British Journal of Occupational Therapy

Since the Griffiths Report (1988), the profile of community care has risen. At the same time, economic constraints imposed on the health care system have led to increased pressure on acute hospital beds. This has had an effect on the nature of the occupational therapy service. At the Royal Infirmary of Edinburgh NHS Trust, a move has been taken to address this challenge by setting up an occupational therapy service in the Acute Medical Admission Unit (AMAU). This article examines the role of occupational therapy in this setting and provides details of a 6-month audit. It was identified that occupational therapy in this area enabled people to be discharged home successfully within a 48-hour period and, as a result of the early screening in the AMAU, the assessment of patients in the medical services began on average 3 days earlier.

Arguments about the blurring of roles between the members of multidisciplinary community mental health teams and the generic style of intervention within them are well rehearsed. However, an empirical description of the daily work practice of occupational therapists in this field has not yet been attempted. This article presents a study examining the choices made by 12 therapists in the south east of England when working with their clients. Part 1 reports quantifiable findings on intervention media chosen over a 4-week period, drawn from diary data.

The results revealed diverse patterns of intervention choices. However, an emphasis on anxiety management chosen 295 times (16% of intervention selections), supportive counselling chosen 348 times (18% of selections) and problem-solving discussion with clients about aspects of their daily lives chosen 255 times (13% of selections) emerged. Follow-up interviews explored each participant's rationale for the patterns of practice highlighted by the diaries, which will be illustrated and discussed in part 2.

This is the third of three papers which explores the growing influence of problem-based learning (PBL) within professional curricula. Part 1 documented the emergence of PBL in a climate of world-wide change. Part 2 presented the model of Dimensions of Learner Experience and argued that it offers a framework for broadening current understandings of learner experience on diverse PBL programmes. Part 3 discusses the findings of the study, which extend earlier work around the concept of disjunction in learning, and the notion of enabling and disabling forms in relation to three different understandings of learner stance.

Disjunction is a concept seen by many as a starting point for learning and, in this study, particular issues appeared to arise from PBL, often in the form of paradoxes, which prompted different forms of disjunction. The study concludes by suggesting that the concept of learner stances offers a framework that challenges current understandings of learner experience on programmes that adopt PBL. It argues that PBL may prompt new forms of transition in relation to students' past, present and future constructions of learning and of themselves as learners.

This article describes a qualitative study which aimed to explore the implications of the implementation of the Manual Handling Operations Regulations (MHOR) 1992 for the patient. Ten participants, where the use of a hoist was indicated in view of the MHOR 1992, were interviewed individually in their own homes. Through this method, those aspects influencing acceptance or rejection of the use of a hoist were established and the meanings of the experiences for those individuals were clarified. The results of the study have implications for practice. For some participants, the use of a hoist involved physical, social and psychological levels of response. To implement MHOR 1992 successfully, these issues must be acknowledged and addressed.

This article describes a recent study into the unmet equipment needs of people with restricted growth, carried out by the Bath Institute of Medical Engineering. The study involved selecting a group of people to work with, followed by an exploration of their problems in all areas of daily life. A combination of questionnaires and semi-structured interviews was used to achieve the objective. Information gathered from both the questionnaires and the interviews was collated to form a list of equipment needs and general problem areas experienced by the volunteers. This list was circulated as widely as possible to people with restricted growth with a request to assign a priority rating to each item. The results identified six items of high priority which will be designed at the institute over the next 3 years.

Thirty-five stroke patients were assessed on the Rivermead Perceptual Assessment Battery (RPAB) and three functional activities. The activities chosen had reported constructional components. A checklist was developed to measure a person's performance on the constructional components of each activity objectively. The RPAB results were correlated with those of making a sandwich and packing a lunchbox, putting on a cardigan and setting a table. A statistically significant relationship was found between the RPAB and the selected functional tasks. The results also suggest that a clinical relationship exists between performance on the RPAB and the three tasks, therefore assumptions can be made about a person's performance on these tasks using the results from the RPAB.

The aim of the study was to investigate the use of the Rey figure for screening patients for perceptual impairment following stroke. Stroke patients in a trial of a stroke unit were assessed using the Rey figure copy at entry to the study. Those admitted to the stroke unit were also assessed on the Rivermead Perceptual Assessment Battery (RPAB). In 61 patients assessed consecutively on both tests, using conventional clinical cut-off points the Rey figure copy was impaired in 31 out of 32 patients who were impaired on the RPAB. Fifteen patients who failed the Rey figure did not have perceptual problems on the RPAB, indicating that deficits on the Rey figure are not only due to perceptual problems. A receiver operating characteristic curve was plotted to compare different cut-off points. The Rey figure may be used as a brief screening assessment for perceptual deficits following stroke.

An area often neglected in stroke rehabilitation is patients returning to their normal sexual activity. Generally, this is not discussed routinely with patients as part of their rehabilitation, even though for many it plays an important role in their lives.

An investigation was carried out on the Nottingham Stroke Unit to identify whether stroke patients had been able to resume their sexual activity, what information they would find useful and when this should be given. The results showed that sexual activity generally deteriorated after a stroke and that patients and partners wanted relevant information when the patient started spending time at home or just before discharge. There was variation regardinthe need for private consultation and most patients and partners felt that returning to sexual activity should be considered as part of stroke rehabilitation.