American Journal of Occupational Therapy

The Evaluation of Social Interaction (ESI; Fisher & Griswold, 2008) assesses a person's performance of social interaction skills in the natural context with typical social partners during any area of occupation. We used Rasch analysis of 175 observations of 128 people, ages 4–73, to examine internal scale validity, the items’ skill hierarchy and intended purpose, and the ESI's ability to differentiate between people with and without disabilities. The ESI demonstrated validity for 24 of 27 skills and six intended purposes, with a hierarchy of performance. Of the observations, 95.3% demonstrated goodness of fit to the Rasch model, indicating person response validity. People without a disability demonstrated significantly higher social skills performance than those with a known disability (t = 4.468, df = 83 p = .000). The ESI has the potential to provide a quantitative assessment of social interaction performance in the natural context of a person's desired occupation and may be useful for intervention planning and outcome measurement.

The Individuals With Disabilities Education Improvement Act of 2004 (IDEA) requires assistive technology (AT) be considered at the yearly individualized education program (IEP) meeting of every student in special education. IDEA also directs that AT be implemented on the basis of peer-reviewed literature despite a paucity of research on AT’s effectiveness in the public schools. This repeated-measures quasi-experimental study explored AT’s effect in a public school special education setting. Participants (N = 13) were a heterogeneous group of students in 1 school system who had newly provided AT to address academic and communication goals in one school year. Results suggest that relative to other interventions, AT provided by a multidisciplinary team may have a significant effect on IEP goal improvement (t[12] = 5.54, p = .00) for students in special education (F[2] = 9.35, p = .00), which may support AT’s use in special education by occupational therapists as directed by IDEA.

OBJECTIVE. We determined the feasibility and outcomes of the Log Handwriting Program (Raynal, 1990), an 8-week training program based on task-specific practice of handwriting.

METHOD. We used a pretest–posttest design involving 16 first- and second-grade Australian students. Handwriting training sessions occurred in schools for 45 min per week over 8 weeks, in groups of 2 or 3. Weekly homework was provided. The primary outcome measure was the Minnesota Handwriting Assessment (range = 0 to 34; Reisman, 1999). Legibility, form, alignment, size, spacing, and speed were measured.

RESULTS. All six assessment subscales showed statistically significant differences. Legibility improved by a mean of 4.1 points (95% confidence interval = 2.5 to 5.7); form, 5.3 points; alignment, 7.8 points; size, 7.9 points; and space, 5.3 points. Speed decreased by 3.9 points.

CONCLUSION. Preliminary evidence indicates that an 8-week Log Handwriting Program is feasible and improved handwriting in primary school children.

OBJECTIVES. To determine the reliability and aspects of validity of the Evaluation Tool of Children’s Handwriting–Cursive (ETCH–C; Amundson, 1995), using the general scoring criteria, when assessing children who use alternative writing scripts.

METHOD. Children in Years 5 and 6 with handwriting problems and a group of matched control participants from their respective classrooms were assessed with the ETCH–C twice, 4 weeks apart.

RESULTS. Total Letter scores were most reliable; more variability should be expected for Total Word scores. Total Numeral scores showed unacceptable reliability levels and are not recommended. We found good discriminant validity for Letter and Word scores and established cutoff scores to distinguish children with and without handwriting dysfunction (Total Letter <90%, Total Word <85%).

CONCLUSION. The ETCH–C, using the general scoring criteria, is a reliable and valid test of handwriting for children using alternative scripts.

BACKGROUND. The Do–Eat was developed to evaluate daily task performance abilities among children with developmental coordination disorder (DCD). This study investigated the tool’s reliability and validity.

METHOD. Participants were 59 children ages 5 to 6.5 years; 30 children diagnosed with DCD according to the DSM–IV–TR; and a control group of 29 children, who were matched for age, gender, and sociodemographic background.

RESULTS. Both the Do–Eat and the accompanying Parent Questionnaire yielded high internal consistency (αs = .89–.93). Construct validity was demonstrated by significant between-group differences on the Do-Eat (t[57] = 14.09, p < .001) and the Parent Questionnaire (t[57] = 3.64, p < .001). Significant correlations between children’s scores on the sensory–motor component of the Do–Eat and the Movement Assessment Battery for Children final score confirmed concurrent validity (r = −.86, p < .001).

CONCLUSIONS. Results suggest that the Do–Eat is a reliable, valid tool for identifying children at risk for DCD.

Evidence-based exercise and relaxation recommendations for people with breast cancer–related lymphedema (BCRL) are needed. We report a randomized controlled study of one program, designed to achieve synergistic improvements in physical and emotional BCRL symptoms. People in the treatment group received an exercise and relaxation program, The Breast Cancer Recovery Program (N = 16). The control participants (N = 16) continued with health professionals’ recommendations. Participants were tested at entry, 2.5 weeks, 5 weeks, and 3 months. Treatment group participants, compared with control participants, demonstrated significant treatment effects for improved bioimpedance z, arm flexibility, quality of life, mood at 3 months, and weight loss. Adherence was high for this safe and effective program, which improved lymphedema physical and emotional symptoms.

