Helene Polatajko

The Canadian Occupational Performance Measure: An Outcome Measure for Occupational Therapy

The Canadian Association of Occupational Therapists, in collaboration with Health and Welfare Canada have developed and published a conceptual model for occupational therapy, the Occupational Performance model. This paper describes the development of an outcome measure, The Canadian Occupational Performance Measure (COPM), which is designed to be used with these guidelines for client-centred clinical practice. The COPM is an outcome measure designed for use by occupational therapists to assess client outcomes in the areas of self-care, productivity and leisure. Using a semi-structured interview, the COPM is a five step process which measures individual, client-identified problem areas in daily function. Two scores, for performance and satisfaction with performance are obtained. This paper describes the rationale and development of the COPM as wellas information about its use for therapists.

Pilot Testing of the Canadian Occupational Performance Measure: Clinical and Measurement Issues

The Canadian Occupational Performance Measure (COPM) is a measure of a clients self-perception of occupational performance in the areas of self-care, productivity and leisure. The COPM is administered using a semi-structured interview in which the client identifies significant issues in daily activities which are causing difficulty. Extensive pilot testing of the COPM has been completed with 268 clients in communities across Canada and in New Zealand, Greece and Britain. Results indicate the COPM has a median administration time of 30 minutes, is able to identify a wide range of occupational performance issues and appears to be responsive to changes in perception of occupational performance over time. A number of clinical and measurement issues centering around the interview, test construction, scoring, timing of the assessment, respondents, and the assessment process are discussed.

An International Consensus on Children with Developmental Coordination Disorder

Within every elementary school classroom there is usually at least one child, distinguished by a pervasive slowness in the easy acquisition of the everyday motor skills learnt by his/her peers without apparent effort. In spite of normal intelligence and freedom from diagnosed neurological disorders, this child has a great deal of difficulty mastering motor tasks requiring precision, timing and accuracy. As a consequence, the child experiences a great deal of difficulty in numerous areas of performance both in the school and in the home. Parents and teachers alike search for answers to problems manifestly beyond their power to influence. With increased frequency they are turning to the occupational therapist working in the school for remediation of the associated difficulties in handwriting, independent management of self-care activities, leisure activities and social interaction. Unfortunately the resources, both economic and informational, necessary to provide adequate intervention for these children with mild motor problems are frequently inadequate to meet the need. This inadequacy is, in no small measure, due to the lack of consensus existing around the disability. For many years, in many disciplines, the disability has been discussed under a variety of labels including: minimal cerebral palsy; minimal brain dysfunction; MOTS DES CLÉS

A CLINICAL TRIAL OF THE PROCESS-ORIENTED TREATMENT APPROACH FOR CHILDREN WITH DEVELOPMENTAL CO-ORDINATION DISORDER

The process‐oriented treatment (PORA) approach is a time‐limited programme aimed at increasing the kinaesthetic performance of children with mild motor problems in order to improve their motor performance. The approach was compared with a traditional or general motor approach and with no treatment in a randomized clinical trial of 75 children with developmental co‐ordination disorder. The children were assessed before and after treatment and after a six‐week follow‐up period. The results were mixed. The study provides evidence of the severity of so‐called “mild” motor problems of children referred to occupational therapy. The data suggest that these children do not improve spontaneously, and that their motor problems are very resistant to treatment. The data also suggest that an appropriate treatment strategy might be one that involves direct, repetitive training of a specific skill.

Handwriting Error Patterns of Children with Mild Motor Difficulties

A large proportion of children referred to school-based occupational therapists experience difficulty with handwriting. Illegible handwriting is found to have secondary effects on school achievement and self-esteem. The purpose of this study was to identify handwriting error patterns of children with mild motor difficulties and to examine the relationship between handwriting error patterns and perceptual-motor abilities. Sixty-six children aged 7 to 12 years old with mild motor difficulties were involved in the study. The results indicated three possible handwriting error patterns: (1) Execution Factor; (2) Aiming Factor; (3) Visual-Spatial Factor. The Execution Factor was associated with visual-motor skill and sensory discrimination; the Aiming Factor was correlated with visual-motor and fine-motor performance. There were no significant associations with perceptual-motor abilities for the Visual-Spatial Factor.

