bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Casting on Upper Extremity Motor Disorders After Brain Injury
Authors: Hill Judy
Published: April 2012

Objectives. This study compares casting to traditional techniques, such as passive range of motion, static stretch, and splinting, in the treatment of the hypertonic upper extremity in individuals with severe brain injury.

Method. Fifteen subjects with brain injury were randomly assigned to one of two groups. One group received a month of casting followed by a month of traditional therapy; the second group received 1 month of traditional therapy followed by casting. The subjects’ limbs were evaluated for range of motion, clinical indications of spasticity, and functional use of the extremity at three intervals – before intervention. after the first month of intervention, and after the second month of intervention. Two sample t-tests and paired t-tests were used in data analysis.

Results. All but one subject showed a greater improvement in range of motion with casting than with traditional treatment; 11 subjects showed a greater improvement in clinical measures of spasticity with casting. There was no apparent correlation between these measures and functional use of the extremity.

Conclusion. These findings suggest that casting is more effective than traditional techniques in reducing contracture and in decreasing hypertonicity in some cases. The greater improvements in these motor indicators with casting did not translate into greater gains in functional use of the upper extremities.
Illness Behavior After Severe Brain Injury: Two Case Reports
Authors: Giles Gordon Muir
Published: April 2012

This paper introduces the concept of illness behavior to occupational therapists working with patients with acquired neurological impairments. The paper presents two case reports of patents with unequivocal severe brain trauma who demonstrated help-seeking and dependency behaviors that could not he accounted for by brain damage alone. Incorporating the illness behavior concept in an understanding of the patients’ behavior difficulties assisted in the development of an appropriate treatment plan and interventions. This paper emphasizes that severe neurological sequelae and illness behavior may coexist in the same patient. Without an understating of the personality and environmental factors that may influence recovery, rehabilitative efforts may be less than optimally effective.
Technology for Adults With Multiple Impairments: A Trilogy of Case Reports
Authors: Bailey Diana M.
Published: April 2012

Three persons with severe physical and cognitive impairments, residents of a facility for persons with mental retardation, learned to use switch-controlled assistive devices. Previous case reports have described the technology and techniques used to enable these women to explore their surroundings. Material was collected, organized, and analyzed in three sections: clients, powered devices, and treatment approaches. The purpose was to affirm tenets that often provide the basis for treatment when powered activities are used in occupational therapy with adults with severe impairments. Client enthusiasm, responsiveness, and stamina can be predictive of success in using technology. Powered devices can elicit a client’s drive for competence, aid therapists in assessing the cognitive level of adults with extreme physical disability, and allow persons with multiple impairments to interact with objects in their environment. When clients learn to use powered devices, success will be self-perpetuating. Persons with multiple impairments using powered devices are well served by conditional clinical reasoning.
A Competency-Based Training Program in Early Intervention
Authors: Hinojosa Jim , Moore Deborah S. , Sabari Joyce S. , Doctor Rochelle G.
Published: April 2012

This paper describes a federally funded training program developed to prepare entry-level occupational therapists to deliver early intervention services. The program had two phases. Phase I was designed to provide occupational therapy supervisors with advanced skills for supervising and teaching the students about the provision of early intervention services. These skills were specific supervisory strategies and learning techniques designed to facilitate optimal communication between the student, the supervisor, and the academic faculty members, as well as to facilitate consistency of information between workshops and practices in the clinic. Phase II involved a 12-week clinical fieldwork experience for the students in an early intervention program combined with didactic programs at the university. Both supervisors and students provided feedback on the program.

Supervisors reported that the training strengthened their supervisory skills and techniques. Students reported that the training helped them to clarify the role of occupational therapy in early intervention and that they had developed skills critical to providing family-centered early intervention. These skills included both providing direct treatment to children and working in partnership with families and caregivers.
Ethnographic Analysis: A Study of Classroom Environments
Authors: Griswold Lou Ann Sooy
Published: April 2012

Objectives. Occupational therapists assess and adapt an environment to enhance clients’ abilities to function. Therapists working in schools may assess several classroom environments in a week. Identifying relevant information in an efficient manner is essential yet presents a challenge for school therapists.

Method. In this study, ethnographic research methodology was used to analyze the plethora of data gained from observations in eight classrooms.

Results. Three major categories were identified to structure observations: activities, people, and communication. These categories were used to compile a Classroom Observation Guide that gives therapists relevant questions to ask in each category.

