bluuebunny/crossref_metadata_2025 huggingface dataset:
Why the Profession of Occupational Therapy Will Flourish in the 21st Century
Authors: Nelson David L.
Published: October 2011

The use of occupation as a therapeutic method is the essence of the profession of occupational therapy. This core of therapeutic occupation is flexible across cultures, times, health care environments, and different philosophies of the nature of the human being. Given this adaptability, the profession espouses diverse models of practice—the multiple frames of reference that guide therapeutic occupation for different populations in different settings. Across the history of the profession, therapeutic occupation has been the common core of otherwise different approaches to intervention. Although each of the many past and current models of practice has a different viewpoint, the common factor is the synthesis of occupational forms designed to elicit meaningful and purposeful occupational performance. Occupational synthesis is the essential act of the occupational therapist. It is necessary that occupational therapists confirm the power of therapeutic occupation through research that examines the profession’s central principles. Occupational therapists are also urged to use the term occupation consistently and proudly in their interactions with recipients of therapy, fellow health care professionals, and each other. The profession of occupational therapy will flourish because occupation, its core, is so basic to human health yet so flexible, depending on the needs of the individual human being.
Equivalence Reliability of the Functional Independence Measure for Children (WeeFIM®) Administration Methods
Authors: Sperle Patricia A. , Ottenbacher Kenneth J. , Braun Susan L. , Lane Shelly J. , Nochajski Susan
Published: October 2011

Objective. This study examined the equivalence reliability of two administration methods for the Functional Independence Measure for Children (WeeFlM®). The two methods were direct observation of child performance and parental interview.

Method. Thirty children between the ages of 19 months and 71 months with identified developmental disabilities were included in this study. The direct observation and interview methods were administered in random order to each subject within a 3-week period. The direct observation was completed in the educational setting, and the WeeFIM interview was obtained by either in-person interview or telephone interview with the parent.

Results. The intraclass correlation coefficient (ICC) for total WeeFIM ratings was .93, indicating consistency between the two administration methods. Analysis of the WeeFIM Motor (13 items) and Cognitive (5 items) domains yielded ICC values of .93 and .75, respectively, suggesting greater consistency for items measuring motor related skills.

Conclusion. The results demonstrate good agreement for total ratings when the WeeFIM is administered by direct observation and by interview with a parent. The findings establish the clinical usefulness of information collected by clinical interview.
The Model of Functional Deficits Associated With Hallucinations
Authors: MacRae Anne
Published: October 2011

Objectives. The Model of Functional Deficits associated with hallucinations is used as part of the clinical documentation in the San Jose State University Psychosocial Occupational Therapy Clinic. On the basis of this model, hallucinations are classified according to functional deficits and whether the deficits are a result of the content or intrusiveness of the hallucinations. This classification is important because it helps occupational therapists know the full extent of the dysfunction through understanding the underlying pathology. The purpose of this classification is to assist in the development of clinical treatment plans that incorporate techniques for coping with hallucinations.

Method. The sample included 39 clients seen in the clinic over a 4-year period. Student occupational therapists were responsible for documenting the classifications using the Model of Functional Deficits associated with hallucinations. The clients’ charts were then reviewed retrospectively to classify the hallucinations according to the clients’ functional deficits. The classification system ranged from Class 0, insufficient information, to Class VI, persistent hallucinations with profound functional deficits. With these classifications, interventions were planned with the clients in order for them to practice coping mechanisms (e.g., self instruction, decreased stimulation, increased stimulation) to maintain function during their hallucinations.

Results. The findings indicated that 54% of the clients continued to experience hallucinations (i.e., Class II–Class V), although all received psychotropic medication, thus necessitating continuing therapeutic intervention.

Conclusion. This model helps identify specific client experiences that can then be used to develop occupational therapy interventions.
The Impact of the Classroom Environment on Defining Function in School-Based Practice
Authors: Orr Catherine , Schkade Janette
Published: October 2011

Objective. Whether the environment is stressed in function–dysfunction decisions appears to depend on where in the hierarchy of components of complex tasks and of role skills the evaluating therapist is focused. This study examined the intervention planning decisions of occupational therapists who used the Model of Student Role Adaptation, which emphasizes the complex tasks involved in the student role. The purpose of the study was to determine whether these therapists were responding to environmental demands in planning their interventions.

Method. Special education teachers selected tasks that they believed were the most essential for student functioning within their classroom environments. These selections were compared with the goals and objectives developed by occupational therapists who serve children in these settings.

Results. Chi square analysis indicated a significant relationship between tasks designated by the teacher participants as environmental demands and those included in occupational therapy intervention planning.

