Theses and Dissertations

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Open Access
A neurological approach measuring attentional variations among children with high-functioning autism spectrum disorder, sensory processing difficulties and age-matched peers
(Colorado State University. Libraries, 2015) Marshall, Emily A., author; Davies, Patricia, advisor; Gavin, William, committee member; Khetani, Mary, committee member; LaGasse, Ashley Blythe, committee member
Children with high functioning autism (HFA) and children with sensory processing difficulties (SPD) can have challenges processing auditory stimuli, which may contribute to difficulties with performance of everyday tasks. Few studies assess relationships between neurological measures with behavioral attention measures, yet the benefits of doing so are invaluable in understanding the brain and behavior connections in children who have difficulties processing sensory information. Therefore, this study focuses on examining the impact of neurological auditory processing on performance on tasks that require attention among children with HFA, SPD and typically developing (TD) controls. Participants included 20 children with HFA (mean age = 8.94 ± 2.03 years), 9 children with SPD (mean age = 6.57 ± 1.26 years), and 22 TD gender and age-matched peers (mean age = 8.46 ± 2.39 years). Groups were compared according to behavioral assessment of everyday task performance and a neurological paradigm. The Test of Everyday Attention for Children (TEA-Ch) evaluates a child's attention during tasks that correspond with three subtypes of attention, while the orientation and habituation electroencephalography (EEG) paradigm allows for sensory gating and habituation neural processing measurement and analysis. Based on the TEA-Ch scores, children in with HFA and SPD groups had significant differences with attention demands, especially in the domains of control/shift and sustained attention, when compared to the TD group. On the neurological measures, children with HFA displayed similar sensory gating abilities as compared to TD peers, including a reduction of both N1 and N2 amplitudes from tone 1 to tone 2, while children with SPD showed difficulties with sensory gating of N1 amplitudes only. Habituation analysis revealed significantly larger N2 amplitudes at tone 8 when compared to tone 2 among all groups suggesting that habituation does not occur for N2 amplitude among children in all three groups. A significant interaction occurred between tone and group for N1 amplitudes of children with SPD and the control group suggesting that the children in the control group did not habituate but the children in the SPD group did habituate. Analysis of N1 and N2 amplitude responses to tone 1 in a train without a deviant resulted in no significant differences among all three groups. However, while no differences were found between groups for the first tone, for N1 both HFA and TD groups had significant larger amplitude to the deviant tone in the 5th position, as compared to amplitude of brain response to the tone prior to the deviant. Children with SPD also had significantly larger N1 and N2 amplitudes to the deviant tones in the 4th and 5th positions, when compared to the amplitudes to the tone prior to the deviant. SPD and TD groups had an interaction at N2 amplitudes in the train with the deviant in the 4th positions. The SPD group displayed increased amplitudes at N2 to the deviant while TD decreased N2 amplitudes to the deviant. Regression analysis was conducted to assess relationships between the subtests of the TEA-Ch data and the neurological auditory processing phenomena. For the TD group this analysis revealed a strong relationship between attentional control/shift tasks and N2 amplitudes at tone 1 in the series without a deviant. For children with HFA, there was a significant relationship between attentional control/shift tasks and N1 amplitudes at tone 1 in the train without a deviant. Children with SPD also had a relationship between selective attention measures and N1 amplitudes at tone 1 in the train without a deviant. Results suggest that children with HFA, SPD and TD controls have distinct neuronal profiles related to attention. A better understanding of these group differences may help to elucidate the differential impact of auditory processing capacities on task performance in children with disabilities. This knowledge may inform how occupational therapists select therapeutic approaches, scaffold attention demands, and stimulate the adaptive response during interventions focused toward improving everyday task performance.
