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Acknowledgment

Elizabeth Domholdt was the sole author of the first three editions of Rehabilitation
Research and author emerita of the fourth edition. We wish to express our gratitude to her
as this edition could not have been completed without her pioneering authorship. Her vision
in previous editions, her knowledge coupled with outstanding writing and organization, and
her ­commitment to bringing research principles and applications into the clinical milieu
were invaluable stepping stones as we fashioned the new edition. We sincerely hope that we
have enhanced her vision and labors.

Russell E. Carter, PT, EdD

Jay Lubinsky, PhD, CCC-A/SLP, ASHA Fellow

vii
 Contents

SECTION ONE SECTION SIX

Research Fundamentals Measurement
1 Rehabilitation Research, 1 18 Measurement Theory, 231
2 Theory in Rehabilitation Research, 11 19 Methodological Research, 249
3 Evidence-Based Practice, 23
SECTION SEVEN
4 Finding Research Literature, 33
Data Analysis
5 Research Ethics, 42
20 Statistical Reasoning, 259
SECTION TWO 21 Statistical Analysis of Differences:
Research Design The Basics, 281
6 Research Paradigms, 55 22 Statistical Analysis of Differences:
Advanced, 298
7 Variables, 68
23 Statistical Analysis of Relationships:
8 Research Validity, 76
The Basics, 318
9 Selection and Assignment of
24 Statistical Analysis of Relationships:
Participants, 92
Advanced, 329

SECTION THREE
SECTION EIGHT
Experimental Designs Being a Consumer of Research
10 Group Designs, 107
25 Evaluating Evidence One Article at a
11 Single-Subject Designs, 120 Time, 345
26 Synthesizing Bodies of Evidence, 363
SECTION FOUR
Nonexperimental Research for SECTION NINE
Rehabilitation
Implementing Research
12 Overview of Nonexperimental
27 Implementing a Research Project, 377
Research, 143
28 Publishing and Presenting
13 Clinical Case Reports, 153
Research, 399
SECTION FIVE Appendices
Research Beyond the Everyday
Appendix A: Random Numbers Table, 409
14 Qualitative Research, 159
Appendix B: Areas in One Tail of the Standard
15 Epidemiology, 176 Normal Curve, 414
16 Outcomes Research, 194 Appendix C: Questions for Narrative Evaluation of a
17 Survey Research, 215 Research Article, 415

viii
 Contents ix

Appendix D: Basic Guidelines for Preparing a Journal Appendix G: Sample Platform Presentation Script
Article Manuscript, 418 with Slides, 463
Appendix E: American Medical Association Style:
Sample Manuscript for a Hypothetical Index, 471
Study, 423
Appendix F: American Psychological Association
Style: Sample Manuscript for a
Hypothetical Study, 443
This page intentionally left blank
REHABILITATION
RESEARCH
Principles and Applications
This page intentionally left blank
 SECTION
ONE Research Fundamentals

CHAPTER
1
Rehabilitation Research

CHAPTER OUTLINE

Definitions of Research Barriers to Rehabilitation Research The Clinician-Researcher Dichotomy

Research Challenges the Status Quo
Research Is Creative
Research Is Systematic
Reasons for Developing
Rehabilitation Research
Develop Body of Knowledge
Determine Whether Interventions
Work
Improve Patient and Client Care
Lack of Funds
Lack of Research Mentors
Lack of Time
Lack of Familiarity with the Research
Process
Lack of Statistical Support
Ethical Concerns About Use of
Human Participants and
Animal Subjects
Overcoming Barriers
The Scientist-Practitioner
Status of Rehabilitation Research
Professional Association Goals
Research Publication Vehicles
Educational Standards
Research Funding
Summary

Rehabilitation professionals believe that the work we do
makes a difference in the lives of the people we serve.
Rehabilitation research is the means by which we test
that belief. In the rapidly changing and increasingly
accountable world of health care, it is no longer enough
to say that we do good work or to note that patients
or clients feel better after we’ve intervened. Rather, we
must be willing to search for, or even create, evidence
about the value of our practices and then modify those
practices in response to the evidence. Rehabilitation
professionals who embrace evidence-based practice also
embrace the challenge of learning about rehabilitation
research.
Learning about rehabilitation research involves
developing a diverse set of knowledge and skills in
research methodologies, research design, statistical and
qualitative analysis, presentation, and writing. At the
same time a practitioner or student is acquiring these
new skills, he or she is forced to reexamine the status
quo, the conventional wisdom of the rehabilitation
professions. This combination of trying to learn new
material while challenging previously held beliefs can
engender frustration with the new material and doubt
about previous learning. Some clinicians, unable to cope
with such uncertainty, retreat to anecdotes and intu-
ition as the basis for their work in rehabilitation. Others
delight in the intellectual stimulation of research and
commit themselves to developing an ­ evidence-based
practice. Such clinicians balance the use of existing
but unsubstantiated practices with critical evaluation
of those same practices through regular review of the
­professional literature and thoughtful discussion with
colleagues. Furthermore, these professionals may par-
ticipate in clinical research to test the assumptions
under which they practice.
This introductory chapter defines research, examines
reasons for and barriers to implementing rehabilitation
research, and considers the current status of rehabili-
tation research. Based on this foundation, the rest of
the book presents the principles needed to understand
research and suggests guidelines for the application of
those principles to rehabilitation research.

1
2 Section One n
Research Fundamentals
DEFINITIONS OF RESEARCH
Research has been defined by almost every person who
has written about it. Kettering, an engineer and philan-
thropist, had this to say:
“Research” is a high-hat word that scares a lot of peo-
ple. It needn’t; … it is nothing but a state of mind—a
friendly, welcoming attitude toward change.… It is
the problem-solving mind as contrasted with the let-
well-enough-alone mind. It is the composer mind
instead of the fiddler mind. It is the “tomorrow”
mind instead of the “yesterday” mind.1(p. 91)
We think his words, published in 1961, still ring true.
Payton, a physical therapist who has written widely
about research, indicates that “research should begin
with an intellectual itch that needs scratching.”2(p. 8)
Kazdin, a psychologist, speaks about various research
methods, noting that “they have in common careful
observation and systematic evaluation of the subject
matter.”3(p. 2) Portney and Watkins,4 Polit and Beck,5
Stein and colleagues,6 and Nelson,7 who have written
texts on clinical, nursing, occupational therapy, and
communication disorders research, respectively, all
emphasize the organized, systematic nature of research.
Three important characteristics about research emerge
from these different authors: (1) research challenges the
status quo, (2) it is creative, and (3) it is systematic.
Research Challenges the Status Quo
Definers of research all indicate it as a way of answering
questions. Thus, the first characteristic is that research
challenges the status quo. Sometimes the results of
research may support current clinical practices; other
times the results point to treatment techniques that
are not effective. But whether research does or does not
lead to a revision of currently accepted principles, the
guiding philosophy of research is one of challenge. Does
this treatment work? Is it more effective than another
treatment? Would this person recover as quickly with-
out intervention? The status quo can be challenged in
several ways, as illustrated in the three examples that
follow.
One way of challenging the status quo is to iden-
tify gaps in our knowledge—for example, to identify
common practices about which we know very little.
Because much of our practice as clinicians is based on
the collective wisdom of past professionals, we forget
that much of this practice has not been verified in a sys-
tematic way. However, we are increasingly in the pro-
cess of validating our clinical practices. Many clinicians,
professional associations, and scientists are engaged in
outcomes research (see Chapter 16). Emphasis and lit-
erature on evidence-based practice (see Chapter 3) con-
tinue to grow. The increasing number of meta-analyses
and critical reviews validates some of our clinical prac-
tices and challenges others (see Chapter 4). These recent
developments suggest a powerful research agenda for
rehabilitation providers.
Despite recent efforts, we continue many rehabilita-
tion practices about which few, if any, data exist. A sec-
ond approach to challenging the status quo, therefore,
is to systematically test the effects of these practices.
A third way of challenging the status quo is to test
novel or traditionally avoided treatments. Some exam-
ples of such treatments are (1) use of human magnetic
fields to manage pain8 and (2) application of sensory
integration training to a very wide variety of clinical
conditions.9–11
These examples of challenges to the status quo iden-
tified gaps in knowledge about rehabilitation practice,
may provide support for one set of clinical practices,
and suggest a need for review of another set of clinical
beliefs. Research is about embracing these kinds of chal-
lenges. It is about the willingness to test our assump-
tions, to use what works, and to change our practices in
light of new evidence.
Research Is Creative
The second characteristic of research is that it is cre-
ative. Rothstein, in an editorial, chastised physical ther-
apists for their willingness to accept authoritarian views
of their profession: “Our teachers and our texts tell us
how it should be, and we accept this in our eagerness
to proceed with patient care.”12(p. 895) Researchers are
creative individuals who move past the authoritarian
teachings of others and look at rehabilitation in a differ-
ent way. And, in at least a partial answer to Rothstein,
we note the increasing emphasis on evidence-based
practice and the emergence of the scientist-practitioner.
Virtually every piece of research is the product of a cre-
ative question.13 In any science, “the dualism between
science and creativity is unfounded.”14 “Why?” and
“Why not?” are core questions, as is, “What if …?”
Creative aspects of rehabilitation research are
emphasized in Chapter 2, which presents information
about the use of theory in practice and research, and
Chapter 4, which provides a framework for the devel-
opment of research problems.
Research Is Systematic
The third characteristic of research is that it is system-
atic. In contrast, much of our clinical knowledge is

