Showing papers in "American Journal of Occupational Therapy in 1997"

A Comparison of the Performance of Children With and Without Autism on the Sensory Profile

Abstract: Objective The purpose of this study was to determine whether the Sensory Profile discriminates between children with and without autism and which items on the profile best discriminate between these groups. Method Parents of 32 children with autism aged 3 to 13 years and of 64 children without autism aged 3 to 10 years completed the Sensory Profile. A descriptive analysis of the data set of children with autism identified the distribution of responses on each item. A multivariate analysis of covariance (MANCOVA) of each category of the Sensory Profile identified possible differences among subjects without autism, with mild or moderate autism, and with severe autism. Follow-up univariate analyses were conducted for any category that yielded a significant result on the MANCOVA: Results Eight-four of 99 items (85%) on the Sensory Profile differentiated the sensory processing skills of subjects with autism from those without autism. There were no group differences between subjects with mild or moderate autism and subjects with severe autism. Conclusion The Sensory Profile can provide information about the sensory processing skills of children with autism to assist occupational therapists in assessing and planning intervention for these children.

Tactile defensiveness and stereotyped behaviors.

Abstract: Objectives This study explores the constructs of stereotyped behaviors (e.g., repetitive motor patterns, object manipulations, behavioral rigidities) and tactile defensiveness as relevant to occupational therapy theory and practice and attempts to test their purported relationships in children with developmental disabilities. Method Twenty-eight children with developmental disabilities and autism were assessed on eight factors of stereotyped behavior via a questionnaire and by four measures of tactile defensiveness. The subjects' scores from the questionnaire were correlated with their scores on the tactile defensiveness measures to see what, if any, relationship among these behaviors exists. Results Significant relationships emerged from the data, indicating that subjects with higher levels of tactile defensiveness were also more likely to evidence rigid or inflexible behaviors, repetitive verbalizations, visual stereotypes, and abnormal focused affections that are often associated with autism. No significant association was found between motor and object stereotypes and tactile defensiveness. These relationships could not be explained solely by maturational factors. Conclusion The results suggest that clinicians should include observations of stereotyped behaviors, particularly behavioral rigidities, in conjunction with assessments of sensory defensiveness because these are related phenomena that may pose unique challenges for children with developmental disabilities and autism. Further study is needed to determine the causal mechanisms responsible for these relationships.

The Sensory Profile: The Performance of a National Sample of Children Without Disabilities

Abstract: OBJECTIVES The purpose of this study was to obtain data about a national sample of children without disabilities on the 125-item revision of the Sensory Profile, a tool derived from sensory history items reported in the literature and designed to evaluate children's responses to commonly occurring sensory events. METHOD Parents of 1,115 children completed the Sensory Profile. The children were 3 to 10 years of age and did not have disabilities. Parents used a 5-point Likert scale to report the percentage of time their children engaged in each behavior. Researchers then analyzed the data, using multivariate methods to identify trends in performance and age and gender differences. RESULTS Ninety-one (73%) of the profile's 125 items were found to be uncommon behaviors for this national sample of children without disabilities. Although age and gender differences were significant (p < .001), effect sizes were so small (i.e., below .2) that differences were not meaningful for clinical application (i.e., mean differences less than .5 points). Only two items in the visual category approached a 1-point difference when comparing younger and older children. CONCLUSION There were no meaningful gender differences on the revised Sensory Profile, and only 2 items approached a meaningful difference related to age. Nearly three fourths of the items on the profile were uncommon for children without disabilities. If children with various disabilities display these behaviors, the Sensory Profile can be useful in evaluation and program planning for children with disabilities.

Occupational therapy practice: focusing on occupational performance.

