Jan Miller Polgar

Linking Occupational Participation and Occupational Identity: An Exploratory Study of the Transition from Driving to Driving Cessation in Older Adulthood

Abstract Changes in the ability to participate in meaningful occupations are common during and following significant life changes and/or events. Using qualitative methods, this study explored how changes in occupational participation can influence an individuals identity as exemplified during the transitional period from driving to driving cessation in older adulthood. The findings discussed in this paper illustrate the interdependent relationship that exists between occupational participation and occupational identity. In particular, this study highlights the potential consequences on identity when meaningful occupations are disrupted. The findings in this study lend support to previous findings, which identified a critical link between engagement in meaningful occupations and identity as an occupational being. Given that individuals may experience many transitional periods in their lifetime, this study provides preliminary evidence regarding the importance of occupational adaptation. Based on findings in this study, occupational participation may provide the context in which individuals begin the process of reconstructing their lives thereby linking their past and future occupational self.

Enabling Occupational Performance: Optimal Experiences in Therapy.

Occupational therapists believe that engagement in occupation contributes to health through an individually balanced use of time, a positive focus for ones physical and mental energy, and the provision of a sense of purpose. Flow is a construct which describes optimal experiences or enjoyment in everyday activities. A review of the literature suggests that the theory of optimal experience is complementary to occupational therapy beliefs and that an understanding of the flow experience may contribute to our understanding of human occupation. Specifically, flow may be useful in understanding those aspects of the occupation, environment and person that contribute to a “just right” challenge, and to enabling occupational performance through enjoyable, structured and purposeful activity. Occupational therapists are encouraged to explore whether optimal experiences facilitate occupational performance for individuals with a disability. Future research could explore whether the occupational opportunities available to persons with a disability provide the degree of challenge required to elicit the optimal experience. Finally, research could explore whether the client-driven selection of meaningful occupation, and therapist enablement of the “just right” challenge, influences optimal experience, occupational performance, and life satisfaction for those with a disability.

Effectiveness of a wheelchair skills training program for powered wheelchair users: a randomized controlled trial

OBJECTIVES To test the hypothesis that powered wheelchair users who receive the Wheelchair Skills Training Program (WSTP) improve their wheelchair skills in comparison with a control group that receives standard care, and secondarily to assess goal achievement, satisfaction with training, retention, injury rate, confidence with wheelchair use, and participation. DESIGN Randomized controlled trial. SETTING Rehabilitation centers and communities. PARTICIPANTS Powered wheelchair users (N=116). INTERVENTION Five 30-minute WSTP training sessions. MAIN OUTCOME MEASURES Assessments were done at baseline (t1), posttraining (t2), and 3 months posttraining (t3) using the Wheelchair Skills Test Questionnaire (WST-Q version 4.1), Goal Attainment Score (GAS), Satisfaction Questionnaire, injury rate, Wheelchair Use Confidence Scale for Power Wheelchair Users (WheelCon), and Life Space Assessment (LSA). RESULTS There was no significant t2-t1 difference between the groups for WST-Q capacity scores (P=.600), but the difference for WST-Q performance scores was significant (P=.016) with a relative (t2/t1 × 100%) improvement of the median score for the intervention group of 10.8%. The mean GAS ± SD for the intervention group after training was 92.8%±11.4%, and satisfaction with training was high. The WST-Q gain was not retained at t3. There was no clinically significant difference between the groups in injury rate and no statistically significant differences in WheelCon or LSA scores at t3. CONCLUSIONS Powered wheelchair users who receive formal wheelchair skills training demonstrate modest, transient posttraining improvements in their WST-Q performance scores, have substantial improvements on individualized goals, and are positive about training.

Trunk Muscle Activity During Wheelchair Ramp Ascent and the Influence of a Geared Wheel on the Demands of Postural Control

OBJECTIVES To quantify levels of torso muscular demand during wheelchair ramp ascent and the ability of a geared wheel to influence trunk muscle activity. DESIGN Repeated-measures design. Each participant completed manual wheelchair ramp ascents for each combination of 4 ramp grades (1:12, 1:10, 1:8, and 1:6) and 3 wheel conditions (in gear, out of gear, and a standard spoked wheel) in a block randomized order by wheel condition. SETTING Biomechanics laboratory. PARTICIPANTS Healthy novice wheelchair users (N=13; 6 men) from a university student population. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Peak electromyographic activity, expressed as a percentage of maximal voluntary isometric contraction (MVIC) of the abdominals, latissimus dorsi, and erector spinae during ramp ascent. Temporal location of peak electromyographic activity (EMG) within a propulsive cycle and integrated electromyographic activity for a single propulsive cycle. RESULTS Abdominal peak activity increased 13.9% MVIC while peak posterior trunk muscle activity increased 4.9% MVIC between the shallowest and steepest ramp grades (P<.05). The geared wheel prevented increased peak activity of the rectus abdominis and external oblique (P>.05). Only peak electromyographic timing of the erector spinae was influenced during the push phase by increasing ramp slope. CONCLUSIONS Increased trunk muscular demand as a result of increasing ramp slope is required to enhance stiffness of the spinal column and provide a stable base during manual propulsion. Manual wheelchair users with compromised activity capacity, compromised abdominal muscle strength, or both, may be able to navigate more difficult terrains while using a geared wheelchair wheel because of reduced demands from the abdominal musculature in the geared wheel condition.

