bluuebunny/crossref_metadata_2025 huggingface dataset:
Volition as Narrative: Understanding Motivation in Chronic Illness
Authors: Helfrich Christine , Kielhofner Gary , Mattingly Cheryl
Published: April 2012

This paper expands the current concept of volition in the Model of Human Occupation. The present version views personal causation, values, and interests as traits that determine choices to engage in occupations. Through a detailed investigation of the life histories of two persons with psychiatric disorders, this paper illustrates how volition is embedded in a personal narrative. Two features of narratively organized volition are highlighted: (a) how narrative places decisions and actions within a plot, thus giving them meaning in the context of a whole life, and (b) how the personal narrative motivates the person by serving as a context for choosing and action. Thus, the paper illustrates how persons seek to narrate their lives and live their life narratives.
Effects of Continuous Passive Motion on the Edematous Hands of Two Persons With Flaccid Hemiplegia
Authors: Dirette Diane , Hinojosa Jim
Published: April 2012

Objectives. This study evaluated the effect of the use of a continuous passive motion device for the edematous hands of two persons with flaccid hemiplegia.

Method. The subjects were both 1 month post–cerebrovascular accident with left-sided hemiplegia. Each subject’s routine therapy program was maintained throughout this ABA design study. During the first week, baseline data were gathered, during the second week the intervention was provided (2 hr Of continuous passive motion device use), and during the third week data were gathered with treatment withdrawn. Edema was measured with a hand volumeter and finger Circumference.

Results. The continuous passive motion device had an effect in reducing edema in the hands of the two subjects.

Conclusion. The continuous passive motion device is a readily available tool that could enhance the treatment of edematous hands of persons with flaccid hemiplegia by offering a contribution to already established treatment protocols. Further research is needed, however, to establish guidelines for use.
Enhancing Occupational Performance Through an Understanding of Perceived Self-Efficacy
Authors: Gage Marie , Polatajko Helene
Published: April 2012

The construct of perceived self-efficacy, proposed to explain the discrepancy between skill and actual performance, has received widespread attention in the psychological and medical literature. This paper describes the construct in detail, including the difference between self-esteem and perceived self-efficacy, and proposes a goodness of fit with occupational therapy practice.

It is postulated that attention to the assessment and monitoring of perceived self-efficacy, along with the use of activities that closely approximate the actual activities to be performed in the community, will result in improved occupational performance and thus, better occupational therapy outcomes. Occupational therapists are challenged to identify and incorporate this construct into their day-to-day clinical programs to enhance treatment outcomes.
Medical Considerations and Practice Guidelines for the Neonatal Occupational Therapist
Authors: Hunter Jan , Mullen Jan , Dallas Dara Varga
Published: April 2012

Provision of safe and effective occupational therapy in neonatal intensive care units requires an understanding of neonatal medical conditions and treatment modalities. This article explains basic medical concepts and technology with terminology frequently encountered in neonatal intensive care. Discussions of neonatal thermoregulation, respiratory care, hemodynamic monitoring, and metabolic support are presented as general areas of focus. Equipment usage and precautions are included. Several case studies illustrate the incorporation of medical knowledge into neonatal occupational therapy practice.
Dreams, Dilemmas, and Decisions for Occupational Therapy Practice in a New Millennium: A Canadian Perspective
Authors: Polatajko Helene J.
Published: April 2012

This article presents the hope that, in the 21st century and the millennium it ushers in, the world will eliminate the concept of handicap by creating an environment where persons with different abilities can live with dignity. In this world, the focus of occupational therapy will shift from reducing impairment through purposeful activity to preventing handicap through enablement. Basic assumptions about occupational therapy and its values are provided, including that the ultimate goal of practice is the enablement of occupational competence.
Comparing Motor and Process Ability of Persons With Suspected Dementia in Home and Clinic Settings
Authors: Nygård Louise , Bernspång Birgitta , Fisher Anne G. , Winblad Bengt
Published: April 2012

Objectives. Evaluating functional level of persons with diagnosed or suspected dementia is an important part of occupational therapy. The importance of the environment is often highlighted. We investigated the ability of clients with suspected dementia to perform instrumental activities of daily living (IADLs) in the clinic versus in their homes.

Method. We used the Assessment of Motor and Process Skills (AMPS) to measure the motor and process skill ability of 19 clients with suspected dementia.

Results. Using two-tailed paired t-tests ,we found no overall difference in IADL motor or process performance between the clinic and home settings. However, of the 19 clients, 6 had motor ability measures, whereas 5 had process ability measures that differed significantly between the two settings.

