Showing papers in "American Journal of Occupational Therapy in 1990"
343 citations
TL;DR: The procedures are presented and the argument made that goal attainment scaling is a viable method by which one can document therapeutic change and demonstrate clinical accountability.
Abstract: The demand for clinical accountability and the documentation of therapeutic effectiveness continues to increase in health-related settings. Therapists are attempting to address this increasing demand by adapting methods based on traditional experimental models of research to evaluate their clinical practice. Experimental and quasi-experimental designs, however, are often limited usefulness in clinical environments for a variety of practical and ethical reasons. This paper presents a method of evaluating the effectiveness of a therapeutic intervention called goal attainment scaling, which involves goal setting procedures and assessment techniques that are practice-based and practitioner-oriented. The procedures are presented and the argument made that goal attainment scaling is a viable method by which one can document therapeutic change and demonstrate clinical accountability.
193 citations
159 citations
TL;DR: In this paper, the authors investigated the developmental progression in pencil and crayon grip using 320 non-functional children aged 3.0 to 6.11 years, with 20 boys and 20 girls at each 6-month age interval.
Abstract: This study was designed to investigate the developmental progression in pencil and crayon grip. The subjects were 320 nondysfunctional children aged 3.0 to 6.11 years, with 20 boys and 20 girls at each 6-month age interval. On the basis of a review of the literature, developmental pencil and crayon grips were defined for the study, and the type of grips each child used to perform a drawing task and a coloring task were recorded. Many children at each age level used mature pencil grips. A developmental progression, however, was shown by the percentage change of children at each age level who used mature grips. Forty-eight percent of the youngest group used mature grips, compared with 90% of the oldest children. Two pencil grips-dynamic and lateral tripod-appear to be common in older children. Differences in the developmental progression of pencil grip were noted between boys and girls and between a drawing task and a coloring task.
133 citations
132 citations
TL;DR: 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.
Abstract: 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.
105 citations
TL;DR: The patient-therapist relationship as envisioned by therapists and patients is examined to help occupational therapists recommit to the patient as a vital partner in a collaborative relationship.
Abstract: The patient-therapist relationship in occupational therapy has been a blend of competence and caring with the emphasis fluctuating over the years between these two features. When patients tell stories about their experiences, they reveal widely differing views of occupational therapists, partly because of the different ways therapists manifest competence and caring during patient-therapist interactions. Images from stories suggest that some therapists unwittingly disappoint their patients. This paper examines the patient-therapist relationship as envisioned by therapists and patients to help occupational therapists recommit to the patient as a vital partner in a collaborative relationship.
97 citations
TL;DR: Medical factors associated with the length of transition to complete oral feeding were identified through correlational and multiple regression analyses and 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.
Abstract: 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.
95 citations
TL;DR: The results suggest that the subjects' classifications of occupations and interpretations of their meanings are important sources of information for both the science of occupation and occupational therapy practice.
Abstract: The self-perceived quality of time use of 15 community-based adults with spinal cord injuries was compared with that of 12 age- and sex-matched nondisabled adults through the use of the Activity Configuration Log (modified from an unpublished clinical assessment developed by Claudia Allen). Differences in how subjects classified their daily occupations were found between and within groups, especially for the categories of Work, Self-Maintenance, and Other. The results suggest that the subjects' classifications of occupations and interpretations of their meanings are important sources of information for both the science of occupation and occupational therapy practice. The subjects with spinal cord injuries had a high rate of unemployment (67%) and much more daily free time than did their nondisabled counterparts. The affective quality of particular occupations was found to be related to the affective quality of the entire day. Occupational therapists agreed more with each other than with the subjects with disabilities when classifying occupations. Implications for practice and research are provided.
94 citations
94 citations
TL;DR: A writing readiness program used with three groups of children aged 5 to 7 years showed a 17-month growth in readiness skills within 1 year and a significant sex effect: the boys showed more gains than the girls.