Open Access
A picture of traumatic brain injury identification policy in U.S. schools by state
(Colorado State University. Libraries, 2015) Mathias, Kelsey, author; Sample, Pat L., advisor; Greene, David, committee member; Daunhauer, Lisa, committee member
The Individuals with Disabilities Education Improvement Act of 2004 (IDEA, P.L. 108-446) gives definitions for each disability category and general eligibility criteria that apply to all of the disability categories. Each state is allowed by IDEA to have their own definitions for each category, and it is up to the individual states whether they require more specific guidelines for eligibility criteria or if they want to use what is written in the legislation. This study examines the definition and eligibility criteria each of the 50 states in the United States use specifically for the traumatic brain injury (TBI) disability category. In this nation-wide descriptive study, members of the Department of Education for each state were contacted either to verify definitions and eligibility criteria uncovered from existing documentation found through the National Association of State Head Injury Administrators and state Department of Education websites; update the data that were found; or provide data that were missing from the initial search. Results indicated that 45 states fit in the “federal definition category,” and 6 states fit in the “own definition category” for the TBI definitions. For eligibility criteria, 27 states fit in “medical identification,” 11 states fit in “discretion of IEP team,” and 12 states fit in the “no TBI specific criteria” category. Currently, all states identify less than 1% of students receiving special education services as having a TBI, with the exception of Massachusetts (5.11%). The findings of this study demonstrate the discontinuity within the states in the policies and procedures used to determine special education eligibility.
Open Access
A pilot study: inhibition in eating behavior of children through eating in the absence of hunger paradigm and electroencephalography
(Colorado State University. Libraries, 2017) Karges, Sunny, author; Davies, Patti, advisor; Gavin, Bill, advisor; Johnson, Susan, committee member; Shomaker, Lauren, committee member
Objective. Eating behaviors contribute to the issue of obesity. The purpose of this research is to determine if there is an association between neural inhibition and behavioral inhibition relating to eating in children (age 4-6 years). Method. Neural inhibition was measured via EEG recordings during go/no-go task using visual food cues. Behavioral inhibition was measured via the amount consumed in free access phase of Eating in the Absence of Hunger (EAH) protocol. Other outcome measures included: Child Feeding Questionnaire (CFQ), a survey developed based on the Picky Eating in Toddlers and Preschoolers Questionnaire, and body mass index (BMI) measurements. Results. This study found a significant correlation between BMI and kcal consumed in free access phase of EAH protocol (p=.006). This study did not find significant correlation between neural inhibition, as measured by N2 amplitude during no-go tasks, and kcal during free access phase. Conclusions. Neural processing of young children possibly varies from that of older children and adults. Further research should be conducted to determine the development of neural processing in children as well as the relationship between development and behavioral inhibition related to eating behaviors.
Open 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.
Open Access
A systematic mapping review of animal-assisted therapies for adults with Alzheimer's disease and related dementias: implications for occupational therapy
(Colorado State University. Libraries, 2016) Rose, Michelle, author; Wood, Wendy, advisor; Hooper, Barbara, committee member; Bruemmer, Jason, committee member
The objective of this thesis was to map the current state of knowledge of animal-assisted therapies (AAT) for people with Alzheimer’s disease and related dementias (ADRD) and to derive implications for occupational therapy in addressing dementia-specific quality of life (QoL). This study located 13 peer-reviewed articles related to AAT for adults with ADRD. These articles were written in English, published between 2004-2014, primary sources, and described a health professional as either designing or providing AAT. A data extraction tool was used to record data on the health professionals, participants, interventions, outcomes, and theories. All 13 articles described an outcome related to dementia-specific QoL, hence confirming that the AAT literature addresses QoL for adults with ADRD. Furthermore, 85% of these articles mentioned interventions that were activity-based, thus empathizing that activities, or occupations, may elicit positive outcomes related to QoL. These findings suggest that using animals in therapy may facilitate positive change. These results were also easily “mapped” on to a widely adopted and influential model in occupational therapy, the Person-Environment-Occupation Model. Therefore, incorporating animals into intervention plans in occupational therapy offers a promising avenue for addressing QoL for this population.
