bluuebunny/crossref_metadata_2025 huggingface dataset:
Waiting To Get Better: A Dilemma Regarding Habits in Daily Occupations After Stroke
Authors: Wallenbert Inger , Jonsson Hans
Published: October 2011

The purpose of this study was to explore and gain an understanding of how habits are experienced when performing daily occupations after a stroke. In-depth interviews were conducted with 7 participants and a constant comparative method was used for data analysis. Four men and three women with stroke between the ages of 42 and 82 years participated in the study. The interviews were conducted 1.5 to 7 months after the participants had been discharged from hospital to their home. The findings show that the participants experienced frustration when performing daily occupations because changes in their performance meant that former habits could not automatically be reestablished; daily occupations had to be re-organized and planned with greater deliberation than had been required prior to the stroke. In reestablishing their daily occupations, the participants experienced an ongoing conflict about whether or not to develop new habits. Although adaptation and change would be beneficial in the short-term, both also represented giving up possible improvements, and participants seemed to consider that their eventual recovery and independence would be compromised if they allowed themselves to alter their habits. This dilemma led to a sensation of waiting: waiting to get better, waiting for another solution and waiting for the treatment to make an impact. As a result, few new habits were established in daily occupations. The findings suggest that occupational therapists need to be aware of the dilemma clients may perceive regarding decisions about whether or not to adapt and develop new habits during poststroke recovery.
Scholarship and Practice: Bridging the Divide
Authors: Kielhofner Gary
Published: October 2011

There is evidence that the growth theory and research about occupation produced by academics are not consistently translated into occupational therapy practice. Rather, practitioners often report finding such theory and research to be of limited relevance to and/or difficult to implement in their everyday work. Although many factors contribute to this academic-practice gap one important contributor is how knowledge is traditionally viewed and generated in academia. Changes in traditional views about academic knowledge and its relationship to practice both outside and within occupational therapy are discussed. Ways that occupational therapy scholarship can be more clearly grounded in everyday practice are examined drawing from experience with participatory research. Consideration is given to how researchers and practitioners might share power and have a more effective dialogue.
Occupational Goals of Mothers of Children With Disabilities: Influence of Temporal, Social, and Emotional Contexts
Authors: Donovan J. Mark , VanLeit Betsy J. , Crowe Terry K. , Keefe Elizabeth B.
Published: October 2011

OBJECTIVE. The purpose of this study was to describe the occupational concerns and goals of mothers who care for children with disabilities.

METHOD. Retrospective data collected from 38 mothers of children with disabilities using the Canadian Occupational Performance Measure (COPM) were analyzed qualitatively.

RESULTS. Six themes emerged: (I) doing and being alone: taking care of my own health and well-being; (II) doing and being with others: expanding my social life; (III) improving my child’s quality of life; (IV) household management: organizing time and resources; (V) balancing work, home, and community responsibilities; and (VI) sharing the workload.

CONCLUSION. Overarching patterns in the data suggested that the occupational performance of mothers of children with disabilities is constrained by time, overlaid by difficult emotions, and involves a desire for increased social contact. Qualitative analysis of data from the COPM may provide insight into contextual factors that affect occupational performance as well as signaling point of entry for therapists to facilitate client-centered occupational goals.
Meanings and Purposes of Caring for a Family Member: An Autoethnography
Authors: Hoppes Steve
Published: October 2011

Engagement in two interlinked areas of occupation, familial social participation and caring for my father at the end of his life, led to a journey of self-discovery. A qualitative research methodology, autoethnography, is used to develop a narrative that examines engagement in these two occupations before, during, and after my father’s illness and death. I discuss meanings and purposes of familial social participation and caregiving, suggesting that transforming fear of death to awareness of death is a central purpose of caregiving. Implications for therapists and caregivers include considerations about the value of occupation, discussion of a continuum of caregiving, examination of boundaries when caring for a parent, thoughts about the roles of altruism, love, anger, and “bad faith” in caregiving, and analysis of sons as caregivers for fathers. Further research on meanings and purposes of caregiving is proposed.
Cultural Competency in Occupational Therapy: Beyond a Cross-Cultural View of Practice
Authors: Odawara Etsuko
Published: October 2011

The purposes of this paper are two. The first purpose is to contribute to cultural competence in occupational therapy practice. The second is to contribute to occupational therapy literature about culture and cultural analysis related to practice. This paper introduces a cultural analysis of stories about the therapeutic process with two Japanese therapists and their Japanese patients. Two therapeutic situations, including therapists’ and their patients’ experiences, are interpreted by the author, a Japanese occupational therapist, as critical incidents for reflection to improve culture general competence. The stories illustrate the patients’ perception of life with illness and, particularly, the emergence of their cultural values within the therapy process. The analyses focus on how an understanding of the patients’ illness experience is integrated into the therapy process and how the therapeutic interventions reflect the culture. In one case, the therapeutic occupation of cooking links to the meaning found in the traditional Japanese woman’s role. In the second case, the therapist–patient relationship, based on local rather than western social relationships, promoted the patient’s engagement in meaningful occupations. Reflection on these stories, which illustrate an alternative cultural view of occupations and therapeutic relationships, may assist occupational therapists in the development of improved level of cultural competence.
Positive Consequences of Surviving a Stroke
Authors: Gillen Glen
Published: October 2011

