bluuebunny/crossref_metadata_2025 huggingface dataset:
Occupational Adaptation: Toward a Holistic Approach for Contemporary Practice, Part 2
Authors: Schultz Sally , Schkade Janette K.
Published: April 2012

This paper introduces a practice model based on the occupational adaptation frame of reference (Schkade & Schultz, 1992). The occupational adaptation practice model emphasizes the creation of a therapeutic climate, the use of occupational activity, and the importance of relative mastery. Practice based on occupational adaptation differs from treatment that focuses on acquisition of functional skills because the practice model directs occupational therapy interventions toward the patient’s internal processes and how such processes are facilitated to improve occupational functioning. The occupational adaptation practice model is holistic. The patient’s occupational environments (as influenced by physical, social, and cultural properties) are as important as the patient’s sensorimotor, cognitive, and psychosocial functioning and the patient’s experience of personal limitations and potential is validated. The integration of these concepts drives the treatment process. Through a description of treatment with a variety of patients, this paper presents the model’s diversity and illustrates the relationship between the concepts. The occupational adaptation practice model reflects the uniqueness of occupational therapy and integrates the profession’s historical practice with contemporary interventions and methods.
Recovering Relationships: A Feminist Analysis of Recovery Models
Authors: Brown Kate , Gillespie Diane
Published: April 2012

Two models of recovery based on the concepts of independence and interdependence are contrasted from a feminist perspective. Drawing on social and psychological analyses, the authors critique the overemphasis of independence as the goal of health care and instead advocate a more relational model of therapy that reinforces social and emotional connections between people. Two narratives from occupational therapy are used to illustrate the differing assumptions underlying these models. The authors discuss some of the structural and interactional barriers to the expression of interdependence in health care institutions. They suggest that through purposefully sharing practice experiences and instating collaborative, nonhierarchical models of organization, practitioners can begin to overcome these barriers.
A Woman’s Place: Unpaid Work in the Home
Authors: Primeau Loree A.
Published: April 2012

Household work has only recently become a valid topic of study. Feminist scholars were among the first social scientists to draw attention to women’s unpaid work in the home. Although household work occupations are frequently used for assessment and treatment within practice, occupational therapy literature demonstrates a paucity in the area of these occupations. This review of the feminist literature summarizes theory and research that explore the historical, political, social, and personal meanings of household work. Feminist analysis of household work may sensitize occupational therapists to the complex interactions of these meanings and lead them to the realization that women’s responsibility for unpaid work in the home may have repercussions in the daily lives of both women and men.
Ten Milestone Issues in AOTA History
Authors: West Wilma L.
Published: April 2012

This paper identifies 10 professional questions that the author has labeled milestone issues in the history of the American Occupational Therapy Association. Subjects encompassed by these issues are medical control, certified occupational therapy assistants, licensure, proficiency testing, entry-level degrees, treatment media, maintenance of competency, whether occupational therapists serve patients or clients, professional autonomy, and the status of occupational therapy as a profession. Although this paper is primarily a factual record of events and discussions referenced in official publications, the reader will recognize the insertion of author commentary and opinion in several of the issues discussed.
A Comparison of Performance Measures of an Added-Purpose Task Versus a Single-Purpose Task for Upper Extremities
Authors: Morton Gwen G. , Barnett David W. , Hale Lois S.
Published: April 2012

Occupational therapists often employ multidimensional tasks. These tasks, referred to as added-purpose tasks, provide a person with necessary exercise, yet direct the focus of attention toward another objective or outcome. The assumption is that the additional purpose will result in improved task performance, provided it is sufficiently distracting or meaningful to the person. The present study examined the effects of an added-purpose task compared with a single-purpose task on performance, as measured by the number of repetitions, task duration, and exercise heart rate. Thirty subjects performed either the added-purpose task or the single-purpose task three times during a 2-week period. Each session was terminated when the subject reported that he or she was exercising at a “very hard” rate on a measure of perceived exertion. A multiple analysis of variance for repeated measures indicated no significant difference between the performance of the subjects in the added-purpose versus the single-purpose task group on any of the dependent measures. Solicitation of patients’ assessment of the value and meaningfulness of the rehabilitative task has practical importance.
Efficacy and Efficiency: Self-Designed Versus Instructor-Designed Study Tools
Authors: Stern Erica B. , Hassanein Ruth S.
Published: April 2012

During the course of their education, occupational therapy students learn to administer complex structured assessments. For easier administration of these assessments, students design note cards, which then replace cumbersome test manuals during administration. This study considered whether students could learn test administration with equal efficiency and efficacy if given test administration note cards rather than having to design their own.

