School-based practice patterns: a survey of occupational therapists in Colorado.

OBJECTIVE: This purpose of this study was to describe school-based occupational therapy practice for kindergarten through twelfth-grade students in Colorado and to examine occupational therapy practice in light of current education policy and published views of best practice. METHOD: Study data were provided by 105 occupational therapists and occupational therapy assistants who completed a 24-item questionnaire. RESULTS: Occupational therapists carried an average caseload of 43.68 students; most frequently served kindergarten through third-grade students with perceptual or communicative disabilities; and delivered services most often in pullout treatment areas. Practitioners spent most of their work week providing direct services. Remedial or developmental approaches were used 62% of the time and compensatory and educational approaches 37% of the time. Individualized education program goals addressed by occupational therapists were most frequently developed by the occupational therapist and targeted students' sensory or motor impairments. Workshops on autism and sensorimotor intervention techniques were reported as the primary and preferred forms of professional development. CONCLUSION: The strong majority of reported occupational therapy services contrasted with emerging views of best practice. They were, however, consistent with the Colorado Department of Education's guidelines for "motor specialists" that address occupational therapy, physical therapy, and adaptive physical educators working in schools. Study findings are discussed.     

The Effects of Exercise on the Elderly and Implication for Therapy

Physical and occupational therapy activity and exercise programs have historically been directed toward the restoration of function in the disabled elderly. These professions have not focused their attention on the well or mildly impaired elderly. The current research on exercise and the elderly described here documents the positive benefits of physical activity and exercise programs for the well or mildly impaired elderly. The potential for physical and occupational therapists to provide services to the non-disabled elderly population is explored and a model program is offered as an example of this expanded role for therapists.     

Perceptions regarding school-based occupational therapy for children with emotional disturbances.

The purpose of this study was to identify the perceived appropriateness, extent, and types of services provided by occupational therapists to children with emotional disturbances in public schools. A nationally mailed survey was conducted of randomly selected school occupational therapists derived from the American Occupational Therapy Association School System Special Interest Section list. The sampling frame was 982 with a response rate of 48% (n = 476). Eighty-seven percent of all respondents were supportive of school occupational therapy for students with emotional disturbances, although these students made up only a small proportion of their caseload. The therapists indicated that a variety of intervention approaches were used with most targeting educational areas, especially handwriting. The most commonly reported intervention was sensory integration. Many respondents perceived that they could not provide effective interventions because they were not appropriately trained. Perceived lack of knowledge and confusion about occupational therapy's role may lead to underutilization of occupational therapy for addressing the complex needs of children with emotional disturbances. Further research and discussion are needed in the profession to arrive at consensus regarding what approaches are most appropriate and effective in schools.     

Occupational therapy and participatory research: a partnership worth pursuing.

This paper argues that participatory research is an approach to developing knowledge that can make significant contributions to occupational therapy. One project, working with older adults in Toronto to organize a new seniors' organization, is used to illustrate the ways in which this approach is participatory and how it can be understood as research. Other examples of participatory research from the occupational therapy literature are then presented. These include research among occupational therapists and research with participants who are typically clients of occupational therapy services. The examples are used to illustrate the conceptual links between client-centered, occupation-based occupational therapy and participatory research. Challenges of adopting a participatory research approach in occupational therapy are discussed, although many of these can be addressed through open discussions with participants. The paper concludes that participatory research is an approach to research that should be pursued more actively in occupational therapy.     

Burnout in occupational therapists

Burnout is a job-related condition involving feelings of emotional exhaustion, depersonalization, and reduced personal accomplishment. The Maslach Burnout Inventory (Maslach & Jackson, 1981a) is the instrument most widely used to measure job-related stress in human service professions, such as occupational therapy. This study explored the application of the Maslach Burnout Inventory for use with occupational therapists. The subjects were 99 registered occupational therapists residing in the southeastern United States. Mean scores lower than the aggregate occupational norms provided by the test's authors on the Emotional Exhaustion and Depersonalization subscales supported the need to develop specific norms for occupational therapists. Results of this study indicate that use of the aggregate norms would underestimate the level of experienced burnout. Correlational analyses delineated significant relationships between age and Emotional Exhaustion and Depersonalization, education and Emotional Exhaustion and Depersonalization, years of work as an occupational therapist and Depersonalization and Personal Accomplishment, years in the present position and Personal Accomplishment (intensity only), hours of direct patient contact and Emotional Exhaustion (intensity only), and hours of direct patient contact and Depersonalization (frequency only). These correlates of burnout furnish clues for understanding the development of work-related stress in occupational therapists.     

