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Showing papers in "American Journal of Occupational Therapy in 2001"


Journal ArticleDOI
Winnie Dunn1
TL;DR: This lecture reviews sensory processing literature and proposes relationships between sensory processing and temperament and personality traits, and outlines parameters for developing best practice that supports interventions based on this knowledge.
Abstract: The experience of being human is embedded in sensory events of everyday life. This lecture reviews sensory processing literature, including neuroscience and social science perspectives. Introduced is Dunn’s Model of Sensory Processing, and the evidence supporting this model is summarized. Specifically, using Sensory Profile questionnaires (i.e., items describing responses to sensory events in daily life; persons mark the frequency of each behavior), persons birth to 90 years of age demonstrate four sensory processing patterns: sensory seeking, sensory avoiding, sensory sensitivity, and low registration. These patterns are based on a person’s neurological thresholds and self-regulation strategies. Psychophysiology studies verify these sensory processing patterns; persons with strong preferences in each pattern also have unique patterns of habituation and responsivity in skin conductance. Studies also indicate that persons with disabilities respond differently than peers on these questionnaires, suggesting underlying poor sensory processing in certain disorders, including autism, attention deficit hyperactivity disorder, developmental delays, and schizophrenia. The author proposes relationships between sensory processing and temperament and personality traits. The four categories of temperament share some consistency with the four sensory processing patterns described in Dunn’s model. As with temperament, each person has some level of responsiveness within each sensory processing preference (i.e., a certain amount of seeking, avoiding, etc., not one or the other). The author suggests that one’s sensory processing preferences simultaneously reflect his or her nervous system needs and form the basis for the manifestation of temperament and personality. The final section of this lecture outlines parameters for developing best practice that supports interventions based on this knowledge.

480 citations


Journal ArticleDOI
TL;DR: Evidence is provided to support the four subscales of the Adult Sensory Profile as distinct constructs of sensory processing preferences as well as the four-quadrant model.
Abstract: Objective This article describes a series of studies designed to evaluate the reliability and validity of the Adult Sensory Profile. Method Expert judges evaluated the construct validity of the items. Coefficient alpha, factor analysis, and correlations of items with subscales determined item reliability, using data from 615 adult sensory profiles. A subsample of 20 adults furnished skin conductance data. A heterogeneous group of 93 adults completed the revised Adult Sensory Profile, and item reliability was reexamined. Results Expert judgment indicated that items could be categorized according to Dunn's Model of Sensory Processing. Results suggested reasonable item reliability for all subscales except for the Sensation Avoiding subscale. Skin conductance measures detected distinct patterns of physiological responses consistent with the four-quadrant model. Revision of the Adult Sensory Profile resulted in improved reliability of the Sensation Avoiding subscale. Conclusion The series of studies provides evidence to support the four subscales of the Adult Sensory Profile as distinct constructs of sensory processing preferences.

311 citations


Journal ArticleDOI
TL;DR: Findings from the study suggest that young children with autism have deficits in a variety of sensory processing abilities as measured by the Sensory Profile.
Abstract: Objectives: The purpose of this study was to describe the sensory-based behaviors of young children with autism as reported by their parents on the Sensory Profile. Factor scores of children with autism were compared with those of children without autism. Method: The Sensory Profile questionnaire was completed by parents of 40 children with autism 3 through 6 years of age and parents of 40 children without autism 3 through 6 years of age. Results: The performance of children with autism was significantly different from that of children without autism on 8 of 10 factors. Factors where differences were found included Sensory Seeking, Emotionally Reactive, Low Endurance/Tone, Oral Sensitivity, Inattention/Distractibility, Poor Registration, Fine Motor/Perceptual, and Other. Conclusion: Findings from the study suggest that young children with autism have deficits in a variety of sensory processing abilities as measured by the Sensory Profile. Further research is needed to replicate these findings, to examine the possibility of subgroups on the basis of sensory processing, and to contrast the sensory processing abilities of children with other disabilities to those of children with autism.

