This study investigated the differences in required push, pull and rotating forces for moving fully loaded, floor-based and overhead-mounted full body patient lifting devices with simulated patients of varying weight on a floor of optimal design (i.e. level vinyl tile over concrete). A single person operated the lifting devices for all of the tests. Eighteen male and female volunteer participants, ranging in weight from 51 to 146 kg, acted as patients during the lifting tests. For each test, the simulated patients were pushed and pulled for 3.7 linear metres and were rotated while sitting in the lift slings. Force measurements were acquired using two single axis dynamometers affixed to the lifting devices. Results revealed that, in general, operator input force and torque increased with patient weight category and floor-based lifts required greater force and torque compared to the overhead-mounted lift. Comparison of the required forces with published force limits reveals that the required push and pull force from the various patient lift systems, across all weight categories, were generally acceptable to 90% of the female population. The required forces for these patient transfer tasks, however, could exceed maximum acceptable force limits if the floor surfaces were less than ideal, such as floors composed of carpet, wood, or inclined surfaces. Additional research is needed to assess these conditions.

The present study investigated whether knowledge of results, in the form of visual and audible feedback, would increase the accuracy of time-telling in an individual with an intellectual disability. A 19-year-old male with mild intellectual disability participated in this A1-B1-A2-B2 single-subject study design. The task involved correctly identifying the time given on a computer. Data, based on the Wilcoxon signed-rank test, showed that the participant demonstrated a greater number of correct responses during the intervention phases. Incorporating knowledge of results into a learning strategy for this individual with intellectual disability resulted in an increased ability to accurately identify the correct time on an analogue clock. There is a need to replicate the study design to increase the external validity and generalization of results. The strategies described in the present study may also be useful for occupational therapists who teach individuals with intellectual disability to gain skills in their everyday activities of daily living (ADLs). Copyright (c) 2007 John Wiley & Sons, Ltd.

Content: Intrauterine exposure to maternal diabetes and large size at birth are known risk factors for the subsequent development of insulin resistance and metabolic syndrome (MSX). Although Hispanic youth have been shown to have a high prevalence of MSX, it is unknown whether metabolic abnormalities and a predisposition for glucose intolerance are present at birth. Objective: To determine if abnormalities in insulin sensitivity (SI) exist at or soon after birth in large for gestational age (LGA) neonates born to Hispanic women with and without gestational diabetes. Design/Patients/Setting: Forty-two term Hispanic neonates were enrolled for cross-sectional studies at 24-48h after birth and included: 9 LGA neonates delivered of women with gestational diabetes (LGA-IDM), 12 LGA but not IDM neonates, 11 poorly grown (at 5-10(th)%) and 10 appropriate for gestational age (AGA) neonates. Insulin sensitivity and secretion were measured by shortened fasting intravenous glucose tolerance test. Main Outcome Measure: Insulin Sensitivity Index (SI) within 48h of birth. Results: Neonates were studied at 36+/-11h postnatal, and all groups were euglycemic at the time of study. However, the SI was significantly lower (P<0.05, ANOVA) in LGA-IDM (3.0+/-0.7[SEM] mU/L.min) and LGA-nonIDM (2.2+/-0.4 mU/L.min) cohorts in comparison to poorly grown (5.0+/-0.7 mU/L.min) and AGA controls (5.4+/-0.8 mU/L.min). Insulin secretion did not differ between groups. Conclusions: Reduced SI is present soon after birth in Hispanic LGA neonates born to mothers with and without gestational diabetes, demonstrating the onset of insulin resistance before birth and evidence of altered fetal programming.

