American Journal of Occupational Therapy

OBJECTIVES. Using a taxonomy of object play, this study describes methodological issues in using retrospective video analysis and computer-based coding as a research tool for early identification of autism.

METHOD. Home videos of 32 infants with autism (n = 11), developmental delay (n = 10), and typical development (n = 11) were edited and analyzed for duration and highest level of object play in four hierarchical categories (exploratory, relational, functional, symbolic) using The Observer 3.0.

RESULTS. The three groups had similar levels of engagement with objects, and no statistically significant differences in duration of exploratory play. Higher levels of play were rarely evident at 9–12 months, however, the highest level achieved (functional play) was apparent only in the typical group.

CONCLUSION. This study provides the first naturalistic investigation of object play skills in infants with autism ages 9–12 months. It also demonstrates feasibility for using computer-based coding technology within the context of retrospective video analysis methods. Duration of exploratory play was not a discriminating feature of autism at this early age.

OBJECTIVE. The purpose of this study was to explore current conceptualizations of clinical reasoning in occupational therapy.

METHOD. Using a head-mounted video camera and debriefing interviews following therapy sessions, clinical reasoning data were collected from 13 experienced occupational therapists working in physical rehabilitation. The data were collected and analyzed within a focused ethnographic framework.

FINDINGS. Mattingly and Fleming's (1994) classification of clinical reasoning encompassed most of the thinking processes revealed in the therapists’ debriefing interviews. Therapists also used aspects of pragmatic reasoning (Schell & Cervero, 1993). Additionally, within the forms of procedural, interactive, conditional, and pragmatic reasoning, a new form of “generalization reasoning” is proposed in which therapists draw on past experience or knowledge to assist them in making sense of a current situation or client circumstance.

CONCLUSION. This research builds upon previous classification systems to support the categories of narrative, procedural, interactive, conditional, pragmatic (practice context), and generalization reasoning to explain how occupational therapists think in action. Further research is required to explore this emerging description of clinical reasoning.

The ability to effectively communicate thoughts, feelings, and identity to others is an important aspect of occupational performance. The symptoms of Parkinson’s disease can impair a person’s ability to verbally and non-verbally communicate with others. In order to better understand issues of communication functioning for this population, research tools to describe expressive and communicative behavior during occupation and social interaction are needed. In this study, six persons with Parkinson’s disease participated in individual, videotaped interviews focused on problem solving during daily activities. Three trained graduate students viewed edited clips from the videotapes and completed a rating scale of expressive behavior designed by the authors. Data support the reliability and construct validity of the behavioral rating scale, suggesting that measures of expressive behavior of persons with Parkinson’s disease can be effectively derived using short segments of videotaped activity.

OBJECTIVE. Student academic performance (grades) has traditionally shown a weak correlation with clinical performance (supervisor ratings). A computer-based interactive video client evaluation program was created to determine whether the decision making of occupational therapy students on a client simulation explained variability in fieldwork supervisor ratings not accounted for by grades.

METHOD. Two student cohorts (N = 43; N = 30) selected evaluation procedures for a client with a cerebrovascular accident from on-screen menus and recorded and interpreted client responses as shown on videodisc. Multiple regressions were calculated in which grades and simulation scores were used to predict fieldwork supervisor ratings.

RESULTS. In cohort 1, grade in a physical disabilities course predicted 31% of the variance in supervisor ratings, whereas the simulation score for “completeness” accounted for an additional 12%, F(2, 39) = 16.75, p < .0001, adjusted R ² = .434. Students with better grades received higher ratings, whereas students who evaluated the simulated client less exhaustively received higher ratings. For cohort 2, fieldwork ratings were best predicted by a combination of several simulation efficiency scores (number of correct answers given per unit time), F(4, 21) = 6.17, p < .002, adjusted R ² = .453. Mostly, higher efficiency scores were associated with higher supervisor ratings.

CONCLUSION. Video simulations of client encounters may measure decision-making skills not measured by grades, in particular, making correct decisions in a timely manner within a realistic context.

OBJECTIVE. The purpose of this study was to examine qualities of caregiver–child interactions during daily activities of healthy children born full-term and of children born prematurely and very low birth weight with and without white matter disorder.

METHOD. Three groups of 12 caregiver–child dyads, representing three levels of child biological risk, were matched on birth history, maternal education, ethnicity, and child gender. Ten expert clinicians used videotapes to rate behaviors of caregivers and their 30-month-old children engaging in dressing and snack activities. Correlations between ratings of three qualities were examined: caregiver directiveness, caregiver engagement, and child engagement.

RESULTS. There were no significant differences between groups for the average caregiver and child ratings. However, correlations between caregiver directiveness and caregiver engagement ranged across the three groups from greatest to least biological risk (i.e., r = .63, .35, –.67, respectively). In the full-term group, correlations between the caregiver qualities of directiveness and engagement and child engagement were r = .62 and –.69, respectively. In contrast, the correlations between the caregiver and child qualities were small in the two very-low-birth-weight groups.

