bluuebunny/crossref_metadata_2025 huggingface dataset:
Medicare Reimbursement in Home Care
Authors: DePaoli Toni-Ann L. , Zenk-Jones Paula
Published: April 2012

This article presents the Medicare requirements and guidelines for reimbursement of occupational therapy, specific charting recommendations, and the Medicare review process.
Examining the Reliability and Validity of the Play History
Authors: Behnke Cindy Jill , Menarchek Fetkovich Marilee
Published: April 2012

Few occupational therapy tools exist that evaluate play totally and systematically. The purpose of this study was to examine the Play History Interview and establish its value as a scientific clinical tool. The parents of 15 disabled and 15 nondisabled children between the ages of 1 and 7½ years were interviewed about their children’s play behaviors using the Play History Interview. Children were rated on an ordinal scale according to the criteria outlined on the Play History Chart and Taxonomy for Diagnosis. Interrater and test-retest reliabilities were determined by two independent raters. The scores from the Play History and Minnesota Child Development Inventory were correlated to examine concurrent validity of the Play History. Content validity was studied via a literature review. Significant results suggest that the Play History is a reliable and valid interview in occupational therapy for assessing children’s play behavior.
Splint Modification for Flexor Tendon Repairs
Authors: Lopez Mary Sullivan , Hanley Kevin F.
Published: April 2012

A modification of the Kleinert orthosis providing early controlled mobilization following flexor tendon repair is presented in the article. Ongoing evaluations of the efficacy of the splint are described and implications for use in treatment are reviewed.

The views expressed in this paper are those of the authors and do not reflect official United States Army or U.S. Department of Defense Policy.
Occupational Therapy Management and Job Performance of Staff
Authors: Brollier Chestina
Published: April 2012

This study focuses on two basic research questions: 1. Do discrepancies exist between the way hospital-based occupational therapy department directors perceive their managerial leadership and the way their occupational therapy staff members perceive the directors’ leadership? 2. What effect does the managerial leadership of the directors have on staff occupational therapists’ job performance? Mailed questionnaires were completed by 93 occupational therapy directors and 348 nonmanagerial registered occupational therapists who were employed in hospitals throughout the continental United States.

The directors and their staff members demonstrated significant differences in their assessments of the directors’ managerial leadership styles; directors generally gave themselves higher ratings than did their staff members. The occupational therapy directors gave their staff high job performance ratings. Also, discrepancies between the directors’ and their staff occupational therapists’ ratings of the directors’ leadership styles correlated negatively with staff job performance. The results of the study suggest some potentially beneficial management training topics for department directors.
Sensory Intervention With the Preterm Infant in the Neonatal Intensive Care Unit
Authors: Anderson Jill
Published: April 2012

Sensory intervention, one aspect in the occupational therapy treatment of the high-risk, preterm infant in the neonatal intensive care unit (NICU), is discussed. Normal deviations in the healthy preterm baby’s development at the equivalent age of the full-term baby are identified as a basis for intervention. Environmental factors affecting the preterm infant’s interactions and therapeutic needs, such as the NICU environment and medical intervention, are reviewed. The rationale underlying the selection of sensory evaluation and treatment approaches is based on recent research. These approaches primarily focus on visual, tactile, proprioceptive, vestibular, and, to a lesser degree, auditory stimulation.
Splinting Proximal Interphalangeal Joint Flexion Contractures: A New Design
Authors: Callahan Anne D. , McEntee Pamela
Published: April 2012

Proximal interphalangeal joint flexion contracture is a common and persistent problem in hand rehabilitation. This article discusses the advantages and disadvantages of several current splint designs for correcting this contracture and introduces an alternate design that uses wire in a 3-point pressure system. The advantages of this design include ease of fabrication, patient appeal, and effectiveness.
The Efficacy of the ROM Dance Program for Adults With Rheumatoid Arthritis
Authors: Van Deusen Julia , Harlowe Diane
Published: April 2012

This study examined the efficacy of an exercise and relaxation program for adults with rheumatoid arthritis. The program integrates principles of occupational therapy and T’ai-Chi Ch’uan and was expected to be more effective than traditional exercise and rest regimens because of its expressive and pleasurable elements. There were significant differences between 17 experimental and 16 control subjects on two categories of dependent variables after the former group’s participation in the experimental program. These dependent variables were range of motion measures and subject self-reports of frequency, enjoyment, and benefits of home exercise and rest routines. Pretest, posttest, and 4-month follow-up data were analyzed.

