Student Research Projects 2018

Evaluation of PostureCoach: A Wearable Real-time Biofeedback Device to Prevent Lower Back Pain in Novice Caregivers
Chloe Ng and Kevin Ledda
Introduction: Poor posture during patient handling tasks is a determinant of low back injury in caregiving settings. Traditional training programs relying on lecture-based teaching of body mechanics has shown to be ineffective. The use of real-time biofeedback during caregiving tasks has potential as an alternative training intervention.
Objectives: This study aimed to investigate the user acceptability and effectiveness of PostureCoach, a wearable real-time auditory biofeedback device, as a training tool to reduce the time participants spend in extreme lumbar spine flexion during caregiving tasks.
Methods: Eleven novice participants were recruited and divided into intervention (n=9) and control (n=2) groups. Both groups were provided information on back injury prevention through an educational video. Participants were asked to repeat a set of simulated care activities eight times over two separate sessions held on consecutive days. Individuals in the intervention group received real-time auditory feedback in some trials when their forward spine flexion exceeded a threshold, while the participants in the control group did not. Changes in the amount of forward flexion in the lumbar spine was compared between groups and across trials.
Results: PostureCoach reduced the amount of extreme (80th percentile and 95th percentile) spine flexion of participants during caregiving tasks. This reduction indicates that the participants using PostureCoach’s feedback reduced their risk of back injury compared to the control group.
Conclusions: PostureCoach shows potential as a wearable device to train informal caregivers to avoid unsafe postures during caregiving duties.
Supervisor(s): Mohammadhasan Owlia, Megan Kamachi, Tilak Dutta

Concussions in Special Olympics: Evaluating the Knowledge, Attitudes and Practices of Affiliated Coaches and Managers
Jennifer Gabel and Sebrina Said
Introduction: There is sparse evidence supporting application of interventions improving safety and providing education in the cohort of athletes with intellectual disabilities. Little is known about the concussion knowledge, attitudes, and practices of coaches and managers affiliated with the largest organization working with this population, Special Olympics Canada. It would be a great opportunity to identify the level of concussion knowledge and practices around return to play guidelines for a chance to promote safe sport participation and healthy lives.
Objective: The aim of this study is to describe the current concussion knowledge, attitudes, and practices of coaches and managers associated with Special Olympics Canada and athletes with intellectual disabilities.
Methods: This study used a quantitative cross-sectional study design. A sample of coaches and affiliated managers will participate in an online survey. Descriptive statistics will be used to explore and predict relationships between subject responses, demographics, and concussion knowledge, attitudes, and practices. Results: The total mean score for knowledge symptoms was 23.2 out of 30 and for knowledge true/false questions was 8.4 out of 10. The attitude questions total score mean 5.6 out of 8. The practice questions had a total mean score of 4.6 out of a possible 5 being the strongest section for coaches and manager’s baseline concussion knowledge, attitudes, and practices.
Conclusion: These findings may help inform the need for further education to optimize diagnosis, management, and return-to-play for athletes with intellectual disabilities to enable occupational performance. This study may inform safer concussion management in Special Olympics Canada and lead to further exploration into concrete return to play guidelines. These findings will have implications for improved health, safety, and well-being of athletes with intellectual disabilities.
Supervisor(s): Dayna Greenspoon and Nick Reed

Recovering from Critical Illness: Patients’ Experiences
Hannielle Bernard and Hannah Pape
Purpose: The purpose of this descriptive qualitative study was to gain a deeper understanding of the recovery experiences and needs of survivors of critical illness as they transition from the intensive care unit (ICU) to the community.
Materials and Methods: This study included 15 participants from hospitals in Toronto, Hamilton, and Ottawa. Participants included in the study experienced a critical illness, were ventilated in the ICU for at least 7 days, and were discharged from the ICU. Participants completed semi-structured interviews about their recovery experiences at 6 and 12 months post-discharge from the ICU.
Results: The data was analyzed using a thematic analysis, and 3 themes were identified: 1) physical, emotional, and social changes across recovery; 2) positive and negative changes in relationships; and 3) variability in external and internal resources.
Conclusion: Patients’ experiences of recovery can be both rewarding and challenging. Understanding the experiences of survivors of critical illness and their long-term needs across recovery can help healthcare professionals (HCPs) work with these patients to address patients’ needs, to enhance patients’ well-being, and to enable patients’ engagement in daily life.
Supervisor(s): Jill Cameron

Art and Spinal Cord Injury: Exploring and Evaluating Therapeutic Potential
Ka-Yee Kwan and Ramsha Khan
Introduction: Art has exhibited the potential to increase quality of life, self-esteem, mobility, and social interactions among cohorts with mental or medical conditions. However, research on its use for individuals with spinal cord injury (SCI) has been minimal. Individuals with SCI experience a considerable decline in motor functioning and are at a greater risk of poorer quality of life (QOL) and lower self-esteem than the general population.
Objective: The aim of this study is to investigate the potential of participation in an 8-week occupational therapy-run art group to enhance QOL, self-esteem, and upper extremity functioning of adults with SCI.
Methods: A convergence model of a mixed methods triangulation design was used for this study. Prior to and following participation in the group, semi-structured interviews and quantitative assessments were conducted on 12 adults with SCI. These participants were conveniently sampled into two groups, both held weekly over a period of 8 weeks each. Data analysis was comprised of a thematic analysis for qualitative data and a comparison of pre-post scores using the t-test for quantitative data.
Results: Five themes emerged, including: unique opportunity of art to enable improvement and acceptance in capabilities; social isolation post-injury; art has a unique way to achieve health, physical and mentally; art as a platform to develop a sense of community; and re-discovering sense of self and learning to function with a disability. Participants also experienced variations of change (positive, negative, and no change) for QOL, self-esteem, and hand functioning following participation in this program.
Conclusions: Given that QOL and self-esteem are linked to secondary complications and psychosocial dysfunction, group based therapeutic use of art may improve overall health and perceived life satisfaction amongst individuals with SCI. Improvements in hand functioning are also promising; however, further research is required.
Supervisor(s): Carrie Mizzoni and Debbie Hebert

A Post-Evaluation of Host Organizations’ Views on Student Occupational Therapists’ Impact on Role-Emerging Fieldwork Setting
Raha Saeed and Danielle Himelfarb
Background: Role-emerging fieldwork placements require students to develop professional competencies while implementing occupational therapy practices within organizations where there is no established occupational therapy role. Role emerging placements are valuable learning experiences for students, but the impact of the students have on their host organizations is unknown. The objective of this research project was to evaluate the perceptions of on-site supervisors working within host organizations.
Method: Participants were asked about three domains: (1) change in host organizations’ knowledge of the occupational therapy role, (2) student occupational therapists’ contribution towards mission/vision/values of the organization and (3) change in host organizations’ future occupational therapy employment considerations. On-site supervisors at host organizations participated in an online survey. Descriptive analyses were utilized to describe data trends in the three domains.
Results: Respondents report that hosting a student occupational therapist increased knowledge of the occupational therapy role at that organization. Respondents reported that student occupational therapists had a meaningful impact on the organization and this impact reduced over the course of one year. Respondents did not report a meaningful change in the likelihood of hiring an occupational therapist.
Supervisor(s): Donna Barker and Andrea Duncan

