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Master's Theses Graduate College

4-1992

A Survey of Computer Use in Occupational Therapy Fieldwork

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Martha E. Parks

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 A SURVEY OF COMP UTE R USE IN
OCCUPA TIO NA L THERA PY
FIELDWORK SITES

by

Martha E. Parks

A Thesis
Submitted to the
Faculty of The Gra du ate College
in partial fu lfillment of the
requirements for the
Degr ee of Master of Science
Departme nt of Occupational Therapy

Wester n M i c h iga n University

Kalamazoo, M i c h i g a n
April 1992

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 A S U R V E Y OF COM PU TER USE IN
O C C U P A T I O N A L THERAPY
FIE LD WOR K SITES

M a r t h a E. Parka, M.S.

W e s t e r n M i c h i g a n University, 1992

Eighty-three W e s t e r n Mic hig an University occupational

therapy f i e l dw ork sites were surveyed to determine: (a)

ex ten t of c o mpu ter use, (b) diagnostic categor ie s with

w h i c h computers are used, (c) extent of computer knowledge

of registered oc cup at i o n a l therapists (OTRs), and (d)

adequacy of comp ut er knowledge of fieldwork students.

Forty-seven (56.6%) of the 83 surveys were returned. OTRs

at 36 (76.6%) of the 47 sites currently use computers.

W o r d processing is the mos t common way in w h i c h these OTRs

use computers. The m o s t common clinical use of computers

is p erc ep t u a l / m o t o r assessment and treatment, while the

mo s t common res ea rch use of computers is for report

writing. Head injury, CVA, and motor diso rd ers are the

d iagnostic c ate go r i e s wit h which computers are most

com mon ly used. Twenty-six (55,3%) of the 47 sites employ

at least o n e ' OTR wit h three or more years of computer

experience. Fifteen (31.9%) of the sites e mploy at least

o ne OTR who has never u s e d a computer.

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 ACKNOWLEDGMENTS

I wish to expr ess my sincere appre ci ati on to my

c o m m i t t e e chairperson, Doris A. Smith, M.Ed., OTR, FAOTA,

who has given u n t i r i n g enthusiasm, interest, and support to

this project. I would also like to t hank my committee

members, Cindee Peterson, M . A . , OTR, and Claire R. Callan,

Ed.S, OTR, for t hei r guidance and expertise.

I would like to thank Richard G. Cooper, Ed.D., OTR,

FAOTA, De pa rt m e n t of Occupational Therapy c h a i r per so n at

Western Michigan Uni ve rsi ty (Kalamazoo), as well as Jane

Lyon and Jan Harbach, office staff, for their support of

this project.

A dditionally, I wou ld like to express my gr atitude to

Herber t and V i r g i n i a Guy, my parents, who have lovingly and

consistently s u p p o rte d me throughout the purs ui t of this

degree.

Finally, I o f fer m y deepest thanks and a ppr ec i a t i o n to

Rick Parks, my husband, for his ne ve r-failing encourage­

ment, patience, a n d love.

Martha E. Parks

11

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 O rder N um ber 1347629

A survey of computer use in occupational therapy fieldwork sites

Parks, Martha E., M.S.

Western Michigan University, 1992

UMI
300 N. Zeeb Rd.
Ann Arbor, MI 48106

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Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
 TABLE OF CONTENTS

A CKN OW L E D G M E N T S ........................................... ii

LIST OF T A B L E S .............. iv

IN TRODUCTION ............................................. 1

M E T H O D .................................................... 14

S a m p l e .................................................. 14

I n s t r u m e n t a t i o n ................................... . 14

P r o c e d u r e ............................................. 15

R E S U L T S .................................................... 16

D I S C U S S I O N ................................................. 21

C O N C L U S I O N ............................................... 25

A P P E N D I C E S ............................................... 27

A. S u r v e y ............................................. 28

B. West er n M i c h i g a n Univers it y Human

Subjects In stitutional R e v i e w Boa rd
Approval F o r m ..................................... 36

BI BL IOG RA PHY ............................................. 38

iii

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 LIST OF TABLES

1. Present a nd Intended Future C o m put er Use

of OTRs at F i e l d w o r k S i t e s ........................... 17

2. Diagnost ic Cat ego r i e s / C o n d i t i o n s in Which

Computers A re B ein g U s e d ..................... 19

3. Clinical Uses of Computers by OTRs at Fieldwork

Sites Using Com puters With Head-Injured,
CVA, or Mot or Dis or der Populat io ns .............. 20

iv

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 INTRODUCTION

The a d ve nt of c omputers during the past two decades

has made a signifi can t impact in ne arly every field.

Occupational the ra py is no exception. C omputers are being

used by occupational therapists for a v a r i e t y of a d m i n i s ­

trative, clinical, and research purposes. This study

investigated how c omputers are being us ed in facilities

that serve as f i e ldw ork sites for the oc cupational therapy

department of a mi d w e s t e r n university.

In the early 1970s, two authors, E. I. Smith (1973)

and English (1975), discussed the po tential uses of

com puters in occupational therapy. E. I. Smith (1973)

in vestigated emp loy men t o pportunities in the field of

Information T ech no log y for h omebound d i s ab led persons. She

des cri bed the H o m e bou nd Employm ent P r o jec t at George

Wa shi n g t o n University, Washington, D.C., whi ch was "taking

one step forward in imple men ti ng m ode rn tec hno l o g y that

[was then] av ai lab le in the i nformation industry for the

benefit of the h o m e bo und disabled" (p. 232). E. I. Smith

also dis cus sed the role of the o ccu pational therapist in

the H omebound Employ men t Project.

English (1975) des cri bed the t h en- cur ren t uses of

computers by o ccu pational therapists and su gge ste d possi bl e

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 future uses. English also introduced and defin ed the

concepts of comp ut ers and c omputer programming, outlined

adv an tag es and dis adv a n t a g e s of computer use, and offered

suggestions for e a sin g the a cce pta nc e of computers by

occupational therapists.