Abstract: Changes in the health system require occupational therapy practitioners to focus their concerns on the long-term health needs of people and to help them develop healthy behaviors not only to improve their health, but also to minimize the health care costs associated with dysfunction. Occupational therapy practitioners must initiate efforts in the community to integrate a range of services that promote, protect, and improve the health of the public. This article shares the experiences of Canadian occupational therapy practitioners, who were challenged by their government nearly 15 years ago to establish a system that demonstrates effectiveness by improving the health of occupational therapy clients. By focusing on occupational performance, occupational therapy practitioners assist clients in becoming actively engaged in their life activities. This requires client-centered and family-centered practice and services that span from the agency or institution to the community. Occupational therapy practitioners must work collaboratively with persons in the client's environment (e.g., family members, teachers, independent living specialists, employers, neighbors, friends) to assist the client in obtaining skills and to make modifications to remove barriers that create a social disadvantage. A focus on occupational performance requires occupational therapy personnel to reframe how we think about occupational therapy to a sociomedical context and to take an active role in building healthy communities.

Factor analysis on the Sensory Profile from a national sample of children without disabilities.

Abstract: Objective The purpose of this study was to identify relationships in the 125 items of the revised Sensory Profile, a tool designed to assess children's responses to commonly occurring sensory events. Method Parents of 1,115 children ages 3 to 10 years and without disabilities completed the Sensory Profile. The parents reported the percentage of time their children engaged in each of the 125 behaviors listed on the profile. Results Factor analysis revealed nine discreet factors that indicate sensory modulation and responsiveness: sensory seeking, emotionally reactive, low endurance/tone, oral sensory sensitivity, inattention/distractibility, poor registration, sensory sensitivity, sedentary, and fine motor/perceptual. Conclusions In addition to the traditional method of organizing sensory history information by sensory system, we may need to consider a person's thresholds to sensory events as well as his or her responsiveness to sensation. Because the Sensory Profile factors in these children without disabilities are similar to patterns observed in children with various disabilities, it may be that some sensory processing problems are related to intensity or duration of behaviors as they begin to interfere with functional performance in daily life.

Why the profession of occupational therapy will flourish in the 21st century. The 1996 Eleanor Clarke Slagle Lecture

Abstract: The use of occupation as a therapeutic method is the essence of the profession of occupational therapy. This core of therapeutic occupation is flexible across cultures, times, health care environments, and different philosophies of the nature of the human being. Given this adaptability, the profession espouses diverse models of practice--the multiple frames of reference that guide therapeutic occupation for different populations in different settings. Across the history of the profession, therapeutic occupation has been the common core of otherwise different approaches to intervention. Although each of the many past and current models of practice has a different viewpoint, the common factor is the synthesis of occupational forms designed to elicit meaningful and purposeful occupational performance. Occupational synthesis is the essential act of the occupational therapist. It is necessary that occupational therapists confirm the power of therapeutic occupation through research that examines the profession's central principles. Occupational therapists are also urged to use the term occupation consistently and proudly in their interactions with recipients of therapy, fellow health care professionals, and each other. The profession of occupational therapy will flourish because occupation, its core, is so basic to human health yet so flexible, depending on the needs of the individual human being.

Forced Use of the Upper Extremity in Cerebral Palsy: A Single-Case Design

Abstract: OBJECTIVE Muscle imbalance and poor control of movement can have an impact on the daily occupational functioning of children with cerebral palsy. When one side of the body functions better than the other, children will often prefer to use the less-involved upper extremity for completion of play and self-care activities because they have learned that the other hand does not function as effectively. This study examined a method purported to overcome this learned nonuse of the affected upper extremity by directing the child's attention to this extremity and increasing his or her motivation to use it. The research hypothesis was that restriction of the less-involved hand with a resting splint would result in increased use of the more-involved hand in a child with spastic cerebral palsy. METHOD Initially, two children with cerebral palsy participated in this single-subject, ABA design study, but only one subject complied with the splint-wearing schedule and completed the study. This subject was a 2-year-old girl with greater involvement of the right side than the left. During the experimental phase, she wore a resting splint on her less-involved hand for most of the waking hours of the day to restrict its use. Data were collected over a 7-week period (2 weeks presplinting, 3 weeks splinting, 2 weeks postsplinting) and at a 6-month follow-up. Use of the more-involved extremity was measured through analysis of her performance during 15-min videotaped sessions of free play, administration of items from the Peabody Developmental Fine Motor Scales, and completion of a daily finger-feeding task. RESULTS An improvement in quality, quantity, and variety of use of the more-involved extremity after splinting, with some continuing improvement evident at follow-up, was found. The subject had increased voluntary control of her more-involved arm and hand and used them more spontaneously for completion of daily occupations. CONCLUSIONS Although the results of this single-case design are encouraging, further research with a randomized, controlled design is necessary to determine the effectiveness of the forced-use technique with a larger population.

