Skill acquisition and competency testing for physical agent modality use.

OBJECTIVE: The use of physical agent modalities is not considered an entry-level skill and requires postprofessional education, according to the American Occupational Therapy Association. The purpose of this survey was to determine how occupational therapy practitioners who use physical agents modalities are trained. METHOD: Two hundred fifty occupational therapists were randomly selected from the American Occupational Therapy Association's Physical Disabilities Special Interest Section. The practitioners were surveyed about their use of, education in, competency testing for, and opinions on eight physical agent modalities. RESULTS: Results were based on 100 responses (40% response rate). Of the eight modalities, the most commonly used were hot and cold packs, and the least were transcutaneous electrical nerve stimulators. The most common means of education was on-the-job training, and the least common was higher level accredited education. A majority (71) of respondents reported that no competency testing was being performed at their facilities. In the remaining facilities (29), the majority performed competency tests with no routine frequency, using no particular guidelines for testing and no formal methods for maintaining standards for physical agent modality use. Eighty-five respondents indicated they would be interested in attending continuing education programs on the use of physical agent modalities, and 88 believed that functional activities should follow the use of physical agent modalities within the same treatment session. CONCLUSION: The occupational therapy profession may need specific educational and competency guidelines to assure the qualifications of therapists using physical agent modalities.

The use of voice recognition as a control interface for word processing.

The purpose of this case study was to compare the speed and accuracy of the subject's word processing skills using the Dragon Systems, Incorporated Dragon Dictate voice recognition system, to the speed and accuracy of the subject's current method of accessing a computer by mouthstick. The subject received fifteen hours of training and practice on the voice recognition technology. Following training the subject was asked to type a 216-word document using his mouthstick skills and again using voice recognition. The subject was able to type 13 words per minute using his current method of mouthstick access, resulting in 10 errors or 95.4% accuracy. Using voice recognition technology, the subject dictated 20 words per minute with 3 errors, resulting in 98.6% accuracy. The results of this objective clinical measurement indicate that voice recognition technology may be a viable means of word processing for individuals with severe upper extremity restrictions.

A comparison of performance in added-purpose occupations and rote exercise for dynamic standing balance in persons with hemiplegia.

OBJECTIVES: Adding purpose to daily occupations to promote performance is a basic premise of occupational therapy. This study investigated the hypothesis that in persons with hemiplegia, two added-purpose occupations would elicit more exercise repetitions than a rote exercise. METHOD: In a counterbalanced order, 21 subjects with hemiplegia, aged 51 to 78 years, experienced all three conditions of a dynamic standing balance exercise that involved bending down, reaching, standing up, and extending the arm. One condition of added purpose involved the use of materials (small balls and target); a second added-purpose condition involved the subjects' imagination of the small balls. The third condition was the rote exercise without added purpose. RESULTS: A one-way analysis of variance for related measures indicated that the subjects performed significantly differently in each of the three conditions (p < .001). A Tukey multiple comparison test revealed that the subjects did significantly more exercise repetitions in the added-materials condition and in the imagery-based condition than in the rote exercise condition (p < .05). CONCLUSION: This study demonstrates how added purpose can enhance motor performance in persons with hemiplegia. Purpose may be effectively added to an exercise through the use of materials or imagery.

The touch inventory for elementary-school-aged children: test-retest reliability and mother-child correlations.

OBJECTIVE: The Touch Inventory for Elementary-School-Aged Children (TIE) is a self-report screening assessment for tactile defensiveness. The purpose of this study was to examine test-retest reliability of the TIE and to evaluate agreement between children's TIE scores and scores that mothers gave their children on a modified version of the TIE. METHOD: Twenty-nine children, 6 to 12 years of age, were available for the test-retest portion of the study and were assessed with the TIE with a 1-week interval between sessions. Their mothers completed a modified version of the TIE. RESULTS: Results indicated significant test-retest reliability (r = .91, p < .001), although a more conservative Kappa indicated only moderate agreement. The correlation between mothers' ratings and children's ratings was less significant (r = .56, p = .001), and Kappas were slight or fair, indicating considerable disagreement between mothers and children. CONCLUSION: These results suggest that using information from both mothers and children might provide a more complete picture of tactile defensiveness, but further research is needed before using a mother's assessment when the TIE is implemented as a standard procedure.

Prosthesis training as a context for studying occupational forms and motoric adaptation.

OBJECTIVES: Occupational therapy authors frequently emphasize the importance of the use of objects in the development of motor skill. This study investigated the use of object-produced visual input in learning control of flexion and extension of an above-elbow training prosthesis. METHOD: Fifty-two male college students were randomly assigned to two training procedures: (a) two 1.5-min periods in which they used a flashlight attached to the hook of the prosthesis to connect dots on paper with light, or (b) the same time periods in which they had the opportunity to practice moving an equally weighted prosthesis, but without the light or dots. To assess motoric adaptation after training under one of the two conditions, each subject traced a continuous line through a maze with a pen attached to the hook. Deviations from the line were measured reliably. RESULTS: Data analysis with a Mann-Whitney test revealed that subjects in the group that trained with added materials traced with significantly more skill than subjects in the other group (one-tailed U = 225.5, p = .02). CONCLUSION: As predicted by occupational therapy theory, the object-produced visual input enhanced the learning of a motor skill relevant to rehabilitation. Although there is a need for more study across different occupations and populations, clinicians are urged to consider the possible benefits of the use of objects in the development of motor skills, as opposed to objectless exercise. Prosthetic training provides a useful context for future research addressing theoretical issues in motor learning.

Evaluating level I fieldwork students: a job model.

This article describes how a job model, a behavioral engineering concept used to improve employee performance, was developed to evaluate the clinical performance of occupational therapy students in Level I fieldwork. The job model emphasizes accomplishments and provides immediate feedback on specific skills needed for the successful completion of Level I fieldwork. In a pilot study of 137 students from the Occupational Therapy Teaching Clinic at Western Michigan University, 68 of the students were evaluated with the job model and 69 were evaluated with Western Michigan University's traditional Level I fieldwork evaluation. The results showed that the job model provided a method by which to identify standard values for measuring accomplishments in Level I fieldwork.