Com put ers currently perform a wide varie ty of func­

tions in the field of occupational therapy. One such

function is as an a d m i n ist rat iv e tool in occupational

therapy departments. W amboldt (1986b) desc rib es three

types of software p r o gra ms used for ad min i s t r a t i v e purposes

in occupational therapy: data base, spreadsheet, and word

processing. She notes that a data base program is ap­

pro pri ate for org an i z i n g large amounts of information, such

as pati ent files, att en dan ce records, inventory lists,

vendor lists, and p u r c h a s e order records. Spreadsheets,

which a llo w one to w o r k with numbers in rows and columns,

can be useful for pr e p a r i n g reports of m o n t h l y statistics,

such as pro du ct i v i t y of individual therapists, or for p r e ­

pa ring de par tme nt budgets. A word pro ces sor may be used

for creating, storing, and print ing patients' reports, as

well as for crea ti ng and u pdating home p r o g ram s for p a ­

tients .

The t hree functions of data base, spreadsheet, and

wo rd p ro ces sin g are a v a i l abl e in integrated software p a c k ­

ages. A t h e r api st using integrated software can easily

shift from one function to another or can use two or three

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 of the functions simultaneously. For example, the t h e r a ­

pist could extract at te nda nce data from a spreadsheet p r o ­

gr am and insert it into a m o nt hly report crea ted wi th the

wor d processor.

Wh ile co mputers are used by ma ny occupational thera­

pists as a d m in ist ra tiv e tools, the use of com puters is not

limited to administration. Com puters are curr en tly being

used in a variet y of clinical applications. Comp ut er- bas ed

environmental control units (ECUs) are an example of such

a clinical application. The com put er -ba sed ECU enables a

d isabled p e rso n to oper ate electrical devices remotely,

using a control such as a p neumatic switch, a pressure

switch, or "voice input" (Sidler, 1986). The disabled

person is also aff or ded the abil it y to use the computer as

a tool, just as a non -disabled person could. As Vander-

heiden (1982) p oints out, "it is very important to remember

that disabled p e ople also need to use the same programs and

accomplish the same tasks as anyone else" (p. 136). ECUs

may be used by s everely physic all y d isabled individuals,

allowing them "unexpected levels of independence and f r e e ­

dom...to say nothing of the pot ent ia ls it offers for

reduced a tt endant care for personal needs" (Sidler, 1986,

p. 60).

A n o the r clinical use of com put ers is augmentative

communication. A u g m e n t a t i v e communic ati on refers to "ways

in which mic roc o m p u t e r s and related aids are used to

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 'speak' for i ndividuals who are non-vocal" (Sidler, 1986,

p. 63). "Peripheral d e v i c e s " — eq uipment used to enter

data, retrieve data, or t ransfer data to a storage m e d i u m —

may be added to the computer to enab le it to "speak," or

the comp ut er itself m a y have a built -in "speaking" device.

The use of m icr oc o m p u t e r s has been e xplored to assist the

disa ble d wi th co nve rs a t i o n and to improve com mu nic ati on

both in writin g and by te le phone (Vanderheiden, 1981).

Treviranus and Tanno ck (1987) d escribed a "scanning" key­

board that allows a p hys ic all y dis ab led p erson to access

the comp ute r using an ap propriate switch. (A switch is a

device that t ran sla te s volitional m o v em en t into an elec­

tronic signal recogni zed by the computer. The switch may

be act iv ate d by any specific v o l u nt ary movement, such as

head movement, eyebrow movement, sipping, or puffing, that

the individual can reliably control.) The authors used

case studies involving two young boys with cerebral p alsy

to illustrate the potential c o m mu nic ati ve uses of the

scanning keyboard.

Cog nit ive retraining is another area in w hic h o c c u p a ­

tional therapists are using computers in a clinical se t ­

ting. "The 1991 Closing The G a p R e s our ce Directory" (1991)

lists software that is curr ent ly avai lab le for use in

special ed uc ati on or rehabilitation. The software is

listed under three general categori es of software: Access

Software, Skill De velopment Software, and Professional

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 M ana gem en t Software. Skill D e vel op men t S o f tw are includes,

among o ther categories, a cate gor y of software c a lled "Co g­

nitive Re dev elo pme nt ." The dire ct ory defi nes Cog nitive

Red ev e l o p m e n t Software as "software that provides r e t r a i n ­

ing in skills lost throug h trauma" (p. 206). This software

is used to treat deficits in p roblem-solving, attention,

c ognitive strategies, visual scanning, reaction time, c o n ­

ceptual skills, memory skills, and audi tor y and visual

discrimination. The dire ct ory lists more tha n 200 pieces

of C og nitive R e d ev elo pm ent Software that are pr ese nt ly

av ail ab le to rehabili ta tio n professionals.

Computers are als o being used c l i n i cal ly in vocational

training and retrai nin g (Glenn, Miller, & Broman, 1976).

As early as 1976, occupational therapi st s were e x p e r i m e n t ­

ing with using "voice control" to enable two q u ad ri ple gic

clients to program a r e mot ely -lo ca ted c omputer entirely

through the use of a "voice terminal." Vo ice control has

led to new p oss ib i l i t i e s in the area of employment in the

information industry for the severely disabled. Bush and

Peterson (1990) stated that "innovative employme nt t e c h n o l ­

ogy has been dev eloped through robotic a s s i sti ve devices to

enable individuals to return to an in dependent work setting

by pro vid in g the user control of the e nvi ro nme nt through

voice activation" (p. 51). Bush a nd Peterson de scribed a

v o i c e- act iva ted robotic work cell that enables individuals

wit h severe upper extr emi ty limitations to use a m i c r o p r o ­

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 cess or- ba sed w o r k s t a t i o n to p e r f o r m two office m an age m e n t

functions. The w ork st a t i o n is equip ped with a robotic arm

that can p e r f o r m func tio ns such as retrieving p r i n t e d m a ­

terials from shelves or from a printer. The w o r k s ta tio n

also makes it p o s sib le to place and receive phone calls and

to store phone numbers in a directory.