Program participants showed significantly greater upper extremity range of motion 4 months after completing the program although the reported frequency of exercise and rest was greater in the control group. Postprogram reports of enjoyment were significantly higher for experimental than for control subjects. If these initial results are confirmed in further studies, the efficacy of the use of purposeful activity for exercise and rest will be supported. This study also supports the integration of Eastern and Western frames of reference in the treatment of patients with chronic illness.
Bilateral Hand Performance With Divided Attention After a Cerebral Vascular Accident
Authors: Dittmar Christy M. , Gliner Jeffrey A.
Published: April 2012

A divided attention task was used with 10 left or right cerebral vascular accident (CVA) subjects who had return of functional movement in the affected extremities. The primary task was one subtest of the Jebson Hand Function Test. The secondary task was a foot press to a series of auditory cues. Four measurements were obtained for each subject at intervals of 1 month, 2 months, and 3 months after the stroke. Comparison scores on this procedure were also obtained on 5 normal subjects.

The results indicated that dividing attention in the CVA subjects significantly decreased the performance on the primary task. The performance with the affected limb improved over the 3-month time period and reached a level of performance that was not significantly different from that of the unaffected limb for either the undivided or divided attention task. Implications for occupational therapy environments and consideration of attention limitations are discussed.
Behavioral Treatment of Attention Deficits in Mentally Impaired Subjects
Authors: Burgess Paul W. , Mitchelmore Stuart , Giles Gordon M.
Published: April 2012

This paper describes an operant approach to the remediation of the behavioral aspects of attention deficits in three mentally impaired subjects. Two of the subjects also displayed severe atypical psychiatric disorders. Contingent reinforcement within an ABAC experimental design was used to increase levels of attending behavior. The efficacy of this approach within a group setting was demonstrated. Results suggest that some forms of additional deficit may be treated behaviorally despite differing etiologies of the cognitive deficit. The implications for occupational therapy are discussed within the context of the design of the ward program.
Ethical Reasoning and Informed Consent in Occupational Therapy
Authors: Kyler-Hutchison Penny
Published: April 2012

Two major ethical theories, the teleological and the deontological, are defined and briefly discussed. A subsequent discussion explores how the ethical principles of informed consent and patient autonomy operate in medical decisions. The application to occupational therapy is left for the reader’s judgment.
A Therapeutic Work Program for Head-Injured Adults
Authors: Lyons Jill Leffler , Morse Amy Ripple
Published: April 2012

The Therapeutic Work Program operates in an ambulatory care setting and aids in assessing and developing prevocational skills in adults with head injuries. The program has eight phases, including initial evaluation, individual and group treatment, and prevocational assessment and treatment. We conducted a phone survey to evaluate the program’s effectiveness and found that 79% of the 29 respondents participated in occupational activities (i.e., they were competitive or volunteer employees, homemakers, or students), a greater percentage than reported by other prevocational programs for patients with head injuries.
Neuroscience and Occupational Therapy: Vital Connections
Authors: Farber Shereen D.
Published: April 2012

This paper presents the hypothesis that in-depth knowledge of the neurosciences serves as a common denominator that enhances our ability to interpret all aspects of human behavior. Neurobiological information can be used to design research to evaluate our existing treatment philosophy and methodology and to develop new theories and technology. Because occupational therapy addresses widely divergent diagnostic populations, three separate areas along the practice continuum were selected to demonstrate the application of neurobiological concepts: (a) neuroimmunomodulation, (b) organic bases of psychopathology, and (c) traumatic brain injury. Philosophical statements regarding effective methods of teaching neurobiology to occupational therapists are included.
Knowledgeability of Theories of Occupational Therapy Practitioners in Israel
Authors: Javetz Rachel , Katz Noomi
Published: April 2012

A reflective occupational therapist is conceived as one who values theory and uses it as a tool for setting and solving problems in clinical situations. In this study, we investigated the extent of knowledgeability of theories of occupational therapy practitioners in Israel. Data were collected in two stages: (a) through personal interviews with a representative sample of all occupational therapists (n = 98) with the use of a semistructured questionnaire and (b) through telephone interviews of recent graduates of one school (n = 40) with the use of a shortened version of the original questionnaire. The findings from an open-ended question concerning knowledgeability of theories reflected (a) the degree of the theories’ scientific development, (b) the differentiation between models conceived as theories and those seen as techniques for treatment, and (c) the changes in professional curricula resulting from scientific and clinical developments in the field. In addition, a more general knowledge level, termed recognition, showed a consistent understanding of the theories and treatment modalities relevant in the practitioners’ specialty areas. The results of this study indicate a need for further articulation of theory in clinical practice as well as better educational preparation of the “reflective practitioner” (Schön, 1983).
Occupational Therapy Treatment Practices With Infants in Early Intervention
Authors: Gorga Delia
Published: April 2012

This paper explores occupational therapy treatment practices for infants (birth to age 2 years) in early intervention programs. Generic treatment is viewed as the facilitation of the infant’s independence through improved motor control, sensory modulation, adaptive coping, sensorimotor development, social–emotional development, daily living skills, and play. Treatment practices in specialized settings, that is, in a neonatal intensive care unit and in a follow-up program for high-risk infants, are outlined. The efficacy of intervention is discussed in light of recent research findings and of the comments made by critics of early intervention.
Occupational Therapy and the Postpolio Syndrome
Authors: Young Grace R.
Published: April 2012

