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",isbn:"978-1-80355-403-7",printIsbn:"978-1-80355-402-0",pdfIsbn:"978-1-80355-404-4",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!0,isSalesforceBook:!1,hash:"360fe5dabd12a1f91a5658a5fe3eff66",bookSignature:"Associate Prof. Murat Eyvaz and Dr. Ahmed Albahnasawi",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/11934.jpg",keywords:"Hydrogen Sources, Hydrogen Production, Hydrogen Safety, Hydrogen Storage Methods, Environmental Impacts of Hydrogen, Synthetic Fertilizer Production, Aromatization, Hydrocracking, Hydrodesulfurization, Fuel Cells, Gas Turbines, Hydrogen Driven Vehicles",numberOfDownloads:null,numberOfWosCitations:0,numberOfCrossrefCitations:null,numberOfDimensionsCitations:null,numberOfTotalCitations:null,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"February 18th 2022",dateEndSecondStepPublish:"March 18th 2022",dateEndThirdStepPublish:"May 17th 2022",dateEndFourthStepPublish:"August 5th 2022",dateEndFifthStepPublish:"October 4th 2022",remainingDaysToSecondStep:"2 months",secondStepPassed:!0,currentStepOfPublishingProcess:3,editedByType:null,kuFlag:!1,biosketch:"Dr. Eyvaz is a pioneering researcher in environmental sciences and engineering, who has co-authored numerous journal articles and conference papers and has four patents on wastewater treatment systems.",coeditorOneBiosketch:"Dr. Albahnasawi is a pioneering researcher in environmental sciences and engineering, who has co-authored numerous journal articles and conference papers on water and wastewater treatment and waste remediation.",coeditorTwoBiosketch:null,coeditorThreeBiosketch:null,coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"170083",title:"Associate Prof.",name:"Murat",middleName:null,surname:"Eyvaz",slug:"murat-eyvaz",fullName:"Murat Eyvaz",profilePictureURL:"https://mts.intechopen.com/storage/users/170083/images/system/170083.png",biography:"Dr. Murat Eyvaz is an associate professor in the Environmental Engineering Department, Gebze Technical University, Turkey. His research interests include applications in water and wastewater treatment facilities, electrochemical treatment processes, filtration systems at the lab and pilot-scale, membrane processes (forward osmosis, reverse osmosis, membrane bioreactors), membrane manufacturing methods (polymeric membranes, nanofiber membranes, electrospinning), spectrophotometric analyses (UV, atomic absorption spectrophotometry), chromatographic analyses (gas chromatography, high-pressure liquid chromatography). He has co-authored many journal articles and conference papers and has taken part in many national projects. He serves as an editor and reviewer for many indexed journals. Dr. Eyvaz has four patents on wastewater treatment systems.",institutionString:"Gebze Technical University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"5",totalChapterViews:"0",totalEditedBooks:"6",institution:{name:"Gebze Technical University",institutionURL:null,country:{name:"Turkey"}}}],coeditorOne:{id:"323629",title:"Dr.",name:"Ahmed",middleName:null,surname:"Albahnasawi",slug:"ahmed-albahnasawi",fullName:"Ahmed Albahnasawi",profilePictureURL:"https://mts.intechopen.com/storage/users/323629/images/system/323629.png",biography:"Dr. Ahmed Albahnasawi is a post-doctorate fellow in the Environmental Engineering Department, Gebze Technical University, Turkey. His graduate work focused on the investigation of the treatability of the sequential anoxic-aerobic batch reactors followed by ceramic membrane for textile wastewater treatment. Based on his Ph.D. research, Dr. Albahnasawi published three journal articles and participated in three international conferences. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"47512",title:"Occupational Therapy in Autism",doi:"10.5772/59168",slug:"occupational-therapy-in-autism",body:'Autism, a developmental disability, is defined by behavioural characteristics. Primary features of autism are described as problems in language skills, plays and social interaction [1]. It is considered a spectrum disorder, as the abilities of children with autism may very greatly from one child to another [2]. Symptoms begin during early childhood and distinctive incompetence and limited, repetitive behaviours are seen in socio-communicative field. In addition to these primary features, individuals with autism generally have sensory processing and sensory integration dysfunction, which affect adaptive behaviour and participating daily activities. Many children with autism are unable to register many of the sensations from their environment. They cannot integrate those sensations to form a clear perception of space. Atypical sensory registration and orientation can interfere with the processes of inhibition and facilitation in sensory systems. Some self-stimulatory behaviour is the expression of a sensory need in children with autism. Assessing sensory integrative functioning in children with autism is critical for planning and implementing effective intervention in occupational therapy [3-5]. As far as motor functions are concerned, motor impairments have been reported in children with autism. The studies shown that problems are observed in coordination, posture and balance control, locomotion and motor preparation in individuals with autism [6-10].
Due to sensory integration dysfunction, individuals with autism have difficulty fulfilling the roles they are expected to accomplish in their life and they can display behaviours that can hinder their participation in daily life. The primary aim of occupational therapy practices is to ensure that the individuals with autism participate in communal life through minimizing the difficulties in the daily activities they experience at home, school or in communal life and maximizing their independency. Occupational therapists believe that the individual with autism’s community participation can be increased through their participation in meaningful and purposeful activities they have in their daily roles and aims to achieve. They also make use of client-centred and holistic therapeutic interventions both in analysing and evaluating the problems which individuals with autism face and in their treatment and support system.
Occupational therapy interventions, which are designed according to standardized assessment tests, questionnaires, skilled observations, provide considerable advantage in dealing with the problems individuals with autism and their families face in daily life.
This chapter will give information on standardized assessment tests and practices applied in occupational therapy interventions such as sensory integration therapy, auditory integration training, activities of daily living training, play therapy, social skills training, cognitive behavioural therapy, school based intervention, recreational activities and sports and vocational rehabilitation.
Current estimates indicate that accompanying sensory processing problems are reported in more than 80% children with autism. Hyper or hypo reactivity to sensory inputs is now a diagnostic criterion for Autism Spectrum Disorders in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition [11, 12]. A. Jean Ayres, an occupational therapist, developed the sensory Integration theory [13]. Theory is based on neuroscience, developmental psychology, occupational therapy and education sciences. Sensory integration therapy is a common method used in paediatric occupational therapy. Results of a survey made on occupational therapists working with children with autism report that 99% of therapists stated that they were referring to sensory integration therapy [14]. According to this theory; 1.sensorymotor development is important for learning 2. Individual’s interaction with environments shapes brain development 3. Neurological system has plasticity capability. 4. Meaningful sensory-motor activity is a strong mediator of plasticity [15]. Sensory integration is a process of organizing sensory information in brain in order to create an adaptive response. The aim of sensory integration therapy is to provide controlled and meaningful sensory experiences so that the child can spontaneously and appropriately form responses that require integration of those sensations [16].
According to the theoretical basis of sensory integration vestibular, proprioceptive, tactile, auditory and visual systems as well as olfaction (sense of smell) and gestation (sense of taste) have a significant importance. The tactile/proprioceptive and vestibular/proprioceptive systems interact routinely with the auditory and visual systems to supply the multimodal sensory information needed to make a meaningful motor response. It’s reported that sensory integration is a dynamic process that sustains during development and sensory information can be organized as a result of interaction with environment [17].
Skin has numerous receptors that perceive touching, pressure, texture, heat, pain and movement. A signal is transmitted to the related parts of the brain when tactile receptors are stimulated with touch, heat or vibration. Tactile system is a sensory system that affects behaviour both physically and mentally. Sense of touch is quite important for neural organization and praxis development [16, 18].
Vestibular receptors related with balance and gravity, and located in inner ear consist of semi-circular canals, utricle and saccule. Semi-circular canals are responsible for detection of angular, fast, short bursts of motion, and result in phasic limb movements and momentary head righting. Vestibular system is a system that affects balance, eye movements, posture, muscle tonus and attention [16, 19].
This system is related with position and movement. Pushing and pulling activities related with muscles and joints are activities that provide maximum stimulation for this system. Proprioceptive system provides information on postural and oculomotor control, position in space and balance together with vestibular and visual system. In terms of the problems reported in vestibular and proprioceptive system, difficulties in good body scheme and laterality development, poor balance, poor postural control and difficulties in coordinated movements are observed in children with autism [2, 16-18].
Children who are hypo responsive against proprioceptive stimulation have weak proprioceptive discrimination and awareness and fail to use proprioceptive input correctly. Therefore they tend to break their toys easily and have low postural tonus. Bites, pushes, hits, scratches, bumps, hurls, hangs and aggressive behaviours as well as self stimulatory and hyperactive behaviours such as banging head, biting hands are observed in children seeking for proprioceptive inputs [20].
The sound information from each ear goes to auditory cortex of opposite hemisphere. The relation between the auditory system and valgus nerve is important in sensory modulation [16].
The light received stimulates retina in order to send sensory input to the processing centre in the brain. Integration of visual inputs with different senses provides our awareness about our environments. Visual and vestibular systems work together for perceptual motor integration and visual perception [16, 18].
Different senses of tastes ensure that we like the food we eat and distinguish those that may be harmful [16].
Smell is directly processed via limbic system and creates memories and associations that influence some of our choices and preferences [16].
It’s reported that sensory processing problems observed in individuals with autism are associated with behavioural and/or functional performance problems and specifically stereotypical or repetitive are associated with self-calm or sensory seeking [21]. The studies show that repetitive behaviours, behaviours such as climbing, turning and twirling may indicate existence of sensory processing behaviours [12].
Sensory registration, modulation, discrimination and praxis defined as motor behaviour planning capability are performance components, which are important for sensory integration. Sensory registration is receiving different stimulus from body or environment [17]. Sensory registration process is important for the individual to perform effective function by paying attention. Children with autism who have sensory registration problems fail in creating appropriate adaptive responses against pain, touch, movement, taste, smell, light and sound [22]. Sensory modulation is defined as “capacity to regulate and organize the degree, intensity, and the nature of responses to sensory input in a graded and adaptive manner” [17]. Sensory discrimination is important for development of motor functions, postural tonus and postural adjustment. Different sensory modulation problems such as hyporesponsivity, hyperresponsivity, sensory avoiding or sensory seeking are reported in children with autism. Hypersensitivity is the most common auditory and tactile defensiveness. High pain tolerance is the most significant indicator of hypo responsiveness in children with autism [2].
Difficulty in starting and sustaining a social interaction and relation, delays in speaking or communication disorders such as echolalia, repetitive stereotypical plays, visually focusing on any object, cognitive deficits and confusions in impacts and results of behaviours are common sensory integrative – related behaviours in children with autism spectrum disorder. Poor sensory processing affects the child with autism in successful involvement in daily life activities such as playing and participating in social activities with peers, tooth brushing, eating, self care etc. [23].
It is important to identify sensory responsiveness (over, under or labile) and sensory preferences (likes and dislikes) praxis and sensory processing problems that affect involvement in daily life activities in the assessment of sensory integration in children with autism [25].
Numerous tests like given below are used for assessment of sensory integration in occupational therapy.
Tests such as
Besides standardized assessments, many occupational therapists refer to clinical observations for assessment of sensory and praxis functions. Clinical observation of postural control, behaviour organization and vestibular functions offer significant information in addition to sensory tests. It’s important to observe playing skills, social interaction and other relevant behaviours of the child in child’s natural settings [23].
It’s reported that sensory integration therapy should be individually implemented with the consideration of the “inner drive” of the child, based on the sensory experience, challenge and interest and in a structured environments with active participation of the child [16, 22]. More effective feed-forward mechanism required for optimum adaptive response are created with child-directed actions. In responding children with autism, it is important to use controlled and meaningful sensory stimulus to create organized behaviour and to make environmental adaptations when needed. Due to the problems in body awareness, a child with autism fails in receiving sufficient tactile, proprioceptive and vestibular inputs from his/her body. Therefore, environmental arrangements should be adjusted according to motor planning and body awareness required for praxis. It’s important to refer to sensory experiences that motivate and please the child with complex motor planning, social interaction and language skills. Therapist should integrate activities that contain sensory experiences required by the child into daily routine in cooperation with the family, caregivers and teachers [23]. Validity of the results in sensory integration studies are reported to be influenced by different practices in the intervention process and it’s further reported that “Ayres Sensory Integration Fidelity Measure” which is a reliable and applicable verification measure for studies on sensory integration disorders should be used [36, 37].
Fidelity measure consists of 10 essential elements is used in clinic based sensory integration treatment. These essential elements are as follows: a) ensuring safety b) presenting a range of sensory opportunities (specifically tactile, proprioceptive, and vestibular) c) Using activity and arranging the environment to help the child maintain self regulation and alertness d) challenging postural, ocular, oral, or bilateral motor control e) is challenging praxis and organisation of behaviour f) collaborating with the child on activity choices g) tailoring activities to present the “ just –right challenge”, h) ensuring that activities are successful, i) supporting the child’s intrinsic motivation to play, and j) establishing a therapeutic alliance with the child [37].
Proprioception is defined as a cornerstone in sensory integration therapy. Muscle movements against resistance or gravity, traction, compression, movements related with muscles and joints provide proprioceptive stimulus and are used to improve motor coordination, to increase body awareness and to help arousal level modulation [2, 20].Practices like jumping on trampoline, climbing a mountain of bolster and crash onto mats, jumping games, roller skating, bicycle riding, throwing and catching a heavy ball, wheelbarrow walking, pulling and pushing activities, carrying or moving heavy objects, imitating animal walks that require heavy work (crab, bear), swinging from trapeze bar, wearing a weighted west, weighted blanket, wearing ankle or wrist weights in activities stimulates proprioceptive system [23, 38]. (Figure 1)
Activity examples for proprioseptive and vestibular system stimulation
Activities like playing with dough or clay type materials, drawing on mirror with shaving cream, finger painting, drawing shapes with fingers in sand, foam etc, massage, vibrating toys, using different textures for playing and bathing, playing hide and seek games in dried beans or rice, asking the child to define shapes drawn on this/her back with fingers, finding objects from a bag full of rice or beans etc. can be used to improve tactile awareness [23, 38].
