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Browsing Theses and Dissertations by Author "Atler, Karen, committee member"
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Item Open Access College veterans' experiences of involvement in cognitive behavioral therapy for insomnia program(Colorado State University. Libraries, 2018) Smith, Jessica, author; Eakman, Aaron, advisor; Atler, Karen, committee member; Hughes, Shannon, committee memberObjective. Despite quantitative research which indicates that cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for chronic insomnia, there is little qualitative research which exists regarding the experiences related to participation and adherence. The purpose of this study was to explore veterans' experiences of adherence to a multicomponent CBT-I program and its impact on occupational engagement. Method. To answer the two research questions:1)What, from the perspective of veteran participants, influenced adherence to a multicomponent CBT-I program? And 2) How is adherence to multicomponent CBT-I experienced in relation to its impacts on occupational engagement? Qualitative data were gathered through the use of semi-structured interviews which were then transcribed and coded via a process of First and Second Cycle coding by three separate researchers. Self-Determination Theory (SDT) was used as a guiding framework to interpret results related to motivation in the current study due to its proven application in behavior change programs such as CBT-I. Results. Qualitative data analysis revealed the presence of three categories that captured the experience of adherence and occupational engagement as a result of participation in a CBT-I program: Extrinsic Forms of Motivation Influenced Adherence, Social Environment can Support or Hinder Adherence and Bidirectional Relationship between Activities and Routines. Extrinsic Forms of Motivation were influenced by the receipt of a reward, emotional responses (i.e. guilt), past experiences and understanding the mechanisms that impact sleep and gaining "tools" as a result of this understanding. An additional motivating factor came from the body itself. As the body's sleep-wake system became entrained as a result of continued adherence, participants experienced the body as motivating. The social environment was determined to be composed of factors within the home and outside of the home. Both people and obligations (such as being a part of a sports team) had the potential to support or hinder adherence to CBT-I components. Additionally, there was evidence that coursework and academic commitments associated with being a college student were important facets of the social environment that influenced participants' ability to adhere. Finally, research revealed that activities and routines played an important role in adherence. The restructuring of activities and the purposeful use of activities as a way to occupy waking time were strategies participants used to support adherence. The development of routines also went on to aid in building sleep drive, which in turn positively impacted adherence. Conclusion. The present study provides novel qualitative data regarding adherence and occupational engagement as a result of participation in CBT-I that can be understood in regards to three categories: Extrinsic forms of motivation influenced adherence, social environment can support or hinder adherence and bidirectional relationship between activities and routines. Designing CBT-I programs which are built on factors that are experienced as supportive has the potential to impact overall adherence and therefore effectiveness, of CBT-I programs.Item Open Access Effect of yoga and group occupational therapy on community reintegration and perceived activity constraints for people with chronic stroke(Colorado State University. Libraries, 2016) Bolster, Ruby, author; Schmid, Arlene, advisor; Atler, Karen, committee member; Portz, Jennifer, committee memberPurpose: People with stroke commonly experience perceived activity constraints, or barriers to engaging in activity, as well as challenges with community reintegration. The aim of this study was to assess the impact of an 8-week yoga and group occupational therapy (OT) intervention (Merging Yoga and OT: MY-OT) on perceived activity constraints and community reintegration among individuals with chronic stroke. We also assessed the correlation between perceived activity constraints and community reintegration in this sample. Method: This non-controlled pilot study employed a pre- and post-test design. Fourteen people with chronic stroke participated in MY-OT and completed assessments at baseline and at the completion of the 8-week intervention. Results on an established activity constraints questionnaire and the Reintegration to Normal Living Index (RNLI) were analyzed using Wilcoxon Signed Rank tests. Results: Perceived activity constraint scores improved significantly (76.82±10.97 vs 87.08±9.5, p=.005; 13% change), as did RNLI scores (79.25±15.45 vs 97.92±11.46, p=.004; or a 24% improvement). Perceived activity constraint and RNLI scores demonstrated an excellent and significant correlation (rs=.864, p=0.001). Conclusions: When working with people with chronic stroke, rehabilitation professionals may consider group OT combined with yoga. Rehabilitation professionals may target perceived activity constraints in order to improve community reintegration.Item Open 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 memberPeople 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.Item Embargo 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 memberA 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.Item Open Access Life after caregiving: understanding everyday resilience in the context of the bereavement phase of the caregiver journey(Colorado State University. Libraries, 2020) Seidle, Julie Silver, author; Sample, Pat, advisor; Atler, Karen, committee member; Eakman, Aaron, committee member; Fruhauf, Christine A., committee memberDementia is a progressive illness that results in cognitive decline for aging adults requiring increased assistance with everyday life as symptoms worsen over time. An illness that is found largely in older adults, dementia rates are rising with the aging population. Dementia often is considered one of the most challenging illnesses for caregivers, given its progressive nature and the individual's subsequent, increased, and complex care needs. Much of the daily care for individuals with dementia is carried out by family members including spouses. Due to the ever-changing complexity of dementia care, spousal dementia caregivers (SDCs) are at an increased risk for negative health and well-being impacts, compared to their non-caregiving cohorts. The caregiving trajectory for SDCs inevitably includes the loss of the spouse, which ushers in one of the most difficult and disruptive role transitions experienced during the life course. The caregiver journey, however, does not necessarily end when the individual with dementia dies, but begins the final bereavement phase of the caregiver journey. This dissertation examines the experience of SDCs and the role of resilience during the bereavement phase of the caregiver journey. I conducted a phenomenological study to increase our understanding of the everyday lived experience of resilience for SDCs during the bereavement phase of the caregiver journey. I also completed a phenomenographical study to capture how SDCs conceptualized their experience during the bereavement phase of the caregiver journey. I offer key takeaways from the studies, then discuss my research approach and recommendations for future research and practice addressing resilience and dementia caregiving. I end this dissertation by situating my work within Occupational Science and Rehabilitation Science.Item Open Access Phase-locking of gamma and beta in an auditory EEG paradigm and their relationship to self-reported sensory sensitivities(Colorado State University. Libraries, 2013) Phares-Zook, Kelly P., author; Davies, Patricia, advisor; Gavin, William, committee member; Atler, Karen, committee member; Seger, Carol, committee memberPhase-locking factor (PLF), one way to analyze electroencephalography (EEG) data, is the consistency of the brain's response in particular frequency bands to stimuli across multiple trials. Studies in the past have correlated PLF of different brainwave frequencies to behaviors; however, none have looked at the correlation to sensory sensitivities. The objective of the present study was to examine the relationship between PLF and behavioral measures in neurotypical adults. The participants were 38 neurotypical adults aged 18-25. This study involved an auditory paradigm in which three series of eight tones each were presented to the participant while he or she watched a movie. The first series presented eight tones that were identical, the second series presented a deviant tone in the 4th position with the other seven tones identical to the tones presented in the first series, and the third series had a deviant tone presented in the 5th position with the other 7 tones identical to the tones in the first series. These series of tones were presented in pseudorandom fashion while the participants' brainwaves were recorded with an EEG system. To examine the relationship between the consistency of the brain's response to these tones and sensory sensitivities, the participants filled out the Adult/Adolescent Sensory Profile (AASP). It was hypothesized that the PLF value at the onset of the first tone in the series of tones with no deviants would be greater than the subsequent tones in the same series. In the series of tones with no deviants, PLF for gamma (30-50 Hz) for tone 1 was higher than all but one of the PLF responses to subsequent tones. PLF in the beta region (18-30 Hz) in response to tone 1 was higher than the PLF response to all subsequent tones in the series with no deviants. Some, but not all, of these findings reached significance. It was also hypothesized that PLF at the onset of a deviant tone would be greater than PLF at the onset of non-deviant tones 2-8 in the same series. For the series of tones with a deviant in the 4th position, gamma increased from tone 3 to tone 4 for central electrode sites and decreased for frontal electrode sites, although none