Religion Out of the Dark: A Collaborative, Analytic Autoethnography
Moira Ruthralingam and Emma Greenberg
Introduction. Religious identity is a meaningful aspect of many individuals’ lives and is occupationally expressed through a diversity of traditions, rituals, and practices; however, many occupational therapists feel unprepared to address this concept in practice. More research is needed to better understand the factors that influence how occupational therapy students develop ease with discussing religious identity as it is expressed in the occupational lives of others. Comfort with these discussions is particularly pressing in contexts of social diversity that require inclusive approaches to practice. Objectives. This study aims to explore factors affecting engagement in conversations about religion in an occupational therapy context.
Methods. This study takes the form of a collaborative, analytical autoethnography, that draws on the authors’ unique perspectives and varied religious identities. Through reflective journals and audio-taped discussion sessions, we explore questions arising from personal, work, and academic interactions concerned with religious identity and expression, including cross-cultural dialogue. Data was transcribed and analyzed for emerging themes relating to our research objective.
Results. Findings focus on common themes that arose from our collaborative reflections. Themes are explored as they fit into three categories relating to engagement in religion-based conversations: underlying inhibitors, barriers in an occupational therapy context, and enablers in action.
Conclusion. The insights examined in this study may facilitate reflections on attitudes and behaviours and increase productive conversations around religion with one another and ultimately in practice.
Supervisor(s): Jill Stier and Barry Trentham

Systematic Review of the DASH Measurement Properties for Joint-Specific Disorders
Charlotte Usas and Samuel Yiu
Introduction: The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure was developed to measure physical functioning and symptoms in persons with any or multiple disorders across the upper extremity (UE). Generally considered a regional measure, the DASH suits many research and clinical purposes with its whole extremity focus. Recently, the DASH has been criticized by joint-specific groups questioning its use for proximal and distal disorders. Therefore, there is a need to evaluate current evidence of the DASH’s measurement properties.
Aims: To determine if sufficient evidence exists to support the use of the DASH in evaluating change for two regionally distinct patient populations: painful shoulder conditions and localized wrist/hand joint pain.
Methods: A systematic review was conducted on the measurement properties of the DASH using the instrument selection process proposed by OMERACT. Two reviewers screened and selected relevant articles from a thorough literature search. Quality of reported methods was assessed using the COSMIN-OMERACT Good Methods Checklist. Data was extracted and synthesized on articles with good methods and results compared to international standards.
Results: 19 articles were identified examining test-retest reliability, construct validity, responsiveness, and thresholds of meaning. Synthesis was stratified by region: shoulder conditions and localized wrist/hand joint pain. For shoulder, consistent findings supported each measurement property from studies reporting good methods. In wrist/hand joint pain, findings supported all measurement properties except test-retest reliability, which was absent. Furthermore, correlations with shoulder and wrist/hand instruments in these studies were all significant and large.
Conclusions: The evidence supports the performance of the DASH in both shoulder and wrist/hand joint pain patient populations and the original intention of the DASH as a tool that could be used in different regions of the UE. More evidence is needed for test-retest reliability in the wrist/hand joint pain population.
Supervisor(s): Dorcas Beaton

An Innovative Approach to Measuring Youth Concussion Recovery: Occupational Performance
Robyn Chen Sang and Yasira Vawda
Introduction: Concussion is a common injury in youth. While most youth recover within four weeks, a subset experience ongoing symptoms beyond this period. These symptoms can impact a youth’s capacity for occupational performance and engagement in meaningful activities. While studies have found that low intensity active rehabilitation interventions reduce post-concussion symptoms in these youth, studies have yet to measure change in occupational performance and satisfaction.
Objectives: To identify occupational performance issues experienced by youth post-concussion, and changes in performance and satisfaction following participation in a six-week active rehabilitation intervention. This study also explores the relationship between changes in occupational performance issues and self-reported symptoms.
Methods: A pretest-posttest experimental design study was conducted. Forty-one youth ages 9 to 18 completed a six-week low intensity active rehabilitation intervention. Data was collected pre- and post-intervention using the Canadian Occupational Performance Measure and Post-Concussion Symptom Inventory. Paired t-test, Pearson correlation, and descriptive analyses were conducted.
Results: Youth reported a broad range of occupational performance issues across all domains of the Canadian Occupational Performance Measure. The most frequently reported occupational performance issues were school (34.97%) and sport related (31.29%) activities. Paired t-test analysis demonstrated positive change in both performance and satisfaction of occupational performance issues after active rehabilitation intervention (p < .001). For youth ages 13 to 18, Pearson correlation analysis revealed that as self-reported symptoms decreased, occupational performance improved (r = -.412, p = .015). However, no significant relationship was found between self-reported symptoms and change in satisfaction ratings (r = -.335, p = .053).
Conclusions: Results inform understanding of the specific occupational performance issues experienced by youth post-concussion. Findings suggest that using a measure of occupational performance can provide a meaningful measure of functional recovery, and can help identify targeted functional approaches to paediatric concussion management.
Supervisor(s): Anne Hunt, Dayna Greenspoon, and Nick Reed

How Do We Determine Self-Determination? A Systematic Review of Self-Determination Measures for Youth with Disabilities
Sharon Wu and Shekinah Resella
Purpose. To systematically review the literature that uses the ARC self-determination scale (ARC) and the AIR self-determination scale (AIR) in youth with disabilities and to assess the clinical utility and responsiveness of the two measures.
Methods. Electronic searches of PsychINFO, Embase, Medline, Scopus, CINAHL and ERIC were conducted to search for articles that used the ARC and AIR. Studies were included if the sample was between the ages 8-21 and had a recorded disability. Results. 52 articles studies were included; 20 of them measured pre- and post- test self-determination. Our systematic review indicated that there were more studies that used ARC compared to AIR. Amongst the included studies, the majority of samples were recruited from schools or transitional services and examined self-determination in children with learning or intellectual disabilities. When analyzing the clinical responsiveness of these measures, the ARC detected more significant change compared to the AIR.
Conclusions. Additional research is needed to further evaluate if these scales can be used in confidence, psychometrically and clinimetrically. Considerations of other self-determination measures should also be explored. The findings will inform the evaluation and future creation of more appropriate and sensitive measures related to self-determination in different settings of pediatric rehabilitation.
Supervisor(s): Laura Hartman, Gillian King, and Amy McPherson

Communication Tools Used in Childhood Obesity Discussions: A Scoping Review
Kate MacTavish and Alexandra Cistrone
Introduction: Obesity can impact a child’s physical, social and emotional health, and have lasting negative effects into adulthood. Pediatric healthcare professionals play an essential role in the prevention and management of childhood obesity; however, they are unaware of communication tools (i.e. growth charts, pictures and handouts) to help facilitate positive discussions. Our objective was to identify available resources and tools to aid healthcare professionals in weight-related conversations. Methods: CINAHL, Medline and PsycINFO were systematically searched between 2016 and 2017 to update a list of tools identified by an earlier scoping review. Inclusion criteria were: (i) Use or development of an identified communication tool; (ii) Tool used with children between the ages of 2 and 18 and/or their parents; (iii) Tool used in weight-related discussion (i.e., weight, overweight, obesity, or healthy lifestyles); and (iv) Tool used by a healthcare professional in a formal healthcare setting. Results: In addition to the five tools previously identified in research, four tools were retrieved based on criteria and author consensus. Tools were assigned a clinical utility rating using an adapted scale to demonstrate tool strength. Many of the tools had been recently developed and have not been evaluated by stakeholders in clinical practice.
Conclusion: This study provides a list of communication tools that can be used by healthcare professionals when having weight-related discussions with children and/or their parents. Despite the importance of initiating weight-related conversations with this population, tools, particularly those that are evidence-based, are lacking to help guide these discussions.
Supervisor(s): Amy McPherson and Shauna Kingsnorth

