American Journal of Occupational Therapy

OBJECTIVE. The purpose of this study was to examine the benefits of a summer handwriting instruction course offered to community elementary-age students.

METHODS. Twenty-six students participated in the study and attended instruction for 1 hour per day for 2 weeks. Pre- and posttesting with the Evaluation Tool of Children’s Handwriting (ETCH) were conducted. Parents were also asked to rate their child’s handwriting at pretest, posttest, and 3 months posttest.

RESULTS. Participants made significant improvement in two subtests of the ETCH and in parent ratings between pretest and posttest. Parent ratings remained significantly improved 3 months posttesting. Additional results suggest that children who received special education during the previous school year improved their handwriting scores on the ETCH to a greater degree than those who did not receive special education.

CONCLUSION. A new service delivery model for handwriting instruction has the potential to benefit students. Occupational therapists should consider offering handwriting training to students in the summer especially if deterioration of performance is anticipated.

OBJECTIVE. The aim of this study was to investigate the effects of two interventions (sensorimotor and therapeutic practice) on handwriting and selected sensorimotor components in elementary-age children.

METHOD. Thirty-eight children 6 to 11 years of age with handwriting dysfunction but no identified educational need were randomly assigned to one of the two intervention groups or a control group. Intervention groups met four times per week over 5 weeks. Handwriting was measured pre- and postintervention using the Test of Handwriting Skills. Visual perception (motor-reduced), visual-motor integration, proprioception, and in-hand manipulation were also measured.

RESULTS. Children receiving therapeutic practice moderately improved handwriting whereas children receiving sensorimotor intervention declined in handwriting performance. The control group did not change significantly. Sensorimotor impairment was noted at pretest in three or four components and selected sensorimotor component function improved with intervention.

CONCLUSION. Therapeutic practice was more effective than sensorimotor-based intervention at improving handwriting performance. Children who received sensorimotor intervention improved in some sensorimotor components but also experienced a clinically meaningful decline in handwriting performance.

OBJECTIVES. Handwriting is a work activity for children, hence it may be evaluated based on ergonomic factors. This study investigated whether nonproficient handwriters could be distinguished by biomechanical ergonomic factors during handwriting, as well as by measures of handwriting efficiency. Furthermore, the relationships among ergonomic factors, handwriting quality, efficiency, and measures of the handwriting process were examined.

METHODS. Fifty proficient and 50 nonproficient third-grade handwriters performed a handwriting task on an electronic tablet. Biomechanical ergonomic factors, measures of handwriting quality, and efficiency were rated using the Hebrew Handwriting Evaluation. Handwriting process measures were obtained from a computerized system.

RESULTS. Biomechanical ergonomic factors and handwriting efficiency measures significantly differentiated between the study groups. Significant correlations were found among ergonomic factors and handwriting quality, efficiency, and process measures.

CONCLUSION. Nonproficient handwriting is a work activity that is often characterized by inferior biomechanical ergonomics, handwriting quality, efficiency, and significantly different handwriting process measures. Results provide insights that can assist in planning intervention.

The growth of computer keyboard use in the workplace is believed to be one important determinant of the increased prevalence of work-related musculoskeletal disorders of the upper extremity (MSD-UE). One possible contributing factor to the development of MSD-UE is the flat standard keyboard, which places the forearm and wrist in biomechanically awkward postures. This meta-analysis examines the efficacy of three alternative keyboard designs, adjustable slope (AS), split fixed-angle (FA), and adjustable open-tented (AT), in reducing forearm pronation, wrist extension, and ulnar deviation. Analyses of pooled effect size from six studies indicated that the AT had a large effect on pronation (r = 0.85) and ulnar deviation whereas the FA had a large effect only on ulnar deviation (r = 0.79). The AS was found to have a large effect (r = 0.66) on wrist extension. The FA had a moderate effect on pronation (r = 0.33) and wrist extension (r = 0.30). None of these keyboards were found to have a significant effect on all three postures. This meta-analysis has implications for clinicians by providing objective information that may assist with the selection of an alternative keyboard that best reduces an identified problematic posture.

An important goal of occupational therapy is to foster clients’ participation in daily life. The daily lives of children occur mainly within their homes and schools. Homework is an occupation whose performance affects children’s participation in both home and school. A qualitative study of parental self-reports of the strategies they use to foster their children’s successful engagement in homework was conducted.

In this paper, we examine three cases from this study using the activity setting concept from the ecocultural theory of family accommodation. The three cases were chosen based on their diversity: ethnic and religious background, socioeconomic status, presence of a stay-at-home mother, and presence of children with special needs.

The analysis of these cases illustrates that strategies used by parents to foster their children’s engagement in homework reflect their values and priorities, their expectations of their children, and their perceptions of their children’s strengths and limitations. The concept of activity setting can be useful for occupational therapists to analyze family situations when they are developing home treatment programs.

