American Journal of Occupational Therapy

Having a work-related identity is central to being an adult in America. Going to work and engaging in prescribed work behaviors in the workplace is the usual or typical way that adults achieve worker identities. The purpose of this study, developed from an ethnography of people who make crafts at home and sell their work at craft fairs, was to examine how worker identity is constructed when individuals do not have the external markers of a socially identified job and workplace. I used participant observation of craft fairs and other craft venues, and interviews of people who do this work, as major sources of data. Results of the analysis of the data related to worker identity demonstrated that these crafters followed basic steps, or rules, to achieve such a worker identity. These rules, some for work at home and some for other social contexts, encompassed complex behaviors learned through the process of doing the work as well as from other crafters. The conclusions of the study are first, that individual and social identity formation as a worker involves complex processes for which rules and guidelines do exist. Second, these rules are often discovered through the process of doing the work. Third, the meaning of work and the individual and social identities of being a worker are individual, and finally, knowledge of worker identity formation is gained through the study of both those who successfully achieve such an identity and those who do not.

OBJECTIVE. The objective of this phenomenological study was to understand the meanings of the lived experiences of persons with long-term mental illness at a social working cooperative.

METHOD. Eighteen participants were interviewed either two or three times while participating in a working cooperative in a community psychosocial rehabilitation program. Data were analyzed and interpreted using the Empirical, Phenomenological, Psychological (EPP) method (Karlsson, 1993).

RESULTS. The findings revealed a meaning-structure consisting of one main constituent that characterized the cooperative as a normalizing life-world. Three phases contributed to the normalization process. In the first phase the participants experienced a shift from an unsatisfying occupational context to an enriching occupational life-world. In the second phase participants had the possibility to satisfy some of their occupational and social needs. During this phase, experiences of being productive and needed, commitment to others, development of their skills, and competence in work tasks and social activities were expressed, all of which contributed to personal growth and a more positive view of self. In the third phase, the meaning of the cooperative changed for some participants, who expressed this through their readiness to leave and take a further step into the life-world outside the cooperative.

CONCLUSION. The study emphasizes that the cooperative is an important alternative to employment for participants with severe mental illness who do not have the capacity to be employed in the community or who do not want to leave the life-world of the cooperative that gives them pride, joy, and satisfaction.

OBJECTIVE. The purpose of this study was to describe the characteristics of play activities and playfulness in a group of Mayan children in southern Belize.

METHOD. This qualitative study involved participant observation in the daily occupations of 20 children from five Mayan families over a 2-week period. Analysis of the field notes, using open and closed coding, revealed themes specific to customs of child rearing, play activities, and playfulness.

FINDINGS. The primacy of adult work is a major cultural principle that influences Mayan children's daily occupations. Parents did not encourage play but permitted play if it did not interfere with work. Children found ways to integrate play activities and playfulness into their daily occupations.

CONCLUSION. The statement, “play is a child's major occupation,” may not be a universally held belief. Parental values and customs of child rearing should be considered in order to provide culturally sensitive and relevant services.

OBJECTIVE. The purpose of this research was to study how the speed and legibility of fourth-grader’s hand writing was affected by type of pencil grip on the Evaluation Tool of Children’s Handwriting-Cursive.

METHOD. Ninety-five typically developing students and 6 students receiving special education services completed the Evaluation Tool of Children’s Handwriting-Cursive (ETCH-C). Photographs were taken of their pencil grips while they wrote the alphabet. One-way ANOVAs were calculated to compare legibility rates and writing speeds by type of pencil grip.

RESULTS. Ninety-nine of the students used one of four pencil grips including the dynamic tripod (38 students), the dynamic quadrupod (18), the lateral tripod (22), and the lateral quadrupod (21). One student used the four-finger pencil grip and one used the interdigital pencil grip. Mean cursive writing speeds were similar for all pencil grips except for the interdigital grasp. Speeds obtained were slower than recently published fourth-grade speeds ranging from a mean of 29.45 to 34.75 letters per minute.

CONCLUSION. This study found the lateral quadrupod and four-finger pencil grips to be as functional as the dynamic tripod, lateral tripod, and dynamic quadrupod pencil grips. This study provides average handwriting speeds for fourth-grade students on the ETCH-C.