Developing Best Practices for Educating High School Students with Developmental Disabilities on Sexual Health
Megan Richmond and Breanna Ling
Introduction: Sexual health education is important to occupational therapy and occupational science because sexual identity and expression have a profound effect on an individual’s life. Individuals with developmental disabilities mature sexually in the same way as individuals without developmental disabilities; however, there is a lack of evidence regarding the best practices for an education program that delivers sexual health education to this population. As a result, individuals with developmental disabilities lack important knowledge on sexuality and are more vulnerable to risky sexual behaviours and their implications.
Objectives: The aim of this study is to develop evidence based guidelines for a sexual health education program for high school students with developmental disabilities to be used by health practitioners and educators.
Methods: 5 teachers, 3 caregivers, and 1 student with a developmental disability participated in individual, semi-structured interviews conducted through a Qualitative Descriptive Paradigm. Interview data was transcribed and analyzed through Content Analysis.
Practice Implications: The results include topics that should be addressed in the program and strategies that can be used to teach sexual health to this population. These findings can be used to inform occupational therapists and educators of the best practices for teaching sexual health education to high school students with developmental disabilities.
Conclusions: The occupation of sexuality affects one’s overall physical and emotional health. Evidence based guidelines will promote occupational engagement by providing this population with knowledge to safely engage in sexual relationships.
Supervisor(s): Deb Cameron, Mona Sidler-Hosios, and Tracey Methven

The Dementia Sibling Study: Brothers and Sisters Sharing Caregiving Responsibilities
Natasha Tsang and Amy Law
Background. Experiences in providing dementia care differ between son and daughter caregivers, but little is known about how they negotiate their caregiving roles as a unit.
Purpose. This study explored the relationship between mixed-gender siblings and the negotiation process for distributing caregiving tasks when providing care for a parent with dementia.
Method. This descriptive qualitative research design recruited ten English-speaking mixed-gender sibling pairs who are caring for a parent with dementia. Online surveys or separate qualitative semi-structured interviews were completed. A preliminary thematic analysis was conducted for the qualitative data.
Findings. Five major themes were identified: goal of shared caregiving is to meet parents needs, sisters often take the lead, practical issues affect sharing of caregiving activities, caregiving personal resources or skills, and sharing caregiving influences relationship quality.
Implications. Occupational therapists can support caregivers at the negotiation stages to ensure tasks are divided satisfactorily to prevent caregiver burden and burnout.
Key words: brother, sister, Alzheimer’s Disease, caregiver, relationship
Supervisor(s): Jill Cameron and Nira Rittenberg

Understanding the Attitudes and Preferences of Current and Future Older Adults in the Use of Robots to Facilitate Occupational Performance
Charmaine Chiang and Michelle (Caiwei) Li
Background. With the increased rate of aging in Canada’s population, older adults are more inclined to “age in place”. Service robots have gained recognition for their ability to assist in daily occupations. However, there is limited research on how these robots should look, act, and function.
Purpose. The aim of this study is to identify the acceptability and preferences of current and future older adults to understand how to develop and incorporate robots into their daily lives.
Method. 15 current and 21 future older adults completed a survey to explore their attitudes on service robots. Descriptive statistics, Mann-Whitney tests, and Chi-Squared tests were used to analyze data.
Findings. The acceptability and preferences in the design and function of service robots identified by older adults overlap with their younger counterparts.
Implications. Findings from this study provide insights in the development and application of user-centred service robots to facilitate aging in place.
Supervisor(s): Alex Mihailidis

Indigenous Occupational Understandings of Tobacco Use: Challenging Prevailing Assumptions
Maryam Hassany and Maryam Shahzad
Background. For many Indigenous people, smoking is associated with self-identity and history, therefore understanding the meaning of smoking and reframing smoking as an occupation may mitigate prevailing biases and support positive health changes for Indigenous people.
Purpose. This study explores the characteristics and meanings of smoking for Indigenous groups in Canada, the United States, New Zealand, and Australia, as captured in literature.
Methods. A scoping review of peer-reviewed literature and Indigenous narratives is in progress using Arksey and O’Malley’s (2005) five stages and an Indigenous consultation stage. Data were extracted and charted using a descriptive analytical framework, counted, and thematically analyzed.
Results. Preliminary results suggest that smoking has unique meaning for Indigenous groups. Five themes emerged: Smoking to connect history to Indigenous identity, smoking as belonging, smoking to focus on here and now, smoking to manage psychological stressors, and smoking to fill time.
Conclusion. Prevailing conceptualizations of smoking as maladaptive need to be challenged by exploring the meanings of smoking for Indigenous populations and situating smoking in the context of Indigenous lives. Acknowledging smoking as a meaningful occupation can foster humility and awareness when interacting and collaborating with Indigenous people in clinical, research, and policy settings.
Supervisor(s): Dawn Maracle and Jane Davis

Developing and Validating a Big Store Multiple Errands Test
Kristen Antoniak and Julie Clores
The Multiple Errands Test (MET) is an ecologically valid assessment that characterizes how executive dysfunction manifests in everyday activities. To date, clinicians have been required to develop site-specific versions or use virtual versions in order to administer the assessment. However, clinical time constraints may impede this process. For others, the wide variety of available versions of the MET makes it difficult to interpret the test results. Therefore, a community-based version that can be used in various locations is needed. The aim of this study is to develop a version of the MET that can be used in a department store setting, to establish its content validity, and to assess the feasibility and interrater reliability with community dwelling adults. To assess content validity, experts on the MET were asked to review the proposed Big Store version and evaluate the task consistency with previously published versions. To assess feasibility and interrater reliability, a convenience sample of 14 community dwelling adults were individually assessed by two trained raters. Intraclass correlation coefficients (ICCs) were calculated to determine reliability. The Big Store MET appears to be consistent with previously published versions based on the experts’ feedback during the test development phase. The results from the piloting phase demonstrate that the Big Store MET is feasible in a department store setting, as participants did not omit any of the 12 tasks. The number of total errors were also consistent with the performance of healthy participants in previous studies. The ICCs scores were high (ICCs =.92-.99), suggesting good interrater reliability for all scores, except for frequency of strategy use. This study extends the clinical usage of the MET in community-based settings across North America. Further work is warranted to determine this assessment’s ability to discriminate performance between individuals with executive dysfunction and healthy controls.
Keywords: Multiple Errands Test; executive functioning; cognition
Supervisor(s): Deirdre Dawson, Emily Nalder, and Danielle Jensen

The Occupational Therapy Role in Addressing Weight-Related Topics in Children with Disabilities
Murray Talisa and Emily Speelziek
Background. Occupational therapists should be well-suited to address weight-related topics with children with disabilities. However, previous research shows that many do not feel competent or confident in doing so.
Purpose. To understand in more detail occupational therapists’ perspectives on roles, barriers and supports in relation to addressing overweight and obesity in children with disabilities.
Method. This study consisted of six semi-structured telephone interviews with paediatric occupational therapists. Interviews were recorded, transcribed and subject to thematic analysis.
Findings. Occupational therapists have a functional lens that enables them to play a unique role in addressing weight-related issues in children with disabilities through collaboration, education and connection. Institutional barriers, lack of knowledge, unclear scope of practice, and discomfort limit clinicians’ abilities to address overweight and obesity in practice.
Implications. To work more effectively with this population, a multi-systems approach with more learning opportunities, more time, more family involvement and more collaboration is essential.
Supervisor(s): Amy McPherson, Nick Reed, and Tasha Carter

Robot-Assisted Video Game Rehabilitation for Individuals with Unilateral Spatial Neglect
Michelle Nguyen and Gillian Szeto
This report will evaluate the feasibility of the pilot study through a mock trial of the protocol. Two lab volunteers participated in the mock trial which consisted of one assessment session and one treatment session. This mock trial allowed participants to provide feedback on the design of the pilot study protocol as well as allow researchers to determine the feasibility, timing, and demands of the therapeutic sessions. Findings will inform implementation of the proposed pilot study. The pilot study will use a single-group pre-post design pilot study is to investigate the feasibility and preliminary effectiveness of robot-assisted gaming therapy to improve attention in peripersonal space for individuals who have unilateral spatial neglect (USN) following a stroke. Video game therapy is expected to improve peripersonal spatial awareness in individuals with USN. These improvements may help reduce the impairment and functional ramifications with chronic stroke. Findings from this study will contribute to current literature on video games as a form of therapy for USN. The study protocol uses a table top end effector robot to interact with on-screen games through a monitor.
Supervisor(s): Rosalie Wang and Debbie Hebert

