American Journal of Occupational Therapy

OBJECTIVE. This study investigated the effects of school-based occupational therapy services on students’ handwriting.

METHOD. Students 7 to 10 years of age with poor handwriting legibility who received direct occupational therapy services (n = 29) were compared with students who did not receive services (n = 9) on handwriting legibility and speed and associated performance components. Visual-motor, visual-perception, in-hand manipulation, and handwriting legibility and speed were measured at the beginning and end of the academic year. The intervention group received a mean of 16.4 sessions and 528 min of direct occupational therapy services during the school year. According to the therapists, visual-motor skills and handwriting practice were emphasized most in intervention.

RESULTS. Students in the intervention group showed significant increases in in-hand manipulation and position in space scores. They also improved more in handwriting legibility scores than the students in the comparison group. Fifteen students in the intervention group demonstrated greater than 90% legibility at the end of the school year. On average, legibility increased by 14.2% in the students who received services and by 5.8% in the students who did not receive services. Speed increased slightly more in the students who did not receive services.

CONCLUSION. Students who received occupational therapy services demonstrated improved letter legibility, but speed and numeral legibility did not demonstrate positive intervention effects.

OBJECTIVE. The purpose of this study was to investigate the effect of kinesthetic training on handwriting performance in first-grade students 6 to 7 years of age who had kinesthetic deficits and handwriting difficulties.

METHOD. With a randomized–blinded three group research design, 45 children were assigned to either a kinesthetic training group, a handwriting practice group, or a no treatment group. Kinesthesis and handwriting legibility were measured before and after intervention. Teachers’ judgments of handwriting legibility in the classroom setting were sought at 4 weeks after the intervention to see whether any improvement gained would be maintained in the natural setting. Two-way repeated-measures analysis of variance was used for data analyses.

RESULTS. At posttest, all groups showed significant improvement of kinesthesis, with no significant difference in the magnitude of improvement among the groups. There was no significant improvement of handwriting legibility as measured by a standardized test in any of the groups, although teachers indicated improvement of handwriting legibility in the classroom setting in all groups. Teachers also reported maintenance of handwriting legibility at 4 weeks after posttest.

CONCLUSION. Kinesthetic training did not improve handwriting or kinesthesis in these children. The findings of this study offer no support for use of kinesthetic training to improve handwriting legibility in first-grade students.

OBJECTIVES. This study examined the relationships between sixth-grade students’ handwriting speed and legibility and their keyboarding speed and error rate. A second purpose was to examine how well handwriting performance discriminates students as slow or fast in computer keyboarding.

METHOD. After participation in a school-required keyboarding class, 40 sixth-grade students were asked to copy a familiar poem using handwriting and keyboarding. Handwriting legibility and speed and keyboarding speed and errors were measured. Relationships among these variables were analyzed using Pearson product-moment correlations and discriminant analysis.

RESULTS. Keyboarding speed correlated with handwriting legibility (n = 38, r = .361, p = .026), suggesting that handwriting performance accounts for 12% to 13% of the variance in keyboarding performance. Handwriting speed and legibility together accurately categorized 71% of students as slow or fast in keyboarding. On average, students were able to keyboard faster than handwrite. Of the 20 slowest handwriters, 75% achieved more text production with keyboarding than with handwriting.

CONCLUSION. Keyboarding performance demonstrated low to moderate correlation with handwriting performance, suggesting that these forms of written expression require distinctly different skills. Most students who were slow at handwriting or had poor legibility increased the quantity and overall legibility of text they produced with a keyboard. These results suggest that keyboarding has the potential to increase and improve a student’s written output.

The history of occupational therapy may be understood as a continual transaction between two cultural discourses: pragmatism and structuralism. Pragmatism is a way of thinking that presupposes humans are agentic by nature and knowledge is tentative and created within particular contexts. Structuralism is a way of thinking that assumes humans are composites of recurring general frameworks and that knowledge is objective and can be generalized to multiple contexts. Early in the field’s history, both pragmatist and structuralist assumptions about the human and knowledge produced different readings, or interpretations, of what constituted the appropriate tools, methods, and outcomes for occupational therapy. Consequently, occupational therapy adopted an interesting mix of pragmatist language regarding the human and structuralist approaches to knowledge, resulting in professional identity problems still experienced today. However, recent developments offer an opportunity for occupational therapists to correct old identity problems through critically evaluating incompatible assumptions and carefully reading the prevailing cultural ethos.

OBJECTIVE. This study examines psychometric characteristics of the Melville-Nelson Self-Care Assessment (SCA), which is designed for occupational therapists working in skilled nursing facilities (SNFs) and subacute rehabilitation. Like the federally mandated Minimum Data Set, the SCA assesses seven self-care occupations in two ways: self-performance and support needed.

METHOD. Participants were SNF patients receiving subacute rehabilitation. Primary and secondary diagnoses varied widely; mean age was 76.5 years (SD = 9.8). Using the SCA, the Functional Independence Measure (FIM™), and the Klein-Bell Activities of Daily Living Scale, four teams of raters independently and simultaneously assessed 54 women and 14 men at admission and discharge; 40 participants were available for reassessment in their homes after discharge.

RESULTS. Total self-performance scores on the SCA showed (a) interrater reliability (mean ICC = .94); (b) concurrent validity with relevant areas of the FIM (rho = −.85) and the Klein-Bell (rho = −.86); (c) responsiveness in detecting change from admission to discharge, t(67) = 6.3, p < .001, with a large effect size of 1.10; and (d) moderate predictive validity of caregiving time in the home (rho = −.44) and overall function in the home as measured by the total FIM (rho = −.55) and total Klein–Bell (rho = −.54) scores. The self-performance and support measures for the seven self-care areas all had acceptable interrater reliability and concurrent validity. Eating, personal hygiene, and bathing showed little or no responsiveness to change from admission to discharge, whereas positive change was substantial in bed mobility, transfers, dressing, and toileting.

