British Journal of Occupational Therapy

The Casson Memorial Lecture 2005, given on 23 June at the 29th Annual Conference of the College of Occupational Therapists, held at the Devonshire Park Centre, Eastbourne. The conference theme was ‘Activity, Participation, Occupation’.

There are still major problems being encountered by occupational therapists when they attempt to access relevant research material. One of the main reasons for this is that there are currently relatively few occupational therapists who are involved in any form of research on a regular basis.

This article highlights the potential of the journal club as a means of introducing occupational therapists to research that will both be relevant to their work area and form a substantial part of their continuing professional development. A brief overview of the format and content of journal clubs both in occupational therapy and in other health care professions is intended to encourage occupational therapists to initiate their own journal clubs as a method of bridging the theory-practice gap that still exists in their profession.

Various research studies have explored the factors that predispose people with spinal cord injuries to pressure sore development. Two hundred risk factors have been associated with pressure sore occurrence. One of the variables commonly reported to affect pressure sore occurrence is a decreased level of activity (Vidal and Sarrias 1991, Fuhrer et al 1993). This concurs with the philosophy of occupational therapy that a reduction in activity can generate pathology (Miller et al 1988).

This research study investigated whether decreased participation in occupational activities (work, leisure and activities of daily living) was related to pressure sore occurrence in paraplegic men. The sample was selected randomly from the occupational therapy discharge files of a rehabilitation facility in Saudi Arabia. The data were collected by means of a telephone questionnaire from a total of 58 men, over a 3-month period.

The study showed that there was a large increase in unemployment in paraplegic men following injury (from 10% to 59%) and, as might be expected, manual workers were more vulnerable than office workers. The study found no significant association between pressure sore occurrence and whether or not the individual was employed. However, it showed a statistically significant association between unemployment and pressure sores severe enough to lead to hospitalisation. The study also found a statistically significant association between individuals' independence in activities of daily living and the number of pressure sores that they had reported in the last 2 years.

These findings indicate the potential importance of clients remaining occupationally active for their wellbeing and the significant contribution that occupational therapists can make by enabling rehabilitation of occupational activities.

Little is written in the occupational therapy literature about sexual expression and professional practice. This opinion piece presents two opposing opinions. One argues for its inclusion as part of an holistic approach. The other, developed from published emails, argues for its exclusion, because sexual expression is not seen as an occupational activity. These professional perspectives are set against the lived experiences of physically disabled people. From this consumer perspective, the omission of sexual expression from practice can be viewed as potentially damaging. A proposed way forward is to increase the awareness and skills of occupational therapists in this domain of practice.

The open question, ‘What prevents you from reaching occupational balance?’, was posed within a questionnaire aimed at exploring the meanings of occupation, health and wellbeing with a cohort of first-year occupational therapy students during their initial few weeks at university. Their written responses to the question about occupational balance were analysed and are discussed in this paper. Not surprisingly, occupational balance appeared to be achieved by only a few and more by chance than design.

People, time and money factors were identified as the main impediments to achieving occupational balance, with psychological and emotional pressures being at the forefront. Interestingly, despite these barriers, the overall educational benefit of considering the occupational balance question in this way raised the students' awareness of its relationship to health and wellbeing. This increased awareness might have longer-term health benefits, both personally and professionally, which would be worthy of further research.

The aim of this literature review was to examine occupational therapy input for children with acquired brain injury (ABI). Although 3,462 citations were identified by the literature search, only 10 articles met the criteria and were relevant to the review. The studies found that children with ABI had continuing difficulties, post-injury and postdischarge, with motor skills, self-care skills, cognition and behaviour. However, substantial numbers of children with continuing problems did not access therapy, particularly in the year postdischarge.

Occupational therapy is often part of inpatient paediatric rehabilitation, but there is a lack of research investigating the effectiveness of therapy. The review notes the dearth of research and literature in this field and suggests that further research is needed to underpin practice.