OBJECTIVE. We examined the efficacy of a remotely based arm rehabilitation regimen. A 62-year-old man participated in occupation-based, task-specific practice of activities of daily living (ADLs) >3 years after stroke. The entire regimen was administered over the Internet using personal computer–based cameras and free network meeting software.

METHOD. Fugl-Meyer Assessment (FM), Action Research Arm Test (ARA), and Canadian Occupational Performance Measure (COPM) were administered before intervention. One week after treatment, FM, ARA, and COPM were readministered.

RESULTS. The participant exhibited reduced impairment and reduced functional limitation. He also expressed enhanced satisfaction with his ability to perform ADLs and rated his ADL performance better after intervention. The participant could now drive using both hands, use eating utensils, and catch and throw a ball.

CONCLUSION. Data suggest feasibility and efficacy of a remotely based, inexpensive approach using functional electrical stimulation for affected arm rehabilitation after stroke.

The investment of time and self to develop therapeutic relationships with clients appears incongruent with today’s time-constrained health care system, yet bridging the gap of these incongruencies is the challenge therapists face to provide high-quality, client-centered, occupation-based treatment. This case report illustrates a shift in approach from biomechanical to occupational adaptation (OA) in an orthopedic outpatient clinic. The progress of a client with lupus-related arthritis who was 6 days postsurgery is documented. The intervention initially used a biomechanical frame of reference, but when little progress had been made at 10 weeks after surgery, a shift was made to the more client-centered OA approach. The Canadian Occupational Performance Measure was administered, and an OA approach was initiated. On reassessment, clinically important improvements were documented in all functional tasks addressed. An OA approach provides the bridge between the application of clinical expertise, client-centered, occupation-based therapy and the time constraints placed by payer sources.

Objective numerical data on swallowing function are needed to aid in eating and swallowing intervention and preventive rehabilitation. Using noninvasive methods, the influences of age and differences in size of water bolus on laryngeal activity and respiratory activity were examined in healthy young and older women. Swallowing function was influenced by age and bolus size. Influence of bolus size was recognized only in duration of laryngeal movement in younger women, with no apparent influence in older women. Results for older women were thought to be related to declines in swallowing function with the physiological aging of respiratory and swallowing muscles. In the future, noninvasive methods need to be developed for evaluating function and therapeutic effects against swallowing function impairment and to provide objective numerical data for health insurers.

OBJECTIVE. We investigated motor control and muscle activation when reaching for and grasping objects with a reacher compared with the unaided hand.

METHOD. In a repeated-measures counterbalanced design, 41 healthy participants with no previous experience using a reacher were randomly assigned to a sequence of four conditions. Movements of the wrist and fingers were recorded using a three-dimensional Qualisys camera system for assessing reach and grasp. Muscle activations from finger and arm flexors and extensors were recorded by surface electromyography.

RESULTS. Participants exhibited a smaller grasp aperture, longer reaching time, and more muscle activity when they used a reacher.

CONCLUSION. Efficient motor control, which requires both time and practice, is needed to successfully use a reacher. Clients presented with reachers without sufficient time to develop motor skills unique to reacher use may be more likely to abandon this assistive device and fail to benefit from its function.

We investigated how induced blur affects performance on the Trail Making Test and Digit Symbol Test routinely used in occupational therapy cognitive evaluations. The study used a factorial design with both age (young and old adults) and simulated blur levels of near visual acuity (20/50 and 20/100) manipulated between participants. A sample of 124 healthy, community-living adults was used in the final analysis. Significant differences (p < .05) were found in performance for young participants between 20/50 and 20/100 blur level as well as between 20/20 and 20/100 blur level for the Digit Symbol Test. Scores for old participants decreased as a function of blur but were not significant. This study illustrates that cognitive evaluations used throughout the lifespan may require the appropriate visual acuity level to maximize performance. Occupational therapists’ understanding of client factors and their effect on performance is fundamental to the client evaluation process.

OBJECTIVES. We sought to determine the criterion validity of the Useful Field of View (UFOV) assessment and Stroke Drivers’ Screening Assessment (SDSA) through comparison to the results of on-road assessment.

METHOD. This was a prospective study with people with stroke. Outcome measures used were UFOV, SDSA, and the results of on-road assessment.

RESULTS. Both the results on UFOV (Divided Attention subtest, p < .01; Selective Attention subtest, p < .05) and SDSA (p < .05) were significantly related to the recommendation from on-road assessment. The Divided Attention subtest of the UFOV had the highest sensitivity value (88.9%).

CONCLUSIONS. UFOV and SDSA are valid assessments of driving ability for stroke. The Divided Attention subtest of the UFOV can guide decision making of occupational therapists in stroke driver rehabilitation and in determining those who require further assessment on road because they pose a safety risk. Screening assists people with stroke to decide whether they are ready to have an on-road assessment.

OBJECTIVE. We examined the relationship between handwriting and keyboarding performance and between these writing modes and underlying performance skills.