This exploratory study focused on gaining insight into the psychological experience of stroke survivors undergoing inpatient rehabilitation. Specifically it investigated whether stroke survivors undergoing inpatient rehabilitation were able to identify any positive consequence of their stroke. This phenomenon, also know as benefit finding or positive reframing, has recently received more attention in the coping literature examining reactions to severe illness.

Using a case series methodology and qualitative analytic techniques, 16 stroke survivors were interviewed using standardized open-ended questions related to identification of positive consequences attributed to surviving a stroke. Sixty-three percent of the patients interviewed were able to identify positive consequences of their stroke. The following five themes regarding positive consequences of stroke emerged from this case series: increased social relationships, increased health awareness, change in religious life, personal growth, and altruism. It was concluded that some individuals who have survived an acute stroke are able to reframe their experience in a positive light. This study provides occupational therapists and others with further insight into the coping mechanisms of those individuals who have survived a stroke. The need for further research is stressed.
Problems With Dressing in the Frail Elderly
Authors: Mann William C. , Kimble Christine , Justiss Michael D. , Casson Elena , Tomita Machiko , Wu Samuel S.
Published: October 2011

OBJECTIVE. Dressing is an important activity of daily living, yet many older adults have difficulty due to impairments. The purpose of this study was to explore the use of assistive devices for dressing by older persons with impairments, and to look at differences among frail elders with no dressing difficulty, upper-extremity-only dressing difficulty, lower-extremity-only dressing difficulty, and both upper- and lower-extremity dressing difficulty.

METHOD. We conducted in-home interviews and functional assessments with 1,101 elderly persons with activities of daily living and/or instrumental activities of daily living limitations in Western New York and Northern Florida. Participants were assigned to one of four groups based on Functional Independence Measure™ item scores for upper-extremity dressing and lower-extremity dressing. Descriptive statistics were used to report results.

RESULTS. Compared to women, there were relatively more men with lower-extremity dressing difficulty than with upper-extremity dressing difficulty. The group with both upper- and lower-extremity dressing difficulty reported the highest level of pain and scored lowest on all measures of functional status and mental status. The most commonly used dressing devices were associated with lower-extremity dressing.

CONCLUSION. There are differences in gender, health status, functional status, and mental status among elderly persons grouped by upper- or lower-extremity dressing difficulty. Results suggest that therapists should consider such differences as gender and type of difficulty (upper- or lower-extremity dressing) in both therapeutic approaches and recommendations for assistive devices. Pain is another important consideration, but it can often be reduced during dressing by using assistive devices.
Occupational Therapy Workforce Needs: A Model for Demand-Based Studies
Authors: Powell Janet M. , Griffith Sonya L. , Kanny Elizabeth M.
Published: October 2011

PURPOSE. To provide a model for assessing occupational therapy workforce needs by using a demand-based approach to determine current workforce status in the Northwest region. Regional information may have implications for addressing national occupational therapy service needs.

METHOD. A questionnaire was sent to a proportional random sample of 234 facilities that hire occupational therapy practitioners. Data were collected in July–August 2003 using structured mailing and follow-up procedures.

RESULTS. Response rate was 79%. Twenty-four percent reported occupational therapy vacancies and 11% occupational therapy assistant vacancies; 48% predicted an increase in occupational therapy positions in the next 2 years and 41% an increase in occupational therapy assistant positions. Sixty-three percent of respondents reported difficulty in hiring.

DISCUSSION. This study identifies an occupational therapy workforce shortage in the Northwest. Management of a shortage is critical, for even short-term adjustments could lead to permanent changes in service provision. This study demonstrates the importance of current information on the status of the national workforce and serves as a model for future studies.
An Occupational Perspective on the Concept of Participation in the International Classification of Functioning, Disability and Health—Some Critical Remarks
Authors: Hemmingsson Helena , Jonsson Hans
Published: October 2011

The International Classification of Functioning, Disability and Health (ICF; World Health Organization, 2001) provides an international and interprofessional scientific basis for understanding and studying health. The concept of participation plays an important role in the classification and has become a central construct in health care, rehabilitation, and in occupational therapy. The aim of this paper is to provide a critical analysis of the concept of participation in the ICF. As background, the origins and current presentation of the ICF are presented. The use and function of the ICF and the contemporary discussions regarding the classification are reviewed. An occupational perspective on participation in the ICF reveals major shortcomings regarding the subjective experience of meaning and autonomy. Furthermore, the ICF has limitations in capturing different kinds of participation in a single life situation. Following these analyses we discuss the advantages and shortcomings of using the ICF, and how an occupational perspective can contribute to an ongoing discussion about the development of the ICF.
The Effect of Three Alternative Keyboard Designs on Forearm Pronation, Wrist Extension, and Ulnar Deviation: A Meta-Analysis
Authors: Baker Nancy A. , Cidboy Erin L.
Published: October 2011