Conclusion. The results suggest that the occupational therapist participants were responding to the environmental demands of the classroom when constructing their intervention plans.
The Interest Checklist: A Factor Analysis
Authors: Klyczek James P. , Bauer-Yox Nancy , Fiedler Roger C.
Published: October 2011

Objective. The purpose of this study was to determine whether the 80 items on the Interest Checklist empirically cluster into the five categories of interests described by Matsutsuyu, the developer of the tool.

Method. The Interest Checklist was administered to 367 subjects classified in three subgroups: students, working adults, and retired elderly persons. An 80-item correlation matrix was formed from the responses to the Interest Checklist for each subgroup and then used in factor analysis model to identify the underlying structure or domains of interest.

Results. Results indicated that the Social Recreation theoretical category was empirically independent for all three subgroups; the Physical Sports and Cultural/Educational theoretical categories were empirically independent for only the college students and working adults; and the Manual Skills theoretical category was empirically independent for only the working adults.

Conclusion. Although therapists should continue to be cautious in their interpretation of patients’ Interest Checklist scores, the tool is useful for identifying patients’ interests in order to choose meaningful activities for therapy.
Therapists’ Consistency in Following Their Treatment Plans for Sensory Integrative and Perceptual-Motor Therapy
Authors: Humphries Thomas W. , Snider Laurie , McDougall Beth
Published: October 2011

Objectives. Treatment integrity is concerned with whether treatment conditions as provided are consistent with specifications for the treatment. Therapists’ consistency in following their treatment plans that called for the use of sensory integrative and perceptual-motor techniques was evaluated.

Method. Three occupational therapists were rated on their consistency in 46 sessions each of sensory integrative and perceptual-motor therapy. Ratings were made both earlier (1 month) and later (4 months) in treatment. Consistency was rated with a five-point scale for 10 categories of the treatment plans.

Results. Overall consistency did not differ significantly (86% for sensory integrative techniques and 79% for perceptual-motor techniques). Perceptual-motor activities showed less consistency early in treatment but approached the level for sensory integrative techniques by later treatment sessions. Consistency differed significantly among therapists for sensory integrative activities that addressed tactile defensiveness and perceptual-motor activities associated with fine coordination and dexterity.

Conclusion. Despite the less structured, more child-centered nature of sensory integrative techniques, consistency in using these techniques was as high as that found for more scripted, program-centered, perceptual-motor techniques. Therapists reported that gaining the interest and attention of some children with the more structured perceptual-motor activities was more difficult early in treatment but could be achieved with time. Differences in consistency among therapists require verification with a larger sample.
Geriatric Occupational Therapy: The Uncertain Ideology of Long-Term Care
Authors: Hasselkus Betty Risteen , Dickie Virginia Allen , Gregory Cynthia
Published: October 2011

The search for the good life is used as a framework for understanding the meaning of geriatric practice to occupational therapists. Data consisted of a subset of phenomenological interviews drawn from a nationwide study of 148 occupational therapists in all areas of practice. Narratives of satisfying and dissatisfying experiences with older clients were analyzed to understand the uniqueness of therapists’ lived experiences in geriatrics. The realities of practice with older clients— the settings, the meanings and symbols of continuity in old age, and the older client’s uncertain future—merge to create an uncertain ideology in geriatric occupational therapy. We suggest that a fundamental task of occupational therapists in geriatrics, as they seek the good life for themselves and their older clients, is to reconcile the realities of practice with traditional rehabilitation ideologies by redefining themselves and their roles in practice.
Occupation as Spiritual Activity
Authors: Howard Brenda S. , Howard Jay R.
Published: October 2011

Although spirituality is rarely explicitly mentioned in the occupational therapy literature, it is implied as an interwoven part of the human system. This article explores the meaning of occupation in the context of sociological and Judeo–Christian theological frameworks and the meaning of spirituality in the occupational therapy clinic. A case is made for acknowledging spirituality in clinical reasoning as a centralizing component of the patient’s motivation and assignment of meaning to life.
Occupational Meanings and Spirituality: The Quest for Sobriety
Authors: Moyers Penelope A.
Published: October 2011

This article compares two differing models of intervention for persons with alcohol dependence—the Moyers Model for occupational therapy and Alcoholics Anonymous (AA). Both models were found to share practice strategies but to differ in their emphasis on spirituality and self-control. Additionally, the Moyers Model was basically procedural in its description of the clinical reasoning process, whereas AA places great emphasis on the spiritual aspects of recovery. Because this disparity may lead to confusion when the person with alcohol dependence is involved in both an occupational therapy program (using Moyers Model) and an AA program, the Moyers Model was revised to include a conditional reasoning structure (i.e., a process for therapists to help clients find meaning in actions). By providing opportunities to explore meaning through action during occupations, the revised Moyers Model is both more consistent with the AA principles of spiritual recovery and in keeping with the occupational therapy philosophy of addressing the needs of the whole person.
Religious Orientation and Pain Management
Authors: Low Jaclyn Faglie
Published: October 2011

Occupational therapists may find pain management less effective than anticipated for the patient’s condition. In exploring additional avenues of relief, it is important to look beyond physical agents. The therapist must sort physical, psychological, and spiritual components of pain to provide appropriate intervention or referral.

