bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Treatment Approaches Used After Carpal Tunnel Release Surgery
Authors: Groves Elin J. , Rider Barbara A.
Published: April 2012

Two treatment approaches used by two hand clinics were compared for patients who had undergone carpal tunnel release surgery. One of the clinics used an exercise program consisting of progressive resistive exercise; the other clinic used limited activity and no specific exercise program. Measurements of grip strength and active and passive wrist flexion and extension were taken 3 weeks and 6 weeks after surgery and then analyzed to determine if significant differences existed between the two treatment approaches. A significant difference was found only in active wrist extension, which increased after 3 weeks of a progressive resistive exercise program. Grip strength was also greater after 3 weeks of exercise; however, the increase was not statistically significant. The study raises a question about the efficacy of postoperative treatment for patients who have had carpal tunnel release surgery.
Normal Adult Performance on Constructional Praxis Training Tasks
Authors: Neistadt Maureen E.
Published: April 2012

This study used a balanced factorial design to examine the performance of normal young adults on a parquetry block assembly task that occupational therapists use to treat constructional deficits in adults. Ninety-six 18- to 34-year-old right-handed college students or college graduates (48 men and 48 women) were tested. Independent variables were subjects’ sex, presence or absence of color on the model design card, and amount of detail on the model design card. Dependent variables were speed and accuracy of design construction. Results of a factorial analysis of variance with the three variables showed that the subjects’ total time scores were significantly related to their sex and to the presence or absence of color and the amount of detail on the design card. Interaction effects were significant for sex by amount of detail and for color by amount of detail. The results were used to generate clinical performance criteria and graded levels of difficulty for this modality. The subjects’ learning and test behaviors were examined to generate ideas for treatment and for future research.
A Custom-Made Head Pointer for Children
Authors: Jewell Kaaren H.
Published: April 2012

Severely physically disabled adults and children may be able to use a head pointer to access an augmentative communication system or to participate in activities. This paper describes how to make and fit a thermoplastic head pointer and how to train a child to use it.
Added-Purpose Versus Rote Exercise in Female Nursing Home Residents
Authors: Yoder Rita M. , Nelson David L. , Smith Doris A.
Published: April 2012

Seven recent experimental and quasi-experimental studies have compared the exercise of subjects instructed to pursue some added goal (often termed purposeful activity) with the exercise of subjects instructed to exercise without the suggestion of an added goal (often termed nonpurposeful activity). This article suggests a new terminology for this type of independent variable and describes an experiment within this developing tradition. An occupational form designed, through materials and instructions, to elicit a rotary arm exercise with the added purpose of stirring cookie dough was compared with an occupational form designed to elicit the rotary arm exercise with no added purpose. The subjects were 30 elderly female nursing home residents randomly assigned to the occupational forms. Results indicated that the added-purpose, occupationally embedded exercise condition elicited significantly more exercise repetitions than did the rote exercise condition (one-tailed p = .012). Exercise duration and exercise stoppages were also recorded. This study provides additional support for the traditional occupational therapy idea of embedding exercise within occupation. Suggestions are made for future research involving the experimental analysis of therapeutic occupation.
Visual Perception of Objects: An Approach to Assessment and Intervention
Authors: Toglia Joan Pascale
Published: April 2012

This paper proposes an alternative to the deficit-specific approach that has been used to guide the visual perceptual assessment and treatment of brain injured adults. Recent theoretical advances in visual object perception are combined with a cognitive rehabilitation model to provide a framework for occupational therapy assessment and treatment of object-processing dysfunction. Assessment guidelines are presented that emphasize the analysis of residual function by specifying the task conditions that influence visual perception. A case study illustrates clinical application of this approach. Implications for research are discussed.
A Part-Time Level II Fieldwork Program
Authors: Adelstein Laurie A. , Cohn Ellen S. , Baker Robin C. , Barnes Mary Alicia
Published: April 2012

This paper describes an alternative to the traditional Level II fieldwork program for master’s degree students in occupational therapy. In this part-time 9-month program, students complete the fieldwork requirement while simultaneously balancing academic responsibilities. One advantage of this program over the traditional 3-month program is that the extended length of time offers students the opportunity to develop clinical skills beyond the technical level.
Home Adaptations for Persons With Chronic Disabilities: An Educational Model
Authors: Levine Ruth E. , Gitlin Laura N.
Published: April 2012

This paper offers a method by which to train students in the provision of culturally relevant, in-home environmental adaptations for persons with chronic disabilities. On the basis of a theoretical framework, the student therapist learns about the client’s life-style and offers adaptations that evolve from a collaborative problem-solving process. The training process has been developed and refined over a 3-year period. A case study illustrates the student’s application of theory and practice and the outcome for the client of this service provision approach.
Evolving Educational Practices in Occupational Therapy: The War Emergency Courses, 1936–1954
Authors: Colman Wendy
Published: April 2012

