Susan L. Garber; The Prepared Mind. Am J Occup Ther 2016;70(6):7006150010. https://doi.org/10.5014/ajot.2016.706001
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Every day, in clinics and hospitals around the world, occupational therapists care for patients with serious problems requiring viable solutions. Each patient is unique, and his or her problem does not necessarily correspond to existing practice models. Practitioners must adapt standard approaches to provide effective outcomes, yet problems exist for which few or no beneficial approaches have been identified. Such clinical issues require solutions to be generated de novo from the practitioner’s body of knowledge and past experience. Yet, no single new intervention can be used without prior validation of its efficacy. Only a therapist with a prepared mind can accept such challenges, recognize what is known and not yet known, design studies to acquire that needed knowledge, and translate it into successful clinical treatment strategies. The occupational therapist with a prepared mind is one willing to seize unexpected opportunities and construct new paradigms of practice. Innovation through scientific inquiry requires a prepared mind.
The value of a college education is not the learning of many facts but the training of the mind to think.
The People Who Get On in This World Are the People Who Get Up and Look for the Circumstances They Want and, If They Can't Find Them, Make Them.
What specific patient characteristics needed to be addressed so that healthy skin was maintained?
How did one’s body build and posture effect pressure distribution (Garber & Krouskop, 1982)?
For the patient in the side-lying position in bed, what position of the legs would reduce trochanteric pressure (Garber, Campion, & Krouskop, 1982)?
What was the effect of cushion covers on pressure redistribution?
What lifestyle factors influenced adherence to recommendations for prevention?
What were the risks of recurrence once the person with a spinal cord injury returned to his or her home and community (Rodriguez & Garber, 1994)?
In wisdom gathered over time, I have found that every experience is a form of exploration.
Houston VA Rehabilitation Research and Development Center of Excellence on Healthy Aging With Disabilities under the leadership of Arthur Sherwood (Garber, Rintala, Holmes, Rodriguez, & Friedman, 2002; Rintala, Garber, Friedman, & Holmes, 2008)
Rehabilitation Research and Training Center on Community-Oriented Services for Persons With Spinal Cord Injury under the leadership of Marcus Fuhrer at Baylor College of Medicine (Fuhrer et al., 1993)
Spinal Cord Injury Model System Program at TIRR under the leadership of R. Edward Carter (Donovan, Carter, Bedbrook, Young, & Griffiths, 1984)
Pressure Ulcer Prevention Study at the University of Southern California under the leadership of Florence Clark (Clark et al., 2014)
Rehabilitation Engineering Research Center on Spinal Cord Injury at the University of Pittsburgh under the leadership of David Brienza (Wu, Garber, & Bogie, 2015).
Each time an occupational therapist treats a patient, a clinical experiment is performed in which the objective is to replicate a successful outcome of a past experiment.
A. Jean Ayres, observing a relationship between sensory processing problems and motor and academic learning problems in children, developed the theory of sensory integration (Ayres, 1963, 1977). This theory resulted in numerous tests and interventions therapists would use to understand the inadequacies of current practice with children with sensory insufficiency.
In the 1950s, Margaret Rood used cutaneous stimulation to improve function in patients with neuromuscular impairments (Rood, 1954, 1958).
Josephine Moore studied the limbic system and its effect on behavior (Moore, 1976).
Shereen Farber developed theories on occupational therapy and neuroscience (Farber, 1989).
Laura Gitlin, a social scientist, collaborated with occupational therapists to study adaptive processes in old age (Gitlin, Corcoran, & Leinmiller-Eckhardt, 1995).
Wilma West encouraged us to think about our role in prevention and the socioeconomic and cultural causes of disease and dysfunction outside hospital settings (West, 1968; Wiemer & West, 1970).
Florence Clark developed the concept of occupation in lifestyle redesign in her Well Elderly Study (Clark et al., 2001; Jackson, Carlson, Mandel, Zemke, & Clark, 1998) and later in the Pressure Ulcer Prevention Study (Clark et al., 2014).
David Nelson and Gary Kielhofner developed models of care (Kielhofner, 2008; Nelson, 1997; Parkinson, Forsyth, & Kielhofner, 2006).
Theories such as occupational adaptation were examined (Schultz & Schkade, 1992).
Joan Rogers advocated for us to use clinical reasoning skills when collecting and using data and making patient care decisions (Rogers, 1983).
Chance favors the prepared mind.
At the first level, the entry-level student becomes the skilled practitioner trained in current occupational therapy philosophy, methodology, and theory.
The second level consists of clinical supervisors who can incorporate new knowledge and techniques into practice methods. These are the people who take new advances and integrate them into existing, traditional practice models and see them implemented by clinicians.
The third level includes the people who develop new knowledge, both fundamental and translational. They generate new knowledge through rigorous study and translate it into proven superior clinical practice interventions.
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