Lisa Klinger

Occupational Adaptation: Perspectives of People with Traumatic Brain Injury

Abstract This paper describes a qualitative study carried out to understand the process of occupational adaptation after traumatic brain injury. Seven people, injured two to seventeen years previously, were interviewed. Transcripts were analysed using the constant comparative method, with peer review, journaling, and a member‐checking group to maximize truthfulness. Participants described experiencing a change in self‐identity following injury that was related to, and influenced, occupational adaptation. Self‐identity and engagement in occupation were closely related. Acceptance of the new self was fundamental to successful occupational adaptation. Participants also shifted environmental contexts of doing to reflect their new persona. Reframing self‐identity was thus an important aspect of participants’ rehabilitation. These findings resonate with other qualitative studies with brain injury survivors, theories of occupational adaptation, and social psychological perspectives. Yet, the literature on brain injury rehabilitation rarely discusses the need to address self‐identity. Occupational science can play an important role by integrating these bodies of literature.

A Systematic Review of Multidisciplinary Outcomes in the Management of Chronic Low Back Pain

OBJECTIVE Previous research has provided an inconsistent message as to the effectiveness of multidisciplinary programs to improve employment outcomes in clients with Chronic Low Back Pain (CLBP). The primary aims of this review were to: 1) update the evidence for the multidisciplinary treatment of CLBP to improve employment outcomes 2) assess what knowledge supports occupational therapy as contributing to a multidisciplinary approach in the treatment of CLBP. PARTICIPANTS Working-age adults experiencing CLBP who took part in controlled trials evaluating multidisciplinary programs between July 1998 and July 2009. METHODS Updated guidelines provided by the Cochrane Collaboration Back Review Group (BRG) were used to perform a systematic review to identify, appraise, and synthesize research evidence relevant to our research questions. RESULTS Twelve unique articles were found, after a database search and citation tracking, only two of which were high quality. Our findings suggest that there is still conflicting evidence for the effectiveness of multidisciplinary programs to improve employment outcomes in CLBP. CONCLUSIONS The results are discussed with reference to current methodological limitations found in the literature. Furthermore, occupational therapists were found to be underutilized in the included studies and future multidisciplinary programs should take advantage of the wide range of skills that occupational therapists can contribute in this practice area.

Struggling to Maintain Occupation While Dealing With Risk: The Experiences of Older Adults With Low Vision

The primary aim of this descriptive phenomenological study was to describe the core aspects of living with low vision in later life among older adults (aged 70 years and older) who had not accessed rehabilitation services for low vision. Thirty-four older adults from urban and rural areas participated in a semi-structured qualitative interview and a telephone follow-up. Drawing on an occupational science perspective and using Giorgi and Giorgis (2003) method of analysis, the essence of the experience of living with low vision was identified as struggling to maintain valued and necessary occupations while dealing with risk. Additional themes included enhanced sense of risk, striving for independence, and shrinking physical and social life spaces. Findings are interpreted in relation to occupational adaptation and environmental influences on occupation, and implications for the role of occupational therapists are discussed.

When Self-Presentation Trumps Access: Why Older Adults with Low Vision Go without Low Vision Services

Reasons were sought for low-vision service nonuse in a group of Canadian seniors with self-reported low vision. Audio-recorded semistructured interviews were completed with 34 seniors with low vision: age range (70 to 94 years; mean: 82 years); 16 urban dwellers (12 women); 18 rural dwellers (14 women). Qualitative content analysis and template analytic techniques were applied to transcriptions. Informant nonuse of low-vision services involved: insufficient knowledge, managing for now, and practitioner behavior (inadequate rehabilitation education and management). Underlying seniors’ attitudes that shaped their self-presentation and service nonuse included a strong need for independence, a contextualization of vision loss relative to other losses, and an acceptance of vision loss in life. Service delivery strategies should consider not only knowledge access and healthcare practitioner behavior but also senior self-presentation strategies (e.g., viewing aids as counterproductive to independence). Subtle rural-urban attitudinal differences may further delay access for rural seniors; further research is advised.

