Biomedical subjects

M E Neistadt

Publications and source records attributed to M E Neistadt.

At least 19 recordsLinked to original sources

PubMed1998

Clinical reasoning case studies as teaching tools.

OBJECTIVE: Students are taught how to apply clinical reasoning methods through a variety of teaching methods, including the use of case studies. Various types of case studies have been described in the literature: paper cases, videotape cases, simulated client cases, and real client cases. This study examined the effectiveness of a new type of paper case study--the clinical reasoning case study--in teaching the clinical reasoning process to occupational therapy students. METHOD: Four seniors in an undergraduate occupational therapy program completed intervention plans in response to both traditional medical model and clinical reasoning paper case studies. Qualitative methods were used to analyze intervention plans and videotaped discussion about this learning experience. RESULTS: Themes discovered in the data sources suggest that compared with traditional case studies, the clinical reasoning case studies increased the quality of participants' intervention plans, participants' confidence levels about their plans, and participants' understanding of the clinical reasoning process. Participants also reported preferring clinical reasoning case studies over traditional paper case studies. CONCLUSION: The clinical reasoning case studies are effective teaching tools because they provide students with a holistic picture of the client and his or her occupational therapy treatment. In addition, these case studies model the clinical reasoning process by organizing client information according to the types of clinical reasoning that would be used to gather that information. Occupational therapy educators may find this type of paper case study useful in introducing students to the intervention planning process.

Female↗

PubMed1998

Teaching clinical reasoning as a thinking frame.

OBJECTIVE: Clinical reasoning concepts can be viewed as descriptions of mental operations or as a thinking frame--a structure to organize and support clinical thinking. This study examined an approach for teaching clinical reasoning as a thinking frame to occupational therapy students. METHOD: A quasi-experimental, pretest-posttest design was used with a convenience sample of 10 undergraduate occupational therapy seniors. All participants (a) acquired the thinking frame of clinical reasoning concepts through explicit instruction and (b) practiced that thinking frame with an external aid--the Clinical Reasoning Case Study Format. The accuracy of participants' definitions of clinical reasoning concepts before and after this learning experience were examined to assess their acquisition of the thinking frame. The content of clinical reasoning case studies were examined to assess students' application of the thinking frame to clinical situations. RESULTS: Wilcoxon signed rank tests done on presemester and postsemester definitions ratings indicated that the latter were rated significantly higher than the former for (a) narrative reasoning (p = .008), (b) procedural reasoning (p = .005), (c) interactive reasoning (p = .006), (d) pragmatic reasoning (p = .008), and (e) conditional reasoning (p = .01). The content of participants' clinical reasoning case studies indicated that they were able to apply clinical reasoning concepts. CONCLUSION: The results suggest that using a clinical reasoning thinking frame to organize clinical observations is an effective way to help entry-level occupational therapy students learn and apply clinical reasoning concepts.

Adult↗

PubMed1997

Teaching diagnostic reasoning: using a classroom-as-clinic methodology with videotapes.

OBJECTIVES: The purpose of this study was to examine the effect of a "classroom-as-clinic" format, using videotaped occupational therapy evaluations, on students' diagnostic reasoning skills. In the classroom-as-clinic format, students write a problem list on the basis of preliminary client information before viewing the videotape. METHOD: A post-hoc experimental design was used to compare the accuracy of treatment plan problem lists for two groups of senior occupational therapy students--one group viewed two videotapes of client-therapist interactions without a classroom-as-clinic format (n = 82), and one group viewed the same videotapes within the context of a classroom-as-clinic format (n = 45). Both groups viewed the same two videotapes. Videotape 1 was of a client with a brain stem infarct, and Videotape 2 was of a client with traumatic brain injury. RESULTS: Subjects experiencing a classroom-as-clinic format identified significantly more occupational therapy problems for Videotape 1 than those who did not have preevaluation information. There was no significant difference between the two subject groups in the accuracy of their problem lists for Videotape 2. Only subjects in the non-classroom-as-clinic group showed a significant improvement from Videotape 1 to Videotape 2 in occupational therapy problem identification. CONCLUSION: This study suggests that to be truly effective when used videotapes, the classroom-as-clinic methodology needs to be combined with explicit coaching in problem sensing and problem definition.

Adult↗

PubMed1996

Analysis of the orthopedic content in an occupational therapy curriculum from a clinical reasoning perspective.