Understanding the Potential of Occupation: A Qualitative Exploration of Seniors’ Perspectives on Activity

Abstract: This article presents the results of a qualitative study that explored the characteristics and potential of occupation. Semistructured interviews with 12 seniors who live in the community followed by member-checking groups were used to explore informants' perspectives on the importance and role of occupation in their lives by asking them about their activities. Themes pertinent to the characterization of activity, the contributions of activity, and a condition allowing for the potential of activity emerged from the inductive analysis. These themes provide information about how occupation naturally functions in the lives of seniors and suggest a tentative conceptualization of the characteristics and potential of occupation. The findings have implications for research regarding occupation and for clinical practice aimed at enabling occupation.

Occupation as Spiritual Activity

Abstract: Although spirituality is rarely explicitly mentioned in the occupational therapy literature, it is implied as an interwoven part of the human system. This article explores the meaning of occupation in the context of sociological and Judeo-Christian theological frameworks and the meaning of spirituality in the occupational therapy clinic. A case is made for acknowledging spirituality in clinical reasoning as a centralizing component of the patients' motivation and assignment of meaning to life.

Equivalence Reliability of the Functional Independence Measure for Children (WeeFIM®) Administration Methods

Abstract: Objective This study examined the equivalence reliability of two administration methods for the Functional Independence Measure for Children (WeeFIM). The two methods were direct observation of child performance and parental interview. Method Thirty children between the ages of 19 months and 71 months with identified developmental disabilities were included in this study. The direct observation and interview methods were administered in random order to each subject within a 3-week period. The direct observation was completed in the educational setting, and the WeeFIM interview was obtained by either in-person interview or telephone interview with the parent. Results The intraclass correlation coefficient (ICC) for total WeeFIM ratings was .93, indicating consistency between the two administration methods. Analysis of the WeeFIM Motor (13 items) and Cognitive (5 items) domains yielded ICC values of .93 and .75, respectively, suggesting greater consistency for items measuring motor-related skills. Conclusion The results demonstrate good agreement for total ratings when the WeeFIM is administered by direct observation and by interview with a parent. The findings establish the clinical usefulness of information collected by clinical interview.

Sensory Processing in the Postinstitutionalized Child

Abstract: OBJECTIVE The purpose of this study was to examine whether children adopted from Romanian orphanages have difficulty with sensory processing and related behaviors. METHOD Seventy-three children adopted from Romanian orphanages were compared with 72 peers who were typically developing. The subjects' ages ranged from 3 to 6 years. The parent-report Developmental and Sensory Processing Questionnaire was used to assess sensory processing and related behaviors. The tool consists of questions in six sensory processing domains and five related behavioral domains. RESULTS Multiple t tests indicated that the subjects adopted from Romanian orphanages demonstrated significantly greater problems than those in the control group on five of the six sensory processing domains: touch, movement-avoids, movement-seeks, vision, and audition. Additionally, the Romanian subjects exhibited significantly greater problems than the control subjects on four of the five behavioral domains: activity level, feeding, organization, and social-emotional. CONCLUSIONS These findings substantiate clinical observations and parent reports of sensory processing deficits in children adopted from Romanian orphanages and highlight the critical importance of the environment for sensory integration. The findings also enhance our understanding of how children who were previously institutionalized respond to the human and physical environment.

