(eBook PDF) Pedretti's Occupational

Therapy: Practice Skills for Physical

Dysfunction 8th Edition
Go to download the full and correct content document:
https://ebooksecure.com/product/ebook-pdf-pedrettis-occupational-therapy-practice-s
kills-for-physical-dysfunction-8th-edition/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Early’s Physical Dysfunction Practice Skills for the

Occupational Therapy Assistant 4th Edition Mary
Elizabeth Patnaude - eBook PDF

https://ebooksecure.com/download/earlys-physical-dysfunction-
practice-skills-for-the-occupational-therapy-assistant-ebook-pdf/

(eBook PDF) Adult Physical Conditions Intervention

Strategies for Occupational Therapy Assistants

http://ebooksecure.com/product/ebook-pdf-adult-physical-
conditions-intervention-strategies-for-occupational-therapy-
assistants/

(eBook PDF) Kielhofner's Research in Occupational

Therapy: Methods of Inquiry for Enhancing Practice 2nd
Edition

http://ebooksecure.com/product/ebook-pdf-kielhofners-research-in-
occupational-therapy-methods-of-inquiry-for-enhancing-
practice-2nd-edition/

(eBook PDF) Occupational Therapy for Children and

Adolescents 7th Edition

http://ebooksecure.com/product/ebook-pdf-occupational-therapy-
for-children-and-adolescents-7th-edition/
(eBook PDF) Occupational Therapy in Mental Health: A
Vision for Participation 2nd Edition

http://ebooksecure.com/product/ebook-pdf-occupational-therapy-in-
mental-health-a-vision-for-participation-2nd-edition/

(eBook PDF) Willard and Spackman's Occupational Therapy

13th Edition

http://ebooksecure.com/product/ebook-pdf-willard-and-spackmans-
occupational-therapy-13th-edition/

(Original PDF) Willard and Spackman's Occupational

Therapy, 12th Edition

http://ebooksecure.com/product/original-pdf-willard-and-
spackmans-occupational-therapy-12th-edition/

Willard and Spackman's Occupational Therapy 13th

Edition (eBook PDF)

http://ebooksecure.com/product/willard-and-spackmans-
occupational-therapy-13th-edition-ebook-pdf/

Neurologic interventions for physical therapy Third

Edition Kessler - eBook PDF

https://ebooksecure.com/download/neurologic-interventions-for-
physical-therapy-ebook-pdf-2/
vi Contributors
Carolyn Glogoski, PhD, OTR/L
Associate Professor
Department of Occupational Therapy
San Jose State University
San Jose, California
Jennifer S. Glover, MS, OTR
(Contributor to the 7th edition)
Occupational Therapist
Department of Rehabilitation
Life Care Center of Aurora
Aurora, Colorado
Julie McLaughlin Gray, PhD, OTR/L,
FAOTA
Associate Chair of Curriculum and Faculty
Associate Professor of Clinical Occupational
Therapy
Chan Division of Occupational Science and
Occupational Therapy
University of Southern California
Los Angeles, California
Denise Haruko Ha, OTR/L, CBIS
Occupational Therapist II
Occupational Therapy Vocational Services
Rancho Los Amigos National Rehabilitation
Center
Downey, California
Agnes Haruko Hirai, MA, OTR/L, HTC,
PAM
Occupational Therapy Supervisor II
Rehabilitation Services, Occupational
Therapy
LAC-USC Medical Center
LAC Department of Health Services
Los Angeles, California
Carole Adler Hughes, BA, OT/L
Spinal Cord Injury Clinical Specialist
Rehabilitation Consultant
San Jose, California
Jennifer Kaye Hughes, MOT, OTR/L
University of Texas
MD Anderson Cancer Center
Department of Rehabilitation Service
Houston, Texas
Cynthia C. Ivy, OTD, OTR, CHT
Associate Clinical Professor
Northern Arizona University
Phoenix, Arizona
Associate Professor
Physical Medicine and Rehabilitation
Mayo Clinic
Phoenix, Arizona
Vicki Kaskutas, OTD, OTR/L, FAOTA
Associate Professor in Occupational Therapy
and Medicine
Assistant Director of Post-Professional OT
Doctoral Degree Program
Washington University School of Medicine
St. Louis, Missouri
Amy Phillips Killingsworth, MA, OTR/L
(Retired)
Professor Emerita
Department of Occupational Therapy
San Jose State University
San Jose, California
Jean S. Koketsu, MS, OTR/L
Lecturer
Department of Occupational Therapy
San Jose State University
San Jose, California
Occupational Therapist
On Lok Lifeways
San Jose, California
Barbara L. Kornblau, JD, OT/L, FAOTA,
DASPE, CCM, CDRS, CPE
Adjunct Professor and Professor of
Occupational Therapy (Courtesy)
Department of Occupational Therapy
Florida A & M University
Tallahassee, Florida
Mark Kovic, OTD, OTR/L
Associate Program Director and Associate
Professor
Occupational Therapy, College of Health
Sciences
Midwestern University
Downers Grove, Illinois
Sheama Krishnagiri, PhD, OTR/L,
FAOTA
Occupational Therapist and Education
Consultant
Private Practice
Los Angeles, California
Dawn Kurakazu, OTR/L
Occupational Therapist II
Rehabilitation Medicine
LAC-USC Medical Center
Los Angeles, California
Donna Lashgari, DHSc, OTR/L, CHT
Supervisor
Hand Therapy Department
Stanford Health Care
Redwood City, California
Lecturer
Department of Occupational Therapy
San Jose State University
San Jose, California
Sonia Lawson, PhD, OTR/L, FAOTA
Associate Professor
MS Professional Program Director
Department of Occupational Therapy and
Occupational Science
Towson University
Towson, Maryland
Gayle Jean San Marco, OTR/L, CDRS
Program Coordinator
Driver Preparation Program
Center for Rehabilitation Medicine
Northridge Hospital Medical Center
Northridge, California
Maureen Michele Matthews, OT/L
Occupational Therapist III
Good Samaritan Hospital
San Jose, California
Independent Occupational Therapist
REACH (a program for stroke survivors)
Palo Alto, California
Rochelle McLaughlin, MS, OTR/L, RYT,
Certified MBSR Instructor
Lecturer
Department of Occupational Therapy
San Jose State University
San Jose, California
Host, Revolutionary Wellness Talk Radio on
VoiceAmerica’s Health and Wellness
Channel
Publisher, Revolutionary Wellness Magazine
Lauro A. Munoz, OTR, MOT, FAOTA
Occupational Therapist
Houston, Texas
Lynne F. Murphy, EdD, OTR/L
Assistant Professor
Department of Occupational Therapy
East Carolina University
Greenville, North Carolina

Jennifer Nicholson, MOT, OTR/L
Occupational Therapist
University of Texas
MD Anderson Cancer Center
Department of Rehabilitation Service
Houston, Texas
Sandra Hattori Okada, OTR/L, MSG,
CDRS
Occupational Therapy Driving Evaluator
Rancho Los Amigos National Rehabilitation
Center/Rancho Research Institute
Downey, California
Annemarie E. Orr, OTD, OTR/L
Occupational Therapist
Department of Rehabilitation
Occupational Therapy Services
Walter Reed National Military Medical
Center
Bethesda, Maryland
Jill J. Page, OTR/L
VP Work and Industry Services
Drayer Physical Therapy Institute
Hummelstown, Pennsylvania
Karen Parecki, MS, OTR/L, ATP
Occupational Therapist
Physical Medicine and Rehabilitation
VA Palo Alto Health Care System
Palo Alto, California
Lorraine Williams Pedretti, BS, MS, OT
(Retired)
Professor Emeritus
Department of Occupational Therapy
San Jose State University
San Jose, California
Shawn Phipps, PhD, MS, OTR/L, FAOTA
Chief Quality Officer
Associate Hospital Administrator
Rancho Los Amigos National Rehabilitation
Center
Downey, California
Vice President
American Occupational Therapy Association
Adjunct Assistant Professor of Clinical
Occupational Therapy
Chan Division of Occupational Science and
Occupational Therapy
University of Southern California
Los Angeles, California
Michael Pizzi, PhD, OTR/L, FAOTA
Wellness Lifestyle Coach
Associate Professor
Department of Occupational Therapy
Dominican College
Orangeburg, New York
Contributors vii
Linda Anderson Preston, MS, OTR/L, Tim Shurtleff, OTD, OTR/L
CHT Instructor
Clinical Specialist Program in Occupational Therapy
Patricia Neal Outpatient Therapy Center Washington University
Roane Medical Center St. Louis, Missouri
Harriman, Tennessee
Ashley Uyeshiro Simon, OTD, OTR/L
Samia Husam Rafeedie, OTD, OTR/L, Assistant Professor of Clinical Occupational
BCPR, CBIS Therapy
Director of the Occupational Therapy USC Occupational Therapy Faculty Practice
Professional Program Chan Division of Occupational Science and
Assistant Professor of Clinical Occupational Occupational Therapy
Therapy University of Southern California
Chan Division of Occupational Science and Los Angeles, California
Occupational Therapy
University of Southern California Jerilyn (Gigi) Smith, PhD, OTR/L, FAOTA
Los Angeles, California Associate Professor
Occupational Therapist Department of Occupational Therapy
Department of Occupational Therapy San Jose State University
Keck Hospital of USC San Jose, California
Los Angeles, California
Graham Teaford, MS, OTR/L
S. Maggie Reitz, PhD, OTR/L, FAOTA Occupational Therapist
Vice Provost On Lok Lifeways
Office of the Provost Lecturer
Towson University Department of Occupational Therapy
Towson, Maryland San Jose State University
San Jose, California
Pamela Richardson, PhD, OTR/L, FAOTA
Associate Dean and Professor of Michelle Tipton-Burton, MS, OTR/L
Occupational Therapy Lecturer
College of Applied Sciences and Arts Department of Occupational Therapy
San Jose State University San Jose State University
San Jose, California San Jose, California
Patient Care Coordinator
Pamela Roberts, PhD, OTR/L, SCFES, Rehabilitation Case Management
FAOTA, CPHQ, FNAP Santa Clara Valley Medical Center
Director and Professor San Jose, California
Physical Medicine and Rehabilitation
Cedars-Sinai Medical Center Ana Verran, MA, OTR/L, CDRS
Los Angeles, California Research Adjunct Instructor
Chan Division of Occupational Science and
Marjorie E. Scaffa, PhD, OTR/L, FAOTA Occupational Therapy
Professor University of Southern California
Department of Occupational Therapy Los Angeles, California
University of South Alabama
Mobile, Alabama J. Martin Walsh, OTR/L, CHT
Executive Director
Kathleen Barker Schwartz, EdD, OTR, Hand Therapy Certification Commission
FAOTA (Retired) Sacramento, California
Professor Emerita
Department of Occupational Therapy
San Jose State University
San Jose, California
viii Contributors

