The model of occupational functioning leads the author to conceptualize occupation both as treatment end goal and as means to remediate impairments. In both dimensions, meaningfulness and purposefulness are key therapeutic qualities. Purposefulness is hypothesized to organize behavior and meaningfulness to motivate performance. These aspects of occupation need explication through research. Some questions that need to be answered include the following: How does purposefulness of occupation-as-end organize a person's life? Does purposefulness of occupation-as-means organize particular behavioral responses? What effect does meaningfulness of occupation-as-end have on achievement of role performance? Does meaningfulness of occupation-as-means motivate perseverance and effort during therapy?

Goal-directed reach enabled persons with stroke to display characteristics typical of reach to a target by persons who have not had a stroke better than reaching out in space. These findings support the occupational therapy practice of using objects in a functional context to improve coordinated movement. However, the nature of the objects to be used requires further study.

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One clinical implication is that internally focused instructions can contribute to slower and less forceful reach in adults with and without CVA. This research reinforces the need for therapists to consider their use of instruction during the evaluation and treatment of movement disorders.

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