anecdotal, or is passed on by prominent practitioners
who teach a particular treatment to eager colleagues
or students. As Hicks noted,… “after all, many of the
therapeutic techniques currently in practice have been
developed over the years and consequently are tried
and tested.”15(p. 3) Anecdotal claims for the effectiveness
of treatments are colored by the relationship between
the clinician and patient and typically do not control
for factors, other than the treatment, that may account
for changes in the condition of the patient or client.
The systematic nature of some research methodologies
attempts to isolate treatment effects from other influ-
ences not ordinarily controlled in the clinic setting.
Other methodologies focus on systematic description
of the phenomenon of interest, rather than control
of the research setting. Much of this text presents the
systematic principles that underlie research methods:
Sections 2 through 5 (Chapters 6 through 17) cover
research design, Section 6 (Chapters 18 and 19) dis-
cusses measurement tools, and Section 7 (Chapters 20
through 24) introduces data analysis.
REASONS FOR DEVELOPING
REHABILITATION RESEARCH
There are at least three reasons for conducting rehabili-
tation research: (1) to develop a body of knowledge for
the rehabilitation professions, (2) to determine whether
interventions work, and (3) to improve patient and cli-
ent care. Each of these reasons is examined in the sec-
tions that follow.
Develop Body of Knowledge
The “body of knowledge” rationale for rehabilitation
research is related to the concept of a profession. The
characteristics of a profession have been described by
many authors but include several common elements.
Houle16 divided the characteristics of a profession into
three broad groups: conceptual, performance, and collec-
tive identity characteristics (Box 1-1). One of the critical
performance characteristics is mastery of the theoretical
knowledge that forms the basis for the profession.
The theoretical foundations of the rehabilitation
professions, discussed further in Chapter 2, include
concepts such as occupation, disablement, and move-
ment science.
Although the knowledge base for our professions
has grown and continues to grow, rehabilitation pro-
fessionals and students still work to develop ways of
identifying important theoretical constructs as well as
ways of understanding them. Kinsella and Whiteford17
offer, as an example, a way of structuring the concept of
Chapter 1 n
Rehabilitation Research 3
Box 1-1
Characteristics of a Profession
Conceptual Characteristic
Establishment of a central mission
Performance Characteristics
Mastery of theoretical knowledge
Capacity to solve problems
Use of practical knowledge
Self-enhancement
Collective Identity Characteristics
Formal training
Credentialing
Creation of a subculture
Legal reinforcement
Public acceptance
Ethical practice
Penalties
Relations to other vocations
Relations to users of service
List developed from Houle CO. Continuing Learning in the
Professions. San Francisco, Calif: Jossey-Bass; 1981.
“evidence-based practice,” a concept that has achieved
widespread recognition. Kenyon and Blackinton applied
aspects of motor-control theory to a clinical case, further
integrating theory and the development of the knowl-
edge base for physical therapy.18 The search for defini-
tion and understanding of what may seem like basic
concepts is far from complete.
Determine Whether Interventions Work
The second major rationale we offer for performing
rehabilitation research relates to determining whether
interventions work.
The need for research on the effectiveness of
­rehabilitation interventions was highlighted by Brummel-
Smith19 when he summarized the research recommen-
dations of a National Institutes of Health Task Force
on Medical Rehabilitation Research and applied them
to rehabilitation of older adults. He noted four major
areas in need of study: the natural history of disabil-
ity, functional assessment and ­performance evaluation,
intervention issues, and rehabilitation service delivery.
In discussing intervention issues, he identified a need
both to “evaluate effectiveness of existing interventions
and to develop novel approaches to care,”19(p. 895) noting
that “current interventions have not received the type
4 Section One n
Research Fundamentals
of careful scrutiny that is now expected of medical inter-
ventions.”19(p. 895) More recently, the ­sentiment is sum-
marized by Hicks, who notes, “healthcare professionals
have an imperative to ensure that their clinical decisions
can be justified on empirical grounds …” and further
laments, “good quality research studies that address fun-
damental issues in care provision have not been as plen-
tiful as is either desirable or necessary.”15(p. vii)
Improve Patient and Client Care
The third reason for rehabilitation research is perhaps
the most important one: improving patient and cli-
ent care. This, of course, is not completely separate
from the reason of finding out whether our treatments
work. However, once we find out what works and what
does not, and under what circumstances, research can
improve care by helping clinicians make good decisions
about the use of existing practices or by providing sys-
tematic evaluation of the effectiveness of new practices.
When we know what has or has not been supported
by research, we can make intelligent, evidence-based
decisions about which clinical procedures to use with
our clients. Clinical research about these procedures
could provide additional evidence that would help
practitioners make informed decisions about recom-
mending the procedures.
Although there are many areas of rehabilitation prac-
tice for which evidence is thin, there are other areas in
which clinicians who are committed to ­evidence-based
practice can find a rich body of evidence on which
to base their work. Chapter 4 gives a hint about the
large and growing amount of literature available (and
how to find it) to rehabilitation scientist-­practitioners.
The increase in meta-analyses and critical reviews (see
Chapters 4 and 26) points to not only how much is avail-
able but also how useful it is. A search for meta-analyses
and critical reviews in the period 2009 through 2012 for
all journals related to physical therapy or occupational
therapy indexed in the CINAHL search engine (see
Chapter 4) yielded more than 16,000 results. Results of
the same search for speech-language pathology in the
same period yielded more than 11,000 results.
In addition to helping clinicians make judgments
about the use of existing treatments, research can be
used to test new procedures so that clinicians can make
evidence-based decisions about whether to add them
to their clinical repertoire. For example, body-weight–
supported treadmill ambulation, although established,
continues to undergo modifications in need of such
testing. In theory, body-weight–supported treadmill
ambulation should enable patients to improve their
ambulation function by training in a way that ensures
safety, does not require handheld assistive devices, uses
relatively normal gait patterns, and has reduced energy
demands when compared with unsupported walking.
A recent innovation included the use of robots to assist
with body-weight support.20 Clinicians with a good
knowledge base in research will be able to critically
evaluate this article to determine whether they can
apply the results to the clinical situations in which they
work. Chapters 25 and 26 present guidelines for evalu-
ating research literature.
BARRIERS TO REHABILITATION
RESEARCH
In 1975, Hislop, a physical therapist, articulated one
major philosophical barrier to research in the profession:
A great difficulty in developing the clinical science of
physical therapy is that we treat individual persons,
each of whom is made up of situations which are
unique and, therefore, appear incompatible with the
generalizations demanded by science.21(p. 1076)
Although this conceptual barrier may still loom large
for some practitioners, many more concrete obstacles
to rehabilitation research have been documented.22–24
These obstacles include lack of familiarity with research
methodology, lack of statistical support, lack of fund-
ing, lack of a mentor, and lack of time. An additional
obstacle is concern for ethical use of humans or ani-
mals in research activities. Although the cited authors’
comments go back several years, we think they are still
valid; given the economy and demand for productiv-
ity at the writing of this book, they may be even more
problematic than previously thought. However, this
book should help to overcome several of the obstacles,
particularly those pertaining to research methodology.
Lack of Funds
The scope of this text will not directly help in over-
coming lack of funding, although information in
Chapter 27 will help you gain access to funds that are
available. Funding, especially from public sources, is
largely a political process; we urge readers to take part
in that arena to advocate for research budgets.
Lack of Research Mentors
Another example is lack of research mentors.
Contemporary research is often done in teams. Ideally,
novice researchers would be invited by experienced
researchers to become members of working research
teams with ongoing projects, external funding, and