METHOD. Sixty-three young, healthy adults who used the computer daily were recruited for this study by means of a convenience sample (mean = 25.3, standard deviation = 3.0); 15 were slow keyboarders and 17 were fast keyboarders. Participants were administered handwriting and keyboarding assessments, as well as measures of finger function, kinesthetic processing, and eye movement.

RESULTS. Although handwriting and keyboarding speed were moderately correlated, these activities did not share underlying performance skills. In addition, different correlation patterns between written communication modes and performance skills were found among slow and fast keyboarders.

CONCLUSION. Results suggest that occupational therapists and educators should consider a variety of factors before recommending keyboarding as an alternative written communication method for people with handwriting difficulties. Moreover, different recommendations appear to be warranted for slow and fast keyboarders.

Reactions to death have been studied extensively from psychological, behavioral, and physiological perspectives. Occupational adaptation to loss has received scant attention. Qualitative research was undertaken to identify and describe occupational responses in bereavement. The constant comparative approach was used to analyze and interpret the occupational responses. Adaptive strategies of occupational accommodation and assimilation were used after the death of a family member. Desire to sustain bonds with the deceased motivated specific occupational engagements. These occupational responses served to reconstruct meaning after the death of a family member. These findings contribute to understanding adaptation after death by adding an occupational perspective to previous theories. Occupational therapists’ abilities to support clients after loss can be enhanced through appreciation of occupational accommodation and assimilation and the role of continuing occupational bonds after the death of a loved one.

Occupational therapists are encouraged to reflect on doing, being, and becoming not only as it relates to the development of their profession but also in their own lives (Wilcock 1999). This article is a description of that process for me and my family in our journey through perinatal loss. This autoethnography uses a personally situated account of perinatal death. This article is a form of self-narrative that places me and my family in social context through the lens of an occupational therapist. This article aims to convey the meanings attached to the experience of grief and loss in the context of participation in everyday occupations. By sharing a perspective on the lived experience and connecting it to the literature on grief and occupation, readers will be able to decide if the connection holds as valid from a theoretical and clinical perspective.

Experience sampling examined how temporality, the lived experience of time, varied related to specific activity qualities and experiences in everyday life. Thirty-five students completed electronic surveys regarding their current activity and feelings and rated the activity's novelty and complexity, their depth of emotional and intellectual engagement, the direction and depth of attention, and the demands of the activity on their skills. Using configural frequency analysis and an analysis of narrative responses, configurations of factors (types) associated with variations in perceived temporalities were described. Four composite types identified occurred with any temporality. In most habitual activities, time was perceived as passing the same as clock time. Most faster or timeless temporalities occurred in complex, novel, and skill-requiring activities that engaged participants. Unexpected activity configurations were also associated with accelerated perceptions of time. Occupational therapists may use this knowledge to assist clients to redesign activities that promote positive experiences without high activity demands.

Occupational therapy practitioners may encounter challenges when they try to incorporate evidence into practice. To embrace evidence-based practice (EBP), clinicians must have readily available, relevant, and concisely summarized evidence. Although researchers have described the importance and process of EBP, less has been written about how to efficiently integrate evidence into practice. Clinicians may benefit from examples of reasoning, strategies, and resources to successfully integrate evidence. This article reviews the steps of EBP and offers recommendations to overcome common barriers. For EBP to become integrated into practice, greater communication and collaboration among all stakeholders must occur. EBP and knowledge translation require multiple processes and coordinated efforts. Therefore, everyone from practitioners to employers has a role in increasing EBP and transferring knowledge for practice. To encourage discussion and actions, the article provides implications and recommendations for practitioners, researchers, educators, organizations, and policymakers.

The American Occupational Therapy Association’s Centennial Vision articulates the need for occupational therapy to be science driven and evidence based in major practice areas. This article provides a review on the state of the occupational therapy research published in the American Journal of Occupational Therapy (AJOT) in the area of productive aging in the past 2 years (2008–2009). The article identifies the types of research published, assesses how well the journal is meeting the Centennial Vision in productive aging research, and discusses implications for utilization of the evidence by occupational therapy practitioners. Although many basic research articles provide a foundation for future intervention development and further define practice roles, the AJOT articles addressing productive aging represent diverse research questions and have produced a body of knowledge that is not easily translated to practice. More effectiveness studies are needed to provide adequate evidence for occupational therapy intervention with older adults.

I describe the findings of one of the largest randomized controlled trials (RCTs) of rehabilitation after traumatic brain injury (TBI) ever conducted, examine the theoretical relationship between cognitive and functional rehabilitation after TBI, and describe the historical preference for cognitive (top-down) rather than functional (bottom-up) interventions. I also contrast the goals and principles of cognitive rehabilitation and of the neurofunctional approach of Giles and Clark-Wilson (1993; Giles, 2005)—a bottom-up approach. Findings of the RCT provide empirical support for both functional and cognitive interventions following acute TBI. In addition, they provide evidence that each type of intervention offers significant advantages for a specific subpopulation. The clinical implications of these findings for occupational therapy practitioners are discussed.