Use and Results of MOHO Global Assessments in Community Mental Health: A Practice Analysis

This practice analysis reports an evaluation of occupational therapists' utilization of assessments derived from the Model of Human Occupation (MOHO) within adult community mental health settings. An audit of all documented assessments recorded details of (1) the number of assessments completed by each of the occupational therapists, and (2) the specific occupational difficulties identified across all assessments. Thirty-eight assessments had been completed, with a total of 35 service users. Results show variation in practice among occupational therapists in their application of MOHO assessments and, further, that the range of occupational difficulties identified for the client cohort is diverse.     

The case for proprioception

In formulating a theory of perception that does justice to the embodied and enactive nature of perceptual experience, proprioception can play a valuable role. Since proprioception is necessarily embodied, and since proprioceptive experience is particularly integrated with one’s bodily actions, it seems clear that proprioception, in addition to, e.g., vision or audition, can provide us with valuable insights into the role of an agent’s corporal skills and capacities in constituting or structuring perceptual experience. However, if we are going to have the opportunity to argue from analogy with proprioception to vision, audition, touch, taste, or smell, then it is necessary to eschew any doubts about the legitimacy of proprioception’s inclusion into the category of perceptual modalities. To this end, in this article, I (1) respond to two arguments that Shaun Gallagher (2003) presents in “Bodily self-awareness and objectperception” against proprioception’s ability to meet the criteria of object perception, (2) present a diagnosis of Gallagher’s position by locating a misunderstanding in the distinction between proprioceptive information and proprioceptive awareness, and (3) show that treating proprioception as a perceptual modality allows us to account for the interaction of proprioception with the other sensory modalities, to apply the lessons we learn from proprioception to the other sensory modalities, and to account for proprioceptive learning. Finally, (4) I examine Sydney Shoemaker’s (1994) identification constraint and suggest that a full-fledged notion of object-hood is unnecessary to ground a theory of perception.     

Beyond Hopelessness

Abstract

The researchers conducted a needs assessment survey of practicing school-based occupational therapists to determine the incidence of grief within existing caseloads, current awareness of the issue, related concerns, and willingness or resistance to address grief in the intervention environment. The survey was administered to a representative sample of 150 school-based therapists throughout the state of Ohio. Fifty-six therapists responded with usable data.

The results suggest that the students who are currently on occupational therapy (OT) caseloads face a large number of grief issues. Although a majority of therapists reported addressing grief issues, only a small percentage typically do so for a variety of reasons. The school therapists offered a number of explanations for the limited follow-through on this issue. These findings support the profession's recent efforts to further establish occupational therapy as a well-recognized and respected provider of interventions to address the mental health and psychosocial needs of children in school settings.     

Proprioception and Motor Control in Parkinson's Disease

ABSTRACT

Parkinson's disease (PD) is a neurodegenerative disorder that leads to a progressive decline in motor function. Growing evidence indicates that PD patients also experience an array of sensory problems that negatively impact motor function. This is especially true for proprioceptive deficits, which profoundly degrade motor performance. This review specifically address the relation between proprioception and motor impairments in PD. It is structured around 4 themes: (a) It examines whether the sensitivity of kinaesthetic perception, which is based on proprioceptive inputs, is actually altered in PD. (b) It discusses whether failed processes of proprioceptive-motor integration are central to the motor problems in PD. (c) It presents recent findings focusing on the link between the proprioception and the balance problems in PD. And (d) it discusses the current state of knowledge of how levodopa medication and deep brain stimulation affect proprioceptive and motor function in PD. The authors conclude that a failure to evaluate and to map proprioceptive information onto voluntary and reflexive motor commands is an integral part of the observed motor symptoms in PD.     

Occupational Therapy in a Community-Based Prevention Program

Occupational Therapists have shifted their practice base from a primarily medical model to one involving many different services within the community. Members of this discipline as well as those of the entire health-care field have discovered that preventionj based programs better anticipate and meet consumer needs. The community program described here serves 3, 4, and 5-year -old socio-culturally disadvantaged preschoolers. The program occurs weekly in a local library and includes the librarian's story hour and special activities designed and implemented by the occupational therapists. By observing each child's behavior, occupational therapists can compare normal growth and development with a particular population. The design and delivery of such programs is influenced by many factors including, but not limited to, financing, community values and institutions, and the occupational therapist's understanding of prevention. Increased understanding, as well as the potential application, of occupational therapy's contribution to the prevention of health related problems are further enhanced by the utilization of this program as a field training site for occupational therapy students.     

