bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effectiveness of Sensory Integration Therapy to Improve Functional Behaviour in Adults with Learning Disabilities: Five Single-Case Experimental Designs
Authors: Urwin Rosalind , Ballinger Claire
Published: April 2015

This paper describes a research project using a single-case experimental design (A-B-A), which aimed to explore the impact of sensory integration therapy (SIT) on level of engagement and maladaptive behaviour (measured through timed scores) and function (using Goal Attainment Scaling, GAS) for five learning disabled adults with tactile sensory modulation disorder.

Each phase lasted 4 weeks and consisted of 24 measurements in total. Individually tailored SIT was given twice weekly for 4 weeks during the intervention phase (B), immediately prior to each individual's participation in his or her prescribed horticulture task. The changes between phases in engagement, maladaptive behaviours and function scores, measured as the difference between baselines and intervention, were analysed visually and statistically for each participant.

The intervention produced significant improvements in engagement for participant four, with a highly significant deterioration in scores for all five participants on withdrawal of SIT. All the participants' maladaptive behaviour decreased significantly on the introduction of SIT. Although there was no significant change to GAS scores for four participants, participant four's score improved significantly with SIT. The withdrawal of SIT resulted in a highly significant deterioration in GAS scores for participants one, two, four and five. This study may be the first to suggest that SIT is effective in improving functional performance in adults with a learning disability with a tactile sensory modulation disorder.
An Investigation of the Effectiveness of the Quebec User Evaluation of Satisfaction with Assistive Technology via a Postal Survey
Authors: Goodacre Lynne , Turner Gina
Published: April 2015

The need to involve users of assistive technologies in the evaluation of equipment has been stressed consistently and linked directly with equipment use. However, in clinical practice obtaining feedback that is informed by prolonged use within the home can be difficult to achieve owing to current working practices. This paper describes the experience of using the Quebec User Evaluation of Satisfaction with Assistive Technology in a postal survey and discusses the potential application of this method of administration in routine practice to obtain user evaluation.
Internationalisation and Impact Factors: A Communication from the Editorial Board
Authors: Corr Susan , Goodacre Lynne , Atwal Anita , Mountain Gail , Steward Barbara , Ballinger Claire , Barnett Upma
Published: April 2015

In response to correspondence relating to the need to consider the internationalisation of the British Journal of Occupational Therapy and to achieve an impact factor rating, this communication from its Editorial Board discusses the issues involved and provides information on work in progress. The relevance to clinical practice is also highlighted. It is hoped that this communication will lead to discussion on the future direction of the journal.
Home Assessment Visits within the Acute Setting: a Discussion and Literature Review
Authors: Welch Amanda , Lowes Sylvia
Published: April 2015

The emphasis on the effective and efficient use of finite resources within acute hospitals has led to close attention being paid to the length of patients' hospital stay and the assessment of risk in facilitating timely hospital discharge. Occupational therapy home assessment visits are valued by the multidisciplinary team as a means of assessing a patient's level of function and environmental risk to ensure safe discharge from hospital.

Occupational therapists' education and training and experience mean that they are well placed to predict levels of function postdischarge and to anticipate any problems that may occur in activities of daily living. However, for patients the home assessment visit can be a stressful and bewildering experience. The short-term focus on equipment provision combined with limited postdischarge intervention may not meet patient and carer expectations or concerns with longer-term issues.

Although there is a body of evidence to support this intervention, the requirement for evidence-based practice means that there is a need for additional research around the areas of optimal timing, selection of patient groups, therapist's rationale, patient and carer perspectives and any effect that home assessments may have on readmission rates. This paper discusses the literature in relation to the practice of home assessment visits from the acute setting.
The Canadian Occupational Performance Measure: Does it Address the Cultural Occupations of Ethnic Minorities?
Authors: Fisher Sarah
Published: April 2015

This study is the first to examine the cultural sensitivity of the Canadian Occupational Performance Measure (COPM), as reported by occupational therapists who have used it with people from an ethnic minority background. The research was conducted as part of a Master's degree, held in Boston, USA, and funded by the Elizabeth Casson Trust, UK. Twenty-five practising occupational therapists from North America answered an emailed survey and, from this sample, three were interviewed by telephone.

The findings showed that the practitioners perceived the COPM as able to address the cultural occupations of ethnic minorities; however, they felt that including examples of cultural occupations and children's occupations and modifying the rating scales would improve the tool. Two of the three therapists interviewed worked with children and, because of this, there was a focus on children's occupations that was only revealed in the second part of the research.

