bluuebunny/crossref_metadata_2025 huggingface dataset:
Validity of the Behavioral Inattention Test (BIT): Relationships With Functional Tasks
Authors: Hartman-Maeir Adina , Katz Noomi
Published: April 2012

Objectives. The Behavioral Inattention Test (BIT) is a standardized assessment for unilateral visual neglect. It comprises six conventional and nine behavioral subtests. The purpose of this study was to add to the validation of the behavioral subtests.

Method. Forty Israeli subjects with right cerebrovascular accident (CVA), from both day center and hospital settings, were evaluated on three measures: the BIT, performance tasks, and a checklist of activities of daily living (ADL).

Results. Seven of the nine BIT behavioral subtests differentiated significantly between subjects with visual neglect and those without neglect; six of the nine subtests correlated significantly with parallel performance tasks or ADL checklist items.

Conclusion. These results support the construct and predictive validity of most of the BIT behavioral subtests as functional measures of unilateral neglect, thus, the BIT is recommended for use by occupational therapists. Inclusion of a relative score for right and left omissions within the BIT is recommended.
Visual Perception and Praxis in Adults After Stroke
Authors: York Christine Draves , Cermak Sharon A.
Published: April 2012

Objectives. The purpose of this study was to examine the performance of persons with right cerebrovascular accident (RCVA) and persons with left cerebrovascular accident (LCVA) on a variety of measures of praxis and visual perception in order to examine the relative contributions of the left and right cerebral hemispheres to praxis and perception.

Methods. Forty-five subjects, 15 with RCVA, 15 with LCVA, and 15 without CVA (control subjects), were tested on three tests of praxis – praxic production, gesture comprehension, and gesture discrimination – and selected tests of visual perception, including the Judgment of Line Orientation Test, the Motor Free Visual Perception Test, the Hooper Visual Organization Test, and the Line Bisection Test.

Results. Subjects in both groups with CVA performed more poorly on all of the tests than did control subjects. The group with LCVA performed most poorly on tests of gesture comprehension and praxis production, whereas the group with RCVA performed most poorly on tests of gesture discrimination and visual perception.

Conclusion. These findings suggest that both the right and left cerebral hemispheres contribute to different aspects of praxis. Elements of visual perception may be related to gesture comprehension, gesture discrimination, and praxis production in adults who have had stroke. These findings have clinical implications regarding instructional style and perceptual and praxis training.
Innovation and Leadership in a Mental Health Facility
Authors: Cook Joanne Valiant
Published: April 2012

For 3½ years an occupational therapist persevered in efforts to introduce an innovative outpatient service of multidisciplinary team case management within a general community hospital. The service was intended to meet the needs of discharged clients with severe mental illnesses who were attempting to live successfully and satisfactorily in the community. The reality of attempting to initiate change in medical bureaucracies involves ongoing negotiation and persuasion, issues of power and politics, differing cultural visions, and strongly committed leadership. This case study describes the developmental process of innovation and the contribution of occupational therapy philosophy and practice to the therapist’s emergent leadership in promoting cultural change. Some of the lessons to be learned from this case study by others who would attempt institutional innovation include articulating a clear vision that uses new language, building coalitions, and being flexible and persistent.
Developmental Dyspraxia by Any Other Name: Are They All Just Clumsy Children?
Authors: Missiuna Cheryl , Polatajko Helene
Published: April 2012

The recent introduction of the diagnostic category developmental coordination disorder (DCD) (American Psychiatric Association [APA], 1987, 1994), has generated confusion among researchers and clinicians in many fields, including occupational therapy. Although the diagnostic criteria appear to be similar to those used to define clumsy children, children with developmental dyspraxia, or children with sensory integrative dysfunction, we are left with the question: Are children who receive the diagnosis of DCD the same as those who receive the other diagnoses, a subgroup, or an entirely distinct group of children? This article will examine the theoretical and empirical literature and use the results to support the thesis that these terms are not interchangeable and yet are not being used in the literature in a way that clearly defines each subgroup of children. Clear definitions and characteristic features need to be identified and associated with each term to guide occupational therapy assessment and clinical research.
Adults With Traumatic Brain Injury: Three Case Studies of Cognitive Rehabilitation in the Home Setting
Authors: Schwartz Susan Miron
Published: April 2012

This article discusses the use of occupational therapy in the home setting and the individual application of treatment methods. Three case studies are presented that involve adults with acquired brain injury with memory deficits. The treatment methods used were (a) saturational cuing with behavioral chaining and positive reinforcement, (b) a coordinated team approach incorporating family or significant others and other therapists, and (c) environmental adaptations. A decision-making model and the dynamic assessment approach were used as a framework for treatment planning.