The results showed that the subjects using instructor-designed cards earned written test and practical examination scores similar to those of the subjects using self-designed cards. The subjects using instructor-designed cards spent significantly less (p = .003) total time in study than did the subjects using self-designed cards. The difference in time between the two groups was attributable to the time spent designing note cards. Therefore, distribution of instructor-designed note cards appears to offer equally effective and significantly more efficient learning when compared with that produced when students design their own cards. The differences in efficacy and efficiency were found to be similar for students of different learning styles.
Returning to School After a Spinal Cord Injury: Perspectives From Four Adolescents
Authors: Mulcahey M. J.
Published: April 2012

A phenomenological approach was used to explore the experience of returning to school following a spinal cord injury. Four adolescents who sustained spinal cord injuries and returned to premorbid school environments were interviewed concerning their perceptions, feelings, and experiences of returning to school. The responses were coded into six themes: people, role change, self-image, coping strategies, accessibility, and feelings. The themes were discussed as to their relevance on returning to school following a spinal cord injury. The research participants’ suggestions on ways to ease the transition from the rehabilitation environment to the school environment and implications of the study are included.
A Quality Implementation of Title I of the Americans With Disabilities Act of 1990
Authors: Rybski Debra
Published: April 2012

The Americans with Disabilities Act (ADA) of 1990 (Public Law 101–336) will have a major effect on private sector employers. Employers with 25 or more employees must provide qualified persons with disabilities equal access to employment with or without reasonable accommodations by July 1992. Employers with 15 to 24 employees must comply with the law by July 1994. Occupational therapy managers must understand the employment provisions of the law and develop strategies for implementation in order to comply with its regulations. This paper suggests the use of a total quality management approach, as espoused by W. E. Deming (1986), as a framework for an implementation plan. This approach focuses on quality improvement in the organization, respect of all workers for their abilities, replacement of fear of persons with disabilities with respect, and the building of partnerships between employers and employees with disabilities. A summary of the provisions of Title 1 as well as a checklist of measures and a sample job description that adheres to the regulations of Title 1 is presented to prepare an organization to become compliant. Occupational therapists are seen as uniquely skilled professionals who can contribute greatly in their own organizations as well as act as consultants to other managers in implementing Title 1 of the ADA using a total quality approach.
Upper Extremity Functional Changes Following Selective Posterior Rhizotomy in Children With Cerebral Palsy
Authors: Kinghorn Judith
Published: April 2012

Spasticity in children with cerebral palsy may inhibit function and reduce progress in therapy. Selective posterior rhizotomy, a neurosurgical procedure, has been found to effectively reduce spasticity in selected cases. The literature suggests that positive changes in upper extremity function results from this surgery. At the Alberta Children’s Hospital in Calgary, Alberta, Canada, all candidates for this surgery are screened by the neuromotor clinic team, which includes an occupational therapist, a speech therapist, and a physical therapist. This paper outlines the specific changes seen in the upper extremity functions of 7 children over a 12-month period following their surgeries. The data collected suggest the children had improved function in activities of daily living, play skills, balance, and endurance. This paper focuses on the changes in activities of daily living and recommends future direction for research in this area.
Occupational Therapy Entry-Level Program Applicants: A Survey of Northwest Schools
Authors: Dudgeon Brian J. , Cunningham Susie
Published: April 2012

Recruitment of occupational therapy students requires both expansion and broadening of ethnic, cultural, age, sex, and geographic distribution. Information used to guide recruitment activities can be limited, quickly outdated, and regionally nonspecific. Applicants to all entry-level programs in the Northwest were surveyed to assess trends that could influence recruitment practices. One hundred thirty-five (82.8%) of the 163 applicants surveyed responded to a questionnaire that probed for sources of exposure to occupational therapy, career goals, and educational preferences. Applicants indicated having an initial interest in allied health or education fields, yet only 36% began college with occupational therapy education in mind. Volunteer or work experience in specific practice settings was identified by approximately 80% of the applicants as an influence in seeking an education in occupational therapy. Career influences, goals, and educational program preferences did not differ among applicants based on age, residential background, grades, or previous degree. An absence of applicants of ethnic minority allows limited application of findings to these targeted groups.
Outcomes Assessment and Program Evaluation: Partners in Intervention Planning for the Educational Environment
Authors: Stern Karen A. , Kramer Paula
Published: April 2012

Accountability of educational institutions is a current trend in academia. Outcomes assessment provides a method of evaluating educational programs to ensure they are meeting their objectives. This paper presents an overview of outcomes assessment and describes its relationship to and integration with program evaluation. It also describes the implementation of an outcomes assessment program at Kean College of New Jersey, Union, New Jersey. A model for assessment within occupational therapy programs, which parallels a model for intervention planning, is introduced and discussed.
Treatment Choices: Rehabilitation Services Used by Patients With Multiple Personality Disorder
Authors: Richert Gail Zehner , Bergland Christy
Published: April 2012

