Julie McLaughlin Gray PhD, OTR/L, FAOTA (she/her/hers)

As the U.S. population shifts away from a White majority, it is imperative that the health care workforce reflect the diversity of client populations served. Increased diversity in the health care workforce fosters access to more personalized, culturally responsive, and client-centered care, thereby facilitating improved outcomes and reduced health disparities. Occupational therapy education programs function as gatekeepers for diversity and need to be accountable for representation in the profession and to produce graduates who reflect the diversity of the broader population. Holistic admission practices, which ensure that no single factor excludes an applicant from admission, are recognized as a meaningful strategy for increasing student diversity in higher education and provide a pathway to create a representative workforce with the ability to improve care disparities and client outcomes. As one of the largest occupational therapy programs in the country, and located in a diverse urban area, the University of Southern California’s Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy has embraced the profession’s responsibility toward greater health equity through holistic admissions. In this column, we discuss holistic admission best practices and report diversity outcomes resulting from enactment of these practices within our occupational therapy education program.

Occupational balance is a central concept in occupational science, but it is complex and lacks an agreed-upon definition. Further, the concept has not been given significant attention by scholars outside Western societies. Building upon traditional Chinese culture and Chinese scholars’ Human Complex System Theory, this article presents a proposed Model of Occupational Harmony, offering an Eastern understanding of how the orchestration of everyday occupations relates to health and well-being. The notion of occupational harmony highlights harmonious human-environment transactions as the essence of the phenomenon and integrates multiple perspectives in previous occupational balance literature, including activity patterns, time use, occupational characteristics, need satisfaction, and biological rhythms. It is asserted that occupational harmony can be characterized as complex equilibria among three pairs of two-sided occupational characteristics and achieved via harmony among five dimensions of occupational engagement and coherence across multiple levels of human-environment transactions. This article is a beginning theoretical conceptualization of occupational harmony, allowing occupational scientists to embrace the complexity of the orchestration of occupational engagement.

Keywords. Occupational science, Occupational balance, Culture, Occupational engagement, Systems theory

Clinical Reasoning: Forms of Inquiry in a Therapeutic Practice presents the findings of a multiyear qualitative study of the clinical reasoning of occupational therapists through ethnographic and action research methods. The clinical reasoning of 14 therapists in a large teaching hospital was examined by a team of researchers, including several of the therapists themselves, through participant observation, review of videos, and extensive interviews with the therapists and some patients. Findings revealed three different types of clinical reasoning, procedural, interactive, and conditional, which expert therapists combined in what authors named a three-track mind. Due to the profession’s core values and commitment to treating the whole person and, especially, the phenomenological or lived experience of illness or disability, many occupational therapists experienced tensions between expectations of the institution’s focus on the medical model and their professional commitment to treating the personal and complex experiences associated with navigating disability and illness in everyday life.

Keywords. clinical reasoning, three-track mind, novice versus expert, underground practice, phenomenology, occupational therapy

The COVID-19 pandemic emerged in early 2020, as did calls to bring an occupational perspective to an evolving situation. However, the role of occupation-focused education in facilitating responses to the global crisis was missing from this dialogue. This paper aims to address that gap by describing the development of a new course delivered at the University of Southern California in 2020 and 2021. Grounded in occupational science, this special topics course aimed to meet various teaching and learning needs for the post-professional occupational therapy doctorate program. This paper describes how the focus, format, and content of the course developed through a backward design approach to address topics related to the COVID-19 pandemic and intersecting, ongoing crises of structural racism and health and social inequalities. The primary course assignment, a knowledge mobilization product, provided students novel opportunities to leverage their occupational perspectives in response to emergent issues. The paper concludes by addressing three interrelated topics: the importance of institutional mechanisms that facilitate responsive educational innovations; the need to track the teaching and learning impacts of such innovations; and how such innovations reflect the importance of occupational science education.

Keywords. Occupational science; Backward design; Knowledge mobilization; Professional education; Occupational therapy

Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.

This study explored office workers' perspectives on including artificial intelligence (AI) in their office workspace. Following an iterative analysis of six focus-group interviews with a total of 45 participants, three constructs emerged. Rich discussions demonstrated how acceptability of an AI workstation is complex and affected by the person, context, and their occupations.

Workplace environments have a significant impact on worker performance, health, and well-being. With machine learning capabilities, artificial intelligence (AI) can be developed to automate individualized adjustments to work environments (e.g., lighting, temperature) and to facilitate healthier worker behaviors (e.g., posture). Worker perspectives on incorporating AI into office workspaces are largely unexplored. Thus, the purpose of this study was to explore office workers’ views on including AI in their office workspace. Six focus group interviews with a total of 45 participants were conducted. Interview questions were designed to generate discussion on benefits, challenges, and pragmatic considerations for incorporating AI into office settings. Sessions were audio-recorded, transcribed, and analyzed using an iterative approach. Two primary constructs emerged. First, participants shared perspectives related to preferences and concerns regarding communication and interactions with the technology. Second, numerous conversations highlighted the dualistic nature of a system that collects large amounts of data; that is, the potential benefits for behavior change to improve health and the pitfalls of trust and privacy. Across both constructs, there was an overarching discussion related to the intersections of AI with the complexity of work performance. Numerous thoughts were shared relative to future AI solutions that could enhance the office workplace. This study’s findings indicate that the acceptability of AI in the workplace is complex and dependent upon the benefits outweighing the potential detriments. Office worker needs are complex and diverse, and AI systems should aim to accommodate individual needs.