Conclusion. The results suggest that if we want to know how a person with suspected dementia performs in IADLs in a specific environment we should test him or her in that environment.
Three Images of Interdisciplinary Team Meetings
Authors: Crepeau Elizabeth Blesedell
Published: April 2012

Teams are an essential aspect of health care today, especially in rehabilitation or chronic illness where the course of care is frequently long, complex, and unpredictable. The coordinative function of teams and their interdisciplinary aspects are thought to improve patient care because team members bring their unique professional skills together to address patient problems. This coordination is enacted through the team meeting, which typically results in an integrated care plan. This professional image of team meetings is explicit and addresses the description and provision of care as objective and rational activities. In contrast, the constructed and ritualistic images of health care team meetings are implicit and concern the less objective and rational aspects of planning care. The constructed image pertains to the definitional activity of team members as they try to understand patient troubles and achieve consensus. This process involves the individual clinical reasoning of team members and the collective reasoning of the group. The ritualistic image is that aspect of team meetings in which the team affirms and reaffirms its collective identity. Drawing from field research of geropsychiatric team meetings, this article defines and explicates these images, focusing on the constructed and ritualistic aspects of team meetings and the influence of these images on group function.
Current Practice Among NeuroDevelopmental Treatment Association Members
Authors: DeGangi Georgia A. , Royeen Charlotte Brasic
Published: April 2012

Objectives. The purposes of this study were (a) to describe how neurodevelopmental treatment (NDT) is currently being provided by occupational therapists, physical therapists, and speech–language therapists (e.g., setting, duration, frequency, techniques used), (b) to determine which populations are viewed by clinicians as most responsive to NDT intervention, and (c) to examine clinicians’ attitudes and beliefs regarding NDT philosophy, role delineation, and provision of NDT service.

Method. A sample of 431 members of the NeuroDevelopmental Treatment Association, Inc. responded to a questionnaire examining current practice in NDT.

Results. Respondents typically provided NDT once or twice a week with an emphasis on qualitative movement and functional performance. Persons with mild to moderate levels of motor dysfunction were viewed as responding best to NDT. Therapists reported using an eclectic approach that combines NDT with other treatment approaches. The three disciplines reported using different types of NDT handling techniques to accomplish discipline-specific goals. There was a strong belief that NDT is a total management program that considers the client’s functioning in many settings and that families should be involved in the client’s therapy program.

Conclusion. There was wide consensus that the theoretical tenets underlying NDT need revision to consider current theoretical thinking and practice.
Motor Learning and Occupational Therapy: The Organization of Practice
Authors: Jarus Tal
Published: April 2012

This article addresses implications for the practice of occupational therapy when that therapy is guided by theories of motor learning. In occupational therapy, clients must learn or relearn motor skills through the use of activities. The occupational therapist must present activities in a manner that elicits the retention and transfer of the desired skills for use in functional settings. Therefore, the therapist should strive for acquisition conditions that facilitate retention and transfer of the learned skills. The processes that underlie motor learning should guide therapy. Three major factors that affect motor learning are environmental conditions, cognitive processes, and movement organization. Examination of the clinical implications of these factors, however, results in contradictory predictions regarding optimal practice conditions for motor skills. This article explores the successful integration of these factors and its application in occupational therapy practice. It is suggested that increasing the difficulty of the learning context during practice is beneficial for retention.
Multiple Mentoring Relationships Facilitate Learning During Fieldwork
Authors: Nolinske Terrie
Published: April 2012

Fieldwork provides a means by which students are socialized into their profession and their careers. During Level I and Level II fieldwork, students acquire and apply the knowledge, skills, and altitudes that will enable them to achieve entry-level competence. The experiences that students have during Level II fieldwork influence their subsequent career choices. To support these experiences, students form a variety of helping relationships with faculty members, clinicians, peers, family, and friends. This article examines the role and responsibilities of the student as protégé and of the clinical educator as information peer, collegial peer, special peer, and mentor In light of the challenges faced by most clinicians secondary to health care reform, an alternative to the one-to-one supervision model is presented. The multiple mentoring model of fieldwork supervision has several advantages: (a) fieldwork educators work with students according to their strengths and interests; (b) the model promotes collegiality and clinical reasoning skills because students use each other as resources and observe different fieldwork educators approaching similar situations; and (c) the model allows a fieldwork site to accept more students at one time, while minimizing stress on any one fieldwork educator A frame-work defining the functions of the mentor-protégé relationship is provided, with an emphasis on the effect that clinical educators have in their roles as mentors, guides, role models, and teachers who provide opportunities for the student to develop entry-level competency in a chosen profession.
A Group Approach to Mental Health Fieldwork
Authors: Hengel Janice L. , Romeo Janice L.
Published: April 2012