This article identifies mental health rehabilitation services for patients with multiple personality disorder. Through the use of a literature review and a retrospective examination of 20 patients’ records, the frequency of discipline-specific services is noted in occupational therapy, art therapy, movement therapy, vocational counseling, and recreational therapy. Recommendations for practice and program development include ongoing education about multiple personality disorder and continual assessment of the patient’s functional level to identify subsequent treatment needs and services.
An Occupational Therapy Life Skills Curriculum Model for a Native American Tribe: A Health Promotion Program Based on Ethnographic Field Research
Authors: DeMars Patricia A.
Published: April 2012

A unique, nontraditional occupational therapy role focusing on primary prevention, community health promotion, and enhancement for a nonpatient population is examined. The purpose of this ongoing consultancy project was to develop a series of life skills and prevocational programs for an ethnic population of native Americans from elementary school through high school and post-secondary adulthood levels in British Columbia, Canada, from 1986 to 1990. This consultancy evolved from a philosophy of renewing and preserving the culturally distinct ethnic heritage and tribal integrity of this native American community.

Knowledge about sociocultural systems theory, anthropology, and developmental cognitive-behavioral learning theories are combined with ongoing clinical experience in psychosocial occupational therapy practice and consultancy principles to develop life skills and an educational, community-based prevention/wellness educational program model. Subsequent modifications of the original model, with consultancy recommendations for implementation of future programs, are based on tribal members’ feedback and concerns elicited with psychosocial and ethnographic interviewing techniques during villager community meetings. The replicability of this primary prevention and wellness life skills program model offers numerous possibilities for occupational therapists to develop similar programs within the cultural contexts and perceived needs of specific ethnic groups in other nontraditional community-based settings.
Cross-Cultural Occupational Therapy: A Critical Reflection
Authors: Kinébanian Astrid , Stomph Marjan
Published: April 2012

In the Netherlands, Dutch health care professionals, including occupational therapists, are confronted with a growing number of patients whose cultural backgrounds differ from theirs. Acknowledging this influx, the Dutch government allocated a grant for educating occupational therapy students on cross-cultural care. This paper summarizes the information we collected from a survey of Dutch occupational therapists on treatment of immigrants and briefly describes the eight educational tools we developed for the two occupational therapy curricula. Two of these tools are described fully – first, a critical essay on the white middle-class values and norms that underlie occupational therapy theory and practice, and second, the guidelines for developmental policies to use in the treatment of immigrant patients. Case studies illustrate how the values of our profession create obstacles to cross-cultural care.
Reliability and Construct Validity of the Clinical Observations of Motor and Postural Skills
Authors: Wilson Brenda , Pollock Nancy , Kaplan Bonnie J. , Law Mary , Faris Peter
Published: April 2012

The Clinical Observations of Motor and Postural Skills (COMPS) is a screening tool for children with motor incoordination. A study of reliability (test-retest, interrater, and internal consistency) and construct validity with 132 children, both with and without developmental coordination disorder, is reported here. Test-retest reliability over 2 weeks was high: .92 for a group of 48 children. Interrater reliability for occupational therapists experienced in pediatrics was also excellent: .87 for a group of 72 children. Internal consistency of the COMPS was high, particularly when one of the seven items (Schilder’s arm extension) was deleted. The test discriminates well between children with and without motor problems and has many properties of a good screening test.
Performance of Preschoolers on the Pediatric Clinical Test of Sensory Interaction for Balance
Authors: Richardson Pamela K. , Atwater Sarah W. , Crowe Terry K. , Deitz Jean C.
Published: April 2012

The purposes of this study were to describe the performance of 40 children aged 4 and 5 years on the Pediatric Clinical Test of Sensory Interaction for Balance (P-CTSIB) and to determine whether age- and gender-related differences were present. The P-CTSIB measures standing balance when sensory input is systematically altered. Kruskal-Wallis one-way analyses of variance by ranks (p ≤ .05) were used for comparisons by age and gender. When the 4-year-olds were compared with the 5-year-olds, significant duration differences were found in 4 of the 6 conditions in the heel-toe position of the P-CTSIB. The age-related differences on the remaining 2 heel-toe conditions, as well as on Condition 6 of the feet-together position, approached significance. Gender differences with 4-year-olds and 5-year-olds combined were statistically non-significant in all instances; however, girls performed better on 9 of the 12 conditions of the P-CTSIB. The results indicate that the feet-together position can discriminate between children without balance deficits and children with balance deficits. The heel-toe position is difficult for children aged 4 and 5 years without balance deficits and consequently has limited diagnostic value for this age group.
Test-Retest Reliability Study of the Pennsylvania Bi-Manual Worksample
Authors: Paul Stanley
Published: April 2012

