American Journal of Occupational Therapy

OBJECTIVE. The purpose of this study was to describe the occupational concerns and goals of mothers who care for children with disabilities.

METHOD. Retrospective data collected from 38 mothers of children with disabilities using the Canadian Occupational Performance Measure (COPM) were analyzed qualitatively.

RESULTS. Six themes emerged: (I) doing and being alone: taking care of my own health and well-being; (II) doing and being with others: expanding my social life; (III) improving my child’s quality of life; (IV) household management: organizing time and resources; (V) balancing work, home, and community responsibilities; and (VI) sharing the workload.

CONCLUSION. Overarching patterns in the data suggested that the occupational performance of mothers of children with disabilities is constrained by time, overlaid by difficult emotions, and involves a desire for increased social contact. Qualitative analysis of data from the COPM may provide insight into contextual factors that affect occupational performance as well as signaling point of entry for therapists to facilitate client-centered occupational goals.

Engagement in two interlinked areas of occupation, familial social participation and caring for my father at the end of his life, led to a journey of self-discovery. A qualitative research methodology, autoethnography, is used to develop a narrative that examines engagement in these two occupations before, during, and after my father’s illness and death. I discuss meanings and purposes of familial social participation and caregiving, suggesting that transforming fear of death to awareness of death is a central purpose of caregiving. Implications for therapists and caregivers include considerations about the value of occupation, discussion of a continuum of caregiving, examination of boundaries when caring for a parent, thoughts about the roles of altruism, love, anger, and “bad faith” in caregiving, and analysis of sons as caregivers for fathers. Further research on meanings and purposes of caregiving is proposed.

OBJECTIVE. To understand parents’ perspectives about the strategies they use to promote social participation of their school-age children with acquired brain injuries (ABI) in home, school, and community life.

METHOD. A descriptive research design employing a semistructured interview format was used. Interviews were conducted in the homes of 16 families of school-age children with ABI discharged up to 7 years earlier from one inpatient rehabilitation program. Data were examined using content and constant-comparison analyses.

RESULTS. Parents needed time to allow the recovery process to unfold for themselves and their children and developed strategies that fit into or assisted with managing family routines. Over time parents developed insight into the activity demands and their child’s potential success to participate in desired activities. Based on these insights, parents used “anticipatory planning,” which involved previewing upcoming events and activities and using strategies to promote positive and prevent negative experiences for their children. Specific strategies that parents used to promote social participation were classified into three categories: Creating opportunities, teaching skills, and regulating cognitive and behavioral function.

CONCLUSIONS. Understanding how families use and integrate strategies within the context of their daily lives and what factors influence strategy use may provide practitioners with insights needed to support families in promoting their children’s social participation.

BACKGROUND. Caring for one’s children is among the most ubiquitous of occupations. However, few studies have examined the ergonomic risks involved in parents caring for children at home.

PURPOSE. The purpose of this study was to identify the frequency, type, and severity of musculoskeletal symptoms in parents of children less than 4 years old. The study further examined the factors that contribute to musculoskeletal pain in this sample.

METHODS. A convenience sample of 130 parents with children younger than 4 years old completed a seven-page survey that included questions related to the parents’ demographics, their musculoskeletal discomfort, their performance of child-care tasks with high biomechanical risks (such as carrying a child in a car seat), and parents’ perceived psychological strain related to caring for their children.

RESULTS. Ninety-two percent (92%) of the providers were mothers. Sixty-six percent (66%) of the sample reported the presence of musculoskeletal pain. The parts of the body most affected were the low back (48%), neck (17%), upper back (16%), and shoulders (11.5%). Factors associated with musculoskeletal pain were performing child-care tasks defined as having high biomechanical risks (p = .001), the perception that caring for children is highly demanding (p = .003), and performing hobbies less than 1 hour per week (p = .04). Parents’ working status, age, and participation in other daily activities were not significantly related to musculoskeletal discomfort.

