American Journal of Occupational Therapy

Objectives. The purpose of this study was to investigate whether maternal endocrine activation during pregnancy would affect the neurobehavioral state of primate offspring in a manner similar to that observed in human infants from pregnancies involving maternal substance abuse or maternal stress.

Method. Twenty-two rhesus monkey (Macaca mulatta) infants were derived from females administered either adrenocorticotrophic hormone (ACTH), which increased the mother’s endocrine activity, or saline solutions for 14 consecutive days during mid-pregnancy. On days 15 and 30 postpartum, infants underwent brief separations from their mothers and were Videotaped for later evaluation of neurobehavioral state.

Results. Infants from mothers administered ACTH spent significantly more time in a drowsy state than did controls (p < .04), and the increased drowsiness tended to be most pronounced during the post separation period, when acute stress was highest. In contrast, controls remained in a more active alert state (p < .03), presumably searching for their mother, a species-typical adaptive response to maternal separation. Female infants spent more time in distressed state than did males on day 15, and the proportion of time in distressed state decreased in all infants after administration of. 2 ml of 24% sucrose solution.

Conclusion. The results demonstrate that neurobehavioral state alterations are found in infants from mothers with increased endocrine activity during pregnancy. Neurobehavioral state disorganization can have an adverse impact on the human infant’s concurrent and subsequent occupational performance. These findings establish the usefulness of the nonhuman primate model for advancing knowledge on early contributions to the development of human infant occupational behavior.

Objective. The purpose of this study was to investigate the effect of haptic attributes of objects on infants’ grasping patterns and evaluate whether this effect is influenced by the infant’s age (i.e., phase of motor development).

Method. Grasping patterns of 180 infants who were typically developing were measured by the Posture and Fine Motor Assessment of Infants (PFMAI); the PFMAI-I was administered to infants 2 months to 6 months of age (n =60), and the PFMAI-II was administered to infants 6 months to 12 months of age (n = 120). Grasping patterns were compared for ages by month and for three objects, each with differing haptic features. The interaction between age and object was analyzed.

Results. Grasping patterns were significantly different when scores by age in months were compared. In addition, grasping patterns differed depending on the object and its haptic features and were influenced by the interaction between object held and age. Certain haptic features were associated with primitive grasp at younger ages and precision grasp at older ages. More mature skiffs were observed when the objects’ haptic features appeared to match an infant’s perceptual-motor skill.

Conclusion. The haptic features of objects influence an infant’s grasping patterns, and this influence changes with the infant’s age. These results suggest that therapists attempt to match the haptic features of objects to the infant’s perceptual-motor skiff in intervention in order to enhance grasping patterns.

Objective. This study examined the roles that play occupies within current occupational therapy practice with preschoolers.

Method. Two hundred twenty-four pediatric occupational therapists completed mail questionnaires designed to ascertain how they use play in their practice, their knowledge and use of play assessments, and potential constraints on their use of play.

Results. Although respondents indicated that play was important in motivating children and frequently used play as a treatment modality or reinforcer, they Less frequently assessed play behaviors or wrote treatment goals and objectives related to play. Differences were found between school-based and non-school-based respondents regarding the discipline or model that addresses play in the work setting, the use of play assessments, and constraints that Limit the use of play in the work setting.

Conclusion. The results suggest a need for increasing the emphasis on play in entry-Level curricula and continuing education, improving clinician access to valid and reliable play assessments, and completing studies designed to examine the use and efficacy of play in occupational therapy intervention.

Objectives. This study examined the use of aides in occupational therapy practice, the supervision and training of aides, and practitioners’ attitudes toward the use of aides.

Method. A questionnaire was mailed to a systematically selected sample of 510 occupational therapists and occupational therapy assistants. The response rate was 74%.

Results. The use of occupational therapy aides is prevalent in a variety of settings. Forty percent of respondents reported that they currently work with aides, whereas 23 % reported that they have never worked with aides. Occupational therapy aides perform a variety of tasks and receive various levels and amounts of supervision and training. Of those respondents who delegated specific skilled tasks to aides, 76% reported daily contact for purposes of supervision and training. Nineteen percent who currently work or have worked with aides reported being in a situation where an ethical issue arose related to aide use.

Conclusion. On the basis of the data, it is suggested that occupational therapy practitioners would benefit from taking a proactive role in determining how aides can be used to maximize service delivery while maintaining quality services. There also appear to be ethical concerns related to appropriate delegation of tasks to aides and to their supervision and training.

Objective. Students are taught how to apply clinical reasoning methods through a variety of teaching methods, including the use of case studies. Various types of case studies have been described in the literature: paper cases, videotape cases, simulated client cases, and real client cases. This study examined the effectiveness of a new type of paper case study—the clinical reasoning case study—in teaching the clinical reasoning process to occupational therapy students.