282 citations


Journal ArticleDOI
TL;DR: Once occupation and activity are recognized as two separate and equally valuable concepts, they offer a rich set of theoretical relations for exploration and will enhance disciplinary discourse and research as well as enhance the intervention efficacy, moral surety, and political strength of the profession.
Abstract: Activity and occupation are two core concepts of occupational therapy that are in need of differentiation. Occupation is defined here as a person's personally constructed, one-time experience within a unique context. Activity is defined as a more general, culturally shared idea about a category of action. The ways in which subjectivity and context are handled within the concepts of occupation and activity are keys to disentangling them. The proposed untangling of the two concepts into distinct definitions is congruent with their historical origins as well as with current definitional trends. Once occupation and activity are recognized as two separate and equally valuable concepts, they offer a rich set of theoretical relations for exploration. The clarity that will result from differentiating occupation and activity will enhance disciplinary discourse and research as well as enhance the intervention efficacy, moral surety, and political strength of the profession.

247 citations


Journal ArticleDOI
TL;DR: Recognizing the stages in the process of transition from student to therapist may assist in educational curriculum development and clinical support and supervision for new graduates.
Abstract: Objectives The transition from classroom to clinical practice challenges many health professional students. This study used a phenomenological approach to explore the lived experience of rehabilitation students during their final placement and first year of practice. Method Students (n = 6) in occupational therapy and physical therapy wrote reflective journals every 2 weeks during their final fieldwork placement and first year of practice. The researchers independently analyzed the journals for common themes. An independent peer completed a blind analysis of two journals. Data were also compared with published first-person accounts of novice practitioners. Results The lived experience of the first year of practice included four consecutive stages: Transition, Euphoria and Angst, Reality of Practice, and Adaptation. Themes from the journals included great expectations, competence, politics, shock, education, and strategies. Conclusion Recognizing the stages in the process of transition from student to therapist may assist in educational curriculum development and clinical support and supervision for new graduates. Educators need to continue to make education practice relevant while maintaining a theoretical perspective.

152 citations


Journal ArticleDOI
TL;DR: The Interactive Metronome training appears to facilitate a number of capacities, including attention, motor control, and selected academic skills, in boys with ADHD.
Abstract: Objective The purpose of this study was to determine the effects of a specific intervention, the Interactive Metronome, on selected aspects of motor and cognitive skills in a group of children with attention deficit hyperactivity disorder (ADHD). Method The study included 56 boys who were 6years to 12 years of age and diagnosed before they entered the study as having ADHD. The participants were pretested and randomly assigned to one of three matched groups. A group of 19 participants receiving 15 hr of Interactive Metronome training exercises were compared with a group receiving no intervention and a group receiving training on selected computer video games. Results A significant pattern of improvement across 53 of 58 variables favoring the Interactive Metronome treatment was found. Additionally, several significant differences were found among the treatment groups and between pretreatment and posttreatment factors on performance in areas of attention, motor control, language processing, reading, and parental reports of improvements in regulation of aggressive behavior. Conclusion The Interactive Metronome training appears to facilitate a number of capacities, including attention, motor control, and selected academic skills, in boys with ADHD.

142 citations


Journal ArticleDOI
TL;DR: Evidence from this longitudinal study indicates that a special type of occupation--engaging occupation with six constituents--was an important determinant of retirement satisfaction.
Abstract: This article presents the results from a longitudinal study of retirement. Data were collected through interviews with 12 Swedish participants over a 7-year period, beginning when they were still working and continuing through their early years of retirement. The findings show that the participants' narrative anticipations of retirement interacted with the events of ongoing life. Sometimes these events influenced the outcomes of the retirement process unpredictably. Consequently, retirement was often full of surprises and temporary periods of turbulence. Although some participants managed a transition into a satisfying pattern of retirement, others found it an ongoing process of frustration and dissatisfaction. Evidence from this longitudinal study indicates that a special type of occupation--engaging occupation with six constituents--was an important determinant of retirement satisfaction. This key finding is discussed with regard to its implications for theory development as well as its practical implications related to the importance of differentiating occupations and attending to the interaction between internal motivation and external expectations in the occupational pattern.

136 citations


Journal ArticleDOI
TL;DR: In this article, subjective and contextual dimensions of occupational experience, elements of the occupational design process, and how these factors produce therapeutic power through the appeal, intactness, and accuracy of interventions are discussed.
Abstract: Two forces are converging, creating conditions both challenging and potentially fruitful for occupational therapy The profession's knowledge base describing occupation is growing exponentially At the same time, functional outcomes of intervention are being increasingly valued within the health care environment Other professions imitate and claim our areas of expertise in the most flattering and dangerous ways To benefit from the convergence of these forces, occupational therapy must expeditiously translate understanding of occupation into powerful occupation-based practice Three bridges must be built: a generative discourse, demonstration sites, and effective education The occupational design approach offers important conceptual tools with which to rapidly build these bridges to powerful practice Described here are subjective and contextual dimensions of occupational experience, elements of the occupational design process, and how these factors produce therapeutic power through the appeal, intactness, and accuracy of interventions