Abstract: 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 (greater than 15 points) showed a 17-month growth in readiness skills within 1 year. The group of children with mental retardation (IQ less than 80) showed a significant sex effect: The boys showed more gains than the girls. Implications of these findings are discussed.
TL;DR: 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.
Abstract: 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 offroad, 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 3-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. Language: en
TL;DR: Although the measurements used in this study were reliable, they did not support the association of shoulder subluxation with shoulder pain in stroke patients, and Clinicians wishing to reduce shoulder pain with stroke patients should direct their treatment accordingly.
Abstract: Twenty-four patients with stroke were studied (a) to determine the interrater reliability of a clinical measurement of shoulder subluxation, (b) to confirm the interrater reliability of the Ritchie Articular Index (Bohannon & LeFort, 1986) for measuring shoulder pain, (c) to establish the relationship between the Ritchie index scores and shoulder lateral rotation range of motion measured at the point of pain (SROMP), and (d) to determine the relationship between shoulder subluxation and shoulder pain. The agreement between the two examiners' (the authors) measurements of subluxation was "almost perfect" (Landis & Koch, 1977, p. 165). The agreement between the two examiners' Ritchie index measurements was "substantial" (Landis & Koch, 1977, p. 165). The Ritchie index and SROMP measurements correlated significantly. Neither the Ritchie index nor the SROMP measurements correlated significantly with subluxation. Although the measurements used in this study were reliable, they did not support the association of shoulder subluxation with shoulder pain in stroke patients. Clinicians wishing to reduce shoulder pain in stroke patients should direct their treatment accordingly.
TL;DR: Most therapists who left the profession did not return to practice because they felt professionally out of date and unable to compete with younger therapists.
Abstract: This study examined the reasons why occupational therapists have left the field of occupational therapy. The purpose of the study was to find ways to prevent attrition and to bring back those who have left the field as a means to address the profession's personnel shortage. Questionnaires from 696 therapists who have left the profession were analyzed. The therapists' most common reasons for leaving were (a) childbearing and child rearing; (b) geographic relocation and subsequent inability to find a job; (c) excessive paperwork; (d) desire for increased salary and promotional opportunities; (e) high caseloads, stress, and burnout; (f) the actual practice of occupational therapy not being what was expected; (g) dissatisfaction with bureaucracy; (h) the chronicity and severity of the clients' illnesses; and (i) an inability to find part-time work. Most therapists who left the profession did not return to practice because they felt professionally out of date and unable to compete with younger therapists.
TL;DR: The results of analyses performed on a subgroup of 11 subjects with hemiplegia were similar, suggesting that CPM with limb elevation may be an effective method by which to reduce hand edema for this patient population.
Abstract: The purpose of this study was to evaluate the efficacy of the use of continuous passive motion (CPM) of the digits in combination with limb elevation to reduce hand edema. The effects of 30 min of CPM of the digits with the limb elevated were compared with the effects of 30 min of limb elevation alone. Each of 16 subjects with hand edema of varied etiology received both treatments, one on each of 2 consecutive days. Measures of hand volume, finger circumference, and finger stiffness were taken before and after each treatment. Analyses comparing mean percentage change scores for both treatments showed large and significant treatment effects for all three dependent measures. The findings indicate that, for this sample, CPM with limb elevation was a more effective treatment for the reduction of hand edema than limb elevation alone. The results of analyses performed on a subgroup of 11 subjects with hemiplegia were similar, thus suggesting that CPM with limb elevation may be an effective method by which to reduce hand edema for this patient population.
TL;DR: 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.
Abstract: 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.
TL;DR: 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.
Abstract: 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.
TL;DR: A 26-item screening scale, the Touch Inventory for Elementary-School-Aged Children (TIE), as well as its psychometric characteristics are presented.
Abstract: The syndrome of tactile defensiveness, first described by Ayres in 1964, has undergone continued study as well as related theory development. No standardized assessment for tactile defensiveness, however, currently exists. This paper presents a 26-item screening scale, the Touch Inventory for Elementary-School-Aged Children (TIE), as well as its psychometric characteristics. Normative data and precautions for proper use of the TIE are also given.