Conclusion. Using the Classroom Observation Guide, occupational therapists can recommend classroom activities that suit a particular teacher’s style. For example, working with a teacher who prefers structured activities with clear time and space boundaries for one specific purpose, a therapist might suggest organized sensorimotor games with a distinct purpose to be carried out for a given time period.
A Meal Preparation Treatment Protocol for Adults With Brain Injury
Authors: Neistadt Maureen E.
Published: April 2012

Adults with acquired brain injury often demonstrate dysfunction in meal preparation due to deficits in component cognitive–perceptual skills. Although occupational therapy for these clients routinely includes meal preparation training, there are no protocols in the occupational therapy literature to help structure that activity to address clients’ cognitive–perceptual deficits. This paper describes a meal preparation treatment protocol based on cognitive–perceptual information processing theory that has been pilot tested in a treatment outcome study with adult men with traumatic or anoxic acquired brain injury. In that study, the group of 23 subjects treated with this meal preparation protocol showed significant improvement in their meal preparation skill, as measured by the Rabideau Kitchen Evaluation-Revised (RKE-R), a test of meal preparation skill, and in their cognitive–perceptual skill, as measured by the WAIS-R Block Design Test. The treatment protocol includes descriptions of the structure, grading, and cuing methods for light meal preparation activities.
Interdisciplinary Team Approach in the Rehabilitation of Hip and Knee Arthroplasties
Authors: Erickson Barbara , Perkins Max
Published: April 2012

Use of an interdisciplinary case management team approach in the treatment of patients with hip or knee arthroplasty has resulted in a decrease in length of stay and achievement of functional outcomes at the authors’ center. Case management was used to standardize patient care and to measure each patient’s progress toward independence against established criteria of treatment outcomes. Outcomes established for physical therapy were ambulation distance, performance of a home exercise program, stair climbing, amount of active knee flexion (for knee arthroplasties), and incorporation of hip precautions. Outcomes for occupational therapy were bed mobility, chair transfers, toilet transfers, and activities of daily living with emphasis on lower extremity dressing. The case management team consists of an occupational therapist, an occupational therapy assistant, a physical therapist, and two nurses. The specific role of the occupational therapy personnel in this team approach is to maximize, by discharge, a patient’s functional level of independence in activities of daily living. Data from a 6-month period indicated that occupational therapy goals were achieved for 79% of the 33 knee arthroplasty patients and 73% of the 37 hip arthroplasty patients.
COMPETE: A Model for Vocational Evaluation, Training, Employment, and Community for Integration for Persons With Cognitive Impairments
Authors: Mann William C. , Svorai Susan Braun
Published: April 2012

This paper describes a job skills training program for young adults with cognitive impairments called COMPETE, an acronym for Computer Preparation: Evaluation, Training, and Employment. Participants in COMPETE trained in use of information-age machines, (e g., computers, fax machines). The 3-year demonstration project resulted in successful placement of 17 of 27 persons who were unemployed before entering the program.
The Effect of Oral Support on Sucking Efficiency in Preterm Infants
Authors: Einarsson-Backes Lynn M. , Deitz Jean , Price Robert , Glass Robin , Hays Ross
Published: April 2012

Objective. The purpose of this study was to determine the effectiveness of oral support on feeding efficiency in preterm infants who were identified by the medical team as poor feeders.

Method. Thirteen premature infants between 34 and 40 weeks’ postconceptional age were selected from a group of infants at Children’s Hospital and Medical Center in Seattle, Washington. They were fed twice within a 26-hr period, once with oral support and once without. The order of occurrence of these two conditions was randomly selected without replacement to assure that an equal number of both conditions occurred during the first feed. Only the first 2 min of the feed were used in data analysis.

Results. A statistically significant difference (z = − 2.62, p < .01, two-tailed) in volume intake occurred between the oral support condition (M = 10.9 cc) and the no oral support condition (M = 4.8 cc).

Conclusion. This study validates the use of oral support as an effective treatment technique to enhance sucking efficiency in preterm infants.
A Global Perspective on Feeding Assessment in the Neonatal Intensive Care Unit
Authors: Glass Robin P. , Wolf Lynn S.
Published: April 2012

A comprehensive assessment of feeding performance of infants in the neonatal intensive care unit (NICU) includes not only the traditional approaches of evaluating oral motor control and sensory responses but also evaluation of other factors. Infant feeding is a highly complex and integrated process involving numerous body systems. A global assessment would determine the infant’s feeding function in the key areas of state and behavior, tactile responses, motoric control, oral motor function, physiologic control, and coordination of Sucking, swallowing, and breathing. Information is obtained through skilled clinical observation as well as from technological monitors or medical tests and procedures. This article provides an overview of a comprehensive assessment that occupational therapists may use when providing service to infants in the NICU.
Parent and Occupational Therapist Collaboration in the Neonatal Intensive Care Unit
Authors: Holloway Elise
Published: April 2012

