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WAR DEPARTMENT TECHNICAL MANUAL 
OCCUPATIONAL 
THERAPY 
DEPARTMENT • DECEMBER 1944 WAR DEPARTMENT TECHNICAL MANUAL 
TM 8-291 
OCCUPATIONAL 
THERAPY 
WAR DEPARTMENT 
DECEMBER 1944 
For sale by Superintendent of Documents, U. S. Government Printing Office, Washington 25, D. C. 
United Stales Government Printing Office 
Washington : 1944 WAR DEPARTMENT 
Washington 25, D. C., 15 December 1944 
TM 8-291, Occupational Therapy, is published for the information and 
guidance of all concerned. 
[AG 300.7 (16 Oct 44)] 
By order of tht Secretary of War: 
Official : 
J. A. ULIO 
Major General 
The Adjutant General 
G. C. MARSHALL 
Chief of Stajf 
Distribution: 
AGF (10) ; ASF (10) ; AAF (10) ; T of Opns, Attn; Surg (10) ; Sv C 
(15) ; GH (75) ; T/O & E 8-550 (75) ; 8-560 (55); 8-590 (35) 
For explanation of symbols, see FM 21-6 CONTENTS 
Paragraph Page 
CHAPTER 1. INTRODUCTION. 
Section I. General. 
General X 1 
II. Mission of reconditioning. 
Mission of reconditioning 2 1 
CHAPTER 2. AN OVERVIEW OF OCCUPATIONAL THERAPY. 
Section I. Definition of occupational therapy. 
Definition of occupational therapy 5 2 
Purpose 4 2 
Scope 6 2 
Values that result from use of occupational therapy 3 2 
II. Administration of an occupational therapy department. 
Staff organization 7 3 
Personnel 8 3 
Facilities 9 3 
Supply and equipment 10 3 
Reconditioning classes 11 4 
CHAPTER 3. FUNCTIONAL OCCUPATIONAL THERAPY. 
Definition 12 5 
Scope 13 5 
Treatment 14 5 
Coordination with physical therapy 15 5 
General precautions 1(5 5 
Adaptation of position and equipment (5 
Joint limitations 18 7 
Muscle weakness 19 g 
Incoordination 20 9 
Thoracic disorders 21 10 
Cardiac disorders ! 22 14 
Blindness 23 14 
CHAPTER 4. TREATMENT OF AMPUTEES. 
Section I. General remarks. 
General remarks 24 30 
II. Purpose of occupational therapy for amputees. 
Psychological purposes of early treatment 25 30 
Treatment in pre-prosthetic stage 26 30 
Training in use of a prosthesis 27 31 
Cate of prostheses 28 31 
III. Treatment in upper extremity amputations. 
Partial hand 29 31 
Forearm 30 32 
Upper arm 31 40 
Shoulder disarticulation 32 40 
One arm and partial hand 33 40 
Bilateral 34 41 
Bilateral with additional loss or handicap 35 46 Paragraph Page 
IV. Treatment in lower extremity amputations. 
Pre-prosthetic stage 36 48 
Training in use of prothesis 37 49 
V. Prosthetic achievement chart. 
Purpose 38 53 
Application 39 54 
CHAPTER 5. OCCUPATIONAL THERAPY IN NEUROPSYCHIATRIC 
DISORDERS. 
Section I. Overview. 
Overview of problem 40 55 
Purpose 41 55 
Administration 42 55 
Prescription 43 56 
Technique of application of occupational therapy 44 56 
II. Psychoneuroses. 
Technique of application of occupational therapy in 
psychoneuroses 45 57 
III. Psychoses. 
Technique of application of occupational therapy in 
psychoses , 46 58 
IV. Other neuropsychiatric conditions. 
Technique of occupational therapy in other psychiatric 
disorders 47 59 
Precautions 48 60 
CHAPTER 6. DIVERSIONAL HANDICRAFT ACTIVITIES. 
Dehnition and purpose 49 61 
Organization and administration 50 61 
Coordination of Red Cross activities with occupational 
therapy 51 61 
Types of activities 52 63 
Precautions 53 63 
Suggested ward activities 54 66 
Red Cross recreation program 55 66 
CHAPTER 7. INDUSTRIAL THERAPY. 
