American Journal of Occupational Therapy

Objective. This study examined the effect of commonly used long and short styles of commercially produced wrist extension orthoses on the activity of the proximal muscles of the shoulder and elbow and on wrist flexor and extensor muscle activity.

Method. While 17 women between 22 and 40 years of age (M = 26.6) performed a specified movement wearing each of the two styles of orthosis and without an orthosis, their motor unit recruitment of five proximal joint muscle groups, wrist extensors, and wrist flexors was measured by surface electromyography.

Results. Motor unit recruitment was significantly greater in both orthosis conditions for four of five proximal muscles and for wrist flexors. There were no significant differences between the short and long orthosis conditions for proximal muscle groups.

Conclusion. Wearing a wrist extension orthosis appears to place additional stress on the proximal joint musculature beyond that found without splint use. The study has implications for the prescription of wrist extension orthoses, especially for patients whose proximal joints are already compromised.

Occupational therapists are increasingly urged to carry out evidenced-based practice; however, little is known regarding their present practice and perceptions of evidence-based practice. To explore this phenomenon, a qualitative study was completed using a grounded theory approach. Semi-structured interviews were carried out with eight occupational therapists who worked in diverse practice settings. Participants were asked to reflect on their own views of evidence-based practice and their use of evidence in therapy. Data were analyzed inductively using constant comparison analysis. Participants’ perceptions of evidence-based practice were described in three broad categories. To these occupational therapists, evidence-based practice is: (a) a process of looking for understanding; (b) associated with research, and; (c) a potential threat to the occupational therapist. These findings produce a basis from which recommendations are made to increase the use of evidence-based practice by occupational therapists.

Objective. The purpose of this study was to determine how occupational therapists perceive postprofessional education, specifically the reasons for pursuing or not pursuing graduate education, as well as to examine the factors that seem most important.

Method. Seven hundred and fifty members of the American Occupational Therapy Association who did not have advanced degrees were surveyed. Respondents were asked why they did or did not want to pursue postprofessional education and, for those respondents interested in graduate study, what factors were most important. The important factors were examined across the levels of age, years of experience, practice areas, and regions.

Results. Surveys were returned by 314 members (a response rate of 42%), with 22% indicating interest in postprofessional education and 78% indicating no interest. For reasons not to pursue postprofessional education, respondents indicated that they were not interested in returning to intensive coursework and that a higher degree would not help in the advancement of their career. The two major reasons for pursuing graduate education included personal development and to increase skills and knowledge. As age increased, interest in graduate school decreased; interest was highest in the 3–6 years of experience range. Practice-specific programs was the area of specialization most desired; other important factors were cost of program and clinical work emphasized.

Conclusion.Results suggested that a relatively low number of occupational therapists consider pursuing postprofessional education. Thus, if graduate education is essential for the advancement of the profession, emphasis must be on clarifying the need for and value of postprofessional education.

The practice of outcomes research is growing in all segments of the health care industry, yet few practitioners and researchers are prepared to deal with the completion of statistical analyses that characterize the new focus on results. This article discusses basic model formulation and interpretation. It also encourages the use of statistical models that study the simultaneous effects of many variables on an outcome and gives examples of relationships among variables that are not simple and linear. The methods are illustrated with a dataset consisting of stroke rehabilitation inpatients discharged during a 3-year period with an admission date that is within 1 year after stroke.

Objectives. This article describes the development of an assessment of functional disability for use with proxyrespondents of community-dwelling persons who have Alzheimer’s disease as well as a study testing its reliability.

Method. Panels composed of health care professionals and caregivers of persons with Alzheimer’s disease were used to develop the Disability Assessment for Dementia (DAD). Fifty-nine caregivers participated in the refinement of the content and the testing of reliability.

Results. The DAD includes 40 items: 17 related to basic self-care and 23 to instrumental activities of daily living. It demonstrated a high degree of internal consistency (Cronbach’s alpha = .96) and excellent interrater (N = 31, ICC = .95) and test–retest (N = 45, ICC = .96) reliability. In addition, it was found not to have gender bias.

Conclusion. This instrument may help clinicians and caregivers of the population with Alzheimer’s disease make decisions regarding the choice of suitable interventions.

Objective. Two studies examined the reliability and validity of the Self-Assessment of Occupational Functioning (SAOF), a 23-item self-assessment of perceptions of strengths and weaknesses relative to occupational functioning, grounded in the Model of Human Occupation.

Method. The first study examined the test–retest reliability of the SAOF, and involved 37 college students without disabilities who completed the SAOF twice. The second study, which involved 39 young persons hospitalized with psychiatric disorders, examined internal consistency reliability of the SAOF, and examined correlations between SAOF scores and composite scores on the Self-Perception Profile, a widely used measure of perceived competence. In addition, data from both studies were combined to examine the ability of the SAOF to discriminate between the college students without disabilities and the young persons with psychiatric disorders.

Results. Kappa and intraclass correlation coefficients (ICCs) were used to examine test–retest reliability and Cronbach’s alpha was used to examine internal consistency. Acceptable levels of test–retest (ICCs) and internal consistency (Cronbach’s alpha) reliability were found for the subscale and total scores of the SAOF. However, test–retest reliability (kappa) was lower than desirable for many of the individual SAOF items. The young persons with psychiatric disorders had lower item, subscale, and total scores on the SAOF than did the college students without disabilities. In addition, a discriminant analysis predicting group membership (college students without disability vs. young persons with psychiatric disorder) correctly classified 76.6% of the participants based on the four subscale scores of the SAOF.

Conclusion. The SAOF has the potential to be a reliable and valid clinical assessment; however, additional research is needed.

