American Journal of Occupational Therapy

This article was taken from Dr. Moyers Cleveland’s address given at the AOTA Annual Conference & Expo, held in Orlando, Florida, April 29–May 2, 2010.

In Orlando, I was introduced to the AOTA audience as American chef, author, and television personality Julia Child, who introduced French cuisine and cooking techniques to the American mainstream through her cookbooks and television programs. To underscore the metaphor of a soufflé representing the occupational therapy profession, I appeared onstage in an apron and holding a mixing bowl, pretending to be the great Julia Child.

This article was taken from Dr. Florence Clark’s address given at the AOTA Annual Conference & Expo, held in Orlando, Florida, April 29–May 2, 2010.

OBJECTIVE. We examined whether tailored activity pacing intervention was more effective at reducing pain and fatigue than general activity pacing intervention.

METHOD. Adults with knee or hip osteoarthritis (N = 32) stratified by age and gender were randomized to receive either tailored or general pacing intervention. Participants wore an accelerometer for 5 days that measured physical activity and allowed for repeated symptom assessment. Physical activity and symptom data were used to tailor activity pacing instruction. Outcomes at 10-week follow-up were pain (Western Ontario and McMaster Universities Osteoarthritis Index) and fatigue (Brief Fatigue Inventory).

RESULTS. Compared with general intervention, the tailored group had less fatigue interference (p = .02) and trended toward decreased fatigue severity (p = .09) at 10-wk follow-up. No group differences were found in pain reduction.

CONCLUSION. Tailoring instruction on the basis of recent symptoms and physical activity may be a more effective symptom management approach than general instruction given the positive effects on fatigue.

OBJECTIVE. Our objectives were (1) to quantify arm–hand use of older adults without a disability and to determine the effects of hand dominance, gender, and day on hand usage and (2) to determine the factors that predict arm–hand use. This information will enhance understanding of the extent of the client’s occupational performance.

METHOD. Twenty men and 20 women, ages 65–85, wore wrist and hip accelerometers for 7 consecutive days. Manual dexterity and grip strength were assessed. A three-way factorial analysis of variance and multiple linear regressions were conducted.

RESULTS. The activity kilocounts from both wrist accelerometers revealed a significant interaction effect between hand and gender (F[1, 190] = 24.4, p < .001). Enhanced manual dexterity of the right hand was associated with greater right-hand use.

CONCLUSION. Arm–hand use is a novel dimension of hand function measuring the extent of real-life occupational performance in the client’s home.

OBJECTIVE. We examined the effects of cheek and jaw support on the feeding ability of inefficient feeders born prematurely.

METHOD. Twenty preterm infants served as their own controls. Each infant received either intervention (feeding with oral support) or control (feeding without oral support) for 2 consecutive feedings per day on 2 consecutive days.

RESULTS. Infants displayed a greater intake rate during the intervention feedings, both during the first 5 min (p = .046) and throughout the entire feeding (p = .023). The percentage of leakage during the first 5-min feeding was smaller in the intervention condition than in the control condition (p = .040). No significant differences were found between the two conditions in the sucking, physiological, and alertness variables.

CONCLUSION. Findings confirm oral support as a safe and effective strategy to improve the feeding performance of preterm infants who are poor feeders.

A single-subject design was used to assess the effectiveness of therapy ball chairs on classroom participation in 6 boys with autism spectrum disorder (ASD). The sensory processing pattern of each participant was assessed using the Sensory Processing Measure. Data on in-seat behavior and engagement were collected using digital video recordings during Circle Time. During baseline, participants sat on chairs. During intervention, participants sat on therapy ball chairs. Social validity was assessed by means of a questionnaire completed by the teacher. Each child demonstrated a unique response. The ball chair appeared to have a positive effect on in-seat behavior for the child who had the most extreme vestibular–proprioceptive-seeking behaviors. Children with poor postural stability were less engaged when sitting on the therapy ball chair. The results illuminate the complex nature of children with ASD and the importance of using sound clinical reasoning skills when recommending sensory strategies for the classroom.