The growth of computer keyboard use in the workplace is believed to be one important determinant of the increased prevalence of work-related musculoskeletal disorders of the upper extremity (MSD-UE). One possible contributing factor to the development of MSD-UE is the flat standard keyboard, which places the forearm and wrist in biomechanically awkward postures. This meta-analysis examines the efficacy of three alternative keyboard designs, adjustable slope (AS), split fixed-angle (FA), and adjustable open-tented (AT), in reducing forearm pronation, wrist extension, and ulnar deviation. Analyses of pooled effect size from six studies indicated that the AT had a large effect on pronation (r = 0.85) and ulnar deviation whereas the FA had a large effect only on ulnar deviation (r = 0.79). The AS was found to have a large effect (r = 0.66) on wrist extension. The FA had a moderate effect on pronation (r = 0.33) and wrist extension (r = 0.30). None of these keyboards were found to have a significant effect on all three postures. This meta-analysis has implications for clinicians by providing objective information that may assist with the selection of an alternative keyboard that best reduces an identified problematic posture.
School-Based Practice Patterns: A Survey of Occupational Therapists in Colorado
Authors: Spencer Karen C. , Turkett Amanda , Vaughan Roberta , Koenig Sandra
Published: October 2011

OBJECTIVE. This purpose of this study was to describe school-based occupational therapy practice for kindergarten through twelfth-grade students in Colorado and to examine occupational therapy practice in light of current education policy and published views of best practice.

METHOD. Study data were provided by 105 occupational therapists and occupational therapy assistants who completed a 24-item questionnaire.

RESULTS. Occupational therapists carried an average caseload of 43.68 students; most frequently served kindergarten through third-grade students with perceptual or communicative disabilities; and delivered services most often in pullout treatment areas. Practitioners spent most of their work week providing direct services. Remedial or developmental approaches were used 62% of the time and compensatory and educational approaches 37% of the time. Individualized education program goals addressed by occupational therapists were most frequently developed by the occupational therapist and targeted students’ sensory or motor impairments. Workshops on autism and sensorimotor intervention techniques were reported as the primary and preferred forms of professional development.

CONCLUSION. The strong majority of reported occupational therapy services contrasted with emerging views of best practice. They were, however, consistent with the Colorado Department of Education’s guidelines for “motor specialists” that address occupational therapy, physical therapy, and adaptive physical educators working in schools. Study findings are discussed.
Factors Affecting Patient Recruitment in an Acute Rehabilitation Randomized Controlled Trial
Authors: Lannin Natasha , Cusick Anne
Published: October 2011

OBJECTIVE. To evaluate factors associated with randomized controlled trial patient recruitment by therapists.

METHOD. Survey of 18 (of a possible 26) therapists who had agreed to recruit patients for a randomized controlled trial (78% response rate).

RESULTS. Sixteen respondents had enrolled at least one patient. The site at which the therapist worked neither influenced the likelihood that a therapist would contact the researcher nor influenced the recruitment rate. Seventeen respondents reported that they contacted the researcher to discuss one or more of their patients for potential inclusion in the trial. Factors reported by therapists as reasons why they did not recommend the trial to eligible patients were not specific to study inclusion or exclusion criteria, rather were linked to personal judgments about patient suitability for the study. Regression analysis indicated that being enrolled or having completed master’s level postgraduate studies, and choosing not to refer patients because of concern for their poor medical prognosis were the only factors that significantly influenced recruitment rate (p < 0.001).

CONCLUSION. Recruitment practices vary amongst therapists. Selection of therapists with postgraduate qualifications as recruiters may be an effective way to enhance recruitment rate.
A Comparison of Visual-Perceptual and Visual-Motor Skills Between Palestinian and Israeli Children
Authors: Josman Naomi , Abdallah Taisir M. , Engel-Yeger Batya
Published: October 2011

PURPOSE. This pioneer study examines the visual-motor and visual-perceptual performance of Israeli and Palestinian children, and makes comparisons among these respective populations according to age, place of residence, and parental education. In addition, the study evaluates the validity of standardized assessment tools for use with Palestinian children, with the view of establishing a sound assessment battery for this underserved population.

METHODS. Participants included 101 Israeli and 125 Palestinian children from kindergarten, first grade, and second grade who underwent visual-motor and visual-perceptual tests.

RESULTS. Significant differences were found between the two cultural groups in all assessments. Results also refer to grade, place of residence, and parents’ education variables.