Definition 56 67 
Purpose 57 67 
Scope , 58 67 
Precautions : 59 67 
Correlation with reconditioning program 60 67 
Job placement 61 71 
Mechanics of industrial therapy 62 72 
Prevocational activities in convalescent hospitals 63 75 CHAPTER 1 
INTRODUCTION 
Section I. GENERAL 
Place in series. This is one of three manuals on reconditioning. They are: 
TM 8-290 Educational Reconditioning 
TM 8-291 Occupational Therapy 
TM 8-292 Physical Reconditioning 
1. GENERAL, a. When a man enters the Army, the military training program 
prepares him physically and mentally for his duties as a soldier. Military drill, 
marches, and physical training produce good physical condition and develop 
endurance and stamina. Special courses, maneuvers, and field problems provide 
information and knowledge to enable him to perform successfully the duties 
of a soldier. When his training is completed, he should be in good physical 
condition and possess the mental attitudes necessary to the effective soldier. 
b. The soldier who has been wounded or rendered inactive because of pro- 
longed illness loses the efficiency that has been developed. His physical strength 
deteriorates. Concern for himself, worry over personal affairs, and the anxiety 
that accompanies long convalescence, contribute to a loss of confidence which 
may result in apathy and indifference. These attitudes actually retard recovery, 
and often produce unfortunate mental states which result in ineffectual service 
and, in some instances, maladjustment to military or civil environment. 
c. The critical personnel needs of the armed forces and war industries 
demand maximum conservation of manpower. Each day that a patient’s recovery 
is delayed represents a loss of man hours in support of the war effort. If the 
convalescent soldier is to realize the greatest benefit of army medical service, 
his physical, mental, and emotional needs must be considered. Recognizing this 
responsibility to the soldier and to the war effort, The Surgeon General has 
established reconditioning as a part of professional medical care. 
Section II. MISSION OF RECONDITIONING 
2. MISSION OF RECONDITIONING. The purpose of the Reconditioning 
Program is to accelerate the return to military duty of convalescent patients in 
the highest state of physical and mental efficiency consistent with their capacities 
and the type of duty to which they are being returned. Or, if the soldier is 
disqualified for further military service, the Reconditioning Program must 
provide for his return to civilian life in the highest possible degree of 
physical fitness, well oriented in the responsibilities of citizenship and prepared 
to adjust successfully to socal and vocational pursuits. The mission is accom- 
plished by a coordinated program of Educational Reconditioning, Physical 
Reconditioning, and Occupational Therapy. CHAPTER 2 
AN OVERVIEW OF OCCUPATIONAL THERAPY 
Section I. DEFINITION OF OCCUPATIONAL THERAPY 
3. DEFINITION OF OCCUPATIONAL THERAPY. Occupational therapy is 
that form of treatment characterized by assignment to purposeful physical 
tasks and prescribed by a medical officer. It may be prescribed for restoration 
of function to injured or diseased muscles and joints; for controlled activity 
for nervous or mental disorders; for readjustment attending chronic diseases; 
for reeducation in permanent disabilities and for purposeful utilization of 
leisure time. 
4. PURPOSE. To provide functional and constructive activity under medical 
supervision for the purpose of hastening the recovery of individual patients. 
5. SCOPE. There are four main types of occupational therapy that are applied 
in the convalescent treatment of disease or injury. These are diversional 
therapy, functional therapy, industrial therapy, and prevocational training in 
shop experience. 
a. Diversional therapy includes the simple arts and crafts, hobbies, and 
allied "handicraft” activities which serve to divert the mind from preoccupation 
with illness. A wide range of interests may be employed such as, dramatics, 
music, photography, the graphic arts, electricity, woodworking, leather working, 
radio and motor mechanics, and avocational pursuits. 
b. Functional therapy has a prescribed purpose. It is directed toward the 
restoration of function in injured or diseased muscles and joints, improving 
general physical condition, and contributing to the return of physical and 
mental health. 
c. Industrial (work) therapy utilizes the every day work situations. The 
patient is assigned to perform some useful work with a definite goal in mind. 
For example, the patient with a shoulder injury who needs to strengthen his 
muscles may be directed to saw wood or paint high surfaces. He performs 
useful work for the hospital, but also aids himself by strengthening his atonic 
arm and shoulder girdle muscles and indirectly by improving his general 
physical condition. 
d. Prevocational therapy comprises those prescribed exploratory shop proc- 
esses which are planned to develop aptitudes and interests in a specific occupa- 
tion to be used as a guide to vocational training under the Veterans’ Adminis- 
tration. 
