bluuebunny/crossref_metadata_2025 huggingface dataset:
Fieldwork in Schools: A Model for Alternative Settings
Authors: Griswold Lou Ann Sooy , Strassler Beth Seybold
Published: April 2012

Objective. An exploratory study was conducted at the University of New Hampshire to increase the number of school-based fieldwork opportunities for occupational therapy students and to guide the development of a model for first-time fieldwork supervisors in schools.

Method. Responses to a questionnaire completed by 119 occupational therapists working in schools in northern New England provided a description of both school-based occupational therapy practice and of their needs as supervisors. Interviews with 12 occupational therapists who had supervised fieldwork students in schools provided qualitative information.

Results. Findings suggested that school-based practice issues such as working part time, traveling between schools, and using variety of service delivery models created particular challenges for fieldwork supervisors in schools. A process of addressing fieldwork supervisors’ concerns during recruitment and in a fieldwork supervisor seminar and providing on going support resulted in successful fieldwork experiences for occupational therapy students.

Discussion. This process of studying a practice setting in order to develop a model for fieldwork that addresses the uniqueness of the setting may be used to develop fieldwork opportunities in other practice settings as well.
Applied Research During Fieldwork: Interdisciplinary Collaboration Between Universities and Clinics
Authors: Bloomer Judith S.
Published: April 2012

This article describes the concept of incorporating occupational therapy research during fieldwork. Three models are presented that use applied research within a framework of collaboration between community clinicians and occupational therapy education programs. These models include an established honors baccalaureate program in Canada (Model 1) and suggested modifications of this model both for an undergraduate program (Model 2) and for a combined entry-level postbaccalaureate occupational therapy certificate/interdisciplinary graduate program (Model 3) in the United States. Occupational therapy clinicians and academic educators who work in areas where collaborative research relationships between universities and community clinics are not already established are encouraged to consider adopting or modifying one of the models described in this article.
Use of Standardized Activities of Daily Living Rating Scales in Spinal Cord Injury and Disease Services
Authors: Watson Anne H. , Kanny Elizabeth M. , White David M. , Anson Denis K.
Published: April 2012

Objective. Although standardized activities of daily living (ADL) rating scales offer advantages in reliability and consistency of reporting, the literature has revealed that most occupational therapists tend to use informal assessments and reporting methods. This study investigated the use of standardized ADL rating scales by occupational therapists who treat patients with spinal cord injury and disease (SCI/D).

Method. Fifty-two SCI/D rehabilitation sites were selected by stratified random sampling, and surveys were completed by the occupational therapist in each site who worked most extensively with patients with SCI/D. Occupational therapists at 49 of the sites completed the survey.

Results. Survey results indicated that 68% of the respondents tend not to use standardized ADL rating scales in their work with SCI/D patients. Of those who used standardized ADL rating scales, the Functional Independence Measure (FIM) was more widely used than any other Most respondents learned about this measure on the job. Many of the respondents indicated that a limitation of the FIM was its inability to detect progress in their patients with SCI/D.

Discussion. The results indicate that although widely used, the FIM may need to be supplemented by other standardized ADL rating scales in order for a therapist to objectively document the progress made by patients with SCI/D. To be able to choose the most appropriate assessment tools, students and practicing therapists need to be educated in a variety of standardized ADL rating scales.
To Fail or Not to Fail? A Course for Fieldwork Educators
Authors: Ilott Irene
Published: April 2012

Objective. Assigning a failing grade to a student is one of the most important yet problematic responsibilities of a fieldwork educator, for it challenges both personal and professional values. This article describes and evaluates a 1-day course designed to prepare educators for this responsibility.

Method. The course was offered five times in 1989 and 1990 by the Derby School of Occupational Therapy, Derby, England, and was attended by 101 fieldwork educators. Surveys were administered to these educators immediately after the course and again 4 and 12 months later.

Results. Respondents reported increases in confidence and in their ability to differentiate between students’ competence and incompetence. These changes were related to three factors: an understanding of the affective responses associated with a fail scenario, the reinforcement of effective methods of supervision, and the maintenance of professional standards.