Fieldwork opportunities in mental health settings are limited and difficult to find. There is increased pressure for occupational therapy supervisors to accept more students although they have less time to devote to them. This article describes a group approach to training occupational therapy students that was used at one fieldwork site. The occupational therapy staff members were each responsible for specific teaching assignments that allowed them to work with a number of students simultaneously. Program development and evaluation meetings created an alternative forum for exploring ideas and practice issues and for providing guidance and supervision. This approach reduced the amount of time each therapist spent with students, provided students with several role models, and encouraged independent thinking in students.
Job Site Analysis Facilitates Work Reintegration
Authors: Canelón Mario Francisco
Published: April 2012

The Americans with Disabilities Act (ADA) offers challenges and opportunities in rehabilitative care for returning clients to previous employment after medical illness or injury. The process of work reintegration begins with assessing the client’s rehabilitation potential to return to work. When clinical reasoning indicates a good rehabilitation potential, a job site analysis (JSA) is conducted to determine the essential functions of the client’s work. Upon completion of the JSA, a variety of strategies can be used for successfully returning the client to work. The three case reports in this article illustrate that a JSA can serve as the basis for formulating a holistic treatment plan that addresses skill performance areas affecting work readiness for clients with neurologic and orthopaedic conditions and can facilitate successful work reintegration for these clients. The JSA links clients’ rehabilitative care and work reentry after medical illness or injury and maximizes positive outcomes in reintegrating these clients to the workplace in compliance with ADA provision Title 1, Employment.
Factors Influencing Entry-Level Occupational Therapists’ Attitudes Toward Persons With Disabilities
Authors: Eberhardt Kim , Mayberry Wanda
Published: April 2012

Negative attitudes exhibited by rehabilitation professionals could have adverse consequences for persons with disabilities in their achievement of desired outcomes. Because occupational therapists are in a position to exert considerable influence in the therapeutic relationship, this study explored entry-level occupational therapy practitioners’ equal status contact with and attitudes toward persons with disabilities.

Method. Questionnaires were sent to 402 entry-level occupational therapists. These questionnaires consisted of: a demographic scale, the Disability Social Distance Scale, the Contact With Disabled Persons Scale, and a Similarity Scale (constructed for this study to evaluate the concept of equal status). Data analysis explored the relationship between 172 respondents’ equal status perception and contact with persons with disabilities and their attitudes toward persons with disabilities.

Results. Respondents exhibited generally positive attitudes toward persons with disabilities. Perceived equality, personal and professional contact, and the majority of demographic factors were not significantly corrected with their attitudes toward persons with disabilities. Respondents who specified working with persons without disabilities in the wellness capacity exhibited more positive attitudes than those working with persons with biomechanical and neurological disabilities. In addition, respondents who had a greater frequency of professional contact with persons with disabilities also appeared to experience more personal contact with persons with disabilities.

Conclusion. Entry-level occupational therapists’ attitudes toward persons with disabilities may not only be influenced by parameters of the contact variable but also by the profession’s holistic philosophy, the occupational therapy educational curricula, and the personal characteristics of those who choose to pursue a career in occupational therapy.
Working Memory and Older Adults: Implications for Occupational Therapy
Authors: Andiel Corinna , Liu Lili
Published: April 2012

Atkinson and Shiffrin’s (1968) modal model of memory is still commonly used by rehabilitation professionals to evaluate memory impairment in older adults. However, research to date has been unable to indicate that short-term memory declines with age. These findings have led some rehabilitation professionals to mistakenly conclude that short-term memory is not affected by the aging process. This article reviews both the traditional concept of short-term memory, as outlined by Atkinson and Shiffrin, and the more recent conceptualization of short-term memory in terms of Baddeley and Hitch’s (1974) model of working memory. The implications of the concept of working memory has implications for occupational therapy interventions for older adults. For example, clients with dementia may experience difficulties in performing tasks that require drawing inferences. Similarly, language that contains vague references may present problems for these clients. In addition, changes in working memory in older adults suggest that they may experience difficulties with medication management and what Rule, Milke, and Dobbs (1992) called wayfinding. Therefore, evaluations of working memory would provide a better indication of older adults’ memory performance than the modal model.
Computer-Assisted Instruction as a Learning Resource for Applied Anatomy and Kinesiology in the Occupational Therapy Curriculum
Authors: Toth-Cohen Susan
Published: April 2012

Objectives. The purpose of these studies was to examine the learning outcomes of a computer-assisted instruction (CAI) tutorial in applied anatomy and kinesiology for occupational therapy students and to determine its applicability for use in two university settings.