OBJECTIVE: To investigate whether the performance of a multisegment motor task is influenced by reading a segment-specific action word. METHOD: Twenty-four participants performed tasks that involved reaching for a bottle, grasping it, lifting and placing it on a shelf, and returning their hand to the starting position. At the initiation of each task, participants read either aloud or silently five randomly provided, task-related words (reach, grasp, lift, place, and return). RESULTS: Reading task-related words significantly affected the reach and lift/place segments in the direction of the hypothesis (p < 0.05) but not the return segments. Grasp times were shorter and grasp velocities were higher when participants read aloud or silently the words grasp and place for the grasp segment (p < 0.05). CONCLUSIONS: The results suggest that in young adults, motor performance may be influenced by precuing or priming the brain with performance-related words. A meaning of a motor performance can be manipulated by contextually relevant language, which can facilitate performance.

OBJECTIVE: A common practice in occupational therapy is to have clients choose an object that they prefer to be used during treatment. This practice assumes that a preference for chosen items will hold greater meaning and result in higher quality of movement. Little research has been conducted that specifically addresses the effect that preference has on quality of movement. Therefore, the purpose of this study was to contribute to the knowledge by determining whether preference affects quality of movement. METHOD: Forty-three healthy right-hand-dominant adult women between the ages of 18 and 60 years in Northwest Ohio engaged in this study. Each participant rank-ordered 15 magazines from most preferred to least preferred. The participant then reached for her most preferred, neutrally preferred, and least preferred magazines. RESULTS: When participants reached for the neutrally preferred magazines, movement time was significantly slower and movement units were significantly greater (less smooth) than when they reached for a magazine perceived as being the least preferred (p <.017). No differences were found between the three conditions in terms of displacement, peak velocity, or percentage of time to peak velocity, nor between the most preferred and the other two preferences. CONCLUSION: This study has shown that preference may not be an influential factor when performing simple reaches for magazines. Although there was a difference between the neutrally preferred and least preferred conditions, the goal when reaching during the neutrally preferred condition may have been different (i.e., to glean more information from the magazine cover) than when reaching in the least preferred condition (e.g., to reach for and discard the magazine as quickly as possible). These results reflect the complexity involved in the formation of meaning, of which preference is a part. Further exploration of individual preferences as well as personal goal formation and their impact on success in occupations of daily living is needed.

OBJECTIVE: Developing useful movement with the affected extremity in persons with cerebrovascular accidents (CVAs) is a common occupational therapy goal. The purpose of this study was to examine the effects of perceived risk in an occupational form on upper-extremity movement dynamics in persons who have had CVAs. METHOD: Twenty-eight persons (M = 69.6 years, SD = 15.6 years) with post-CVA participated in the randomly assigned, repeated measures counterbalanced study. In the higher risk condition, participants reached for and grasped a raw egg in an egg carton, transported it, and placed it in a bowl with other raw eggs. The same procedure was completed in the lower risk condition with weight-matched plastic eggs. Participants completed both conditions with their affected and unaffected upper extremities. Dependent variables included total movement time and movement units. RESULTS: The higher risk condition produced statistically significantly longer movement times (p < or =.001), but no difference in movement units (p >.05) compared to the lower risk condition. The affected extremity had significantly longer overall movement times (p < or =.001), but no difference in movement units (p >.05) compared to the unaffected extremity. CONCLUSION: When higher levels of perceived risk are present in an occupational form, slower movements are elicited among persons who have had a CVA. The occupational therapist can grade tasks from relatively lower risk to tasks with relatively higher risk to help patients achieve desired variability in their movement patterns. By doing this, the patient will be better prepared for everyday situations that vary widely in degree of risk.

The purpose of this study was to investigate the effect of high versus low frequency knowledge of results (KR) in a group of 16 individuals with developmental delay and in gender and age-matched average individuals learning a motor skill on a laptop computer. Participants were randomly assigned to either a 100% KR or a 50% KR group. KR was provided during the acquisition phase according to group assignment as participants learned the motor skill, whereas no KR was provided during the retention phase. Results indicated both populations who received 50% KR in the acquisition phase demonstrated better performance in the retention phase than those who received 100% KR. The results of this study suggest that, as has been found in the average population, feedback that is too frequent can interfere with learning and retention of tasks for individuals with developmental disabilities (DD). Limitations involved the small sample size along with the task potentially being artificial in nature. Future research is needed to study further the effects of frequency of KR on skill acquisition, particularly in instrumental activities of daily living in this population.

