bluuebunny/crossref_metadata_2025 huggingface dataset:
Upper Limb Sensation in Children with Congenital Limb Deficiencies: Implications for Function and Prosthetic Use
Authors: Johnson Lindy , Hickey Annabel , Scoullar Barbara , Chondros Patty
Published: April 2015

Little is known about sensation in children with upper limb congenital deficiencies. Is sensation different in the deficient limb? If so, does sensation influence function and determine whether or not a prosthesis is used? This study was undertaken to measure sensation in children with transradial congenital limb deficiencies and to explore possible associations with function and prosthetic use.

Twenty-four children and adolescents were evaluated on touch pressure and kinaesthesia measurement tools. The participants' parents were required to rate their child's performance on everyday functional activities and, where appropriate, report on their child's patterns of prosthetic use. The results revealed that most participants had better touch pressure sensation at the stump circumference of the deficient limb, not only compared with the same level on the intact limb (p = 0.06) but also compared with the hand (p = 0.008). All the participants demonstrated perfect scores for kinaesthetic awareness for both limbs. No strong association was found between touch pressure and performing functional activities or prosthetic use patterns.

This study is an important contribution to understanding upper limb sensation in children with congenital limb deficiencies and the implications for function and prosthetic use. Further research involving multiple centres would provide an adequate sample size to explore more fully sensation in children with congenital upper limb deficiencies and its possible association with function and prosthetic use.
Views from the Inside, Part 1: Routes to Diagnosis — Families' Experience of Living with a Child with Arthritis
Authors: Britton Carrie , Moore Ann
Published: April 2015

This is the first of a trilogy of articles that presents the experiences and perspectives of 46 families about what it is like to live with and care for a child with juvenile idiopathic arthritis (JIA).

An independent professional recruited the children from a random sample of families who attended consecutive outpatient appointments at the juvenile arthritis clinic and who fulfilled the inclusion criteria. Qualitative and quantitative data from self-completion questionnaires, transcripts from semi-structured interviews with family members in their homes, family-filmed video diaries, and diaries written by siblings and children with arthritis were analysed. These different types of data were gathered over 18 months in order to collect information about the fluctuating nature of this disease and the impact of this changeability on family members.

Part 1 concentrates on a brief presentation of relevant literature, presents a simplified map of the findings and introduces the families' early experiences of seeking and coping with the diagnosis of JIA. The article explores the myth that arthritis only affects elderly and infirm people, explains the mirage effect and discusses the significance of different routes to diagnosis. The majority of the families felt that these early events had a significant, sometimes considerable, impact upon how they coped later, including how they related subsequently to health care professionals and engaged with continuing prescribed health care programmes.

The findings report the families' experiences as recipients of health care by many different professionals and relate to their recollection and interpretation of events. Research into the professionals' perspectives would be illuminating but did not fall within the scope of the present study. The experiences of families of children with arthritis are shared by families of children with other chronic conditions and by other carers and service users.
The Competence of Mental Health Occupational Therapists
Authors: Greaves Amanda Jane , King Robert , Yellowlees Peter , Spence Susan , Lloyd Chris
Published: April 2015

This research sought to investigate the self-perceived competence of mental health occupational therapists in Queensland. The research is a post-hoc analysis of survey results that formed part of the 1995 Professional Development Strategy for Adult Mental Health Services for the Queensland Health Mental Health Unit. A sample of 55 occupational therapists was compared with other professionals in relation to both general self-efficacy and efficacy in specific competencies. The devised scale for measuring self-efficacy was found to have a high level of internal reliability.

The results indicated that the general self-perceived competence of occupational therapists for the whole sample was comparable to that of other professional groups, but that in the community-based sample it was significantly higher than that of social workers or nurses. In addition, occupational therapists in community settings had significantly higher general self-perceived competence than occupational therapists in hospital locations. Greater length of experience in mental health was strongly predictive of higher levels of competence for occupational therapists than for other professionals.

The results suggest that occupational therapists have adapted well to the demands of multidisciplinary community practice. The possible reasons for these results, and the implications for competency-based recruitment and training, are presented.
Chronic Fatigue Syndrome: An Evaluation of an Occupational Therapy Inpatient Intervention
Authors: Cox Diane L
Published: April 2015

It has been stated that, although most chronic fatigue syndrome (CFS) patients can be treated in primary care and that cognitive behaviour therapy and prescribed, graded aerobic exercise appear to be promising in outpatient management, a minority of patients will require inpatient care (Royal Colleges of Physicians, General Practitioners and Psychiatrists 1996). To date, little has been written on the need for and impact of an inpatient approach for patients with CFS. This study builds on previous work to show how patients with complex CFS responded to a specifically designed occupational therapy inpatient programme, using the principles of cognitive behaviour therapy and graded activity.