133 citations


Journal ArticleDOI
TL;DR: The suitability of the Movement Assessment Battery for Children for use with Hong Kong Chinese preschool children was examined and cross-cultural differences were found on a number of the test items.
Abstract: Objective There is little information available on the appropriateness of tests developed in the West for children of different ethnicities. The aim of this study was to examine the suitability of the Movement Assessment Battery for Children (Movement ABC) for use with Hong Kong Chinese preschool children. Method The performance of 255 Hong Kong Chinese children between the ages of 4 years and 6 years was compared with that of the 493 children of the same age from the United States who took part in the most recent standardization of the Movement ABC. Results The test content was found to be suitable for use with Hong Kong Chinese children. However, cross-cultural differences were found on a number of the test items. Chinese children performed significantly better on items contained in the manual dexterity and dynamic balance sections, whereas American children were better at the projection and reception of moving objects. Conclusion These findings highlight the need to ensure that norms for all tests are appropriate for the specific cultural groups being assessed.

126 citations


Journal ArticleDOI
TL;DR: Quantitative data indicated that overall, NISA members perceive an improvement in their subjective quality of life and sense of well-being, and their perceptions are supported by minimal use of crisis services and hospitalization, improved socioeconomic status, and several members' success in obtaining paid employment.
Abstract: Northern Initiative for Social Action (NISA) is a consumer-run, occupation-based, nonprofit organization located in northeastern Ontario, Canada. The NISA organization has grown in response to research revealing few opportunities for participation in personally meaningful and socially valued occupation for persons with mental illness living in the community of study. This article describes a mixed-design research study conducted by the ParNorth Research Unit of NISA and an occupational therapist. The study purposes were to (a) better understand the emerging characteristics of the NISA program and identify which the participants found helpful; (b) evaluate whether participation in NISA improved members' quality of life; and (c) ascertain whether participation reduced members' need for more traditional and costly methods of care (e.g., hospitalization, crisis services). Focus groups, daily participant observation, a quality of life interview, a consumer member survey and objective review of hospitalization data were used for data collection. Qualitative results indicated that NISA helped to meet participants' being, belonging, and becoming needs. Quantitative data indicated that overall, NISA members perceive an improvement in their subjective quality of life and sense of well-being. Their perceptions are supported by minimal use of crisis services and hospitalization, improved socioeconomic status, and several members' success in obtaining paid employment either within or outside NISA. Future challenges include the need to clearly describe the evolving NISA model and to ensure that the growth of this new organization does not exceed secured human or fiscal resources.

122 citations


Journal ArticleDOI
TL;DR: A major barrier to adherence to home modification recommendations is that many older people do not believe that home modifications can reduce their risk of falling.
Abstract: Objective This study examined adherence to home modification recommendations made by an occupational therapist and attempted to identify predictors of adherence. Method An experienced occupational therapist visited the homes of 178 people (mean age = 764 years) to evaluate for and recommend appropriate home modifications for falls prevention. One year later, a research assistant visited these persons' homes to assess adherence. Results At least one home modification was recommended in 150 of the 178 homes visited. The most common recommendations were to remove mats and throw rugs (48%), to change footwear (24%), and to use a nonslip bathmat (21%). In the 121 homes revisited after 12 months, 419 home modifications had been recommended, and 216 (52%) were met with partial or complete adherence. The only significant predictors of adherence were a belief that home modifications can prevent falls and having help at home from relatives. Conclusion A major barrier to adherence to home modification recommendations is that many older people do not believe that home modifications can reduce their risk of falling.