Com pu ter s are al so being used in the a ssessment of

occupational therapy clients. OT FACT (Functional A s s e s s ­

ment C om pil ati on Tool), a new software p r o g r a m for c o l l e c t ­

ing, compiling, and reporting a sse ss men t data, is being

m a r ke ted by the A m e r i c a n Occupational T h e rap y Assoc iat ion

(AOTA) (R. 0. Smith, 1990). OT FACT is used to manage data

from assessments. It is designed to pull toget he r i n f o r m a ­

tion gathered from e xisting occupational therapy evaluation

instruments and p r ovi de an overall functional pe rfo r m a n c e

p r o fil e of a client (AOTA, 1990, p. 79). OT FACT compiles

evaluations in five areas: role integration, activities of

performance, integ rat ion skills of.performance, components

of performance, and environment.

There are also numerous piec es of software on the

m ark et that are des ign ed to be used in the actual a s s e s s ­

ment of the client. This software t y p i cal ly measures v i ­

sual/perceptual skills, attention, conceptual skills, or

p rob lem - s o l v i n g skills. Ass es sme nt software is often r e ­

viewed in "Software and Techn olo gy Reviews," a column that

appears p e r i o d i c a l l y in The Amer ica n Journal of O c c u p a t i o n ­

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 al T h e r a p y .

Rec reational software is also cu r r e n t l y ava ila ble to

the occupational t h e r api st for clinical use. Sidler (1986)

de scr ib es the ad v a n t a g e of using comp ut er games in t r e a t ­

ment :

Ma ny c o m pu ter "arcade" games can be selected

and adapt ed for clinical use by a p p l y i n g t r a d i ­
tional a c t iv ity a nalysis c o n c ept s in i d e nti fy­
ing their features. Wh ile most t her ap i s t s now
p refer educati on al game software, the m o t i v a ­
tional q u a l i t i e s of recreational g ames m ay be a
great he lp w i t h an un res po n s i v e or wit hdrawn
patient. (p. 76)

Co mpu te rs m ay be used c l i n i c a l l y in the treatment of

perceptual deficits. As Wambo ldt (1986a) states: "The

c omputer has the a b il ity to presen t p r e cis e stimuli and

provid e non-biased, e nco ur a g i n g responses, as well as to

report obj ect ive data on the p a t i ent 's progress" (p. 26).

The stimuli p r e s en te d by the computer are desiy ned to

ch allenge the pati ent w i t h p erceptual d eficits to learn new

com pe nsa tor y techniques.

In addition to u sing co mputers for a d m i ni str ati ve and

clinical purposes, occup ati on al therapists are also using

c omputers in research. A study by Nelson, Peterson, Smith,

Boughton, and Whalen (1988) des cribes a research protocol

in which c omp uters wer e used as data collecti on tools.

Each of three obs erv er s had a portable computer. The c o m ­

puter of the m i ddl e o b s er ver was p r o g ra mm ed to signal re­

cordin g intervals t h rou gh "beeps" that we re audib le only

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 to the observers. T h e three c om puters w e r e p r o g r a m m e d to

create a data file from the observers' responses to visual

prompts as they a p p e a r e d on the computer display.

Using a c o m put er as a data c o l l ec tio n tool makes it

easier for the o ccu pational t herapist to coll ect research

data. Additionally, the unit in g of physiolo gic al m o n i t o r ­

ing eq uip men t and microcomputers has made occupational

therap y research ea sier to conduct. As Sidler (1986)

states:

Practici ng th era pi sts can now collect data and

raise research q u e s t ion s that were onc e i m p o s ­
sible except in settings d e s ign ed for research.
Data can be a u t o m a t i c a l l y selected and stored for
individual patients, for example. Baseline data
can be com pa red ov er time with treatment sessions
to d e t e r mi ne progress, (p. 69)

Occupational therap ist s are also using compu ter iz ed

literature search services to a ssi st wit h research. One

such service, OTDBASE, is a cli ni ca l l y - o r i e n t e d index and

data base that con tai ns relevant information about all a r ­

ticles pu bli she d in eight occupational therap y journals

from 1970 to the p r es en t (Ernest, 1990). OTDBA SE contains

only occupational therap y literature, and it is the only

service that contains i nformation about all of the articles

found in all eight of the journals. The oc cu pational t h e r ­

apy researcher can search for art icl es about a particu lar

topic.

OT SOURCE is anot he r c o m put er information system

ava ilable to assist occupational t herapists w i t h research

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 ("OT SOURCE to be Demonstr at ed, " 1991). OT SOURCE features

a series of data bases and e lectronic b ulletin boards that

can easily be acc ess ed from a compu te r using a "modem." (A

m o d e m is a de vice that transmits comp ute r data over t e l e ­

p hone lines.) The data bases include OT B ibl io graphic

System (an in-depth library of occupational therapy lit er a­

ture), Job Bank (with listings of occ up ational therapy

po sitions across the country), AO TA Pr oducts Catalog (which

contains the latest p u b lic ati ons and pro duc ts available

from AOTA), and Official Actions (official documents of

AOTA). The bulletin boards av ai lab le throug h OT SOURCE

include professional resource listings, AOTA's volunteer

sector VIPs, C ont inu in g Education and Association Calen­

dars, and a "Member Q & A Board" that allows users of OT

SOURCE to c ommunicate with one another.

In recent years, numerous studies have been conducted

to determine how occupational therapists (and other health

professionals) are using computers. Spicer and McMillan

(1987) con duc ted a survey of 298 occupational the rap y d e ­

par tm ent directors to elicit (a) dep art me nt demographics;

(b) availa bi lit y of computers; (c) types of hardware,

software, and peripheral devices used; (d) m ajo r purposes

and functions for computers; (e) important factors r e g a r d ­

ing the choice of computers and equipment; and (f) the

factors most influential in inhibiting the use of com­

pu ters .

