REASONING AND THE ART OF THERAPY FOR SPINAL-CORD INJURY

In this pilot study, qualitative methodology was used to examine the c linical reasoning of four experienced occupational therapists as they presented and modified therapeutic activities to treat patients with s pinal cord injuries. The therapists demonstrated the multilayered thin king discovered in previous research, but hierarchical structuring of knowledge emerged as an unexpectedly dominant theme in their reasoning . Examples of hierarchical thinking about therapeutic activity include d creating mental files of therapy tasks and materials sequenced from elementary to advanced and determining the level of difficulty at whic h to present an activity in order to build the patient's skills in a s tepwise manner. The therapists reported that they learned to make deci sions about the use of activities in treatment by observing skilled cl inicians and by treating patients.