bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined Bracing, Electrical Stimulation, and Functional Practice for Chronic, Upper-Extremity Spasticity
Authors: Hardy Kathleen , Suever Kacia , Sprague Amie , Hermann Valerie , Levine Peter , Page Stephen J.
Published: September 2010

OBJECTIVE. Conventional methods for managing upper-extremity (UE) spasticity are invasive, usually require readministration after a certain time period, and do not necessarily increase UE function. This study examined efficacy of combining two singularly efficacious modalities—UE bracing and electrical stimulation—with functional training to reduce UE spasticity and improve function.

METHOD. Two chronic stroke patients exhibiting UE spasticity were administered the Modified Ashworth Scale (MAS), the upper-extremity section of the Fugl-Meyer Impairment Scale (FM), the Box and Block Test (B&B), and the Arm Motor Ability Test (AMAT). They were then individually fitted for a brace and subsequently participated in treatment sessions occurring 2 days/wk for 5 wk, consisting of (1) 30-min clinical sessions, during which the UE was braced in a functional position while cyclic electrical stimulation was applied to the antagonist extensors of the tricep and forearm, and (2) 15-min, clinically based training sessions, occurring directly after the clinical session.

RESULTS. After intervention, participants exhibited 1-point reductions in MAS scores for the affected fingers, FM score increases, and increased ability to perform AMAT activities,. Three months later, both participants retained these changes.

CONCLUSION. Data point to a noninvasive, promising method of managing spasticity and rendering functional changes.
Examining Content Validity and Reliability of the Assessment of Children’s Hand Skills (ACHS): A Preliminary Study
Authors: Chien Chi-Wen , Brown Ted , McDonald Rachael
Published: September 2010

OBJECTIVE. We developed the Assessment of Children’s Hand Skills (ACHS) to evaluate hand skills using naturalistic observation and examined the assessment's interrater and test–retest reliability.

METHOD. We developed the hand skill framework, performed expert review, and pilot tested the ACHS. The ACHS's reliability was examined by recruiting 54 children (30 typically developing children and 24 children with disabilities).

RESULTS. The test–retest reliability for the ACHS was satisfactory at the individual item level (0.42 ≤ κ ≤ 0.79) and the total scale level (Spearman’s ρ = 0.78, p < .01). Moderate interrater agreement of the total scale scores was demonstrated (ρ = 0.63, p < .01), but individual items exhibited varied interrater agreement.

CONCLUSION. The ACHS demonstrated adequate content validity and preliminary reliability evidence and could be used to quantify children’s hand skill use. Construct validity should be established in a clinical setting.
Promoting Healthy Lifestyles With Aging: Development and Validation of the Health Enhancement Lifestyle Profile (HELP) Using the Rasch Measurement Model
Authors: Hwang Jengliang Eric
Published: September 2010

This study was conducted to develop and validate the Health Enhancement Lifestyle Profile (HELP), a self-report measure for examining various aspects of health-related lifestyle in older adults. Data derived from 253 community-dwelling older adults were analyzed through the Rasch measurement model. Unidimensionality and data-model fit of HELP were largely supported through the analyses of principal components of residuals, fit statistics, local dependency, and differential item functioning. The item hierarchy formed through logits provided an expected pattern of healthy lifestyle behaviors. Acceptable to good person separation and reliability statistics supported the clinical applicability and consistency of the HELP scores. Finally, analysis of the rating scale structure confirmed the functioning of the 0- to 5-point rating scale used. HELP can assist in monitoring lifestyle risk factors and measuring the outcome of services aimed at promoting healthy lifestyles among older adults.
Effectiveness of Rehabilitation in Enhancing Community Integration After Acute Traumatic Brain Injury: A Systematic Review
Authors: Kim Hwan , Colantonio Angela
Published: September 2010

OBJECTIVE. We assessed evidence for post–acute traumatic brain injury (TBI) rehabilitation interventions used to enhance community integration (CI) relevant to occupational therapy.

METHOD. We conducted a systematic review of intervention studies on TBI rehabilitation from 1990 to 2007.

RESULTS. We analyzed and summarized 10 studies that met the inclusion criteria. Of 10 studies, 7 found that post–acute TBI rehabilitation benefits CI; all effective studies involved occupational therapy or involved interventions occupational therapists can do.