Test-retest reliability of a vocational assessment battery called the Pennsylvania Bi-Manual Worksample (PBWS) (Roberts, 1969) was examined in this study. The PBWS was administered to 30 adults with developmental disabilities at two different times, with an interval of 7 to 10 days between administrations. The subjects, who had mild to moderate degrees of mental retardation and ranged in age from 25 to 51 years, were chosen randomly from a group of 95 employees of a sheltered workshop for adults with developmental disabilities in western New York. When the scores from the two test administrations were compared to determine test-retest reliability, a high intraclass correlation value of .98 was found, which indicates that the PBWS provides consistent information about the vocational skills of adults with developmental disabilities.
The Classroom as Clinic: Applications for a Method of Teaching Clinical Reasoning
Authors: Neistadt Maureen E.
Published: April 2012

This study examined the efficacy of one method for teaching diagnostic reasoning to occupational therapy students. During a clinical reasoning seminar in their first academic year, 80 entry-level occupational therapy master’s degree students in three successive classes were given three different levels of exposure to classroom-as-clinic or in-class evaluations of adults with physical or psychosocial disabilities. During the following summer, most students completed their first Level II fieldwork experience. Students’ grades for a second-year classroom-as-clinic experience with adults with physical disabilities were then compared across groups to determine the relative effect of the different seminar formats and fieldwork experiences. Students who had experienced in-class evaluations during their first academic year wrote significantly more accurate second-year evaluations than those who had not. Students who had completed psychosocial Level II fieldwork experiences were as accurate on their evaluations as students who had had physical dysfunction fieldwork experiences. The results suggest that in-class evaluations improve students’ diagnostic reasoning skills.
Reliability Analysis in Therapeutic Research: Practice and Procedures
Authors: Ottenbacher Kenneth J. , Tomchek Scott D.
Published: April 2012

Twenty studies examining the reliability of assessment devices and outcome measures in therapeutic research were reviewed and analyzed. The 20 investigations contained 215 quantitative reliability values published in either the American Journal of Occupational Therapy or Physical Therapy during the past 5 years. The reliability studies were classified as interrater, intrarater, test-retest, or internal consistency. Examination of interrater reliability accounted for 41% of all reported reliability values. Studies published in Physical Therapy were more likely to be concerned with test-retest reliability, whereas studies published in the American Journal of Occupational Therapy more often focused on interrater reliability. Examination of the data revealed that the intraclass correlation coefficient (ICC) was the most frequently reported estimate of reliability, accounting for 57% of all reported reliability coefficients. Further review of the results indicated that Pearson product-moment correlations and percentage of agreement indexes accounted for 22% of all reliability values reported in the studies examined. The Pearson product-moment correlation measures association or covariation among variables, but not agreement, and percentage agreement indexes do not correct for chance agreement. The argument is made that product-moment correlations and percentage agreement indexes are inadequate measures of interrater, intrarater or test-retest agreement. They should be used and interpreted with caution.
The Use of a Game to Promote Arm Reach in Persons With Traumatic Brain Injury
Authors: Sietsema Janine M. , Nelson David L. , Mulder Rebecca M. , Mervau-Scheidel Deborah , White Bob E.
Published: April 2012

This study tested a principle of occupational therapy and motor learning theory in the context of neurodevelopmental treatment techniques. Ten trials of occupationally embedded intervention (playing Simon,™ a computer-controlled game) were compared with 10 trials of rote arm-reach exercise. A counterbalanced design was structured so that each subject experienced each condition one week apart. Subjects were 17 men and 3 women with traumatic brain injury who exhibited mild to moderate spasticity in the upper extremity. Maximum distance from hip to wrist during active reach of the affected extremity was measured by digitization of videotape with the Motion Analysis™ EV-3D system. Results indicated that the use of the game elicited significantly more range of motion than the rote exercise (t (19) = 5.77, p < .001). These results support the use of an occupationally embedded intervention for persons with traumatic brain injury and add to the theoretical base of occupational therapy.
Women’s Mental Health: Implications for Occupational Therapy
Authors: Nahmias Rochelle , Froehlich Jeanette
Published: April 2012

This article describes issues of sexism in the mental health profession. Theoretical bias in psychiatry and the sociopolitical status of women are both linked to the inappropriate mental health treatment of women. A relational model of women’s psychological development is offered as an alternative theoretical perspective for understanding the mental health needs of women. Ways to integrate this perspective in occupational therapy practice are included.
A Hierarchical Model for Evaluation and Treatment of Visual Perceptual Dysfunction in Adult Acquired Brain Injury, Part 1
Authors: Warren Mary
Published: April 2012

