Biomedical subjects

Wendy J Coster

Publications and source records attributed to Wendy J Coster.

18 recordsLinked to original sources

PubMed2006

Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: I. Activity outcomes.

OBJECTIVE: To examine score agreement, precision, validity, efficiency, and responsiveness of a computerized adaptive testing (CAT) version of the Activity Measure for Post-Acute Care (AM-PAC-CAT) in a prospective, 3-month follow-up sample of inpatient rehabilitation patients recently discharged home. DESIGN: Longitudinal, prospective 1-group cohort study of patients followed approximately 2 weeks after hospital discharge and then 3 months after the initial home visit. SETTING: Follow-up visits conducted in patients' home setting. PARTICIPANTS: Ninety-four adults who were recently discharged from inpatient rehabilitation, with diagnoses of neurologic, orthopedic, and medically complex conditions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Summary scores from AM-PAC-CAT, including 3 activity domains of movement and physical, personal care and instrumental, and applied cognition were compared with scores from a traditional fixed-length version of the AM-PAC with 66 items (AM-PAC-66). RESULTS: AM-PAC-CAT scores were in good agreement (intraclass correlation coefficient model 3,1 range, .77-.86) with scores from the AM-PAC-66. On average, the CAT programs required 43% of the time and 33% of the items compared with the AM-PAC-66. Both formats discriminated across functional severity groups. The standardized response mean (SRM) was greater for the movement and physical fixed form than the CAT; the effect size and SRM of the 2 other AM-PAC domains showed similar sensitivity between CAT and fixed formats. Using patients' own report as an anchor-based measure of change, the CAT and fixed length formats were comparable in responsiveness to patient-reported change over a 3-month interval. CONCLUSIONS: Accurate estimates for functional activity group-level changes can be obtained from CAT administrations, with a considerable reduction in administration time.

Activities of Daily Living↗

PubMed2006

Measuring patient-reported outcomes after discharge from inpatient rehabilitation settings.

OBJECTIVE: To examine the sensitivity of the Short Form Activity Measure for Post-Acute Care (AM-PAC) in comparison to the Functional Independence Measure (FIM) across a 12-month period after discharge from rehabilitation hospital. DESIGN: Prospective longitudinal study. Patients were recruited while receiving inpatient services from facilities in the north-east USA and interviewed 1, 6 and 12 months thereafter. PATIENTS: Convenience sample of 516 patients at baseline (65% retention at the final follow-up) receiving rehabilitation services for neurological, lower extremity orthopedic, or complex medical conditions. Mean age 68.3 years; 47% male. MAIN OUTCOME MEASURES: AM-PAC Physical and Movement, Personal Care and Instrumental, and Applied Cognitive Activity scales; FIM Motor and Cognitive scales. RESULTS: All 3 AM-PAC scales were sensitive to both positive and negative change across the follow-up period. Standardized response means for the AM-PAC were consistently larger than for the FIM across patient and severity groups. A greater percentage of patients showed positive change that exceeded the minimal detectable change on the AM-PAC than on the FIM both 6- and 12-month follow-ups. CONCLUSION: The short-form AM-PAC scales are more sensitive measures of change in functional activity performance over time in the general population of persons who receive inpatient rehabilitation services compared to the FIM. Thus, the AM-PAC offers a short, comprehensive, and sensitive measure of positive and/or negative change in patients' ability to perform important activities of daily life.

Aged↗

PubMed2006

Agreement in functional assessment: graphic approaches to displaying respondent effects.

OBJECTIVE: The objective of this study was to examine the agreement between respondents of summary scores from items representing three functional content areas (physical and mobility, personal care and instrumental, applied cognition) within the Activity Measure for Postacute Care (AM-PAC). We compare proxy vs. patient report in both hospital and community settings as represented by intraclass correlation coefficients and two graphic approaches. DESIGN: The authors conducted a prospective, cohort study of a convenience sample of adults (n = 47) receiving rehabilitation services either in hospital (n = 31) or community (n = 16) settings. In addition to using intraclass correlation coefficients (ICC) as indices of agreement, we applied two graphic approaches to serve as complements to help interpret the direction and magnitude of respondent disagreements. We created a "mountain plot" based on a cumulative distribution curve and a "survival-agreement plot" with step functions used in the analysis of survival data. RESULTS: ICCs on summary scores between patient and proxy report were physical and mobility ICC = 0.92, personal care and instrumental ICC = 0.93, and applied cognition ICC = 0.77. Although combined respondent agreement was acceptable, graphic approaches helped interpret differences in separate analyses of clinician and family agreement. CONCLUSIONS: Graphic analyses allow for a simple interpretation of agreement data and may be useful in determining the meaningfulness of the amount and direction of interrespondent variation.