Jacqueline Reese Walter, PhD, OTR/L,
CHT
Associate Professor
Department of Occupational Therapy
Nova Southeastern University
Davie, Florida
Mary Warren, PhD, OTR/L, SCLV, FAOTA
Associate Professor
Department of Occupational Therapy
Co-Director
Center for Low Vision Rehabilitation
University of Alabama at Birmingham
Birmingham, Alabama
Christine M. Wietlisbach, OTD, MPA, Kristin Winston, PhD, OTR/L
CHT MSOT Program Director
Assistant Professor Associate Professor
West Coast University Occupational Therapy
Los Angeles, California University of New England
Occupational Therapist Portland, Maine
Eisenhower Medical Center
Rancho Mirage, California
Assistant Professor
Rocky Mountain University of Health
Professions
Provo, Utah
 We are honored to dedicate this eighth edition of Pedretti’s Occupational
Therapy: Practice Skills for Physical Dysfunction to Lorraine Williams Pedretti.
Lorraine Williams Pedretti was selected by the American Occupational
Therapy Association as one of the 100 Influential People in the field of
occupational therapy as part of the profession’s centennial celebration. Her
thoughtfulness, love of her profession, and dedication to the education of her
students provided the impetus to embark on the daunting task of writing and
editing an original textbook (and ensuing editions) for evaluation and
treatment of adults with physical disabilities. As academic colleagues of
Professor Pedretti, we were inspired by her example and challenged to accept
the responsibility to continue in her footsteps to contribute to the
advancement of the profession. It is our hope that our efforts have honored
her example and lived up to her faith in us.
We would also like to dedicate this edition to occupational therapy students
(past, present, and future) who are the future of our wonderful profession:
may you find the happiness and fulfillment that we have as proud
occupational therapists.
F O R E WO R D
It is an honor and a privilege to write the foreword to the eighth
edition of Pedretti’s Occupational Therapy: Practice Skills for
Physical Dysfunction. I was the book’s original author and the
primary editor of the first five editions. The book was first
published in 1981. It has been widely used by occupational
therapy students in the United States and abroad for 36 years.
Over this time, it has enjoyed a reputation for its practical and
comprehensible writing, and for covering the essential theoreti-
cal and practical information needed for clinical practice. As
editions progressed, the text evolved to keep pace with changes
in the rapidly growing body of knowledge and expanding areas
of clinical practice in occupational therapy. It is very gratifying
for me to know that this book continues to be an important
resource for students, occupational therapy educators, and cli-
nicians in the profession.
I was very pleased that my professional colleagues at San
Jose State University, Dr. Heidi McHugh Pendleton and Dr.
Winifred Schultz-Krohn, will continue as the book’s editors. Dr.
Pendleton, who was my student many years ago, joined the
faculty of San Jose State University in 1987 after many years of
clinical practice, working with clients with physical dysfunction.
It was gratifying to witness her professional and academic
development, to observe her numerous professional achieve-
ments, and to see her earn the doctorate in the field. After
serving a term as Chair of the Department of Occupational
Therapy at San Jose State University from 2008-2012, she
returned to teaching courses in the history and theory of occu-
pational therapy and professional development. She received
the Lifetime Achievement Award from the Occupational
Therapy Association of California in 2011.
Dr. Winifred Schultz-Krohn came to San Jose State University
in 1996 with excellent credentials and qualifications. She has
many years of clinical practice in pediatrics, is a board-certified
pediatric occupational therapist, and has previous academic
experience. She has extensive education and expertise in neuro-
logical dysfunction. Professor Schultz-Krohn was awarded the
prestigious regional Jefferson Award for more than 17 years of
pro bono occupational therapy services to the San Jose Family
Homeless Shelter. Her tireless volunteer work ranged from
developing and supervising a summer OT fieldwork program
to providing practicum and research opportunities to hundreds
of occupational therapy students. She received the Outstanding
Professor Award for San Jose State University in 2014. Professor
Schultz-Krohn is currently Chair of the Department of Occu-
pational Therapy at San Jose State University.
These editors are professional and academic leaders in the
field. They have published numerous articles and book chapters
and have received many professional awards and recognitions.
They have clinical and academic expertise and a wealth of
professional knowledge that makes them eminently qualified
for their editorial roles. They have done an excellent job in
x
authoring chapters, editing, and coordinating the preparation
of the sixth, seventh, and now the eighth editions.
These editors have assembled a roster of excellent contribu-
tors: leaders and experts in the occupational therapy profession
who are well qualified to write on their respective subjects. As
the profession grew and changed, the content and format of the
textbook evolved to reflect those changes. Therefore, more
contributors were invited to participate in the preparation of
each edition. There are over 60 contributors in the eighth
edition, 21 of whom are new contributors.
The content of the eighth edition reflects the substantive
changes that have occurred in occupational therapy philosophy
and practice. The content has been restructured and is based
on the new Occupational Therapy Practice Framework-3, with
expanded emphasis on evidence-based practice and emerging
practice areas. The content reflects new research and theories,
new techniques, and current trends in the profession while
maintaining a focus on client-centered practice. This edition
continues to include case studies, clinical reasoning skills,
ethical questions and concerns, factors of cultural diversity,
and practice notes that are threaded throughout the book.
There is one new chapter: Chapter 49, Occupational Therapy
in Hospice and Palliative Care; and a new section added to
Chapter 7, Section 2, The Therapeutic Use of Self: Embodying
Mindfulness in Occupational Therapy. The enhanced content
will teach the student essential clinical reasoning skills and
provoke thinking about potential ethical and cultural con-
siderations in treatment. There is comprehensive coverage of
physical dysfunction. Chapters on evaluation of joint range of
motion (21) and muscle strength (22) have a whole new look
with full color photos and drawings, as well as approaches to
simplify and clarify the evaluation processes. Especially exciting
is the accompanying Evolve website for students and instruc-
tors. This development brings this textbook into the electronic
information age and has great potential for independent
study by students and as a resource for occupational therapy
educators.
Writing and editing a textbook is no small task. It takes a
great deal of time, patience, and persistence. It involves dealing
with numerous people—editors, contributors, vendors, models,
photographers, and artists. I was so fortunate that my worthy
colleagues agreed to adopt this textbook and keep the produc-
tion going after my retirement. I am very grateful that they have
produced this excellent work and so pleased that it will continue
to be associated with the occupational therapy program of
excellence at San Jose State University.
Lorraine Williams Pedretti, MS, OT (retired)
Professor Emeritus
San Jose State University

It was a great honor to be asked to assume the editorship of the
eighth edition of Pedretti’s Occupational Therapy: Practice Skills
for Physical Dysfunction. To continue to follow in the footsteps
of the inimitable Lorraine Pedretti is at once an awesome
responsibility and a rewarding journey. The opportunity to
work with authors, each a leading expert in his or her field,
continues to be an unparalleled experience of the exceptional
ability of stellar occupational therapists to organize their time
and unselfishly devote their scholarship to the education of
future generations of the profession.
Since the publication of the seventh edition, there have been
changes within the profession and within the clinical practice
of occupational therapy for clients with physical dysfunction.
Many of those changes served to shape the approach we took
to the new edition and are reflected within the context of each
of the chapters. Our mission and intention was to embrace
these changes and continue to honor the primacy of occupation
that has been the foundation of this textbook for the past several
editions.
The eighth and latest edition is framed and guided by
the Occupational Therapy Practice Framework: Domain and
Process—3rd (OTPF-3), designed to describe the focus and
dynamic process of the profession. Key to the OTPF-3 is its view
of the overarching goal of occupational therapy; that is, engage-
ment in occupation to support participation in life. This con-
ceptualization of the importance of occupation is emphasized
throughout the text. The concepts of process and practice,
evaluation and intervention, performance skills and patterns,
contexts and activity demands, client factors, and intervention
applications are all thoroughly illustrated throughout.
To honor the centrality of the client to occupational therapy
practice, the chapters begin with case studies, which are then
threaded throughout, guiding the reader through the informa-
tion and relating the content to the specific case descriptions.
Thus, the reader is able to experience the clinical reasoning and
decision-making skills of the expert clinicians who authored the
chapters. Authors of individual chapters were asked to follow
the initial presentation of their case studies by crafting several
probative or “critical thinking” questions that would pique the
readers’ curiosity, further motivating their attention to and
questioning of the chapter content and consequently facilitating
the learning process. Direct answers to these critical thinking
P R E FA C E
questions are provided either within or at the end of each of
the chapters.
This textbook, written for an intended audience of occupa-
tional therapy graduate students and as a reference for practic-
ing occupational therapists, has always been acknowledged for
its practical application and focus on practice. Theory and
evidence-based content are presented in each chapter and then
applied using case descriptions as a foundation for practice.
Occupational therapy’s role in health and wellness, as well as
prevention, is addressed throughout the text. Similarly, occupa-
tional therapy’s commitment to the importance of considering
cultural and ethnic diversity is reflected in every chapter.
The eighth edition continues to feature the OT Practice
Notes and the Ethical Considerations boxes that are highlighted
throughout many of the chapters. The information contained
in these boxes (pulled from the chapter content) conveys ideas
that are relevant to students’ future practice areas and thoughts
about some of the possible ethical dilemmas and decisions with
which they might be confronted. New support materials include
the Evolve website, which includes both a link to student-related
materials as well as an instructor link with access to the Instruc-
tor’s Resource Manual and a test bank.
During the process of editing this book, including the stages
of envisioning and designing the content and format, selecting
the authors, and reading and giving input to their work, we were
guided by our commitment to honoring the occupational
welfare of our clients, particularly adults with physical disabili-
ties, through excellent preparation of their future occupational
therapists. To that end we sought preeminent authors, those
who not only had recognition for expertise in their topic area,
but who also embraced the primary importance of occupation
to their practice and scholarship. Our goal was to engender
excitement in the reader for occupational therapy in the area of
physical dysfunction, while providing cutting-edge information
and promoting models of best practice. Our extensive and
rewarding clinical and academic careers in the profession of
occupational therapy and our experiences with hard-working
and inspiring clients and students served as the inspiration for
our best efforts, which we trust are evident in this book.
Heidi McHugh Pendleton
Winifred Schultz-Krohn
xi
AC K N OW L E D G M E N T S

We would like to thank the authors, past and present, for their exceptional contributions and
willingness to continue the tradition of excellence that has come to be associated with the Pedretti
book. The impressive list of authors for the eighth edition continues the Pedretti reputation for
including nationally and internationally known experts in their topic areas and disciplines. We
are fortunate to feature contributions from new authors and included among them are admin-
istrators, educators, researchers, and master clinicians.
We would also like to acknowledge the superb contribution of the dedicated editors and staff
at Elsevier. We are especially grateful to Jolynn Gower, Content Development Manager; Kellie
White, Executive Content Strategist; and Courtney Sprehe, Senior Content Development Special-
ist, who patiently and painstakingly mentored us through the long and arduous editing process.
They are simply outstanding! Our thanks go to Rich Barber, Senior Project Manager, who, with
exceptional attention to detail, made sure that the final product reflected the efforts of all
involved.
To those publishers and vendors who permitted us to use material from their publications,
we extend our sincere gratitude. Photographers and artists, and the clients and models who posed
for photographs, are gratefully acknowledged. We are grateful to the contributors who were
particularly generous in finding just the right photographs to capture the importance of occupa-
tion to participation in life—we thank you!
Finally, we would like to extend heartfelt appreciation to our colleagues, friends, and families,
without whose help and support this accomplishment could not have been achieved. Special
expressions of thank you go to the faculty and staff at San Jose State University, who could be
counted upon for their support and good wishes during this process.
Heidi McHugh Pendleton extends her gratitude to her husband, Forrest Pendleton (for
immeasurable love and support without which this endeavor could never have succeeded) and
to her sisters, Deirdre McHugh and Kathleen McHugh (for a lifetime of support). Her love and
appreciation go to all of her nieces, nephews, and stepson, including Dar, Jim, Nicky, Elizabeth,
Jimmy D, Megan, Kelsey, Jamie, Jessica, and Katie—their love and enthusiasm make everything
possible. She would like to also extend gratitude to her brother-in-law, H. Duncan Mason, MD,
and to occupational therapy student, Morgan Gralla, from Towson University, who contributed
their expertise to identify and correct inadvertent misinformation in a chapter from the last
edition. It is always our intention to present the best information available, and we deeply
appreciate feedback from our readers.
Winifred Schultz-Krohn extends a huge thank you to her always supportive, ever-patient
husband, Kermit Krohn. His tireless love made the project possible. She is also very grateful for
the support and encouragement received from her brother, Tom Schultz; his wife, Barb Fraser;
and niece, Sarah; her sister, Donna Friedrich; husband, Don; nephews, Brian and Andrew;
Andrew’s wife, Kirsten; and grand nephew, Zachary; sister, Nancy Yamasaki; and husband, Bryan.
The co-editors would like to thank each other—great friends at the beginning of the process—
we were able to be there for each other, make our own unique contributions, and ultimately
sustain our friendship throughout the process, emerging even better friends in the joy of our
accomplishment.