Open Access
A systematic mapping review of equine-assisted activities and therapies for children with autism: implications for occupational therapy
(Colorado State University. Libraries, 2015) McDaniel, Brittany Caitlin, author; Wood, Wendy, advisor; Hooper, Barbara, committee member; Bruemmer, Jason, committee member
Equine-assisted activities and therapies (EAAT) are often used to promote the health and wellbeing of children with autism. However, the diverse body of literature investigating the effects of EAAT has yet to be systematically synthesized. This study aimed to determine the current state of knowledge pertaining to the use of EAAT for children on the autism spectrum in relation to their ability to participate in everyday occupations where they carry out their lives at home, school, and in the community. A systematic mapping review identified the empirical methods, treatment strategies, theories, and outcomes present in the literature. Database searching and a rigorous process of inclusion and exclusion identified 25 peer-reviewed papers relevant to EAAT for children with autism. Data were extracted from each paper and analyzed in Microsoft Access and Microsoft Excel. Eighty percent (20 papers) of the literature was research, all of which employed quantitative designs. The most commonly studied treatment strategies were therapeutic riding (10 papers) and hippotherapy (4 papers). A variety of theories for why EAAT may be therapeutic were proposed, including the movement of the horse, horse-human interaction, positive reinforcement, social interactions, and sensory processing. A variety of outcomes were studied, including communication, sensory processing, balance, autism severity, behavior, and quality of life. Strengths and gaps of knowledge are identified, leading to recommendations for future practice and research.
Open 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.
Embargo
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.
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.
Embargo
Acute care rehabilitation utilization, access, and outcomes among hospitalized adults with traumatic brain injury
(Colorado State University. Libraries, 2024) Bukhari, Rayyan A., author; Graham, James, advisor; Weaver, Jen, committee member; Davalos, Deana, committee member; Sharp, Julia, committee member
Objective: The purpose of this dissertation was to conduct three research studies aimed at gaining a comprehensive understanding of the barriers and facilitators to equitable access to and timing of rehabilitation services, community discharge, and unplanned 90-day post-discharge hospital readmission among individuals hospitalized with Traumatic brain injury (TBI). Introduction: There are approximately 2.5 million TBI-related emergency department visits, 288,000 TBI-related hospitalizations, and 61,000 TBI-related deaths reported each year (Centers for Disease Control and Prevention, 2019). TBI is associated with high rates of disability, including limitations in performing basic activities of daily living (ADLs), such as self-care, and/or in performing physical tasks, such as mobility (Klima et al., 2019; Jessica Lo et al., 2021; Whiteneck et al., 2016). Individuals who are hospitalized with TBI should receive equitable access to multidisciplinary care, including rehabilitation services (occupational therapy [OT], and physical therapy [PT]) to address potential self-care issues, physical limitations, and cognitive deficits (National Academies of Sciences & Medicine, 2022). Early onset of acute care rehabilitation services can have positive long-term benefits for patients, including improved function, increased mobility, and enhanced quality of life (Andelic et al., 2012; Bernhardt et al., 2017; C. Y. Wang et al., 2021). A primary focus of acute care rehabilitation services is to improve patients' functional performance (Ejlersen Wæhrens & Fisher, 2007). Following acute care stays, community discharge is generally viewed as quality care indicator in acute care settings (Department of Health and Human Services [HHS], 2019). Readmission is a common concern for those who have chronic illnesses or injuries, and it is associated with higher healthcare expenses and lower quality of care (Jencks et al., 2009). Readmission rates after TBI contribute considerably to these costs, making lowering readmission rates a universal goal (Canner et al., 2016). Despite research advances and policy changes, barriers and challenges remain facing individuals with TBI (National Academies of Sciences & Medicine, 2022). Not all individuals with TBI have early access to rehabilitation services, are discharged to the community, or can avoid hospital readmission. Although several studies have addressed these issues in general population, variability in community and personal level factors among individuals with TBI need to be addressed (Office of Disease Prevention and Health Promotion & Services., 2020). Therefore, these dissertation studies are aimed at providing empirical support, further understanding, and increasing our knowledge around factors that influence individuals with TBI acute care rehabilitation services utilization and outcomes. Method: This dissertation is comprised of three studies. In Study One, we investigated how Social Determinants of Health (SDoH) impact access to and timing of rehabilitation services. Multivariable logistic and Cox regression analyses (i.e., time-to-event analyses) were used to calculate odds ratios for the likelihood of receiving OT and PT services, and hazard ratios for the duration to initiation of services among those who received these services. In Study Two, we explored whether the relationship between acute care OT/PT utilization and community discharge is moderated by functional or physical performance at discharge. Multivariable moderation logistic regression models were used to calculate odds ratios for the likelihood of community discharge among those who utilized OT/PT services. In both OT and PT models, we computed the main effect of OT/PT utilization on community discharge, the main effect of functional/physical (ADL/Mobility) performance scores at discharge on community discharge, and the moderating effect of ADL/mobility scores on the relationship between OT/PT utilization and community discharge. In Study Three, we examined the association between discharge functional status and unplanned hospital readmission. Logistic regression was performed to calculate odds ratios for the likelihood of unplanned 90-day hospital readmission among those who received rehabilitation services during their acute care stay. Results: In Study One, all community-level SDoH such as education attainment, income, and rurality did not show significant associations with access to or timing of acute rehabilitation services (p-values= 0.09 – 0.95). In Study Two, both ADL/mobility performance scores at discharge significantly moderated the relationship between OT/PT utilization and community discharge (ORs= 0.99, 95% CIs [0.98, 1.00]). In Study Three, neither discharge functional nor mobility scores were associated with readmission (p-values= 0.14 – 0.17). Among the three dissertation studies, several covariates such as age, presence of a significant other, race/ethnicity, health insurance type, TBI severity, length of stay, and comorbidity burden showed significant associations with access to or timing of acute rehabilitation services, community discharge, and readmission status (p-values= 0.04 – <0.001). Conclusion: Further investigations are needed to 1) ascertain whether our community-level SDoH variables, based on the first three digits of zip codes, adequately capture individual experiences and their impact on healthcare, or if community-level education, income, and rurality genuinely do not affect access to and timing of therapy services for hospitalized patients with TBI; 2) determine whether the consideration of ADL/mobility scores at discharge alone limits our understanding of the relationship, failing to encompass other patient-level factors that could either facilitate or impede a safe community discharge; and 3) determine whether discharge functional and mobility scores were too restrictive in capturing the full benefits of acute care rehabilitation services in reducing the risk of unplanned 90-day readmission risk in hospitalized patients with TBI.
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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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Advancing the transition to employment for young adults with intellectual disabilities through assessment, self-report, and learning from lived experience
(Colorado State University. Libraries, 2024) Parsons, Cristina C., author; Persch, Andrew C., advisor; Schmid, Arlene A., advisor; Graham, James, committee member; Hickey, Matt, committee member; Cleary, Dennis, committee member
This dissertation seeks to advance the transition to employment for young adults with intellectual disabilities through three distinct approaches. First, we explore the construct of self-determination specifically as it pertains to the employment of young adults with intellectual disabilities. Second, we intentionally refine an assessment of "vocational fit" for self-report by young adults with intellectual disabilities. Third, we examine how young adults with intellectual disabilities and their families experience barriers to engagement in self-advocacy in navigating complex systems intended to assist with the transition to work. In Study 1, we found evidence to support the idea that the context of employment plays a bigger role in the construct of self-determination than is explicated in current self-determination theories. We learned in Study 2 that young adults with intellectual disabilities can interpret and respond appropriately to a self-report version of a vocational fit assessment. In Study 3, findings taught us that the complexities of support systems intended to assist young adults with intellectual disabilities in reaching their employment goals drastically affects their and their families' ability to advocate for their rights and needs. Taken together, these studies present a multi-faceted approach to improved assessment, inclusion, and access necessary for the successful transition to employment for young adults with intellectual disabilities.
