bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the Transition to Community Living After Discharge From an Acute Care Hospital: An Exploratory Study
Authors: Gage Marie , Cook Joanne Valiant , Fryday-Field Karen
Published: October 2011

Objectives. This study was conducted to obtain patients’ experiences in making the transition from an acute care hospital to their homes in the community.

Method. Data were gathered through group and telephone interviews with a volunteer sample of 27 discharged patients. Analysis involved two stages: categorization of shared themes and interpretation of individual occupational experiences.

Results. Informants described their experiences of transition in terms that were analytically categorized as Perceived Self-Efficacy, Resources, Dimensions of Occupation, and Environmental Constraints and Opportunities. Analysis of individual patient transcripts suggests the presence of an hierarchical ordering of desired occupations.

Conclusion. Understanding patients’perceptions of enabling and disabling experiences has implications for predischarge and postdischarge practice in occupational therapy.
The Efficacy of an Early Prevention Program Facilitated by Occupational Therapists: A Follow-Up Study
Authors: Parush Shula , Hahn-Markowitz Jeri
Published: October 2011

Objective. This study examined the long-term effect of an early prevention program on mothers’ knowledge, attitudes, and practices with regard to their children’s development. The prevention program focused on increasing the mothers’ sensitivity to their children’s needs and their awareness of the importance of their role in their children’s early development.

Method. Fifty-five mothers and their infants received approximately .5 hours of intervention once every 8 weeks during the infants’ first year of life. A control group of 54 mothers and their infants did not receive the intervention. Subjects’ knowledge of their children’s sensory, motor, and language abilities; their beliefs in their ability to influence their children’s development; and an indication of whether they implemented their knowledge were all measured with the Knowledge, Attitude, and Practices Questionnaire (KAP) 1.5years to 2 years after completion of the prevention program.

Results. KAP scores of the intervention group were higher than the scores of the control group, suggesting that the prevention program helped mothers acquire greater knowledge and more appropriate attitudes and practices about child development.

Conclusion. This study supports the theory that the effect of a primary prevention program during the first year of a child’s life can be sustained for 1 year to 2 years.
The Mechanisms for Adult-Onset Apraxia and Developmental Dyspraxia: An Examination and Comparison of Error Patterns
Authors: Poole Janet L. , Gallagher Jere , Janosky Janine , Qualls Clifford
Published: October 2011

Objectives. The purpose of this study was to determine whether persons with developmental dyspraxia and apraxia make similar errors during the performance of four types of tasks.

Method. Three groups of subjects with dyspraxia or apraxia (i.e., children with learning disabilities and dyspraxia, young adults with learning disabilities and dyspraxia, older adults with left-hemisphere brain damage with apraxia) and three groups of age-matched control subjects (i.e., children, young adults, older adults) were observed performing transitive, intransitive, verbal command and imitation tasks. Performance was scored on the basis of the types of errors made. Errors were classified as conceptual (nonrelated, unrecognizable, sequencing) or production (omission, perseveration, related, internal configuration, external configuration, incorrect movement, body part as object).

Results. No significant difference was found between conceptual and production error patterns for any group. In addition, there was no significant difference between the dyspraxia and apraxia groups or among the control groups on the specific types of production errors made. However, the dyspraxia and apraxia groups differed in the type of conceptual error made on the intransitive task. The body-part-as-object error was the most frequently made error on the transitive, verbal command, and imitation tasks, whereas the movement error was the most frequently made error on the intransitive task.

Conclusion. Subjects with dyspraxia or apraxia make similar errors, suggesting that the praxis behaviors are similar.
Teaching Diagnostic Reasoning: Using a Classroom-as-Clinic Methodology With Videotapes
Authors: Neistadt Maureen E. , Smith Ruth E.
Published: October 2011

Objectives. The purpose of this study was to examine the effect of a “classroom-as-clinic ”format, using videotaped occupational therapy evaluations, on students’ diagnostic reasoning skills. In the classroom-as-clinic format, students write a problem list on the basis of preliminary client information before viewing the videotape.

Method. A post-hoc experimental design was used to compare the accuracy of treatment plan problem lists for two groups of senior occupational therapy students—one group viewed two videotapes of client-therapist interactions without a classroom-as-clinic format (n = 82), and one group viewed the same videotapes within the context of a classroom-as-clinic format (n = 45). Both groups viewed the same two videotapes. Videotape 1 was of a client with a brain stem infarct, and Videotape 2 was of a client with traumatic brain injury.

Results. Subjects experiencing a classroom-as-clinic format identified significantly more occupational therapy problems for Videotape 1 than those who did not have preevaluation information. There was no significant difference between the two subject groups in the accuracy of their problem lists for Videotape 2. Only subjects in the non-classroom-as-clinic group showed a significant improvement from Videotape 1 to Videotape 2 in occupational therapy problem identification.