Conclusion. It is recommend that the topic of failure be included in all fieldwork educator training courses.
Building Inclusive Community: A Challenge for Occupational Therapy
Authors: Grady Ann P.
Published: April 2012

Occupational therapy was founded on values of choice, relevance, and active participation in meaningful occupations. To assure choice in daily living, learning, work, and play for persons with disabilities or significant health issues, occupational therapy practitioners are challenged to gain increased understanding of the unique culture and community of each person and family with whom they work; create opportunities for these persons to develop their capabilities in community settings of their choice; promote more interactive models of practice in which the practitioner affects the arrangements between the person and society; work with communities to welcome the gifts of diversity; and develop skill in analyzing environments and facilitating environmental interaction. The environment category of the spatiotemporal adaptation theory is expanded and a communication model for collaboration in building individual community is proposed as means for addressing the challenges.
A Problem-Based Learning Curriculum for Occupational Therapy Education
Authors: Royeen Charlotte Brasic
Published: April 2012

To prepare practitioners and researchers who are well equipped to deal with the inevitable myriad changes in health care and in society coming the 21st century, a new focus is needed in occupational therapy education. In addition to proficiency in clinical skills and technical knowledge, occupational therapy graduates will need outcome competencies underlying the skills of critical reflection.

In this article, the author presents (a) the rationale for the need for change in occupational therapy education, (b) key concepts of clinical reasoning and critical reflection pertaining to the outcome such change in occupational therapy education should address, (c) problem-based learning as a process and educational method to prepare occupational therapists in these competencies, and (d) the experience of the Program in Occupational Therapy at Shenandoah University in Winchester, Virginia, in implementing a problem-based learning curriculum.
Gender Differences in Work Performance on the Baltimore Therapeutic Equipment Work Simulator
Authors: Esmail S. , Bhambhani Y. , Brintnell S.
Published: April 2012

Objectives. The purposes of this study were to (a) establish biomechanical and physiological normative data for healthy young women performing three tasks on the Baltimore Therapeutic Equipment work simulator (BTE): wheel-turn, push-pull, and overhead-reach; and (b) compare these data with previously reported values for healthy men of a similar age group.

Method. Twenty women completed five test sessions: (a) task familiarization on the BTE to determine the work intensity that was perceived as hard on the Borg scale, (b) incremental test on an arm crank ergometer to measure peak oxygen uptake (VO2) and peak heart rate (HR), and (c) one of the three tasks in random order for 4 min during the next three sessions. Physiological responses were monitored with a metabolic cart interfaced with an electrocardiogram.

Results. Torque, work, and power during the three tasks were significantly higher (p <.05) in men than in women. The absolute VO2 (L. min-1) during these tasks was higher in men, but when the VO2 was calculated relative to body weight (ml.kg-1 .min-1). no significant (p > .05) gender differences were observed. Computation of energy expenditure relative to body weight and power output (cal.kg-1 .W-1) indicated that women expended significantly (p < .05) more energy than men. No significant (p > .05) gender differences were observed for VO2 and HR when the values were expressed as a percentage of their respective peaks.

Conclusions. Findings indicated that (a) the functional work capacity is significantly lower in women than in men, (b) women are less efficient than men when the energy expenditure is expressed per unit of body weight and power output, and (c) the relative physiological stress in men and women is similar under these conditions.
The Allen Cognitive Level Test and Social Competence in Adult Psychiatric Patients
Authors: Penny Neil H. , Mueser Kim T. , Thomas North C.
Published: April 2012

Objectives. The purpose of this study was to investigate the relationship between cognitive disability and social skills in an acute care adult inpatient psychiatric population (n = 55).

Method. Independent ratings of patient’s social skills were made during a semistructured interview using the Social Interaction Test (SIT), followed by measurement of cognitive disability using the revised Allen Cognitive Level Test (ACL-90). Reliability of the assessments was established.

Results. Significant correlations were found between the ACL-90 and SIT scores: patients with greater cognitive disability had poorer social skills. ACL-90 scores were not related to gender or diagnosis. A gender difference was found for SIT scores with women having better social skills than men.

Conclusion. These findings suggest there is a relationship between cognitive disability and social skills in adult psychiatric inpatients. Implications for occupational therapy treatment include better integration of the grading of the cognitive and social requirements of tasks to achieve optimal functioning.
Use of Occupational Therapists in Mental Health Settings in South Carolina
Authors: Trickey Becki A. , Kennedy Doris Beth
Published: April 2012

Objectives. Severe workforce shortages in occupational therapy require an examination of viable practice areas for occupational therapists. The mental health practice area has experienced greater shortages than have other areas of occupational therapy; in South Carolina, only 2% of occupational therapists work in mental health. This study was undertaken to examine the use of occupational therapists in mental health settings in South Carolina.

Method. A survey was sent to administrators at 52 South Carolina mental health facilities to collect information on the use of occupational therapists, the associated economic issues, and the perception of the roles of occupational therapists.

Results. Among the 34 respondents, 39% hired occupational therapists on a part-time or contractual basis, and 17% had full-time occupational therapist positions; 33% hired certified occupational therapy assistants on a part-time or contractual basis, and 11% had full-time certified occupational therapy assistant positions. Occupational therapy positions decreased over a 5-year period, and respondents cited the cost of salaries and problematic recruitment as two of the major contributing factors. The need for occupational therapy services was ranked as the number one factor both for increased and decreased use of occupational therapists. Personnel factors were highly ranked for facilities with decreased use whereas patient-related factors were highly ranked for facilities with increased use.