Method. Two separate pilot studies were conducted at two universities. In each study, the learning outcomes of an experimental group of occupational therapy students using a CAI program and a control group using books to study the same material were compared. Learning outcomes were assessed with posttest achievement test scores on an applied anatomy and kinesiology test and responses to an attitude questionnaire with Likert-scale items and open-ended questions.

Results. There was no significant difference in the means on achievement test scores for the experimental and control groups in the first pilot study. In the second study, the CAI group scored significantly higher on the achievement test than the control group. In both pilot studies, subjects displayed significantly more positive attitudes toward the CAI program as a learning tool than they did toward traditional self-study with books.

Conclusion. A CAI program in applied anatomy and kinesiology can be an effective supplemental resource for occupational therapy students and can offer a learning experience that students value and perceive as helpful. Establishment of clear learning objectives, use of a theoretical base to design instruction, and development and testing in different educational settings can help improve the quality of CAI programs and ensure their relevance to other curricula.
Materials-Based, Imagery-Based, and Rote Exercise Occupational Forms: Effect on Repetitions, Heart Rate, Duration of Performance, and Self-Perceived Rest Period in Well Elderly Women
Authors: Thomas Julie Jepsen
Published: April 2012

Objectives. This study extends previous research that contrasted occupational forms with elderly persons living in institutions to include elderly women living independently. In addition to differences in number of repetitions elicited, the current study measured heart rate response and perceived rest period duration.

Method. Forty-five women over the age of 65 years were randomly assigned to one of three occupational forms: materials based (kicking a balloon), imagery based (kicking an imaginary balloon), and rote exercise (performing a kicking movement without a balloon or imagery prompt). Subjects were instructed to perform the assigned lower-extremity movement until they fatigued and after a self-determined period of rest indicated when they felt able to do another set of movements. Dependent variables included number of repetitions of movement, heart rate (at baseline, at completion of movements, at end of rest period), duration of movement, and self-perceived rest period. Group means for each variable were compared using analyses of variance.

Results. Groups showed no significant difference in baseline and demographic data. Subjects in the materials-based occupational form performed significantly more repetitions and required a significantly longer self-perceived rest period than subjects in the imagery-based and rote exercise forms. There were no significant differences among the groups for heart rate response. Duration of movement and number of repetitions variables were strongly correlated (r = .95), indicating lack of independence.

Conclusions. The materials-based occupational form elicited a quantitatively different performance than the other forms. Given the relatively fuller experience (i.e., interaction with an object, clear objective) of the materials-based form, an occupational form that has added meaning for the person appears to result in enhanced performance when compared with forms that lack strong meaning and suggest more limited purposes.
A Meta-Analysis of the Effectiveness of Occupational Therapy for Older Persons
Authors: Carlson Mike , Fanchiang Shan-Pin , Zemke Ruth , Clark Florence
Published: April 2012

Given the current health care debate, it is imperative to document the usefulness of various health services for older persons, a rapidly growing population at increased risk for a wide variety of physical and functional impairments. A meta-analysis was conducted to examine the degree of effectiveness of occupational therapy for older persons. For a sample of 15 distinct tests of occupational therapy, a positive unweighted mean effect size of .51 (.54 when corrected for instrument unreliability) was obtained, along with a highly significant cumulative result for treatment success (p < .001). Beneficial treatment effects extended to activities of daily living–functional and psychosocial outcomes. The results for physical outcomes suggested a beneficial effect, although not every meta-analytic test yielded significant results. It was concluded that factors such as publication bias or poor study design are incapable of accounting for the positive meta-analytic result and that occupational therapy represents a worthwhile treatment option for older persons.
Life Domains and Adaptive Strategies of a Group of Low-Income, Well Older Adults
Authors: Clark Florence , Carlson Mike , Zemke Ruth , Frank Gelya , Patterson Karen , Ennevor Bridget Larson , Rankin-Martinez Allyn , Hobson LuAn , Crandall Jennifer , Mandel Deborah , Lipson Loren
Published: April 2012

Older adults are at increased risk for a variety of physical and functional limitations that threaten their ability to lead independent and fulfilling lives. Consequently, they stand to benefit from personalized strategies of adaptation that enable them to achieve successful outcomes in their daily activities and desired goals. In the current investigation, a qualitative descriptive methodology was used to document the perceived life domain of importance and associated strategies of adaptation of 29 residents of Angelus Plaza, a federally subsidized apartment complex in downtown Los Angeles for low-income, well older adults. On the basis of interview data, 10 life domains were identified, and within each domain, a typology of adaptive strategies was derived. The domains were activities of daily living (ADL), adaptation to a multicultural environment, free time usage, grave illness and death–spirituality, health maintenance, mobility maintenance, personal finances, personal safety, psychological well-being and happiness, and relationships with others. Although the typology should not be generalized to a geriatric population, therapists may wish to refer to it to gain a sense of the extent to which certain adaptive strategies may be applicable to the lives of particular older adults to whom they deliver services. The teaching of these adaptive strategies could then be incorporated into an individualized treatment plan.