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 10

Anothe r study of occupational therapi sts (Marina,

1984) surveyed 34 O n ta rio r e h a bil ita ti on units to d et ermine

how occupational therap ist s use mi cro co m p u t e r s for pati ent

treatment.

A third study (McCray & Blakemore, 1985) investigated

a number of aspects of com put er use in re hab ili ta tio n

facilities, using a tw o- pha se study of appr oxi mat el y 4,200

r eha bilitation facilities nationwide. The study iden­

tified: (a) the current extent of com pu ter use in r e h a b i l ­

itation facilities; (b) how com puters are being used in

administration, reh abi lit at ion services, and pro duc ti on

management; (c) the specific types of hardw ar e and software

co nfi gu rat ion s that have been installed; (d) the trends

that are likely to lead to the increased u se of co mputers

in rehabili tat ion facilities; and (e) the feasibi lit y of

developing a national netwo rk of rehabil it ati on facility

computer users.

None of these surveys ad dressed the question of w h e t h ­

er or not occupational therap y students are receiving a d e ­

qu ate e du cation and t raining in the use of computers. Nor

did they m e nti on edu ca tio n and training of therapi sts in

facilities where com puters are in use. According to Nave

and Browning (1983), however, ed ucation is an important

consideration:

R eha bil i t a t i o n pr of es s i o n a l s do indeed have a

major re spo nsi bi lit y to become a ware of and r e ­
sponsive to the te chnological adva nce me nts that
have ap plication for the field. One way in which

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 11

this goal can and should be a c c o m p l i s h e d is

t h r o u g h l o n g -te rm educational programs, (p. 365)

Similarly, in a study con ducted by Yuen, Smith, and A l l ­

dr edge (1991), the majority (61%) of the graduate-level

o ccu pational ther ap y students from four u n iv ers it ies in the

Eastern United States who were surveyed agreed that an

in tro ductory c o m p ut er course should be included in the

o ccu pational t h er apy curriculum. Additionally, 94% of the

respondents plan ned to learn more about using computers

wi thi n the next two years, though fewer than one -third of

the respondents had r eceived any formal compu ter training

in their u n d e r g r a d u a t e or graduate programs.

Several articles have des cribed occ upational therapy

d ep art men ts at d i f f ere nt u n iversities that do include t e c h ­

nology and com put er courses in their curricula. Gil kes on

and Kro usk op (1987) d escribed a graduate-level progra m in

rehabili tat ion t ech no log y at Texas W o man 's University

(TWU), Denton, Texas:

The c u r r i c u l u m in this p r ogr am has been designed

to achieve the fol lowing goals: (a) prov ide
occupational th era pis ts wit h a backgrou nd in
basic en gineering technology concepts a n d p r i n ­
ciples and (b) provi de instruction for practici ng
occupational therapi sts and other a p p r o pr iat e
reh ab ili tat io n p r o fe ss ion als in c u r r e ntl y a v a i l ­
able te chn olo gy to help them serve their disa ble d
c l i e nt ele in a m o r e co st- e f f e c t i v e manner, (p.
751)

The Univers ity of W is con s i n - M a d i s o n is another u n i v e r ­

sity that offers an occupational therapy cu r r i c u l u m with a

speciali zat ion that incorporates t e c h n o l o gy- re lat ed courses

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 12

(R. O. Smith, 1989). This p r og ram is an i n t e r d i sc ipl ina ry

te chn ol ogy program called TechSpec, which has two major

thrusts: (1) direct t raining and (2) development and

distri but io n of t raining materials. Dire ct training occurs

at the founda tio n level (elective courses only) or at the

speciali zat ion level (required courses as well as elec­

tives). The t r a in in g ma ter ial s that are deve lop ed and

distr ib ute d include teaching wo rk boo k s / g u i d e s and an im­

p l eme nta tio n manual for TechSpec. These mat eri als are

offered, at cost, to faculties of other institutions, to

cu rri cu lum planners, and to the public.

The occupational ther ap y de par tme nt at Boston U n i v e r ­

sity offers a sequence of graduate-level cours es leading to

a maste r' s degree with a spec ial iz ati on in computer t e c h ­

nology (Ruben, 1990). Students in the program take two

core courses that teach them how to adapt computers for

p eop le with disabilities. A practicum is r equired after

each comp ut er course. To c omplete the computer technology

sequence, students take courses on physical d i sab ili ti es or

on computers.

As the recent literature shows, computers are being

used by occupational th er api sts for a va r i e t y of purposes.

In addition, the occupational t h er apy departments of at

least three u n i ver sit ie s include techno log y and computer

courses in their curricula. No literature was found,

however, that discussed the comp ute r training and kn owledge

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 13

o btained by occ upational therapy students in other u n i v e r ­

sities. A dditionally, no literature was found that ad­

dressed student pr e p a r a t i o n for c omputer usage during

fi eldwork experiences.

This study of fie ld wor k sites was c onducted to d e t e r ­

mine: (a) the e x ten t of computer s oftware and hardware

use, (b) the d iag nos ti c categories wit h w h i c h computers are

used, (c) the extent of computer kn owledge of r egistered

occupational therapi st s (OTRs), and (d) the ade qua cy of

co mputer kn owledge of fiel dw ork students.

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 METHOD

Sample

The sample was obta ine d by co mpi lin g a list of o c c u p a ­

tional thera py level II fie ldwork sites whi ch have had at

least one We s t e r n M i c h ig an U niv er s i t y (WMU), Kalamazoo, o c ­

cupational t h e rap y fi eld wor k student per year in each of

two of the years 1988, 1989, and 1990. Eighty-three f i e l d ­

w ork sites met these criteria.

