WORK: A Journal of Prevention,Assessment & Rehabilitation

The interaction that occurs between individuals and their environment is central to all work and rehabilitation practice. In the past, rehabilitation has focused more on facilitating personal adaptation and less on understanding the influence of the environment on behavior. Eight person-environment models, developed by other disciplines but of relevance to rehabilitation, are presented and discussed. The way in which each of these models views the person, the environment, the person-environment relationship, and adaptation is compared and contrasted to views inherent in rehabilitation practice. The literature suggests that rehabilitation is gradually moving from an interactive perspective of person-environment fit toward a transaction view that more accurately acknowledges the complexity and the entwined nature of these issues.

The majority of poor people in the United States are women. This article discusses the causes and occupational limitations of being a poor woman in affluent America. The inequality women face at work and the impact of the welfare institution are both central issues in the proliferation and feminization of poverty. Occupational therapists treating poor women must be aware of the implications poverty has on occupational choices. As they seek to enhance the lives of poor women, therapists must be prepared to assist them in specific struggles of oppression, budgeting, parenting, self-esteem, and work and in the use of the social welfare system. This paper offers information and questions to occupational therapists who work with women living in poverty.

Title I is the employment provision of the Americans With Disabilities Act (ADA). Mental Illness is one category the ADA includes under its term mental impairment. This paper provides background on the ADA and discusses common functional limitations for individuals with psychiatric disabilities, as well as possible reasonable accommodations an employer may be required to provide under the law.

This paper is based on a keynote address “The Just Right Challenge” given on October 14, 1993, at Massachusetts Association for Occupational Therapy Annual Conference in Marlborough, MA. The occupational therapy profession is accountable to the society it serves. This paper outlines some key internal and external influences affecting the profession as it prepares for the next decade. Internal influences include the sphere of expertise, role clarification, and competencies. External influences include the use of service extenders, cross training, and practice parameters.

The trend in developing return-to-work services and/or injury-prevention education programs has become a focus in marry hospital-based rehabilitation programs and physical therapy private practices during the past decade. Occupational therapy practitioners are well prepared for contributing to these programs. One of the three areas of occupational performance defined in the occupational therapy literature is “work”. Facilitating maximum independence, preventing further disability, and promoting health are areas occupational therapy practitioners always consider, regardless of the injury or illness. This article discusses industrial rehabilitation programs and the role of occupational therapy practitioners participating in such programs.

A correlational study was carried out to consider whether a program based on a work-hardening paradigm would result in objective improvements in return-to-work rates relative to a functional-activities approach. Subjects, 165 nurses, were obtained from the Alberta Workers' Compensation Board Rehabilitation Centre client files. The clients were described relative to their age, accident-to-admission times, length of stay, and other relevant measures. A logistic regression was carried out to ascertain whether a work-hardening program versus a functional-activities program would be more effective in facilitating return-to-work rates. The logistic regression was carried out controlling for other relevant predictor variables. The results indicated that clients who received a work-hardening program were statistically more likely to return to work.

This paper describes the results of the program-development phase of the Vocational Training Facility (VTF) taking place at the Palo Alto Veterans Affairs Medical Center Rehabilitation Research and Development Center. The VTF staff has developed a self-paced, multimedia curriculum comprised of adapted training packages, interactive videos, and additional training and testing materials designed to teach entry-level desktop publishing and reasonable accommodation skills to individuals with spinal cord injuries. The curriculum is taught via the Macintosh^™ computer to allow independent, “hands-off” access to training materials. Each student is given an integrated workstation that is equipped with the Desktop Vocational Assistant Robot (De VAR); a set of low-and high-technology assistive hardware, software, and devices; and ergonomic furniture and adaptations customized to fit individual learning and access needs. Each student completes a 12-week, full-time training program followed by a 3-month internship with a local corporate sponsor. This paper summarizes the evaluation results of the VTF program by the first nine students, with spinal cord injuries ranging paraplegia to high-level quadriplegia, who have completed the program.

Computer technology has enabled the DCH Outpatient Hand Therapy Clinic to formulate specialty evaluations and forms as well as perform a commercially developed comprehensive hand evaluation. Computers have the capability of creating attractive, diverse, and practical products in much less time and with more accuracy than when manually generated. We have learned that even the most inexperienced computer user can become proficient. Technology, creativity, and necessity have allowed us to expand beyond the EVAL^® to word processing, form generation, and data-base management.

Driving skills are sometimes overlooked in the learning-disabled child's development until late adolescence or early adulthood. This late consideration of a complex skill may present an overwhelming challenge to a developmentally delayed individual. A case study of a successful learning-disabled driver suggests that childhood predriving skills, specialized training, and an integrated network of resources help to ensure the learning disabled driver's success.

Preemployment screening tests have been analyzed in the past for their validity and predictability. This study (for a specific work population) demonstrates correlation between a control group and the tested group of workers which effectively assesses the probability of injury. In the study, 17 variables were utilized to determine the classification of a prospective worker into a high risk or a low risk group with strong statistical significance.

Most of us hold opinions on contemporary issues in work practice, in all its broad dimensions. “Sounding Board” is a regular feature of this publication, designed to provide a forum for expressing such views, whether mainstream or controversial.

The opinions expressed in this section may not necessarily represent the views of the editor, the publisher, or the editorial board but are intended to stimulate discussion or to provoke a response. Readers who wish to comment on the ideas put forth in “Sounding Board” should address their comments to the editor.