The interface between health care and religion is strongest at the point of confrontation with a life-changing event. Literature addressing the relationship between religious orientation and pain perception differentiates among major religions but not among differences in beliefs of diverse denominational groups. Understanding beliefs about pain may be indispensable to its effective management.

Productivity demands necessitate sensitivity to factors other than the physical in order to avoid ineffective treatment. The patient’s beliefs can be explored within the contexts of initial evaluation and the course of treatment. Knowledge of the mechanics of pain and treatment modalities can be augmented by awareness of the influence of beliefs on response to treatment.
A Consecutive Series of Adults With Brain Injury Treated With a Washing and Dressing Retraining Program
Authors: Giles Gordon Muir , Ridley Jonathan Edward , Dill Ann , Frye Susan
Published: October 2011

Objectives. Single-case reports indicate that behavioral methods can assist persons with brain injury to redevelop self-care skills. However, the proportion of patients who could benefit from these interventions is unknown. The present study used a specific retraining protocol to treat all patients admitted to a single facility over a 3-year period who were unable to wash and dress independently.

Method. Four patients out of 48 met the study criteria and were treated with the washing and dressing protocol. Three had traumatic brain injury, and one had brain injury after cerebral bleed. The training program involved behavioral observation, task analysis, consistent practice, and cue fading. The Adaptive Behavior Scale was used to measure behavior change.

Results. Three subjects achieved rapid independence in washing and dressing (20 days, 37 days, and 11 days of treatment), and one did not show significant clinical improvement.

Conclusion. All patients admitted to the facility during a 3-year period who required washing and dressing retraining were treated with the same protocol. The consecutive series design prevented researchers from selecting patients who they believed were good treatment candidates; therefore, the findings support the general applicability of the training program.
Therapists’ Perceptions of Pediatric Occupational Therapy Interventions in Self-Care
Authors: Swart Stacy Koser , Kanny Elizabeth M. , Massagli Teresa L. , Engel Joyce M.
Published: October 2011

Objectives. This study examined the congruence between pediatric occupational therapists’ self-care interventions and occupational therapy’s philosophical base, which focuses on performance of self-care skills as primary in evaluation and intervention.

Method. A questionnaire was mailed to 252 therapists serving children ages birth to 6 years. The questionnaire asked for therapists’ perceptions about the importance, uniqueness, and frequency of 10 areas of intervention, including self-care.

Results. Perceived importance of self-care was found to be strongly related to perceived frequency of self-care intervention. Practice setting was significantly associated with perceptions of uniqueness of self-care, and team membership status was significantly associated with importance of self-care. Most respondents perceived self-care intervention to be important (86%) and unique (80%) to occupational therapy. Seventy percent regularly provided intervention for self-care.

Conclusions. The therapists’ perceptions reflected continued regard for self-care as an important and unique area of pediatric occupational therapy but were somewhat discrepant with the actual frequency of self-care interventions.
Interrater Reliability of the Technology Team Assessment Process
Authors: Embleton Amy J. , Spencer Karen C.
Published: October 2011

Objective. This study examined the interrater reliability of the Technology Team Assessment Process (TTAP).

Method. Students ages 9 to 12 years who have learning disabilities received a TTAP assessment, which was videotaped. Five independent raters trained in the assessment process observed the videotapes and rated each student with the TTAP recording forms. Additionally, each rater made specific assistive technology recommendations on the basis of his or her evaluation.

Results. lntraclass correlation coefficients revealed that only one of four sections of the TTAP investigated had low to moderate interrater reliability for the students evaluated.

Conclusion. The results of this study suggest that the TTAP, in its present form, cannot be used with confidence to assess students with learning disabilities and requires more extensive development and testing.
The Relationship Between Pretheoretical Assumptions and Clinical Reasoning
Authors: Hooper Barb
Published: October 2011

This single-case study explored what internal beliefs or commitments one therapist holds about the nature of reality and how those beliefs influence her delivery of occupational therapy services. Data were collected through three in-depth interviews and through observation of the therapist conducting treatment sessions.

