Pragmatism and structuralism in occupational therapy: the long conversation

The history of occupational therapy may be understood as a continual transaction between two cultural discourses: pragmatism and structuralism. Pragmatism is a way of thinking that presupposes humans are agentic by nature and knowledge is tentative and created within particular contexts. Structuralism is a way of thinking that assumes humans are composites of recurring general frameworks and that knowledge is objective and can be generalized to multiple contexts. Early in the field's history, both pragmatist and structuralist assumptions about the human and knowledge produced different readings, or interpretations, of what constituted the appropriate tools, methods, and outcomes for occupational therapy. Consequently, occupational therapy adopted an interesting mix of pragmatist language regarding the human and structuralist approaches to knowledge, resulting in professional identity problems still experienced today. However, recent developments offer an opportunity for occupational therapists to correct old identity problems through critically evaluating incompatible assumptions and carefully reading the prevailing cultural ethos.

The evolution of our occupational perspective: the journey from diversion through therapeutic use to enablement

Occupational Therapy, in the broad sense of the term, has become the most serious problem before the statesmen of every nation in the world at the present time. All over the civilized globe, the widespread disease of unemployment (lack of occupation) is monopolizing the attention of national parliaments and world conferences. Everywhere the effort is being made to remedy human dissatisfaction and mental unrest by providing daily tasks so that minds may be occupied, bodies may be healthy, and the means of sustenance may be found (Howland, 1993, p. 4).

The history of occupational therapy assistants in Canada: a comparison with the United States

In the middle of the twentieth century, the role of occupational therapy assistant was introduced in North America. Although the role, utilization and training of assistant personnel have raised much controversy and debate within the profession, Canada and the United States have taken very different paths in terms of dealing with these issues. This paper focuses on the history of occupational therapy assistants in Canada, using the experience in the United States for comparison purposes. The occupational therapy literature and official documents of the professional associations are used to present a chronology of major historical events in both countries. Similarities and differences emerge in relation to historical roots; training model and standards of education; certification, regulation, and standards of practice; career laddering and career mobility; and professional affiliation. The paper concludes with a summary of issues which require further exploration, debate and resolution if the profession is to move forward in Canada.

Beyond the unobtrusive observer: reflections on researcher-informant relationships in urban ethnography

Ethnographic research involves the creation and ongoing renegotiations of relationships between researchers and informants. Prolonged engagement contributes to the complexity as relationships deepen and shift over time and participants accumulate a substantial reservoir of shared experiences. Reflections about the relationships we have co-constructed with informants in several research projects have contributed to our identification of several critical aspects of building and maintaining researcher-informant relationships in cross-cultural research. Aspects of relationship work specifically related to conducting ethnography with children, within the communities in which researchers live, and within the practice of occupational therapy are discussed.

Adjustments to managed health care: pushing against it, going with it, and making the best of it

In this qualitative study of managed health care and occupational therapy practice, participants described how their practice had changed, suggested that students be educated to communicate the value of occupational therapy and to navigate corporate medicine, and expressed ethical concerns regarding reimbursement versus therapy goals. In-person, individual, focused interviews were conducted with 25 therapists in the southeastern Atlantic states. Participants' perceptions ofpervasive changes in practice due to managed health care reflected three themes of meaning: the "pushing against it" personal-professional struggle; the "going with it" businesslike perspective, and the "making the best of it" optimistic outlook. These findings provide insight into therapists' occupational adaptation to managed health care.

Clinical interpretation of "occupational therapy goal achievement for persons with postacute cerebrovascular accident in an on-campus student clinic"

Occupational therapy practitioners, educators, and researchers can gain important information from Lavelle and Tomlin's study for initiating programs that meet the needs of a population of persons who typically cannot access occupational therapy services. The study provides evidence of the effectiveness of occupational therapy for persons with postacute CVA for clinicians seeking alternative funding for community-based practice. The study also suggests that the free university clinic in which Lavelle and Tomlin's research took place was providing a valuable service to persons living near the university, creating important links between the university and the community in which it resides. Lastly, the study raises intriguing questions that provide research opportunities for occupational therapy practitioners, educators, and students that can enhance our understanding of the impact of occupational therapy services on persons long after a CVA.

Contemporary trends and practice strategies in pediatric occupational and physical therapy

This paper identifies and reflects on recent trends in pediatric occupational therapy and physical therapy practice. These trends were initially identified by the student authors for a Maternal and Child Health (MCH) leadership seminar, which was conducted as part of the postprofessional graduate program in physical therapy at the University of Washington. Trends were then reviewed and discussed among the student and faculty authors. Consensus was reached on the most important trends, which were subsequently summarized in this paper. The first part of the paper reviews the impact of these trends on current and future clinical practices in health, educational, and community-based settings. The second part of the paper offers proposed directions to meet the challenges presented by the trends in four key areas; (1) research, (2) professional education, (3) enhancing family-centered care, and (4) advocacy.

