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Item Low Body Trust Predicts Lower Interoceptive-Based Regulation in Maltreated Youth.(2025-11-12) Petrenchik, TheresaBackground Early maltreatment negatively impacts interoceptive awareness (IA), the attention to internal states and bodily sensations in daily life. Body trust, the belief that one can rely on internal bodily sensations as safe and accurate cues for needs, emotions, and states of arousal, is especially compromised. In the absence of body-based awareness youth struggle to develop a coherent sense of self because they lack reliable internal feedback about their own experiences. Prolonged and early experiences of abuse and neglect are associated with a pervading lack of trust in the bodily self and body sensations which persistently alters the ways in which maltreated youth relate to their bodies. Objectives Assess the extent to which interoceptive-based Body Trust is uniquely associated with attention regulation, emotional awareness, self-regulation and body listening in a clinical sample of maltreated youth. Method Participants: A clinical sample of 132 youth (ages 7–17) receiving mental health services for early abuse and neglect. Mean age of 12 years, with 54% female and 80% in adoptive or guardian care. Design & Analysis: Secondary analysis of Multidimensional Assessment of Interoceptive Awareness-Youth (MAIA-Y)8 cross-sectional data. Body Trust scores were dichotomized at the sample grand mean (M=3.45): Lower Trust Group (n=59) and Higher Trust Group (n=73). Four dependent variables: Attention Regulation, Emotional Awareness, Self-Regulation, and Body-Listening were analyzed in separate SPSS v31 GLM Univariate Regressions (α = .05). Results: A majority of youth (80%) reported Low Body Trust (LBT). Across all four MAIA-Y dimensions, LBT uniquely predicted lower interoceptive-based regulation (|β| = .72–1.18, all p < .001; R² = .12 -.25). LBT had the largest negative effect on Self -Regulation, accounting for 25% of the difference in Self-Regulation scores across the study sample. In comparison with the higher Body Trust group, youth with LBT scored: • 0.72 points lower on Attention Regulation; • 0.88 points lower on Emotional Awareness; • 1.18 points lower on Self-Regulation; • 0.81 points lower on Body-Listening Conclusion Youth with LBT have difficulty initiating and completing body-based strategies that shift states into functionally adaptive zones.Item Early maltreatment and interoceptive awareness in youth: Associations among age, sex and child sexual abuse(2025-09-22) Petrenchik, TheresaBackground: Early maltreatment negatively impacts interoceptive awareness (IA), the attention to internal states and bodily sensations in daily life. Body trust, the belief that one can rely on internal bodily sensations as safe and accurate cues for needs, emotions, and states of arousal, is especially compromised. Although this has significant implications for for emotional regulation, self-awareness, and treatment limited research has examined IA in clinical samples of maltreated youth. Objective: The purpose of this study was to examine age and sex related differences in interoceptive awareness in a clinical sample of youth receiving treatment for complex trauma. A second aim was to examine the relationship between substantiated child sexual abuse (CSA) and body trust. Participants and setting: Data are from a clinical sample of 131 maltreated youth (ages 7–17) receiving therapeutic services for abuse and neglect. Mean age of 12 years, with 54 % female and 80 % in adoptive or guardian care. Methods: The study involved a secondary analysis of Multidimensional Assessment of Interoceptive Awareness-Youth (MAIA-Y) cross-sectional data. Two-way ANOVAs examined main and interaction effects for age and sex on five MAIA-Y scales. Linear regression analyzed the relationship between CSA and body trust. Results: Attention Regulation (p = .03, η2p = .04) was significantly higher in the older age group (11–17). Significant age by sex interactions emerged for Attention Regulation (p = .025, η2p = .04), Self-Regulation (p =.02, η2p = .04), and Trusting (p < .001, η2p = .11). Adolescent females (11–17) scored significantly lower than males and younger females on all three measures. CSA uniquely explained a proportion of low body trust scores (p = .005, R2 = .07). Conclusions: Adolescent females with early maltreatment demonstrate unique vulnerabilities in self-regulatory aspects of interoceptive awareness. These findings underscore the need for developmentally sensitive, gender specific