Functional Decline in Canada: A Scoping Review
Michael Rizzo and Kenny Cordon
PURPOSE. Canada’s senior population is projected to grow to 25% of the total population. An aging population will require more healthcare and homecare needs that Canada’s healthcare system will have to adapt and meet. Functional loss: restriction in an individual’s ability to complete activities of daily living (ADLs) and instrumental activities of daily living (IADLs), will need to be better quantified in order to estimate the future care needs of an older adult with activity limitations. The purpose of this study was survey the literature and identify normative data on functional decline–specifically, the ability to complete ADLs/IADLs in the normative Canadian older adult population.
METHODS. Keywords and medical subject headings (MESH terms) related to “functional decline” were entered into various databases. Articles were mined from journals specific to aging and older adult healthcare and homecare such as the Journal of Gerontology and Geriatrics and the Canadian Geriatrics Journal, as well as select textbooks to identify normative data related to functional decline. Another approach was to identify articles related to the development of standardized ADL/IADL assessments commonly used by occupational therapists. Through a formal data request, raw data from the Canadian Institute for Health Information (CIHI) pertaining to The Home Care Reporting System (HCRS) was secured and screened.
FINDINGS. Currently there is limited normative data pertaining to functional decline with age in Canada’s normative older adult population outside of the CIHI raw data.
CONCLUSION. As Canadian researchers begin to disclose the quantitative findings regarding functional change from national longitudinal studies, i.e. the Canadian Longitudinal Study of Aging (CLSA), health care professionals and clinicians will be better positioned to assess the future care needs of ageing adults.
Supervisor(s): Mathew Rose and Danielle Naumann

Examining Participation, Quality of Life, and Psychological Well-being of Individuals with a Brain Injury Living in the Community
John Nguyen and Stier Tara
A brain injury often results in a wide variety of both short-term and long-term physical, sensory, cognitive, occupational, and emotional changes. While there is a plethora of research conducted on rehabilitation in the acute stages of an acquired brain injury (ABI), less is known about long-term outcomes and what factors, such as services accessed, may impact these outcomes. The purpose of the study was to describe the occupational participation patterns, quality of life, and psychological well-being of individuals with an ABI. Descriptive exploratory secondary analysis of data collected from two hundred and forty adults with ABI from a community-based not-for-profit organization that offers services for individuals and families living with ABI in the regions of Peel, Halton and Dufferin in Ontario were reviewed (including using the Mayo-Portland Adaptability Inventory, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, and Quality of Life after Brain Injury). The data was analyzed using an independent samples t-test and a one-way Analysis of Variance (ANOVA). Differences in the outcome measures were evident based on the types of services accessed, type of injury, and gender. Participants who accessed case management, psychology, and neuropsychiatry reported greater difficulty completing everyday activities, greater symptoms of anxiety and depression, as well as lower quality of life. Participants with a traumatic brain injury (TBI) showed poorer outcomes compared to participants with non-traumatic ABI. Women had more difficulty completing everyday activities and reported more depressive and anxiety related symptoms compared to men. The findings provide information on important life outcomes after a brain injury, which can help in evaluating programs, and inform future decisions about service delivery.
Supervisor(s): Emily Nalder, Deborah Tang

Family Perspectives on Assisted Dying
Kyle Diab and Simon McKendry
Background. Medical assistance in dying (MAiD) was recently legalized in Canada as an end-of-life care option for eligible individuals. Presently, there is limited research regarding family caregivers’ perspectives on MAiD.
Purpose. To explore the needs, attitudes, perspectives, and experiences of family members who are involved in the care of individuals with grievous and irremediable conditions.
Method. This study employs a qualitative descriptive design. Data was collected through either a semi-structured telephone interview or an anonymous online survey. Data was transcribed and analyzed using a thematic analysis approach.
Findings. Findings from 12 participants identified four primary themes: 1) intellectual support for MAiD while experiencing complex emotions; 2) providing care in the context of MAiD; 3) the lack of negative impact on relationships; and 4) source, content, and delivery as important characteristics of support for caregivers.
Implications. Findings may assist clinicians to support family caregivers in the context of MAiD.
Supervisor(s): Jill Cameron, Kevin Reel

Exploring the Community Integration Experiences of Paratransit Users with Cognitive Impairments
Tsering Wangmo and Joshua Robinson
Introduction: Individuals with cognitive impairments may benefit from paratransit access offering door-to-door transportation service to alleviate cognitive and environmental demands associated with driving and independent use of conventional public transit. Lack of paratransit access due to strict eligibility criteria for the service limit community access, hindering community integration.
Objective: The study aimed to explore the effect of paratransit access on community integration from the perspectives of adults living with cognitive impairments.
Method: A qualitative exploratory design was used and six adults living with neurocognitive impairments using paratransit services were interviewed. Data were analyzed using inductive thematic analysis.
Results: Four themes emerged around the participants’ paratransit use: 1) enhanced mobility; 2) perceived benefits in well-being; 3) regained independence; and 4) cognitive challenges with paratransit service use.
Conclusion: The findings of this study provide a better understanding of the community integration experiences of paratransit users with cognitive impairments.
Supervisor(s): Deirdre Dawson and Emily Nalder

Recovering from Critical Illness: Caregivers’ Experiences
Jenn Yung and Shawna Fu
Purpose: Caregivers of individuals discharged from intensive care units (ICUs) experience physical and psychosocial effects that affect their everyday life. Currently, limited evidence exists regarding effective supports for their long term needs throughout the ICU survivor’s recovery trajectory. This study explores the experiences of caregivers of ICU survivors and identifies caregivers’ needs from ICU discharge to their return home.
Materials and Methods: This study used a qualitative descriptive method to understand the informational, instrumental, and emotional support needs of caregivers throughout the survivor’s care in the ICU, general ward, rehabilitation, and at home. 19 caregivers of individuals who received ventilation for a minimum of 7 days in ICU were recruited through maximal variation sampling from six different hospitals. Data was collected through semi-structured interviews and then analyzed using thematic analysis.
Results: Three themes were identified: 1) changes in everyday life, 2) positive and negative changes in relationships, and 3) variability in resources affect recovery experience.
Conclusions: The caregiving experience is influenced by changes in everyday life, relationship changes, and variability in internal and external resources. To effectively support family caregivers’ needs and enhance continuity of care, healthcare professionals should consider the complex and unique experiences of ICU caregivers.
Supervisor(s): Jill Cameron

Clinician Experiences with Knowledge Translation: Implementing CO-OP in Stroke Rehabilitation
Claire Racette and Foujan Minooei Saberi
Purpose: Cognitive Orientation to daily Occupational Performance (CO-OP) approach is an evidence-based, top-down approach that is feasible to use in inpatient stroke rehabilitation and has been associated with occupational performance improvements in people with cognitive impairments post-stroke. A multi-faceted knowledge translation (KT) support program was developed and provided to healthcare staff from five Canadian inpatient stroke rehabilitation units to facilitate the implementation of CO-OP with patients with cognitive impairment. This study will describe clinician experiences during the CO-OP KT study.
Methods: This qualitative study utilized semi-structured interviews to describe the experiences of 5 clinicians who were part of the CO-OP KT study. Directed content analysis, guided by the integrated-Promoting Action on Research Implementation in Health Services Framework, was used to uncover categories of experiences that clinicians experienced while implementing CO-OP into practice.
Results: Factors that influenced implementation of CO-OP were: usability of CO-OP within inpatient rehabilitation (innovation), attitudes towards practice change (recipient), the culture of the healthcare system (context), and teaching strategies utilized during interprofessional training (facilitation).
Conclusions: Clinicians must balance competing priorities while implementing a complex new approach. This study improves understanding of how to best implement CO-OP and other emerging interventions that may require significant changes in practice.
Supervisor(s): Jane Davis, Beth Linkewich, Sara McEwen