The typology also provides a broad picture of the kinds of adaptive strategies used by the older adults as a way of coping and adapting to their setting. Although some of the domains do not differ from those typically addressed in occupational therapy textbooks on geriatric care (e.g., ADL, health maintenance), others seem uniquely tailored to the specifics of the Angelus Plaza context (e.g., personal safety). Finally, certain domains emerged that may be highly relevant to older adults in most settings but are not typically the focus of occupational therapy programs (e.g., grave illness and death–spirituality, relationships with others). The emergence of these domains from our data suggests that therapists may wish to consider them more in treatment if they are convinced that they possess local relevance.
Shoulder Pain and Subluxation After Stroke: Correlation or Coincidence?
Authors: Zorowitz Richard D. , Hughes Mary B. , Idank David , Ikai Tetsuo , Johnston Mark V.
Published: April 2012

Objective. Few studies have concomitantly examined shoulder subluxation and other potential causes of shoulder pain in persons who have had a stroke. This study explores whether shoulder pain after stroke is related to shoulder subluxation, age, limitations in shoulder range of motion, and upper extremity motor impairment.

Method. Shoulder pain was measured with a visual analog scale in 20 subjects admitted to a rehabilitation hospital within 6 weeks of onset of their first stroke. Degree of shoulder pain was correlated with vertical, horizontal, and total asymmetries of glenohumeral subluxation; age; shoulder flexion, abduction, and external rotation; and the upper extremity subscore of the Fugl-Meyer Motor Assessment.

Results. Shoulder pain after stroke was not correlated with age (rk = .019, P = .916); vertical (rk = .081, P = .324), horizontal (rk = .126, P = .241), or total asymmetry (rk = −.098, p =.288); shoulder flexion (rk = .049, p = .390) or abduction (rk = −.074, p = .337); or Fugl-Meyer scores (rk= −.123, P = .257). In contrast, shoulder pain was strongly correlated with degree of shoulder external rotation (rk = −.457, P = .006).

Conclusion. These results do not support a strong relationship between shoulder subluxation and pain after stroke. Appropriate precautions should be taken to prevent range of motion limitations that may result in shoulder pain.
An Analysis of Score Patterns of Children With Attention Disorders on the Sensory Integration and Praxis Tests
Authors: Mulligan Shelley
Published: April 2012

Objectives. The purpose of this study was to identify and describe the score patterns of children with attention deficit hyperactivity disorder (ADHD) on the Sensory Integration and Praxis Tests (SIPT) and to determine whether their score patterns differ significantly from those of children without ADHD.

Method. In this retrospective study, the score patterns of 309 children with ADHD were compared with a group of 309 children without ADHD. The children were matched by norm group (reflecting age), gender, and the presence or absence of a learning disability. Both descriptive statistics and multivariate techniques were used.

Results. Subjects with ADHD demonstrated relative strengths in the areas of nonmotor visual perception and localization of tactile input and weaknesses with vestibular processing and in most areas of praxis or motor planning. Certain SIPT scores of subjects with ADHD were found to differ significantly from those of subjects without ADHD. The SIPT test that best discriminated the two groups was Space Visualization.

Conclusions. The results suggest that it may be helpful for therapists to consider the areas of praxis and vestibular processing in the evaluation and treatment of children with ADHD and that in clinical practice, it would be difficult to distinguish children with ADHD from those without on the basis of their SIPT scores. However, the ways in which the SIPT score patterns of children with ADHD differed from those without assist our understanding of the brain areas and neurological systems involved in children with ADHD.
Teaching Strategies for the Development of Clinical Reasoning
Authors: Neistadt Maureen E.
Published: April 2012

A primary aim of occupational therapy education is to teach students how to think like practitioners, that is, how to engage in clinical reasoning. Since the early 1980s, occupational therapy clinical reasoning research has elucidated a language that describes the various types of thinking therapists use in clinical practice, a language that has the potential to make previously tacit thought processes accessible to conscious examination and improvement. Occupational therapy educators can use that language to make their teaching of clinical reasoning more explicit to students. The article examines occupational therapy teaching methods using the language of clinical reasoning, categorizing them by the types of clinical reasoning they promote. Current clinical reasoning language is reviewed, and teaching strategies to facilitate the various types of clinical reasoning are described.
Providing Effective Occupational Therapy Services: Data-Based Decision Making in School-Based Practice
Authors: Clark Gloria Frolek , Miller Linda E.
Published: April 2012