A quasi-experimental study was carried out using current inpatients with those on the waiting list as a comparison. At 6 months following discharge, a significant difference between the groups in terms of symptoms and level of ability was not demonstrated. However, a significant effect was shown in patients' perceived health, length of time tired and management of the illness. Thirty-one (72%) of the inpatient group, compared with 10 (53%) of the comparison group, stated that they felt better than the previous year. Thirty-one (72%) of the inpatient group, compared with 7 (37%) of the comparison group, indicated better management of their illness. These findings give some evidence of the need for an inpatient CFS management programme for specific patients with complex CFS.
Occupational Therapy in Social Services: A Missed Opportunity?
Authors: Riley Jill
Published: April 2015

The College of Occupational Therapists' recent document, A Strategy for Modernising Occupational Therapy Services in Local Health and Social Care Communities - a Consultation (COT 2002), has provoked debate within the profession on the future delivery of occupational therapy services across health and social care. This seems an appropriate time to reflect on events of 30 years ago when, following the initial separation of health and social services, the profession was faced with the dilemma as to where occupational therapists should be located. This paper looks at the events and issues influencing the profession's decisions then, using a grounded theory approach and drawing on literature and documentation.

At that time, discussions raised concerns about the division of skills, adherence to the ethical code and the status within the profession of occupational therapists working in local authorities. The profession's immaturity, lack of autonomy and medical orientation were key factors in influencing its response, which focused on drawing all occupational therapists into the health service. Despite lengthy discussions and consultations, the profession could not influence events and some local authority occupational therapists automatically became part of the newly set-up social services departments. Analysis reveals a possible missed opportunity to establish a firm foundation for occupational therapy in social services, the consequences of which are still evident today.
Organisational Change and Occupational Therapy
Authors: Lloyd Chris , King Robert
Published: April 2015

Major restructuring of health care services has meant changes in service delivery, organisational structures and work practices. There has been a significant impact on the roles and responsibilities required of health care professionals in the current health care environment. The literature reveals that this often brings about conflict between professional values and organisational values. Although many of the current changes in health care are compatible with the philosophy of occupational therapy, there are policy and organisational factors that have an impact on occupational therapy practice and service delivery.

In this article, the emerging characteristics of the contemporary health care environment are identified and the strengths and weaknesses of the profession in adapting to this environment are discussed. It is argued that the survival and growth of the profession are dependent on the extent to which it is able to capitalise on strengths, overcome weaknesses, articulate its overall purpose and function and redefine its role and scope of practice in order to meet changed societal and organisational demands.
Generic and Specialist Occupational Therapy Casework in Community Mental Health Teams
Authors: Harries Priscilla A , Gilhooly Ken
Published: April 2015

The aim of this research was to conduct a cluster analysis on data from 40 community mental health occupational therapists to determine if subgroups of therapists had differing referral prioritisation policies. A Ward's cluster analysis showed four clusters to be present.

These four subgroups of occupational therapists were found to differ according to several factors: the percentage of role dedicated to specialist occupational therapy or generic work, satisfaction with the balance in these roles, the number of hours worked, the number of professionally trained team members and the presence of referral prioritisation policies. The subgroups were named the aspiring specialists, the satisfied specialists, the satisfied genericists and the chameleons (those not set in applying a consistent or specific policy).

The policies that led to mainly generic working gave greatest importance to clients who were potentially violent or at risk of suicide. The policies that led to more of an occupational therapy role gave particular importance to the reason for referral and the client's diagnosis.

The College of Occupational Therapists has recommended that the majority of casework should be focused on specialist occupational therapy interventions (Craik et al 1998): most of the participants in this study were not meeting this recommendation. Although some aspired to being more specialist, the pressures to work generically may have been affecting referral policies.
The Single Assessment Process: An Opportunity for Collaboration or a Threat to the Profession of Occupational Therapy?
Authors: Cohen Zoë A
Published: April 2015

The single assessment process is being introduced into the care of older people across health and social services in order to streamline assessments, target resources carefully and improve client-centred practices with a focus on outcomes. Health professions may view this change as a threat because it recommends collaborative working practices that are outside professional tribal boundaries; occupational therapy may be perceived as particularly sensitive to such threats. In order to work in new ways and survive change, learning needs to take place both formally and informally and structures that facilitate the development of professional roles and responsibilities need to exist at organisational level.
A Delphi Survey of Best Practice Occupational Therapy for Parkinson's Disease in the United Kingdom
Authors: Deane K H O , Ellis-Hill C , Dekker K , Davies P , Clarke C E
Published: April 2015

This study was designed to determine the character of best occupational therapy practice for Parkinson's disease in the United Kingdom. Two hundred and forty-two occupational therapists treating people with Parkinson's disease were sent a Delphi survey containing statements about best practice and asked to indicate their level of agreement with each statement. The second survey contained the same list of statements, with group levels of agreement from the first round for each statement. The respondents re-rated their answers and gave their opinion on the efficacy of various interventions.

