Childhood obesity is a serious public health concern, and although the complexity of this issue is now recognized, programming has yet to consider the interconnected nature of the contributing factors. This study, guided by grounded theory, sought to discover how mothers are attempting to promote health in a seemingly obesogenic environment. Data were collected via 22 semi-structured interviews, 55 personal diary entries, and 11 parenting style questionnaires. Constant comparative analysis occurred until theoretical saturation, and strategies to increase trustworthiness were used. Themes included (a) Managing Time, Managing Chaos; (b) Cultural Infatuation with Food; (c) Managing Health from a Distance; (d) Fluctuating Challenges and Supports; (e) Strategies; and (f) Resulting Actions/Interactions. Additionally, a substantive-level theory was developed. Findings highlight the importance of developing contextually relevant, family-based interventions for overweight children and their families, and propose a shift in current program development for this population.
The purpose of this study was to determine if there were differences in pressure relieving abilities among six commonly prescribed wheelchair cushions and whether differences were related to the participant's body mass. In addition, the participant's perception of cushion comfort was investigated. A convenience sample of 40 adult wheelchair users were recruited from a rehabilitation hospital. Participants sat on the following six cushions for 5 minute periods: Flexseat, Jay 2, Pindot, ROHO High, ROHO Low, and Stimulite. Pressure measurements were recorded with the Xsensor Pressure Mapping System, a new instrument available to therapists. It was discovered that ROHO High and ROHO Low cushions were more effective in relieving pressure than the other cushions. Cushion pressure relieving abilities were largely dependent on the individual's body mass. ROHO cushions were also perceived to be more comfortable than all other cushions tested regardless of body mass and pressure relief.
The purpose of this study was to investigate the impact of unilateral neglect on activities of daily living (ADL). Participating in the study were 46 right-brain stroke patients evaluated on the Klein-Bell ADL Scale, the Draw-A-Man-Test, the Random Chinese Word Cancellation Test, and physical variables. Based on the results of the Draw-A-Man Test, and of the Random Chinese Word Cancellation Test, patients were divided into groups. The results showed that patients demonstrating concurrent personal and extrapersonal neglect were significantly lower in ADL performance than patients with extrapersonal neglect and patients with test results within normal range, but that the latter two groups did not differ from each other statistically. ADL performance was found to be related to physical variables. However, after controlling the effects of these physical variables by a partial correlation, the presence of concurrent personal and extrapersonal neglect was significant as it related to ADL performance.
This study examined the effectiveness of an occupational therapy intervention to facilitate intrinsic motivation in individuals with psychiatric illness who had motivational deficits. The clinical problem, motivational deficits, was referred to the passive or coercive behaviors resulting from cumulative psychosocial frustrations. The intervention was based on a motivational frame of reference developed by the researcher, involving strategies of autonomy support and moderate structure. The research design was a mixed-effects nested design, involving one experimental group and one control group, and two different groups of therapists to carry out the two types of treatment. The treatment was carried out in one-hour, twice-a-week individual therapy sessions for 12 weeks. The results showed that the motivational intervention effectively facilitated intrinsic motivation, and that there was a corresponding change in social behavior observed by independent therapists. It was concluded that the motivational frame of reference has potential to be used in occupational therapy practice, and further research is needed to investigate its long-term effects.
This study examined interlimb coupling in a left hemiplegic population. Participants were 20 healthy individuals and 18 individuals who were status post right cerebral vascular accident with left hemiparesis. Participants oscillated each elbow at both preferred-unilateral and preferred-symmetrical bilateral rates. One-tailed paired t-tests using frequency of oscillation and peak velocity supported the hypothesis that the unaffected limb would adapt its movement dynamics from the unilateral to the bilateral movement conditions (ps < .0125), while the affected limb did not differ its performance across the unilateral and bilateral conditions (ps >. 0125). No significance (p > .0125) was found between the unilateral and bilateral performances for either of the normal group's limbs. This study suggests that during bilateral movements, the affected limb may constrain the unaffected limb. More research is needed to examine the coupling relationship between the affected and unaffected limbs and how occupation may facilitate the ability to adapt to novel situations.
Since play wears many faces, occupational therapists (OTs) are concerned with the ways it may be expressed. Because adaptability is an important by-product of approaching activity in a playful manner, playfulness is a valuable outcome of occupational therapy. The Test of Play fulness (ToP) is an observational assessment requiring no special equipment. It represents a conceptualization of playfulness drawn from the literature. The purpose of this paper was to trace the development of the ToP and examine its preliminary construct and concurrent validity and inter-rater reliability. Validity and reliability were examined using the many-faceted Rasch analysis. Concurrent validity was examined by comparing children's ToP scores with their scores on the Children's Playfulness Scale. Results suggested that the ToP is both valid and reliable when applied to children, with or without disabilities, between 15 months and 10 years.