The child may be asked to listen his/her favourite soft music on headphones in order to reduce auditory sensitivity [23].
Activities such as linear swinging on a swing or ball on facedown position, throwing and catching objects while swinging, sliding down a slide, climbing, using scooter board or skateboard, jumping games, rolling activities, toys like rocking horse can be used to reduce sensitivity against vestibular senses. The child tolerates linear vestibular stimulus more than rotational stimulus [23, 38].
Toys and pens with lights, throwing balls at a target while swinging, games of ball throwing and catching, bubble blowing can be used to improve ocular-motor control [23, 38].
Ball catching games can be played on the floor or on a ball or while sitting in different positions on a swing [23, 38].
Activities such as creating shapes by tearing papers with both hands, making shapes with play dough, cutting papers etc. with scissors, making necklace by placing beads through a string, closing/opening clothe fasteners, ball catching and throwing and clapping type hand games[23, 38].
Therapeutic activities, which are for sensory processing and facilitate skills such as initiation, sequencing, bilateral coordination, timing and imitation can be used [5]. Activities of clapping and rhythm patterns hand games, building obstacle courses, activities that require whole body movements and timing such as kicking a rolled ball, hitting a ball with a bat, imitation of animal postures etc. can be used to improve motor planning [23, 38].
Sensory integration therapy is a clinical based intervention that uses play activities and sensory integration principles to increase adaptive responses of children [12]. In a systematic review research by Benson and Koomar, 27 studies on the impact of sensory integration approach on children were reviewed. It’s reported that sensory integration approaches are effective in terms of sensory-motor skills, motor planning, socialization, attention and behavioural regulation, skills related with reading, active participation in plays and personal goal attainment, however, the findings are limited due to small sample size, different practice dosages, therapy duration and result measurements not being appropriate [39].
Schaaf
Pfeiffer
Some studies report that sensory integration therapy does not have a positive impact due to small sample size, short therapy duration, no fidelity measure, study design and due to the fact that assessments are not blinded [47-51].
The last systematic review study by Smith et al. on sensory integration notes that evidence based studies where blinded evaluation, larger samples and randomised trial are used should be conducted [12].
Auditory processing problems are one of the sensory processing disorders commonly reported in children with autism. These disorders are classified either as auditory hypersensitivity or auditory underresponsivity [3, 52, 53] and Rimland and Edelson reported that nearly 40% of 17.000 children with autism have sound sensitivity [54].
Auditory Integration Therapy is a technique developed by Dr Guy Berard, an otorhinolaryngologist in order to reduce abnormal sound sensitivity in autism spectrum disorders. In this method, electronically modulated music is listened by headphones for half an hour twice a day for 10 days. Audio metrical assessment is made before the therapy. Auditory integration training devices filters peak frequencies against which the individual has hypersensitivity. It aims to regulate behaviour by reducing hypersensitivity. The filtered music is modulated by a brief dampening of high and low frequencies for periods ranging from 250 milliseconds to 2 seconds [54-56].
445 individuals with autism who received auditory integration therapy were reported to have a decrease in problem behaviours and increased hearing acuity and the observed changes remained stable for nine months [57].
Changes in brain functions were measured before and after auditory integration therapy with positron emission tomography and an increase in occipital lobe activity and a decrease in hyper metabolism in frontal lobe were reported [58]. Auditory therapy according to Tomatis method is reported to create an increase in daily life skills, motor skills, socialization and communication skills in 6 cases. Furthermore, decrease in hyperactivity, atypical behaviours and increase in attention was reported in cases [59]. Brockett
Activities of daily living (ADLs) are oriented toward taking care of one’s own body and include bathing, dressing, eating, feeding, bowel and bladder management, functional mobility, personal device care, personal hygiene and grooming, sexual activity and toilet hygiene. These activities are “fundamental to living in a social world; they enable basic survival and well-being”. Instrumental activities of daily living (IADLs) may require more complex interactions with one’s environment; these activities support daily life within the client’s home and community. IADLs include: communication management, home establishment and management, meal preparation and clean up, financial and health management and maintenance, community mobility, shopping, safety and emergency maintenance, care of others and pets, child rearing and religious observance. Children and young people learn to perform ADL and IADL activities with socially appropriate ways in order to engage in education in family and society, game playing, leisure, social participation and work occupations [65].
Individuals with autism generally have the risk of limited engagement in activities. Studies show that such individuals engage in less activities less frequently and have weaker daily life skills when compared with individuals with other developmental disorders or with typical development [66-70]. Most common areas reported by families are limited independence in dressing, rigid eating routines, interruption of eating time because of difficult behaviour, limited independence and discomfort in many hygiene tasks, obvious difficulty in toilet training, limited engagement in chores and continuous and intense supervision to provide safety [71]. Engagement of individuals with autism in daily living activities may be effected by core characteristics specific to autism as well as sensory processes. Studies show that 42-88 % of individuals with autism experience sensory integration disorders [72-76]. Koenig and Rudney demonstrate in a review that children and adolescents who have sensory processing deficits have difficulties in completing their daily occupations, including ADLs and IADLs [77]. While the literature underlines the need to increase evidence-based studies, sensory integration deficits of individuals and sensory features of environment should not be ignored in assessments and interventions for activity engagements of individuals with autism.
ADL and IADL assessments start with analysis of occupational performance. For this purpose, interviews, inventories, observation and various standardized tests can be used as an assessment method. In the initial stage, interview with family, child, teacher and other care givers is important in learning child’s skills, habits, routines and roles, environmental features, goals and dreams [78]. If the family reports difficulties about some ADL or IADLs of child, therapist should observe the child in clinic or ideally at home if possible and in child’s environment during the activity. Assessment should contain information on social, cultural and physical environment, which affect activity performance as much as motor, process and communication/ interaction skills of the child. Environmental factors such as division of labour division of family members for child’s care, safety issues in physical environment and cultural habits and social routines of family may be registered. Task analysis is made to define activity demand, activity is divided into steps and reviewed, steps are listed and requirements are defined. The Functional Independence Measure for Children (WEFIM), Waisman Activities of Daily Living (W-ADL) Scale, The Paediatric Evaluation of Disability Inventory (PEDI), The Vineland Adaptive Behaviour Scales, The Assessment of Motor and Process Skills (AMPS), The Canadian Occupational Performance Measure (COPM) and Sensory Profile (SP) for sensory integration are some of the examples of standardized methods that can be used in the assessment of performance in daily living activities [29, 79-85].
Occupational therapists may refer to different approaches to improve ADL and IADL performances in children, including 1) establishing and maintaining performance, 2) activity adaptations or compensatory methods [78].
At the initial stage of intervention, therapist uses an activity analysis to define which steps of activity process are problematic and defines behavioural and educative methods to be used [78].
Behavioural approaches has been used, often in combination with other approaches, to obtain a baseline of the child’s behaviours and as a way of establishing clear goals. Behavioural methods like reinforcement and token systems are useful in attainment and sustainment of skills in individuals with autism. Furthermore, besides guiding learning, they may facilitate visual (showing), verbal (speaking or written information), tactile (guidance or using a part of body) or environmental (colour coded materials) cues. Cues are important to improve the quality of performance and to brief individual on what to do in the next step. As individuals with autism may experience difficulties in understanding natural cues and verbal communication, context or activity demands such as use of prompting can be modified [86].
One of the important training methods used in ADL training is chaining. Training of complex skills generally requires chaining steps of the task. Three chaining options are available for functional task training: a) Backward chaining in which the last step of the task is trained first, followed by the second to last step and the last step, and so on, progressing backward through the chain, b) Forward chaining in which the first step of the chain is trained first, followed by the first and second step, and so on, progressing forward through the chain c)Whole task method in which each step of the chain is trained on each presentation [87]. Another method is time-delay procedures. The time-delay cueing system typically involves two training stages: 1) A cue designed to elicit the next step in the chain is delivered so as to coincide with the stimulus (i.e., the completion of the previous step in the chain). 2) A defined interval is inserted between the occurrence of the stimulus and the response-eliciting cue [88]. These educational methods include strategies that occupational therapists can use in skill training. Repetition and development of habits and routines are required to sustain the skill after it is learned and to reduce environmental supports. Furthermore, generalization of skill in different environments should be emphasized [78].
Compensatory strategies may include modification of task or task method, use of assistive technology or modification of environment. Therapists may also refer to the combination of these methods [78]:
“Grading” is a method commonly used by therapists. Grading is adaptation of task or parts of a task according to the capability of child. Activity is divided into subtasks with task analysis and task is modified depending on the difficulty or easiness level for the child [78].
Individuals with autism can process visual information easier than auditory information [89]. Visually based interventions include visual (e.g., picture, written) schedules, visually organized tasks, written or pictorial scripts, rule reminder cards, and visual task analyses [90]. Such interventions are reported to be effective in individuals with autism [90, 91]. These activities may be used for individuals with autism to learn activities of daily living skills, to foresee daily routine and to become independent from various environments [92].
In literature, technologies like video modeling, video prompting, handheld devices, structured computer games and virtual reality environments are used for training purposes. Research incorporating technology has consistently demonstrated good effects to daily living skills for children with autism. Additionally, assistive technology requirement of occupational therapist, which technological tool is applicable and proper assessment of factors related with accessing technology such as economical status of family are important [92-95].
Creating sensory-friendly environments and implementing adaptive sensory strategies are important for effective ADL and IADL performance in children with sensory modulation problem. For instance, environment should be structured to be silent when an activity is performed with a child who has auditory-hyperresponsiveness responses. Use of earphone is recommended in environments that cannot be controlled. Another example is that preparation of a child with deep pressure and organized, rhythmical touches might be facilitating before starting a dressing activity with a tactile defensive child [23].
Besides being an activity that exists in every stage of life, play is the most proper way for a child to learn the world he/she lives in and to express emotions such as happiness, anxiety, and joy particularly during the first years of life. Bundy describes it as ‘’play is a transaction between an individual and the environmental that is intrinsically motivated, internally controlled, and free of many of constraints of objective reality’’ [96].
Play is primer occupation of the child. Through play, children can gain developmental milestones, learn about occupational role, behaviours, and how to interact safely and appropriately within their environment. Children with autism display atypical and insufficient play skills at different levels. This atypical and insufficient play skill is generally reported as playing with a toy stereotypically (rotating, shaking, sequencing, putting one on top each other) which is not suitable for its function, lack of social skill, flexibility and creativity skill to continue the play. Developments in symbolic activity, play and social relation areas observed in children younger than three years of age are not generally reported in children with autism [97]. Rare interaction of children with autism with their peers limits their attainment of playing in solitary and group plays with their peers [98]. Since game playing requires developed motor planning and praxis skill, this may result in child’s showing motor planning and praxis during play [96].
Occupational therapists are concerned with the occupation of play and the child developing as a lifelong player [99, 100]. Providing engagement with play in children with autism is one of the most important parameters of occupational therapy interventions [101]. The primary goal of occupational therapy interventions in children with autism is to ensure attainment of motor planning and praxis skills, which will improve child’s concrete thinking and play setting skills [99-101].
Play is multidimensional phenomenon that includes entertainment, spontaneous problem solving skill and creativity and requires collaboration of different disciplines [101-103]. Engagement in play and sustainability of play continue as long as the self-motivation and creativity of the player continue. Active engagement of children with autism in play and sustainment of play with adaptive response is one of the most important objectives in occupational therapy interventions [96, 99-101].
Our senses (tactile, visual, auditory, olfactory, gustatory, proprioceptive and vestibular) help us to collect information from the environment we live in and provide that we give adaptive responses suitable for the environment and we generalize what we learn. Sensory information is effective in the establishment of body scheme, which is one of the most components of motor planning skill [13, 104-106]. Studies reported that integration of tactile, visual, proprioceptive and vestibular sensory inputs offer improvement of body-spatial awareness [106-108]. When children with autism fail to produce adaptive response suitable for their environment and have insufficient body scheme, such may lead to negative experiences in their occupational performances and may result in anxiety, frustration, anger and avoidance [109]. Therapeutic play used in occupational therapy intervention can lead the child into a motivating activity with inner drive that encourages active movement, self direction, interaction, sensory building blocks and help addressing occupational performance and occupational profile of the child with autism [106, 109]. A study assessing the effectiveness of play therapy in literature reports that DIR-Floor Time and similar developmental approaches have a positive impact on emotional functioning, communication, and daily living skills and moreover creates positive changes in parent-child interactions [110]. It’s noted that play based occupational therapy improves motor and social skills in children with developmental delay [111]. Hebert reports in his study that therapeutic plays practiced for children with developmental delay in line with their occupational frameworks improve their non-verbal and verbal communication skills [112]. As noted by such evidence-based studies, well structured play which is commonly used in occupational therapy interventions has a positive impact on motor skill and planning, communication-interaction and social skills of children with autism.
Play is what children to do and they expend considerable social, cognitive and motor resources while playing, therefore play assessment may provide very meaningful insights about a child’s interests, functional abilities and behaviours [113-115]. The selection of a play assessment will vary depending upon the developmental status of the child, the purpose of the assessment and the intervention plan. Test of Playfulness [114], Knox Preschool Play Scale [115], Play History [116-118] and Trans-disciplinary Play-based Assessment [119], My Child\'s Play [120, 121] tests are among the common standardized tests used to plan occupational therapy interventions for the improvement of play skills [117]. Furthermore, occupational therapists frequently refer to Observations of Factors Influencing Playfulness Form [121, 122] to plan their interventions.