One hundred and fifty occupational therapists (62%) completed both rounds. Ninety-nine per cent of the respondents agreed that Parkinson's disease required lifelong provision of occupational therapy, within multidisciplinary teams, and that the social and psychological aspects of the disease were as important as the physical ones. The occupational therapists had confidence in many techniques for achieving physical, social and psychological goals. However, 40% of the respondents could not rate the efficacy of social and psychological techniques owing to a lack of knowledge.

There was a high level of consensus nationally on the character of best practice occupational therapy for Parkinson's disease. The survey highlighted a need for more postgraduate training, especially in psychological techniques.
The Negotiation and Use of Personal Assistance by Women with Chronic Arthritis
Authors: Goodacre Lynne , Goodacre John
Published: April 2015

The aim of this study was to gain a greater understanding of the impact of chronic arthritis on the functional ability of women, the strategies that they used to maintain their function and the integration of these strategies into their lifestyles. A qualitative approach was adopted, using semi-structured interviews, personal diaries and focus groups. Twelve women with chronic arthritis participated over a period of 2 years. All the interviews and focus group discussions were transcribed and coded. The data analysis involved the development of a thematic framework to identify recurring themes and their relationships.

The negotiation and use of personal assistance emerged as an important strategy used by the women. It was highlighted as a complex strategy owing to the number of factors influencing its use, the personal connotations of being a recipient of assistance and the need to negotiate levels of assistance with other family members. Insights into the women's use of assistance have the potential to inform the way in which this strategy is approached in educational programmes and also highlight the need to address how people with chronic arthritis communicate their need for assistance and negotiate help within the family.
Active and Passive Shoulder Range of Motion in Healthy Older People
Authors: McIntosh Lynette , McKenna Kryss , Gustafsson Louise
Published: April 2015

This study was conducted to determine the effect of increasing age on four shoulder movements and to explore the need for normative data for shoulder range of motion (ROM) in people aged 50 years and older. Forty-one participants were conveniently recruited according to four age categories: 50–59 years, 60–69 years, 70–79 years and 80 years and over. Goniometric measurement of bilateral active and passive ROM for flexion, abduction, internal rotation and external rotation was analysed using paired sample t-tests and compared with the norms of the American Academy of Orthopaedic Surgeons (AAOS) using one sample t-tests.

Passive ROM was greater than active ROM for all movements (p<0.001). Active and passive ROM were significantly (p<0.01) lower than the AAOS norms, except for passive external rotation (p = 0.07). The General Linear Model procedure was used to determine the effect of age, gender, activity level, work history and body mass index on active ROM. The results showed that age (p = 0.001) and work history (p = 0.012) significantly influenced flexion, work history (p = 0.008) significantly influenced abduction and gender (p = 0.018) significantly influenced internal rotation. None of the independent variables influenced active external rotation.

Preliminary normative data are presented as percentiles by age and work history for clinical reference. Comparing patients' ROM measurements with age-related and activity-related norms will assist occupational therapists in establishing realistic goals during rehabilitation.
The Casson Memorial Lecture 2003: Past Conditional, Present Indicative, Future Indefinite
Authors: Walker Marion F
Published: April 2015

The Casson Memorial Lecture 2003, given on 11 July at the 27th Annual Conference of the College of Occupational Therapists, held at the Scottish Exhibition and Conference Centre, Glasgow. The conference theme was ‘Design for Living Life’.
Assessment of Bathing in Occupational Therapy
Authors: Gooch Hilary
Published: April 2015

Personal cleanliness is important for all of us. The ability to bath independently is considered important by occupational therapists and their clients. This paper describes the assessment methods used by occupational therapists working with adults with physical disabilities. In addition, it explores the factors that were considered important during the assessment and solution phases of bathing intervention.

