- ItemEmbargoOccupational therapists' perspectives on their unique role in pelvic health(Colorado State University. Libraries, 2023) Fyhrie, Jennifer, author; Schmid, Arlene A., advisor; Weaver, Jennifer, committee member; Fruhauf, Christine A., committee memberIntroduction: Pelvic floor dysfunction (PFD) may present as urinary/fecal incontinence, pelvic organ prolapse, and/or pelvic pain. These symptoms have been shown to cause disruption to individuals' activities of daily living and decrease quality of life. Conservative estimates indicate 28 million women are affected by PFD worldwide. The core of occupational therapy (OT) is to mitigate barriers to engagement in occupations of one's choosing, yet there is a gap in the literature detailing occupational therapy practitioners' (OTP) perspectives on their unique contributions in pelvic health. Methods: This exploratory descriptive study utilized an online survey to purposively recruit OTPs and screen individuals for an interview. Inclusion criteria required that participants a) be a licensed or retired OTP, b) have at least one year experience as an OTP, and c) have any professional experience in pelvic health. One-on-one semi-structured interviews occurred on a virtual platform, were audio-recorded, and transcribed. Using Dedoose software, thematic inductive analysis was conducted. Results: Thirty-one individuals completed the survey, 21 were eligible to participate, and 13 participated in an interview. It was found that OTPs believe they offer a unique contribution to the pelvic health field. Three primary qualitative themes were generated that elaborate on this belief: OTPs apply a psychosocial lens, the OT approach is comprehensive, and OTPs use occupation-focused interventions when working with people with PFD (e.g., consider the influence of client mental health as client preferences, culture, and lifestyle). Conclusion: This study identified the perceptions of OTPs regarding their unique approach to working with clients in pelvic health. Data suggests that OTPs complement the biomechanical focus of other pelvic health providers by recognizing the role of mental health and intervening to down-regulate the nervous system.
- ItemEmbargoInvestigating 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.
- ItemEmbargoPromoting adherence to cognitive-behavioral therapy for insomnia in the medically complex case(Colorado State University. Libraries, 2023) Lovell, Emily R., author; Eakman, Aaron, advisor; Weaver, Jennifer, committee member; Broussard, Josiane, committee memberObjective. The purpose of this study is to explore how a medically complex case responded to cognitive-behavioral therapy for insomnia (CBT-I) in a community-based setting based on adherence to treatment recommendations. Method. A mixed-methods retrospective case study design was used to explore answers to two research questions: 1) How effective is CBT-I for an individual with insomnia comorbid with bipolar disorder? 2) How is CBT-I tailored for an individual with insomnia comorbid with bipolar disorder in a real-world setting? 3) How do we assess adherence to CBT-I delivered by an occupational therapist? Data sources included sleep diaries, service logs, pre-/post-treatment assessments, and interviews with the client and therapist. Results. Improvements in sleep latency, wake after sleep onset, early morning awakening, total sleep time, and sleep efficiency were observed. The most noteworthy improvements were a gain of almost two hours of total sleep time and a post-treatment SE of 95%. Likewise, scores on the Insomnia Severity Index, Epworth Sleepiness Scale, Sleep Disorders Symptoms Checklist-25, Dysfunctional Beliefs and Attitudes about Sleep scale, Sleep Hygiene Index, Quick Inventory of Depressive Symptomatology, and Patient Health Questionnaire-9 all improved to the extent that the client no longer met criteria for chronic insomnia. Overall adherence to the behavior components of CBT-I was very high. High motivation and scheduling and engaging in activities emerged as factors that promote adherence from the interview conducted with the client. A therapeutic relationship emerged as a factor that promotes adherence from the interview conducted with the therapist. Conclusion. CBT-I can be safely delivered by occupational therapists to individuals with bipolar disorder. Large improvements in sleep were observed and the client had high adherence to treatment protocols.
- ItemEmbargoOccupational therapists' perspectives and role with illness-induced trauma from medical conditions(Colorado State University. Libraries, 2023) Beyers, Camryn, author; Schmid, Arlene A., advisor; Weaver, Jennifer A., committee member; Currin-McCulloch, Jen, committee memberIllness-induced trauma might cause a disruption in an individual's occupational performance. This study examined occupational therapy practitioner's perspectives and role in addressing illness-induced trauma in practice. In this explanatory sequential mixed methods design, twenty-four occupational therapists completed an online survey and ten occupational therapists participated in a semi-structured 1:1 interview. Survey questions asked about their knowledge of illness-induced trauma. Interview questions asked therapists about how they incorporate illness-induced trauma knowledge and trauma-informed care into their practice. Quantitative results showed that the majority of occupational therapists did not receive formal trauma-informed care training, 96% agreed that psychological trauma has a significant impact on rehabilitation outcomes, and 8% agreed that current guidelines for trauma-informed care adequately consider the needs of clients with illness-induced trauma. Qualitative results indicated three major themes: occupational therapy approaches, illness-induced trauma's effect on rehabilitation, and barriers to providing trauma-informed care. Findings suggest that occupational therapy practitioners have a unique perspective on addressing illness-induced trauma and their ability to practice trauma-informed care could support a client's ability to process and heal after a traumatic medical event.
- ItemEmbargoOccupational therapists: the quarterbacks of pelvic healthcare(Colorado State University. Libraries, 2023) Le Fevre, Eleanor, author; Schmid, Arlene, advisor; Weaver, Jen, committee member; Fruhauf, Christine, committee memberBackground: The ability to effectively manage chronic issues has a large impact on a person's quality of life. Pelvic floor dysfunction (PFD) is a chronic and debilitating disorder which affects millions of people worldwide. PFD is often placed lower in the hierarchy of treatable medical conditions yet has a substantial impact on a person's functional capability. Pelvic health occupational therapists (PHOT)s are emerging practitioners in PFD management. PHOTs provide a client-centred, holistic approach to care. To date PHOT is not well described in the literature or well known in the practice of pelvic healthcare. Aim: To investigate the perceptions of PHOTs, their value in the management of PFD, and how this value is communicated to other healthcare providers (OHCP)s. Methods: This qualitative research study included a demographic survey and one-to-one interviews with PHOTs and lead researchers. Thirteen PHOTs were interviewed by a lead researcher and provided data on their perceptions and interactions with OHCPs. Data collection was completed over a five-month period from July 2022-December 2022. Data collection ended once saturation in responses was reached. Data were analyzed by lead researchers using an in vivo coding process, creation of categories and code book. I created themes and sub-themes driven by the data. Results: Two main themes were created from the data with PHOT participants supporting inclusion of OT in pelvic healthcare; (1) pelvic healthcare is an interdisciplinary field; (2) more practitioners are needed in PHOT. Conclusion: PHOTs perceptions and value on interdisciplinary teams are key to increased communication between PHOTs, OHCPs, and the clients they serve. Further research is needed to define the PHOT role and impact as part of an interdisciplinary team.