A meditation on the use of hands. Previously published in Scandinavian Journal of Occupational Therapy 1995; 2: 153-166.

The theme of mind-body unity is fundamental to occupational therapy. Nonetheless, the field continues to embrace a dualism of mind and body. This dualism persists because the field views the body only as an object, ignoring how the body is lived.

Psychometric properties of the work environment impact scale: a cross-cultural study.

This study examined the psychometric properties of the Work Environment Impact Scale in the United States and Sweden. Thirteen American and four Swedish occupational therapists used the scale (in English and Swedish respectively) to rate 21 (11 American and 10 Swedish) subjects. Results of a Rasch analysis of the data, indicate that the items work well together to measure the construct of work environment impact.

A closed-loop stepper motor waist-pull system for inducing protective stepping in humans.

Past approaches for inducing protective stepping to preserve standing balance in humans have either lacked the flexibility of control over the initial conditions of falling, or involved considerable mass which limits mobility of the system. This report describes the design and function of a stepper motor closed-loop waist-pull system for evoking protective stepping responses. Bench testing with applied load-motion profile combinations indicated performance degradation for force levels greater than 204 N which was well within the levels encountered in human experiments.

Meaning and misunderstanding in occupational forms: a study of therapeutic goal setting.

Objective: This study examined occupational therapists' use of the occupational form of goal setting as therapy and its impact on clients.

Method: The study method was qualitative, using participant observation and interviewing as the main source of data.

Results: The findings illustrated that therapists work both to give substance to the occupational form and to create the context of an implied narrative that imbues it with particular meanings.

Q-methodology: definition and application in health care informatics.

Objective: To introduce the Q-methodology research technique to the field of health informatics. Q-methodology--the systematic study of subjectivity--was used to identify and categorize the opinions of primary care physicians and medical students that contributed to our understanding of their reasons for acceptance of and/or resistance to adapting information technologies in the health care workplace.

Design: Thirty-four physicians and 25 medical students from the Chicago area were surveyed and asked to rank-order 30 opinion statements about information technologies within the health care workplace.

The impact of obesity on hypertension management in African Americans.

Blood pressure is strongly related to body weight, and control of obesity is a critical component of hypertension prevention and control. Data from multicenter studies such as the Trials of Hypertension Prevention, the Trials of Antihypertensive Interventions and Management, and the Trial of Nonpharmacologic Interventions in the Elderly help to set aside previous questions about whether the association of obesity with hypertension applies to African Americans. Given the high prevalence of overweight among African Americans, especially women, the issue is not whether weight reduction should be a component of hypertension prevention and treatment but how to design and implement programs that will help overweight African American men and women achieve permanent weight loss.

Managed care: survival skills for the future.

The last two decades have been a time of dramatic and consistent change in the way health care is delivered. The use of managed care strategies by health care providers impacts occupational therapy practitioners directly, yet they are often ill-prepared to respond to changes constructively. With adequate preparation, occupational therapy practitioners may not only respond to organizational change, but play a major role in helping to shape their organization's future.

The Volitional Questionnaire: psychometric development and practical use.

This article describes the Volitional Questionnaire and presents recent empirical efforts to develop and validate this instrument. The Volitional Questionnaire is an observational method of gathering data on motivation that is designed for persons who are unable to self-report their own motives. Studies to date suggest that the instrument can provide a valid measure of volition, though a number of limitations of the tool are noted.

Functional scale discrimination at admission and discharge: Rasch analysis of the Level of Rehabilitation Scale-III.

Objective: To determine the construct validity of the Level of Rehabilitation Scale-III (LORS-III) with a special focus on this instrument's capability to discriminate rehabilitation inpatient activities of daily living (ADL)/mobility and communication/cognition ability at admission and discharge.

Design: Rasch analysis of existing data sets in the LORS-III American Data System (LADS).

Patients: Existing admission and discharge data from 3056 rehabilitation inpatients (musculoskeletal injury, cerebrovascular accident, multiple injuries/diseases, brain injury, neuromuscular disorder, and spinal cord injury) entered into LADS between April 1992 and January 1993.

The effects of intrathecally administered baclofen on function in patients with spasticity.

The purpose of this article is to review the literature on the effects of intrathecally administered baclofen on impairment in spasticity and muscle activation patterns, on functional limitations in mobility and self-care, and on disability in daily life roles. We found plentiful evidence of improvement in spasticity, spasms, and bladder function and some reports of improved patterns of muscle activation and kinematics of single-joint movement. Improved ability to accomplish transfers, self-care, and locomotion is less consistently studied but has also been reported in about 60% to 70% of patients.