Instrum ent ati on

A survey was d e v e lop ed to elicit: (a) demogra phi c

information, (b) e xtent of computer use, (c) computer h a r d ­

war e/ equ ipm en t use, (d) c omputer software use, (e) extent

of compu te r knowledge of OTRs, and (f) extent of c omputer

knowledge of f ieldwork students.

The survey was reviewed by three occupational thera­

pists who use com puters and are familiar with research

design. Their suggestions for improving the design and

clarity of the survey were incorporated into the final

version. See Appendix A for a copy of the survey.

14

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 15

Pro cedure

The survey was m a i l e d to f i e l d wo rk supervisors at each

of the fie ldwork sites in the sample. A cover letter,

a ttached to each survey, req uested that the fieldwork

supervisor forward the survey to the head of each o c c u p a ­

tional t h e rap y department, and that the head of the d e p a r t ­

ment compl et e and return the survey within two weeks. A

reminder card was ma iled to the fie ldw ork sites asking the

head of each oc cupational therapy department to return the

survey if he or she had not alre ady done so. Of the 83

surveys distributed, 47 (56.6%) wer e returned.

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 RESU LTS

Th i r t y - t h r e e (70.2%) of the respondents c ho se to

identify their sites. Of those, 17 (51.5%) wer e from

Michigan, four (12.1%) from Illinois, three (9.1%) from

Indiana, two each (6.1% each) from O h i o and California, and

one each (3.0% each) f r o m Connecticut, Georgia, Maryland,

Virginia, and Wisconsin.

Forty-five sites p r o v i d e d i nformation about the number

of OTRs employed at the site. This number ranged from 1 to

55, with an average of 7.82 OTRs p er site. Twe nty-seven

sites provided in formation about the number of clients

served by their OTRs d uri ng 1990. This number ranged from

22 to 7,596 clients, with an average of 810.44 clients

served per site in 1990.

OTRs at 36 (76.6%) of the 47 sites are c ur rently using

computers. These OTRs are using computers for a vari et y of

administrative, clinical, and r esearch purposes. In a d d i ­

tion, OTRs at 3 (6.4%) of the sites plan to begin using

co mputers w ithin 60 months, w hi le OTRs at 8 (17.0%) of the

sites do not cur re ntl y use computers and do not pla n to

begin using them wi thin 60 months. Table 1 gives a d d i t i o n ­

al information on the number of sites curr en tly using,

pla nni ng to use, or not plan nin g to use computers for

16

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 17

Table 1

Present and Intended Future Compu te r Use

of OTRs at F i e l d wo rk Sites (n=47)

Plan to Do not Plan

P r e s ent ly use With- to use W i t h ­
Com pu ter Use Using in 60 Months in 60 Months

AD M I N I S T R A T I V E
Wor d Processing 27 (57.4%) 3 (6.4%) 17 (36.2%)
G e n e rat ing Reports 18 (38.3%) 5 (10.6%) 24 (51.1%)
A cco unt in g/ 16 (34.0%) 2 (4.3%) 29 (61.7%)
Bo okk ee pin g
Data Base/ 14 (29.8%) 4 (8.5%) 29 (61.7%)
M a i lin g Lists
Gra phi cs 13 (27.6%) 3 (6.4%) 31 (66.0%)
Spreadsheets/Bus­ 12 (25.5%) 4 (8.5%) 31 (66.0%)
iness Projections
Q u a lit y A ss urance 10 (21.3%) 5 (10.6%) 32 (68.1%)

CLINICAL
Perce ptu al/ Mot or 26 (55.3%) 4 (8.5%) 17 (36.2%)
Cog nit ive Training/ 24 (51.1%) 4 (8.5%) 19 (40.4%)
Retraining
R e c r e a tio n/G ame s 21 (44.7%) 2 (4.2%) 24 (51.1%)
Co mmu nication 20 (42.6%) 4 (8.5%) 23 (48.9%)
As ses sm ent 14 (29.8%) 6 (12.8%) 27 (57.4%)
Vocational T r a i n ­ 14 (29.8%) 4 (8.5%) 29 (61.7%)
ing /Retraining
Environmental 12 (25.5%) 3 (6.4%) 32 (68.1%)
Control

RESE ARC H
Re port Writing 13 (27.7%) 6 (12.8%) 28 (59.5%)
Data Collection 10 (21.3%) 7 (14.9%) 30 (63.8%)
Data Analysis 9 (19.2%) 8 (17.0%) 30 (63.8%)

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 18

various administrative, clinical, and research purposes.

Occupational th era p i s t s use co mp ute rs with a variety

of diagnos tic categories /co ndi tio ns , as shown in Table 2.

The most c ommon co ndi tio ns are head injury, c e r e b rov asc ula r

accident (CVA), and m o t o r disorders. Tw e n t y - f i v e (53.2%)

of the sites use com put ers with the head -in ju red popula­

tion, 18 (38.3%) of the sites use c o m p ut er s with CVA

clients, and 15 (34.0%) of the sites use computers with

clients who have m o t o r disorders. Ten of t hes e sites use

co mputers wit h all t hre e d iag nos tic categories, 13 sites

use computers with two of the three categories, and three

sites use the m with on ly one of the c a t e g o r i e s . ) Table 3

depicts clinical uses of co mpu te rs by the OTRs who in d i ­

cated they use co mpu te rs wit h the head- injured, CVA, or

motor disorder populations.