Computer Graphics↗

PubMed2005

Assessing mobility in children using a computer adaptive testing version of the pediatric evaluation of disability inventory.

OBJECTIVE: To assess score agreement, validity, precision, and response burden of a prototype computerized adaptive testing (CAT) version of the Mobility Functional Skills Scale (Mob-CAT) of the Pediatric Evaluation of Disability Inventory (PEDI) as compared with the full 59-item version (Mob-59). DESIGN: Computer simulation analysis of cross-sectional and longitudinal retrospective data; and cross-sectional prospective study. SETTING: Pediatric rehabilitation hospital, including inpatient acute rehabilitation, day school program, outpatient clinics, community-based day care, preschool, and children's homes. PARTICIPANTS: Four hundred sixty-nine children with disabilities and 412 children with no disabilities (analytic sample); 41 children without disabilities and 39 with disabilities (cross-validation sample). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Summary scores from a prototype Mob-CAT application and versions using 15-, 10-, and 5-item stopping rules; scores from the Mob-59; and number of items and time (in seconds) to administer assessments. RESULTS: Mob-CAT scores from both computer simulations (intraclass correlation coefficient [ICC] range, .94-.99) and field administrations (ICC=.98) were in high agreement with scores from the Mob-59. Using computer simulations of retrospective data, discriminant validity, and sensitivity to change of the Mob-CAT closely approximated that of the Mob-59, especially when using the 15- and 10-item stopping rule versions of the Mob-CAT. The Mob-CAT used no more than 15% of the items for any single administration, and required 20% of the time needed to administer the Mob-59. CONCLUSIONS: Comparable score estimates for the PEDI mobility scale can be obtained from CAT administrations, with losses in validity and precision for shorter forms, but with a considerable reduction in administration time.

Adolescent↗

PubMed2005

Neuroimpairments, activity performance, and participation in children with cerebral palsy mainstreamed in elementary schools.

Participation and activity performance (motor and cognitive or behavioural) were examined in 148 children with cerebral palsy (CP; 87 males, 61 females; mean age 9y 8mo, SD 1y 11mo; range 6y 1mo to 13y 7mo), mainstreamed in fully inclusive (n=100) and in self-contained classes (n=48) within general schools in Israel, using the School Function Assessment. Differences in participation within these groups were analyzed in relation to the type of CP (mainly spastic hemiplegia, spastic diplegia, and spastic tetraplegia), the level of impairment according to the Gross Motor Function Classification System (GMFCS; level II 55%, level III 37%, and level IV 8%), and additional neuroimpairments. Univariate analyses of variance revealed significant differences in levels of participation and levels of activity performance between different types of CP and GMFCS levels. With regard to additional neuroimpairments, significant differences in participation were found for fully included children with speech and language impairments and those with learning disability within the self-contained group. Physical activity performance partly accounted for differences in participation between children with different types of CP and different levels of motor impairment. These findings suggest that within the mainstreamed environment, participation and activity performance increase as motor disability and/or additional neuroimpairments (speech and language impairments and learning disability) decrease.

Activities of Daily Living↗

PubMed2005

Measuring physical function in patients with complex medical and postsurgical conditions: a computer adaptive approach.

OBJECTIVE: To examine whether the range of disability in the medically complex and postsurgical populations receiving rehabilitation is adequately sampled by the new Activity Measure--Post-Acute Care (AM-PAC), and to assess whether computer adaptive testing (CAT) can derive valid patient scores using fewer questions. DESIGN: Observational study of 158 subjects (mean age 67.2 yrs) receiving skilled rehabilitation services in inpatient (acute rehabilitation hospitals, skilled nursing facility units) and community (home health services, outpatient departments) settings for recent-onset or worsening disability from medical (excluding neurological) and surgical (excluding orthopedic) conditions. Measures were interviewer-administered activity questions (all patients) and physical functioning portion of the SF-36 (outpatients) and standardized chart items (11 Functional Independence Measure (FIM), 19 Standardized Outcome and Assessment Information Set (OASIS) items, and 22 Minimum Data Set (MDS) items). Rasch modeling analyzed all data and the relationship between person ability estimates and average item difficulty. CAT assessed the ability to derive accurate patient scores using a sample of questions. RESULTS: The 163-item activity item pool covered the range of physical movement and personal and instrumental activities. CAT analysis showed comparable scores between estimates using 10 items or the total item pool. CONCLUSION: The AM-PAC can assess a broad range of function in patients with complex medical illness. CAT achieves valid patient scores using fewer questions.