Conclusion. This study suggests that to be truly effective when used with videotapes, the classroom-as-clinic methodology needs to be combined with explicit coaching in problem sensing and problem definition.
Evaluation of Daily Living Tasks: The Home Care Advantage
Authors: Rogers Joan C. , Holm Margo B. , Stone Ronald G.
Published: October 2011

Occupational therapists working in home care have an advantage over those working in other settings because they can observe the influence of the naturalistic context on task performance. However, to use this advantage, therapists working in home care must use an evaluation approach that enables them to capture the client-task-context transaction. In this article, we discuss the ability of four “ evaluation approaches”—norm-referenced, criterion-referenced, dynamic, informal—to provide information about the client-task-context transaction that therapists need in order to plan effective intervention. The potential of each approach for identifying clients’ performance problems, suggesting etiologies, determining rehabilitation potential, and guiding intervention is analyzed, and the appropriateness of each approach for application in the home is appraised. This analysis highlights the utility of combining the criterion-referenced and dynamic assessment approaches for use in home care. A sequential process for integrating these two approaches is provided, and the proposed outcomes to be obtained from this process are identified.
OTR–COTA Collaboration in Home Health: Roles and Supervisory Issues
Authors: Glantz Coralie H. , Richman Nancy
Published: October 2011

This article describes the registered occupational therapist (OTR)-certified occupational therapy assistant (COTA) team within the home health setting. It reviews regulations and guidelines for supervision, team interactions, and collaboration with other health care professionals and paraprofessionals. With the complexities of providing treatment in a client’s home, the team members must combine their resources to successfully achieve desired outcomes. The article addresses various areas in which quality OTR-COTA collaboration enhances therapy effectiveness in reaching established treatment goals in a realistic and creative manner.
The Use of Low-Load Prolonged Stretch Devices in Rehabilitation Programs in the Pacific Northwest
Authors: Nuismer Barbara A. , Ekes Ann M. , Holm Margo B.
Published: October 2011

Objective. This retrospective study examined the use of low-load prolonged stretch (LLPS) orthoses for contracture management.

Method. The records of 17 patients from skilled nursing facilities, hand clinics, and hospitals were reviewed. There was a total of 18 contractures (2 wrist, 12 elbow, 4 knee) secondary to neurological and orthopedic pathologies. Chart review focused on patient demographic information, range of motion (ROM) and functional outcomes, and wear schedules.

Results. The use of LLPS orthoses significantly increased ROM for the whole sample, which in turn significantly improved the subjects functional outcomes. When the sample was divided into two pathology groups to compare a predominately geriatric population with neurological pathologies to a somewhat younger population with a history of musculoskeletal pathology, both groups showed a significant gain in ROM with the use of the LLPS orthoses.

Conclusion. Use of LLPS orthoses for contracture management can mediate the losses in ROM and function that occur with joint contractures.
Understanding the Potential of Occupation: A Qualitative Exploration of Seniors’ Perspectives on Activity
Authors: Rudman Deborah Laliberte , Cook Joanne Valiant , Polatajko Helene
Published: October 2011

This article presents the results of a qualitative study that explored the characteristics and potential of occupation. Semistructured interviews with 12 seniors who live in the community followed by member-checking groups were used to explore informants’ perspectives on the importance and role of occupation in their lives by asking them about their activities. Themes pertinent to the characterization of activity, the contributions of activity, and a condition allowing for the potential of activity emerged from the inductive analysis. These themes provide information about how occupation naturally functions in the lives of seniors and suggest a tentative conceptualization of the characteristics and potential of occupation. The findings have implications for research regarding occupation and for clinical practice aimed at enabling occupation.
“Doing” in Mental Health Practice: Therapists’ Beliefs About Why It Works
Authors: Moll Sandra , Cook Joanne Valiant
Published: October 2011

Objective. The purpose of this study was to explore the beliefs of occupational therapists working in mental health regarding the therapeutic value of “doing” as a treatment modality. Doing was defined as any activity or action-oriented approach that was identified and used by the participating therapists.

Method. Eleven occupational therapists working in a variety of mental health areas were observed as they conducted 3 to 6 regularly scheduled therapy sessions. They were then interviewed about their activity-related beliefs. Audiotapes of the 44 treatment sessions and 11 interviews were transcribed and then coded to identify emergent themes and categories of beliefs about activity.

Results. Participants used a variety of activities in both task-based and verbally based treatment sessions. Multiple reasons for activity use were cited, particularly in relation to the task-based sessions. Two main themes related to the value of activity were (a) benefits of activity for the client and (b) benefits in facilitating the process of therapy. Categories of client-related benefits included skill development; impairment reduction; self-awareness; positive self-concept; interaction or connection with others; healthy, balanced routines; pleasure; and enhancement of occupational role performance. Perceived effects on the therapeutic process included creating a therapeutic context, enhancing client readiness, facilitating communication, and providing an organizing framework.

