform, were audio-recorded, and transcribed. Using Dedoose software, thematic inductive analysis was conducted. Results: Thirty-one individuals completed the survey, 21 were eligible to participate, and 13 participated in an interview. It was found that OTPs believe they offer a unique contribution to the pelvic health field. Three primary qualitative themes were generated that elaborate on this belief: OTPs apply a psychosocial lens, the OT approach is comprehensive, and OTPs use occupation-focused interventions when working with people with PFD (e.g., consider the influence of client mental health as client preferences, culture, and lifestyle). Conclusion: This study identified the perceptions of OTPs regarding their unique approach to working with clients in pelvic health. Data suggests that OTPs complement the biomechanical focus of other pelvic health providers by recognizing the role of mental health and intervening to down-regulate the nervous system.
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    Investigating the neural mechanisms of rhythmic entrainment and auditory priming using EEG
    (Colorado State University. Libraries, 2023) Mingils, Susan, author; Davies, Patricia, advisor; Stephens, Jaclyn, advisor; Atler, Karen, committee member; LaGasse, Blythe, committee member
    A body of literature on rhythmic entrainment, the synchronization of behaviors to rhythmic stimuli in the environment, shows auditory rhythmic cuing can improve motor performance in neurotypical and clinical populations. This is thought to be driven by underlying communication, i.e., functional connectivity, between auditory and motor brain regions. Surprisingly, some clinical research shows rhythmic entrainment interventions, designed to enhance motor performance, may improve cognitive performance as well. However, it is unclear if improved cognitive performance during rhythmic entrainment reflects changes in functional connectivity. Evidence from cognitive neuroscience suggests rhythmic auditory stimuli may direct attentional resources through the synchronization of certain neural oscillations with the rhythmic pulse. Neural oscillations are repetitive patterns of brain activity which can be measured noninvasively at the scalp using electroencephalography (EEG). Measuring how neural oscillations from spatially distinct brain regions synchronize with each other reflects changes functional connectivity. Before functional connectivity during rhythmic entrainment can be studied, research is first needed to establish connectivity patterns when processing auditory rhythmic stimuli (auditory condition) and during self-paced rhythmic motor performance (motor condition), which was the goal of Study 1. Overall, the results of Study 1 provide evidence that the auditory condition may promote more efficient functional connectivity with increased activation in localized brain regions, while the motor condition may utilize long-range low-frequency neural oscillations to suppress activity in task-irrelevant brain regions to sustain attention. A recent EEG study by our lab compared the neural oscillations of participants who listened to auditory rhythmic stimuli presented for a little over five minutes (auditory-first group) to participants who completed a self-paced rhythmic motor task for about minutes (motor-first group) prior to tapping along to auditory rhythmic cues (rhythmic entrainment condition). One important finding was a greater "priming effect" in the auditory-first group, who showed reduced neural resources needed during rhythmic entrainment compared to the motor-first group. Thus, auditory priming, compared to motor priming, may result in a more efficient use of neural resources during rhythmic entrainment. However, the optimal duration of auditory priming to promote efficient brain and behavior function is unknown. Therefore, the goal of Study 2 was to determine how different durations of auditory priming affect brain efficiency in neurotypical individuals, as measured using EEG. Overall, the results of Study 2 found that a duration of about two minutes may be optimal for auditory processing of rhythmic stimuli. However, more research is needed to confirm if auditory priming reduces neural resources needed during rhythmic entrainment compared to no priming and if auditory priming improves motor performance. Rhythmic entrainment and auditory priming are both important principles of rhythm-based interventions used in rehabilitation. A better understanding of their neural mechanisms in neurotypical individuals provides a necessary foundation for future research examining these processes in clinical populations and as a component of clinical interventions.