Medical care of infants in the neonatal intensive care unit (NICU) is so complex that professionals have been almost exclusively responsible for providing care to the infants and information to their families. Although federal law now mandates early intervention programs and service providers to include families in decision making and treatment implementation for their children, family-centered care has generally not been implemented in the NICU. This article offers suggestions for occupational therapists from members of the Parent Connection, an NICU parent support group. They state that a therapist can have the greatest effect on an infant’s development by helping the parents develop skills to nuture their infant the way that they choose.
Developing Competency in the Neonatal Intensive Care Unit: A Hospital Training Program
Authors: Hyde Ann S. , Jonkey Barbara W.
Published: April 2012

There are few specialized programs available to train occupational therapists and physical therapists to treat competently in a neonatal intensive care unit (NICU), yet hospitals are trying to fill such positions and the need for advanced training is essential. A hospital-based program that provides clinical NICU training to therapists from other hospitals is presented. The program is short-term and highly individualized and emphasizes learning pertinent medical information, nonintrusive evaluation skills, and therapeutic intervention with advanced clinical judgment.
Dreams, Dilemmas, and Decisions for Occupational Therapy Practice in a New Millennium: An American Perspective
Authors: Yerxa Elizabeth J.
Published: April 2012

This article presents the assumption that the 21st century will have characteristics that are important to occupational therapists and the persons they serve. These characteristics include increases in chronicity, knowledge of human purpose, complexity of living, emphasis on personal power, awareness of demands from the environments where persons live and work, and a new conceptualization of health as persons’ capacities to achieve goals through a repertoire of skills. The 21st century can lead into the millennium of occupation because occupational therapists can help persons become their own agents of competency, remove social barriers to their self-definition, and thrive in their environments.
The Ecology of Human Performance: A Framework for Considering the Effect of Context
Authors: Dunn Winnie , Brown Catana , McGuigan Ann
Published: April 2012

In theory and in practice, context (as an area of concern to occupational therapists) has not received the same attention as performance components and performance areas. The Ecology of Human performance serves as a framework for considering the effect of context. Context is described as a lens from which persons view their world. The interrelationship of person and context determines which tasks fall within the person’s performance range. The Ecology of Human Performance framework provides guidelines for encompassing context in occupational therapy theory, practice, and research.
The Relationship Between Occupational Form and Occupational Performance: A Kinematic Perspective
Authors: Wu Ching-yi , Trombly Catherine A. , Lin Keh-chung
Published: April 2012

Objectives. This study examined, through kinematic analysis, the effect of occupational form on reaching performance. The hypothesis was that reaching performance would show an enhanced quality of movement in materials-based occupation (i.e., pick up a pencil and prepare to write one’s own name) than in imagery-based occupation (i.e., pretend to pick up a pencil and prepare to sign one’s own name) and in exercise (i.e., move the arm forward). It was further hypothesized that imagery-based occupation would elicit better performance than exercise.

Method. The reaching performance was measured, using WATSMART™ (Waterloo Spatial Motion Analysis & Recording Technique), by the variables including reaction time, movement time, number of movement units, total displacement, the amplitude of peak velocity, and percentage of reach in which peak velocity occurred. A repeated-measures counterbalanced research design was used with 37 female college students. Contrast analysis was used to test the hypotheses.

Results. Materials-based occupation elicited enhanced quality of movement performance, as compared with imagery-based occupation and exercise. However, exercise seemed to elicit better performance than imagery-based occupation.

Conclusion. The practical implication is that materials-based occupation might be used to elicit enhanced quality of reaching movement in occupational therapy intervention.
Using the Assessment of Motor and Process Skills to Compare Occupational Performance Between Clinic and Home Settings
Authors: Park Steve , Fisher Anne G. , Velozo Craig A.
Published: April 2012

Objectives. The study described in this article examined the effect of home versus clinic settings on the instrumental activities of daily living (IADL) performance of older adults.

Method. Twenty older adults living in the community were evaluated in their homes and in an occupational therapy clinic with the Assessment of Motor and Process Skills (AMPS). The motor and process ability measures were compared between the two settings with many-faceted Rasch analysis.

Results. The subjects’ motor ability measures tended to remain stable from clinic to home settings. The process ability measures tended not to remain stable from Clinic to home settings, because 10 of the 20 subjects performed significantly better in their homes.