Occupational therapists frequently use sensory integration framework where sensory differences of individuals are taken into account in improving play skills of children with autism. Developmental approaches like Dr. Stanley Greenspan’s “Floor Time” method which aims to turn the relation between children and their families into a play with mutual interaction that contains trust and pleasure and philosophy of “Follow the child’s lead” [123-126]. Additionally, virtual reality studies are also included under play interventions [127]. During occupational therapy interventions, in addition to therapeutic use of play, occupational therapists play an effective role in the organization of play environment and parent education with the consideration of developmental level, challenges and strengths of child [128].
It’s important for the occupational therapists to implement therapy programs designed according to sensory integration framework, under the leadership of child in structured environments for the improvement of motor skill, social-emotional well-being, cognitive process, praxis, attention, intimacy, interaction expression, use of feelings/ideas and logical thinking development of child with autism in play based occupational therapy interventions [129].
Social skills have a significant place in diagnosis of autism. Children with autism experience difficulties in using non-verbal behavioural social skills such as eye-to-eye gaze, facial expression, body postures and gestures to regulate social interaction; failure interaction with peers, problems on sharing enjoyment, interests or achievements with other people and problems in social–emotional reciprocity and may require support as of early ages. Individuals with autism have difficulty in understanding nuances and informal rules, which are spontaneously used during communication. Such social interaction problems may lead to indifference, teasing or bullying. Social interaction efforts of many individuals with autism result in negative experiences as the individual is over stimulated or confused and negatively effects the social engagement of individual. Studies report that negative reactions against individuals with autism from their environment are more challenging that their communication problems [130]. Difficulties in social skill behaviours observed in individuals with autism are defined with neuropsychological models such as the theory of mind [131, 132], executive functions [133, 134] and weak central coherence [135, 136].
Theory of mind is defined as the capacity of interpreting, deducing and explaining the underlying mental situations in other’s behaviours. Preschool children are expected to have developed their theory of mind skills. Insufficient development of theory of mind are reported to lead to difficulties in interpreting emotional status from voice tone and facial expression and in social skills and negatively affects empathy skill of individual [131, 132]. Theory of mind is used to describe the major deficits in social functionality and communication in autism [132].
Dynamic and complicated nature of information process in brain reveals definition of high-level cognitive functions and concept of executive functions. This theory covers skills such as self-regulation of behaviour sequence, flexibility, response inhibition, planning and organization of behaviour. Executive functions where prefrontal cortex play a central role provides that an individual thinks about himself/ herself and defines what can happen in future and how they can be affected [133]. Executive functioning in autism is an approach studied fort he last 20 years. Studies on executive functioning and frontal lobe functions report that performances of children with autism in executive functions are lower than expected [133, 134]. Social skill deficits, namely executive function disorders or stereotypical behaviours, which are considered to be caused by their deficits, are observed in individuals on the spectrum and in their relatives [132-134].
According to weak central coherence model, information received from different sources cannot be integrated in autism [135]. Meaningful and consistent meronymy relation cannot be established from stimulus perceived due to information processing deficit. Weak central coherence can be associated with disadvantages experienced by individuals with autism in areas such as learning, social, language and cognitive skills etc. and it’s reported to be the reason for behavioural deviations in these areas [136].
Different disciplines commonly agree that autism is centrally a social skill deficit and therefore this area should be the first area to be targeted in training [137]. In social skill studies for children with autism, attainment of basic skills such as eye contact, using expressions like hello, thank you which are the basics for social communication, answering questions like how are you, playing with peers and getting in line in plays etc. are targeted with priority [137, 138].
There are many advanced social skills that should be attained by a child with autism after the attainment of basic social skills. These social skills can be classified under four main groups; communication skills: self introduction, asking proper questions to meet someone new, starting a conversation, involving in a conversation, not deviating from topic of the conversation, listening in a proper position, not keeping the talk too long, changing the topic properly, using voice tone, facial expression and body posture according to the topic of the conversation [139-141].
Social interaction skills (friendship): These are the skills like touching properly, ringing, answering a call, helping a friend properly, asking for help, spending time together, acting at a proper distance depending on the type of relation, respecting ideas of others, not feeling uncomfortable with changes in rules etc. [140].
Social interaction skills (playing): These are the skills like engagement in play, sharing toys, playing games with rules, getting into a line during play, coping with winning and defeat [140, 141].
Emotion recognition and management skills: They include skills like awareness on emotions, consoling a sad person, anger control and expressing anger properly, accepting criticisms, coping with mocking, sharing happiness, coping with making mistakes, not feeling uncomfortable when trying new things. [140, 142].
Social skill training is not a routine part of occupational therapy interventions for individuals with autism. Occupational therapy interventions play an important role in designing intervention programs for the assessment and improvement of insufficient social initiations and responses against any occupational performance of the individual with autism at home, school or in society, and in enhancing social participation of individual [130].
In social skill studies with children with autism, skills are tried to be taught face to face or in groups or some skills are taught during playtime with parents or peers [140, 141]. It’s reported that a shift can be made from individual works to group works for the development of empathy skill [139]. These working principles are also taken into consideration in occupational therapy interventions [16].
Among the studies on improvement of social skills in children with autism, there are researchers who think that “theory of mind” is the problem [133, 142, 143], and studies, which refer to, structured training programs [140, 144] or developmental approaches [145]. More than one technique is used in some studies. For instance various techniques like scenarios, social skill groups, self-control, class interventions, video modelling, social plays, peer training, peer mediation and circle of friends are used together [146-148]. There are also studies where a single technique is used like social stories [149], peer mediation etc. [150]. It’s reported that social skill training of children with autism is more effective in communication with other children in a natural group setting [151].
In a study where 79 studies on children with autism under the age of 12 were reviewed, it was noted that modeling and reinforcement, approach, peer training, scenarios and social stories were used [138]. It’s further noted that programs designed with techniques of approaches to learn social skills in groups or socially are more effective in children with autism [138, 152].
In occupational therapy, social skills of individuals with autism are assessed with observational standardized tests and checklists [153]. Standardized tests helps assessment of social skills and daily living skills of an individual with autism. Vineland Adaptive Behaviour Scale [83] and Social Skills Rating System [154] can be given as an example of such tests.
Occupational therapists may make structured interviews with parents and caregivers in addition to the standardized tests, and make observations in the natural settings and structured play settings of the child. During the assessment, informal rating scales can be used in the observation of social skills of the child such as spontaneously engaging in communication, imitation, socially responding, eye contact, game playing, asking for help/ helping, adjusting voice tone, using body language, expressing emotions verbally and non-verbally, giving proper responses, distance with others during communication and interaction [16, 128, 155].
Occupational therapy interventions for improvement of social skills in individuals with autism should be client-centred, with concrete narrations, supporting active engagement in cooperation with family and teachers in the natural settings of the individual and should consider emotional differences. Individuals with autism may experience significant difficulties in implementing the social rules despite having memory skills that facilitate repeating and memorizing these rules. Occupational therapists can give social skills training with creatively referring to the routine daily activities of the individual with autism during the sessions. A therapy program which starts with individual works of 30-90 minutes where necessary considerations and modifications are made over an activity related with the occupations of the individual with autism in his/her life and progresses with group works is considered as an ideal occupational therapy intervention. Adult-mediated or peer-mediated activities can be used in intervention. Teaching that the same response would not be proper in every social situation with the consideration of social hierarchy and group work principles during the intervention is an important detail of the intervention [16, 128, 155].
Social Stories and Social Autopsies, Social Skills Lessons and Activities, Jump Starters, Social Skills Activities for Special Needs, and Walker Social Skills Curriculum: The Accepts Programme, Do-Watch-Listen-Say” Framework, Video Modeling methods are frequently used in occupational therapy interventions [156-158].
Occupational therapy interventions designed to improve occupational performance in line with the basic principles given above may help in the development of social skills in individuals with autism and can increase their social engagement levels.
The cognitive behavioural approach assumes that a person\'s cognitive function and beliefs influence their behaviour, and that by helping a person dispute their irrational thoughts, they will be empowered to change their behaviour [159].
Each person’s beliefs are developed through his or her own life experiences. These experiences can be lived as well as watched (observational learning, vicarious reinforcement etc.). Individuals with autism can have problems on learning from society, and vicarious reinforcement is key aspects of Bandura\'s social learning theory [160]. Cognitive behavioural therapy is used primarily to help individuals with autism to regulate their emotions, develop impulse control, and improve their behaviour as a result. In addition, some individuals with autism struggle with fears and anxiety, or may become depressed. Cognitive behavioural therapy has been shown to be helpful for reducing anxious and depressed feelings and behaviour by making changes in thoughts and perceptions of situations through a change in cognition. The key ingredient of cognitive behaviour therapy based occupational therapy, which distinguishes it from regular behaviour therapy, is working on change in cognition or how thinking is processed [160, 161]. Occupational therapists seek to reduce challenging behaviours, such as interruptions, obsessions, meltdowns or angry outbursts, while also teaching individuals how to become familiar with and manage certain feelings that may arise during activities of daily living. Cognitive behavioural therapy can be individualized which matches client-centred approach of occupational therapy, and as a result, is very effective at improving very specific behaviours and challenges in each individual with autism. Stabilizing emotions and improving behaviour allows individuals with autism to prepare for and respond more appropriately in specific situations [159-161].
Occupational therapists working with individuals with autism refer to at least one behavioural approach, generally the frameworks of model of human occupation and biopsychosocial model in their therapy interventions [159, 162, 163]. Occupational therapists support the cognitive behavioural therapies implemented in line with these models with making changes in individual-environment-activity areas [159, 162-164]. Following cognitive behavioural therapy, occupational therapist assists an individual with autism to identify and change their irrational thoughts, then take this learning and use it in real life opportunities [159, 162, 163].
Although studies on mental health are frequently observed when cognitive behavioural therapy based occupational therapy interventions are reviewed, visually based interventions such as video modeling where behavioural changes are targeted with various activities have been demonstrated to be effective with children with autism. This approach has wide utility, is appropriate for a range of ages and abilities of children with autism. There are video modeling studies such as Video Self (modeling Tape the child and play back to give feedback), Video Instruction (tape another student doing the behaviour) and Video Feed-Forward Tape. These studies show the child the complete behaviour and promotes independent functioning, and can be used to address numerous learner objectives of occupational therapy, including behavioural, self-help, communication, and social objectives [164-166].
Occupational therapists generally work in line with model of human occupation and biopsychosocial model in the interventions of cognitive behavioural-based therapies in individuals with autism [159, 162, 163]. Besides the assessments of occupational therapy frame of reference, assessments such as 5 Point Scale, Power Cards, Bibliotherapy, Video Modeling, Situations-Options-Consequences-Choices-Strategies-Simulation, Social Autopsies, Comic Strip Conversation, Social Stories and Hidden Curriculum are used [156, 167-173]. Furthermore, a review also found that ILAUGH Model had already been researched and demonstrated to be a relevant learning hurdle for individual with autism [174].
There are some programs designed for children and adolescents to teach awareness of energy levels and self-regulation. Alert Programme “How Does Your Engine Run? ” is one of them and it teaches awareness of energy levels and how to bring the energy level back to the centre and it focuses on self-regulation skills according to sensory integration theory [175].
Occupational therapists also aim to improve the skills of exploring feelings in their activities with children with autism. For this purpose, programs of
Anxiety can be debilitating for a child with autism. Learning about emotions helps children recognize connections between thinking and feeling, and helps them identify the physiological effects of anxiety on the body (sweating, increased heart rate, crying, etc.). Learning and teaching to explore feelings can help the child with autism to identify situations that make them anxious and learn how to perceive the situation differently [179]. Therefore, occupational therapists frequently refer to self-management training in coping with anxiety and stress in their studies with children with autism. Effectiveness of intervention in individuals with autism who receive cognitive behavioural therapy based occupational therapy is assessed with Goal Attainment Scale (GAS) [35].
Occupational therapy in school is quite different from clinic based occupational therapy. School-based occupational therapists focus on learning, developing skills which increase the student’s independence in the school environment, and also educating the school personnel about the different considerations required for students to eliminate the barriers from participation [180-183].
Everything the occupational therapist does with student in school must be related to develop educational skills of the student with autism. The occupational therapist evaluates, assesses and accommodates functional abilities of the student with autism in school classrooms, hallways and other related education areas. The occupational therapist works with teachers to help student’s acquire functional abilities necessary to access and use educational materials and be independent in the school [183]. Occupational therapists work with the students with autism on adapting or modifying school equipment/materials to help them function better in classrooms, the lunchroom, or restrooms. Other assistance includes helping students with autism to be sensory stable and participate in activities outside of the school through mobility on field trips, sports events, on playgrounds and within the community. Students with autism face a demanding environment at school [183-185]. Presentation methods for educational materials must be modified to meet the challenges of students with autism, such as their ability to communicate, view and manipulate educational materials, and move about the school. Occupational therapists work closely with teachers to promote the highest level of function possible for a child with autism pursuing educational goals like fine and gross motor skills and attention skills [185-188].
Occupational therapists use screening, assessment, and clinical observation tools and strategies to analyse why child with autism is having functional and sensory difficulties in educational settings not to establish interventions in school settings. During their interventions occupational therapists use some of the standardized tests like Sensory Profile [189, 190], Bayley Scales of Infant Development-II [191], Peabody Developmental Motor Scale [192], Bruininks-Oseretsky Test of Motor Proficiency [193], and Pediatric Evaluation of Disability Inventory Test [82] in school setting [194].