The nature of the tool, its ability to focus on occupation and the therapist's interview skills were identified as the reasons that the COPM is effective in addressing the cultural occupations of ethnic minorities. Additional research is needed using a larger sample to validate these findings.
Student Practice Contexts: Changing Face, Changing Place
Authors: Wood Anna
Published: April 2015

A survey was undertaken to identify emerging areas for practice placements as the first part of a three-phase project. Quantitative data pertaining to the number of non-traditional and role-emerging placements taking place were obtained. Qualitative data were gathered to identify the impetus for creating these types of placement, the ways that they were assessed and reviewed and their potential for further development.

The questionnaire was circulated to 27 practice placement tutors, 24 of whom responded. The data were anonymised. Twenty-one of the practice placement tutors stated that their higher education institutions offered placements outside the National Health Service or local authority services. Mental health settings were the largest provider of both non-traditional placements (29%) and role-emerging placements (37%). The survey generated detailed responses on the strengths and challenges of these placements and the majority of the participants were in favour of further development in this area.
Spirituality: A Review of How Occupational Therapists Acknowledge, Assess and Meet Spiritual Needs
Authors: Johnston Diane , Mayers Christine
Published: April 2015

The importance of considering an individual's spirituality and the confusion over definition have been emphasised by the interest shown in this subject over the past decade. A working definition to help to reduce confusion was presented at the College of Occupational Therapists' annual conference in 2004 and it was felt that it would be useful both to review the attitudes and practices of occupational therapists in this area and to evaluate how they assess and meet spiritual needs. It appeared that practical spiritual needs were often thought of only in terms of religious and cultural traditions or rituals and, as a result, the potential of everyday meaningful occupations was not considered fully. Therefore, the use of occupation was reviewed in relation to meeting spiritual needs. Finally, the perceived barriers to incorporating spirituality into practice were investigated. The review showed that:

▪ Although a majority of participants recognise the importance of spirituality to health and illness and the potential benefits to treatment, the number of therapists actually incorporating spiritual needs into daily practice does not demonstrate this recognition ▪ Some occupational therapists feel confident about addressing and assessing spiritual concerns explicitly, but this tends to be situation based and dependent on factors such as client-therapist relationship, therapist awareness of spiritual issues and the expression of spiritual need by the client ▪ Further exploration of the potential of everyday occupations that address the spiritual needs of both religious and non-religious clients needs to be undertaken ▪ Spirituality needs to be addressed more fully in undergraduate occupational therapy programmes.
The Artistry of Judgement: A Model for Occupational Therapy Practice
Authors: Paterson Margo , Higgs Joy , Wilcox Susan
Published: April 2015

This paper reports on a model developed through qualitative research to examine the intriguing topic of the artistry of judgement in occupational therapy. The construct of professional practice judgement artistry or PPJA was developed (Paterson and Higgs 2001) to explore the cognitive, metacognitive and humanistic aspects of judgement in professional practice. Fifty-three occupational therapy educators and practitioners from four Commonwealth countries (Australia, Canada, New Zealand and the United Kingdom) participated in focus groups and individual interviews over a one-year period in 2001–2. This research identified a number of dimensions and elements that constitute judgement artistry.

The model offers a valuable insight into understanding expertise in professional practice in an era when practitioners are struggling with a demand for increased scientific research knowledge to provide evidence for best practice. This research paper recognises the value of the art of occupational therapy and supports a client-centred approach to practice.
Working Together for Change
Authors: Keever Brendan Mc
Published: April 2015

Engaging those who provide services with those who actually receive services has often been problematic. This opinion piece is based on a housing campaign – the Homes Fit For Children Campaign – and shows how an issue can be raised to a political level. It is an illustration of good practice, demonstrating how occupational therapists can have a pivotal role in change and how real partnership working can make a difference. Although this is not an easy road, with the potential for positive change it is a road worth travelling.
What Evidence Exists for Work-Related Injury Prevention and Management? Analysis of an Occupational Therapy Evidence Database (OTseeker)
Authors: McCluskey Annie , Lovarini Meryl , Bennett Sally , McKenna Kryss , Tooth Leigh , Hoffmann Tammy
Published: April 2015

This study aimed to summarise the quantity and quality of research contained in an online evidence database (OTseeker) in one practice area, work-related injury prevention and management, to highlight the available evidence.

In May 2004, the systematic reviews and randomised controlled trials (RCTs) contained in OTseeker were analysed. The number and proportion of systematic reviews and RCTs and the number and proportion of RCTs meeting each of the 10 criteria on the PEDro scale (partitioned) were calculated and the topics and conclusions of the systematic reviews were summarised.