  • ItemEmbargo
    Promoting adherence to cognitive-behavioral therapy for insomnia in the medically complex case
    (Colorado State University. Libraries, 2023) Lovell, Emily R., author; Eakman, Aaron, advisor; Weaver, Jennifer, committee member; Broussard, Josiane, committee member
    Objective. The purpose of this study is to explore how a medically complex case responded to cognitive-behavioral therapy for insomnia (CBT-I) in a community-based setting based on adherence to treatment recommendations. Method. A mixed-methods retrospective case study design was used to explore answers to two research questions: 1) How effective is CBT-I for an individual with insomnia comorbid with bipolar disorder? 2) How is CBT-I tailored for an individual with insomnia comorbid with bipolar disorder in a real-world setting? 3) How do we assess adherence to CBT-I delivered by an occupational therapist? Data sources included sleep diaries, service logs, pre-/post-treatment assessments, and interviews with the client and therapist. Results. Improvements in sleep latency, wake after sleep onset, early morning awakening, total sleep time, and sleep efficiency were observed. The most noteworthy improvements were a gain of almost two hours of total sleep time and a post-treatment SE of 95%. Likewise, scores on the Insomnia Severity Index, Epworth Sleepiness Scale, Sleep Disorders Symptoms Checklist-25, Dysfunctional Beliefs and Attitudes about Sleep scale, Sleep Hygiene Index, Quick Inventory of Depressive Symptomatology, and Patient Health Questionnaire-9 all improved to the extent that the client no longer met criteria for chronic insomnia. Overall adherence to the behavior components of CBT-I was very high. High motivation and scheduling and engaging in activities emerged as factors that promote adherence from the interview conducted with the client. A therapeutic relationship emerged as a factor that promotes adherence from the interview conducted with the therapist. Conclusion. CBT-I can be safely delivered by occupational therapists to individuals with bipolar disorder. Large improvements in sleep were observed and the client had high adherence to treatment protocols.
  • ItemEmbargo
    Occupational therapists' perspectives and role with illness-induced trauma from medical conditions
    (Colorado State University. Libraries, 2023) Beyers, Camryn, author; Schmid, Arlene A., advisor; Weaver, Jennifer A., committee member; Currin-McCulloch, Jen, committee member
    Illness-induced trauma might cause a disruption in an individual's occupational performance. This study examined occupational therapy practitioner's perspectives and role in addressing illness-induced trauma in practice. In this explanatory sequential mixed methods design, twenty-four occupational therapists completed an online survey and ten occupational therapists participated in a semi-structured 1:1 interview. Survey questions asked about their knowledge of illness-induced trauma. Interview questions asked therapists about how they incorporate illness-induced trauma knowledge and trauma-informed care into their practice. Quantitative results showed that the majority of occupational therapists did not receive formal trauma-informed care training, 96% agreed that psychological trauma has a significant impact on rehabilitation outcomes, and 8% agreed that current guidelines for trauma-informed care adequately consider the needs of clients with illness-induced trauma. Qualitative results indicated three major themes: occupational therapy approaches, illness-induced trauma's effect on rehabilitation, and barriers to providing trauma-informed care. Findings suggest that occupational therapy practitioners have a unique perspective on addressing illness-induced trauma and their ability to practice trauma-informed care could support a client's ability to process and heal after a traumatic medical event.
  • ItemEmbargo
    Occupational therapists: the quarterbacks of pelvic healthcare
    (Colorado State University. Libraries, 2023) Le Fevre, Eleanor, author; Schmid, Arlene, advisor; Weaver, Jen, committee member; Fruhauf, Christine, committee member
    Background: The ability to effectively manage chronic issues has a large impact on a person's quality of life. Pelvic floor dysfunction (PFD) is a chronic and debilitating disorder which affects millions of people worldwide. PFD is often placed lower in the hierarchy of treatable medical conditions yet has a substantial impact on a person's functional capability. Pelvic health occupational therapists (PHOT)s are emerging practitioners in PFD management. PHOTs provide a client-centred, holistic approach to care. To date PHOT is not well described in the literature or well known in the practice of pelvic healthcare. Aim: To investigate the perceptions of PHOTs, their value in the management of PFD, and how this value is communicated to other healthcare providers (OHCP)s. Methods: This qualitative research study included a demographic survey and one-to-one interviews with PHOTs and lead researchers. Thirteen PHOTs were interviewed by a lead researcher and provided data on their perceptions and interactions with OHCPs. Data collection was completed over a five-month period from July 2022-December 2022. Data collection ended once saturation in responses was reached. Data were analyzed by lead researchers using an in vivo coding process, creation of categories and code book. I created themes and sub-themes driven by the data. Results: Two main themes were created from the data with PHOT participants supporting inclusion of OT in pelvic healthcare; (1) pelvic healthcare is an interdisciplinary field; (2) more practitioners are needed in PHOT. Conclusion: PHOTs perceptions and value on interdisciplinary teams are key to increased communication between PHOTs, OHCPs, and the clients they serve. Further research is needed to define the PHOT role and impact as part of an interdisciplinary team.