Occupational Therapists' Beliefs and Practices With Regard to Spirituality and Therapy

Abstract: OBJECTIVE What is the role of occupational therapists with regard to clients' spirituality? What activities address spirituality in occupational therapy? Whom do practitioners think should be responsible for helping clients with their spiritual needs? The objectives of this study were to address these and other related questions by validating a previously used questionnaire and establishing a baseline of occupational therapists' opinions and practices about spirituality and therapy on which future research can be built. METHOD A previously piloted questionnaire was revised to investigate the opinions of 500 U.S. registered occupational therapists about spirituality and therapy. The 54% return rate yielded a sample of 270 respondents. RESULTS Nearly 79% of the respondents agreed that the questionnaire accurately measured their opinions about therapy and spirituality. Spirituality is an important part of life for 89% of the respondents, helps 79% with daily job responsibilities, and is viewed as a very important dimension of health and rehabilitation by 84%. However, 63% were either undecided or disagreed that addressing spirituality was within the scope of occupational therapy practice. CONCLUSION In general, the respondents reported that spirituality is important and helpful in their personal lives and a very important dimension of the health and rehabilitation of their clients. However, less than 40% of the respondents indicated that addressing clients' spiritual needs was within the scope of their professional practice, and the majority (82%) reported that their academic training did not prepare them to address the spiritual needs of clients. The questionnaire, now validated with a national sample, may be used for follow-up studies to further investigate the role of spirituality in health and rehabilitation.

Acknowledging a spiritual dimension in occupational therapy practice.

Abstract: Phenomenology, an approach for understanding the essence of how people experience living, has been a frequent topic in recent occupational therapy literature. Interest in this topic has been inspired by the belief that purpose and meaning are important dimensions of occupation that can be harnessed to foster success in the intervention process. Some articles have suggested that creating meaning through occupation requires not only great skill, but also a knowledge of the clients' \"stories,\" described as narrative understanding (Helfrich & Kielhofner, 1994; Helfrich, Kielhofner, & Mattingly, 1994; Mallinson, Kielhofner, & Mattingly, 1996; Mattingly, 1991). Through narrative understanding, therapy practitioners can help clients create meaning through what Englehardt (1977) described as the central value of occupational therapy: \"engagement in the world\" (p. 672). This emphasis on the relationship between meaning and occupation has deep historical roots. Neuropsychiatrist Adolph Meyer (1922) avowed that occupational therapy represented an important manifestation of human philosophy, namely \"the valuation of time and work\" (p. 6) and the role of performance and completion in bringing meaning to life. Meyer cited Pierre Janet's reference to the\" 'fonction du real'-the realization of reality, bringing the very soul of man out of dreams of eternity to the full sense and appreciation of actuality\" (p. 6). Meyer's treatise on the virtues of occupation contains two important observations: that persons experience life through daily occupation and thar they concern themselves with finding mean-

Off-Road Driving Evaluations for Persons With Cerebral Injury: A Factor Analytic Study of Predriver and Simulator Testing

Abstract: OBJECTIVES: Off-road evaluations composed of psychometric testing and simulator driving are commonly used in rehabilitation settings to assess a person's fitness to resume driving after a cerebral injury Although the results of these evaluation methods separately provide information about ability to drive, there is no clear understanding about what is measured in comprehensive off-road evaluations as a whole This study explored the interrelationship of perceptual, cognitive, behavioral, and operational variables that form the basis for off-road evaluations in order to determine whether there are basic dimensions underlying performance in these evaluations and to derive a small set of variables that could help in refining methods for evaluating persons with cerebral injuries METHODS: One-hundred six persons with cerebral damage due to brain injury or cerebrovascular accident were administered a predriver evaluation that consisted of selected neuropsychometric tests Subjects were also evaluated in a driving simulator that measured their operational responses to filmed driving situations and assessed their behaviors Principal component analysis was used to identify manifest and latent variables contributing to the results of the evaluations RESULTS: The analysis produced a model with five independent (orthogonal) eigenvectors, or factors, for this population: Higher Order Visuospatial Abilities, Basic Visual Recognition and Responding, Anticipatory Braking, Defensive Steering, and Behavioral Manifestations of Complex Attention These factors accounted for 6614% of the total variance in the subjects' responses to comprehensive off-road evaluations CONCLUSION: These factors were useful in understanding driving performance and the role of predriver and simulator testing in driver evaluations Language: en

Statement--fundamental concepts of occupational therapy: occupation, purposeful activity, and function.