Of the 2330 records contained in OTseeker, 346 (14.8%) related to work-related injury prevention and management (86 systematic reviews and 260 RCTs). Of the 260 RCTs, the majority (n = 140, 53.8%) scored between 3/8 and 5/8 for internal validity on the PEDro scale (partitioned); a few scored 6/8 or more (n = 13, 5.0%). The majority of the RCTs scored 2/2 for the reporting of results (n = 217, 83.5%). Evidence was identified, mostly for the treatment of low back pain, to support the use of multidisciplinary biopsychosocial rehabilitation including workplace visits, back schools, workplace exercise, and advice to stay active and/or return to normal activities.

OTseeker contains a substantial body of research on the effectiveness of work-related injury prevention and management, although this research is of varying methodological quality.
And Then I Lost That Life: A Shared Narrative of Four Young Men with Schizophrenia
Authors: Gould Alicia , DeSouza Sharon , Rebeiro-Gruhl Karen L
Published: April 2015

A qualitative research study was conducted to explore the occupational needs and interests of young men, aged 18–30 years, who had been diagnosed with schizophrenia. Four men participated in two focus groups and described their daily occupations, both before and after diagnosis.

The constant comparative method of data analysis was used to generate the categories inductively, yielding several common themes and stories. A shared narrative was subsequently identified, which best reflected the collective lost dreams, disruptions and losses resulting from a diagnosis of schizophrenia.

The chapters of the participants' narrative describe a common struggle of attempting to rebuild lives in spite of persistent perceived barriers. The research sheds light upon the use of occupation in assisting young men to reclaim lost dreams and lives, as well as upon the impact of diagnosis on occupational engagement.
Evaluating the Impact of Mobility-Related Assistive Technology on the Lives of Disabled People: A Review of Outcome Measures
Authors: Harris Anne , Pinnington Lorraine L , Ward Christopher D
Published: April 2015

Sixteen outcome measures that could be used within the field of mobility assistive technology were reviewed. The aim was to assess how these tools measured activity and participation in relation to mobility. Each measure considered some useful aspect of participation, but none took sufficient account of the needs of those with mobility impairments or could evaluate adequately the impact of different technologies. To support client-centred and evidence-based practice, an outcome measure that evaluates the impact of mobility assistive technology on activity and participation is required.
Evidence-Based Occupational Therapy: It's Time to Take a Global Approach
Authors: Ilott Irene , Taylor M Clare , Bolanos Cristina
Published: April 2015

This opinion piece advocates that the time is right to adopt a worldwide strategic approach to evidence-based occupational therapy (EBOT). This means globalising the evidence and localising decision making in a context-sensitive way. The main barriers to and needs for collaborative action over the next 10 years are identified. The analysis is based on our experience and on reflections upon an international meeting on EBOT held in Washington DC in 2004. We hope to challenge readers to think about what they can do to make EBOT a reality for everyone everywhere.
In-order-to Analysis: An Alternative to Classifying Different Levels of Occupational Activity
Authors: Paley John , Eva Gail , Duncan Edward A S
Published: April 2015

There have been several attempts to produce an authoritative classification scheme capable of discriminating between ‘occupation’, ‘activity’, ‘task’, ‘action’ and so on, but no consensus has ever been achieved. This paper tries to diagnose the reasons for this failure to arrive at a satisfactory method of classifying different levels of occupational activity.

The paper begins with a detailed analysis of the Taxonomic Code for Occupational Performance (TCOP), the most recent attempt to produce such a scheme, and suggests that it has a number of counterintuitive implications. These are, however, rooted in a deeper problem, one which underlies not only the TCOP project but all attempts to classify occupational behaviour. Ultimately, it is argued, the classification agenda is misconceived, because it rests on the assumption that occupational terms represent real structures in the world: that they reflect (or should reflect) the way in which human doing is intrinsically divided into levels, units, sets or clusters. It is this assumption that the authors believe to be mistaken, for there is no ‘intrinsic division’ to which occupational terms can be assigned.

The paper concludes by proposing a form of analysis which, it is argued, should replace classification schemes: in-order-to analysis (IOTA). This kind of analysis, which is explained and illustrated, seeks to determine the relations between various goals that the client has and the things that he or she must be able to do in order to achieve them. It is suggested that IOTA is what various attempts at classification have been groping for, but that it captures occupational therapy's characteristic form of clinical reasoning far more effectively.
An Exploration of Ways of Knowing Employed within Occupational Therapy
Authors: Galle Liz , Whitcombe Steven W
Published: April 2015

This report presents the findings of a literature-based project with the aim of exploring the ways of knowing employed within occupational therapy. The study explored knowledge generated from the positivist and naturalistic paradigms and considered the appropriateness for occupational therapy. It sought to highlight ways of knowing that included more than just ‘scientific’ research evidence and explored theoretical understandings and personal and experiential knowing. The findings suggest that a practical artistry approach has a particular significance in day-to-day practice.
An Exploration of the Perceptions and Experiences of Basic Grade Occupational Therapists Employed in a Development Post within an NHS Trust
Authors: Siddons Sue , Rouse Simon
Published: April 2015

This study investigates an innovative concept for the employment of basic grade staff in development posts, whereby the control of and direction for their learning and development needs are given over to them.