CONCLUSION. Many CI programs show positive results and should be studied more rigorously. Such promising programs should also be considered when decisions about post–acute TBI rehabilitation services for clients are being made. To further establish that post–acute TBI rehabilitation interventions improve CI, future studies should include intervention strategies based on injury severity, a control group, and longer term follow-up. The role of occupational therapy in these effective programs should be further explored.
Child and Youth Practice Area Publications in theAmerican Journal of Occupational Therapyin 2008 and 2009: A Content Analysis, Methodology Overview, and Summary
Authors: Brown Ted
Published: September 2010

In this review, 39 articles published in the American Journal of Occupational Therapy in 2008 and 2009 that were categorized in the practice area of children and youth were examined using content analysis. The most frequent type of research published was basic research, which accounted for 38.5% (n = 15) of the 39 studies published on the topic. Instrument development and testing and effectiveness studies were the next two most frequently noted research approaches, accounting for 25.6% (n = 10) and 20.5% (n = 8) of the studies, respectively. Among the 8 effectiveness studies, the level of evidence distribution was as follows: Level I, 3; Level III, 2; Level IV, 1; and Level V, 2. Quantitative studies were the predominant research paradigm used with 76.9% (n = 30) of the studies.
Occupational Therapist Home Evaluations: Inequalities, But Doing the Best We Can?
Authors: Lysack Catherine L. , Neufeld Stewart
Published: September 2010

OBJECTIVE. The purpose of this study was (a) to describe the occupational therapy recommendations provided to patients discharged to inner city homes, and (b) to examine the relationship between patient health insurance and the number and type of occupational therapist recommendations for equipment and home modifications.

METHOD. An archival review was conducted of all referrals to the home evaluation program (n = 755) at a large urban rehabilitation hospital between January 1, 1994, and December 31, 1998. Additional patient demographic data and Functional Independence Measure (FIM) data were obtained in electronic form from the hospital information database.

RESULTS. Analysis of results showed that while the pattern of equipment and modification recommendations varied little, publicly insured patients received fewer home modification recommendations compared to privately insured patients (t = 3.7; p < .0005), and were discharged from rehabilitation with significantly lower functional independence (MANOVA F = 3.9; p = .05).

CONCLUSION. Results alert occupational therapists to the relationship between health insurance and treatment recommendations and point to patient advocacy and health policy as potential pathways to desired a achieve social change.
Test–Retest Reliability and Convergent Validity of the Fatigue Impact Scale for Persons With Multiple Sclerosis
Authors: Mathiowetz Virgil
Published: September 2010

OBJECTIVE. The test–retest reliability and the convergent validity of the Fatigue Impact Scale (FIS) were evaluated using secondary data from 54 persons with multiple sclerosis (MS).

METHODS. This reliability and validity study used FIS data from before and after two control periods to evaluate test–retest reliability. Convergent validity of the FIS with the Fatigue Severity Scale and with subscales of the SF-36 Health Survey was evaluated using data collected before the first control period.

RESULTS. No significant differences between before and after FIS measurements and intraclass correlation coefficients ranging from .68 to .85 indicate that the FIS has good test–retest reliability except for the physical subscale. The expected moderate correlations between the FIS and several subscales of the SF-36 support its convergent validity. In contrast, the unexpected low correlation between the FIS and Fatigue Severity Scale does not support convergent validity.

CONCLUSION. The FIS has adequate reliability and validity and is recommended to evaluate the effectiveness of fatigue management interventions such as energy conservation education for persons with MS.
Impact of the Social Environment on Occupational Experience and Performance Among Persons With Unilateral Neglect
Authors: Tham Kerstin , Kielhofner Gary
Published: September 2010

OBJECTIVE. The purpose of this study was to gain an understanding of social environmental influences on occupational experience and performance over the course of rehabilitation of four persons with unilateral neglect.

METHODS. The Phenomenological Psychological Method (Karlsson, 1993) was used to gather and analyze qualitative data on four women over a 4-month period. Four women were interviewed five to seven times each and observed during their rehabilitation process. Analysis focused on how these persons with unilateral neglect experienced and responded to their interactions with others in their everyday lives.

FINDINGS. As perceived by the study participants, rehabilitation professionals and relatives demonstrated a sequence of strategies for dealing with and helping the women perform despite their unilateral neglect. The sequence of strategies reflects the changing experience of neglect over time. The strategies used by professionals and family members during the rehabilitation process enabled these women to reclaim and occupy the neglected half of the world. Moreover, the women with neglect learned to incorporate others as extensions of their bodies in order to compensate for their ongoing inability to directly experience the left half of the world.

CONCLUSION. The results suggest that it is important for others (e.g., therapists, nurses, or relatives) to understand the client’s changing experience of neglect and adjust their support and collaboration accordingly. Occupational therapy intervention for persons with neglect could potentially become more effective by systematically incorporating the kinds of strategies identified in this study. Moreover, therapists could consult with others to increase their understanding and effectiveness in interacting with persons who have unilateral neglect.
The Significance of Being Occupied: The Social Construction of Childhood Occupations
Authors: Lawlor Mary C.
Published: September 2010

