American Journal of Occupational Therapy

OBJECTIVES. Objectives of this study were to examine similarities and differences in physical recovery and psychosocial adaptation, engagement in occupations and relationships, perceived outcomes and expectations, and adaptive issues and strategies of 5 participants from an ongoing longitudinal study of adaptation to hand injury.

METHODS. Participants were tracked for 12 months using quantitative measures of physical recovery and psychosocial adaptation, and qualitative adaptation interviews focused on the impact of an injury experience in clients’ daily lives. A computerized graphic format documented changes over time in key quantitative and qualitative indicators in individual Adaptation Trajectories.

RESULTS. Findings included the importance of motivating occupations and relationships, changes over time in expectations for the future, and differences between independent and interdependent adaptive strategies following hand injury.

DISCUSSION. Connections between the International Classification of Functioning and Disability domains of body systems, activity capabilities, and social participation were examined. Findings support the value of individualized, occupation-based therapy that addresses the mind and spirit as well as physical recovery in occupational therapy practice with hand injury clients.

The purpose of this phenomenological study was to explore the experiences of occupational adaptation among a small number of older Dutch persons with physical disabilities. Occupational adaptation was tentatively defined as overcoming disabling influences on occupational functioning. Eight occupational therapy clients, who were living in the community, were interviewed using an open in-depth interview format. A phenomenological analysis resulted in descriptions of occupational adaptation as a process that required these clients’ active engagement. The clients recruited already familiar problem-solving strategies and personal resources as well as resources in their social and physical environments to identify prospects of potential solutions and to create solutions to overcome constraints on occupational functioning. Furthermore, participants strived for finding satisfaction through occupations, a meaning theme which emerged as the object of occupational adaptation. Satisfaction through occupations was found in maintaining daily routines and engaging in fulfilling occupations.

OBJECTIVE. In clinical practice, occupational therapists identify characteristics or demands of a task and, to improve coordination or problem solving ability, grade it along the complexity dimension. Effects of increased complexity of functional tasks have not been studied to date. The purpose of this study was to continue to examine the characteristics of occupation by testing the effect of task complexity on motor performance in elderly people.

METHOD. A counterbalanced repeated-measures design was used. Twenty-eight elderly people without motor problems (9 men, 19 women) performed checker game moves ranging from one to four steps. Only the first segment of movement from start position to the first designated place was kinematically analyzed and compared among the four conditions because it has been shown in earlier studies that differences in strategy are apparent from the first segment.

RESULTS. Generally, the more complex moves elicited higher peak velocity (indicating greater force employed, F [3,72] = 3.45, p = .0210) and more movement units (indicating a less smooth and less efficient movement, F [3,72] = 4.71, p = .0047) than a simple move.

CONCLUSION. The results indicate that in this study, task complexity affects forcefulness and smoothness of motor performance, supporting the practice of activity analysis and gradation along the complexity dimension in occupational therapy. When treating elderly people in clinics, therapists may increase the number of steps within a task to facilitate the force embedded in movement, or decrease the number of steps to facilitate smooth and economical movement.

Culture influences occupation as well as perceptions of health, illness, and disability. Therapists are aware of the need to address culture in interventions. However, definitions of culture can be unclear, providing little guidance to therapists about how to recognize its effects in therapeutic encounters. A pragmatic definition of culture as emergent in everyday interactions of individuals encourages reconsideration of the main elements of culture, that it is learned, shared, patterned, evaluative, and persistent but changeable. Understanding of culture as emergent in interaction, including therapeutic intervention, suggests three important characteristics that therapists can cultivate to enhance clinical encounters: careful attention, active curiosity, and self-reflection and evaluation.

You can observe a lot by watching.

Culture not only assigns a name to occupation through its language, but it also shapes the form it takes and the meaning with which it is imbued. When an individual chooses an occupation, psychological and physical concerns as well as cultural practices, values, and beliefs come into play. Although occupational therapists are trained to be culturally competent, their grasp of the importance of cultural considerations can be enhanced through detailed accounts of the way in which such concerns affect clinical practice. In this paper, I describe in detail my observations of how differences between American and Japanese culture have created tensions in occupational therapy practice in Japan. Further, largely through a case presentation, I illustrate the necessity for incorporating in-depth cultural considerations as a central part of the occupational therapy process. I argue that the study of culture and the production of culture-specific occupational therapy theories will contribute to best practice. I conclude by demonstrating that universal as well as culture-specific theories are needed to nurture occupational therapy.

OBJECTIVE. The purpose of this study was to describe the factors that led elementary school teachers to refer students with handwriting difficulties to occupational therapy, the criteria they used to determine acceptable handwriting, and the handwriting outcomes they looked for after occupational therapy services.