Conclusion. The findings highlight factors that may contribute to recent trends of fewer occupational therapists in South Carolina choosing mental health as a primary practice area.
Performance of Americans and Israelis With Cerebrovascular Accident on the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA)
Authors: Cermak Sharon A. , Katz Noomi , McGuire Elizabeth , Greenbaum Sara , Peralta Chrys , Maser-Flanagan Valerie
Published: April 2012

Objective. The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) measures the cognitive performance of persons with cerebrovascular accident(CVA). Although this assessment was developed and standardized in Israel, it is frequently used in the United States. The purpose of this study was to identify whether differences in performance on the LOTCA existed between Americans and Israelis who have had strokes. Additionally, this study was designed to compare the performance of persons with right CVA with the performance of persons with left CVA because the normative data for the LOTCA does not include separate information for these two groups.

Method. The LOTCA was administered to 25 Americans with CVA (19 right CVA and 6 left CVA) and 56 Israelis with CVA (26 right CVA and 30 left CVA).

Results. On the majority of LOTCA subtests, there were no significant differences between American and Israeli subjects. Only one subtest, Orientation to Time, revealed significant differences between Americans and Israeli subjects both for subjects with right CVA and subjects with left CVA. Examination of subjects with right CVA versus subjects with left CVA also indicated few differences. Only one subtest, Pegboard Construction, revealed significant differences between subjects with right CVA and subjects with left CVA for both American and Israeli subjects.

Conclusion. The LOTCA is an appropriate tool for occupational therapists to use in assessing Americans who have had strokes. In addition, for the most part, the subtests of the LOTCA assess cognitive-perceptual abilities that are not specific to the right or left cerebral hemisphere.
The Effect of Environmental Regulations on Postural Control After Stroke
Authors: Abreu Beatriz C.
Published: April 2012

Objectives. The primary objective of this study was to examine the effect of environmental predictability on postural control after stroke. A reaching task for seated subjects was used as the postural perturbation. Trajectory stability (the pathway followed by the subject’s body center of pressure with respect to time during the reaching task) was used as the index of postural control. It was hypothesized that trajectory stability would be greater under predictable conditions.

Method. A specially designed electromechanical system was used to measure the trajectory stability ratios for 100 subjects, 50 with poststroke hemiplegia and 50 who had not had stroke. All subjects completed a task that required reaching to the left versus reaching to the right, under predictable versus unpredictable conditions. Postural control was measured via a trajectory instability ratio in both the anterior-posterior and medial-lateral planes.

Results. Although the effect of predictability on postural control was significant, it was not as hypothesized for both groups. There was greater trajectory stability under unpredictable conditions when reaching to the right as measured in both the anterior-posterior and medial-lateral planes and when reaching to the left as measured in the medial-lateral plane.

Conclusion. These findings refute the assumption of the hierarchical, predictable-to-unpredictable-environment model for postural control evaluation and treatment. The relationship between information processing demands and postural skill is probably more complex than the simple linear association implied. Perhaps the two conditions, predictable and unpredictable, should be worked on concurrently, not sequentially.
An Exploratory Study of How Occupational Therapists Develop Therapeutic Relationships With Family Caregivers
Authors: Clark Catherine A. , Corcoran Mary , Gitlin Laura N.
Published: April 2012

Family members, who provide 70% to 80% of all long-term care, have often been perceived by occupational therapists as a barrier to, rather than a partner in, effective care for elderly persons. This perception suggests that in order 10 build effective partnerships to manage complex issues, occupational therapists working with elderly persons must develop effective strategies for involving family members in the therapeutic process. This article describes a pilot study that examined how occupational therapists engage family caregivers of elderly persons receiving home care services. A qualitative descriptive approach was used to explore the behaviors demonstrated by two occupational therapists when working with family caregivers. The findings point to four primary types occupational therapist–caregiver interaction, categorized as: caring, partnering, informing, and directing. These interaction styles were compared with current literature describing state-of-the-art occupational therapy practices with older adults and family caregivers. An emphasis was placed on examining how therapeutic interactions can evoke different caregiver responses and influence the development and maintenance of collaborative therapeutic relationships. The results of this pilot study can sever as a framework for further exploration of interactive strategies that promote caregiver empowerment and ultimately influence the ability of families to assume responsibility for the long-term care required by many chronically disabled older adults.
Interactive Journals: An Educational Strategy to Promote Reflection
Authors: Tryssenaar Joyce
Published: April 2012