The treatment technique chosen depended on the skill to be learned and the patient’s learning style. Each case required the selection of environmental adaptations including (a) use of family and attendants as cotherapists; (b) a tape-recorded message, played daily; and (c) an appointment book for daily things to do. Each case demonstrated prolonged therapy for skill acquisition with this patient population.
Families Who Live in Chronic Poverty: Meeting the Challenge of Family-Centered Services
Authors: Humphry Ruth
Published: April 2012

Family-centered occupational therapy services are based on a collaborative relationship that does not always come easily. Role performance in parenting a child with special needs and being a consumer of occupational therapy services can be partially understood in terms of environmental context. Although occupational therapists recognize the need to adjust services to the cultural and economic backgrounds of families, most of the available literature has examined the contribution of ethnic differences.

A particular challenge for occupational therapists may be treating clients and their families who live in chronic poverty. This article examines chronic poverty as it shapes parenting the child with special needs and subsequently the caregiver’s participation in occupational therapy services. A framework for understanding cultural differences is used to suggest constrasting value orientations between families who live with persistent poverty and occupational therapists. A family-centered approach challenges the professional to understand varied influences on caregiving. Suggestions are offered to enhance communication between therapists and caregivers.
A Study of the Development of Traits of Entry-Level Occupational Therapy Students
Authors: Donohue Mary V.
Published: April 2012

Objectives. This study compared the personality traits of entry-level occupational therapy students before and after their participation in 2 years of academic and clinical education in order to examine the change of traits in their professional personality profile.

Method. Forty-nine occupational therapy students completed the 18 scales of the California Psychological Inventory during their first fall and second spring semesters. This time span included two Level I and one Level II fieldwork experiences.

Results. T tests were used to analyze the students’ scales. Students’ scores in the second test showed a statistically significant increase in 13 of the 18 scales as compared to their first test scores. Achievement via independence and psychological-mindedness emerged as the highest ranking personality traits of the students in their second test scores.

Conclusion. The occupational therapy curriculum may have influenced the scores of the entry-level students, in both intellectual and psychosocial traits, in a positive direction.
The Profession’s Image, 1917–1925, Part I: Occupational Therapy as Represented in the Media
Authors: Ambrosi Elizabeth , Schwartz Kathleen Barker
Published: April 2012

This first part of a two-part article examines how occupational therapy was represented in the media during the formative years of the profession, 1917–1925. Through an examination of 44 articles published in The New York Times during these years, three common themes emerged: restoration of persons with disabilities to social usefulness, the many facets of occupational therapy, and achieving public recognition of occupational therapy. This analysis indicates that the media portrayed occupational therapy as a small but important profession primarily concerned with restoring patients to economic and social usefulness. This favorable portrayal was in keeping with the values of the times and may have contributed to promoting public acceptance of the profession.
Development of In-Hand Manipulation and Relationship With Activities
Authors: Humphry Ruth , Jewell Kaaren , Rosenberger Robin Cole
Published: April 2012

Objectives. This study examines the age-related increase of in-hand manipulation, the consistency of using a manipulation strategy, and the relationship between the frequency of in-hand manipulation and activities that typically require use of intrinsic hand control.

Method. Children (N = 184) between 2 years and 7 years of age were observed during selected activities that could elicit three forms of in-hand manipulation: rotation, finger-to-palm translation, and palm-to-finger translation. The child’s use of a manipulation strategy was recorded. Activities that required manipulation of objects including a spoon, buttons, and crayons were also observed.

Results. The study demonstrated that the frequency of two types of in-hand manipulation increases with age and illustrated the uneven nature of development of different types of in-hand manipulation. Even when the child had the ability, use of in-hand manipulation as a movement strategy was inconsistent. Small but significant relationships between in-hand manipulation skill and performance in selected activities were found when the effects of age were controlled.

Conclusion. On a practical level, the findings raise questions as to whether maturity of in-hand manipulation may be a factor limiting performance in the everyday activities of typically developing children.
Motor Problems in Children With Developmental Coordination Disorder: Review of the Literature
Authors: Willoughby Colleen , Polatajko Helene J.
Published: April 2012

Occupational therapists frequently work with children with developmental coordination disorder (DCD) in hopes of enhancing their occupational performance. There is debate among researchers and health care professionals about whether the motor coordination problems experienced by children with DCD have a physiological basis or whether they are the result of a developmental delay. Even among researchers who agree that these difficulties are of physiological origin, there is a lack of consensus as to whether these motor problems are multisensory or unisensory. This article focuses on the physiological explanation, presents a review of the literature on the possible physiological origins of motor coordination problems in children with DCD, and shows that the current literature on the physiological basis of DCD requires more empirical evidence to substantiate either multisensory or unisensory theories of motor dysfunction in children with DCD. The debate over the nature of motor problems in children with DCD has two implications for occupational therapists: that there is no one way to treat these children and that the cause of the difficulty varies from child to child.
Assistive Devices Used by Home-Based Elderly Persons With Arthritis
Authors: Mann William C. , Hurren Dianne , Tomita Machiko
Published: April 2012

Objective. This article examines assistive device use by home-based elderly persons with arthritis.