The purpose of this paper is to explore theoretical and developmental foundations for interpreting children’s engagement with activity in the typically social worlds of childhood. Drawing upon longitudinal ethnographic data, I argue for the need to reframe the study of childhood occupation to the study of “socially occupied beings” as a means of enhancing our understanding of children’s experiences. The focus is on childhood experiences that are socially constructed through adult and child co-created action sequences. The unit of analysis is constructed around a child or children, their adult partners in action, the social world of engagement, and the cultural context. The interpretive focus is on acts and actors, acting in a socially constructed world. Two microethnographic examples are provided; the first relates to an observation of a mother and her children playing in a hospital corridor and the second to an occupational therapist and child engaged in jointly constructed activity within a therapy session. These segments illustrate pragmatic and conceptual understandings of the interconnectedness of social relatedness, intersubjectivity, social action, and engagement. Further development of theoretical and research models is needed to capture the essence of children as socially occupied beings, doing something with someone else that matters.
Occupational Therapy in Transitioning Adolescents to Post-Secondary Activities
Authors: Spencer Janet E. , Emery Lynnda J. , Schneck Colleen M.
Published: September 2010

OBJECTIVE. The purpose of this study was to examine the perceptions of special education directors on the current role of occupational therapy in high school transition programs for adolescent students with disabilities. Additionally, barriers to providing occupational therapy services and perceptions about new occupational therapy services were examined.

METHOD. A mailed questionnaire was administered to all special education directors in a rural state in the United States. One hundred and four (57.5%) responses were received. Descriptive statistics were generated with an emphasis on percentages to examine current occupational therapy services in high school transition programs and barriers to service delivery.

RESULTS. In this study, occupational therapists provided less than one fifth of transition services in high schools for students with disabilities. They provided more assistive technology consults (30.3%), task or environmental modification (25.8%), and Individualized Education Plan (IEP) and Individualized Transition Plan (ITP) planning (20%) than other providers. Barriers to occupational therapy use included funding, lack of interagency planning, and lack of parent participation. About 35% of special education directors suggested that additional occupational therapy services were needed for adolescents with cognitive disabilities and for job performance and related work skills programming.

CONCLUSION. Occupational therapists in this study provided ancillary services to high school students with disabilities with greater emphasis on technology, task or environmental modification, and IEP or ITP planning, as perceived by special evaluation directors.
Children With Disturbances in Sensory Processing: A Pilot Study Examining the Role of the Parasympathetic Nervous System
Authors: Schaaf Roseann C. , Miller Lucy Jane , Seawell Duncan , O’Keefe Shannon
Published: September 2010

This study was a preliminary investigation of parasympathetic nervous system (PNS) functioning in children with disturbances in sensory processing. The specific aims of this study were to (1) provide preliminary data about group differences in parasympathetic functions, as measured by the vagal tone index, between children with disturbances in sensory processing and those without; (2) determine effect size and power needed for future studies; and (3) to lay the foundation for further examination of the relations of parasympathetic functioning and functional behavior in children with disturbances in sensory processing.

Participants were 15 children, nine with disturbances in sensory processing and six typically developing children. Heart period data were continuously collected for a 2-minute baseline and during administration of the 15-minute Sensory Challenge Protocol, a unique laboratory protocol designed to measure sensory reactivity (Miller, Reisman, McIntosh, & Simon, 2001). Groups were compared on vagal tone index, heart period, and heart rate using two-tailed, independent sample t tests.

Children with disturbances in sensory processing had significantly lower vagal tone than the typically developing sample (t(13) = 2.4, p = .05). Statistical power analysis indicated that, for future studies, a sample size of 20 in each group would yield adequate statistical power. Although the number of subjects in this pilot study is small, the results from this study support further investigations of parasympathetic functions and functional behavior in children with disturbances in sensory processing.
Practitioners’ Reading Patterns, Attitudes, and Use of Research Reported in Occupational Therapy Journals
Authors: Philibert Darbi Breath , Snyder Patricia , Judd Debra , Windsor Mary-Margaret
Published: September 2010

Occupational therapists are encouraged to use research-based evidence to guide practice. In this study, we investigated whether members of the American Occupational Therapy Association read their flagship journal, the American Journal of Occupational Therapy (AJOT), or other scholarly journals. Therapists’ attitudes about research, their reading patterns, and their use of research in clinical practice were also explored. A proportional, random sample of 626 therapists from five states was mailed a questionnaire; 52% were returned. Of the 328 respondents, 85% reported reading AJOT. For those who did not read AJOT, barriers cited included time constraints, difficulty interpreting results, lack of clinical information, and too much scientific information. Attitudes about research generally were positive, although ratings regarding the usefulness of research to inform clinical practices were less favorable. Attitudes about and use of research ratings were not strongly related to practice settings, educational degree level, years of experience, or state of residence. Results suggest education and clinical practice changes may be necessary to support therapists’ use of empirical evidence in practice contexts.
Mothers’ and Fathers’ Interactions With Children With Motor Delays
Authors: Ganadaki Eftichia , Magill-Evans Joyce
Published: September 2010

OBJECTIVE. In early intervention programs, parents are often asked to teach their child new skills. As fathers are increasingly involved in intervention, clinicians need more information on fathers’ unique interactive style. This pilot study compared mothers’ and fathers’ parent–child interactions during a teaching episode to identify similarities and differences in order to better understand parents’ strengths.