xii
 CONTENTS

PART I O
 verview: Occupational Therapy 13 Sleep and Rest, 305
Jean S. Koketsu
Foundations for Physical Dysfunction
14 Work Evaluation and Work Programs, 336
1 The Occupational Therapy Practice Framework and the Denise Haruko Ha, Jill J. Page, Christine M. Wietlisbach
Practice of Occupational Therapy for People With 15 Americans with Disabilities Act and Related Laws that
Physical Disabilities, 1 Promote Participation in Work, Leisure, and Activities of
Heidi McHugh Pendleton, Winifred Schultz-Krohn Daily Living, 374
2 History and Practice Trends in Physical Dysfunction Barbara L. Kornblau
Intervention, 16 16 Leisure Occupations, 401
Kathleen Barker Schwartz Sheama Krishnagiri, Megan Chang
17 Assistive Technology, 415
Denis Anson
PART II O
 ccupational Therapy Process
and Practice
PART IV P
 erformance Skills and Client Factors:
3 Application of the Occupational Therapy Practice Evaluation and Intervention
Framework to Physical Dysfunction, 24
Section 1: The Occupational Therapy Process, 25 18 Performance Skills: Definitions and Evaluation in the
Section 2: Practice Settings for Physical Context of the Occupational Therapy Practice
Disabilities, 37 Framework, 435
Winifred Schultz-Krohn, Heidi McHugh Pendleton Mark Kovic, Winifred Schultz-Krohn
4 Evidence-Based Practice for Occupational Therapy, 47 19 Evaluation of Motor Control, 444
Lynn Gitlow, Elizabeth DePoy Linda Anderson Preston
5 Health Promotion and Well-Being for People With 20 Occupation-Based Functional Motion Assessment, 470
Physical Disabilities, 58 Alison Hewitt George, Amy Phillips Killingsworth
Michael A. Pizzi, S. Maggie Reitz, Marjorie E. Scaffa 21 Joint Range of Motion, 477
6 Personal and Social Contexts of Disability: Implications Tim Shurtleff, Vicki Kaskutas
for Occupational Therapists, 71 22 Evaluation of Muscle Strength, 512
Sandra E. Burnett Vicki Kaskutas
7 Teaching Activities in Occupational Therapy, 92 23 Evaluation of Sensation and Intervention for Sensory
Section 1: Teaching Strategies in Occupational Dysfunction, 580
Therapy, 93 Michelle R. Abrams, Cynthia C. Ivy
Section 2: The Therapeutic Use of Self: Embodying 24 Evaluation and Treatment of Visual Deficits After
Mindfulness in Occupational Therapy, 99 Brain Injury, 594
Pamela Richardson, Rochelle McLaughlin Mary Warren
8 Documentation of Occupational Therapy Services, 120 25 Evaluation and Intervention for Perception
Jerilyn (Gigi) Smith Dysfunction, 631
9 Infection Control and Safety Issues in the Clinic, 141 Shawn Phipps
Alison Hewitt George 26 Evaluation and Treatment of Limited Occupational
Performance Secondary to Cognitive
Dysfunction, 645
PART III O
 ccupational Performance and the Glen Gillen
Performance Areas: Evaluation 27 Eating and Swallowing, 669
and Intervention Jerilyn (Gigi) Smith
28 Pain Management, 701
10 Activities of Daily Living, 155 Joyce M. Engel
Jean S. Koketsu
11 Mobility, 230
Section 1: Functional Ambulation, 232 PART V T he Occupational Therapy Process:
Section 2: Wheelchair Assessment and Implementation of Intervention
Transfers, 237
Section 3: Transportation, Community Mobility, 29 Therapeutic Occupations and Modalities, 710
and Driving Assessment, 257 Jacqueline Reese Walter, Kristin Winston
Deborah Bolding, Carole Adler Hughes, Michelle Tipton-Burton, 30 Orthotics, 728
Ana Verran Section 1: Hand Orthotic Fabrication: Principles,
12 Sexuality and Physical Dysfunction, 289 Practice, and Decision Making, 729
Michelle Tipton-Burton, Richard Delmonico With contributions from Section 2: Arm Supports, 754
Gordon Umphred Burton Donna Lashgari, Michal Atkins, Jane Baumgarten

xiii
xiv Contents
31 Traditional Sensorimotor Approaches to Intervention, 766
Section 1: Traditional Sensorimotor Intervention
Approaches, 771
Section 2: Proprioceptive Neuromuscular Facilitation
Approach, 773
Section 3: Neurodevelopmental Treatment
Approach, 789
Winifred Schultz-Krohn, Julie Mclaughlin-Gray
32 Motor Learning, 798
Shawn Phipps, Pamela Roberts
PART VI Intervention Applications
33 Cerebrovascular Accident (Stroke), 809
Glen Gillen
34 Traumatic Brain Injury, 841
Michelle Tipton-Burton
35 Degenerative Diseases of the Central Nervous
System, 871
Section 1: Amyotrophic Lateral Sclerosis, 873
Section 2: Alzheimer’s Disease, 878
Section 3: Huntington’s Disease, 885
Section 4: Multiple Sclerosis, 889
Section 5: Parkinson’s Disease, 893
Winifred, Schultz-Krohn, Diane Foti, Carolyn Glogoski
36 Spinal Cord Injury, 904
Jennifer Bashar, Carole Adler Hughes
37 Disorders of the Motor Unit, 929
Alison Hewitt George
38 Arthritis, 945
Lisa Deshaies
39 Hand and Upper Extremity Injuries, 972
J. Martin Walsh, Nancy Chee
40 Orthopedic Conditions: Hip Fractures and Hip, Knee,
and Shoulder Replacements, 1004
Section 1: Hip Fractures and Replacement, 1007
Section 2: Knee Joint Replacements, 1017
Section 3: Shoulder Joint Replacements, 1021
Lynne F. Murphy, Sonia Lawson
41 Low Back Pain, 1030
Ashley Uyeshiro Simon
42 Burns and Burn Rehabilitation, 1048
Dawn Kurakazu, Agnes Haruko Hirai
43 Amputations and Prosthetics, 1083
Section 1: General Considerations in Upper Limb
Amputations, 1084
Section 2: Upper Limb Amputations, 1085
Section 3: Lower Limb Amputations, 1107
Annemarie E. Orr, Jennifer S. Glover, Chelsey L. Cook
44 Cardiac and Pulmonary Disease, 1117
Maureen Michele Matthews
45 Cancer and Oncology Rehabilitation, 1134
Brent Braveman, Lauro A. Munoz, Jennifer Kaye Hughes,
Jennifer Nicholson
46 Special Needs of the Older Adult, 1142
Samia Husam Rafeedie
47 HIV Infection and AIDS, 1167
Michael Pizzi, Graham Teaford
48 Polytrauma and Occupational Therapy, 1184
Sharon Dekelboum, Karen Parecki
49 Occupational Therapy in Hospice and Palliative
Care, 1195
Janice Kishi Chow
 PEDRETTI’S
Occupational Therapy
PRACTICE SKILLS FOR PHYSICAL DYSFUNCTION
This page intentionally left blank
PART I Overview: Occupational Therapy Foundations for
Physical Dysfunction

1
The Occupational Therapy Practice
Framework and the Practice of Occupational
Therapy for People With Physical Disabilities
Heidi McHugh Pendleton, Winifred Schultz-Krohn

LEARNING OBJECTIVES
After studying this chapter, the student or practitioner will be
able to do the following:
1. Briefly describe the evolution of the Occupational Therapy
Practice Framework, from the original OTPF through
the OTPF-3.
2. Describe the need for the OTPF-3 in the practice of
occupational therapy (OT) for persons with physical
disabilities.
3. Describe the fit between the OTPF-3 and the ICF, and
explain how they inform and enhance the occupational
therapist’s understanding of physical disability.
4. Describe the elements of the OTPF-3, including domain
and process and their relationship to each other.
5. List and describe the components that make up the OT
domain and give examples of each.
6. List and describe the components that make up the OT
process and give examples of each.
7. Briefly describe the OT intervention levels, and give an
example of each as it might be used in a physical disability
practice setting.

CHAPTER OUTLINE
“The Occupational Therapy Practice Framework:
Domain and Process,” Third Edition (OTPF-3)—
Overview, 2
Evolution of the Occupational Therapy Practice
Framework, 3
Need for the Occupational Therapy Practice
Framework, 3
Fit Between the OTPF-3 and the International Classification
of Functioning, Disability, and Health (ICF), 3
The OTPF-3: Description, 4
The Occupational Therapy Domain, 4
The Occupational Therapy Process, 8
Skills That Inform and Guide the Occupational Therapy
Process, 9
Types of Occupational Therapy Intervention, 10
Strategies for Learning the OTPF-3, 12
The OTPF-3: Its Use in This Book, 14
Summary, 14

KEY TERMS
Client factors International Classification of Performance skills
Contexts Functioning, Disability, and Process
Domain Health (ICF) Targeted outcomes
Environment Intervention “The Occupational Therapy Practice
Evaluation Occupations Framework: Domain and Process,”
Performance patterns third edition

