American Journal of Occupational Therapy

OBJECTIVE. This article examines descriptors of race, ethnicity, and social class in case material in 145 articles published in The American Journal of Occupational Therapy from 1975 to 1998.

METHOD. Ethnicity labels and descriptors of occupation or other indicators of social class in case examples describing adults were collected. Frequencies of these labels and descriptors were compared with the population demographics of the 1990 U.S. census using chi-square goodness-of-fit analyses.

RESULTS. Reported indicators of race and social class were inconsistent and primarily absent in the literature, making comparisons with the U.S. population difficult. When missing race labels were assumed to be White, the case material showed disproportionate racial distributions compared with that of the U.S. population, with persons of minority races being significantly underrepresented.

CONCLUSION. The findings suggest that appropriate representation of race and social class in occupational therapy literature has not yet been achieved. The authors suggest a change in documentation conventions for occupational therapy literature and clinical writing.

As the demographics of the United States continue to change and we become a more pluralistic society, the increased diversity of the occupational therapy workforce and our consumers calls for an examination of the profession’s stance on multiculturalism and diversity. Using the metaphor of dance, this article identifies the dance partners as the organization’s leaders and its members. A historical review of the profession from the 1940s to the present traces the partners’ steps to determine which led the dance of diversity during the profession’s development. In this review, I discovered that the period when the profession most effectively and productively explored issues of diversity was during the early- to mid-1990s—a time when the organization and its members worked in harmony. At that time, occupational therapy’s dance with diversity flowed with rhythm and synchronicity.

OBJECTIVE. African-American elders were recruited from a transitional unit after hospitalization and tracked for 6 months in the community after discharge to (a) examine functional outcomes on the unit and in the community and (b) identify patterns of participation in daily life activities. The International Classification of Impairments, Disabilities, and Handicaps (ICIDH-2) framework provided the structure to examine the connections among body systems, functional outcomes, and social participation for this population that has been underrepresented in past research.

METHOD. A mixed design combined qualitative and quantitative methods, including qualitative interviews to document personal adaptive experience, a standardized functional assessment to identify functional outcomes, and a structured format to record activity participation.

RESULTS. Findings revealed that 11 of the 17 participants improved their functional outcomes after discharge. Three patterns of activity participation identified were self-care, self-care and household management, and mixed activities. Contextual influences were diverse family support arrangements.

CONCLUSION. Complex relationships were identified among body systems, functional outcomes, and daily life activities that were influenced by individual values and support arrangements.

This study investigated how two groups of zoo chimpanzees, one that lived in a small and mostly barren physical habitat yet had a successful social history and the other that lived in a larger and more enriched physical habitat yet had a turbulent social history, invested time occupationally. Different ecological synergies were found to emerge from these respective conditions and to influence time use in highly particularistic ways. As related to considerations of adaptedness, the limits of enriched physical environs when coupled with a dearth of social facilitation were revealed, as were the limits of social facilitation within impoverished physical spaces. Findings suggest that occupational therapists’ expertise in activity analysis could be enlarged to encompass analysis of naturally socially embedded ways of doing things across multiple contexts. To advance the ethic of occupational justice, functional assessments of individuals could also be expanded into functional assessments of the occupational aliveness of proximate life environments.

Describing development as sequential sensorimotor, cognitive, and psychosocial milestones does not explain how children learn to do or improve their occupations. In response to changes within occupational therapy and challenges in early intervention, this article focuses on development of occupation and proposes a dynamic system perspective. Contemporary research suggests that processes are in place to ensure that children develop as occupational beings. Social participation and caregiving routines guide the child toward becoming occupational by introducing intentional acts and by endowing experiences with meaning. A self-organizing process enables children to integrate their immature capacities and engage in occupations. Simultaneously, caregiving shapes these emerging behaviors, ensuring that performance is culturally compatible. Finally, using self-organization to maintain occupational engagement enables the child to accommodate to maturing abilities and environmental challenges. This reorganized pattern in turn is the basis for developmental changes, new behaviors, and refinement of current abilities. Application of concepts is made to acquisition of skills for eating a meal.

OBJECTIVE. This study compared the total wrist range of motion permitted by four different styles of wrist extension orthoses and the free hand.

METHOD. Using a repeated-measures, counterbalanced design, 40 healthy female volunteers 20 to 39 years of age shot a basketball while free handed and while wearing each of four wrist extension orthoses: AlignRite; Rolyan D-Ring Long; Rolyan D-Ring Short; and a custom-made, thumb hole design orthosis. The motion at the wrist was measured by an electrogoniometer.

RESULTS. No significant differences were found in total wrist motion permitted among the four orthotic conditions. Analyses revealed that the custom-made orthosis allowed significantly less palmar flexion and significantly more dorsiflexion than the three commercially available orthoses. All orthoses significantly restricted wrist movement compared with the free hand.