Journal ArticleDOI
TL;DR: The findings suggest that for these 5 children with PDD, the use of a weighted vest resulted in an increase in attention to task and decrease in self-stimulatory behaviors.
Abstract: Objective This study examined the effectiveness of using a weighted vest for increasing attention to a fine motor task and decreasing self-stimulatory behaviors in preschool children with pervasive developmental disorders (PDD). Method Using an ABA single-subject design, the duration of attention to task and self-stimulatory behaviors and the number of distractions were measured in five preschool children with PDD over a period of 6 weeks. Results During the intervention phase, all participants displayed a decrease in the number of distractions and an increase in the duration of focused attention while wearing the weighted vest. All but 1 participant demonstrated a decrease in the duration of self-stimulatory behaviors while wearing a weighted vest; however, the type of self-stimulatory behaviors changed and became less self-abusive for this child while she wore the vest. During the intervention withdrawal phase, 3 participants experienced an increase in the duration of self-stimulatory behaviors, and all participants experienced an increase in the number of distractions and a decrease in the duration of focused attention. The increase or decrease, however, never returned to baseline levels for these behaviors. Conclusion The findings suggest that for these 5 children with PDD, the use of a weighted vest resulted in an increase in attention to task and decrease in self-stimulatory behaviors. The most consistent improvement observed was the decreased number of distractions. Additional research is necessary to build consensus about the effectiveness of wearing a weighted vest to increase attention to task and decrease self-stimulatory behaviors for children with PDD.

Journal ArticleDOI
TL;DR: The results of the published research provide practicing occupational therapists with a range of factors to consider when prescribing adaptive equipment to older adults, and future research is needed to identify what constitutes optimal device use, what factors provide personal motivation for using assistive devices, and how home visits influence use.
Abstract: Objective The purpose of this review was to identify the major findings of published research on the factors influencing older adults' use of adaptive equipment. Method Fourteen studies involving an older adult sample were selected from major electronic bibliographic databases searched with a series of key words related to aging and equipment use. Results of these studies were compared to determine the most common factors influencing the use of adaptive equipment among older adults. Results Although the reviewed studies varied in their sampling strategies and designs, many results were similar. Between 47% and 82% of prescribed equipment continues to be used by older adults, with use decreasing over time. Findings from published studies show that equipment suitability, adequate training, and pre-prescription home visits contribute to these rates of use. Lack of fit among the person, his or her environment, and the equipment was the primary reason identified for nonuse. Conclusion The results of the published research provide practicing occupational therapists with a range of factors to consider when prescribing adaptive equipment to older adults. Although the findings of this review demonstrate remarkable consistency across existing research findings, future research is needed to identify what constitutes optimal device use, what factors provide personal motivation for using assistive devices, and how home visits influence use.

Journal ArticleDOI
TL;DR: Preliminary findings support the hypothesis that wearing a weighted vest to apply deep pressure increases on-task behavior during fine motor activities.
Abstract: Objective Children described as having attention deficit hyperactivity disorder often demonstrate inability to sustain visual attention during classroom fine motor activities. This study investigated the effect of wearing a weighted vest (deep-pressure sensory input) on children's on-task behavior in the classroom. Method Four students with documented attention difficulties and hyperactivity were timed with a stopwatch to measure their on-task behavior during fine motor activities in the classroom. All 4 students were timed for six 15-min observations without wearing a weighted vest and for six 15-min observations while wearing a weighted vest. Results On-task behavior increased by 18% to 25% in all 4 students while wearing the weighted vest. Additionally, 3 of the 4 students frequently asked to wear the vest other than during the observation times. Conclusion These preliminary findings support the hypothesis that wearing a weighted vest to apply deep pressure increases on-task behavior during fine motor activities.

Journal ArticleDOI
TL;DR: A significant negative correlation was found between the percentage of IEP objectives met variable and three collaborative variables--team meetings, reviewing progress, and develop goals and objectives, indicating that as the frequency of these team processes increased, fewer objectives were met.
Abstract: Objective A descriptive, correlational study using a survey instrument and record review was designed to describe collaboration practices between teachers and occupational therapists in public schools and to explore relationships of these practices to individual education plan (IEP) objectives and teachers' perceptions of occupational therapy contributions to student skill development. Method Forty teachers of students who receive occupational therapy comprised the sample. Descriptive statistics and Spearman rank order correlations were used to describe the practices and to determine associations among the variables. Results and conclusions The findings indicated that teachers and occupational therapists were using collaborative team practices, such as jointly developing goals and objectives, collaboration within the classrooms, jointly monitoring interventions, and jointly reviewing student progress. However, scheduling team meetings was difficult. The majority of respondents stated that occupational therapy contributed to student skill development, and as collaboration practices increased, the teachers' perceptions of occupational therapy contribution to student skill development increased. A significant negative correlation was found between the percentage of IEP objectives met variable and three collaborative variables--team meetings, reviewing progress, and develop goals and objectives. This finding indicated that as the frequency of these team processes increased, fewer objectives were met.