Conclusion. These findings support the idea that process skill abilities are affected by the environment to a greater degree than are motor skill abilities and that for persons living in the community, the familiar home environment tends to support IADL performance. If an occupational therapist wants to know how a person performs IADLs, the therapist should evaluate that person’s performance in the environment in which the client will be functioning.
Motor Behavior Research: Implications for Therapeutic Approaches to Central Nervous System Dysfunction
Authors: Mathiowetz Virgil , Haugen Julie Bass
Published: April 2012

This article reviews the models and theories of motor behavior that are the foundation for the traditional approaches to central nervous system (CNS) dysfunction and presents a new theoretical model and approach that are beginning to influence practice. Reflex, hierarchical, and systems models of motor control and developmental and motor learning theories are discussed. The relationships of these models and theories to past, present, and future treatment approaches to CNS dysfunction are explored. The assumptions and limitations of the muscle reeducation, neurodevelopmental, and motor relearning approaches are discussed. A contemporary task-oriented approach based on the systems model is proposed and contrasted with traditional neurodevelopmental approaches.
Measuring Perceived Self-Efficacy in Occupational Therapy
Authors: Gage Marie , Noh Samuel , Polatajko Helene J. , Kaspar Violet
Published: April 2012

Objectives. Occupational therapists sometimes observe an alarming discrepancy between the occupational performance skills developed in the clinical setting and the degree to which the client willingly puts these skills to use outside the clinical environment. The literature strongly suggests that perceived self-efficacy partially explains’ this discrepancy; however, an understanding of perceived self-efficacy has not yet been integrated into the practice of occupational therapy. Both a lack of awareness of the construct and a lack of ability to assess perceived self-efficacy within the occupational performance domain are responsible for this lack of integration into practice. This article presents the development, reliability, and validity testing of a measure of perceived self-efficacy developed particularly for use by occupational therapists, the Self-Efficacy Gauge.

Method. Reliability and validity testing was performed through use of a mailed survey( n = 126). Test–retest reliability, internal consistency, and alternate form reliability were examined. In addition, the subjects’ scores on the Gauge were compared to actual performance and a hopelessness scale.

Results. The Self-Efficacy Gauge has a reasonable degree of reliability when used on a clinical sample whose perceived self-efficacy for occupational performance activities is unlikely to change. The results also provide preliminary support for the validity of the instrument.

Conclusion. It is recognized that without a gold standard for comparison, validity testing will be an ongoing need.
The Successful Fieldwork Student: Supervisor Perceptions
Authors: Herzberg Georgiana L.
Published: April 2012

Qualitative research methodology was used to explore supervisor perceptions of learning style characteristics required for student success in fieldwork. A focus discussion group was used to elicil success themes identified by clinicians. These themes were compared to learning style themes previously identified in quantitative studies. Techniques of conversation analysis were used to assess congruence of verbalized themes with participant interactions during the discussion group. Themes that emerged were the importance of teamwork, active experimentation, flexibility, adaptability, and doing. Discussion participants actively modeled teamwork.
Performance of Israeli Versus U.S. Preschool Children on the Miller Assessment for Preschoolers
Authors: Schneider Eleanor , Parush Shula , Katz Noomi , Miller Lucy J.
Published: April 2012

Objectives. The Miller Assessment for Preschoolers (MAP) is a scale that can be used to evaluate preschool children with suspected preacademic problems. Before implementing the MAP in Israel, it was necessary to determine whether the U.S. norms were applicable to the Israeli preschool population.

Method. In a pilot study carried out in Israel, the Hebrew version of the MAP was administered to 2 age groups of 30 children each. The scores of Israeli children were compared with the U.S. norms on each of the MAP’s 27 subtests, the five performance indices, and the total score.

Results. There were no significant differences between the Israeli sample and the U.S. standardization sample in either age group on the MAP total score; significant differences were found in both age groups on the Foundations Index and on some specific subtests. Israeli children performed below U.S. norms on the Foundation Index.

Conclusion. These findings indicate that the performance of Israeli children of overall in these two age groups is not significantly different from the performance of U.S. children. If future research demonstrates that these findings are stable across all age groups and for larger samples, the implication is that the MAP can be administered and scored in Israel with the scoring methodology and normative information developed in the United States. However, because of the poorer performance of Israeli children on the Foundations Index, we recommend that specific Israeli norms be developed.
Socialization to the Culture of a Rehabilitation Hospital: An Ethnographic Study
Authors: Spencer Jean , Young Mary Ellen , Rintala Diana , Bates Sarah
Published: April 2012

Objectives. Most previous research on rehabilitation of patients after spinal cord injuries has dealt with the attainment of outcomes valued by staff members or with the prediction of successful outcomes based on sociodemographic characteristics of patients. This study examined the rehabilitation process from the insider’s perspective of an individual patient to determine his view of important adaptive problems and to examine how these problems were addressed.

Methods. Ethnographic methods were used for fine-grained documentation of the experiences of one 30-year-old man with spinal cord injury. Daily interviews were conducted with this patient during his 116 days of inpatient rehabilitation. An interdisciplinary research team analyzed the data with the constant comparative method to identify a number of recurring themes.

Results. Findings indicate that in addition to learning how to function in the local world of the rehabilitation hospital, the patient also learned a new identity as a person with a long-term disability.