This paper uses evidence collected from both written and oral history sources to present one approach to understanding the way in which educational practices evolved in occupational therapy. The paper introduces two fundamental positions regarding the nature, scope, and content of professional preparation for occupational therapists. For expediency, these viewpoints are labeled academicism and experientialism. This paper traces the interaction of these positions in the development and implementation of the War Emergency Courses. The implications for educational policy in occupational therapy arising from that program are also examined.
Child Abuse as an Antecedent of Multiple Personality Disorder
Authors: Baldwin Lynda C.
Published: April 2012

Until recently, few cases of multiple personality disorder were diagnosed in children. Today, the number of cases is increasing at an alarming rate and appears to be most closely associated with repeated sexual and physical abuse. This paper focuses on reports of childhood multiple personality disorder in the literature, the etiology of this disorder, family dynamics, the differences between childhood and adult multiple personality disorder, credibility problems in children, reasons for failure to diagnose multiple personality disorder in children, treatment, and signs and symptoms to look for in the clinical setting.
Expressive Therapy in Conjunction With Psychotherapy in the Treatment of Persons With Multiple Personality Disorder
Authors: Higdon John F.
Published: April 2012

This article examines the prevalence and complexity of multiple personality disorder as well as the contributions that psychiatry and occupational therapy make in its treatment. The value of activity is that it serves as a nonverbal mediator of communication. Activities are also useful in helping the therapist to obtain a patient’s history, which is necessary for abreaction (i.e., the patient’s reliving and recalling of the original abuse). Abreaction is a precursor to the integration of the abusive memories into the patient’s current life.
Considerations and Techniques in the Treatment of Persons With Multiple Personality Disorder
Authors: Fike M. Laurita
Published: April 2012

Occupational therapy intervention with the patient with multiple personality disorder requires an understanding of the complex psychotherapeutic goals for the patient and of the process involved in resolution of the trauma that led to the development of multiple personality. The psychotherapeutic techniques of hypnosis and abreaction affect the provision of occupational therapy services. Hypnotic communication, particularly the use of ideomotor hand signals, often facilitates work with various alter personalities. Occupational therapists may use a developmental approach with both child and adult alter personalities and may also use projective techniques, self-care training, and role and task management techniques. Occupational therapy can act as a stabilizing force for the person with multiple personality disorder through the enhancement of function and competency during the psychotherapeutic process.
Factors Associated With the Transition to Oral Feeding in Infants Fed by Nasogastric Tubes
Authors: Bazyk Susan
Published: April 2012

Following a review of 100 infants fed by nasogastric tubes, medical factors associated with the length of transition to complete oral feeding were identified through correlational and multiple regression analyses. Six of the 100 infants had an extremely lengthy transition or never progressed to oral feeding; the remaining 94 infants progressed to oral feeding within 2 to 58 days. The total number of medical complications correlated significantly and positively with the length of transition. Digestive, respiratory, and cardiac complications were all significant predictors of the length of transition to oral feeding. The results of this study may assist occupational therapists in earlier identification of and intervention for infants fed by nasogastric tubes who are at risk for later oral feeding problems and a longer transition from nasogastric tube to oral feeding.
A Sensorimotor Program for Improving Writing Readiness Skills in Elementary-Age Children
Authors: Oliver Carolyn E.
Published: April 2012

This article discusses a writing readiness program used with three groups of children aged 5 to 7 years. The program combines occupational therapy treatment with a supplementary program implemented by school personnel or parents. The Developmental Test of Visual-Motor Integration–Revised (Beery, 1982) was used to measure the developmental level of the children’s writing readiness skills before and after treatment. The group of children with a significant verbal performance IQ discrepancy (> 15 points) showed a 17-month growth in readiness skills within 1 year. The group of children with mental retardation (IQ < 80) showed a significant sex effect: The boys showed more gains than the girls. Implications of these findings are discussed.
Upper Extremity Assistive Devices: Assessment of Use by Spinal Cord–Injured Patients With Quadriplegia
Authors: Garber Susan Lipton , Gregorio Theresa Lee
Published: April 2012