Conclusion. Occupational therapists working in mental health hold diverse beliefs about the value of doing in treatment. Basing practice on clearly identified and evidence-based beliefs will assist in ensuring a viable and valued future for the profession in this important domain of health services.
The Use of Microwave Ovens by Elderly Persons With Disabilities
Authors: Kondo Tomoko , Mann William C. , Tomita Machiko , Ottenbacher Kenneth J.
Published: October 2011

Objective. This study examined the effectiveness of microwave ovens in assisting elderly persons with disabilities with cooking food.

Method. The participants were five elderly persons who had gross motor, fine motor, or vision impairments but no cognitive impairments. Before the study, none of the participants owned or operated a microwave oven. In this single-subject design off our phases (ABAB), training in microwave oven use was provided between the first A (baseline) and first B (intervention) phases. Participants had access to the microwave oven in their homes only during the B phases. Each phase lasted for 3 weeks, for a total of 12 weeks. The frequency of using cooking appliances, the number of food items prepared, and the time spent preparing meals were recorded through daily self-reports.

Results. All participants showed an increase in the frequency of using cooking appliances for at least one of the two B phases, although they showed different patterns. The number of food items prepared increased in the B phases, except for two participants who were ill. With the introduction of the microwave oven, time spent preparing meals decreased for all five participants, and their participation in meal preparation increased. Although not measured as a study variable, results suggest that the quality of diet also improved with microwave oven use.

Conclusion. Occupational therapy practitioners who serve elderly clients might consider recommending microwave ovens for those who do not have cognitive impairments but who are having difficulty with cooking because of vision impairments or physical disabilities.
Multiskilling: A Survey of Occupational Therapy Practitioners’ Attitudes
Authors: Collins Amy Linn
Published: October 2011

Objective. Multiskilling has been identified as one means of reducing the cost of health care. This study examined occupational therapy practitioners’ knowledge of multiskilling, how it is affecting service delivery and quality of care, and how therapists believe the addition of skills should occur.

Method. A questionnaire was constructed for the survey and mailed to a random sample of 200 occupational therapists and occupational therapy assistants, all of whom were members of the American Occupational Therapy Association.

Results. The 117 respondents had a moderate understanding of multiskilling. They responded that multiskilling is beneficial to both the occupational therapy profession and the clients it serves, but they were also aware of its potential risks or disadvantages. According to respondents, multiskilling occurs formally through defined protocol and, more commonly, informally, driven by necessity and the desire to treat the client most effectively.

Conclusion. The results indicate a need for the occupational therapy profession to define multiskilling and cross training; develop ways of serving clients that respond to administrative needs and constraints while preserving the uniqueness of occupational therapy; and monitor treatment outcomes of all service delivery methods to provide information regarding efficiency, effectiveness, and client satisfaction.
Effects of Object Affordances on Reaching Performance in Persons With and Without Cerebrovascular Accident
Authors: Wu Ching-yi , Trombly Catherine A. , Lin Keh-chung , Tickle-Degnen Linda
Published: October 2011

Objective. This study investigated whether affording objects with different levels of functional support would have an impact on reaching performance in patients after cerebrovascular accident (CVA) and in adults who were neurologically intact. Reaching performance was quantitatively analyzed, using several kinematic variables.

Method. Two groups, 14 participants after CVA and 24 age-matched adults who were neurologically intact, performed a food chopping task under two conditions: enriched affordances and impoverished affordances. Enriched affordances involved reaching forward to a chopper and pushing down on the handle to chop afresh mushroom. Impoverished affordances involved reaching forward to a simulated chopper (i.e., a chopper covered with cardboard) without anything in it and then pushing the handle down. Reaching movement was measured by a three-dimensional motion analysis system.

Results. For the CVA group, the enriched condition of reaching to chop the mushroom resulted in more efficient, direct, smooth, and preplanned movement than the impoverished condition of reaching to push on the chopper handle. The neurologically intact group responded similarly except that the participants’ movement was equally smooth, as measured by movement unit, between the two testing conditions. Force generation, as characterized by peak velocity, was similar for both conditions for both groups.

Conclusion. The finding that enriched affordances had a positive effect on movement kinematics in both CVA and neurologically intact groups suggests that providing natural objects for completing a task and providing functional information on the objects may enhance the functional performance of persons who have had a CVA. These findings should be replicated and extended to confirm the validity of these effects and allow for generalization.
An Outcome in Need of Clarity: Building a Predictive Model of Subjective Quality of Life for Persons With Severe Mental Illness Living in the Community
Authors: Chan Peiying Sarah , Krupa Terry , Lawson J. Stuart , Eastabrook Shirley
Published: October 2011

PURPOSE. The study purpose was to construct a predictive model of subjective quality of life for persons with severe mental illness living in the community with particular attention to participation in occupations.

