This paper focuses on the use of the four specific learner-centered teaching approaches: service-... more This paper focuses on the use of the four specific learner-centered teaching approaches: service-learning, learning through discussion, team-based learning, and a structured research course sequence in an occupational therapy curriculum. These methods are used to develop the four curriculum themes of engagement, critical thinking, innovations in practice, and clinical reasoning. The outcome of these approaches has been that students have taken more responsibility for their learning and shown increased maturity while promoting faculty creativity. Additionally, students have developed skills and interests in social and community engagement, and have sought jobs in community-based practice areas.
This paper focuses on the use of the four specific learner-centered teaching approaches: service-... more This paper focuses on the use of the four specific learner-centered teaching approaches: service-learning, learning through discussion, team-based learning, and a structured research course sequence in an occupational therapy curriculum. These methods are used to develop the four curriculum themes of engagement, critical thinking, innovations in practice, and clinical reasoning. The outcome of these approaches has been that students have taken more responsibility for their learning and shown increased maturity while promoting faculty creativity. Additionally, students have developed skills and interests in social and community engagement, and have sought jobs in community-based practice areas.
A randomized controlled trial investigated the effect of client-centered Occupational Therapy on ... more A randomized controlled trial investigated the effect of client-centered Occupational Therapy on individuals with spinal cord injuries (SCI). Twenty-one subjects, 4 to 6 months post acute rehabilitation, received eight in-home, client-centered Occupational Therapy sessions or eight visits from social visitors. The Functional Independence Measure (FIM), the Craig Handicap Reporting and Assessment Technique (CHART), the Role Checklist and the Life Satisfaction Inventory-A (LSIA) were administered pre and post interventions. Analyses showed no differences between groups on the CHART and the FIM; the Role Checklist showed the Occupational Therapy group took on a limited number of new life roles; however, a statistically significant difference was found between groups post intervention for LSIA (p < 0.05).
Archives of Physical Medicine and Rehabilitation, Nov 1, 1992
... over time. Sequential motor strength examinations using both modalities were performed at 72 ... more ... over time. Sequential motor strength examinations using both modalities were performed at 72 hours, one week, and two weeks post SCI and then one, two, three,four, six, 12, 18, and 24 months post injury. The data analyses ...
Archives of Physical Medicine and Rehabilitation, Jan 5, 1995
Steindler defined a closed kinetic chain as one in which the terminal part of the extremity meets... more Steindler defined a closed kinetic chain as one in which the terminal part of the extremity meets with resistance which restrains its free motion, as in pushing a cart.' We have observed that quadriplegic patients with loss of voluntary muscle activity of the triceps from a cervical spinal cord injury at the C-5 and C-6 levels retain the ability to extend the elbow in a closed kinetic chain system despite a complete lack of triceps activity. Muscles act not only as isolated elements, but also as a part ofan integrated functioning ~y s t e m .~ This is analogous to the use of the gluteus maximus to extend the knee in patients who ambulate with all above-theknee prostheses.' The purpose of this study was to determine if the anterior deltoid and upper pectoral muscles were active in voluntary kinetic closed chain elbow extension. METHODS Ten normal adult male subjects (age range 22-30 years) performed a graded isometric bench press exercise while the shoulder girdle muscles were studied electromyographically. A bipolar bar electrode with 10-mm discs at a 30-mm interelectrode distance, 750-mm leads, and 2-mm plug was used for signal detection (TECA, Pleasantville, NY). A
This study was designed to compare changes in strength after spinal cord injury (SCI) with the us... more This study was designed to compare changes in strength after spinal cord injury (SCI) with the use of a hand held myometer to the manual muscle test (MMT). Eighty-eight C4-C8 Frankel AD tetraplegic subjects were tested at various times up to 2 years post-SCI. Elbow flexor strength on successive examinations were grouped according to their early and later MMT scores (3.5 with no change in MMT, 3.5 to 4.0, and 3.5 to 4.5; 4.0 with no change in MMT, 4.0 to 4.5, and 4.0 to 5.0; 4.5 with no change in MMT, and 4.5 to 5.0). For each group, later myometric measurements (MYO) were expressed as percents of their earlier MYO and were anlayzed using paired Students t-tests. Later MYO were 116, 205, 232% (P>0.05, P<0.002, P<0.05) of their earlier MYO for groups 3.5 with no change in the MMT, 3.5 to 4.0, and 3.5 to 4.5 respectively. Later MYO were 140, 139, 191 % (P<0.05, P<0.02, P<O.OOOl) of their earlier MYO for groups 4.0 with no change in MMT, 4.0 to 4.5, and 4.0 to 5.0 respectively. Later MYO were 127 and 126% (P<O.OI, P<0.02) of their earlier MYO for groups 4.5 with no change in MMT and 4.5 to 5.0 respectively. In conclusion the hand held myometer detected changes in muscle strength not detected by the MMT.