interventions that prioritize restoration of body trust and self-regulatory aspects of interoceptive awareness in trauma treatment.Item Pilot Testing and Validation of an Educational Game on Transportation Challenges for Mobility Device Users(MDPI, 2024) Candiotti, Jorge L.; Park, Sangmi; Lee, Chang Dae; Rafferty, Evan J.; Cooper, Rosemarie; Cooper, Rory A.; Occupational Therapy, School of Health and Human SciencesDespite the increasing use of assistive mobility devices, practical education to navigate real-world ground transportation barriers is lacking. The educational board game, called HERL-Town, was developed to teach safe and effective navigation for mobility device users (MDUs) in the community. The study examined the initial validity, reliability, and overall quality of HERL-Town as an educational tool for overcoming transportation barriers in real-world environments. HERL-Town featured fifty scenarios focused on transportation barriers and strategies, which were assessed for content validity, while the game quality was evaluated using the Model for the Evaluation of Educational Games (MEEGA+) tool. Twenty-three experienced MDUs and four caregivers participated in the study. The results indicated a good quality score of 60.15 and forty-five scenarios met the content validity standards. The overall reliability of the scenarios was moderate (ICC = 0.729). Early psychometric findings suggest HERL-Town as a promising effective educational game for helping new MDUs and their travel companions navigate safe and effective ground transportation barriers, hence enhancing their confidence, independence, and participation in the community.Item Gender as Occupation: The "Doing" of Authentic Expression and Reciprocally Affirming Care for Transgender Individuals(WMU, 2023) DeRolf, Annie; Belkiewitz, Johnna; Wasmuth, Sally; Occupational Therapy, School of Health and Human SciencesThe current predominant view of gender as binary, alongside limited training of affirmative care practices, is severely and negatively impacting transgender and gender diverse (TGD) people. This paper urges the re-conceptualization of gender as an occupation, suggesting that gender is a doing that allows for positive identity development, roles, habits, and routines. Doing gender facilitates meaning-making and the ability to engage in other occupations. However, occupational injustices rooted in discrimination, stigma, and/or implicit biases impede TGD people’s ability to engage in the doing of gender and other occupations. Articulation of conceptual guidelines and interventions to support TGD people’s ability to do gender and other occupations is a critical area of need in occupational therapy literature and practice. In accordance with the profession’s ethical mandate to promote occupational justice, it is critical that occupational therapists become educated and involved in providing affirmative services to support occupational participation for this population.Item Applying the Ecological Model of Human Performance and the SlutWalk Movement to Support those Affected by Rape Culture in the Context of Occupational Therapy(WMU, 2023) Klukken, Angela; Wasmuth, Sally; Occupational Therapy, School of Health and Human SciencesImproving the occupational lives of others is at the heart of occupational therapy practice. Advocacy for clientele is central to this improvement, both at individual and structural levels. We argue that interventions in the Ecological Model of Human Performance (EHP) and the social movement theSlutWalk can offer increased opportunity for occupational therapists to address the harmful implications for clients affected by sexual assault and rape culture. In addition, through the principles of the EHP and the SlutWalk, we propose that occupational therapists can have a hand in eradicating the culture that facilitates and tolerates sexual violence. This paper highlights the barriers women and sexual assault survivors may face to equitable occupational participation, where occupational therapists may establish/restore, alter, create, prevent, and adapt intervention approaches in the client’s context to elicit optimal engagement in meaningful activity.Item Application of a Model of Family-Centered Harm Reduction in Community-Based Programming(WMU, 2023) Belkiewitz, Johnna; Wilburn, Victoria G.; Larson, Sydney; Schrader, Kate; Occupational Therapy, School of Health and Human SciencesCoupling high substance use disorder rates with the effects of the COVID-19 pandemic, our nation faces a growing mental health crisis and a shortage of adequately trained mental