bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upper Limb Rehabilitation following Brain Injury: Complex, Multifaceted and Challenging
Authors: Kuipers Kathy , McKenna Kryss 
Published: April 2015

Neurological upper limb rehabilitation is influenced by a diverse range of factors within the practice environment. Clinical reasoning is the means by which occupational therapists make sense of such factors in order to make decisions that promote individual occupational goals. However, changes in neurological knowledge, the limited availability of research evidence and the need to maintain a focus on client-centred practice in rehabilitation settings are factors that contribute to clinical reasoning uncertainty. A protocol that aims to structure clinical decision making in the light of such diversity has been developed to guide upper limb rehabilitation after brain injury. As part of a larger study designed to determine the conceptual usefulness of the protocol, 11 expert occupational therapists were asked to describe the challenges that they faced in their practice. Four themes emerged from the focus group data, described in terms of (a) the complexity of domain-specific knowledge and the paucity of evidence for practice; (b) the diversity of upper limb presentation; (c) the need to balance client-centred practice and professional duty of care; and (d) uncertainty regarding clinical decision making. Although the data supported the participants' expertise, they nevertheless articulated a need for guidance in structuring the clinical reasoning and decision making underlying neurological upper limb rehabilitation. Various strategies are described that can be used to guide clinical reasoning, including research evidence, the differentiation of situations requiring the application of artistic or scientific knowledge, reflective and reflexive practice, and the application of system aids such as decision-making protocols.
Use of Standardised Assessments and Outcome Measures among a Sample of Irish Occupational Therapists Working with Adults with Physical Disabilities
Authors: Stapleton Tadhg , McBrearty Ciara 
Published: April 2015

This study was carried out to explore the current usage of standardised assessments and outcome measures by occupational therapists working with adults with physical disabilities. A survey research design, using a postal questionnaire specifically designed for the study, was employed. Completed questionnaires were returned by 109 occupational therapists working in a variety of settings, including acute care, community and inpatient rehabilitation. A range of standardised assessments and outcome measures was in use, with an average of four different measures being used by the individual respondents. The most commonly used measures were the Mini Mental State Examination (Folstein et al 1975), Rivermead Behavioural Memory Test (Wilson et al 1985), Functional Independence Measure (Uniform Data System for Medical Rehabilitation 1999), Barthel Index (Mahoney and Barthel 1965) and the Chessington Occupational Therapy Neurological Assessment Battery (Tyerman et al 1986). However, the consistency of use tended to be low. The barriers to a more consistent use of standardised assessments and outcome measures included time restraints, the unsuitability of the available measures and a lack of sensitivity of the available measures to capture the effectiveness of occupational therapy. The findings support those of previous studies exploring this issue among occupational therapists from different areas of practice. The respondents in this study highlighted the need for a multifaceted approach, encompassing educational, managerial and individual responsibility, to address the issue of the usage of standardised assessments and outcome measures among occupational therapists.
School Participation of Pupils with Physical and Psychosocial Limitations: A Comparison
Authors: Egilson Snæfridur , Hemmingsson Helena 
Published: April 2015

Several features in the school environment affect pupils with disabilities, serving as either supports or barriers to their school participation. The purpose of this study was to investigate and look for differences in the pupil-environment fit of students with physical and psychosocial limitations, using the School Setting Interview (SSI). The SSI is a client-centred instrument, which focuses on school activities where adjustments need to be made to accommodate pupils with disabilities and to enable their participation. Descriptive statistics and Mann-Whitney U tests were employed to compare the fit of the two groups and their school environment. The results reveal that, in order to participate actively, both groups of pupils required adjustments to many school settings. Pupils with physical limitations frequently need adjustments, but their needs were met by the schools to a more satisfactory extent than were the needs of pupils with psychosocial limitations. The findings support the usability of the SSI for pupils with various types of limitations. They also stress the importance of eliciting the perspectives of the pupils themselves in order to facilitate the planning and implementation of client-centred occupational therapy interventions in school.
Major Overhaul of Whitley Council System
Authors: Nixon Christopher 
Published: April 2015