Cognitive assessments for older adults: which ones are used by Canadian therapists and why

BACKGROUND: Occupational therapists routinely evaluate cognition in older adults, yet little is known about which assessments they use and for what purposes. PURPOSE: To examine the standardised and non-standardised assessments used by occupational therapists to evaluate cognition. METHOD: A random sample of 1042 Canadian occupational therapists completed the questionnaire by e-mail, post, or Internet website (n=247, response rate: 24.5%). RESULTS: Respondents reported using 75 standardised and non-standardised measures. The assessments were grouped according to theoretical approach: bottom-up (assessment of cognitive components), top-down (assessment of function) and combined (either of above, plus interview). Theoretical approaches were used similarly across regions, despite differences in reporting of particular assessments. Therapists used more bottom-up assessments that were standardised, identified deficits, and easy to administer. They used more top-down assessments that were non-standardised, predicted function, and fit with their theoretical approach. CONCLUSION: It is recommended that standardised top-down assessments be developed to support evidence-based occupational therapy.     

Effectiveness of school-based occupational therapy intervention on handwriting.

OBJECTIVE: This study investigated the effects of school-based occupational therapy services on students' handwriting. METHOD: Students 7 to 10 years of age with poor handwriting legibility who received direct occupational therapy services (n = 29) were compared with students who did not receive services (n = 9) on handwriting legibility and speed and associated performance components. Visual-motor, visual-perception, in-hand manipulation, and handwriting legibility and speed were measured at the beginning and end of the academic year. The intervention group received a mean of 16.4 sessions and 528 min of direct occupational therapy services during the school year. According to the therapists, visual-motor skills and handwriting practice were emphasized most in intervention. RESULTS: Students in the intervention group showed significant increases in in-hand manipulation and position in space scores. They also improved more in handwriting legibility scores than the students in the comparison group. Fifteen students in the intervention group demonstrated greater than 90% legibility at the end of the school year. On average, legibility increased by 14.2% in the students who received services and by 5.8% in the students who did not receive services. Speed increased slightly more in the students who did not receive services. CONCLUSION: Students who received occupational therapy services demonstrated improved letter legibility, but speed and numeral legibility did not demonstrate positive intervention effects.     

Occupational therapy outcomes for clients with traumatic brain injury and stroke using the Canadian Occupational Performance Measure.

The purpose of this study was to determine whether 155 ethnically diverse clients with traumatic brain injury (TBI) and stroke (cerebrovascular accident; CVA) who received occupational therapy services perceived that they reached self-identified goals related to tasks of daily life as measured by the Canadian Occupational Performance Measure (COPM). This study found that a statistically and clinically significant change in self-perceived performance and satisfaction with tasks of daily life occurred at the end of a client-centered occupational therapy program (p < .001). There were no significant differences in performance and satisfaction between the TBI and CVA groups. However, the group with right CVA reported a higher level of satisfaction with performance in daily activities than the group with left CVA (p = .03). The COPM process can effectively assist clients with neurological impairments in identifying meaningful occupational performance goals. The occupational therapist also can use the COPM to design occupation-based and client-centered intervention programs and measure occupational therapy outcomes.     

Three frames of reference in work-related occupational therapy programs

This paper discusses the relationship of a theoretical frame of reference to the implementation of a work-oriented program. Three frames of reference in occupational therapy are reviewed, and work-related theories and approaches available to therapists are categorized under each. Examples of the application of various frames of reference are given through an analysis of work programs described in the occupational therapy literature. We recommend that therapists select and apply frames of reference systematically when developing work programs to facilitate the development of a body of knowledge in this area.     