Human resources in physical therapy: opportunities for service in a rapidly changing health system.

This article illuminates major considerations having an impact on the utilization of human resources in physical therapy. The current and potential impacts of health system forces and trends and health care reform, in general, and scope of practice, team care, supply and demand, and managed care, in particular, are cited and discussed. The manner in which physical therapists perceive and respond to health care needs and access issues and in turn the manner in which the public and policymakers acknowledge physical therapy's growing role in this defining of health and health care are both likely to create new opportunities for service.

Adaptation of Hispanic families to a member with mental retardation.

Adaptation of Hispanic (n = 51) and non-Hispanic (n = 195) white families to having a member with mental retardation was examined using surveys and interviews. We compared these families' demographic characteristics, religious values, and support resources and examined how these factors differentially affected caregiving burden for each group. Surveys and interviews were collected from 51 Hispanic and 195 non-Hispanic white families.

Alzheimer's care and service utilization: generating practice concepts from empirical findings and narratives.

Despite evidence of stress and strain, many of those who take care of relatives with Alzheimer's disease seem to resist using support services. Existing studies of the use of formal care by families of Alzheimer's sufferers are reviewed with special attention to findings relevant to access, particularly perceptions of appropriateness and acceptability or consistency with other needs and values. The conceptual model represented by these findings is then applied to a narrative that serves as a proxy for a real case that might confront a social worker.

Compensation and turnover of direct-care staff in developmental disabilities residential facilities in the United States. II: Turnover.

A representative sample of more than 1,600 residential facilities nationwide was surveyed. Direct-care staff turnover was significantly higher in privately operated community facilities than in public institutions. Turnover was generally higher in private than in publicly operated community facilities.

Vertebral orientations and muscle activation patterns during controlled head movements in cats.

The focus of these experiments was to determine the relationships between head movement, neck muscle activation patterns, and the positions and movements of the cervical vertebrae. One standing cat and one prone cat were trained to produce voluntary sinusoidal movements of the head in the sagittal plane. Video-opaque markers were placed on the cervical vertebrae, and intramuscular patch electrodes implanted in four muscles of the head and neck.

The micropolitics of elder care in Memento Mori, Diary of a Good Neighbor, and A Taste for Death.

Using three novels--Muriel Spark's Memento Mori, Doris Lessing's Diary of a Good Neighbor, and P. D. James' A Taste for Death--we examine themes relating to the social construction of caregiving.

Clinical research in allied health.

Allied health professionals in nutrition and medical dietetics, occupational therapy, physical therapy, and speech-language pathology and audiology play both unique and key cross-cutting roles in the furtherance of clinical research. Clinical research in nutrition and medical dietetics uniquely focuses on food nutrient intake and the metabolic utilization of nutrients. Clinical research in occupational therapy has a special focus on the relationship of impairment to disability, the adaptation to disability and the maximization of function.

Compensation and turnover of direct-care staff in developmental disabilities residential facilities in the United States. I: Wages and benefits.

This study was based on a representative national sample of more than 1,600 residential facilities serving individuals with developmental disabilities in all 50 states and the District of Columbia. The mean starting wage for direct-care workers in publicly operated institutions in FY 1990 was approximately 31% more than the wage for similar workers in privately operated facilities. The mean starting wage in private facilities was only about 3% above the poverty level for a family of three.

Effects of age and resistance training on skeletal muscle: a review.

As humans age, there is a decrease in the ability of skeletal muscle to generate force. This review describes alterations in the neuromuscular systems of humans and animals that may be responsible for the diminished force-generating capacity of older muscles. The effects of resistance training on the force-generating capacity of older muscles in humans and on the neuromuscular systems of humans and animals are then examined.

Work evaluations: critique of the state of the art of functional assessment of work.

The area of work evaluation is fertile ground for future research and development by occupational therapists. Current evaluations of work range from standardized work evaluations associated with vocational rehabilitation to highly technical physical capacity and work capacity instrumentation and equipment often associated with sports medicine. In addition, methods used to identify pain and abnormal illness behavior add the psychosocial component of work evaluation.

Medical social work long-term care referrals for people with HIV infection.

Hospital social workers were surveyed to identify referral efforts and outcomes for clients with human immunodeficiency virus (HIV) infection who required long-term placement. Over a three-month period, none of the 42 identified clients was admitted to a nursing home. In two-thirds of the cases, social workers contacted only one facility, and in about one-sixth of the cases, workers reported no placement attempts.