Showing papers in "American Journal of Occupational Therapy in 1991"
TL;DR: This article presents one model that can be used for the assessment of trustworthiness or merit of qualitative inquiry and several strategies for the achievement of rigor in qualitative research useful for both researchers and consumers of research are described.
Abstract: Despite a growing interest in qualitative research in occupational therapy, little attention has been placed on establishing its rigor. This article presents one model that can be used for the assessment of trustworthiness or merit of qualitative inquiry. Guba's (1981) model describes four general criteria for evaluation of research and then defines each from both a quantitative and a qualitative perspective. Several strategies for the achievement of rigor in qualitative research useful for both researchers and consumers of research are described.
4,430 citations
TL;DR: In this paper, occupational science is described, defined, and distinguished from other social sciences and a general systems model is presented as a heuristic to explain occupation and organize knowledge in occupational science.
Abstract: Occupational science is a new scientific discipline that is defined as the systematic study of the human as an occupational being. A doctoral program in occupational science has been established at the University of Southern California, Los Angeles. With its emphasis on the provision of a multidimensional description of the substrates, form, function, meaning, and sociocultural and historical contexts of occupation, occupational science emphasizes the ability of humans throughout the life span to actively pursue and orchestrate occupations. In this paper, occupational science is described, defined, and distinguished from other social sciences. A general systems model is presented as a heuristic to explain occupation and organize knowledge in occupational science. The development of occupational science offers several key benefits to the profession of occupational therapy, including (a) fulfillment of the demand for doctoral-level faculty members in colleges and universities; (b) the generation of needed basic science research; and (c) the justification for and potential enhancement of practice.
390 citations
TL;DR: This paper examines the use of narrative as a mode of speech that can be contrasted with biomedical discourse, in which disability is framed as physical pathology.
Abstract: Narrative reasoning is a central mode of clinical reasoning in occupational therapy. Therapists reason narratively when they are concerned with disability as an illness experience, that is, with how a physiological condition is affecting a person's life. In this paper, narrative reasoning is contrasted with propositional reasoning, and two kinds of narrative thinking are examined. The first is the use of narrative as a mode of speech that can be contrasted with biomedical discourse, in which disability is framed as physical pathology. The second involves the creation rather than the telling of stories. Therapists try to "emplot" therapeutic encounters with patients, that is, to help create a therapeutic story that becomes a meaningful short story in the larger life story of the patient.
329 citations
TL;DR: It is argued that clinical reasoning involves more than the ability to offer explicit reasons that justify clinical decisions because it is also based on tacit understanding and habitual knowledge gained through experience.
Abstract: This paper offers a concept of clinical reasoning that differs from many of the traditional definitions of clinical reasoning in occupational therapy and the health professions in general. Here, clinical reasoning in occupational therapy is described as a largely tacit, highly imagistic, and deeply phenomenological mode of thinking. It is argued that clinical reasoning involves more than the ability to offer explicit reasons that justify clinical decisions because it is also based on tacit understanding and habitual knowledge gained through experience. Clinical reasoning also involves more than a simple application of theory, particularly theory as understood in the natural sciences, because complex clinical tasks often require that the therapist improvise a treatment approach that addresses the unique meaning of disability as it relates to a particular patient.
282 citations
TL;DR: Experienced occupational therapists seem to shift smoothly from one mode of thinking to another in order to analyze, interpret, and resolve various types of clinical problems.
Abstract: This article reports some of the results of the American Occupational Therapy Association/American Occupational Therapy Foundation Clinical Reasoning Study. Therapists are thought to use three different types of reasoning when solving problems in day-to-day practice. Procedural reasoning guides the therapist in thinking about the patient's physical performance problems. Interactive reasoning is used when the therapist wants to understand the patient as a person. Conditional reasoning is used to integrate the other two types of reasoning as well as to project an imagined future condition or situation for the person. Experienced occupational therapists seem to shift smoothly from one mode of thinking to another in order to analyze, interpret, and resolve various types of clinical problems.
237 citations
TL;DR: The results of the study show that falls are frequent and fear of falling prevalent among the community-based elderly and a comprehensive program designed to reduce the risk of falls is presented.