A qualitative approach was taken, using four semi-structured interviews as the data collection tool. The findings fell into three broad categories of rotation, development and supervision.

The findings were that the participants had experienced some positive learning opportunities within the development posts. The flexibility and element of control that they had over their career pathways were viewed as attractions of the posts compared with a traditional rotation.

Further research and refinement of what the posts offer, both to newly qualified staff and to the occupational therapy service or National Health Service trust as a whole, is recommended.
Constrained Outlines: A Method for Creating Access Guidelines for Individual Wheelchair Users
Authors: Abraham Brian , Johnson Garth R
Published: April 2015

A novel method of identifying solutions for wheelchair access problems is presented. This method was developed in response to difficulties in identifying manoeuvring space requirements, particularly of wheelchair users with large or nonstandard wheelchairs. A simple theoretical model of wheelchair manoeuvring is used. This model allows scaled drawings of the wheelchair outline to be constrained on an adaptation plan, in a way that provides a useful representation of the space required during individual wheelchair manoeuvres. The method can allow speedier assessments, encourages the identification of novel and individual solutions and provides a simple visual account of decision making.
Group Reflective Supervision: Thinking with Theory to Develop Practice
Authors: Wimpenny Katherine , Forsyth Kirsty , Jones Catherine , Evans Esther , Colley Julie
Published: April 2015

This paper presents a scholarship of practice development, that is, an academic/practice partnership, within a participatory action research study. Three teams of mental health occupational therapists and an occupational therapy academic used a group reflective supervision process to support the development of the skills and tools needed to integrate a conceptual practice model. Some of the opportunities and challenges experienced as a result of using this approach are highlighted. The preliminary findings demonstrate that group reflective supervision has provided a valuable space for reflection on practice and enabled therapists to change aspects of their practice as a consequence of thinking with theory.
Qualifying as an Occupational Therapist: An Educational Journey from Ward-Based to Workplace Learning
Authors: Alsop Auldeen
Published: April 2015

This article reviews the ways in which occupational therapy qualifying programmes in the United Kingdom have changed over time as a result of political, sociological, professional and educational influences on the curriculum. Historically, professional and educational strategies were embedded in a set curriculum for a diploma qualification in occupational therapy. Critical observations about the rigidity of training methods and about the potential advantages of providing different educational opportunities for individuals led to greater freedom in curriculum design. The advantages of moving occupational therapy programmes into higher education were eventually acknowledged, leading finally to the award of degrees to those qualifying as occupational therapists.

This article tracks some of the educational developments from 1930, exploring key stances taken on curriculum design and models of programme delivery. The move away from, and back to, workplace learning is described. Future trends in Master's level education, distance learning and service learning are addressed briefly.
Problem-Based Learning within Occupational Therapy Education: A Summary of the Salford Experience
Authors: Davys Deborah , Pope Kirsty
Published: April 2015

The Directorate of Occupational Therapy at Salford University adopted a modified problem-based learning (PBL) approach in March 2004. In recent years, PBL has received mixed reviews as a teaching method within occupational therapy education. As some directorates of occupational therapy consider the introduction of a PBL approach within their curriculum, others are turning away. The authors of this opinion piece have 2 years' experience in delivering a PBL curriculum and have developed an awareness of both the advantages and the pitfalls of this style of educational delivery.
According to the Models of Care for the Treatment of Drug Misusers, Does Occupational Therapy Have a Role in the Treatment of Drug Misuse?
Authors: Davies Rachel
Published: April 2015

This opinion piece explores the role that occupational therapy has in the treatment of drug misuse in accordance with available literature. It describes the document Models of Care for the Treatment of Drug Misusers (MoC) (National Treatment Agency for Substance Misuse 2002, 2006), which sets out the national framework for the commissioning of adult treatment for drug misuse across England. This is followed by a discussion of the role that occupational therapy can play in addressing the interventions outlined in the four tiers. In the MoC document, some services or interventions, such as assessment, work and education, socialising and self-care, are mentioned, in which, according to the literature, occupational therapists could be involved. These interventions are explored citing relevant research.
Is Vocational Rehabilitation a Transition to Recovery?
Authors: Inman Joanne , McGurk Elizabeth , Chadwick Jean
Published: April 2015

This study explored the recovery experiences from being on a vocational rehabilitation scheme for service users with severe and enduring mental health problems. This was the first phase of a vocational rehabilitation service review and development.