Approximately 75,000 polio survivors are experiencing new weakness, pain, and fatigue that are related to their initial disease. These problems affect their functional ability; therefore, they are of concern to occupational therapists. Overwork of a weakened neuromuscular system is believed to be the cause of these late symptoms. This article reviews current writings on the late effects of poliomyelitis. An understanding of the symptoms, causality, and psychosocial ramifications of this phenomenon facilitates effective occupational therapy intervention. Guidelines for occupational therapy assessment and treatment are included.
Variables Affecting Specialty Choice in Occupational Therapy
Authors: Wittman Peggy Prince , Swinehart Susan , Cahill Rosemary , St. Michel Gordon
Published: April 2012

Over the past 15 years, the number of occupational therapists entering the practice area of mental health has greatly declined. To determine the possible reasons for this decline, a random sample of 450 occupational therapy students who graduated in 1986 was surveyed to identify those factors that influence practice choice. Participants were asked to indicate their practice preferences at five points in time: before admission to the academic program, after completion of the academic program, after completion of Level I fieldwork, after completion of Level II fieldwork, and at first employment. The results from 212 questionnaires (a 47% response rate) indicated that the distribution of practice choices remained relatively consistent over time. After completion of the academic program, the choice of mental health practice was seen as negative. Specific negative influences were topic content, teaching methods, and teacher effectiveness. Level I fieldwork was perceived as a negative experience in all five practice areas, but was perceived most negatively in mental health. Level II fieldwork most influenced practice preferences. Specific positive factors were the student supervisor and the patient caseload.
Effects of Continuous Passive Motion and Elevation on Hand Edema
Authors: Giudice Marcia L.
Published: April 2012

The purpose of this study was to evaluate the efficacy of the use of continuous passive motion (CPM) of the digits in combination with limb elevation to reduce hand edema. The effects of 30 min of CPM of the digits with the limb elevated were compared with the effects of 30 min of limb elevation alone. Each of 16 subjects with hand edema of varied etiology received both treatments, one on each of 2 consecutive days. Measures of hand volume, finger circumference, and finger stiffness were taken before and after each treatment. Analyses comparing mean percentage change scores for both treatments showed large and significant treatment effects for all three dependent measures. The findings indicate that, for this sample, CPM with limb elevation was a more effective treatment for the reduction of hand edema than limb elevation alone. The results of analyses performed on a subgroup of 11 subjects with hemiplegia were similar, thus suggesting that CPM with limb elevation may be an effective method by which to reduce hand edema for this patient population.
The Integration of Computers Into the Occupational Therapy Department
Authors: Weiss Patrice
Published: April 2012

Despite the growing interest in and use of microcomputers as an occupational therapy assessment and treatment modality, many factors still limit their widespread adoption in the clinical milieu. Such factors include inadequate background preparation; insufficient financial resources; the overwhelming number of choices of computer hardware, software, and adaptive devices; lack of product support; rapidity of change; and skepticism of administrators and clinicians. The purpose of this paper is to outline procedures that will facilitate the integration of microcomputers into the clinical milieu by (a) identifying the reasons why and how these devices are used improperly; (b) proposing ways to correct these problems; (c) providing recommendations concerning the acquisition of major microcomputer hardware, software, and adaptations; and (d) providing an annotated list of resources for further information.
Relations Between Design Copying and Other Tests of Sensory Integrative Dysfunction: A Pilot Study
Authors: McAtee Shay , Mack Wendy
Published: April 2012

The purpose of this pilot study was to investigate possible relations between performance on the atypical approach parameters of the Design Copying (DC) subtest of the Sensory Integration and Praxis Tests (SIPT) (Ayres, 1989) and scores on the Southern California Sensory Integration Tests (SCSIT) (Ayres, 1980). An existing data set was used that consisted of SCSIT and SIPT–DC scores from 32 children identified by their performance on the SCSIT as having sensory integrative dysfunction. Three questions were addressed: (a) Are there relations between scores on the atypical approach parameters of the SIPT–DC and SCSIT scores? (b) To what extent do the SCSIT scores collectively predict the presence or absence of the SIPT–DC atypical approach parameters? and (c) Are there relations among scores on the SIPT–DC atypical approach parameters? The results suggest that the scores on individual SIPT–DC atypical approach parameters may be related to the scores on the SCSIT subtests. In particular, significant relationships were found between some of the SIPT–DC parameters and the SCSIT subtests that assess visual, tactile, and motor components.
The Level I Fieldwork Process
Authors: Shalik Linda Dean
Published: April 2012