Educational practice is moving away from an “eligibility-oriented” student–problem approach toward a problem-solving approach that connects evaluation and interventions. This approach involves the identification of variables used to frame interventions, and, ultimately, it permits evaluation of intervention effectiveness. This article describes a problem-solving model developed and used within the Heartland Area Education Agency. This model relies on collecting baseline data and ongoing data, producing a basis not only for decision making, but also for evaluating the chosen intervention. This systematic and collaborative approach is used by the educational team to identify concerns about students’ academic and nonacademic performance, to plan interventions, and to establish measurable outcomes.
The Role of Play in Pediatric Occupational Therapy
Authors: Couch Kari J. , Deitz Jean C. , Kanny Elizabeth M.
Published: April 2012

Objective. This study examined the roles that play occupies within current occupational therapy practice with preschoolers.

Method. Two hundred twenty-four pediatric occupational therapists completed mail questionnaires designed to ascertain how they use play in their practice, their knowledge and use of play assessments, and potential constraints on their use of play.

Results. Although respondents indicated that play was important in motivating children and frequently used play as a treatment modality or reinforcer, they Less frequently assessed play behaviors or wrote treatment goals and objectives related to play. Differences were found between school-based and non-school-based respondents regarding the discipline or model that addresses play in the work setting, the use of play assessments, and constraints that Limit the use of play in the work setting.

Conclusion. The results suggest a need for increasing the emphasis on play in entry-Level curricula and continuing education, improving clinician access to valid and reliable play assessments, and completing studies designed to examine the use and efficacy of play in occupational therapy intervention.
Teaching Clinical Reasoning as a Thinking Frame
Authors: Neistadt Maureen E.
Published: April 2012

Objective. Clinical reasoning concepts can be viewed as descriptions of mental operations or as a thinking frame—a structure to organize and support clinical thinking. This study examined an approach for teaching clinical reasoning as a thinking frame to occupational therapy students.

Method. A quasi-experimental, pretest-posttest design was used with a convenience sample of 10 undergraduate occupational therapy seniors. All participants (a) acquired the thinking frame of clinical reasoning concepts through explicit instruction and (b) practiced that thinking frame with an external aid—the Clinical Reasoning Case Study Format. The accuracy of participants' definitions of clinical reasoning concepts before and after this learning experience were examined to assess their acquisition of the thinking frame. The content of clinical reasoning case studies were examined to assess students' application of the thinking frame to clinical situations.

Results. Wilcoxon signed rank tests done on presemester and postsemester definitions ratings indicated that the latter were rated significantly higher than the former for (a) narrative reasoning (p = .008), (b) procedural reasoning (p =.005), (c) interactive reasoning (p =.006), (d) pragmatic reasoning (p = .008), and (e) conditional reasoning (p =. 01). The content of participants' clinical reasoning case studies indicated that they were able to apply clinical reasoning concepts.

Conclusion. The results suggest that using a clinical reasoning thinking frame to organize clinical observations is an effective way to help entry-level occupational therapy students learn and apply clinical reasoning concepts.
Estimates of Driving Abilities and Skills in Different Conditions
Authors: Galski Thomas , Ehle Holly T. , Williams J. Bradley
Published: April 2012

Objectives. This research was a preliminary effort to determine whether various driving situations seemed to require different driving skills and abilities and to identify the relative demands of specific physical, perceptual, cognitive, behavioral, and operational skills and abilities in different driving situations.

Method. Experienced driver evaluators and trainers estimated the magnitude of driving abilities and skills for different photographed driving situations. Pictures of driving scenarios were counter balanced for road type, traffic condition, and weather condition.

Results. A multifactorial analysis of variance of the total score for each scenario revealed significant main effects for road type and traffic condition but not for weather condition. Highway and city driving were rated as significantly more demanding overall than residential driving, but no difference was found between city and highway driving. Estimates of the overall demands for driving in heavy traffic were significantly greater than in light traffic. However, driving in inclement weather was not regarded as significantly more demanding than driving in sunny weather. Additionally, significant interaction effects were found for road type by weather condition and traffic by weather condition but not for road type by traffic condition.

Through multivariate methods to evaluate the significance of individual abilities and skills across conditions, significant main and interactive effects were found for road type, traffic condition, and weather condition. Post hoc analyses showed the impact of these effects on such abilities and skills as scanning, attention and concentration, information-processing speed, and others.