OBJECTIVES: Recent studies have suggested that occupational therapists working with adults with physical disabilities do not use narrative reasoning in practice as much as they use procedural reasoning. This focus on procedural reasoning may be partially shaped by the occupational therapy educational process. The purpose of this analysis was to see whether one accredited occupational therapy curriculum was promoting narrative reasoning relative to its information on adult orthopedics. METHOD: An accredited occupational therapy undergraduate and certificate curriculum was analyzed from both student and faculty perspectives to see what types of clinical reasoning were most emphasized relative to treatment of adults with orthopedic injuries. The student analysis, done by a senior as part of an independent study, looked at the clinical reasoning content of journal articles, an occupational therapy textbook, and occupational therapy lectures relative to adult orthopedic injuries. The faculty analysis, part of a curriculum revision process and independent of the student analysis, looked at the clinical reasoning content of all courses in the curriculum. RESULTS: The student and faculty analyses concurred that although narrative reasoning is taught in this curriculum, narrative reasoning concepts are not well integrated into the adult physical dysfunction course that deals with adult orthopedic injuries. CONCLUSION: Occupational therapy educators may not be integrating narrative reasoning into more procedurally oriented physical dysfunction courses as fully as possible and may, therefore, be fostering procedurally oriented practice in physical dysfunction settings. Curricula evaluations, like the one described in this article, can be a mechanism for examining the types of clinical reasoning emphasized in a given curriculum for a given diagnostic group.

Adult↗

PubMed1996

Teaching strategies for the development of clinical reasoning.

A primary aim of occupational therapy education is to teach students how to think like practitioners, that is, how to engage in clinical reasoning. Since the early 1980s, occupational therapy clinical reasoning research has elucidated a language that describes the various types of thinking therapists use in clinical practice, a language that has the potential to make previously tacit thought processes accessible to conscious examination and improvement. Occupational therapy educators can use that language to make their teaching of clinical reasoning more explicit to students. This article examines occupational therapy teaching methods using the language of clinical reasoning, categorizing them by the types of clinical reasoning they promote. Current clinical reasoning language is reviewed, and teaching strategies to facilitate the various types of clinical reasoning are described.

Decision Making↗

PubMed1995

Methods of assessing clients' priorities: a survey of adult physical dysfunction settings.

OBJECTIVES: Recent clinical reasoning literature has identified a collaborative model of treatment--one that responds to clients' perceptions of their illness and disability experiences--as central to occupational therapy practice. Assessing clients' priorities on admission is essential to that model. METHOD: Surveys from of a convenience sample of 269 occupational therapy directors in adult physical rehabilitation facilities throughout the United States (70.2% response rate) were analyzed to see whether occupational therapists in those settings are assessing clients' priorities on admission, and if so, how. RESULTS: The majority of occupational therapists are using informal interview to determine clients' priorities on admission. Client goals obtained from these interviews are vague and do not specify meaningful occupations; this finding suggests that therapists are setting treatment goals without specific input from clients about their valued activities. CONCLUSION: Occupational therapists have not yet successfully translated their values about client-therapist collaboration into a formal set of procedures for practice.

Adolescent↗

PubMed1995

Treatment activity preferences of occupational therapists in adult physical dysfunction settings.

OBJECTIVES: Research has suggested that using an adaptive approach to provide direct training in occupational behaviors is more effective than using a remedial approach to retrain component skills. This survey was done to see whether occupational therapy practice in physical dysfunction reflects that research. METHOD: Surveys from a convenience sample of 269 (70.2% response rate) occupational therapy directors in adult physical rehabilitation facilities throughout the United States were analyzed to determine the relative rankings of remedial and adaptive activities by therapists in those settings. RESULTS: For all facilities combined, the four most frequently used types of activities, in order of frequency, were self-care, upper extremity exercise, functional mobility, and neuromuscular training. Facilities using multiple formal methods to assess client priorities used functional activities more frequently than other facilities. CONCLUSION: Occupational therapists in adult physical dysfunction settings are not routinely providing client training in the full spectrum of occupational behaviors.

Activities of Daily Living↗

PubMed1994

Using research literature to develop a perceptual retraining treatment protocol.

OBJECTIVES: Treatment protocols derived from research literature can help therapists provide more rigorous treatment and more systematic assessment of client progress. METHOD: This study applied research findings about the influence of task, subject, and feedback parameters on adult performance with block designs to an occupational therapy treatment protocol for parquetry block assembly--an activity occupational therapists use to remediate constructional deficits. Task parameter research suggests that parquetry tasks can be graded according to the features of the design cards, with cards having all block boundaries drawn in being easier than those with some block boundaries omitted. RESULTS: Subject parameter findings suggest that clients' lesions and initial constructional competence can influence their approaches to parquetry tasks. CONCLUSION: Feedback parameter research suggests that a combination of perceptual and planning cues is most effective for parquetry tasks. Methods to help clients transfer constructional skills from parquetry to functional tasks are also discussed.