Discussion. A central theme was the patient’s ongoing attempt to figure out how his future was related to his life before the injury and how he could use previous competencies in adapting to disability. Staff members seemed so intent on teaching the patients new skills that they often discounted the significance of his past experience and failed to engage in helping the patient connect his future life story to his past.
Exploring the Costs and Benefits Drivers of Clinical Education
Authors: Meyers Susan K.
Published: April 2012

Objective. This study was designed to identify monetary and nonmonetary costs and benefits, as well as their drivers, to assist persons in clinical sites who are implementing clinical education to minimize costs and maximize benefits.

Method. Qualitative research methodology involved students, student supervisors, administrators, and patients in a hermeneutic dialectic process of identifying costs and benefits of Level II fieldwork in three clinical sites.

Results. Different costs and benefits were identified by the different groups of respondents. Drivers, or causes, of these costs and benefits reflected unique environmental factors in each site of data collection as well as common factors across the sites.

Conclusion. Clinical education may be enhanced and stress reduced for all persons involved in clinical education through improved communication, structure, education, and support.
Preliminary Assessment of a Fieldwork Education Alternative: The Fieldwork Centers Approach
Authors: Avi-Itzhak Tamara E. , Kellner Hanna
Published: April 2012

Objective. In response to an acute shortage of clinical fieldwork placement opportunities, faculty members of the Department of Occupational Therapy at Tel Aviv University in Israel formulated the Fieldwork Centers Approach (FCA) as an alternative approach to fieldwork education. Under the FCA, groups of two to eight students were assigned to one facility. The number of participating supervisors, who shared all supervision activities, ranged from two to six. Supervision approaches included both one-to-one and group supervision. This article presents the results of an evaluation of the FCA by the first group of students who participated in it.

Method. Twenty-five students were surveyed twice, once after they completed their Level I fieldwork and again after they completed their Level II fieldwork.

Results. Upon completion of Level I fieldwork, 26% of the students indicated that they perceived advantages in the FCA: this percentage rose to 74% upon their completion of Level II fieldwork. No significant differences were found between the students’ fieldwork level and their preference for the FCA vs. a strictly one-to-one, supervisor–student approach. Of the five learning experiences unique to the FCA, four, which received high ratings, represented specific learning experiences and one, which received low ratings, represented a psychological learning experience.

Conclusion. Results indicate that the FCA is a promising approach to fieldwork education. Overall, student evaluations made upon completion of Level II fieldwork were more positive than those made upon completion of Level I fieldwork. Additional research is needed to determine the reasons for this shift in students’ evaluations.
Physical Abuse of Preschoolers: Identification and Intervention Through Occupational Therapy
Authors: Davidson Debora A.
Published: April 2012

Child abuse is a major public health concern in the United States, one that has negative consequences on abused persons’ productivity and mental health throughout their lives. Occupational therapists who work with preschool-aged children are in a strategic position to screen for physical abuse and aid in the rehabilitation of children and families engaged in abuse. This article provides a review of the literature and accounts of clinical experience with children and families in a variety of settings. It offers an overview of behavioral risk factors that have been shown to correlate with physical abuse, including how these factors can be observed within the context of an occupational therapy evaluation. Guidelines for interacting with child protective services via reporting suspected cases of child abuse and working collaboratively with such agencies are provided. Strategies for occupational therapy intervention with abused children and their parents are described. These strategies include using activities to facilitate positive parent–child interaction, educating parents regarding child development and management techniques, and facilitating children’s psychosocial development.
Reasoning and the Art of Therapy for Spinal Cord Injury
Authors: Creighton Cynthia , Dijkers Marcel , Bennett Normajean , Brown Karmen
Published: April 2012

In this pilot study, qualitative methodology was used to examine the clinical reasoning of four experienced occupational therapists as they presented and modified therapeutic activities to treat patients with spinal cord injuries. The therapists demonstrated the multi-layered thinking discovered in previous research, but hierarchical structuring of knowledge emerged as an unexpectedly dominant theme in their reasoning. Examples of hierarchical thinking about therapeutic activity included creating mental files of therapy tasks and materials sequenced from elementary to advanced and determining the level of difficulty at which to present an activity in order to build the patient’s skills in a stepwise manner The therapists reported that they learned to make decisions about the use of activities in treatment by observing skilled clinicians and by treating patients.
Using the Case Method to Develop Clinical Reasoning Skills in Problem-Based Learning
Authors: VanLeit Betsy
Published: April 2012