This paper reports the results of a nationwide study in which the factors that relate to the overall Level I fieldwork implementation were compared across a variety of occupational therapy fieldwork settings. Two questionnaires were used to collect data: One was completed by 395 Level I fieldwork site supervisors, and the other by faculty representatives from 40 professional-level academic occupational therapy programs. The data showed that there were more similarities than differences among the fieldwork sites, thus suggesting that a common process is used in most fieldwork placements. The primary factors that differentiated among the various fieldwork settings were variables that tended to describe the settings demographically (e.g., type of employment setting, funding sources). Interesting differences were found among the various fieldwork settings between the amount of supervision given to Level I students and the amount of independent, treatment-oriented performance by the students.
The Use of Relaxation Training to Enhance Functional Outcomes in Adults With Traumatic Head Injuries
Authors: Lysaght Rosemary , Bodenhamer Eugenia
Published: April 2012

Impaired anxiety management and poor emotional control have a negative effect on the adaptive functioning of persons with head injuries who are in the postacute stages of recovery. This paper outlines a relaxation training program administered individually to 4 adults with severe head injuries. Each subject was in the postacute phase of recovery and had reported stress to be a persistent problem in daily living. The relaxation training protocol combined biofeedback, imagery, autogenic training, and deep breathing. Significant improvement in function, measured by scores on a scale of illness-related dysfunction, support the potential benefits of stress management training as part of functional training programs for persons with traumatic head injuries.
A Prevention Model for Occupational Therapy
Authors: Grossman Judy
Published: April 2012

The role of occupational therapy in prevention has received much discussion but relatively little empirical testing and model building. Because of the evidence linking stress and illness, the life stress process has become a popular area of investigation. More importantly, a role strain model can provide a theoretical guide to occupational therapy practice due to the central importance of adaptive behavior and social competence. To illustrate, the maternal stress study is presented as an example of prevention research that examines the relationship between maternal stress and child psychopathology. Risk factors are identified as the first step in reliable case finding and the design of preventive interventions. Such model building can help occupational therapists develop prevention services for vulnerable populations.
Epistemology and Experimentation: An Examination of Quality Factors in Research Design
Authors: Ottenbacher Kenneth J.
Published: April 2012

Forty-four research articles published in the occupational therapy literature were examined to determine the effect of design quality on study outcome. All 44 of the studies examined involved a parallel-groups comparison design. Twenty-two of the studies included random assignment of subjects to various groups, and the remaining 22 investigations used some nonrandom method to determine subject allocation. A standardized metric (i.e., effect size) was used to determine the effect of the independent variable in the 44 studies. The data analysis revealed that effect-size values were not significantly different between studies that involved random assignment and those not involving random assignment. The argument is made that such design characteristics as random assignment should be examined as moderator variables in any attempt to synthesize findings from multiple studies. Such an approach would treat the design used in a study as one of many possible variables that could influence the outcome. This approach would modify the a priori assumption that one research design is inherently superior to another regardless of the research question or context.
Perceptions of Practitioners, Educators, and Students Concerning the Role of the Occupational Therapy Practitioner
Authors: Vogel Kimberly A.
Published: April 2012

In this study, the attitudes of 348 occupational therapy educators, practitioners, and students were assessed concerning the perceived role of the practitioner. The three groups’ perceptions of the practitioner’s role offers a starting point from which changes in education and practice can be made to reflect the profession’s pending decisions concerning physical modalities, unification of theory and practice, and status of the profession. A 4-point Likert scale was used to measure the subjects’ responses to 19 statements on major professional issues concerning occupational therapy’s unique philosophical base, the appropriateness of certain treatment modalities, and the profession’s future focus. One-way analyses of variance, Student-Newman-Keuls (Winer, 1971) procedures, and t tests were performed to identify attitudinal differences by respondent type, specialty area, and length of clinical experience. The results indicated agreement among all respondents that occupational therapists should be skilled in analyzing activities and that occupational therapy services should be covered by third-party payment. Additionally, strong attitudinal differences were identified among educators, practitioners, and students regarding treatment modalities and therapists’ role characteristics.
Toy Control Program Evaluation
Authors: Stewart Hugh A. , Ormond Cheryl , Seeger Barry R.
Published: April 2012

The Toy Control Program for the Apple IIe microcomputer is a software and hardware package developed for the training of single-switch scanning skills. The specially designed scanning programs provide onscreen visual feedback and activate a battery-powered toy to reinforce performance. This study examined whether the training of preschool subjects in single-switch scanning skills with the Toy Control Program would result in increased task completion scores and increased levels of attention to task, as compared with conditions of toy activation only and microcomputer programs with screen reinforcement only. The results showed that the subjects paid significantly more attention to the toys as reinforcers ( p < .01). No significant difference was found for the performance results of the three conditions. These findings support the use of a program like the Toy Control Program, which integrates the instructional capabilities of a computer with the reinforcement potential of a toy and the creativity of a therapist.
Some Implications of Occupational Therapy’s History for Its Epistemology, Values, and Relation to Medicine
Authors: Yerxa Elizabeth J.
Published: April 2012