Method. Four seniors in an undergraduate occupational therapy program completed intervention plans in response to both traditional medical model and clinical reasoning paper case studies. Qualitative methods were used to analyze intervention plans and videotaped discussion about this learning experience.

Results. Themes discovered in the data sources suggest that compared with traditional case studies, the clinical reasoning case studies increased the quality of participants’ intervention plans, participants’ confidence levels about their plans, and participants’ understanding of the clinical reasoning process. Participants also reported preferring clinical reasoning case studies over traditional paper case studies.

Conclusion. The clinical reasoning case studies are effective teaching tools because they provide students with a holistic picture of the client and his or her occupational therapy treatment. In addition, these case studies model the clinical reasoning process by organizing client information according to the types of clinical reasoning that would be used to gather that information. Occupational therapy educators may find this type of paper case study useful in introducing students to the intervention planning process.

Objective. The purpose of this study was to determine whether multivariate measurement at the initiation of students’ training in occupational therapy could predict clinical performance in Level II fieldwork.

Method. Forty-five students in their first semester were videotaped in pairs and completed personality and emotional communication measures related to the potential for working well with others. Two years later, the students’ clinical performance was rated by Level II fieldwork supervisors.

Results. In the physical rehabilitation fieldwork setting, students who were conventional and quietly concerned were rated higher than students who were unconventional, talkative, and less other-centered. In the pediatric rehabilitation setting, students who were autonomous and nonverbally perceptive were rated higher than students who were interdependent and less perceptive. In the psychiatric rehabilitation setting, students who were emotionally reactive to facial but not body cues of emotion were rated higher than students who had low emotional reactivity and were less perceptive to facial but not body cues.

Conclusion. The varying institutional cultures, types of patients, and roles of occupational therapy across fieldwork settings may require different sets of attributes for working well with others. Educators and supervisors should be aware of these possible differences when fashioning Level I fieldwork experiences.

Objective. This report describes how common student communicative and behavioral characteristics that appear to predict the existence of potential problems during Level II fieldwork were identified in order to develop and implement preventative interventions during the academic curriculum at New York University (NYU).

Record review. A record review of NYU professional Level occupational therapy students from 1986 to 1995 was completed to identify common factors among students who performed well academically but failed clinical fieldwork. Eight communicative and behavioral characteristics were identified: (a) rigidity of thinking, (b) discomfort with the ambiguity that accompanies clinical reasoning, (c) Lack of psychological insight, (d) difficulty interpreting feedback, (e) externalization of responsibility, (f) difficulty Learning from mistakes, (g) discomfort with the physical handling of patients, and (h) dependence on external measures for self-esteem.

Intervention. On the basis of the identified characteristics, five intervention strategies were adopted: (a) academic seminars that address professional behavior and interpersonal skills, (b) faculty feedback to students regarding problematic behaviors, (c) clinician and senior student counseling with identified students, (d) student remediation programs consisting of community service, and (e) student Learning contracts based on specific behavioral objectives. These strategies were administered before Level 11fieldwork to 10 students in the 1996 class who exhibited the characteristics indicative of potential fieldwork failure.

Outcome. Of the 10 students in the 1996 class, 7 passed fieldwork without further difficulty, two failed fieldwork midterm assessments but went on to achieve passing final evaluations, and one failed the final fieldwork assessment but passed an additional third fieldwork experience. The class of 1996, which was the first to receive formal intervention designed to decrease fieldwork failure, demonstrated Lower fieldwork failure rates than did all other classes in the past 10 years.

Objective. Although occupationally embedded exercise is becoming a recognized topic in occupational therapy research, study of this phenomenon in children has been limited. The present study examined whether play elicits therapeutic patterns of movement through the use of two ABA single-case experiments. It was predicted that in two children with hypotonic cerebral palsy, the addition of a favorite game to the occupational form, or treatment environment, would increase functional vertical neck and back extension.

Method. Each subject was positioned in prone on a wedge. During the A phases, each was given verbal directions to hold her head up. During the B phase, a favorite game was introduced. It was predicted that each subject would extend her back and neck in a functional way in order to manipulate and observe the game. The dependent variables were the mean range of neck extension and the mean range of back extension, which were measured by a videotaped, two-dimensional kinematic analysis.

Results. The addition of a favorite game to the occupational form improved vertical neck and back extension while discouraging nonfunctional neck hyperextension and fixing postures in both children.

Conclusion. Embedding exercise within a play occupation enhanced the prone extension of two children with hypotonic cerebral palsy.