Method. Sixty-six persons were interviewed for the State University of New York at Buffalo (University at Buffalo) Rehabilitation Engineering Research Center Consumer Assessment Study, which sought information on need for and current use of assistive devices. Subjects were assigned to a moderate or a severe arthritis group according to the impact of arthritis on their activities.

Results. Subjects in the severe arthritis group had more chronic diseases, a higher level of pain, and a lower level of independence in self-care activities than subjects in the moderate arthritis group. Similarities between the groups included relatively poor health, high rate of medication use, depression, use of a high number of assistive devices (about 10 per person), and an expressed need for additional devices, such as reachers, magnifiers, grab bars, jar openers, and bearing aids. Generally, there was a high rate of satisfaction with the assistive devices used. Most subjects missed being able to participate in at least one activity; most of these activities were active and many related to leisure time.

Conclusion. Findings also revealed that subjects had inadequate information on assistive devices, which suggests the importance of more occupational therapy involvement with elderly persons in selecting devices.
Living With Low Vision: A Personal and Professional Perspective
Authors: Rosenthal Sally Bennett
Published: April 2012

Unlike most readers of this special issue, I have been both a consumer and provider of rehabilitation services. A retinal hemorrhage that occurred when I was in my late twenties signaled the beginning of delayed-onset retinopathy of prematurity–a condition that has been further complicated since that time. In this article, I offer a glimpse of what living with low vision is like by describing activities in my own life and accommodations I have made. My hope is that therapists will learn more about the realities of living with low vision and will seek our additional information that they will incorporate into their practice.
Basic Concepts and Terms for Low Vision Rehabilitation
Authors: Colenbrander August , Fletcher Donald C.
Published: April 2012

As the involvement of occupational therapists in the rehabilitation of people with visual impairments increases, it is important for all professionals involved to communicate clearly by using the most accurate terminology. This article suggests the most appropriate use of terms and concepts. It recommends that the distinctions between the various aspects of vision loss be recognized and that the old dichotomy of legally blind versus legally sighted be replaced by the more detailed classification of the International Classification of Diseases, 9th version, Clinical Modification (ICD-9-CM), Which recognizes multiple levels of visual performance.
Functional Considerations in Evaluation and Treatment of the Client With Low Vision
Authors: Lampert Jessica , Lapolice Deborah J.
Published: April 2012

In evaluating and treating clients who have low vision, the occupational therapist must consider factors in addition to typical measures of the client’s visual acuity, field loss, and oculomotor control. It is important to consider the functional implications of the client’s ocular pathology, including illumination needs, contrast sensitivity, sensitivity to glare, and need for magnification as well as environmental factors such as the amount of pattern in a visual task, the amount of lighting and contrast available, and the conditions under which the task is performed. These factors are all relevant to occupational therapy low vision rehabilitation because each may influence the way in which a client uses his or her residual vision and achieves successful adaptation. This article provides an overview of these factors and presents a suggested protocol for evaluation of the client with low vision.
Occupational Therapy and the Person With Diabetes and Vision Impairment
Authors: Cate Yolanda , Baker Shelley Sikes , Gilbert Mary Pat
Published: April 2012

Diabetes affects 5.2% of the population; many of those persons experience loss of vision as one complication of the disease. Occupational therapists are treating these persons, often for other resulting complications (such as stroke or amputations), or are being asked to adapt techniques or equipment (such as insulin-drawing devices) needed for diabetes management.

Because no guidelines exist for occupational therapy with persons with diabetes or vision loss or both, occupational therapists may be unsure of appropriate treatment approaches. Among the approaches described in the occupational therapy literature, common ones include collaboration with other professionals and incorporation of one or more aspects of the diabetes regimen into the person’s life-style.

When addressing persons who have both diabetes and vision loss, therapists consider their own knowledge base as well as the persons’ needs in managing their diabetes. Treatment ideas include enhancing the visual environment or incorporating tactile and auditory feedback with self-management tasks such as testing blood glucose levels. Collaboration with and referral to diabetes and low-vision professionals are adjuncts to therapy and ensure a comprehensive and ongoing diabetes management program.
A Comparison of Performance in Added-Purpose Occupations and Rote Exercise for Dynamic Standing Balance in Persons With Hemiplegia
Authors: Hsieh Ching-Lin , Nelson David L. , Smith Doris A. , Peterson Cindee Q.
Published: April 2012

Objectives. Adding purpose to daily occupations to promote performance is a basic premise of occupational therapy. This study investigated the hypothesis that in persons with hemiplegia, two added-purpose occupations would elicit more exercise repetitions than a rote exercise.