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    Rasch analysis of the evaluation in Ayres sensory integration (EASI)
    (Colorado State University. Libraries, 2022) Grady, Patricia, author; Bundy, Anita, advisor; Lane, Shelly, committee member; Hepburn, Susan, committee member; Sharp, Julia, committee member
    Sensory Integration (SI) refers to the neurological process by which a person takes in sensory information, interprets this information, and uses it to inform movement and goal-directed action (Ayres, 1989). For children with a variety of diagnoses, as well as some children who are otherwise typically developing, SI may be impaired or delayed (Bundy & Lane, 2020a). Occupational therapists and other clinicians who treat children with sensory integration (SI) dysfunction face a dearth of appropriate instruments to evaluate SI function. The Evaluation in Ayres Sensory Integration (EASI; Mailloux et al., 2018) is a novel assessment tool that may allow therapists to evaluate SI in a way that is aligned with SI theory. EASI consists of 21 individual tests that measure constructs of SI. The EASI authors have collected normative data for children across the globe. However, this data must be assessed for validity and reliability before it can be used as the basis for normative scoring on the EASI. In this dissertation, I used Rasch analysis to evaluate data with 19 of the 21 tests. The Rasch model is a latent-trait psychometric model that (1) transforms ordinal-level data to interval-level data and (2) allows users to assess evidence for construct validity (unidimensionality and invariance) and internal reliability (Bond, Yan & Heene, 2020). For each of the 19 tests, I evaluated item fit statistics, rating scale fit statistics, person fit statistics, principal components analysis (PCA) of standardized residuals, differential item functioning (DIF) based on sex, person reliability index and strata. The dataset for this study comprised 2653 children from 51 countries; all data were collected by trained EASI examiners. Overall, results revealed promising evidence for construct validity and internal reliability of data collected using 16 of the19 EASI tests evaluated in this dissertation. However, across many tests, I observed lower-than-desired person fit statistics and reliability. Notably, these results were not far from the desired values. I hypothesized that these findings are the result of the overall high ability level of the normative population. EASI is designed to evaluate children with lower-than-average or poor SI function; therefore, these findings are not unexpected nor are they particularly concerning. Three EASI tests (Proprioception: Force, Proprioception: Joint Position, and Balance) required substantial revision as a result of these analyses; each had threats to construct validity that exceeded my expectations. In this dissertation, I provided potential solutions for these three tests; future studies will evaluate the extent to which these solutions resolve concerns. In conclusion, the normative data form an acceptable basis for creating norm-based scores for clinical interpretation. However, larger studies must be conducted with clinical populations to ensure that the tests can differentiate between children with and without SI dysfunction. Further, future studies should investigate the role of culture, language and other factors on the validity of EASI test scores.
  • ItemOpen Access
    A qualitative study: the influence of occupational therapy for pelvic floor dysfunction on functioning, disability, and health
    (Colorado State University. Libraries, 2022) Pearce, Delaney M., author; Schmid, Arlene A., advisor; Atler, Karen E., committee member; Fruhauf, Christine A., committee member
    Introduction: Approximately one quarter of all women in the United States experience symptoms of pelvic floor dysfunction (PFD). Occupational therapy (OT) for PFD is a relatively new area of expertise within the field, resulting in limited research on its efficacy. Objectives: Explore the ways in which OT for PFD influences health using the International Classification of Functioning, Disability, and Health (ICF) as a guide. Method: Four participants completed the study. Eligibility criteria included: >18 years old, biologically female, English speaking, self-reported pelvic floor issue, completed OT intervention for PFD within the last two years. Electronic medical records and Pelvic Floor Distress Inventory Questionnaire-10 (PFDI-20) scores prior to and after completing OT intervention for PFD were reviewed, and semi-structured interviews were conducted. Results: Four themes emerged: 1) improved mental health and physiological function, 2) promotion of the mind-body connection, 3) reintroduction of meaning, and 4) relationships with healthcare professionals and sociocultural influences. Each theme is tied to a component of the ICF. Conclusion: OT for PFD has a positive impact on health per the ICF. This may result in better function and participation in everyday life. More research is needed to investigate the generalizability of these findings.