Results suggest that the therapist’s view of reality can be categorized into four areas: (a) what she believes about ultimate reality; (b) what she believes about life, death, and eternity; (c) what she believes about human nature; and (d) what she believes about the nature of knowing. The findings also suggest that this core worldview informs how the therapist fames clinical practice and how she delivers occupational therapy services. Further, both the therapist’s view of reality and her clinical practice are deeply rooted in her sociocultural experiences. This case study provides a rich description of the interrelatedness of sociocultural context, worldview, and clinical reasoning.
Evaluating Patient Motivation in Physical Disabilities Practice Settings
Authors: Carlson Jodi L.
Published: October 2011

Objectives. Motivation is an important factor in and predictor of a person’s recovery from illness, yet no information exists about how occupational therapists actually evaluate patient motivation in clinical practice. This article describes a pilot study of how occupational therapists in physical disabilities settings evaluate patient motivation.

Method. A sample of 150 fieldwork coordinators in physical disabilities treatment centers were surveyed about whether they evaluate patient motivation and about the methods they used to evaluate patient motivation.

Results. Most respondents reported that they evaluate motivation informally and throughout treatment. Respondents evaluate motivation mostly via general discussion, observation of patient conduct and actions, and information from others. Less than one third discussed interests and goals with patients to evaluate motivation. Despite questionable methods of evaluation of motivation, a majority of respondents reported that their evaluation influences their treatment approaches and improves treatment outcomes.

Conclusion. Instruction about the definition and evaluation of motivation may increase the frequency of motivation evaluation in occupational therapy.
The Effects of a Neonatal Positioner on Scapular Rotation
Authors: Monfort Karen , Case-Smith Jane
Published: October 2011

Objective. This clinical study investigated the effects of an individually fabricated prone positioner on heart rate, respiratory rate, and scapular position of premature infants in the neonatal intensive care unit. The prone positioner consisted of dense foam with cutouts to position the shoulders forward and toward midline.

Method. Six measurements of scapular rotation, respiratory rate, heart rate, and behavioral state were made with 20 infants on and off the prone positioner. The repeated measures allowed each infant to act as his or her own control.

Results. Heart and respiratory rates were not significantly different between the two methods of prone positioning. Upward scapular rotation was significantly greater with the infant on the prone positioner. Behavioral state did not influence the results.

Conclusion. These results suggest that a prone positioner can be helpful in the prevention of scapular–humeral tightness and shoulder retraction commonly observed in premature infants.
Moral Tensions and Obligations of Occupational Therapy Practitioners Providing Home Care
Authors: Opacich Karin J.
Published: October 2011

Home care has been valued as a relevant context for the provision of occupational therapy since the inception of the field. The setting provides rich opportunities to restore meaningfulness in living for clients whose lives have been disrupted by illness or untoward events. Additionally the home care setting allows practitioners to exercise professional commitments and to meet ethical obligations congruent with the field of occupational therapy. Nevertheless, the home care arena is not exempt from the pressures that pervade the health care industry.

To thrive in the provision of home care, occupational therapy practitioners must prepare themselves to deal with the philosophic, economic, and moral challenges inherent in the setting. This article explores the moral obligations of occupational therapy practitioners who provide home care. More specifically, it addresses obligations to self to patients, to caregivers, to society, to the profession, to fellow health care providers, and to agencies and payers. Ethical principles associated with each are highlighted, and issues are raised. Home care practitioners who are attuned to the moral commitments imbedded in occupational therapy philosophy will most likely incorporate these tenets into their clinical decisions.
Documenting Progress in Home Care
Authors: McGuire Mary Jo
Published: October 2011

The home is an ideal environment for the practice of occupational therapy. However the tumultuous health care environment of the late 1990s requires practitioners to take special care not only in delivering effective services, but also in documenting the delivery of skilled care. Documentation is the bridge between the delivery of occupational therapy services in the home and the approval for reimbursement of services by third-party payers. This article presents principles for writing reimbursable progress notes for home care that are based on Medicare documents related to occupational therapy. Application of these principles can improve efficiency and excellence in practitioners’ documentation skills.
The Effect of Added-Purpose and Meaningful Occupation on Motor Learning
Authors: Ferguson Janice M. , Trombly Catherine A.
Published: October 2011

Objective. Numerous studies in the occupational therapy literature have investigated the effects of added-purpose (multidimensional, goal-oriented) occupation on performance. Motor learning research has demonstrated that factors that enhance performance measures do not necessarily enhance motor learning. This study examined the effects of both added-purpose and meaningful occupation on motor learning.

Method. Twenty subjects (university students) were randomly assigned to either an added-purpose or rote exercise condition. After a skill acquisition phase, retention and transfer scores were obtained, and subjects were asked to rate the meaningfulness of the occupation on a visual analog scale.

