Maintaining balance relies on integration of inputs from the visual, vestibular, and proprioceptive systems. The auditory system has not been credited with a similar contributory role, despite its ability to provide spatial orienting cues with extreme speed and accuracy. Here, we determined the ability of external auditory signals to reduce postural sway, measured as the root-mean-square velocity of center of pressure of a standing subject, in a series of subjects with varying levels of imbalance standing in the dark. The maximum root-mean-square center of pressure among our subjects decreased from 7.0 cm/sec in silence to 4.7 cm/sec.with the addition of external sound. The addition of sound allowed subjects to decrease sway by 41 percent. The amount of improvement due to sound was 54% of the amount of improvement observed in postural sway when visual cues only were provided to subjects standing in silence. These data support the significant effect of the auditory system in providing balance-related cues and suggest that interventions such as hearing aids or cochlear implants may be useful in improving postural stability and reducing falls.

People who experience the toxic stress of recurrent traumatic events in childhood have a higher risk for mental and physical health problems throughout life. Occupational therapy practitioners have a remarkable opportunity to be involved in addressing this significant public health problem. As health care practitioners already situated in the community, we have a responsibility to lead and assist in establishing and implementing occupation-based programs and to nurture the links between the child welfare system and existing intervention systems. In this article, we review the current research on toxic stress and recommendations made by other health care disciplines and offer strategies for occupational therapy practitioners to begin a dialogue on this critical, emerging issue.

Awareness of the impact of poverty on early childhood participation is crucial in providing adequate and effective services for young children and their families. Through a university-community partnership to support Head Start teachers to broaden their developmental evaluations, the Preschool Activity Card Sort (PACS) was administered to the parents of 81 preschoolers in a semi-structured interview format. Fifty-two (64%) of the children were served by a Head Start program and 29 (36%) were a convenience sample control group. Results from the PACS demonstrate that all of the preschoolers participate in a range of age-appropriate activities. Comparison between the Head Start and control groups revealed differences, with Bonferroni correction, in participation in community mobility (p = .000). It is imperative to provide opportunities for early childhood participation because many community activities are implicitly tied to school readiness. To fully meet the needs of families in impoverished communities, occupational therapists need to seek out the voice of parents and focus on learning opportunities arising naturally in the context of daily living and community experiences.

Importance: Research studies supporting occupational therapy interventions to address feeding, toileting, and sleep can be applied to practice in early intervention and preschool settings to improve the outcomes of young children and their families. Objective: To examine the effectiveness of interventions within the scope of occupational therapy practice to improve activities of daily living, rest, and sleep for children ages 0–5 yr and their families. Data Sources: Five databases (MEDLINE, PsycINFO, CINAHL, OTseeker, ERIC) and Evidence-Based Medicine Reviews, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, and Database of Abstracts of Reviews of Effectiveness were searched for studies published between January 2000 and March 2017. Study Selection and Data Collection: Inclusion criteria were Levels I–III evidence, being within occupational therapy’s scope of practice, including participants with a mean age younger than 6 yr, and addressing self-care, activities of daily living, and rest and sleep. Findings: Forty articles were appraised, and three themes emerged: interventions to address feeding and eating, interventions to address toileting, and interventions to address rest and sleep. Additional subthemes of behavioral approaches, parent and caregiver education, and contextual intervention were revealed. Conclusions and Relevance: Occupational therapy practitioners should consider the use of interventions with moderate or strong evidence as described in this review. Limitations include risk of bias and limited evidence for several interventions. What This Article Adds: This article provides a broader perspective on evidence-based practice by examining studies within the scope of occupational therapy practice published outside of current occupational therapy publications. The review includes studies from nutrition, nursing, and psychology, which address interdisciplinary care, family coaching and education, and behavioral approaches within the professional scope of occupational therapy to improve the functional performance, routines, and quality of life for young children and their caregivers.

Introduction Wolfram Syndrome (WFS) is a rare genetic disease associated with a variety of progressive metabolic and neurologic impairments. Previous research has focused on WFS-related impairments and biomarkers for disease progression; however, information about how WFS impacts participation in daily activities is lacking. Methods WFS (n=45; 20 children, 25 adults) participants completed an online questionnaire about activity participation. Thirty-six non-WFS comparison participants (11 children; 25 adults) completed a portion of the questionnaire. Symptom data from a subset of WFS participants (n=20) were also examined in relation to participation data. Results WFS children and adults had lower participation than non-WFS children and adults in almost all activity domains, and social and exercise-related activities were the most problematic. In the subset of WFS adults with symptom data, poorer vision, balance, gait, hearing, and overall symptom severity related to lower participation. Conclusions WFS appears to negatively impact participation in a variety of activities, and this effect may increase as people age and/or WFS progresses. The most functionally-pertinent WFS symptoms are those associated with neurodegeneration especially vision loss and walking and balance problems. This study revealed symptoms and activity domains that are most relevant for people with WFS and, thus, can inform current practice and treatment development research.