Journal ArticleDOI
TL;DR: The results indicate that although the students in this study wrote more legibly on the short task than on the long task, the type of grasp they used did not affect their legibility.
Abstract: Objective This study examined the influence ofpencil grasp on handwriting legibility during both short and long writing tasks in 46fourth-grade students who were typically developing. Matched samples were used to controlfor variability. Method Regular classroom writing assignments were scoredfor word and letter legibility, and scores were compared using a mixed repeated-measures analysis of variance design. The two independent variables were pencil grasp (dynamic tripod grasp vs. atypical grasp) and task length (short vs. long). Results A significant difference was found between the letter legibility scores on the short task and the letter legibility scores on the long task. Students' legibility was greater on the short task than on the long task across both grasp conditions. No significant difference was found in scores between students who used dynamic tripod grasps and those who used atypical grasps, nor was there a significant interaction between grasp and task length. No significant differences were found between word legibility scores. Conclusion The results indicate that although the students in this study wrote more legibly on the short task than on the long task, the type of grasp they used did not affect their legibility. Because of the limited sample size, the results of this study should be interpreted cautiously. More research in handwriting performance and pencil grasp is needed to provide clear expectations and treatment options for students.

Journal ArticleDOI
TL;DR: Service dogs are used to enhance independence in occupational performance areas and contribute to improvements in psychosocial functioning and could be viewed as a form of assistive technology that occupational therapists may want to consider as an alternative to traditional devices for some clients.
Abstract: Objective The purpose of this study was to describe, qualitatively the use of service dogs by persons with physical disabilities and the meaning of this experience. Method Five service dog owners were observed and interviewed on multiple occasions through an ethnographic approach. Results Identified themes were increased community participation, "closer than family" increased social contact, personal skill development, having fun, responsibility, adjustment, challenges, independence, "someone to watch over me," and "feel like an able-bodied person." Conclusion Service dogs are used to enhance independence in occupational performance areas and contribute to improvements in psychosocial functioning. Given these benefits, service dogs could be viewed as a form of assistive technology that occupational therapists may want to consider as an alternative to traditional devices for some clients.

Journal ArticleDOI
Ellen S. Cohn1
TL;DR: For themselves, parents valued understanding their children's behavior in new ways, which facilitated a shift in expectations for themselves and their children, having their parenting experience validated, and being able to support and advocate for their children.
Abstract: This qualitative study explored parents' points of view regarding their children's participation in occupational therapy using a sensory integration approach. Data were collected through parent interviews and were analyzed using grounded theory methods. The parents' perceptions of the benefits of therapy for their children were categorized into three interrelated constructs: abilities, activities, and reconstruction of self-worth. For themselves, parents valued understanding their children's behavior in new ways, which facilitated a shift in expectations for themselves and their children, having their parenting experience validated, and being able to support and advocate for their children. Implications for family-centered intervention and future research are proposed.

Journal ArticleDOI
TL;DR: The issues and techniques involved when incorporating preschool and elementary-school-age children as informants in qualitative research are summarized to add to the understanding of occupational therapy researchers about children as informant in research.
Abstract: Objective The purpose of this literature review was to summarize the issues and techniques involved when incorporating preschool and elementary-school-age children as informants in qualitative research. Method Literature on children's studies, qualitative research with children as informants, and methods for obtaining children's perspectives were examined. Results Conducting qualitative research with children involves different challenges and research techniques than research with adults. The researcher needs to examine beliefs regarding children's competence, address the inequality of power in the adult-child relationship, and bridge different communication styles. The researcher can employ a variety of techniques and adaptations to help children express themselves. Conclusion This review adds to the understanding of occupational therapy researchers about children as informants in research. The practical suggestions presented can also be used in clinical practice to strengthen children's voices in therapy.

Journal ArticleDOI
TL;DR: The preliminary findings indicate that training to improve awareness of disabilities might improve the ability to learn the use of compensatory techniques in the performance of ADL in clients with unilateral neglect.
Abstract: Objective Awareness of disabilities is known to be a central problem of rehabilitation among clients with large right cerebrovascular lesions and unilateral neglect. The aim of this study was to evaluate the effect of an intervention program focused on improving the awareness of disabilities in four participants with unilateral neglect. The intervention program developed for this study was based on the assumption that awareness of disabilities is a prerequisite for being able to learn and use compensatory techniques in the performance of activities of daily living (ADL). Method The study followed a single-case experimental ABA design. The Assessment of Awareness of Disability was used to measure awareness of disabilities; the Assessment of Motor and Process Skills was used to measure ADL ability; and neuropsychological tests were used to assess unilateral neglect and sustained attention. The intervention program used meaningful and purposeful occupations as therapeutic change agents to improve awareness of disabilities. Results Awareness of disabilities and ADL ability improved in all four participants; unilateral neglect decreased in three participants; and sustained attention improved in two participants. Conclusion The preliminary findings indicate that training to improve awareness of disabilities might improve the ability to learn the use of compensatory techniques in the performance of ADL in clients with unilateral neglect. The effects of the intervention strategy need to be evaluated further in future research.