A survey questionnaire was sent to 108 occupational therapists working in health and social services within Greater London. The findings highlighted that the methods of assessment used most frequently by practitioners were observation in the home or in a simulated environment and face-to-face interviews. During assessment, the components ranked as most important for consideration were ‘mobility’, ‘client priorities’, ‘safety factors’ and ‘medical diagnosis’. During the solution phase similar factors were found, with the additional item of the availability of bathing equipment.

The findings of this study raise questions related to bathing issues and indicate a need for further study. Of particular interest are the questions of client priorities within the process and the high number of practitioners not including water in the assessment of this potentially dangerous activity.
Culture, Cultural Competency and Psychosocial Occupational Therapy: A Middle Eastern Perspective
Authors: Awaad Terri
Published: April 2015

A Western occupational therapist appointed to mental health services for Emirati nationals in Al Ain in the United Arab Emirates is faced with many questions regarding competent practice in what is, to the therapist, a largely alien culture. In an effort to develop a culturally sensitive approach to a new service development, an extensive review was undertaken of the cultural competency and related occupational therapy literature and a framework for culturally competent practice was proposed (Awaad 2003a).

One of the key themes identified was the importance of attaining, and the skilful use in therapy, of specific cultural knowledge. This paper attempts to apply this principle through an exploration of the literature concerned with social, occupational and mental health practices in Middle Eastern Islamic societies and their relationship to psychosocial occupational therapy.
The Nature of Leisure in Adolescence: A Focus Group Study
Authors: Passmore Anne , French Davina
Published: April 2015

Despite the recognition of leisure as a key concept in occupational therapy, there is limited evidence of the theoretical development of leisure within the occupational therapy literature. The wider literature makes claims about the relationship between leisure and health; however, little empirical support for the influence of leisure on wellbeing is demonstrated. Furthermore, leisure is identified as a dominant cultural context of adolescents.

This study examined adolescents' perceptions of leisure in their daily lives. A sample of 119 students, aged 12 to 18 years and recruited from the general population, participated in a series of focus groups. Content analysis established a functional typology of leisure, which permits the grouping of diverse activities into a small number of comprehensive categories, namely achievement, social and time-out leisure. The affective dimensions of enjoyment and freedom of choice were reported to underpin the concept of leisure. The nature and value of these categories are discussed in the light of their genesis in the views of young people themselves. The implications for occupational therapy are addressed.
Quality of Life and Traumatic Brain Injury: A One-Year Longitudinal Qualitative Study
Authors: Conneeley Anne Louise
Published: April 2015

This qualitative study aimed to gain an understanding of the experience of quality of life by those affected by traumatic brain injury. Eighteen patients, their significant other and members of the rehabilitation team were interviewed individually when the patient was discharged from the ward of a neurological rehabilitation hospital, then after 6 months and, again, at one year following discharge from the ward.

When the data were analysed, several factors involved in the subjective experience of quality of life were identified. These included a sense of wellbeing, functional status, personal autonomy and the need for the acceptance of disability. An understanding of the experience of those with traumatic brain injury could raise awareness of the issues involved and hence assist those involved in the care of this client group.
Can Patients with Unilateral Neglect following Stroke Drive Electrically Powered Wheelchairs?
Authors: Dawson Jill , Thornton Heather
Published: April 2015

People with unilateral neglect tend to have persisting disabilities and an increased probability of dependence following stroke. This preliminary research was designed to evaluate the potential use of an indoor electrically powered wheelchair with two people with unilateral neglect.

Two male participants with a single-incident right hemisphere lesion were recruited; they were 32 days and 20 days post-stroke. Both had evidence of unilateral neglect on the Behavioural Inattention Test. An ABA single-subject experimental design was used, with a battery of measures administered every weekday for 6 weeks. The measures were the left collisions made and the time taken when negotiating an obstacle course in a powered wheelchair, and two tabletop tasks: the Star Cancellation Test and the Baking Tray Task. During the intervention phase (B), the participants were given 30 minutes of powered wheelchair training every weekday for 2 weeks.

Both participants made marked improvements in driving accuracy by driving the wheelchair through an obstacle course for about 5 minutes each weekday for 2 weeks during phase A1. This improvement in driving accuracy unexpectedly occurred before the intervention phase (B), when the powered wheelchair training was introduced. Negligible changes in driving accuracy were seen during and after training had commenced. This suggests that negotiating the obstacle course, which was used as a measure, was acting as a form of treatment. The changes seen in the measures of unilateral neglect suggested that the participants learned to drive the powered wheelchair despite persisting neglect.