CONCLUSIONS. Although culture influences children’s performance, children from different societies should be screened and, when necessary, evaluated and treated in order to enable their optimal functioning at school. The validity of the assessment tools used, expressed in the ability to differentiate between Israeli and Palestinian children, should be further studied in order to suggest that these assessments may be considered as part of an evaluation battery for determining the school readiness and ability to advance in grade level among Palestinian children.
An Occupation-Centered Discussion of Development and Implications for Practice
Authors: Humphry Ruth , Wakeford Linn
Published: October 2011

Children’s learning to do everyday activities seems so obvious that the mechanisms bringing about the development of occupations remain essentially unstudied. Therefore, occupational therapy uses developmental models from other disciplines as foundation for practice. We specialists in childhood occupations need a theory-based and empirically tested body of knowledge about the processes leading to change to inform practice and guide interventions during efficacy studies. One body of knowledge about developmental mechanisms views change as originating from within the child and informs practice centered on changing the child. Given the inseparable nature of children and their social environments and daily activities, we introduce the philosophy of contextualism and outline a potential body of knowledge about a change process that is occupation centered. An intervention arising from a contextual perspective illustrates how this way of thinking leads to occupation-centered practice that uses multiple strategies and supports a child’s occupation with social participation with peers.
Shoulder Muscle Activity Increases With Wrist Splint Use During a Simulated Upper-Extremity Work Task
Authors: Mell Amy G. , Friedman Mark A. , Hughes Richard E. , Carpenter James E.
Published: October 2011

OBJECTIVE. The purpose of this study was to test the hypothesis that wearing a wrist splint while performing a common light manufacturing task (moving an object from a bin) increases shoulder muscle activity.

METHODS. Electromyography (EMG) signals were evaluated from the anterior, middle, and posterior deltoid, trapezius, supraspinatus, and infraspinatus of 14 volunteers while they moved an object from a bin. Two test conditions were measured: with and without a wrist splint. The height of the bin was also varied.

RESULTS. Wearing a wrist splint increased maximum EMG for all six muscles and average levels for the deltoid (anterior, middle, posterior) and trapezius. As bin height increased, maximum muscle activity increased in the deltoid (anterior, middle, and posterior) and trapezius, and the average increased in the deltoid (middle and posterior) and trapezius.

CONCLUSIONS. Workplace factors can modify the activation of a patient’s shoulder muscles when he or she is wearing a wrist splint. An ergonomic job analysis should be conducted for patients who are returning to work wearing wrist splints.
Early Intervention Service Eligibility: Implications of Using the Peabody Developmental Motor Scales
Authors: Van Den Wymelenberg Kimberly , Deitz Jean Crosetto , Wendel Susan , Kartin Deborah
Published: October 2011

OBJECTIVE. Occupational therapists, as members of early intervention (EI) teams, are responsible for contributing to equitable decision making regarding service eligibility. Because the two editions of the Peabody Developmental Motor Scales (PDMS) are often used in this process, it is important to study these measures. Therefore, the purpose of this study was to examine the implications of using different editions of the PDMS (PDMS versus PDMS-2) and different types of scores (standard deviation versus percent delay) when determining children’s eligibility for EI.

METHOD. With testing order counterbalanced, 30 candidates for EI evaluation, between 11 months and 34 months corrected age, were tested using both the PDMS and the PDMS-2.

RESULTS. Support for EI eligibility often differed depending on the edition of the PDMS used and the type of score used. When the PDMS was used, as opposed to the PDMS-2, disagreements occurred 23% to 43% of the time. For all disagreements, scores on the PDMS supported EI eligibility, whereas scores on the PDMS2 did not. When support for service eligibility was compared using percent delay scores versus standard deviation scores, disagreements occurred more often for the PDMS (Gross Motor: 17%; Fine Motor: 23%) than for the PDMS-2 (Gross Motor: 7%; Fine Motor: 3%).

CONCLUSIONS. It is important that occupational therapists within a facility, and ideally within a state, identify a single test edition to use as part of the process for determining EI eligibility. Also, if standard scores and percent delay scores point to conflicting decisions (eligibility vs. noneligibility), further evaluation and greater reliance on clinical judgment are advised.
Access to Polling Places in the 2004 Presidential Election: The Experience of One Metropolitan Midwestern City
Authors: Pohl Patricia S. , Froehlich-Grobe Katherine , McKiernan Brian , Vacek Kris M. , Donnelly Michael , Gaughan Julia Gilmore
Published: October 2011