Upper extremity assistive devices prescribed during the rehabilitation of the patient with quadriplegia often are discarded once the patient leaves the hospital. Therefore, we conducted this study to investigate patterns of the prescription and use of such devices and satisfaction with them. An oral questionnaire was administered to 56 spinal cord–injured quadriplegic patients 1 and 2 years after their first rehabilitation experience. Although the patients had discarded 46% of the devices within the 1st year, most of these devices were inexpensive, commercially available devices or devices made by occupational therapists. The respondents’ most frequently cited reasons for discarding a device were “improved physical function” and “alternative solutions found.” The devices retained in use most often were the more costly orthotics such as reciprocal orthoses and ball-bearing feeders. Sixty-four percent of the devices used within the 1st year were still being used at the end of the 2nd year. Thirty-five percent of all devices prescribed during rehabilitation were still in use at the end of 2 years. The results of this study have heightened therapists’ awareness of the efficacy and use of upper extremity assistive devices and have enabled them to eliminate some devices, to modify methods of instructing patients in the use of devices, and to develop alternative products.
Evaluating Productivity and Profitability in Occupational Therapy Contractual Work
Authors: Dickerson Anne
Published: April 2012

The availability of contractual work for occupational therapists is increasing steadily. Because of time constraints, therapists often must select one contract over another. To help the therapist make informed decisions, this paper provides a step-by step process for developing a trend analysis to compare the productivity and profitability of contracts. A case example taken from the author’s own experience illustrates this process.
Evaluating Level I Fieldwork Students: A Job Model
Authors: Winter Ellen Flannery , Peterson Cindee Q. , Winter Henry B.
Published: April 2012

This article describes how a job model, a behavioral engineering concept used to improve employee performance, was developed to evaluate the clinical performance of occupational therapy students in Level I fieldwork. The job model emphasizes accomplishments and provides immediate feedback on specific skills needed for the successful completion of Level I fieldwork. In a pilot study of 137 students from the Occupational Therapy Teaching Clinic at Western Michigan University, 68 of the students were evaluated with the job model and 69 were evaluated with Western Michigan University’s traditional Level I fieldwork evaluation. The results showed that the job model provided a method by which to identify standard values for measuring accomplishments in Level I fieldwork.
Occupational Therapy for Children With Perinatal HIV Infection
Authors: Anderson Jill , Hinojosa Jim , Bedell Gary , Kaplan Margaret T.
Published: April 2012

This article discusses occupational therapy for children with perinatal HIV infection and their caregivers. An interdisciplinary early intervention and preschool program serving these children is described. Current medical and neurological research is reviewed to serve as a basis for occupational therapy intervention. Therapeutic approaches that integrate physical, neurological, developmental, and psychosocial needs are presented.
The Model of Human Occupation and Adults With HIV Infection and AIDS
Authors: Pizzi Michael
Published: April 2012

HIV infection affects all aspects of a person’s occupational functioning. This article examines the application of the Model of Human Occupation (Kielhofner & Burke, 1980) to adults with HIV. An occupational therapy assessment battery based on the model is introduced. Given the physical, psychosocial, and environmental needs of persons with HIV, the assessment must be comprehensive to fully evaluate the effect of HIV on occupational behaviors. Goal planning and treatment follow the assessment process. A case example illustrates the integration of the Model of Human Occupation with clinical practice.
AIDS: Toward a Compassionate Response
Authors: Peloquin Suzanne M.
Published: April 2012

AIDS evokes powerful feelings, often manifestations of fear, among health care providers. To effectively treat patients with AIDS, occupational therapists must acknowledge and reconcile their personal feelings. One way to formulate a compassionate response to patients is to understand the meanings that we give to AIDS, meanings that shape our interpersonal behaviors. Restricted meanings—that the disease constitutes death, sin, crime, war, or community division—place the person with AIDS at risk for compromised care. Recognizing the limitations of these meanings can free therapists to find other meanings that inspire compassion.
The Peabody Developmental Fine Motor Scale: An Interrater Reliability Study
Authors: Stokes Nancy A. , Deitz Jean L. , Crowe Terry K.
Published: April 2012

This study examined the interrater reliability of two raters on the Fine Motor scale of the Peabody Developmental Motor Scales (Folio & Fewell, 1983). The sample comprised 32 children who were 4 or 5 years of age. Half of the children were considered to have normal development and half had an identified developmental delay. The Pearson product-moment correlation coefficients between the two sets of ratings were r = .97 for the delayed group and r = .77 for the normal group. Intraclass correlations were .97 and .76 for the delayed and normal groups, respectively. These figures appear to reflect the increased variance of the performance of the children with developmental delays. The percentage agreement between the two raters was greater for the group of normal subjects. The results suggest that the Fine Motor scale of the Peabody scales includes enough items to minimize the total score difference between two raters. Individual test items with poor agreement between the two raters were identified.
The Reliability of Goniometric Measurements of Active and Passive Wrist Motions
Authors: Horger Margaret M.
Published: April 2012

A reliability study was conducted to determine (a) the intrarater and interrater reliability of goniometric measurement of active and passive wrist motions under clinical conditions and (b) the effect of a therapist’s specialization on the reliability of measurement. Randomly paired therapists performed repeated measurements of active and passive wrist motions in 48 subjects who had been referred to one of four occupational therapy or hand management clinics for evaluation and treatment. The data were analyzed with an intraclass correlation coefficient. A posteriori data analyses were performed to determine the effects of identified sources of error on the reliability of measurement.