CONCLUSION. This study demonstrates the high prevalence of musculoskeletal pain in parents of children under the age of 4 years. It underscores the association between physical and psychological factors in the development of musculoskeletal discomfort. It suggests the need for occupational therapy wellness programs that focus on preventing musculoskeletal discomfort and providing support for the parenting role.

OBJECTIVE. To investigate longitudinal changes in activities of daily living (ADL) dependence and aspects of usability in housing among clients receiving housing adaptation grants in Sweden.

METHODS. The ADL Staircase and the Usability in My Home instruments were used to collect data on three occasions: at baseline 1 month before housing adaptation, at follow-ups 2 to 3 months after housing adaptation completion, and after another 6 to 7 months. In all, 131 clients, living in ordinary housing 24 to 93 years of age were consecutively enrolled.

RESULTS. Overall ADL dependence did not change significantly whereas dependence in “Bathing” decreased over time. “Activity aspects” and “Personal and social aspects” of usability improved at different phases in the process.

CONCLUSION. This study delivers new insights about the complexity of longitudinal person–environment–activity transactions, specifically targeting activity and usability. The results are useful for developing efficient strategies for evaluating housing adaptations within occupational therapy practice and research.

The purpose of this study was to describe how older adults with low vision make decisions to use low vision assistive devices (LVADs). Analysis of participants’ narratives, from both group and individual interviews, revealed three topic areas affecting device use. Two are discussed in this paper: Experiences and Characteristics Leading to Successful LVAD Use Decision Making and Challenges to Successful LVAD Use Decision Making. The third, Adjustment to Low Vision Disability, is briefly discussed. Of particular importance to occupational therapy practitioners in the growing field of low vision rehabilitation was the value placed on low vision rehabilitation services to assist with acquiring devices and integrating them into daily routines. Occupational therapy services were highly regarded. Participants demonstrated the importance of becoming a part of a supportive network of people with low vision to gain access to information about resources. They emphasized the need for systems and policy changes to reduce barriers to making informed decisions about LVAD use. Results indicate that occupational therapists working in low vision can support clients by facilitating development of a support network, acting as liaisons between clients and other health practitioners, especially ophthalmologists, and encouraging policy development that supports barrier-free LVAD acquisition and use. These topics should be incorporated into continuing and entry-level education to prepare practitioners for leadership in the field of low vision rehabilitation.

This study used mixed methods to compare four different styles of case presentation in a course designed to develop the clinical reasoning skills of master’s level occupational therapy students. Modalities used to present cases were printed text, videotape, live interview, and CD-ROM movies delivered on an Internet platform. The researchers sought to determine the relative merits and limitations of each modality from both pedagogical and practical standpoints. Results indicate that the choice of modality does not compromise the ability of students to meet learning objectives related to clinical reasoning; however, several advantages and disadvantages with respect to practical aspects of presentation and learning were identified from instructor and student perspectives. The strength of the overall instructional format, and decisions concerning the amount and type of information provided in the cases were found to be more relevant to the quality of the learning experience than the modality of presentation. Recommendations are provided for structuring clinical reasoning learning experiences that combine the best features from the case modalities examined in this study.

The purposes of this paper are two. The first purpose is to contribute to cultural competence in occupational therapy practice. The second is to contribute to occupational therapy literature about culture and cultural analysis related to practice. This paper introduces a cultural analysis of stories about the therapeutic process with two Japanese therapists and their Japanese patients. Two therapeutic situations, including therapists’ and their patients’ experiences, are interpreted by the author, a Japanese occupational therapist, as critical incidents for reflection to improve culture general competence. The stories illustrate the patients’ perception of life with illness and, particularly, the emergence of their cultural values within the therapy process. The analyses focus on how an understanding of the patients’ illness experience is integrated into the therapy process and how the therapeutic interventions reflect the culture. In one case, the therapeutic occupation of cooking links to the meaning found in the traditional Japanese woman’s role. In the second case, the therapist–patient relationship, based on local rather than western social relationships, promoted the patient’s engagement in meaningful occupations. Reflection on these stories, which illustrate an alternative cultural view of occupations and therapeutic relationships, may assist occupational therapists in the development of improved level of cultural competence.