access to a network of colleagues engaged in similar
work. The importance of research mentors—and the
difficulty in finding them in the rehabilitation profes-
sions—has been discussed for several rehabilitation pro-
fessions.25–27 The picture is possibly made bleaker by the
documented shortage of research-prepared doctoral fac-
ulty in academic programs,28–30 and, at least at this writ-
ing, it is difficult to predict how the advent of required
entry-level professional (i.e., clinical) doctorates will
affect the situation. There may be at least one bright
light in the situation, however. Although the traditional
model of mentoring is that the mentor and protégé are
in the same institution, professional associations have
recently developed research-mentoring programs in
which the mentor and protégé are not necessarily in the
same institution, giving more flexibility to establishing
possible mentor-protégé relationships.31–33
Lack of Time
A third barrier difficult to overcome is lack of time.
Testa34 outlined six major factors that influence the
completion of research. Two of the six factors referred
to “time” directly, and two more (complexity and
funding) are indirectly related to the time that a
researcher has available to devote to the task. Hegde
noted, “Clinicians do not have the needed extra time
for research.”35(p. 10)
Indeed, it is difficult to separate the “time” issue from
the “funding” issue because a lack of external funding
generally limits the time available for research. In the
absence of external funding, tasks with firm deadlines
are given higher priority than research, and the imme-
diate time pressures of the clinic and classroom may
lead clinicians and academicians alike to postpone or
abandon research ideas. One solution is to design stud-
ies that are relatively easy to integrate into the daily
routine of a practice. Chapters 11, 13, and 16 present
a variety of research designs particularly suitable for
implementation in a clinical setting.
Despite these difficulties, there are barriers to
research that can be overcome, which are addressed
in this text. They include lack of familiarity with the
research process, lack of statistical support, ethical con-
cerns, and the clinician-researcher dichotomy.
Lack of Familiarity with the Research
Process
Clinicians sometimes view rehabilitation research as a
mysterious process that occupies the time of an elite
group of professionals, far removed from patient or
client care, who develop projects of little relevance to
Chapter 1 n
Rehabilitation Research 5
everyday practice. Although this characterization is a
caricature, and evidence exists of ways to implement
a research culture in a clinical environment,36 even the
most clinically grounded research uses the specialized
language of research design and data analysis, and those
who have not acquired the vocabulary are understand-
ably intimidated when it is spoken. One goal of this text
is to demystify the research process by clearly articulat-
ing the knowledge base needed to understand it.
Lack of Statistical Support
Another barrier we think can be overcome is lack of sta-
tistical support. Section 7 (Chapters 20 through 24) of
this book provides the conceptual background needed to
understand most of the statistics reported in the rehabil-
itation research literature.37,38 A conceptual background
does not, however, provide an adequate theoretical and
mathematical basis for selection and computation of a
given statistic on a particular occasion, particularly for
complex research designs. Thus, many researchers will
require the services of a statistician at some point in the
research process. Guidelines for working with statisti-
cians are provided in Chapter 27.
Ethical Concerns About Use of Human
Participants and Animal Subjects
Often, rehabilitation research is halted by ethical con-
cerns related to the use of either human participants
or animal subjects. Those who choose to study ani-
mal models should follow appropriate guidelines for
the use, care, and humane destruction of animal sub-
jects. Clinicians who use human participants in their
research must pay close attention to balancing the risks
of the research with potential benefits from the results.
Chapter 5 examines ethical considerations in detail;
Chapter 27 provides guidelines for working with the
committees that oversee researchers to ensure that they
protect the rights of research participants.
The Clinician-Researcher Dichotomy
Yet another barrier to research implementation is the
apparent and widely held belief that clinicians and
researchers have little in common. We refer to this as
the “clinician-researcher” dichotomy. The history of
this situation is a long one, especially in clinical psy-
chology, and accounts of its development are offered
by Hayes and associates39 and Merlo and colleagues.40
Hayes and associates offer two primary reasons for the
dichotomy: “(a) the almost universally acknowledged
inadequacies of traditional research methodology to
6 Section One n
Research Fundamentals
address issues important to practice and (b) the lack of a
clear link between empiricism and professional success
in the practice context.”39(p. 15) By “traditional research
methodologies,” the authors are referring to large-
scale group-data experiments, especially clinical trials.
Hegde also offers the doubt “regarding the extent to
which research affects day-to-day practice.”35(p. 10) Fago
confirms a “widening division between psychology’s
clinical investigators and clinical practitioners.”41(p. 15)
Bishop notes the “general consensus … that the transla-
tion of sport-science research to practice is poor.”42(p. 253)
Clearly, if clinicians do not think that they have much
in common with researchers (including time available,
research training, etc.) and that the research that is
completed has little applicability to their practice, the
production and even consumption of research is going
to be significantly curtailed.
Overcoming Barriers
Overcoming these barriers depends on leaders who are
willing to commit time and money to research efforts,
individuals who are willing to devote time and effort
to improving their research knowledge and skills, and
improved systems for training researchers and fund-
ing research. Cusick’s qualitative study of clinician-­
researchers underscores the importance of making
an individual commitment to becoming a researcher,
accepting responsibility for driving the research process,
and learning to negotiate the administrative and social
systems that make clinical research possible.43 Research
is, however, rarely an individual effort. Therefore, one
key to overcoming barriers to research is to develop pro-
ductive research teams composed of individuals who,
together, have all the diverse skills needed to plan,
implement, analyze, and report research. The different
rehabilitation professions are working to develop such
teams in different ways: the Foundation for Physical
Therapy in 2002 funded its first Clinical Research
Network, designed to increase research capacity in
physical therapy through collaborative arrangements
between academic and clinical sites44; and building
research capacity in the allied health professions has
been of interest to policy-making bodies in the United
States45 and the United Kingdom.46
The Scientist-Practitioner
We wish to make special note of the possible solution
to the barrier of the clinician-researcher dichotomy.
That is the development of the scientist-practitioner
model of education first developed in clinical psychol-
ogy and later applied to other rehabilitative professions.
Thorough histories of the effort are offered by Hayes
and associates39 and Merlo and colleagues.40 Essentially,
the model seeks to provide education so that clinicians
have good research training and researchers have good
clinical training at least to the extent of good under-
standing of both roles.
The history of attempts at developing scientist-­
practitioners is far from over, but we see hopeful trends.
In an abridged meta-analysis of 10 articles, Chang
and colleagues47 concluded that current education of
scientist-practitioners is based on a flawed version of
the model and needs to be more flexible and ­versatile.
That is, with changed attitudes, attainment of the
scientist-practitioner is a reasonable goal. Proposing
­
an educational model based on dialectics, Fago41 offers
several suggestions for overcoming the clinician-­
researcher dichotomy and fostering development of the
scientist-practitioner. In a survey of students from 163
Council of University Directors of Clinical Psychology
(CUDCP) programs, the returns from 611 students,
representing 55 programs, showed that students over-
whelmingly “indicated that science training was very
important to them. Overall, students reported expe-
riencing a fairly balanced emphasis on science and
clinical work, and endorsed receiving a good amount
of high-quality training in science.”40(p. 58) Pettigrew48
and Brobeck and Lubinsky49 offer examples of how stu-
dents in training are actually immersed in the scientist-­
practitioner model during the clinical rotations of their
graduate programs in occupational therapy and/or
speech-language pathology.
Although the past certainly has supported the notion
of a clinician-researcher dichotomy, we are encouraged
by the growth of and attention to “evidence-based
practice” in academic programs and in the rehabilita-
tion professions. Examination of academic curricula
by one of the authors, an accreditation site visitor in
communication sciences and disorders, reveals univer-
sal attention to ways in which students can incorpo-
rate an evidence base into their clinical practice. The
Web site of the American Speech-Language-Hearing
Association devotes considerable space to the subject,50
as do the Web sites of the American Physical Therapy
Association51 and American Occupational Therapy
Association.52 Only time will tell if, and to what extent,
the emphasis on evidence-based practice has influenced
the everyday lives of rehabilitation clinicians.
We do not expect that all clinicians will be prolific
(or even occasional) researchers, but we do ascribe
in this text to the notion that the clinician who is a
­scientist-­practitioner will be able to fulfill at least two
of the three roles suggested by Hayes and associates39:
(1) a knowledgeable consumer of new research, using