Abstract: Each year, about one third of the population over 65 years of age experiences at least one fall (Perry, 1982). Assessment of the incidence of falls and the prevalence, intensity, and covariates of fear of falling among community-based elderly persons was conducted through interviews of 115 residents in a housing development (mean age = 78 years). Fifty-three percent reported having fallen in recent years, 32% in the last year. Fear of falling ranked first when compared with other common fears. In a logistic regression model predicting limitation of activity independent of risk factors for falling, fear of falling was marginally significant (p = .06). The results of the study show that falls are frequent and fear of falling prevalent among the community-based elderly. A comprehensive program designed to reduce the risk of falls is presented.
223 citations
209 citations
164 citations
TL;DR: In this paper, children with physical disabilities who are deprived of normal play opportunities are viewed as having a second disability that hinders their potential for independent behavior and performance.
Abstract: Self-initiated free play experiences are vital for the normal growth and development of all children. In this paper, children with physical disabilities who are deprived of normal play opportunities are viewed as having a second disability that hinders their potential for independent behavior and performance. Physical, social, personal, and environmental barriers that may limit the play experiences of children with physical disabilities are delineated. Studies of the interactions of these children during play are discussed, and a case is made for the promotion of active, free play in the home, the school, and the community. As facilitators of this process, occupational therapists must consider a variety of factors, including the unique capabilities of the child, the influence of parent-child and peer relationships, the role of other caregiving adults, the adaptation of toys and materials, and the impact of the environment and setting.
162 citations
154 citations
TL;DR: The content of the act is described and ways in which occupational therapists can work to promote its effectiveness are discussed, which will benefit people with disabilities.
Abstract: O n.JulY 26,1990, Congress passed the Americans With Disabilities Act of 1990 (Public Law 101-336), which prohibits discrimination against people with disabilities. This legislation represenrs progress in providing people with clisabilities greater access to employment, public transportation, telecommunications, restaurants, museums, and other facilities and services that the general public uses daily. However, the extent to which this legislation will benefit people with disabilities depends on how it is implemented. This article will sum· marize the content of the act and discuss ways in wh ich occupational therapists can work to promote its effectiveness. The Americans With Disabilities Act begins with a description of the policy issue. It notes that 43,000,000 Americans have one or more physical or mental disabilities, including speech and hearing disabilities, and that these people have been subject to discrimination in major areas of I ife Following the statemem of the policy issue, the legislation's purpose is explained:
TL;DR: A multicontext treatment approach that uses five components identified in the cognitive psychology literature as being critical to the process of generalization, including use of multiple environments, identification of criteria for transfer, metacognitive training, and emphasis on processing strategies are proposed.
Abstract: Cognitive perceptual remedial approaches used by occupational therapists in the treatment of adults with brain injury have been criticized because of claims that the effects are not generalizable. Little information is available, however, that can guide the therapist in directly addressing the generalization process. This paper proposes a multicontext treatment approach that uses five components identified in the cognitive psychology literature as being critical to the process of generalization: (a) use of multiple environments, (b) identification of criteria for transfer, (c) metacognitive training, (d) emphasis on processing strategies, and (e) use of meaningful activities. A case report is used to illustrate this treatment approach.
TL;DR: The time-space rhythms of taken-for-granted behavior, the significance of the surveillance zone, and the way in which the environment may come to be a component of the self are identified as themes within being in place that have significant implications for enhancing occupational therapy practice.
Abstract: Emphasis on knowing and doing as focal concerns of occupational therapy has tended to overshadow being as an essential ingredient of human experience. This article advocates greater concern with understanding our clients' being in place--that is, their immersion within a lifeworld that provides the culturally defined spatiotemporal setting or horizon of their everyday lives. It is suggested that naturalistic and qualitative research strategies are appropriate for the exploration of this realm of experience. Illustration is provided from an ethnographic study of aging in a rural Appalachian community. The time-space rhythms of taken-for-granted behavior, the significance of the surveillance zone (space within the visual field of the dwelling), and the way in which the environment may come to be a component of the self, are identified as themes within being in place that have significant implications for enhancing occupational therapy practice.
TL;DR: The authors work in a world of traumas and triumphs; most of the persons they serve come to us out of necessity, struggling with the sequelae of disease and illness or the aftermath of natural or manmade disasters.
Abstract: We work in a world of traumas and triumphs. Most of the persons we serve come to us out of necessity, struggling with the sequelae of disease and illness or the aftermath of natural or manmade disasters. We bring our expertise and compassion; they bring their bodies, minds, and compromised lives. Our worlds converge around a shared task; identifying and enhancing their capacities for daily living. We pursue problems of movement, perception, cognition, affect, and social capacity within the context of their roles and aspirations. Our contacts may be extensive, but often they are brief and only partially fulfilled. Our patients move on with varying degrees of functional ability--some with determination and buoyancy, others with little confidence that life is actually worth living. We remain, frequently knowing little about the factors that have influenced the outcome of our efforts. In spite of their compelling importance to our patients, our professional viability, and the health care system.