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 19

Table 2

Diagnostic Categories/Conditions in Which

Computers Are Being Used (n=47)

Head Injury 25 (53.2%)

CVA /H emi ple gi a 18 (38.3%)

Motor Disorders 16 (34.0%)

Cerebral Palsy 11 (23.4%)

De generative Ne u r o D isorder 11 (23.4%)

Spinal Cord Injury 11 (23.4%)

Learning Disorder 10 (21.3%)

Vocational Limi ta tio n 7 (14.9%)

Hand/Wrist Dis orders 6 (12.8%)

Mental Ret ard a t i o n 6 (12.8%)

Burns 4 (8.5%)

P ervasive Developmental Disorder 4 (8.5%)

Aff ec tiv e Disorders 3 (6.4%)

A rthritis 3 (6.4%)

Dysphagia 3 (6.4%)

Amputees 2 (4.3%)

An xi ety Disorder 2 (4.3%)

Fractures & General Orthope dic s 2 (4.3%)

Onc olo gy 2 (4.3%)

Schizophrenia 2 (4.3%)

Eating Disorders 1 (2.1%)

AIDS 0 (0.0%)

Cardiac D y sf unc tio n 0 (0.0%)

C.O.P.D. 0 (0.0%)

Neona to log y 0 (0.0%)

Sub stance Abuse 0 (0.0%)

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 20

Table 3

Clinical Uses of Co mputers by OTRs at F ie ldwork Sites

Using C o m p ut ers Wi t h Head-Injured, CVA, or
Mot or Disorder Populations

Head Injury CVA Motor

Disorders
(n = 2 5 ) (n=18) (n = 1 6 )

Perceptual/
Motor 23 (92.0%) 17 (94.4%) 14 (87.5%)

Co gnitive Training/
Retra ini ng 22 (88.0%) 18 (100.0%) 13 (81.3%)

Recreation/
Games 17 (68.0%) 12 (66.7%) 12 (75.0%)

Co mmu nication 13 (52.0%) 10 (55.6%) 10 (62.5%)

Environmental
Control 11 (44.0%) 9 (50.0%) 6 (37.5%)

Assessment 11 (44.0%) 10 (55.6%) 7 (43.8%)

Vocational Training/
Retraining 10 (40.0%) 8 (44.4%) 5 (31.3%)

N o t e . Categories do not total 100%, since sites could use

computers for more than one purpose.

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 DISCUSSION

Wor d proces sin g is the most common w ay in w h i c h OTRs

are using computers, w i t h OTRs at 27 (57.4%) of the sites

cur re ntl y using co mputers for this task. The most common

clinical use of co mpu ter s is for p e r c e p t u a l / m o t o r a s s e s s ­

ment and treatment, with 26 (55.3%) of the sites using

co mputers in this way, followed closely by cognitive

training/retraining, with 24 (51.1%) of the sites using

co mputers for this clinical purpose. The most common use

of c omp uters in o ccu pational thera py research is for report

writing, with 13 (27.7%) of the sites using c omp uters in

research report writing.

The populat io n wit h which com puters are mo st f r e q u e n t ­

ly used is the head-injured population. Twe nty -f ive

(53.2%) of the 47 sites use comp ute rs with this population.

Eighteen (38.3%) of the sites use co mputers with CVA

clients, while 15 (34.0%) use the m with clients who have

motor disorders. The m o s t c ommon clinical use of computers

wi th hea d-injured and m oto r dis or der clients is percep­

tual/mo tor assessment and treatment. With CVA clients, the

m o s t common clinical use is co gni tiv e training/retraining.

In a ssessing the e x te nt of computer kn o w l e d g e of the

OT Rs at the fieldwork sites surveyed, the survey revealed

21

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 22

that 26 (55.3%) of t he 47 sites employ at least one OTR

w i t h three or more years of compu te r experience. Fifteen

(31.9%) of the sites em p l o y at least one O T R who has never

used a computer. This suggests that sites are more likely

to e mploy OTRs wi t h three or more years of c o m p u t e r e x p e r ­

ience than they are to e mp loy OTR s w i t h no c o m pu ter e x p e r ­

ience .

The survey also a d d r e s s e d the que sti on of the a d e qu ac y

of com put er kno wledge of fie ldw or k students from West ern

Michigan Univer sit y and from other colleges or univer­

sities. Only 26 (55.3%) of the 47 survey respondents

ans wer ed the q uestion that per tai ned to WMU students, and

only 20 (42.6%) responded to the quest ion that pe rtained to

students from other col leg es or universities. The low

number of sites respondi ng to these qu est io ns and the n u m ­

ber that indicated that the que sti ons were "not a p p l i c a ­

ble," may suggest that fi eld wor k students are not asked to

use computers, or it may suggest that their skills are not

tracked. Of those sites that did respond, however, the

mos t frequent response was that the students' computer

kn o w l edg e tends to be a d e q u a t e for the d e pa rtm ent 's needs.

None of the respondents indicated that the students' com­

puter knowledge "always exceeds our depar tme nt' s needs."

Nor did any of the re spondents indicate that the students'

computer kno wle dge "always falls short of our de partment's

needs." There was a non sig nif ic ant differ en ce betwe en the

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 23

a d e qu acy of c o m pu ter k nowledge of the Western Michigan

Un ive rs ity students and the c o m p ute r kn owl ed ge of the s t u ­

dents from other c o l leg es or universities.

One site reported owning 20 microc omp ut ers . That site

employs 55 OTRs, the most of any site in the survey. Of

the 55 OTRs employed by the site, 8 (14.5%) have been u sing

co mpu te rs for 3 years or longer; 32 (58.2%) for 1-3 years;

10 (18.2%) for 0-1 years; and 5 (9.1%) have never used

computers.

This site c u r r e ntl y uses comp ut ers for the a d m i n i s t r a ­

tive functions of a c c o u n t i n g / b o o k k e e p i n g , word processing,

data base /ma ili ng lists, s p r e a d s h e e ts/ bus in ess projections,

graphics, and g en era tin g reports. Clinically, the site

presently uses co mputers for environmental control, com­

munication, cognitive tr ai ning/retraining, assessment, r e c ­

reation/games, and p e r c e p t u a l / m o t o r assessme nt and t r e a t ­

ment. In the research area, the site p r e s e n t l y uses c o m ­

puters for data co lle c t i o n and report writing. Addition­

ally, the site plans to begin using comp ute rs for q u ali ty

a s s u ran ce and for analy sis of rese arc h data w i th in 0-12

months.