s­ cientifically based clinical procedures; (2) an evaluator
of his or her own clinical practices; and (3) a producer
of new data.
STATUS OF REHABILITATION
RESEARCH
The rehabilitation professions are relative newcomers to
the health care arena, as the “conflagrations of World
War I and II provided the impetus for the development
and growth of the field of rehabilitation.”53(p. 1) Mindful
of the way in which new professions grow, in 1952 Du
Vall, an occupational therapist, wrote about the devel-
opment of the health care professions into research:
A study of the growth and development of any
well established profession will show that, as it
emerged from the swaddling clothes of infancy and
approached maturity, research appeared.54(p. 97)
Research has indeed appeared across the rehabilita-
tion professions. A great deal can be learned about the
current status of rehabilitation research by examining
the role of research in the professional associations
of the various rehabilitation disciplines, by reviewing
the development of research publication vehicles, by
examining the educational standards for the different
rehabilitation professions, and by reviewing research
funding opportunities for rehabilitation and related
research.
Professional Association Goals
All of the major professional associations that pro-
mote the rehabilitation professions take a leading role
in advancing rehabilitation research. The American
Occupational Therapy Association works “through
standard-setting, advocacy, education, and research on
behalf of its members and the public.”55 As part of its mis-
sion statement, the International Society for Prosthetics
and Orthotics includes, “Promoting research and evi-
dence based practice.”56 The American Physical Therapy
Association developed a clinical research agenda in
2000 designed to “support, explain, and enhance phys-
ical therapy clinical practice by facilitating research that
is useful primarily to clinicians.”57(p. 499) That association
has recently revised and broadened the agenda to include
all research, eliminating the limiting word “clinical.”58
Common Program Requirements of the Accreditation
Council for Graduate Medical Education require that
“the curriculum must advance residents’ knowledge of
the basic principles of research, including how research
is conducted, evaluated, explained to patients, and
applied to patient care” and also that “­residents should
Chapter 1 n
Rehabilitation Research 7
participate in scholarly activity.”59 Their recently
introduced “core requirements” include the abil-
ity to “appraise and assimilate scientific evidence.”60
Furthermore, these associations do not simply make
empty statements about their roles in research—they
follow through with actions to promote research in
their respective professions. For example, the American
Speech-Language-Hearing Association’s commitment to
research is shown by its development of a national out-
comes measurement system.61
Research Publication Vehicles
Dissemination of rehabilitation research findings in
peer-reviewed journals is an important indicator of the
status of rehabilitation research. Over the past several
decades, the number of journals with a primary mis-
sion to publish research related to rehabilitation has
increased dramatically, as a journey through any rele-
vant database (see Chapter 4) will attest. As of February
2015, searching the CINAHL database (see Chapter 4)
for journal titles added just since 2000 reveals that 40
new titles have been added relevant to physical therapy,
16 for occupational therapy and 32 for speech-­language
pathology and audiology. The increased importance
of rehabilitation research across time is apparent both
in the ability of the professions to sustain these new
journals and in the emergence of new types of publica-
tions: specialty journals (e.g., Journal of Pediatric Physical
Therapy), interdisciplinary journals (e.g., Journal of
Occupational Rehabilitation), and international journals
(e.g., International Journal of Language and Communication
Disorders).
Educational Standards
As research becomes more important to a profession,
the standards against which education programs
that prepare new practitioners are evaluated can be
expected to reflect this emphasis. A review of educa-
tional program requirements for the various rehabili-
tation professions shows that this is indeed the case,
with requirements for research content, research activ-
ities, or both. The American Speech-Language-Hearing
Association,62 in its standards for educational program
accreditation, requires that “the scientific and research
foundations of the profession are evident in the cur-
riculum” to prepare speech-language pathologists
and audiologists. The Commission on Accreditation
in Physical Therapy Education notes that “physical
therapy upholds and draws on a tradition of scientific
inquiry while contributing to the profession’s body
of knowledge,” requires a “scholarly agenda,” and
8 Section One n
Research Fundamentals
requires “activities that s­ystematically advance the
teaching, research, and practice of physical therapy
through rigorous inquiry.”63 The American Council
on Occupational Therapy Education lists “researcher”
among the roles to be mastered by occupational ther-
apists in training and requires that graduates be pre-
pared as an effective consumer of the latest research.64
Finally, the Accreditation Council for Graduate Medical
Education has enhanced its physical medicine and
rehabilitation residency requirements to include for-
mal curricular elements related to research design and
methodology as well as opportunities to participate in
research projects and conferences.59,60
Research Funding
The creation of a vast government-funded medical
research enterprise began in earnest in the United States
in the 1940s after World War II. One symbol of this
expansion of the research enterprise was the transfor-
mation in 1948 of the National Institute for Health, for-
merly a “tiny public health laboratory,”65(p. 141) into the
plural National Institutes for Health (NIH) that conduct
and support research through many specialized institutes
focusing on particular branches of medicine and health
care. It was not until the 1980s, however, that NIH, as
well as the Centers for Disease Control (in 1992 becom-
ing the Centers for Disease Control and Prevention),
became important sources of funding for rehabilitation
research.66 Today, the NIH’s National Institute of Child
Health and Human Development, National Institute on
Aging, National Institute of Arthritis and Musculoskeletal
and Skin Diseases, National Cancer Institute, National
Institute of Mental Health, National Institute of
Neurological Disorders and Stroke, and National Institute
of Deafness and Other Communication Disorders
are important sources of funding for rehabilitation
researchers.67,68 The National Institute for Disability and
Rehabilitation Research, an arm of the U.S. Department
of Education, is another important source of funding
for rehabilitation research.66 In addition, private foun-
dations associated with the various rehabilitation pro-
fessions, such as the American Occupational Therapy
Foundation, the Foundation for Physical Therapy, and
the American-Speech-Language-Hearing Foundation,
provide nonfederal sources of research funding.69–71 Thus,
even though a lack of funding for rehabilitation research
has been identified as a serious problem for rehabilita-
tion and the rehabilitation professions, a broad set of
government and private sources of funding are available
to rehabilitation researchers who choose to compete for
external funding of their research efforts. You can read
more about funding sources and resources in Chapter 27.
Although the refrains to increase and improve reha-
bilitation research do not seem to change from one
generation of providers to the next, this review of the
status of rehabilitation research shows that, in the sec-
ond decade of this century, professional associations for
the rehabilitation disciplines include the development
of research among their stated goals, that there is a wide
variety of established and emerging journals in which
to publish rehabilitation research, that educational
standards for rehabilitation providers include criteria
related to research, and that external funds for rehabili-
tation research are available from several sources. These
signs of the recent strength of rehabilitation research
must be tempered by the often chaotic economic and
political influences that can limit research funding for
government granting agencies and philanthropic dona-
tions to private ones. Yes, the barriers to research are sig-
nificant. Yes, identifying and using available resources
takes initiative and energy. Yes, making research a pri-
ority in a cost-containment environment is difficult.
However, the incentives to overcome these barriers are
substantial in that the future of rehabilitation within
the health care system and society requires that we
establish a firm base of evidence on which to build our
practice.
SUMMARY
Research is the creative process by which profession-
als systematically challenge their everyday practices.
Developing a body of rehabilitation knowledge, deter-
mining whether rehabilitation interventions work, and
improving patient and client care are reasons for con-
ducting rehabilitation research. Barriers to research are
lack of familiarity with the research process, lack of sta-
tistical support, lack of funds, lack of mentors, lack of
time, and concern for the ethics of using humans and
animals in research. The importance of research to the
rehabilitation professions is illustrated by professional
association goals, publication vehicles for rehabilitation
research, educational standards, and funding for reha-
bilitation research.
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CHAPTER
2
Theory in Rehabilitation Research