  • ItemOpen Access
    Instrument development of the Vocational Fit Assessment – Self-Report and content validity procedures
    (Colorado State University. Libraries, 2022) Thum, Marisa, author; Persch, Andrew, advisor; Atler, Karen, committee member; Sharp, Julia, committee member
    People with intellectual and developmental disabilities (PwIDD) are unemployed in the United States at rates much higher than that of the general population. Current job matching practices rely largely on proxy-report of worker abilities, resulting in decreased opportunity for self-determination. As Patient Reported Outcome Measures rise in popularity in other fields as a means of directing patient-centered care, job matching assessments should follow to support client-directed services. The Vocational Fit Assessment (VFA) is an existing tool which compares proxy-reported worker abilities with job demands and creates job matching reports that guide and support job matching decisions. The aims of this thesis were to 1) adapt the existing Vocational Fit Assessment (VFA) into a format that is appropriate for self-report by people with intellectual and developmental disabilities and 2) develop content validity procedures to assess the adapted assessment, the Vocational Fit Assessment – Self-Report.
  • ItemOpen Access
    Relationships between the wellness of older adults, health status, participation, and social determinants of health: a cross-sectional analysis using the National Health and Aging Trends Study
    (Colorado State University. Libraries, 2022) Parenti, Victoria, author; Graham, James, advisor; Schoessow, Kim, committee member; Miller, Ray, committee member
    Objectives: The primary objective of the current study is to explore the independent effects of different types of health and participation variables on subjective well-being among community-dwelling older adults. A secondary objective is to examine the roles that social determinants of health, including environmental, economic, and social factors, may play in mediating those relationships. Data Source: The National Health and Aging Trends Study (NHATS) includes survey data from a large, nationally representative sample of Medicare beneficiaries ages 65 and older. The data capture a snapshot of later-life functioning, including information on health conditions, self-care, well-being, participation, living arrangements, and many more. NHATS data were developed for public use and have been used in more than 400 scientific publications. Participants aged 65 and older were drawn from Round 9 of NHATS conducted in 2019. Methods: Participants were included in the final sample if they resided in the community and completed a sample person interview (no proxy person interviews were included). Main variables being assessed include the 11 items of Well-Being, hospitalizations, general self-rated health, depressive symptoms, and participation in social activities. Proxy variables from the NHATS were selected to represent the individual domains of the social determinants of health, including economic stability, education, healthcare access, social and community context, and neighborhood and built environment. Bivariate and regression analyses were conducted to explore independent relationships and mediation effects. Results: The data indicate that hospitalizations, self-rated health, depressive symptoms, and participation in social activities are independently associated with subjective well-being. Additionally, indicators for economic stability, education, health literacy, and community context were independently associated with well-being among the sample of Medicare beneficiaries. There was one mediating effect of an individual SDOH domain on the relationship between hospitalizations and subjective well-being after conducting the regression analysis. Conclusion: The results from the current study contribute to a growing body of literature examining relationships between several factors and well-being outcomes for community-dwelling older adults. Data from the current study provide substantial insight on how health status, participation, and SDOH indicators can be used in future research to explore these relationships, and identify populations at risk for occupational justice or health inequities. Future research is warranted to validate measures and indicators of SDOH to further explore their relationships with health and well-being outcomes using national data sets.