This study investigated the attitudes of occupational therapy (OT) and occupational therapy assistant (OTA) educators toward the inclusion of students with disabilities in their educational programs. A nonexperimental design relying on a mailed survey was the methodology selected to examine the following research questions: (1) What are the attitudes of full-time OT and OTA educators who teach in accredited programs in the United States toward inclusion of students with disabilities in their OT programs? and (2) What factors are predictive of positive attitudes of OT faculty towards including students with disabilities in their educational programs? Results indicated that overall OT and OTA faculty have favorable attitudes toward including students with disabilities in their programs. However, consistent with the literature, these attitudes are hierarchical. In other words, attitudes toward inclusion of students with disabilities are different depending on the nature of the disability. Implications for future research are discussed.
The authors have developed a computer-assisted patient education program on exercise and heart health that uses hypermedia-programming techniques. The program design integrated interactive behavioral instructional strategies with attractive multimedia presentations. It also employed user-friendly computer input methods like touch screens to facilitate elderly clients' participation. The learning outcome of patients who were using the computer-assisted educational method was compared to that of patients using the conventional tutorial method. There were 48 cardiac patients (mean age = 58.81) participating in the tutorial-based education, and another 48 (mean age = 56.12) participating in the computer-assisted education program. Results of repeated measures analysis of variance showed that both the computer-assisted instruction (CAI) and tutorial groups had significant improvement in their exercise knowledge (F = 70.68, p, .001) and self-efficacy in applying exercise principles (F = 54.33, p, .002 before and after the training program. A test of between-subjects effects showed that there was a significant main group effect on the exercise knowledge change (F = 29.22, p, .002), but not on the exercise self-efficacy change CF = 1.68, p, .05). In spite of this, the results showed that the CAI group had significantly better exercise knowledge than the tutorial group in both the post-training and follow-up phases. The better learning outcome of the CAI group might be attributed to allowing students to study at their own pace, repeat the difficult parts, and interact with the program contents. Most of the subjects in the computer-assisted group stated they preferred this mode of learning. However, some of them preferred the tutorial method because they could seek help from the tutor when in doubt. From the present results, an interactive multimedia computer-assisted patient education program was demonstrated to be effective for cardiac education. The computer-assisted instructional method is recommended for public health education, such as disease prevention and patients' self-management of chronic diseases.
T he eminent American philosopher and educator John Dewey (1916, 1966, p. 202) advocated the use of "active occupations" as the best means for promoting learning. Dewey argued that the occupational approach to learning is superior to the traditional educational method of training the mental faculties through "monotonously uniform exercise" (p. 66). Dewey's thoughts concerning occupation and learning in healthy citizens influenced the founders of occupational therapy (Breines, 1986). Tracy (1910, p. 13) cited the philosophy of John Dewey and recommended the use of occupations in therapy for persons with mental deficiencies. In 1925, a committee of the American Occupational Therapy Association stated that one of the principal psychological aims of occupation used with patients was to improve "concentration of attention" (Dunton, Adams, Carr, & Robinson, 1925). Little research in the occupational therapy literature has addressed this issue. An exception is Warner (1989), who experimentally compared a hands-on occupation (making ice cream) to a demonstration-only condition in elderly women with cognitive deficits. A t-test supported the superiority of the hands-on occupation. Those outside occupational therapy who have studied these issues (often termed "subject-performed tasks") include Larsson and Ronnberg (1987) and Vakil, Hoffman, and Myzliek (1998).
Understanding the personal meaning of mobility device use and factors influencing use is critical for occupational therapy practitioners to assist clients to incorporate mobility devices into their lives. This exploratory study examined the process of deciding to use mobility devices for nine older adults with current and potential needs. Qualitative methods, including focus groups and narrative interviews, were used to examine the lives of these African-American elderly persons with disabilities living in the community. The participants were encouraged to discuss the meaning and value they placed on mobility device use and the impact the devices had on daily events. Data were analyzed using grounded theory methods. Four themes emerged to describe the process of deciding to use a mobility device: interpreting cues, accepting use, integrating use, and anticipating the future. The importance of assisting with this process by recognizing the activity and environment-specificity of use, and the discontinuation of use as the ultimate objective of mobility device users is discussed.
This study examined the reliability and validity of the Test of Environmental Supportiveness (TOES), as well as correlated data from the Test of Play fulness (ToP) and the TOES. Correlation coefficients for a sample of children with disabilities were compared with coefficients from a sample of typically developing children. Data from 160 children and their environments were used. Following a 15-minute observation of free play, raters, using the ToP, assessed children for playfulness and using the TOES, assessed the environments in which they played for supportiveness. Rater reliability and person response validity met acceptable goodness of fit criteria for the Rasch Measurement model. Scale validity fell below the desired fit because of the failure of one item (space is physically safe) to fit the measurement model. A positive, significant correlation was found between playfulness and environmental supportiveness. The magnitude of the relationship was greater for the typically developing children than it was for the children with disabilities.