If the standardized tests are not appropriate, occupational therapist can give descriptive reports without using standardized scales. It is important to compare the child’s performance with the previous scores than the normative sample. Occupational therapists can use play based performance profiles like Hawaii Early Learning Profile or Transdisciplinary Play-Based Assessment [194]. Additionally ecological/environment inventories should be used to evaluate child with autism within a variety of educational environments (classroom, garden, sports area etc.), curricular expectations; tools/instruments to help gather relevant information; whether the team needs expansion to obtain needed information [195, 196]. And also to determine and work with the educational team to determine functional strengths and challenges and providing information to design instructional programs of the student with autism. Occupational therapist should try to become familiar with the individual education plan [194-196].
Occupational therapists use direct or indirect services for students with autism in school settings. Occupational therapy interventions purposes are to help students with autism to gain independence in daily living activities, feeding and oral functions, play skills, task organization and completion, written communication skills, hand function, sensory integration (processing), visual perception, campus/school mobility, participating on a regular and timely basis, using tools and supplies, participating in activities throughout school settings. Also when skill and strength cannot be developed or improved, occupational therapy offers creative modifications and adaptations for carrying out development-appropriate activities [195, 196].
In school practice, occupational therapists work with students, teachers, families, classes, schools, and school districts. Occupational therapists are experts at identifying ways to engage students with autism in educational activities and supporting them to develop competence in their roles as students.
Recreation, a participation domain of the International Classification of Functioning Disability and Health (ICF), includes involvement in formal and informal activities such as play, sports, going to the theatre, crafts and tourism [197]. Leisure in occupational therapy is described as one of the occupational areas that cover recreational activities.
Besides being pleasant, recreational activities improve the life quality of individuals with autism, develop their social communication and acceptance, reduce inappropriate behaviours, improve fine and gross motor skills and helps in attainment of social skills [203]. Findings of studies on participation of children with autistic disorders in physical activities and sports activities show that sports and physical activities may create opportunities for social interaction, reduce repetitive movements and contribute in development of motor performance and physical suitability as well as self management skills [204-207].
Studies show that children with autism have more limited participation in recreational activities when compared with their peers with typical development or those in other disability groups [208-211]. Core impairments of autism spectrum disorders (i.e., communication impairments, social deficits, and abnormal restrictive, repetitive and stereotyped behaviours) and other features related with disorder (e.g. motor skills differences and maladaptive behaviour) affect recreational participation [212]. Another significant factor is sensory integration problems experiences by individuals with autism. It’s reported that children with autism and sensory difficulties participate in recreational activities less and prefer more informal (not structured) and home activities [213]. Besides all these individual features, the impact of family and environmental factors are also described. The interplay is noted among the child’s impairments, the family’s style, preferences, and demands, as well as environmental or community-based limitations in restricting a given child’s ability to participate in an array of recreational activities [199]. Studies show that participation of families in recreational activities positively affect child’s participation [214]. Furthermore, it’s observed that number of accessible services in society is parallel to participation in these activities [199]. Another factor is acceptance perceived from family, friends and neighbours. Families of children with developmental delay and behavioural problems may discontinues activities outside home as a response to negative reactions of people against the noise and temper tantrums of child [215]. As a conclusion, holistic perspective is important.
Individuals with autism are in need of programs structured and organized with proper support to reveal their recreational interests and to improve their leisure skills [203]. Therefore interdisciplinary teamwork is an important issue. Considering multifaceted factors that affect participation in recreational activities, strong cooperation of families and professionals are required in the planning and implementation of intervention [208]. Occupational therapists are important both with their expertise in occupational participation and their knowledge on sensory integration interventions for participation of individuals with autism in recreational activities. Occupational therapists point out exploration and participation in leisure activities, which are one of the occupational areas. Leisure exploration refers to identifying interests, skills, opportunities, and appropriate leisure activities. Leisure participation is planning and participating in appropriate leisure activities; maintaining a balance of leisure activities with other areas of occupation; and obtaining, using, and maintaining equipment and supplies as appropriate [65].
Occupational therapy assessment with an occupation-based, family-centred and top-down approach starts with an interview with the family and self-report. Family’s perspective on interests and skills of child, life style, economical status, their access to social and community resources should be recorded. Ideally, leisure assessments should be made in the natural settings of the child whenever possible. Interview and observation made in this setting are important to assess physical, social, cultural, attitudinal or organizational environment factors which affect leisure participation of the child and to evaluate child’s performance skills. It is important for the therapist to observe motor, process and social interaction skills and attitudes of the child against others during activities with peers [185].
Paediatric Activity Cart Shorting (PACS), Children’s Assessment of Participation and Enjoyment (CAPE), Canadian Occupational Performance Measure (COPM) are some of the examples of standardized methods that can be used in the assessment of recreational interests and skills of the child [85, 216, 217]. It is important to assess the sensory integration skills of the child and impact of these skills on activities, to define strategies to meet the needs of the child and to create sensory friendly settings. Therefore Sensory Profile (SP) is a standardized scale used in defining sensory difficulties of child [29].
Occupational therapists give trainings to families, friends and teachers on how to facilitate participation of individual besides teaching the most needed skills for participation of children in selected leisure activity. Additionally they give training on use of adaptive equipment required for activities and make environmental modifications.Participation of children with deficits in activities together with their peers without deficits is important for both groups. Some of the study results show that peer support programs are useful for both groups. Structuring recreational activities where children with autism can be together with children with typical development can be an effective for proper modeling and social integration of children with autism and for the positive attitude changes in others [218, 219].
One of the most important highlight of recreation and leisure activities is that they are “intrinsically motivated”. Neurobiological studies show that limbic system which orchestrates motivation and drive in brain is not adequately developed in individuals with autism. According to sensory integration theory by Ayres, purposeful sensory-based activities may increase natural inner drive. Therefore, carefully selected sensory-based activities may help finding activity meaningful and purposeful and sustaining participation [220, 221].
Virtual Reality (VR) technology is an important tool to widen leisure activity spectrum of intellectual and developmental disability population. Easy changeability of virtual environments, adaptation and scaling of difficulty of task according to the skills of the individual can be considered as advantages of VR [222]. Furthermore, it increases motivation and leads to positive impacts on the participation of individuals. In the intervention, its integration to home routine as a recreational activity is considered to be useful.
Many people diagnosed with autism experience difficulties in finding and sustaining jobs. 50-75% of this population is estimated to be unemployed [223]. One of the basic problems of individuals with autism in finding jobs is the deficit in social and communication areas, which require advanced support in the workplace [224]. In addition to these personal features, availability and accessibility of services that support employment and existence of social supports are considered as significant environmental factors that affect employment rates [81]. Studies show that individuals with autism may be successful in business life and are considered as important by their employers together with proper vocational interventions [225-227].
Employment opportunities for individuals with autism may be based on two main categories; a) integrated, competition-based employment with supportive employment opportunities and b) separate, non-competitive opportunities including daily therapy, work activity centres and protected businesses. Supportive employment is a system where individuals are supported in the workplace, long term support is given with work coaching system and the support is reduced as the individual becomes more independent. This approach is based on the assumption that all people can work and argues that we should create long-term support mechanism nationally to support this assumption. So the actual question is not whether or not an individual with autism will work but whether or not there is support services required for the individual’s success in work performance [228].
Studies show that supportive employment opportunities is the effective way for the participation of individuals with autism in work life [229, 230]. Supportive employment programs have a team consisting of different professions and who work together for common goals in the evaluation of work process, its referral, work analysis, work skills training and follow up of the working individual. This team includes occupational rehabilitation consultant, work coach, occupational therapist, physiotherapist, speech therapist, special trainer, psychologist, individual himself/herself, individual’s family and other profession members who may contribute in employment process. Occupational therapists have different roles in assessment, recruitment and training, work development and supportive employment process stages of employment process of individuals with autism. During assessment stage occupational therapists assess sensory and motor skills, professional interests, communication and transportation, daily living activities, cognitive, social and community skills, emergency response and safety in workplace and self-assessment skills. During recruitment and training stage occupational therapist work on training and adaptations about work task and settings, identification and training on auxiliary equipment and technology, training on or compensation of basic cognitive skills like attention, visual perception etc., training of work coaches and supporters on use of auxiliary technologies. During work development stage occupational therapist work for increasing environmental support and reducing barriers, doing work analysis, adjusting improvement of conformity between skills of the individual and expectations of the employer and work development in line with interests and skills of individual. In the supportive employment process stage occupational therapist interested in training of work coaches, training on complex cognitive skills such as problem solving, time management, advocating rights of the individual against the employer and other colleagues and cooperation with interdisciplinary team [231].
Vocational assessment starts with interview, self-report and behavioural observation. Occupational profile is defined for the occupation and occupational performance analysis is made. It’s important to assess strengths, interests and needs of the individual as well as environmental supports and barriers during the interviews [233]. Observation of the individual during occupational performance would provide important information for occupational performance analysis. Other assessments specific to occupational therapy may include sensory-motor skills, socialization skills, cognitive skills and participation in activities of daily living. The Vocational Index, The Autism Work Skills Questionnaire (AWSQ), Vineland Adaptive Behavioural Scale, Adult/Adolescent Sensory Profile, Waisman Activities of Daily Living Scale are examples for standardized assessments that can be used [80, 83, 234-236].
Occupational therapists can train the person about skills required for occupation and train his/her natural supports, such as co-workers, supervisors, or family members in the use of adaptive equipment or techniques, environmental adaptations, sensory needs of the person, and compensatory strategies to help the person perform job tasks. Also teaching and compensating for complex cognitive skills such as problem solving, time management, and sequencing to higher functioning persons with autism is within the scope of occupational therapy [232].
Wilczynski, Trammell and Clarke describes forms of technology that can help individuals with autism acquire and maintain employment. According study assistive technology like computer-based systems, personal computers, video recorders, tablets, iPods, iPads, and other devices; video based instruction like video self-modeling, and video games to teach social interaction, covert audio coaching like video modeling instruction initially and follows with audio prompting and alternative support includes personal digital assistants, smartphones, and other mobile devices that can be used for auditory and visual reminders, time management, organizational skills, and daily living tasks can enhance the natural support available for individuals with autism in the workplace [237]. Occupational therapists can compensate sensory needs through sensory stimulation or inhibition using techniques such as fidget toys, chewing gum, music, weighted clothing, lighting changes, and increases or decreases in environmental stimuli in workplaces.These changes in the sensory environment may lead to improvement in motor processes, which enable the person to be more productive on the job site [232].
This chapter provides a brief overview of the wide variety of occupational therapy intervention approaches for individuals with autism. Individuals with autism demonstrate complex behaviours that reguire the integration of different approaches and methods. Occupational therapy interventions varies according to the needs of the individuals with autism. The overall goal of occupational therapy is to help the individual with autism improve quality of life and to enable individuals to participate in everyday occupations. Sensory integration therapy are often used in conjunction with holistic and client centered occupational therapy treatment plan. This practice area is of great importance to the field of occupational therapy in children with autism. Different approaches can assist an individual with autism in a variety of life roles and tasks if it is incorporated into that individual’s life in appropriate way. Using effective strategies and technics in occupational therapy intervention program provide opportunities to develop wide range of skills in individuals with autism.
The authors would like to thank Deniz Bıyıklı, English language translator, for help in translating and reducting the chapter.
When people are asked why health is important, many are unable to answer it. The reason for this may be due to their lack of awareness of the importance of health and the consequent lack of proper self-care. Health can generally be considered an essential basis of life, but many people still do things that show that health is not a priority in their lives. They spend a lot of time on the opportunities they find but do not spend time learning what is good for them to exercise or stay healthy; they spend their budget on Nonsignificant things. But for a more nutritious diet, they pay less.
According to the World Health Organization’s definition, health is a state of complete physical, mental and social well-being and not only the absence of disease or infirmity. This definition of health has been given more attention since 1978 at the UN Summit in Almaty. Due to the considerable differences in the level of health in different countries of the world, the members of this organization were required to provide Primary Health Care by providing an essential package aimed at reducing the health gap between different countries and with the goal of Health for All by the year 2000. Undoubtedly, one of the most critical concerns and challenges that different countries have faced in providing primary health care to their population has been the lack of resources in the face of the growing need to receive this care during all these years.
So from the perspective of health economists, health is a durable good, or type of capital, that provides services. The flow of services produced from the stock of health capital is consumed continuously over an individual’s lifetime. Each person is assumed to be endowed with a given stock of health at the birth time, such as a year. Over the period, the stock of health depreciates with age and maybe promoted by investments in Health services. Death occurs when an individual’s stock of health falls below a critical minimum level.
To request a product or service, you must ask for it, afford it, and have a specific plan for purchasing it. Desires are, in fact, the unlimited desires and inclinations that people have for goods and services. Imagine being able to afford something if you could afford it or it was not so expensive. When we make choices, scarcity guarantees that many of our desires will never be met. Demand reflects our plan and vision for the demands that will be met. The amount of goods and services that the consumer plans to buy depends on many factors: commodity prices, related commodity prices, personal income, expected future prices, population, advertising, and preferences.
We must first discuss the relationship between the demand for a good or service and the price. All other factors influencing demand must be kept constant to study this relationship called the Citrus Paribus principle. The demand for a good or service is inversely related to its price; as the price increases, the demand for it decreases, and vice versa. Of course, the rate of demand response to price changes is not the same for all goods, which will be discussed in the topic of elasticity [1].