METHODS. The Nursing Child Assessment Teaching Scale was used to observe 10 mothers and 10 fathers interacting with their 10- to 28-month-old children in their homes. The children were receiving early intervention for a motor delay. The Caregiver Scores (parent’s contribution to the interaction) of mothers and others were compared using paired t tests.

RESULTS. Mothers had more optimal interactions as indicated by significantly higher Caregiver scores than fathers, t (9) = 3.83, p = .004. The subscales with statistically significant differences were Caregiver Contingency and Cognitive Growth Fostering. Children's scores when they interacted with their mothers or fathers did not differ.

CONCLUSION. When observing fathers teaching their child new skills, therapists should remember that fathers of children with motor delays (and typically developing children) may use a more task-oriented communication style with less consideration of the child’s actions than do mothers.
Outcomes in Hand Rehabilitation Using Occupational Therapy Services
Authors: Case-Smith Jane
Published: September 2010

OBJECTIVE. The purpose of this study was to measure functional outcomes after outpatient occupational therapy for clients who had upper-extremity injury and surgery or both.

METHODS. A sample of 33 clients referred to occupational therapy outpatient intervention was recruited from five clinics in Ohio. The Canadian Occupational Performance Measure (COPM) was used to guide the occupational therapy sessions and to measure outcomes. The Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Short Form 36 (SF-36) were also administered to the clients pre and post 6 to 8 weeks of hand rehabilitation services. Two to three months after discharge, the clients responded by the telephone to the Community Integration Questionnaire.

RESULTS. The clients received a mean of 13 hours of outpatient occupational therapy services and received no other rehabilitation service. Functional performance gains following 6 to 8 weeks of services were significant (COPM; t(32) = −11.5, p < .001; t(32) = −11.31, p < .001; DASH; t(32) = 9.22, p < .001; t(32) = −9.02, p < .001). Effect sizes on the COPM and DASH ranged between 1.43 and 2.52. Progress in the clients’ goals was moderately correlated to progress in functional measures.

CONCLUSION. Clients with upper-extremity injury or surgery made strong, positive gains in functional measures following client-centered occupational therapy services. The COPM was the most sensitive to client change, followed by the DASH, and then the SF-36.
Weighted Wrist Cuffs for Tremor Reduction During Eating in Adults With Static Brain Lesions
Authors: McGruder Juli , Cors Denise , Tiernan Anne M. , Tomlin George
Published: September 2010

OBJECTIVE. This study examined whether weighting the forearm during feeding decreased tremors and increased functional feeding in adults with intention tremor caused by static brain lesions.

METHOD. Five individuals with various diagnoses, ages 30–81, were videotaped during 8 or 16 meal sessions, alternating treatment and control conditions within each meal. In this single-case design, treatment consisted of application of a weighted fabric wrist cuff and the baseline (control) condition employed an identical cuff with the weights removed. Dependent variables studied were time to acquire and deliver a bite, grams of food eaten, number of times food was spilled, number of times a compensatory technique was used, participant self-rating, and investigator rating of the severity of the tremor.

RESULTS. All five participants demonstrated improvement during treatment in one or more of the dependent variables. t Tests of the means of baseline and treatment half-sessions incorporating conservative control of Type I error revealed the following statistically significant improvements under the weighted condition: Participants 3, 4, and 5 took less time to acquire a bite; Participants 4 and 5 made fewer spills; Participants 3 and 5 showed a diminished tremor. There were no statistically significant decreases in function on any variable for any participants during the weighted condition.

CONCLUSION. The application of weight to the wrist of a person with upper-extremity tremor is accompanied by some functional improvement in self-feeding for some individuals. The size of benefit seems to be sensitive to the amount of weight used.
The Immediate and Short-Term Effects of a Wrist Extension Orthosis on Upper-Extremity Kinematics and Range of Shoulder Motion
Authors: King Stephanie , Thomas Julie Jepsen , Rice Martin S.
Published: September 2010

OBJECTIVE. The purpose of this study was to investigate upper-extremity kinematics and range of shoulder motion while wearing a wrist extension orthosis compared to the free hand at initial testing and after a week’s wear.

METHOD. A convenience sample of healthy women, ages 20–50 years, performed a stacking task and a pouring task, freehanded and splinted, at two times, 1 week apart in this counterbalanced, repeated measures design. A Motion Analysis 3-D system measured quality of movement and range of motion variables. A 2 by 2 analysis of variance (splinted vs. freehanded by time of testing) was used to analyze each variable.

RESULTS. In both tasks, participants tended to move more slowly (p = 0.005) with less direct movements (p < .001) when wearing the orthosis. In stacking, splinted movements were also less smooth than when freehanded (p < .0001). When splinted both tasks required more shoulder abduction (p < .0001) and pouring required more shoulder flexion (p < .0001). Participants demonstrated several improvements in quality of movement and amount of shoulder motion used after a weeks’ orthotic wear, indicating some adaptation to the orthosis with use.