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
An adapted group yoga intervention: the lived experience of individuals with chronic traumatic brain injury
(Colorado State University. Libraries, 2017) Roney, Megan A., author; Schmid, Arlene A., advisor; Sample, Pat L., advisor; Stallones, Lorann, committee member
The purpose of this qualitative phenomenological study was to explore the experiences of individuals with chronic traumatic brain injury (TBI) who participated in an adapted group yoga intervention. Participants attended one-hour yoga sessions twice a week for eight weeks and described their experiences through focus groups and individual interviews. Data accumulated were analysed using a coding process to generate themes of what experiences occurred, how experiences occurred, and why experiences occurred. Participants described experiencing the yoga intervention as a progression from initially expecting physical benefits from yoga to feeling safe and comfortable in the yoga intervention classes and among fellow participants, and to experiencing physical, emotional, and cognitive changes. Participants stated that these experiences carried over into their daily lives, positively impacting their health maintenance and social participation. Participants attributed their experiences to various structural strategies of the intervention including commonalities among participants, the instructor's dual knowledge of yoga and therapeutic rehabilitation, as well as the adaptability of yoga to their personal needs. Additionally, participant experiences were attributed to a re-conceptualization of what yoga should look and feel like, enhanced body awareness, and feeling supported. The fact that the participants generally expressed beneficial outcomes indicates the need to further research adapted yoga interventions for the population of individuals with chronic TBI.
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An exploratory cross- case study of parent and teacher perspectives on children's kindergarten experiences following play-based early childhood education
(Colorado State University. Libraries, 2024) Fyffe, Lisa Ann, author; Davies, Patricia, advisor; Schmid, Arlene, advisor; Quynn, Kristina, committee member; Jennings, Louise, committee member
Play has been the foundational pedagogical approach to early childhood education dating back to the days of Plato (428-347 B.C.E..) and Socrates (469-399 B.C.E.). Yet recent changes in public policy emphasizing academic content mastery at kindergarten entry threaten the tradition of play as the dominant means of learning for young children enrolled in early childhood education centers. Early childhood professionals argue that pedagogy emphasizing approaches to learning, social relationships, and self-management are essential in preschool, and prepare children for subsequent academic instruction. Parents, fearful that their child will not be ready for kindergarten if they are not exposed to academics early on, place pressure on privately funded early childhood centers to provide academic rigor under the guise of school readiness. The desire for children to develop learning readiness through playing stands in contrast to educational reforms priorities of standardized instruction and measurable academic results to support efficacy in early childhood education programs. Early childhood educators, in response to public policy and parental expectations, may design their preschool curriculum with an academic emphasis, thus disrupting the tradition of play as the dominant means of learning for young children. For play to retain its' importance in early childhood education, research will need to demonstrate how play prepares children for kindergarten. This dissertation explores how children fared in kindergarten following play-based early childhood education at a Reggio-Emilia-inspired preschool. The Reggio Emilia-inspired philosophy of early childhood education emphasizes artistic expression, child-led exploration, engaging environments and collaborative relationships to promote children's curiosity and joyfulness with learning (McNally & Slutsky, 2018). Play-based learning is a pedagogical approach to early childhood education grounded in guided play, where the adult curates a learning context towards an educational goal and the child maintains agency and some degree of freedom to explore and discover while learning (Zosh et al., 2018). Cross-case analysis was used to gain a deep understanding of the experiences of four children navigating kindergarten during the Covid-19-affected 2020-2021 school year. Data included: a series of three 1-hour interviews with four mothers and three kindergarten teachers at the onset, midpoint and conclusion of the school year, field visits during remote learning, and artifact collection including work samples and progress reports. The most substantial findings from this longitudinal study center on three main constructs: school readiness, everyday adaptability, and kindergarten performance, which are each addressed in the three manuscripts included in the dissertation. Finally, I situate my dissertation within the Occupation and Rehabilitative Science framework and conclude my dissertation by describing the implications of this dissertation of occupational therapy practice and future scholarship.
