Theses and Dissertations

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Open Access
Girls, boys and a top: gender/environmental differences and a test of playfulness: research version 2
(Colorado State University. Libraries, 1996) Tyler, Rebecca Elin-Geis, author; Bundy, Anita C., advisor; Barrett, Karen Caplovitz, committee member; Short-DeGraff, Peggy, committee member
The effects of gender and the environment on children's playfulness scores using the ToP were examined. Videotapes of 124 children, ages 19 to 118 months were scored by trained raters. One hundred and seven were typically-developing children, seventeen of the children had known disabilities. Results revealed that gender does not appear to be a factor that affects the scores. Also, age does not seem to produce any differences in the scores. However, playfulness scores do appear to differ between the indoor versus the outdoor environment. Six items (Pretends (Ext), Challenges (Ext), Challenges (Int), Exuberance, Plays with Others, and Plays interactively) seem to account for the difference found between the settings. This research suggests that the ToP appears to transcend gender, age and activity. Further research is needed to determine if the ToP in fact, needs to be given in both the indoor and outdoor environments.
Open Access
Do American adults value play and playfulness in children? An exploration of parents' attitudes towards playfulness in their children
(Colorado State University. Libraries, 1996) Pascual, Zennifer Asa, author; Bundy, Anita C., advisor; Barrett, Karen Caplovitz, committee member
The recent trend in American culture grants play and a playful attitude vital places in adult life, and shies away from work as the governing activity of one's life. Previous research, however, found that adults did not value play in their children. This study explored whether American adults' attitudes now support the recent trend recognizing the importance of play and playfulness in children. American parents of preschool children responded to a questionnaire investigating their attitudes towards play and playfulness. Their responses indicated that American adults recognize the value of play for its own sake and can identify the significant individual dimensions that comprise playfulness. Noteworthy was the low valuation parents placed on the sense of humor dimension, for humor is synonymous with playfulness. Discussion on the significance of the results, recommendations for future research, and a review of the history of play, work, and child-rearing attitudes in America are provided.
Open Access
Validity of the AMPS for children and adolescents
(Colorado State University. Libraries, 1996) Poulson, Todd Lars, author; Fisher, Anne G., 1946-, advisor; Fritz, Janet J., 1942-, committee member; Gliner, Jeffrey A., committee member
A vast number of assessments are available for occupational therapists to measure the functional independence of their clients, however, the majority were developed primarily for use with adults and older persons. A scarcity exists of reliable and valid functional assessments of personal activities of daily living (PADL) and instrumental activities of daily living (IADL) for testing children and adolescents. As a result, PADL or IADL assessments designed for use with adults have been applied to the pediatric population, often without being reevaluated for validity or reliability. Unlike most existing tests of PADL or IADL, the Assessment of Motor and Process Skills (AMPS) is unique in that it was designed to be used with school-age children, adolescents, adults, and older persons. The AMPS is a standardized IADL assessment tool used to evaluate a person's functional performance in terms of both motor IADL and process IADL ability. The AMPS was used to evaluate a sample of 162 school-age children and adolescents who had no known diagnosis. Subject goodness-of-fit statistics, generated by the many-faceted Rasch analysis, were examined to determine whether children and adolescents fit the many-faceted Rasch measurement model defined by the AMPS adult calibration sample. Overall findings suggest that school-age children and adolescents demonstrated subject goodness-of-fit to the AMPS process scale, but failed to demonstrate acceptable subject goodness-of-fit to the AMPS motor scale. These findings were supplemented with an analysis of the proportion of individual item ratings that were unexpected or misfit. On both scales, the proportion met our criterion, which was based on a previous analysis of adult well and older well subjects. In addition, we divided the sample into two groups based on age. The comparison of the two groups revealed that for the AMPS motor scale, 88% of misfitting subjects were 8 years of age or younger. This suggests that subjects 8 years of age or younger were more likely to misfit than were subjects 9 years of age or older. Of the 16 AMPS motor skill items only one item, Lifts, was significantly different for children and adolescents than for the AMPS adult calibration sample. However, no meaningful difference was found in young children's subject ability measure, regardless whether the item Lifts was included in the analysis. The results of this study support the use of the AMPS with school-age children and adolescents, although it is important for occupational therapists to be aware that young children may tend to misfit on the AMPS motor scale. In addition, recognizing the lack of valid and reliable assessments of IADL available for children and adolescents, the AMPS meets the need for a standardized evaluation for this population.