The results indicated that measurement of wrist motion by individual therapists is highly reliable and that intrarater reliability is higher than interrater reliability for all active and passive motions. Interrater reliability was generally higher among specialized therapists for reasons not immediately apparent from this study. With the exception of pain, identified sources of error were found to have surprisingly little effect on the reliability of measurement.
Research Attitudes and Activities of Occupational Therapy Clinicians
Authors: Taylor Eve , Mitchell Marlys
Published: April 2012

Two hundred and seventy occupational therapy clinicians, whose primary or secondary employment function was in direct patient service, were surveyed to determine their perceived roles and attitudes regarding research. Results showed a strong belief in the importance of research in the profession, yet minimal involvement in research due to limited time, money, and skill. The role of collaborator with experienced researchers was rated as highly desirable. Few clinicians indicated no interest in research. Implications of the results and suggestions for strategies to increase clinicians’ involvement and satisfaction in research through mutual experiences and continuing education are given.
Integrating Motor Control and Motor Learning Concepts With Neuropsychological Perspectives on Apraxia and Developmental Dyspraxia
Authors: Goodgold-Edwards Shelley A. , Cermak Sharon A.
Published: April 2012

This paper reviews selected pertinent literature on the learning and performance of skilled motor acts. Information on normal motor performance is integrated with that on adult apraxia and related to common problems observed in children with developmental dyspraxia. The process of motor skill acquisition is outlined, and aspects of styles of motor organization, modes of control, premovement organization, sensory organization, and analysis of the types of errors are presented. Recommendations for clinicians working with children with developmental dyspraxia are offered.
The Relationship Between Admission Criteria and Practice Preferences
Authors: Swinehart Susan , Feinberg Judy
Published: April 2012

A continual decline in the number of occupational therapists selecting mental health as their practice area has resulted in a personnel shortage. This study aimed at examining admission criteria to one occupational therapy program and the relationship of these criteria to practice preferences at admission. The question of whether current admission criteria are biased against those applicants preferring mental health practice is pertinent if the personnel shortage in mental health is to be alleviated. An analysis of the differences in practice preferences between accepted, alternate, and rejected groups of applicants indicated that such a bias did not exist. When admission was recalculated with only grade point average instead of the current procedure of a weighted combination of grade point average and interview, it was found that the admitted class would have contained more students preferring mental health practice. Additional research is recommended to further examine admission criteria and their relationship to practice.
Food Store Accessibility
Authors: McClain Linda , Todd Christy
Published: April 2012

Although occupational therapists try to help their wheelchair-bound clients reenter the community or maintain independence, many facilities’ noncompliance with accessibility standards makes such planning difficult. In the present study, a survey was used to investigate the wheelchair accessibility of 20 grocery and convenience stores. The results of the survey indicated that the types of stores with greatest accessibility, in descending order, were (a) rural grocery stores, (b) urban grocery stores, (c) urban convenience stores, and (d) rural convenience stores. No overall differences were found between the urban and rural stores. The types of deficiencies found and their effects on clients’ shopping are described.

A follow-up study was conducted to see if the store managers, who were sent letters notifying them of their stores’ deficiencies, would correct these problems. Six months after notification, the survey was repeated. Five of the 20 managers made changes in specific deficient areas, whereas the remaining 15 made no changes. The survey results and the fact that 25% of the stores made changes after receipt of a letter indicate that occupational therapists can be effective advocates for accessibility and thus provide a vital link to productive living for persons in wheelchairs.
Decreasing Drooling With Oral Motor Stimulation in Children With Multiple Disabilities
Authors: Domaracki Leigh Strawbridge , Sisson Lori A.
Published: April 2012

Many persons with severe and profound disabilities exhibit chronic and excessive drooling, which can have unfavorable effects on their socialization and health. Few treatments to reduce this behavior, however, have been evaluated systematically. In the present investigation, oral motor stimulation was used with 2 children who attended a residential educational facility for students who are blind and who have multiple disabilities. The treatment involved the brushing of the hard palate, the upper and lower gums, the tongue, and the inside of both cheeks at 1-hr intervals during the school day. The efficacy of this approach was demonstrated with a withdrawal experimental design. Because this treatment did not eliminate drooling, vibration was applied to the chin and neck, first in conjunction with the oral motor stimulation and then contingent on the subject’s having a dry face. Vibration did not have additional therapeutic effects. The results of this study are discussed in relation to the existing literature on modification of drooling and the difficulty of effecting change in the behavior of persons with severe and profound mental and physical disabilities.
The Effect of Mouth Closure on Drooling and Speech
Authors: Iammatteo Patricia A. , Trombly Catherine , Luecke Linda
Published: April 2012