  • ItemEmbargo
    Measuring executive function after yoga for adults with acquired brain injury: a pilot study
    (Colorado State University. Libraries, 2022) Grieb, Emily, author; Schmid, Arlene, advisor; Stephens, Jaclyn, committee member; Riggs, Nathaniel, committee member
    Background: Acquired brain injury (ABI) may result in cognitive impairments, particularly deficits in executive function (EF), which may impact engagement in everyday activities. Yoga has been shown to improve various health outcomes for individuals with ABI. This study aims to explore the impact of group yoga on EF for individuals with ABI. Methods and Materials: This was a single-arm pilot study that involved eight weeks of therapeutic group yoga led by a registered yoga teacher. Nine participants attended hour-long, in-person yoga classes once a week. Sessions included seated, standing, and floor postures combined with breathwork and meditation. EF was assessed pre- and post-intervention using the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A) self-report form. Results: The behavioral regulation index improved significantly pre to post yoga. No significant improvements were found on the EF scales, metacognition index, or global executive composite. However, measurable improvements (>5%) were found in the following EF scales: Emotional Control, Plan/Organize, and Organization of Materials. Conclusion: Group-based yoga may improve behavioral regulation for adults with chronic ABI, however further research is needed.
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    The effect of an intensive, outdoor camp on behavioral regulation and praxis in children
    (Colorado State University. Libraries, 2022) Tull, Emily B., author; Lane, Shelly J., advisor; Bundy, Anita C., committee member; Burke, Hannah K., committee member; Butki, Brian, committee member
    Background: Behavioral regulation and praxis skills are both crucial to childhood participation and performance in occupation. Behavioral regulation is the ability to employ executive functions in order to regulate, monitor, and adapt behavior to interact within the environment. Praxis is the ability to recognize object and environment affordance, develop an idea for action, plan the action, and then perform it. It is reflected by successful interactions with people and things in the environment. Purpose: This study examined the impact of a 5-day outdoor camp with integrated occupational therapy supports on behavioral regulation and praxis in 36 children with sensory processing, praxis, and behavioral challenges. Methods: Pre-test/post-test retrospective cohort design. Data were drawn from two parent-report questionnaires completed 3 months pre and 3 months post camp: the Behavior Rating Inventory of Executive Function-2 (BRIEF-2) and the Sensory Processing Measure (SPM). Findings: Linear mixed modelling revealed an association between behavioral regulation and praxis throughout the 6-month timespan. Paired samples t-tests showed significant change in praxis, and positive non-significant change in behavioral regulation. Implications: Practitioners should consider contexts and factors contributing to children's praxis and behavioral regulation skills, as well as the interface between the two characteristics. The use of outdoor camps should be considered in occupational therapy intervention for enhancing children's praxis, as well as participation and performance in occupations.
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    The relationship between assistive technology utilization and academic outcomes for post-secondary students with a mental health condition
    (Colorado State University. Libraries, 2022) Morgione, Carli, author; Malcolm, Matt, advisor; Roll, Marla, committee member; Haddock, Shelley, committee member
    The prevalence of mental health conditions (MHC) in post-secondary students is increasing steadily, affecting as many as 30% of the college student population (Eisenberg et al., 2013). Mental health conditions can affect student's cognitive, social, and emotional functioning including challenges with attention, memory, problem-solving, attendance, and in-class participation, impacting their ability to be successful academically (Brown et al., 2019; Gitlow et al., 2017; Markoulakis & Kirsh, 2013). Previous studies have demonstrated this negative influence, finding presence of a mental health condition in post-secondary students to be related to lower grades (Hysenbegasi et al., 2005; Markoulakis & Kirsh, 2013). Post-secondary institutions need to identify methods to better support these students to promote positive academic and psychosocial outcomes. As part of title II of the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act, assistive technology (AT) and AT support services are legislatively mandated accommodations currently offered to many post-secondary students with disabilities, including students with a disability resulting from a mental health condition. AT was demonstrated to support the cognitive functions impacted by a MHC, such as through note-taking aids, scheduling and reminder technology, and thought organization technologies, to improve students' academic performance and satisfaction (Gitlow, 2021; Malcolm & Roll, 2017a). Limited evidence exists to demonstrate if any relationship exists between students with a mental health condition, utilization of AT services, and academic and psychosocial outcomes. The purpose of this study was to 1) identify predictors of AT service utilization, 2) identify predictors of GPA, and 3) identify predictors of self-advocacy and self-confidence for students with and without a MHC. Results of this study indicate that predictors of higher-grade point average (GPA) included AT service utilization, female gender, increased age, and non-first-generation status. Presence of a MHC was not predictive of AT service utilization, GPA, or ratings of self-advocacy and self-confidence compared to students with disabilities that did not have a mental health condition. Because these findings differ from current literature on the general population of post-secondary students with a MHC, further research is needed to identify if differences in academic and psychosocial outcomes exist for students with disabilities with a MHC compared to students not seeking disability services with a MHC.