Negotiating Competing Occupational Identities of Caregiver and Performance Arts Worker: Uncovering Practices, Processes, and Strategies for Obtaining Balance
Maya Stein and Jasmine Forbes
Rationale: Occupational balance contributes to overall health and wellness. Nonstandard work schedules have a negative impact on family-life occupations (Bohle, Quinlan, Kennedy & Williamson, 2004) and these work schedules are common in the performing arts sector. Literature suggests that passion plays a role in the engagement of different occupations, such as the performing arts, despite the challenges of nonstandard work schedules (Mullen, Davis, & Polatajko, 2012). These challenges are complicated when paired with caregiving responsibilities. Limited literature is available discussing the impact of occupational balance on caregivers working in the performing arts industry.
Objectives: The aims of the study were (a) to understand how participants negotiate the competing, passion fueled occupations of both performing arts work and caregiving, and (b) to uncover strategies for occupational balance so that they may be implemented by other individuals in this field.
Methods: This study used a qualitative, interpretive approach to best understand and interpret the multiple, subjective, context-bound, experiences of four participants using in-depth semi-structured interviews. Braun and Clarke’s (2006) six-phase thematic analysis was used to analyze the interview data.
Results: Experiences of participants resulted in four themes: being grounded in your identity, the changing nature of life, negotiating day to day and life situations, and using strategies available. Overall, there is a need for flexible solutions to mitigate occupational balance.
Conclusions: Our results suggest our participants are often forced to make decisions to support their balance and they need to rely on resources available to maintain that balance. All participants discussed the benefit to changing organizational culture and increased access to resources to support occupational balance.
Supervisor(s): Jane Davis and Hanna Wolf

Are Student Occupational Therapists Prepared to Address Socioeconomic Economic Inequities?
Lucy Bartlett and Naomi Newfield
Introduction: As a main social determinant of health, low income negatively impacts physical and mental health, access to health services, and overall quality of life. Living with low income is complex and is strongly correlated with disability, age, gender, race, and mental illness (Mikkonen & Raphael, 2013). Additionally, income can present barriers to participation in employment, self-care, and leisure occupations. Occupational therapists are well-positioned to help in reducing these socioeconomic, environmental, and personal barriers faced by low income groups. However, research on occupational therapy students’ learning and perception of their role in working with individuals living with low income is unexplored and unmeasured.
Objectives: This study aims to understand occupational therapy students’ perceptions and experiences related to low income and explore student perceptions and knowledge of their professional role in working with low income populations.
Methods: Final year students from 14 Canadian occupational therapy programs were invited to complete an online survey with Likert-style rating and open-ended written questions. Resulting qualitative and quantitative descriptive data was analyzed for student perceptions’ of their professional roles, personal experiences, classroom and fieldwork learning experiences related to working with low income. Practice Implications: With a better understanding of students’ low income learning experiences and perceptions, occupational therapy programs can target reported gaps in students’ knowledge and improve competence in supporting low income groups.
Conclusion: With approximately 13% of North American in low income, student occupational therapists need to be better prepared to advocate for and address socioeconomic inequities of occupational engagement.
Keywords: low income, poverty, student learning, professional roles
Supervisor(s): Lynn Cockburn (Ellen Murray, Farah Hameed, Keri Chambers, Timothy Park)

Occupational Therapy Addressing Military Members and First-Responders: A Scoping Review.
Janice Young and Laya Polowin
Introduction: Military personnel and first responders are exposed to trauma in their vocations, putting them at high risk for mental and physical injury. Trauma can impact an individual’s occupational engagement and well-being. This study examined how occupational therapy services are provided to support and rehabilitate traumatic injury in these populations.
Objectives: To identify the extent, range, and nature of literature on occupational therapy services for military personnel and first responders.
Methods: A scoping review was conducted following Arksey and O’Malley’s (2005) guidelines. The databases Medline, PsycINFO, Embase, AMED, CINAHL, SportDiscus and Cochrane were searched for relevant literature. Data was analyzed for trends in service type and population served.
Findings: 237 articles were found; types of services identified were psychosocial, musculoskeletal, cognitive, and vocational services relevant to traumatic injury. Identified research gaps were for first responders and articles published outside the United States.
Conclusion: Through summarizing and identifying gaps in occupational therapy service literature, this study advocates for increased research and services for these populations.
Supervisor(s): Heather Colquhoun and Bonnie Kirsch

Occupational Therapy Addressing Military Members and First-Responders: A Scoping Review.
Janice Young and Laya Polowin
Introduction: Military personnel and first responders are exposed to trauma in their vocations, putting them at high risk for mental and physical injury. Trauma can impact an individual’s occupational engagement and well-being. This study examined how occupational therapy services are provided to support and rehabilitate traumatic injury in these populations.
Objectives: To identify the extent, range, and nature of literature on occupational therapy services for military personnel and first responders.
Methods: A scoping review was conducted following Arksey and O’Malley’s (2005) guidelines. The databases Medline, PsycINFO, Embase, AMED, CINAHL, SportDiscus and Cochrane were searched for relevant literature. Data was analyzed for trends in service type and population served.
Findings: 237 articles were found; types of services identified were psychosocial, musculoskeletal, cognitive, and vocational services relevant to traumatic injury. Identified research gaps were for first responders and articles published outside the United States.
Conclusion: Through summarizing and identifying gaps in occupational therapy service literature, this study advocates for increased research and services for these populations.
Supervisor(s): Heather Colquhoun and Bonnie Kirsch

Handwriting via Strategy: Study Protocol
Yasmin Fendish and Sylvia Gudziewski
Background/Rationale: School children that have learning disabilities experience greater handwriting challenges than their peers, requiring additional support from school professionals. Many of the referrals that school based occupational therapists receive are for handwriting challenges experienced by children with developmental coordination disorder (DCD). Currently, most handwriting programs used by occupational therapists in Ontario use a bottom-up approach to treatment. Current best practice indicates the use of top-down approaches to address occupational performance issues. However, there are few handwriting resources that adopt a top-down approach. Cognitive Orientation to Occupational Performance (CO-OP) is a cognitive, top down intervention in occupational therapy that is well received by children and appropriate for a wide variety of populations, including children with DCD. Within the CO-OP approach, children are coached to problem-solve through the occupational performance errors they make to come up with strategies to address their own errors. The creation of a CO-OP based handwriting manual would help many school occupational therapists to administer a top-down intervention to address handwriting issues. Purpose: The purpose of this protocol is to identify common handwriting errors made by children with DCD and the strategies they develop via CO-OP to address these errors. A secondary aim of the study is to highlight the need for further study into the CO-OP approach to help inform the creation of a CO-OP based handwriting manual. Method: This protocol uses a combination of consultation with experts and observation of videos based on a parent study that examined the effectiveness of CO-OP in addressing handwriting challenges in children with DCD. Practice Implications: This protocol serves as the basis for future research into, and the development of, a CO-OP based handwriting manual.
Supervisor(s): Helene Polatajko

The Meaning of Dance for Youth with Disability: A Phenomenological Study
Karlie Chalmers and Kerry Parrett
Despite the extensive research that explores the spiritual, personal, and cultural meaning of dance for typically developed individuals, little is known about such meanings of dance for youth with disabilities. Current literature in the area of dance for disabled youth is focused on therapeutic goals, such as physical strengthening and social skill building. This qualitative study explores the subjective dimensions of dance from the perspective of youth with physical and cognitive disabilities, and aims to expand the literature to include their voices and personal experiences. Using a phenomenological approach, the researchers conducted interviews with four youth, aged sixteen to twenty, who were enrolled in a community-based dance program in an urban center in Canada. Interviews were analyzed using an interpretive phenomenological analysis (IPA) approach, wherein coding was manually generated directly from the data itself. Themes included ‘dance class is about friendship and belonging,’ ‘being a ‘good dancer’ has many meanings,’ ‘dance is a place to practice, improve, and receive recognition,’ ‘dance recital is the highlight of the year,’ and ‘an accessible and structured environment.’ This research increases our understanding of the importance of dance for youth with disabilities beyond its therapeutic effects, and can prompt future research that takes a more nuanced approach in exploring the experiences of this population.
Supervisor(s): Debra Cameron, Jade Ryan, and Mallory Ryan