METHOD. A paper questionnaire composed of 31 close-ended questions was mailed to 400 first- through fourth-grade regular education teachers from 32 states to collect data from the 2000–2001 school year. The data were analyzed descriptively using frequency counts and converted to percentages.

RESULTS. Information was obtained from 314 teachers. The main factor for handwriting referral to occupational therapy was that the student was not improving with classroom assistance alone. Teachers chose not being able to read student's writing as the main criterion they used to determine if the student's handwriting was acceptable, and increased legibility was the most important outcome they desired following occupational therapy services for handwriting remediation.

CONCLUSION. The perceptions of regular education teachers on problems with handwriting can provide valuable information to occupational therapy practitioners when providing consultation and direct services related to handwriting in schools.

PURPOSE. To determine whether there is a correlation between handwriting and keyboarding speed and accuracy, and whether handwriting and keyboarding share common underlying components.

METHODS. Sixty-three typically developing 5th-grade students attended a series of 15 keyboarding lessons for a total of 5 hours. Prior to the lessons, cognitive, sensory, and motor skills related to handwriting were evaluated. Prior to and following the lessons keyboarding and handwriting accuracy and speed were also tested. Correlations were employed to examine relationships between handwriting and keyboarding skills and multiple regression analyses were used to examine the contribution of performance components to handwriting and keyboarding performance.

RESULTS. Following keyboarding instruction, a significant correlation was found between handwriting and keyboarding speed, but not in accuracy of these tasks. Similarly, some of the specific tests measuring tactile and oculo-motor functions were found to be related to both handwriting and keyboarding speed, yet accuracy of these tasks did not share common underlying components.

CONCLUSIONS. It appears that handwriting and keyboarding accuracy may entail different skills, suggesting that keyboarding may be a potential alternative writing tool for students with handwriting difficulties. It also appears that when students write slowly, handwriting speed should be considered prior to recommending keyboarding for these students. Additional research is required to further support these findings.

OBJECTIVE. The purpose of this study was to examine the relationship between visual inattention and daily life performance in people with Alzheimer’s disease.

METHODS. Twenty persons with Alzheimer’s disease (Mini Mental Status Exam [MMSE] > 20) and 21 community dwelling persons (MMSE >26) voluntarily participated in this study. One line bisection test and two cancellation tests were used for testing attention abilities. The Functional Spatial Abilities Questionnaire (FSAQ), the Disability Assessment for Dementia (DAD), and the behavioral subtests of the Behavioral Inattention Test (BIT) were used to assess daily functioning. The presence of visuospatial neglect in people with Alzheimer’s disease was determined by comparing performance on the three attention tests with the control group.

RESULTS. People with Alzheimer’s disease who omitted more targets on the symbol cancellation test showed more deficits on the behavioral subtests of the BIT (p = .02). They also used less systematic searching strategies (p = .001), spent more time looking for targets (p = .001), and made more commission errors (p = .007) than controls on the cancellation test. However, those with Alzheimer’s disease who had visuospatial neglect did not differ from those without neglect on the FSAQ, DAD, and most of the BIT behavioral subtests.

CONCLUSION. People with Alzheimer’s disease have visual inattention problems; however, visuospatial neglect did not interfere with their performance in daily activities as measured in this study. Further research focusing on the relationship between visual attention and daily life function as the disease progresses is suggested.

This paper describes the development of an instrument, the Client-Oriented Role Evaluation (CORE), to help meet the needs of rehabilitation clients and clinicians in their joint efforts to define realistic and meaningful therapeutic goals. The CORE is based on a model that captures the relationship among identity, roles, constituent occupations, and personal and environmental determinants. The model encourages a comprehensive approach to examining role change and role loss that occurs with disability. The instrument consists of a series of steps in which role changes are identified, role values are assigned, and satisfaction with role performance is rated at different points in time across the rehabilitation process. A description of the CORE development is presented along with preliminary data from clients involved in a chronic pain rehabilitation program.

The purpose of this qualitative study was to gain understanding of the lived experience of senior stroke survivors who used prescribed wheelchairs in their homes and communities. The study involved semistructured, in-depth interviews that were conducted with 10 participants, ages 70 to 80 years old, who had used a wheelchair for a mean of 5.6 years. A constant comparative inductive method of analysis was performed.

Three different categories of acceptance of wheelchair use were identified; reluctant acceptance, grateful acceptance, and internal acceptance. Increased mobility, varied social response, and loss of some valued roles were common to all three wheelchair acceptance categories. Aspects of level of burden, freedom, and spontaneity varied in degree among the three acceptance categories. As the wheelchair provided opportunity for increased continuity in the lives of these stroke survivors, it appeared to be accepted more fully and viewed more positively. Prestroke lifestyle and values need to be carefully considered in order to maximize acceptance of wheelchair use among senior stroke survivors.