Two associate researchers/service users were integral to the study and increased its validity. A qualitative research method was taken, using a semi-structured interview. Two main themes emerged: moving on and being on the scheme.

The findings were that transitional vocational rehabilitation schemes could have a positive effect on the vocational status, quality of life and mental health of service users with severe and enduring mental health problems given the right environment. It was recommended that the vocational rehabilitation scheme should continue, whilst the support for service users and interagency working alongside the scheme warranted further investigation.

Following the study, the scheme expanded to become an employment service that extends from the public to the independent sector and offers a wider range of vocational rehabilitation schemes within it.
Participation of Children and Young People in Research: Competence, Power and Representation
Authors: Curtin Michael , Murtagh Jane
Published: April 2015

Over recent years, there has been a move away from researching ‘on’ to researching ‘with’ or ‘for’ young people. This reflects the increasingly recognised right of young people to participate in research and to express their views and opinions. It also corresponds with the acceptance that young people both influence and are influenced by the contexts in which they live.

This move has, however, raised many issues that need to be considered when using research methodologies that aim to capture young people's voices, perspectives, interests and rights. Perhaps the most pertinent of these issues are those of competence, power and representation. Without consideration of these issues, it is easy to misrepresent and suppress the very voices and identities that researchers are aiming to represent.

This article illustrates how each issue was dealt with in two research projects conducted with young people who had a motor impairment and with the siblings of young people with a brain injury. It is reflected that occupational therapy researchers should work towards greater collaboration and participation when researching young people. This is particularly relevant because the occupational therapy profession claims to be person-centred and as such this must be reflected in the research that it conducts.
Spirituality and the Shadow: Reflection and the Therapeutic Use of Self
Authors: Collins Mick
Published: April 2015

Occupational therapists are trained to include reflection within their professional practice. The inclusion of spirituality into occupational therapy has the potential to bring the personal dimension of a therapist's spiritual faith or belief into clinical practice. This opinion piece highlights the connection between spirituality and the shadow and identifies the need for reflection on this dynamic relationship. The shadow is discussed in relation to the need for increased awareness and the development of safe parameters when considering the inclusion of spirituality and the therapeutic use of self in clinical practice.
The Use of Creative Activities with People with Mental Health Problems: A Survey of Occupational Therapists
Authors: Griffiths Sue , Corr Susan
Published: April 2015

Creative activities have been used by occupational therapists with people with mental health problems, but limited research has been published about their scope and utility. A cross-sectional survey of occupational therapists was conducted to establish how creative activities were being used for purposes other than psychodynamic therapy.

Of the 66 respondents, 54 (82%) reported using creative activities, with the majority doing so at least once a week. Diverse activities were identified as being used. The inherent nature of creative activities, their ability to meet specific needs and assist with achieving diverse objectives and their usefulness in both 1:1 and group situations were reasons why these activities were being used by occupational therapists.

This research adds to the understanding of the value that occupational therapists place on creative activities in intervention. It will inform further research, including establishing service users' views and exploring the effectiveness of the use of such activities.
The Importance of Maintaining a Focus on Performance Components in Occupational Therapy Practice
Authors: Wilby Helen J
Published: April 2015

Some authors have promoted the need for occupational therapists to prioritise occupation over performance components in their clinical work (Fisher 1992, Mathiowetz 1993, Trombly 1995, Baum and Law 1997, Fortune 2000, Molineux 2004). Nevertheless, there is a strong case to be made for maintaining concurrently a focus on performance components. This case is based on a review of relevant literature, which yielded three ways in which performance component functioning could be used to enhance a person's experience of occupational therapy. It is concluded that there is a sound rationale for maintaining a dual focus on occupational performance and performance components in occupational therapy practice.
Complex Interventions and Complex Systems in Occupational Therapy: An Alternative Perspective
Authors: Duncan Edward A S , Paley John , Eva Gail
Published: April 2015

In recent years, there have been numerous discussions of complex interventions and complex systems in the health care literature. The cue for many of these discussions was the publication of an influential document on complex interventions by the Medical Research Council in 2000, and the appearance of an equally influential series of articles on complex systems in the British Medical Journal in 2001. However, it is not always clear that the work published during the intervening period recognises that complex interventions and complex systems are not, in fact, the same thing.