reached significance. For the series of tones with the deviant in the 5th position, PLF for gamma at tone 5 was greater than at tone 4 for 4/6 electrodes. For the series of tones with a deviant in the 4th position, PLF in the beta region increased from tone 4 to tone 5. For the series of tones with a deviant in the 5th position, PLF in the beta region increased from tone 4 to tone 5 for half of the electrode sites. It was hypothesized that PLF in response to the first tone of a series would not be significantly different from PLF in response to a deviant tone of the same series. PLF in the gamma region did not ever significantly differ from the first tone to the deviant tone. PLF in the beta region did not significantly differ from tone 1 to tone 4 in the series of tones with the deviant in the 4th position, but PLF for tone 1 was significantly higher than PLF for tone 5 for 2/6 electrode sites during the series of tones with the deviant in the 5th position. Lastly, it was hypothesized that individuals who have higher PLF will demonstrate low neurological thresholds as measured by the AASP. Spearman Rho correlations revealed that nearly all significant findings found between PLF and scores on the AASP were positive correlations. Results indicated that better phase-locking in the brain correlates positively with increased sensory sensitivities, as demonstrated by the AASP. Additionally, this study supports prior research indicating that a decrease in PLF does occur from tone 1 to tone 2 when the tones are identical, but questions whether PLF reflects habituation that may occur in response to three or more of the same stimuli.Item Open Access Sensory gating, habituation, and orientation of P50 and N100 event-related potential (ERP) components in neurologically typical adults and links to sensory behaviors(Colorado State University. Libraries, 2013) Greife, Catherine L., author; Davies, Patricia, advisor; Atler, Karen, committee member; Gavin, William, committee member; LaGasse, Ashley B., committee memberThis thesis project used a novel electroencephalography (EEG) auditory paradigm, the orientation/habituation paradigm, to understand brain processing in response to multiple auditory stimuli. This paradigm allowed the exploration of several neurological processes within one task: sensory gating, orientation to deviant stimulus, and habituation and dishabituation. Sensory gating has been studied extensively in individuals with neurological disorders (Arnfred & Chen, 2004; Boutros, Belger, Campbell, D'Souza, & Krystal, 1999; Kisley et al., 2003) and there are a few studies that have examined habituation and orientation in individuals with epilepsy or schizophrenia (Rosburg et al., 2004; Rosburg et al., 2006; Viswanathan & Jansen, 2010). The construct of dishabituation, referring to the brain's processing of standard stimuli after the presentation of a deviant stimulus, has not been studied previously. In addition to exploring these neurological phenomena, this project investigated the relationship between brain processing and scores on sensory behavioral inventories, the Adolescent/Adult Sensory Profile (Brown & Dunn, 2002) and the Sensory Gating Inventory (Hetrick, Erickson, & Smith, 2012). Participants were 38 neurologically typical adults (average age 19.6 ±1.46 years). These adults demonstrated significant sensory gating from stimulus 1 to stimulus 2 at all electrode sites (p < .0005). There was also a significant orientation effect of P50 and N100 to the deviant stimuli. There was no habituation of the P50 ERP component over time and there were mixed results regarding whether or not the P50 was dishabituated when a deviant tone was presented. In contrast to the P50, there were significant linear trends found for N100 at four of the five electrode sites, demonstrating habituation. Additionally, when presented with a deviant stimulus in the middle of a series of standard stimuli, N100 was not dishabituated, and in some cases demonstrated significant increase in habituation after the deviant stimulus. These results indicate that there is some sort of cognitive control over the suppression of the N100 amplitude that is not seen for the suppression of P50. Finally, when correlated with sensory behavior tasks, sensory gating of N100 amplitude was significantly associated with Sensation Avoiding on the Adolescent/Adult Sensory Profile (A/ASP) (Brown & Dunn, 2002). Increase in P50 amplitude to the deviant stimulus, reflecting orientation, was significantly negatively correlated with both Over-Inclusion and Fatigue and Stress Vulnerability of the Sensory Gating Inventory (Hetrick, Erickson, & Smith, 2012) and positively with the Sensation Seeking quadrant of the A/ASP. Increase in N100 amplitude to the deviant stimulus, reflecting orientation, was significantly related to the Touch Processing subscale of the A/ASP.Item Open Access The meaning in occupation: a meta-synthesis of eleven qualitative research articles from the Journal of Occupational Science(Colorado State University. Libraries, 2014) Rumble, Morgan, author; Eakman, Aaron, advisor; Atler, Karen, committee member; Steger, Michael, committee memberThe presence of meaning in