Occupational Therapists’ Decision Making in the Management of Clients with Upper Limb Hypertonicity

This study applied social judgment theory to the exploration of factors influencing occupational therapists’ decision making when they manage upper limb hypertonicity in clients with cerebral palsy. To achieve this goal, both objective and stated policies were investigated. This quantitative study drew information from a literature review and a survey with experienced occupational therapists to identify 12 factors which could influence decision making. Based on these 12 factors 110 case vignettes of individuals with cerebral palsy and upper limb hypertonicity were generated. Intervention decisions were elicited from eighteen experienced occupational therapists for each of the 110 case vignettes. Therapists were also asked to rank the factors in order of perceived importance. Occupational therapists generally used severity of spasticity, wrist and finger posture, and client and family background information to guide their clinical intervention choices. Therapists, however, demonstrated poor insight into the nature of their decision making processes. This was highlighted in the disparity between their stated and objective policies. These findings have implications for both the professional development of therapists and the training of students