TL;DR: The use of an uncued test followed by a cued test may be an effective method for the identification of those children who are most likely to show improvement in in-hand manipulation skills with intervention.
Abstract: The purpose of this study was to assess the influence of verbal and visual cues on 28 nondysfunctional 3- and 4-year-old children's performance of in-hand manipulation skills. During the uncued version of the test (pretest), the children were presented with play activities known to elicit in-hand manipulation skills in young children but were given no cues for specific manipulative skill use. Within 1 week of the pretest, after the children were randomly assigned to groups, a posttest was given in which the children were provided with verbal or visual cues. The results indicate that both visual and verbal cues were effective in increasing the groups' test scores, but no significant differences were found based on the type of cue provided. Approximately 30% of the children in the study showed marked improvement on the posttest scores, whereas the others showed little change. The children who had lower pretest scores showed greater score increases on the posttest than did the children who scored somewhat higher initially. The use of an uncued test followed by a cued test may be an effective method for the identification of those children who are most likely to show improvement in these manipulation skills with intervention. This study's findings lend tentative support to Vygotsky's (1978) zone of proximal development theory and extends the application of his work into the domain of fine motor skills.
TL;DR: The occupational therapist's role in providing job-specific body mechanics instruction in the work environment as a primary method of preventing low back pain is discussed.
Abstract: Thirty young workers (aged 14 to 19 years) em ployed as groundskeepers and custodians were ran domly assigned to two groups; one group received body mechanics instruction and the other did not. The instruction focused on proper spinal alignment in the work environment. Instruction on low back pain began with one classroom session before the subjects'first day of work and continued during employment with two on-site sessions. The effect of instruction was evaluated through the observation ofbody mechanics during actual work perfor mance. The results ofthe study indicate that the group that received instruction performed signifi cantly better than the control group. This paper also discusses the occupational therapist's role in provid ing job-specific body mechanics instruction in the work environment as a primary method ofprevent ing low back pain.
TL;DR: In this article, the assumptions underlying occupational therapy interventions for adult perceptual deficits are delineated and some research questions and strategies with which to test them are suggested, as well as strategies to test these assumptions.
Abstract: Research about occupational therapy interventions for adult perceptual deficits is needed to examine the relative efficacy of different treatments and to scrutinize the theoretical assumptions underlying those treatments. The former purpose relates to providing optimal services to consumers; the latter, to advancing the knowledge base of the profession. Both of these purposes can be achieved if research questions are derived from the assumptions underlying treatments. This paper delineates those assumptions and suggests some research questions and strategies with which to test them.
TL;DR: The present paper describes the evaluation process before casting, the goals of each phase of the casting program, and the follow-up.
Abstract: 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.
TL;DR: The results of this study show that education can affect hand-use patterns, and a similar study on a larger sample of industrial workers at risk for developing cumulative trauma disorder is recommended.
Abstract: 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.
TL;DR: Clinicians are urged to explore the advantages and disadvantages of imagery-based occupations in treatment as well as other recent research investigating ways to add purpose to therapeutic exercise through occupation.
Abstract: 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.
TL;DR: 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.
Abstract: 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.
TL;DR: The issues addressed include child rearing; geographic location; feeling professionally out of date; excessive paperwork; lack of pay and promotional opportunities; returning to school; stress; disillusionment; type of caseloads; illness; desire for more status, autonomy, and challenge; and lack of in-service training and continuing education.
Abstract: The previous paper (Bailey, 1990) reported on the reasons for leaving occupational therapy in a sample of 696 therapists. This follow-up paper discusses the reasons given and suggests ways to retain or reactivate therapists. The issues addressed include child rearing; geographic location; feeling professionally out of date; excessive paperwork; lack of pay and promotional opportunities; returning to school; stress; disillusionment; type of caseloads; illness; desire for more status, autonomy, and challenge; and lack of in-service training and continuing education.