A developmental framework for evaluation and treatment of visual perceptual deficits in adults with acquired brain injury is presented. The framework is based on a review of research conducted on post–cerebrovascular accident subjects and subjects with traumatic brain injuries. Visual perceptual skill is conceptualized as a hierarchy of skill levels that interact and subserve each other. Higher level skills evolve from integration of lower level skills and are subsequently affected by disruption of lower level skills. Oculomotor control, visual field, and acuity form the foundation skills, followed by visual attention, scanning, pattern recognition, memory, and visual cognition. Brain injury can affect the integrity and interaction of each skill level and affect daily living function. Application of this framework dictates a bottom-up approach to evaluation and treatment, emphasizing identification and remediation of deficits in lower level skills to allow normal integration of higher level skill.
The Efficacy of Upper Extremity Inhibitive Casting: A Single-Subject Pilot Study
Authors: Tona Janice L. , Schneck Colleen M.
Published: April 2012

This pilot study was designed to examine the effects of short-term (48-hr) upper extremity inhibitive casting, with an encased thermoplastic splint, on problems related to upper motor neuron damage. The subject was an 8 ½-year-old girl with left upper extremity spasticity. Three different measures were used: (a) rating of videotaped active movements of the child; (b) the Modified Ashworth Scale, a clinical measure of spasticity; and (c) The Biodex System, a measure of torque during passive elbow flexion and extension. After cast removal, subjective improvements were noted in the quality of active movement (through videotapes) and increased awareness and use of the casted hand by the child (through parents’ reports). A trend toward decreased spasticity was demonstrated by the Modified Ashworth Scale and a statistically significant decrease in resistance to passive movement was shown by the Biodex recordings. However, this reduction in symptoms was temporary, lasting less them 3 days. The results of this study suggest that short-term inhibitory casting may prove efficacious in the treatment of the child with cerebral palsy, although further research is needed.
Program Planning: The Clinical Utility of Three Activities of Daily Living Assessment Tools
Authors: Settle Carla , Holm Margo B.
Published: April 2012

A jury of five occupational therapy experts was used to evaluate the clinical utility of three activities of daily living assessment tools that were originally designed for purposes other than individualized occupational therapy assessment or program planning. The three tools were the Index of Independence in Activities of Daily Living, PULSES Profile, and Physical Self-Maintenance Scale. Using the results from each tool, scored for a simulated patient with a right cerebrovascular accident, as well as medical information about the patient, the jury members were asked to plan a treatment program. The consensus of the jury was that the results from each tool did not provide enough information to help them identify the patient’s specific performance problems or the causes of those problems. Therefore, the three tools were considered to have low clinical utility for planning individualized occupational therapy treatment. For use in planning an individualized treatment program, an activities of daily living assessment tool should provide specific information about which component of a task the patient found difficult or was unable to do and the type and level of assistance required.
The Patient–Therapist Relationship: Beliefs That Shape Care
Authors: Peloquin Suzanne M.
Published: April 2012

The results of a previous inquiry suggest that three images of occupational therapists dominate patients’ stories about them: the images of technician, parent, and collaborator or friend. These ways of being in practice can be said to reflect the various understandings that therapists have about how to enact the profession’s commitment to both competence and caring. When therapists act as technicians or authoritarian parents, patients register their disappointment over a valuation of competence that excludes caring actions.

In a more current inquiry into the climate of caring, patients and caregivers reflect about the current health care system and identify three societal constructs that shape a preference for competence over caring: (a) emphasis on the rational fixing of the health care problem, (b) overreliance on methods and protocols, and (c) a health care system driven by business, efficiency, and profit. Occupational therapists who are concerned about complaints that the health care system is increasingly uncaring might benefit from a consideration of the extent to which societal beliefs shape the manner in which they care.
Contingent Interaction During Work and Play Tasks for Mothers With Multiple Sclerosis and Their Daughters
Authors: Crist Patricia
Published: April 2012