Occupational therapy’s history is explored to identify some implications for its directions in the 21st century. The profession was founded upon visionary ideas about the nature of human beings and their vital need for activity. Occupational therapy will make a significant contribution to society if it (a) seeks and applies an epistemology consistent with studying human purposes, (b) fosters its optimistic view of human nature, and (c) clarifies its relationship to medicine and other disciplines.
Tell Me a Story: The Therapeutic Metaphor in the Practice of Pediatric Occupational Therapy
Authors: Fazio Linda S.
Published: April 2012

In the crafting of therapeutic intervention, pediatric occupational therapists are challenged to provide therapeutic modalities that are as stimulating and imaginative as the child’s world, while offering appropriate and meaningful solutions to the child’s problems. Storytelling, coupled with the visual, auditory, and kinesthetic stimulation of guided affective imagery, offers a stimulating treatment approach for both the child or adolescent and the occupational therapist. This paper provides an overview of the use of storytelling, metaphorical forms and expressions, and guided affective imagery in occupational therapy with children.
A Validity Study of the Posture and Fine Motor Assessment of Infants
Authors: Case-Smith Jane
Published: April 2012

This study investigated the concurrent and construct validity of the Posture and Fine Motor Assessment of Infants (PFMAI) (Case-Smith, 1991). The subjects were 90 infants, 65 of whom were healthy and full-term and 25 of whom were premature and had medical risk factors.

Concurrent validity was investigated through administration of the Peabody Developmental Motor Scales (Folio & Fewell, 1983) and the PFMAI (n = 25). Strong positive correlations resulted between the Peabody Gross Motor scale and PFMAI Posture scale and between the Peabody Fine Motor scale and PFMAI Fine Motor scale. Concurrent validity was also measured through correlation scores on the Bayley Scales of Infant Development (Bayley, 1969) with scores on the PFMAI. The correlations between the Bayley Motor scale and the PFMAI Posture scale and between the Bayley Mental scale and the PFMAI Fine Motor scale were high.

Construct validity was estimated through an evaluation of how accurately the PFMAI discriminated between the premature subjects and the full-term subjects . A discriminant analysis indicated that the PFMAI accurately classified 78% of the subjects as being either premature or full-term (i.e., 80% of the full-term subjects and 72% of the premature subjects). When the premature subjects were categorized as low-risk or high-risk according to their medical histories, the PFMAI accurately classified 66.7% of the total subject population as full-term, low-risk premature, or high-risk premature. These results indicate that the PFMAI has the adequate reliability and validity necessary for use as a clinical and a research instrument. Uses of this instrument include obtaining baseline data for planning therapy and evaluating the short-term effectiveness of intervention focused on enhancing posture and movement. The PFMAI can assist occupational therapists in analyzing posture and movement when using a neurodevelopmental approach and provides a prototype for objective measurement of the qualitative aspects of movement.
Comparison of Performance in Materials-Based Occupation, Imagery-Based Occupation, and Rote Exercise in Nursing Home Residents
Authors: Lang Ellen M. , Nelson David L. , Bush Mary Ann
Published: April 2012

Materials-based occupation, imagery-based occupation, and rote exercise have been examined individually by several researchers. The present study compares all three approaches with one another (i.e., kicking a balloon, imagining kicking a balloon, and a control rote exercise) in nursing home residents. The dependent variable was the number of exercise repetitions. The subjects were 12 women and 3 men between 56 and 93 years of age residing in two nursing homes. All subjects experienced the three approaches but in different orders. One-way analysis of variance for related measures indicated a significant difference among conditions (p = .004). The Tukey procedure (Stevens, 1986) determined that the materials-based occupation condition elicited significantly more repetitions than the other two conditions. The difference between the imagery-based occupation and rote exercise was not statistically significant. These findings support our profession’s historical emphasis on the use of physical materials to enhance performance.
The Use of Standardized Assessment in Occupational Therapy: The BaFPE-R as an Example
Authors: Managh Mary F. , Cook Joanne Valiant
Published: April 2012

Before 1970, most assessments administered by occupational therapists were informal and nonstandardized. Since the 1970s, the use of scientifically sound instruments has increased. One such standardized assessment, the Bay Area Functional Performance Evaluation (BaFPE), was developed to measure the functional performance of psychiatric clients. This study was designed to explore the use of a revised version of BaFPE as an example of standardized assessment in occupational therapy.

The BaFPE was selected as an example of an assessment extensively used in psychiatric occupational therapy practice. A qualitative study that used in depth semistructured interviews was conducted with a convenience sample of occupational therapists.