Activities of Daily Living↗

PubMed2004

Functional predictors of school participation by children with disabilities.

This study examined the functional requirements that significantly predicted participation of US elementary school children with a variety of disabling conditions (N = 266), in seven different school settings: Transportation, Transitions, Regular classroom, Special classroom, Mealtime, Bathroom, and Playground. Performance on a number of setting-relevant tasks was expected to be predictive of meaningful participation in each school environment. Stepwise multiple regression analyses were conducted to identify the order of importance of the relevant variables as well as the smaller set of functional tasks that best predicted children's participation in each setting. The results revealed that successful participation in the different elementary school settings was strongly associated with performance of both physical and cognitive/behavioural activities. Furthermore, each setting had a unique set of predictors, suggesting that some aspects of function are context-specific. Findings from this study may inform therapists about the most relevant areas of function that support social and physical participation of children with disabilities who are included in regular schools.

Activities of Daily Living↗

PubMed2004

Score comparability of short forms and computerized adaptive testing: Simulation study with the activity measure for post-acute care.

OBJECTIVE: To compare simulated short-form and computerized adaptive testing (CAT) scores to scores obtained from complete item sets for each of the 3 domains of the Activity Measure for Post-Acute Care (AM-PAC). DESIGN: Prospective study. SETTING: Six postacute health care networks in the greater Boston metropolitan area, including inpatient acute rehabilitation, transitional care units, home care, and outpatient services. PARTICIPANTS: A convenience sample of 485 adult volunteers who were receiving skilled rehabilitation services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Inpatient and community-based short forms and CAT applications were developed for each of 3 activity domains (physical & mobility, personal care & instrumental, applied cognition) using item pools constructed from new items and items from existing postacute care instruments. RESULTS: Simulated CAT scores correlated highly with score estimates from the total item pool in each domain (4- and 6-item CAT r range,.90-.95; 10-item CAT r range,.96-.98). Scores on the 10-item short forms constructed for inpatient and community settings also provided good estimates of the AM-PAC item pool scores for the physical & movement and personal care & instrumental domains, but were less consistent in the applied cognition domain. Confidence intervals around individual scores were greater in the short forms than for the CATs. CONCLUSIONS: Accurate scoring estimates for AM-PAC domains can be obtained with either the setting-specific short forms or the CATs. The strong relationship between CAT and item pool scores can be attributed to the CAT's ability to select specific items to match individual responses. The CAT may have additional advantages over short forms in practicality, efficiency, and the potential for providing more precise scoring estimates for individuals.

Boston↗

PubMed2004

Short-form activity measure for post-acute care.

OBJECTIVE: To develop a comprehensive set of short forms using item response theory (IRT) and item pooling procedures for the purpose of monitoring postacute care functional recovery. DESIGN: Prospective study. SETTING: Six postacute health care networks in the greater Boston area, including inpatient acute rehabilitation, transitional care units, home care, and outpatient services. PARTICIPANTS: A convenience sample of 485 adult volunteers who were currently receiving skilled rehabilitation services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We developed a set of 6 short forms across 3 activity domains from new items and items from existing postacute care instruments. RESULTS: Inpatient- and community-based short forms were developed for each of 3 activity domains: physical & movement, applied cognition, and personal care & instrumental. Items were selected for inclusion on the short forms to maximize content coverage and information value of items across the range of content and to minimize ceiling and floor effects. We were able to match the distribution of sample scores with very good item precision for 1 of the constructs (physical & movement); the other 2 domains (personal care & instrumental, applied cognition) were more challenging because of the variability in patient recovery and ceiling effects. CONCLUSIONS: ITR methods and item pooling procedures were valuable in developing paired sets of short-form instruments for inpatient and community rehabilitation that provided estimates of functioning along a common metric for use across postacute care settings.

Activities of Daily Living↗

PubMed2004

Development of an applied cognition scale to measure rehabilitation outcomes.