Abstract: Deriving from the philosophical basis of the profession, occupation is the core concept of the profession of occupational therapy However, in the occupational therapy literature, the term occupation is used in a variety of ways Occupation, a collection of activities that people use to fill their time and give life meaning, is organized around roles or in terms of activities of daily living, work and productive activities, or pleasure, for survival, for necessity, and for their personal meaning It is the individualized, unique combination of activities that comprises an individual's occupations Purposeful activities have been described in many different ways: as something all people engage in; as tools or media that therapists use to enhance or facilitate performance; and vehicles for bringing about change Purposeful activities are seen as part of the process of occupational therapy Purposeful activities are subset of occupations in that they are goal directed and serve as a major tool in the process of occupational therapy The term function, viewed as the ability to perform activities required in one's occupations has become increasingly important to society in describing the performance or change in individuals This societal shift in ideas has prompted the concept of function, viewed as a product, to become more important than the process of bringing about change Occupational therapy practitioners typically have viewed the process as being just as important as the product When working to improve function, occupational therapy practitioners use purposeful activities that are meaningful to the person in relation to his or her occupational history, preferences, personal goals, and needs Occupational therapy practitioners need to keep the individual's occupations in the forefront of their thoughts when using any purposeful activity and to plan interventions toward improving the individual's ability to function within his or her occupations In the interest of the profession, it is important to concentrate on occupation Furthermore, it is essential that we study our interventions' relationship to occupation and function, and how purposeful activities are used toward supporting the individual's ability to engage in occupation

The effect of added-purpose and meaningful occupation on motor learning.

Abstract: OBJECTIVE Numerous studies in the occupational therapy literature have investigated the effects of added-purpose (multidimensional, goal-oriented) occupation on performance. Motor learning research has demonstrated that factors that enhance performance measures do not necessarily enhance motor learning. This study examined the effects of both added-purpose and meaningful occupation on motor learning. METHOD Twenty subjects (university students) were randomly assigned to either an added-purpose or rote exercise condition. After a skill acquisition phase, retention and transfer scores were obtained, and subjects were asked to rate the meaningfulness of the occupation on a visual analog scale. RESULTS A two-way analysis of variance indicated that only the added-purpose occupation resulted in significantly greater motor learning. Additionally, the added-purpose scores were not influenced by the level of meaning assigned to the occupation. CONCLUSION This study is the first to demonstrate how added-purpose can enhance a more permanent aspect of performance: motor learning. Further research is necessary to determine whether occupations that both are meaningful and have added-purpose are the most effective in enhancing motor learning.

Anticipating retirement: the formation of narratives concerning an occupational transition.

Abstract: Objective This study is the first part of a longitudinal investigation of the retirement process. This stage of the inquiry concerned how older persons anticipate their retirement. Method Thirty-two workers were randomly selected from all workers age 63 years in a suburb of Stockholm. They participated in semistructured interviews about their work and their expectations for retirement. Results The participants narratives illustrated the complex work of interpreting the past and expected meaning in one's occupational life. The narratives, which anticipated widely different future trajectories, revealed many of the challenges and dilemmas of anticipating retirement and the close association of work experience to expectations for retirement. In particular, the narratives highlighted the participants' concerns about maintaining the quality of experience in activity. The findings also demonstrate the process by which persons anticipate and make choices about life change. Conclusions People anticipate retirement through volitional narratives in which they link together past, present, and future. Understanding this volitional process of interpreting, anticipating, and making choices is important to understanding how people adapt to life changes.