Occupational therapy has focused on activity as a catalyst for understanding human roles and interactions, regardless of whether disability or chronic illness is present. Parenting is an important interactional activity accompanied by specific role expectations. This investigation examined the interaction patterns of mothers with multiple sclerosis and their daughters. Thirty-one mothers with multiple sclerosis and their daughters aged 8 to 12 years were compared with 34 mothers without disabilities and their daughters aged 8 to 12 years. Videotaped mother–daughter interactions during a work task and a play task were scored by two raters for 11 different behaviors. These behaviors were collapsed into three behavioral composites–receptiveness, directiveness, and dissuasiveness–for statistical analysis. Statistical analysis revealed no significant differences between the two groups on the behavioral composites for either mothers or their daughters. The two tasks stimulated a different pattern of mother–daughter interactions. For both members of the dyad, interactions during the work task were more directive and less dissuasive than those in the play task. The clinical implication of this finding indicates the importance of understanding the influence of the task selected when observing interaction. Because of recent social and legal changes, understanding parenting and chronic illness is critical.
An Analysis of a Board Game as a Treatment Activity
Authors: Neistadt Maureen E. , McAuley Debra , Zecha Donna , Shannon Robyn
Published: April 2012

Occupational therapists often use tabletop board games in treatment to help adult clients with physical disabilities improve the perceptual, cognitive, sensory, and fine motor skill components of occupational behavior. Detailed activity analyses of these types of activities, including performance norms, are not available in the occupational therapy literature. Such analyses would help therapists consider the multiple skill demands of tabletop games and allow more systematic grading of these treatment activities. This paper presents a model for analyzing therapeutic activities in relation to relevant motor learning and cognitive–perceptual literature. Included in this analysis are a description of the activity, examination of its component skills and of the qualitative features of activity performance, suggestions for grading and for treatment goals, and some preliminary performance standards derived from a pilot study of 18 adults without physical disabilities. The issue of transfer of skills between games and functional activities is also discussed.
Incorporation of Ethnographic Methods in Occupational Therapy Assessment
Authors: Spencer Jean , Krefting Laura , Mattingly Cheryl
Published: April 2012

Many constructs of interest to occupational therapists can only be studied through qualitative methods. Such constructs include meaning of activity or the illness experience and the context in which these occur. The purpose of this paper is to describe how ethnographic methods used in research can be generalized and applied to clinical practice. Ethnography is compared with other qualitative research approaches and a model clinical ethnographic assessment process is described.
The Assessment of IADL Motor Skills: An Application of Many-Faceted Rasch Analysis
Authors: Fisher Anne G.
Published: April 2012

Traditional methods of developing tests have been driven by item content specification and have relied on the use of summed ordinal scores in an attempt to create a quantitative index of ability. There are fundamental problems with this approach to test development. The first problem is that the summing of qualitative ordinal counts to create a total score does not result in a number that is a valid means of making quantitative comparisons of performances. The second problem is that reliance on content experts does not ensure that the test items indeed test the construct in question. As a result, the development of functional assessments based on Rasch measurement models is becoming a preferred method among rehabilitation professionals for constructing tests. Rasch measurement models offer an alternative approach to instrument development that results in unidimensional linear measures based on additive numbers. Rasch analyses also generate goodness-of-fit statistics that can be used to perform confirmatory construct validity analyses of the constructed scales based on (a) formulating expectations about what should happen when a group of persons take a test, and then (b) confirming that the test items fit that model.

This paper describes how the many-faceted Rasch model was used to develop the motor scale of the Assessment of Motor and Process Skills (AMPS) (Fisher, 1992). The process of beginning test development with a theory of expectations related to a constructed scale and then confirming that the scale conforms to these expectations also is demonstrated.
Prediction of Behind-the-Wheel Driving Performance in Patients With Cerebral Brain Damage: A Discriminant Function Analysis
Authors: Galski Thomas , Bruno Richard L. , Ehle Holly T.
Published: April 2012

Rehabilitation specialists, particularly occupational therapists, are often involved in evaluating clients’ fitness to resume driving after cerebral damage due to head injury or stroke. Their available methods include separate or combined administration of predriver, simulator, and behind-the-wheel evaluations. However, use of these methods without a theoretical model on which to base test selection has yielded some criticism and little research about the effectiveness of these methods in predicting driving performance.

Using the authors’ Cybernetic Model of Driving as the basis for assessing abilities and behaviors relevant to driving outcome, this study sought to determine the effectiveness of the evaluation methods by discriminant analysis and measurements of sensitivity in predicting behind-the-wheel failures. Comprehensive evaluations of 106 patients revealed that residual deficits in cognition per se did not render a person unfit to drive and underscored the importance of considering behaviors in determining fitness. The methods of evaluation were shown to be relatively sensitive in predicting outcome; off-road and on-road evaluation reached sensitivities of 90% and 92% with the inclusion of behavioral measures. Formulae for predicting outcome based on methods of evaluation are provided and reasons for failures in behind-the-wheel evaluations are discussed.
The Effects of Options on Performance of an Art Project in Adults With Mental Disabilities
Authors: LaMore Kathy L. , Nelson David L.
Published: April 2012

