The investment of time and self to develop therapeutic relationships with clients appears incongruent with today's time-constrained health care system, yet bridging the gap of these incongruencies is the challenge therapists face to provide high-quality, client-centered, occupation-based treatment. This case report illustrates a shift in approach from biomechanical to occupational adaptation (OA) in an orthopedic outpatient clinic. The progress of a client with lupus-related arthritis who was 6 days postsurgery is documented. The intervention initially used a biomechanical frame of reference, but when little progress had been made at 10 weeks after surgery, a shift was made to the more client-centered OA approach. The Canadian Occupational Performance Measure was administered, and an OA approach was initiated. On reassessment, clinically important improvements were documented in all functional tasks addressed. An OA approach provides the bridge between the application of clinical expertise, client-centered, occupation-based therapy and the time constraints placed by payer sources.
We studied auditory evoked responses to the apparent movement of a burst of noise in the horizontal plane. Event-related potentials (ERPs) were measured in three groups of participants: children in the age range from 9 to 12 years, young adults in the age range from 18 to 34 years, and seniors in the age range from 65 to 80 years. The topographic distribution of grand-averaged ERP activity was substantially greater over the right hemisphere in children and seniors but slightly greater over the left hemisphere in young adults. This finding may be related to age-related differences in the extent to which judgments of sound movement are based on displacement versus velocity information.
We examined hemispheric activation patterns during auditory and visual processing in two groups of children: 13 boys in the age range from 9 to 12 years rated by their parents and teachers as poor listeners and 11 boys in the same age range rated as normal listeners. Three tasks were employed: auditory gap detection, detection of auditory movement, and a control task involving visuospatial discrimination. Electrical activity was recorded from 30 scalp electrodes as participants responded to target stimuli in an event-related potential paradigm. In the visual task, hemispheric activation was relatively symmetric around the midsagittal plane in both groups. In the two auditory tasks, however, hemispheric activation patterns differed significantly between groups. In the normal-listener group, activation was asymmetric to the right hemisphere. In the poor-listener group, however, activation tended toward asymmetry, favoring the left hemisphere. These results suggest that abnormalities in hemispheric lateralization of function may underlie the auditory processing problems of at least some children described as poor listeners.
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