The efficacy of a feeding program to decrease drooling and increase vocalizations by promoting mouth closure was explored in two boys with cerebral palsy through the use of oral facilitation techniques. A single-subject ABA design was repeated across subjects. Baseline 1 consisted of 5 (Subject 1) and 10 (Subject 2) half-hour sessions during which the subjects were fed applesauce and apple juice without treatment. A 1-hr play session followed, during which saliva was collected on an absorbent bib and weighed. Bilabial vocalizations produced by the subjects were recorded and counted. A 12-session intervention phase followed, which was identical to the baseline phase except that treatment was implemented. Treatment consisted of techniques to reduce tactile hypersensitivity before feeding and the application of jaw control during feeding. Baseline 2 consisted of 7 sessions identical to baseline 1. The results suggest that this intervention decreases drooling but does not increase bilabial vocalizations. Longer treatment and follow-up may be needed in future efficacy studies.
Evaluating a Level I Fieldwork Model for Independent Living Skills
Authors: Neistadt Maureen E. , Cohn Ellen S.
Published: April 2012

A model for Level I fieldwork in which students coled independent living skills (ILS) groups in clinical settings and observed occupational therapy evaluation and treatment was implemented in a curriculum and evaluated for its effectiveness. The evaluation surveys from this study suggest that the model is most effective in courses and clinical settings that deal with adult and young adult client populations. All clinicians in these settings believed that the students provided a service to the clients by co-leading ILS groups, and nearly all believed that student-led groups would be valuable for their clients in the future. The students reported learning about group leadership skills and developing creative activity adaptations to meet different clients’ needs. Faculty members want to continue using this model because they think it facilitates students’ integration of clinical and classroom experiences.
An Assessment of Measures to Predict the Outcome of Driving Evaluations in Patients With Cerebral Damage
Authors: Galski Thomas , Ehle Holly T. , Bruno Richard L.
Published: April 2012

The evaluation of the ability of patients to return to driving after cerebral damage stands out as one of the most important tasks confronted by rehabilitation professionals. The present study was designed to critically assess evaluations that were developed at one facility to determine fitness to drive: an off-road, predriver evaluation of skills regarded as important in driving and an on-road, behind-the-wheel evaluation of abilities needed to drive in actual traffic situations. The evaluation results of 37 patients with cerebral damage due to traumatic head injury or cerebrovascular accident were studied retrospectively. Only 4 out of 21 items on the predriver evaluation significantly predicted the outcome of the predriver evaluation and none of the predriver evaluation items predicted the outcome of the behind-the-wheel evaluation. Only 6 of the 26 tasks on the behind-the-wheel evaluation significantly predicted the outcome of the behind-the-wheel evaluation. None of the items on the predriver evaluation or the behind-the-wheel evaluation explained a significant portion of variance related to outcome. The lack of internal and predictive validity of driver evaluations is discussed in light of these findings, and recommendations are given for improving the predictive power of driving evaluations.
Adding Purpose to the Repetitive Exercise of Elderly Women Through Imagery
Authors: Riccio Christine M. , Nelson David L. , Bush Mary Ann
Published: April 2012

Many studies have documented the effectiveness of verbally elicited imagery in the enhancement of motor skills in young, nondisabled populations. The present study examined the effects of verbally elicited imagery in the encouragement of two exercises (i.e., reaching up to pick apples and reaching down to pick up coins) in elderly women. The subjects were 27 women between 62 and 96 years of age who were selected from a nursing home, a residential retirement home, and a foster care home. All of the subjects received imagery as well as control conditions, but in a counterbalanced fashion. The Wilcoxon matched-pairs signed rank tests indicated that the imagery condition elicited significantly more repetitions of the reaching-up exercise than did the control condition (z = 2.25, p [one-tailed] = .012). The results in the reaching-down exercise were generally in the same direction but difficult to interpret statistically. The results are discussed in terms of other recent research investigating ways to add purpose to therapeutic exercise through occupation. Clinicians are urged to explore the advantages and disadvantages of imagery-based occupations in treatment.
Recruitment Standards and Practices in Occupational Therapy, 1900–1930
Authors: Colman Wendy
Published: April 2012

Debate regarding recruitment standards and practices exemplifies various visions of practice that exist within a profession. In occupational therapy, early recruitment criteria provide an example of how the field’s founders envisioned the professional practitioner. As occupational therapy grew in membership throughout the 1920s, that vision was challenged. This paper identifies and describes the recruitment ideas expressed by both the founders of occupational therapy and their challengers from 1900 to 1930 and suggests the influence of their ideas on recruitment standards.
The Effects of Education on Hand Use With Industrial Workers in Repetitive Jobs
Authors: Dortch Howard L. , Trombly Catherine A.
Published: April 2012