Open Access
African American parental values and perceptions toward children's playfulness
(Colorado State University. Libraries, 1997) Porter, Carolyn A., author; Bundy, Anita C., advisor
Since play is the primary occupation of children, and parents have a significant influence in children's lives, it is important to understand the values, beliefs, and childrearing goals of parents in a multicultural society. This study explored the relationship between African American parents' values and beliefs about playfulness and their children's observed playfulness. Forty-seven African American parents from a middle socioeconomic background and their children participated in this study. Observational assessments, the Test of Playfulness (ToP; Bundy, 1997) and the Children's Playfulness Scale (CPS; Barnett, 1990) were used to measure a child's playful approach. Parents completed questionnaires about their children's playfulness (CPS), and their children were observed during free play (ToP). The findings revealed that African American parents shared similar values about playfulness to parents from other cultures. African American parents valued the social and joyful aspects of playfulness highly, whereas items reflecting humor were valued the least. Also, the CPS and ToP are both valid measures of playfulness with African American parents and their children. The results suggested that mothers may be more accurate in judging children's playfulness than fathers. Cultural influences, parental experience, and parents' developmental goals may be contributing factors. Discussion on the significance of the results, recommendations for future research, and a review of African American theoretical conceptions, family characteristics, parental beliefs, and the relationship of play and culture are highlighted.
Open Access
Validity and reliability of a test of environmental supportiveness
(Colorado State University. Libraries, 1997) Harding, Pamela S., author; Bundy, Anita, advisor; Barrett, Karen C., committee member; Hanzlik, Jodie Redditi, committee member
Through playful interactions with people and objects an individual gains valuable knowledge about the world around them. These interactions are also crucial to nurturing play. Research shows the most prominent features of the environment that affect a child's play are--caregivers, playmates (of all ages), objects, and the physical surroundings. The development of a valid way to measure these important features is a crucial step in achieving the knowledge needed to promote play and playfulness. The Test of Environmental Supportiveness (TOES) was designed to provide a comprehensive picture of the environmental features that can affect play. The TOES assesses not just if the features are present but whether or not they are supportive for each child's play. This study investigated the TOES for preliminary validity and inter-rater reliability for use with children 19 to 121 months. The results show promise of both content and construct reliability as well as inter-rater reliability. The TOES was also found to be an easy tool to use requiring no special equipment. Minimal training is needed to score the items.
Open Access
Guatemalan and Nicaraguan children and the test of playfulness
(Colorado State University. Libraries, 1998) Phillips, Heather Ann, author; Bundy, Anita C., advisor; Pressel, Esther, committee member
As play is influenced by culture, culture is influenced by play. Hence, it is important for professionals who work with children from different cultural backgrounds to evaluate play in their young clients. Objective evaluation demands reliable and valid instruments. The purpose of this study was to (a) determine whether the Test of Playfulness (ToP) demonstrates preliminary interrater reliability for Spanish speaking children in Guatemala and Nicaragua; and (b) examine if the ToP demonstrates preliminary construct validity? Specifically, will data from all raters conform to the expectations of the Rasch model even though the raters represent a different socioethnic background? And, will data from at least 95% of the children reflect goodness of fit to the Rasch measurement model? In addition, characteristics of childrearing in Hispanic families, the relationship between play and culture, and the influence of resilience in "at-risk" children are reviewed. Fifteen Guatemalan children with no known disabilities and 15 Nicaraguan children with and without known disabilities participated in this study (16 girls, 14 boys; age range 14 months to 17 years). Goodness of fit statistics generated with Rasch analysis revealed that data from 100% of raters and 97% of participants conformed to the expectations of the Rasch measurement model. Thus, we concluded that the ToP is valid and reliable; that is, the ToP reflects a construct of playfulness that is cross-cultural and it can be given reliably by raters from different socioethnic backgrounds. In addition, the findings revealed several things about Guatemalan and Nicaraguan children's play. (a) The high scores received by many of the children on the ToP suggested these are very playful children (12 of 30 received scores over 1.0). And (b) unexpected ratings on some items may reflect minor cultural variations in playfulness or the effect of raters from different socioethnic backgrounds. Implications and the need for further research are discussed.