OBJECTIVE: To examine the structure and content coverage of an item pool of new items based on the Activity categories from the International Classification of Functioning, Disability and Health and items from existing instruments to measure the applied cognition dimension of function. DESIGN: Prospective study. SETTING: Four postacute care rehabilitation settings (inpatient, transitional care, home care, outpatient) in an urban-suburban area of northeast United States. PARTICIPANTS: Convenience sample of 477 patients (mean age, 62.7 y) receiving rehabilitation services for neurologic, orthopedic, or complex medical conditions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants were administered applied cognition items from the new Activity Measure for Post-Acute Care, the Medical Outcomes Study 8-Item Short-Form Health Survey, and an additional setting-specific measure: the FIM instrument (inpatient rehabilitation); the Minimum Data Set (skilled nursing facility); the Minimum Data Set-Post Acute Care (postacute settings); or the Outcome Assessment and Information Set (home care). Rasch (partial-credit model) analyses were conducted to examine item fit, item coverage, scale unidimensionality, and category difficulty estimates. RESULTS: The majority of items (46/59) could be located along a single continuum. Relatively few people were performing at the lower end of the difficulty scale, and about 25% were at ceiling. CONCLUSIONS: The proposed definition of applied cognition dimension provides a useful guide for item development to measure this dimension. Further work is needed to determine how best to measure function in this domain for people at the upper and lower ends of the continuum.

Adult↗

PubMed2004

Activity outcome measurement for postacute care.

BACKGROUND: Efforts to evaluate the effectiveness of a broad range of postacute care services have been hindered by the lack of conceptually sound and comprehensive measures of outcomes. It is critical to determine a common underlying structure before employing current methods of item equating across outcome instruments for future item banking and computer-adaptive testing applications. OBJECTIVE: To investigate the factor structure, reliability, and scale properties of items underlying the Activity domains of the International Classification of Functioning, Disability and Health (ICF) for use in postacute care outcome measurement. METHODS: We developed a 41-item Activity Measure for Postacute Care (AM-PAC) that assessed an individual's execution of discrete daily tasks in his or her own environment across major content domains as defined by the ICF. We evaluated the reliability and discriminant validity of the prototype AM-PAC in 477 individuals in active rehabilitation programs across 4 rehabilitation settings using factor analyses, tests of item scaling, internal consistency reliability analyses, Rasch item response theory modeling, residual component analysis, and modified parallel analysis. RESULTS: Results from an initial exploratory factor analysis produced 3 distinct, interpretable factors that accounted for 72% of the variance: Applied Cognition (44%), Personal Care & Instrumental Activities (19%), and Physical & Movement Activities (9%); these 3 activity factors were verified by a confirmatory factor analysis. Scaling assumptions were met for each factor in the total sample and across diagnostic groups. Internal consistency reliability was high for the total sample (Cronbach alpha = 0.92 to 0.94), and for specific diagnostic groups (Cronbach alpha = 0.90 to 0.95). Rasch scaling, residual factor, differential item functioning, and modified parallel analyses supported the unidimensionality and goodness of fit of each unique activity domain. CONCLUSIONS: This 3-factor model of the AM-PAC can form the conceptual basis for common-item equating and computer-adaptive applications, leading to a comprehensive system of outcome instruments for postacute care settings.

Activities of Daily Living↗

PubMed2004

Refining the conceptual basis for rehabilitation outcome measurement: personal care and instrumental activities domain.