Open Access
An exploratory study of an equine-assisted intervention for people with dementia living in a residential care facility
(Colorado State University. Libraries, 2017) Busselman, Sarah L., author; Wood, Wendy, advisor; Hooper, Barb, committee member; Breummer, Jason, committee member
There are an estimated 5.3 million Americans diagnosed with Alzheimer's disease or related dementias (Alzheimer's Association, 2015) and the prevalence of dementia is predicted to rise to one million new cases per year. As there is no cure for dementia, health care for people with dementia has begun to incorporate nonpharmacological approaches that aim to improve quality of life. Environmentally based approaches, such as music therapy, aromatherapy, and animal-assisted interventions were found to be effective nonpharmacological interventions for people with dementia (Padilla, 2011b; Wood, Hoesly, Rose, & McLure, in press). Initial evidence produced by Dabelko-Schoeny et al. (2014) indicates that an equine-assisted intervention for people with dementia is feasible and can reduce problematic behaviors. The current mixed methods exploratory case study aimed to investigate: 1) the negative and positive quality of life indicators, and 2) environmental correlates of positive and negative quality of life indicators, specifically occupational opportunities and environmental supports, that are offered during an equine-assisted intervention. The program selected for this study was Riding in the Moment, an equine-assisted intervention for people with dementia. I video recorded observations of four participants during four one-hour sessions of Riding in the Moment. I used the Activity in Context and Time (Wood, 2005) to code quality of life indicators present during eight of the sixteen recorded observations. During the program, I recorded field notes, which were qualitatively analyzed using the Lived Environment Life Quality Model (Wood, Lampe, Logan, Metcalfe, & Hoesly, 2016) to describe the occupational opportunities and physical and social environmental supports. Results revealed that participants with dementia demonstrated more and longer durations of positive quality of life indicators in comparison to negative quality of life indicators during Riding in the Moment. Qualitative findings revealed a number of occupational opportunities offered, such as riding, grooming, and petting the horse. Qualitative findings also revealed various physical and social environmental supports that were critical to supporting engagement. Overall, the Riding in the Moment program was an engaging, equine-assisted intervention that promoted autonomy in an enriched environment.
Open Access
Assessing the immediate impact of a movement tracking-based intervention for unilateral spatial neglect experienced by stroke survivors
(Colorado State University. Libraries, 2015) McFarland, Roxie, author; Malcolm, Matt, advisor; Greene, David, committee member; Pasricha, Sudeep, committee member
To view the abstract, please see the full text of the document.