Results. A two-way analysis of variance indicated that only the added-purpose occupation resulted in significantly greater motor learning. Additionally, the added-purpose scores were not influenced by the level of meaning assigned to the occupation.

Conclusion. This study is the first to demonstrate how added-purpose can enhance a more permanent aspect of performance: motor learning. Further research is necessary to determine whether occupations that both are meaningful and have added-purpose are the most effective in enhancing motor learning.
Occupational Adaptation Intervention With Patients With Cerebrovascular Accident: A Clinical Study
Authors: Gibson Jacquelyn Ward , Schkade Janette K.
Published: October 2011

Objective. The purpose of this study was to examine the use of the Occupational Adaptation frame of reference in the evaluation and treatment of patients with cerebrovascular accident (CVA).

Method. Outcomes of functional independence and discharge environment were measured through a quasi-experimental design. Twenty-five former patients served as the control subjects, and 25 patients admitted after the programmatic implementation of Occupational Adaptation served as the treatment subjects.

Results. Data analyses indicated that the Occupational Adaptation subjects achieved higher levels of functional independence and were discharged to less restrictive environments compared with the control subjects.

Conclusion. Use of intervention guided by the Occupational Adaptation frame of reference was associated with improved functional independence and discharge to less-restricted environments for this group of patients with CVA.
Academic Integration of Occupational Therapy Faculty: A Survey
Authors: Vassantachart Dale S. M. , Rice Gail Taylor
Published: October 2011

Objective. This descriptive study explored the reasons for occupational therapy faculty members selecting academia as a career, their use of faculty development practices, and the relationship of organizational culture to collegial support.

Method. Full-time faculty members (n = 191) from accredited occupational therapy professional programs in the United States completed a questionnaire about their early years in academia.

Results. Respondents indicated that their primary reason for selecting academia as a career was their love of teaching. The most helpful faculty development practice was frequent sharing of ideas with peer faculty members.

Conclusions. The findings support the following recommendations for program administrators and experienced faculty members to assist new faculty members in adapting to academia: (a) support and develop new avenues for sharing ideas in formal and informal settings; (b) develop mentoring programs, with new faculty members observing experienced teachers and receiving feedback and assistance for their own teaching; (c) encourage attendance at instructional seminars; (d) provide resource materials and texts on improving teaching and research skills; (e) allow time for research; and (f) encourage coauthoring of publications.
Student Perceptions of a Problem-Based Learning Course
Authors: Stern Perri
Published: October 2011

Within occupational therapy education, there has been increased attention to curricula and courses that emphasize problem solving, clinical reasoning, and synthesis of information across traditional discipline-specific boundaries. This article describes the development, implementation, and outcomes of a problem-based learning course entitled Selected Cases in Occupational Therapy. The course was designed to help students to integrate the various elements of a specific occupational therapy curriculum and to enhance their abilities to respond to an ever-changing health care environment.

An evaluation of the course by the first 11 students who completed it revealed both strengths and weaknesses. Students responded that the course enhanced their professional behavior, including interpersonal communication skills, team work, and follow-through with professional responsibilities; helped them to integrate the various elements of the total occupational therapy academic program; enhanced their clinical reasoning skills by providing a structure for thinking through clinical issues; and provided personal gain or benefit (i.e., students perceived the course to be a valuable, realistic, and motivating experience). The students also identified several specific course elements that contributed to its integrating function, including content, class session format, and students’ role. Identified course weaknesses included the methods of evaluating student performance and the format and content of specific cases.
Circumventing Burnout in AIDS Care
Authors: Hooley Lynne
Published: October 2011

Previous studies have determined that health care providers who specialize in AIDS care are particularly susceptible to work-related stress and resulting burnout. This qualitative study derived themes from interviews with three occupational therapists in order to examine these findings. Ultimately, stress and burnout were not dominant themes in the interviews. Instead, the prominent themes were Loss; death and dying; boundaries, connecting, and empathy; education; and coping strategies. An accepting attitude toward diversity coupled with the use of both individual and institutional stress management techniques modulated stress and prevented burnout among the study participants.
A Pilot Study of the Theoretical and Technical Competence and Appropriate Education for the Use of Nine Physical Agent Modalities in Occupational Therapy Practice
Authors: Glauner Julie H. , Ekes Ann M. , James Anne E. , Holm Margo B.
Published: October 2011

Objective. This study described occupational therapy practitioners’ perceptions about the content and method of training or education necessary for gaining theoretical and technical competence in the use of nine physical agent modalities (PAMs).

Method. A survey was developed and sent to 543 members of the Physical Disabilities Special Interest Section of the American Occupational Therapy Association who had identified their primary area of practice as hand therapy. One hundred and fifty-one completed surveys (28% response rate) were returned.