Journal ArticleDOI
TL;DR: The three scales of the OPHI-II are valid across age, diagnosis, culture, and language and effectively measure a wide range of persons and can be used validly without formal training.
Abstract: Objective This study examined the validity of the Occupational Identity, Occupational Competency, and Occupational Behavior Settings scales of the second version of the Occupational Performance History Interview (OPHI-II). The study also asked whether the scales' items were targeted to and could effectively discriminate between persons at different levels of adaptation. Method Data were collected from 151 raters on 249 subjects from eight countries and in six languages. Many-faceted Rasch analysis was used to analyze the data. Results The items of each scale worked effectively to measure the underlying construct for which they were designed. All three scales validly measured more than 90% of the subjects, who varied by nationality, culture, age, and diagnostic status. Each scale's items were appropriately targeted to the subjects, and all three scales distinguished subjects into approximately three different levels. More than 90% of the raters used the three scales validly and had approximately the same degree of severity or leniency. The scales were valid across subjects with physical dysfunction and psychiatric conditions as well as subjects with no active diagnosed condition. Conclusion The three scales of the OPHI-II are valid across age, diagnosis, culture, and language and effectively measure a wide range of persons. Raters can readily use the OPHI-II validly without formal training.

Journal ArticleDOI
TL;DR: Athletes scored significantly higher on four of five subsections of the CHART, indicating greater levels of community integration than nonathletes, extend the literature outlining the physical and psychological benefits of sports.
Abstract: Objective The purpose of this study was to determine whether participation in sports by persons with spinal cord injuries (SCIs) affected level of community integration as defined by the World Health Organization and as measured by the Craig Handicap Assessment and Reporting Technique (CHART). Method Forty-eight participants were recruited from a camp for persons with physical disabilities as well as from SCI support groups. Participants were divided into groups of athletes (n = 30) and nonathletes (n = 18) on the basis of their self-reported level of sports participation. Results Athletes scored significantly higher on four of five subsections of the CHART (physical independence, mobility, occupation, social integration), indicating greater levels of community integration than nonathletes. Conclusion These findings extend the literature outlining the physical and psychological benefits of sports. Occupational therapists have a unique opportunity to use the occupation of sports to integrate the roots of the profession with the cultural demands of society.

Journal ArticleDOI
TL;DR: There is considerable variation in the definition of handedness, its effect on grip strength ratios, and the methods of assessing handedness as it relates to grip strength.
Abstract: When estimating preinjury grip strengthfor compensation and rehabilitation purposes, two methods have been identified in the literature: (a) comparison with the unaffected hand and (b) reference to grip strength normative data. The literature is divided about whether a significant difference exists between the grip strengths of a person's two healthy hands. Some researchers argue that handedness affects the grip strength ratio. According to these authors, there is considerable variation in the definition of handedness, its effect on grip strength ratios, and the methods of assessing handedness as it relates to grip strength. The complexity of defining and accurately evaluating handedness is discussed in this literature review. Inappropriateness of the current use of self-report questionnaires for determining handedness for grip strength purposes is highlighted. The impact of the effect of handedness on grip strength ratios cannot be clarified until a consistent definition and evaluation method for assessing handedness is developed. This handedness definition then needs to be applied to appropriately designed hand grip strength studies.

Journal ArticleDOI
Linda Finlay1
TL;DR: The findings revealed that although holism is indeed valued, considerable uncertainty exists about what it actually means, and the therapists studied seemed to understand holism and enact it in different, sometimes contradictory, ways.
Abstract: The profession of occupational therapy is said to have underpinnings of holistic, humanistic, and client-centered values. How does this claim translate into practice? This article reports on a qualitative study in which the practice experiences of 12 occupational therapists in the United Kingdom were explored. Through phenomenological analysis of interviews and participant observation data, the findings revealed that although holism is indeed valued, considerable uncertainty exists about what it actually means. The therapists studied seemed to understand holism and enact it in different, sometimes contradictory, ways. Further, each therapist's practice could be simultaneously reductionistic and holistic, depending on the perceived needs of the situation. Therapists struggled to negotiate the tensions between beliefs and practices and to cope with their uncomfortable feelings when they did not achieve their ideals. Although the occupational therapists in this study strove to be person-centered, the demands of their work context pushed them to be pragmatic and strategic.