  • ItemOpen Access
    Systematic review of therapeutic interventions in occupational therapy for children with traumatic brain injury
    (Colorado State University. Libraries, 2010) Ferland, Erik Richard, author; Sample, Pat, advisor; Greene, David, committee member; Seger, Carol, committee member
    Objective: The aim of this study was to conduct a systematic evidence-based search and review of the published literature pertaining to occupational therapy interventions for children with traumatic brain injuries. Data sources: The databases searched included PsychINFO (EBSCOhost), Academic Search Premier (EBSCOhost), CINAHL (EBSCOhost) and PsycARTICLES (EBSCOhost) as well as the reference lists of articles found. Search terms: Whole words included brain, head. Wild card searches included child*, injur*, p?ediat*, rehab*, interven*, traum*, occupation*, therap*. Inclusion criteria for research articles: The participants must be children and youth with traumatic brain injuries (TBI) sustained from birth -2 1 years old; the intervention must be an associated occupational therapy intervention; the study must include between groups designs, with either quasi-experimental or randomized experimental design, and within subject single subject designs. Data interpretation: The author assessed each article against a rubric that looked at the quality various aspects of the study (e.g. design, methods, and outcome variables). Results: The researcher analyzed six articles with a total of 39 children with TBI. Three articles researched restrain therapy, one researched Lycra-based splints, one researched an antecedent behavioral intervention, and one discussed a problem solving intervention for families of children with TBI. Conclusion: The researchers found positive effects for the CIT interventions, the antecedent behavioral intervention and the family problem-solving intervention. The researchers who looked at the Lycra splinting found mixed results that were inconclusive.
  • ItemOpen Access
    Reliability of TMS measurements of the motor cortex
    (Colorado State University. Libraries, 2010) Causer, Laurie, author; Malcolm, Matt P., advisor; Davies, Patricia, committee member; Seger, Carol A., committee member
    BACKGROUND: Transcranial magnetic stimulation (TMS) was introduced in 1985 and has been used to study the human motor system through a variety of applications including single pulse, paired pulse and repetitive pulse stimulation parameters. Paired pulse TMS studies assess motor cortical excitability, in which the first (conditioning) stimulus (CS) modifies the response to the second (test) stimulus (TS) (Maeda, Gangitano, Thall, & Pascual-Leone, 2002). The time between pulses, or the interstimulus interval, is the distinguishing factor between the application of paired pulse TMS to investigate intracortical inhibition (ICI) or intracortical facilitation (ICF). Studies of cortical excitability using paired pulse TMS can provide novel insights into the pathophysiology of various neurological and psychiatric disorders (Maeda, et ah, 2002) and have begun to be utilized as outcome measures to document changes in cortical excitability in response to repetitive TMS. The stability of the muscle responses known as motor evoked potentials (MEPs) elicited in response to paired pulse stimulation has not been well documented in the literature to date. As such, the primary goal of this study was to establish the test-retest reliability of two paired pulse measures of the motor cortex, ICI and ICF, in two muscle representations; first dorsal interossei (FDI) and abductor pollicis brevis (APB). METHODS: Fifteen healthy individuals, age 19-37 years old, participated in two identical testing sessions held exactly one week apart from each other. Four different types of stimulation (CS, TS, 2ms, and 15ms) were delivered over the motor cortex 20 times in a random order. The corresponding MEPs were recorded and their size were documented using two common methods found in the literature; area under the curve and peak to peak amplitude. RESULTS: Reliability was determined using intra-class correlation coefficients (ICCs). Poor reliability was documented in both methods of analysis; whether twenty trials or ten trials were averaged, and even still after normalizing data, with ICCs ranging from (-.508 - .347). CONCLUSION: Additional studies investigating the test-retest reliability of paired pulse measures of the motor cortex need to be conducted to document the stability of MEPs. Potential sources of variation in MEPs size include electrode placement variation, stimulation intensity changes, coil placement variability, state of the overall nervous system, and the state of the individual muscle (contracted/relaxed). Until the reliability of paired pulse stimulation is established, researchers should use caution linking the changes in the size of MEPs in response to paired pulse stimulation to interventions, disease, or other external factors.