The Journal of neuropsychiatry and clinical neurosciences, 1989
The authors investigated habituation of the eye-blink component of the startle reflex to repeated... more The authors investigated habituation of the eye-blink component of the startle reflex to repeated affectively neutral tactile and auditory stimuli in nine subjects with posttraumatic stress disorder and nine controls. Each group showed rapid habituation in both tactile and auditory modalities.
The encoding processes of recognition and recall for line-drawn faces were investigated. Subjects... more The encoding processes of recognition and recall for line-drawn faces were investigated. Subjects randomly received three-alternative forced-choice tests of recognition and probe recall of 20 male faces. Between each inspection and test, subjects performed an interference task for 10 sec. The interference tasks consisted of either identifying the missing facial feature in line drawings or in photographs, or correctly identifying the misspelled words describing different facial features. The results indicate that recognition performance was higher than proberecall performance for all groups. The analysis of the recognition data suggests that recognition ability decreased as the similarity of the interference task to the target increased. This finding suggests that faces are encoded using visual rather than verbal imagery.
The anterior deltoid muscle has been found to be active during elbow extension in normal voluntee... more The anterior deltoid muscle has been found to be active during elbow extension in normal volunteers and in C6 tetraplegic patients lacking a functional triceps. Using surface electromyography (EMG) on normal volunteers and on patients with spinal cord injury (SCI) at the C6 motor level, we evaluated whether the anterior deltoid and biceps brachii muscles are active during closed chain elbow extension in a simulated weight shift position. Thirteen normal volunteers performed isometric contractions at 5 submaximal levels of force ranging from 4 ± 25 kg. Six SCI patients performed isometric contractions at force levels of 20%, 40%, 60%, 80% and 100% maximum voluntary contraction (MVC). Surface EMG over the right biceps, triceps, and anterior deltoid muscles was recorded for each participant and the root mean square (rms) electromyographic activity level for each muscle was determined at each level of force. Statistical analyses using repeated ANOVA with Tukey HSD post-hoc tests were performed for each level of force. The results indicated increasing rms activity of the triceps and anterior deltoid muscles with increasing force in normal volunteers to a signi®cant degree (P50.05). SCI patients showed signi®cant increasing activity of the anterior deltoid with increasing force, but showed minimal triceps rms activity. In both groups, the biceps showed minimal rms activity. SCI patients exhibited signi®cantly greater rms activity of the anterior deltoid at low force compared with normal volunteers. The results suggest that the anterior deltoid aids in isometric elbow extension during a simulated weight shift maneuver.
This study was designed to test the 1992 International Standards for Neurological and Functional ... more This study was designed to test the 1992 International Standards for Neurological and Functional Classi®cation of Spinal Cord Injury. One hundred and six professionals in the ®eld of spinal cord injury attending an instructional course at the 1994 ASIA Meeting participated in the test. Participants completed a pretest and posttest in which they classi®ed two patients who had a spinal cord injury (one with complete tetraplegia and one with incomplete paraplegia) by sensory and motor levels, zone of partial preservation (ZPP), ASIA Impairment Scale and completeness of injury. Between tests, three members of the ASIA Standards Executive Committee gave presentations on the neurological assessment, scoring, scaling and classi®cation of spinal cord injury and a video of the actual examinations of the two cases was viewed. Percent`correct' (as de®ned by the ASIA Standards Committee) was calculated for sensory and motor levels, ZPP, ASIA Impairment and completeness. Overall, the analyses showed that participants had very little diculty in correctly classifying the patient with complete tetraplegia. Pretests scores ranged from 72% (left motor level) to 96% (complete injury), posttest scores from 73% (left motor level) to 100% correct (complete injury). For the patient with incomplete paraplegia (Case 2), scores were considerably lower. Pretest scores ranged from 16% (right motor level) to 95% correct (incomplete injury); posttest scores from 21% (right motor level) to 97% correct (incomplete injury). The results showed that further revisions of the 1992 Standards and more training is needed to ensure accurate classi®cation of spinal cord injury.