Open Access
Preliminary reliability of the occupational therapist teacher interaction scale
(Colorado State University. Libraries, 2010) Hottovy, Janine Marie Angello, author; Spencer, Karen C., advisor; Daunhauer, Lisa A., advisor; Barrett, Karen Caplovitz, committee member
This preliminary study sought to identify a reliable means of capturing and rating interactions between occupational therapists (OTs) and teachers according to the dyads' qualities of collaboration. Five OT and teacher dyads were recorded in their authentic environments as participants discussed on-going student needs. Judgment study methodology, including using "thin slice" segments from the videotaped interactions, was employed. A coding scheme was created specific to this study's question and by a panel of judges to code the collaborative characteristics of each dyad's interaction. This coding scheme, the Occupational Therapist Teacher Interaction Scale (OTIS), included 23 items and was divided into three subdomains: OT Interaction Qualities, Teacher Interaction Qualities, and Pair Interaction Qualities. Data was analyzed to determine effective reliability using intraclass correlations. Results showed that all three OTIS subdomains achieved effective reliability with an ICC of greater than .75 and that 18 of the 23 individual items did as well. These findings indicate that judgment methodology and the OTIS are reliable means of capturing and rating collaboration between OTs and teachers. Further research is indicated to assess validity of the findings and begin to correlate collaborative practice with student outcomes.
Open 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.
Open 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.
Open 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.
Open 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.
Open Access
Activity participation and motivation in Down syndrome
(Colorado State University. Libraries, 2010) Clader, Emily Jo, author; Daunhauer, Lisa, advisor; Fidler, Deborah J., committee member; Wall, Elizabeth, committee member; Wood, Wendy Hower, committee member
This paper examines activity participation, motivational style, and daily living skills in the Down syndrome (DS) behavioral phenotype. Children with DS (n = 26) and mixed-etiology intellectual disability (ID, n = 18) ages 5 - 22 participated. The CBCL was used to assess activity participation, the Reiss Profile MR/DD measured motivational style, and the VABS measured daily living skills. Children with DS were more motivated by independence than children with ID (p = .001). In the DS group, sports participation was negatively associated with pain avoidance (r = -.429) and frustration avoidance (r = -.518) but positively associated with daily living skills (r = .452). Daily living skills were negatively associated with curiosity. Though children with DS were motivated by independence, this was not necessarily related to function. Individuals with DS may need heightened tolerance for frustration and even pain to maintain motivation for physical activity. Implications for intervention are discussed.
Open Access
The test of everyday attention for children: a confirmatory factor analysis approach
(Colorado State University. Libraries, 2011) Passantino, Deborah, author; Davies, Patricia, advisor; Gavin, William, committee member; Diehl, Manfred, committee member
As the incidence of children diagnosed with Autism Spectrum Disorders (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) continues to grow, the need for objective measures of attentional performance is clearly warranted for evaluating attentional differences and guiding intervention. This study examined the multidimensional nature of attention. Previous research suggests that there may be three types of attention: selective attention, control shift attention, and sustained attention. One hundred and eleven children age six to twelve completed the nine subtests of the Test of Everyday Attention for Children (TEA-Ch, Manly, Robertson, Anderson & Nimmo-Smith, 1999). Using a confirmatory factor analysis approach, this study sought to determine whether a three-factor model, as supported in a prior confirmatory factor analysis study with Australian children (Manly, Nimmo-Smith, Watson, Anderson, Turner, & Robertson, 2001), could be replicated with an American sample, or alternatively if a four factor model, with the addition of divided attention, would better explain the covariance structure of this study's data. An additional objective addressed in this study was whether the three-factor model could be improved by using raw scores while taking the effects of age and gender into account compared the three factor model using scaled scores. A two factor model was also explored