Eighteen subjects participated in a preliminary study to determine the effects of two types of educational programs on the hand-use patterns of industrial workers at risk for developing cumulative trauma disorder (CTD). The subjects were divided into three groups: Two groups received different educational programs and the third group served as the control. One program used a handout as the only educational tool: the other used the handout as well as a hands-on demonstration of the concepts in the handout. Pretests and posttests of the frequency of movements identified with CTD of the hand and wrist during work were administered to all subjects. Both educational programs were significantly effective in reducing the number of at-risk movements performed by workers tested 1 week after receiving the education. No significant difference was found between the two educational programs. The results of this study show that education can affect hand-use patterns, and a similar study on a larger sample is recommended.
The Value of Psychosocial Level II Fieldwork
Authors: Atwater Anne W. , Davis Christine G.
Published: April 2012

The shortage of occupational therapists choosing to practice in mental health and the increase of therapists electing to specialize in other areas led to a pilot study designed to gather information regarding the value of psychosocial Level II fieldwork. A survey was mailed to 152 practicing occupational therapists who had graduated from Colorado State University in Fort Collins between 1983 and 1988; of the surveys returned, 116 were used in this study. The results indicate that the psychosocial Level II fieldwork experience provides therapists with valuable training and experience regardless of their current area of practice or specialization. The results also suggest that to preserve the holistic approach that occupational therapists offer their clients, psychosocial Level II fieldwork must remain a requirement of occupational therapy programs.
Creating Excellence in Patient Care
Authors: Schwartz Kathleen Barker
Published: April 2012

Occupational therapists are working in health care organizations that operate from an efficiency perspective. There is growing criticism that this approach can put quality patient care at risk. This article proposes the excellence perspective as a way to address quality as well as productivity. The excellence perspective is one that occupational therapists can use as a guide to program innovation. It is a perspective that fits with the occupational therapist’s concern for quality patient care and the administration’s concern for productivity. This article examines the excellence perspective and describes its use in business and its potential for health care. A case study that exemplifies excellence in patient care is presented.
Program Evaluation for Accreditation
Authors: Meyers Susan K.
Published: April 2012

Program evaluation in preparation for accreditation provides opportunities for the identification of program strengths, weaknesses, and improvement potential. In the present study, naturalistic inquiry, an evaluation methodology responsive to the concerns of persons with a stake in the program, was successfully used in preparation for the accreditation of an occupational therapy program. The experiences of undergraduate students who implemented the program evaluation as part of an honors elective course describe the process, outcomes, benefits, and problems associated with the use of naturalistic inquiry as a responsive program evaluation.
Upper Extremity Casting: Adjunct Treatment for a Child With Cerebral Palsy Hemiplegia
Authors: Yasukawa Audrey
Published: April 2012

A common upper extremity deformity with hemiplegia is pronation contracture of the forearm in association with flexion contracture of the elbow. Early management of the child with hemiplegic cerebral palsy is critical in optimizing overall function. The use of inhibitory upper extremity casting can enhance function and improve arm-hand position. The present paper describes the evaluation process before casting, the goals of each phase of the casting program, and the follow-up.
A Comparison of Craft Use and Academic Preparation in Craft Modalities
Authors: Dickerson Anne , Kaplan Susan Heling
Published: April 2012

The purpose of this study was to compare the use of crafts in psychiatric occupational therapy practice with the actual craft-related training received by occupational therapy students. Two questionnaires were developed, one related to the crafts used in clinical practice, the other related to the amount and type of craft training received in educational programs. One thousand occupational therapists who work in psychiatry and 139 accredited and developing educational programs were asked to complete the questionnaire appropriate to their setting. The final analysis involved 121 educational programs (87% response rate) and 384 clinical programs (38% response rate). The results suggest that there may be substantial differences between craft related training and actual clinical use of crafts.

The findings imply that educational programs must reevaluate the types of crafts taught and the method by which they are integrated into the total curriculum. Implications for the profession include the need to clarify the role of crafts as a therapeutic modality and to reflect on the future direction of the profession.
Current Concepts of Children’s Perceptions of Control
Authors: Coster Wendy J. , Jaffe Lynn E.
Published: April 2012

Beliefs about control have been identified as an important aspect of the occupational therapy evaluation process because of their potential influence over the course of action chosen. This paper reviews the current status of research and theory in this area as it relates to children. Issues addressed include the drawbacks of the downward extension of adult theoretical models and tests to children, the multidimensionality of perceived control, and the relation between cognitive development and changes in beliefs. Recent revisions in theoretical models and new measures that provide more differentiated information on children’s beliefs about causality and personal efficacy are reviewed. The implications for the selection of instruments and interpretation of results for the assessment of children’s perceived control in clinical practice are discussed.
Wrist Extensor Orthoses: Dexterity and Grip Strength Across Four Styles
Authors: Stern Erica B.
Published: April 2012

Orthoses that are used to stabilize, protect, and support the wrist during functional activities often interfere with normal movement and, therefore, with hand function. This study compared the manual dexterity and grip strength of 20 female subjects while using a free hand and while wearing each of four wrist extensor orthoses: a Futuro prefabricated wrist brace (No. 33), a volar thumbhole orthosis, a volar orthosis with a radial connector bar, and a dorsal orthosis with distal transverse arch support.