Clinical reasoning is increasingly recognized as a crucial component of the occupational therapy process. Different types of clinical reasoning used by occupational therapists have been identified, including scientific, procedural, interactive, narrative, conditional, and pragmatic reasoning. This article describes the use of the case method in the University of New Mexico undergraduate occupational therapy curriculum to facilitate development of occupational therapy students’ problem-solving and reasoning abilities. The case method is a component of problem-based learning that emphasizes small group work to solve clinical problems that are presented as case studies. Students are presented with a variety of case formulas including paper or written cases, videotape cases, simulated client cases, and real client cases to promote the development of specific types of clinical reasoning. Problem-based learning may also hold promise as an educational strategy for fieldwork students and clinicians.
Methods of Assessing Clients’ Priorities: A Survey of Adult Physical Dysfunction Settings
Authors: Neistadt Maureen E.
Published: April 2012

Objectives. Recent clinical reasoning literature has identified a collaborative model of treatment – one that responds to clients’ perceptions of their illness and disability experiences – as central to occupational therapy practice. Assessing clients’ priorities on admission is essential to that model.

Method. Surveys from of a convenience sample of 269 occupational therapy directors in adult physical rehabilitation facilities throughout the United States (70.2% response rate) were analyzed to see whether occupational therapists in those settings are assessing clients’ priorities on admission, and if so, how.

Results. The majority of occupational therapists are using informal interview to determine clients’ priorities on admission. Client goals obtained from these interviews are vague and do not specify meaningful occupations; this finding suggests that therapists are setting treatment goals without specific input from clients about their valued activities.

Conclusion. Occupational therapists have not yet successfully translated their values about client–therapist collaboration into a formal set of procedures for practice.
Treatment Activity Preferences of Occupational Therapists in Adult Physical Dysfunction Settings
Authors: Neistadt Maureen E. , Seymour Susanne G.
Published: April 2012

Objectives. Research has suggested that using an adaptive approach to provide direct training in occupational behaviors is more effective than using a remedial approach to retrain component skills. This survey was done to see whether occupational therapy practice in physical dysfunction reflects that research.

Method. Surveys from a convenience sample of 269 (70.2% response rate) occupational therapy directors in adult physical rehabilitation facilities throughout the United States were analyzed to determine the relative rankings of remedial and adaptive activities by therapists in those settings.

Results. For all facilities combined, the four most frequently used types of activities, in order of frequency, were self-care, upper extremity exercise, functional mobility, and neuromuscular training. Facilities using multiple formal methods to assess client priorities used functional activities more frequently than other facilities.

Conclusion. Occupational therapists in adult physical dysfunction settings are not routinely providing client training in the full spectrum of occupational behaviors.
A Phenomenological Study of Sensory Defensiveness in Adults
Authors: Kinnealey Moya , Oliver Barbara , Wilbarger Patricia
Published: April 2012

This article describes the experiences of five adults who are defensive toward sensations of touch, movement, vision, smell, sound, and taste that most people consider harmless. It also describes the strategies that they use when they perceive environmental stimuli to be aversive. These coping strategies are avoidance, predictability, mental preparation, talking through, counteraction, and confrontation. A conceptual framework is presented to enhance understanding and guide further study of sensory defensiveness in adults.
Performance of Older Adults With and Without Cerebrovascular Accident on the Test of Visual-Perceptual Skills
Authors: Su Chwen-Yng , Chien Tsui-Hsien , Cheng Kuang-Fang , Lin Young-Tso
Published: April 2012

Objectives. The purposes of this study were to (a) investigate whether older subjects with brain damage score lower on the Test of Visual-Perceptual Skills (TVPS) than control subjects without brain damage matched for age and education, (b) determine the demographic effects on test performance in both groups, and (c) determine the capacity of TVPS in identifying visual-perceptual deficits in adults with brain damage.

Method. The study sample consisted of 22 subjects with cerebrovascular accident (CVA) and 155 subjects who were neurologically intact (control group). The TVPS was administered individually to each subject. Raw scores (total response time and accuracy) were analyzed to generate descriptive statistics. Other statistical analyses included analysis of variance, analysis of covariance, discriminant analysis, and Pearson product–moment correlations.

Results. There were significant between-group differences on all TVPS measures, with control subjects performing better than subjects with CVA. Age was shown to affect performance on most subtests of the TVPS in the control group. Education had significant influence over each measure, whereas gender differences were significant only in two subtests. No demographic effects were found in the group with CVA. The total TVPS accuracy score was the most powerful discriminator between the two groups, correctly classifying 74.4% of the subjects. Finally, the total accuracy score inversely correlated with total time score.