Powerful Occupational Therapists: A Community of Professionals, 1950–1980

A powerful community of therapists changed occupational therapy in the United States between 1950 until 1980. These innovators, primarily women, strategically positioned themselves to market the emerging profession. These therapists, categorized as theorists and futurists, political movers and new and old guard sustainers, determined occupational therapy's direction. Participating in the 1950s rehabilitation, the 1960s equal rights, and the 1970s women's movements, the community of therapists separated from the male-dominated medical model to gain professional and scientific authority. An internal tension arouse between those therapists embracing an objective, and arguably male, science and those supporting a characteristically feminine caring philosophical base.     

Velocity discrimination: reliability and construct validity in older adults

The aim of this study was to determine whether a test of velocity discrimination is a reliable and valid measure of proprioception in healthy older adults. Results revealed excellent test-retest reliability over a 2-week period. Velocity discrimination also indicated good construct validity with modest correlations with center of pressure sway outcomes in eyes open and closed conditions as well as stair climbing time. Good construct validity was identified by velocity discrimination sensitivity to age with a higher mean value for the older participants than for the younger participants. These findings suggest velocity discrimination is a valid and reliable measure of velocity sense, which may be included with measures of position and movement sense to enhance the proprioceptive testing repertoire among researchers. Implications of these results are discussed in terms of evaluation of proprioceptive training programs aimed to enhance postural control.     

Visuomotor Adaptation and Proprioceptive Recalibration

ABSTRACT

Motor learning, in particular motor adaptation, is driven by information from multiple senses. For example, when arm control is faulty, vision, touch, and proprioception can all report on the arm's movements and help guide the adjustments necessary for correcting motor error. In recent years we have learned a lot about how the brain integrates information from multiple senses for the purpose of perception. However, less is known about how multisensory data guide motor learning. Most models of, and studies on, motor learning focus almost exclusively on the ensuing changes in motor performance without exploring the implications on sensory plasticity. Nor do they consider how discrepancies in sensory information (e.g., vision and proprioception) related to hand position may affect motor learning. Here, we discuss research from our lab and others that shows how motor learning paradigms affect proprioceptive estimates of hand position, and how even the mere discrepancy between visual and proprioceptive feedback can affect learning and plasticity. Our results suggest that sensorimotor learning mechanisms do not exclusively rely on motor plasticity and motor memory, and that sensory plasticity, in particular proprioceptive recalibration, plays a unique and important role in motor learning.     

Principles of Occupational Therapy Group Outcome Assessment in Mental Health

In today's penurious health care climate, occupational therapists must scrutinize their practice and substantiate their interventions in order to remain viable service providers. This article proposes a method of occupational therapy outcomes assessment in mental health care that is rooted in client-centered functional outcomes. Since little consensus exists on which instruments are most effective, this article begins with an outline of broadly accepted principles for assessment of patient outcomes in mental health. Next, we describe a practical method for selecting outcomes measures in interdisciplinary settings. Finally, we offer pragmatic solutions to address barriers to outcome assessment.     

Behavioral Health Competence: An Exploration of Army Reserve Occupational Therapists

In this study the behavioral health competence of Army Reserve occupational therapists (OTs) was examined by the authors through electronic survey to determine current levels of competence and highlight pre-deployment training needs. Results indicated that while Army Reserve OTs report high levels of behavioral health competence, many questions regarding diagnosis, assessment, evaluation, treatment planning, intervention, and progress arose throughout deployment. OTs often relied on skills from Level II fieldwork education and entry-level didactic education for competency. Perceived competencies may be compromised by curriculum changes in entry-level education, available fieldwork settings, and a lack of adequate training currently available prior to deployment.     

Abortion and Mental Health

Abstract

Unwanted pregnancy and abortion are common life events, and therapists are likely to work with clients who experience them. Legal abortion currently entails little physical or mental health risk; most women currently cope effectively with these life events without need of clinical intervention. But current abortion politics include efforts to make abortion a more threatening, stressful, and stigmatized experience and to create a “postabortion syndrome.” Using a stress and coping framework, we examine how antiabortion activists spread myths and misinformation aimed at women's appraisal processes, and discuss approaches therapists can use to enhance women's strategies for coping with abortion. We also discuss specific issues and useful techniques for counseling about abortion concerns, including cultural sensitivity and strategies for promoting positive sexual health.     