CHAPTER OUTLINE

Relationships Among Specific, or Practice, Theory Question Identification and

Theory, Research, and Practice Evaluating Theory Selection
Definitions of Theory Putting Theory into Practice: Research Methods Identification
Level of Restrictiveness Research, Questions, and Selection
Least Restrictive Definition Hypotheses, and Problems Criteria for Evaluating Research
Moderately Restrictive Definition Developing Answerable Research Problems
Most Restrictive Definition Questions Study Is Feasible
Tentativeness of Theory Topic Identification and Selection Problem Is Interesting
Testability of Theory Problem Identification and Problem Is Novel
Scope of Theory Selection Problem Can Be Studied Ethically
Metatheory Theoretical Framework Question Is Relevant
Grand Theory Identification and Selection Summary
General, or Middle-Range, Theory

All of us have ideas about how the world operates. We
may even dub some of our ideas “theories.” Think of the
kind of banter that goes back and forth among a group of
friends sharing a meal. “I have this theory that my car is
designed to break down the week before payday.” “The
theory was that my mom and her sisters would rotate
who cooks Christmas dinner.” “Here’s my theory—the
electronics manufacturers wait until I buy a new gadget
and then they come out with a new, improved model.”
When do ideas about the nature of the world become
theories? What distinguishes theory from other modes of
thought? Is theory important to the applied disciplines of
rehabilitation practitioners? Does theory drive practice, or
does practice drive theory? The purpose of this chapter is
to answer these questions by examining the relationships
among theory, practice, and research; by defining theory
and some closely related terms; by presenting examples of
theories categorized by scope extent; and by suggesting a
general approach to evaluating theory.
RELATIONSHIPS AMONG THEORY,
RESEARCH, AND PRACTICE
Theory is important because it holds the promise of guid-
ing both practice and research. Figure 2-1 presents a sche-
matic drawing, showing the expected relationships among
theory, research, and clinical practice. Theory is generally
developed through reflection on experience (e.g., “It
seems to me that patients who pay for their own therapy
follow home exercise instructions better than those whose
insurance companies cover the cost”) or from logical
speculation (e.g., “If pain is related to the accumulation
of metabolic by-products in the tissues, then modalities
that increase local blood flow should help reduce pain”).1
Theories developed by reflections on experience may draw
on the careful observations of clinicians in practice or may
flow from qualitative research studies that develop theo-
ries grounded in qualitative data (see Chapters 6 and 14
for more information). Theory, however it is generated, is
then formally tested through research. Based on research
results, the theory is confirmed or modified, as are clinical
practices based on the theory. Unfortunately, theory and
practice are often disconnected from one another, lead-
ing Kielhofner to “underscore the need for better ways
to connect theoretical explanation and practice.”2(p. 14)
Further, he suggests that “when knowledge is developed
and organized as a part of practical problem solving, the
gap between theory and practice can be eliminated.”2(p. 14)
If research is conducted with animals, with normal
human participants, or with techniques that differ
from typical clinical practice, then the results are not
directly applicable to the clinical setting. However, such

11
12 Section One n
Research Fundamentals

Reflection upon Logical DEFINITIONS OF THEORY

experience speculation
Theories are, by nature, abstractions. Thus, the language
Theory of theory is abstract, and there are divergent definitions
of theory and its components. Instead of presenting a
single definition of theory, this section of the chapter
Research
examines three elements of various definitions of the-
Changes in ory: level of restrictiveness, tentativeness, and testability.
practice

Revised theory Level of Restrictiveness

Changes in
practice
More research
Figure 2-1 Relationships among theory, research, and
practice.
research results may lead to modification of theory, and
modification of theory may in turn lead clinicians to
rethink the ways in which they treat their patients or
clients. (The application of the general case—changes
in theory—to the specific case—changes in the treat-
ment of a client—is an illustration of deductive reason-
ing.) In contrast, if research is conducted with a clinical
population and types of interventions that can be eas-
ily implemented in actual practice, then clinicians may
be able to change their practices based on the research
results. The accumulated results of clinical implemen-
tation can lead to modification of theory, which is an
example of inductive reasoning. It is incumbent on the
authors of research reports to help readers connect the-
ory and practice through thoughtful discussion of the
practical implications—both applicability and limita-
tions—of their work.
Definitions of theory differ in their level of restrictive-
ness, and the level of restrictiveness of the definition then
has an impact on the purposes for which a theory can be
used. Table 2-1 summarizes the distinctions between the
definitions and purposes of theories with different levels
of restrictiveness. Restrictiveness addresses how inclu-
sive or wide ranging are specific instances covered by
a definition. As a theory becomes more restrictive, the
requirements for inclusion are more specific. Different
types of theory may be appropriate to different points in
the development of a profession and its body of knowl-
edge, with descriptive theory emerging first, predictive
theory next, and finally explanatory theory.
To illustrate the differences among various levels of
restrictiveness and their corresponding purposes, a sim-
ple example about hemiplegia is developed throughout
this section of the chapter. This example is not meant
to be a well-developed theory; it is merely an illustra-
tion based on a clinical entity that many rehabilitation
professionals should have encountered at some point in
their professional education or practice.
Least Restrictive Definition
The least restrictive form of theory, descriptive theory,
requires only that a phenomenon be described—and

Table 2-1
Level of Restrictiveness in Theory Definitions
LEVEL OF RESTRICTIVENESS
Least Moderate Most

Definition Account for or characterize Specify relationships between Specify relationships and
phenomena constructs form a deductive system
Purpose Description Prediction Explanation
Comments Subdivided into ad hoc and Sometimes referred to as Can take the form of if-then
categorical theories conceptual frameworks or statements
models
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 d. Artistic qualities of Hawthorne’s versions; how far can these be shown in
the school?
e. The ethical element: how treated?
f. Typical lessons.
7. Whittier’s “Snow Bound.”
a. Its historical value as a presentation of a type of civilization: occupation,
pleasures, interests, types of character.
b. Its literary value as an ideal treatment of its theme.
c. The point of view that of an old man’s retrospect. How far is this
appreciable by children?
d. The study of this poem involves also attention to structure, diction,
allusions, poetic descriptions, and metrical form.
e. Typical passages treated in lessons.
8. Longfellow’s “Evangeline.”
a. The poet’s departure from historical fact; its justification.
b. The idyllic element; the descriptions.
c. The central theme, and its treatment in the first and second parts of the
poem.
d. The different quality of the two parts; predominance of description and
the meditative element in the second.
e. Metrical structure.
f. What things in the poem can be made especially interesting to young
people?
9. Scott’s “Ivanhoe.”
a. Its free treatment of historical fact. The difference between historic and
poetic truth.
b. The historical novel: its general relations to history; to be regarded
primarily as literature, not as history.
c. The portrayal of ideals and customs of a past age: types of characters;
structure (plot) of the book built in accordance with this purpose.
d. Difficulties of language, allusions, etc.
e. Means of arousing interest in romantic literature. Comparisons with other
books commonly read by children.
10. Shakspere’s “Julius Cæsar.”
a. Historical basis, anachronisms, etc.
b. The nature of its appeal to young readers.
 c. Treatment of verbal difficulties and of the dramatic form.
d. The action, the characters, the dramatic motives and situations.

V. Composition

1. Object of Teaching Composition.

1. Shall it be “literary,” or aim merely at adequate expression?
2. Elements involved in the Problem: Form and Subject Matter.
1. Importance of subject matter in giving motive and interest, and in
determining form.
2. Subjects for composition to include topics from school work and from daily
life: to be made real, as far as possible. Reality dependent upon interest and the
consciousness of an audience.
3. Preparation for the work. Importance of oral treatment, of the gathering and
ordering of facts and ideas. Originality not to be expected.
4. Composition units: necessity of training in both sentence and paragraph.
Value of outlines, and of drill in sentences.
5. Criticism of written work.
a. General aims.
b. Means of making criticism effective.
c. The object to make pupils self-critical without checking spontaneity.
References: Laurie, Hinsdale, Chubb and Carpenter, Baker and Scott as cited
above.