The occupational therapists who were interviewed described and explained making several adaptations and modifications to the recommended administration and scoring of the BaFPE. An analysis of the interview data suggested that standardized assessments are valued as indicators of professional status. However, the interview responses also suggested that the demands of test standardization were incongruent with the values that guide occupational therapy practice.

The findings of this study suggest that the future development and use of standardized instruments should be consistent with the values of the profession. In particular, assessments that recognize the diverse nature and needs of individual clients are required.
Workstation Robotics: A Pilot Study of a Desktop Vocational Assistant Robot
Authors: Taylor Barry , Cupo Mary E. , Sheredos Saleem J.
Published: April 2012

Rehabilitation robots are increasingly being viewed as an appropriate assistive technology interface for persons with disabilities. The Desktop vocational Assistant Robot (DeVAR™) system is a voice-controlled robotic workstation designed to enable persons with severe mobility impairments to function independently in a work environment. This study examined the overall efficacy of the DeVAR™ system, the level of expertise required for therapist and support personnel, routine maintenance requirements, and the readiness of the device for a multicenter evaluation.

Two precommercial DeVAR™ workstations were installed at selected sites. The pilot study spanned 8 months in which staff members and four subjects with high-level quadriplegia evaluated the systems extensively. Responses were generally favorable regarding ease of use and overall training process. Subjects recommended modifications, including incorporation of a noise cancellation microphone, more effective use of workstation space, and addition of vocational tasks. All respondents thought that if the recommended changes were implemented, DeVAR™ would have potential as a vocational assistant.

The small number of subjects was due to the limited subject pool available for the study. On the basis of pilot results, the Veterans Administration Rehabilitation Research and Development Service, Baltimore, Maryland, is conducting a national multicenter evaluation to determine the overall utility and commercial readiness of the DeVAR™ system.
Single-Switch Computer Access for Infants and Toddlers
Authors: Swinth Yvonne , Anson Denis , Deitz Jean
Published: April 2012

Computer access was studied with children between the ages of 6 months and 18 months with no known handicapping conditions. The research focused on determining at what age young children can access a computer using a single-switch system to run a simple cause-and-effect program. The sample consisted of 80 children divided into four groups (6 to 8 months, 9 to 11 months, 12 to 14 months, and 15 to 17 months). Results demonstrated that some children as young as 6 months of age could control a computer-based, cause-and-effect program using a single-switch access system. Therefore, professionals who work with children with disabilities may consider introducing computers to children at this age or to children who are functioning near this cognitive developmental level.
The Development of Technology Competencies and Training Guidelines for Occupational Therapists
Authors: Hammel Joy M. , Smith Roger O.
Published: April 2012

The ability to use technology has become a survival skill in our society. This paper discusses technology trends related to the demands of the Information Age, the increasing availability of information and assistive technologies, and the impact of recent civil rights legislation mandating that persons with disabilities be given equal access to technologies that can enhance functional performance. Occupational therapists must become competent in the application and integration of these technologies into reasonable accommodation interventions if we are to meet the changing needs of persons with disabilities. To address this need for technology training, a multitiered set of technology competencies specifically designed for occupational therapy practitioners was authored by the American Occupational Therapy Association Technology Special Interest Section and reviewed by occupational therapists with technology expertise. The process of developing these competencies and recommendations for implementing them within occupational therapy educational programs are discussed.
Clinical Evaluation of the Hemi Wheelchair Cushion
Authors: Cron Laura , Sprigle Stephen
Published: April 2012

A foam cushion was designed for wheelchair users who propel their wheelchairs with the assistance of one lower extremity. It allows users to extend one hip to reach the ground without having to slide forward on the seat, thus maintaining a more erect posture. The cushion was evaluated to identify contraindications for its use. Eleven subjects (10 stroke patients and 1 patient with an above-the-knee amputation) were tested on the Hemi Wheelchair Cushion and on a second cushion chosen by their primary occupational therapists. Seat interface pressures, both before and after dynamic movement, sitting balance, and wheelchair mobility were measured for each cushion.

An analysis of mean pressure values revealed no significant difference between the cushions (p = .80). Average pressures after dynamic movement showed a statistically significant difference from pressures before activity (p < .05). Subjective evaluation revealed that the Hemi Wheelchair Cushion did not adversely affect sitting balance or wheelchair mobility, and no contraindications for its use were identified. The results of this clinical evaluation indicate that the Hemi Wheelchair Cushion is an economical and appropriate option for wheelchair users who propel themselves with the assistance of one leg.
Measurement-Related Problems in Functional Assessment
Authors: Fisher William P.
Published: April 2012

Occupational therapists, like other rehabilitation professionals, have accepted ordinal raw scores as a sufficient basis for developing evaluation tools. This paper summarizes problems commonly found in evaluation methods based on summing ordinal raw item scores and demonstrates how Rasch measurement models provide a solution to the construction of calibrated (linear) measures.