This paper discusses a recent contribution to the occupational therapy literature, in which the confusion between complex interventions and complex systems drives the argument. It identifies six claims made by Creek et al (2005) and suggests that only one of them is accurate. Specifically, it argues that, although occupational therapy is sometimes a complex intervention, there is no reason to suppose that it is a complex system; nor is there any good reason to believe that occupational therapy outcomes are intrinsically unpredictable. The paper concludes with an explanation of why this topic is important, and why confusing the two (very different) kinds of complexity risks compromising the idea of evidence-based practice.
Art and Recovery in Mental Health: A Qualitative Investigation
Authors: Lloyd Chris , Wong Su Ren , Petchkovsky Leon
Published: April 2015

Arts programmes are provided as part of the psychosocial rehabilitation for consumers with a mental illness. Consumers have reported that involvement in the arts has facilitated their recovery. This qualitative study was conducted to explore the ways in which involvement in an Australian community arts programme contributed to the recovery process. It also aimed to gain an understanding of intrinsic recovery, which focuses on personal satisfaction and meaning.

Eight consumers with a mental illness who were members of a community-based arts programme participated in in-depth semi-structured interviews. The themes that were analysed thematically from the interviews included art as a medium of expression and self-discovery, and changes in internal conditions (spirituality, empowerment and self-validation). The findings revealed the usefulness of arts programmes in providing the external environment that facilitates internal recovery.
Who's Carrying the Baby?
Authors: Evans Nina , Orpwood Roger
Published: April 2015

Parents who are wheelchair users face the practical problem of manoeuvring a wheelchair at the same time as pushing a pushchair. The Bath Institute of Medical Engineering (BIME) has designed a pushchair to attach to a manual wheelchair. This paper describes the rationale behind the project and how disabled parents have been integral to the design process. The process and findings of the evaluation programme are reported.

Evaluation is important to designers to understand the outcomes of their work. ‘It's as simple as needing to know whether assistive technology works’ (Smith 1998, p20). This process also provides insights to occupational therapists to guide them in their professional judgements about whether an equipment solution can meet user requirements.
The Casson Memorial Lecture 2007: Diversity amongst Occupational Therapists — Rhetoric or Reality?
Authors: Taylor M Clare
Published: April 2015

The Casson Memorial Lecture 2007, given on 21 June at the 31st Annual Conference of the College of Occupational Therapists, held at Manchester Central, Manchester.
Application of Nonlinear Dynamics Theory to Neuro-Occupation: A Case Study of Alcoholism
Authors: Haltiwanger Emily , Lazzarini Ivelisse , Nazeran Homer
Published: April 2015

Nonlinear dynamics systems theory, also referred to as chaos theory, is infiltrating the biomedical and social sciences, including the practice of occupational therapy. Consequently, the Neuro-occupation model has emerged for the treatment of different illnesses, in which a therapist strives to apply the benefits of this theory. This model provides occupational therapists with a method of anticipating the natural flux between underlying or hidden order and chaos in occupations, which allows individuals to function at their highest level. These occupations typically involve the interaction of numerous variables over time. By considering a nonlinear dynamics approach in illnesses such as alcoholism, occupational therapists may understand how meaningful occupations serve as a catalyst to facilitate change, which may assist in better understanding the effect of the therapeutic relationship with the clients they serve. This paper explains the nonlinear dynamics of the interventions in a single case study on alcoholism using the Neuro-occupation model.
Occupational Therapy for Children with Attention Deficit Hyperactivity Disorder (ADHD), Part 1: A Delineation Model of Practice
Authors: Chu Sidney , Reynolds Frances
Published: April 2015

An occupational therapy delineation model of practice is presented, which guides a multidimensional understanding of the psychopathology of attention deficit hyperactivity disorder (ADHD) and its management. Previous research has established that occupational therapists lack detailed training or theory in this field. The delineation model of practice is based on a literature review, clinical experience and a consensus study carried out with occupational therapists to determine their priorities for the evaluation of, and intervention with, children with ADHD.

Part 1 of this article presents the model and examines its implications for evaluation and intervention at the levels of child, task and environment. A family-centred assessment and treatment package, based on the delineation model, is described. Part 2 of this article will report the results of a multicentre study, which was designed to evaluate the effectiveness of this package.
Preparing Occupational Therapy Students for Practice Placements: Initial Evidence
Authors: Spiliotopoulou Georgia
Published: April 2015