The site that owns 20 mic roc o m p u t e r s uses co mpu ter s

w i t h the following d iag no sti c c ate go rie s/conditions: ampu­

tees, arthritis, burns, cerebral palsy, CVA/hemiplegia,

d eg ene rat iv e neuro disorder, dysphagia, f ractures and g e n ­

eral orthopedics, hand/wr ist disorders, head injury, mo tor

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 disorders, and spinal cor d injury. Whi le this site is

p r o b a b l y not a typical one, it m ay represent a future trend

in the ex panding use of c omputers by occup at ion al thera­

pists .

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 CONCLUSION

Computer use is very common in the occupational

t h era py fie ldwork sites surveyed, with OTRs at 76.6% of the

sites already using comp ute rs and an additional 6.4% of the

sites pla nni ng to begin using computers w ithin the next

five years. The range of tasks for w hi ch comp ute rs are

use d is broad, as is the div ers it y of diagnostic catego­

ries/conditions with which computers are used. The c o m ­

pu ter appears to be gaining c re di bil ity as an occupational

therap y tool.

With computers gainin g p o p u lar it y and widespre ad use

in occupational therapy, it will soon be impera tiv e that

occupational therapy c u r ric ula offer introductory computer

courses. Such courses wo uld benefit occupational therapy

students in several ways. They would enable the students

to acquire a basic fam ili a r i t y with the computer as an

occupational therapy tool. They would help students attain

a higher level of comfort in working wi th computers.

Additionally, students w oul d benefit by learning to use a

wo r d process in g software package that could s ubs equently

a ssi st them in c o m p le tin g th ei r course assign me nts while

still in college.

25

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 26

A replication of this study would be valuable and

might serve to indicate how occupational therapy computer

uses are changing. Future researchers might also conduct

a survey of occupational therapy curricula to determine

exactly which computer courses are being taught in the

various colleges and universities. Another study of inter­

est might focus on the question of whether therapists them­

selves are initiating computer use or whether therapists

are required— perhaps by the administrators at the various

facilities— to use computers. Additionally, future re­

searchers could survey OTRs to determine their levels of

computer experience and knowledge or to determine what sort

of computer training is deemed necessary. Most important­

ly, research is needed to determine the efficacy of the

computer as an occupational therapy tool of practice and to

identify the need for skill acquisition prior to entering

the field.

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 Appen dic es

27

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 A p p e ndi x A

Survey

28

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 29

OccjDa!io'-ai Tne-aov Deca'imem K a ia n a z o o M ic n ig a n a M C B 'S G S 1

6 1 6 3 8 7 -3 0 5 0

W e s t e r n M i c h ig a n U n iv e r s it y

February 20, 1991

Dear Fieldwork Supervisor:

The attached survey has been sent to your fieldwork center because
you have supervised two or more Western Michigan University
fieldwork students during the past three years.

Martha Guy, for her thesis to meet part of the requirements for a
Master of Science in Occupational Therapy, has developed this
survey to determine:
(1) how occupational therapists at fieldwork sites are using
computers, and
(2) how well prepared Western Michigan University's
occupational therapy students are to meet the computer
needs of the fieldwork site.

We anticipate that this research will provide information valuable

to our curriculum, with regard to computer education and training.
Please ask the head of your occupational therapy department to
complete this survey and return it to us by Friday, March 8, 1991.

Results of this survey will be reported as group data. However, if

the respondent is willing to have the survey information included
in the fieldwork manual (which is kept on file at Western Michigan
University and which gives information about individual sites),
there is a place on the top of the survey to sign, giving this
approval. This would allow students preparing for their fieldwork
affiliations to obtain information about the computer uses as well
as modalities at your facility. This signature is completely
optional.

Thank you very much for your cooperation.

AOTA Claire R. Callan, Ed.S. ,OTR

Chairperson Fieldwork Coordinator

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 30

SURVEY OF COMPUTER USE

IN WESTERN MICHIGAN UNIVERSITY'S
OCCUPATIONAL THERAPY FIELDWORX SITES
Results of this survey will be reported as group data. However, if
you are willing to have this survey placed in the fieldwork manual
■(which is kept on file at Western Michigan University and which gives
information about individual sites), please sign below and give the
name of your facility and unit. This would allow students preparing
for their fieldwork affiliations to obtain information about the
methods, activities and computer uses at your facility. Your
signature is completely optional.
Signature _________________________________ __________________
Name of facility ________________________________ _________
Name of unit (if applicable) ___________ ______________________

DEMOGRAPHIC INFORMATION
How many full time OTRs does your occupational therapy
department have? ___
2 . How many clients did your OTRs serve last year";
Please check all of the following methods and activities which
are provided by your OTRs:
Amputee Training Minor Crafts
Behavior Modif'n Muscle Group
Biofeedback Muscle Testing & ROM
Brunnstrom NDT
Ceramics Needlework
Cognitive Eval'n Pain Management
& Training Perceptual Test
Coma Stimulation PreVoc Work Test
Computer Access PreVoc Work Sample
Cooking PreVoc On-Job
Daily Living Projective
Skills Psychodrama
Design/Fabricate Rood
Splints Sensorimotor
Driver Evaluation SI Evaluation/Training
£ Training Social Skills
Edema Control Swimming
Evaluate for Therapeutic Groups
Functional Brace Weaving
Fabricate Adaptive Woodworking - Hand
Equipment Woodworking - Machine
Gardening Work Hardening
Group Recreation Other:
Homemaking
Leather