Many patients with unilateral neglect are not given the chance to drive an electrically powered wheelchair owing to concerns about safety. This preliminary study suggests not only that this patient group can learn to drive indoors safely but also that this may be achieved with minimal therapeutic intervention. Further work needs to be carried out in this area.
Chronic Pain: Gaining Understanding through the Use of Art
Authors: Henare Diane , Hocking Clare , Smythe Liz
Published: April 2015

Many people have chronic pain yet little is known about what it is like to live with pain on a permanent basis and how this experience affects people. This article reports the findings of a phenomenological study into the meaning of chronic pain for 14 people who were attending a pain management programme in New Zealand. The data for the study comprised artwork produced by the participants in the course of the programme and their explanation of its meaning.

Five main themes emerged from the data analysis: gaining pain and losing self, redefining self, identity through others, being hopeful and being on a journey. The study found a strong association between participation in valued occupation, the maintenance and redefinition of identity, experiencing oneself as competent and being hopeful about the future. The research process supported the use of art as an expressive medium in occupational therapy.
Clinical Reasoning: How do Pragmatic Reasoning, Worldview and Client-Centredness Fit?
Authors: Unsworth Carolyn A
Published: April 2015

Using both clinical reasoning data and literature from the past 20 years, this paper sought to examine the relationship between client-centred practice and clinical reasoning, to explore the concept of pragmatic reasoning and to present a diagrammatic conceptualisation of our knowledge of clinical reasoning in occupational therapy.

The clinical reasoning literature published between 1982 and 2001 was reviewed and this information was combined with the findings from a study which used a head-mounted video camera to collect data and then explore the clinical reasoning of 13 experienced occupational therapists. The data were collected and analysed within a focused ethnographic framework.

The findings showed that clinical reasoning occurred in the context of client-centred practice, but that a reciprocal relationship appeared to exist between client-centred practice and interactive reasoning. It also appeared that pragmatic reasoning was related only to the therapist's practice context and that all forms of reasoning were influenced by the therapist's worldview. A diagram was developed to depict this current understanding of the modes of clinical reasoning.

While clinical reasoning has been described as the guiding force in a therapeutic practice, we are only just beginning to understand the nature of reasoning and reflection and how clinicians think. Further research is required to build and test the emerging theory of clinical reasoning in occupational therapy.
Numbers in Evidence
Authors: Paley John , Eva Gail
Published: April 2015

There is a tendency among some health care professionals to suppose that numbers are inherently problematic: they limit, they distort and they somehow imply reductionism. Allegedly, if one uses numbers — for example, as a quantitative researcher — one is inevitably overlooking the essential components: the psychological, the spiritual and the complex social aspects of human life. Here, it is argued that numbers provide a necessary dimension to our way of understanding. The difference between qualitative and quantitative research has nothing to do with the philosophical stance of the researcher. It is simply a matter of different research tools, which are fit for different purposes.
A Qualitative Study Comparing the Experiences of Tilt-in-Space Wheelchair Use and Conventional Wheelchair Use by Clients Severely Disabled with Multiple Sclerosis
Authors: Dewey Ann , Rice-Oxley Margaret , Dean Taraneh
Published: April 2015

The aim of this study was to explore and compare the experiences of tilt-in-space wheelchair use and conventional wheelchair use in severely disabled clients with multiple sclerosis and significant spasticity.

The research design was a descriptive qualitative approach, using in-depth audio-taped interviews in clients' homes carried out over a 9-month period. A total of 23 clients (7 tilt-in-space wheelchair users and 16 conventional wheelchair users) were recruited from three adjacent district wheelchair services in South-East England. The criteria for recruitment were that the clients were severely disabled with multiple sclerosis, had significant spasticity and were full-time wheelchair users, usually requiring hoisting. Their carers were also interviewed.

The majority of tilt-in-space wheelchair users (6 out of 7) reported that their chairs were comfortable compared with only half of those in conventional wheelchairs (8 out of 16). The positive aspects of tilt-in-space wheelchair provision included comfort, improved postural support, enhanced seating stability, relief of pressure and being able to rest sitting out of bed for prolonged periods, often for more than 6 hours a day. One person reported improved catheter drainage and another reported reduced spasms. The negative aspects of tilt-in-space wheelchairs included their bulky size and lack of manoeuvrability compared with conventional wheelchairs. All the wheelchair users had experienced difficulty with transport and many had relied on family and friends to help with the purchase of expensive adapted vehicles. In conclusion, the majority of the tilt-in-space users were satisfied with their wheelchair, particularly in terms of comfort.
Occupational Therapy and Evidence-Based Practice in Mental Health
Authors: Lloyd Chris , Bassett Hazel , King Robert
Published: April 2015

Evidence-based practice (EBP) represents a paradigm shift in health care. This review has two aims. The first is to consider the merits of EBP, especially in respect of its use in mental health settings. The second is both to identify psychosocial interventions that have an established evidence base for effectiveness and to provide an analysis of the quality of this evidence and its implications for occupational therapy. Supported employment, family psychoeducation, assertive case management and integrated substance use treatment are examined in detail.