Conclusion. The TVPS may be useful in screening for visual-perceptual impairments in adults with CVA. Age, gender, and educational level have no significant impact on the magnitude of visual-perceptual dysfunctions.
Validity of Clinical Measures of Shoulder Subluxation in Adults With Poststroke Hemiplegia
Authors: Hall Jacqueline , Dudgeon Brian , Guthrie Mark
Published: April 2012

Objectives. Shoulder subluxation after cerebrovascular accident has been associated with chronic pain, orthopedic complications, peripheral nerve damage, and autonomic dysfunction. Clinical diagnosis and gradation of subluxation is problematic due to the lack of precision in frequently used measures. The objective of this study was to assess the validity of clinical techniques used to assess inferior subluxation of the hemiplegic shoulder by comparing these techniques with radiographic measurement.

Method. In 20 male subjects with hemiplegia, the presence, type, and degree of subluxation was assessed with three clinical measures: palpation, arm length discrepancy, and thermoplastic jig measurement. Anterior-posterior X rays of the hemiplegic shoulder were taken after clinical examination.

Results. Spearman rank correlation coefficients between the X rays and the three clinical measures were relatively low. Palpation had the highest correlation ( rs= .76), followed by arm length discrepancy ( rs = .46), and thermoplastic jig measurement ( rs = .42).

Conclusion. These findings provide cautious optimism about using these clinical measures to identify subluxation. Although detection was best with palpation, the likely inability to determine clinical overcorrecting of subluxation makes use of palpation alone suspect. Improved techniques of arm length measurement may provide a solution to this problem. These findings further necessitate that improved procedures for clinical assessment of subluxation be developed.
Relation of Perceptual and Body Image Dysfunction to Activities of Daily Living of Persons After Stroke
Authors: Rubio Kerry Brockmann , Van Deusen Julia
Published: April 2012

Perceptual and body image disturbances are common sequelae in persons who have had stroke. There is much evidence to substantiate a relationship between impaired perceptual functioning and impaired functioning in activities of daily living (ADL). In regard to body image dysfunction, the linking of unilateral neglect and poor ADL functioning has been widely examined; however, the relationship of other body image disturbances, such as somatoagnosia, to ADL has received little examination. Research on the above relationships are reviewed in this article. The Behavioural Inattention Test and Arnadoltir OT-ADL Neurobehavioral Evaluation are discussed as two assessments that determine perceptual and body image dysfunction through ADL. The literature on intervention for perceptual and body image dysfunction in relation to ADL primarily concerns the difference between the restorative and functional retraining approaches and treatment suggestions. Because specific gaps are noted in this area of study, future research ideas are suggested.
Outcomes of Tendon Transfer Surgery and Occupational Therapy in a Child With Tetraplegia Secondary to Spinal Cord Injury
Authors: Mulcahey M. J. , Smith Brian T. , Betz Randal R. , Weiss Albert A.
Published: April 2012

Objective. Tendon transfer surgery to augment hand function lost to spinal cord injury (SCI) has gained acceptance as a rehabilitation option for adults but has yet to be fully explored in children. In this study, hand function and performance of activities of daily living in an 11-year-old child with an SCI were evaluated before and after surgical transfers of the brachioradialis to the flexor pollices longus and the extensor carpi radialis longus to the flexor digitorum profundus.

Method. With the use of a single-subject AB design, repeated measures of pinch force, the Jebsen Test of Hand Function for Children and the Grasp and Release Test were obtained before tendon transfer surgery and at 2 ½, 6, and 12 months after surgery. Activities of daily living were assessed with the Functional Independence Measure (FIM) and the Common Object Test (COT) before surgery and 12 months after surgery.

Results. Each assessment revealed a significant improvement in hand function after surgery. Pinch force was measurable only after tendon transfers and increased throughout the first year. By two standard deviation analyses, after surgery there were significantly more task completions for all Grasp and Release Test objects, and task completion times were shorter for the light and heavy objects of the Jebsen Test of Hand Function for Children. FIM results showed that self-catheterization and Cutting food were possible only after surgery, and results of the COT revealed new unilateral and bilateral abilities that facilitated the client’s independence in writing, eating, applying toothpaste, and brushing teeth.

Conclusion. This single-subject study demonstrates the benefits of tendon transfers for active grasp in a child with an SCI.
Normative Data for Grip Strength of Elderly Men and Women
Authors: Desrosiers Johanne , Bravo Gina , Hébert Réjean , Dutil Élisabeth
Published: April 2012

Objectives. Grip strength is an important prerequisite for good performance of the upper limb, hence it is important to evaluate it correctly. However, one of the main difficulties in evaluating the grip strength of elderly patients is the absence of valid norms. Therefore, the objective of this study was to develop normative data for maximum grip strength of persons aged 60 years and older.

Method. The grip strength of 360 subjects aged 60 years and older, randomly recruited by age and gender strata, was evaluated with the Jamar dynamometer and the Martin vigorimeter according to the protocol of the American Society of Hand Therapists.

