American Journal of Occupational Therapy

OBJECTIVE. The purpose of this study was to investigate the association between participation in goal-specific outpatient occupational therapy and improvement in self-identified goals in adults with acquired brain injury.

METHOD. Thirty-one persons with traumatic brain injury of mixed chronicity participated at three sites located in different regions of the United States. Using a repeated-measures design, therapy that usually was offered at each site to achieve specific goals was followed by a no-treatment period. Participants completed the Canadian Occupational Performance Measure Performance subscale (COPM-P) and Satisfaction subscale (COPM-S), and the Community Integration Questionnaire (CIQ) at admission, discharge, and 1 to 18 weeks after discharge. Goal attainment scales were developed at admission and scored at discharge; the differences for each site were tested, using dependent t tests. Gains for the treatment period (admission to discharge) in COPM subscales and the CIQ were compared with gains during the no-treatment period (discharge to followup) for each site, using dependent t tests. The results were synthesized meta-analytically across the sites.

RESULTS. The participants identified a total of 149 goals, 81% of which were achieved. Goal attainment T scores improved significantly (Z = 7.52, p < .001), and the combined effect size was large (r = .94). The COPM-P (Z = 4.13, p < .001) and COPM-S (Z = 4.25, p < .001) showed significantly greater gains during the treatment (average 15.3 weeks) versus the no-treatment (average 9.9 weeks) period. Effect size estimates were large: .71 and .76, respectively. Gain scores of the CIQ did not differ significantly (Z = .75, p = .22, r = .29) between periods.

CONCLUSION. Participation in goal-specific outpatient occupational therapy that focused on teaching compensatory strategies was strongly associated with achievement of self-identified goals and reduction of disability in adults with mild to moderate brain injury.

OBJECTIVE. The Árnadóttir OT-ADL Neurobehavioral Evaluation (A-ONE) is a standardized assessment that links performance in activities of daily living (ADL) to neurobehavioral impairments. This study tested the construct validity of the A-ONE.

METHOD. From two hospitals in Iceland, 42 patients between 45 and 87 years of age who had sustained either a right or a left cerebrovascular accident (CVA) were evaluated on the Functional Independence Scale (FIS) and Neurobehavioral Specific Impairment Subscale (NSIS) of the A-ONE. The Mann Whitney U test and chi-square test were used to explore possible differences between the performance of participants with left and right CVA. Descriptive statistics were calculated for demographic data and for items on the FIS and NSIS. The level of significance was set at p < .05.

RESULTS. Three of 18 ADL items observed on the FIS and 13 of 46 items on the NSIS discriminated at a statistically significant level between the left and right CVA groups.

CONCLUSION. The results provide minimal support for the construct validity of the A-ONE related to differentiating between ADL performance of persons with left and right CVA. However, results regarding the ability of the A-ONE to detect and lateralize impairments agreed with literature regarding lesion sites for the impairments.

OBJECTIVE. The purpose of this study was to examine the predictive relationship of categorization and deductive reasoning abilities to performance of instrumental activities of daily living (IADL) among adults with brain injury.

METHOD. A correlational research design was used to examine the performance of 19 patients from a neurosurgery acute care unit on Toglia’s Category Assessment (TCA), the Deductive Reasoning test (DR), and the Observed Tasks of Daily Living–Revised.

RESULTS. Multiple regression analysis indicated that categorization and deductive reasoning accounted for a significant proportion of the variance in IADL performance scores, with deductive reasoning making the greater contribution. Demographic characteristics such as age and education reduced the power of the previous variables, especially of the categorization.

CONCLUSION. The results of this study indicate that assessments of categorization and deductive reasoning abilities of persons with brain injury may be good predictors of IADL functional performance. Results support the use of the TCA and DR as quick measures of a person’s cognitive and functional abilities. Furthermore, this study provides preliminary results to support that categorization and deductive reasoning abilities are fundamental for the performance of IADL skills.