Objective. Using single-subject research design, the effects of an occupational therapy intervention emphasizing sensory integration with five preschool children with autism were examined.

Method. In the AB design, nonengagement, mastery play, and interaction were measured, using videotape clips of each child’s free play in the preschool. Following a 3-week baseline, an occupational therapist provided one-on-one sessions and consultation to teachers for 10 weeks.

Results. When baseline and intervention phases were compared, four children demonstrated decreased frequency of nonengaged behavior, and three demonstrated increased frequency of mastery (goal-directed) play. Improvements in frequency of interaction were minimal.

Conclusion. The results support descriptions in the literature regarding the behavioral changes that children with autism can make when participating in intervention using a sensory integration approach.

Objective. The purpose of this study was to examine the current practice patterns of occupational therapists experienced in working with children with autism spectrum disorders.

Method. Occupational therapists experienced in providing services to 2-year-old to 12-year-old children with autism completed a mail questionnaire describing practice patterns, theoretical approaches, intervention techniques, and preferred methods of preparation for work with children with autism.

Results. Of those contacted, 72 occupational therapists met the study criteria and returned completed questionnaires. Practice patterns included frequent collaboration with other professionals during assessment and intervention. Intervention services were typically provided in a one-to-one format with the most common techniques being sensory integration (99%) and positive reinforcement (93%). Theoretical approaches included sensory integration (99%), developmental (88%), and behavioral (73%). Evaluations relied heavily on nonstandardized tools and clinical observations. Educational methods identified as most helpful were weekend workshops (56%) and on-the-job training (52%).

Conclusion. This study clarified the nature of current occupational therapy practice patterns for 2-year-old to 12-year-old children with autism. Additional studies are needed to examine the efficacy of current evaluation and intervention methods, as well as to explore the relevance of available standardized assessments for this population.

Objective. Although the prevalence of children with pervasive developmental disorders (PDD) has increased, empirical data about the role and practices of occupational therapists have not been reported in the literature. This descriptive study investigated the practice of occupational therapists with children with PDD.

Method. A survey was mailed to 500 occupational therapists in the Sensory Integration Special Interest Section or School System Special Interest Section of the American Occupational Therapy Association in eastern and midwestern United States. The valid return rate was 58% (292 respondents). The survey used Likert scale items to measure frequency of performance problems observed in children with PDD, performance areas addressed in intervention, perceived improvement in performance, and frequency of use of and competency in intervention approaches.

Results. The respondents primarily worked in schools and reported that in the past 5 years they had served an increasing number of children with PDD. Most respondents provided direct services and appeared to use holistic approaches in which they addressed multiple performance domains. They applied sensory integration and environmental modification approaches most frequently and believed that they were most competent in using these approaches. Respondents who reported more frequent use of and more competence in sensory integration approaches perceived more improvement in children’s sensory processing. Respondents who reported more frequent use of and more competence in child-centered play perceived more improvement in children’s sensory integration and play skills.

Objective. Native American children have not been widely represented in the normative samples of standardized tests assessing motor development. This study investigated the cultural relevance of the Peabody Developmental Motor Scales (PDMS) in 2-year-old Native American children who are typically developing.

Method. The PDMS was administered to a sample of 44 Pueblo children who were 24 months through 35 months of age and typically developing. Each child’s family also completed a parent questionnaire addressing the child’s development and family demographics. Participant scores were compared with those of the normative sample.

Results. The sample scored significantly lower than the normative sample (p ≤ .001) on the Fine Motor Scale, and, when gender was taken into consideration, all but the older girls (30 months–35 months of age) had significantly lower scores. All but the younger girls (24 months–29 months of age) scored within the normal range on the Gross Motor Scale.

Conclusion. Our results with this small sample suggest that caution be used when comparing motor performance (especially fine motor abilities) of 2-year-old Native American children against the PDMS normative data.

Objective. This study investigated one aspect of the role of school-based occupational therapists working with students with complex health care needs during the school day.

Method. One hundred seventy-two occupational therapists working in school systems were surveyed with regard to their involvement with children with complex health care needs, particularly specific complex health care procedures performed, knowledge of policies, training in the administration of health-related procedures, and perceived levels of competency.

Results. Sixty-eight (61%) of the therapists reported having children with complex health care needs on their caseload; of these, 65% reported involvement in seizure monitoring and 24% reported performing gastrostomy feedings. Most respondents reported an awareness of policies regarding administration of medication, gastrostomy feeding, and seizure monitoring in their school system. Respondents’ main role with this population included activities in positioning, environmental modification, and staff instruction.

Conclusion. The major role of occupational therapists working in school systems involved providing direct intervention with the student and not conducting or instructing others in health-related procedures. Therapists also served as a resource on health-related issues for school personnel.

Objective. To determine the effect of HIV infection on the motor performance of children and preadolescents, the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) was administered to see whether performance scores (raw and standard) would change with duration of the disease.

Method. Thirty-four children and preadolescents were tested on the BOTMP at initial diagnosis of HIV positive and again at 6-month intervals over a 2-year period for a total of five test sessions. The participants’ scores on the Gross, Fine, and Battery Composites, as well as eight individual subtests, were compared with those of children who were developing typically.

Results. Gross Composite and Battery Composite percentile scores were consistently 1 to 2 standard deviations below the means for the normal reference populations over the 2-year period. Fine Composite scores were closer than +.5 standard deviation to the mean for the normal reference population.

Conclusion. Gross motor function was more impaired than fine motor function in this sample of children and preadolescents who were HIV positive, and this pattern was unchanged after 2 years of infection. The BOTMP can be useful both to identify specific areas of motor deficits and to monitor changes in motor function over time after application of interventions.