The long awaited McCarthy Report on the working of the Whitley Council machinery was published on December 2. It has 144 pages including appendices and is priced at £1.15, obtainable from the Department of Health & Social Services, Room 333, Friars House, 157–168 Blackfriars Road, London, S.E.1. Lord McCarthy was appointed by the Secretary of State for Social Services in April 1975 as a special adviser to the Department of Health and charged with the specific task of reviewing the workings of the N.H.S. Whitley Council machinery and reporting to the Secretary of State. Lord McCarthy is a Fellow of Nuffield College and Oxford Management Centre and is an acknowledged expert on industrial relations. His main findings and recommendations are summarised here. Whitley negotiations are carried out by a Whitley General Council and eight functional Councils which deal with various groupings of N.H.S. staff. Occupational therapists are represented on the Whitley P. T. ‘A’ functional Council. Approximately one million N.H.S. staff are represented on all Whitley Council.
Ready for Work?
Authors: Bailey Diana 
Published: April 2015

This report is the result of a special project undertaken in October 1979 during clinical placement at Chase Village Mental Handicap Unit. It is presented in two parts. The first part, in this issue, includes a survey of agencies concerned with preparation of mentally handicapped adults for work or with providing a work setting; and a discussion of effective pre-work training, employment placement and follow up service. Part two, in next month's journal, discusses assessment of work-related skills and offers ideas for an assessment procedure with a report form. Conclusions and suggestions are based on reading and visits. It is hoped that suggested methods will form the basis for practical development of work skill assessment and training programmes for mentally handicapped adults.
Ready for Work?
Authors: Bailey Diana 
Published: April 2015

This report is the result of a special project undertaken in October 1979 during clinical placement at Chase Village Mental Handicap Unit. It is presented in two parts. The first part, in last month's journal, included a survey of agencies concerned with preparation of mentally handicapped adults for work or with providing a work setting; and a discussion of effective pre-work training, employment placement and follow up service. Part two, in this issue, discusses assessment of work-related skills and offers ideas for an assessment procedure with a report form. Conclusions and suggestions are based on reading and visits. It is hoped that suggested methods will form the basis for practical development of work skill assessment and training programmes for mentally handicapped adults
Profiles of the Members of the College of Occupational Therapists'
Authors: Board Advisory 
Published: April 2015

The College of Occupational Therapists is fortunate in having a number of distinguished and knowledgeable people on its Advisory Board and short ‘profiles’ of them are to be published in this and subsequent issues. Any reader wishing to seek the advice of a member of the Advisory Board on clinical, educational or other matters must ADDRESS THE REQUEST (typed please) c/o 20 Rede Place and not directly to the individual concerned. This is to ensure that the duplication of similar requests does not occur; and that no single member of the Advisory Board is over-burdened with requests for advice. (Any query which can be answered without reference to an Adviser will be dealt with by H.Q. staff.) There exists a fund of experience and knowledge upon which to draw and the use of it should benefit the profession.
Service Provision to Black People: A Study of Occupational Therapy Staff in Physical Disability Teams within Social Services
Authors: David Paul A 
Published: April 2015

This research derived Its Impetus from the need to recognise that we live in a multiracial and multicultural society. Thus, the responses of caring agencies to individuals must be governed by the fact that there are varying needs depending on cultural and racial backgrounds, and the services that are provided need to be geared to all sectors of the community. The study focused on the occupational therapists and occupational therapy assistants In physical disability teams in a social services department and the service they provided to their black clients. The aim was to assess how effectively these professionals were meeting their obligations, as specified in the Race Relations Act 1976 and the city's equal opportunities policy. The article also looks at the features of policy and practice that inhibit occupational therapists and their assistants in responding to black people.
Expert Clinicians' and Students' Views on Clinical Reasoning in Occupational Therapy
Authors: Strong Jenny , Gilbert Jillian , Cassidy Susan , Bennett Sally 
Published: April 2015

In this study, an examination was made of the clinical reasoning processes used by expert occupational therapists and post-clinical fourth-year occupational therapy students. Using nominal group technique, the factors involved in clinical reasoning were derived and their relative importance determined. The most highly valued skill for the experts was good communication, while the most highly valued skill for the students was a knowledge of and understanding of disability. The experts considered a wider range of factors when making clinical decisions than did the students, and rated their level of clinical reasoning at a higher level than did the students. For the experts, the factors identified as important in clinical reasoning were concerned more with gaining an understanding of the patients both by using general principles of diagnosis and illness and by gaining an understanding of the illness as it affected the individual patient. Meanwhile, for the students, greater emphasis was placed upon the influence of pragmatic factors on treatment, such as resources, time constraints and other environmental factors.
Factitious Disorders in Occupational Therapy: Sad Cases or Incorrigible Rogues?
Authors: Barnitt Rosemary E 
Published: April 2015