Rasch measurement models are contrasted with Stevens’s lax definition of measurement and Guttman’s unreasonably rigid requirements. The simple Rasch model is a probabilistic formulation of the fundamental requirements for additive linear measurement. This formulation retains Guttman’s concept of order, but construes it probabilistically, making it neither too lax (random) nor too rigid. When a measure is based on a theory of what counts as an observation of more or less of something, Rasch measurement models are useful for constructing valid measures.
Reliability of the Worker Role Interview
Authors: Biernacki Susan D.
Published: April 2012

The Worker Role Interview is a semistructured interview designed to be used as the psychosocial–environmental component of the initial rehabilitation assessment for the injured worker. Interrater reliability of the Worker Role Interview was computed for three raters for a sample of 30 adult subjects receiving rehabilitation due to an upper extremity injury. Reliability was assessed with the intraclass correlation approach. The coefficients estimating interrater reliability for six content areas ranged from .46 to .92 with a total value of .81. Three out of six content areas received ratings well below the accepted standard of .80, suggesting further need for instrument refinement in select areas. Test-retest reliability was computed for one rater for a sample of 20 subjects. The intraclass coefficient values ranged from .86 to .94 with a total value of .95 indicating high test-retest reliability.
The Baltimore Therapeutic Equipment Work Simulator: Biomechanical and Physiological Norms for Three Attachments in Healthy Men
Authors: Bhambhani Y. , Esmail S. , Brintnell S.
Published: April 2012

Objectives. The Baltimore Therapeutic Equipment (BTE) work simulator is routinely used by occupational therapists in functional capacity evaluation. Currently, there is a lack of normative data for various attachments on this instrument. The purposes of this study were to (a) establish norms for the biomechanical and physiological responses during three tasks on the BTE work simulator, namely, wheel-turn, push-pull, and overhead-reach; (b) compare these responses during the three tasks, and (c) examine the interrelationships of these responses during the tasks.

Method. Twenty healthy men completed five testing sessions: (a) task familiarization on the BTE work simulator to identify the work intensity, which was perceived as hard on the Borg scale; (b) an incremental arm ergometer exercise test to determine their peak oxygen uptake (pV̇O2) and peak heart rate (pHR), and (c) one of the three tasks on the BTE work simulator for 4 min in each of the next three sessions.

Results. Analysis of variance indicated that torque, work, and power during the overhead-reach were significantly higher (p = .000) compared with the wheel-turn and push-pull tasks. However, no significant differences (p > .05) were observed among the tasks for the V̇O2 and HR, which were approximately 50% and 70% of pV̇O2 and pHR respectively. Although there was a significant relationship (p < .05) among tasks for the torque, work, and power, the common variance ranged only between 38% and 67%. The relative pV̇O2 was significantly related to work (p = .028) and power (p = .027) only during the push-pull task but not the wheel-turn and overhead-reach tasks.

Conclusions. These results suggest that occupational therapists should include as many tasks as possible when designing functional capacity evaluation test batteries, and that there is no consistent relationship between cardiorespiratory fitness and performance of various tasks on the BTE work simulator.
Use of Substitute Food Textures for Standard Eating Assessment in Children With Cerebral Palsy and Children Without Disabilities
Authors: Tcheremenska Alexandra R. , Gisel Erika G.
Published: April 2012

Objective. Eating assessment is the first step toward amelioration of eating problems in children. A quantitative evaluation tool with three standard textures of food has been developed to determine the severity of an eating problem. However, children occasionally refuse some of the standard textures. Much time and effort could be saved if substitute textures could be used for testing. The purpose of this study was to examine the feasibility of using substitute food textures.

Method. Twenty children (10 without disabilities, 10 with cerebral palsy and eating impairments) with a mean age of 8.2 years(SD = 4.1) years were tested with three standard and three substitute textures of food (solid, viscous, puree). Eating time (in seconds) and chewing cycles were compared between standard and substitute textures as well as between children without disabilities and children with eating impairments.

Results. Substitutes for pureed and viscous, but not solid textures could be used for children without disabilities; in children with eating impairments, substitutes for viscous and solid, but not pureed textures could be used.