Of these orthoses, the Futuro prefabricated wrist brace afforded the best overall dexterity, although it was significantly slower (p < .05) than the other orthoses in a writing subtest. Of the custom-made orthoses, the volar style with radial connector bar afforded the best overall dexterity.

All of the orthoses significantly (p < .01) reduced grip strength. The Futuro prefabricated wrist brace afforded the strongest grip strength of the four orthoses studied, and the volar thumbhole orthosis permitted the strongest grip among the custom-made orthotic styles.
Therapeutic Factors in Occupational Therapy Groups
Authors: Falk-Kessler Janet , Momich Christine , Perel Sharla
Published: April 2012

A survey was administered to patients and their therapists in an attempt to assess which therapeutic factors were perceived as helpful in occupational therapy groups. The patients’ responses were compared to their therapists’ for similarities and differences. Both groups highly valued factors of group cohesiveness, instillation of hope, and interpersonal learning. The therapists also valued guidance and identification, which the patients did not. Least valued by the patients were guidance, existential factors, and identification; least valued by the therapists were self-understanding, family reenactment, and existential factors.
Spatial Disorientation in Persons With Early Senile Dementia of the Alzheimer Type
Authors: Liu Lili , Gauthier Louise , Gauthier Serge
Published: April 2012

Although spatial disorientation is frequently observed in persons with Alzheimer disease, it is not well understood. A descriptive study was conducted to examine spatial skills associated with spatial orientation. Spatial tasks were selected and grouped into three types of spatial skills: perceptual, cognitive, and functional. These spatial tasks were administered to a group of 15 persons with senile dementia of the Alzheimer type (SDAT) (early Alzheimer disease) and a group of 15 control subjects. The results indicated that the subjects with SDAT were impaired on half of the perceptual spatial tasks and all of the cognitive spatial tasks. On the functional spatial tasks, however, the subjects with SDAT showed impaired skills in the new environment but intact skills in familiar environments.

Spatial disorientation poses a danger and limits a person’s ability to independently perform daily activities that require navigation outside of the home. Occupational therapy should therefore include the assessment of spatial orientation skills in persons who are in the early stages of dementia.
A Survey of Occupational Therapy Curricula
Authors: Marshall Edwinna
Published: April 2012

Cross-sectional surveys were conducted of occupational therapy professional and technical programs. Part 1 describes general studies and prerequisite requirements for an entry-level baccaluareate degree in occupational therapy. Part 2 presents general studies, prerequisites, and technical curriculum of the occupational therapy assistant programs. Program directors design and manage professional programs based on their knowledge of academia, higher education, accreditation essentials, and consumer needs. Descriptive data of educational prerequisites and curriculum content are used in program evaluation and planning for accreditation, institutional strategic planning, marketing, projection of future needs, and facilitation of communication between curricula.
An Emerging View of Mastery, Excellence, and Leadership in Occupational Therapy Practice
Authors: Burke Janice Posatery , DePoy Elizabeth
Published: April 2012

The recent focus on clinical reasoning in occupational therapy, specifically on how therapists solve complex problems, has stimulated interest in how master clinicians think in practice. By gaining insight into how clinicians think and what they think about when they identify and solve problems, we may be able to identify clinical reasoning patterns and processes that occupational therapy students and novice therapists need to experience in order to progress in their practice or to emerge as leaders in their field. Observation of the way in which clinical masters and leaders view challenges and solve problems as manifested in their clinical reasoning may provide new and potential therapists with clues as to how to best hone their skills and knowledge for future success in practice.