Keywords. workspace; office work; computer workstations; artificial intelligence

Musculoskeletal sonography is rapidly extending beyond radiology; however, best practices for successful integration into new practice contexts are unknown. This study explored non-physician experiences with the processes of training and integration of musculoskeletal sonography into rehabilitation. Qualitative data were captured through multiple sources, and iterative thematic analysis was used to describe two occupational therapists' experiences. The dominant emerging theme was competency, in three domains: technical, procedural, and analytical. In addition, three practice considerations were illuminated: (a) understanding imaging within the dynamics of rehabilitation, (b) navigating nuances of interprofessional care, and (c) implications for post-professional training. Findings indicate that sonography training for rehabilitation providers requires multi-level competency development and consideration of practice complexities. These data lay a foundation on which to explore and develop best practices for incorporating sonographic imaging into the clinic as a means for engaging clients as active participants in the rehabilitation process to improve health and rehabilitation outcomes.

Sonography is a relatively inexpensive imaging modality that provides real-time, dynamic views of anatomical structures. This session will discuss the results of a qualitative descriptive study that revealed a wide range of uses for sonography by occupational therapists.

Objective. To identify the potential utility of musculoskeletal sonographic imaging in upper-extremity rehabilitation.

Method. Two occupational therapists in an outpatient hand rehabilitation clinic were recruited by convenience, were trained in the use of sonography, and implemented sonographic imaging in their clinical practice. Qualitative data were obtained during and after the implementation period by means of questionnaires and interviews. Data collection, analysis, and interpretation were completed in an iterative process that culminated in a thematic analysis of the therapists' perceptions.

Results. The data indicate four potential areas of utility for musculoskeletal sonography in upper-extremity rehabilitation: (1) mastering anatomy and pathology, (2) augmenting clinical reasoning, (3) supplementing intervention, and (4) building evidence.

Conclusion. Numerous potential uses were identified that would benefit both therapist and client. Further exploration of complexities and efficacy for increasing patient outcomes is recommended to determine best practices for the use of musculoskeletal sonography in upper-extremity rehabilitation.

Objectives. Non-physician rehabilitation providers (e.g., occupational/physical therapists) have requisite expertise for effective use of point-of-care musculoskeletal sonography (MSKUS); however, professional curriculums provide only introductory-level image interpretation, at best. This multi-method study evaluated post-professional competency development and the complexities of clinical integration of MSKUS by non-physician rehabilitation providers.

Methods. Three occupational therapists (OTs) received weekly, 2-3 hour, hands-on training from a RMSK-credentialed OT for 3 months. Training included ultrasound physics, imaging protocols, image acquisition, optimization and analysis. Prior to implementing MSKUS in the hand therapy clinic, minmum competency for selecting protocols, acquiring and interpreating images was determined using patient scenerios. During a 10-month implementation, therapists self-rated competency in image acquisition and interpretation on a 10-point visual analogue scale following each MSKUS use. Data were divided into early, mid, and late time periods to evaluate competency development. Semi-structured interviews throughout and following implementation provided deeper understanding of the complexities of clinical integration. Three researchers identified themes through interative anlaysis of interview transcripts and multiple consensus meetings.

Results. Competency for acquiring images significantly increased (p < .05) between the early and mid phase (4.9 to 6.9), whereas competency for image interpretation did not show a significant increase until the late phase (5.8 to 7.6). Qualitative themes included numerous technical competencies nested within real-time interaction with the client, as well as perceived clinical use and professional constraints.

Conclusions. Utilization of MSKUS by non-physician rehabilitation providers diverged from diagnostic techniques to patient-centered applications (e.g., education, biofeedback). Post-professional MSKUS training programs for these providers will require an unique approach to address the various nested competencies and clinical considerations that differ from training provided to physicians and sonographers.

This article addresses a difficulty that many occupational therapists experience: maintaining occupation as the core of their therapeutic intervention. This difficulty not only results from but also contributes to occupational therapy's struggle with professional identity. Current manifestations of the problem are described as component-driven practice and the narrowing of occupation to basic activities of daily Living. The concepts of occupation as ends and occupation as means are proposed as a practical solution to guide treatment planning and merge remediation and adaptation within a single occupational session. Each concept is investigated in terms of its history within the profession and its usefulness for analyzing and solving therapeutic problems. These concepts are discussed as useful guidelines to help occupational therapists not only in their clinical decision making but also in their understanding and expression of the field's unique expertise. A case example, applying occupation as ends and occupation as means to evaluation and treatment, is presented.

Phenomenology began as a movement in philosophy that deals with the essences of objects, or phenomena as they present themselves in human consciousness. The founding father of phenomenology, Husserl, believed that through rigorous examination of objects, as they are presented in one’s consciousness, a person could come to intuitively know the essence of those objectivities, or realities. He proposed that other disciplines might benefit from phenomenology as a way of identifying the main objectivities with which the discipline deals, before undertaking other inquiry. The phenomenological method outlines the steps of such an investigation. This paper uses the steps of the phenomenological method to explore the essence of occupation.