6. VALUES THAT RESULT FROM USE OF OCCUPATIONAL THERAPY* 
a. Physical. Occupational therapy aids in the restoration of function to in- 
• Manual of Occupational Therapy, American Medical Association, 1943 reprinted from War Medicine. jured or diseased joints, nerves, tendons and muscles, restores self confidence, 
and develops physical and mental coordination. 
b. Mental. The mental values that accrue from occupational therapy serve 
to divert the mind from thoughts of illness, encouraging healthy minds by 
combatting restlessness and boredom. Mental distress is eased, the attention is 
aroused, and opportunity for self-expression and for development of initiative 
is provided. 
c. Social. Social values of occupational therapy result from the development 
of group cooperation, providing opportunity for social contacts in normal 
activities through a ready means of socialization. The morale of patients in 
the wards and in the hospital is raised. 
d. Economic. The economic effects from occupational therapy are incidental 
to the primary purpose. Means are provided whereby evaluation of the dis- 
ability in terms of vocational requirements is afforded, and whereby a measure 
of work tolerance is established. 
Section II. ADMINISTRATION OF AN OCCUPATIONAL 
THERAPY DEPARTMENT 
7. STAFF ORGANIZATION. The work of the occupational therapy depart- 
ment will be under medical direction. The success of therapy is related to the 
extent of interest of the responsible medical officer and occupational therapy 
staff. 
a. For administrative purposes, the Chief of the Reconditioning Service, a 
medical officer, will direct and correlate the activities of occupational therapy 
with the physical and educational activities of the Reconditioning Program. 
b. In functional occupational therapy with physical injuries, the therapist 
will work in close cooperation with the medical officer in charge of the Physical 
Therapy Department, or under the direction of the Chief of the Orthopedic 
Section. 
c. In the treatment of neuropsychiatric patients, the therapist will work in 
close cooperation with the Chief of the Neuropsychiatric Service. 
8. PERSONNEL. The value and effectiveness of occupational therapy depend 
on the training and experience of the therapists. Occupational therapists must 
have a sound concept of the conditions treated and the techniques to be em- 
ployed. There must be sufficient understanding of medical and surgical dis- 
orders and of the mental reaction of individuals in order that medical officers’ 
prescriptions be intelligently executed. As a general rule, one occupational 
therapist should be provided for each 250 hospital patients. 
9. FACILITIES. Adequate space will be provided in all hospitals that operate 
occupational therapy shops. Well-lighted rooms are desirable on or above the 
ground level. Two shops will usually be necessary, a general shop for functional 
work with physical injuries and a neuropsychiatric shop, located within or 
near the neuropsychiatric section of the hospital. Plans have been prepared by 
The Surgeon General’s Office to cover alterations or construction where 
necessary. 
10. SUPPLY AND EQUIPMENT. All items of basic equipment and addi- 
tional maintenance supplies issued for use in occupational therapy departments will be furnished to hospitals through Medical Department supply channels, 
Supply List No. 9N464. 
11. RECONDITIONING CLASSES, a. Occupational Therapy for Class 4 pa- 
tients will consist chiefly of diversional activities. In some instances it will be 
necessary to treat functional cases who are still confined to bed. Lap-boards 
or specially designed bed tables make it possible to use projects that otherwise 
would not be practical. 
b. Occupational Therapy for Class 3 patients will consist chiefly of assign- 
ments of patients to work in either the functional or neuropsychiatric shop or 
in light work about the hospital wards. 
c. Classes 2 and 1 will also benefit from occupational therapy. Woodwork- 
ing or motor mechanics, hobby shop activities, and diversional activities or 
industrial (work) therapy will be prescribed. CHAPTER 3 
FUNCTIONAL OCCUPATIONAL THERAPY 
12. DEFINITION. Functional occupational therapy is that type of work treat- 
ment prescribed by a medical officer for the restoration of function to impaired 
muscles and joints. Secondary purposes of treatment include the improvement 
of general physical condition, the increase of work tolerance, and the stimula- 
tion of mental acuity through interesting activity. 
13. SCOPE. There are three main disability groups, which may occur sepa- 
rately or in combination, to be considered in the application of functional 
occupational therapy: 
a. Joint limitation. 
b. Muscle weakness. 
c. Incoordination. 
14. TREATMENT. Functional occupational therapy is based on the funda- 
mental principles of physical treatment as applied in physical medicine. 
a. Graded force for joint limitation. 
b. Graded resistance for muscle weakness. 
c. Muscle reeducation for incoordination. 
15. COORDINATION WITH PHYSICAL THERAPY. Physical therapy uses 
the modalities of heat, light, massage, exercise, water, and electricity for their 
therapeutic effect upon diseased or injured tissues. For the same purpose 
occupational therapy applies such activities as carpentry, printing, radio repair, 
fly-tying, and gardening. It has been demonstrated that when occupational 
therapy is used in conjunction with physical therapy motion returns more 
rapidly than when either is used alone. An accepted form of coordinated 
treatment is: physical therapy in as early a stage as possible accompanied by 
occupational therapy when active motion is indicated. When maximum benefit 
has been obtained from physical therapy that treatment is discontinued and 
occupational therapy continues with increased grading of activity and resistive 
motion. 
