Karen Whalley Hammell

Fatigue and spinal cord injury: a qualitative analysis

ObjectivesTo explore experiences of fatigue among people with spinal cord injuries (SCIs) and factors perceived to contribute to fatigue.SettingKelowna, Prince George, Vancouver and Victoria, British Columbia, Canada.Study designCollaborative, qualitative methodology.MethodsFour focus groups were undertaken simultaneously with a total of 29 participants, comprising a purposive sample of men and women: 21 people with complete and incomplete SCI of high and low tetraplegia and paraplegia, 2 family members, 2 assistants and 4 occupational therapists. Interpretive analysis was grounded in the themes identified in the data.ResultsFatigue was perceived to have cognitive, emotional and physical dimensions and to exert a profound effect on the lives of many people with SCI, such that pleasurable activities were often eschewed to enable the accomplishment of more mundane tasks. Factors most consistently associated with fatigue were pain, depression and hopelessness, side effects of medications, poor quality sleep, spasticity, poor posture, diet, and the effort required to accomplish routine and self-care tasks.ConclusionsFatigue is a complex phenomenon, interlinked with pain, depression and hopelessness that significantly diminishes the quality of life following SCI. Further research is required to provide greater understanding of this issue and to determine appropriate and comprehensive forms of intervention.

Client-Centred Practice: Ethical Obligation or Professional Obfuscation?

Occupational therapists claim to practise in a client-centred and needs-led manner, yet disabled people can perceive occupational therapists to be accountable not to their clients but to their employers. This opinion piece argues that the profession has failed to address the ethical implications of being gatekeepers to the resources that clients need while professing to be ‘needs-led’; and contends that we must choose either client-centred or therapist-centred practice (in which occupational therapists protect their own interests). Because therapist-centred practice contravenes the existing Code of Ethics and Professional Conduct, either appropriate censure or a rewriting of the Code is required.

Client-centred occupational therapy: the importance of critical perspectives

AbstractBackground: The occupational therapy profession has proclaimed itself to be client-centred for over 30 years, but until recently this assertion remained largely unchallenged. Critical thinkers, who have begun to explore client-centred practice in occupational therapy, highlight the necessity for further critical reflection. Aims. This paper aims to define what constitutes “critical” thinking; and to persuade occupational therapists of the importance of employing critical perspectives towards the profession’s assumptions and assertions regarding occupational therapy’s “client-centred” practices. Major findings. Critical thinking is not solely a process of carefully and thoughtfully weighing various arguments or evidence, but of additionally appraising the ideological and structural contexts in which these positions or evidence have arisen. Critical perspectives towards occupational therapy’s client-centred practices identify the ways in which power is exercised by the profession, and culturally spe...Abstract Background: The occupational therapy profession has proclaimed itself to be client-centred for over 30 years, but until recently this assertion remained largely unchallenged. Critical thinkers, who have begun to explore client-centred practice in occupational therapy, highlight the necessity for further critical reflection. Aims. This paper aims to define what constitutes “critical” thinking; and to persuade occupational therapists of the importance of employing critical perspectives towards the profession’s assumptions and assertions regarding occupational therapy’s “client-centred” practices. Major findings. Critical thinking is not solely a process of carefully and thoughtfully weighing various arguments or evidence, but of additionally appraising the ideological and structural contexts in which these positions or evidence have arisen. Critical perspectives towards occupational therapy’s client-centred practices identify the ways in which power is exercised by the profession, and culturally specific and disabling ideologies are perpetuated. Practice conclusion. Critical thinking enables occupational therapists to reflect on their own inequitable access to privilege and power, and reduces the potential for the profession to re-inscribe dominant ideologies that devalue disabled people and justify their inequitable opportunities. Because critical thinking demands a readiness to restructure one’s thinking, and decreases the risk of acting on faulty assumptions, it is an essential component of client-centred practice.

Managing fatigue following spinal cord injury: a qualitative exploration.

Purpose. To identify, from the perspectives of people with spinal cord injury (SCI), (a) appropriate components of a fatigue management programme; and (b) important outcomes or indicators of success. Method. Collaborative, qualitative methodology comprising four focus groups undertaken simultaneously in Kelowna, Prince George, Vancouver and Victoria, British Columbia, Canada. Participants included a purposive sample of 21 men and women with complete and incomplete SCI of high and low tetraplegia and paraplegia. Two family members, two care-providing assistants and four occupational therapists provided additional information (total n = 29). Interpretive data analysis identified common themes addressing each research question. Results. Building on those strategies they perceived to facilitate coping with fatigue, the participants identified 10 components of a helpful fatigue management programme. Dimensions of ‘successful’ outcomes from such a programme reflected quality of life concerns: enabling people with SCI to do the things they value, enhancing their sense of control over their lives, reducing pain and helplessness, increasing motivation and enhancing relationships strained by fatigue. Conclusions. This study identifies many of the necessary elements of a fatigue management programme to meet the specific needs of people with SCI; and ascertains important indicators of a successful programme from the perspectives of those who must live with the outcomes.