and behavioral health providers. As occupational therapists work toward recognition as qualified providers in this practice area, we must ensure that future therapists can meet client needs. Traditional mental and behavioral health educational practices in occupational therapy use a model of harm reduction that minimizes negative outcomes for a select subset of the population engaging in specific “high-risk” behaviors, such as individuals engaging in substance use and sexual activity. Expanding our understanding of the harm reduction model and incorporating a more holistic trauma-informed care lens can better ensure beneficence for all clients. To do this, educational institutions must train students to identify harm in all of its contexts, such as the household dysfunction of cohabitating with a family member with substance use disorder, and apply practical treatments for addressing the impacts of dynamic family systems through occupation-based interventions. This paper illustrates a family-centered harm reduction model and offers a community-based educational intervention that allows occupational therapy students to gain valuable trauma-informed care practice skills through hands-on experiences.Item Discovering Provider Awareness of Mobility Assistive Technologies and Clinical Guidelines- A Comparative Analysis with Consumer Responses(Wolters Kluwer, 2024) Lee, Chang Dae; Peterson, Sara; Joseph, James; McKernan, Gina; Cooper, Rosemarie; Koontz, Alicia M.; Dicianno, Brad E.; Cooper, Rory A.; Occupational Therapy, School of Health and Human SciencesObjective: This study aims to enhance the accessibility and quality of mobility-assistive technology by investigating and bridging knowledge gaps between mobility-assistive technology providers and consumers with ambulatory limitations. Design: A survey was conducted among mobility-assistive technology providers in the United States, consisting of sections on awareness, knowledge importance and desire, and knowledge sources. The responses were compared to data collected from consumers in a previous study. Results: A total of 144 mobility-assistive technology providers participated, with 60% having received academic or professional training in relevant fields. Analysis revealed significant knowledge gaps between providers and consumers, particularly in assistive technology assessment tools and knowledge sources. Moderate gaps were also observed in areas such as clinical practice guidelines, desired mobility-assistive technology information, and knowledge sources. However, the gaps in other areas were relatively small. Conclusions: This study highlights the knowledge gaps between mobility-assistive technology providers and consumers, hindering the optimal utilization and fulfillment of user needs. Providers possess valuable information that consumers may lack, positioning them as primary knowledge sources. Addressing these gaps through targeted interventions, improved communication channels, and enhanced education can enhance the utilization of mobility-assistive technology and improve outcomes for individuals with ambulatory limitations.Item Current State, Needs, and Opportunities for Wearable Robots in Military Medical Rehabilitation and Force Protection(MDPI, 2024) Cooper, Rory A.; Smolinski, George; Candiotti, Jorge L.; Satpute, Shantanu; Grindle, Garrett G.; Sparling, Tawnee L.; Nordstrom, Michelle J.; Yuan, Xiaoning; Symsack, Allison; Lee, Chang Dae; Vitiello, Nicola; Knezevic, Steven; Sugar, Thomas G.; Schneider, Urs; Kopp, Verena; Holl, Mirjam; Gaunaurd, Ignacio; Gailey, Robert; Bonato, Paolo; Poropatich, Ron; Adet, David J.; Clemente, Francesco; Abbas, James; Pasquina, Paul F.; Occupational Therapy, School of Health and Human SciencesDespite advances in wearable robots across various fields, there is no consensus definition or design framework for the application of this technology in rehabilitation or musculoskeletal (MSK) injury prevention. This paper aims to define wearable robots and explore their applications and challenges for military rehabilitation and force protection for MSK injury prevention. We conducted a modified Delphi method, including a steering group and 14 panelists with 10+ years of expertise in wearable robots. Panelists presented current wearable robots currently in use or in development for rehabilitation or assistance use in the military workforce and healthcare. The steering group and panelists met to obtain a consensus on the wearable robot definition applicable for rehabilitation or primary injury prevention. Panelists unanimously agreed that wearable robots can