Practice placements are a crucial part of occupational therapy education, yet they can be a stressful experience for students, practice placement educators and the university. This may contribute to a shortage of placements. The effectiveness of a 4-week preparation, with second-level full-time students at Brunel University, prior to a practice placement was evaluated by a two-part analysis. First, the students' perspective on the effectiveness of the preparation is presented. This is followed by a comparison of placement grades between the current cohort of students (academic year 2006–2007), who attended the preparation, and the previous cohort of students (academic year 2005–2006), who did not have this opportunity.
What Influences Purpose in Life in First-Episode Psychosis?
Authors: Turner Niall , Jackson Deirdre , Renwick Laoise , Sutton Marie , Foley Sharon , McWilliams Stephen , Kinsella Anthony , O'Callaghan Eadbhard
Published: April 2015

Although purpose in life (PIL) is significant to psychological wellbeing, there is little published research on PIL among those with a mental illness. This prospective study of first-episode psychosis (n = 54) included assessment of symptomatology, PIL and duration of untreated psychosis. The results showed that the baseline PIL scores of those with first-episode psychosis were lower than those of other populations. This was worsened by a long duration of untreated psychosis and was linked to depression. The study concludes that psychosis results in many losses for the individual, including PIL. Meaningful occupation can address this lost sense of purpose and the occupational difficulties associated with psychosis.
Occupational Therapy for Children with Attention Deficit Hyperactivity Disorder (ADHD), Part 2: A Multicentre Evaluation of an Assessment and Treatment Package
Authors: Chu Sidney , Reynolds Frances
Published: April 2015

A family-centred occupational therapy assessment and treatment package for children with attention deficit hyperactivity disorder (ADHD) was evaluated. The package involves a multidimensional evaluation and a multifaceted intervention, which are aimed at achieving a goodness-of-fit between the child, the task demands and the environment in which the child carries out the task. The package lasts for 3 months, with 12 weekly contacts with the child, parents and teacher.

A multicentre study was carried out, with 20 occupational therapists participating. Following a 3-day training course, they implemented the package and supplied the data that they had collected from 20 children. The outcomes were assessed using the ADHD Rating Scales, pre-intervention and post-intervention. The results showed behavioural improvement in the majority of the children. The Measure of Processes of Care – 20-item version (MPOC-20) provided data on the parents' perceptions of the family-centredness of the package and also showed positive ratings.

The results offer some support for the package and the guiding model of practice, but caution should be exercised in generalising the results because of the small sample size, lack of randomisation, absence of a control group and potential experimenter effects from the research therapists. A larger-scale randomised controlled trial should be carried out to evaluate the efficacy of an improved package.
‘Gardening without Borders’: Reflections on the Results of a Survey of Practitioners of an ‘Unstructured’ Profession
Authors: Fieldhouse Jon , Sempik Joe
Published: April 2015

For several years, the social and therapeutic horticulture (STH) movement has been considering its own gradual professionalisation, as a way of raising its profile and ensuring standards of training and practice. A survey of 119 STH practitioners showed that the vast majority of respondents wanted a national body and the registration of projects and/or practitioners; over half wanted a protected job title; and there was a wish for more research-based evidence. The implications of this survey for the STH movement are discussed and issues of potential interest for occupational therapists are highlighted.
An Investigation of the Number and Cost of Assistive Devices Used by Older People Who Had Fallen and Called a 999 Ambulance
Authors: Logan P A , Murphy A , Drummond A E R , Bailey S , Radford K A , Gladman J R F , Walker M F , Robertson K , Edmans J A , Conroy S
Published: April 2015

Some assistive devices, such as walking frames and bath boards, are provided by health and social services, but some are bought by people through shops, the internet and magazines or second hand. Using a face-to-face interview, the number and cost of assistive devices bought by people who had fallen and called a 999 ambulance were investigated.

Two hundred and four older people (mean age 83 years, 72/35% men) who had fallen and called an emergency ambulance were interviewed at home by a research occupational therapist. A structured questionnaire about the cost and use of assistive devices was completed. Functional ability was measured using the Barthel Index and the Nottingham Extended Activities of Daily Living Scale.

One hundred and ten people (54%) had bought their own devices, spending a median of £700 each. People with multiple sclerosis, cancer, heart conditions and Parkinson's disease had spent over twice as much as those with osteoarthritis, stroke, diabetes and dementia.