1
2 PART I Overview: Occupational Therapy Foundations for Physical Dysfunction
THREADED CASE STUDY
Kent and Karen, Part 1
Kent is a highly skilled and very competent occupational therapist with
more than 25 years of clinical experience. He works in a large rehabilita-
tion center with adult clients who have physical disabilities. He currently
is the supervising occupational therapist on the spinal cord injury (SCI)
unit. Through his reading of OT publications,3,14,15,18,23 attendance at
conferences and workshops, and interactions with his OT staff and
interning OT students, he has become increasingly knowledgeable
about the Occupational Therapy Practice Framework (OTPF) and its
current version, the OTPF-3. When the OTPF-3 was published, he ini-
tially was annoyed that, among the many challenges to his professional
time and efforts, he would have to learn, yet again, a new “language”
to provide competent interventions, and that even before he had mas-
tered the first two models, a third, updated edition had appeared. He
couldn’t help thinking, “Why fix something that isn’t broken?” He reluc-
tantly acknowledged the necessity for the change. Now, however, he
is impressed by what he has learned so far, and he is convinced that
he can no longer postpone delving into and really learning the OTPF-3
and integrating it into his clinical practice.
Throughout his practice, Kent has found it helpful to relate new or
novel OT information he is learning to the relevant circumstances that
either he or one of his clients is experiencing; in this way he considers
the impact the new information might have on either his own life or that
of his client.
Kent has decided that, as he works on learning the OTPF-3 (also
referred to as the Framework), he will keep in mind one of his recently
admitted clients, Karen. Karen is a single, 25-year-old woman who lives
alone in her own apartment and works as an administrative assistant
for a busy law office. Karen incurred a cervical SCI and now has C6
functional quadriplegia/tetraplegia that necessitates use of a wheelchair
for mobility. By keeping Karen in mind, Kent expects not only to learn
the changes and updates to the Framework, but also to reinforce his
new knowledge by putting it to immediate use in his practice.
Critical Thinking Questions
As you read through the chapter, keep in mind the challenges that learn-
ing the OTPF-3 and integrating it into his practice will pose for Kent. Think
of strategies you might recommend or use yourself to learn and integrate
the information into your practice. In addition, consider the objectives
for the chapter, outlined previously, and also these questions:
1. Why was there a need for the OTPF and its subsequent second
and third versions, and how do they fill that need?
2. How might the specific information presented about the OTPF-3
apply to Kent or Karen?
3. Are there tools that Kent and other OT practitioners can use to
help them learn the OTPF-3 and integrate it into their practice?
THE OCCUPATIONAL THERAPY PRACTICE
FRAMEWORK: DOMAIN AND PROCESS,
THIRD EDITION (OTPF-3)—OVERVIEW
Many changes have occurred in the practice of occupational
therapy for persons with physical disabilities since the publica-
tion of the previous edition of Occupational Therapy: Practice
Skills for Physical Dysfunction in 2014. OT practice settings are
increasingly moving away from traditional healthcare environ-
ments, such as the hospital and rehabilitation center, and have
made significant strides moving more toward the home and
community milieus. The provision of OT service has become
progressively more client centered, and the concept of occupa-
tion is increasingly and proudly named as both the preferred
intervention and the desired outcome of the services. Clinicians,
researchers, and scholars have sought to implement evidence-
based practice by learning more about the benefits of occupa-
tion not only to remediate problems after the onset of physical
disability, but also to anticipate and prevent physical disability
and promote wellness. Not surprisingly, economic concerns
have severely shortened the amount of time allotted for OT
services, thus necessitating more deliberate and resourceful
decisions about how these services can be delivered most
effectively.
In response to these changes and many other practice
advances, came a change, or evolution, in the language that
occupational therapists use to describe what they do and how
they do it. This change, in turn, resulted in the document “The
Occupational Therapy Practice Framework: Domain and
Process,” published in 2002 by the American Occupational
Therapy Association (AOTA) in the American Journal of Occu-
pational Therapy (AJOT).1 (The model set forth in the docu-
ment is commonly referred to as the Occupational Therapy
Practice Framework [OTPF] or just the Framework.)
The OTPF is a tool developed by the OT profession to more
clearly articulate and enhance the understanding of what OT
practitioners do (occupational therapy domain) and how they
do it (occupational therapy process). The intended beneficiaries
of all three editions of the OTPF were envisioned as including
not only OT practitioners (an internal audience), but also the
recipients of OT services (referred to as clients), other health-
care professionals, and those providing reimbursement for OT
services (an external audience).
The first version of the Framework was put into practice, and
its relevance and efficacy were assessed; this evaluation resulted
in the OTPF-2,2 which was published in the AJOT in 2008. The
same rigorous examination was applied to produce the current
version, “The Occupational Therapy Practice Framework:
Domain and Process,” third edition (OTPF-3), which appeared
in the AJOT in 2014.3
The OTPF-3 is an important document that every OT prac-
titioner should have and consult frequently. It can be down-
loaded from the AOTA website (http://www.aota.org) by
selecting AJOT (under Publications & News at the top of the
homepage) and then the March/April 2014 issue; a PDF copy
of this document can be downloaded and printed for conve-
nience to members of the AOTA. Another helpful tool for learn-
ing the Framework is the introductory article by Youngstrom
titled, “The Occupational Therapy Practice Framework: The
Evolution of Our Professional Language,”27 which appeared in
the November/December 2002 issue of the AJOT.
It is not the intention of this chapter to supplant the com-
prehensive OTPF-3 document, but rather, to describe the model
and increase the reader’s understanding of the OTPF-3 and its
relationship to the practice of occupational therapy with adults
with physical disabilities. To achieve this, the chapter begins
with a discussion of the history of the OTPF-3, followed by
sections describing the need for the OTPF-3 and the fit between
the OTPF and the World Health Organization’s (WHO) Inter-
national Classification of Functioning, Disability, and Health
(ICF). Next, a detailed description of the Framework is pre-
sented, with emphasis on explicating the domain of occupa-
tional therapy through examples from the case study and
introducing the OT process (discussed in depth in Chapter 3)
in the application of the Framework to individuals with physical
dysfunction. The types of OT intervention proposed by the
Framework 3 are examined and illustrated by examples typi-
cally used in physical disabilities practice settings. The chapter
 CHAPTER 1 The Occupational Therapy Practice Framework
concludes with suggestions and strategies for learning the
OTPF-3 and an overview of how the latest version of the Frame-
work is integrated as a unifying thread throughout the remain-
ing chapters in the book.
Evolution of the Occupational Therapy
Practice Framework
In 1999 the AOTA’s Commission on Practice (COP) was charged
with reviewing the “Uniform Terminology for Occupational
Therapy,” third edition (UT-III), a document that had been
published by the association 5 years earlier.4 Under the leader-
ship of its chair, Mary Jane Youngstrom, the COP sought feed-
back from numerous OT practitioners, scholars, and leaders in
the profession about the continued suitability of the UT-III, to
determine whether to update the document or to rescind it.
Previous editions of the UT, in 1979 and 1989, had been simi-
larly reviewed and updated to reflect changes and the evolving
progress of the profession. The reviewers found that the UT-III,
although considered a valuable tool for occupational therapists,
lacked clarity for both consumers and professionals in associ-
ated fields about what occupational therapists do and how they
do it. Furthermore, they found that the UT-III did not ade-
quately describe or emphasize OT’s focus on occupation, the
foundation of the profession.12
Given the feedback from the review, the COP determined
that a new document was needed, one that would preserve the
intent of the UT-III (outlining and naming the constructs of
the profession) while providing increased clarity about what
occupational therapists and OT assistants do and how they do
it. Additionally, it was determined that the new document
would refocus attention on the primacy of occupation as the
cornerstone of the profession and desired intervention out-
comes, in addition to showing the process occupational thera-
pists use to help their clients achieve their occupational goals.
Need for the Occupational Therapy Practice Framework
The original OTPF and the revised versions (OTPF-2 and
OTPF-3) make it clear that the profession’s central focus and
actions are grounded in the concept of occupation. Although
some of what occupational therapists do could be construed by
clients and other healthcare professionals as similar to or even
duplication of the treatment efforts of other disciplines, for-
mally delineating occupation as the overarching goal of all that
OT does, and clearly documenting supportive goals intended to
achieve that main goal, establishes the profession’s unique con-
tribution to client intervention.
This is not to say that before the OTPF, OT practitioners
did not recognize or focus on occupation or occupational
goals with their clients—most did. However, in the physical
disabilities practice setting, with the reductionistic, bottom-up
approach and pervasive influence of the medical model, occu-
pation was seldom mentioned or linked to what was being done
in OT. A premium seemed to be placed on “medical speak,” and
it was difficult, if not impossible, to document occupational
performance or occupational goals using the types of documen-
tation characteristic of physical disabilities practice settings.
Kent, the therapist from the case study, still occasionally experi-
ences the medical team members’ heightened interest when he
reports muscle grades and sensory status, and their quizzical,
glazed-over looks when he describes his clients’ difficulties
resuming homemaking, leisure, or other home and community
skills. The OTPF-3 provides a means of communicating to
3
healthcare professionals who are not occupational therapists
that engagement in occupation should be the primary outcome
of all intervention.
The OTPF-3 provides a language and structure that com-
municates occupation more meaningfully. It empowers occu-
pational therapists to restructure evaluation, progress, and
other documentation forms to reflect the primacy of occupa-
tion in what OT does, and it shows the interaction of all the
aspects that contribute to supporting or constraining the
client’s participation. Thus, by clearly showing and articulating
the comprehensive nature of OT’s domain of practice to clients,
healthcare professionals, and other interested parties, occupa-
tional therapists enlist support and demand for their services
and, most importantly, ensure that clients receive the unique
and important services that OT provides. Equally important,
the OTPF-3 positions the client as a collaborator with the occu-
pational therapist at every step of the process, thereby empow-
ering the individual as a change agent and reframing the image
of the client as a passive recipient of services.13
Fit Between the OTPF-3 and the International
Classification of Functioning, Disability, and Health (ICF)
There appears to be an excellent fit between the OTPF (all edi-
tions) and the ICF. About the same time the UT-III was being
studied for continued suitability for contemporary language
and practice, the World Health Organization (WHO) was revis-
ing its language and classification model. The result, the Inter-
national Classification of Functioning, Disability, and Health,
contributes to the understanding of the complexity of having a
physical disability.26 The ICF “moved away from being a ‘conse-
quences of disease’ classification to become a ‘components of
health’ classification,”26 progressing from impairment, disabil-
ity, and handicap to body functions and structures, activities,
and participation. In the ICF, body structures refers to the ana-
tomic parts of the body, and body functions refers to a person’s
physiological and psychological functions. Also considered in
this model is the impact of environmental and personal factors
as they relate to functioning. The ICF adopted a universal model
that considers health along a continuum that shows the poten-
tial for everyone to have a disability. WHO perceived this as a
radical shift—from emphasizing people’s disabilities to focus-
ing on their level of health.
The ICF also provides support and reinforcement for OT to
specifically address activity and activity limitations encountered
by people with disabilities.26 In addition, it describes the impor-
tance of participation in life situations, or domains, including
(1) learning and applying knowledge; (2) general tasks and task
demands; (3) communication; (4) movement; (5) self-care; (6)
domestic life areas; (7) interpersonal interactions; (8) major life
areas associated with work, school, and family life; and (9) com-
munity, social, and civic life. All of these domains are histori-
cally familiar areas of concern and intervention for the OT
profession. Although a physical disability may compromise a
person’s ability to reach up to brush his or her hair, the ICF
redirects the service provider to also consider activity limita-
tions that may result in restricted participation in desired life
situations, such as sports or parenting. A problem with a per-
son’s bodily structure, such as paralysis or a missing limb, is
recognized as a potentially limiting factor, but that is not the
focus of intervention.
OT practitioners believe that intervention provided for
people with physical disabilities should extend beyond a focus
4 PART I Overview: Occupational Therapy Foundations for Physical Dysfunction