OBJECTIVE: Occupational therapists are routinely involved in upper-extremity rehabilitation in persons with stroke. Recently we have reported that self-speech can be used to facilitate simple reach in young and older adults. The purpose of this study is to examine whether self-speech-induced facilitation of simple reach can be translated in persons with stroke. METHOD: Following a counterbalanced repeated-measure design, seven persons with right brain stroke performed reaching and placing a glass on a cabinet shelf under four concurrent speech conditions of vocalizing the word "yeah" with both hemiplegic and nonhemiplegic sides. These four conditions are self-vocalization, external vocalization, imaginary vocalization, and no vocalization. Consistent with our previous study, in this study we also recorded the movement kinematics of angular movement of the upper arm. RESULTS: Reaching velocity was significantly higher under self-vocalization conditions compared to the reaching velocity under no vocalization or other vocalization conditions (p <.05). Motor performance in terms of velocity, nonhemiparetic side was significantly better than hemiparetic side (p <.05). CONCLUSION: The results suggest that self-speech can be used in facilitating movements in patients with stroke. When working with patients with right hemispheric stroke, therapists might explore possibilities of using patient's self-speech to enhance the quality of movement performance.

OBJECTIVE: To investigate interlimb coupling in an adult population with left hemiplegia and an age-matched control group to better understand the unique motor control issues in stroke rehabilitation. DESIGN: A chi-square analysis was performed to compare the distribution of participants adopting a given movement pattern ratio during 2 different bimanual movement tasks for both groups. The task involved oscillating the upper limbs at the elbow in asymmetric patterns, with 1 limb oscillating at twice the frequency of the other. SETTING: Testing was done in the subjects' residences or in an outpatient clinic. PARTICIPANTS: Participants were between the ages of 45 and 75 years (mean +/- standard deviation, 63+/-9.4y), right handed, and included 18 left hemiparetic and 18 control subjects. Selection criteria for the hemiparetic group included status after nonhemorrhagic stroke within the distribution area of the right middle cerebral artery (RMCA). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Relative phase of the upper extremities. RESULTS: The hemiplegic group produced predominantly an in-phase 1-to-1 movement pattern, whereas the control group exhibited antiphase, 2-to-1 movement harmonics and, to a lesser extent, in-phase movement patterns. CONCLUSIONS: This study suggests that brain damage caused by stroke in the RMCA distribution area results in the reduction of selectable interlimb movement patterns. Specifically, bimanual upper extremity movement tended to be highly coupled in an in-phase movement pattern. Research is needed to examine the ability of stroke survivors to learn bilateral upper-extremity tasks at less stable levels of interlimb coupling.

The purpose of this study was to compare upper extremity range of motion when using a straight-handled long-handled sponge versus a bent-handled long-handled sponge. Thirty-eight participants ranging in age from 20 to 55 years were randomly assigned to one of two order groups: straight-bent or bent-straight. The task involved touching a buzzer placed over thoracic vertebrae 6 and 7 with the long-handled sponge. The dependent variable was right upper extremity range of motion. Significant range of motion differences were found in wrist flexion-extension, elbow flexion-extension, and shoulder abduction-adduction between the straight-handled and the bent-handled long-handled sponge (p <.05). No significant differences were found with ulnar and radial deviation of the wrist, wrist supination-pronation, or shoulder flexion (p >.05). These results suggest that within a normal population, the bent handle may be more beneficial to individuals who have decreased range of motion in shoulder abduction-adduction and wrist flexion-extension, whereas the straight handle may be more accommodating to those with decreased range of motion in the elbow. Implications for therapeutic evaluation include ensuring proper evaluation of range of motion of all upper extremity joints in order to provide assistive devices that serve individual needs. Future research should include special populations with upper extremity orthopedic conditions as well as different degrees of handle bending with the long-handled sponge.