American Journal of Occupational Therapy

Autism is increasingly viewed as an expression of an unidentified neurological disorder. Because understanding of neurological dysfunction is basic to evaluation and treatment in occupational therapy, this article provides a comprehensive and critical review of the literature since 1985 concerning the neuropsychology of autistic disorder. The research is categorized into four basic types: (a) neuropsychological testing of functional abilities, (b) treatment studies based on neuropsychological hypotheses, (c) autistic-related diseases and genetic disorders, and (d) neuroanatomical and neurophysiological studies. The research shows a spectrum of neurological impairments within the brain stem, cerebellum, midbrain, and frontal lobe. These impairments are associated with deficits in socioemotional skills, sensory processing, motor planning, and cognitive flexibility. This research suggests that persons with autistic disorder need evaluation and treatment of a wide spectrum of functional deficits.

Spasticity in children with cerebral palsy may inhibit function and reduce progress in therapy. Selective posterior rhizotomy, a neurosurgical procedure, has been found to effectively reduce spasticity in selected cases. The literature suggests that positive changes in upper extremity function results from this surgery. At the Alberta Children’s Hospital in Calgary, Alberta, Canada, all candidates for this surgery are screened by the neuromotor clinic team, which includes an occupational therapist, a speech therapist, and a physical therapist. This paper outlines the specific changes seen in the upper extremity functions of 7 children over a 12-month period following their surgeries. The data collected suggest the children had improved function in activities of daily living, play skills, balance, and endurance. This paper focuses on the changes in activities of daily living and recommends future direction for research in this area.

Forty-six graduate students participated in a study to investigate the effect of elbow position on grip-strength measurements. Sixteen males and 30 females, aged 21 to 46 years, participated in the study. Data collection procedures followed standardized grip-strength testing guidelines established by the American Society of Hand Therapists, with the exception of elbow position. Grip-strength measurements were taken with the elbow positioned at 0°, 45°, 90°, and 135° of flexion. The results showed a significantly stronger grip-strength measurement at 0° of flexion and the weakest grip-strength measurement at 135° of flexion. This study supports the use of a standardized method for hand strength testing. The knowledge that grip-strength measurement is highest when the elbow is fully extended could affect treatment planning.

The purpose of this study was to ascertain the applicability of the Allen Cognitive Level Test (ACL) (Allen, 1982, 1985), developed for use with adult psychiatric patients, to emotionally disturbed children aged 8 to 15 years. The subjects’ performance on the ACL was compared with their performance on two other instruments that measure features of cognition: the Developmental Test of Visual-Motor Integration (VMI) (Beery & Buktenica, 1982) and the Perceptual Memory Task (McCarron, 1984). Pearson product-moment correlations were computed to study the relationships of the ACL, the Perceptual Memory Task full-scale and sub-scale scores, and the VMI raw and age-equivalent scores. The Perceptual Memory Task scores showed little or no correlation with the ACL scores. Correlations of the ACL with the VMI scores revealed moderate but significant coefficients. A relationship between age and ACL score was found. Preliminary data would indicate that the ability of emotionally disturbed children to function in the school environment depends on their mastery of task demands and that occupational therapy intervention cannot be based solely on age or level of intelligence.

The purpose of this paper is to provide educators and administrators in higher education with a greater understanding of how the Americans With Disabilities Act of 1990 (ADA) (Public Law 101–336) may affect institutions of higher education and to suggest ways that occupational therapists can assist institutions of higher education to comply with the ADA. When educators attempt to comply with the ADA in systems of higher education, the complexity of universities calls for a model reflective of that complexity. The systems approach to higher education, a model based on the general systems theory, is suggested as such a model. The three essential components of the model – input (i.e., applicants to a university), throughput (i.e., enrolled university student), and output (i.e., the student being graduated) – are acted on by many subsystems of the university. Some of those likely to be affected are application procedures, transportation, housing, dining facilities, and curricula. In planning ways to comply with the ADA, educators in higher education may find that many of these subsystems are required to adapt and make reasonable accommodations for the student with a disability. The model can be used to help identify those subsystems that will be affected by the law and to facilitate planning to comply with the law.

Although occupational therapists most often work with persons to help them adapt to change in their lives, they can also work in systems of higher education and help the systems to plan and implement programs related to the ADA. The most effective programs are usually those that are well planned and designed from a holistic perspective, rather than those that are developed as a reaction to a specific situation or incident, that is, programs that are proactive rather than reactive. By using the systems approach to higher education, occupational therapists can focus on those components and subsystems within a university that may be affected by the ADA and meet the individual needs of a university.

This study examines the ways in which 272 recently certified occupational therapists learned of the profession of occupational therapy and the factors that influenced their decisions to choose occupational therapy as a career. The data were analyzed according to age, sex, and geographic region to identify potential ways to improve recruitment efforts. The results indicated that therapists most often learned of the profession while working in a health care setting. First exposure to occupational therapy was usually through an acquaintance in the profession, a family member, or a friend. The primary reasons for choosing occupational therapy included a desire to help people with disabilities, the promise of challenge and variety, the opportunity to work in a health care setting, and the belief that jobs are plentiful. The factors most likely to dissuade people from the profession were the expense of an education and lack of a clear understanding of occupational therapy.

This article describes the use of The Book of Questions (Stock, 1987) as a tool for assessment and as a catalyst for social interaction in an acute short-term inpatient psychiatric unit. Examples of questions and how they can be used to provide information for the evaluation of personality style and social and interpersonal skills are provided. Group objectives, membership criteria and format, and leadership techniques are discussed. Analysis of the group activity and patients’ responses to the group indicates that a group structured around The Book of Questions facilitates social interaction and is easily transferable to social activities outside of the structured therapeutic group setting and hospital environment.