METHOD. Persons with severe mental illness (N = 154) rated their subjective quality of life. Several measures for each of the following categories of variables were completed: demographics, clinical, social participation, and self-measured well-being. Regression analysis was used to determine the significant predictors for each category and then to build the predictive model from these significant variables.

RESULTS. Symptom distress accounted for the most variance (33%) in subjective quality of life, followed by psychological integration (3%) and physical integration (2%).

CONCLUSIONS. The study suggests that occupational therapists should attend to subjective experience of symptoms to influence quality of life. Therapists are also in a good position to address their clients’ sense of belonging to their communities and to enable community participation.
A Comparative Analysis of Case Presentation Modalities Used in Clinical Reasoning Coursework in Occupational Therapy
Authors: Lysaght Rosemary , Bent Margaret
Published: October 2011

This study used mixed methods to compare four different styles of case presentation in a course designed to develop the clinical reasoning skills of master’s level occupational therapy students. Modalities used to present cases were printed text, videotape, live interview, and CD-ROM movies delivered on an Internet platform. The researchers sought to determine the relative merits and limitations of each modality from both pedagogical and practical standpoints. Results indicate that the choice of modality does not compromise the ability of students to meet learning objectives related to clinical reasoning; however, several advantages and disadvantages with respect to practical aspects of presentation and learning were identified from instructor and student perspectives. The strength of the overall instructional format, and decisions concerning the amount and type of information provided in the cases were found to be more relevant to the quality of the learning experience than the modality of presentation. Recommendations are provided for structuring clinical reasoning learning experiences that combine the best features from the case modalities examined in this study.
A Conceptual Framework To Increase Usability of Outcome Research for Evidence-Based Practice
Authors: Sudsawad Pimjai
Published: October 2011

Although evidence-based practice is the current practice approach recommended for use in occupational therapy, practitioners often report difficulties in using research evidence because of its content and presentation. This paper discusses a conceptual model that researchers can use to create research evidence that is easier for practitioners to understand and use. The Diffusion of Innovations Theory is used as a framework to identify desirable characteristics that may facilitate practitioners’ adoption and utilization of research evidence. The concepts of social validity, ecological validity, and clinical significance are presented and discussed as ways to create those desirable characteristics that could make research information more usable for evidence-based practice. Examples for implementation of the conceptual model are also discussed.
Reliability and Validity of the Test of Visual-Perceptual Skills (Non-Motor)–Revised for Chinese Preschoolers
Authors: Chan Phoebe L. C. , Chow Susanna M. K.
Published: October 2011

OBJECTIVE. The reliability and validity of the Test of Visual-Perceptual Skills (Non-Motor)–Revised (TVPS–R) were examined for its usefulness on Hong Kong Chinese preschoolers.

METHOD. Content validity was evaluated by six experts. Test–retest reliability, construct validity, and criterion validity were examined on 66 typically developing preschoolers while concurrent validity was examined on these preschoolers plus 52 preschoolers with visual-perception difficulties.

RESULTS. Test–retest reliability was high for the total score (intraclass correlation coefficient [ICC] =.88), but not for all subtests (ICC ranged .38 to .77) or for individual items (mean kappa = 0.32). The standard error of measurement (SEM; 1.53) and internal consistency (Cronbach’s alpha = .90) were satisfactory. Evidence supporting the test’s validity included a significant developmental trend (F = 4.99, p < .001), a lack of gender bias (F = .04, p = .84), and positive known-group differentiation (Wilks’s lambda = 52.42, p < .001). The correlation between the Motor-Free Visual-Perceptual Test–Revised composite score and the TVPS–R composite was moderate at r = .60.

CONCLUSIONS. When based on the total scores, the TVPS–R was reliable and valid. The use of subtest scores and item scores for decision making or treatment planning is not recommended.
The Effects of Peer-Play Level on Initiations and Responses of Preschool Children With Delayed Play Skills
Authors: Tanta Kari J. , Deitz Jean C. , White Owen , Billingsley Felix
Published: October 2011

The potential impact of peer-play opportunities on the overall development of young children has been welldocumented in the social development, occupational therapy, and special education literature. However, the effect of peer characteristics on the manifestation and facilitation of specific types of play roles and behaviors has received little attention. This topic is of key importance to occupational therapists who are striving to develop interventions that enhance the development of social participation and play in preschool children.