VI. Grammar

1. Historical Review.
1. Historical changes in the idea of English grammar.
2. Attempt, in the Renaissance period, to Latinize the grammar of English.
Persistence of this point of view.
3. Recent changes due to philological study.
4. What now constitutes English grammar?
5. What problems remain unsolved?
2. Objects of Teaching Grammar.
 1. Various theories: for correctness of expression and for discipline.
2. Modern notions of authority in usage, and of the province of grammar.
3. Amount of Grammar to be Taught.
1. How much grammar shall be taught in the schools?
2. What things are of most value?
3. Importance of syntax; of study of forms.
4. The Order of Treatment.
1. Syntax or etymology first?
2. A study of the methods of development adopted by some of the
representative textbooks.
References: Laurie, Hinsdale, Carpenter, Baker and Scott, and Chubb. Liddell,
“English Historical Grammar,” Atlantic Monthly, Vol. LXXXII. Sweet, New English
Grammar, Part II. Barbour, The Teaching of English Grammar; Goold Brown,
Grammar of Grammars (Introduction). Krapp, Syllabus of English Language and
Grammar (Columbia University Extension Syllabi, Series A, No. 5).

I I . T H E T E A C H I N G O F M AT H E M AT I C S I N E L E M E N TA RY
SCHOOLS

By David Eugene Smith, LL.D.

I. The History of the Subject

1. Advantages to a Teacher in Studying the History of the Subject

Taught.
2. The Early History of Arithmetic.
3. The Growth of Number Systems.
4. The Development of Arithmetic as Known at Present.
References: Smith, The Teaching of Arithmetic, New York, 1909, chap. i; and
in general the sections in this syllabus correspond to the chapters in this work. The
Teaching of Elementary Mathematics, New York, 1900. Ball, A Primer of the
History of Mathematics, London, 1895, and A Short Account of the History of
Mathematics, London, 4th edition, 1908. Fink, History of Mathematics, translated
by Bennan and Smith, Chicago, 1900. Cajori, History of Elementary Mathematics,
New York, 1896, and History of Mathematics, New York, 1893. On Greek
Arithmetic see Gow, History of Greek Mathematics, Cambridge, 1884.
 II. The Reasons for Teaching Arithmetic

1. The Ancient Point of View.

2. Content of the Primitive Logistic, or Art of Calculation.
a. Early counting.
b. Early writing of numbers. The development of notations.
c. The Influence of the Hindu-Arabic notation.
3. Content of the Early Arithmetic, or Theory of Numbers.
a. Connection with mysticism.
b. Contributions of Pythagoras and his school.
c. The effect upon modern arithmetic.
4. The Reasons for Teaching in the Middle Ages.
a. The Church schools.
b. The reckoning schools.
c. The effect upon modern arithmetic.
5. The Reasons Developed by the Renaissance.
a. Influence of commerce.
b. Influence of printing. The crystallization of arithmetic.
c. The effect upon the subject matter of modern arithmetic.
6. The Reasons of To-day.
a. The practical value. Whatever pretends to be practical in arithmetic
should really be so.
b. The question of “mental discipline.” The rise of this doctrine. The results
of a psychological study of the question. The tangible part of
“mental discipline.”
c. The interest in the subject for its own sake. The game element of
mathematics. The historical development of the science of
arithmetic from the primitive game.
References: Smith, The Teaching of Arithmetic, chap. ii, to the chapters of
which no further reference will be made, this syllabus being merely a synopsis of
that work. Teaching of Elementary Mathematics, pp. 1-70. Young, The Teaching of
Mathematics, New York, 1907, pp. 41-52, 202-256. On the historical side, consult
Fink, History of Mathematics, Chicago, 1898. Ball, Short History of Mathematics,
New York, 1908. Cajori, History of Elementary Mathematics, New York. Jackson,
The Educational Significance of Sixteenth Century Arithmetic, New York, 1906.
Branford, A Study of Mathematical Education, Oxford, 1908.
 III. What Arithmetic should include

1. From the Practical Standpoint.

a. The utilities of arithmetic overrated. A detailed consideration of the
various topics usually studied.
b. The effect of tradition upon the matter of arithmetic.
2. From the Standpoint of Mental Discipline. Discipline a Matter of
Method rather than one of Topics.
3. From the Standpoint of Interest in the Subject for its Own Sake.
References: Smith, Teaching of Elementary Mathematics, p. 19. Young, pp.
23-242.

IV. The Nature of the Problem

1. The Great Change in Recent Years brought about by Two Causes.

a. The study of social needs.
b. The study of child psychology.
2. The Peculiar Needs of America. The Bearing of these Needs upon the
Teaching of Arithmetic.
3. Child Psychology and the Problems still Awaiting Solution.
References: Smith, Teaching of Elementary Mathematics, p. 21. Young, pp.
97-103, 210-218. Saxelby, Practical Mathematics, and similar works.

V. The Arrangement of Material

1. Recent Changes brought about from a Consideration of Child

Psychology.
2. The Growth of the Textbook.
a. The Treviso arithmetic of 1478, and the early arithmetics of Italy,
Germany, France, England, and Holland.
b. The two-book series.
c. The three-book series.
d. The extreme spiral arrangement.
3. The Modern Curriculum in Arithmetic.
a. Its origin.
 b. Its present status.
c. Improvements to be considered.
References: Young, pp. 178-188.

VI. Method

1. The Meaning of Method.

2. How the Ancients probably taught Calculation.
a. Various forms of the abacus.
b. The abacus at the time of the Renaissance.
c. The effect upon arithmetic of abandoning the abacus in western Europe.
3. Causes of the Rise of the Rule.
4. Revival of Objective Teaching.
Trapp (1780), von Busse (1786), and Pestalozzi (about 1800).
5. The Early Followers of Pestalozzi.
Tillich (1806), Krancke (1819), Grube (1842).
6. Types of Later Methods.
a. Counting.
b. Ratio.
c. Extreme spiral.
d. Pure concrete work as a basis.
e. Pure abstract work as a basis.
7. The Ease and Futility of Creating Narrow Methods.
References: Smith, Teaching of Elementary Mathematics, pp. 71-97. Seeley,
Grube’s Method of Teaching Arithmetic, New York, 1888. Soldan, Grube’s Method
of Teaching Arithmetic, Chicago, 1878. C. A. McMurry, Special Method in
Arithmetic, New York, 1905. McLellan and Dewey, The Psychology of Number,
New York, 1895. Young, pp. 53-150.

VII. Mental or Oral Arithmetic

1. Historical Status of Oral Arithmetic.

2. Revival under Pestalozzi’s Influence. The Work of Warren Colburn
in this Country.
 3. Causes of the Decline of this Form of Work.
4. The Claims of Oral Arithmetic upon the School To-day. The Practical
and Psychological Views of the Problem.
5. The Nature of the Oral Work,—Abstract and Concrete.
6. The Time to be allowed to the Subject.
References: Smith, Teaching of Elementary Mathematics, p. 117. Handbook to
Arithmetics, p. 6. Young, p. 230.

VIII. Written Arithmetic

1. What should be the Nature of the Written Arithmetic?

2. Object of the Business Form of Solution.
3. Object of Written Analysis.
4. Necessity of Recognizing Two Kinds of Written Work.
5. How to Mark Papers.
References: Smith, Teaching of Elementary Mathematics, pp. 121-129.

IX. Children’s Analyses

1. The Object in Requiring Analyses.

2. What should be expected of Children in this Respect?
3. Explanations of Fundamental Operations. Relation to the Formal
Rule.
4. Explanation of Applied Problems.
5. Relation to the Work in English.
6. The Limit of Primary Work, “Two-step Reasoning.”
References: Smith, Handbook to Arithmetics, p. 9. Young, p. 205.

X. Interest and Effort

1. Status of Arithmetic from the Standpoint of Interest.

2. Danger of Overemphasis upon Interest.
3. Lessening of Interest with the Lessening of Effort.
4. Safe Basis for Increase of Interest.
 5. Effect of a Genuine, Spontaneous Interest upon Increase of Effort
and of Power.