Inventing Illness or disability for social, emotional or financial gain has been known to occupational therapists since the early days of professional practice. Despite this, there is little literature that is relevant to therapists' practice. In medicine, the condition has attracted a number of labels from ‘polysurgical’ to ‘conversion hysteria’. More recently, the subject has received renewed popular interest because of media coverage of dramatic and newsworthy cases of Munchausen's syndrome and Munchausen's syndrome by proxy. Within the medical literature, the 1994 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) now Includes a section titled ‘Factitious disorders’. The definition of these disorders is given as ‘physical or psychological symptoms which are intentionally produced or feigned in order to assume the sick role’. In occupational therapy, evidence from the letters page suggests that such clients are known and talked about, but that there are few procedures or guidelines for dealing with them. A tension is apparent between therapists who view these clients as wilfully behaving badly for gain (incorrigible rogues) and therapists who view these clients as having profound psychological problems (sad cases). The differing implications for service delivery, where one or other of these beliefs is strongly held, are divisive. In this article, the nature of factitious disorders in occupational therapy is explored, using examples from research into ethical dilemmas and information from respondents to the letters page of this journal. From these it appears that therapists are skilled at identifying such clients, but how and by whom the client should be confronted and treated remains unresolved In a number of workplaces.
Clinical Decision Making in Familiar Cases: A Model of the Process and Implications for Practice
Authors: Hagedorn Rosemary 
Published: April 2015

This qualitative study describes the clinical reasoning and decision-making processes used by experienced occupational therapists in physical practice when deciding on the first intervention in a familiar type of case. The main finding was that therapists use schematic processing to speed the identification of problems and to indicate potential solutions and actions. Such processing is rapid and automated. Theory appears to become embedded in practice to the point where the therapist is no longer conscious of using it. A model of the mental problem space generated by therapists during decision making is proposed and the implications for practice are discussed. This model may help to explain some of the differences observed in the reasoning of novice and experienced practitioners. The sample is too small to permit generalisation, but the findings are compatible with theories of cognition and problem solving and also with the results of studies into medical decision making.
Using the Occupational Performance History Interview (OPHI): Therapists' Reflections
Authors: Fossey Ellie 
Published: April 2015

Clinical interviews provide occupational therapists with sensitive and versatile sources of information; however, reliable means to collect and interpret this information are necessary for effective clinical decision making. The Occupational Performance History Interview (OPHI) is a semi-structured interview, designed to address the need for a reliable and clinically useful interview tool in occupational therapy. This article describes a qualitative research study, in which four experienced therapists reflected on their use of the OPHI to interview people referred to a psychiatric day hospital service. The therapists' reflections, based on listening to audiotapes of these interviews, focused on the interview procedure and on themselves as interviewers. They illustrate how the conduct and interpretation of interviews may be guided by interactive reasoning and professional values. The development of a conversational interviewing style, whilst using this semi-structured interview tool, is also described. To develop reliable interview tools that are also consistent with the particular values and perspective of occupational therapy, consideration might usefully be given to using evaluation criteria applied to qualitative research, as well as conventional scientific criteria of reliability and validity.
Some of the Implications of Caring for a Child or Adult with Cerebral Palsy
Authors: Pimm Paul L 
Published: April 2015

Many studies have suggested that the presence of a child or adult with a disability in a family can, and does, have a significant impact upon family members, in particular the primary caregiver. Research findings have indicated that there may be social isolation, lack of awareness of services, poor service delivery and psychiatric disorders among parents. However, there have been fewer psychosocial studies on specific conditions such as cerebral palsy and fewer still that consider objectively the impact of caring upon both mothers and fathers caring for their son or daughter throughout a life span. This article, part of a larger research undertaking, presents some key survey findings from a study of 235 mothers and fathers of children and adults with cerebral palsy. The parents evaluated the caring process and their satisfaction with the professionals involved in service delivery. The prevalence of psychiatric morbidity among the parents is also reported. The findings indicate that the mental well-being of many fathers and even more mothers was severely affected by the caring process. High levels of parental dissatisfaction with some professionals are reported.
Evaluating the Sensory Integrative Functions of Mainstream Schoolchildren with Specific Developmental Disorders
Authors: Chu Sidney 
Published: April 2015