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 31

COMPUTER UBS
4. Below la a list of computer uses. Please use the following key
to mark each category as it applies to your OTRs' present or
future computer use:
1 - Presently using a computer(s) for this purpose.
2 •» Not using for this purpose, will be within0-12 months.
3 - Not using for this purpose, will be within 13-24 months.
4 - Not using for this purpose, will be within 25-60 months.
5 » Not using for this purpose, and do not plan to.
ADMINISTRATIVE
Accounting/Bookkeeping
Word Processing
Data Base/Mailing Lists
Spreadsheets/Business Projections
Graphics
Generating Reports
Quality Assurance
other (Please specify) _____ ____________________
other (Please specify) _________________________
Other (Please specify) _________________________
CLINICAL
Environmental Control
Communication
Cognitive Training/Retraining
Vocational Training/Retraining
Assessment
Recreation/Games
Perceptual/Motor
Other (Please specify) ____________________________
Other (Please specify) ____________________________
Other (Please specify) _________________________ ___
RESEARCH
Data collection
Data Analysis
Report Writing
Other (Please specify) ____________________________
Other (Please specify) ____________________________
other (Please specify) ___________ ________________
OTHER USES
Please specify any other areas in which computers are or will be
used by your OTRs.

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 32

If your^OTRs are using computers, with which diagnostic

categories/conditions are they being used?
Affective Disorders Hand/Wrist Disorders
AIDS Head Injury
Amputees Learning Disorder
Anxiety Disorder Mental Retardation
Arthritis Motor Disorders
Burns Neonatology
Cardiac Dysfunction Oncology
Cerebral Palsy Pervasive Developmental
C.O.P.D. Disorder
CVA/Hemiplegia Schizophrenia
Degenerative Neuro Spinal Cord Injury
Disorder Substance Abuse
Dysphagia Vocational Limitation
Eating Disorders Other:
Fractures & General
Orthopedics

COMPUTER HARDWARE/EQUIPMENT
Indicate the number of computers in each category owned or leased
by your occupational therapy department.
Category of Computer Own Lease
Microcomputer
Minicomputer
Mainframe computer

7. List the manufacturer and model of each computer used in your

occupational therapy department (e.g. IBM PS-2, Apple lie, etc.)
Manufacturer

What type(s) of peripheral hardware do your OTRs use? (e.g. dish

drive, speech synthesizer, printer, switches/controls, etc.)

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 33

9. Can the hardware be adapted to meet patient needs? ____

If yes, how is the hardware adapted? It no, what changes are
needed? _______________________________________________

10. Do your OTRs desire any adaptive hardware that is not

commercially available? ____

COMPUTER SOFTWARE
11. Please list the software that your department uses, and check the
column appropriate to its use (A*»Administrative, C-Clinical,
R**Research, 0«other) .
Software h S. E 2

Do the programs meet your department's needs?

If not, what changes are needed?

12. Does your facility develop any of its own occupational therapy
software? ____
It so, who develops it (e.g. engineer, computer programmer,
etc.)?

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 34

COMPUTER KNOWLEDGE

13. Please indicate the number of OTRs in your department who fall
into each of the following categories relative to computer
experience.
Have been using computers for 3 years or longer.
Have been using computers for 1-3 years.
Have been using computers for 0-1 years.
Havenever used computers.

14. Please indicate the way(s) in which OTRs in each experience

category have gained their computer experience. Place a check in
each box which applies.
OTRs who have been using computer:
3 years 1-3 0-1
or longer years years
Classes taken for
college credit
Non-credit college
classes taken
Other commercially avail­
able classes taken
Community education
classes taken
On-the-job training
(self-taught)
On-the-job training
(directed)
Self-taught (not
on-the-job)
Other (please specify)

other (please specify)

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 35

15. How would you rata the computer knowledge of the Western Michigan
University occupational therapy students who have done their
fieldwork in your occupational therapy department? (Check one.)
Computer knowledge of WMU students:
always exceeds our department's needs.
_____ usually exceeds our department's needs.
_____ tends to be adequate for our department's needs.
usually falls short of our department's needs.
always falls short of our department's needs.
Not applicable.
Comments: _______________________________________ ____________

16. How would you rate the computer knowledge of the occupational
therapy students from colleges/universities other than Western
Michigan University who have done their fieldwork in your
occupational therapy department? (Check one.)
Computer knowledge of non-WMU students:
always exceeds our department's needs.
usually exceeds our department's needs.
tends to be adequate for our department's needs.
usually falls short of our department's needs.
always falls short of our department's needs.
Not applicable.
Comments: ____________________________________________________

You are finished with the questionnaire. Please insert it in the

enclosed postage-paid envelope and return it to us by Friday, March
8, 1991.

THANK YOU VERY MUCH FOR COMPLETING THIS QUESTIONNAIRE.

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 App end ix B

W e s t e r n M i c h i g a n U niv er sit y Hu man Subj ect s

Institutional Re v i e w B oard
Approval Form

36

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 H um an Su&iects In s titu tio n a l Review Boa-a

W estern M ic h ig a n U n iv e r s i t y

Date: January 7, 1991

To: Martha E. Guy _

From.- Mary Anne Bunda, Chair

Re: HSIRB Project Number: 9 1 - 0 1 - 0 2 J

This letter w ill serve as confirmation that your research protocol, "A Survey of Computer Use in
Occupational Therapy Fieldwork Sites," has been approved under the exempt category of review by the
H5IRB. The conditions and duration of this approval are specified in the Policies of Western Michigan
University. You may now begin to implement the research as described in the approval application.

You must seek reapproval for any changes in this design. You must also seek reapproval if the project
extends beyond the termination date.

The Board wishes you success in the pursuit of your research goals,

xc. Doris Smith, Occupational Therapy

Approval Termination: January 7, 1992

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 BI BL IOG RA PHY

Am e r i c a n Occupational T h e ra py Association. (1990).

Co mpu te r inform ati on p a c k e t . Rockville, MD: Author.

Bush, M. A., & Peterson, C. (1990). E val ua t i n g the p h y s i ­

cally d isabled p a t ien t for robotic a s s i s t i v e devices.
In D. Clark (Ed.), Te chn o l o g y review '90: Perspec­
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