Journal ArticleDOI
TL;DR: Aspects of relationship work specifically related to conducting ethnography with children, within the communities in which researchers live, and within the practice of occupational therapy are discussed.
Abstract: Ethnographic research involves the creation and ongoing renegotiations of relationships between researchers and informants. Prolonged engagement contributes to the complexity as relationships deepen and shift over time and participants accumulate a substantial reservoir of shared experiences. Reflections about the relationships we have co-constructed with informants in several research projects have contributed to our identification of several critical aspects of building and maintaining researcher-informant relationships in cross-cultural research. Aspects of relationship work specifically related to conducting ethnography with children, within the communities in which researchers live, and within the practice of occupational therapy are discussed.

Journal ArticleDOI
TL;DR: A review of the research designs used to study MS suggests that more rigorous research is necessary to fully understand treatment effectiveness and more research must be done to establish the effectiveness of occupational therapy treatment at the life role level.
Abstract: This article provides a meta-analysis of the current best evidence for the use of occupational therapy with clients with multiple sclerosis (MS). A review of the literature identified 23 articles that examined the effectiveness of occupational therapy-related treatments on clients with MS. Meta-analytic analysis suggests that occupational therapy-related treatments were effective in treating the deficits associated with MS (r = .52), particularly for outcomes in the capacity and ability (r = .52; e.g., muscle strength, range of motion, mood) and task and activity (r = .57; e.g., dressing, bathing, ambulation) levels. A review of the research designs used to study MS suggests that more rigorous research is necessary to fully understand treatment effectiveness. Further, more research must be done to establish the effectiveness of occupational therapy treatment at the life role level.

Journal ArticleDOI
TL;DR: The Roho cushion was more effective in relieving pressure at the seating surface than the Jay and Pindot cushions.
Abstract: Objective Previous studies have suggested that no single wheelchair pressure-relieving cushion material was optimal for all persons with spinal cord injury (SCI). The purpose of this study was to compare the effectiveness of the short-term pressure-relieving ability of the three most commonly prescribed wheelchair cushions (Roho, Jay, Pindot) for a person with SCI. Method The number of pressure sensors registering at the buttock-cushion interface during wheelchair sitting was measured by the Xsensor Pressure Mapping System after 5 min of sitting. An alternating treatments research design, with an initial baseline and a final treatment phase ending with the most effective cushion for relieving pressure, was used for the clinical evaluation. Measurements were compared using visual inspection and a Wilcoxon signed ranks test. Results Data analyses indicated that the number of pressure sensors that registered potential harmful levels of pressure at the buttock-cushion interface for the Roho cushion was significantly less than those of the Jay and Pindot cushions. Conclusion The Roho cushion was more effective in relieving pressure at the seating surface than the Jay and Pindot cushions.