Conclusion. Evaluators’ quantified estimates of driving demands showed driving as a complex task that (a) requires high levels of abilities and skills in all situations; (b) demands greater abilities in some situations than in others; and (c) involves different kinds and various degrees of abilities and skills, depending on the demand characteristics of the situation.
Putting Occupation Into Practice: Occupation as Ends, Occupation as Means
Authors: Gray Julie McLaughlin
Published: April 2012

This article addresses a difficulty that many occupational therapists experience: maintaining occupation as the core of their therapeutic intervention. This difficulty not only results from but also contributes to occupational therapy’s struggle with professional identity. Current manifestations of the problem are described as component-driven practice and the narrowing of occupation to basic activities of daily living. The concepts of occupation as ends and occupation as means are proposed as a practical solution to guide treatment planning and merge remediation and adaptation within a single occupational session. Each concept is investigated in terms of its history within the profession and its usefulness for analyzing and solving therapeutic problems. These concepts are discussed as useful guidelines to help occupational therapists not only in their clinical decision making but also in their understanding and expression of the field’s unique expertise. A case example, applying occupation as ends and occupation as means to evaluation and treatment, is presented.
Competence and the Occupational Therapy Entrepreneur
Authors: Foto Mary
Published: April 2012

That which constitutes competence in an occupational therapy entrepreneur is not well delineated, even though the role of entrepreneur requires that such a person possess a particular set of knowledge and skills in order to be competent. The question of competence in an occupational therapy entrepreneur is increasingly important because the number of practitioners assuming this role has grown in recent times. Indeed, a connection exists between the competence of occupational therapy entrepreneurs and the future stature of the profession. Still, the issue remains: How will occupational therapy entrepreneurs be judged competent? Peer evaluation is one possibility, but the ultimate measure will be marketplace success.
Career Transition From Clinician to Academician: Responsibilities and Reflections
Authors: Crist Patricia
Published: April 2012

Being an educator is just as much an art and a science as is being a clinician. This article describes the faculty role and its basic responsibilities for occupational therapy practitioners who are considering the transition to academic educator positions. The faculty role has unique characteristics. Differentiating therapy activities from academic activities is an essential part of a career transition from clinician to academician. This article also describes the various features of the academic context and its impact on individual performance, how to assess readiness for the faculty role, and the typical application process.
Sensory Integrative–Based Occupational Therapy and Functional Outcomes in Young Children With Pervasive Developmental Disorders: A Single-Subject Study
Authors: Linderman Tami M. , Stewart Katherine B.
Published: April 2012

Objective. This single-subject study explored the effects of sensory integrative–based occupational therapy provided in an outpatient clinic on the functional behaviors of two young children with pervasive developmental disorder (PDD) at home.

Method. The participants were two 3-year-old boys with PDD. Before the study, the participants had not received a consistent program of sensory integrative–based occupational therapy. Before the baseline phase, three target behaviors were identified for each child, using an adapted version of Cook’s revised Functional Behavior Assessment for Children with Sensory Integrative Dysfunction. These target behaviors were operationalized and used as repeated measures taken in the home during both the 2-week baseline and treatment phases. The treatment phase was 11 weeks for Participant 1 and 7 weeks for Participant 2.

Results. Both participants displayed significant improvements in the areas of social interaction, approach to new activities, response to holding or hugging, and response to movement. Decreases were noted in the frequency and duration of disruptive behaviors (e.g., high activity levels, aggressive behaviors), with an increase in functional behaviors, such as spontaneous speech, purposeful play, and attention to activities and conversation. Concurrent interventions that were not part of this study (e.g., initiation of speech therapy, preschool, vitamins) may have confounded these results.

Conclusions. These findings support the application of sensory integrative–based occupational therapy as a part of the services provided to some children with PDD. Further research is needed to replicate these findings and to isolate the effects of sensory integrative–based occupational therapy because both participants were receiving other interventions at the time of this study.
Construct Validity of the In-Hand Manipulation Test: A Discriminant Analysis With Children Without Disability and Children With Spastic Diplegia
Authors: Miles Breslin Dina M. , Exner Charlotte E.
Published: April 2012

Objective. This study examined the construct validity of the In-Hand Manipulation Test (IMT) by assessing the test’s ability to discriminate between samples of children with and without known fine motor problems.

Method. The IMT was administered to 55 children without known fine motor problems and 24 children with spastic diplegia who had mild to moderate fine motor problems. Construct validity was estimated by evaluating how accurately the IMT classified the children as having or not having fine motor problems on the basis of total score.

Results. A discriminant analysis indicated that IMT total score correctly classified 83.33% of the participants as having or not having fine motor problems.