due to high correlations between the latent factors in the three factor model. Confirmatory factor analysis indicated that a two-factor model using age-scaled scores best explained the covariance structure in this sample's data, χ2 (26, N=111) = 34.65, p = .120, NFI = .79, NNFI = .89, CFI = .92. Whereas, the three-factor model using age-scaled scores was less desirable, χ2 (24, N=111) = 34.63, p = .074, NFI = .79, NNFI = .86, CFI = .91. Although not as strong as some of the comparative fit indices of the Manly et al. (2001) normative study, overall the indices of fit of this study's two-factor model yielded a better solution than the three-factor model. These results suggest that selective attention and control shift attention may not reflect separate constructs of attention as shown in the Manly, et al. (2001) study. Additionally, the use of age-scaled scores in the three-factor model was superior to raw scores with age and gender controlled, χ2 (24, N=111) = 42.07, p = .013, NFI = .71, NNFI = .75, CFI = .83. Furthermore, the four-factor model using age-scaled scores, χ2 (21, N=111) = 34.25, p = .034, NFI = .79, NNFI = .81, CFI = .89 was also less desirable than the two-factor model using age-scaled scores. Because this study confirms the ability to assess multidimensional aspects of attention, the TEA-Ch may be a valuable tool for practitioners and researchers. However, one possible drawback of the TEA-Ch is the hour required for children to complete its nine subtests. A briefer screening tool of the first four subtests of the TEA-Ch is suggested when time constraints arise. However, further analysis is recommended to determine if the four subtests in the TEA-Ch screening tool are optimal. Thus, additional research is needed with respect to shorter multidimensional assessments of attention to inform intervention and consequently improve the quality of life for children with attentional differences.
Open Access
Pediatric traumatic brain injury: investigating factors associated with problematic behaviors
(Colorado State University. Libraries, 2011) Darnell, Holly, author; Sample, Pat L., advisor; Daunhauer, Lisa, committee member; Stallones, Lorann, committee member
Children with traumatic brain injury (TBI) are currently under-identified and under-served in the American school system. The present study investigated factors associated with problematic behaviors including gender, number of head injuries and reported symptoms. Parents of students in grade school (K-12) from three research groups (children with TBI, children with learning disabilities and typically developing children) rated their child's behaviors and symptoms, and provided an injury history using the Brain Check Survey. Contrary to current literature, in the present study boys were not found to have more severe behaviors than girls overall for the TBI group, but rather both genders were rated similarly on behaviors. Analysis between behaviors and number of injuries was not completed as the TBI sample lacked variability in the number of injuries sustained per child. More severe symptoms were correlated with more severe behaviors overall for all three groups, with the TBI group demonstrating the strongest associations and more severely rated behaviors overall. Occupational therapists should consider that girls with a TBI may exhibit behaviors as severe as boys when evaluating children in order to ensure a proper diagnosis. Symptoms associated with behaviors being exhibited in children also should be evaluated and treated, as such interventions may result in improved behaviors.
Open Access
Staff satisfaction in a long term care facility undergoing culture change
(Colorado State University. Libraries, 2012) Knight, Kerri Lyn, author; Wood, Wendy, advisor; Sample, Pat, committee member; Vacha-Haase, Tammi, committee member
An instrumental case-study look at perceptions of staff satisfaction at a long-term care facility undergoing the process of implementing culture change reforms was presented. Participants included CNAs, RNs and LPNs, managers, and therapists and therapy aides who participated in homogeneous and heterogeneous forum group discussions. Dissatisfaction was found in the work environment, breakdown of communication, and perceptions of leadership; satisfaction was found in enforcement of accountability, successful communication, suggestions for improvement and meaningful work experiences. The main conclusion was that the opportunities for empowerment are vital to staff members' experience of satisfaction; specifically, supporting staff authority and acknowledging effort, implementing systematic communication, cultivating positive relationships, and implementing staff suggestions to optimizing psychological benefits of the work experience.