CONCLUSION. In this study, a wrist extension orthosis interfered with the quality of upper-extremity movement and required more range of shoulder movement compared to the free hand. Future research is needed to determine whether persons with upper-extremity conditions (i.e., arthritis, carpal tunnel syndrome) respond similarly to wrist orthoses. Therapists should consider discussing with patients how their wrist splint could affect their hand performance and help patients learn techniques to reduce stress on their proximal joints.
Adult Norms for a Commercially Available Nine Hole Peg Test for Finger Dexterity
Authors: Oxford Grice Kimatha , Vogel Kimberly A. , Le Viet , Mitchell Ana , Muniz Sonia , Vollmer Mary Ann
Published: September 2010

The Nine Hole Peg Test is commonly used by occupational therapists as a simple, quick assessment for finger dexterity. The purpose of this study was to evaluate the interrater and test–retest reliability of the commercially available Smith & Nephew Rehabilitation Division version of the Nine Hole Peg Test, and to establish new adult norms for the Nine Hole Peg Test for finger dexterity utilizing this particular version. Two of the researchers established interrater and test–retest reliability by evaluating 25 occupational therapy student volunteers. Seven hundred and three subjects, ranging in age from 21 to 71+ years, were tested to establish norms, using the standard protocol. Results showed high interrater reliability and only moderate test–retest reliability. Scores obtained by using the commercially available version were not statistically different from previously published norms (Mathiowetz, Weber, Kashman, & Volland, 1985). This study supports the original norms and further assists occupational therapists to evaluate dexterity accurately.
The Nature of Clinical Reasoning With Groups: A Phenomenological Study of an Occupational Therapist in Community Mental Health
Authors: Ward Judith D.
Published: September 2010

OBJECTIVE. The purpose of this paper is to examine the clinical reasoning of an occupational therapist in group practice in mental health. It emerged from a larger phenomenological study of expert occupational therapy practitioners in community mental health.

METHOD. Data were gathered through intensive, semi-structured interviews with 1 day of participant observation. Analysis was an iterative process in which emerging themes were identified for reflection and interpretation. Previously established categories of clinical reasoning were used as a structure for describing the results.

RESULTS. A rich description of clinical reasoning in psychosocial task groups is presented using interactive, narrative, conditional, and pragmatic reasoning. The gestalt of community practice is illustrated, as the therapist describes the multiple levels of consciousness used in her consideration of, and response to, clients within the context of the larger environment.

CONCLUSION. This study suggests that an examination of occupational therapy with psychosocial groups is a rich area for research to extend our understanding of clinical reasoning in occupational therapy.
Interrater Reliability and Discriminant Validity of the Deductive Reasoning Test
Authors: Goverover Yael , Hinojosa Jim
Published: September 2010

OBJECTIVE. The purpose of this study was to determine the interrater reliability and discriminant validity of Toglia’s Deductive Reasoning test for individuals with brain injuries.

METHOD. Forty-two individuals with brain injuries and 51 participants without disabilities ranging in age from 18 to 84 years were given the Deductive Reasoning test three consecutive times. A between groups repeated measure design was used to examine differences between the two groups in performance of the Deductive Reasoning test across the three trials.

RESULTS. An interclass correlation coefficient (ICC) was statistically significant, indicating good interrater reliability for participants without disabilities. A repeated measures analysis of variance (ANOVA) comparing performance across trials and between groups revealed a significant group main effect, F(1,91) = 52.68, p < .001, thus, participants with brain injuries performed significantly lower on the test than participants without disabilities. This analysis also revealed a significant increase in all participants’ scores across trials, F(1.63, 148.67) = 35.094, p < .001.

CONCLUSION. Findings confirm acceptable interrater reliability of the Deductive Reasoning test. Further, comparison of the performance of the two groups supports the discriminant validity of the Deductive Reasoning test for individuals with brain injuries. Thus, the Deductive Reasoning test was found to be an appropriate, valid, and reliable assessment tool for occupational therapists to assess deductive reasoning skills in individuals with brain injuries. Additional research is needed to continue to investigate the psychometric value of the Deductive Reasoning test so that clinicians and researchers can use it appropriately.
Quality of Life and Symptom Severity for Individuals With Chronic Fatigue Syndrome: Findings From a Randomized Clinical Trial
Authors: Taylor Renée R.
Published: September 2010

OBJECTIVE. Chronic fatigue syndrome is a profoundly disabling condition characterized by severe, unrelenting fatigue and a number of other physical and cognitive symptoms. Currently, there is no cure or widely accepted treatment for chronic fatigue syndrome, and few rehabilitation programs exist to address quality of life issues in chronic fatigue syndrome. In the present randomized clinical trial, the effects of an integrative, con-sumer-driven rehabilitation program on quality of life and symptom severity for individuals with chronic fatigue syndrome were examined.

METHOD. Forty-seven participants were randomly assigned to either an immediate program group (n = 23) or a delayed program control group (n = 24) and assessed with the Chronic Fatigue Syndrome Symptom Rating Scale and the Quality of Life Index before the program, after program participants completed the group phase, and after program participants completed the one-on-one phase. It was hypothesized that the program would lead to improvements in quality of life and an overall reduction in symptom severity.