The demand curve is a geometric location of points where the dependent variable is the rate of use of a good, and the independent variable is the price of that good; in general, the demand curve shows the maximum demand for a good at different prices and also represent the ultimate price for a certain amount of a good. Usually, the price variable is shown on the y axis and the amount of goods or services on the x-axis (Figure 1).
Demand curve.
This shows the maximum amount someone is willing to pay for a small increment in consumption rate. Care should be taken in using the “demand” to mean the amount of consumption of a particular good or service at a specific price and to use it to mean a range of corresponding values in the price range (for example, one point on the demand curve versus the whole Points on the curve). The demand for a good or service is a function of its relative price and buyers’ income. The demand curve is a two-dimensional representation of this process. Responding to price changes is moving along the demand curve and responding to changes in revenue as the entire demand curve changes and shifts (Figure 2). Some of the characteristics of the demand side that should always be kept in mind when using the demand curve in healthcare, especially when making normative statements about well-being, are: Uncertainty on the part of the consumer about the likelihood of future illness; Side effects, the effectiveness of treatment methods and their possible cost. When sick, people experience anxiety, disability, suffering, and pain that may not be considered in the theory of desirability; It is also important to note that there may be an external demand for care and treatment of a person in addition to their need; And the fact that the price at which the applicant responds to the service or goods may in no way be an accurate reflection of the final cost of providing that product or service to the service provider.
Change in demand curve.
We can also consider the demand curve as a payment ability curve that measures the ultimate benefit. This curve shows the highest price a person is willing and able to pay for the last unit purchased. If there are fewer goods available, the highest price that a person is willing and able to pay for a larger unit will be high. But as the quantity of available goods increases, the ultimate benefit of each additional unit decreases, and the highest price offered on the demand curve decreases.
In addition to the price of the product in question, which is inversely related to the demand for that product, we can examine the relationship between the demand for a product and other factors in the space of the demand curve.
A complementary good is a good that is used with another commodity, and if the price of one of these commodities increases, in addition to the demand for that commodity, the demand for the other commodity also decreases.
Medical care consists of countless goods and services that maintain, improve, or restore a person’s health. For example, a young man may have wrist surgery to repair a torn tendon so he can return to work, an older woman may have cataract surgery to improve her vision, or a parent may have to Bring their child to a healthcare center for an annual dental checkup to prevent future problems. Prescription drugs, prescription glasses, and dentures are examples of medical supplies, while surgeries, periodic physical examinations, and visits to medical professionals are examples of medical services. Preventive and medical care are heterogeneous, making it difficult to measure and quantify medical care units accurately. Medical care services have four characteristics that distinguish these from other goods and services: intangibility, inseparability, inventory, and inconsistency.
Intangibility means that the five senses are incapable of evaluating medical services. Unlike new shoes, a vegetable salad dinner, or a new cell phone, the consumer cannot see, taste, or touch medical services. Indivisibility also means that the production and consumption of a medical service take place simultaneously. For example, when you see an ophthalmologist for an examination, you use ophthalmic services right at the time of production. In addition, a patient is often seen as both a producer and a consumer. Inventory is directly related to inseparability. Because the production and consumption of a medical service occur simultaneously, healthcare providers cannot store or maintain medical services. For example, a physiotherapist cannot provide a list of different physiotherapy services to meet demand during busy times. Finally, inconsistency means that the variety, composition, and quality of medical services are very different. Although different people may see a doctor simultaneously, there are various reasons for visiting a doctor. One person may see a doctor because of a typical physical problem, while another may see a doctor because of a heart attack. The combination of prescribed medical care or the frequency of its use can vary significantly from person to person and at different times [4, 5].
The following factors affect the demand for healthcare:
Needs (based on patient perception)
Patient preferences
Price or cost of use
Income
transportation cost
waiting time
Quality of care (based on patient perception)
The use of healthcare depends on demand and availability. If planners allocate resources based on need rather than demand, they may find themselves in a situation where some services are underused, and some services are overused.
Just as the healthcare market is different from other commodities, so is the demand for healthcare different from the simple demand model. One of the differences is that healthcare is not demanded because it is self-satisfying. After all, healthcare itself does not lead to satisfaction. Instead, healthcare is in demand because people are satisfied with their activities when they are healthy. So the demand for healthcare is a derived demand.
Patients’ perceptions of their need and capacity to benefit from healthcare are strongly influenced by physicians and healthcare providers. Although in economics, it is assumed that consumers can make informed decisions about their consumption patterns, healthcare consumers delegate this decision-making power to healthcare workers who are more aware of them. This phenomenon is due to information asymmetry between healthcare providers and patients, which carries the risk of induced demand by providers to increase revenue. Another complication stems from the fact that healthcare is highly heterogeneous. Each patient has a relatively different combination of pain and symptoms. Therefore each patient needs to purchase a fairly different package of care that both the patient and the physician have uncertainty about its effectiveness in meeting the need.
Another critical difference is that many health services are paid for by third parties. Payments by third parties or insurance companies Although they significantly increase people’s purchasing power for healthcare, it is also important to note that they can lead to ethical risks and increase demand for services that patients may not need.
Demand for healthcare depends on the level of consumption of an individual in case of illness; the amount of consumption can differ according to the factors affecting the demand, such as income, service price, education, norms, social traditions, and quality. A person’s decision to use or use services is related to his or her illness/injury status rather than healthcare. Developing countries are focused on promoting healthcare as an essential policy to improve health outcomes and fulfill international obligations and universal coverage of health services. However, many policies have focused more on improving physical access than on the demand-side healthcare needs pattern. In low-income countries, allocating scarce financial resources is based on clear criteria for the impact of investment in the health sector on service demand.
In these countries, due to the lack or weakness of social security systems, the occurrence of the disease leads to increased health costs and reduced labor productivity and leads to a loss of household welfare. In developed countries, due to insurance, many health services are used with minimal consumer participation in the payment; however, in developing countries, concerns about less use of health services, to the extent of supply. Or poor access is associated. However, even in health services, due to various barriers on the demand side, related to the cost of treatment, travel costs, and quality of services, the rate of exploitation is low. Also, the importance of a person’s health status in a clinical context is related to the analysis and social evaluation of a person’s health and social environment. Studies have shown that the risk of death is related to people’s perception of the health importance of maintaining it. Since one of the priorities of health policymakers is to improve people’s health, various factors that directly and indirectly affect the demand for health services should be examined more carefully. Identifying the factors influencing individuals’ decision to request healthcare services and choosing from different providers. Therefore, evaluating the determinants of demand for health services will introduce and implement appropriate incentive schemes to encourage better health services. Because health is one of the essential components of human capital and healthy human beings are the center of sustainable development, health can significantly increase the ability of individuals to perform various activities, including productive activities. As a result, people are looking for health. At the individual level, health is mainly influenced by multiple factors such as biological factors, lifestyle, purchased non-medical services, purchased medical services and goods, and different socio-economic characteristics. People’s understanding and expectation of healthcare quality are essential because the perceived quality of health services often affects health services’ behavior and consumption patterns [6].
Grossman used human capital theory to explain the demand for healthcare. According to human capital theory, people invest in themselves through education and health to increase their income. Grossman proposed an approach in which many important aspects of the demand for health services differ from the traditional demand approach:
That consumers are looking for health and demand health services to achieve it.
To achieve health, consumers buy health services from the market and combine them with their efforts to improve health, such as diet and exercise.
The health gained lasts more than a period and is not immediately depreciated to be analyzed as a capital good.
Most notably, health can be considered as both a consumer good and a capital good. From the people’s point of view, health is a consumer product because it makes them feel better. As a capital good, it is also suitable for people’s health because it increases the number of healthy days of life to work and earn money. Figure 3 provides a simple diagram that explains the concept of health capital. Just as one thinks that cars or laptops are capital goods that use the flow of their services over time, one can also understand the savings of one’s health capital, the outcome of which is “healthy days”. Outflow may be considered as one dimension of healthy days or measured in several dimensions of physical, mental health, and limited activity. People consume a range of health inputs, including healthcare inputs, diet, exercise, and time, so they invest in health savings. These investments help maintain or improve consumers’ health reserves, providing them with healthy days. Over time, health reserves may either grow, remain constant, or decrease with age due to illness or injury. As mentioned in Box 3, many technologies may generate health capital, using different amounts of time or health goods and services. Figure 3 shows how the ultimate goal of “healthy days” guides consumer decisions about the amount, time, and cost of investing in health storage. We will see that the prices of healthcare, the rate of wages of individuals, and their productivity in the production of health determine how resources are allocated between health capital and other goods and services that people buy. Consider a consumer who buys market inputs (e.g., medical care, food, clothing) and combines them with his or her own time to generate a health capital reserve that increases his or her utility [2].
Investing in health.
As an economic principle, the price of a good and the demand for that good are inversely related. That is, the higher the price of a commodity, the less demand there is for that commodity, and the lower the price of a good, the greater the demand for it. Price elasticity of demand shows that a one percent change in a good price causes a few percent changes in the demand. For example, if the price of a car rises by one percent, the demand for it will fall by a few percent, and vice versa, if the price of a vehicle falls by one percent, the demand will increase by a few percent.
Three things can happen when we calculate the price elasticity for a commodity:
When a one percent change in the price of a commodity occurs, the demand for that commodity changes by more than one percent. These types of goods are very price sensitive.
When a one percent change in a good price causes the demand for that good to change by less than one percent, this type of product is called inelastic. Demand for this type of goods shows a mild reaction to price changes.
The third case is when a one percent change in the price of a good causes a one percent change in the demand for that good.
If there is an inverse relationship between price and demand, demand elasticity will always be negative because the percentage change in one face or denominator is a negative fraction. Therefore, after calculating the price elasticity of demand, if the result, regardless of the negative sign of the number, becomes more than one, the commodity with elasticity is less than one, the good without elasticity, and if it is equal to one, the good has a single elasticity.
Although the price elasticity of a commodity can be determined only by collecting price information and calculating, some factors affect this ratio.
Alternative goods: The more alternative goods there are, the higher the price elasticity of that product. That is, when the price changes, the demand for that product changes more drastically. Also, price changes in a product cause a shift in the demand for alternative goods. In the healthcare sector, there are usually few alternatives to a health or medical intervention.
Complementary goods: When a product has a supplement, a change in the price of a complementary product causes a change in the demand for another product. Maternal and child care can be mentioned as complementary goods in the field of health (Figure 4).
Types of elasticity.
Commodity prices: In general, if the price of a commodity is very low, the amount of demand does not react to price changes. But high-priced products are attractive. On the other hand, different results are obtained depending on the price at which the demand elasticity is calculated. As mentioned initially, the price of a product has an inverse relationship with the amount of demand. When the price is precisely in the middle of the demand curve of a commodity, the commodity has a single elasticity. Also, if the price is less than the midpoint, the product in that range is unattractive. If the price is above the midpoint, the product will be pulled. You can see this in the chart below.
Marginal modes in demand elasticity.
Ove Odredbe i uvjeti ističu pravila i regulacije u svezi korištenja IntechOpenove stranice www.intechopen.com i svih poddomena u vlasništvu IntechOpena, tvrtke sa sjedištem u 5 Princes Gate Court, London, SW7 2QJ, Ujedinjeno Kraljevstvo.
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\\n\\nMi koristimo kolačiće. Korištenjem IntechOpenove stranice slažete se s korištenjem kolačića u skladu s IntechOpenovom Politikom privatnosti. Većina modernih, interaktivnih stranica koristi kolačiće kako bi omogućila ponovno pronalaženje korisničkih detalja kod svakog posjeta. Na našoj stranici kolačići se uglavnom koriste kako bi omogućili funkcionalnost i olakšali posjetiteljima korištenje stranice.
\\n\\nIntechOpen ili njegovi suradnici niti u jednom slučaju neće biti odgovorni za štete (štete uključuju gubitak podataka ili profita, druge poslovne prekide, te sve ostale štete) koje nastanu zbog korištenja materijala na IntechOpenovoj stranici ili nemogućnosti da se iste koriste, čak i ako je IntechOpen ili njegov predstavnik o takvoj šteti obaviješten pismenim ili usmenim putem. Neke jurisdikcije ne dozvoljavaju ograničenja garancija ili ograničenja obveza za posljedične ili slučajne štete pa se u tom slučaju ova ograničenja možda ne odnose na vas.
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\\n\\nOve Odredbe i uvjeti su sastavljeni u skladu s odredbama prava Ujedinjenog Kraljevstva, a za sve sporove nadležan je sud u Londonu, Ujedinjeno Kraljevstvo.
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\n\nSljedeća terminologija odnosi se na Odredbe i uvjete, te na sve naše ugovore:
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\n\nKompanija, tvrtka, mi, naše odnosi se na tvrtku IntechOpen;
\n\nStranke, strane odnosi se na klijenta i na nas, ili samo na klijenta ili nas.
\n\nSve odredbe koje se odnose na ponudu, prihvat ili razmatranje plaćanja, a za koja mi pružamo asistenciju klijentu, bilo na ugovoreni ili fiksni način, a s ciljem da se ostvare potrebe i želje klijenta u svezi s našim uslugama, su podložne zakonskim odredbama Ujedinjenog Kraljevstva.
\n\nOsim ako nije suprotno navedeno, IntechOpen i/ili svi davatelji licence vlasnici su intelektualnog vlasništva nad svim materijalima na www.intechopen.com. Sva prava intelektualnog vlasništva su pridržana. Stranice sa www.intechopen.com možete gledati, preuzimati, dijeliti, dijeliti poveznice i printati za osobnu uporabu, a temeljem pravila sadržanih u ovim Odredbama i uvjetima.