According to federal law, polling places must be accessible to persons with disabilities. The rate of compliance with these laws, however, is not known. Our purpose was to determine whether polling places in the Greater Kansas City area were physically accessible to persons with disabilities. Students, faculty, and staff members from four professional programs representing two universities completed surveys at 128 polling places on the day of the 2004 Presidential election. Over the 14 items of interest, compliance ranged from 75% to 99%. The highest rate of deficiencies was found in the lack of a ramp with a handrail to the entrance of the polling place. Only 43% of the polling places were compliant in all of the 14 survey items. Despite laws mandating that polling places be accessible to persons with disabilities, restrictions in access persist. Persons with disabilities may still find polling places inaccessible on Election Day.
Integration and Application of a Home Treatment Program: A Study of Parents and Occupational Therapists
Authors: Segal Ruth , Beyer Claudia
Published: October 2011

The purpose of this article is to describe parental adherence to home treatment programs. A qualitative exploratory study with six parents and eight occupational therapists who used the brushing and compression technique (Wilbarger Protocol) was conducted. Participants were interviewed one or two times, exploring their experiences in adhering to the protocol. Data analysis focused on facilitators and hindrances to parental adherence and on occupational therapists’ strategies used to encourage it. Parents identified their children’s responses to brushing, its perceived efficacy, and interaction of the protocol with family daily schedules, as factors influencing their adherence. Occupational therapists identified only family daily schedules as influencing parental adherence. The findings are discussed in the context of the ecocultural theory of family accommodations.
Searches and Content of the OTseeker Database: Informing Research Priorities
Authors: Bennett Sally , McKenna Kryss , Tooth Leigh , Hoffmann Tammy , McCluskey Annie , Strong Jenny
Published: October 2011

BACKGROUND. A strategic and prioritized approach to occupational therapy research is needed, particularly given the limited research funding available. Comparing occupational therapists’ information needs with the research evidence available can potentially inform research debate within the profession. This study aimed to identify research topics most often sought by users of the OTseeker database and to compare these with the quantity of topics available in the database.

METHOD. A random sample of keyword search terms submitted to OTseeker (n = 4,500) was coded according to diagnostic and intervention categories, and compared with the amount of research contained in OTseeker in 2004.

RESULTS. Most frequently sought topics were relevant to the diagnostic categories of pediatric conditions (19%), neurology and neuromuscular disorders (17%), and mental health (17%). Most frequently sought intervention topics included modes of service delivery, sensory interventions, and physical modalities. Although many frequently sought topics had a correspondingly high volume of research in OTseeker, a few areas had very little content (e.g., fine motor skill acquisition, autistic spectrum disorder). This information is offered to inform discussions about research priorities and resource allocation for research within occupational therapy.
National Status of the Entry-Level Doctorate in Occupational Therapy (OTD)
Authors: Griffiths Yolanda , Padilla René
Published: October 2011

A multifaceted survey was conducted to identify the factors that academic occupational therapy (OT) programs were considering in making decisions as to whether the entry-level clinical doctorate (OTD) is a viable alternative for their institutions. The survey was sent in the summer of 2004 to program directors of all (150) occupational therapy programs in the United States. Responses were received from 111 programs (response rate of 74%). Quantitative (demographic) and qualitative (factor identification) data were compiled and analyzed. Supporting factors for the development of entry-level OTD programs included (a) coexistence of physical therapy doctorate program, (b) enhanced preparation of graduates, and (c) improved student recruitment. Impeding factors included (a) limited resources, (b) philosophical objections, and (c) lack of demand. In addition, results suggested that overall there is greater support for the OTD as a postprofessional degree. The study provided a historical record of current decision making in occupational therapy academic programs. In addition, the results of the study suggest a need for the development of national consensus regarding the place of the OTD in occupational therapy education.
Outcomes of Selected Cases From the American Occupational Therapy Foundation’s Curriculum Mentoring Project
Authors: Provident Ingrid M.
Published: October 2011

This study investigated the outcomes of a yearlong formal curriculum-mentoring project sponsored by the American Occupational Therapy Foundation. Five occupational therapy faculty groups were selected through a competitive application process and paired with mentors to assist in curriculum change. The experiences of each of the teams were studied using multiple methods of data collection, including semistructured interviews conducted in person and via telephone, a mailed questionnaire, and bimonthly electronic journal entries. The process and outcomes of two representative cases are reported in this qualitative, critical case study analysis. Overall, the faculty groups in each of the two teams seemed to benefit from mentoring in differing degrees as a result of their participation in this curriculum mentoring project. An important finding was that a well-focused mentoring plan with clearly outlined expectations needs to be established at the onset of any formal mentoring project. Additionally, a systematic, strategic plan agreed on by both mentors and participants, with a clear outline of responsibilities, will enhance the outcomes of a mentoring relationship.
Personal Preference and Quality of Reach in Healthy Adult Women
Authors: Rice Martin S. , Renock Lisa A.
Published: October 2011

OBJECTIVE. A common practice in occupational therapy is to have clients choose an object that they prefer to be used during treatment. This practice assumes that a preference for chosen items will hold greater meaning and result in higher quality of movement. Little research has been conducted that specifically addresses the effect that preference has on quality of movement. Therefore, the purpose of this study was to contribute to the knowledge by determining whether preference affects quality of movement.