BACKGROUND: Rehabilitation outcome measures routinely include content on performance of daily activities; however, the conceptual basis for item selection is rarely specified. These instruments differ significantly in format, number, and specificity of daily activity items and in the measurement dimensions and type of scale used to specify levels of performance. We propose that a requirement for upper limb and hand skills underlies many activities of daily living (ADL) and instrumental activities of daily living (IADL) items in current instruments, and that items selected based on this definition can be placed along a single functional continuum. OBJECTIVE: To examine the dimensional structure and content coverage of a Personal Care and Instrumental Activities item set and to examine the comparability of items from existing instruments and a set of new items as measures of this domain. METHODS: Participants (N = 477) from 3 different disability groups and 4 settings representing the continuum of postacute rehabilitation care were administered the newly developed Activity Measure for Post-Acute Care (AM-PAC), the SF-8, and an additional setting-specific measure: FIM (in-patient rehabilitation); MDS (skilled nursing facility); MDS-PAC (postacute settings); OASIS (home care); or PF-10 (outpatient clinic). Rasch (partial-credit model) analyses were conducted on a set of 62 items covering the Personal Care and Instrumental domain to examine item fit, item functioning, and category difficulty estimates and unidimensionality. RESULTS: After removing 6 misfitting items, the remaining 56 items fit acceptably along the hypothesized continuum. Analyses yielded different difficulty estimates for the maximum score (eg, "Independent performance") for items with comparable content from different instruments. Items showed little differential item functioning across age, diagnosis, or severity groups, and 92% of the participants fit the model. CONCLUSIONS: ADL and IADL items from existing rehabilitation outcomes instruments that depend on skilled upper limb and hand use can be located along a single continuum, along with the new personal care and instrumental items of the AM-PAC addressing gaps in content. Results support the validity of the proposed definition of the Personal Care and Instrumental Activities dimension of function as a guide for future development of rehabilitation outcome instruments, such as linked, setting-specific short forms and computerized adaptive testing approaches.

Activities of Daily Living↗

PubMed2002

Developing a responsive measure of change for paediatric brain injury inpatient rehabilitation.

PRIMARY OBJECTIVE: To describe conceptual and methodological issues to be addressed in developing a responsive clinical performance measure for paediatric brain injury inpatient rehabilitation. Selected statistical approaches used to examine responsiveness of two functional activity scales (daily and social behavioural activity) of a prototype measure are presented to illustrate these issues. RESEARCH DESIGN: Retrospective chart review. METHODS AND PROCEDURES: Data on 65 children, aged 6 months to 18 years (X = 9.5 years) were collected during 1998 and 1999 from eight sites in the USA. Responsiveness was examined using effect sizes and a number of parametric and non-parametric tests. MAIN OUTCOMES AND RESULTS: Significant improvements from admission to discharge were found on all item and scale scores (p < 0.001). Moderate significant relationships were found between activity scale change scores and external ratings of change. CONCLUSIONS: Findings provide evidence that the activity scales have the potential to be responsive and point to issues that will need to be addressed in future measurement development.

Activities of Daily Living↗

PubMed2002

Late life function and disability instrument: I. Development and evaluation of the disability component.

BACKGROUND: Efforts to evaluate the effectiveness of clinical and community-based interventions designed to impact late-life disability have been hindered significantly by limitations in current instrumentation. More conceptually sound and responsive measures of disability are needed. METHODS: Applying Nagi's disablement model, we wrote questionnaire items that assessed disability in terms of frequency and limitation in performance of 25 life tasks. We evaluated their validity and test-retest reliability with 150 ethnically and racially diverse adults aged 60 and older who had a range of functional limitations, using factor analysis and Rasch analytic techniques to examine and refine the instrument. RESULTS: Our analyses resulted in a 16-item disability component with two dimensions, one focused on frequency of performance and the other addressing limitation in performance of life tasks, with two disability domains within each dimension. The frequency dimension consisted of a personal and a social role domain, and the limitation dimension consisted of an instrumental and a management role domain. Expected differences in summary scores of known-functional limitation groups support the validity of this instrument. Test-retest intraclass correlations of the reproducibility of each overall dimension summary score were moderate to high (intraclass correlation coefficients .68-.82). CONCLUSIONS: The Late-Life Function and Disability Instrument has potential to assess meaningful concepts of disability across a wide variety of life tasks with relatively few items.

Activities of Daily Living↗

PubMed2002

Late Life Function and Disability Instrument: II. Development and evaluation of the function component.

BACKGROUND: Self-reported capability in physical functioning has long been considered an important focus of research for older persons. Current measures have been criticized, however, for conceptual confusion, lack of sensitivity to change, poor reproducibility, and inability to capture a wide range of upper and lower extremity functioning. METHODS: Using Nagi's disablement model, we wrote physical functioning questionnaire items that assessed difficulty in 48 common daily tasks. We constructed the instrument using factor analysis and Rasch analytic techniques and evaluated its validity and test-retest reliability with 150 ethnically and racially diverse adults aged 60 years and older who had a range of functional limitations. RESULTS: Our analyses resulted in a 32-item function component with three dimensions--upper extremity, basic lower extremity, and advanced lower extremity functions. Expected differences in summary scores of known-functional limitation groups support its validity. Test-retest stability over a 1- to 3-week period was extremely high (intraclass correlation coefficients =.91 to.98). CONCLUSIONS: The Late-Life Function and Disability Instrument has potential to assess activity concepts related to upper and lower extremity functioning across a wide variety of daily physical tasks and individual levels of physical functioning.