16. GENERAL PRECAUTIONS, a. Prescription. Activity needs of the patient 
will not be treated without adequate prescription from the medical officer. 
b. Posture. Fundamental posture principles will be observed to insure good 
body mechanics. 
c. Compensation. Achievement of motion desired is determined by the 
position of the work in relation to the patient. Compensation, or the substitu- 
tion of uninvolved parts for the part being treated, must be avoided by the 
teaching of correct motion. In cases of permanent disability, however, instruc- 
tion in substitution is indicated. 
5 Figure 1. Cord knotting exercises, elbow injured by gunshot wound. 
d. Fatigue. Evaluation of the patient’s individual fatigue level should be 
made in terms of repetition of motion, intensity of motion, change of activity 
and interest. Although the emphasis of functional occupational therapy is pre- 
dominately on the disability, treatment of the injured part as related to general 
physical condition must not be overlooked. 
17. ADAPTATION OF POSITION AND EQUIPMENT, a. In functional 
occupational therapy, it is important that accuracy of treatment be maintained 
with reference to— 
(1) Range and direction of motion. 
(2) Degree of physical exertion required. 
b. In certain cases of physical disability, it may not be possible to achieve 
the desired joint or muscle action without adjustment. This adjustment may 
be achieved through adaptation of— 
(1) Equipment and material. 
(2) Position of work in relation to position of patient. 
c. Selected methods of adaptation follow: 
(1) Built-up tool handles. 
(2) Flexion and extension sand-blocks. 
(3) Suspension sling. 
6 (4) Extension beater on loom. 
(5) Springs for added resistance to bicycle saw, loom, or printing press. 
(6) Special pedal attachments for bicycle saw. 
(7) High, low, or off-center position of work. 
d Special equipment should be considered a temporary expedient in grad- 
ing activity toward the normal use of standard equipment, except in certain 
cases of permanent disability. 
18. JOINT LIMITATION, a. Causes. Joint disabilities are most frequently 
caused by infections, burns, fractures, sprains, dislocations, arthritis, immobili- 
zation in plaster or splints, frost bite, deficiency diseases or from bullets, 
mortar, grenade and shell fragments. 
b. Results. Conditions which may result from these diagnoses are: contracted 
muscles and tendons, contracted capsules and ligaments, adhesions, scar tissue, 
swelling, arthritic changes, and loss of joint space. 
c. Treatment. The principle of occupational therapy for joint limitation is 
graded stretching. Joint measurements should be taken at regular intervals so 
that treatment may be graded with progress as indicated: 
(1) Motion within existing range. (See fig. 1.) 
(2) Motion beyond the existing range. (See fig. 2.) 
Figure 2. Patient sanding for elbow extension. (3) Motion beyond existing range with outside force added, such as 
weight of tool. (See fig. 3.) 
d. Special precautions. (1) Prolonged pain indicates over-activity. 
(2) Swelling and inflammation, if undue and persistent, should be reported 
to the medical officer and, upon his recommendation, activity may be decreased 
or discontinued. 
(3) Loss of joint motion is usually indicative of too little or too much 
activity and treatment should be adjusted accordingly. 
(4) Appropriate choice of activity, or adequate protection where open 
lesions occur. 
19. MUSCLE WEAKNESS, a. Causes. Muscle weakness is usually caused by 
infections, burns, mortar, bullet, grenade, and shell fragments, arthritis, or pro- 
longed immobilization. 
b. Results. Conditions which may result from these diagnoses are: 
(1) Central, cerebral, or peripheral nerve involvement. 
(2) Atrophy of disuse. 
c. Treatment. The principle of occupational therapy for muscle weakness is 
graded resistance. Muscle testing should be done at intervals and work graded 
to the present muscle findings. Particular attention must be paid to maintenance 
of motion and muscle tone in surrounding joints and muscle groups. 
Figure 3. Elbow extension beyond existing range tvith outside force added by weight of plane. Figure 4. Sling eliminates gravity and patient exercises muscles weakened by immobilization. 
(1) Motion with gravity eliminated. (See fig. 4.) 
(2) Motion against gravity. (See fig. 5.) 
(3) Motion with outside resistance added. (See fig. 6.) 
d. Special precautions. (1) Over-stretching. 
