The historical development of neuroscience in physical rehabilitation

Neuroscience and occupational therapy in physical rehabilitation have developed along parallel tracks. As physicians began to study the neural bases of motor control, they also began to reconsider the sequelae of "hopeless" diagnoses as conditions that they could influence. This change in some physicians' understanding of the neural mechanisms of motor control influenced other clinicians' ideas about patient care. Early work on treatment of patients with cerebral palsy and polio led to improvements in treatment approaches used to facilitate motor skill and functional motor ability in patients with upper motor neuron disorders. From the 1950s to the present, therapists have refined their treatment techniques as knowledge from neuroscience has become available. A few therapists, who are gradually increasing in number, have turned to the laboratory to study basic neuroscience problems that affect clinical treatment. This article describes the development of neuroscience research and neurorehabilitation theories and indicates common themes.

Managed care: opportunities and challenges for occupational therapy in the emerging systems of the 21st century

Overall, occupational therapy seems reasonably well situated to prosper in a cost-conscious environment of the future. But the profession's standing in the next century will depend on its ability to build on its strengths and assist in cost containment by avoiding unnecessary or duplicative services and by fostering versatility through the education of generalists. Above all, the profession must recognize that patients will measure quality in terms of results and satisfaction related to the impact of their health on their everyday lives.

Outcomes research: the history, debate, and implications for the field of occupational therapy

The field of occupational therapy, as with all facets of health care, has been profoundly affected by the changing climate of health care delivery. The combination of cost-effectiveness and quality of care has become the benchmark for and consequent drive behind the rise of managed health care delivery systems. The spawning of outcomes research is in direct response to the need for comparative databases to provide results of effectiveness in health care treatment protocols, evaluations of health-related quality of life, and cost containment measures. Outcomes management is the application of outcomes research data by all levels of health care providers. The challenges facing occupational therapists include proving our value in an economic trend of downsizing, competing within the medical profession, developing and affiliating with new payer sources, and reengineering our careers to meet the needs of the new, nontraditional health care marketplace.

Life-style performance: from profile to conceptual model

The Life Style Performance Model provides a framework for knowing and understanding a person's total activity repertoire within the context of his or her human and nonhuman world. The model enables occupational therapy practitioners to gain a holistic perspective, thus ensuring that interventions will have more clearly discernible relevance to individual needs, interests, capacities, and self-other expectations. It presents a way of conceptualizing the interrelatedness of person, environment, activity profile, and quality of life. This article addresses these dynamic relationships in a manner that makes it possible to plan and implement interventions that hold maximum potential for eliciting and sustaining a person's intrinsic motivation to pursue an evolving life-style optimally satisfying to self and significant others.

Our journey together

These three challenges of political activism, public awareness, and patient advocacy were met through a broad range of activities by many committed AOTA members. During the past 3 years, our membership has grown, our number of educational programs at the professional, technical, and postprofessional levels has dramatically increased, and our visibility as a profession has bloomed. Promotion of the benefits of occupational therapy to society is in evidence throughout the land and throughout the world. My heartfelt thanks go to all the Executive Board members, the state presidents, the representatives and National Office staff for their active partnership with our members, making these achievements for the profession possible. As our journey together takes on a new relationship, Nikolai Gogol provides us with a final thought: And for a long time yet, led by some wondrous power, I am fated to journey hand in hand with my strange heroes and to survey the surging immensity of life, to survey it through the laughter all can see and through the tears unseen and unknown by anyone (1842/1961 no page number available).

Occupation: purposefulness and meaningfulness as therapeutic mechanisms. 1995 Eleanor Clarke Slagle Lecture

The model of occupational functioning leads the author to conceptualize occupation both as treatment end goal and as means to remediate impairments. In both dimensions, meaningfulness and purposefulness are key therapeutic qualities. Purposefulness is hypothesized to organize behavior and meaningfulness to motivate performance. These aspects of occupation need explication through research. Some questions that need to be answered include the following: How does purposefulness of occupation-as-end organize a person's life? Does purposefulness of occupation-as-means organize particular behavioral responses? What effect does meaningfulness of occupation-as-end have on achievement of role performance? Does meaningfulness of occupation-as-means motivate perseverance and effort during therapy?

Burnout in occupational therapists and physical therapists working in head injury rehabilitation

OBJECTIVES

Burnout has been linked to job retention in occupational therapy, physical therapy, and other health professions. Professional development activities are often suggested to reduce burnout, but little empirical evidence supports this contention. This study explored the prevalence of burnout among occupational and physical therapists working in head injury rehabilitation and evaluated the relationship between burnout and professional development activities.

METHOD

Forty therapists working full-time in head injury rehabilitation were surveyed. Correlations between subscale scores of the Maslach Burnout Inventory (i.e., Emotional Exhaustion, Depersonalization, and Personal Accomplishment) and responses to a survey of professional development activities are reported.

RESULTS

Professional development activities are most strongly associated with feelings of personal accomplishment. Emotional exhaustion was relatively high among these therapists, but few feelings of depersonalization were evident.

CONCLUSIONS

Professional development activities in the workplace may augment feelings of personal accomplishment and minimize burnout as an issue in job retention. Strategies to effectively identify and manage therapists' feelings of emotional exhaustion require further study.

Understanding cortical visual impairment in children

This article presents a review of the literature and a case study on a child with cortical visual impairment. The literature review covers the diagnosis, etiology, prevalence, prognosis, and a comparison of the differences between children with cortical visual impairment and those with ocular impairment. The case study presents occupational therapy intervention strategies specific to cortical visual impairment and results of treatment.

The profession's image, 1917-1925, Part II: Occupational therapy as represented by the profession

This second part of a two-part article examines the representation of occupational therapy during its formative years, 1917-1925. It focuses on the image of the profession as it was described in the early professional journals and compares this image with that projected by the media (as described in Part I). Both the media and professional literature presented a similar image of occupational therapy: that of a profession that offered the promise of returning persons with disabilities to useful occupation within society. In today's health care system, where every profession espouses the goal of returning patients to full functioning, it is important to remember that in 1917 only one profession held that goal. The portrayal in the media and in the professional literature of occupational therapy at that time confirms this image.

Integrating the concepts of health promotion and community into occupational therapy practice

Health reform activities in Canada have encouraged health care professionals to examine new and innovative ways to share their skills, not only with other professionals, but with the public. Historically, occupational therapists have been encouraged by leaders in the profession to expand their practice and to share their skills through active participation with their communities. Health promotion has been identified as a process through which this expansion can be pursued. In order for occupational therapists to contribute to their communities in a meaningful way, the concepts of health promotion and community require definition, development and reflection within their model of practice. Through a discussion of these concepts, this paper encourages occupational therapists to develop, expand and integrate new practice roles within the community by integrating health promotion into their practice.