The 2000 Eleanor Clarke Slagle Lecture. Our mandate for the new millennium: evidence-based practice

The health care environment of the past quarter century went through numerous evolutionary processes that affected how occupational therapy services were provided. The last iterations of these processes included requests for the evidence that supported what we were doing. This year's Eleanor Clarke Slagle Lecture (a) examines the strength of the evidence associated with occupational therapy interventions--what we do and how we do it--(b) raises dilemmas we face with our ethical principles when some of our practices are based on limited evidence, and (c) proposes a framework of continued competency to advance the evidence base of occupational therapy practice in the new millennium.

Japanese occupational therapy in community mental health and telehealth

Help for people with mental health problems in Japan has traditionally centred on inpatient medical care. In a revision of the Mental Health Welfare Law planned for 2001, responsibility for the support of people with mental health problems will be transferred from central government to local government. Furthermore, local government will, in turn, delegate administrative tasks to a 'community life support centre'. We believe that such a centre could be linked to a university with a telehealth network. Connection to the network could benefit people with mental health problems living at home. We also believe that occupational therapists are ideally positioned to play a significant role in community life support centres. With the expected sustained growth in Japanese occupational therapy, it could become a key profession in the rehabilitation of people with mental health problems.

Cognitive rehabilitation: a pilot survey of therapeutic modalities used by Canadian occupational therapists with survivors of traumatic brain injury

This pilot study used survey methodology to gather initial information from Canadian occupational therapists on 1) the delivery of cognitive rehabilitation services for survivors of traumatic brain injury and 2) the therapeutic approaches and modalities used currently to manage residual cognitive impairments. A questionnaire was developed, field-tested and mailed to 27 sample sites across Canada, selected non-randomly. Twenty returned questionnaires (74%) were included in the data pool. The findings revealed that a wide range of cognitive impairments were seen very often, with impairments in memory being most common. Respondents used both a cognitive remediation and compensatory approach and a combination of therapeutic modalities to address impairments of orientation, attention, and memory. There was an interesting and overlapping range of specific modalities identified. Inpatient and outpatient services were offered to survivors, primarily within the first year post-injury. These occupational therapists used various resources to develop expertise in cognitive rehabilitation. Possible implications of the pilot study findings for Canadian occupational therapists are high-lighted and discussed.

Handwriting: current trends in occupational therapy practice

The objective of this survey was to describe assessment and treatment approaches commonly used by occupational therapists for children exhibiting handwriting and related fine motor difficulties. Secondarily, the application of weights as a treatment modality was also explored. Fifty experienced paediatric occupational therapists from Ontario (46%), Quebec (22%) and six other Canadian provinces, were surveyed by telephone. The majority of therapists indicated that they evaluated gross/fine motor and perceptual skills, motor planning, quality of movement and sensory functioning for this population, while psychosocial and environmental factors were often not formally evaluated. Evaluations most commonly utilized included the Beery, Bruininks-Oseretsky and Gardner Tests. Standardized handwriting assessments were rarely employed. All used an eclectic treatment approach with sensorimotor most frequently selected (90%). Work setting and years of experience did not influence the treatment approach favoured.

Reflections on a renaissance of occupation

At the close of the 20th century, there is a renaissance of occupation in occupational therapy and occupational science. Kielhofner (1992) offers an intraprofessional explanation that the growing interest in occupation recaptures occupational therapy's lost identity. An extraprofessional explanation is that postmodern ideas and social practices have helped to create a societal context in which a renaissance of occupation is welcome. Postmodernism raises questions and awareness of power, diversity, temporality, and situatedness in which normative ideas of occupation as paid work can be challenged. Since occupation is of primary concern to occupational therapy and occupational science, the authors reflect on postmodernism and its influence on a renaissance of occupation in these two fields. These reflections consider what such a renaissance means for occupational therapists and occupational scientists in the 21st century.

Practices of recycling assistive technology in Quebec

The aim of this study was to document professional factors to be considered in implementing a provincial policy of recycling assistive technology in Quebec. A qualitative study was conducted with 22 experts from various sectors: health professionals (including occupational therapists), industry and community. They were interviewed using a semi-structured questionnaire. Data collection also involved observing recycling practices and analyzing working documents. Implementation strategies were considered from the perspectives of health professionals, the commercial sector, users of assistive technology and government administrators. Factors that contribute to tension between occupational therapists and other players are discussed. It is recommended that occupational therapists take a united position on this issue such that their voices may have more weight in intersectoral collaborations.

The promotion of evidence-based occupational therapy practice in Canada

Occupational therapists must utilize evidence in decision making in order to define approaches for occupational therapy service which attain optimal client outcomes, promote consistency, continuity and cost containment, and validate the role of occupational therapy to clients, payers and other health professionals. CAOT has undertaken many initiatives to teach the skills, provide the tools and facilitate the generation and dissemination of evidence required for evidence-based occupational therapy. CAOT recognizes the importance of working in partnership with other stakeholders involved in occupational therapy practice in Canada in order to successfully break down barriers to the integration of evidence in occupational therapy practice.