be grouped into three main applications, as follows: (1) primary and secondary MSK injury prevention, (2) enhancement of military activities and tasks, and (3) rehabilitation and reintegration. Each application was presented within the context of its target population and state-of-the-art technology currently in use or under development. Capturing expert opinions, this study defines wearable robots for military rehabilitation and MSK injury prevention, identifies health outcomes and assessment tools, and outlines design requirements for future advancements.Item Wheeled mobility use outcomes: a systematic review protocol of measurement properties(Wolters Kluwer, 2024-09) Mendoza, Kiera; Loeser, Madison; Ouellet, Béatrice; Best, Krista L.; Paula, Rushton W.; Kenyon, Lisa K.; Hinrichs, Rachel J.; Chase, TonyNumerous tools have been developed to measure constructs related to wheelchair use. Currently, no toolkit comprehensively details assessments of wheeled mobility device use based on the quality of their measurement properties. The current review aims to systematically identify high-quality assessment tools that measure different aspects of wheeled mobility use. The objectives are two-fold: i) to synthesize outcome measures that assess use of wheeled mobility devices, and ii) to evaluate measurement properties of the assessment tools. The populations of interest are manual wheelchair users, power wheelchair users, and scooter users of any age, diagnosis, or setting. Instruments of any type will be included. The JBI methodology for systematic reviews of measurement properties will guide this review. A search strategy will be developed to search the following databases: MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (EBSCOhost), PsycTests (EBSCOhost), Web of Science, and Google Scholar. The article selection process, data extraction, and quality appraisal will be performed by 2 independent reviewers, with a third reviewer being consulted to achieve consensus. The methodological quality of the studies will be assessed through the Consensus Standards for the Selection of Measurement Instruments (COSMIN) Risk of Bias tool and the COSMIN Checklist. The quality of the pooled evidence and individual measurement properties will be graded using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the COSMIN Criteria for Good Measurement Properties recommendations. Measurement properties of each instrument will be described, with the goal of developing a toolkit that identifies appropriate assessment tools for wheeled mobility use outcomes.Item Bridging the Humanities and Health Care With Theatre: Theory and Outcomes of a Theatre-Based Model for Enhancing Psychiatric Care via Stigma Reduction(APA, 2022-12-22) Wasmuth, Sally; Pritchard, Kevin T.; Belkiewitz , Johnna; Occupational Therapy, School of Health and Human SciencesObjective: This article describes the rational, methods, implementation, and effectiveness of Identity Development Evolution and Sharing (IDEAS), an evidence-supported, narrative theater-based training that reduces stigma among health care providers to increase health care equity in psychiatric rehabilitation. Method: The IDEAS model has been used to reduce provider bias toward patients. From May 2017 to January 2020, we interviewed people from three patient groups who have been harmed by stigma, including Black women, transgender, and gender-diverse people, and people with substance use disorders. These interviews informed the creation of three theatrical scripts that were performed by professional actors for audiences of health care providers from January 2020 to May 2022. The performances aimed to raise conscious awareness of implicit provider biases and to provide a reflective opportunity to ameliorate these biases. The purpose of IDEAS is to improve experiences in health care settings such as psychiatric rehabilitation of patients from groups who have been harmed by stigma. We used paired-samples t tests to compare pre/postprovider stigma, measured via the Acceptance and Action Questionnaire-Stigma (AAQ-S). Results: Sociodemographic factors for providers who viewed IDEAS were similar across all three performances. IDEAS significantly decreased AAQ-S scores (t = 11.32, df = 50, M = 13.65, 95% confidence limit: [11.32, 15.97], p < .0001). Conclusions and implications for practice: IDEAS reduces provider stigma to support positive clinical encounters with diverse patient populations. These findings are relevant for psychiatric rehabilitation settings, which seek to establish positive rapport between providers and patients.