Method. In a counterbalanced order, 21 subjects with hemiplegia, aged 51 to 78 years, experienced all three conditions of a dynamic standing balance exercise that involved bending down, reaching, standing up, and extending the arm. One condition of added purpose involved the use of materials (small balls and target); a second added-purpose condition involved the subjects’ imagination of the small balls. The third condition was the rote exercise without added purpose.

Results. A one-way analysis of variance for related measures indicated that the subjects performed significantly differently in each of the three conditions (p < .001). A Tukey multiple comparison test revealed that the subjects did significantly more exercise repetitions in the added-materials condition and in the imagery-based condition than in the rote exercise condition (p < .05).

Conclusion. This study demonstrates how added purpose can enhance motor performance in persons with hemiplegia. Purpose may be effectively added to an exercise through the use of materials or imagery.
Therapeutic Occupation: A Definition
Authors: Nelson David L.
Published: April 2012

This article builds on prior work and defines terms basic to the profession of occupational therapy. The prior work defined occupation as the relationship between occupational form and occupational performance and defined related terms, such as meaning, purpose, developmental structure, impact, and adaptation. This article shows how these terms relate to therapeutic occupation, a special type of occupation. Therapeutic occupation through occupational synthesis is the core of occupational therapy. Occupational synthesis is the design of the occupational form by the occupational therapist in collaboration with the recipient of services to advance therapeutic evaluation or achieve a therapeutic goal. Therapeutic occupation, then, is meaningful, purposeful occupational performance leading to assessment, adaptation, and compensation, all in the context of occupational synthesis. Finally, the idea of therapeutic occupation through occupational synthesis is related to frames of reference and models of practice in occupational therapy today.
A Comparison of Verbal Evaluation of Clients With Limited English Proficiency and English-Speaking Clients in Physical Rehabilitation Settings
Authors: Wardin Karen
Published: April 2012

Objectives. Recent literature has emphasized collaborative goal setting between therapists and clients and has sought to increase therapists’ awareness of treating in cross-cultural settings. How occupational therapists verbally evaluate clients with limited English proficiency (LEP) is important to these topics and underdeveloped in the literature.

Method. Seventy-four occupational therapists working with adult clients with LEP in physical rehabilitation settings in large U.S. metropolitan areas were surveyed to discover the time taken, methods used, and themes surrounding verbal evaluation, including use of translators and respondents’ linguistic abilities. A follow-up telephone interview of 12 survey respondents clarified these discoveries.

Results. Respondents reported taking 11.5 min more to verbally evaluate clients with LEP than for English-speaking clients and reported understanding the treatment needs of clients’ with LEP after verbal evaluation less well. Respondents with higher abilities in second languages reported better understanding of clients’ needs than monolingual respondents.

Conclusion. Methods for cross-lingual verbal evaluation need to be identified so that therapists can collaborate with clients with LEP in planning culturally sensitive treatment.
Improving Sexual Rehabilitation Services: The Patient’s Perspective
Authors: McAlonan Sally
Published: April 2012

Objectives. The purpose of this study was to examine, from the perspective of persons with spinal cord injury (SCI), the efficacy of sexual rehabilitation services. This input was sought to provide relevant information for enhancing services and for purposes of curricular planning.

Method. Data from 12 persons with SCI were gathered through interviews. Qualitative methodology was used to analyze interview transcripts. The results were categorized into the following themes: descriptions of sexual rehabilitation services received, evaluation of services received, and recommendations for improving services.

Results. The majority of participants reported receiving some type of sexual rehabilitation services, but many reported dissatisfaction with the quality and quantity of sexuality-related services received. A complex interplay of factors such as age, gender, severity of injury, time since injury, mood, sexual experience before injury, and marital status seemed to influence the participants’ needs, preferences, and readiness for these services.

Conclusion. The results provide information about how future services can be improved and what benefits and limitations exist in the role of occupational therapy in sexual rehabilitation.
How Forearm Position Affects Grip Strength
Authors: Richards Lorie Gage , Olson Bonni , Palmiter-Thomas Pamela
Published: April 2012

Objective. Several studies have indicated that changing body positions results in altered grip strengths. Although one might expect that grip strength would be influenced by the position of the forearm during gripping due to the biomechanical properties of the forearm and hand muscles, no investigations of this variable have been undertaken.