Clinicians and educators are becoming increasingly aware of sensory integrative dysfunctions (SIDs) in mainstream schoolchildren with specific developmental disorders (SDDs). This study was designed (1) to determine whether or not SID occurred significantly in mainstream schoolchildren aged 5–8 years, referred to the Ealing Paediatric Occupational Therapy Service (EPOTS); (2) to explore the patterns and nature of SID found In such a group; and (3) to ascertain any relationships between certain types of SID and specific behavioural traits. The study adopted a differential research method. The subjects were two groups of children aged 5–8 years. The experimental group (EG) consisted of 25 children referred to EPOTS. The control group (CG) consisted of 18 mainstream schoolchildren with no known dysfunction. All subjects were administered the Sensory Integration and Praxis Tests (SIPT) and Clinical Observations of neurobehavioural and neuromuscular functions. The Conners' Parent Rating Scales – 93 (CPRS-93) was used to evaluate specific behavioural traits in the EG children. The results of statistical analysis supported that mainstream schoolchildren with SDD (EG, n=25) referred to EPOTS had significantly lower scores (p<.001) in the SIPT than a normal control group of children (CG, n=18) with matched demographic data. The EG children showed significant neurobehavioural and neuromuscular dysfunctions (p<.05) in comparison with the CG in the Clinical Observations. The percentage of EG children with scores similar to the six SIPT clusters was 44%, which is higher than the figure of 29.6% produced by the test publisher. There was no consistent correlation between the SIPT variables and the variables identified in the CPRS-93. Although the findings were not conclusive, some partial pattern could be identified.
Review of Wheelchair Services in England
Authors: Jelier Pamela , Turner-Smith Alan 
Published: April 2015

This article reviews the results of investigations into wheelchair service provision in the United Kingdom since its devolution to National Health Service trusts in 1991. The following key issues persist: – Funding: The existing dilemma is to find how far a comprehensive service can be provided in a climate with decreasing, real-term funding. – Staffing: The availability of specialist staff on a multidisciplinary team is variable across the country. Some people are not being used in a manner that is suitable to their education and training. – Education and training. Educational backgrounds are variable; however, guidelines for standards have been published for occupational therapists, physiotherapists and rehabilitation engineers. – Accessibility: Users are often not provided with enough information to feel that they have been able to contribute to the prescription of their wheelchairs. – Assessment and prescription: This procedure varies from being based on a referral form to individual meetings between the therapist and the user. – Audit. User satisfaction and the provision of data for purchasers are the advantages of doing regular audits. Where the standards of provision are decided at local level without national guidelines, it is important that information about successful outcomes on limited resources is shared among service managers, therapists and rehabilitation engineers.
Rationales for the Use of Occupation in 19th Century Asylums
Authors: Paterson Catherine F 
Published: April 2015

The use of occupation was a key aspect of moral treatment, the reformed management of the ‘mad’1 in the late 18th and 19th centuries. Physicians observed that the lack of occupation exacerbated symptoms, and held the philosophical and religious beliefs that occupation was intrinsically good and that patients should be encouraged to become useful members of society. They propounded that occupation could divert or provide respite from the patients' delusional or painful thoughts; could counteract symptoms by stimulating the withdrawn, calming the excited and channelling the activity of the obsessive; could be used to strengthen underdeveloped mental faculties or improve existing ones; and, finally, could provide bodily exercise which induced tranquil and refreshing sleep. Some American authors have already explored the links between moral treatment and occupational therapy. This article attempts to identify the rationales for occupation in a British context.
Managing Health and Safety: A Role for Occupational Therapists
Authors: Cullum Frederick W H 
Published: April 2015

The management of health and safety requires employers to undertake risk assessments, identifying hazards in the workplace and the associated risks. They are then required to eliminate or reduce the level of risk to employees through the introduction of adequate control measures. Some health and safety legislation develops this aspect of assessment further, such as the Manual Handling Operations Regulations 1992 and the Health and Safety (Display Screen Equipment) Regulations 1992. The Disability Discrimination Act 1995 also places a number of duties on employers, some of which have an impact on health and safety. The Management of Health and Safety at Work Regulations 1992 requires employers to have access to competent advice to assist them to comply with the legislation. There are many people who can provide such advice: safety practitioners, occupational health nurses and physicians, occupational hygienists, physiotherapists and occupational therapists. The role of each practitioner needs to be appreciated by the employer and there should be systems in place that will allow referral within a reasonable timescale and contact between practitioners to work as a team. The benefits from having access to an occupational therapist can be demonstrated through the use of examples that highlight reduced costs to the employer from both reactive and proactive involvement. There are also a number of benefits to be gained by the employee.