Activities of Daily Living↗

PubMedDate not supplied

Participation readiness at discharge from inpatient rehabilitation in children and adolescents with acquired brain injuries.

OBJECTIVE: To describe the extent of readiness for participation in home, school and community life at discharge from inpatient rehabilitation and selected factors associated with participation readiness in children and adolescents with acquired brain injuries. METHODS: Staff from eight sites used retrospective review to complete a prototype clinical performance measure on up to 10 of their most recent discharges. Data were obtained on 65 children and adolescents, aged 6 months to 18 years (X = 9.5 years). The extent of participation readiness was analysed descriptively. Associations between selected variables and participation readiness were examined using correlation and multiple regression analyses. RESULTS: Only 3-27% of the children were deemed ready for age-expected participation at discharge in 15 domains of home, school and community life. Social behavioural activity performance at discharge explained 74% of the variance associated with participation readiness at discharge. CONCLUSIONS: The low percentage of children deemed ready for age-expected participation has implications for post-discharge programming, since 82% of the children were discharged home. Participation readiness may not be an easily achievable goal or may not be fully addressed during inpatient rehabilitation. Preliminary findings suggest that social-behavioural activity performance is a key variable to be considered in efforts to promote participation readiness.

Activities of Daily Living↗

PubMedDate not supplied

Psychometric properties of the scorable self-care evaluation.

OBJECTIVE: The purpose of this study was to examine evidence for the reliability and validity of the Scorable Self-Care Evaluation (SSCE), an 18-item assessment of observed and perceived self-care performance commonly used with persons with psychiatric disabilities. METHOD: As part of a longitudinal study, 70 adults with psychiatric disabilities were administered two cognitive measures, the Wisconsin Card Sorting Test and the Logical Memory subscales of the Weschler Memory Scale, at baseline, and the SSCE at follow-up. After transforming the weighted item scores, intraclass correlation coefficients were used to examine inter-rater reliability and Rasch analysis was used to examine internal consistency of the SSCE. Spearman rank-order correlations were used to examine construct validity. RESULTS: High interrater reliabilities were found for the four subscale scores (ICCs ranging from .96 to 1.00, p < .001) and the total scores (ICC = .98, p < .001) of the SSCE. Rasch analysis indicated that no items misfit; however, some items showed a weak distribution across all possible scores. The SSCE subscale and total scores correlated to varying degrees with the cognitive measures. CONCLUSION: The SSCE has the potential to be a reliable and valid clinical measure, as demonstrated by the results of the current study. However, these results were only achieved using a transformation of the current scoring system for the SSCE, pointing to the need for further revision of the test items and scoring system.

Activities of Daily Living↗

PubMedDate not supplied

The relation between length of institutionalization and sensory integration in children adopted from Eastern Europe.

OBJECTIVE: To examine the relation between length of institutionalization and sensory integration in children adopted from Eastern Europe. METHOD: The Sensory Integration and Praxis Tests (SIPT) and the Developmental and Sensory Processing Questionnaire were administered to 60 adopted children, 4 years to 8 years, 11 months of age. Thirty had longer institutionalization histories (mean: 34 months; LIH group) and the other 30 had shorter institutionalization histories (mean: 3 months; SIH group). RESULTS: The LIH group demonstrated significantly lower scores than the SIH group on the SIPT in vestibular-proprioceptive, visual, and praxis areas, and effect sizes ranged from .09 to 1.13. The LIH group also had significantly more frequent behaviors suggestive of sensory modulation dysfunction compared to the SIH group, particularly in touch and movement seeking, vision, and audition. Effect sizes ranged from 0 to 1.39. CONCLUSION: Longer lengths of institutionalization are associated with more atypical sensory discrimination, praxis, and sensory modulation scores in children adopted from Eastern European orphanages. The areas of sensory integration that appear to be more vulnerable to deprived conditions in early childhood are vestibular-proprioceptive, tactile, visual, auditory, and praxis. Adopted children with lengthy periods of institutionalization may benefit from occupational therapy for early sensory integrative and developmental screenings.

Adoption↗