Occupational Therapy's Role with Victims of Domestic Violence

ABSTRACT

Occupational therapists encounter individuals who are victims of domestic violence in many different settings. The role of the occupational therapist with each client depends on that client's specific needs, the treatment setting, and the skills and beliefs of the therapist. This article presents a theoretical argument for why the occupational therapist should choose to be involved in the treatment of domestic violence. The Model of Human Occupation provides a framework for understanding functional issues related to domestic violence. Methods of assessment and treatment are presented using this model. A continuum of levels of involvement including referrals for resources or treatment, direct and indirect treatment and program consultation is offered. Each level is illustrated with case vignettes demonstrating the therapist's role. Issues related to the challenge of working in domestic violence and reasons that women may refuse intervention are also discussed.     

Anger Management

Many occupational therapy techniques and theories addressing anger have been incluenced by general misconceptions about anger within the field of psychology and the general public. Until occupational therapists develop a unique perspective for defining anger and understanding how anger affects one's ability to function in one's occupational roles, they will continue to depend upon other professions to provide information on addressing anger problems. Part one of this two-part series on anger management formulates a construct of normal anger pertinent to occupational therapy practice and identifies complexities and misconceptions which have obscured the nature of anger. The second article presents basic concepts of anger management and mismanagement, provides clinical applications of these concepts, and delineates how anger affects human occupation. To accomplish this purpose, the Model of Human Occupation was used as a framework for integrating information on anger from the social sciences into a perspective of anger useful for the occupational therapist.     

Inertial constraints on limb proprioception are independent of visual calibration

When the coincidence of a limb's spatial axes and inertial eigenvectors is broken, haptic proprioception of the limb's position conforms to the eigenvectors. Additionally, when prisms break the coincidence between an arm's visual and actual positions, haptic proprioception is shifted toward the visual-spatial direction. In 3 experiments, variation of the arm's mass distribution was combined with prism adaptation to investigate the hypothesis that the proprioceptive effects of inertial and visual manipulations are additive. This hypothesis was supported across manipulations of plane of motion, body posture, proprioceptive target, and proprioceptive experience during prism adaptation. Haptic proprioception seems to depend on local, physical reference frames that are relative to the physical reference frames for the body's environmental position and orientation.     

The use of proprioception and tactile information in haptic search

To investigate how tactile and proprioceptive information are used in haptic object discrimination we conducted a haptic search task in which participants had to search for either a cylinder, a bar or a rotated cube within a grid of aligned cubes. Tactile information from one finger is enough to detect a cylinder amongst the cubes. For detecting a bar or a rotated cube amongst cubes touch alone is not enough. For the rotated cube this is evident because its shape is identical to that of the non-targets, so proprioception must provide information about the orientation of the fingers and hand when touching it. For the bar one either needs proprioceptive information about the distance and direction of a single finger’s movements along the surfaces, or proprioceptive information from several fingers when they touch it simultaneously. When using only one finger, search times for the bar were much longer than those for the other two targets. When the whole hand or both hands were used the search times were similar for all shapes. Most errors were made when searching for the rotated cube, probably due to systematic posture-related biases in judging orientation on the basis of proprioception. The results suggest that tactile and proprioceptive information are readily combined for shape discrimination.     

THE ROLE OF THEORY

In his psychosocial theory of development, Erik Erikson poses a viable framework from within which occupational therapists may evaluate and assess adjustment to dysfunction. Occupational therapist are familiar with the application of Erikson's eight stages to developmental problems. The authors present suggestions for the application of this theory to a variety of psychosocial and physical dysfunctions affecting mental health. These problems may result in the need to resolve Eriksonian crises at later points rather than regarding each crisis from a purely age-oriented developmental view. Awareness of the role of theory in the clinical application of occupational therapy skills may suggest new approaches for the therapist.     

Clinical Decision Making in Alzheimer's Disease

In the treatment of Alzheimer's Disease the occupational therapy goal is to enable persons to function as optimally as possible. Maximizing the patient's functioning in daily life necessitates a framework for clinical reasoning. Clinical reasoning currently emphasizes what persons can do but may fail to recognize the complex factors involved in what a person actually will do. A framework to guide clinical decision making for persons with Alzheimer's disease based on the model of human occupation was developed. The use of this framework is illustrated through a case application.     

Pathogenesis: A New Therapist Personality Dimension Related to Therapeutic Effectiveness

The pre-project TATs of ten therapists were rated for “pathogenesis” and these ratings later correlated with their patient's level of functioning after six months of treatment. Outcome was measured in a variety of data modalities: intellectual tests, thought disorder measures, projectives, clinical status interviews, and hospitalization. Significant correlations were obtained on five of eight outcome measures. Patients of more benign (or less pathogenic) therapists demonstrated greater foresight, less schizophrenic thought disorder, greater intellectual functioning, were rated as healthier in the Clinical Status Interview, and spent less time in the hospital than patients of more pathogenic therapists.