Exploring the Perspectives of Stroke Survivors on an Outpatient Peer Support Group and its Impact on Occupational Performance: A Qualitative Study
Whitney Wilson and Nicolette Gowan
Background: Stroke survivors often experience environmental isolation and decreased occupational performance after they have been discharged from the hospital (Sabari, 2001). Evidence has shown the benefit of peer groups on psychological, social, and cognitive functioning, though few studies have measured the impact of these groups on occupational performance of stroke. Purpose: A qualitative approach was adopted to explore the perceived impact of an outpatient stroke survivor peer support program on occupational performance of attendees. Method: Semi-structured interviews guided by the Canadian Model of Occupational Performance and Engagement (CMOP-E) were conducted with members of an outpatient stroke survivor peer support group. Interview responses were analyzed using inductive thematic analysis. Findings: Eight themes emerged within the data collected. All themes indirectly relate to occupational performance, however three themes, ‘learning from others’, ‘giving back’, and ‘occupational engagement’ explicitly describe benefit of the group on occupational performance and engagement. Implications: Findings help elucidate the elements of peer support groups that have potential to impact occupational performance which can be used to improve the studied peer group and, potentially, other similar groups.
Supervisor(s): Tiziana Bontempo, Ludmilla Ferreira, Elizabeth Ulder, Chetan Phadke

Older Adults’ Decision About Technology Adoption
Megan Chen and Olivia Leung
Introduction: Current research in technology adoption has focused on older adults’ technology use, with less exploration of factors that influence older adults’ decisions and perspectives on technology adoption.
Objectives: To identify potential factors that influence older adults’ decisions on technology adoption to: 1. inform best practices for technological development; and 2. provide healthcare professionals with a better understanding of older adults’ perspectives on technology adoption.
Methods: This qualitative descriptive study used existing video recordings from two interactive workshops involving 40 participants including older adults, informal caregivers, social and healthcare professionals/managers, policy makers, researchers, and representatives of the technology industry. The video recordings were collected through two interactive methods: Show and Tell and Technology Interaction. A secondary thematic analysis was conducted to identify recurring factors that influence older adults’ decisions regarding technology adoption, with a consideration to gender and its possible influence.
Results: Eight overarching themes emerged as influencing older adults’ decisions regarding the adoption of technology. These fell into personal and technical-based factors: 1. user friendly, 2. multifunctionality, 3. cost, 4. external assistance available; 5. design features, 6. values, 7. resource intensive, 8. perception.
Conclusion: As the world’s population ages, technology adoption can offer many potential benefits and support optimal independence. Show and Tell is an interactive method that illuminates personal views on technology adoption. This is especially useful for healthcare professionals’ clinical considerations when making technology recommendations for older adults. Contrastingly, Technology Interaction is an interactive method that developers can employ to elucidate generalizable, technical-based factors regarding different technology products. It is imperative that technology developers take older adults’ perspectives on technology use into consideration during the developmental process, as they are ultimately the intended consumers and users.
Supervisor(s): Arlene Astell, Alexandra Hernandez, Shital Desai

Navigating the Transition to Motherhood: Exploring Experiences of New Mothers
Jennifer Burnside and Emma Adams
Background. Becoming a mother is considered a major developmental transition that is often accompanied by significant life changes and a period of occupational disruption. Many new mothers experience difficulties in managing the dynamic shift in roles and incorporating their newborn’s daily routines into theirs. Purpose. This study explores how new mothers navigate the transitions in their occupations and roles in the first 18 months of motherhood. Method. Semi-structured interviews and the construction of an occupational timeline were conducted with six new mothers with self-identified struggles. The data were analyzed using a constant comparative method approach to identify common themes. Findings. The themes include preparing for motherhood, navigating the sleep-wake cycle, experiencing disruption of occupational repertoire, establishing a support system, re-engaging in disrupted occupations, and re-claiming self-identity. Implications. This study highlights the importance of re-engaging in meaningful occupations as new mothers experience a period of occupational disruption, and consequently a loss of self-identity as they are unable to engage in their typical occupational repertoire.
Supervisor(s): Jane Davis and Deb Cameron

A Scoping Review: Career Development for Youth with Physical Disabilities
Isabelle Ingles and Lopez Larissa
Purpose: Unemployment and underemployment rates are considerably higher for youth with physical disabilities compared to typically developing youth, indicating limited opportunities for career exploration, planning, and development. The aim of this study is to describe the components of existing career development programs for youth with physical disabilities and explore whether they address meaningful employment. Method: A scoping review was undertaken using the methodology of Arskey and O’Malley (2005) using five databases to synthesize common components using thematic analysis. Eligible articles included (a) youth aged 29 and under with a physical disability; (b) empirical research on career development programs; (c) published in a peer-reviewed journal between 2000 and February 2018. Results: Of the 2,865 articles retrieved in our search, eight articles met the inclusion criteria. The articles involved 1,564 participants across three countries. The common components synthesized were: (a) role-model/mentorship; (b) group/peer involvement; (c) job search and interview skills training; (d) individualized process; (e) self-efficacy and self-concept; (f) academic focus; (g) career exposure/experiential learning; (h) problem-solving skills (i); employer education; (j) occupational therapy lens.
Conclusions: The information gathered has the potential to inform more effective and client-centered programs to support this population.
Key terms: Physical disability; youth; career development; program components
Supervisor(s): Sally Lindsay

Finding the Right Fit: Adaptive Clothing for Women with Hemiparesis
Madalina Oancea and Laura Cox
Background. Chronic hemiparesis can impact occupations like dressing, decreasing one’s self-esteem and creating barriers to participation, particularly for women. Limited research has examined the dressing experiences and methods of this population with outerwear. Purpose. This study examined the methods, person and clothing factors that affect coat donning and doffing of women following stroke. Methods. An observational descriptive qualitative design was used to video record eleven women with chronic hemiparesis while donning and doffing winter coats and describing their experience. Themes were then identified using a tabular task analysis. Findings. Five themes were observed related to methods of donning and doffing, fastening the coat, and person and clothing factors that influenced dressing. Implications. A better understanding of factors that influence dressing of women with chronic hemiparesis can inform adaptive clothing designs and help occupational therapists provide dressing strategies to enhance client independence.
Key words: Stroke, activities of daily living, qualitative, coat
Supervisor(s): Debbie Hebert and Rosalie Wang

Understanding the Influence of Social Connectedness on Community Engagement Following Dysvascular Amputation
Leonithas Meridis and Jessica Lima
Introduction: As the population ages, the number of people with dysvascular lower limb amputation (LLA) will continue to rise as diabetes and other vascular related-conditions becomes more common. Most of the research to date has focused on the short-term outcomes related to function and health following in-patient rehabilitation for LLA but very little is known about long-term effects of living with LLA in the community.
Objective: To better understand the impact of dysvascular LLA on community participation and perceived loneliness.
Methods: A convenience sample of community-dwelling adults with dysvascular LLA who received care at St. John’s Rehab, Parkwood Institute, and WestPark healthcare Centre were recruited to participate in the study (N= 32). Using a cross-sectional telephone survey, participants underwent a battery of questionnaires collecting data on their mobility status, health status, social wellbeing and social connectedness (Interpersonal Support Evaluation List; Social Network Index; UCLA Loneliness Scale), self-efficacy (Washington Self-Efficacy Scale) and community participation (Reintegration to Normal Living Index). Correlational and t-test analyses were completed to determine the factors influencing community participation outcomes.
Result: higher levels of social connectedness and lower ratings of perceived loneliness were associated with higher levels of community participation following dysvascular LLA.
Conclusions: The findings from this study provide new insight into the association between social connectedness and community participation outcomes post-dysvascular LLA. Independent variables such as marital status and yearly income were variables found to significantly influence community participation and social connectedness scores, with the participants’’ living situation also identified as a factor influencing social connectedness ratings. Suggestions on what can be done at the individual and societal level to maximize their wellbeing are discussed. In particular, the findings can serve to assist healthcare professionals to better identify and prepare socially “at-risk” persons with dysvascular LLA to better participate in their communities once discharged from rehabilitation.
Supervisor(s): Sander Hitzig (St. John’s Rehab), Stephanie Cimino (St. John’s Rehab), Amanda Mayo (St. John’s Rehab), Sara Guilcher (St. John’s Rehab).