It is proposed that occupational therapists working in mental health give priority to psychosocial interventions that are based on evidence and incorporate these into their practice. It is further proposed that, in implementing EBP, practitioners take an active evaluating position in relation to published evidence, paying particular attention to the evidence of effectiveness in equivalent clinical environments.
Patient Perceptions of the Quality of Information Provided in a Hospital Stroke Rehabilitation Unit
Authors: Tooth Leigh , Hoffmann Tammy
Published: April 2015

This study explored the extent, source and format of the information received by stroke rehabilitation patients and their perceptions of the quality of that information. Additionally, the readability levels of the written materials received were assessed. Fifteen patients were interviewed approximately 1.8 months post-inpatient rehabilitation.

Occupational therapists were the principal sources of information about returning home, equipment/ assistive devices, activities/exercise after stroke and the physical effects of stroke. The patients wanted additional information on the following topics that occupational therapists can address: treatments after stroke, the causes of stroke, risk factors/future prevention, stroke support groups, what to expect in rehabilitation and emotional problems/ difficulties during recovery.

Most information was verbal. Although 70% of the patients felt that they had not received enough information and 87% identified gaps in what they had received, the information was considered relevant to their needs, easy to read/understand and helpful in coping with lifestyle changes. Two-thirds had received written information, written at an average grade 12 equivalent; this was a level too high for educating lay people about health.

The implications for occupational therapists are that general information may be being provided at the expense of the information of most importance to the patients. Occupational therapists should assess and address patients' informational needs and identify the patients' preferred formats for receiving the information. The assessment of readability is also useful.
‘Baking Gives You Confidence’: Users' Views of Engaging in the Occupation of Baking
Authors: Haley Lesley , McKay Elizabeth Anne
Published: April 2015

The quality of care in acute inpatient areas has been identified as unacceptable and, in some areas, as counter-therapeutic (Sainsbury Centre for Mental Health 1998). Occupational therapy continues to make a significant contribution within this practice area. However, specific research that has addressed the acute service user's perspective of engagement in occupation is limited.

This qualitative study explored 12 mental health service users' perspectives of engagement in the occupation of baking through a semi-structured interview. The findings identified that the opportunity to acquire new skills and, importantly, confidence while producing an end product stimulated the participants to attend the treatment session. The engagement in baking was also influenced by the participants' desire to add structure to their daily routine.

The study concludes that the physical and social environment in which the therapy takes place is a powerful motivating factor in facilitating individuals to participate in an occupation. The findings emphasise the importance of engagement in occupations, in conducive settings that meet the individual's needs. The study highlights that baking has many recognisable benefits for service users, offering a flexible and valued occupation.
The Application of Cognitive Orientation to Daily Occupational Performance (CO-OP) with Children 5–7 Years with Developmental Coordination Disorder
Authors: Ward Amanda , Rodger Sylvia
Published: April 2015

There has been an increase in the use of cognitive frameworks in occupational therapy with children with developmental coordination disorder (DCD). Investigations into the utility of one such cognitive approach, namely Cognitive Orientation to (daily) Occupational Performance (CO-OP), with children with DCD have shown the intervention to be effective with children over 7 years. However, there has been limited research into its utility with younger children.

This paper presents two case studies to demonstrate the use of CO-OP with children aged 5–7 years. Two boys with DCD engaged in 10 sessions of CO-OP. These younger children were found to be able to use the global framework (Goal, Plan, Do, Check) to improve their task performance, to develop plans using domain-specific strategies and to engage in checking strategies. Issues relating to attention, motivation and goal setting are discussed in the context of the two case studies.
Overcoming Problems with Generic Working for Occupational Therapists Based in Community Mental Health Settings
Authors: Reeves Scott , Mann Lynn Summerfield
Published: April 2015

This report presents details of the design, delivery and evaluation of a short course aimed at enhancing occupation-focused practice among occupational therapists working in community mental health settings. The course was offered in response to concerns about an increasing amount of generic working that a number of therapists were undertaking. Consequently, it was felt that their professional role was being eroded within their multidisciplinary teams.