on recovery of physical skills and address the person’s engage-

ment, or active participation, in occupations. This viewpoint is
the cornerstone of the OTPF-3 and previous versions. Such
active participation in occupation is interdependent on the
client’s psychological and social well-being, which must be
simultaneously addressed through the OT intervention. This
orientation is congruent with the emphasis reflected in the ICF.
In many instances the language of the UT-III was different
from that used and understood by the external audience of
other healthcare professionals. Similarly, the terminology of the
previous WHO classification frequently differed from that used
by the audience with which the organization was trying to
communicate (eg, healthcare professionals and other service
providers). The goals of the new WHO classifications, the ICF,
are to increase communication and understanding about the
experience of having a disability and unify services. In a similar
manner, the original OTPF, and now the updated OTPF-3, was
designed to increase others’ knowledge and understanding of
the OT profession and, where appropriate, to incorporate the
language of the ICF, as will be seen in the following discussion
of the OT domain and process.
Detailed information on the ICF can be found in the docu-
ment referenced in this chapter,26 or an overview of the docu-
ment can be downloaded from http://www.who.int/icf/cfm. A
helpful resource for learning the ICF is the Beginners Guide to
the ICF, which can also be accessed at the website http://
www.who.int/classifications/icf. Additional and annually updated
documents on the ICF also are available at this website.
THE OTPF-3: DESCRIPTION
The OTPF-3 is composed of two interrelated parts, the domain
and the process. The domain comprises the focus and factors
addressed by the profession, and the process describes how
occupational therapy does what it does (evaluation, interven-
tion, and outcomes)—in other words, how it puts the domain
into practice. Central to both parts is the essential concept of
occupation. The definition of occupation used by the develop-
ers of the original Framework is:
Activities … of everyday life, named, organized, and given value
and meaning by individuals and a culture. Occupation is every-
thing people do to occupy themselves, including looking after
themselves, … enjoying life, … and contributing to the social
and economic fabric of their communities.16
The Occupational Therapy Domain
The domain of occupational therapy encompasses the gamut of
what occupational therapists do, along with the primary concern
and focus of the profession’s efforts. Everything that occupa-
tional therapy does or is concerned about, as depicted in the
domain of the OTPF-3, is directed at supporting the client’s
engagement in meaningful occupation that ultimately affects
the health, well-being, and life satisfaction of that individual.
The five broad areas, or categories, of concern that constitute
the OT domain are occupations, client factors, performance
skills, performance patterns, and context and environment (Fig.
1.1). In the first two editions of the Framework, activity demands
constituted a sixth category in the domain. However, in the
OTPF-3, it was removed from that position and “placed in the
overview of the process to augment the discussion of the occu-
pational therapy practitioner’s basic skill of activity analysis”3
(OTPF-3, p. S2). The developers of the OTPF-3 pointed out that
there is a complex interplay among all of these areas or aspects
of the domain, that no single part is more critical than another,
and that all aspects are viewed as influencing engagement in
occupations. Furthermore, the success of the OT process (eval-
uation, intervention, and targeted outcomes) is incumbent on
the occupational therapist’s expert knowledge of all aspects
of the domain. The expert practice of occupational therapy
requires the therapeutic use of self, clinical reasoning (knowl-
edge of theory and evidence), and skills in activity analysis and
activity demands to create the overview that guides each step of
the process.
Occupations
Occupational therapists frequently use the terms occupation
and activity interchangeably. In the Framework, the term