The Use of Low-Load Prolonged Stretch Devices in Rehabilitation Programs in the Pacific Northwest

Abstract: Objective This retrospective study examined the use of low-load prolonged stretch (LLPS) orthoses for contracture management. Method The records of 17 patients from skilled nursing facilities, hand clinics, and hospitals were reviewed. There was a total of 18 contractures (2 wrist, 12 elbow, 4 knee) secondary to neurological and orthopedic pathologies. Chart review focused on patient demographic information, range of motion (ROM) and functional outcomes, and wear schedules. Results The use of LLPS orthoses significantly increased ROM for the whole sample, which in turn significantly improved the subjects' functional outcomes. When the sample was divided into two pathology groups to compare a predominately geriatric population with neurological pathologies to a somewhat younger population with a history of musculoskeletal pathology, both groups showed a significant gain in ROM with the use of the LLPS orthoses. Conclusion Use of LLPS orthoses for contractive management can mediate the losses in ROM and function that occur with joint contractures.

Understanding the Transition to Community Living After Discharge From an Acute Care Hospital: An Exploratory Study

Abstract: OBJECTIVES This study was conducted to obtain patients' experiences in making the transition from an acute care hospital to their homes in the community. METHOD Data were gathered through group and telephone interviews with a volunteer sample of 27 discharged patients. Analysis involved two stages: categorization of shared themes and interpretation of individual occupational experiences. RESULTS Informants described their experiences of transition in terms that were analytically categorized as Perceived Self-Efficacy, Resources, Dimensions of Occupation, and Environmental Constraints and Opportunities. Analysis of individual patient transcripts suggests the presence of an hierarchical ordering of desired occupations. CONCLUSION Understanding patients' perceptions of enabling and disabling experiences has implications for predischarge and postdischarge practice in occupational therapy.

Helping Clients Develop Hopes for the Future

Abstract: The purposes of this article are (a) to examine cognitive, emotional, and spiritual aspects of hope as reflected in the literature; (b) to describe three clinical approaches that have been used in occupational therapy to engage clients in development of hopes for the future; and (c) to consider practical issues that have been raised by therapists seeking to incorporate development of hopes in their practice. Literature from health care and the social sciences indicates that cognitive, emotional, and spiritual aspects of hope are interwoven in a complex process that evolves over time after major loss. Three alternative clinical strategies for collaborating with clients in developing hopes are reviewed, including a goal-setting and goal-attainment approach, an occupational change approach, and a life history approach. These clinical strategies are illustrated by the stories of an elderly mental health client, an adult rehabilitation client, and an adolescent orthopedic client, which are drawn from research in which the authors have been involved. Discussion of issues involved in incorporating hope work into daily practice is based on the experiences of practicing therapists who participated in a workshop. These include pragmatic issues of documentation and reimbursement of this aspect of practice as well as clinical issues of how to develop hopes among clients who appear hopeless.

In-Hand Manipulation in Young Children: Rotation of an Object in the Fingers

Abstract: Objective The purpose of this study was to look at the development of two in-hand skills of rotation. Three questions were asked: (a) Do boys' and girls' performance differ significantly? (b) Does performance improve with age? and (c) Can periods of rapid improvement with age be seen on the tasks presented? Method The in-hand manipulation skill of rotation was measured in 154 right-handed children between the ages of 3-0 years and 6-11 years as well as in 13 adults. The participants were videotaped as they either turned over small pegs in a pegboard or rotated a peg in their fingertips. The number of pegs dropped when turning and placing them back in the board, the number of times a peg could be rotated in the fingertips, the time it took to complete each task, and the methods participate used to accomplish the two tasks were recorded from the videotapes. Results The results indicated no differences between the performance of boys and girls on any of the variables studied, but performance did change with age, and periods of rapid change were identified. Further, when compared on methods used, the children did not achieve the same speed or consistency as the adult participants. Conclusion The development of in-hand manipulation skills of rotation involves improvement in the dimension of speed, method, and consistency. Observation of these skills in a child can add to a therapist's understanding of the child's fine motor abilities. The variability in children's performance needs to be considered in both evaluation and treatment planning.