Open Access
Assessing the impact of a music therapy program on attention in children with autism using behavioral and neurophysiological measures
(Colorado State University. Libraries, 2021) Coates, Carolyn, author; Davies, Patricia L., advisor; Merz, Emily, committee member; Stephens, Jaclyn, committee member; LaGasse, Blythe, committee member
Children with Autism Spectrum Disorders (ASD) are known to have difficulty with auditory sensory processing. Music therapy is a common intervention approach for children with autism to address numerous behavioral and sensory challenges using auditory stimuli. Auditory processing capabilities have also been linked with attention skills and with attentional challenges often observed in children with ASD. This study seeks to understand the differences between children with ASD and their typically developing peers in auditory processing and attention. An additional study goal is to evaluate impacts of a music therapy protocol on those constructs. Baseline measurements were collected for 10 children with ASD using the Test of Everyday Attention in Children (TEA-Ch) and EEG under a sensory registration paradigm. These data were compared to those of age- and sex-matched typically developing peers (n = 10). The children with ASD participated in biweekly music therapy over 5 weeks for a total of 10 sessions and then completed the same assessments during a post-test. The sensory registration paradigm measured passive responses to four auditory tones at two different intensities (50 and 70 dB) and two different frequencies (1 and 3 kHz). The resultant event related potentials (ERPs) were averaged into a waveform for each child at each tone and amplitudes and latencies were calculated for N1, P2, N2 and P3 components. The TEA-Ch resulted in an overall attention score and a score for each of three subdomains of attention: sustained, selective and switching. Results indicated that children with ASD performed more poorly on the TEA-Ch with significantly poorer scores in overall attention, selective attention, and sustained attention. A series of independent sample t-tests on ERP components revealed few significant differences but a trend of increased latency at N1, P2, and N2 in children with ASD for each of the four tones. Children with ASD had lower amplitude of N1 components and greater amplitude P2 components compared with the typically developing children. Following the music therapy intervention, children with ASD improved significantly in selective attention and showed a trend of improvement in switching and total attention compared to pre-testing scores. The music therapy did not result in statistically significant changes in EEG results, but a trend of increased latency was noted for N1, P2, and N2. Amplitude of the P3 component decreased following the music therapy intervention in response to the high and loud tone when age was used as a covariate. Some significant associations were found between the latency of N1, P2, and N2 and sustained and selective attention in response to the 1kHz 70dB tone across all participants at baseline (TD children and children with ASD before music therapy). In conclusion, this study shows that children with ASD have different neural processing of simple auditory tones and reduced performance in multiple domains of attention. The music therapy intervention is a promising approach to improving attention skills. The intervention did not appear to alter neural processing in the expected way of children with ASD performing more like their typically developing peers. Further research at this foundational level of neural processing may help clarify the differences in processing between children with ASD and their typically developing peers and may provide a way of monitoring interventions which seek to alter neural processing to target attentional skills and behaviors.
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
Auditory sensory processing in children with sensory processing disorder and autism spectrum disorder
(Colorado State University. Libraries, 2016) Pott, Christine Elizabeth, author; Davies, Patricia L., advisor; Gavin, William J., committee member; LaGasse, Blythe, committee member
Sensory processing has long been a topic of interest in the field of occupational therapy. This study sought to replicate the results of Davies and Gavin (2007) which examined differences in auditory sensory processing between children with sensory processing disorder (SPD) and typically developing (TD) children as well as expand the results to a sample of children with high functioning autism spectrum disorder (ASD). Additionally, this study sought to relate the neurophysiological measures of sensory processing to a behavioral assessment measuring sensory processing. We hypothesized that the results of Davies and Gavin (2007) would be replicated and expanded to include children with ASD and measures from the Sensory Profile (SP) would relate to the participants' neurological measures of sensory processing. 62 TD children, and 21 children each with SPD and ASD were recruited as part of a convenience sample. Participants’ brainwaves were recorded through electroencephalography (EEG) while they watched a silent movie and listened to a sensory gating paradigm consisting of two paired clicks and a sensory registration paradigm consisting of 4 tones of varied intensity and frequency. From the sensory gating paradigm P50 amplitudes were obtained. From the sensory registration paradigm amplitudes and latencies for N100, P200, N200, and P300 were obtained. Analyses revealed that while the results of Davies and Gavin (2007) were partially replicated, in that sensory gating was able to be significantly predicted from sensory registration the same pattern of sensory hyper and hypo-responsivity was not observed. Results indicate that the Sensory Profile does in part relate to the neurophysiological measures of sensory processing. This study confirmed that auditory sensory processing does differ between children with SPD, children ASD, and TD children. It contributes to occupational therapy's understanding of sensory processing in children and also towards increased understanding of how the SP relates to underlying neurological mechanisms.