Gitlin L N, Burgh D
Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Am J Occup Ther. 1995 Nov-Dec;49(10):994-1000. doi: 10.5014/ajot.49.10.994.
Occupational therapists play a critical role in determining which assistive devices are provided to older adults and when and how instruction occurs during rehabilitation. This exploratory qualitative study used focus group methodology and Fleming's concept of the therapist with a three-track mind to examine how occupational therapists describe the process of issuing assistive devices to elderly persons in rehabilitation. We identified six interrelated steps involved in issuing an assistive device to an older person with a cerebrovascular accident. These steps were the selection of a device, an activity, a site for instruction, a method of instruction, the time to introduce a device during hospitalization, and reinforcement of its use. Therapists used procedural, interactive, and conditional reasoning to make decisions within each step and individualize device training. The findings from this study underscore the complex series of decisions and skilled clinical judgments involved in issuing assistive devices to older persons. Additionally, the study shows that focus group methodology is a valuable approach by which to identify how therapists reason about specific therapeutic practices.
职业治疗师在确定向老年人提供哪些辅助设备以及在康复过程中何时以及如何进行指导方面发挥着关键作用。这项探索性定性研究采用焦点小组方法和弗莱明提出的具有三轨思维的治疗师概念，来研究职业治疗师如何描述在康复过程中向老年人发放辅助设备的过程。我们确定了向脑血管意外的老年人发放辅助设备涉及的六个相互关联的步骤。这些步骤包括设备的选择、一项活动、指导地点、指导方法、住院期间引入设备的时间以及对其使用的强化。治疗师在每个步骤中运用程序推理、互动推理和条件推理来做出决策并对设备训练进行个性化。这项研究的结果强调了向老年人发放辅助设备所涉及的一系列复杂决策和熟练的临床判断。此外，该研究表明焦点小组方法是一种有价值的方法，可用于确定治疗师如何对特定治疗实践进行推理。