Method. This study examined the effect on grip strength of moving the forearm among supinated, neutral, and pronated positions while maintaining the standard position recommended by the American Society of Hand Therapists. The mean of three grip trials in each position was recorded for each of 106 subjects.

Results. Grips in forearm supination were the strongest, followed by grips in the neutral position. Grips in pronation were the weakest.

Conclusions. The changes in grip strength observed with variations in forearm position further support the necessity of a standard position for testing grip strength. The knowledge of how changes in body position affect the strength of the grip can be used to design environments and tools to maximize biomechanical abilities.
Life-Style Performance: From Profile to Conceptual Model
Authors: Fidler Gail S.
Published: April 2012

The Life Style Performance Model provides a framework for knowing and understanding a person’s total activity repertoire within the context of his or her human and nonhuman world .The model enables occupational therapy practitioners to gain a holistic perspective, thus ensuring that interventions will have more clearly discernible relevance to individual needs, interests, capacities, and self–other expectations. It presents a way of conceptualizing the interrelatedness of person, environment, activity profile, and quality of life. This article addresses these dynamic relationships in a manner that makes it possible to plan and implement interventions that hold maximum potential for eliciting and sustaining a person’s intrinsic motivation to pursue an evolving life-style optimally satisfying to self and significant others.
The Effects of a Prefeeding Stimulation Program on Preterm Infants
Authors: Gaebler Christine P. , Hanzlik Jodie Redditi
Published: April 2012

Objective. This study examined the effects of stroking and a perioral and intraoral prefeeding stimulation program on healthy, growing, preterm infants in a Level II special care nursery. Only infants without cardiac, gastrointestinal, or central nervous system problems were included in the study.

Method. Two groups of nine randomly assigned, medically stable preterm infants, born between 30 weeks and 34 weeks gestation, were selected for the study. All infants were introduced to nipple feeding at approximately 34 weeks postconceptual age. The infants in the control group received a 5-min stroking protocol before feeding; the infants in the experimental group received a 5-min stroking protocol in addition to a perioral and intraoral stimulation program.

Results. Compared with the control group, the experimental group had a decreased number of gavage feedings, greater weight gain, and fewer days of hospitalization. The experimental group also had higher scores on the Revised-Neonatal Oral Motor Assessment nutritive suck scale than the control group.

Conclusion. On a preliminary basis, the findings from this study establish the efficacy of occupational therapy in a Level II special care nursery for healthy, growing, preterm infants. Further, the specific treatment strategies conducted with the infants receiving the experimental procedures have also been preliminarily established as effective in enhancing the infants’ feeding skills, resulting in weight gain and decreased hospital stays as compared with their counterparts in the control group. However, our findings cannot be generalized to preterm infant populations who are at greater medical risk than the infants in our study because of the potentially hazardous effects that could result. Implications of the results for intervention programs and future research are discussed.
Perceptions of Computer Literacy Among Occupational Therapy Students
Authors: Williams Adelle M. , Agho Augustine O. , Holm Margo B.
Published: April 2012

Objective. Educational programs for the occupational therapist and the occupational therapy assistant are mandated to include content on technologies in their curricula. Given the increasing use of technology skills among occupational therapists, especially computer technology skills, it seemed judicious to ascertain the current and desired levels of skill of occupational therapy students as well as their opinions about computer technology.

Method. Program directors from five baccalaureate-level curricula distributed the Computer Opinion Survey and the Computer Knowledge Survey to 109 junior and senior occupational therapy students. The students were instructed to complete and return questionnaires to their program directors who, in turn, forwarded the questionnaires to the principal investigators.

Results. Respondents were generally positive about computer technology, and the level of knowledge they desired about computer technology applications in occupational therapy was much greater than their current level of knowledge. Although respondents’ positive attitudes were significantly correlated with their current levels of computer knowledge, no significant relationship was established among positive attitudes, current levels of computer knowledge, and number of computer courses completed before entering an occupational therapy curriculum.