Results. The respondents indicated that theoretical and technical expertise necessary for competent use of PAMs varied according to the type of modality being considered Continuing education courses were identified as the best method for gaining theoretical and technical competence for the use of deep thermal agents, such as ultrasound and electrical stimulation agents, whereas entry-level professional education and on-the-job training were identified as most appropriate for superficial thermal agents, such as paraffin bath and hot and cold packs.

Conclusion. The results suggest that considerations regarding the type and amount of education necessary for gaining theoretical and technical competence in the use of PAMs depend on the type of modality being addressed. These differences should be considered in the future development of competency objectives for the use of PAMs.
The Relationship of the Allen Cognitive Level Test to Demographics, Diagnosis, and Disposition Among Psychiatric Inpatients
Authors: Henry Alexis D. , Moore Karen , Quinlivan Maureen , Triggs Marcia
Published: October 2011

Objective. This study examined the relationship of the Allen Cognitive Level Test (ACL) to demographics, diagnosis, and disposition after hospitalization among persons with psychiatric disorders.

Method. Data were retrospectively collected from medical records, including initial occupational therapy evaluation notes, on 62 female and 38 male patients consecutively admitted to an urban, acute psychiatric inpatient unit. Collected was information on demographics, diagnosis, mental and physical health history, initial ACL scores, role involvement, and discharge living situation (DLS).

Results. Patients with higher initial ACL scores were more likely to be younger, to have lived independently before admission, to have been given nonpsychotic diagnoses, and to have been suicidal before admission. Although DLS was most strongly correlated with Living situation before admission, ACL scores showed the second strongest correlation to DLS. Patients with higher ACL scores were significantly more likely to be discharged to independent living than were patients with Lower ACL scores.

Conclusions. These results provide evidence that patients’ cognitive Level, as measured by the ACL, may be a useful predictor of community functioning. However, further research is needed to validate the Cognitive Disabilities Model.
A Review of Balance Instruments for Older Adults
Authors: Whitney Susan L. , Poole Janet L. , Cass Stephen P.
Published: October 2011

Objective. The purpose of this article is to review balance instruments developed within the past 10 years that can be used in the clinic or home environment. The use of such instruments may assist in identifying older adults who are at risk for falling, a major problem that can result in impaired function and loss of independence.

Method. Six instruments were reviewed: the Berg Balance Scale (Berg), the Clinical Test of Sensory Interaction and Balance (CTSIB), the Functional Reach Test, the Tinetti Balance Test of the Performance-Oriented Assessment of Mobility Problems (Tinetti), the Timed “Up and Go” Test (TU>), and the Physical Performance Test (PPT). Considered were what aspects of balance are assessed, time needed to administer the instrument, tools or equipment needed, evidence of reliability and validity, advantages and disadvantages, and the target population.

Results. The Berg, Tinetti, and PPT measure a variety of aspects of balance, whereas the Functional Reach, TU>, and CTSIB measure more narrow aspects of balance. All six instruments have been used with older adults and do not require much equipment. The instruments differ in their reliability and validity.

Conclusion. Familiarity with balance instruments can be helpful in selecting the one most appropriate for clinical setting and clients in order to institute appropriate prevention programs, such as environmental modifications and lifestyle adaptations.
Creating an Occupational Therapy Level II Fieldwork Experience in a County Jail Setting
Authors: Provident Ingrid M. , Joyce-Gaguzis Kelly
Published: October 2011

Although occupational therapy services have been rendered in prisons historically, only one occupational therapy program currently exists in a county jail: the Allegheny County Jail Project (ACJ Project). The offenders who populate county jails experience occupational deprivation. The participants of the ACJ Project have benefited from occupational therapy intervention that was initiated during incarceration and continued following their release from jail in order to help them resume productive life roles and to reduce the reoccurrence of engagement in criminal behaviors (recidivism rate). As of June 2003, the ACJ Project has successfully affected the lifestyle patterns of its participants and overall public safety by helping 63% of participants secure gainful employment and by helping 91.8% of participants maintain their freedom after prison. The purpose of this report is to describe the process and benefits of implementing fieldwork opportunities for Level II occupational therapy students in a best practice occupational therapy program in a nontraditional environment: a county jail.
Using a Head-Mounted Video Camera To Explore Current Conceptualizations of Clinical Reasoning in Occupational Therapy
Authors: Unsworth Carolyn A.
Published: October 2011

OBJECTIVE. The purpose of this study was to explore current conceptualizations of clinical reasoning in occupational therapy.

METHOD. Using a head-mounted video camera and debriefing interviews following therapy sessions, clinical reasoning data were collected from 13 experienced occupational therapists working in physical rehabilitation. The data were collected and analyzed within a focused ethnographic framework.