Reflection is an essential component of clinical reasoning in occupational therapy practice. The specialty area of mental health practice can elicit awareness and introspection for occupational therapy students at personal and professional levels. This article, a qualitative case study, describes the use of interactive journals in the mental health component of an undergraduate occupational therapy curriculum to foster and develop reflective skills. Students kept journals and submitted them biweekly; faculty members responded to the journals in writing within 24 hr. The journals were analyzed for common themes over the length of the course as well as at each biweekly period. Frequent themes were students’ increased awareness and openness to the specialty area and positive changes in attitude associated with new knowledge and experiences. The results indicate that interactive journals in academic courses have the potential to be an effective strategy to promote reflection.
Effects of Afternoon Rest on the Performance of Geriatric Patients in a Rehabilitation Hospital: A Pilot Study
Authors: Creighton Cynthia
Published: April 2012

Objective. When a person is hospitalized, he or she enters an environment in which time is structured very differently than it is in everyday life. Research with healthy young subjects in sleep laboratories has indicated that disruption in activity-rest cycles significantly affects mood, physical skills, and cognitive performance. Older persons whose daily routines are upset when they become patients in a hospital may be even more vulnerable to performance deficits. This pilot study was implemented in a regional rehabilitation center as an initial step in exploring the relationships between variations in schedule and geriatric patients’ functioning while hospitalized.

Method. Single-subject methodology was used to study six elderly fracture patients’ responses to the addition of an afternoon nap to their daily routine. Data were collected each morning and afternoon, during “nap” and “no nap” weeks, with simple measures of alertness, concentration, strength, coordination, and reaction time.

Results. Tendencies toward late afternoon drowsiness and, in some cases, improved cognitive performance, were observed when naps were provided.

Conclusion. Data about the ways in which hospital routine affects performance can guide occupational therapists in advocating for balanced programs of activity and rest for older rehabilitation patients.
The Touch Inventory for Elementary-School-Aged Children: Test–Retest Reliability and Mother–Child Correlations
Authors: Bennett Jennifer W. , Peterson Cindee Q.
Published: April 2012

Objective. The Touch Inventory for Elementary-School-Aged Children (TIE) is a self-report screening assessment for tactile defensiveness. The purpose of this study was to examine test–retest reliability of the TIE and to evaluate agreement between children’s TIE scores and scores that mothers gave their children on a modified version of the TIE.

Method. Twenty-nine children, 6 to 12 years of age, were available for the test–retest portion of the study and were assessed with the TIE with a 1-week interval between sessions. Their mothers completed a modified version of the TIE.

Results. Results indicated significant test–retest reliability ( r = .91, p < .001), although a more conservative Kappa indicated only moderate agreement. The correlation between mothers’ ratings and children’s ratings was less significant ( r = .56, p = .001), and Kappas were slight or fair, indicating considerable disagreement between mothers and children.

Conclusion. These results suggest that using information from both mothers and children might provide a more complete picture of tactile defensiveness, but further research is needed before using a mother’s assessment when the TIE is implemented as a standard procedure.
Understanding the Family Perspective: An Ethnographic Framework for Providing Occupational Therapy in the Home
Authors: Gitlin Laura N. , Corcoran Mary , Leinmiller-Eckhardt Susan
Published: April 2012

This article presents a framework for providing occupational therapy services to family members caring for elderly persons in the home that is based on four key principles derived from ethnographic methodology: identification of an informant, use of an emic (insider) approach, engagement in self-reflection, and interpretation of information. The underlying strategy is to use these principles to derive an understanding of the personal meaning of caregiving, the way in which care is provided, and the specific aspects of caregiving that are problematic from the perspective of the family member. Services are then developed that reflect individual need as expressed by the caregiver and that fit the fundamental values and belief system of the family unit. A case example is presented to illustrate the framework in action in a home situation with family members caring for an elderly person with dementia.
Adaptation to Macular Scotomas in Persons With Low Vision
Authors: Schuchard Ronald A.
Published: April 2012

Persons with scotomas in their central 20° of vision often do not notice these blind spots within their visual field and have visual performance difficulties far exceeding what would be expected from standard vision tests. Before persons with macular scotomas can be assisted to optimally use their remaining vision for a better quality of life, more must be known about how the visual system adapts to a macular scotoma. Important issues include spatial and temporal characteristics of perceptual completion and metamorphopsia, development of preferred retinal loci for fixation and visual search, and dynamics of the preferred retinal locus development in terms of the changes in the eye movement system. With a full understanding of the visual system’s adaptation to macular scotomas, new low vision devices and training techniques can be proposed to promote independence in activities of daily living for the person with low vision.
Considerations in Evaluation and Treatment of the Child With Low Vision
Authors: Hyvärinen Lea
Published: April 2012