The purpose of this study was to examine the differences in initiation and response exhibited by preschoolaged children with social-play delays when participating in free-play dyads with peers of differing developmental levels. A single-subject alternating treatments design was replicated across five preschool-aged children with developmental play delays. Each child was paired with one peer who had lower developmental play skills and one peer who had higher developmental play skills. The arranged dyads were given the opportunity to play together in a specially designed playroom at their school. Their interactions were videotaped and later coded. All five children generally showed more initiation and response to initiation during play with higherlevel peers, although one participant showed less differentiation for initiation than the other four children. An occupational therapist working with a preschool child with play delays and wanting to facilitate the child’s initiation and response in play situations should consider pairing the child with play delays with a child who has higher play skills.
Comparison of Test of Infant Motor Performance (TIMP) Item Responses Among Children With Cerebral Palsy, Developmental Delay, and Typical Development
Authors: Barbosa Vanessa Maziero , Campbell Suzann K. , Smith Everett , Berbaum Michael
Published: October 2011

Impairment of children’s motor performance might limit participation in family and community life. Therefore, identification of motor impairments is important in support of early intervention to prevent limitations in children’s occupational performance. The purpose of this paper is to examine item performance on the Test of Infant Motor Performance (TIMP) in a group of infants later diagnosed as having cerebral palsy (CP), developmental delay, or typical development. Particularly, we aimed to determine if specific TIMP items have a strong relationship at particular ages with the presence of a later diagnosis of CP. Exploratory graphic representation and Rasch differential item analysis were employed to investigate each individual TIMP item’s behavior in discriminating among children with different outcomes. Items discriminating among the three outcome groups included: hand to mouth, neck control, rolling, and pull to sit items, particularly at ages term, 9 weeks, and 12–13 weeks corrected age. Children with CP presented “advanced” performance in items using extension patterns and slow development or regression in items requiring antigravity and balanced used of flexion-extension patterns of muscle activity.
The Conceptualization, Formative Evaluation, and Design of a Process for Student Professional Development
Authors: Ledet Lana , Esparza Christina Kaufman , Peloquin Suzanne M.
Published: October 2011

This article describes a process for student professional development and the efforts of faculty over almost 2 decades to conceptualize, formatively evaluate, and refine it. Initiated in 1987, the process underwent numerous changes to address both conceptual and pragmatic concerns derived from faculty and student ad hoc feedback. Currently in place is a process that addresses these concerns while lending itself to effective use among master’s level students. The development and iteration of the process is offered as a case for consideration by other educators engaged in similar efforts.
The Problem With Prevention: The Case of Spina Bifida
Authors: Neville-Jan Ann
Published: October 2011

In this paper, I present a viewpoint about prevention and spina bifida that is not usually expressed within the occupational therapy literature. Using an autoethnographic account, I convey my experiences as a person with impairments from spina bifida in order to problematize current preventive efforts undertaken to eradicate this birth defect. This self-reflexive account connects my personal experiences to historical and medical views about spina bifida. The messages inherent in preventive efforts are discussed from a disability rights perspective. Occupational therapists are challenged to examine their attitudes toward disability, act as advocates in their practice, and, in a more informed manner, support or contest policy initiatives.
Therapists I Have Known and (Mostly) Loved
Authors: Paikoff Holzmueller Roberta L.
Published: October 2011

This manuscript embeds the author’s firsthand experiences with pediatric occupational therapy with her expertise as a developmental psychologist interested in families and their collaborations with service professionals. The author’s own experiences are used to illustrate points made in literature regarding parent–professional collaborations, as well as points made in interviews of other parents of young children with special needs. It is hoped that the article can serve as a “starting off” point for discussions and partnership building between pediatric occupational therapists and the children and families they serve.
Outcomes Associated With a Summer Handwriting Course for Elementary Students
Authors: Marr Deborah , Dimeo Sandra B.
Published: October 2011

OBJECTIVE. The purpose of this study was to examine the benefits of a summer handwriting instruction course offered to community elementary-age students.

METHODS. Twenty-six students participated in the study and attended instruction for 1 hour per day for 2 weeks. Pre- and posttesting with the Evaluation Tool of Children’s Handwriting (ETCH) were conducted. Parents were also asked to rate their child’s handwriting at pretest, posttest, and 3 months posttest.

RESULTS. Participants made significant improvement in two subtests of the ETCH and in parent ratings between pretest and posttest. Parent ratings remained significantly improved 3 months posttesting. Additional results suggest that children who received special education during the previous school year improved their handwriting scores on the ETCH to a greater degree than those who did not receive special education.

CONCLUSION. A new service delivery model for handwriting instruction has the potential to benefit students. Occupational therapists should consider offering handwriting training to students in the summer especially if deterioration of performance is anticipated.
Managing Usual and Unexpected Pain With Physical Disability: A Qualitative Analysis
Authors: Dudgeon Brian J. , Tyler Erica J. , Rhodes Lorna A. , Jensen Mark P.
Published: October 2011

OBJECTIVE. With physical disabilities, persons often experience secondary pain that adds to restrictions in activity and participation. We investigated pain-management strategies used by those with physical disabilities.

METHOD. Qualitative phenomenological inquiry was used in multiple interviews with (N = 28) adults with physical disabilities (9 with amputation, 7 with cerebral palsy, and 12 with spinal cord injury) and subsequent thematic analysis.