The Spiritual Depth of Occupation: Making Worlds and Making Lives

Abstract: W hen it comes to discerning a spiritual dimension in occupational therapy, it helps to consider the kind of seeing that causes three-dimensional picrures to emerge from designs called steteograms. Stereograms are patrerns of brightly rendered bands or figures, their overall effect much like gift wrapping. Experts give this cue for finding the rhird dimension: Gaze through the patrern to some point beyond it (Baccei, 1994). This broad way of seeing, freed from a fix on details but still led by them, yields a vibrant picture. The discovery is awesome. The dimensionaliry of the srereogram can go unnoriced. Because the deep dimension emerges only when a viewer knows how to look, the term that best fits the requisite looking is discemment, an act of seeing through or seeing into that yields discovery (Webster's Collegiate Dictionary, 1993). The patterns of occupation and occupational therapy seem much like srereograms. Within them is a depth nOt always seen.

Role Perceptions of Mothers With Young Children: The Impact of a Child’s Disability

Abstract: OBJECTIVE The purpose of this study was to examine and compare the perceived past, present, and future occupational roles of mothers of young children. Awareness of the role demands placed on mothers will assist occupational therapists in addressing the needs of children with disabilities within the family context. METHOD One hundred and thirty-five mothers of children 6 months to 5 years of age completed the Role Checklist, which examines participants' perceptions of past, present, and future occupational roles. Forty-five participants had children with multiple disabilities and major functional limitations, 45 had children with Down's syndrome, and 45 had children who were typically developing. RESULTS The group of mothers of children who were typically developing was found to have significantly more present roles than the other two groups. All three groups lost significant numbers of roles from past (before birth of child) to present and anticipated adding significant numbers of future roles. There were no significant differences among the three groups in value placed on occupational roles. CONCLUSION Role demands of caring for a young child were high for all participants, particularly if the child had a disability. Participants seemed to respond to these demands by giving up other discretionary roles in order to meet their caregiving obligations. Thus, asking mothers of children with disabilities to take on therapy-related caregiving tasks may contribute to role strain.

The relationship between pretheoretical assumptions and clinical reasoning.

Abstract: This single-case study explored what internal beliefs or commitments one therapist holds about the nature of reality and how those beliefs influence her delivery of occupational therapy services. Data were collected through three in-depth interviews and through observation of the therapist conducting treatment sessions. Results suggest that the therapist's view of reality can be categorized into four areas: (a) what she believes about ultimate reality; (b) what she believes about life, death, and eternity; (c) what she believes about human nature; and (d) what she believes about the nature of knowing. The findings also suggest that this core worldview informs how the therapist frames clinical practice and how she delivers occupational therapy services. Further, both the therapist's view of reality and her clinical practice are deeply rooted in her sociocultural experiences. This case study provides a rich description of the interrelatedness of sociocultural context, worldview, and clinical reasoning.

In-hand manipulation in young children: translation movements

Abstract: Objective The purpose of this study was to look at the development of in-hand translation skills in young children; that is, the child's ability to move a small object from the fingers into the palm and from the palm to the fingers. Three questions were asked: (a) Do boys' and girls' performance differ significantly? (b) Does the performance of the children improve with age? and (c) Can periods of rapid improvement with age be seen on the tasks presented? Method In-hand manipulation translation was measured with a pegboard task for 154 right-handed children between 3-0 years and 6-11 years of age and 13 adults. Participants were videotaped as they picked up two to five pegs, one at a time; stored them in the hand; and moved the pegs out of storage to place them in the pegboard. The number of pegs handled in each trial as well as the methods used to move the peg to and from the palm were recorded. Results Boys and girls did not show significant differences in their performance, but when slight differences did occur, they favored the girls. Age was found to be a significant factor in both the number of pegs handled and the method used in handling them. The older children tended to place more pegs successfully and were more likely to use the methods most commonly used by the adults. A major finding was the marked difference in how the children solved the problem of moving the peg in and out of the palm compared with the adults. The adults used gravity to assist the movement of the peg; the children tended to use methods that allowed them to maintain contact with the peg throughout the movement. Conclusion In-hand manipulation translation skills appear to have a long developmental course. Children are closer to adults in their ability to perform the task than in the methods that they use. This study shows the importance of observing how children perform tasks, not just whether they complete the tasks. Differences in the methods used help to determine efficiency. Observation of these skills in children may expand a therapist's understanding of children's fine motor abilities.