CONCLUSION. This instrument is recommended for use as part of a comprehensive occupational therapy model of practice in SNFs and subacute rehabilitation.

OBJECTIVE. The purpose of this study was to determine the psychometric properties of the Assessment of Computer Task Performance, specifically, the test–retest reliability, internal consistency, construct validity, and ability to discriminate between known groups.

METHOD. This assessment comprises 14 standardized and timed tasks. It was administered to 24 persons with upper-extremity impairments and 30 with no impairments by a trained occupational therapist. To assess the test–retest reliability, participants in the impaired group were retested within 2 to 7 days. Intraclass correlation coefficients were calculated to determine test–retest reliability. Internal consistency was assessed with Cronbach’s alpha, and factor analysis was conducted to examine construct validity. The Mann Whitney U Test was used to assess the test’s ability to discriminate between the groups.

RESULTS. Results indicated that the tool has excellent reliability and internal consistency, can discriminate between groups, and has appropriate construct validity.

CONCLUSION. The Assessment of Computer Task Performance provides occupational therapists with an accurate test to measure computer performance and can assist them in providing computer access services.

The term confluent education describes a flowing together of the affective and cognitive elements of learning. Confluent education accords high value to affect because of its core principle that the realization of human potential includes attention to the affective elements of human nature. This article reviews the literature on confluent education, extends a previous introduction of the topic, and proposes an integration of affect into all realms of occupational therapy practice. The visual metaphors, philosophical principles, and practical strategies developed in the literature on confluent education are useful when applied to the functions of occupational therapy practitioners engaged in direct care, education, or research. Because the contexts within which occupational therapy practice occurs today often challenge its affective elements, the author proposes confluence as a timely approach. To advance into the future with the affective strength that has characterized occupational therapy since its inception is a matter of reclaiming the profession’s heart.

OBJECTIVE. This study extended previous work of Rice, Leonard, and Carter [AJOT, 52(8), 621–626] and examined the relationship between grip and pinch strengths and the forces produced while accessing common household containers in healthy, elderly persons.

METHOD. Forty-two women and 9 men 60 years of age and older were assigned randomly to one of four order groups in a counterbalanced, repeated-measures design. Grip strength was measured via a dynamometer and pinch strength via a pinch meter. The forces required to access six common household containers were measured with force sensing resistors applied to each container. Data analysis included Pearson product-moment correlations between the dependent variables of grip and pinch strength and force produced on the containers. Analyses of variance were used to determine differences by gender on the dependent measures and order of presentation of containers.

RESULTS. A fair relationship (r = .31 to .44) was found between grip and pinch strength and the ability to open three containers. Little or no relationship was found between grip and pinch strength and the ability to open the remaining three containers (r = −.03 to .25). Significant gender differences existed on overall strength and the force used to access two of the six containers. No order effects were found.

CONCLUSIONS. Strong relationships did not exist between the grip and pinch strength and the amount of force the elderly participants used to open the containers, which is similar to what Rice et al. found for younger persons. The participants appeared to use a greater proportion of their available strength when accessing the containers than did their younger counterparts previously studied. Further research is needed to determine at what level of weakness one would expect to see performance deficits in common daily occupations.

OBJECTIVE. The purpose of this study was to explore the effects of a powered mobility riding toy on the participation behaviors of young children with complex developmental delays.

METHOD. A single-subject withdrawal design was used to study the effects of powered mobility on child-initiated movement occurrences, initiation of contact with others, and affect. The participants were two young children with complex developmental delays, including spastic quadriplegia. The intervention consisted of having the children use a powered mobility riding toy in their school settings during gym class and outdoor recess.

RESULTS. Primary findings were that use of the powered mobility riding toy (a) increased the number of self-initiated movement occurrences; (b) appeared to have some effect on initiation of contacts with adults and, for one child, negative adult initiations and positive peer initiations; and (c) did not have a clear impact on the amount of positive affect.

CONCLUSION. For some young children with severe motor impairments and developmental delay, use of a powered mobility device may increase self-initiated movement occurrences during free play.

OBJECTIVE. The purpose of this study was to identify the sensory processing patterns of children with Asperger syndrome.

METHOD. Researchers compared the performance of 42 children with Asperger syndrome and 42 children without disabilities on section and factor scores of the Sensory Profile.

RESULTS. As reported by parents on the Sensory Profile, the children with Asperger syndrome were significantly different from children without disabilities on 22 of 23 items. This result was obtained with good power estimates (.997–1.00) and large effect sizes (O2 = .267–.732). Both groups of children performed the same on modulation of visual input affecting emotional responses and activity level.

CONCLUSION. This study provides initial evidence that clear differences exist in the sensory processing patterns of children with Asperger syndrome when compared with peers without disabilities.

Perceptions of the Same Site Model (SSM) of fieldwork, where students complete a Level I and Level II fieldwork requirement in the same setting, were examined by survey. The benefits, drawbacks, and implications of the SSM are discussed. Fieldwork educators and students identified gaining familiarity with the setting, increased comfort and decreased anxiety, and preparation for Level II fieldwork as benefits of this model. The SSM survey results suggest that this model may be helpful in decreasing stress associated with fieldwork as experienced by students and fieldwork educators.