American Journal of Occupational Therapy

This article reports findings from interviews that explored the meanings occupational therapists attach to independence as a value and a therapeutic goal in interactions with elderly clients. Through a historical review of the literature, we trace the changing use of this term and identify two analytically distinct concepts associated with it: independence as self-reliance in activity and independence as autonomy, self-determination, or choice. We show how the latter has emerged in contemporary service contexts to represent an ideal of client-centered practice for persons with chronic disabilities, such as frail elderly clients. Using a “critical incident” interview approach with 12 Australian occupational therapists, we identified the therapists’ explicit and implicit understandings of independence as a value concept and practice issue. Our findings suggest that a mismatch often exists between idealized and practice-based talk about independence and that therapists narrativize this opposition around what we call “the safety clause.” That is, therapists invoke concerns about safety and duty of care as a caveat to implementing their independence ideals and justifying the retention of professional control. We identify key issues that therapists need to address if the rhetoric of independence-related client-centered practice is to be achieved in reality.

OBJECTIVE. Verbal instructions comprise an important element of clinical practice, however, their effectiveness in promoting movement organization in persons with cerebrovascular accident (CVA) has not been well investigated.

METHOD. A counterbalanced, repeated-measures design was used to examine the effects of externally focused (task-related) versus internally focused (movement-related) instructions on movement kinematics during three functional reaching tasks. Participants included 16 persons with stroke who were able to perform the tasks with their affected arm and 17 age-matched adults without neurological impairments.

RESULTS. Significantly shorter movement time and greater peak velocity were evident when reaching under the external-focus condition of all tasks than for the internal-focus condition.

CONCLUSION. One clinical implication is that internally focused instructions can contribute to slower and less forceful reach in adults with and without CVA. This research reinforces the need for therapists to consider their use of instruction during the evaluation and treatment of movement disorders.

OBJECTIVE. This study examined differences between the dominant and nondominant hands of children during an object release task under various accuracy and speed constraints.

METHOD. Fifteen children 7 to 14 years of age who were typically developing released an instrumented object held with a precision grip onto a stable or unstable surface at a self-paced or quick speed while temporal and force measures were recorded.

RESULTS. Few differences were found between the two hands under stable, self-paced conditions. However, given accuracy constraints, object replacement with the nondominant hand took longer than the dominant hand. The nondominant hand exhibited different force coordination patterns than the dominant hand when both accuracy and speed constraints were imposed.

CONCLUSION. Task constraints differentially affected the performance of the dominant and nondominant hands during this object release task. The results suggest that clinicians should incorporate various task constraints into hand preference evaluations and during “dominance retraining.”

OBJECTIVE. This experimental research study evaluated the impact of an 8-week psychosocial occupational therapy intervention program for mothers who have children with disabilities.

METHOD. Thirty-eight mothers of children with disabilities were randomly assigned to participate either in the treatment or the control group (19 in each). The occupational therapy intervention was designed to facilitate increased perceptions of satisfaction with time use and occupational performance, thereby positively affecting maternal and family well-being. The Canadian Occupational Performance Measure (COPM) was administered to measure self-perceptions of occupational performance and satisfaction over time.

RESULTS. No significant differences were found between the two groups on time use perceptions. Although no significant differences were found between the two groups on the COPM Performance subscale, the treatment group demonstrated significantly greater score increases (p < .05) on the COPM Satisfaction subscale.

CONCLUSION. This preliminary study suggests that attending to the time use and occupational concerns of mothers of children with disabilities can have a positive impact on their satisfaction with occupational performance.

OBJECTIVE. The purpose of this study was to better understand occupational therapists’ experiences of making a difference in parent–child relationships.

METHOD. In this qualitative, instrumental case study, occupational therapists working in early intervention were asked to reflect on and describe occasions in which they believed that they made a real difference in parent–child relationships. The primary investigator interviewed nine experienced pediatric occupational therapists.

RESULTS. All nine therapists highly valued the parent–child relationship and focused on these relationships in therapy. Eight themes emerged that described the therapists’ practice insights and methods by which the therapists facilitated the parent–child relationship.

CONCLUSION. The occupational therapists in this study reflected insights that resonate with the literature regarding the role of the parent–child relationship in the development of children. The authors raise the question about the adequacy of instruction at the pre-service level that prepares therapists to both assess and facilitate the parent–child relationship in early intervention.

The findings of a small qualitative interview study with 8 parents of 6 children with developmental coordination disorder are reported. The parents discussed the social consequences of their children’s motor difficulties. The new International Classification of Functioning, Disability and Health was used as a framework for the analysis of the interview transcripts. The analysis revealed that the parents believed that their children’s impairments restrict their participation in society. The interactions between impairment and participation are interpreted in the context of stigma and its management. The significance of occupational therapy interventions in the area of physical activity play to children’s social life is discussed.