Conclusions. Even though the respondents were computer literate (i.e., they had a general working knowledge of the uses, limitations, and impact of computers), no relationship was established between their previous computer course work and their current knowledge of the use of computer technology in occupational therapy. The linkage between generic computer literacy and knowledge of its relationship to the use of computer technology in occupational therapy was not evident to this sample of junior and senior students.
The Use of Drama and Puppetry in Occupational Therapy During the 1920s and 1930s
Authors: Phillips Mary Ellen
Published: April 2012

The occupational therapy literature was reviewed to determine how drama was used as a clinical modality in the 1920s and 1930s. It appears that the emergence of the Little Theater Movement in the early 1900s, which enabled amateurs to perform publicly, provided the impetus for occupational therapists to use drama as purposeful activity. The theatrical modes most frequently used were pageantry, puppetry, and comedic plays. Additionally, the collective nature of drama facilitated group-centered treatment. Noble, a psychiatrist at Sheppard and Enoch Pratt in Maryland, used drama for insight-oriented therapy and recommended that occupational therapists use drama for treatment of persons with mental illness. Drama in occupational therapy still exists in some psychiatric settings, although a new discipline known as drama therapy, which is a division of the creative arts therapies, has arisen. Although drama therapy addresses psychodynamic goals, drama also can be used in occupational therapy to promote competence, enhance self-concept, and improve socialization.
The Other Side of the Coin: Growing Up With a Learning Disability
Authors: Fanchiang Shan-Pin C.
Published: April 2012

This study is a narrative analysis of the life history of Dale, a 25-year-old man with a learning disability who received sensory integrative treatment in early childhood. The analysis revealed that Dale’s self likely developed through occupational engagement with three interconnected themes: “my mother said” and “parental tricks”; “adrenaline surges” and “hell-raising”; and work, “deal making,” and self-construction. These themes depict Dale’s self-construction, character development, occupation selection, and adaptation. In addition, these themes revealed how his parents used principles based on his sensory needs and learning problems to organize his childhood occupations and assist with his adaptation. The concept of occupational metamorphosis is also proposed to describe a person’s search for and selection of occupations that satisfy biological and sensory needs. This study supports the idea that the complex nature of adaptation can be revealed through an occupational history, and that adaptation is multifaceted and not absolute.
Jenny’s Story: Reinventing Oneself Through Occupation and Narrative Configuration
Authors: Price-Lackey Pollie , Cashman Jenny
Published: April 2012

Two life history interviews were conducted to discover how one woman, Jenny, experienced a traumatic head injury, rehabilitation, and recovery. Narrative analysis of the transcribed interviews revealed a rich story of how Jenny had fashioned her identity and character through childhood occupations, including studying classical literature and music, and of how she drew upon resources developed in childhood to engineer her recovery. It also illustrated how Jenny used a recursive process of narrative construction and engagement in self-devised graduated occupations, including studying, playing music, writing, computer graphics, and theater production, to create a new identity and develop capacities to process complex information and exercise creativity.

Jenny’s story illustrates the usefulness of gaining a perspective on patients as occupational beings through the gathering of life histories focused on occupation, the importance of collaborative patient-therapist goal setting, and the necessity for considering both the doing (practic) and the meaning (narrative) aspects of occupation. Her story supports many scholars’ arguments that the therapeutic relationship, and thus occupational therapy practice, may be enhanced through the use of life history interviewing in occupational therapy evaluation and treatment.
Perceptions and Experiences of Occupational Therapists in Rural Schools
Authors: Wills Karen , Case-Smith Jane
Published: April 2012

Occupational therapy practice in rural schools is influenced by a number of factors unique to rural settings, such as geographic barriers, cultural diversity, limited access to external resources, and lack of personnel with specialist skills. The purpose of this ethnographic study was to identify the unique experiences of occupational therapists who practice in rural schools and to explore how they perceived their roles in rural schools. Six occupational therapists were interviewed and observed in the field. Analysis of interview data revealed five themes: (a) jack-of-all-trades, which described how the participants viewed themselves as generalists; (b) bridging the span between services, which described their roles in coordinating the students’ medical services, which tended to be disjointed; (c) the world can get kind of lonely out there, which described the sources of support seen as reducing their sense of isolation; (d) trust and teaming, which described their attempts to provide an integrated intervention service and the challenges they faced; and (e) I cannot do it all, but I wish I could, which described how they selected their service delivery models to meet the demands of their practice. The participants believed that their work in rural schools required creativity, resourcefulness, and self-reliance. These characteristics, as well as support from their colleagues, were important to coping with the challenges of practice in rural schools.
Occupational Therapy Task Observation Scale (OTTOS)©: A Rapid Method for Rating Task Group Function of Psychiatric Patients
Authors: Margolis Russell L. , Harrison Sharon A. , Robinson Hilary J. , Jayaram Geetha
Published: April 2012

Objective. We designed a simple rating instrument, the Occupational Therapy Task Observation Scale (OTTOS)©, to facilitate evaluation and documentation of patient performance during occupational therapy task groups and to improve the communication between occupational therapists and other treatment team members.

Method. After analysis of other rating instruments, a preliminary version of OTTOS was designed, extensively field tested, and further modified. Interrater reliability was determined, and validity was tested against three established rating instruments: the Bay Area Functional Performance Evaluation, the Comprehensive Occupational Therapy Evaluation Scale, and the Milwaukee Evaluation of Daily Living Skills.