METHOD. Forty-three healthy right-hand-dominant adult women between the ages of 18 and 60 years in Northwest Ohio engaged in this study. Each participant rank-ordered 15 magazines from most preferred to least preferred. The participant then reached for her most preferred, neutrally preferred, and least preferred magazines.

RESULTS. When participants reached for the neutrally preferred magazines, movement time was significantly slower and movement units were significantly greater (less smooth) than when they reached for a magazine perceived as being the least preferred (p < .017). No differences were found between the three conditions in terms of displacement, peak velocity, or percentage of time to peak velocity, nor between the most preferred and the other two preferences.

CONCLUSION. This study has shown that preference may not be an influential factor when performing simple reaches for magazines. Although there was a difference between the neutrally preferred and least preferred conditions, the goal when reaching during the neutrally preferred condition may have been different (i.e., to glean more information from the magazine cover) than when reaching in the least preferred condition (e.g., to reach for and discard the magazine as quickly as possible). These results reflect the complexity involved in the formation of meaning, of which preference is a part. Further exploration of individual preferences as well as personal goal formation and their impact on success in occupations of daily living is needed.
Occupational Engagement in Persons With Schizophrenia: Relationships to Self-Related Variables, Psychopathology, and Quality of Life
Authors: Bejerholm Ulrika , Eklund Mona
Published: October 2011

Previous research suggests that having schizophrenia involves not being fully equipped to engage in daily occupations. This study was aimed at exploring relationships between occupational engagement and the issues of self-related variables, psychiatric symptoms, and quality of life. Seventy-four outpatients with schizophrenia entered the study. Instruments used in this study were Profile of Occupational Engagement in People with Schizophrenia, Locus of Control, Mastery, Sense of Coherence, Brief Psychiatric Rating Scale, and Lancashire Quality of Life Profile. The results showed that a high level of occupational engagement was related to higher ratings of self-related variables, fewer psychiatric symptoms, and better ratings of quality of life, and vice versa. A significant difference and a linear trend were found among the three subgroups of different levels of occupational engagement and the estimated variables. In the regression model, negative symptoms and internal locus of control together explained 47% of the variance in occupational engagement. The results add a new dimension to understanding mental health and suggest the importance of assessing the level of occupational engagement.
Use and Perceived Effectiveness of Energy Conservation Strategies for Managing Multiple Sclerosis Fatigue
Authors: Matuska Kathleen , Mathiowetz Virgil , Finlayson Marcia
Published: October 2011

OBJECTIVE. This study describes the use and perceived effectiveness of energy conservation strategies by persons with multiple sclerosis after participation in an energy conservation course.

METHOD. One hundred twenty-three participants completed a survey about their use of energy conservation strategies.

RESULTS. All strategies were newly used by at least 50% of the participants and rated as effective. Strategies that involved rest and delegation were used most and rated most effective, followed by modifying priorities and standards. The most common reason for not implementing strategies was that participants were already using them.

CONCLUSION. Persons with multiple sclerosis who participated in an energy conservation course implemented a number of new energy conservation strategies and reported them as effective.
Identifying Gravitational Insecurity in Children: A Pilot Study
Authors: May-Benson Teresa A. , Koomar Jane A.
Published: October 2011

OBJECTIVE. This study developed an observational assessment of gravitational insecurity (GI), the GI Assessment, and examined its preliminary reliability and validity evidence.

METHOD. The GI Assessment consisted of 15 activities that created conditions characterized as fear-inducing for children with gravitational insecurity. Three behavioral categories—avoidance, emotional, and postural responses—were scored for each activity. Participants were 18 children with gravitational insecurity, ages 5–10 years, and a matched group of children who were typically developing. Forty-eight preschoolers who were typically developing, ages 2–4 years, were examined for developmental trends.

RESULTS. Significant differences were found between groups. Discriminant analysis classified 83% of the gravitationally insecure group and 100% of the typical group. Interrater reliability for the total test was .79. Performance of preschool children suggested a developmental age trend.

CONCLUSION. The GI Assessment is a promising clinical tool for objectively identifying children with gravitational insecurity.
Development of an Assessment for Ideational Praxis
Authors: May-Benson Teresa A. , Cermak Sharon A.
Published: October 2011

OBJECTIVE. This study developed an assessment of ideational praxis, examined its psychometric properties, and analyzed age and gender trends in children who were typically developing.

METHOD. Part 1 developed items and scoring criteria of the Test of Ideational Praxis (TIP) and examined interrater reliability and internal consistency. Part 2 studied performance of 80 typically developing children between ages 5 and 8 years.

RESULTS. The TIP demonstrated acceptable interrater reliability (ICC = .85) and internal consistency (coefficient alpha = .74). Children who were typically developing demonstrated age and gender trends. Girls scored higher than boys, and older children scored higher than younger children.