\n\nMi koristimo kolačiće. Korištenjem IntechOpenove stranice slažete se s korištenjem kolačića u skladu s IntechOpenovom Politikom privatnosti. Većina modernih, interaktivnih stranica koristi kolačiće kako bi omogućila ponovno pronalaženje korisničkih detalja kod svakog posjeta. Na našoj stranici kolačići se uglavnom koriste kako bi omogućili funkcionalnost i olakšali posjetiteljima korištenje stranice.
\n\nIntechOpen ili njegovi suradnici niti u jednom slučaju neće biti odgovorni za štete (štete uključuju gubitak podataka ili profita, druge poslovne prekide, te sve ostale štete) koje nastanu zbog korištenja materijala na IntechOpenovoj stranici ili nemogućnosti da se iste koriste, čak i ako je IntechOpen ili njegov predstavnik o takvoj šteti obaviješten pismenim ili usmenim putem. Neke jurisdikcije ne dozvoljavaju ograničenja garancija ili ograničenja obveza za posljedične ili slučajne štete pa se u tom slučaju ova ograničenja možda ne odnose na vas.
\n\nMaterijali koji se pojavljuju na IntechOpenovoj stranici mogu sadržavati manje greške, tipfelere ili fotografske greške. IntechOpen može napraviti promjene na bilo kojem materijalu koji se nalazi na stranici u bilo koje vrijeme.
\n\nIntechOpen nije formalno povezan niti s jednom vanjskom stranicom čije poveznice vode na www.intechopen.com, osim ako to nije izravno navedeno. Iz tog razloga IntechOpen nije odgovoran za sadržaj koji se pojavljuje na takvim stranicama. Poveznica na IntechOpenovu stranicu ne implicira povezanost sa IntechOpenom. Korištenje takvih poveznica isključiva je odgovornost korisnika.
\n\nZadržavamo pravo vlasništva nad cjelokupnom stranicom www.intechopen.com i nad svim materijalom na toj stranici. Koristeći se našim uslugama, slažete se da maknete sve poveznice na našu stranicu odmah nakon što to od vas zatražimo. Također, zadržavamo pravo da ove Odredbe i uvjete, i politiku o poveznicama izmjenimo u bilo koje vrijeme. Koristeći se poveznicama na naše stranice slažete se s ovim Odredbama i uvjetima.
\n\nAko smatrate da je bilo koja poveznica na našoj stranici sumnjiva iz bilo kojeg razloga, molimo vas da nas kontaktirate. U tom slučaju razmotrit ćemo micanje poveznice s naše stranice, iako nismo obvezni to napraviti.
\n\nBez prethodne privole i izričite pisane dozvole, ne možete stvarati okvire oko naših stranica ili koristiti druge tehnike koje na bilo koji način mogu promijeniti prezentaciju ili izgled naše stranice.
\n\nIntechOpen može ove Odredbe izmijeniti u bilo koje vrijeme i bez prethodne obavijesti. Koristeći ovu stranicu vi se slažete s trenutnim Odredbama i uvjetima koje su na snazi.
\n\nOve Odredbe i uvjeti su sastavljeni u skladu s odredbama prava Ujedinjenog Kraljevstva, a za sve sporove nadležan je sud u Londonu, Ujedinjeno Kraljevstvo.
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Heat stress decreases the secretion of luteinizing hormone and estradiol resulting in reduced length and intensity of estrus expression, increased incidence of anoestrus and silent heat in farm animals. Oocytes exposed to thermal stress lose its competence for fertilization and development into the blastocyst stage, which results in decreased fertility because of the production of poor quality oocytes and embryos. Furthermore, low progesterone secretion limits the endometrial functions, and subsequently embryo development. In addition, the increased secretion of endometrial prostaglandin F2 alpha during heat stress threatens the maintenance of pregnancy. In general, the percentage of conception rate was found to be reduced by 4.6% for each unit increase in temperature humidity index (THI) above 70, and heat stress during pregnancy further slows down the growth of the foetus and results in lower birth weight. In tropical and subtropical regions, during hot days, the testicular temperature may increase and impair both the spermatogenic cycle and semen quality, which culminates in decreased bull fertility. The effects of heat stress on livestock can be minimized via adapting suitable scientific strategies comprising physical modifications of the environment, nutritional management and genetic development of breeds that are less sensitive to heat stress. In addition, the summer infertility may be countered through advanced reproductive technologies involving hormonal treatments, timed artificial insemination and embryo transfer, which may enhance the chances for establishing pregnancy in farm animals.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Govindan Krishnan, Madiajagan Bagath, Prathap Pragna,\nMallenahally Kusha Vidya, Joy Aleena, Payyanakkal Ravindranathan\nArchana, Veerasamy Sejian and Raghavendra Bhatta",authors:[{id:"89780",title:"Dr.",name:"Veerasamy",middleName:null,surname:"Sejian",slug:"veerasamy-sejian",fullName:"Veerasamy Sejian"},{id:"177210",title:"Dr.",name:"Raghavendra",middleName:null,surname:"Bhatta",slug:"raghavendra-bhatta",fullName:"Raghavendra Bhatta"},{id:"177220",title:"Dr.",name:"M",middleName:null,surname:"Bagath",slug:"m-bagath",fullName:"M Bagath"},{id:"201967",title:"Dr.",name:"Govindan",middleName:null,surname:"Krishnan",slug:"govindan-krishnan",fullName:"Govindan Krishnan"},{id:"201968",title:"Ms.",name:"Archana",middleName:null,surname:"Pr",slug:"archana-pr",fullName:"Archana Pr"},{id:"201969",title:"Ms.",name:"Pragna",middleName:null,surname:"Prathap",slug:"pragna-prathap",fullName:"Pragna Prathap"},{id:"201970",title:"Ms.",name:"Aleena",middleName:null,surname:"Joy",slug:"aleena-joy",fullName:"Aleena Joy"},{id:"201971",title:"Dr.",name:"Vidya",middleName:null,surname:"Mk",slug:"vidya-mk",fullName:"Vidya Mk"}]},{id:"55006",doi:"10.5772/intechopen.68650",title:"Immunocastration as Alternative to Surgical Castration in Pigs",slug:"immunocastration-as-alternative-to-surgical-castration-in-pigs",totalDownloads:1876,totalCrossrefCites:9,totalDimensionsCites:19,abstract:"Surgical castration of piglets is a routine practice in pig production used to prevent the incidence of boar taint of pig meat, which may develop in entire male pigs as they reach puberty. This practice is being presently questioned in the European Union, and there is a strong initiative to end it. The initiative is presently voluntary; however, key stakeholders of European pig production sector have signed a declaration, and the actions undertaken by them already affect the business. Before such new concepts in pig production can be implemented, alternative solutions are needed, one of them being immunocastration. The present chapter will thus focus on the presentation of immunocastration as one of the promising alternatives to surgical castration. Theoretical and practical aspects of immunocastration in pig production will be described, and the advantages and disadvantages of this alternative will be summarised. Physiological principles of immunocastration and impacts on metabolism, growth performance, body composition and meat quality will be described and aspects of public acceptability reviewed.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Marjeta Čandek-Potokar, Martin Škrlep and Galia Zamaratskaia",authors:[{id:"23161",title:"Dr.",name:"Marjeta",middleName:null,surname:"Čandek-Potokar",slug:"marjeta-candek-potokar",fullName:"Marjeta Čandek-Potokar"},{id:"198220",title:"Dr.",name:"Martin",middleName:null,surname:"Škrlep",slug:"martin-skrlep",fullName:"Martin Škrlep"},{id:"198221",title:"Prof.",name:"Galia",middleName:null,surname:"Zamaratskaia",slug:"galia-zamaratskaia",fullName:"Galia Zamaratskaia"}]},{id:"55696",doi:"10.5772/intechopen.69444",title:"Estrus Cycle Monitoring in Wild Mammals: Challenges and Perspectives",slug:"estrus-cycle-monitoring-in-wild-mammals-challenges-and-perspectives",totalDownloads:1852,totalCrossrefCites:0,totalDimensionsCites:6,abstract:"The knowledge of reproductive physiology is of paramount importance to guide reproductive management and to make possible future application of assisted reproduction techniques (ARTs) aiming ex situ conservation of wild mammals. Nevertheless, information on the basic reproductive aspects of wild mammals remain scarce, and appropriate management practices have not yet been developed for all the species. This chapter discusses the methods most currently used for reproductive monitoring in wild females. Additionally, the difficulties regarding their use in different species and the possibilities of these procedures in captivity or in free-living mammals are addressed.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Alexandre R. Silva, Nei Moreira, Alexsandra F. Pereira, Gislayne C.X.\nPeixoto, Keilla M. Maia, Lívia B. Campos and Alana A. Borges",authors:[{id:"90066",title:"Dr.",name:"Alexandre",middleName:"Rodrigues",surname:"Silva",slug:"alexandre-silva",fullName:"Alexandre Silva"},{id:"177090",title:"Dr.",name:"Alexsandra Fernandes",middleName:null,surname:"Pereira",slug:"alexsandra-fernandes-pereira",fullName:"Alexsandra Fernandes Pereira"},{id:"177093",title:"MSc.",name:"Gislayne Christianne Xavier",middleName:null,surname:"Peixoto",slug:"gislayne-christianne-xavier-peixoto",fullName:"Gislayne Christianne Xavier Peixoto"},{id:"198314",title:"Prof.",name:"Nei",middleName:null,surname:"Moreira",slug:"nei-moreira",fullName:"Nei Moreira"},{id:"198315",title:"MSc.",name:"Keilla Moreira",middleName:null,surname:"Maia",slug:"keilla-moreira-maia",fullName:"Keilla Moreira Maia"},{id:"198316",title:"MSc.",name:"Lívia Batista",middleName:null,surname:"Campos",slug:"livia-batista-campos",fullName:"Lívia Batista Campos"},{id:"198317",title:"MSc.",name:"Alana Azevedo",middleName:null,surname:"Borges",slug:"alana-azevedo-borges",fullName:"Alana Azevedo Borges"}]},{id:"56522",doi:"10.5772/intechopen.69549",title:"Role of Melatonin in Reproductive Seasonality in Buffaloes",slug:"role-of-melatonin-in-reproductive-seasonality-in-buffaloes",totalDownloads:1725,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"Buffaloes are characterized by seasonal reproductive activity. Anestrus buffalo heifers and lactating buffaloes were used to study the effect of melatonin treatment on the resumption of ovarian activity during out-of-breeding season. Buffaloes of treated group were injected or implanted with melatonin (18 mg melatonin/50 kg body weight). Using CIDR-eCG protocol preceded with melatonin successfully achieved estrus behavior and induced conception rate during out-of-breeding season. Furthermore, the reproductive performance of buffaloes during out-of-breeding season was clearly improved by melatonin implantation in conjunction with CIDR-eCG protocol due to the luteotrophic effect of melatonin expressed as increasing diameter of CL (corpus luteum) and progesterone concentration. This improvement resulted in greater values of conception rate, in melatonin implanted compared to not implanted buffaloes. Melatonin implantation in anestrus buffalo heifers increased the diameter of largest follicles and melatonin concentration but progesterone and luteinizing hormone (LH) concentrations were decreased. In addition, melatonin implantation in anestrus lactating buffaloes increased the SOD (superoxide dismutase) enzyme activity. Sustained release of exogenous melatonin significantly protects against oxidative stress while increasing beneficial total antioxidant capacity (TAC) concentration in summer-stressed anestrus buffaloes. Melatonin implantation in conjunction with CIDR-eCG protocol successfully improved some blood metabolites, in anestrus buffalo heifers during out-of-breeding season under tropical conditions.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Tamer Awad Ramadan",authors:[{id:"197651",title:"Dr.",name:"Tamer",middleName:"Awad",surname:"Ramadan",slug:"tamer-ramadan",fullName:"Tamer Ramadan"}]},{id:"54974",doi:"10.5772/intechopen.68651",title:"Markers for Sperm Freezability and Relevance of Transcriptome Studies in Semen Cryopreservation: A Review",slug:"markers-for-sperm-freezability-and-relevance-of-transcriptome-studies-in-semen-cryopreservation-a-re",totalDownloads:1586,totalCrossrefCites:0,totalDimensionsCites:4,abstract:"Advances in sperm assessment techniques have offered new perspectives to improve the technology of semen cryopreservation. This review addresses some recent achievements in the proteomics of seminal plasma and spermatozoa and exemplifies its importance as markers for sperm fertility following cryopreservation. Recent advances in transcriptome studies on sperm RNA-Seq data have generated new information aimed to unravel the physiological roles of RNAs in the sperm-egg fertilization processes and their associations with male fertility. The relevance of the sperm freezability markers and the potential associations of RNA-profiling sequences with the sperm biological functions have been discussed.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Leyland Fraser",authors:[{id:"199650",title:"Dr.",name:"Leyland",middleName:null,surname:"Fraser",slug:"leyland-fraser",fullName:"Leyland Fraser"}]}],mostDownloadedChaptersLast30Days:[{id:"55696",title:"Estrus Cycle Monitoring in Wild Mammals: Challenges and Perspectives",slug:"estrus-cycle-monitoring-in-wild-mammals-challenges-and-perspectives",totalDownloads:1852,totalCrossrefCites:0,totalDimensionsCites:6,abstract:"The knowledge of reproductive physiology is of paramount importance to guide reproductive management and to make possible future application of assisted reproduction techniques (ARTs) aiming ex situ conservation of wild mammals. Nevertheless, information on the basic reproductive aspects of wild mammals remain scarce, and appropriate management practices have not yet been developed for all the species. This chapter discusses the methods most currently used for reproductive monitoring in wild females. Additionally, the difficulties regarding their use in different species and the possibilities of these procedures in captivity or in free-living mammals are addressed.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Alexandre R. Silva, Nei Moreira, Alexsandra F. Pereira, Gislayne C.X.