A CRITICAL LOOK AT VESTIBULAR DYSFUNCTION IN LEARNING-DISABLED CHILDREN

The purpose of this study was to investigate the vestibular dysfunction hypothesis in learning disabilities. The data indicated that there was no significant difference in vestibular function between normal and learning‐disabled children; that there was no significant correlation between vestibular function and academic achievement; and that there was no significant educational relevance in categorizing learning‐disabled children according to vestibular dimensions.

Occupational Performance Measures: A Review Based on the Guidelines for the Client-centred Practice of Occupational Therapy

In 1987, Health and Welfare Canada and the Canadian Association of Occupational Therapists Task Force recommended that work go forward to develop an outcome measure for occupational therapy which reflects the Occupational Performance Model. The first step in this process was to review critically those outcome measures which assess occupational performance and that are currently available in the literature. This paper will present the review process, describe in more detail eight assessments that fulfilled many of the review criteria, discuss the limitations of these measures using the “Guidelines for the Client-centred Practice of Occupational Therapy as the framework, and make recommendations for the development of a new outcome measure for use in occupational therapy.

A Descriptive Study of Adults with Suspected Learning Disabilities

This article documents a descriptive study of 80 adults considered to have learning disabilities. The study was initiated by the Language and Learning Disabled Adults Task Force in London, Ontario, for the purpose of developing a profile of the self perceived characteristics and needs of the adult population with learning disabilities in Southwestern Ontario. The study also served as a vehicle for implementation of the Intake Questionnaire, an instrument with potential as a screening device for service agencies working with adults with learning disabilities. A self-referred and agency-referred sample of 80 adults completed the Intake Questionnaire. Data were collected in the areas of demography, education, employment, health, and psychosocial characteristics, aspirations, and cooperation with further testing. Results describe people with ongoing specific problems in education, employment, and psychosocial functioning who aspire to learn more about themselves and their learning disabilities.

Skill Acquisition during Fieldwork Placements in Occupational Therapy

A critical shortage of occupational therapy fieldwork placements has led therapists to pose the question: how many hours of fieldwork are actually required in order for a student to acquire the breadth and depth of clinical competence required for entry level practice? In this study, student scores on the Performance Evaluation of Occupational Therapy Students, gathered over a four year period, were utilized to address this question. The level of competence expected of a new graduate on the CAOT Occupational Profile (Bridle, 1981) was used as the criterion against which student scores were judged. Statistical analyses were performed to determine the level of acquisition of occupational therapy skills and techniques, by item and by groups of items; to identify “core” and “specialty” items; and to determine whether 1200 hours of fieldwork is the optimal choice for students to be able to demonstrate clinical competence in the field. Results indicate that, while most students attain many of the skills and techniques pertinent to occupational therapy, competence is reached only on those core skills which are frequently encountered and which have actually been experienced by the student across a number of placements. Recommendations include a re-examination by the profession of the expectations which have been set for an entry-level graduate.

VISUAL-OCULAR CONTROL OF NORMAL AND LEARNING-DISABLED CHILDREN

Much of the data typically presented to support the vestibular dysfunction hypothesis among learning‐disabled children is based on a measure of vestibular function that is confounded by visual input. Thus these data may provide evidence of deficits in visual‐ocular function in this population. To explore this possibility the authors investigated the differences in visual‐ocular function, in particular optokinetic nystagmus (OKN), between normal and learning‐disabled children. Children were tested for reflxation saccades, smooth ocular pursuit, spontaneous nystagmus, gaze nystagmus and OKN. The testers were blind to the group to which the children belonged. No significant differences were found between the groups on any of the variables. It is concluded that there is no difference in nystagmic behaviour between normal and learning‐disabled children, and that the differences in eye movements reported among learning‐disabled children should not be attributed to the visual‐ocular control functions investigated here.