Student perceptions of a problem-based learning course.

Abstract: Within occupational therapy education, there has been increased attention to curricula and courses that emphasize problem solving, clinical reasoning, and synthesis of information across traditional discipline-specific boundaries. This article describes the development, implementation, and outcomes of a problem-based learning course entitled Selected Cases in Occupational Therapy. The course was designed to help students to integrate the various elements of a specific occupational therapy curriculum and to enhance their abilities to respond to an ever-changing health care environment. An evaluation of the course by the first 11 students who completed it revealed both strengths and weaknesses. Students responded that the course enhanced their professional behavior, including interpersonal communication skills, team work, and follow-through with professional responsibilities; helped them to integrate the various elements of the total occupational therapy academic program; enhanced their clinical reasoning skills by providing a structure for thinking through clinical issues; and provided personal gain or benefit (i.e., students perceived the course to be a valuable, realistic, and motivating experience). The students also identified several specific course elements that contributed to its integrating function, including content, class session format, and students' role. Identified course weaknesses included the methods of evaluating student performance and the format and content of specific cases.

The Use of Service Learning in Client Environments To Enhance Ethical Reasoning in Students

Abstract: OBJECTIVES This study examined the effects of two service-learning experiences on the psychosocial and moral reasoning development of occupational therapy students. The assumption was that ethical reasoning ability can be facilitated through participation in value-laden experiences. METHOD Participants visited older adults in nursing homes (n = 19) or interacted with persons with disabilities in community settings (n = 33). All participants reflected on their experiences through weekly journals. Psychosocial and moral reasoning development were measured at the beginning and end of the experiences with the Student Development Task and Lifestyle Inventory and the Sociomoral Reflection Measure-Short Form. RESULTS Participants in both groups exhibited a significant time-related increase in psychosocial development but no increase in moral reasoning. Participants interacting with persons with disabilities exhibited a decrease over time in moral reasoning compared with the participants interacting with older adults. CONCLUSION Service learning effected a change in the participants' psychosocial development indicative of developing an appreciation for dignity, equality, and justice. These are core concepts in occupational therapy and are viewed as important in ethical reasoning. The lack of advancement and current level of moral reasoning in these undergraduate students raises a question as to their readiness to engage in ethical reasoning as entry-level practitioners.

Prediction Of Academic And Clinical Performance Of Occupational Therapy Students In An Entry-level Master's Program

Abstract: OBJECTIVE The relationships between clinical outcomes and predictors used to screen applicants for entrance into a Master in Occupational Therapy (MOT) program were examined. METHOD MOT student records from 1986 to 1992 were used to gather data for three dependent variables and six predictor (independent) variables. The dependent variables used to gauge student success were grade point average in occupational therapy courses (OT-GPA), client attendance at an on-site clinic, and therapy outcomes of clients at that clinic. The predictor variables were undergraduate GPA, scores on the three sections of the Graduate Record Examination, reference forms, and essays. RESULTS The models used to predict OT-GPA and therapy outcomes were significant (p < .05), and the incremental validity of several predictors was established. The model used to predict client attendance was not significant. CONCLUSION The findings regarding OT-GPA support the continued use of all the predictors except the reference forms. Although it was possible to develop a model to predict client outcomes, the usefulness of the model is difficult to interpret.