  • ItemOpen Access
    Skills to succeed: a questionnaire developed to measure self-advocacy skills before and after intervention in university students
    (Colorado State University. Libraries, 2010) Mohar, Jayne Gonda, author; Schelly, Catherine, advisor; Davies, Patricia, advisor; DiGregorio, Gaye, committee member; Kuk, Linda, committee member
    Objective. Diversity of learners attending post-secondary education is increasing, but students from diverse backgrounds including racial/ethnic minorities, first-generation college students, and students with disabilities continue to graduate at lower rates than their peers. Non-academic skills are an important part of student success in postsecondary education, and self-advocacy is a piece of a non-academic skill set that can lead to greater student retention and increased graduation rates. The purpose of this study was to develop a questionnaire to measure self-advocacy skills in university students and to determine the effectiveness of a self-advocacy intervention. Method: A quasi-experimental, mixed design study was used to determine the quality of a questionnaire to identify self-advocacy skills in college sophomores and the effectiveness of the questionnaire to measure the improvement of self-advocacy skills alter receiving a self-advocacy intervention. A diverse group of 36 students in a Learning Community at Colorado State University were given a questionnaire before the start of fall semester 2009. Students received a self-advocacy intervention to target areas of lower performance based on the pre-intervention questionnaire results and were given a follow-up survey at the end of fall semester. Results: Descriptive statistics indicated that half of the 30 Likert scale questions on the self-advocacy questionnaire did not have ceiling effects. Paired r-tests revealed a significant increase in one self-advocacy area and a decrease in two self-advocacy skill areas. When racial/ethnic groups, first-generation students, and students with disabilities were compared, differences were found in how Asian/Pacific Islander and Hispanic/Latino(a) students answered questions regarding self-advocacy skills. Qualitative data analysis further defined sophomore students’ perceived needs and definitions of self-advocacy. Conclusion: Literature supports that sophomore students often report a decrease in self-efficacy related to their academic experience as they measure their ability or chance for academic success. Students reported a need for increasing motivational and academic skills (test taking, studying) as the top areas for needing improvement. In addition to adding control groups, further refinement of the self-advocacy questionnaire and intervention is required in order to effectively measure and target the student identified self-advocacy needs.
  • ItemOpen Access
    Effects of universal design for learning instructor training as perceived by students and instructors
    (Colorado State University. Libraries, 2010) Colgan, Wendy, author; Davies, Patricia, advisor; Schelly, Cathy, advisor; Gingerich, Karla, committee member
    Objective: The number and diversity of students enrolling in higher education is increasing; however, persistence and retention rates are still an area that needs attention. Universal Design for Learning is an approach that helps provide the greatest educational access to all students. Providing education and professional development to educators in this area may prove to be beneficial to all students. Method: This quasi-experimental and mixed method design study, examined the change in the implementation of UDL teaching techniques and strategies in college classrooms after UDL instructor training, as perceived by instructors and students. In addition, student perceptions on what promotes an effective teaching and learning environment were examined. UDL questionnaires were designed, tested, redesigned and refined in the first ACCESS project. The questionnaires were used to measure change after UDL training. In the second ACCESS project, ACCESS II staff worked closely with instructors and students of Psychology 100 courses at Colorado State University. Six instructors teaching nine sections of Psychology 100 agreed to participate in the UDL training. At the beginning and end of the semester a total of 1,164 students enrolled in those nine sections and the instructors were administered the UDL questionnaire. Quantitative as well as qualitative data were collected and analyzed using data analysis software including SPSS 18.0 and Atlas ti 6.0. Results: The results of the t-test demonstrated that students as well as instructors reported a significant increase in the use of UDL strategies and techniques after the UDL training. Students reported a significant increase in their instructors’ use of UDL strategies and techniques after the UDL training on 6 of the 28 questions pertaining to UDL principles. All six of these questions had effect sizes representing small to medium change. Instructors also reported a significant increase in their self-perceptions regarding their use of UDL techniques and strategies after the UDL training on 2 of the 27 questions pertaining to UDL principles. Although they did not reach statistical significance, 13 of 27 questions on the instructors’ questionnaire had effect sizes that represent small to larger than typical change from pre to post UDL training. In addition, valuable insight regarding student perceptions on what promotes an effective teaching and learning environment, such as what engages them, and what helps and hinders their learning were obtained. Conclusion: The results of this research are promising and indicate that even just as few as five one-hour sessions of instructor training in the area of Universal Design for Learning (UDL) may increase the amount of UDL techniques and strategies used in the classroom and enhance the learning experiences of all students. The large effect sizes are promising and indicate meaningful change. In addition, techniques and strategies reported by students, in regards to what promotes an effective teaching and learning environment, align with the three principles of UDL: Multiple means of representation, expression and engagement. The increasingly diverse postsecondary population only increases the urgency to leave traditional teaching strategies behind and take on a new pedagogical approach that embraces diversity.