The power of power wheelchairs: Mobility choices of community-dwelling, older adults

Abstract Background: Power wheelchairs are purported to have a positive effect on health, occupation, and quality of life. However, there is limited knowledge about what factors shape power wheelchair use decisions. Aims/objectives: A study was undertaken to understand the mobility choices of community-dwelling, power wheelchair users. Methods: A series of semi-structured qualitative interviews was conducted with 13 older adult power wheelchair users. Participants were interviewed at enrollment and four months later. Data analysis was informed by Bourdieu’s theoretical constructs of habitus, capital, and field. Results: Three main styles of power wheelchair use were identified: reluctant use, strategic use, and essential use, and each type is illustrated using an aggregate case study. Conclusion/significance: These findings highlight the need to alter the power relationship that exists between prescribers and device users and to effect policy changes that enable people with physical impairments to make as wide a range of mobility choices as possible.

Spinal Cord Injury; Quality of Life; Occupational Therapy: Is There a Connection?:

Although occupational therapists frequently state that one of their primary goals is that of enhancing quality of life, this does not appear to be supported by either their outcome measures or their literature. Studies have shown that satisfaction with quality of life following a spinal cord injury is not predicted by either degree of impairment or disability. Handicap is negatively correlated with quality of life and this may require interventions that are focused towards the environment rather than the individual. Occupational therapists may need to adopt a more client-centred approach to practice, in which assessment, Intervention and outcome measures are sensitive to the subjective views of the individual, thus enabling therapists to understand more of what quality of life means to each client.

Occupational Therapy in the Management of High Level Quadriplegia

The rehabilitation of the high level quadriplegic patient has been largely ignored in occupational therapy literature. With the comparatively recent survival of these patients and the low expectation for rehabilitation potential, as this has traditionally been viewed, the design of a therapy programme is a challenge to the vision and skills of the occupational therapist. This article outlines many of the available equipment options and indicates the unique rote that the occupational therapist has to play in increasing the quality of life for this patient group.

Respecting global wisdom: Enhancing the cultural relevance of occupational therapy’s theoretical base

Dominant models of occupation that inform the international occupational therapy profession have been delineated predominantly by able-bodied, middle class, middle-aged, white, urban, North America...Dominant models of occupation that inform the international occupational therapy profession have been delineated predominantly by able-bodied, middle class, middle-aged, white, urban, North American Anglophone academics with Judeo-Christian backgrounds, thus reflecting the culturally-specific perspectives of a global minority. Because these models exclude priorities and occupations valued by the global majority, they are demonstrably inadequate. This opinion piece highlights the imperative of incorporating the wisdom of a diversity of global peoples into occupational therapy’s theories of occupation to enhance the possibility that the profession’s theories and practices will be culturally relevant, safe and inclusive, rather than ethnocentric, imperialistic and potentially irrelevant.

Workload Measurement: A Tool for Accountability

Measurement of workload practice is the cornerstone of management. Fundamental to the issue of workload measurement and any subsequent costing is the sensitivity of the tool used for data collection. It is proposed that the use of an appropriate tool for the collection of data will enable the provision of an improved service to both consumer and funding agency. This article presents one data collection tool, which has enabled a detailed analysis of present workload and has provided data for service planning and staffing projections.

Further concerns for occupational therapy conferences

Dear Editor, I read with interest the letter entitled ‘Scholarly communication and concerns for our conferences’ by Lannin et al. (2009). To their timely concerns about scholarly communication I should like to add a concern of my own. I am aware that from time to time an abstract is submitted to an occupational therapy conference that presents original ideas and innovative ways of thinking about theory, research or practice. The abstract receives excellent scores from enthusiastic reviewers but is rejected by the conference committee on the basis that it does not fit into a thematic grouping with other, similar papers. By definition, of course, something that is unconventional will fail to fit with all that is conventional. However, the predilection for matching each conference paper with other, similar papers reflects a format that fosters and rewards ‘thinking as usual’. To me, this is a serious concern, because it discourages originality, promotes the status quo and exposes occupational therapists to a narrow range of ideas. This is the antithesis of the sceptical approach to orthodoxy and dogma demanded of a selfprofessed scientific profession. A scientific discipline is defined as one that assures ‘a culture of healthy scepticism: a readiness to doubt claims and assumptions about the “rightness” of any particular theory or intervention’ (Brechin & Sidell, 2000, p. 12). It is unlikely that the ‘rightness’ of any occupational therapy theory or practice will be doubted if papers presenting innovative ideas are rejected because they fail to conform. Although conference committees undeniably have a difficult task in scheduling paper presentations, I contend that it is exactly those papers that do not fit within existing ideological boxes that our profession most needs to hear. Said (1979) argued that professionals must always be on guard against the received ideas handed down in their profession; against being too smug, too insulated and too confident in ideological straightjackets. This task is inordinately difficult when our profession enforces the parameters of permissible knowledge. Karen Whalley Hammell Occupational Science and Occupational Therapy, University of British Columbia Email: ik.hammell@sasktel.net