Many older people buy their own assistive devices at a considerable cost to themselves. As social services direct payments allow people to manage their own care packages, more people will be buying direct and may be looking for advice.
Occupational Therapists Report Increased Use of Outcome Measures after Participation in an Education Programme
Authors: Cook Catherine , McCluskey Annie , Bowman Julia
Published: April 2015

This before-and-after study involved 36 occupational therapists who attended a one-day workshop on outcome measurement. The participants were given nine ready-to-use outcome measures and follow-up support. Outcome measure use was evaluated after 4 months using a self-report questionnaire. The proportion of therapists reporting use of outcome measures increased from 65.7% at baseline (23/36 participants) to 91.4% at 4 months post-workshop (32/35 participants). There was a small increase in the range of outcome measures used across the sample, from 15 at baseline to 18 after 4 months. Although the proportion of therapists measuring outcomes improved markedly after 4 months, it is not known if these behaviours were maintained in the longer term.
Occupational Therapy Home Assessments: More than Just a Visit? An Audit of Occupational Therapy Practice in Oncology and Palliative Care
Authors: Hoy Jane , Twigg Vivienne , Pearson Elizabeth
Published: April 2015

Occupational therapists at a specialist cancer centre found home assessments to be the most time-consuming intervention. To evaluate the breakdown of time and total time use for this intervention, 15 occupational therapists working in the area of oncology and palliative care participated in an audit. A total of 107 home assessments was audited. The results indicated that the total time for an average home assessment in the audit ranged between 3.31 hours and 5.59 hours. They also highlighted that the time spent in preparation and follow-up was similar to the time spent in travel and the visit itself.
An Exploration of the Neural Control of Multitasking and the Implications for Practice
Authors: Cook Clare
Published: April 2015

This paper aims to explore some of the published evidence concerning the skill of multitasking, including the neuroanatomy associated with this skill, and the assessments and interventions used within the rehabilitation setting. Multitasking is an essential skill for any person to be able to live independently. It involves a number of functions associated with the frontal lobe and is one of the components of dysexecutive syndrome. Although much has been written about other aspects of executive function, multitasking has only been researched in more detail over the last decade. It is an area of particular concern for occupational therapists aiming to rehabilitate people who have sustained a brain injury.
Early Psychosis: Treatment Issues and the Role of Occupational Therapy
Authors: Lloyd Chris , Waghorn Geoff , Williams Philip Lee , Harris Meredith G , Capra Carina
Published: April 2015

Research has demonstrated that the establishment of early intervention services within mental health organisations is an effective method of reducing the impact of psychosis on a young person's life. The research literature and available clinical practice guidelines describe key intervention areas that have an impact on the effectiveness of the early intervention service. These include: comprehensive assessment, social functioning, weight control, substance misuse and vocational recovery. Early intervention services can develop effective programmes to address these areas.

The occupational therapist can have a defined role in this setting, primarily across the three domains of assessment, intervention and advocacy. Effective assessment by an occupational therapist provides information on the occupational role functioning of a young person. Intervention services provide consultative and direct treatment to assist the young person in engaging in developmentally and culturally appropriate occupational roles. Advocacy involves educating members of the multidisciplinary mental health team about the role and potential outcomes of occupational therapy. By assessing, intervening and advocating for young people with early psychosis, individual therapists can contribute to developing a central role for occupational therapy in the field of early psychosis.
Making Informed Choices in the Context of Service User Empowerment and the Mental Capacity Act 2005
Authors: O'Brien Tish , Bannigan Katrina
Published: April 2015

The personal choices that people make are critical in enabling their engagement in meaningful occupation. Although choice is important, it has to be recognised that not all service users make informed choices to assist their recovery. This opinion piece explores the role of occupational therapists in facilitating informed choice in the light of service user empowerment and the Mental Capacity Act 2005. The opinion offered is the need to recognise the continuing role of occupational therapists in challenging some of the choices that service users make in order to enable their engagement in meaningful occupation, despite the current changes in policy and legislation.
Achieving Optimal Functional Outcomes in Community-Based Rehabilitation following Acquired Brain Injury: A Qualitative Investigation of Therapists' Perspectives
Authors: Doig Emmah , Fleming Jennifer , Kuipers Pim
Published: April 2015

The aim of this study was to explore therapists' opinions about the rehabilitation approaches that they perceived contributed to positive outcomes for people with acquired brain injury in community-based rehabilitation settings in order to develop a set of practice principles for clinicians working in this area. Semi-structured interviews were conducted with eight Australian and three British therapists, with a mean of 5.2 years' experience of working with people with acquired brain injury in community-based rehabilitation settings. The interviews were analysed thematically. A summary of the themes was presented to a larger group of acquired brain injury service providers (n = 35) for validation.

The participants emphasised the importance of environmental factors, such as collaboration with and inclusion of others in rehabilitation, especially those in the person's support network. Strategy use, client-centred goal setting, the provision of education and the development of a therapeutic relationship were identified as facilitators in community-based rehabilitation. Problems with self-awareness and motivation, drug and alcohol use, and behavioural difficulties were commonly identified barriers to optimal outcomes. The key practice principles derived from the findings were the need for community-based rehabilitation for people with acquired brain injury to be (1) environment focused and contextually appropriate, (2) collaborative and (3) goal directed and client centred.