FINDINGS. Mattingly and Fleming's (1994) classification of clinical reasoning encompassed most of the thinking processes revealed in the therapists’ debriefing interviews. Therapists also used aspects of pragmatic reasoning (Schell & Cervero, 1993). Additionally, within the forms of procedural, interactive, conditional, and pragmatic reasoning, a new form of “generalization reasoning” is proposed in which therapists draw on past experience or knowledge to assist them in making sense of a current situation or client circumstance.

CONCLUSION. This research builds upon previous classification systems to support the categories of narrative, procedural, interactive, conditional, pragmatic (practice context), and generalization reasoning to explain how occupational therapists think in action. Further research is required to explore this emerging description of clinical reasoning.
Self-Care at School: Perceptions of 6-Year-Old Children
Authors: Chapparo Christine J. , Hooper Elizabeth
Published: October 2011

Occupational therapists who work with young children routinely evaluate self-care and consider it an important domain of practice. Little is known about what children perceive is important self-care or what they experience as self-care within a school context. Without knowledge about children’s perspectives of self-care, occupational therapists cannot know whether or not they are targeting areas that are central to children’s needs. The purpose of this naturalistic study was to explore 6-year-old children’s perceptions of self-care in their school day. Participant observation and group interviewing were used to elicit descriptive information from 24 Grade One children, attending an elementary school located in Sydney, Australia. A fishing game, drawing activity, and excerpts from a videotape of their day at school were used as stimuli to explore how the children described and attributed meaning to their self-care occupations. Findings showed that children described self-care at school two ways. First, they named specific self-care tasks that mirrored adult views of self-care and represented culturally shared views of the concept of self-care across ages. Second, children described highly individual views about self-care that were derived from their own experience of doing self-care at school. These views seemed to be based on their personal perceptions of salient factors in operation at the time of self-care performance such as social and physical contexts, perceived skill, and expectations of others. The findings suggest that occupational therapy assessment and intervention for self-care include sensitivity to experiential differences between adult views of self-care and those of children. This sensitivity should include an attempt to understand children’s experiences of self-care in specific contexts such as school.
School-Based Practice: Acquiring the Knowledge and Skills
Authors: Brandenburger-Shasby Sharon
Published: October 2011

The purpose of this descriptive study is to investigate the perceptions of occupational therapists working in school-based settings regarding their level of preparation for practice. The Survey of School-Based Practice was mailed to 1,102 occupational therapists working in school-based practice (SBP) throughout the United States. The mailing was based on a random sampling of 20% of the School System Special Interest Section of the American Occupational Therapy Association. Results were based on 450 returned completed surveys representing a response rate of 41%. The results were analyzed according to the respondents years of experience in SBP, entry (less than 3 years), transitioning from another practice setting with less than 1 year in SBP, and experienced with 3 or more years experience in SBP. The results indicated the majority of occupational therapists perceive themselves to be poorly prepared for this practice area based on entry-level education alone. Statistically significant differences were seen between continuing education needs and level of experience in SBP. Continuing education and mentoring were most often listed by therapists as preparing them for SBP. Implications for the profession are discussed.
Identifying Older Drivers at Risk of Traffic Violations by Using a Driving Simulator: A 3-Year Longitudinal Study
Authors: Lee Hoe C. , Lee Andy H.
Published: October 2011

OBJECTIVES. This prospective longitudinal study aims to determine which simulated driving tasks of a personal computer (PC)-based driving simulator can be used to identify problematic older drivers, using their 3-year driver violation points record as the outcome measure.

METHODS. A total of 129 urban community-dwelling older drivers volunteered to participate in the study. Using a driving simulator, specific driving tasks were devised to test the performance of older drivers. Their officially recorded driver violation points were retrieved immediately after the simulated driving assessment and thereafter for the following 2 years. Self-reported driving records were also collected during the same period. Hierarchical Poisson regression analysis, adjusting for gender, age, and driving exposure (hours of driving per week), was then undertaken to determine those driving tasks that affected the frequency of traffic violations.

RESULTS. All participants incurred at least one driver violation point during the 3-year period. The simulated driving tasks found to be significantly associated with the incidence of traffic violations were working memory and use of indicator.