CONCLUSION. Results suggest patterns of caregiver interactions during daily activities may vary according to the child’s level of biological risk. Caregivers of children with the greatest risk (i.e., white matter disorder) were both engaging and directive of their children during the activities, whereas caregivers of full-term children were less engaging when directive. The findings suggest that caregivers may be adjusting the level of their social and emotional assistance during caregiver–child interactions to the level of their children’s abilities.

Occupational therapists who work with young children routinely evaluate self-care and consider it an important domain of practice. Little is known about what children perceive is important self-care or what they experience as self-care within a school context. Without knowledge about children’s perspectives of self-care, occupational therapists cannot know whether or not they are targeting areas that are central to children’s needs. The purpose of this naturalistic study was to explore 6-year-old children’s perceptions of self-care in their school day. Participant observation and group interviewing were used to elicit descriptive information from 24 Grade One children, attending an elementary school located in Sydney, Australia. A fishing game, drawing activity, and excerpts from a videotape of their day at school were used as stimuli to explore how the children described and attributed meaning to their self-care occupations. Findings showed that children described self-care at school two ways. First, they named specific self-care tasks that mirrored adult views of self-care and represented culturally shared views of the concept of self-care across ages. Second, children described highly individual views about self-care that were derived from their own experience of doing self-care at school. These views seemed to be based on their personal perceptions of salient factors in operation at the time of self-care performance such as social and physical contexts, perceived skill, and expectations of others. The findings suggest that occupational therapy assessment and intervention for self-care include sensitivity to experiential differences between adult views of self-care and those of children. This sensitivity should include an attempt to understand children’s experiences of self-care in specific contexts such as school.

The death of a loved one disrupts family-members’ occupational lives. This paper explores the role and course of occupation during a time when my nephew died. A qualitative research methodology, autoethnography, is used to develop the narrative. I found that familiar occupations lost meaning during this time and even seemed absurd. Paradoxically, occupation helped forge a vital pathway back to health and reconstruction of meaning. Four stages of occupation during a family crisis are proposed: maintenance, dissolution, ambivalence, and restoration and adaptation. Reflections on occupational therapists’ role during family crises are discussed, as are implications for further research.

The purpose of this descriptive study is to investigate the perceptions of occupational therapists working in school-based settings regarding their level of preparation for practice. The Survey of School-Based Practice was mailed to 1,102 occupational therapists working in school-based practice (SBP) throughout the United States. The mailing was based on a random sampling of 20% of the School System Special Interest Section of the American Occupational Therapy Association. Results were based on 450 returned completed surveys representing a response rate of 41%. The results were analyzed according to the respondents years of experience in SBP, entry (less than 3 years), transitioning from another practice setting with less than 1 year in SBP, and experienced with 3 or more years experience in SBP. The results indicated the majority of occupational therapists perceive themselves to be poorly prepared for this practice area based on entry-level education alone. Statistically significant differences were seen between continuing education needs and level of experience in SBP. Continuing education and mentoring were most often listed by therapists as preparing them for SBP. Implications for the profession are discussed.

OBJECTIVES. This prospective longitudinal study aims to determine which simulated driving tasks of a personal computer (PC)-based driving simulator can be used to identify problematic older drivers, using their 3-year driver violation points record as the outcome measure.

METHODS. A total of 129 urban community-dwelling older drivers volunteered to participate in the study. Using a driving simulator, specific driving tasks were devised to test the performance of older drivers. Their officially recorded driver violation points were retrieved immediately after the simulated driving assessment and thereafter for the following 2 years. Self-reported driving records were also collected during the same period. Hierarchical Poisson regression analysis, adjusting for gender, age, and driving exposure (hours of driving per week), was then undertaken to determine those driving tasks that affected the frequency of traffic violations.

RESULTS. All participants incurred at least one driver violation point during the 3-year period. The simulated driving tasks found to be significantly associated with the incidence of traffic violations were working memory and use of indicator.

CONCLUSIONS. This longitudinal study demonstrated that the driving simulator was able to identify unsafe older drivers at risk of traffic violations if appropriate simulated driving tasks were used. Such a screening tool should be adopted prior to administering a more detailed but expensive road test.

Although occupational therapy services have been rendered in prisons historically, only one occupational therapy program currently exists in a county jail: the Allegheny County Jail Project (ACJ Project). The offenders who populate county jails experience occupational deprivation. The participants of the ACJ Project have benefited from occupational therapy intervention that was initiated during incarceration and continued following their release from jail in order to help them resume productive life roles and to reduce the reoccurrence of engagement in criminal behaviors (recidivism rate). As of June 2003, the ACJ Project has successfully affected the lifestyle patterns of its participants and overall public safety by helping 63% of participants secure gainful employment and by helping 91.8% of participants maintain their freedom after prison. The purpose of this report is to describe the process and benefits of implementing fieldwork opportunities for Level II occupational therapy students in a best practice occupational therapy program in a nontraditional environment: a county jail.