The revised Frameworks (both the OTPF-2 and OTPF-3),

rather than adopting a single definition, used several definitions
found in the OT literature2,3 (OTPF-3, pp. S5–S6). The commit-
tee charged with producing the OTPF-3 ultimately suggested
that an array of selected definitions of the term occupation,
offered by the scholars of the profession, would add to an
understanding of this core concept (see OTPF-3, pp. S5–S6).3
In adopting the essence of these definitions, the developers of
the OTPF-3 characterized the profession’s focus on occupation
in a dynamic and action-oriented form, which they articulated
as “achieving health, well-being and participation in life through
engagement in occupation”3 (OTPF-3, p. S2). This phrase links
the two parts of the Framework, providing the unifying theme
or focus of the OT domain and the overarching target outcome FIG 1.1 Occupational therapy domain. (From the American
of the OT process—an inextricable linkage between domain Occupational Therapy Association: Occupational therapy prac-
and process that the authors of the OTPF-3 described as “trans- tice framework: domain and process, Am J Occup Ther March/
actional”3 (OTPF-3, p. S4). April[Suppl]:S4, 2014.)
 CHAPTER 1 The Occupational Therapy Practice Framework
occupation encompasses the term activity. Occupations may be
characterized as being meaningful and goal directed but not
necessarily considered by the individual to be of central impor-
tance to her or his life. Similarly, occupations may also be
viewed as (1) activities in which the client engages, (2) activities
that have the added qualitative criteria of giving meaning to the
person’s life and contributing to his or her identity, and (3)
activities the individual looks forward to engaging in. For
example, Karen, Kent’s client with quadriplegia, regards herself
as an excellent and dedicated clothes and accessories shopper;
holidays and celebrations always include her engagement in her
treasured occupation of shopping. Kent, on the other hand,
regards the activity of shopping for clothes as important only
to keep himself clothed and maintain social acceptance. Kent
avoids the activity whenever possible. Each engages in this activ-
ity to support participation in life but with a qualitatively dif-
ferent attitude and level of enthusiasm. In the OTPF-3, both of
these closely related terms are used, to recognize that individual
clients determine the occupations he or she regards as meaning-
ful and those that are simply necessary or are activities that
support the person’s participation in life. For Kent, shopping is
a necessary occupation or activity, but for Karen, it is a favorite
occupation.
The occupation category of the domain includes eight com-
prehensive types of human activities or occupations. Each is
outlined in the following discussion; a list of typical activities
included in each type is provided; and examples from the physi-
cal disability perspective, as provided by Karen’s circumstances,
are presented.
Performance Skills and Performance Patterns
Remember that throughout the OTPF-3 document, there is no
correct or incorrect order in which to study or follow the areas
of the domain—there is no hierarchy: “All aspects of the domain
transact to support achieving health, well-being, and participa-
tion in life through engagement in occupation”3 (OTPF-3,
p. S4). With this in mind, the next main areas of the domain to
consider are performance skills and performance patterns. Both
are related to the client’s performance capabilities in the areas
of occupation previously described, and they can be viewed
as the actions and behaviors observed by the occupational
therapist as the client engages in occupations.
The category of performance skills includes three compo-
nents of concern: motor skills, process skills, and social interac-
tion skills. The client’s successful engagement in occupation or
occupational performance depends on his or her having or
achieving adequate ability in performance skills. In the OTPF-3,
performance skills are defined as “observable elements of action
that have an implicit functional purpose; skills are considered
a classification for actions, encompassing multiple capacities
(body functions and bodily structures) and when combined,
underlie the ability to participate in the desired occupations and
activities”3 (OTPF-3, p. S25). Briefly, performance skills are the
abilities clients demonstrate in the actions they perform. Prob-
lems in any of the three areas of performance skills are the focus
for formulating short-term goals or objectives to reach the long-
term goal of addressing participation in occupation.
Motor skills consist of actions or behaviors a client uses to
move and physically interact with tasks, objects, contexts, and
environments, including planning, sequencing, and executing
new and novel movements. In Table 3 of the OTPF-3, motor
skills are defined as “occupational performance skills observed
5
as the person interacts with and moves task objects and self
around the task environment”7 (eg, activity of daily living
[ADL] motor skills, school motor skills). Examples of motor
skills include coordinating body movements to complete a job
task, anticipating or adjusting posture and body position in
response to environmental circumstances such as obstacles, and
manipulating keys or a lock to open a door.
Kent observed Karen as she played a game of bridge with
friends one afternoon in the OT clinic. Observing her perfor-
mance skills, particularly her motor skills, Kent noted that
Karen looped one elbow around the upright of her wheelchair,
leaned her trunk toward the table, reached her other arm toward
the cardholder, and successfully grasped a card, using tenodesis
grasp, after three unsuccessful attempts. Kent perceived this as
indicating that Karen felt the need to calibrate her attempts and
endure or persist (see Chapter 36).
The OTPF-3 defines process skills as “occupational perfor-
mance skills (eg, ADL process skills, school process skills)
observed as a person (1) selects, interacts with, and uses task
tools and materials; (2) carries out individual actions and steps;
and (3) modifies performance when problems are encoun-
tered.”7 Simply stated, process skills are observable actions taken
to manage and modify the occupational task; for example, using
knowledge, attending to and discerning solutions to problems
with, and organizing the task, including choosing appropriate
tools and methods for performing the task.
Kent also observed Karen’s process skills as she set up her
cardholder so that her cards were not visible to her opponents
(selecting and gathering proper equipment and arranging the
space), perused her cards, paused, rearranged them using her
tenodesis hand splint/orthotic device (attending to the task,
using knowledge of the rules of bridge, and selection of proper
equipment), and then stated her bid (demonstrating discern-
ment, choosing, and problem solving).
Social interaction skills, the third category of performance
skills, are “skills observed during the ongoing stream of a social
exchange.”7 These observable behaviors indicate how the client
conveys his or her intentions and needs and coordinates social
behavior to interact with people. Such skills could include
asking for information, expressing emotion, and interacting
with or relating to others in a manner that supports engagement
in the occupation at hand.
During the card game Kent was able to observe a wide array
of examples of Karen’s social interaction skills. He saw Karen
furrowing her brow; squinting her eyes shut in a thoughtful,
cogitating manner; pursing her lips; and showing neither hap-
piness nor despair on her face as she studied her cards in the
cardholder (expressing affect consistent with the activity of card
playing and thus demonstrating or displaying appropriate emo-
tions and cognitive skill in determining her next strategy). As
she reached for the cards, the holder moved out of her reach;
she turned and asked the friend next to her to push it back,
cautioning her in a smiling and light manner, “Don’t you dare
look!” (demonstrating her ability to multitask—asking for
assistance and simultaneously using socially acceptable teasing
behavior [social interaction skills] that enlists an opponent’s
cooperation in preserving the secrecy of her cards, thus convey-
ing or disclosing the image of a savvy card player). Her observ-
able performance skills supported Karen’s continued inclusion
with friends in a favorite leisure occupation.
Each of these particular motor skills, process skills, and social
interaction skills categories has detailed lists of representative
6 PART I Overview: Occupational Therapy Foundations for Physical Dysfunction
THREADED CASE STUDY
Kent and Karen, Part 2
As Kent perused the list of activities of daily living (ADLs) in Table 1 of
the OTPF-3, he noted that virtually every category, with the exception of
eating (which involves the ability to keep and manipulate food in the mouth
and the ability to swallow), would be a concern for his client, Karen,
because of the nature and extent of her SCI disability. When Kent dis-
cussed this list with Karen, she viewed practically all as necessary activi-
ties, but she personally valued feeding, sexual activity, and personal
hygiene and grooming as being extremely important to her satisfactory
participation in life. Karen was a little surprised to learn that sexual activity
was included. “So this is occupational therapy?” she thought. “Maybe I’ll
wait awhile before I talk about this topic, but it’s good to know I’m
expected to be interested.”
For the present, Karen turned her attention to and took particular interest
in the activities included in the personal hygiene and grooming category
and its detailed description:
Obtaining and using supplies, removing body hair (use of razors, tweez­
ers, lotions, etc.), applying and removing cosmetics, washing, drying,
combing, styling, brushing and trimming hair; caring for nails (hands and
feet), caring for skin, ears, eyes, and nose, applying deodorant, cleaning
mouth, brushing and flossing teeth; or removing, cleaning, and reinserting
dental orthotics and prosthetics3 (OTPF-3, p. S19).
The numerous details reminded her of how important all these groom-
ing activities were to her, and they indicated the scope of the daily activi-
ties she would like to address in OT. Of particular concern to Karen were
the grooming activities of plucking her eyebrows and styling her hair;
these were bodily care activities she regarded as very personal. In fact,
she was reluctant to let anyone do these for her. Although under similar
circumstances Kent might have gladly deferred these two ADLs, it was
clear that Karen would prioritize them as personally meaningful occupa-
tional goals.
In studying the list of ADLs, Kent noted that, just like personal hygiene
and grooming, each ADL item listed had a similarly helpful definition and
detailed list of examples in the tables throughout the OTPF-3 document.
He remembered reading that these lists were provided to give a few
examples, that they were not to be considered exhaustive, and in fact,
that there was an expectation that the lists would be modified and
expanded on as the Framework became more familiar and integrated into
practice.
ADLs (also referred to as personal activities of daily living [PADLs]
or basic activities of daily living [BADLs]) are activities that have to do
with accomplishing one’s own personal body care. The body care activi-
ties included in the ADL category are bathing/showering, toileting and
toileting hygiene, dressing, swallowing/eating, feeding, functional mobil-
ity, personal device care, personal hygiene and grooming, and sexual
activity.
Instrumental activities of daily living (IADLs) are “activities to support
daily life within the home and community that often require more complex
interactions than those used in ADLs”3 (OTPF-3, p. S19). The specific
IADLs included in the domain are care of others (including selecting and
supervising caregivers), care of pets, childrearing, communication man-
agement, driving and community mobility, financial management, health
management and maintenance, home establishment and management,
meal preparation and cleanup, religious and spiritual activities and expres-
sion, safety and emergency maintenance, and shopping.
Knowing that the IADL shopping was certain to be a priority occupation
for Karen, Kent made a note of the full description of shopping from the
corresponding lists of IADLs in Table 1 of the OTPF-3. Shopping is
described there as “Preparing shopping lists (grocery and other); select-
ing, purchasing, and transporting items; selecting method of payment and
completing money transactions; included are Internet shopping and
related use of electronic devices such as computers, cell phones and
tablets”3 (OTPF-3, p. S20). This is not as detailed as some descriptions,
but it is a good start for looking at the related activities that would have
to be addressed if Kent and Karen were to collaborate on Karen’s resump-
tion of engagement in shopping. Kent also noted that the occupation
category of driving and community mobility included both driving and the
use of public transportation, another IADL that would be important to
explore with Karen as she contemplates returning to paid work. In fact,
the entire list of IADLs held numerous concerns to be addressed in OT.
Rest and sleep, recognized as an occupation in the OTPF-3, “includes
activities related to obtaining restorative rest and sleep to support healthy,
active engagement in other occupations”3 (OTPF-3, p. S20). The compo-
nent activities constituting rest and sleep include rest, sleep preparation,
and sleep participation (see Chapter 13 for an expanded discussion of this
important occupation). Karen’s sleep occupations will be significantly
changed as a result of her diagnosis. To name just two of the concerns
OT will have to address, she will need to be repositioned frequently during
the night for skin precautions, and equipment will have to be set up to
manage her bladder function while she sleeps.
Education is an occupation that includes “activities needed for learning
and participating in the environment”3 (OTPF-3, p. S20). Specific education
activity subcategories include formal education participation, informal per-
sonal educational needs or interests exploration (beyond formal educa-
tion), and informal personal education participation. Table 1 of the OTPF-3
includes more details about the specific activities in each of these
subcategories.
Work includes activities associated with both paid work and volunteer
efforts (see Chapter 14). Specific categories of activities and concerns
related to the occupation of work include employment interests and
pursuits, employment seeking and acquisition, job performance, retire-
ment preparation and adjustment, volunteer exploration, and volunteer
participation3 (OTPF-3, pp. S20–S21).
Activities associated with the occupation play are described as “any
spontaneous or organized activity that provides enjoyment, entertainment,
amusement, or diversion.”19 Considered under this area of occupation are
play exploration and play participation3 (OTPF-3, p. S21).
Leisure is defined as “nonobligatory activity that is intrinsically motivated
and engaged in during discretionary time, that is, time not committed to
obligatory occupations such as work, self-care or sleep.”19 Leisure explora-
tion and leisure participation are the major categories of activity in leisure
occupations3 (OTPF-3, p. S21) (see Chapter 16). Karen shared with Kent
her interests in spending leisure time listening to music, traveling, antiqu-
ing, swimming, playing bridge, and reading books. As Kent was studying
the description of leisure, it occurred to him that for Karen, shopping might
be characterized as a leisure occupation in addition to an IADL. It probably
would depend on the circumstances or context in which she engaged in
the shopping, he thought—another parameter of the OTPF-3 domain he
would be learning.
Social participation is another occupation that encompasses the “inter-
weaving of occupations to support desired engagement in community and
family activities as well as those involving peers and friends7; also, involve-
ment in a subset of activities that involve social situations with others5
and that support social interdependence.7 Social participation can occur in
person or through remote technologies, such as telephone calls, computer
interaction, and video conferencing”3 (OTPF-3, p. S21). The occupation of
social participation further encompasses engaging in activities that result
in successful interaction at the community, family, and peer/friend levels.
(Just as for previously discussed occupations, see the OTPF-3, Table 1,
for definitions and more detailed information about the breadth of activi-
ties that constitute OT’s involvement in work, play, leisure, and social
participation.)
Like Kent, readers currently learning the OTPF-3 could benefit from
studying the expanded lists to broaden their understanding of the OT
domain. As Kent studied these sections of Table 1, he found it helpful to
make note of the content of each one that included specific activities that
would be relevant to Karen when she engaged in the occupations. For
example, Kent considered the range of job skills and work routines neces-
sary for Karen to return to her paid position as an administrative assistant.
He also made a list of similar concerns involved in resumption of her
preferred play and leisure occupations, including swimming, reading, and
board games. Kent was reminded of the importance of considering the
activities that can support or constrain Karen’s continued social participa-
tion in her community as a Girl Scout leader, in her family as the oldest
daughter, and with her treasured circle of friends.
 CHAPTER 1 The Occupational Therapy Practice Framework
skills annotated with definitions, descriptions, and examples
(see OTPF-3, Table 3).3
Performance patterns are observable patterns of behavior
that support or constrain the client’s engagement in occupation.
Types or categories of patterns include habits, routines, roles,
and rituals. In the OTPF-3, the habits of an individual are
described as “automatic behavior that is integrated into more
complex patterns that enable people to function on a day-to-
day basis”3; they can be “useful, dominating, or impoverished
and either support or interfere with performance in areas of
occupation”3 (OTPF-3, p. S27). Examples of habits listed in
Table 4 of the OTPF-3 include automatically putting car keys
in the same place and spontaneously looking both ways before
crossing the street3 (OTPF-3, p. S27). Routines reflect the “pat-
terns of behavior that are observable, regular, repetitive, and
that provide structure for daily life. Furthermore, routines can
be satisfying, promoting, or damaging. Routines require
momentary time commitment and are embedded in cultural
and ecological contexts”3 (OTPF-3, p. S27). Routines show how
the individual configures or sequences occupations throughout
his or her daily life. Habits typically contribute (positively or
negatively) to a person’s occupational routines, and both are
established with repetition over time. The role category of per-
formance patterns is regarded as being composed of “sets of
behaviors expected by society, shaped by culture, and may be
further conceptualized and defined by the client”3 (OTPF-3,
p. S27). Rituals are described as “symbolic actions with spiritual,
cultural, or social meaning, contributing to the client’s identity
and reinforcing values and beliefs. Rituals have a strong affective
component and represent a collection of events”3 (OTPF-3,
p. S27). Table 4 of the OTPF-3 outlines definitions and exam-
ples of performance patterns for organizations and populations
(OTPF-3, p. S27).
Performance patterns for the individual, and the ways these
can support (or, by inference, hinder) occupational perfor-
mance, are further illustrated in Part 3 of the Kent and Karen
case study.
Contexts and Environments
The OTPF-3 states that a “client’s engagement in occupation
takes place within a social and physical environment situated
within context.”3 Environment “refers to the external physical
and social conditions that surround the client and in which the
client’s daily life occupations occur”3 (OTPF-3, p. S28). The
physical environment includes the natural and the constructed,
nonhuman environments and the objects in them, and the
social environment that encompasses the presence, relation-
ships, and expectations of persons, groups, and organizations
with whom the client has contact”3 (OTPF-3, p. S28). Contexts
are regarded as the variety of interrelated conditions, circum-
stances, or events that surround and influence the client and in
which the client’s daily life occupations take place. Contexts can
either support or constrain health, well-being, and participation
in life through engagement in occupation. In the OTPF-3
domain, contexts are composed of four categories, or types:
cultural, personal, temporal, and virtual. One of the categories
of context is regarded as external to the individual (ie, the
virtual context); some are viewed as internal to the client (eg,
personal context). Some contexts, such as culture, provide an
external expectation of behavior that is often converted into an
internal belief. Table 5 in the OTPF-3 provides detailed defini-
tions and examples of each of these categories. For example, the
7
THREADED CASE STUDY
Kent and Karen, Part 3
Some might view Karen’s engagement in the occupation of paid work
as an example of the role of worker. Inherent in this role are accepted
norms that customarily include regular attendance, timely adherence to
schedules, and acceptance of responsibility for completing assign-
ments. Karen’s work role is consistent with the sets of behaviors that
would be expected of an administrative assistant at a busy law firm,
including arriving at work on time, handling e-mail and other correspon-
dence in a professional manner, managing the office budget and payroll
according to accepted audit practices, and interacting with her supervi-
sors, co-workers, and supervisees in a fair and respectful manner, to
name just a few. In tribute to her stellar work performance, a ritual that
has evolved as part of Karen’s work role experience at the law office is
the annual Holiday Shopping Day. Karen and her three administrative
assistant colleagues are given the Friday before the holiday off with pay.
A town car picks them up at their homes and transports them to the
downtown shopping district, where they are given a generous gift card,
a spa morning, lunch at a downtown restaurant, an afternoon of shop-
ping, and town car transportation home at the end of the day.
Karen’s workday routine involves waking at 6:30 am; showering,
grooming, and dressing; driving to work, with a stop for breakfast on
the way; and arriving at her workplace early (at 7:45 am) for an 8:00 am
expected work start. A habit that Karen regards as beneficial to her
workday routine is her scrupulous use of her day planner to record
appointments, phone numbers, and additions to her things-to-do list.
Another habit she believes contributes to the success of her workday
routine is selecting her clothes the night before to save time in the
morning, thus ensuring a punctual arrival at work. A habit that negatively
affects her daily work routine is hitting the snooze button on her cell
phone clock app. Both Kent and Karen recognize that although Karen
may resume her work occupation or worker role, her SCI has substan-
tially altered her ability to carry out expected behaviors and her custom-
ary habits and routines; she will have to develop the ability to establish
new and expanded habits and routines. Successful integration of these
new habits and routines will undoubtedly determine the continuation of
Karen’s participation in the highly anticipated and beloved Holiday Shop-
ping Day ritual.
Karen’s occupational performance, performance skills, and patterns
will be significantly influenced by the next two main areas of the domain
to be discussed: contexts and environments, and client factors.
category of context labeled “personal” context describes “fea-
tures of the individual that are not part of the health status”3
(OTPF-3, p. S28). Personal context includes age, gender, socio-
economic status, and educational status; it also can include
group membership (eg, volunteers, employees) and population
membership (eg, members of society)3 (OTPF-3, p. S28).
Each of these contexts and environments, as they pertain to
Karen’s specific circumstances, will significantly affect her future
engagement in occupation. Karen’s physical environment
includes aspects that will support her engagement in occupa-
tion, including an accessible work site; a reliable and accessible
system of public transportation in her neighborhood; and a
well-appointed downtown area of stores, shops, and restaurants
within wheelchair distance. Aspects of her physical environ-
ment that may interfere with resumption of occupations include
Karen’s second floor apartment and small bathroom, which are
inaccessible to a wheelchair. Supportive aspects of Karen’s per-
sonal context are her college education in business and the fact
that she has unemployment insurance, which will supplement
her sick leave and continue her health coverage. From a social
environment perspective, Karen is supported both by her family
Another random document with
no related content on Scribd:
with . As will be seen, the latter condition will be satisfied for all
the electrons in the atoms of elements of low atomic weight and for a
greater part of the electrons contained in the atoms of the other
elements.
If the velocity of the electrons is not small compared with the
velocity of light, the constancy of the angular momentum no longer
involves a constant ratio between the energy and the frequency of
revolution. Without introducing new assumptions, we cannot therefore
in this case determine the configuration of the systems on the basis
of the considerations in Part I. Considerations given later suggest,
however, that the constancy of the angular momentum is the principal
condition. Applying this condition for velocities not small compared
with the velocity of light, we get the same expression for as that
given by (1), while the quantity in the expressions for and is
replaced by and in the expression for by