Male occupational therapists in Ontario: a survey of work-related issues

Job satisfaction greatly influences an individual's decision to remain in his or her work situation. In many studies, one of the primary reasons for men leaving the profession of occupational therapy was due to job dissatisfaction. The purpose of this study was to further investigate the issue of job satisfaction in male occupational therapists. In March 1992, a survey was mailed to all (n = 82) male occupational therapists practicing in Ontario. A 67% (n = 55) response rate was obtained. This study addressed several factors pertaining to job satisfaction and other work-related issues. When using the median years of OT work experience (ie. seven) to divide the sample, two items were found to be significantly different when using one-way analyses of variance (ANOVA's): "satisfaction with the standing of the profession" and cumulative "satisfaction variable" items. In this study, less experienced male occupational therapists reported themselves to be less satisfied, more inclined to leave the profession or pursue another profession, but did not feel more isolated than their more experienced counterparts. The means of all items revealed a feeling of dissatisfaction on the Likert-scale used in this survey. Although no statistical significance could be achieved, a clear trend existed toward a lower level of satisfaction among the less experienced group.     

Provision of dysphagia services in a developing nation: Infrastructural challenges

Abstract

This study investigates occupational therapy for early communication in children with autism spectrum disorders (ASD). The research explored the role of occupational therapists in supporting children with ASD to become better communicators by considering their inter-professional collaboration with speech-language pathologists. Convenience samples of 21 clinical occupational therapists and speech-language pathologists were recruited to participate in semi-structured audio-recorded focus groups, using a qualitative design. Distinct views included a child-centred focus from speech-language pathologists, whereas occupational therapists spoke of the child through societal viewpoints, which later pointed to occupational therapists’ proficiency in enabling skill generalization in ASD. An equal partnership was consistently reported between these clinicians, who identified the same objectives, shared strategies, joint treatments, and ongoing collaboration as the four main facilitators to inter-professional collaboration when treating children with ASD. Three unique roles of occupational therapy comprised developing non-verbal and verbal communication pre-requisites, adapting the setting, educating-partnering-advocating for the child, and providing occupation-based intervention. These three themes meshed with the discipline-specific occupational therapy domains represented in the Person–Environment–Occupation framework. When working in inter-professional collaboration, speech-language pathologists and occupational therapists agree that occupational therapy is indispensable to early intervention in enabling communication in ASD.     

Opening feminist histories of occupational therapy.

This paper frames the history of occupational therapy in feminist terms. It focuses on gender segregation in occupational therapy, the influence of class and race in shaping opportunities for occupational therapists, and the place of feminism in the goals and achievements of the occupational therapy profession. Such issues have been addressed by feminist scholars in histories of women in medicine, nursing, and other helping professions. These sources help place the achievements of occupational therapy within the context of women's historic entry and advancement in the American work force.     

5~21岁儿童和青少年作业治疗实践指南(二)

近年来,关于鼓励并支持儿童和青少年最大限度地参与以活动和作业为基础干预措施的文献越来越多。本实践指南对5~21岁儿童和青少年以活动和作业为基础的干预措施中3项系统综述进行整合,旨在为其在家庭、学校和社区的作业治疗服务,提供决策指导和最佳实践支持。     

基于作业分析任务导向性训练对脑卒中患者上肢功能的疗效

目的 研究基于作业分析的任务导向性训练对脑卒中偏瘫患者上肢的功能效果.方法 2019年1月至2020年11月住院治疗60例脑卒中患者,按照随机数字表法分为对照组(n=30)和观察组(n=30).对照组患者在接受正规的神经内科药物治疗、针灸治疗的基础上采用常规康治疗,其中包括传统的作业治疗.观察组患者在对照组治疗基础之上...     

Assessment of Rehabilitation Infrastructure in Peru

Objective

To assess rehabilitation infrastructure in Peru in terms of the World Health Organization (WHO) health systems building blocks.