TL;DR: Occupational therapy should include the assessment of spatial orientation skills in persons who are in the early stages of dementia, because spatial disorientation poses a danger and limits a person's ability to independently perform daily activities that require navigation outside of the home.
Abstract: Although spatial disorientation is frequently observed in persons with Alzheimer disease, it is not well understood. A descriptive study was conducted to examine spatial skills associated with spatial orientation. Spatial tasks were selected and grouped into three types of spatial skills: perceptual, cognitive, and functional. These spatial tasks were administered to a group of 15 persons with senile dementia of the Alzheimer type (SDAT) (early Alzheimer disease) and a group of 15 control subjects. The results indicated that the subjects with SDAT were impaired on half of the perceptual spatial tasks and all of the cognitive spatial tasks. On the functional spatial tasks, however, the subjects with SDAT showed impaired skills in the new environment but intact skills in familiar environments. Spatial disorientation poses a danger and limits a person's ability to independently perform daily activities that require navigation outside of the home. Occupational therapy should therefore include the assessment of spatial orientation skills in persons who are in the early stages of dementia.
TL;DR: The occupational therapy process involves the assessment and treatment of problems in occupational status and involves the creation of a clinical image of the patient through cue acquisition, hypothesis generation, cue interpretation, and hypothesis evaluation.
Abstract: The occupational therapy process involves the assessment and treatment of problems in occupational status. Assessment entails the sensing and defining of patients' problems and is accomplished through diagnosis. As a process, diagnosis involves the creation of a clinical image of the patient through cue acquisition, hypothesis generation, cue interpretation, and hypothesis evaluation. This sequence of cognitive activities is called diagnostic reasoning. As a product, diagnosis summarizes a patient's occupational deficits in terms of occupational role performance, occupational performance, and the components of occupational performance. To serve adequately as a basis for planning intervention, the occupational therapy diagnosis describes the problem, explains the potential cause of the problem, gives the cues whereby the problem is recognized, and names the pathologic agent. Occupational therapy assessment is broader than diagnosis and includes a delineation of the patient's assets as well as deficits. In the resolution of problems in occupational status, assets may be used to offset deficits. The clinical image represents a balanced view of occupational status by reflecting assets and deficits.
TL;DR: In this paper, a review of commonly accepted principles of motor learning and application of these principles to occupational therapy treatment is presented, focusing on the stage of the learner, type of task, feedback, practice, and facilitation of skill acquisition.
Abstract: The processes underlying skill acquisition depend on the nature of the task and the stage of the learner. In addition, feedback and practice are two potent learning variables when used appropriately in the instruction of motor tasks. Occupational therapists involved in the training and retraining of motor skills can benefit from knowledge of instructional methods used by coaches and physical educators. This paper reviews commonly accepted principles of motor learning and applies these principles to occupational therapy treatment. The stage of the learner, type of task, feedback, practice, and facilitation of skill acquisition are emphasized. Specific examples of how occupational therapists can use motor learning principles in treatment are given.
TL;DR: It is proposed that similarities in the reasoning strategies of the members of the two professions are a result of use of the scientific model that calls for hypothetical reasoning, and differences are accounted for by the difference in the particular focus, goals, and tasks of theTwo professions and the nature of the practice in those arenas.
Abstract: This article highlights some observations made in the American Occupational Therapy Association/American Occupational Therapy Foundation Clinical Reasoning Study, an ethnographic study of 14 occupational therapists working in a large teaching hospital. Concepts and premises that frequently appear in the clinical reasoning in medicine literature are discussed and compared and contrasted to observations and interpretations made of the practice and reasoning strategies of the occupational therapists who were participants in the Clinical Reasoning Study. It is postulated that similarities in the reasoning strategies of the members of the two professions are a result of use of the scientific model that calls for hypothetical reasoning. Differences, it is proposed, are accounted for by the difference in the particular focus, goals, and tasks of the two professions and the nature of the practice in those arenas. Five hypotheses are proposed as questions for further research in clinical reasoning in occupational therapy.