Low Vision: A Preliminary Exploration of Its Impact on the Daily Lives of Older Women and Perceived Constraints to Service Use

Although low vision in later life has the potential to negatively impact on all areas of occupational performance and quality of life, estimates suggest that less than one-tenth of older adults with low vision currently use low-vision rehabilitation services (LVRS) designed to increase occupational performance. This phenomenological study examines the lived experience of 4 older adults with low vision who are not using LVRS. Themes relate to maintaining daily life and independence, coping with vision loss, and avoiding LVRS. Gaps in current low-vision service provision and suggestions for future service delivery are identified.

Directions for advancing the study of work transitions in the 21st century

OBJECTIVES The purpose of this article is to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. PARTICIPANTS Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. METHODS A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. FINDINGS Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. CONCLUSIONS Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

Rest is a Meaningful Occupation for Women with Hip and Knee Osteoarthritis

Rest is often acknowledged as an integral part of occupational therapy and occupational science, yet little is known about the experience of rest. This article arose from a question posed by the researchers during an earlier phenomenological study of womens experiences of adapting to osteoarthritis. A secondary analysis of the interview and focus group data from the initial study was conducted to answer the question, “How is rest experienced by these women with hip and knee osteoarthritis?” For these 11 women between the ages of 60 and 75 years, rest is a meaningful occupation that contributes to well-being and the achievement of occupational balance. Rest sometimes requires adaptation and is often enfolded with other occupations. Rest is described as different from sleep, which diverges from many classifications of rest in health frameworks. These findings suggest that rest is an important occupational experience and belongs in models of occupational therapy.

Contributing to operations of community agencies through integrated fieldwork experiences.

Background. Occupational therapists are change agents who are well equipped to participate in community development. Community development projects can help agencies in many ways, including determining needs, educating stakeholders, developing novel programs, finding and creating resources, marketing the agency, and creating or implementing policy. In order for service agencies to profit, they need an understanding of the skills occupational therapists can offer. The best way to gain that knowledge may be through direct experience. Purpose. This paper describes the benefits that flow to community agency partners and to occupational therapy students from an innovative, integrated fieldwork model that links students with service agencies. Key Issues. This approach has demonstrated many benefits to community partners, while allowing all students in an occupational therapy program to have community development experience. Implications. This is a cost-effective way to demonstrate the value of occupational therapy and to deliver multiple community development projects.

The Effect of Visuospatial Neglect on Functional Outcome and Discharge Destination: An Exploratory Study

ABSTRACT Background and Purpose: The purpose of this study was to evaluate the effect of visuospatial neglect on functional outcome and discharge destination in individuals with right brain damage. Methods: Sixteen subjects agreed to participate in the study and 6 of these subjects demonstrated visuospatial neglect. During two different data collection periods, participants were evaluated with the Rivermead Behavioral Inattention Test, the Functional Independence Measure (FIM), the Mini-Mental State Examination, the Berg Balance Scale, and the Chedoke-McMaster Impairment Inventory. Results: Admission and discharge FIM scores were significantly lower for subjects with visuospatial neglect. The discharge destination for the group with visuospatial neglect demonstrated a trend toward supported living (i.e., long-term care). The groups did not differ significantly in onset to rehabilitation admission interval or length of rehabilitation stay. Conclusions: The presence of visuospatial neglect may predict the need for greater amounts of caregiver assistance at discharge.

Assessing communication accessibility in the university classroom: Towards a goal of universal hearing accessibility

Measures of accessibility typically focus on the physical environment and aspects relating to getting into and out of spaces. The transient sound environment is less well characterized in typical accessibility measures. Hearing accessibility measures can be based upon physical indices or functional assessment. The physical measures are indices that use signal-to-noise ratios to evaluate audibility while the functional assessment tool adopts universal design for hearing (UDH) principles derived from principles of universal design. The UDH principles include (1) Optimization of the hearing environment for all; (2) Optimization of interactions between persons and objects to promote better hearing in an environment; (3) Optimization of opportunities for people to have multiple choices of interactions with one another; (4) Optimization of opportunities for people to perform different activities in and across environments; (5) Optimization of opportunities for people to have safe, private, and secure use of the environment while minimizing distraction, interference, or cognitive loading; and (6) Optimization of opportunities for people to use the environment without extra steps for hearing access during preparatory, use and/or after use phases. This paper compares the two approaches using case examples from post-secondary classrooms in order to describe the potential advantages and limitations of each.