Habilitation of infants and children with visual impairments should be based on a thorough understanding of their visual capabilities and limitations. Comprehensive evaluation of visual function includes measurement of visual acuity, contrast sensitivity, visual field, color vision, adaptation, visual sphere, accommodation, and oculomotor functions. It is best completed through a team approach that uses therapists, special educators, and physicians. A complete evaluation also includes examination of the effect of other motor functions on the use of vision. Nearly all aspects of a child’s vision can be measured in play situations with tests that are easy to use. However, further education of nonphysician team members in refractive errors, optics, and function of optical devices may be necessary to ensure an accurate and thorough evaluation.
Understanding Cortical Visual Impairment in Children
Authors: Baker-Nobles Linda , Rutherford Ann
Published: April 2012

This article presents a review of the literature and a case study on a child with cortical visual impairment. The literature review covers the diagnosis, etiology, prevalence, prognosis, and a comparison of the differences between children with cortical visual impairment and those with ocular impairment. The case study presents occupational therapy intervention strategies specific to cortical visual impairment and results of treatment.
Effects of a Program on Symmetrical Posture in Patients With Hemiplegia: A Single-Subject Design
Authors: Wu Shin-Han , Huang Hwei-Tau , Lin Chi-Fang , Chen Mei-Hsiang
Published: April 2012

Objectives. Asymmetrical posture during static stance has been identified as a common problem in persons with hemiplegia. This study examined the effect of an activity-based therapy regimen on symmetric weight bearing and midline position of center of gravity (COG) in three adult subjects with hemiplegia.

Method. An ABAB single-subject design was used. The intervention program, including sanding in front of a standing table and play a bean bag game, was introduced for 30 min each day during each intervention phase. Quantitative measurements of the weight distribution and the midline position of COG were taken with the Balance Master System (version 2.20).

Results. Visual inspection and statistical analysis of the data revealed a significant improvement in symmetric weight distribution and midline position of COG. The study suggests that this program may be a promising alternative to a variety of postural rehabilitation programs for persons with hemiplegia.

Conclusion. Insecurity caused by poor stabilization and abnormal reactions to body weight bearing in an antigravity position might contribute to asymmetric postures. Results of this study suggest that an activity-oriented program can be effective in helping the persons with hemiplegia achieve symmetric stances.
The Meaning of Sea Kayaking for Persons With Spinal Cord Injuries
Authors: Taylor Leah Peri Siegel , McGruder Juli Evans
Published: April 2012

Objectives. Research has described benefits of physical, athletic, and avocational activity on improving self-esteem, quality of life, and locus of control in persons with disabilities. The objective of this study was to identify meaningful components of the experience of sea kayaking as described by persons with spinal cord injury (SCI).

Method. Three subjects with SCI who had participated in recreational kayaking were interviewed. Qualitative research methods included strategies from Guba’s model for rigor in qualitative research, Spradley’s interviewing guidelines, and Good’s method of semantic network analysis. Three interviews of approximately 45 min in length were conducted with each subject. Initial interviews began with a single question: “Tell me about sea kayaking.” Subsequent questions contained only concepts and terms used in the subjects’ responses.

Results. The subjects valued the novelty, challenge, safety, sociability, and natural environment aspects of sea kayaking. Perceptions of the self as able in the eyes of others and the need for support in pursuit of outdoor leisure activities were themes that figured prominently in the subjects’ discourse.

Conclusion. Subjects’ comments indicate that meaningful time use and the construction of an identity after injury are linked. This link has also been suggested in the rehabilitation literature. This information suggests the use of therapeutic intervention that supports a person’s adjustment to an irreversible SCI.
The Effect of an Inhibitive Weight-Bearing Splint on Tone and Function: A Single-Case Study
Authors: Kinghorn Judith , Roberts Gwen
Published: April 2012

Objective. This single-case study was designed to duplicate Smelt’s (1989) study of the effects of the application of an inhibitive weight-bearing splint on upper-extremity muscle tone and function in a child with cerebral palsy.

Method. Data on tone were collected by tracing the hand when weight bearing in the extended arm posture. Data on function were collected by observing block play for active grasp and voluntary release and ball play.

Results. Results indicate that after the application of an inhibitive weight-bearing splint, tone changed minimally, fine motor functional task changes were variable, and arm–hand position improved. Subjective reports by family and other caregivers, however, suggest that tone decreased and function increased.