Reflex modification procedures were used to test sensory processing in premature infants to exami... more Reflex modification procedures were used to test sensory processing in premature infants to examine the relationship between respiratory abnormalities and brainstem neuronal function. A total of 73 premature infants at risk for apnea and/or infants receiving methylxanthine therapy was given a 12-h pneumocardiogram and reflex modification test at a comparable postconceptional age, before discharge. Reflex modification was tested using a controlled eyeblink-eliciting tap to the glabella presented either alone or with a 1 kHz 90-dB SPL tone. The amplitude of the glabellar tap eyeblink and acoustically modified blink were lower in infants discharged on cardiac/apnea monitors (n = 36) than in the unmonitored group (1.44 and 1.59 volts versus 2.15 and 2.39 V, p< 0.005, respectively). At follow-up, 12 monitored infants had clinically significant apnea after discharge. The records of this subgroup of infants revealed a significantly lower augmentation of the glabellar eyeblink response when compared to all infants screened for respiratory abnormalities and to the other monitored babies (p < 0.01). The data suggest that abnormalities of the ventilatory pattern and occurrence of clinical apnea in preterm infants may in some measure be related to acoustic sensory processing, implying an alteration of brainstem neuronal function and organization. (Pediatr Res 26: 576-582,1989) Abbreviations SPL, sound pressure level (re: 0.0002 dynes/cm 2) ABR, auditory brainstem response M, monitored infants, n = 36 U, unmonitored infants, n = 37 Ap, infants monitored and with apnea following discharge, n = 12 sAp, infants screened and without apnea following discharge, n = 61 MsAp, infants monitored and without apnea following discharge, n = 24 HR, heart rate RM, reflex modification PNG, pneumocardiogram PB, periodic breathing A«D, apnea density LA, longest apnea TST, total sleep time REM, rapid eye movement
This paper focuses on the use of the four specific learner-centered teaching approaches: service-... more This paper focuses on the use of the four specific learner-centered teaching approaches: service-learning, learning through discussion, team-based learning, and a structured research course sequence in an occupational therapy curriculum. These methods are used to develop the four curriculum themes of engagement, critical thinking, innovations in practice, and clinical reasoning. The outcome of these approaches has been that students have taken more responsibility for their learning and shown increased maturity while promoting faculty creativity. Additionally, students have developed skills and interests in social and community engagement, and have sought jobs in community-based practice areas.
This paper focuses on the use of the four specific learner-centered teaching approaches: service-... more This paper focuses on the use of the four specific learner-centered teaching approaches: service-learning, learning through discussion, team-based learning, and a structured research course sequence in an occupational therapy curriculum. These methods are used to develop the four curriculum themes of engagement, critical thinking, innovations in practice, and clinical reasoning. The outcome of these approaches has been that students have taken more responsibility for their learning and shown increased maturity while promoting faculty creativity. Additionally, students have developed skills and interests in social and community engagement, and have sought jobs in community-based practice areas.
A randomized controlled trial investigated the effect of client-centered Occupational Therapy on ... more A randomized controlled trial investigated the effect of client-centered Occupational Therapy on individuals with spinal cord injuries (SCI). Twenty-one subjects, 4 to 6 months post acute rehabilitation, received eight in-home, client-centered Occupational Therapy sessions or eight visits from social visitors. The Functional Independence Measure (FIM), the Craig Handicap Reporting and Assessment Technique (CHART), the Role Checklist and the Life Satisfaction Inventory-A (LSIA) were administered pre and post interventions. Analyses showed no differences between groups on the CHART and the FIM; the Role Checklist showed the Occupational Therapy group took on a limited number of new life roles; however, a statistically significant difference was found between groups post intervention for LSIA (p &amp;amp;amp;amp;amp;amp;lt; 0.05).
Archives of Physical Medicine and Rehabilitation, Nov 1, 1992
... over time. Sequential motor strength examinations using both modalities were performed at 72 ... more ... over time. Sequential motor strength examinations using both modalities were performed at 72 hours, one week, and two weeks post SCI and then one, two, three,four, six, 12, 18, and 24 months post injury. The data analyses ...