CONCLUSION. The TIP is the first objective assessment for identification of ideational abilities and is a reliable assessment tool. Further research is needed to validate the construct of ideation and examine the TIP’s ability to discriminate between children with and without ideational difficulties.
The Effect of Sound-Based Intervention on Children With Sensory Processing Disorders and Visual–Motor Delays
Authors: Hall Leah , Case-Smith Jane
Published: October 2011

This study investigated the effects of a sensory diet and therapeutic listening intervention program, directed by an occupational therapist and implemented by parents, on children with sensory processing disorders (SPD) and visual–motor delays. A convenience sample was used of 10 participants, ages 5 to 11 years, with SPD and visual–motor delays. In the first phase, each participant completed a 4-week sensory diet program, then an 8 week therapeutic-listening and sensory diet program. The Sensory Profile was completed by the participants’ parents before and after both study phases. The Draw-A-Person test, Developmental Test of Visual Motor Integration (VMI), and Evaluation Tool of Children’s Handwriting (ETCH) were administered before and after each phase. Over 12 weeks, the participants exhibited significant improvement on the Sensory Profile, increasing a mean of 71 points. Parents reported improvements in their children’s behaviors related to sensory processing. Scores on the VMI visual and ETCH legibility scales also improved more during the therapeutic listening phase. Therapeutic listening combined with a sensory diet appears effective in improving behaviors related to sensory processing in children with SPD and visual–motor impairments.
Occupational Therapy Using a Sensory Integrative Approach: A Case Study of Effectiveness
Authors: Schaaf Roseann C. , Nightlinger Kathleen McKeon
Published: October 2011

OBJECTIVE. This article presents a case report of a child with poor sensory processing and describes the disorder’s impact on the child’s occupational behavior and the changes in occupational performance during 10 months of occupational therapy using a sensory integrative approach (OT-SI).

METHOD. Retrospective chart review of assessment data and analysis of parent interview data are reviewed. Progress toward goals and objectives is measured using goal attainment scaling. Themes from parent interview regarding past and present occupational challenges are presented.

RESULTS. Notable improvements in occupational performance are noted on goal attainment scales, and these are consistent with improvements in behavior. Parent interview data indicate noteworthy progress in the child’s ability to participate in home, school, and family activities.

CONCLUSION. This case report demonstrates a model for OT-SI. The findings support the theoretical underpinnings of sensory integration theory: that improvement in the ability to process and integrate sensory input will influence adaptive behavior and occupational performance. Although these findings cannot be generalized, they provide preliminary evidence supporting the theory and the effectiveness of this approach.
Chronic Pain and Occupation: An Exploration of the Lived Experience
Authors: Fisher Grace S. , Emerson Linda , Firpo Camille , Ptak Jan , Wonn Jennifer , Bartolacci Gwen
Published: October 2011

OBJECTIVE. There is limited research on the relationship between chronic pain and occupation. This phenomenological research study explored the lived occupational experiences of people who have chronic pain.

METHOD. Via demographic questionnaires, semistructured interviews, and field notes, data were collected on 13 participants with various types of pain.

RESULTS. Thematic analysis yielded one main theme: “Chronic Pain Is Life Changing.” The following subthemes also emerged: “Chronic Pain Triggers Emotional Distress”; “Chronic Pain Reveals the Strength of Relationships”; “Chronic Pain and Occupation Are Reciprocally Related Forces”; and “Chronic Pain Elicits Innovative Adaptive Responses.” Study participants reported experiencing myriad troubling emotions; however, they resourcefully modified their routines and tasks and found enhanced meaning in favored occupations.

CONCLUSIONS. This study illuminates the importance of therapeutic listening, the innovativeness of people who have chronic pain, and the possible therapeutic potential of occupation.
The Lived Experience of Recapturing Self-Care
Authors: Guidetti Susanne , Asaba Eric , Tham Kerstin
Published: October 2011

This study sought to identify the characteristics of the lived experience of recapturing self-care after a stroke or a spinal cord injury (SCI). Five people who had had a stroke and six with SCI who were in the midst of recapturing self-care (1–3 months after onset) were interviewed. All interviews were analyzed using the Empirical, Phenomenological, and Psychological method. Four main characteristics were present among all of the participants’ lived experiences: (a) becoming familiar with the new body, (b) recapturing self-care through trying, (c) reclaiming control, and (d) feeling uncertainty in the continued recapturing process.