The relationships among the presence of options, interest, preference, choice, meaning, purpose, and performance in occupation are central to occupational therapy knowledge. This Study examined whether giving adults with mental disabilities options at the beginning of an art occupation would motivate them to paint more than when not given options. The Sample consisted of 13 men and 9 women; ages ranged from 24 to 76. The subjects were yoked in pairs. One subject from each pair was given a choice of which of five ceramic objects to paint. The second subject was instructed to paint the same type of object that the first subject had chosen. Three days to 1 week later, roles were reversed. The number of times the subject applied the paint to the object after dipping the brush into paint was recorded by the researcher. Each subject was also timed with a stopwatch from the first time paint was applied to the time the subject indicated completion of the activity. The Wilcoxon matched-pairs signed-ranks test revealed that subjects painted significantly more (Z = 2.9, p < .01) when they had a choice than when they did not have a choice.
Perceiving Patients and Their Nonverbal Reactions
Authors: Svidén Gunilla , Säljö Roger
Published: April 2012

The topic of interest underlying the present study concerns cognitive and conceptual development in adulthood. Specifically, we examined the ways in which professional education affects occupational therapy students’ perceptions and descriptions of patients’ nonverbal behavior. Thirteen subjects viewed 3 videotapes of patients in treatment and then described the patients’ responses. They viewed the videotapes twice. at the beginning of student training and one and a half years later. Results indicated that at the second viewing, the subjects’ accounts became more differentiated, more complex, and less conclusive. Also on the second viewing, subjects were more likely to corroborate their inferences concerning patients’ emotional reactions with concrete observations, but did not describe patients in common theoretical categories. This result indicates that subjects find it difficult to discuss individual cases in relation to newly acquired theoretical knowledge. We conclude that, rather than increased instruction in theory, students need increased opportunity to analyze individual cases by means of theoretical knowledge.
Handwashing Practices Among Occupational Therapy Personnel
Authors: Marcil William M.
Published: April 2012

Handwashing is the most effective method of preventing the spread of nosocomial infection. Despite its simplicity, handwashing is frequently omitted by health care personnel. To date there have been no studies of the handwashing practices of occupational therapists. A telephone survey of 50 occupational therapy personnel indicated that the majority (60%) washed their hands with a liquid, antimicrobial soap 9 or more times during the work day with a wash duration of 10 seconds or less. Analyses revealed no statistically significant differences between handwashing frequency and duration and age, years in practice, position, academic degree, or work setting. Overall, handwashing technique was found to be lacking.

All respondents stated that handwashing was important to occupational therapy practice and most agreed that it was just as important for therapists as it was for physicians and nurses. Most agreed that hands should be washed both before and after each patient contact. However, few respondents actually did so regularly. Most respondents indicated that they received their knowledge of handwashing from inservice training at their place of employment. Their occupational therapy educational programs did not provide basic information on handwashing techniques.
Outcome Analysis of Work-Hardening Programs
Authors: King Phyllis M.
Published: April 2012

The competitive marketplace and the demand for accountability by health care payers are strongly influencing the need for work hardening programs to participate in program evaluation and produce outcome data. This study compiled program performance data on 22 work programs in Wisconsin over an 11-month period. Client data related to demographics of gender, age, occupation, insurance coverage, diagnosis, services clients received, patterns of attendance, and outcomes upon discharge were collected. Results described the majority of the clients treated in the work hardening programs to be men, aged 26 to 46 years, with occupations classified in the miscellaneous category according to the Dictionary of Occupational Titles. The reimbursement source for the majority of work program clients was worker’ s compensation. The most frequent condition treated was injury to the lumbar spine. Most clients were treated and discharged within a 3-week period. More than half of the clients served returned to their usual and customary jobs.
Clinical Reasoning in Occupational Therapy: An Integrative Review
Authors: Schell Barbara A. , Cervero Ronald M.
Published: April 2012

The occupational therapy literature has been comprehensive reviewed to identify various theoretical answers to the question of what is clinical reasoning. Authors to date have two primary answers to this question, which we labeled scientific reasoning and narrative reasoning. Additional literature addresses the influence of personal and practice Contexts on clinical practice. These are labeled pragmatic reasoning and are proposed to be an integral part of clinical reasoning. Pragmatic reasoning considers issues such as reimbursement, therapists’ skills, and equipment availability. To be comprehensive, further study of clinical reasoning should include these contextual issues as an inherent part of the clinical reasoning process.
Use of Uniform Terminology by Occupational Therapists
Authors: Borst Michael J. , Nelson David L.
Published: April 2012