Adult↗

PubMed1994

The effects of different treatment activities on functional fine motor coordination in adults with brain injury.

OBJECTIVES: Occupational therapists frequently work to improve the fine motor coordination skills of adults who have dexterity deficits secondary to brain injury. Most therapists use a combination of tabletop and functional activities to foster improved coordination in these clients. This study examined the effects of puzzle construction and kitchen activities on fine motor coordination in a group of 45 men with brain injury, as measured by pretest and posttest performance on two subtests of the Jebsen-Taylor Test of Hand Function. METHOD: Subjects were randomly assigned to either a parquetry block assembly group (n = 22) or a meal preparation group (n = 23). RESULTS: Subjects in the functional meal preparation group showed significantly greater improvement in dominant-band dexterity for picking up small objects than subjects in the tabletop puzzle activity group. Other coordination test results were comparable for the two treatment groups. CONCLUSION: These findings suggest that functional activities may be better than tabletop activities for fine motor coordination training with this population.

Adolescent↗

PubMed1994

Perceptual retraining for adults with diffuse brain injury.

Occupational therapy for adults with perceptual dysfunction secondary to diffuse acquired brain injury from trauma or anoxia often includes remedial retraining with treatment tasks, like construction of puzzles, to provide clients with practice in deficit perceptual skills. Therapists using this approach assume that adults with brain injury learn specific perceptual skills from retraining exercises and can transfer those skills across all activities (including self-care and community living activities) that require those skills. This review of outcome studies about remedial perceptual retraining for adults with diffuse acquired brain injury suggests that those learning assumptions hold true only for clients with localized lesions and preserved abstract reasoning who have been explicitly taught to transfer learning across a variety of treatment activities. Recommendations about ways to assess clients' learning potential and appropriateness for remedial retraining include keeping track of the number of repetitions clients need to relearn functional tasks and systematically varying functional tasks during training to see how easily clients can transfer learning across variations of the same task.

Adult↗

PubMed1994

The neurobiology of learning: implications for treatment of adults with brain injury.

The effectiveness of occupational therapy interventions for adults with brain injury is largely dependent on how well clients are able to learn the new strategies, techniques, and information therapists are trying to teach them. Neuroscience research in the past two decades has provided some intriguing hints about the neurological processes that may underlie that learning. Understanding this research might stimulate new occupational therapy ideas about more effective ways to facilitate recovery and learning in adults with brain injury. This review presents an overview of the physical, biochemical, and electrical changes in nerve cells that have been found to accompany learning in adults with and without brain injury. Recommendations for treatment derived from the review include teaching to clients' levels of learning and information-processing strengths.

Animals↗

PubMed1994

A meal preparation treatment protocol for adults with brain injury.

Adults with acquired brain injury often demonstrate dysfunction in meal preparation due to deficits in component cognitive-perceptual skills. Although occupational therapy for these clients routinely includes meal preparation training, there are no protocols in the occupational therapy literature to help structure that activity to address clients' cognitive-perceptual deficits. This paper describes a meal preparation treatment protocol based on cognitive-perceptual information processing theory that has been pilot tested in a treatment outcome study with adult men with traumatic or anoxic acquired brain injury. In that study, the group of 23 subjects treated with this meal preparation protocol showed significant improvement in their meal preparation skill, as measured by the Rabideau Kitchen Evaluation-Revised (RKE-R), a test of meal preparation skill, and in their cognitive-perceptual skill, as measured by the WAIS-R Block Design Test. The treatment protocol includes descriptions of the structure, grading, and cuing methods for light meal preparation activities.

Activities of Daily Living↗

PubMed1993

An analysis of a board game as a treatment activity.

Occupational therapists often use tabletop board games in treatment to help adult clients with physical disabilities improve the perceptual, cognitive, sensory, and fine motor skill components of occupational behavior. Detailed activity analyses of these types of activities, including performance norms, are not available in the occupational therapy literature. Such analyses would help therapists consider the multiple skill demands of tabletop games and allow more systematic grading of these treatment activities. This paper presents a model for analyzing therapeutic activities in relation to relevant motor learning and cognitive-perceptual literature. Included in this analysis are a description of the activity, examination of its component skills and of the qualitative features of activity performance, suggestions for grading and for treatment goals, and some preliminary performance standards derived from a pilot study of 18 adults without physical disabilities. The issue of transfer of skills between games and functional activities is also discussed.

