Patient Case Formulations and Oppressive Disability Discourses in Occupational Therapy Education.

BACKGROUND.: Patient case formulations have become a standard feature in occupational therapy (OT) education. Despite their demonstrated benefits in optimizing student learning, patient case formulations may unintentionally convey oppressive disability discourses. PURPOSE.: The purpose of this paper is to illustrate and invite critical reflection on the use of patient case formulations in reinforcing ableist discourses and assumptions in OT education and practice. KEY ISSUES.: Through the lens of critical disability theory and Crip theory, the author demonstrates how patient case formulations are often reflective of institutionalized ableism that functions to support oppressive disability discourses in the profession, contributing to harmful healthcare practices. IMPLICATIONS.: The ongoing use of patient case formulations rooted in oppressive disability discourses perpetuates oppressive constructions of disabled people in OT education and practice. A radical shift towards pedagogical materials and practices that support identity-affirming disability discourses would be more aligned with the profession's expressed values.

Current Landscape of Teaching Diversity in Occupational Therapy Education: A Scoping Review.

IMPORTANCE: Critical research in health professions education makes clear the role of educational institutions in perpetuating problematic discourses related to diversity, as well as their potential role in dismantling and rebuilding those discourses to reflect the realities of power relations that create systemic injustice. OBJECTIVE: To provide a comprehensive overview of current pedagogical practices and educational paradigms used by occupational therapy educators to teach concepts of, and skills for, equity and diversity. DATA SOURCES: Seven education and health care databases were searched for articles published between 2007 and 2018. STUDY SELECTION AND DATA COLLECTION: Consensually developed criteria were refined until an agreement rate of >80% was achieved among the authors. Inclusion criteria focused on entry-level occupational therapy education across the world and explicitly examined approaches to teaching diversity. All articles meeting the criteria were kept for full-text review (N = 87). FINDINGS: Diversity in professional occupational therapy education programs is taught within five main underlying educational paradigms and theories: competency-based (44%), social justice (29%), critical (11%), social accountability (10%), and constructivism (6%). Within these paradigms, 14 key pedagogical practices were applied, with community service learning (37%), international service learning (25%), and didactic or course-based practices (23%) making up the majority of pedagogical practices. CONCLUSIONS AND RELEVANCE: Although current occupational therapy research demonstrates a trend toward critical paradigms and practices, problematic cultural competency theories and uncritical international service learning practices continue to dominate occupational therapy education for diversity. Educators should implement pedagogies and approaches within critical educational paradigms. WHAT THIS ARTICLE ADDS: This article highlights the importance to occupational therapy education of attending to coherence across educational ethics, paradigms, and learning outcomes in teaching for diversity and health equity.

The use of static progressive and serial static orthoses in the management of elbow contractures after complex fracture dislocation injuries: A pediatric case study.

INTRODUCTION: Contractures are the most common complication after traumatic injury to the elbow. Although evidence supporting the use of static progressive and serial static orthoses to help recover range of motion after these complex injuries is growing, there is currently a paucity of literature exploring its efficacy in pediatric populations. CASE DESCRIPTION: The following case study presents the results of the use of static progressive and serial static orthoses with a young patient who presented with both elbow extension and flexion contractures after a complex fracture dislocation injury. RESULTS: A noted and consistent improvement in both elbow extension and flexion can be observed after commencement of the static progressive and serial static orthoses. These results are consistent with the literature exploring the efficacy of these orthoses with adult populations with traumatic elbow injuries. DISCUSSION: Further studies evaluating the use of static progressive and serial static orthoses in the management of elbow contractures after traumatic injuries in pediatric populations is needed to establish best practices with this particular patient population.

The Use of Dynamic Assist Orthosis for Muscle Reeducation following Brachial Plexus Injury and Reconstruction.

Therapeutic management of brachial plexus injuries remains complex. The impact of brachial plexus injuries on everyday human functioning should not be underestimated. Early active-assisted range of motion following such injuries may prevent myostatic contractures, minimize muscle atrophy, facilitate muscle fiber recruitment, and enable a faster return to baseline strength levels. The dynamic assist elbow flexion orthosis proposed is designed to provide patients with a graded system for muscle reeducation and function. No clinical data are currently available on the use of this orthosis design; however, this article presents a treatment option based on sound clinical reasoning to facilitate rehabilitation following this devastating injury.

The effectiveness of orthoses in the conservative management of thumb CMC joint osteoarthritis: An analysis of functional pinch strength.

STUDY DESIGN: The study was a retrospective cohort analysis for a 19-month period from May 2013 to December 2014. INTRODUCTION: Although the use of orthoses has long been a staple of conservative treatment measures for individuals with osteoarthritis of the thumb carpometacarpal (CMC) joint, there remains little evidence exploring its effectiveness in improving functional outcomes for this client population. PURPOSE OF THE STUDY: The purpose of this study was to assess the effectiveness of 3 frequently used orthoses in improving the functional pinch strength of adults with a diagnosis of thumb CMC joint osteoarthritis. METHODS: A retrospective cohort analysis was conducted to determine whether pinch strength improved after orthotic fabrication, and fitting in patients referred to a hand therapy clinic. RESULTS: Patients who received a Colditz design orthosis had a mean increase of 2.64 lb with regard to functional pinch strength after orthotic fabrication and fitting. Patients who received a Comfort Cool orthosis (North Coast Medical, Morgan Hill, CA) had a mean increase of 2.47 lb, whereas patients who received a Thumb Spica orthosis had a mean increase of 3.25 lb. There was no evidence of any statistically significant difference in the average improvements in pinch strength between the Colditz design orthosis and the Comfort Cool orthosis. CONCLUSIONS: Results from this study demonstrate that orthosis wear consistently increases the functional pinch strength of individuals with thumb CMC joint osteoarthritis. Large-scale multisite research studies comparing various orthotic designs are necessary to help therapists determine best practice interventions for the conservative management of thumb CMC joint osteoarthritis. LEVEL OF EVIDENCE: 2(c).

Facilitators and Barriers to Learning in Occupational Therapy Fieldwork Education: Student Perspectives.

PURPOSE: The purpose of this study was to gain a comprehensive understanding of the facilitators of and barriers to learning within occupational therapy fieldwork education from the perspective of both Canadian and American students. METHOD: A qualitative study using an online open survey format was conducted to gather data from 29 occupational therapy students regarding their fieldwork experiences. An inductive grounded theory approach to content analysis was used. RESULTS: Individual, environmental, educational, and institutional facilitators of and barriers to learning within occupational therapy fieldwork education were identified. CONCLUSION: This study's findings suggest that learning within fieldwork education is a highly individual and dynamic process that is influenced by numerous factors. The new information generated by this study has the potential to positively affect the future design and implementation of fieldwork education.

Rehabilitation following thumb CMC, radiocarpal, and DRUJ arthroplasty.

Hand therapy is essential after arthroplasty around the wrist. This article includes therapy guidelines and goals after surgical reconstruction of the thumb carpometacarpal joint, radiocarpal joint, and distal radioulnar joint. Typical concerns and treatment options are addressed. Tables and figures are included to guide the hand therapist in the process of returning this patient population to pain-free function.

Static progressive orthosis for patients with limited radial and/or ulnar deviation: an innovative orthotic design.

After injury to the wrist and forearm, therapists and patients frequently work to regain the motions of wrist flexion/extension and forearm pronation/supination. Although these motions play a vital role in everyday functioning, for some, limitations in wrist radial/ulnar deviation can also present functional challenges. These authors describe the creation and utilization of a static progressive orthosis to assist a patient in regaining wrist radioulnar deviation