  • ItemOpen Access
    A theory-driven logic model of equine-assisted psychotherapy for at-risk youth
    (Colorado State University. Libraries, 2021) Kelly, Erin, author; Wood, Wendy, advisor; Schmid, Arlene A., committee member; Stallones, Lorann, committee member
    Mental health issues among adolescent and young adult populations are highly prevalent. Mental illness can impact long term success and puts individuals at risk of negative quality of life outcomes. Equine-assisted psychotherapy interventions for at-risk youth are intended to support the development of important life skills and mitigate the risk factors one may be facing. The purpose of this study was to assess an equine-assisted psychotherapy program for at risk youth, the Equine Assisted Life Skills Training (EALST) program, using the structure of a theory-driven logic model. Using a qualitative description approach, I developed a theory-driven logic model to understand the underlying aspects of the EALST program. The aspects included the theoretical assumptions, resources, activities, outputs, outcomes, and impact of the program. I conducted semi-structured interviews with eight program stakeholders, with the questions aimed at explicating stakeholder's conceptualizations of each of these logic model categories. The results of the analysis of these interviews were mapped into a logic model format. This particular type of logic model focused on elucidating the theoretical assumptions of the program stakeholders in order to develop existing program theory. These theoretical assumptions, along with the other aspects of the logic model, will support the program providers in further developing their working theories and more effectively implementing the program. Next steps include identifying measures of hypothesized outcomes in order to test and further refine the identified program theory.
  • ItemOpen Access
    The revised dual task screen: analysis of dual task motor and cognitive costs in healthy, young adult athletes
    (Colorado State University. Libraries, 2021) Giessler Gonzalez, Kalena, author; Stephens, Jaclyn A., advisor; Davies, Patricia L., committee member; Tracy, Brian L., committee member
    Premature return-to-play clearance can put an athlete with sports-related concussion (SRC) at risk for further injury, making proper diagnosis and management of SRC in athletes crucial. However, objective measures that are currently used in SRC management have limitations, including poor test-retest reliability, reliance on baseline testing, and insufficient difficulty for high-performing athletes. More complex tasks, including dual task measures (i.e. simultaneous motor and cognitive task performance) can detect subtle, residual deficits in athletes with SRC. While dual tasks have been shown to have potential benefit for SRC management, many dual task paradigms are limited by high cost, long administration times, and low portability. Thus, we developed the revised Dual Task Screen (DTS), a measure designed to be completed and scored in fewer than 10 minutes using only portable, low-cost instruments. The revised DTS is comprised of two subtasks: a Lower Extremity (LE) subtask and an Upper Extremity (UE) subtask. This study evaluates if the revised DTS was sensitive to dual task motor and cognitive costs (i.e. significantly poorer performance on dual trials compared to single trials) in 22 healthy, young adult athletes. We observed statistically significant dual task motor costs for the primary and secondary motor outcome measures on the LE subtask, as well as the outcome measure on the UE subtask. While the revised DTS elicited numerical dual task cognitive costs on the LE outcome measure and UE outcome measure, only the UE subtask elicited performance differences that were statistically significant. The results from our study indicate that the revised DTS is a promising and clinically feasible measure for use in SRC management.