Occupational therapists working with infants in neonatal intensive care units (NICUs) make positioning recommendations to optimize self-regulation, with little published data supporting this practice. In this retrospective descriptive study, 15 hospitalized preterm infants (M _{gestational age} = 32 weeks) were videotaped during noncaregiving periods in order to record the frequency of specific behaviors in relation to six infant positions (prone nested, prone un-nested, side-lying nested, side-lying un-nested, supine nested, and supine un-nested). Behaviors coded were those that suggest infant stress or motor efforts at self-regulation, as defined for the original study. Mixed effects regressions and post-hoc Tukey Honestly Significant Difference tests were used to analyze the data, after the calculation of a ratio of the number of behaviors in each position. Higher ratio values reflect a greater occurrence of behaviors.

The number of motor self-regulatory and stress behaviors were related to infant position, with the highest ratios of behaviors observed in side-lying un-nested and the lowest in prone nested. Behavior ratios did not differ between prone un-nested and prone nested, nor between supine un-nested and supine nested. More self-regulatory and stress behaviors were related to longer periods of fussing and crying. Longer periods of light sleep were related to fewer stress behaviors.

Infants performed the fewest stress behaviors in prone nested, prone un-nested, or side-lying nested. These positions may benefit infants in the NICU by reducing the need for motor-based self-regulatory behaviors and potentially conserving energy for growth.

OBJECTIVE. Elderly inner-city women (n = 125) greater than the age of 60 and living alone and who were consecutively admitted to a large, urban, university-based rehabilitation hospital were followed to (a) examine the power of standardized clinical measures to predict who was living alone 18 months after discharge, (b) determine whether live-alone women at 18 months’ follow-up were more independent in instrumental activities of daily living (IADL) than women who were not living alone, and (c) investigate whether women who return home to live alone and have low or declining physical function are at risk for subsequent relocation or death.

METHOD. Data from four standardized assessments (physical function, cognition, comorbidity, and depression) and demographic information were gathered during in-patient rehabilitation. Self-report IADL data were collected via telephone interviews at 3, 6, and 18 months’ follow-up.

RESULTS. Statistical analysis of results showed that physical function, cognition, and comorbidity were significant and independent predictors of living alone at 18 months’ follow-up. Women living alone at 18 months reported significantly greater IADL independence than women who were not living alone. Path analysis confirmed that the relationship between the clinical measures and living situation at 18 months was mediated by self-reported IADL functioning.

CONCLUSION. Standard clinical data obtained at discharge are useful to identify who can return home to live alone after rehabilitation, but in-home assessment of IADL remains key to understanding the complex skills required to live alone.

OBJECTIVE. Errors occur in all health care professions. Practice errors, however, have not been systematically examined in occupational therapy. The purpose of this study was to examine occupational therapists’ responses to practice errors in physical rehabilitation settings.

METHOD. A qualitative focus group research method was used in this study and a total of 35 occupational therapists from four different states who had practice experience in physical rehabilitation settings participated in four focus groups. Focus group discussions were transcribed verbatim and analyzed by two investigators of the study. Qualitative software program, NUD*IST Vivo was used to aid the data analysis process.

RESULTS. Five major themes were generated from the data regarding practice errors, which included (1) Concept of practice error: It is against our standards; (2) Perceived causes of practice error: Not just an individual matter; (3) Emotional responses: I felt horrible; (4) Impact on practice: Doing things differently; and (5) Management of practice error: Being honest and taking initiative. Occupational therapists perceived practice error from a broad perspective and identified physical and psychosocial issues as practice error.

CONCLUSION. Most practice errors described by participants appeared to be preventable. Despite the tremendous emotional distress in reaction to making an error, participants valued the learning in the experience and made constructive practice changes. Findings of the study have implications for current educational training programs and practice such as the development of clinical reasoning related to patient safety and assertiveness training for hierarchical situations.

OBJECTIVE. Fatigue is a common, troublesome symptom for persons with multiple sclerosis. This study evaluated the effects of an energy conservation course on fatigue impact for persons with multiple sclerosis whose symptoms cause moderate to severe disability.

METHODS. Thirty-seven persons with progressive multiple sclerosis participated in an 8-week experimental energy conservation course treatment and an 8-week control period of traditional treatment using a crossover design. The Fatigue Impact Scale (FIS) was used to assess fatigue impact before and after the experimental and control periods, and 8 weeks post-energy conservation course.

RESULTS. After participation in the energy conservation course, the average FIS total score and physical, cognitive, and psychosocial subscale scores decreased significantly, whereas the total and subscale scores did not change significantly during the control period. Additionally, decreased fatigue impact was maintained 8 weeks after course completion for evaluated participants.

CONCLUSION. This study provides evidence that this energy conservation course can be a beneficial intervention for persons with progressive multiple sclerosis.