Conclusion. The results of this study suggest the need to find more accurate means of measuring changes of tone and function in children with cerebral palsy. Selection criteria for suitable candidates for the weight-bearing splint are presented.
A Therapist’s Guide to Children’s Self-Esteem
Authors: Willoughby Colleen , King Gillian , Polatajko Helene
Published: April 2012

The term self-esteem is frequently used by occupational therapists and other health care professionals who work with children. There are differing interpretations as to what this term actually means. In this article, we use Susan Harter’s model of self-esteem to define the nature of self-esteem and apply it to clinical practice. We outline the developmental characteristics important to consider when addressing the self-esteem of young children, such as the findings that young children’s self-esteem is often more related to their perceptions of parental acceptance than perceptions of competence and that children are generally unable to accurately verbalize their level of self-esteem until 8 years of age. Specific implications for occupational therapy evaluation include whether the use of self-report or observer-report measures is preferable and whether self-esteem or self-concept should be measured. We discuss when to address self-esteem and which dimensions of self-esteem should be treated. The dimensions of self-esteem that are identified as low during the evaluation and that the child perceives to be important are addressed. The reevaluation issue of what specifically should be measured after intervention is also discussed. For example, it is recommended that the reevaluation instrument be sensitive to the domains of self-concept targeted for intervention.
Predictors of Functional Outcome Among Adolescents and Young Adults With Psychotic Disorders
Authors: Henry Alexis D. , Coster Wendy J.
Published: April 2012

Adolescents and young adults who experience the onset of a psychotic disorder often demonstrate major disruptions in occupational and social functioning. Yet, certain persons appear to be at a greater risk for impaired functioning after an episode of psychosis than others. This review of the psychiatric research literature on outcomes in psychotic disorders identifies several variables predictive of occupational and social functioning among young persons with both affective and nonaffective psychoses. Variables predictive of functional outcomes include diagnosis, symptom severity, duration of onset of symptoms, age of onset of symptoms, gender, stressful life events, premorbid functioning, and social supports. A model for conceptualizing the relationships of these variables to functioning is presented, and the implications for occupational therapy practice and research are discussed.
Clients’ Perceptions of Discharge Housing Decisions After Stroke Rehabilitation
Authors: Unsworth Carolyn
Published: April 2012

Objective. The purpose of this research was to examine the perceptions of older persons with stroke concerning the discharge housing decisions made during their rehabilitation program. The research explored clients’ locus of control, their perceptions of the role of the rehabilitation team and their family in the decision, and their perceptions of their activities of daily living skills.

Method. Sixty-two subjects with stroke completed four measures: (a) the Functional Independence Measure (FIM), (b) a housing information questionnaire, (c) a semistructured interview, and (d) the Bialer Locus of Control Scale. Rehabilitation team members also completed the FIM and housing information questionnaire for each subject. These instruments were used to collect data relating to clients’ perceptions of their functional status, discharge from the hospital, housing options available, and locus of control.

Results. Despite the team or family opinions on discharge housing, subjects saw housing decisions as primarily their own. The majority of subjects were reluctant to consider alternatives to returning home, even though they have self-care deficits and frequently reported that the presence of a spouse and family members were important to support their return home. Subjects generally seemed unaware of the influence of team and family opinions and the impact of their functional status on their discharge housing. Subjects’ locus of control seemed unrelated to satisfaction with the discharge decision process.

Conclusion. Clients who have had a stroke could use assistance to determine housing that is appropriate for their living skills. Discussions with clinicians concerning accommodation options may lead to a smoother transition from the hospital to longer term housing for clients after stroke.
Metaphor and Meaning in a Clinical Interview
Authors: Mallinson Trudy , Kielhofner Gary , Mattingly Cheryl
Published: April 2012

This study examined the narrative features of 20 life histories gathered from psychiatric patients with the Occupational Performance History Interview. The aim was to identify how narrative features were present in the patient interview responses and to illustrate how such narrative features can be located. We found that the patients organized their interview responses with deep metaphors that served to “emplot, ” or give meaning to, the life story. This article illustrates how patients used the deep metaphors to both circumscribe and frame possible solutions to the problems in their lives. Deep metaphors are consistent, recurring images of a life story that give coherence to, and aid in, the interpretation of the events of that life. Moreover, we explored how metaphors can be located in patient life histories and their implications for occupational therapy.
Soft Versus Hard Resting Hand Splints in Rheumatoid Arthritis: Pain Relief, Preference, and Compliance
Authors: Callinan Nancy J. , Mathiowetz Virgil
Published: April 2012

Objectives. This study compared soft versus hard resting hand splints on pain and hand function in 39 persons with rheumatoid arthritis. Splint preference was also evaluated to determine its effects on splint wear compliance.

Method. A repeated measures research design was used to compare the two experimental conditions, wearing a soft splint versus a hard splint on the dominant hand for 28 days at night only, and an unsplinted control period of 28 days.

