American Journal of Occupational Therapy

The use of occupation as a therapeutic method is the essence of the profession of occupational therapy. This core of therapeutic occupation is flexible across cultures, times, health care environments, and different philosophies of the nature of the human being. Given this adaptability, the profession espouses diverse models of practice—the multiple frames of reference that guide therapeutic occupation for different populations in different settings. Across the history of the profession, therapeutic occupation has been the common core of otherwise different approaches to intervention. Although each of the many past and current models of practice has a different viewpoint, the common factor is the synthesis of occupational forms designed to elicit meaningful and purposeful occupational performance. Occupational synthesis is the essential act of the occupational therapist. It is necessary that occupational therapists confirm the power of therapeutic occupation through research that examines the profession’s central principles. Occupational therapists are also urged to use the term occupation consistently and proudly in their interactions with recipients of therapy, fellow health care professionals, and each other. The profession of occupational therapy will flourish because occupation, its core, is so basic to human health yet so flexible, depending on the needs of the individual human being.

Objectives. The purpose of this study was to obtain data about a national sample of children without disabilities on the 125-item revision of the Sensory Profile, a tool derived from sensory history items reported in the literature and designed to evaluate children’s responses to commonly occurring sensory events.

Method. Parents of 1,115 children completed the Sensory Profile. The children were 3 to 10 years of age and did not have disabilities. Parents used a 5-point Likert scale to report the percentage of time their children engaged in each behavior Researchers then analyzed the data, using multivariate methods to identify trends in performance and age and gender differences.

Results. Ninety-one (73%) of the profile’s 125 items were found to be uncommon behaviors for this national sample of children without disabilities. Although age and gender differences were significant (p < .001), effect sizes were so small (i.e., below .2) that differences were not meaningful for clinical application (i.e., mean differences less than .5 points). Only two items in the visual category approached a 1-point difference when comparing younger and older children.

Conclusion. There were no meaningful gender differences on the revised Sensory Profile, and only 2 items approached a meaningful difference related to age. Nearly three fourths of the items on the profile were uncommon for children without disabilities. If children with various disabilities display these behaviors, the Sensory Profile can be useful in evaluation and program planning for children with disabilities.

Objective. This study examined the equivalence reliability of two administration methods for the Functional Independence Measure for Children (WeeFlM^®). The two methods were direct observation of child performance and parental interview.

Method. Thirty children between the ages of 19 months and 71 months with identified developmental disabilities were included in this study. The direct observation and interview methods were administered in random order to each subject within a 3-week period. The direct observation was completed in the educational setting, and the WeeFIM interview was obtained by either in-person interview or telephone interview with the parent.

Results. The intraclass correlation coefficient (ICC) for total WeeFIM ratings was .93, indicating consistency between the two administration methods. Analysis of the WeeFIM Motor (13 items) and Cognitive (5 items) domains yielded ICC values of .93 and .75, respectively, suggesting greater consistency for items measuring motor related skills.

Conclusion. The results demonstrate good agreement for total ratings when the WeeFIM is administered by direct observation and by interview with a parent. The findings establish the clinical usefulness of information collected by clinical interview.

Objectives. This study investigated issues related to the use of environmental control units (ECUs) with persons who have spinal cord injury and disease (SCI/D) to ascertain what, if any, changes are needed to optimize occupational therapy service delivery in this area.

Method. A questionnaire was mailed to 120 occupational therapists employed by facilities nationwide that serve persons with SCI/D. The survey addressed the occupational therapist’s role in the recommendation and use of ECUs, funding sources, and training needs. The response rate was 89% (n = 107).

Results. Most respondents (88%) indicated that occupational therapists were the predominant professionals in their facilities who evaluated and recommended ECUs. The majority of respondents (84%) reported using ECUs in hospital-based treatment with persons with SCI/D. However, respondents only recommended ECUs for home use for fewer than 25% of their clients. High cost and the lack of third-party reimbursement were the primary reasons that deterred respondents from recommending ECUs for home use. Fifty-five percent of the respondents reported a need for basic training and 86% for more in-depth education and training in environmental control technologies.

Conclusion. Outcomes data are needed to support the use of ECUs and to educate third-party payers about the benefits of ECUs for clients with quadriplegia in order to increase rates of reimbursement. In addition, occupational therapists themselves may need improved training in evaluating and training clients in the use of ECU technology.

Objective. This study is the first part of a longitudinal investigation of the retirement process. This stage of the inquiry concerned how older persons anticipate their retirement.

Method. Thirty-two workers were randomly selected from all workers age 63 years in a suburb of Stockholm. They participated in semistructured interviews about their work and their expectations for retirement.

Results. The participants’ narratives illustrated the complex work of interpreting the past and expected meaning in one’s occupational life. The narratives, which anticipated widely different future trajectories, revealed many of the challenges and dilemmas of anticipating retirement and the close association of work experience to expectations for retirement. In particular, the narratives highlighted the participants’ concerns about maintaining the quality of experience in activity. The findings also demonstrate the process by which persons anticipate and make choices about life change.

Conclusions. People anticipate retirement through volitional narratives in which they link together past, present, and future. Understanding this volitional process of interpreting, anticipating, and making choices is important to understanding how people adapt to life changes.

Objectives. The Model of Functional Deficits associated with hallucinations is used as part of the clinical documentation in the San Jose State University Psychosocial Occupational Therapy Clinic. On the basis of this model, hallucinations are classified according to functional deficits and whether the deficits are a result of the content or intrusiveness of the hallucinations. This classification is important because it helps occupational therapists know the full extent of the dysfunction through understanding the underlying pathology. The purpose of this classification is to assist in the development of clinical treatment plans that incorporate techniques for coping with hallucinations.

Method. The sample included 39 clients seen in the clinic over a 4-year period. Student occupational therapists were responsible for documenting the classifications using the Model of Functional Deficits associated with hallucinations. The clients’ charts were then reviewed retrospectively to classify the hallucinations according to the clients’ functional deficits. The classification system ranged from Class 0, insufficient information, to Class VI, persistent hallucinations with profound functional deficits. With these classifications, interventions were planned with the clients in order for them to practice coping mechanisms (e.g., self instruction, decreased stimulation, increased stimulation) to maintain function during their hallucinations.

Results. The findings indicated that 54% of the clients continued to experience hallucinations (i.e., Class II–Class V), although all received psychotropic medication, thus necessitating continuing therapeutic intervention.

Conclusion. This model helps identify specific client experiences that can then be used to develop occupational therapy interventions.

Objective. Whether the environment is stressed in function–dysfunction decisions appears to depend on where in the hierarchy of components of complex tasks and of role skills the evaluating therapist is focused. This study examined the intervention planning decisions of occupational therapists who used the Model of Student Role Adaptation, which emphasizes the complex tasks involved in the student role. The purpose of the study was to determine whether these therapists were responding to environmental demands in planning their interventions.

Method. Special education teachers selected tasks that they believed were the most essential for student functioning within their classroom environments. These selections were compared with the goals and objectives developed by occupational therapists who serve children in these settings.

Results. Chi square analysis indicated a significant relationship between tasks designated by the teacher participants as environmental demands and those included in occupational therapy intervention planning.

Conclusion. The results suggest that the occupational therapist participants were responding to the environmental demands of the classroom when constructing their intervention plans.