Archives of Physical Medicine and Rehabilitation, Jan 5, 1995
Steindler defined a closed kinetic chain as one in which the terminal part of the extremity meets... more Steindler defined a closed kinetic chain as one in which the terminal part of the extremity meets with resistance which restrains its free motion, as in pushing a cart.' We have observed that quadriplegic patients with loss of voluntary muscle activity of the triceps from a cervical spinal cord injury at the C-5 and C-6 levels retain the ability to extend the elbow in a closed kinetic chain system despite a complete lack of triceps activity. Muscles act not only as isolated elements, but also as a part ofan integrated functioning ~y s t e m .~ This is analogous to the use of the gluteus maximus to extend the knee in patients who ambulate with all above-theknee prostheses.' The purpose of this study was to determine if the anterior deltoid and upper pectoral muscles were active in voluntary kinetic closed chain elbow extension. METHODS Ten normal adult male subjects (age range 22-30 years) performed a graded isometric bench press exercise while the shoulder girdle muscles were studied electromyographically. A bipolar bar electrode with 10-mm discs at a 30-mm interelectrode distance, 750-mm leads, and 2-mm plug was used for signal detection (TECA, Pleasantville, NY). A
This study was designed to compare changes in strength after spinal cord injury (SCI) with the us... more This study was designed to compare changes in strength after spinal cord injury (SCI) with the use of a hand held myometer to the manual muscle test (MMT). Eighty-eight C4-C8 Frankel AD tetraplegic subjects were tested at various times up to 2 years post-SCI. Elbow flexor strength on successive examinations were grouped according to their early and later MMT scores (3.5 with no change in MMT, 3.5 to 4.0, and 3.5 to 4.5; 4.0 with no change in MMT, 4.0 to 4.5, and 4.0 to 5.0; 4.5 with no change in MMT, and 4.5 to 5.0). For each group, later myometric measurements (MYO) were expressed as percents of their earlier MYO and were anlayzed using paired Students t-tests. Later MYO were 116, 205, 232% (P>0.05, P<0.002, P<0.05) of their earlier MYO for groups 3.5 with no change in the MMT, 3.5 to 4.0, and 3.5 to 4.5 respectively. Later MYO were 140, 139, 191 % (P<0.05, P<0.02, P<O.OOOl) of their earlier MYO for groups 4.0 with no change in MMT, 4.0 to 4.5, and 4.0 to 5.0 respectively. Later MYO were 127 and 126% (P<O.OI, P<0.02) of their earlier MYO for groups 4.5 with no change in MMT and 4.5 to 5.0 respectively. In conclusion the hand held myometer detected changes in muscle strength not detected by the MMT.
The Journal of neuropsychiatry and clinical neurosciences, 1989
The authors investigated habituation of the eye-blink component of the startle reflex to repeated... more The authors investigated habituation of the eye-blink component of the startle reflex to repeated affectively neutral tactile and auditory stimuli in nine subjects with posttraumatic stress disorder and nine controls. Each group showed rapid habituation in both tactile and auditory modalities.
The encoding processes of recognition and recall for line-drawn faces were investigated. Subjects... more The encoding processes of recognition and recall for line-drawn faces were investigated. Subjects randomly received three-alternative forced-choice tests of recognition and probe recall of 20 male faces. Between each inspection and test, subjects performed an interference task for 10 sec. The interference tasks consisted of either identifying the missing facial feature in line drawings or in photographs, or correctly identifying the misspelled words describing different facial features. The results indicate that recognition performance was higher than proberecall performance for all groups. The analysis of the recognition data suggests that recognition ability decreased as the similarity of the interference task to the target increased. This finding suggests that faces are encoded using visual rather than verbal imagery.