Results. Arthritis pain was considerably less during both splinted periods when compared with the pretest. Subjects identified fewer joints as being painful during the soft splint condition than during the unsplinted condition. There were no significant differences among conditions on hand function measures. Splint preference was 57% for the soft splint, 33% for the hard splint, and 10% for no splint. Splint wear compliance was significantly better with the soft splint (82%) than with the hard splint (67%).

Conclusion. The findings indicate that resting hand splints are effective for pain relief and that persons with rheumatoid arthritis are more likely to prefer and comply with soft splint use for this purpose. Individualized splint prescription that focuses on client comfort and preference may enhance splint wear compliance.
Minimal Forces to Move Patients
Authors: Zelenka John P. , Floren Andrew E. , Jordan J. J.
Published: April 2012

Objectives. Health care workers who have patient transfer duties are at risk for back injury. Transferring patients between beds and gurneys is a rigorous pulling task that requires back, leg, and arm strength. This study analyzed the efficiency of commercially available transfer devices, namely a patient roller, patient shifter, and draw sheet.

Method. With the use of one or two force scales attached to each transfer device, the amount of force needed to transfer 15 participants, weighing from 101 lb to 240 lb, back and forth between a bed and a gurney was measured. Ten transfers per device per participant were performed.

Results. The patient roller was superior to the patient shifter and draw sheet in reducing transfer forces. Additionally, gurney-to-bed transfers tended to be more demanding for all transfer devices and for heavier participants.

Conclusions. The patient roller was the most efficient transfer device in moving participants compared with the draw sheet and patient shifter. Transfer forces can be estimated with the use of linear equations, with patient weight, direction of transfer and transfer device as the independent variables. These estimated forces can assist occupational therapists in the returning their injured health care coworkers to patient transfer duties. The results further indicated that high forces are required to transfer patients; therefore, patient-transfer personnel should obtain assistance when moving patients.
Use of Electronic Music as an Occupational Therapy Modality in Spinal Cord Injury Rehabilitation: An Occupational Performance Model
Authors: Lee Brenda , Nantais Tom
Published: April 2012

This article describes an electronic music program that allows clients with spinal cord injury (SCI) to form musical bands and play songs while performing therapeutic exercise in an occupational therapy program. Clients create the music by activating upper extremity exercise devices that are connected to a synthesizer through a computer. The bands choose the songs they would like to play and meet twice a week for 1 hr to practice. The 8-week program often concludes with a public performance.

The music program is intended to motivate client participation in physical rehabilitation while promoting self-esteem, emotional expression, and peer support. It is based on the model of occupational performance and the theory purposeful activity. To date, 33 persons have taken part. Client, therapist, and public response has been positive because this program highlights the abilities of persons with SCI, thereby encouraging their reintegration into the community.
Development of Critical Paths for Postacute Brain Injury Rehabilitation: Lessons Learned
Authors: Abreu Beatriz C. , Seale Gary , Podlesak Joyce , Hartley Leila
Published: April 2012

One important tool for case management is critical path analysis. This article explains four critical pathways developed by an interdisciplinary team for a postacute brain injury rehabilitation program. The heterogeneity of the brain injury population mandates the need for systematic coordination of direct care services. Yet, variations in the neurobehavioral consequences of brain injury necessitate differing goals and treatment tracks for individual clients. The critical pathways in this setting define and describe the procedures and services to be rendered from admission to discharge to achieve optimal goals for four treatment program tracks: Return to Work, Return to School, Functional Independence, and Neurorehabilitation. The tracks reflect a hierarchy of expectations for information processing and functional performance. Critical pathways provide a tool for enhancing communication among service providers and external case managers and for determining the extent to which a client’s course of treatment compares with a clinical standard considered to be ideal. This article compares the four critical pathways, provides representative case samples, and discusses lessons learned in the development and implementation process.
Managed Mental Health Care: Reflections in a Time of Turmoil
Authors: VanLeit Betsy
Published: April 2012

This article reviews the history, growth, and evolution of managed care in mental health and substance abuse treatment. Specific issues described are stigma, the important social dimensions and chronicity of some types of mental illness and chemical dependency, and reliance on the public sector for care. Opportunities and challenges for occupational therapists in the rapidly changing mental health system are discussed, including the use of interdisciplinary teams, the importance of measuring functional outcomes of interventions, the need to develop clinical guidelines, the importance of the community setting and a continuum of services, ethical dilemmas, and the importance of assertive occupational therapy advocacy and involvement in health care reform.
Right-Hemispheric Activation Approaches to Neglect Rehabilitation Poststroke
Authors: Lin Keh-chung
Published: April 2012