The purpose of this study was to examine reliability and validity of the Test of Playfulness (ToP) (Bundy, 1998) with children who have physical disabilities but no known cognitive limitations, to compare their scores with those of able-bodied peers, and to examine any patterns of difference in test items between groups. Data from all of the children in the normative ToP data set meeting inclusion criteria (n = 25) were paired with data from the able-bodied child in the normative ToP data set who was closest in age and of the same gender. Data for all of the children were gathered during two, 15-minute video taped free play sessions. Playfulness was evaluated on 24 items. Rasch analysis revealed evidence that 100% of the raters scored the ToP reliably and data from 88% of the children with disabilities conformed to the pattern of playfulness typical of most of the children represented in the test's normative data set. Four ToP items accounted for most of the unexpected ratings. The mean ToP score of the two groups did not differ Although decreased playfulness does not appear to be a sequela to physical disability future research is needed to monitor ToP validity and potential differences in patterns of playfulness in children who have physical disabilities.
The Emory Motor Function Test (Wolf, Lecraw, Barton, & Jann, 1989) and the TEMPA (Test Évaluant les Membres superiors des Personnes Âgées) (Desrosiers, Hébert, & Dutil, 1991) are assessments of upper extremity (UE) motor skill. The TEMPA evaluates both speed and quality of movement. The Emory evaluates speed of movement; we modified the Emory by performing quality of movement ratings. The current study tests the inter-rater and test-retest reliability of these instruments in measuring the UE motor skills of individuals post-stroke. Scores on the Emory had inter-rater and test-retest interclass correlation coefficients of greater than .99. The speed of execution and the functional rating scores on the TEMPA also exhibited high inter-rater and test-retest reliabilities, interclass correlation coefficients (ICCs) > .83. While the task analysis ratings for the unilateral TEMPA tasks and the combined ratings were reliable (ICCs > .83), the task analysis ratings for the bilateral TEMPA tasks were less reliable (ICCs ranged from .69 to <.1). Individuals with stroke performed more poorly on both the Emory and the TEMPA than those without stroke. We discuss additional strengths and weaknesses of using each instrument to assess motor skill deficits post-stroke.
t: Occupational Therapy Journal of Research is 20 years old. As a new editor takes the helm, it is time to reflect on the progress that has occurred in occupational therapy during that time, and to consider what may be needed in the next two decades. The Journal enters adulthood at a time when the profession it serves is at a crossroad. During the final two decades of the 20th century, the occupational therapy profession in the United States passed many significant milestones. The number of practitioners grew at a historic rate, spurred in part by societal need and in part by the opening of an unprecedented number of academic programs. Most states enacted legislation controlling practice, and graduate programs at the doctorallevel emerged. The increased emphasis on graduate education could be interpreted as recognition of the importance of theory and research in ensuring effective practice. However, evidence suggests this is not the case. Consider some observations that seem to support this conclusion. During these two decades, United States' subscriptions to The Occupational Therapy Journal of Research, although increased in absolute numbers, actually decreased as a proportion of the number of therapists in the country. The number of Journal issues per year also declined. Instead, new publications emerged designed to sell advertising space and communicate "practice-related" information in a popular, easy-to-assimilate fashion. In general, these publications are largely devoid of references to theory or underlying research. Perhaps more troubling are decisions by occupational therapy
The Occupational Therapy Journal of Research (OTJR) was developed through a vision of Wilma West in 1981 to advance the understanding of the role that occupation plays in fostering participation and enhancing health. As the journal enters its third decade I am pleased to become the editor and with that role I accept the challenge posed by Christiansen and Bonder in the last issue of OTJR to help foster more research and focus those efforts around questions of activity and participation. OTJR will strengthen the original vision with a targeted focus, and a new name beginning with the winter 2002 issue will be OTJR: Occupation, Participation and Health. OTJR will serve as a forum for work that is organized to answer questions that will improve our understanding of occupation and participation and its impact on health. In the past 10 years, we have seen rehabilitation models evolve to be centered not only on reducing impairment but also to enable individuals to participate fully in daily life. Models developed by the National Center of Medical Rehabilitation Research at the National Institutes of Health, The Institute of Medicine, and now the World Health Organization with the ICIDH-2 have all expanded the focus of disability from one of limiting impairment to include the factors that emerge from barriers in the environment that limit a person's participation in activities and occupations that have meaning for the individual. Occupation and participation have been central to occupational therapy since its inception in 1917. It has always been important to have our work visible. The increased focus on activity and participation in health care delivery and the increasing needs of society that are so visible with the emerging population of aging, and those with chronic illness and disability make it critical that knowledge
The purpose of this study is to demonstrate that Labovian analysis can be useful to occupational therapy researchers who wish to understand and develop models to study clinical narratives. This qualitative study uses the Labovian method to analyze an occupational therapy manager's narrative telling of her response to a managerial crisis—loss of several staff while trying to safeguard the existence of her department. A description of Labov and Waletzky's (1967) structure for narrative analysis is followed by a demonstration analysis and development of a model for the manager's style of social interaction. Finally, the usefulness of the Labovian method for occupational therapy researchers is discussed.