RESULTS. Linear growth models were estimated comparing program and control conditions over time using random-effects regression analyses. Significant condition by time interactions were observed for the main outcomes of symptom severity and overall quality of life. Effect sizes for these interactions involving symptom severity (Cohen’s d = 0.71) and overall quality of life (Cohen’s d = .66) were moderate.

CONCLUSIONS. Findings indicate that consumer driven programs such as this one can have a positive impact on symptom severity and quality of life over time for individuals with chronic fatigue syndrome.
Concerns About the Future Among Older Adults With Multiple Sclerosis
Authors: Finlayson Marcia
Published: September 2010

Multiple sclerosis (MS) is a chronic, progressive neurological disease that causes demyelination of the central nervous system. Typically diagnosed in adulthood, it does not significantly reduce life expectancy. The goal of this exploratory study was to describe the health-related concerns and service needs of 27 older adults with MS, ages 55 to 81 years. Through in-depth interviews using a phenomenological approach, fear of the future was found to be a predominant concern among the participants. Within this fear, participants expressed particular concerns about experiencing further losses of mobility and independence, becoming a burden on caregivers, and having to move to a nursing home. The findings raise three major challenges for occupational therapists that include: (1) developing or modifying interventions that can enable older adults with MS to gain a sense of control over their future, (2) working with families affected by MS together with other disciplines such as psychology and social work, and (3) advocating for more and better community support options for persons with MS.
Outcomes of a Vocational Program for Persons With AIDS
Authors: Kielhofner Gary , Braveman Brent , Finlayson Marcia , Paul-Ward Amy , Goldbaum Lauren , Goldstein Karen
Published: September 2010

Advances in medical treatment combined with changes in the demographics of persons who are becoming infected with autoimmune deficiency syndrome (AIDS) have transformed this illness from a rapidly progressing to a chronically disabling condition in a short period of time. This paper describes the development, implementation, and outcomes of a program of vocational services for persons with AIDS. This program was studied using a single group design, in which participatory action research strategies were used to investigate and improve the program as it unfolded. In addition to examining the overall outcomes of services, the study aimed to discover which components were most helpful to participants and which participants were most likely to benefit from the program.

Of 129 participants of who initially enrolled, 39 dropped out before finishing the program. Sixty of the 90 participants who completed the program achieved employment, returned to school, or began a volunteer position or internship. Consequently, the overall success rate was 46.5% and the success rate for program completers was 66.7%. The occupational narrative, which participants told in their initial assessment interview, was closely associated with both program completion and successful outcomes. This association adds support to the importance of narrative for understanding participants and predicting future behavior, as well as for the therapy process.
Occupational Adaptation: The Experiences of Older Persons With Physical Disabilities
Authors: Bontje Peter , Kinébanian Astrid , Josephsson Staffan , Tamura Yumi
Published: September 2010

The purpose of this phenomenological study was to explore the experiences of occupational adaptation among a small number of older Dutch persons with physical disabilities. Occupational adaptation was tentatively defined as overcoming disabling influences on occupational functioning. Eight occupational therapy clients, who were living in the community, were interviewed using an open in-depth interview format. A phenomenological analysis resulted in descriptions of occupational adaptation as a process that required these clients’ active engagement. The clients recruited already familiar problem-solving strategies and personal resources as well as resources in their social and physical environments to identify prospects of potential solutions and to create solutions to overcome constraints on occupational functioning. Furthermore, participants strived for finding satisfaction through occupations, a meaning theme which emerged as the object of occupational adaptation. Satisfaction through occupations was found in maintaining daily routines and engaging in fulfilling occupations.
Cultural Tensions in Occupational Therapy Practice: Considerations From a Japanese Vantage Point
Authors: Kondo Tomoko
Published: September 2010

Culture not only assigns a name to occupation through its language, but it also shapes the form it takes and the meaning with which it is imbued. When an individual chooses an occupation, psychological and physical concerns as well as cultural practices, values, and beliefs come into play. Although occupational therapists are trained to be culturally competent, their grasp of the importance of cultural considerations can be enhanced through detailed accounts of the way in which such concerns affect clinical practice. In this paper, I describe in detail my observations of how differences between American and Japanese culture have created tensions in occupational therapy practice in Japan. Further, largely through a case presentation, I illustrate the necessity for incorporating in-depth cultural considerations as a central part of the occupational therapy process. I argue that the study of culture and the production of culture-specific occupational therapy theories will contribute to best practice. I conclude by demonstrating that universal as well as culture-specific theories are needed to nurture occupational therapy.
Visuospatial Inattention and Daily Life Performance in People With Alzheimer’s Disease
Authors: Liu Chiung-ju , McDowd Joan , Lin Keh-chung
Published: September 2010

OBJECTIVE. The purpose of this study was to examine the relationship between visual inattention and daily life performance in people with Alzheimer’s disease.