This paper describes a study that examined the relationship of mastery, excellence, and leadership in occupational therapy. Ten master clinicians were interviewed to determine the characteristics of their mastery and excellence in practice and to explore the degree to which they engaged in leadership behavior. The findings revealed that mastery, excellence, and leadership are independent of one another but that some characteristics are common to all of these phenomena.
Staff Development Through Analysis of Practice
Authors: Slater Deborah Yarett , Cohn Ellen S.
Published: April 2012

Dreyfus and Dreyfus’s (1986) five-stage model of skill acquisition is integrated with findings from the American Occupational Therapy Association/American Occupational Therapy Foundation Clinical Reasoning Study. This model is presented as an organizing framework for staff development. Strategies for the recognition and retention of experienced clinicians who can serve as mentors for newer colleagues are identified.
Occupational Therapy Work-Hardening Programs: A Demographic Study
Authors: Wyrick Joane M. , Niemeyer Linda Ogden , Ellexson Melanie , Jacobs Karen , Taylor Sallie
Published: April 2012

A survey was conducted of 192 work-hardening and work-adjustment programs to gain an overview of practice patterns. The questionnaire covered program affiliation, services offered, staffing, program scheduling, average length of treatment per client, equipment used, physical settings, program status, number of clients seen each week, and types of functional outcome studies and research. The results demonstrate the tremendous growth of the involvement of occupational therapy in work hardening. This demographic study provides baseline information that can assist in the examination of trends and the development of new programs.
A Pilot Study of Differences in Play Behavior Between Children of Low and Middle Socioeconomic Status
Authors: von Zuben Maria Veronica , Crist Patricia A. , Mayberry Wanda
Published: April 2012

Although play is an important activity of childhood, it is often a neglected modality in occupational therapy. Poverty has been identified as a factor that adversely affects the play of children when a limited number of factors are studied. The purpose of this pilot study was to explore multiple play behaviors that may be related to socioeconomic status. The developmental play ages of 41 middle socioeconomic status preschool children (22 boys, 19 girls) and 43 low socioeconomic status preschool children (24 boys, 19 girls) were assessed with a modified version of the Preschool Play Scale (Bledsoe & Shepherd, 1982; Knox, 1974). Teachers rated the children’s play behavior after a minimum of 2 months of interaction in their preschool classrooms. No significant differences between these two groups of children were found for developmental play age, play dimensions, or play categories. It was concluded that the exposure to positive experiences, such as peer interaction and preschool setting, may minimize the effects of poverty conditions on the play behavior of children.
The Able Self: Adaptive Patterns and Choices in Independent Living for a Person With Cerebral Palsy
Authors: McCuaig Margaret , Frank Gelya
Published: April 2012

An ethnographic approach was used to study adaptation to independent living of a 53-year-old woman with cerebral palsy in a West Coast Canadian city. The subject’s adaptation through her use of technology (including augmentative communication systems and a powered wheelchair), activity routines, and social supports was documented with the life history method. Short-term accommodations to disruption or breakdown of stable adaptations were observed through participant observation. The criterion of function alone was found insufficient to account for the subject’s choice of adaptive techniques, routines, and social supports. Adaptive choices appeared to depend on the subject’s desire to be perceived as able, especially as mentally competent, to the greatest extent possible. The way field experiences may be used to challenge professionals’ assumptions, in this case, concerning disability and treatment, is modeled for future ethnographic research in occupational therapy.
Assessment and Treatment of a Pediatric Patient in Chronic Care: Ethnographic Methods Applied to Occupational Therapy Practice
Authors: Frank Gelya , Huecker Esther , Segal Ruth , Forwell Susan , Bagatell Nancy
Published: April 2012

Ethnographic methods were used to examine how an experienced occupational therapist assesses and treats a pediatric patient within a relatively long-term clinical relationship. Treatment goals for this preverbal child with Hirschsprung disease, who began occupational therapy at 22 months of age, included (a) introduction of oral feeding to reduce dependence on total parenteral nutrition through intravenous feeding and (b) facilitation of exploratory play, which had been developmentally delayed during extensive periods of immobilization during medical care. This article shows how the meaning of therapeutic activities changes for the patient over time, as the occupational therapist builds trust through affect attunement, validates his or her empathic interpretations, and develops common understandings with the patient’s family and others within the social and cultural contexts of chronic care.
Use of Treatment Activities in Occupational Therapy
Authors: Taylor Eve , Manguno Jeanne
Published: April 2012

The purpose of this study was to determine the treatment activities used most often by occupational therapists associated with the Louisiana State University Medical Center’s (LSUMC’s) occupational therapy program. The results of this study were used to make changes in the teaching of treatment activities in the program. Two samples of clinicians – 83 fieldwork supervisors and 59 former LSUMC students, mainly from the southeastern region of the country – identified how frequently their clinics had used each of 67 listed treatment activities in the past year. The results showed that noncraft activities were ranked as being used more frequently than either major or minor craft activities. This was true in all settings and all specialty areas of practice. In both groups, across all areas of practice, self-care and social skills activities ranked among the top five positions of activities frequently used in practice. Therapists in physical disabilities settings used crafts less frequently than therapists in mental health settings. As a result of this study, changes have been made in the teaching of treatment activities at LSUMC: Those activities that were ranked in the study as frequently used have been emphasized, and those ranked as infrequently used have been given less emphasis or deleted from the curriculum.