Journal ArticleDOI
TL;DR: It is proposed that occupational concerns become the primary consideration guiding the selection of assessments, and three broad strategies to evaluate the use of available assessments within occupation-based evaluations are outlined.
Abstract: In the early 1990s, occupational therapists were challenged to refocus their evaluation processes. Specifically, they were urged to focus on their clients’ abilities to do what they want and need to do and to carry out meaningful occupation rather than evaluating the components underlying occupational performance problems (Fisher, 1992a, 1994a; Law et al., 1994; Mathiowetz, 1993; Trombly, 1993). Subsequently, the call for occupation-based assessment has been repeated and amplified (cf., Baum & Law, 1997; Coster, 1998). Several compelling rationales for this refocusing have been offered. First, evaluations that do not focus on the occupations that clients find problematic will not communicate the purpose of occupational therapy to clients or colleagues and, thus, will contribute to confusion and dissatisfaction with occupational therapy services (Fisher & ShortDeGraff, 1993; Trombly, 1993). As Baum and Law (1997) noted, clients need to understand the purpose of occupational therapy and its potential outcomes as much as therapists need to understand clients’ occupational performance problems. Failure to communicate the purpose or anticipated outcomes of intervention would, in effect, compromise the principles of client-centered occupational therapy because clients cannot fully engage in processes they do not understand (Pollock & McColl, 1998). In addition, failing to communicate the purpose of intervention is contrary to the increasing consumer demand that any evaluation of function is both relevant and useful to the person being assessed (Batavia, 1992). A second area of concern is which aspect of a client’s performance to measure. Until recently, occupational therapists assumed that a strong correlation exists between performance components and occupational performance. Based on this assumption, evaluation of the components that underpin performance appeared to provide a good basis for intervention. A growing body of research, however, has revealed that improvement in performance components does not automatically translate into improved occupational performance (Fisher, 1992b; Mathiowetz & Haugen, 1995; Schmidt, 1988; Trombly, 1995, 1999). Thus, an increase in concentration span, for example, may not carry over into improved performance of work tasks. A third concern is that occupational therapists who focus their evaluations solely on performance components risk focusing treatment around those components, thus failing to address critical occupational issues. These issues might include, for example, volitional aspects of performance (Fisher, 1992b) or attitudinal, organizational, or physical environmental barriers to occupation (Roulstone, 1998). As Kielhofner (1993) argued, therapists’ attention can become diverted from the person who has the condition to the medical condition itself. In addition, evaluations that focus on performance components are unlikely to reveal clients’ capabilities and adaptive strategies or to contribute to understanding the interaction between people and their environments (Mathiowetz, 1993). Overall, a consensus seems to be developing that evaluations that focus directly on occupation are most true to the basic concepts of occupational therapy (Coster, 1998; Fisher, 1992a; Gillette, 1991; Trombly, 1993). The complexities of implementing occupation-based assessments, however, have received little attention. This article suggests that conceptualizing occupation in terms of meaning, function, form, and performance components may provide a useful framework to guide clinical reasoning about what to assess. I propose that occupational concerns become the primary consideration guiding the selection of assessments, and I outline three broad strategies to evaluate the use of available assessments within occupation-based evaluations. These strategies are presented in Figure 1. An assumption underlying the discussion is that occupational therapy evaluations and interventions are guided by theory. Examples of the influence of theoretical frameworks on clinical reasoning are incorporated throughout the discussion.

Journal ArticleDOI
TL;DR: In this paper, the authors describe the transition from manual to powered mobility and its influence on occupational performance (organization of daily tasks, assumption of responsibility, roles, interests) and feelings of competence, adaptability, and self-esteem.
Abstract: OBJECTIVE This quantitative study describes the transition from manual to powered mobility and its influence on occupational performance (organization of daily tasks, assumption of responsibility, roles, interests) and feelings of competence, adaptability, and self-esteem. METHOD The Occupational Performance History Interview (OPHI) was used with a convenience sample of 8 participants with both static and progressive conditions to measure retrospectively changes in occupational performance after the change from a manual wheelchair to a powered mobility device (PMD). The Psychosocial Impact of Assistive Device Scale (PIADS) was used to measure participants' perceptions of the impact of the PMD on their competence, adaptability, and self-esteem. RESULTS A comparison of the pretest and posttest means on the OPHI scores showed a significant improvement in occupational performance (p = .001) after the introduction of PMDs. The PIADS scores showed a positive impact of 2 or greater for 75% of the participants on 19 of 26 items. Scores were similar to scores in a PIADS database of persons with comparable conditions. No significant relationship between occupational performance and psychosocial impact was demonstrated. CONCLUSION Results suggest that the transition to a PMD enhances occupational performance, competence, adaptability, and self-esteem for persons with severe mobility impairments.

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TL;DR: Type of MS and seeing an occupational therapist were the two strongest predictors of possessing assistive devices among respondents.
Abstract: Objective This study describes the types of assistive devices in the possession of persons with multiple sclerosis (MS) and identifies factors that best predicted the probability of possessing these devices. Method A secondary analysis using frequency distributions and logistic regression of existing cross-sectional data was completed. Data were from an anonymous mail survey of members of the Multiple Sclerosis Society of Canada (Atlantic Division) (N = 906). Results Mobility aids and grab bars were the most commonly reported assistive devices. Seeing an occupational therapist, not working, having a progressive type of MS, having more activity limitations and more symptoms, and having MS for a longer period were found to increase the probability of possessing assistive devices. Conclusion The descriptive results of this study are similar to studies of assistive technology use by older adults and persons with other chronic conditions. Type of MS and seeing an occupational therapist were the two strongest predictors of possessing assistive devices among respondents.