METHODS. Twenty persons with Alzheimer’s disease (Mini Mental Status Exam [MMSE] > 20) and 21 community dwelling persons (MMSE >26) voluntarily participated in this study. One line bisection test and two cancellation tests were used for testing attention abilities. The Functional Spatial Abilities Questionnaire (FSAQ), the Disability Assessment for Dementia (DAD), and the behavioral subtests of the Behavioral Inattention Test (BIT) were used to assess daily functioning. The presence of visuospatial neglect in people with Alzheimer’s disease was determined by comparing performance on the three attention tests with the control group.

RESULTS. People with Alzheimer’s disease who omitted more targets on the symbol cancellation test showed more deficits on the behavioral subtests of the BIT (p = .02). They also used less systematic searching strategies (p = .001), spent more time looking for targets (p = .001), and made more commission errors (p = .007) than controls on the cancellation test. However, those with Alzheimer’s disease who had visuospatial neglect did not differ from those without neglect on the FSAQ, DAD, and most of the BIT behavioral subtests.

CONCLUSION. People with Alzheimer’s disease have visual inattention problems; however, visuospatial neglect did not interfere with their performance in daily activities as measured in this study. Further research focusing on the relationship between visual attention and daily life function as the disease progresses is suggested.
Acceptance and Meanings of Wheelchair Use in Senior Stroke Survivors
Authors: Barker Donna J. , Reid Denise , Cott Cheryl
Published: September 2010

The purpose of this qualitative study was to gain understanding of the lived experience of senior stroke survivors who used prescribed wheelchairs in their homes and communities. The study involved semistructured, in-depth interviews that were conducted with 10 participants, ages 70 to 80 years old, who had used a wheelchair for a mean of 5.6 years. A constant comparative inductive method of analysis was performed.

Three different categories of acceptance of wheelchair use were identified; reluctant acceptance, grateful acceptance, and internal acceptance. Increased mobility, varied social response, and loss of some valued roles were common to all three wheelchair acceptance categories. Aspects of level of burden, freedom, and spontaneity varied in degree among the three acceptance categories. As the wheelchair provided opportunity for increased continuity in the lives of these stroke survivors, it appeared to be accepted more fully and viewed more positively. Prestroke lifestyle and values need to be carefully considered in order to maximize acceptance of wheelchair use among senior stroke survivors.
Occupational Therapy Assessment of Open-Road Driving Performance: Validity of Directed and Self-Directed Navigational Instructional Components
Authors: Mallon Kerry , Wood Joanne M.
Published: September 2010

OBJECTIVE. The purpose of this study was to validate an assessment tool used by occupational therapists to evaluate on-road driving performance.

METHODS. The driving assessment was conducted over a 15-km route that consisted of a range of traffic situations and contained both directed and self-directed navigational instruction. The driving performance of four groups of drivers of different ages and visual characteristics was assessed independently by an occupational therapist and driving instructor using a range of scoring criteria.

RESULTS. The occupational therapist scores were significantly affected by the drivers’ age and visual characteristics (directed navigation, F(3,133) = 6.05, p = 0.001; self-directed navigation, F(3,133) = 5.04, p < 0.002), and these group differences were greater for self-directed navigational instruction. The occupational therapist scores were highly correlated with the driving instructor’s global driver safety rating (r = 0.76, p < 0.001).

DISCUSSION. The driving assessment instrument was a valid measure of on-road driving performance relative to an independent global driving safety evaluation. The instrument provided detailed information regarding driving performance and highlighted areas of difficulty, particularly when drivers followed self-navigational instruction.
Using Deweyan Philosophy To Rename and Reframe Adaptation-to-Environment
Authors: Cutchin Malcolm P.
Published: September 2010

John Dewey’s philosophy has been suggested as having been formative in the philosophy of occupational therapy, but the occupational therapy literature offers few analyses of Dewey’s work and its implications for the discipline. I offer an abbreviated analysis of Deweyan philosophy and then assess how adequately that philosophical corpus has been interpreted in the occupational therapy literature. My conclusion is that significant inconsistencies exist between a Deweyan perspective and selected concepts in occupational therapy. I take particular issue with the concept of adaptation-to-environment and specifically with aspects of that conceptualization that I term “environment as container,” “subjective–internalized focus,” and “mechanization of processes.” I offer an alternative concept, “place integration,” that is more consistent with Dewey’s philosophy. The advantages of the conceptual renaming and reframing are discussed.
Effects of Problem-Based Learning on Clinical Reasoning in Occupational Therapy
Authors: Scaffa Marjorie E. , Wooster Donna M.
Published: September 2010

OBJECTIVE. Problem-based learning (PBL) has been described as an educational method that enhances clinical reasoning skills. The purpose of this study was to determine the effects of an intensive, problem-based course on the development of clinical reasoning skills of undergraduate occupational therapy students.