Conclusion. The IMT has adequate construct validity to classify the participants of this study and for continued use as a research instrument to assess children’s in-hand manipulation skills. Additional validity studies of the IMT are needed with other samples of children before its use for clinical purposes.
Regression Modeling Strategies: An Illustrative Case Study From Medical Rehabilitation Outcomes Research
Authors: Nick Todd G. , Hardin J. Michael
Published: April 2012

The practice of outcomes research is growing in all segments of the health care industry, yet few practitioners and researchers are prepared to deal with the completion of statistical analyses that characterize the new focus on results. This article discusses basic model formulation and interpretation. It also encourages the use of statistical models that study the simultaneous effects of many variables on an outcome and gives examples of relationships among variables that are not simple and linear. The methods are illustrated with a dataset consisting of stroke rehabilitation inpatients discharged during a 3-year period with an admission date that is within 1 year after stroke.
Current Practice of Occupational Therapy for Children With Autism
Authors: Watling Renee , Deitz Jean , Kanny Elizabeth M. , McLaughlin John F.
Published: April 2012

Objective. The purpose of this study was to examine the current practice patterns of occupational therapists experienced in working with children with autism spectrum disorders.

Method. Occupational therapists experienced in providing services to 2-year-old to 12-year-old children with autism completed a mail questionnaire describing practice patterns, theoretical approaches, intervention techniques, and preferred methods of preparation for work with children with autism.

Results. Of those contacted, 72 occupational therapists met the study criteria and returned completed questionnaires. Practice patterns included frequent collaboration with other professionals during assessment and intervention. Intervention services were typically provided in a one-to-one format with the most common techniques being sensory integration (99%) and positive reinforcement (93%). Theoretical approaches included sensory integration (99%), developmental (88%), and behavioral (73%). Evaluations relied heavily on nonstandardized tools and clinical observations. Educational methods identified as most helpful were weekend workshops (56%) and on-the-job training (52%).

Conclusion. This study clarified the nature of current occupational therapy practice patterns for 2-year-old to 12-year-old children with autism. Additional studies are needed to examine the efficacy of current evaluation and intervention methods, as well as to explore the relevance of available standardized assessments for this population.
Occupational Therapy With Children With Pervasive Developmental Disorders
Authors: Case-Smith Jane , Miller Heather
Published: April 2012

Objective. Although the prevalence of children with pervasive developmental disorders (PDD) has increased, empirical data about the role and practices of occupational therapists have not been reported in the literature. This descriptive study investigated the practice of occupational therapists with children with PDD.

Method. A survey was mailed to 500 occupational therapists in the Sensory Integration Special Interest Section or School System Special Interest Section of the American Occupational Therapy Association in eastern and midwestern United States. The valid return rate was 58% (292 respondents). The survey used Likert scale items to measure frequency of performance problems observed in children with PDD, performance areas addressed in intervention, perceived improvement in performance, and frequency of use of and competency in intervention approaches.

Results. The respondents primarily worked in schools and reported that in the past 5 years they had served an increasing number of children with PDD. Most respondents provided direct services and appeared to use holistic approaches in which they addressed multiple performance domains. They applied sensory integration and environmental modification approaches most frequently and believed that they were most competent in using these approaches. Respondents who reported more frequent use of and more competence in sensory integration approaches perceived more improvement in children’s sensory processing. Respondents who reported more frequent use of and more competence in child-centered play perceived more improvement in children’s sensory integration and play skills.
Emissions halted of the potent greenhouse gas SF5CF3
Authors: Sturges W. T. , Oram D. E. , Laube J. C. , Reeves C. E. , Newland M. J. , Hogan C. , Martinerie P. , Witrant E. , Brenninkmeijer C. A. M. , Schuck T. J. , Fraser P. J.
Published: April 2012

Abstract. Long term measurements in background air (Cape Grim, Tasmania) and firn air (NEEM, Greenland) of the potent long-lived greenhouse gas SF5CF3 show that emissions declined after the late 1990s, having grown since the 1950s, and became indistinguishable from zero after 2003. The timing of this decline suggests that emissions of this gas may have been related to the production of certain fluorochemicals; production of which have been recently phased out. An earlier observation of closely correlated atmospheric abundances of SF5CF3 and SF6 are shown here to have likely been purely coincidental, as their respective trends diverged after 2002. Due to its long lifetime (ca. 900 yr), atmospheric concentrations of SF5CF3 have not declined, and it is now well mixed between hemispheres, as is also shown here from interhemispheric aircraft measurements. Total cumulative emissions of SF5CF3 amount to around 5 kT.