As stated in Part I., a calculation based on the ordinary mechanics

gives the result, that a ring of electrons rotating round a positive
nucleus in general is unstable for displacements of the electrons in
the plane of the ring. In order to escape from this difficulty, we have
assumed that the ordinary principles of mechanics cannot be used in
the discussion of the problem in question, any more than in the
discussion of the connected problem of the mechanism of binding of
electrons. We have also assumed that the stability for such
displacements is secured through the introduction of the hypothesis
of the universal constancy of the angular momentum of the electrons.
As is easily shown, the latter assumption is included in the
condition of stability in §1. Consider a ring of electrons rotating round
a nucleus, and assume that the system is in dynamical equilibrium
and that the radius of the ring is , the velocity of the electrons
the total kinetic energy , and the potential energy . As shown in
Part I. (p. 21) we have . Next consider a configuration of
the system in which the electrons, under influence of extraneous
forces, rotate with the same angular momentum round the nucleus in
a ring of radius . In this case we have , and on

account of the uniformity of the angular momentum and

. Using the relation , we get

We see that the total energy of the new configuration is greater than
in the original. According to the condition of stability in §1 the system
is consequently stable for the displacement considered. In this
connexion, it may be remarked that in Part I. we have assumed that
the frequency of radiation emitted or absorbed by the systems cannot
be determined from the frequencies of vibration of the electrons, in
the plane of the orbits, calculated by help of the ordinary mechanics.
We have, on the contrary, assumed that the frequency of the radiation
is determined by the condition , where is the frequency,
Planck’s constant, and the difference in energy corresponding to
two different “stationary” states of the system.
In considering the stability of a ring of electrons rotating round a
nucleus for displacements of the electrons perpendicular to the plane
of the ring, imagine a configuration of the system in which the
electrons are displaced by , ,.... , respectively, and
suppose that the electrons, under influence of extraneous forces,
rotate in circular orbits parallel to the original plane with the same
radii and the same angular momentum round the axis of the system
as before. The kinetic energy is unaltered by the displacement, and
neglecting powers of the quantities , .... , higher than the
second, the increase of the potential energy of the system is given by
where is the radius of the ring, the charge on the nucleus, and
the number of electrons. According to the condition of stability in §1
the system is stable for the displacements considered, if the above
expression is positive for arbitrary values of ,.... . By a simple
calculation it can be shown that the latter condition is equivalent to
the condition

where denotes the whole number (smaller than ) for which

has its smallest value. This condition is identical with the condition of
stability for displacements of the electrons perpendicular to the plane
of the ring, deduced by help of ordinary mechanical
considerations[28].
A suggestive illustration is obtained by imagining that the
displacements considered are produced by the effect of extraneous
forces acting on the electrons in a direction parallel to the axis of the
ring. If the displacements are produced infinitely slowly the motion of
the electrons will at any moment be parallel to the original plane of
the ring, and the angular momentum of each of the electrons round
the centre of its orbit will obviously be equal to its original value; the
increase in the potential energy of the system will be equal to the
work done by the extraneous forces during the displacements. From
such considerations we are led to assume that the ordinary
mechanics can be used in calculating the vibrations of the electrons
perpendicular to the plane of the ring—contrary to the case of
vibrations in the plane of the ring. This assumption is supported by
the apparent agreement with observations obtained by Nicholson in
his theory of the origin of lines in the spectra of the solar corona and
stellar nebulæ (see Part I. pp. 6 & 23). In addition it will be shown
later that the assumption seems to be in agreement with experiments
on dispersion.
The following table gives the values of and from
to .
, , ; , ,
1 0 0 9 3.328 13.14
2 0.25 0.25 10 3.863 18.13
3 0.577 0.58 11 4.416 23.60
4 0.957 1.41 12 4.984 30.82
5 1.377 2.43 13 5.565 38.57
6 1.828 4.25 14 6.159 48.38
7 2.305 6.35 15 6.764 58.83
8 2.805 9.56 16 7.379 71.85
We see from the table that the number of electrons which can
rotate in a single ring round a nucleus of charge increases only
very slowly for increasing ; for the maximum value is
; for , ; for , . We see, further,
that a ring of electrons cannot rotate in a single ring round a
nucleus of charge ne unless .
In the above we have supposed that the electrons move under the
influence of a stationary radial force and that their orbits are exactly
circular. The first condition will not be satisfied if we consider a
system containing several rings of electrons which rotate with
different frequencies. If, however, the distance between the rings is
not small in comparison with their radii, and if the ratio between their
frequencies is not near to unity, the deviation from circular orbits may
be very small and the motion of the electrons to a close
approximation may be identical with that obtained on the assumption
that the charge on the electrons is uniformly distributed along the
circumference of the rings. If the ratio between the radii of the rings is
not near to unity, the conditions of stability obtained on this
assumption may also be considered as sufficient.
We have assumed in §1 that the electrons in the atoms rotate in
coaxial rings. The calculation indicates that only in the case of
systems containing a great number of electrons will the planes of the
rings separate; in the case of systems containing a moderate number
of electrons, all the rings will be situated in a single plane through the
nucleus. For the sake of brevity, we shall therefore here only consider
the latter case.
Let us consider an electric charge uniformly distributed along
the circumference of a circle of radius .
At a point distant from the plane of the ring, and at a distance
from the axis of the ring, the electrostatic potential is given by

Putting in this expression and , and using the

notation

we get for the radial force exerted on an electron in a point in the

plane of the ring

where
 The corresponding force perpendicular to the plane of the ring at a
distance from the centre of the ring and at a small distance from
its plane is given by

where

A short table of the functions and is given on p. 35.

Next consider a system consisting of a number of concentric rings
of electrons which rotate in the same plane round a nucleus of charge
. Let the radii of the rings be , ,...., and the number of
electrons on the different rings , ,....

Putting , we get for the radial force acting on an

electron in the th ring where

the summation is to be taken over all the rings except the one
considered.
If we know the distribution of the electrons in the different rings,
from the relation (1) on p. 28, we can, by help of the above,
determine , , .... The calculation can be made by successive
approximations, starting from a set of values for the ’s, and from
them calculating the ’s, and then redetermining the ’s by the
relation (1) which gives , and so on.

As in the case of a single ring it is supposed that the systems are

stable for displacements of the electrons in the plane of their orbits. In
a calculation such as that on p. 30., the interaction of the rings ought
strictly to be taken into account. This interaction will involve that the
quantities are not constant, as for a single ring rotating round a
nucleus, but will vary with the radii of the rings; the variation in ,
however, if the ratio between the radii of the rings is not very near to
unity, will be too small to be of influence on the result of the
calculation.
Considering the stability of the systems for a displacement of the
electrons perpendicular to the plane of the rings, it is necessary to
distinguish between displacements in which the centres of gravity of
the electrons in the single rings are unaltered, and displacements in
which all the electrons inside the same ring are displaced in the same
direction. The condition of stability for the first kind of displacements
is given by the condition (5) on p. 31., if for every ring we replace

by a quantity , determined by the condition that is equal to

the component perpendicular to the plane of the ring of the force—
due to the nucleus and the electrons in the other rings—acting on one
of the electrons if it has received a small displacement . Using the
same notation as above, we get

If all the electrons in one of the rings are displaced in the same
direction by help of extraneous forces, the displacement will produce
corresponding displacements of the electrons in the other rings; and
this interaction will be of influence on the stability. For example,
consider a system of concentric rings rotating in a plane round a
nucleus of charge , and let us assume that the electrons in the
different rings are displaced perpendicular to the plane by , ,....
respectively. With the above notation the increase in the
potential energy of the system is given by
The condition of stability is that this expression is positive for arbitrary
values of ,.... . This condition can be worked out simply in the
usual way. It is not of sensible influence compared with the condition
of stability for the displacements considered above, except in cases
where the system contains several rings of few electrons.
The following Table, containing the values of and for
every fifth degree from to , gives an estimate of
the order of magnitude of these functions:—

20 0.132 0.001 0.002

25 0.011
30 0.333 0.021 0.048
35 0.490 0.080 0.217
40 0.704 0.373 1.549
45 1.000 ......... .........
50 1.420 1.708 4.438
55 2.040 1.233 1.839
60 3.000 1.093 1.301
65 4.599 1.037 1.115
70 7.548 1.013 1.041

indicates the ratio between the radii of the rings

. The values of show that unless the ratio of
the radii of the rings is nearly unity the effect of outer rings on the
dimensions of inner rings is very small, and that the corresponding
effect of inner rings on outer is to neutralize approximately the effect
of a part of the charge on the nucleus corresponding to the number of
electrons on the ring. The values of show that the effect of
outer rings on the stability of inner—though greater than the effect on
the dimensions—is small, but that unless the ratio between the radii
is very great, the effect of inner rings on the stability of outer is
considerably greater than to neutralize a corresponding part of the
charge of the nucleus.
The maximum number of electrons which the innermost ring can
contain without being unstable is approximately equal to that
calculated on p. 32. for a single ring rotating round a nucleus. For the
outer rings, however, we get considerably smaller numbers than
those determined by the condition (5) if we replace by the total
charge on the nucleus and on the electrons of inner rings.
If a system of rings rotating round a nucleus in a single-plane is
stable for small displacements of the electrons perpendicular to this
plane, there will in general be no stable configurations of the rings,
satisfying the condition of the constancy of the angular momentum of
the electrons, in which all the rings are not situated in the plane. An
exception occurs in the special case of two rings containing equal
numbers of electrons; in this case there may be a stable configuration
in which the two rings have equal radii and rotate in parallel planes at
equal distances from the nucleus, the electrons in the one ring being
situated just opposite the intervals between the electrons in the other
ring. The latter configuration, however, is unstable if the configuration
in which all the electrons in the two rings are arranged in a single ring
is stable.

§3. Constitution of Atoms containing very few Electrons.

As stated in §1, the condition of the universal constancy of the

angular momentum of the electrons, together with the condition of
stability, is in most cases not sufficient to determine completely the
constitution of the system. On the general view of formation of atoms,
however, and by making use of the knowledge of the properties of the
corresponding elements, it will be attempted, in this section and the
next, to obtain indications of what configurations of the electrons may
be expected to occur in the atoms. In these considerations we shall
assume that the number of electrons in the atom is equal to the
number which indicates the position of the corresponding element in
the series of elements arranged in order of increasing atomic weight.
Exceptions to this rule will be supposed to occur only at such places
in the series where deviation from the periodic law of the chemical
properties of the elements are observed. In order to show clearly the
principles used we shall first consider with some detail those atoms
containing very few electrons.
For sake of brevity we shall, by the symbol , refer
to a plane system of rings of electrons rotating round a nucleus of
charge satisfying the condition of the angular momentum of the
electrons with the approximation used in §2. , ,... are the
numbers of electrons in the rings, starting from inside. By , ,...
and , ,... we shall denote the radii and frequency of the rings
taken in the same order. The total amount of energy emitted by
the formation of the system shall simply be denoted by
.

N=1. Hydrogen.
In Part I. we have considered the binding of an electron by a
positive nucleus of charge , and have shown that it is possible to
account for the Balmer spectrum of hydrogen on the assumption of
the existence of a series of stationary states in which the angular
momentum of the electron round the nucleus is equal to entire
multiples of the value , where is Planck’s constant. The formula
found for the frequencies of the spectrum was

where and are entire numbers. Introducing the values for , ,

and used on p. 29, we get for the factor before the bracket
[29]; the value observed for the constant in the Balmer
spectrum is .
For the permanent state of a neutral hydrogen atom we get from
the formula (1) and (2) in §2, putting
These values are of the order of magnitude to be expected. For
we get , which corresponds to ; the value for the
ionizing potential of a hydrogen atom, calculated by Sir J. J. Thomson
from experiments on positive rays, is [30]. No other definite
data, however, are available for hydrogen atoms. For sake of brevity,
we shall in the following denote the values for , , and
corresponding to the configuration by , and .
At distances from the nucleus, great in comparison with , the
system will not exert sensible forces on free electrons. Since,
however, the configuration:

corresponds to a greater value for than the configuration , we

may expect that a hydrogen atom under certain conditions can
acquire a negative charge. This is in agreement with experiments on
positive rays. Since is only , a hydrogen atom cannot be
expected to be able to acquire a double negative charge.