Exploring Mother-Child Cooperative Occupational Engagement: Discerning Key Features
Tamar Chemel and Jazmine Rei Que
Introduction: Cooperative occupational engagement in mother-child interactions occurs when mother and child mutually show interest in both the activity they are doing and one another. Literature examining mother-child interactions has focused predominantly on relationships and related outcomes (e.g., attachment style, emotional availability). However, the nature of mother-child interactions around occupational engagement in an activity, in its own right, is relatively unexamined. By exploring cooperative occupational engagement as a primary focus, this study attempts to create new opportunities for maximizing mother and child outcomes.
Objectives: The purpose of this study is to describe the nature of cooperative occupational engagement between mother and child and its impact on the child during a video-taped play session.
Methods: An observational descriptive research design was used to examine pre-recorded videos of mother-child interactions during a play and clean-up session of dyads enrolled in an early intervention program for mothers with a history of substance use issues. Videos were selected through an extreme sampling approach to distinguish between successful and unsuccessful mother-child interactions. Activity mapping was used to track the movement of mother and child in space and their interactions during the video sessions were documented descriptively. Data analysis incorporated the triangulation of data collected from activity mapping and the content analysis of the descriptive transcripts .
Results: Findings suggest the presence of key features of mother-child interactions around activities that support successful cooperative occupational engagement and facilitate the child’s motivation to explore their environment.
Conclusions: Occupational therapists are often involved in early prevention programs, such as educating at-risk parents and suggesting strategies to overcome occupational performance issues. Findings of this study propose potential targets for intervention to enable mothers and their children to engage cooperatively in daily activities.
Supervisor(s): Helene Polatajko, Jane Davis, Mary Motz

Perceived Barriers to Culturally Sensitive Care for Youth with Obesity
Mariya Zatolokina and Tal Klachook
Introduction: Obesity is a serious public health challenge in Canada, with greatest increases in prevalence among the youth demographic. Obesity is a risk factor for physical and psychosocial illnesses and is a leading cause of chronic disease. Given that chronic diseases account for nearly half of the medical expenditures in Canada, a more sustainable model of care is required. Evidence suggests culturally sensitive care can improve health outcomes and promote an inclusive healthcare approach. However, the relationship between youth obesity and culturally sensitive care is under-examined in a Canadian context. Considering the cultural diversity of youth and their families in Canada, it is important to understand whether cultural barriers are affecting healthcare experiences.
Objective: The study seeks to identify what youth with obesity and their caregivers perceive as barriers to culturally sensitive care when seeking weight-related services.
Method: Using a qualitative descriptive study design, researchers will collect data through focus groups with youth with obesity and their families. Results will be analyzed using thematic analysis.
Practice Implications: Findings may contribute to an increased awareness of cultural barriers in weight-management services. Occupational therapists possess the necessary skills required to support youth with obesity, and can apply this knowledge to provide holistic and evidence based care. These results may influence the development of innovative weight-management protocols, policies, and programs.
Conclusions: Information collected from youth with obesity and their caregivers can inform best practice guidelines for culturally sensitive care, and program development.
Supervisor(s): Elizabeth Mansfield and Ian Zenlea

It’s Surprisingly Complex: Sponsors’ Narratives on Private Refugee Sponsorship
Lauren Stacey and Brett Hnatiw
Background. The need for refugee resettlement has never been greater as unprecedented numbers of displaced persons flee their homelands. Canada’s private refugee sponsorship program engages groups of citizens to provide resettlement support. There is minimal research examining private sponsorship relationship dynamics and how they may enable or limit integration. Currently, no research exists looking at how occupational therapy and allyship are relevant to the relationship. This is a conspicuous shortcoming as resettlement is a period of occupational transition and deprivation.
Purpose. This research sought to understand how sponsors’ experience the refugee-sponsor relationship.
Method. Narrative interviews were analyzed using directed content analysis from a critical occupational and allyship perspective. Findings. Five themes were identified: (1) ‘it took over my life…but I’d do it again; (2) navigating the complexities of Canadian life; (3) experiencing sponsor group dynamics; (4) like parent, like sponsor; (5) and countering expectations.
Implications. These themes highlighted how allyship and critical occupational perspectives may inform how sponsors can understand, name, and frame the relationship, and how occupational therapy may contribute to building effective sponsorship teams.
Supervisor(s): Barry Trentham

Rethinking Home: Exploring Alternate Housing Options for Older Adults
Guy Pfaff
Background: Given demographic trends and the identified limitations of current housing options for Canadian older adults, new models are needed for this diverse population. Alternative ways of living like cohousing and shared housing are emerging.
Purpose: The purpose of this study is to examine the relationship between the home environment and occupational engagement for older adults through a Swedish cohousing model and a Canadian shared home.
Methods: Using a critical realist lens and case study design, researchers completed interviews with 12 older adults, as well as home observation and document analysis.
Findings: Study findings illustrate how alternative housing environments can, in different ways, support older adults’ occupational engagement and thus promote health and wellbeing for this population.
Implications: Cohousing and shared housing are innovative ways of “aging-in-community” that may be part of a complex housing solution for Canadian older adults. Opportunities also exist at a policy level to better promote occupational engagement for those aging at home or in more traditional senior housing.
Supervisor(s): Barry Trentham

Concussion in Canadian Youth Soccer: Evaluating Knowledge, Attitudes and Practices of Youth Team Officials
Laura Burnett and Kate Robertson
Introduction: Despite the high incidence of concussion amongst youth soccer players, there is a lack of evidence on the impact of education strategies on concussion knowledge, attitudes, and practices in this population. As team coaches are important stakeholders in youth sport, it is vital that we understand the role that coach concussion education may play in promoting a safer environment for young athletes.
Objective: The objective of this study is to investigate the impact of a concussion education seminar on the knowledge, attitudes, and intended practices of youth soccer coaches.
Methods: This study used a quantitative, pre-test post-test quasi-experimental design. A survey on knowledge, attitudes, and intended practices was completed by 110 youth soccer coaches from a large soccer association in Toronto before and after an in-person concussion education seminar led by an occupational therapist. We used descriptive statistics, paired t-tests, Wilcoxon signed-rank tests and McNemar tests to determine if significant changes occurred as a result of the seminar.
Results: There was a significant increase in knowledge of concussion symptoms following the education seminar. Furthermore, in the attitudes and practices section, there was a significant increase in more favourable answers following the education seminar. Significantly more coaches stated that they had the knowledge and confidence to manage return-to-play following the education seminar.
Conclusions: A single education seminar led by an occupational therapist can have a positive impact on the concussion knowledge, attitudes, and intended practices of youth soccer coaches. The results of this study can inform the content and structure of future concussion education programs run by occupational therapists. These results will make a valuable contribution to the limited literature on concussion in youth soccer, and may promote safer environments for youth sport.
Supervisor(s): Nick Reed and Katherine Wilson