TL;DR: The results suggest that children with handwriting difficulties may demonstrate a lower grip score than children without handwriting problems and that among children with poor handwriting, those with decreased proprioceptive-kinesthetic finger awareness may demonstrateA lower grip scores than those with good proprioception-kinesthesia awareness.
Abstract: The purpose of this study was to compare nondysfunctional children with and without handwriting difficulties for an examination of grip and hand preference. Additionally, in the group of children with handwriting difficulties, the children with decreased proprioceptive-kinesthetic finger awareness were compared with the children without such a decrease. The results suggest that children with handwriting difficulties may demonstrate a lower grip score than children without handwriting problems. In addition, among children with poor handwriting, those with decreased proprioceptive-kinesthetic finger awareness may demonstrate a lower grip score than those with good proprioceptive-kinesthetic awareness. Children with poor hand-writing also show less hand preference than those with good handwriting.
TL;DR: Mothers of preschool children with cerebral palsy selected activities that were doable and that they could integrate into their daily routines and interactions that were enjoyable for the child and not stressful for the mother, the family.
Abstract: Data from 8 mothers of preschool children with cerebral palsy were collected through intensive interviews concerning their experience with home programs. The data were analyzed with qualitative techniques. Each mother had previously participated in or attempted to use a home treatment program with her child, but none was currently doing so. The mothers' descriptions suggest that they selected activities that were doable and that they could integrate into their daily routines and interactions. Some important characteristics of these activities were that they were enjoyable for the child and not stressful for the child, the mother, or the family.
TL;DR: The process of achieving a balance between professional power and an understanding of the patient's experience may be fostered in education and in clinical supervision through increased emphasis on the importance of understanding the values and beliefs of patients and on the development and refinement of interactive skills.
Abstract: Occupational therapists, like other health care professionals, must balance their application of treatment techniques with an understanding of their patients' life experiences This paper reviews the literature from interpretive and medical sociology regarding the interplay between professional power and the achievement of an understanding of another person It analyzes how an occupational therapist, during a single treatment session, enters into her patient's life-world and simultaneously controls and manages the treatment process The concepts of knowledge schemata (the expectations and beliefs people bring to a situation) and footings (the shifts in alignment, or focus, that occur during interaction) are central to this analysis The process of achieving a balance between professional power and an understanding of the patient's experience may be fostered in education and in clinical supervision through increased emphasis on the importance of understanding the values and beliefs of patients and on the development and refinement of interactive skills
TL;DR: This article found that those students who had had contact with persons with disabilities beyond the context of a caregiver-care receiver relationship had significantly more positive attitudes than did those students without such contact.
Abstract: Persons with disabilities are devalued by society. Occupational therapists may be contributing to this devaluation through their attitudes. This study focused on the attitudes of undergraduate students. From a sample of 223 occupational therapy students and 326 business students at an Australian university, it was found, with the use of the Attitudes Toward Disabled Persons Scale-Form A (Yuker, Block, & Young, 1966), that the attitudes of freshman occupational therapy students did not differ significantly from those of their business-major peers. Furthermore, the occupational therapy students' attitudes did not vary with the years of undergraduate education completed. However, those students who had had contact with persons with disabilities beyond the context of a caregiver-care receiver relationship (i.e., those students who had assumed roles that emphasized valued attributes of the person with a disability) had significantly more positive attitudes than did those students without such contact. Educational curricula must address the issue of students' attitudes and, in particular, the facilitation of valued social role contact with persons with disabilities.
TL;DR: The high correlation between the scores on the Fugl-Meyer Test and the Functional Test for the Hemiplegic/Paretic Upper Extremity indicates that either test may be used for the assessment of upper extremity motor function.
Abstract: The relationship between upper extremity motor function and independence in basic activities of daily living in subjects with hemiplegia was explored. The Barthel Index (Mahoney & Barthel, 1965) and the Fugl-Meyer Test (Fugl-Meyer, Jaasko, Leyman, Olsson, & Steglind, 1975) were selected as the standard instruments for the evaluation of activities of daily living and upper extremity motor function, respectively, because their validity and reliability have been demonstrated many times. The Functional Test for the Hemiplegic/Paretic Upper Extremity (Wilson, Baker, & Craddock, 1984a, 1984b) was also used for the evaluation of upper extremity motor function. The results obtained in 18 subjects with hemiplegia indicate that the scores on the Barthel Index are poorly correlated with both the Fugl-Meyer Test and the Functional Test for the Hemiplegic/Paretic Upper Extremity scores. It is suggested that variables other than motor function, such as the learning of compensatory techniques and perceptual-cognitive status, are responsible for this discrepancy because they can influence activities of daily living performance in persons with hemiplegia. The high correlation between the scores on the Fugl-Meyer Test and the Functional Test for the Hemiplegic/Paretic Upper Extremity indicates that either test may be used for the assessment of upper extremity motor function.