Results. The final version of OTTOS contains two parts, 10 items for evaluation of specific task functions and 5 items for rating general behavior. Field use demonstrated that the scale successfully tracked changes in functional capacity and included most facets of patient function evaluated during task groups. Use of OTTOS required minimal training, and scoring required less than 2 min for each patient. The correlation between the scores of experienced occupational therapists was high (.92 for the total scores). The correlation between OTTOS and the other rating instruments ranged from .880 to .340; the highest correlations, as expected, were with test subscales that most closely resembled OTTOS.

Conclusion. Preliminary data indicated that OTTOS offers a reliable and valid method for rapidly rating the function of patients with psychiatric illness attending task groups. In addition, use of OTTOS improved the communication between occupational therapists and other health care providers, facilitated the education of occupational therapy students, and met the documentation requirements of third-party payers.
Managed Care Fundamentals: Implications for Health Care Organizations and Health Care Professionals
Authors: Landry Charles , Knox Joe
Published: April 2012

Managed care is changing our health care delivery system as radically as the computer chip has changed telecommunications. Health care professionals and organizations that do not understand managed care’s implications will not be prepared for the future. For example, one implication of managed care is payment capitation, which is the transfer of financial risk from the insurer to the provider. As a result, health care providers, including occupational therapy professionals, need to be better managers of scarce resources by recognizing the cost implications among various alternative procedures while still delivering quality care. Under managed care with capitation, occupational therapists will need to learn to provide services within the parameters of a fixed budget, requiring reengineering of the therapies and processes of care and a considerable reduction in the procedures and modalities for any given treatment or therapy. As a result, patients will be required to do more for themselves, and occupational therapists will have to become better patient educators and motivators. Additionally, managed care will require changes in professional curriculums, emphasis through continuing education, and assimilation of better cost information to practitioners to facilitate decision making. Implications of managed care other than payment capitation are assigning to enrollees a gatekeeper who is responsible for limiting access to costly specialty services, practicing utilization review to audit usage patterns and provide constructive recommendations to reduce costs and improve service quality, and forming networks and associations among medical providers for developing economies of scale and providing an integrated continuum of health care services to enrollees.
Interest Among Occupational Therapy Managers in Measuring Workload for Case Costing
Authors: Cockerill Rhonda , Scott Elizabeth , Wright Maureen
Published: April 2012

Objectives. Interest in costing health care delivery on an individual case basis has increased in recent years as concern with overall health care costs has heightened. Costing exercises have been largely oriented around medical classification systems. Measures to incorporate the contributions of allied health activities such as occupational therapy are relatively recent. The objective of this study was to examine the attitudes and opinions of senior occupational therapy managers toward workload measurement on the basis of case mix.

Method. A survey was sent to all 198 senior occupational therapy managers in accredited Canadian facilities, which was completed by 182 respondents for a response rate of 92%. The questionnaire asked about workload measurement system(s) currently used, satisfaction with the system(s), and needs and expectations of workload systems in general.

Results. The majority of respondents were using a time recording workload measurement system and expressed relatively low levels of satisfaction with it. Current systems were unable to provide costing data, which respondents ranked as very important for themselves as managers. The majority of respondents believed that it would be useful or very useful to be able to cost occupational therapy services by a diagnostic grouping system and to establish standard protocols per diagnosis, standard times per procedure per institution, and standard times per procedure for the profession.

Conclusion. There is support for developing or expanding current methods of measuring workload. Senior occupational therapy managers would like to be able to predict their workload prospectively, a step that will accommodate the move toward case costing and program management.
The Experience of Head Injury on the Impairment of Gender Identity and Gender Role
Authors: Gutman Sharon A. , Napier-Klemic Jeanette
Published: April 2012

Objectives. This study explored the disruption of gender identity and gender role as a result a traumatic brain injury (TBI).

Method. Four adults (two men, two women) who sustained a TBI between the ages of 18 and 30 years and were at least 1 year postinjury participated in six 1-hr interviews concerning changes in (a) perceived masculinity or femininity, (b) involvement in intimate relationships, (c) enactment of gender roles, and (d) organization of activities that support gender roles.

Results. The men expressed greater feelings of gender inadequacy postinjury than did the women and appeared to have greater difficulty resolving rites of passage (e.g., achievement of the adult work role, marriage, parenting) and developmental issues characteristic of the life stage at which they experienced their injury. The men appeared to depend more heavily on traditional gender-specific activities before and after injury to define and support gender role; the women relied more on cross-gender activities. The women appeared to be able to maintain more preinjury activities postinjury than did the men.