RESULTS. Among those with physical disabilities, a distinction is made between usual and unexpected pains. Usual pain is experienced consistently or as a consequence of not getting adequate rest, exercise, or stress-free time. Managing usual pain involves uses of prevention (e.g., exercise/fitness) and/or pragmatic actions through scheduling and pacing daily activities and taking interim retreats. Unexpected pain is experienced periodically and requires an immediate response and change of activity. To manage, persons describe making efforts to create a mind and body disassociation, activating safety nets to support function and alleviate pain, and making decisions to persevere with activity and participation.

CONCLUSION. Advising those with physical disabilities to do proactive planning for both usual and unexpected pain may help them to use varied pain-management strategies to enhance function and minimize negative impacts on participation.
Level I Fieldwork Today: A Study of Contexts and Perceptions
Authors: Johnson Caryn R. , Koenig Kristie P. , Piersol Catherine Verrier , Santalucia Susan E. , Wachter-Schutz Wendy
Published: October 2011

The last comprehensive examination of the Level I fieldwork experience was performed 15 years ago (Shalik, 1990) and addressed the different types of settings in which fieldwork occurred; amounts and types of supervision; structure and scheduling of the Level I experiences; and the effects of supervising Level I students on productivity. Although every occupational therapy and occupational therapy assistant student encounters a number of Level I fieldwork opportunities, little is available describing the process and contexts of the Level I fieldwork experience today. This study, which examines 1,002 student reports on Level I fieldwork experiences, finds that Level I fieldwork today occurs in a wide variety of physical disability, pediatric, mental health, and emerging practice settings. Findings also indicate that, whereas most fieldwork educators are occupational therapy practitioners, more fieldwork educators are non–occupational therapists than in the past. Furthermore, although students reported opportunities to practice observation and communication across all settings, practice of other clinical skills was specific to type of settings, and opportunities to practice were limited. Student perceptions about opportunities for experiencing occupation-based practice, observation of theory in practice, and how students value different types of fieldwork experiences are addressed. In addition, this study explores the expansion of Level I fieldwork into emerging practice arenas and how students perceive those experiences.
Perception of Client-Centered Practice in Occupational Therapists and Their Clients
Authors: Maitra Kinsuk K. , Erway Frances
Published: October 2011

OBJECTIVE. The purpose of this study was to comparatively analyze the perceptions of clients and occupational therapists regarding their involvement in the process of client-centered practice.

METHOD. Participants (11 occupational therapists, 30 clients) in adult/geriatric health care facilities were each engaged in a semistructured interview to determine their perceptions of client-centered practice, specifically in the goal-setting process. Descriptive statistics were used to analyze the item data. In addition, one-way analysis of variance was computed to identify the differences of opinions in clients and occupational therapists on the process of client-centered practice in four facilities: long-term-care or rehabilitation, hospital outpatient, hospital inpatient, and nursing homes.

RESULTS. The occupational therapists in this study indicated use of the principles of client-centered practice in their delivery of occupational therapy services. Their clients, however, displayed mixed perceptions about their role as active participants in client-centered practice and all responded in the negative when asked if they were aware of the approach. Perceptual differences existed between the occupational therapists and their clients in relation to the use of client-centered practice, because their responses to similar questions varied. Last, type of facility significantly influenced clients’ knowledge of certain aspects of their treatment processes in the following four areas: (a) treatment goal selection, (b) encouragement provided in setting clients’ goals, (c) clients’ perception of the importance in the goal-setting process, and (d) education of clients about their participatory role in the goal-setting process.

CONCLUSION. Results suggest that a perceptual gap exists between occupational therapists and their clients in relation to their stated use of and participation in client-centered practice. In light of the results, development of a systematic strategy by occupational therapists to elicit the roles that their clients desire to play in the therapeutic process may be an effective intervention to ensure that occupational therapists and their clients are able to fulfill their roles in client-centered practice.
Perceived Risk: Effects on Reaching and Placing Performance in Persons With Cerebrovascular Accident
Authors: Fuller Holly M. , Thomas Julie Jepsen , Rice Martin S.
Published: October 2011

OBJECTIVE. Developing useful movement with the affected extremity in persons with cerebrovascular accidents (CVAs) is a common occupational therapy goal. The purpose of this study was to examine the effects of perceived risk in an occupational form on upper-extremity movement dynamics in persons who have had CVAs.

METHOD. Twenty-eight persons (M = 69.6 years, SD = 15.6 years) with post-CVA participated in the randomly assigned, repeated measures counterbalanced study. In the higher risk condition, participants reached for and grasped a raw egg in an egg carton, transported it, and placed it in a bowl with other raw eggs. The same procedure was completed in the lower risk condition with weight-matched plastic eggs. Participants completed both conditions with their affected and unaffected upper extremities. Dependent variables included total movement time and movement units.

RESULTS. The higher risk condition produced statistically significantly longer movement times (p ≤ .001), but no difference in movement units (p > .05) compared to the lower risk condition. The affected extremity had significantly longer overall movement times (p ≤ .001), but no difference in movement units (p > .05) compared to the unaffected extremity.