Conclusion. Children with eating impairments may be more sensitive than children without disabilities to small changes in food consistencies or other characteristics of the food. Thus, in standardized testing, food textures should not be arbitrarily interchanged.
Fieldwork Education and Students With Disabilities: Enter the Americans With Disabilities Act
Authors: Kornblau Barbara L.
Published: April 2012

For occupational therapy students with disabilities, making the transition from the classroom to clinical fieldwork presents an interesting challenge to clinical fieldwork supervisors and academic fieldwork advisors. The Americans with Disabilities Act (ADA) and other laws have changed the rules by requiring fieldwork sites and academic programs to make accommodations for students with disabilities. Occupational therapy’s basic philosophy combined with the occupational therapist’s training in task analysis, functional limitations of disabilities, modification of the environment and clinical reasoning skills, places the occupational therapist in a natural position to make these reasonable accommodations. The author presents the DIALOGUE system, a method of communication designed to make a smooth transition to ADA compliance in the fieldwork arena.
Occupationally Embedded Exercise Versus Rote Exercise: A Choice Between Occupational Forms by Elderly Nursing Home Residents
Authors: Zimmerer-Branum Sheri , Nelson David L.
Published: April 2012

Objectives. The provision of options in the occupational form that encourages meaningful choices and subsequent purposeful occupational performances is a basic premise of occupational therapy. This study examines the preferences of elderly nursing home residents when presented with an occupationally embedded exercise versus a rote exercise and addresses the methodological problems identified in similar past research.

Method. Fifty-two elderly nursing home residents were presented with a choice between an occupationally embedded exercise that involved unilateral dunking of a small, spongy ball into a basketball hoop and a rote exercise that involved moving the arm above the head in a simulation of the dunking exercise. Both exercises required flexion of the shoulder joint. Random assignment of the 52 subjects into one of four groups controlled for the order of the presentation of the exercises and the order of the choice statements.

Results. Sixty-nine percent of the subjects chose the occupationally embedded exercise. Analysis with the significance of a proportion statistic revealed a statistically significant difference (z = 2.77; p (one-tailed) = .003).

Conclusion. Results were consistent with the hypothesis that elderly nursing home residents would tend to choose the occupationally embedded exercise. To further confirm this basic premise of occupational therapy, future studies that investigate therapeutic patterns of movement embedded in common occupations are recommended.
Recruitment and Retention Strategies Used by Occupational Therapy Directors in Acute Care, Rehabilitation, and Long-Term-Care Settings
Authors: Smith Patrick , Schiller M. Rosita , Grant H. Kay , Sachs Larry
Published: April 2012

Objectives. Occupational therapy directors need to recruit and retain therapists to ensure both the delivery of high-quality services and the viability of their departments. At present, research on the recruitment and retention of occupational therapists is limited; recruitment and retention strategies can be cited, but their utility and effectiveness have not been determined.

Method. A survey was designed to identify the recruitment and retention strategies used in various practice settings and the perceived level of effectiveness of those strategies that were used. The surveys were mailed to 500 occupational therapy directors. Once the sample size was adjusted to exclude non-eligible subjects, the eligible sample size was 471. Of these, 320 (68%) were usable.

Results. Ten of the 23 recruitment strategies listed on the survey were used by more than 70% of the respondents. The top three recruitment strategies were staff member referrals, professional development opportunities, and newspaper advertisements. Seventeen of the 23 retention strategies listed on the survey were used by more than 70% of the respondents. The top three retention strategies were interpersonal staff member relationships, employee appraisals, and continuing education.

Conclusion. Findings suggest that occupational therapy departments’ recruitment and retention plans could be improved by expanding the number of strategies used and by incorporating techniques that appeal to a broader range of therapists.
The Effects of Dynavision Rehabilitation on Behind-the-Wheel Driving Ability and Selected Psychomotor Abilities of Persons After Stroke
Authors: Klavora Peter , Gaskovski Peter , Martin Kathleen , Forsyth Rick D. , Heslegrave Ron J. , Young Margaret , Quinn Robert P.
Published: April 2012

Objective. Many conventional rehabilitation exercises, such as pencil-and-paper and computer tasks, may not train perceptual and motor skills as applied to a complex, multiskill activity such as driving. The present study examined the usefulness of the Dynavision apparatus for driving-related rehabilitation. The Dynavision was designed to train visual scanning, peripheral visual awareness, visual attention, and visual-motor reaction time across a broad, active visual field.

Method. Ten persons with a cerebrovascular accident participated in the study. All had failed behind-the-wheel driving assessments. Subjects participated in a 6-week Dynavision training program using exercises designed to impose various motor, perceptual, and cognitive demands.

Results. Dynavision training resulted in significantly improved behind-the-wheel driving assessments as compared to expected outcomes. Comparisons between pretests, posttests, and follow-up tests on a number of Dynavision, response, and reaction time variables showed significant improvements and maintenance effects. Dynavision performance, and, to a lesser extent, choice visual reaction and response times, were found to differentiate between persons assessed as safe and unsafe to drive, and between older and younger drivers. Subject self-reports suggested that a variety of training-related improvements had occurred in everyday functioning.

Conclusion. Dynavision training shows some rehabilitative promise for improving driving and basic psychomotor skills. Future research on the benefits and limitations of this apparatus should use finer laboratory skill measures and more comprehensive tests of driving and daily functioning to assess more thoroughly skill improvements in persons after stroke.