\nPeixoto, Keilla M. Maia, Lívia B. Campos and Alana A. Borges",authors:[{id:"90066",title:"Dr.",name:"Alexandre",middleName:"Rodrigues",surname:"Silva",slug:"alexandre-silva",fullName:"Alexandre Silva"},{id:"177090",title:"Dr.",name:"Alexsandra Fernandes",middleName:null,surname:"Pereira",slug:"alexsandra-fernandes-pereira",fullName:"Alexsandra Fernandes Pereira"},{id:"177093",title:"MSc.",name:"Gislayne Christianne Xavier",middleName:null,surname:"Peixoto",slug:"gislayne-christianne-xavier-peixoto",fullName:"Gislayne Christianne Xavier Peixoto"},{id:"198314",title:"Prof.",name:"Nei",middleName:null,surname:"Moreira",slug:"nei-moreira",fullName:"Nei Moreira"},{id:"198315",title:"MSc.",name:"Keilla Moreira",middleName:null,surname:"Maia",slug:"keilla-moreira-maia",fullName:"Keilla Moreira Maia"},{id:"198316",title:"MSc.",name:"Lívia Batista",middleName:null,surname:"Campos",slug:"livia-batista-campos",fullName:"Lívia Batista Campos"},{id:"198317",title:"MSc.",name:"Alana Azevedo",middleName:null,surname:"Borges",slug:"alana-azevedo-borges",fullName:"Alana Azevedo Borges"}]},{id:"55491",title:"Mitigation of the Heat Stress Impact in Livestock Reproduction",slug:"mitigation-of-the-heat-stress-impact-in-livestock-reproduction",totalDownloads:4243,totalCrossrefCites:9,totalDimensionsCites:23,abstract:"Heat stress affects the fertility and reproductive livestock performance by compromising the physiology reproductive tract, through hormonal imbalance, decreased oocyte quality and poor semen quality, and decreased embryo development and survival. Heat stress decreases the secretion of luteinizing hormone and estradiol resulting in reduced length and intensity of estrus expression, increased incidence of anoestrus and silent heat in farm animals. Oocytes exposed to thermal stress lose its competence for fertilization and development into the blastocyst stage, which results in decreased fertility because of the production of poor quality oocytes and embryos. Furthermore, low progesterone secretion limits the endometrial functions, and subsequently embryo development. In addition, the increased secretion of endometrial prostaglandin F2 alpha during heat stress threatens the maintenance of pregnancy. In general, the percentage of conception rate was found to be reduced by 4.6% for each unit increase in temperature humidity index (THI) above 70, and heat stress during pregnancy further slows down the growth of the foetus and results in lower birth weight. In tropical and subtropical regions, during hot days, the testicular temperature may increase and impair both the spermatogenic cycle and semen quality, which culminates in decreased bull fertility. The effects of heat stress on livestock can be minimized via adapting suitable scientific strategies comprising physical modifications of the environment, nutritional management and genetic development of breeds that are less sensitive to heat stress. In addition, the summer infertility may be countered through advanced reproductive technologies involving hormonal treatments, timed artificial insemination and embryo transfer, which may enhance the chances for establishing pregnancy in farm animals.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Govindan Krishnan, Madiajagan Bagath, Prathap Pragna,\nMallenahally Kusha Vidya, Joy Aleena, Payyanakkal Ravindranathan\nArchana, Veerasamy Sejian and Raghavendra Bhatta",authors:[{id:"89780",title:"Dr.",name:"Veerasamy",middleName:null,surname:"Sejian",slug:"veerasamy-sejian",fullName:"Veerasamy Sejian"},{id:"177210",title:"Dr.",name:"Raghavendra",middleName:null,surname:"Bhatta",slug:"raghavendra-bhatta",fullName:"Raghavendra Bhatta"},{id:"177220",title:"Dr.",name:"M",middleName:null,surname:"Bagath",slug:"m-bagath",fullName:"M Bagath"},{id:"201967",title:"Dr.",name:"Govindan",middleName:null,surname:"Krishnan",slug:"govindan-krishnan",fullName:"Govindan Krishnan"},{id:"201968",title:"Ms.",name:"Archana",middleName:null,surname:"Pr",slug:"archana-pr",fullName:"Archana Pr"},{id:"201969",title:"Ms.",name:"Pragna",middleName:null,surname:"Prathap",slug:"pragna-prathap",fullName:"Pragna Prathap"},{id:"201970",title:"Ms.",name:"Aleena",middleName:null,surname:"Joy",slug:"aleena-joy",fullName:"Aleena Joy"},{id:"201971",title:"Dr.",name:"Vidya",middleName:null,surname:"Mk",slug:"vidya-mk",fullName:"Vidya Mk"}]},{id:"55324",title:"The Role of Androgens in Ovarian Follicular Development: From Fertility to Ovarian Cancer",slug:"the-role-of-androgens-in-ovarian-follicular-development-from-fertility-to-ovarian-cancer",totalDownloads:1755,totalCrossrefCites:0,totalDimensionsCites:0,abstract:"Androgens, steroid hormones produced by follicular cells, play a crucial role in the regulation of ovarian function. They affect folliculogenesis directly through androgen receptors (ARs) or indirectly through aromatization to estrogens. Androgens are thought to be primarily involved in preantral follicle growth and prevention of follicular atresia. It also seems possible that they are involved in the activation of primordial follicles. According to the World Health Organization, endocrine-disrupting chemicals (EDCs) are substances that alter hormonal signaling. EDCs comprise a wide variety of synthetic or natural chemicals arising from anthropogenic, industrial, agricultural, and domestic sources. EDCs interfere with natural regulation of the endocrine system by either mimicking or blocking the function of endogenous hormones as well as acting directly on gene expression or through epigenetic modifications. Disruptions in ovarian processes caused by EDCs may originate adverse outcomes such as anovulation, infertility, or premature ovarian failure. In this chapter, we aim to point out a possible involvement of androgen excess or deficiency in the regulation of ovarian function. We will summarize the effects of EDCs expressing antiandrogenic or androgenic activity on female physiology. Continuous exposition to even small concentration of such compounds can initiate oncogenesis within the ovary.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Malgorzata Duda, Kamil Wartalski, Zbigniew Tabarowski and\nGabriela Gorczyca",authors:[{id:"177042",title:"Ph.D.",name:"Malgorzata",middleName:null,surname:"Duda",slug:"malgorzata-duda",fullName:"Malgorzata Duda"},{id:"177918",title:"Dr.",name:"Zbigniew",middleName:null,surname:"Tabarowski",slug:"zbigniew-tabarowski",fullName:"Zbigniew Tabarowski"},{id:"205391",title:"MSc.",name:"Kamil",middleName:null,surname:"Wartalski",slug:"kamil-wartalski",fullName:"Kamil Wartalski"},{id:"205392",title:"MSc.",name:"Gabriela",middleName:null,surname:"Gorczyca",slug:"gabriela-gorczyca",fullName:"Gabriela Gorczyca"}]},{id:"56522",title:"Role of Melatonin in Reproductive Seasonality in Buffaloes",slug:"role-of-melatonin-in-reproductive-seasonality-in-buffaloes",totalDownloads:1726,totalCrossrefCites:2,totalDimensionsCites:5,abstract:"Buffaloes are characterized by seasonal reproductive activity. Anestrus buffalo heifers and lactating buffaloes were used to study the effect of melatonin treatment on the resumption of ovarian activity during out-of-breeding season. Buffaloes of treated group were injected or implanted with melatonin (18 mg melatonin/50 kg body weight). Using CIDR-eCG protocol preceded with melatonin successfully achieved estrus behavior and induced conception rate during out-of-breeding season. Furthermore, the reproductive performance of buffaloes during out-of-breeding season was clearly improved by melatonin implantation in conjunction with CIDR-eCG protocol due to the luteotrophic effect of melatonin expressed as increasing diameter of CL (corpus luteum) and progesterone concentration. This improvement resulted in greater values of conception rate, in melatonin implanted compared to not implanted buffaloes. Melatonin implantation in anestrus buffalo heifers increased the diameter of largest follicles and melatonin concentration but progesterone and luteinizing hormone (LH) concentrations were decreased. In addition, melatonin implantation in anestrus lactating buffaloes increased the SOD (superoxide dismutase) enzyme activity. Sustained release of exogenous melatonin significantly protects against oxidative stress while increasing beneficial total antioxidant capacity (TAC) concentration in summer-stressed anestrus buffaloes. Melatonin implantation in conjunction with CIDR-eCG protocol successfully improved some blood metabolites, in anestrus buffalo heifers during out-of-breeding season under tropical conditions.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Tamer Awad Ramadan",authors:[{id:"197651",title:"Dr.",name:"Tamer",middleName:"Awad",surname:"Ramadan",slug:"tamer-ramadan",fullName:"Tamer Ramadan"}]},{id:"54974",title:"Markers for Sperm Freezability and Relevance of Transcriptome Studies in Semen Cryopreservation: A Review",slug:"markers-for-sperm-freezability-and-relevance-of-transcriptome-studies-in-semen-cryopreservation-a-re",totalDownloads:1586,totalCrossrefCites:0,totalDimensionsCites:4,abstract:"Advances in sperm assessment techniques have offered new perspectives to improve the technology of semen cryopreservation. This review addresses some recent achievements in the proteomics of seminal plasma and spermatozoa and exemplifies its importance as markers for sperm fertility following cryopreservation. Recent advances in transcriptome studies on sperm RNA-Seq data have generated new information aimed to unravel the physiological roles of RNAs in the sperm-egg fertilization processes and their associations with male fertility. The relevance of the sperm freezability markers and the potential associations of RNA-profiling sequences with the sperm biological functions have been discussed.",book:{id:"5861",slug:"theriogenology",title:"Theriogenology",fullTitle:"Theriogenology"},signatures:"Leyland Fraser",authors:[{id:"199650",title:"Dr.",name:"Leyland",middleName:null,surname:"Fraser",slug:"leyland-fraser",fullName:"Leyland Fraser"}]}],onlineFirstChaptersFilter:{topicId:"1384",limit:6,offset:0},onlineFirstChaptersCollection:[],onlineFirstChaptersTotal:0},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:8,limit:8,total:0},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:8,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:98,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:286,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:105,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:9,numberOfPublishedChapters:101,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. 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Science",numberOfPublishedBooks:9,numberOfPublishedChapters:100,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:11,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],subseriesList:[{id:"22",title:"Applied Intelligence",scope:"This field is the key in the current industrial revolution (Industry 4.0), where the new models and developments are based on the knowledge generation on applied intelligence. The motor of the society is the industry and the research of this topic has to be empowered in order to increase and improve the quality of our lives.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/22.jpg",keywords:"Machine Learning, Intelligence Algorithms, Data Science, Artificial Intelligence, Applications on Applied Intelligence"},{id:"23",title:"Computational Neuroscience",scope:"Computational neuroscience focuses on biologically realistic abstractions and models validated and solved through computational simulations to understand principles for the development, structure, physiology, and ability of the nervous system. This topic is dedicated to biologically plausible descriptions and computational models - at various abstraction levels - of neurons and neural systems. This includes, but is not limited to: single-neuron modeling, sensory processing, motor control, memory, and synaptic plasticity, attention, identification, categorization, discrimination, learning, development, axonal patterning, guidance, neural architecture, behaviors, and dynamics of networks, cognition and the neuroscientific basis of consciousness. Particularly interesting are models of various types of more compound functions and abilities, various and more general fundamental principles (e.g., regarding architecture, organization, learning, development, etc.) found at various spatial and temporal levels.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/23.jpg",keywords:"Single-Neuron Modeling, Sensory Processing, Motor Control, Memory and Synaptic Pasticity, Attention, Identification, Categorization, Discrimination, Learning, Development, Axonal Patterning and Guidance, Neural Architecture, Behaviours and Dynamics of Networks, Cognition and the Neuroscientific Basis of Consciousness"},{id:"24",title:"Computer Vision",scope:"The scope of this topic is to disseminate the recent advances in the rapidly growing field of computer vision from both the theoretical and practical points of view. Novel computational algorithms for image analysis, scene understanding, biometrics, deep learning and their software or hardware implementations for natural and medical images, robotics, VR/AR, applications are some research directions relevant to this topic.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/24.jpg",keywords:"Image Analysis, Scene Understanding, Biometrics, Deep Learning, Software Implementation, Hardware Implementation, Natural Images, Medical Images, Robotics, VR/AR"},{id:"25",title:"Evolutionary Computation",scope:"Evolutionary computing is a paradigm that has grown dramatically in recent years. This group of bio-inspired metaheuristics solves multiple optimization problems by applying the metaphor of natural selection. It so far has solved problems such as resource allocation, routing, schedule planning, and engineering design. Moreover, in the field of machine learning, evolutionary computation has carved out a significant niche both in the generation of learning models and in the automatic design and optimization of hyperparameters in deep learning models. This collection aims to include quality volumes on various topics related to evolutionary algorithms and, alternatively, other metaheuristics of interest inspired by nature. For example, some of the issues of interest could be the following: Advances in evolutionary computation (Genetic algorithms, Genetic programming, Bio-inspired metaheuristics, Hybrid metaheuristics, Parallel ECs); Applications of evolutionary algorithms (Machine learning and Data Mining with EAs, Search-Based Software Engineering, Scheduling, and Planning Applications, Smart Transport Applications, Applications to Games, Image Analysis, Signal Processing and Pattern Recognition, Applications to Sustainability).",coverUrl:"https://cdn.intechopen.com/series_topics/covers/25.jpg",keywords:"Genetic Algorithms, Genetic Programming, Evolutionary Programming, Evolution Strategies, Hybrid Algorithms, Bioinspired Metaheuristics, Ant Colony Optimization, Evolutionary Learning, Hyperparameter Optimization"},{id:"26",title:"Machine Learning and Data Mining",scope:"The scope of machine learning and data mining is immense and is growing every day. It has become a massive part of our daily lives, making predictions based on experience, making this a fascinating area that solves problems that otherwise would not be possible or easy to solve. This topic aims to encompass algorithms that learn from experience (supervised and unsupervised), improve their performance over time and enable machines to make data-driven decisions. It is not limited to any particular applications, but contributions are encouraged from all disciplines.