OBJECTIVE. We investigated the clinical utility of combined use of Goal Attainment Scaling (GAS) and the Canadian Occupational Performance Measure (COPM) to plan goals and measure progress in a community rehabilitation setting.

METHOD. Fourteen participants with traumatic brain injury completed an outpatient, goal-directed 12-wk occupational therapy program; 53 goals were generated. Performance and satisfaction self-ratings and GAS ratings were collected before and after intervention. Self-awareness, motivation to change, and perceived client-centeredness measures were taken before intervention.

RESULTS. Sensitivity to change was demonstrated by significant improvements after intervention for total performance self-ratings on the COPM and GAS T scores.

CONCLUSION. Combined use of these tools, although time consuming, resulted in goals that were perceived almost unanimously as client centered, despite most participants' having moderate or severe impairment in self-awareness. The process also enabled subjective and objective demonstration of goal achievement, thereby supporting the clinical utility and treatment validity of the combined use of these tools.

We examined the effect that long-handled shoehorn (LHSH) length and body mass index (BMI) have on hip range of motion (ROM) in female adults. Thirty-eight female participants were asked to don a shoe using 18-, 24-, and 30-in. LHSHs. Significant differences in hip flexion were found between the 18- and the 24-in. shoehorns and between the 18- and the 30-in. shoehorns. A significant positive relationship was found between BMI and internal rotation for each of the LHSHs. The results suggest that healthy women with low BMIs using a 24- or 30-in. LHSH have the greatest chance of not violating hip flexion or hip internal rotation ROM precautions. Implications suggest that therapists consider individual BMI and available hip ROM before prescribing an LHSH. A follow-up study is needed involving populations who would likely benefit from using LHSHs.

We describe reconstructive surgeries, therapy, prostheses, and adaptations for a patient who experienced bilateral amputation of all five fingers of both hands through the proximal phalanges in January 1992. The patient made considerable progress in the use of his hands in the 10 mo after amputation, including nearly a 120% increase in the active range of flexion of metacarpophalangeal joints. In late 1992 and early 1993, the patient had “on-top plasty” surgeries, in which the index finger remnants were transferred onto the thumb stumps, performed on both hands. The increased web space and functional pinch resulting from these procedures made many tasks much easier. The patient and occupational therapists set challenging goals at all times. Moreover, the patient was actively involved in the design and fabrication of all prostheses and adaptations or he developed them himself. Although he was discharged from occupational therapy in 1997, the patient continues to actively find new solutions for prehension and grip strength 18 yr after amputation.

OBJECTIVE. The purpose of this study was to determine whether chronometry is appropriate for monitoring engagement in mental practice by comparing the time taken for people with chronic stroke to mentally and physically practice five tasks.

METHOD. Eighteen stroke participants mentally and physically rehearsed each task. Time was recorded for each of the three trials per task.

RESULTS. Participants required significantly more time to physically practice than to mentally practice tasks (all p < .05). A significantly greater amount of time for mental practice of the more-affected arm than for the less-affected arm was also observed (p < .01).

CONCLUSION. Because there was no agreement between the time taken to mentally and physically practice the tasks, chronometry does not appear to be valid for monitoring mental practice in this population.

OBJECTIVE. We examined the effect of switching from a familiar to an unfamiliar setting on household task performance in healthy adults. We also examined the influence of the cognitive functions abstract reasoning and memory on the ability to adapt to different environments.

METHOD. Thirty healthy adults were observed in two different settings while they performed two daily tasks. We evaluated process skill abilities in task performance, time needed to perform each task, memory functioning, and abstract reasoning.

RESULTS. Performance of both tasks required significantly more time in the unfamiliar kitchen. Scores on process skill abilities were significantly lower in the unfamiliar kitchen. We found no associations between environmental effects and abstract reasoning or memory.

CONCLUSION. We found environmental effects on task performance in healthy adults. These findings have important implications for rehabilitation practice. Addressing facilitation of transfer of training effects to familiar environments is of great importance to rehabilitation programs.