The findings indicate that a prerequisite for recapturing self-care was to get experience from doing to become familiar with the new body, which makes explicit the importance of enabling self-care in the rehabilitation process after stroke or SCI. The findings can be used in clinical practice to improve the understanding of how to better plan individualized self-care intervention.
Recovery After Hip Fracture: What Can We Learn From the Canadian Occupational Performance Measure?
Authors: Edwards Mary , Baptiste Sue , Stratford Paul W. , Law Mary
Published: October 2011

This study sought to determine the extent to which the Canadian Occupational Performance Measure (COPM) assessed performance in elderly people after hip fracture. Correlations were found between the COPM and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Although functional improvement was noted, participants did not attain the functional status they had before hip fracture. The greatest recovery occurred within the first 130 days after surgery. These findings suggest some central implications for occupational therapy practice, although further research is required to determine the optimal time for intervention to begin. Because the COPM is sensitive to change in function in patients recovering from hip fracture, COPM use with this population is desirable and advisable.
Evaluation of Computer-Access Solutions for Students With Quadriplegic Athetoid Cerebral Palsy
Authors: Man David W. K. , Wong Mei-Sheung Louisa
Published: October 2011

People with multiple physical impairments are not capable of using proper pointer devices, thus diminishing their opportunities to communicate and learn through computers. This research design used a replicated single-case experimental approach to compare the individual performance of two students with speech impairments and quadriplegic athetoid cerebral palsy in using four different computer-access solutions (the CameraMouse, the ASL Head Array mouse emulator, the CrossScanner, and the Quick Glance Eye Tracking System). The results demonstrate statistical significance in the correlation of movement time and accuracy to the level of comfort and satisfaction, which was used to guide the selection of computer-access solutions for clinical interventions. The WinFitts and Assessment of Comfort tests used in this study can be replicated for further clinical research into computer-access systems.
Bottle-Feeding Behaviors in Preterm Infants With and Without Bronchopulmonary Dysplasia
Authors: Howe Tsu-Hsin , Sheu Ching-Fan , Holzman Ian R.
Published: October 2011

OBJECTIVE. This study compared bottle-feeding behaviors in preterm infants with and without bronchopulmonary dysplasia (BPD) during the initial hospitalization.

METHOD. Individual sucking characteristics and feeding transitional rates were compared in 41 preterm infants (22 boys, 19 girls) with BPD and 99 infants (44 boys, 55 girls) without BPD. Observations of the first bottle feeding and observations of the last feeding before discharge were obtained from medical records of all infants retrospectively.

RESULTS. On discharge, infants with BPD, unlike those without BPD, continued to have an immature sucking pattern and required longer hospital stays to attain full oral feeding (p < .001). No differences were found between the BPD and non-BPD groups in time needed for feeding and use of oral support.

CONCLUSION. These results suggest that feeding transitional rate, rather than sucking pattern, may be a better discharge indicator for infants with BPD.
Reducing Tube Feeds and Tongue Thrust: Combining an Oral–Motor and Behavioral Approach to Feeding
Authors: Gibbons Bridget G. , Williams Keith E. , Riegel Katherine E.
Published: October 2011

OBJECTIVE. A treatment package combining oral–motor and behavioral interventions was implemented for a 6-year-old girl with Down syndrome referred to an intensive day treatment feeding program for gastrostomy tube dependence and food refusal. The participant exhibited a tongue thrust, resulting in the expulsion of all foods presented.

METHOD. An oral–motor procedure was used to reduce the tongue thrust and allow the food to be swallowed. This procedure was paired with positive reinforcement and escape prevention to increase oral consumption of liquids and solids. A multiple-probe design was used to evaluate treatment effectiveness.

RESULTS. By the end of treatment, tube feedings were eliminated and tongue thrust was significantly reduced.

CONCLUSION. This intervention demonstrated the successful combination of oral–motor and behavioral components in the treatment of a severe feeding problem. It could serve as a model for the development of future interventions.
Analysis of Proximal and Distal Muscle Activity During Handwriting Tasks
Authors: Naider-Steinhart Shoshana , Katz-Leurer Michal
Published: October 2011

OBJECTIVE. In this study we sought to describe upper-extremity proximal and distal muscle activity in typically developing children during a handwriting task and to explore the relationship between muscle activity and speed and quality of writing.

METHOD. We evaluated 35 third- and fourth-grade Israeli children using the Alef–Alef Ktav Yad Hebrew Handwriting Test. Simultaneously, we recorded the participants’ upper trapezius and thumb muscle activity by surface electromyography. Using the coefficient of variation (standard deviation divided by mean amplitude) as a measure of variability within each muscle, we analyzed differences in muscle activity variability within and between muscles.

RESULTS. The proximal muscle displayed significantly less variability than the distal muscles. Decreased variability in proximal muscle activity was associated with decreased variability in distal muscle activity, and decreased variability in the distal muscles was significantly associated with faster speed of writing.

CONCLUSION. The lower amount of variability exhibited in the proximal muscle compared with the distal muscles seems to indicate that the proximal muscle functions as a stabilizer during a handwriting task. In addition, decreased variability in both proximal and distal muscle activity appears to be more economical and is related to faster writing speed. Knowledge of the type of proximal and distal muscle activity used during handwriting can help occupational therapists plan treatment for children with handwriting disabilities.