Although infrequently discussed in the professional literature, visionary language and visual imagery are identifiable elements within occupational therapy’s culture. They seem part of the profession’s desire to characterize, affirm, and renew itself. One early vision of practice, that of reaching for heart as well as hands, is the subject of this inquiry that extends a prior discussion of visions in occupational therapy. Central to the inquiry are the early vision’s (a) origin, exemplification, and clarity of meaning within one autobiographical text and (b) merits for the profession’s characterization, affirmation, and renewal. The early vision of reaching for heart as well as hands may benefit the profession today by characterizing the ethos of occupational therapy as integrative, affirming its practice as occupational, and inspiring its practitioners to renew a commitment to caring.

Using the clinical phenomenon of posttraumatic stress disorder related to traumatic hand injuries, this article conceptually explores the theoretical construct of neuro-occupation on the basis of these conditions. Neuro-occupation is an evolving concept that combines knowledge and understanding of occupation with knowledge and understanding of how the human brain functions in environmental context; thus, the concept is important to the core of occupational therapy practice. The first section of the article introduces the concept of neuro-occupation; the second provides an overview of posttraumatic stress disorder and traumatic hand injury. To help therapists better understand behavior seen in clinical settings, the third section presents key neuro-occupational processes pertaining to posttraumatic stress disorder, using clinical application examples. Finally, a query about the value of neuro-occupation as a developing theoretical construct is put forth.

OBJECTIVES. This preliminary study examined sensory processing and its relationship to occupational performance in children with fragile X syndrome (FXS) to guide research and evidence-based practice.

METHOD. Fifteen school-aged boys with full-mutation FXS were assessed with three occupational performance measures (School Function Assessment, Vineland Adaptive Behavior Scales, play duration) and three sensory processing measures (Sensory Profile, Tactile Defensiveness and Discrimination Test–Revised, Sensory Approach–Avoidance Rating). Data were analyzed using partial correlation procedures.

RESULTS. Several significant correlations were found, independent of effects of age and IQ. Avoidance of sensory experiences (internally controlled) was associated with lower levels of school participation, self-care, and play. Aversion to touch from externally controlled sources was associated with a trend toward greater independence in self-care—opposite of expectations.

CONCLUSION. This study links sensory processing vulnerabilities with individual differences in occupational performance and supports a dynamic view of self-organizing systems. Children’s uses of avoidant versus independent behaviors may reflect different self-regulatory or coping strategies that potentially mediate the relationship between sensory processing deficits and occupational behaviors and warrant further investigation.

OBJECTIVE. The purpose of this study was to examine the ability of the Miller Assessment for Preschoolers (MAP) to predict academic performance of Israeli preschoolers after a period of 5 to 7 years.

METHOD. Thirty children who were classified according to the MAP as preschoolers at risk (n = 15) and not at risk (n = 15) for pre-academic problems were tracked after 5 to 7 years. Follow-up evaluations were done on motor, visual-motor integrative, and cognitive performance components; reading and handwriting academic performance areas; and a variety of measures taken to establish overall school functional status.

RESULTS. Results indicate that children classified by the MAP as preschoolers at risk performed significantly worse 5 to 7 years later on visual-motor, cognitive, and reading and handwriting tests than those preschoolers classified not at risk and demonstrated reduced overall school functional status.

CONCLUSION. The findings indicate that the MAP can predict academic performance even over a 5-year to 7-year interval. Furthermore, by linking academic performance data to performance components of children in different cultures, our investigation contributes to the overall understanding of children’s functioning.

OBJECTIVE. A national survey was conducted to identify occupational therapists’ current attitudes and values in their working relationships with parents of preschool children with developmental disabilities. This study replicated a 1987 national survey that examined therapists’ relationships with parents of preschool children with cerebral palsy.

METHOD. Surveys were sent to a random sample of 400 therapists, with 199 returned from respondents who identified themselves as working with preschool children with developmental disabilities. After calculating descriptive statistics for each item in the survey, a one-way analysis of variance was performed to test for differences based on four demographic variables.

RESULTS. Respondents reported that working with parents, more than any other aspect of intervention, had the greatest impact on the progress of a child with disabilities. Consistent with the 1987 survey, respondents believed that parents focus on their own adjustment to their child’s disability as well as on their child’s progress more than any other issues. Therapists continue to report satisfaction when generating positive change for child and parent through education and use of clinical knowledge and skill.