CONCLUSION. When higher levels of perceived risk are present in an occupational form, slower movements are elicited among persons who have had a CVA. The occupational therapist can grade tasks from relatively lower risk to tasks with relatively higher risk to help patients achieve desired variability in their movement patterns. By doing this, the patient will be better prepared for everyday situations that vary widely in degree of risk.
The Occupational Therapy Practice Checklist for Adult Physical Rehabilitation
Authors: Huebner Ruth A. , Custer Melba G. , Freudenberger Linda , Nichols Laurie
Published: October 2011

OBJECTIVE. Although the practice of occupational therapy is described in textbooks, research, and professional standards, a tool for outcomes research is needed.

METHOD. The Occupational Therapy Practice Checklist (OTPC), based on the Model of Occupational Performance (Pedretti, 1996), includes domains of adjunctive, enabling, purposeful, and occupational performance. Practices are also identified by phase of therapy (early, middle, late). The OTPC was piloted with 40 adults in an outpatient physical rehabilitation center.

RESULTS. The Kuder Richardson 20 coefficient of internal consistency was .91. Practices on the OTPC discriminated between clients with and without neurological disorders.

CONCLUSION. The OTPC has potential for yielding knowledge about occupational therapy practice. Results of the pilot show that occupational therapy practice was not linear, as theorized, but rather a complex integration of techniques.
Validity of the Cognitive Behavioral Driver’s Inventory in Predicting Driving Outcome
Authors: Bouillon Louise , Mazer Barbara , Gelinas Isabelle
Published: October 2011

OBJECTIVE. This study seeks to (a) compare Cognitive Behavioral Driver’s Inventory (CBDI) scores for clients who passed and failed a driving evaluation and for diagnostic groups (left cerebrovascular accident [CVA], right CVA, traumatic brain injury [TBI], and cognitive decline); (b) determine sensitivity, specificity, and positive and negative predictive values of the CBDI; (c) compare validity of the CBDI with other tools; and (d) identify factors associated with outcome.

PARTICIPANTS. This historical cohort study included clients with neurological conditions who completed a driving evaluation.

MEASURES. CBDI, Motor-Free Visual Perception Test (MVPT), Bells test, and driving results were extracted from the charts.

RESULTS. Mean CBDI (p < 0.0001) and MVPT (p < 0.0001) scores were significantly worse for those failing compared to passing the driving evaluation. Sensitivity of the CBDI was 62%, specificity was 81%, positive predictive values were 73%, and negative predictive values were 71%. Results varied according to diagnostic group.

CONCLUSIONS. The CBDI is not sufficiently predictive of outcome to replace a driving evaluation, and is predictive only for clients with R-CVA and TBI. Evaluation of driving should vary according to diagnosis.
Maternal Attitudes and Self-Definition as Related to Perceptions of Infant Temperament
Authors: Pizur-Barnekow Kris
Published: October 2011

Maternal childbearing attitudes and self-definition as related to maternal perceptions of infant temperament were investigated in a pilot study. Maternal attitudes, self-definition, and perceptions of infant temperament were determined through mothers’ self-report. Results indicated that maternal attitudes—including self-confidence and feelings toward infants and children—were positively related to maternal perceptions of infant temperament. That is, mothers who reported low self-confidence and negative feelings toward infants and children in general also rated their infants’ temperament as more negative. In addition, maternal work experience involving children was inversely related to maternal perceptions of infant temperament, in that those mothers who had more work experience with children rated their infants as being more difficult. The findings are consistent with Sameroff’s transactional model of development (Sameroff & Chandler, 1975) wherein both the psychological and behavioral aspects of mother and infant create the milieu for further development.
Cross-Cultural Reproducibility of the Brazilian Portuguese Version of the Role Checklist for Persons With Chronic Obstructive Pulmonary Disease
Authors: Cordeiro Júnia R. , Camelier Aquiles , Oakley Frances , Jardim José R.
Published: October 2011

OBJECTIVE. This article presents the results of a cross-cultural reproducibility and test–retest reliability study of a Brazilian version of the Role Checklist, in a population with chronic obstructive pulmonary disease (COPD).

METHODS. The English version was translated and culturally adapted into Brazilian Portuguese, then administered twice at a 2-week interval to a group of 25 clinically stable individuals with COPD.

RESULTS. Cross-cultural adaptation led to adjustments in some terms used in the checklist. Values obtained for kappa suggested moderate-to-substantial agreement for Part I and Part II. No statistically significant correlations were found between agreement and variables of gender, occupation, marital status, level of education, level of depression, or severity of bronchial obstruction.

CONCLUSION. The Brazilian Portuguese version of the Role Checklist was found content valid and reliable for persons with COPD and probably for the Brazilian population in general.
Splinting for Osteoarthritis of the Carpometacarpal Joint: A Review of the Evidence
Authors: Egan Mary Y. , Brousseau Lucie
Published: October 2011

OBJECTIVE. Our objective was to review the evidence regarding the effectiveness of splinting for carpometacarpal osteoarthritis.