Unilateral neglect is a common neurological syndrome resulting from right-hemisphere strokes and has important prognostic value for functional outcome. This article identifies three approaches to neglect rehabilitation that are based on right-hemispheric activation mechanisms: (a) the lateralized task approach, (b) the controlled sensory stimulation approach, and (c) the limb activation approach. Their theoretical bases, experimental findings, and practical implications for neglect remediations are discussed. Meta-analytic procedures were used to critically review and statistically combine the results from potentially relevant studies, including 9 group design studies and 22 single-subject studies. An overall mean effect size r of .77 was found for the group design studies. For the studies with individual subjects as units of analysis, an overall mean r of .89 was obtained. This review provided empirical support for intervention in cases of unilateral neglect on the basis of brain activation mechanisms. Some appropriate areas for further research include evaluating treatment efficacy against functional criteria, refining intervention procedures in keeping with the advances in brain activation research, and identifying the optimal conditions for promoting generalized training.
The Volitional Questionnaire: Psychometric Development and Practical Use
Authors: Chern Jen-Suh , Kielhofner Gary , de las Heras Carmen Gloria , Magalhaes Livia C.
Published: April 2012

This article describes the Volitional Questionnaire and presents recent empirical efforts to develop and validate this instrument. The Volitional Questionnaire is an observational method of gathering data on motivation that is designed for persons who are unable to self-report their own motives. Studies to date suggest that the instrument can provide a valid measure of volition, though a number of limitations of the tool are noted. Implications for use of the Volitional Questionnaire in practice and for further refinement and future research are discussed.
Continuity and Change: Past Experience as Adaptive Repertoire in Occupational Adaptation
Authors: Spencer Jean Cole , Davidson Harriett A. , White Virginia K.
Published: April 2012

Narratives are gaining recognition as important ways occupational therapists and other clinicians can think about the life stories of clients. The purpose of this article is to examine a conceptualization of how changes from one chapter to another occur in life stories, using the metaphor of an adaptive repertoire, and to consider how this notion can be useful in helping clients maintain continuity and a coherent life story in times of change. Three premises based on the concept of adaptation address (a) configurations of occupational forms embedded in particular local worlds, (b) cumulative development of an adaptive repertoire that allows one to perform both competently and appropriately, and (c) adaptive transitions and application of one’s repertoire to new circumstances. Implications for research and clinical practice in occupational therapy also are examined.
The Effect of Switch Control Site on Computer Skills of Infants and Toddlers
Authors: Glickman Lisa , Deitz Jean , Anson Denis , Stewart Katherine
Published: April 2012

Objective. The purpose of this study was to determine whether switch control site (hand vs. head) affects the age at which children can successfully activate a computer to play a cause-and-effect game.

Method. The sample consisted of 72 participants randomly divided into two groups (head switch and hand switch), with stratification for gender and age (9–11 months, 12–14 months, 15–17 months). All participants were typically developing. After a maximum of 5 min of training, each participant was given five opportunities to activate a Jelly Bean switch to play a computer game. Competency was defined as four to five successful switch activations.

Results. Most participants in the 9-month to 11-month age group could successfully use a hand switch to activate a computer, and for the 15-month to 17-month age group, 100% of the participants met with success. By contrast, in the head switch condition, approximately one third of the participants in each of the three age ranges were successful in activating the computer to play a cause-and-effect game.

Conclusion. The findings from this study provide developmental guidelines for using switches (head vs. hand) to activate computers to play cause-and-effect games and suggest that the clinician may consider introducing basic computer and switch skills to children as young as 9 months of age. However, the clinician is cautioned that the head switch may be more difficult to master than the hand switch and that additional research involving children with motor impairments is needed.
Theory Application by School-Based Occupational Therapists
Authors: Storch Beth A. , Eskow Karen Goldrich
Published: April 2012

Objectives. Recent literature indicates that there is an inconsistent use of theory to guide clinical actions by occupational therapists, including those working in pediatrics. The purpose of this study was to describe school-based therapists’ theory application by collecting information about what frames of reference they used and why.

Method. Of the 72 school-based therapists in the mid-Atlantic states who agreed to respond to a questionnaire, 51 (70.8%) returned the questionnaire. Information about demographics, what frames of reference were used, and why they were used was obtained from the questionnaire.

Results. Respondents reported using a multitheoretical approach, with sensory integration theory and neurodevelopmental theory being the predominate frames of reference applied but not the only ones used. The frames of reference were used on the basis of several factors, including the children’s needs and the respondent’s education.

Conclusion. Formal and continuing education seems to have a great effect on school-based occupational therapists as they develop their personal conceptual frameworks.