The ramifications of regulatory reform.

This article examines the regulatory reform proposals for the health care workforce recently proposed by politicians and members of the Pew Health Professions Commission. These proposals attempt to address issues related to state practice acts, competence, advanced practice, "boundaryless" practice, the disciplinary process, consumerism, and umbrella legislation. Questions are presented for each issue to guide practitioners when deliberating about possible actions professional organizations can take in proposing legislation at the state level. Various external forces shape each issue and lead to the need to seek such regulatory reform as improving disciplinary processes and activity, assessing competence beyond the entry level, and increasing involvement of consumers. However, there are risks associated with any proposed regulatory reform, particularly if one realizes the potential financial costs associated with competency assessment and advanced-practice regulation. We must also carefully examine any reform proposals that advocate title protection and the licensing of invasive procedures in place of licensing professionals. The fact remains that the impact on quality of care and long-term cost-effectiveness from the unrestricted use of less qualified professionals and unlicensed aide-level personnel to provide skilled services has not been adequately determined.

The relationship of compliance and grip strength return post-carpal tunnel release surgery.

This study examined the relationship of compliance and grip strength return 6 weeks post-carpal tunnel release surgery on a sample of 11 factory workers residing in the midwest. The percent difference between pre-operative and post-operative grip strengths was - 6.00%. An ANOVA ruled out age as a significant factor in grip strength return (F=1.20, P=0.351). A two sample t-test for gender differences in return of grip strength proved insignificant as well (t=1.01, P=0.351). The low negative correlation between participant self-report of compliance and percent difference of grip strength was - 0.426. Work was reported as the most significant barrier to compliance. Results of this study suggested that 6 weeks of occupational therapy may not be sufficient for recovery to pre-operational grip strength status. Participants with the greatest amount of compliance in combination with returning to work soon after surgery demonstrated the weakest grip strength. This result implied that the exercise program in association with returning to work may have been too strenuous. Return to work and resulting work demands should be taken into consideration when prescribing home exercise programs. These conclusions are to be considered tentative and cannot be generalized because of the small sample size used to generate the data in this study.

Occupational meanings and spirituality: the quest for sobriety.

This article compares two differing models of intervention for persons with alcohol dependence--the Moyers Model for occupational therapy and Alcoholics Anonymous (AA). Both models were found to share practice strategies but to differ in their emphasis on spirituality and self-control. Additionally, the Moyers Model was basically procedural in its description of the clinical reasoning process, whereas AA places great emphasis on the spiritual aspects of recovery. Because this disparity may lead to confusion when the person with alcohol dependence is involved in both an occupational therapy program (using Moyers Model) and an AA program, the Moyers Model was revised to include a conditional reasoning structure (i.e., a process for therapists to help clients find meaning in actions). By providing opportunities to explore meaning through action during occupations, the revised Moyers Model is both more consistent with the AA principles of spiritual recovery and in keeping with the occupational therapy philosophy of addressing the needs of the whole person.

Occupational therapy intervention with the alcoholic's family.

In this paper, the role of occupational therapy in the treatment of the family affected by alcoholism is explored. Literature is reviewed to analyze occupational therapists' current approaches for interacting with the family. A family-treatment approach, based on systems theory, is organized into three hierarchical treatment levels that accommodate the family's maladaptive roles. Family treatment methods thought most likely to produce the desired results are delineated according to treatment level. Treatment Level 1 focuses on reduction of maladaptive role behaviors of the family that enable the person's drinking. At Treatment Level 2, family members are taught coping skills that weaken their reliance on maladaptive roles. Emotional development is stimulated at Treatment Level 3 through confrontation of continued use of maladaptive roles.

Neurocognition and alcoholism:.

Various neurocognitive deficits related to alcoholism interfere with participation in intensive treatment programs which often have strong learning components. Some of these learning impairments resolve with abstinence (timedependent recovery). Others, which normally do not recover with abstinence, may be remediated with selected neurocognitive stimulation (experiencedependent recovery). An overview of research findings examining experiencedependent recovery is provided, along with a neurocognitive model for occupational therapy intervention during detoxification of the person with alcohol dependence. Emphasis is given to occupational therapy evaluation and assessment of neurocognitive recovery and the corresponding treatment strategies designed to facilitate experience-dependent recovery in alcoholism.

Collaborating for political action.

Students involved in this university-state association collaboration have expressed excitement in helping to create progressive changes for occupational therapists and their consumers. After graduation, many of these students have continued their participation in IOTA's legislative committee and have assumed leadership roles in other IOTA activities. IOTA has benefited from this collaboration in terms of improved responsiveness during the legislative stage of an issue's life cycle.