METHODS. A systematic review was conducted. Clinical considerations, occupational therapy exemplars, and further research questions were identified.

RESULTS. There was fair evidence for the effectiveness of splinting to relieve pain and improve function. There was no clear evidence of the superiority of one type of splint over another for pain relief, comfort, or function. Patient preference regarding type of splint varied.

CONCLUSIONS. Research to date indicates that splinting may help relieve pain in persons with carpometacarpal osteoarthritis. Further investigation is recommended using controlled methodology, more thorough reporting of outcomes, and tracking of analgesic use.
Interrater and Intrarater Reliability of the Assisting Hand Assessment
Authors: Holmefur Marie , Krumlinde-Sundholm Lena , Eliasson Ann-Christin
Published: October 2011

OBJECTIVE. The aim of this study was to evaluate interrater and intrarater reliability for the Assisting Hand Assessment.

METHOD. For interrater reliability, two designs were used: 2 occupational therapists rated the same 18 children, and 20 occupational therapists rated the same 8 children. For intrarater reliability, 20 raters each rated one child twice. Both English and Swedish versions of the instrument were used. Intraclass correlation coefficients (ICCs) and standard error of measurement (SEM) were calculated.

RESULTS. ICCs for the sum score for the interrater were 0.98 (two raters) and 0.97 (20 raters) and for the intrarater 0.99. SEM was 1.5 for interrater and 1.2 for the intrarater study, which gave an error interval of ± 3 raw scores for interrater and ± 2.4 raw scores for intrarater.

CONCLUSION. This study shows excellent interrater and intrarater reliability for sum scores.
Factors Influencing the Use of Energy Conservation Strategies by Persons With Multiple Sclerosis
Authors: Holberg Christa , Finlayson Marcia
Published: October 2011

OBJECTIVE. To examine the factors influencing the implementation and continued use of energy conservation strategies among persons with multiple sclerosis.

METHOD. A qualitative research design was used. Eight persons with multiple sclerosis who participated in a 6-week energy conservation educational course delivered by teleconference were interviewed using a semistructured, open-ended format. Participants were asked about their thoughts, feelings, and actions resulting from course participation. They also were engaged in a card-sort activity to promote discussion about using the energy conservation strategies. The data were analyzed thematically.

FINDINGS. Three themes directly addressed and interacted to enhance or hinder the use of energy conservation strategies: (1) experience with the disease, (2) sense of self, and (3) environmental factors. The fourth theme of education emphasized how participation in the educational course and use of the strategies afterward gave participants a new ability to manage their lives with multiple sclerosis.

PRACTICE IMPLICATIONS. The findings of this study demonstrated that the use of energy conservation strategies is not dependent on a single factor but rather on complex, interrelated contextual factors.
Lessons Learned: A Pilot Study on Occupational Therapy Effectiveness for Children With Sensory Modulation Disorder
Authors: Miller Lucy Jane , Schoen Sarah A. , James Katherine , Schaaf Roseann C.
Published: October 2011

OBJECTIVE. The purpose of this pilot study was to prepare for a randomized controlled study of the effectiveness of occupational therapy using a sensory integration approach (OT-SI) with children who have sensory processing disorders (SPD).

METHOD. A one-group pretest, posttest design with 30 children was completed with a subset of children with SPD, those with sensory modulation disorder.

RESULTS. Lessons learned relate to (a) identifying a homogeneous sample with quantifiable inclusion criteria, (b) developing an intervention manual for study replication and a fidelity to treatment measure, (c) determining which outcomes are sensitive to change and relate to parents’ priorities, and (d) clarifying rigorous methodologies (e.g., blinded examiners, randomization, power).

CONCLUSION. A comprehensive program of research is needed, including multiple pilot studies to develop enough knowledge that high-quality effectiveness research in occupational therapy can be completed. Previous effectiveness studies in OT-SI have been single projects not based on a unified long-term program of research.
Validating the Diagnosis of Sensory Processing Disorders Using EEG Technology
Authors: Davies Patricia L. , Gavin William J.
Published: October 2011

OBJECTIVE. This study tested the assumption of sensory integration theory that states that a relationship exists between brain function and the behavioral manifestations of sensory integrative dysfunction.

METHOD. Electroencephalographic measures were used to examine brain processing in 28 children with sensory processing disorders (SPD) and 25 children who were typically developing, ages 5–12 years.

RESULTS. Children with SPD demonstrated less sensory gating than children who were typically developing. A significant relationship between sensory gating and age was found in children who were typically developing but not in children with SPD. Brain activity correctly distinguished children with SPD from children who were typically developing with 86% accuracy.

CONCLUSION. These results present empirical evidence that children with SPD display unique brain processing mechanisms compared to children who are typically developing and provide external validity for the diagnosis of SPD.