CONCLUSION. Results suggest that efforts to foster family-centered intervention in occupational therapy educational programs are increasing therapists’ confidence and skills in working with parents of children with disabilities. Implications for occupational therapy practice and education include a need for therapists to expand their knowledge and expertise in working effectively with vulnerable families. Educators need to focus on teaching strategies not only to refine the role of occupational therapy as a direct treatment provider, but also to incorporate creative ways to deal with the psychosocial issues of parents and families.

OBJECTIVE. The purpose of this study was to determine whether writing tool type and angle of writing surface affect grasp.

METHOD. Fifty-one children 23 to 24 months of age who were typically developing drew with a primarymarker, colored pencil, and small piece of crayon on a table and an easel. The marker and pencil were presented pointing left, right, and toward the child. The order of writing tool presentation was counterbalanced. Grasps were scored with a 5-point rating system and analyzed with dependent t tests.

RESULTS. Children used a more mature grasp when drawing with a piece of crayon than with a pencil. No difference in grasp maturity was found when using a pencil compared with a marker. A more mature grasp when drawing on the easel compared with the table was used with the crayon but not with the marker or pencil.

CONCLUSION. Results imply that a short writing tool combined with a vertical surface can influence the grasp of young children.

OBJECTIVE. The purpose of this study was to examine occupational therapists’ use and perceptions of written education materials for clients and the factors that therapists consider before distributing written materials to clients. This study also aimed to determine whether use and perceptions of these materials differed for older clients.

METHOD. A random sample of 50 occupational therapists from Queensland, Australia, working in adult physical disabilities settings was surveyed with a structured questionnaire. Data were analyzed descriptively and with nonparametric statistics.

RESULTS. Of 49 participants who used written materials, 54% had given them to more than half of their last 10 clients, regardless of the clients’ age. Written materials, most often information sheets developed by the participants themselves; handwritten notes; and pamphlets were principally used to reinforce verbal information. Clients’ cognitive abilities, primary language, communication skills, vision, and level of education most often were considered before distributing written materials. Although participants generally were positive about the content and effectiveness of materials, ratings were significantly less positive related to older clients.

CONCLUSION. Client education was a core treatment modality for participants in this study, with written media most commonly being used to supplement verbal education. Because participants were least positive about the effectiveness of written materials for older clients, further development of materials for this audience may be indicated.

OBJECTIVE. Limited information is available on how sleep and play positions affect infant gross motor skills and occupational development. The overall objective of this descriptive developmental pilot study was to compare normative and sampled infants relative to sleep and awake positioning using the Denver II Gross Motor Sector.

METHOD. A cross-sectional sample of 66 infants 2.0 (n = 23), 4.1 (n = 26), and 6.0 (n = 17) months of age were administered the Denver II Gross Motor Sector. Caregivers identified infants’ primary sleep positions and amount of awake-time in prone. Data were analyzed using chi-square goodness-of-fit tests.

RESULTS. The sample of 2.0-month-old supine and side sleeping infants differed significantly from the normative population on three gross motor milestones. Two-month-old infants spending 15 min or fewer of awake-time in prone passed the gross motor milestones at significantly lower percentages than the normative population. No significant differences were noted between sampled and normative populations at 4.1 and 6.0 months of age.

CONCLUSION. Results suggest that infant gross motor development may be related to sleep and play positioning. Information regarding infants’ sleep and awake positioning may be important to occupational therapists when evaluating gross motor development. Implications for caregiver education and future research are proposed.

Occupational therapists who are interested in exporting occupational science concepts or occupational therapy practice principles to different cultural groups often encounter problems surrounding the translation of information from one language to another. The case example presented in this article illustrates how one might go about generating a valid translation of a questionnaire with the use of current cross-cultural research guidelines for the translation process. Issues surrounding cultural relevance and linguistic meaning are of central concern in the translation process.

OBJECTIVE. The purpose of this study was to create a Spanish version of the Role Checklist that is content valid and reliable and to demonstrate usefulness of a translation method.

METHOD. A modified version of the translation method of Hachey, Jumoorty, and Mercier was used to translate the English Role Checklist into Spanish. The English and Spanish versions were then evaluated for test–retest reliability at a 2-week interval, using 14 bilingual college students.

RESULTS. The intralanguage correlation was .907 for Part I and .798 for Part II.

CONCLUSION. A content valid and reliable Spanish version of the Role Checklist was created, using replicable translation methods.