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/26.jpg",keywords:"Intelligent Systems, Machine Learning, Data Science, Data Mining, Artificial Intelligence"},{id:"27",title:"Multi-Agent Systems",scope:"Multi-agent systems are recognised as a state of the art field in Artificial Intelligence studies, which is popular due to the usefulness in facilitation capabilities to handle real-world problem-solving in a distributed fashion. The area covers many techniques that offer solutions to emerging problems in robotics and enterprise-level software systems. Collaborative intelligence is highly and effectively achieved with multi-agent systems. Areas of application include swarms of robots, flocks of UAVs, collaborative software management. Given the level of technological enhancements, the popularity of machine learning in use has opened a new chapter in multi-agent studies alongside the practical challenges and long-lasting collaboration issues in the field. It has increased the urgency and the need for further studies in this field. We welcome chapters presenting research on the many applications of multi-agent studies including, but not limited to, the following key areas: machine learning for multi-agent systems; modeling swarms robots and flocks of UAVs with multi-agent systems; decision science and multi-agent systems; software engineering for and with multi-agent systems; tools and technologies of multi-agent systems.",coverUrl:"https://cdn.intechopen.com/series_topics/covers/27.jpg",keywords:"Collaborative Intelligence, Learning, Distributed Control System, Swarm Robotics, Decision Science, Software Engineering"}],annualVolumeBook:{},thematicCollection:[],selectedSeries:{title:"Artificial Intelligence",id:"14"},selectedSubseries:null},seriesLanding:{item:{id:"7",title:"Biomedical Engineering",doi:"10.5772/intechopen.71985",issn:"2631-5343",scope:"Biomedical Engineering is one of the fastest-growing interdisciplinary branches of science and industry. The combination of electronics and computer science with biology and medicine has improved patient diagnosis, reduced rehabilitation time, and helped to facilitate a better quality of life. Nowadays, all medical imaging devices, medical instruments, or new laboratory techniques result from the cooperation of specialists in various fields. The series of Biomedical Engineering books covers such areas of knowledge as chemistry, physics, electronics, medicine, and biology. This series is intended for doctors, engineers, and scientists involved in biomedical engineering or those wanting to start working in this field.",coverUrl:"https://cdn.intechopen.com/series/covers/7.jpg",latestPublicationDate:"May 7th, 2022",hasOnlineFirst:!0,numberOfOpenTopics:3,numberOfPublishedChapters:96,numberOfPublishedBooks:12,editor:{id:"50150",title:"Prof.",name:"Robert",middleName:null,surname:"Koprowski",fullName:"Robert Koprowski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTYNQA4/Profile_Picture_1630478535317",biography:"Robert Koprowski, MD (1997), PhD (2003), Habilitation (2015), is an employee of the University of Silesia, Poland, Institute of Computer Science, Department of Biomedical Computer Systems. For 20 years, he has studied the analysis and processing of biomedical images, emphasizing the full automation of measurement for a large inter-individual variability of patients. Dr. Koprowski has authored more than a hundred research papers with dozens in impact factor (IF) journals and has authored or co-authored six books. Additionally, he is the author of several national and international patents in the field of biomedical devices and imaging. Since 2011, he has been a reviewer of grants and projects (including EU projects) in biomedical engineering.",institutionString:null,institution:{name:"University of Silesia",institutionURL:null,country:{name:"Poland"}}},subseries:[{id:"7",title:"Bioinformatics and Medical Informatics",keywords:"Biomedical Data, Drug Discovery, Clinical Diagnostics, Decoding Human Genome, AI in Personalized Medicine, Disease-prevention Strategies, Big Data Analysis in Medicine",scope:"Bioinformatics aims to help understand the functioning of the mechanisms of living organisms through the construction and use of quantitative tools. The applications of this research cover many related fields, such as biotechnology and medicine, where, for example, Bioinformatics contributes to faster drug design, DNA analysis in forensics, and DNA sequence analysis in the field of personalized medicine. Personalized medicine is a type of medical care in which treatment is customized individually for each patient. Personalized medicine enables more effective therapy, reduces the costs of therapy and clinical trials, and also minimizes the risk of side effects. Nevertheless, advances in personalized medicine would not have been possible without bioinformatics, which can analyze the human genome and other vast amounts of biomedical data, especially in genetics. The rapid growth of information technology enabled the development of new tools to decode human genomes, large-scale studies of genetic variations and medical informatics. The considerable development of technology, including the computing power of computers, is also conducive to the development of bioinformatics, including personalized medicine. In an era of rapidly growing data volumes and ever lower costs of generating, storing and computing data, personalized medicine holds great promises. Modern computational methods used as bioinformatics tools can integrate multi-scale, multi-modal and longitudinal patient data to create even more effective and safer therapy and disease prevention methods. Main aspects of the topic are: Applying bioinformatics in drug discovery and development; Bioinformatics in clinical diagnostics (genetic variants that act as markers for a condition or a disease); Blockchain and Artificial Intelligence/Machine Learning in personalized medicine; Customize disease-prevention strategies in personalized medicine; Big data analysis in personalized medicine; Translating stratification algorithms into clinical practice of personalized medicine.",annualVolume:11403,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/7.jpg",editor:{id:"351533",title:"Dr.",name:"Slawomir",middleName:null,surname:"Wilczynski",fullName:"Slawomir Wilczynski",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y000035U1loQAC/Profile_Picture_1630074514792",institutionString:null,institution:{name:"Medical University of Silesia",institutionURL:null,country:{name:"Poland"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"5886",title:"Dr.",name:"Alexandros",middleName:"T.",surname:"Tzallas",fullName:"Alexandros Tzallas",profilePictureURL:"https://mts.intechopen.com/storage/users/5886/images/system/5886.png",institutionString:"University of Ioannina, Greece & Imperial College London",institution:{name:"University of Ioannina",institutionURL:null,country:{name:"Greece"}}},{id:"257388",title:"Distinguished Prof.",name:"Lulu",middleName:null,surname:"Wang",fullName:"Lulu Wang",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRX6kQAG/Profile_Picture_1630329584194",institutionString:null,institution:{name:"Shenzhen Technology University",institutionURL:null,country:{name:"China"}}},{id:"225387",title:"Prof.",name:"Reda",middleName:"R.",surname:"Gharieb",fullName:"Reda Gharieb",profilePictureURL:"https://mts.intechopen.com/storage/users/225387/images/system/225387.jpg",institutionString:"Assiut University",institution:{name:"Assiut University",institutionURL:null,country:{name:"Egypt"}}}]},{id:"8",title:"Bioinspired Technology and Biomechanics",keywords:"Bioinspired Systems, Biomechanics, Assistive Technology, Rehabilitation",scope:'Bioinspired technologies take advantage of understanding the actual biological system to provide solutions to problems in several areas. Recently, bioinspired systems have been successfully employing biomechanics to develop and improve assistive technology and rehabilitation devices. The research topic "Bioinspired Technology and Biomechanics" welcomes studies reporting recent advances in bioinspired technologies that contribute to individuals\' health, inclusion, and rehabilitation. Possible contributions can address (but are not limited to) the following research topics: Bioinspired design and control of exoskeletons, orthoses, and prostheses; Experimental evaluation of the effect of assistive devices (e.g., influence on gait, balance, and neuromuscular system); Bioinspired technologies for rehabilitation, including clinical studies reporting evaluations; Application of neuromuscular and biomechanical models to the development of bioinspired technology.',annualVolume:11404,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/8.jpg",editor:{id:"144937",title:"Prof.",name:"Adriano",middleName:"De Oliveira",surname:"Andrade",fullName:"Adriano Andrade",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRC8QQAW/Profile_Picture_1625219101815",institutionString:null,institution:{name:"Federal University of Uberlândia",institutionURL:null,country:{name:"Brazil"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"49517",title:"Prof.",name:"Hitoshi",middleName:null,surname:"Tsunashima",fullName:"Hitoshi Tsunashima",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYTP4QAO/Profile_Picture_1625819726528",institutionString:null,institution:{name:"Nihon University",institutionURL:null,country:{name:"Japan"}}},{id:"425354",title:"Dr.",name:"Marcus",middleName:"Fraga",surname:"Vieira",fullName:"Marcus Vieira",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0033Y00003BJSgIQAX/Profile_Picture_1627904687309",institutionString:null,institution:{name:"Universidade Federal de Goiás",institutionURL:null,country:{name:"Brazil"}}},{id:"196746",title:"Dr.",name:"Ramana",middleName:null,surname:"Vinjamuri",fullName:"Ramana Vinjamuri",profilePictureURL:"https://mts.intechopen.com/storage/users/196746/images/system/196746.jpeg",institutionString:"University of Maryland, Baltimore County",institution:{name:"University of Maryland, Baltimore County",institutionURL:null,country:{name:"United States of America"}}}]},{id:"9",title:"Biotechnology - Biosensors, Biomaterials and Tissue Engineering",keywords:"Biotechnology, Biosensors, Biomaterials, Tissue Engineering",scope:"The Biotechnology - Biosensors, Biomaterials and Tissue Engineering topic within the Biomedical Engineering Series aims to rapidly publish contributions on all aspects of biotechnology, biosensors, biomaterial and tissue engineering. We encourage the submission of manuscripts that provide novel and mechanistic insights that report significant advances in the fields. Topics can include but are not limited to: Biotechnology such as biotechnological products and process engineering; Biotechnologically relevant enzymes and proteins; Bioenergy and biofuels; Applied genetics and molecular biotechnology; Genomics, transcriptomics, proteomics; Applied microbial and cell physiology; Environmental biotechnology; Methods and protocols. Moreover, topics in biosensor technology, like sensors that incorporate enzymes, antibodies, nucleic acids, whole cells, tissues and organelles, and other biological or biologically inspired components will be considered, and topics exploring transducers, including those based on electrochemical and optical piezoelectric, thermal, magnetic, and micromechanical elements. Chapters exploring biomaterial approaches such as polymer synthesis and characterization, drug and gene vector design, biocompatibility, immunology and toxicology, and self-assembly at the nanoscale, are welcome. Finally, the tissue engineering subcategory will support topics such as the fundamentals of stem cells and progenitor cells and their proliferation, differentiation, bioreactors for three-dimensional culture and studies of phenotypic changes, stem and progenitor cells, both short and long term, ex vivo and in vivo implantation both in preclinical models and also in clinical trials.",annualVolume:11405,isOpenForSubmission:!0,coverUrl:"https://cdn.intechopen.com/series_topics/covers/9.jpg",editor:{id:"126286",title:"Dr.",name:"Luis",middleName:"Jesús",surname:"Villarreal-Gómez",fullName:"Luis Villarreal-Gómez",profilePictureURL:"https://mts.intechopen.com/storage/users/126286/images/system/126286.jpg",institutionString:null,institution:{name:"Autonomous University of Baja California",institutionURL:null,country:{name:"Mexico"}}},editorTwo:null,editorThree:null,editorialBoard:[{id:"35539",title:"Dr.",name:"Cecilia",middleName:null,surname:"Cristea",fullName:"Cecilia Cristea",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYQ65QAG/Profile_Picture_1621007741527",institutionString:null,institution:{name:"Iuliu Hațieganu University of Medicine and Pharmacy",institutionURL:null,country:{name:"Romania"}}},{id:"40735",title:"Dr.",name:"Gil",middleName:"Alberto Batista",surname:"Gonçalves",fullName:"Gil Gonçalves",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002aYRLGQA4/Profile_Picture_1628492612759",institutionString:null,institution:{name:"University of Aveiro",institutionURL:null,country:{name:"Portugal"}}},{id:"211725",title:"Associate Prof.",name:"Johann F.",middleName:null,surname:"Osma",fullName:"Johann F. Osma",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDv7QAG/Profile_Picture_1626602531691",institutionString:null,institution:{name:"Universidad de Los Andes",institutionURL:null,country:{name:"Colombia"}}},{id:"69697",title:"Dr.",name:"Mani T.",middleName:null,surname:"Valarmathi",fullName:"Mani T. Valarmathi",profilePictureURL:"https://mts.intechopen.com/storage/users/69697/images/system/69697.jpg",institutionString:"Religen Inc. | A Life Science Company, United States of America",institution:null},{id:"205081",title:"Dr.",name:"Marco",middleName:"Vinícius",surname:"Chaud",fullName:"Marco Chaud",profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bSDGeQAO/Profile_Picture_1622624307737",institutionString:null,institution:{name:"Universidade de Sorocaba",institutionURL:null,country:{name:"Brazil"}}}]}]}},libraryRecommendation:{success:null,errors:{},institutions:[]},route:{name:"profile.detail",path:"/profiles/421216",hash:"",query:{},params:{id:"421216"},fullPath:"/profiles/421216",meta:{},from:{name:null,path:"/",hash:"",query:{},params:{},fullPath:"/",meta:{}}}},function(){var e;(e=document.currentScript||document.scripts[document.scripts.length-1]).parentNode.removeChild(e)}()