The anterior deltoid muscle has been found to be active during elbow extension in normal voluntee... more The anterior deltoid muscle has been found to be active during elbow extension in normal volunteers and in C6 tetraplegic patients lacking a functional triceps. Using surface electromyography (EMG) on normal volunteers and on patients with spinal cord injury (SCI) at the C6 motor level, we evaluated whether the anterior deltoid and biceps brachii muscles are active during closed chain elbow extension in a simulated weight shift position. Thirteen normal volunteers performed isometric contractions at 5 submaximal levels of force ranging from 4 ± 25 kg. Six SCI patients performed isometric contractions at force levels of 20%, 40%, 60%, 80% and 100% maximum voluntary contraction (MVC). Surface EMG over the right biceps, triceps, and anterior deltoid muscles was recorded for each participant and the root mean square (rms) electromyographic activity level for each muscle was determined at each level of force. Statistical analyses using repeated ANOVA with Tukey HSD post-hoc tests were performed for each level of force. The results indicated increasing rms activity of the triceps and anterior deltoid muscles with increasing force in normal volunteers to a signi®cant degree (P50.05). SCI patients showed signi®cant increasing activity of the anterior deltoid with increasing force, but showed minimal triceps rms activity. In both groups, the biceps showed minimal rms activity. SCI patients exhibited signi®cantly greater rms activity of the anterior deltoid at low force compared with normal volunteers. The results suggest that the anterior deltoid aids in isometric elbow extension during a simulated weight shift maneuver.
This study was designed to test the 1992 International Standards for Neurological and Functional ... more This study was designed to test the 1992 International Standards for Neurological and Functional Classi®cation of Spinal Cord Injury. One hundred and six professionals in the ®eld of spinal cord injury attending an instructional course at the 1994 ASIA Meeting participated in the test. Participants completed a pretest and posttest in which they classi®ed two patients who had a spinal cord injury (one with complete tetraplegia and one with incomplete paraplegia) by sensory and motor levels, zone of partial preservation (ZPP), ASIA Impairment Scale and completeness of injury. Between tests, three members of the ASIA Standards Executive Committee gave presentations on the neurological assessment, scoring, scaling and classi®cation of spinal cord injury and a video of the actual examinations of the two cases was viewed. Percent`correct' (as de®ned by the ASIA Standards Committee) was calculated for sensory and motor levels, ZPP, ASIA Impairment and completeness. Overall, the analyses showed that participants had very little diculty in correctly classifying the patient with complete tetraplegia. Pretests scores ranged from 72% (left motor level) to 96% (complete injury), posttest scores from 73% (left motor level) to 100% correct (complete injury). For the patient with incomplete paraplegia (Case 2), scores were considerably lower. Pretest scores ranged from 16% (right motor level) to 95% correct (incomplete injury); posttest scores from 21% (right motor level) to 97% correct (incomplete injury). The results showed that further revisions of the 1992 Standards and more training is needed to ensure accurate classi®cation of spinal cord injury.
Reflex modification procedures were used to test sensory processing in premature infants to exami... more Reflex modification procedures were used to test sensory processing in premature infants to examine the relationship between respiratory abnormalities and brainstem neuronal function. A total of 73 premature infants at risk for apnea and/or infants receiving methylxanthine therapy was given a 12-h pneumocardiogram and reflex modification test at a comparable postconceptional age, before discharge. Reflex modification was tested using a controlled eyeblink-eliciting tap to the glabella presented either alone or with a 1 kHz 90-dB SPL tone. The amplitude of the glabellar tap eyeblink and acoustically modified blink were lower in infants discharged on cardiac/apnea monitors (n = 36) than in the unmonitored group (1.44 and 1.59 volts versus 2.15 and 2.39 V, p< 0.005, respectively). At follow-up, 12 monitored infants had clinically significant apnea after discharge. The records of this subgroup of infants revealed a significantly lower augmentation of the glabellar eyeblink response when compared to all infants screened for respiratory abnormalities and to the other monitored babies (p < 0.01). The data suggest that abnormalities of the ventilatory pattern and occurrence of clinical apnea in preterm infants may in some measure be related to acoustic sensory processing, implying an alteration of brainstem neuronal function and organization. (Pediatr Res 26: 576-582,1989) Abbreviations SPL, sound pressure level (re: 0.0002 dynes/cm 2) ABR, auditory brainstem response M, monitored infants, n = 36 U, unmonitored infants, n = 37 Ap, infants monitored and with apnea following discharge, n = 12 sAp, infants screened and without apnea following discharge, n = 61 MsAp, infants monitored and without apnea following discharge, n = 24 HR, heart rate RM, reflex modification PNG, pneumocardiogram PB, periodic breathing A«D, apnea density LA, longest apnea TST, total sleep time REM, rapid eye movement
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