OBJECTIVE. The ability to use perceptual cues within the environment to guide movement accurately can be acquired implicitly in that skill may increase while the learner is not consciously aware of what cues are being used. In this study, the implicit learning capabilities of children with and without developmental coordination disorder were compared.

METHOD. Twenty-two children (11 with developmental coordination disorder, 11 without the disorder) played a computer game where they “caught” a descending ball image with a paddle on the screen. The dependent variable was accuracy of catch, as measured by the score on the computer game. On training trials, a visual cue appeared 50% of the time that signaled the direction of the ball. On probe trials, the visual cue was false. After completing the task, the children were interviewed about their conscious awareness of the cue. A mixed factorial analysis of variance (ANOVA) was used to analyze the data for group comparisons.

RESULTS. Of the 22 children, only 6 indicated that they were aware of the cue. A mixed factorial ANOVA was significant for greater error when the visual cue was false, F(1.12, 22.49) = 27.27, p = .000, indicating that the children responded to the cue. No difference was found between groups in game performance.

CONCLUSION. Children with developmental coordination disorder in this study were able to implicitly recognize and use a perceptual cue to enhance their performance on a computer game. Strategies that foster implicit learning may be relevant to occupational therapy intervention.

Although occupational therapists emphasize a balance among the three occupational areas of self-care, productivity, and leisure in people’s lives, leisure often is focused on less than the other areas in both the research literature and clinical practice. Very little research has been conducted on the benefits of leisure activities in adults with congenital disabilities. The information contained in this article is a secondary analysis of the interview protocols of nine adults (30–50 years of age) with either cerebral palsy or spina bifida. The primary purpose of the interview was to determine protective processes surrounding turning points in the lives of persons with disabilities. This secondary analysis allowed us to determine the benefits and meaning of leisure for this population. Consistent with literature that focused on either persons without disabilities or persons with acquired disabilities, the participants in the present study reported that involvement in leisure activity provides mental and physical health benefits, enjoyment, opportunity to develop a self-concept and increase self-esteem, and opportunities to build and enhance social relationships. All these benefits enable people to find meaning in life through doing, belonging, and understanding self in the context of their worlds.

OBJECTIVES. This study examined concurrent validity of the Evaluation Tool of Children’s Handwriting–Cursive (ETCH-C) by comparing ETCH-C total legibility percentage scores with handwriting grades from teachers. The study also identified the legibility percentage score discriminating between satisfactory and unsatisfactory handwriting.

METHOD. The participants were 101 fourth graders who completed two handwriting instruments. Three teachers sorted the Cursive Practice and Review work sheets into A, B, C, and unsatisfactory groups to establish handwriting grade. The study compared ETCH-C total legibility percentage scores with teacher grading, using personal judgment of handwriting on the Cursive Practice and Review work sheet.

RESULTS. Mean legibility percentage scores increased significantly as handwriting grade increased. The concurrent validity coefficients were .61 for ETCH-C total words and .65 for ETCH-C total letters and handwriting grade. ETCH-C legibility percentage scores discriminating satisfactory from unsatisfactory handwriting ranged from 73% to 82% on ROC (receiver operating characteristic) curves.

CONCLUSION. Results support the concurrent validity of the ETCH-C with handwriting grades. A 75% word legibility percentage score discriminated satisfactory and unsatisfactory handwriting.

OBJECTIVE. The purpose of this study was to describe functional performance in activities of daily living (ADL) and the use of technical aids among persons with late effects of polio.

METHOD. Abilities in ADL of 150 participants 20 to 82 years of age were assessed with the Sunnaas Index of ADL, and the participants’ use of technical aids was recorded.

RESULTS. The activities in which most participants were independent were eating, daily hygiene, and communication. Many needed technical aids, adaptation of their homes, or both to perform mobility-related activities and to dress or undress, take a bath or shower, cook, or manage toilet visits. In total, 86 (57%) used mobility aids such as canes, crutches, and walkers. Thirty-one (21%) used wheelchairs within or outside the home. Bath and shower aids were the most commonly used technical aids other than mobility aids. The activity where most participants depended on others was housework.

CONCLUSION. In spite of their disabilities, most participants performed well in many ADL, functioning independently by using technical aids and by living in an adapted environment.

This case report summarizes the evaluation and treatment used to provide occupational therapy services to a man living with multiple sclerosis. Primary impairments included ataxia, paraparesis, and decreased endurance. The focus of this case study was on improving the client’s ability to use powered mobility to access the community despite severe ataxia.

A task-oriented approach was used as a frame of reference to guide the evaluation and intervention process. The primary goals of intervention were to control the degrees of freedom required for task participation and simultaneously increase postural stability, resulting in independent control of a power wheelchair. A combination of occupational therapy interventions is illustrated, including assistive technology, positioning, orthotic prescription, and adaptation of movement patterns.