An assessment of occupational therapists' roles and attitudes toward sexual rehabilitation of the disabled.

Sexual adjustment is believed to be a fundamental aspect of the medical and psychosocial rehabilitation of the disabled and chronically ill. A sample of 26 occupational therapists involved in adult rehabilitation services were given a list of specific tasks identified in the literature to be related to medical (physical) aspects of sexual rehabilitation. The results indicated that a small percentage of occupational therapists participate in these tasks. The majority believed that the tasks were important in occupational therapy but that their preparation to perform the tasks was inadequate. The subjects, as a group, held positive attitudes toward sexual rehabilitation and considered it a legitimate aspect of health care for which an appropriate content should be integrated into the basic curricula in occupational therapy.     

Patient performance level during inpatient physical rehabilitation: therapist, nurse, and patient perspectives

A study was undertaken to contrast the perspectives among rehabilitation nurses, physical therapists, and occupational therapists in their ratings of patient mobility and self-care capabilities. Staff members rated every patient (n = 66) whose stay on a physical rehabilitation inpatient unit ended within a specified three-month period. Considerable divergence of views was found in all six areas rated, with nurses rating patients at admission as significantly less independent than did the therapists. This difference remained in the ratings at discharge in four of the six areas. Additionally, those patients able to be interviewed (n = 53) were surveyed as to the degree to which they saw progress (or deterioration) during their stay. Correlations between these patient ratings and change ratings by the staff were not statistically significant. The findings suggest the need for additional communication among the various disciplines, as well as between staff members and patients, to work toward a consensus view of the rehabilitation process.     

Perceptions of physical therapy competencies in rheumatology. Physical therapists versus rheumatologists

The purpose of this article is to report the differences in perceptions among three groups of respondents who assessed the importance of 80 competencies for entry-level physical therapists who treat patients with arthritis. Nonparametric statistics were used to analyze the responses of physical therapists and rheumatologists who completed a questionnaire regarding the competencies. I used the Kruskal-Wallis one-way analysis of variance to make group comparisons and the Mann-Whitney U test to complete pair-wise comparisons. The results revealed significant differences of opinion among the groups (p = .007) for 20 of the 80 competencies. The significant differences in opinion were among physical therapy clinical educators (n = 100), physical therapy arthritis health professionals (n = 108), and rheumatologists (n = 80). Although the results suggested that some groups perceived certain physical therapy competencies in rheumatology to be useful but not essential for the entry-level physical therapist to perform, considerable variability existed within groups. Despite the variance in opinions, teaching of these competencies should be included in the entry-level physical therapy curriculum or in clinical settings.     

Changes in health status for persons with wrist or hand impairments receiving occupational therapy or physical therapy.

OBJECTIVE: The purpose of this study was to describe changes of health status as perceived by clients with hand or wrist impairments who received rehabilitation in acute, orthopedic outpatient facilities from occupational therapy or physical therapy personnel. METHOD: One thousand three hundred ninety-nine adults with wrist (n = 692) or hand (n = 707) impairments who were treated between July 1996 and June 1997 were selected from the Focus On Therapeutic Outcomes, Inc. (FOTO) national rehabilitation database. Each client completed a health status questionnaire on intake and discharge. Data consisted of number of outpatient visits, duration of treatment episode, and health status scores for six functional scales. Measures of intensity, global health status, global utilization, and client satisfaction were calculated. Outcomes were evaluated across occupational therapists and physical therapists. RESULTS: Clients perceived improvement (p < .05) in their health status over the course of therapy. Number of visits and measures of health status and client satisfaction were similar across type of therapist. Episode duration was longer (p < .05) and intensity was less (p < .05) for clients seen by occupational therapists. CONCLUSION: Clients receiving rehabilitation in acute orthopedic outpatient centers perceived improvement in their functional abilities and health and well-being (global health status and individual functional scales) over the time during which treatment was provided. Results confirm the responsiveness of the outcomes instrument to clinical change in the clients' perception of their health status over the course of therapy and support the use of health status as a measure of clinical outcome.