Open Access
Attentional demands do affect amplitudes of N1 and N2 in the sensory gating paradigm in neurotypical adults and children
(Colorado State University. Libraries, 2012) Phelan, Shannon E., author; Davies, Patricia, advisor; Gavin, William, committee member; Cleary, Anne, committee member
Past research has shown that N1 and N2 ERP components may be related to attention; however, few studies have measured N1 and N2 amplitudes when attention was manipulated. In this study, two ERP sensory gating paradigms were used in which attention was manipulated by requiring participants either to focus their attention on the auditory stimuli (FA) or to watch a movie that distracted them from the auditory stimuli (SGM). To examine the relationship of N1 and N2 amplitudes to performance on three types of attention (selective, sustained, and control/switch) all participants completed the Test of Everyday Attention for Children (TEA-Ch). Participants were 23 healthy adults aged 20-30 and 20 typically developing children aged 6-10. Across both groups, N1 amplitude was significantly larger for the FA compared to the SGM paradigm, F(1, 36) = 40.62, p < .001, and for the first click compared to the second, F(1, 36) = 40.62, p < .001. Adults showed larger N1 amplitudes compared to children and group main effect approached but did not reach significance, F(1,36) = 3.211, p = .082. Across both groups, N2 amplitude showed a trend for being larger in the SGM compared to the FA paradigm, F(1, 23) = 3.91, p = .06, and the first click was significantly larger than the second, F(1, 23) = 22.38, p < .001. Adults showed a trend for larger N2 amplitudes compared to children although group main effect did not reach significance, F(1,23) = 1.841, p = .188. For N2, significant interactions for paradigm x group, F(1, 23) = 4.12, p = .05, and click x group, F(1, 23) = 5.21, p = .03 were found. Separate regression analyses controlling for group membership revealed that subtest scores from all subsystems on the TEA-Ch were significant predictors of N1 amplitude for click 2 in the FA paradigm only; selective attention and control/switch attention subtest scores were the strongest predictors. Sustained attention and control/switch attention subtest scores of the TEA-Ch significantly predicted N2 amplitudes for click 1 in the FA paradigm only. The results suggest that N1 amplitude increases when attention is directed towards the task for adults and children alike. Alternatively, N2 amplitude shows a trend for increased amplitude when attention is directed away from the stimuli and children respond differently than adults. N1 has shown that it may represent a more global type of attention while N2 may be related to an ability to dismiss information.
Open Access
Utility of the participation and environment measure for children and youth (PEM-CY) for programmatic assessment and intervention planning: a mixed methods study
(Colorado State University. Libraries, 2013) Cliff, Anna Beth, author; Khetani, Mary, advisor; Schelly, Catherine, committee member; Daunhauer, Lisa, committee member
The purpose of this mixed methods sequential explanatory study was to examine the utility of the Participation and Environment Measure for Children and Youth (PEM-CY) for use by a community service agency, Adaptive Recreation Opportunities (ARO), for programmatic assessment and service planning to promote children's community participation. The study used two distinct, interactive phases, which included collection and analysis of quantitative data (Phase 1) and sequential collection and analysis of qualitative data (Phase 2) to determine if qualitative results could be used to further explain results from the quantitative phase. The first phase of the study (quan) included gathering PEM-CY data from 23 families who were receiving services from ARO to better understand patterns in children's community participation and environmental supports and barriers to participation in community activities. Results from Phase 1 were summarized into a report and used during Phase 2 (QUAL) to gather the perspectives of 7 ARO staff via semi-structured interviews. Phase two findings suggest that ARO staff perceived the PEM-CY to provide for a more comprehensive and detailed initial assessment process to identify individual and program-level needs. Providers were also able to delineate a core decisional process for leveraging PEM-CY results to develop an intervention plan with families. Future validation with parents and considerations for enabling collaborative and feasible uptake of the decisional process by parents and providers is discussed.