Adult↗

PubMed1993

The relationship between constructional and meal preparation skills.

The purpose of this descriptive, correlational study was to explore the relationship between constructional abilities and meal preparation skills--a previously unstudied relationship. Fifty-four men with head injury, aged 18 to 52, in long-term rehabilitation programs, were given a battery of constructional, functional, and coordination tests: (1) the WAIS-R Block Design test; (2) a Parquetry Block test; (3) the Rabideau Kitchen Evaluation-Revised (RKE-R); and (4) two subtests of the Jebsen Hand Function Test. Results showed significant associations between constructional abilities and meal preparation skill. Pearson correlations were -0.51 (p = 0.0001) between WAIS-R Block Design test and RKE-R scores, and 0.50 (p = 0.0001) between Parquetry Block test and RKE-R scores. Partial correlations controlling for the effects of coordination also yielded significant correlations between WAIS-R Block Design test and RKE-R scores (r = -0.36, p = 0.05) and between Parquetry Block test and RKE-R scores (r = 0.39, p = 0.03). Constructional abilities, then, may contribute to meal preparation performance.

Activities of Daily Living↗

PubMed1992

Occupational therapy treatments for constructional deficits.

Occupational therapists use both adaptive and remedial approaches to perceptual retraining in adults with head injury. This experimental treatment outcome study compared the effects of adaptive and remedial treatments for constructional deficits on meal preparation competence and on constructional abilities in adult men with head injury. Forty-five subjects, 18 to 52 years of age, in long-term rehabilitation programs were randomly assigned to one of two treatment groups. A remedial group (n = 22) received individual training with parquetry block assembly, and an adaptive group (n = 23) received individual training in food preparation activities. Both groups received training for three 30-min sessions per week for 6 weeks, in addition to their regular rehabilitation programs. Results of analyses of variance and paired t tests on perceptual and functional test scores showed task-specific learning in both groups and suggested that training in functional activities may be the better way to improve performance in such activities in this population.

Adaptation, Physiological↗

PubMed1992

The classroom as clinic: applications for a method of teaching clinical reasoning.

This study examined the efficacy of one method for teaching diagnostic reasoning to occupational therapy students. During a clinical reasoning seminar in their first academic year, 80 entry-level occupational therapy master's degree students in three successive classes were given three different levels of exposure to classroom-as-clinic or in-class evaluations of adults with physical or psychosocial disabilities. During the following summer, most students completed their first Level II fieldwork experience. Students' grades for a second-year classroom-as-clinic experience with adults with physical disabilities were then compared across groups to determine the relative effect of the different seminar formats and fieldwork experiences. Students who had experienced in-class evaluations during their first academic year wrote significantly more accurate second-year evaluations than those who had not. Students who had completed psychosocial Level II fieldwork experiences were as accurate on their evaluations as students who had had physical dysfunction fieldwork experiences. The results suggest that in-class evaluations improve students' diagnostic reasoning skills.

Adult↗

PubMed1990

A critical analysis of occupational therapy approaches for perceptual deficits in adults with brain injury.

Research about occupational therapy interventions for adult perceptual deficits is needed to examine the relative efficacy of different treatments and to scrutinize the theoretical assumptions underlying those treatments. The former purpose relates to providing optimal services to consumers; the latter, to advancing the knowledge base of the profession. Both of these purposes can be achieved if research questions are derived from the assumptions underlying treatments. This paper delineates those assumptions and suggests some research questions and strategies with which to test them.

Brain Injuries↗

PubMed1990

Evaluating a Level I fieldwork model for independent living skills.

A model for Level I fieldwork in which students co-led independent living skills (ILS) groups in clinical settings and observed occupational therapy evaluation and treatment was implemented in a curriculum and evaluated for its effectiveness. The evaluation surveys from this study suggest that the model is most effective in courses and clinical settings that deal with adult and young adult client populations. All clinicians in these settings believed that the students provided a service to the clients by co-leading ILS groups, and nearly all believed that student-led groups would be valuable for their clients in the future. The students reported learning about group leadership skills and developing creative activity adaptations to meet different clients' needs. Faculty members want to continue using this model because they think it facilitates students' integration of clinical and classroom experiences.

Activities of Daily Living↗