N=2. Helium.
As shown in Part I., using the same assumptions as for hydrogen,
we must expect that during the binding of an electron by a nucleus of
charge a spectrum is emitted, expressed by
 This spectrum includes the spectrum observed by Pickering in the
star Puppis and the spectra recently observed by Fowler in
experiments with vacuum tubes filled with a mixture of hydrogen and
helium. These spectra are generally ascribed to hydrogen.
For the permanent state of a positively charged helium atom, we
get

At distances from the nucleus great compared with the radius of

the bound electron, the system will, to a close approximation, act
on an electron as a simple nucleus of charge . For a system
consisting of two electrons and a nucleus of charge , we may
therefore assume the existence of a series of stationary states in
which the electron most lightly bound moves approximately in the
same way as the electron in the stationary states of a hydrogen atom.
Such an assumption has already been used in Part I. in an attempt to
explain the appearance of Rydberg’s constant in the formula for the
line-spectrum of any element. We can, however, hardly assume the
existence of a stable configuration in which the two electrons have
the same angular momentum round the nucleus and move in different
orbits, the one outside the other. In such a configuration the electrons
would be so near to each other that the deviations from circular orbits
would be very great. For the permanent state of a neutral helium
atom, we shall therefore adopt the configuration

Since

we see that both electrons in a neutral helium atom are more firmly
bound than the electron in a hydrogen atom. Using the values on p.
38, we get
these values are of the same order of magnitude as the value
observed for the ionization potential in helium, assume[31],
and the value for the frequency of the ultra-violet absorption in helium
determined by experiments on dispersion [32].

The frequency in question may be regarded as corresponding to

vibrations in the plane of the ring (see p. 30). The frequency of
vibration of the whole ring perpendicular to the plane, calculated in
the ordinary way (see p. 32), is given by . The fact that
the latter frequency is great compared with that observed might
explain that the number of electrons in a helium atom, calculated by
help of Drude’s theory from the experiments on dispersion, is only
about two-thirds of the number to be expected. (Using
the value calculated is .)

For a configuration of a helium nucleus and three electrons, we

get

Since for this configuration is smaller than for the configuration

, the theory indicates that a helium atom cannot acquire a
negative charge. This is in agreement with experimental evidence,
which shows that helium atoms have no “affinity” for free
electrons[33].
In a later paper it will be shown that the theory offers a simple
explanation of the marked difference in the tendency of hydrogen and
helium atoms to combine into molecules.

N=3. Lithium.
In analogy with the cases of hydrogen and helium we must expect
that during the binding of an electron by a nucleus of charge ,a
spectrum is emitted, given by

On account of the great energy to be spent in removing all the

electrons bound in a lithium atom (see below) the spectrum
considered can only be expected to be observed in extraordinary
cases.
In a recent note Nicholson[34] has drawn attention to the fact that
in the spectra of certain stars, which show the Pickering spectrum
with special brightness, some lines occur the frequencies of which to
a close approximation can be expressed by the formula

where is the same constant as in the Balmer spectrum of

hydrogen. From analogy with the Balmer- and Pickering-spectra,
Nicholson has suggested that the lines in question are due to
hydrogen.
It is seen that the lines discussed by Nicholson are given by the
above formula if we put . The lines in question correspond to
; if we for put , we
get lines coinciding with lines of the ordinary Balmer-spectrum of
hydrogen. If we in the above formula put , we get
series of lines in the ultra-violet. If we put we get only a single
line in visible spectrum, viz.: for which gives
, or a wave-length closely
coinciding with the wave-length of one of the lines
of unknown origin in the table quoted by Nicholson. In this table,
however, no lines occur corresponding to .
For the permanent state of a lithium atom with two positive
charges we get a configuration
 The probability of a permanent configuration in which two
electrons move in different orbits around each other must for lithium
be considered still less probable than for helium, as the ratio between
the radii of the orbits would be still nearer to unity. For a lithium atom
with a single positive charge we shall, therefore, adopt the
configuration:

Since , we see that the first two

electrons in a lithium atom are very strongly bound compared with the
electron in a hydrogen atom; they are still more rigidly bound than the
electrons in a helium atom.
From a consideration of the chemical properties we should expect
the following configuration for the electrons in a neutral lithium atom:

This configuration may be considered as highly probable also

from a dynamical point of view. The deviation of the outermost
electron from a circular orbit will be very small, partly on account of
the great values of the ratio between the radii, and of the ratio
between the frequencies of the orbits of the inner and outer electrons,
partly also on account of the symmetrical arrangement of the inner
electrons. Accordingly, it appears probable that the three electrons
will not arrange themselves in a single ring and form the system:

although for this configuration is greater than for .

 Since , we see that the outer
electron in the configuration is bound even more lightly than the
electron in a hydrogen atom. The difference in the firmness of the
binding corresponds to a difference of in the ionization
potential. A marked difference between the electron in hydrogen and
the outermost electron in lithium lies also in the greater tendency of
the latter electron to leave the plane of the orbits. The quantity
considered in §2, which gives a kind of measure for the stability for
displacements perpendicular to this plane, is thus for the outer
electron in lithium only , while for hydrogen it is . This may have
a bearing on the explanation of the apparent tendency of lithium
atoms to take a positive charge in chemical combinations with other
elements.
For a possible negatively charged lithium atom we may expect the
configuration:

It should be remarked that we have no detailed knowledge of the

properties in the atomic state, either for lithium or hydrogen, or for
most of the elements considered below.

N=4. Beryllium.
For reasons analogous to those considered for helium and lithium
we may for the formation of a neutral beryllium atom assume the
following stages:
although the configurations:

correspond to less values for the total energy than the configurations
and .
From analogy we get further for the configuration of a possible
negatively charged atom,

Comparing the outer ring of the atom considered with the ring of a
helium atom, we see that the presence of the inner ring of two
electrons in the beryllium atom markedly changes the properties of
the outer ring; partly because the outer electrons in the configuration
adopted for a neutral beryllium atom are more lightly bound than the
electrons in a helium atom, and partly because the quantity , which
for helium is equal to , for the outer ring in the configuration is
only equal to .
Since , the beryllium atom will
further have a definite, although very small affinity for free electrons.
 §4. Atoms containing greater numbers of electrons.

From the examples discussed in the former section it will appear

that the problem of the arrangement of the electrons in the atoms is
intimately connected with the question of the confluence of two rings
of electrons rotating round a nucleus outside each other, and
satisfying the condition of the universal constancy of the angular
momentum. Apart from the necessary conditions of stability for
displacements of the electrons perpendicular to the plane of the
orbits, the present theory gives very little information on this problem.
It seems, however, possible by the help of simple considerations to
throw some light on the question.
Let us consider two rings rotating round a nucleus in a single
plane, the one outside the other. Let us assume that the electrons in
the one ring act upon the electrons in the other as if the electric
charge were uniformly distributed along the circumference of the ring,
and that the rings with this approximation satisfy the condition of the
angular momentum of the electrons and of stability for displacements
perpendicular to their plane.
Now suppose that, by help of suitable imaginary extraneous
forces acting parallel to the axis of the rings, we pull the inner ring
slowly to one side. During this process, on account of the repulsion
from the inner ring, the outer will move to the opposite side of the
original plane of the rings. During the displacements of the rings the
angular momentum of the electrons round the axis of the system will
remain constant, and the diameter of the inner ring will increase while
that of the outer will diminish. At the beginning of the displacement
the magnitude of the extraneous forces to be applied to the original
inner ring will increase but thereafter decrease, and at a certain
distance between the plane of the rings the system will be in a
configuration of equilibrium. This equilibrium, however, will not be
stable. If we let the rings slowly return they will either reach their
original position, or they will arrive at a position in which the ring,
which originally was the outer, is now the inner, and vice versa.
 If the charge of the electrons were uniformly distributed along the
circumference of the rings, we could by the process considered at
most obtain an interchange of the rings, but obviously not a junction
of them. Taking, however, the discrete distribution of the electrons
into account, it can be shown that, in the special case when the
number of electrons on the two rings are equal, and when the rings
rotate in the same direction, the rings will unite by the process,
provided that the final configuration is stable. In this case the radii
and the frequencies of the rings will be equal in the unstable
configuration of equilibrium mentioned above. In reaching this
configuration the electrons in the one ring will further be situated just
opposite the intervals between the electrons in the other, since such
an arrangement will correspond to the smallest total energy. If now
we let the rings return to their original plane, the electrons in the one
ring will pass into the intervals between the electrons in the other, and
form a single ring. Obviously the ring thus formed will satisfy the
same condition of the angular momentum of the electrons as the
original rings.
If the two rings contain unequal numbers of electrons the system
will during a process such as that considered behave very differently,
and, contrary to the former case, we cannot expect that the rings will
flow together, if by help of extraneous forces acting parallel to the axis
of the system they are displaced slowly from their original plane. It
may in this connexion be noticed that the characteristic for the
displacements considered is not the special assumption about the
extraneous forces, but only the invariance of the angular momentum
of the electrons round the centre of the rings; displacements of this
kind take in the present theory a similar position to arbitrary
displacements in the ordinary mechanics.
The above considerations may be taken as an indication that
there is a greater tendency for the confluence of two rings when each
contains the same number of electrons. Considering the successive
binding of electrons by a positive nucleus, we conclude from this that,
unless the charge on the nucleus is very great, rings of electrons will
only join together if they contain equal numbers of electrons; and that
accordingly the numbers of electrons on inner rings will only be , ,
,.... If the charge of the nucleus is very great the rings of electrons
first bound, if few in number, will be very close together, and we must
expect that the configuration will be very unstable, and that a gradual
interchange of electrons between the rings will be greatly facilitated.
This assumption in regard to the number of electrons in the rings
is strongly supported by the fact that the chemical properties of the
elements of low atomic weight vary with a period of . Further, it
follows that the number of electrons on the outermost ring will always
be odd or even, according as the total number of electrons in the
atom is odd or even. This has a suggestive relation to the fact that the
valency of an element of low atomic weight always is odd or even
according as the number of the element in the periodic series is odd
or even.
For the atoms of the elements considered in the former section we
have assumed that the two electrons first bound are arranged in a
single ring, and, further, that the two next electrons are arranged in
another ring. If the configuration will correspond to a
smaller value for the total energy than the configuration . The
greater the value of the closer will the ratio between the radii of the
rings in the configuration approach unity, and the greater will
be the energy emitted by an eventual confluence of the rings. The
particular member of the series of the elements for which the four
innermost electrons will be arranged for the first time in a single ring
cannot be determined from the theory. From a consideration of the
chemical properties we can hardly expect that it will have taken place
before boron ( or carbon , on account of the
observed trivalency and tetravalency respectively of these elements;
on the other hand, the periodic system of the elements strongly
suggests that already in neon an inner ring of eight
electrons will occur. Unless the configuration
corresponds to a smaller value for the total energy than the
configuration ; already for the latter configuration,
however, will be stable for displacements of the electrons
perpendicular to the plane of their orbits. A ring of electrons will
not be stable unless is very great; but in such a case the simple
considerations mentioned above do not apply.