Open Access
Factor analysis of the Brain Check Survey
(Colorado State University. Libraries, 2013) Pickle, Sarah, author; Sample, Pat, advisor; Greene, David, advisor; Daunhauer, Lisa, committee member
Children who have a traumatic brain injury (TBI) are under-identified and lack appropriate educational supports to help them achieve their academic goals. Because TBI can greatly impact a child's ability to succeed at school, there is a need for a convenient and effective way to screen for TBI in students who are struggling in school so they can obtain appropriate school-based services. The purpose of this study was to work toward establishing construct validity for the Brain Check Survey (BCS), which is a parent-report questionnaire intended to help school personnel screen for possible TBI in students. The BCS can act as a starting point in the process of qualifying students for Special Education, a 504 Plan, or Response to Intervention assistance. In five different school districts in Colorado, parents completed the BCS for their child who was recruited from one of three groups: has identified TBI, is currently receiving special education services for diagnosed specific learning disabilities, or is considered typically developing. Construct validity was tested using multiple factor analyses: 1) all participants combined (typically developing, traumatic brain injury, and specific learning disability), 2) elementary, middle, and high school level categories of all participants, and 3) all ages from the typically developing group only. These factor analyses confirmed the two-factor construct of the BCS that measures student Symptoms and Behaviors. The analysis also gave insight into two distinct aspects of behaviors that the instrument is measuring: Cognitive Processing and Behavior Control. The positive findings from this factor analysis study suggest that the BCS has strong construct validity and can be effective in screening students for possible TBI.
Open Access
Occupational therapy and time use of people with dementia in long term care facilities: confirming a conceptual practice model
(Colorado State University. Libraries, 2013) Lampe, Jenna L., author; Wood, Wendy, advisor; Eakman, Aaron, committee member; Lynham, Susan A., committee member
This study aimed to further develop a dementia-specific, occupational therapy conceptual model, the Lived Environment Life Quality (LELQ) Model, by asking: how do expert occupational therapists understand and promote positive time use patterns of residents with dementia in long term care facilities? Although occupational therapists are well-situated to promote such patterns for residents with dementia, time use has not been a focus of practice. Using an action research approach, six occupational therapists were chosen through selective sampling of extreme cases. Data were collected via twelve 90-minute interviews and six focus groups. Data analysis included coding, peer review, matrix and thematic analysis, and reflexive journaling. Overall, participants confirmed time use as represented by the LELQ Model as valid. While time use patterns were implicit in their practices, they viewed every moment as a possible moment of engagement and residents as if wearing a quilt with colorful squares symbolizing potential for meaningful daily time use. Participants also recognized that workers in dementia care can sometimes view residents with dementia through a pessimistic lens akin to a gray and stifling quilt, one symbolizing lack of potential for positive time use and leading to staff alienation and negative spiraling of residents' quality of life. Conclusions are that the LELQ Model is a valid conceptual practice model tool for promoting a focus on time use patterns as a vital quality of life indicator. Further, focusing on occupational engagement across the day can be seen as the core of occupational therapy philosophy, a means to avoid occupational deprivation, and a moral obligation of occupational therapists.
Open Access
Pediatric traumatic brain injury and educational identification: estimating injury severity using data from a TBI screening tool
(Colorado State University. Libraries, 2013) Holzrichter, Sarah, author; Sample, Pat, advisor; Greene, David, committee member; Daunhauer, Lisa, committee member
Traumatic brain injury is a significant source of disability in children and its sequelae can significantly impact a child's academic abilities and school success. Only a small percentage of children who sustain a TBI, however, will receive academic supports specific to TBI, whether through an IEP, 504 plan, or Response to Intervention. The Brain Check Survey (BCS) is a parent-report screening tool designed to be used in educational settings to screen for past incidents that may have caused brain injuries as well as for behaviors and symptoms that may be related to a past TBI and that are impacting a specific student's school performance. In the state of Colorado, having a parent complete the BCS is one of the steps used to determine if a child has a "credible history" of brain injury that is necessary to qualify the child for services. As of yet, however, there are no guidelines given for how to interpret the portion of the BCS that inquires about past incidents that may have caused a brain injury. The purpose of this study was to develop a model for interpreting this portion of the BCS and for roughly estimating the severity of any of the student's past head-related injuries. An Injury-Severity Classification Model (ISCM) was developed and inter-rater reliability tested for its use. Data from completed BCS forms collected in five different Colorado school districts were used for analysis. Additionally, preliminary testing of the model's construct validity was conducted using the resulting severity groups and their presenting behaviors and symptoms as reported on the BCS. High inter-rater reliability was established for the ISCM and its utility was demonstrated for estimating past injury severity among students already identified as having sustained a TBI and receiving services, as well as among students currently receiving no special services. Recommendations are made for revisions of the Injury-Severity Classification Model (ISCM) and for future research.