XI. Improvements in the Technique of Arithmetic

1. History of the Improvement in Symbolism.

2. How the Present seeks to carry on this Improvement.
a. The difficulties that are met.
b. Dangers of too much symbolism.
c. The proper criterion for selection.
3. The Equation in Arithmetic.
a. Object.
b. Dangers to be avoided.
4. The Process of Subtraction as a Type.
a. The various historical methods considered.
b. The criterion for a selection.
c. The claims of the various processes to-day.
5. The Process of Division as a Type.
a. The history of division.
b. Present points at issue.
c. The probable future.
6. Proportion as a Type.
a. History of proportion and the “Rule of Three.”
b. Present symbolism and status.
c. Probable future of the subject.
7. Future Problems Relating to Technique.

XII. Certain Great Principles of Teaching Arithmetic

A summary of the larger principles for the guidance of teachers.

XIII. General Subjects for Experiment

1. The Use of Games.

 2. Chief Interests of Children.
3. Results of Emphasizing:
a. The abstract problem.
b. The concrete problem.
4. Amount of Time to be assigned to Arithmetic.
5. Relative Amount of Time to be devoted to:
a. Oral arithmetic.
b. Written arithmetic.
6. The Best Basis of Arrangement of an Arithmetic.

XIV. Details for Experiment

Professor Suzzallo’s list of details as set forth in The Teachers College Record,
January, 1909, p. 43, and in Smith, The Teaching of Arithmetic, chap. xiv.

XV. The Work of the First School Year

1. Arguments for and against no Formal Arithmetic in this Year.

2. The Leading Mathematical Features for the Year.
3. The Number Space of the Year.
a. For counting.
b. For operations.
4. The Work to be accomplished in Addition.
5. The Work in the Other Operations.
6. The Fraction Concepts to be considered.
a. Part of an object.
b. Part of a group.
c. The idea of “half as much.”
7. Denominate Numbers.
8. The Question of the Use of Objects.
9. Symbolic Work and Technical Expressions.
10. Nature of the Problems of this Year.
11. The Time Limit upon Work.
 References: Smith, The Teaching of Elementary Mathematics, p. 99.
Handbook to Arithmetics, p. 11. C. A. McMurry, Special Method in Arithmetic.

XVI. The Work of the Second School Year

1. The Leading Mathematical Features.

2. Number Space for the Year.
3. Counting.
a. The origin of the “counting method.”
b. The extremes to which it may be carried.
c. The proper use of counting in teaching.
4. The Addition Table. Relation to Counting.
5. The Method of Treating Subtraction reviewed.
6. The Multiplication Table.
a. Arguments for and against learning tables.
b. Extent of the work for this year.
c. Relation to counting.
7. Division.
a. Relation to multiplication.
b. Arrangement of work in short division.
8. Fractions.
a. Extent of the work.
b. Nature of the objective work.
9. Denominate Numbers.
a. Extent of the work.
b. Use of the measures. Visualizing the great basal units.
10. Nature of the Symbols to be considered.
11. Nature of the Problem Work.
a. Abstract.
b. Concrete.

XVII. The Work of the Third School Year

 1. Peculiar Necessity for Preparation for this Year’s Work.
2. Leading Mathematical Features.
a. Beginning of rapid written work.
b. Multiplication table completed.
c. Most important tables of denominate numbers.
d. Work extended to two-figure multipliers and the beginning of long
division.
3. Number Space may extend to 100,000.
4. The Roman Numerals.
a. Extent to which this work should be carried in various school years.
b. Historical sketch of the system and of its uses.
5. The Counting Method further considered. Its Values and its
Dangers.
6. The Writing of United States Money. Operations.
7. Square and Cubic Measure.
a. Extent.
b. Nature of objective work.
8. Suggestions as to Four Operations.
a. Addition. Practical value of checks on all operations.
b. Subtraction, as discussed in section XI.
c. Multiplication. Should the tables extend to 12 × 12? Devices.
d. Division. Algorism considered historically and practically.
e. Historical note as to the number of operations.
9. Extent of Work with Fractions.
10. Nature of the Problems.
References: Smith, Teaching of Arithmetic, chap. xvii, p. 73. Handbook to
Arithmetics, p. 29.

XVIII. The Work of the Fourth School Year

1. Leading Mathematical Features.

2. Number Space.
3. The Four Operations.
 a. Nature of the oral work.
b. Criteria for judging written work.
c. Speed versus accuracy.
4. Nature of the Work in Common Fractions.
a. Historical sketch of various fractions.
b. Change in the practical uses of common fractions.
5. Denominate Numbers.
a. What tables are of value? Historical sketch of tables.
b. Visualizing the basal units.
c. Accuracy in reduction.
6. Nature of the Problems.
References: Smith, Handbook to Arithmetics, p. 43.

XIX. The Work of the Fifth School Year

1. Leading Mathematical Features.

2. Necessity for and Nature of Preliminary Review.
3. Number Space. Modern Tendencies in Using Large Numbers.
4. Nature of the Review of the Four Operations.
a. Suggestions for rapid addition and subtraction.
b. Checks on multiplication and division.
c. Twofold nature of division.
5. Common Fractions.
a. Nature of the theoretical explanations.
b. What should be expected of children in this regard.
6. Denominate Numbers.
a. Extent of reductions.
b. Nature of the operations.
7. How to solve Problems.
8. Introduction to Percentage.
9. Nature of the Problems.
References: Smith, Handbook to Arithmetics, p. 53.
 XX. The Work of the Sixth School Year

1. Leading Mathematical Features.

2. The General Solution of Problems.
a. How the world has solved problems.
b. Modern improvements.
3. Percentage.
a. Nature of the subject.
b. History of the subject.
c. Suggestions for treatment.
d. The most important applications.
4. Ratio and Proportion.
a. History.
b. Present value, and probable future status.
5. Nature of the Problems.

XXI. The Work of the Seventh School Year

1. Leading Mathematical Features.

2. Review of our Numbers. Historical Notes.
3. Review of the Fundamental Operations.
4. Types of Subjects Treated.
a. Longitude and time. Origin, value, new features.
b. Percentage. What cases are the most important?
5. Introduction of Algebraic Work considered. Nature of Mensuration.
6. Nature of the Problems.

XXII. The Work of the Eighth School Year

1. Leading Mathematical Features.

2. Nature of the Business Applications.
a. Banking. Extent to which the work should be carried.
b. Partial payments. Historical view of the value of the subject.
c. Partnership. Value of the historical view.
 d. Simple accounts.
e. Exchange. Wherein its value lies.
f. Taxes. Insurance.
g. Corporations. Arguments for and against the study of investments.
3. The Metric System.
a. Why taught. Historical view.
b. Extent of the work.
c. Practical suggestions in teaching.
4. Powers and Roots.
a. Historical view.
b. Present values. Extent of the work.
5. Mensuration.
a. Extent to which it should be carried.
b. Geometry in the eighth year.
c. The formula.
6. Algebra in the Eighth Year.
a. Historical view. Present values.
b. Extent to which it should be carried.
7. Nature of the Problem.
8. A Comparison of American and Foreign Schools.

I I I . T H E T E A C H I N G O F G E O G R A P H Y.

By Richard Elwood Dodge, A.M.

I. The Scope and Purpose of School Geography

1. School Geography a Part of Science of Geography.

Relation of elementary school work to that in secondary school and college.
2. Definition of Geography.
Meaning of this and growth of idea.
A. “Study of earth in its relation to life.”
B. The emphasis of “causal notion” in school geography.
 Rational geography.
3. Scope of School Geography.
A. Possible scope as wide as the subject.
Complexity of subject.
B. Practical scope determined by abilities and needs of children, and by
necessary sequence of steps in geography study.
C. Consequent difficulties for school teachers, even in earlier years.
4. School Geography must be:
A. Unit in each part and as a whole.
Practical reasons for unity.
B. Usable at every step.
Importance of this in early grades.
C. Closely related to nature work on one hand, and secondary work on the
other.
D. Based on children’s experiences and earlier knowledge.
5. Purpose of School Geography Teaching:
A. To teach children geography. Interpretation of this.
Relation of subject to children. Approach to adults’ point of view.
a. Knowledge of principles of geography.
b. Knowledge of facts that make principles clear.
c. Knowledge of facts necessary for daily life.
Other facts that must be included.
B. Power.
a. To use materials and results gained in classroom and elsewhere.
b. To seek out, organize and use new materials.
This suggests method of conducting a portion of class work.
c. To think accurately and clearly.
Importance of geography as a means of training in scientific thinking.
References: Dodge, R. E., The Teaching of Geography, to which no further
references will be made, this syllabus being a synopsis of that work. Teachers
College Record, March, 1901, pp. 3-9. Journal of Geography, November and
December, 1904; April, 1905; September, 1906. McMurry, C. A., Special Method in
Geography, chap. i. Geikie, A., The Teaching of Geography, chap. i.