Results. Grip strength diminishes curvilinearly with age, and men are consistently stronger than women. The data are presented by the means, standard deviations, and range, and as predictive equations obtained by regression analysis. In addition to age and gender, hand circumference and body height proved to be the best indicators of grip strength for this population of elderly subjects.

Conclusion. The random recruitment of subjects, the high participation rate in the study, and the comparability of the subjects who agreed to participate and those who refused give this study the high external validity that is essential to any norm study. The predictive equations will help occupational therapists to better estimate the expected grip strength of elderly patients than they could if using only age and gender.
Sexual Orientation: Its Relevance to Occupational Science and the Practice of Occupational Therapy
Authors: Jackson Jeanne
Published: April 2012

This article examines how sexual orientation may be relevant to the study of occupations and the practice of occupational therapy. It is suggested that a lesbian, gay, or bisexual orientation may influence the occupations in which a person engages, the symbolic interpretation of those occupations, and the environmental contingencies of those occupations, and thus is an appropriate topic for occupational scientists to address. With the use of clinical reasoning studies and literature on authentic occupational therapy, it is argued that a person’s lesbian, gay, or bisexual orientation may be relevant to the therapeutic process if therapists are to truly achieve an intersubjective understanding of the patient’s world and create an environment in which the patient is able to live a meaningful life. Given this argument as a foundation, the article explores why sexual orientation may be overlooked in some of the theoretical perspectives that guide practice. The narrative perspective on identity is introduced as one potentially valuable way that occupational therapy researchers and practitioners may understand sexual orientation and its relationship to occupation. Specifically it is suggested that sexual orientation may be understood, in part, as a symbolic theme of meaning that informs values and convictions that may then be expressed in one’s choice of occupations.
Impact of Spinal Cord Injury on the Life Roles of Women
Authors: Quigley M. Claire
Published: April 2012

This qualitative study was conducted to explore and describe the role experience of five women whose lives were disrupted by a traumatic spinal cord injury and who later returned to their communities after completing intensive rehabilitation programs. In-depth interviews and participant observations were used to examine the experiences of these women. The findings exemplify how the women’s use of adaptation and negotiation and the development of a new role as self-advocate facilitated the reestablishment of their life roles. As the women’s occupational roles were redefined, the processes of adaptation and negotiation were evident in three aspects of their lives: daily routines, relationships, and environment. Through their new role of self-advocate, architectural and attitudinal barriers were negotiated and adapted so that roles could be explored. These findings indicate that community reentry involves the ongoing process of negotiation and adaptation of life roles. The use of life histories during the rehabilitation phase is suggested as a way for therapists to develop meaningful treatment plans that stimulate patients’ adaptation process and ultimately enhance community reentry.
The Profession’s Image, 1917–1925, Part II: Occupational Therapy as Represented by the Profession
Authors: Ambrosi Elizabeth , Schwartz Kathleen Barker
Published: April 2012

This second part of a two-part article examines the representation of occupational therapy during its formative years, 1917–1925. It focuses on the image of the profession as it was described in the early professional journals and compares this image with that projected by the media (as described in Part I). Both the media and professional literature presented a similar image of occupational therapy: that of a profession that offered the promise of returning persons with disabilities to useful occupation within society. In today’s health care system, where every profession espouses the goal of returning patients to full functioning, it is important to remember that in 1917 only one profession held that goal. The portrayal in the media and in the professional literature of occupational therapy at that time confirms this image.
Providing Low Vision Rehabilitation Services With Occupational Therapy and Ophthalmology: A Program Description
Authors: Warren Mary
Published: April 2012

This article describes a low vision rehabilitation program operating within a hospital-based outpatient rehabilitation clinic. The program uses a team approach combining ophthalmology and occupational therapy services. Patients are referred to the program by their primary care physician for a low vision evaluation completed jointly by the ophthalmologist and occupational therapist .The ophthalmology portion of the evaluation includes assessment of visual acuity, contrast sensitivity function, and macular perimetry with a scanning laser ophthalmoscope. The occupational therapy evaluation focuses on assessing the functional limitations experienced by the patient due to the vision loss and determining how the patient is best able to use remaining vision to complete daily activities. Occupational therapy treatment emphasizes training the patient to use remaining vision as efficiently and effectively as possible to complete daily activities and includes training in use of optical devices. Because of the specialized nature of the service provided, additional postgraduate preparation is needed to enable occupational therapists to provide effective low vision rehabilitation.
Overview of Technology for Low Vision
Authors: Beaver Kathleen A. , Mann William C.
Published: April 2012

This article provides an overview of technology resources and services to assist persons with low vision in maintaining independent function in the home, community, and educational and vocational settings. Case studies are provided to demonstrate the integration of technology into the lives of persons with low vision.