PURPOSE. Research in the field of brain injury rehabilitation has tended to regard return to work as a measure of outcome. Researchers have not paid particular attention to the experiences of people living with a brain injury. The aim of the phenomenological study reported here was to identify and describe what characterizes the meaning of work to those with acquired brain injury.

METHODS. Ten participants of working age were interviewed about the meaning of work 1–5 years after being inflicted with a brain injury. Data were analyzed and interpreted using the Empirical Phenomenological Psychological method.

RESULTS. The findings revealed a meaning structure consisting of four main characteristics. Work was no longer experienced as the primary event in life and the social dimension had become more important. The perceived competence and work identity were threatened after the injury. A common theme across all interviews was the struggle to return to a state of normality, and working was considered to be evidence of success.

CONCLUSION. The findings described the altered meaning of work 1–5 years after brain injury. This knowledge should lead to an increased understanding among occupational therapists engaged in work rehabilitation after brain injury and can serve as a basis for individualized intervention strategies.

OBJECTIVE. The match between the reading level of occupational therapy education materials and older clients’ reading ability and comprehension was determined. The sociodemographic and literacy characteristics that influenced clients’ reading ability and comprehension were investigated.

METHOD. The reading level of 110 written education materials (handouts, brochures, and information leaflets), distributed to older clients (65 years of age and older) by occupational therapists working in Queensland hospitals, was analyzed using the Flesch formula. The reading ability of 214 older persons (mean age 77 years, 63% female) was assessed using the Rapid Estimate of Adult Literacy in Medicine. Participants’ comprehension of information of increasing reading difficulty was measured using the Cloze procedure.

RESULTS. The written materials required a mean reading level between the ninth and tenth grades. Participants’ mean reading ability was seventh to eighth grade. Therefore some materials may have been too difficult for participants to read and understand. Participants with a managerial or professional or clerical background (p = 0.001) and those who perceived they read well (p = 0.001) had a significantly higher reading ability. Older age was significantly related to poorer comprehension (p = 0.018), with participants 75 years of age and over having a mean comprehension score of 25.6 compared to 30.3 for those 65 to 74 years of age.

CONCLUSION. Occupational therapists must analyze the reading level of the written education materials they develop for and use with clients by applying readability formulas. There should be a match between the reading level of written materials and clients’ reading ability. Clients’ reading ability may be assessed informally by discussing years of education and literacy habits or formally using reading assessments. Content and design characteristics should be considered when developing written education materials for clients.

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.

OBJECTIVE. With physical disabilities, persons often experience secondary pain that adds to restrictions in activity and participation. We investigated pain-management strategies used by those with physical disabilities.

METHOD. Qualitative phenomenological inquiry was used in multiple interviews with (N = 28) adults with physical disabilities (9 with amputation, 7 with cerebral palsy, and 12 with spinal cord injury) and subsequent thematic analysis.

RESULTS. Among those with physical disabilities, a distinction is made between usual and unexpected pains. Usual pain is experienced consistently or as a consequence of not getting adequate rest, exercise, or stress-free time. Managing usual pain involves uses of prevention (e.g., exercise/fitness) and/or pragmatic actions through scheduling and pacing daily activities and taking interim retreats. Unexpected pain is experienced periodically and requires an immediate response and change of activity. To manage, persons describe making efforts to create a mind and body disassociation, activating safety nets to support function and alleviate pain, and making decisions to persevere with activity and participation.

CONCLUSION. Advising those with physical disabilities to do proactive planning for both usual and unexpected pain may help them to use varied pain-management strategies to enhance function and minimize negative impacts on participation.

OBJECTIVES. The purpose of this pilot study is to describe the use of the Kinesio Taping® method for the upper extremity in enhancing functional motor skills in children admitted into an acute rehabilitation program.

METHOD. Fifteen children (10 females and 5 males; 4 to 16 years of age), who were receiving rehabilitation services at the Rehabilitation Institute of Chicago participated in this study. For 13 of the inpatients, this was the initial rehabilitation following an acquired disability, which included encephalitis, brain tumor, cerebral vascular accident, traumatic brain injury, and spinal cord injury. The Melbourne Assessment of Unilateral Upper Limb Function (Melbourne Assessment) was used to measure upper-limb functional change prior to use of Kinesio Tape®, immediately after application of the tape, and 3 days after wearing tape. Children’s upper-limb function was compared over the three assessments using analysis of variance.

RESULTS. The improvement from pre- to posttaping was statistically significant, F(1, 14) = 18.9; p < .02.

CONCLUSION. These results suggest that Kinesio Tape may be associated with improvement in upper-extremity control and function in the acute pediatric rehabilitation setting. The use of Kinesio Tape as an adjunct to treatment may assist with the goal-focused occupational therapy treatment during the child’s inpatient stay. Further study is recommended to test the effectiveness of this method and to determine the lasting effects on motor skills and functional performance once the tape is removed.