II. The Persons involved in School Geography Teaching

1. The Duties of the Scientific Geographer.
A. Should help make content sound geographically.
He should be source of geography materials.
B. Should ascertain that work will insure good training in elements of
geography.
Adapted to pupils and valuable as foundation for good later work.
C. Should outline method in large so as to produce geographic progress.
D. Should assist in substituting good for bad details and help choose
between essentials and non-essentials.
2. The Obligations of the Supervisor or Superintendent.
A. Must recognize goal to be reached from standpoint of good geography,
and relations of school geography to other phases of geographic
education.
B. Should accept materials and larger plan of geographer.
Arrange time of schedule.
C. Should see that children’s general training is not sacrificed and special
training is secured.
D. Should insure that work is practical and usable.
E. Must see that relations to other subjects are emphasized.
Causal notion again.
3. The Obligations and Opportunities of the Teacher.
A. Must know more subject matter than he expects to give pupils.
B. Must know purposes and scope of course—his part in course as a whole.
Also must know preparation furnished by earlier year’s work.
C. Must know relations to other work in the curriculum as a whole and in
geography particularly.
D. Must know ways subject must be organized and presented to his grade
so as best to gain aims desired.
General and special method.
4. The Position of Children in Reference to Work.
A. Meaning of “To teach children geography.”
B. The preparation that may be expected in different grades.
C. Children’s interest in work.
D. Pupils must be trained to work and think.
E. Goals are knowledge and power. Importance of rational repetition, of
reviews and map work.
 Reference: Dodge, Journal of Geography, v, p. 385. The Opportunity of the
Geographer in Promoting School Geography.

III. The Organization of a Course of Study

1. Course as a Whole.
A. Must be capable of being judged as good by geographers.
B. Must lead to knowledge and power.
C. Must be arranged so as to lead from known to unknown along lines of
least resistance but not least effort.
D. Method of approach of mature mind must not always be followed.
2. Some Fundamental Considerations.
A. No one course available for all localities.
B. Course should start with home geography.
C. Should lead next to elementary knowledge of world whole.
D. The emphasis to be given to continental work.
Division of work by grades.
E. Disadvantages of teaching all continents twice.
The following compromise is suggested as in general workable:
a. Twice: North America, United States, Europe, and perhaps portions of
Asia.
b. Once: Asia, Africa, Australia, and South America.
Present importance of South America.
F. Plan of intermediate work should differ from plan of upper grades.
“Concentric Circles.”
G. The place of physical geography in the course of study:
a. Home geography: observational side.
Danger of overemphasis, of giving wrong outlook.
b. Intermediate grades: give setting to life side.
Larger facts only.
c. Upper grade: basis of work.
Not to be taught as a topic by itself but as a means to an end.
H. Emphasis of industries and commercial side.
I. “Following interests of children,”—best meaning of phrase. Value and
dangers.
Recent interest in industrial education places a renewed obligation on
geography to be practical and to be free from fads.
 Developing interest. Temporary and permanent interests.
References: Teachers College Record, March, 1901, pp. 9-15. McMurry, C. A.,
Special Method in Geography, chap. ii. Redway, J. W., New Basis of Geography,
chap. x. Bagley, W. C., Function of Geography in Elementary Schools, Journal of
Geography, Vol. III, p. 222. Dodge, Richard E., “Some Suggestions Concerning a
Course of Study in Geography,” Journal of Geography, vii, pp. 7-14.

IV. Home Geography and World Whole

1. Certain General Considerations.

A. Home geography not a subject or a division of geography, but a method
of approach to field as a whole,—cannot have a uniform course for
all places.
B. Method of procedure must be from known to unknown through analysis
of experiences of pupils.
C. Work should not call for knowledge of distant places.
D. Lessons should become more intensive and scope more extensive.
E. Topics should be taken up in definite sequence so far as possible.
F. Definitions, if any, to be summaries at close of developed points and not
points of departure.
G. Units developed to be good geography units which may be used as
basis for comparison over world. Heat, storms, woods, for
instance, are not good units. Crossroads or city corners good
units.
H. Local history to be brought in as much as possible.
Should be intimately related to geography and may often be point of
departure.
I. Importance of observation of local conditions.
Reasons for giving a certain place to processes of earth change.
2. Topics in Home Geography.
A. Social:
a. Simple life groups and relations.
(1) Home, village, city, etc. (2) Needs and means of communication.
(3) Need for government. Form not to be included. (4) Reasons for
trade. Simple illustrations. (5) Industrial features. (6) Universality of
similar features over world.
B. Earth:
a. Forms of landscape as related to life.
 b. Forms of drainage as related to life.
c. Soils and their use. Classification a minor matter.
d. Simpler atmospheric phenomena.
e. Direction and distance.
f. Maps.
g. Gravity.
3. Topics often included.
A. Suitable to few localities: Volcanoes, mountains, ocean.
B. Not geographical:
a. Name and functions of officers of local government.
b. Building of a house or mechanical details of any trade.
c. Topics in geology such as formation of coal, marble, etc.
C. Beyond powers of pupils.
a. Form of earth, relation of bodies in solar system.
b. Rotation and revolution of earth.
c. Theory of storms.
4. Summaries:
A. Must be simple and easily drawn from previous work.
B. Must be of such a nature that they can be expanded as years go on
without overturning base learned in earlier years.
C. Examples of good summaries:
a. Wind is air moving horizontally.
b. River is a stream of water and detritus flowing through the land.
D. Examples of bad summaries:
a. A lake is a body of water surrounded by land.
b. Mountains are high elevations of land.
c. A divide is the high land which separates two rivers.
d. A river is a stream of water which flows into the sea.
e. Hollow places in the land filled with water are called lakes.
f. A swamp is a tract of land soaked with water.
5. Some Simple Units of Home Geography to indicate Basis of Choice of
Topics.
A. The home:
a. Simplest group of individuals which illustrates essentials of larger
groups.
 b. A unit of government: need of government in home and in any group.
c. Division of labor in home illustrates a world truth as to relations of
individuals and groups.
B. Groups of homes.
a. Country four corners.
b. Village.
c. City.
d. Location of such cities as Vienna, Constantinople, Chicago.
C. Simpler surface features.
a. Why important,—travel over, seen as landscape.
b. Why emphasize landscape and not forms first?
c. Plains,—why most important? Life relation to.
d. Rolling lands.—Relations to life.
e. Mountain regions.—Relations to life (should, in many localities, be
deferred to later work).
References: Teachers College Record, March, 1901, pp. 15-17. Davis, W. M.,
“Home Geography,” Journal of Geography, p. 1. Geikie, A., The Teaching of
Geography, chap. ii. McMurry, C. A., Excursions and Lessons in Home
Geography.
6. First Knowledge of World Whole.
A. Expansion of home geography outward to ocean.
a. How to present form of earth—relation to home, necessities and
luxuries.
b. Parts of earth that may be related to home in developing knowledge of
world whole, based on experience of pupils.
(1) Northern North America and Europe—furs. (2) Southern North
America—bananas, woods, cacao. (3) Northern South America—
India rubber, coffee, Brazil nuts. (4) Southern South America—
hides, and meat products. (5) West Central Europe—embroideries,
wine, cheese. (6) Southern Europe—olives, cork. (7) Southeastern
Asia—tea, silks, spices, fire-crackers. (8) Central Africa—ivory,
palm oil. (9) Southern Africa—diamonds. (10) Southwestern Asia—
rugs. (11) Australia—wool.
7. How to lead up to Climate of World.
A. Points to be brought out:
a. Direction and distance in time.
b. Similarity of purpose of life. Food, clothing, shelter.