OBJECTIVE. The purpose of this study was to validate a laboratory-based driving simulator as an off-road screening tool for older adult drivers by measuring their visual attention skill, and to determine how the visual attention skill changes across time in a 45-minute simulated driving test.

METHOD. One hundred and twenty-nine community-dwelling older drivers volunteered to take part in the study. A range of driving scenarios was devised and implemented in a simulator setting to assess the driving skills of the participants. Visual attention skill, an important contributing factor to motor vehicle crashes, was assessed by the participant's reaction times to a sequence of 14 visual stimuli during the primary task of sustained driving. Repeated measures of analysis of variance (ANOVA) were undertaken to determine the effects of age and gender on the visual attention skill. Trend analysis was performed to investigate how repeated exposures to the visual stimulus affected the reaction time.

RESULTS. The visual attention skill of older drivers was found to decline with age (F _(1,126) = 42.52, p value = 0.002), whereas the effect of gender was not significant. Participants increased their speed of reaction times for the first half of the testing then slowed down during the second half.

CONCLUSION. That visual attention skill declined with age was consistent with the literature, and validated the driving simulator as an effective screening tool for older adult drivers. With rapid advancements in computer technology, the driving simulator will likely play an important role in assisting occupational therapists with off-road assessment of older drivers.

OBJECTIVE. This study investigated the effects of qualitative and quantitative knowledge of results (KR) on the acquisition of a motor skill. It was hypothesized that there would be differences in performance during skill acquisition and retention, depending on the type of feedback given. Qualitative KR was in the form of verbal encouragement and quantitative KR was in the form of an algebraic number representing an error score.

METHODS. Seventy-seven adults were randomly assigned to one of four feedback conditions, Quantitative, Qualitative, Quantitative and Qualitative, and no feedback (Control). Participants learned an isometric force production skill. Data were collected during skill acquisition and retention phases. Computer hardware and custom software were used to collect data and administer the feedback conditions of the independent variable.

RESULTS. There was a statistically significant difference in the Acquisition Phase for the main effect of Condition F (3,73) = 6.35, p < .05, and for Block F (9,657) = 2.07, p < .05, but there was no statistically significant Condition X Block interaction F (27,657) = 1.02, p > .05. Pair-wise comparisons revealed statistically significant differences between conditions containing qualitative feedback and conditions containing no qualitative feedback (p < .05). The main effect of condition was significant F (3,73) = 3.00, p < .05 in the retention phase, however there were no significant pair-wise comparisons (p > .05).

CONCLUSION. The results of this study suggest that in a healthy adult population, qualitative feedback, by itself and when combined with quantitative feedback, resulted in superior skill acquisition, but not in the retention of that skill. The artificiality of the task along with differing modes of feedback (audible versus visual) are two potentially limiting factors to this study. Future research that controls for these factors may yield more definitive findings about the role that qualitative feedback has in improving motor performance and learning.

The purpose of this study was to identify the perceived appropriateness, extent, and types of services provided by occupational therapists to children with emotional disturbances in public schools. A nationally mailed survey was conducted of randomly selected school occupational therapists derived from the American Occupational Therapy Association School System Special Interest Section list. The sampling frame was 982 with a response rate of 48% (n = 476).

Eighty-seven percent of all respondents were supportive of school occupational therapy for students with emotional disturbances, although these students made up only a small proportion of their caseload. The therapists indicated that a variety of intervention approaches were used with most targeting educational areas, especially handwriting. The most commonly reported intervention was sensory integration.

Many respondents perceived that they could not provide effective interventions because they were not appropriately trained. Perceived lack of knowledge and confusion about occupational therapy’s role may lead to underutilization of occupational therapy for addressing the complex needs of children with emotional disturbances. Further research and discussion are needed in the profession to arrive at consensus regarding what approaches are most appropriate and effective in schools.

OBJECTIVE. The purpose of this study was to provide information regarding the validity of using the Allen Cognitive Levels Screen (ACL-90 version) by comparing functional cognitive performance between adolescents living in the community and adolescents residing in mental health facilities.

METHOD. Sixty-three adolescents were assessed using the ACL-90: 32 adolescents living in the community, and 28 adolescents residing in residential mental health facilities.

RESULTS. Using a one-tailed t test, performance scores for adolescents residing in the community were statistically higher than those for adolescents living in residential mental health facilities (t (34) = 4.3, p < .001).

CONCLUSION. This study suggests the validity of the ACL-90 as an assessment to use for screening the cognitive functional performance of adolescents.