TL;DR: It is recommended, therefore, that information about assistive technology be disseminated to personnel at all levels of community-based care, and the importance of technical aids in home care is illustrated.
Abstract: The growing elderly population will increase the need for assistive technology in the form of technical aids and housing adaptations to facilitate independence in activities of daily living. In this study, which was undertaken to facilitate a better understanding of the life-styles of the disabled elderly and the role of technical aids, 57 disabled persons over 74 years of age were studied. All of the subjects were residents of a rural Swedish community. The subjects had a total of 422 aids, an average of 7.4 per person. Seventy-five percent of the aids were being used, and 42 persons had at least one aid that granted autonomy. This finding illustrates the importance of technical aids in home care. It is recommended, therefore, that information about assistive technology be disseminated to personnel at all levels of community-based care.
TL;DR: The results indicated that stroke patients showed significant deficits in perceptual performance, some of which correlated with activities of daily living performance.
Abstract: Twenty-five male stroke patients were assessed with the use of a battery of perceptual tests (Gross Visual Skills [Baum, 1981]. Adult Visual-Perceptual Assessment [Baylor University Medical Center, Occupational Therapy Department, 1980], Manikin and Feature Profile subtests of the Arthur Point Scale of Performance Tests [Arthur, 1943; Buros, 1974, 1978], Judgment of Line Orientation [Benton, Varney, & DeS. Hamsber, 1978], Bender Visual Motor Gestalt Test [Bender, 1946], Haptic Visual Discrimination Test [McCarron & Dial, 1976, 1979a, 1979b], Block Design and Object Assembly subtests of the Wechsler Adult Intelligence Scale-Revised [Wechsler, 1981], and Test of Three-Dimensional Constructional Praxis [Benton, 1973a; Benton & Fogel, 1962]). Also administered was the Klein-Bell ADL Scale (Klein & Bell, 1982) to measure performance of activities of daily living. The research questions were as follows: (a) To what extent did this sample of stroke patients differ from the nomative samples on perceptual performance? (b) To what extent did any tests of perceptual performance correlate with performance of activities of daily living? and (c) What, if any, instruments were more useful in discriminating the perceptual performance of stroke patients from that of normative samples? The results indicated that stroke patients showed significant deficits in perceptual performance, some of which correlated with activities of daily living performance. Patients with right hemispheric lesions performed similarly to those with left hemispheric lesions except on the Haptic Visual Discrimination Test.
TL;DR: The results showed no statistically significant differences between the experimental and control groups in activity involvement or satisfaction with that involvement, suggesting that many environmental factors strongly influence activity participation and satisfaction.
Abstract: The purpose of this study was to determine the efficacy of occupational therapy intervention related to the leisure activities of stroke survivors. Forty discharged stroke patients were randomly assigned to an experimental group, which received occupational therapy intervention related to leisure activities, or to a control group. An independent evaluator assessed the patients' involvement in activities and satisfaction with that involvement on three separate occasions. The results showed no statistically significant differences between the experimental and control groups in activity involvement or satisfaction with that involvement. There are likely two reasons for these findings. First, the intervention was limited in scope (i.e., only five therapist visits), and second, many environmental factors strongly influence activity participation and satisfaction.
TL;DR: The criteria of genuineness and trustworthiness are proposed as crucial for the evaluation of the soundness of available research methodologies for the extension of occupational science and the role that nonscientific ways of knowing may play in the understanding of human occupation.
Abstract: Debate currently exists on the soundness of various research methodologies in the social sciences. In the present paper, this question is addressed in relation to the emerging discipline of occupational science. First, the discipline of occupational science is defined. Next, two competing methodologies--Paradigm 1, Positivistic, and Paradigm 2, Naturalistic--are contrasted. The criteria of genuineness and trustworthiness are proposed as crucial for the evaluation of the soundness of available research methodologies for the extension of occupational science. Next, exemplars of research methodologies that meet these criteria are described. In the conclusion, the role that nonscientific ways of knowing, such as art and literature, may play in the understanding of human occupation is discussed.