The course had two broad learning aims: to explore and understand the issues and problems of generic working practices and to understand how Kielhofner's (2002) occupation-focused model of practice could be used to help occupational therapists to strengthen their professional role.

A single-cohort pre/post test design was employed to assess the impact of the course. Questionnaires were distributed at the start of the course and directly following its completion. The findings revealed that the course was well received by the participants. Most felt that it had enhanced their understanding of the issues and problems of generic practice. It was also felt that the course had provided the participants with the confidence to begin addressing the problems of generic working within their respective teams.
Neuro-Occupation: The Nonlinear Dynamics of Intention, Meaning and Perception
Authors: Lazzarini Ivelisse
Published: April 2015

This paper suggests revisiting and re-exploring the concepts of intention, meaning and perception through neuro-occupation, which theoretically operationalises nonlinear brain dynamics and occupation. A review of theory and research suggests that intention, meaning and perception are instrumental in understanding the client's unfolding life experiences through a self-organised process.

In describing the organisation of the nonlinear dynamics of brain activity, it becomes apparent how intention, meaning and perception are the fundamental components of how human beings create meaning by engaging in self-directed and self-determined actions; hence, occupations. Through a fresh point of view and an improved understanding of the concepts of intention, meaning and perception, occupational therapy and occupational science may find common ground to integrate many diverse approaches into a more unified field.
Is Discrepancy between Actual and Preferred Work Activities a Factor in Work-Related Stress for Mental Health Occupational Therapists and Social Workers?
Authors: Lloyd Chris , McKenna Kryss , King Robert
Published: April 2015

In the Western developed nations, the changing pattern of mental health care provision has necessitated mental health staff adopting new approaches to service delivery across a diverse and expanding range of service settings. The impact of changed service delivery on Australian mental health professionals is an area that has not been well studied. The aim of the study was to identify the current clinical work activities performed by occupational therapists and social workers and whether there was a discrepancy between the actual and preferred work activities. The study also aimed to identify whether any discrepancy between their actual and preferred clinical work activities was associated with higher levels of stress.

A cross-sectional survey of 304 (response rate 76.6%) occupational therapists and social workers in Australian mental health services was conducted. A work activities scale developed specifically for this study and the Mental Health Professionals Stress Scale were used to measure actual and preferred work activities and stress respectively.

Both groups experienced a discrepancy between their actual and preferred work activities, with the occupational therapists and the social workers mostly wanting to undertake a diverse range of activities to a significantly greater extent than they currently were. As predicted, stress was associated with the discrepancy between the kind of work that the participants wanted to do and the kind of work that their job actually entailed. Health workers require assistance to adapt to their new work roles and to achieve a balance between generic and discipline-specific competencies. This has implications for education and professional training.
Occupation Matters: Do Techniques and Media Matter?
Authors: Spalding Nicola J , Hong Chia Swee
Published: April 2015

The theme of the College of Occupational Therapists' annual conference this year, ‘Occupation Matters’, led two occupational therapy lecturers to reflect on the place of occupation, in the form of techniques and media, within their curriculum. Despite a strong rationale for it remaining on the curriculum, there was an awareness that this might not reflect the reality of practice. It is suggested that many occupational therapists are not using techniques and media because they lack the confidence to do so. Such a lack of confidence could therefore be addressed in the occupational therapy curriculum, using experiential learning and evidence-based practice.
The Practice Education of Occupational Therapy Students with Disabilities: Practice Educators' Perspectives
Authors: Hirneth Michael , Mackenzie Lynette
Published: April 2015

Practice educators play a key role in ensuring that occupational therapy students with disabilities are not excluded from educational experiences. However, little is known about how practice education for occupational therapy and other health professional students with disabilities can be facilitated effectively.

A qualitative pilot study was conducted to obtain phenomenological data from clinical practice educators on this subject. Stratified sampling was used to select six occupational therapists from throughout New South Wales, Australia, who had supervised students with a wide range of disabilities. Individual semi-structured interviews were conducted to explore the subjective experiences of and strategies employed by the participants when supervising a student with a disability.

The participants often described the adoption of a ‘therapist’ role with these students. This approach was perceived as less effective than an ‘educator’ role in developing students' initiative and clinical reasoning skills. The participants identified both the need for more support and education from universities and the need for improved evaluation strategies to accommodate students' needs while maintaining professional standards. To ensure positive practice education outcomes for students with disabilities, future undertakings should focus on developing collaboration between universities, students and practice educators.
Accreditation of Practice Educators: An Expectation Too Far?
Authors: Craik Christine , McIntyre Anne , Gallagher Margaret
Published: April 2015

The successful completion of practice placements is essential to the education of occupational therapists; however, ensuring quality placements is challenging for occupational therapy educators. In 2000, Brunel University introduced a revised system of accreditation of practice educators which involved attendance at a course, the supervision of a student and the submission of an essay to be assessed.