CONCLUSION. The commercially available wrist extension orthoses offered little difference in the amount of restriction they provided. The custom orthosis restricted movement to a different portion of the available range than did the commercial orthoses. Future research should examine how different strapping techniques on custom-made orthoses affect total range of motion permitted at the wrist. Knowledge of patterns of restriction among various styles of orthoses will help therapists to select the most appropriate orthosis for a client‘s individual needs.

Measurement of interface (or contact) pressure is important in assessing tissue viability in relation to pressure sore prevention and may be achieved through pressure mapping techniques. This article reports on two pilot studies using the Force Sensing Array pressure mapping system in a laboratory setting. The purpose of Study 1 was to examine the consistency of readings from the system across 1-min trials of repositioning, and Study 2 aimed to investigate changes in interface readings over a 20-min sitting period. Analyses on measurements of average pressure (mean of all sensor values) and maximum pressure (highest individual sensor value) were performed using the t test and repeated-measures analysis of variance. The results demonstrated that the use of average and maximum pressure measurements reflected only low reliability and that 6 min was likely to be the optimal sitting time required before stable pressure measurement. However, because of the limitations of using small convenience samples of healthy participants (n = 44 for Study 1, n = 20 for Study 2), these studies should be replicated with larger samples of healthy participants and then verified with disabled populations before adoption into clinical practice.

OBJECTIVE. The purpose of this study was to assess and compare cognitive functioning in adults with unilateral hemispheric injury due to either congenital damage or an ischemic event in young adulthood.

METHOD. Adults with cerebral palsy resulting from left hemispheric brain damage were compared with adults who had a unilateral stroke in either the left or the right hemisphere. Our primary interest was to determine the impact on hemispheric dominance as revealed by dichotic listening, a task that assesses the bias for preferential listening and processing of sounds. Performance also was determined on a language-related task (word finding) and a spatial task (dot localization).

RESULTS. Scores on the Quick Neurological Screening Test indicated that all participants demonstrated significant neuromotor deficits, whereas scores on the Barthel Index indicated that the participants were functional in basic activities of daily living. On cognitive assessments, healthy control participants demonstrated a pronounced left-hemisphere dominance and right-ear advantage; participants with injury to the left hemisphere showed a strong shift toward a right-hemisphere and left-ear dominance. In particular, injury of congenital origin appeared to foster this neural reorganization and localization of language-related functions into the healthy hemisphere. This shift was associated with a deterioration of performance on both the language and the spatial tasks.

CONCLUSION. The importance of appreciating subtle deficits after unilateral injury is important in therapy. The dichotic listening test may provide a simple and useful means for evaluating persistent unilateral brain dysfunction in the clinical setting.

OBJECTIVE. Fostering career adaptability may improve vocational outcomes for adolescents. This study examined the responses of adolescents on the Adolescent Role Assessment (ARA) to explore its usefulness as a measure of career adaptability.

METHOD. The ARA was administered to 101 adolescents 12 to 17 years of age. Descriptive statistics, reliability analysis, and factor analysis were generated from the ARA scores. Dominant narrative themes were coded into the six domains of the ARA and into the domains identified in the factor analysis.

RESULTS. The internal consistency of the ARA was low with few differences in findings across age. The identified factors—developing aspirations, self-efficacy, interpersonal competencies, and autonomy—are consistent with constructs of career adaptability found in the literature and differentiated low and high scorers.

CONCLUSION. Major changes to the ARA content and scaling or development of a new assessment of career adaptability using the factor structure are recommended for clinical and research applications.

The role of the occupational therapist working in the school system is to facilitate a student’s task performance or ability to do purposeful and meaningful activities so that the student benefits from the educational experience. To fulfill this role, occupational therapists need assessments that address functional performance issues in the classroom and provide information for effective programming and consultation. The School Version of the Assessment of Motor and Process Skills (School AMPS) is an observational evaluation of functional skills in the classroom. Common classroom activities are observed to assess a child’s school motor and school process skills. This study examined the validity of the School AMPS by comparing it to the Peabody Developmental Motor Scale–Fine Motor (PDMS-FM), a common assessment used in local area school districts in Edmonton, Alberta. Results show a higher correlation of the PDMS-FM with the motor scale of the School AMPS than with the process scale of the School AMPS, which was expected. The School AMPS appears to be a promising instrument for measuring the constructs of school motor and school process skills within a naturalistic setting.

This article describes emic and etic approaches to measurement in terms of a process of associating indicators and constructs. In this process, it is important to establish evidence of an adequate range of indicators and a relevant association of indicators and constructs and to recognize that such evidence places bounds on the interpretation of measurement outcomes. A passage from one of P. L. Travers’s Mary Poppins stories provides a counterpoint for this article’s discussion of these key aspects of emic and etic methods of measuring human individuality.