Conclusion. Postinjury possession of a personally satisfying sense of gender appears to be related to the ability to maintain much of the preinjury activities that defined and supported the participants’ sense of masculinity or femininity. The ability to satisfactorily resolve rites of passage or developmental issues characteristic of the life stage at which the brain injury occurred appears to be related to the ability to participate in activities that define and express gender role during that particular life stage.
Reliability of Potential Clinical Measures of Muscle Tone in the Elbows of Patients After Stroke
Authors: Worley J. Scott , Harmon Nan , Miller Georganna J. , Hollis Sharon Bowen , Harlow Sue , Briggs Vickie
Published: April 2012

Objectives. This study investigated the reliability of joint resting position (EJP), resistance to passive movement (ERM), and the angle of appearance of the resistance (EAR) as measures of muscle hypertonus of elbow flexors in patients after stroke. Previously, similar measures had been found reliable when applied to measuring shoulder and wrist hypertonus in patients after stroke.

Method. Forty-five subjects with stroke were randomly selected from occupational therapy admissions at two rehabilitation centers. Tone of elbow flexors was measured twice at the same sitting by two examiners. EJP and EAR were measured with a goniometer, and ERM was measured with a resistance rating scale. Correlations were calculated between first and second measurements by center and by high tone and poor upper extremity function subgroups (with correction for multiple correlations) to determine reliability.

Results. Each of the three measures was highly reliable as demonstrated by a high correlation in at least one of the subgroups (Center 1: EJP, r =.964 for high tone subgroup; ERM, r =.789, EAR, r =.902, both in poor upper extremity function subgroup; and Center 2: EJP, r =.892, ERM, r =.938, both in poor upper extremity function subgroup; EAR, r =.666 for all subjects; all p values < .05). Correlations were especially high when data for subjects with high upper extremity function were eliminated.

Conclusion. Reliability of these three methods of measuring upper extremity muscle tone enhances their usefullness as well as therapists’ confidence in their judicial application.
The Historical Development of Neuroscience in Physical Rehabilitation
Authors: Cohen Helen , Reed Kathlyn L.
Published: April 2012

Neuroscience and occupational therapy in physical rehabilitation have developed along parallel tracks. As physicians began to study the neural bases of motor control, they also began to reconsider the sequelae of “hopeless” diagnoses as conditions that they could influence. This change in some phyicians’ understanding of the neural mechanisms of motor control influenced other clinicians’ ideas about patient care. Early work on treatment of patients with cerebral palsy and polio led to improvements in treatment approaches used to facilitate motor skill and functional motor ability in patients with upper motor neuron disorders. From the 1950s to the present, therapists have refined their treatment techniques as knowledge from neuroscience has become available. A few therapists, who are gradually increasing in number, have turned to the laboratory to study basic neuroscience problems that affect clinical treatment. This article describes the development of neuroscience research and neurorehabilitation theories and indicates common themes.
Work and Leisure: Transcending the Dichotomy
Authors: Primeau Loree A.
Published: April 2012

The contribution of a balance of work and leisure to health and a sense of well-being is a common sense assumption in everyday knowledge as well as in occupational therapy. The impact of the organization and balance of occupations in daily life on health, adaptation, life satisfaction, and a sense of well-being are central issues in occupational science. One of occupational science’s potential contributions to society is the ability to provide understanding and insights that transcend common sense assumptions and everyday knowledge about occupations. This article will address, through a review of the literature, some of the limitations inherent in belief about a healthy balance of work and leisure. It will demonstrate how distinctions between work and leisure are culturally bound and perpetuate the assumption that they are dichotomous experiences. This dichotomy is shown to be a false one and must be transcended in order to explore the question of what is a healthy balance within daily life. This article concludes with consideration for occupational therapy research and practice that may arise from transcendence of the dichotomy of work and leisure.
Legitimizing Occupational Therapy’s Knowledge
Authors: Wood Wendy
Published: April 2012

Proceeding from the ethic that occupational therapy is the rightful keeper of its own practice and knowledge, this article strives to bring the profession’s knowledge concerning the role of occupation in adaptation into sharp relief. Knowledge generated by many occupational therapists represented in the profession’s historic literature, scholarship, practice models, position papers, and research is analyzed through a heuristic framework that distinguishes the process from the state of adaptation. This analysis offers evidence that, in the service of persons with profound and often medically incurable disabilities, occupational therapy has begun to explicate the role of occupation as a vital adaptive medium and cornerstone of quality in daily living. Related areas of knowledge development in which legitimate progress can be claimed are suggested. Nevertheless, it is argued that occupational therapy’s knowledge must be further developed and its societal value better communicated through the concerted efforts of all practitioners, educators, and researchers.