CONCLUSIONS. This longitudinal study demonstrated that the driving simulator was able to identify unsafe older drivers at risk of traffic violations if appropriate simulated driving tasks were used. Such a screening tool should be adopted prior to administering a more detailed but expensive road test.
The Meaning of Computers to a Group of Men Who Are Homeless
Authors: Swenson Miller Kathleen , Bunch-Harrison Stacey , Brumbaugh Brett , Kutty Rekha Sankaran , FitzGerald Kathleen
Published: October 2011

The purpose of this pilot study was to explore the experience with computers and the meaning of computers to a group of homeless men living in a long-term shelter. This descriptive exploratory study used semistructured interviews with seven men who had been given access to computers and had participated in individually tailored occupation based interventions through a Work Readiness Program. Three themes emerged from analyzing the interviews: access to computers, computers as a bridge to life-skill development, and changed self-perceptions as a result of connecting to technology. Because they lacked computer knowledge and feared failure, the majority of study participants had not sought out computers available through public access. The need for access to computers, the potential use of computers as a medium for intervention, and the meaning of computers to these men who represent the digital divide are described in this study.
Finding Common Ground With Patients: The Centrality of Compatibility
Authors: Rosa Susan Ayres , Hasselkus Betty Risteen
Published: October 2011

This research examines the lived experiences of six novice occupational therapists (0–2 years experience) and eight career occupational therapists (≥ 5 years in the everyday practice in adult rehabilitation. The study focused specifically on therapists’ experiences of working together with patients and the ways in which these experiences unfolded over the course of therapy. Data were generated using a combination of phenomenological interviews with all 14 therapist-participants (Phase I) and participant observation of four therapist-patient dyads throughout the course of rehabilitation therapy (Phase II). Verbatim transcriptions of all interviews from Phase I and Phase II and field notes from Phase II were analyzed using a narrative approach. The analysis revealed that Finding Common Ground was a shared meaning of working together with patients regarding therapy goals and expectations. Findings suggest that occupational therapists may resist negotiating differences with patients over therapy goals and expectations and instead rely primarily on compatibility as the basis of finding common ground. Findings reveal the importance for occupational therapists to be (1) open to negotiating differences with patients over goals and expectations, (2) aware of the ideologies that may influence their practices, and (3) adequately prepared to deal effectively with the challenging interpersonal aspects of practice.
The Ergonomics of Caring for Children: An Exploratory Study
Authors: Sanders Martha J. , Morse Tim
Published: October 2011

BACKGROUND. Caring for one’s children is among the most ubiquitous of occupations. However, few studies have examined the ergonomic risks involved in parents caring for children at home.

PURPOSE. The purpose of this study was to identify the frequency, type, and severity of musculoskeletal symptoms in parents of children less than 4 years old. The study further examined the factors that contribute to musculoskeletal pain in this sample.

METHODS. A convenience sample of 130 parents with children younger than 4 years old completed a seven-page survey that included questions related to the parents’ demographics, their musculoskeletal discomfort, their performance of child-care tasks with high biomechanical risks (such as carrying a child in a car seat), and parents’ perceived psychological strain related to caring for their children.

RESULTS. Ninety-two percent (92%) of the providers were mothers. Sixty-six percent (66%) of the sample reported the presence of musculoskeletal pain. The parts of the body most affected were the low back (48%), neck (17%), upper back (16%), and shoulders (11.5%). Factors associated with musculoskeletal pain were performing child-care tasks defined as having high biomechanical risks (p = .001), the perception that caring for children is highly demanding (p = .003), and performing hobbies less than 1 hour per week (p = .04). Parents’ working status, age, and participation in other daily activities were not significantly related to musculoskeletal discomfort.

CONCLUSION. This study demonstrates the high prevalence of musculoskeletal pain in parents of children under the age of 4 years. It underscores the association between physical and psychological factors in the development of musculoskeletal discomfort. It suggests the need for occupational therapy wellness programs that focus on preventing musculoskeletal discomfort and providing support for the parenting role.
Changes in ADL Dependence and Aspects of Usability Following Housing Adaptation—A Longitudinal Perspective
Authors: Fänge Agneta , Iwarsson Susanne
Published: October 2011

OBJECTIVE. To investigate longitudinal changes in activities of daily living (ADL) dependence and aspects of usability in housing among clients receiving housing adaptation grants in Sweden.

METHODS. The ADL Staircase and the Usability in My Home instruments were used to collect data on three occasions: at baseline 1 month before housing adaptation, at follow-ups 2 to 3 months after housing adaptation completion, and after another 6 to 7 months. In all, 131 clients, living in ordinary housing 24 to 93 years of age were consecutively enrolled.

RESULTS. Overall ADL dependence did not change significantly whereas dependence in “Bathing” decreased over time. “Activity aspects” and “Personal and social aspects” of usability improved at different phases in the process.

CONCLUSION. This study delivers new insights about the complexity of longitudinal person–environment–activity transactions, specifically targeting activity and usability. The results are useful for developing efficient strategies for evaluating housing adaptations within occupational therapy practice and research.