Determining Effective Locator Tones for a Broader Population: A Pilot Study
Daniel Liang and Havin Nadarajah
Background. Locator tones refer to the sounds emitted from accessibility pedestrian signal devices, which inform pedestrians with visual impairment to activate a street-crossing push button.
Purpose. To determine the ability of younger and older adults without sensory loss (vision and hearing) to detect and localize locator tones of varying frequency.
Methods. Nine younger adults and one older adult with self-reported auditory difficulty on the right side participated in our laboratory-based descriptive quantitative study. Two locator tones were emitted from seven speakers at different locations relative to the individual, who stood in the centre of a sound proof dome. Following the emittance of the tones, the angles of the participants relative to the tones were measured to determine participants’ accuracy in localizing these tones. Inferential statistics tests were used.
Findings. There was no statistically significant difference between young adults and older adults for localizing the locator tones at any of the speaker locations. The older adult produced more average absolute error on the side they experienced auditory difficulties for both tones.
Implications. This study provides a basis for the development of a protocol to investigate modifications in locator tone specifications, with the findings highlighting the need to include a larger sample of individuals with auditory impairments.
Supervisor(s): Alison Novak, Stephanie Yung, and George Chan

An Occupational Perspective of People with Addiction during Treatment at a Rapid Access Clinic
Shan Lee and Sameer Ratti
Introduction: Addiction is a crisis affecting Canadians across the country, along with their families and caregivers. Rapid Access Clinics (RACs) are a novel means of providing immediate patient care, but with its often biomedical focus there is limited research understanding how it affects functional well-being and occupational engagement – a factor previously proposed to promote recovery and prevent relapse – in people with addiction (PWA).
Objectives: This pilot study explored the lived experiences and recovery needs of PWA undergoing RAC care through a thematic analysis, specifically focusing on their functional status, resources in their recovery environment, and their relationship with addictions.
Methods: One-on-one semi-structured interviews were conducted with five individuals accessing care at a RAC in Toronto, Ontario. The interviews were guided by questions from the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS) tool. Components from the Canadian Model of Occupational Performance and Engagement were used to initially code the narrative data, from which themes were derived to capture participants’ experiences from an occupational perspective.
Results: Preliminary analysis revealed themes on addiction impacting participants’ environment, functional status, occupational engagement and individual well-being at large. This study highlights factors relevant to PWA accessing RAC services, illustrating where they are in their recovery journey, and the factors contributing to the relationship with their substance use.
Conclusions: These findings could inform future studies on RAC services for PWA; an occupational perspective and a focus on function could influence further investigations on the role this service plays in recovery for this population.
Supervisor(s): Andrea Duncan BscOT, MBA OT Reg. (Ont.); Hricha Rakshit MScOT, OT Reg. (Ont.) and RP; and Christy Pickles, MScOT, MHSc, OT Reg. (Ont.)

Are Student Occupational Therapists Prepared to Address Socioeconomic Inequities?
Lucy Bartlett and Naomi Newfield
Introduction: Income is a main social determinant of health and negatively impacts physical, mental health, access to health services, and overall quality of life. Low income is complex and is strongly correlated with disability, age, gender, race, mental illness (Mikkonen & Raphael, 2013), and presents barriers to participation in employment, self-care, and leisure occupations. Occupational therapists are well-positioned to address these socioeconomic, environmental, and personal barriers. However, occupational therapy students’ learning and perception of their role with low income individuals is unexplored.
Objectives: This study aims to understand students’ perceptions and experiences related to low income and explore student perceptions of their professional role with low income populations.
Methods: Fourteen Canadian occupational therapy programs were asked to invite final year students to complete an online survey with Likert-style rating and open-ended questions. Resulting qualitative and quantitative descriptive data was analyzed for student perceptions and experiences related to working with low income.
Results: Of the 88 responding students, 91% agreed or strongly agreed that it is part of their role to assist and advocate for marginalized groups, yet 57% disagreed or strongly disagreed that they had learned enough about low income within their program.
Discussion: Occupational therapy students report not learning enough about low income but identify a professional role with this group. Programs should provide students with more hands-on exposure related to low income.
Conclusion: As approximately 13% of North America lives in low income, student occupational therapists need to be prepared to advocate for and address socioeconomic inequities.
Supervisor(s): Lynn Cockburn (Ellen Murray, Farah Hameed, Keri Chambers, Timothy Park)

Grip Strength and Reaction Time: Dual-Task Performance in Youth with Concussions
Chelsea Holung and Matthew Sutherland
Context: Current concussion assessment protocols for youth are limited by the reliance on subjective symptom reporting, which may not reflect an accurate index of neurological deficits, putting youth at risk for re-injury. Single-task protocols assess objective measures (e.g. cognition and physical abilities) in isolation, which lacks sensitivity in detecting functional limitations. Dual-task protocols are a first step to establishing ecological validity. Exploring the use of objective functional performance measures through single- and dual-task paradigms may provide a more accurate index of readiness to return to activity for youth with concussions.
Objective: To understand the effect of concussions on grip strength and reaction time compared to healthy, non-concussed youth using single- (grip strength and reaction time) and dual-tasks (tasks concurrently performed). Design: Prospective cross sectional study. Setting: Hospital concussion clinic.
Participants: A total of 8 healthy, non-concussed youth (ages 13-18) (n = 8; mean age = 15.53, std dev = 1.73) and 4 youth who have sustained a concussion (n = 4; mean age = 14.70, std dev = 1.00). Methods: Average and maximal grip strength and reaction time measured for single- and dual-tasks using a computerized physiological assessment battery; values measured for both dominant and non-dominant hands. For each hand, single-tasks measured 6 times per task and dual-task measured for a total of 3 times. Dual-task costs were calculated to explore potential changes in performance measures between single- and dual tasks.
Results: Descriptive statistics of group means and standard deviations were used to compare across and within groups (dominant vs non-dominant hand). Grip strength and reaction time performance was increased in the control group during both single- and dual-tasks. The first trial of grip strength for each task was stronger compared to subsequent task repetitions. Dual task cost in the concussion group was greater than in controls for non-dominant grip strength, and dominant and non-dominant reaction time measurement.
Conclusion: The concussion group demonstrated increased dual-task cost which may be attributed to an increase in cognitive load caused by completing two tasks concurrently.
Supervisor(s): Karolina Urban, Nick Reed, Katherine Wilson, Anne Hunt, Kelsey Gamble, and Stephanie Raheb

Perspectives of Key Stakeholders on Implementing Community-Based Rehabilitation in Trinidad and Tobago
Lauren Crump and Emma Lee Shepherd
Purpose: Community based rehabilitation (CBR) is an effective multi-sectoral approach focused on the equalization of opportunities and social inclusion of persons with disabilities in underserved countries. The aim of this study was to discover current perspectives that key stakeholders have about CBR as well as their opinions on how to implement successful programming for CBR in Trinidad and Tobago.
Method: Semi-structured interviews were conducted with 13 professionals employed in healthcare, governmental positions, or within disability organizations who had a good understanding of the healthcare system in Trinidad and Tobago. Snowball sampling was used to identify potential participants. The project utilized a qualitative descriptive framework and data were analyzed using qualitative thematic analysis.
Results: Six themes emerged through the interviews. These include the status of the current healthcare system, systemic gaps and CBR, culture/society and disability, the need for education, government policy and disability, and the importance of empowerment for persons with disabilities.
Conclusion: Key stakeholders have identified CBR as a potential service to fill the gaps in healthcare that exist in Trinidad and Tobago. Information collected from these key stakeholders provides insight into the rehabilitation needs of this Caribbean country and may help determine if CBR can and should be implemented into the country’s healthcare system.
Supervisor(s): Deb Cameron