An audit revealed that a total of 314 therapists attended 15 courses between 2000 and 2003; of these, 243 (77%) subsequently supervised students and 32 (10%) became accredited. The requirement to accredit practice educators, which is a commendable attempt to ensure quality, may paradoxically have been detrimental in achieving quality. The College of Occupational Therapists' apparent change of emphasis on this topic is welcomed.
Activity Pacing in Chronic Pain Management: One Aim, but Which Method? Part One: Introduction and Literature Review
Authors: Birkholtz Marietta , Aylwin Louise , Harman Rachel Megan
Published: April 2015

People with chronic pain often adopt activity patterns that can exacerbate their pain and undermine their quality of life. Activity pacing is considered an essential component of occupational therapy in pain management and other clinical areas to counteract the overactivity-underactivity cycle.

Part one of this paper provides an introduction and literature review on the subject of activity pacing in chronic pain management. Based on case histories, the psychosocial issues arising from underactivity or overactivity, or a combination of the two, are explained. It is demonstrated that activity pacing is ill-defined and subject to discrepancies in practice. In particular, guidance regarding quota-based practice to prevent pain-contingency remains unresolved. Part one concludes that research is needed to clarify both the theory and the practice of activity pacing.

Part two of this paper will present the outcomes of a national occupational therapy survey on activity pacing.
Subtle Realism and Occupational Therapy: An Alternative Approach to Knowledge Generation and Evaluation
Authors: Duncan Edward A S , Nicol Margaret M
Published: April 2015

Occupational therapists are increasingly engaging in research. As this occurs, important and challenging questions are being asked about the most appropriate research approaches to use. Strongly held perspectives of what best constitutes evidence often conflict with influential hierarchies of research. The British Journal of Occupational Therapy has, in recent years, published a variety of papers and letters that have presented and defended effectively the differing perspectives of research approaches. Each of these has presented challenges to occupational therapy research. This opinion piece supports a combinist approach to research. It presents and defends such an approach from a subtle realist perspective.
From ‘Gibbering Idiot’ to ‘Iceman’, Kenny's Story: A Critical Analysis of an Occupational Narrative
Authors: Finlay Linda
Published: April 2015

Narratives can offer rich, valuable and powerful insights. However, they do not stand on their own: they need to be interpreted and contextualised. This paper offers a critical analysis of the occupational narrative of one man's journey towards finding a new occupational identity after experiencing mental health problems.

The narrative reveals something of the man's, Kenny's, lived experience and his occupational needs, drivers and trajectory. The value of occupation (rather than simply employment) is demonstrated. The narrative is then briefly analysed: first, by taking a phenomenological approach focusing on the lived experience and, secondly, by taking a social constructionist approach which highlights how the story is both performed and co-constructed.

This two-pronged analysis demonstrates how narratives are produced and constructed in particular social contexts. How we understand a narrative depends on how we frame it and the theoretical perspectives that we bring to bear. It is important to be reflexive – that is, to be critically self-aware – as we engage in narrative inquiry.
Activity Pacing in Chronic Pain Management: One Aim, but Which Method? Part Two: National Activity Pacing Survey
Authors: Birkholtz Marietta , Aylwin Louise , Harman Rachel Megan
Published: April 2015

Part one of this paper suggested that, in order to attain activity goals, it is important to replace activity contingent on pain with activity contingent on quota, such as time or number. This is one aspect of activity pacing, which can help to break the detrimental overactivity-underactivity cycle. However, there are few established guidelines regarding activity pacing. Part two reports a study which sought to answer two questions: what are the main principles underlying activity pacing and how are activity pacing principles taught?

A questionnaire was posted to all 78 members of the National Occupational Therapy Pain Association in order to sample current practice. The 49 (63%) respondents endorsed nine behaviours contributing to activity pacing, including planning activities, breaking activities into manageable parts, increasing activity amounts gradually and alternating tasks. The occupational therapists used varied methods to teach these behaviours and only half of them used time as the unit of increase. These therapists disagreed about how long to continue timer use for and what activities to use it for.

The importance of time-contingency in activity pacing, and related teaching methods, is contentious. No alternatives were suggested to time-contingency to break the pattern of pain-contingency in activities. Studies are urgently needed concerning the efficacy of time-contingency, the efficacy of any alternatives and their acceptability to patients.