METHOD. A quasi-experimental pretest–posttest design was used with a convenience sample of 48 undergraduate seniors. All students participated in an intensive 5-week, 30-hour, PBL course scheduled just prior to Level II fieldwork. The Self-Assessment of Clinical Reflection and Reasoning (SACRR) developed by Royeen, Mu, Barrett, and Luebben (2001) was administered on the first and last days of the course.

RESULTS. The Wilcoxon Signed Ranks Test revealed statistically significant differences in pre- and posttest scores for 11 of 26 items on the SACRR. In addition, the overall total score increased from 96.88 to 102.55 (p < .01).

CONCLUSION. The results suggest that a short, but intensive PBL course in the senior year of an occupational therapy curriculum can significantly facilitate the development of students’ clinical reasoning skills.
Agency in the Making: Adult Immigrants' Accounts of Language Learning and Work
Authors: MILLER ELIZABETH R.
Published: September 2010

This article considers language learner agency from a poststructuralist perspective, focusing on how agency is discursively constituted as individuals position themselves and are positioned as (potential) agents within ideologically defined spaces. As such, I regard agency as inherently unstable and as a discursively mobilized capacity to act. Drawing on a corpus of 18 interviews with adult immigrant small business owners in the United States, this study uses both quantitative and qualitative discourse analytic approaches in considering (a) recurrent linguistic constructs used across interviews to position interviewees as (in)agentive characters in the story worlds of their autobiographical accounts; (b) how these constructs are mobilized in the co‐constructed positioning work of interviewer and interviewees; and (c) so‐called common sense ideological discourses by which the interviewees are constituted as agents who rationally and responsibly make self‐generated choices and act on them. This multilayered positioning work constrained interviewees to speaking from positions oflanguage learnerorimmigrantorsmall business owner, but at the same time such positioning mobilized recognizable subjectivities for them, enabling them to act in interpretable and meaningful ways.
Using data assimilation to study extratropical Northern Hemisphere climate over the last millennium
Authors: Widmann M. , Goosse H. , van der Schrier G. , Schnur R. , Barkmeijer J.
Published: September 2010

Abstract. Climate proxy data provide noisy, and spatially incomplete information on some aspects of past climate states, whereas palaeosimulations with climate models provide global, multi-variable states, which may however differ from the true states due to unpredictable internal variability not related to climate forcings, as well as due to model deficiencies. Using data assimilation for combining the empirical information from proxy data with the physical understanding of the climate system represented by the equations in a climate model is in principle a promising way to obtain better estimates for the climate of the past. Data assimilation has been used for a long time in weather forecasting and atmospheric analyses to control the states in atmospheric General Circulation Models such that they are in agreement with observation from surface, upper air, and satellite measurements. Here we discuss the similarities and the differences between the data assimilation problem in palaeoclimatology and in weather forecasting, and present and conceptually compare three data assimilation methods that have been developed in recent years for applications in palaeoclimatology. All three methods (selection of ensemble members, Forcing Singular Vectors, and Pattern Nudging) are illustrated by examples that are related to climate variability over the extratropical Northern Hemisphere during the last millennium. In particular it is shown that all three methods suggest that the cold period over Scandinavia during 1790–1820 is linked to anomalous northerly or easterly atmospheric flow, which in turn is related to a pressure anomaly that resembles a negative state of the Northern Annular Mode.
Spatial and temporal evaluation of erosion with RUSLE: a case study in an olive orchard microcatchment in Spain
Authors: Taguas E. V. , Cuadrado P. , Ayuso J. L. , Yuan Y. , Pérez R.
Published: September 2010

Abstract. Soil loss is commonly estimated using the Revised Universal Soil Loss Equation (RUSLE). Since RUSLE is an empirically based soil-loss model derived from surveys on plots, the high spatial and temporal variability of erosion in Mediterranean environments and scale effects mean that it is necessary to evaluate the model in other spatial units such as the microcatchment. In this study, a series of topographic and soil surveys was carried out on a microcatchment of 6.7 ha in a mountainous area under no-tillage farming with bare soil in order to examine spatial and temporal results produced by RUSLE. GPS measurements of the microrelief height differences were used in a control area in the microcatchment to compare observed erosion and deposition with RUSLE predictions. Erosion points located in certain areas correlate very closely with RUSLE predictions, while the distribution of deposition points showed no correlations with RUSLE predictions. Secondly, a time series of daily rainfall data was used to calculate annual erosivity values, which were fitted to an appropriate distribution function. It was determined that the rainfall distribution best fitted the Pearson type III distribution function. Next, efforts were made to quantify the long term erosion and to check the suitability of the land-use and management under different thresholds of tolerance. It was found that values of erosivity in the study area with a return period of 10 years generate a mean annual erosion of 5 t ha−1 yr−1. On the study scale, RUSLE allowed us to locate the most erosive areas and to combine the suitability of the soil land-use and the management with the frequency of the annual erosivity. In addition, an annual sediment delivery ratio of approximately 47% was estimated for the period 2005–2006.