one's life is recognized to be important for fostering health and well-being. Humans create meaning through occupation, but whether there are similarities across the components of meaning for individuals remains unanswered. Meaning is revealed through language and narrative, which necessitates a qualitative, interpretive approach to its study (Polkinghorne, 1988). Qualitative research has supplied rich data about the meaning of occupation for various cultures, populations, and activities, but to-date, there has not been a systematic review to identify if general patterns of meaning and experience exist in occupation. Following a framework synthesis approach to qualitative meta-synthesis, the current exploratory study examined positive subjective experiences associated with occupation to uncover elements of the meaning of occupation. Two higher-order themes were discovered, social meaning and selfhood, that contained multiple themes as well as four additional themes including satisfaction, pleasure/enjoyment, stimulating, and health and well-being. Complex interconnections between themes also arose and are discussed.Item Open Access The therapeutic use of yoga in occupational therapy for individuals with stroke(Colorado State University. Libraries, 2018) Andrews, Alexandra P., author; Schmid, Arlene A., advisor; Atler, Karen, committee member; Portz, Jennifer Dickman, committee memberThe purpose of this study was to provide a description of the experiences of occupational therapists (OT) who are currently using yoga in occupational therapy practice for individuals that have experienced a stroke. Specifically, this study aimed to understand how and why OTs may be integrating yoga into rehabilitation for stroke. Ten OTs from around the United States completed a survey and comprehensive interview. Interview data was analyzed using an iterative process and both deductive and inductive coding. Themes in the data emerged related to the perceived benefits of integrating yoga in occupational therapy for stroke including: how yoga promoted client-centered recovery; that yoga brought "context" to therapy; and how yoga could be used to address multiple physical, emotional, and psychosocial needs following stroke. Based on these findings, yoga is currently being integrated into health care and specifically into occupational therapy. Yoga may be a beneficial means of therapy for individuals post-stroke to aide in physical and psychosocial rehabilitation and increase reintegration into life after stroke. While this study highlights a sample of OTs using yoga in practice, these findings do not serve as a guideline for OTs, but rather describe why OTs have chosen to use this complementary approach.Item Open Access Type II diabetes mellitus self-management: relating diabetes distress, social support, self-efficacy, and performance of diabetes self-care activities(Colorado State University. Libraries, 2020) Dawson, Christine, author; Malcolm, Matthew, advisor; Atler, Karen, committee member; Williford, Anne, committee memberType 2 Diabetes Mellitus (T2DM) is a widespread chronic disease that negatively impacts an individual's health and well-being, particularly when uncontrolled. Due to the nature of T2DM, individuals are responsible for the challenge of self-managing the disease. Several factors act as barriers and facilitators to self-management, but the literature has failed to establish consensus about how these factors interact with one another. The present study utilized a correlational design to examine the relationships among diabetes distress, social support, self-efficacy, and performance of diabetes self-care activities. A total of 33 adults with T2DM participated in the study by completing a battery of surveys regarding performance of diabetes self-care activities and psychosocial factors. Self-efficacy was associated with diabetes distress (ρ = -.419). Support satisfaction was related to both self-efficacy (ρ = .495) and diabetes distress (ρ = -.431), although relationships were not found with other aspects of social support. We did not find any significant relationships among the psychosocial variables and performance of diabetes self-care activities, though both psychosocial factors and performance of diabetes self-care activities were linked to key health indicators like A1C and BMI. Our findings suggest that these psychosocial factors should be areas of interest for healthcare practitioners, researchers, and individuals with T2DM. Diabetes distress, self-efficacy, and social support should be assessed and monitored, in addition to performance of diabetes self-care activities. Future research should continue to explore relationships among psychosocial and contextual factors and their potential impact on ability to successfully self-manage T2DM.Item Open Access Understanding the experience of type 2 diabetes using multiple methods and perspectives(Colorado State University. Libraries, 2019) Klinedinst, Tara C., author; Malcolm, Matt, advisor; Gloeckner, Gene, committee member; Atler, Karen, committee member; Nelson, Tracy, committee member; Chard, Chrissy, committee memberTo view the abstract, please see the full text of the document.