OBJECTIVE. The purpose of the study was to determine if there were significant relationships between dysfunction in sensory modulation, symptoms of affective disorders, and adaptive behaviors in children and adolescents with Asperger’s disorder between 6 and 17 years of age.

METHOD. Parents of 50 children and adolescents between 6 and 17 years of age diagnosed with Asperger’s disorder based on the Diagnostic and Statistical Manual of Mental Disorders-IV criteria completed the (a) Sensory Profile for children 6 to 10 years of age or the Adolescent/Adult Sensory Profile for adolescents 11 to 17 years of age; (b) the Adaptive Behavior Assessment System: Parent Version; (c) Revised Children’s Manifest Anxiety Scale Adapted Parent’s Version; and (d) the Children’s Depression Inventory Adapted Parent’s Version. Descriptive statistics and the Pearson product-moment coefficient of correlation calculations were used for data analysis.

RESULTS. The results indicated that there were significantly strong positive correlations between sensory defensiveness and anxiety (r = .476, p = .000) in children and adolescents with Asperger’s disorder. There were also significant relationships between symptoms of depression and hyposensitivity in the total group (r = .214, p = .05) and the older group (r = .492, p = .027). There were no significant relationships between depression and overall adaptive behavior (r = –.243, p = .089) or anxiety and overall adaptive behavior (r = –.108, p = .455). Significantly strong inverse relationships were found between the specific adaptive behaviors of functional academics, leisure, social skills, and symptoms of depression. Functional academics were also significantly inversely related to anxiety. Specifically, sensory hyper- and hypersensitivity were significantly inversely related to community use and social skills.

CONCLUSION. The data supports positive relationships between anxiety and sensory defensiveness in all age ranges and a relationship between depression and hyposensitivity in older children. Stronger inverse relationships were apparent between specific adaptive behaviors including: (a) symptoms of depression and functional academics, leisure, social skills; (b) anxiety and functional academics; and (c) both sensory hyper- and hyposensitivity and community use and social skills. In this study, as the symptoms of affective disorders increased in children and adolescents with Asperger’s disorder, the functional performance in the adaptive behaviors of functional academics and social skills appeared to decrease. Performance in the adaptive behaviors of community use and socials skills appeared to decrease as symptoms of dysfunction in sensory modulation increase. Further research is necessary to determine the impact of treatment for dysfunction on sensory modulation on affective disorders and performance in specific adaptive behaviors.

This exploratory study focused on gaining insight into the psychological experience of stroke survivors undergoing inpatient rehabilitation. Specifically it investigated whether stroke survivors undergoing inpatient rehabilitation were able to identify any positive consequence of their stroke. This phenomenon, also know as benefit finding or positive reframing, has recently received more attention in the coping literature examining reactions to severe illness.

Using a case series methodology and qualitative analytic techniques, 16 stroke survivors were interviewed using standardized open-ended questions related to identification of positive consequences attributed to surviving a stroke. Sixty-three percent of the patients interviewed were able to identify positive consequences of their stroke. The following five themes regarding positive consequences of stroke emerged from this case series: increased social relationships, increased health awareness, change in religious life, personal growth, and altruism. It was concluded that some individuals who have survived an acute stroke are able to reframe their experience in a positive light. This study provides occupational therapists and others with further insight into the coping mechanisms of those individuals who have survived a stroke. The need for further research is stressed.

Although evidence-based practice is the current practice approach recommended for use in occupational therapy, practitioners often report difficulties in using research evidence because of its content and presentation. This paper discusses a conceptual model that researchers can use to create research evidence that is easier for practitioners to understand and use. The Diffusion of Innovations Theory is used as a framework to identify desirable characteristics that may facilitate practitioners’ adoption and utilization of research evidence. The concepts of social validity, ecological validity, and clinical significance are presented and discussed as ways to create those desirable characteristics that could make research information more usable for evidence-based practice. Examples for implementation of the conceptual model are also discussed.