Uniform Terminology for Occupational Therapy – Second Edition (American Occupational Therapy Association, 1989b) was published to foster consistency in terminology among occupational therapists. In this study, agreement between occupational therapists and Uniform Terminology about the definition and categorization of 15 terms was examined. Agreement was measured on 113 responses from a randomly selected sample of 180 occupational therapists. Low levels of agreement were found on both definition of terms (71.9 mean percentage of agreement, SD = 12.4) and categorization of terms into larger conceptual categories (34.9 mean percentage of agreement, SD = 11.7). Therapists selected an alternative definition more often than the one given by Uniform Terminology on 2 of 15 terms and selected an alternative categorization more often than the one given in Uniform Terminology on 8 of 15 terms. These results indicate that therapists do not agree with many Uniform Terminology definitions and categorizations.
Age Differences in Functional Performance
Authors: Dickerson Anne E. , Fisher Anne G.
Published: April 2012

We compared the functional performance of 20 young adult women and 20 older adult women on two types of tasks. One type of task was normal instrumental activities of daily living (e.g., meal preparation, home maintenance) that were meaningful, familiar, and well practiced. The other type was a contrived, relatively unfamiliar task of wrapping a package. Although young and old women did not differ significantly in their familiarity with the two tasks, results from two repeated measures MANOVAs revealed a significant age difference in both activities. This finding suggests that older adults show age-related decline with tasks even when those tasks are familiar, practiced, and ecologically valid.
Combining Practice and Research
Authors: Colborn Anne Pas
Published: April 2012

Although many authors advocate research involvement for occupational therapists involved in clinical practice, no formal studies existed of the personal, educational, and workplace environmental factors thought to affect therapists’ ability to integrate clinical research with practice. This exploratory, descriptive study surveyed 103 occupational therapists reporting work functions of both direct patient care and research. Major findings included: (a) workplace learning circumstances focusing on performance and application of clinical research were important for adopting a dual practice–research role, (b) research activities reflected the evolving character of the role, (c) administrative support and a personal commitment to research were critical for success, and (d) formal research courses were important, but so were informal discussions regarding application and problem solving. The findings have implications for university curricula, continuing education, and clinical environments.
Improvement in Upper Extremity Function and Trunk Control After Selective Posterior Rhizotomy
Authors: Beck Alison J. , Gaskill Sarah J. , Marlin Arthur E.
Published: April 2012

Selective posterior rhizotomy is being increasingly used in the treatment of spasticity associated with cerebral palsy. Anecdotal reports in the literature note that this procedure results in improved upper extremity function and trunk control. We present a systematic analysis of the results of selective posterior rhizotomy performed on patients with cerebral palsy at Santa Rosa Children’s Hospital. Patients were videotaped before surgery and one year postoperatively. These videos were reviewed blind by an occupational therapist who graded patients’ performance on three tasks: assumption of side sitting, maintenance of side sitting, and block building. Statistically significant improvements were noted in all three categories with p values of .0003, .0001, and .0044 respectively. These results support the anecdotal reports of improvement in upper extremity function and trunk control with selective posterior rhizotomy.
The Effect of Upper Extremity Trauma on Handedness
Authors: Walsh William W. , Belding Nancy N. , Taylor Eve , Nunley James A.
Published: April 2012

The effect of severe trauma on handedness was studied through patient responses from 146 questionnaires that were correlated with individual chart review. Subjects were asked to designate their hand use preference, before and after injury, when performing 16 activities. The incidence of change in hand use was determined within four diagnostic types and five designated anatomical levels of injury. Results indicated a significant difference in the way subjects in different diagnostic types and anatomical levels of injury performed. Simple, short activities that did not require sustained fine motor coordination were reported as being performed more easily with a different hand after injury than complex, continuous activities that required sustained fine motor coordination. Significant differences in job duties and place of employment were found for the anatomical level of an injury but not for diagnostic type. Findings suggest that the diagnostic type, the anatomical level of an injury, and the complexity of a task should be considered before changes in hand use are recommended.
The Effect of Occupational Therapy Intervention on Mothers of Children With Cerebral Palsy
Authors: Case-Smith Jane , Nastro Mary Ann
Published: April 2012

Using the interviewing techniques and ethnographic methodology reported by Hinojosa, we explored the relationships between mothers of preschool children with cerebral palsy and their children’s occupational therapists. Data from two interviews with five mothers were transcribed, organized into topics, and, through constant comparative analysis, formulated into themes. One theme, “Is anybody listening?” suggested that professionals often disregard information provided by the mothers; a second theme, “Not another one,” revealed the importance of continuity of care and the patient hardship of frequently changing therapists. Consistent with Hinojosa’s study, all of the mothers sought duplicative therapy. All of the mothers had established positive relationships with their occupational therapists and described them as skilled agents of change who were effective in helping their children and who were valuable sources of information and support.