The Myth of Neutral Technology

The meaning that assistive technology (AT) holds for the user is a key determinant of whether the device will be used or abandoned. Two concepts, stigma and liminality (existing in a state of transition), are used to frame users’ perceptions of the assistive technology they use, as generated through research projects investigating aspects of assistive technology use. Implications of the meaning of AT to the design and selection process are described. Assistive technology that is seen as a tool, as just another way of achieving a desired activity is much more likely to be assimilated into the user’s daily life. Technology perceived in this manner enables people to share activities with others and augment their personal abilities. Alternately, technology can be seen as a visible sign of disability, reinforcing stigma associated with a disability and the perception of the AT user as existing somewhere between health and illness. Individuals with this view of technology may avoid or resist use of technology, resulting in avoidance of meaningful activities and both social and physical isolation. These findings support the conclusion that technology is not neutral. Inclusion of users in both the design and selection process and understanding the meaning that AT use holds are integral to the development of assistive technology that achieves the desired outcome of enabling participation in daily life.

Use of a geared wheelchair wheel to reduce propulsive muscular demand during ramp ascent: Analysis of muscle activation and kinematics

BACKGROUND Shoulder muscle overuse has been linked to the high prevalence of shoulder injuries in manual wheelchair users. Ramp ascent is a barrier that is often faced by manual wheelchair users that requires higher muscle activations than level wheelchair propulsion. Additionally, reported subjective measures of shoulder pain are reduced amongst manual wheelchair users when using a wheelchair wheel outfitted with a gear mechanism. The purpose of the current investigation was to investigate shoulder muscle activation levels and upper limb kinematics during ramp ascent with and without the use of a geared wheel. METHODS Thirteen healthy participants (6 male and 7 female) performed ramp ascent on four ramp grades (1:12, 1:10, 1:8, 1:6) using three wheel conditions (gear, no gear, standard). Electromyographic (EMG) activity of select shoulder muscles as well as kinematics of the right upper limb were collected during ramp ascent. Peak and integrated EMG as well as peak wrist, elbow, and shoulder kinematics were obtained from all ramp ascent trials. FINDINGS Peak EMG of the shoulder flexors decreased by an average of 17% (P0.0229) during ramp ascent with the geared wheel. Integrated EMG increased by 67% (P0.0034) as a consequence of an 86% increase (P=0.0009) in ramp ascent duration during the geared wheel condition. There were no significant differences between the non-geared and standard wheel conditions. INTERPRETATION Caution must be used if using the gear ratio for prolonged periods due to potential for muscle fatigue since the overall muscle effort to move a fixed distance is higher with the gear ratio. Reducing peak demands may benefit wheelchair users with performing more strenuous tasks of daily living.

Assistive Technology as an Enabler to Occupation: What's Old is New Again

CANADIAN JOURNAL OF OCCUPATIONAL THERAPY n OCTOBER 2006 199

Older drivers' opinions of criteria that inform the cars they buy: A focus group study

Safe driving in older adulthood depends not only on health and driving ability, but also on the driving environment itself, including the type of vehicle. However, little is known about how safety figures into the older drivers vehicle selection criteria and how it ranks among other criteria, such as price and comfort. For this purpose, six focus groups of older male and female drivers (n=33) aged 70-87 were conducted in two Canadian cities to explore vehicle purchasing decisions and the contribution of safety in this decision. Themes emerged from the data in these categories: vehicle features that keep them feeling safe, advanced vehicular technologies, factors that influence their car buying decisions, and resources that inform this decision. Results indicate older drivers have gaps with respect to their knowledge of safety features and do not prioritize safety at the time of vehicle purchase. To maximize the awareness and uptake of safety innovations, older consumers would benefit from a vehicle design rating system that highlights safety as well as other features to help ensure that the vehicle purchased fits their lifestyle and needs.

Consumer-Based Approaches Used in the Development of an Adaptive Toileting System for Children with Positioning Problems

A research and development project was initiated to address concerns that existing commercial toileting systems are generally cumbersome to use, costly, and do not effectively support children in the best biomechanical and physiological position for independent toileting. Others have found that “homemade” adaptations are often necessary to improve the fit of these systems. To address these problems, a research and development project wasinitiated to develop a better toileting system. A multiphase research project involving a series of focus groups with parents, therapists, and other rehabilitation professionals (phase 1), classroom trials to evaluate a fitting prototype (phase 2), and home trials of a functional version (phase 3) was undertaken in the design of a better toileting system. Consumer feedback from these trials was used to develop a commercial version.1 This paper reviews each phase of the design process and discusses how consumer perspectives and clinical feedback were integrated into the design of the final product. In addition, features of the final product are described.

Homebound Older Individuals Living in the Community: A Pilot Study

SUMMARY The purpose of the present study was to gain a better understanding of the subjective experiences of homebound older individuals living in the community using the interpretive phenomenology approach. The following research questions were examined: (1) What are the daily experiences of this group? (2) How do they manage to remain living in the community; what supports do they access and what needs are not currently being met? Interviews were conducted with nine homebound seniors. Interview transcript content was analysed for themes including: Outlook on Life, Daily Activities, Need for Assistance, Assistive Devices, Transportation, Limitations to Occupational Performance, and Barriers to Participation. Suggestions for future program development within the community are identified.