(2) Fatigue. Returning nerve function should be conserved and developed 
by avoiding work beyond the point of fatigue. 
(3) The presence of anesthetic areas will necessitate precautions to prevent 
damage to skin tissue. 
20. INCOORDINATION, a. Causes. Incoordination may be caused by infec- 
tions, cerebral concussions, hemorrhage, mortar, bullet, grenade and shell frag- 
ments, skull or spine fractures, or vetebral dislocations. 
b. Results. Conditions which may result from these diagnoses are cerebral 
and central nervous system lesions. 
c. Treatment. The principle of occupational therapy for incoordination is 
muscle reeducation. 
(1) Start muscle reeducation with large muscle groups eliminating the 
finer movements. (See fig. 7.) 
(2) Train in accurate, single joint motion and progress to combined mo- 
tions. (See fig. 8.) 
9 (3) Increase speed of performance as accuracy is attained. 
(4) Instruct patient in correct motions to insure carry-over into daily 
routine. 
d. Special precautions. Work with power tools and other potentially dan- 
gerous equipment is contraindicated because of impaired balance. 
21. THORACIC DISORDERS, a.'Causes. Chest disorders are most frequently 
caused by pneumonia,, pneumonitis, bronchiectasis, empyema, lung abscess, 
tuberculosis, gunshot and shrapnel wounds.. 
b. Results. Conditions that result from these diagnoses, pertinent to func- 
tional occupational therapy, are joint limitation and muscle weakness in the 
thoracic and shoulder areas, and general body weakness. 
Figure 5. Patient with shoulder injury strengthens muscles by working in position against gravit Figure 6. Added resistance of weight and spring on hand lever printing press exercise shoulder. 
Figure 7. Furniture refinishing requires motion of large muscle groups of the arm. 
11 Figure 8. Type setting requires fine coordination. ■ 
Figure 9■ Fly-tying may be done ivithout involving shoulder motion. Figure 10. Arm and leg activity through wide range of motion increases respiration. 
13 c. Treatment. The principle of occupational therapy for thoracic disorders 
is graded activity. 
(1) Activity without increase of respiration. 
Example: Manual activity that does not involve shoulder motion such as 
fly-tying. (See fig. 9.) 
(2) Activity with increase of respiration. 
Example: Arm and leg activity that necessitates wide range of motion, such 
as the bicycle saw. (See fig. 10.) 
(3) Activity to increase muscle power and range of joint motion in sec- 
ondarily involved areas. 
Example: Use of shoulder girdle against resistance, as in gardening. (Sec 
fig. 11.) 
d. Special precautions. (1) Particular attention should be paid to tempera- 
ture, fatigue, drainage, and presence of substances irritable to the respiratory 
tract. 
(2) Where joint limitation and muscle weakness occur, precautions as indi- 
cated under these headings will apply. 
22. CARDIAC DISORDERS, a. Causes, Cardiac disorders are more commonly 
caused by rheumatic heart disease, bacterial infections of the heart or its 
coverings, coronary disease, hypertension, syphilis, and thyrotoxicosis. 
b. Results. Conditions which may result from these diagnoses are decom- 
pensation, general weakness, and reduced capacity of the individual for inten- 
sive work activity. 
c. Treatment. The principle of occupational therapy for cardiac disorders 
is graded activity. 
(1) Activity in bed involving light finger motions only. (See fig. 12.) 
(2) Activity in bed involving forearm and upper arm motions. (See fig. 13.) 
(3) Ambulatory activity, preferably off the ward. (See fig. 14.) 
d. Special precautions. (1) Controlled activity must be planned to combat 
the restlessness caused by anxiety and boredom. 
(2) Correct posture during activity should be maintained. 
23. BLINDNESS, a. Causes. Blindness is usually caused by lacerations, con- 
cussions, gunshot and shrapnel wounds, infections, and such diseases as 
glaucoma and syphilis. 
b. Results. The condition which results from blindness is a deprivation of 
an essential visual means of orientation. 
c. Treatment. (1) Activity depending more on touch than on vision and 
within the patient’s existing dexterity. 
(2) Encouragement of patient gradually and consistently to extend scope 
of environment thus developing tactile and kinesthetic sense, and space per- 
ception. 
(3) Aim toward those activities which demand a high standard of precision 
in workmanship, such as typing, weaving, and cord knotting. 
d. Special precautions, (1) In early stages of blindness, familiarize patient 
with physical environment and any changes made therein. 
(2) Avoid excesses of sympathy. 
(3) Avoid doing things for the patient; emphasize independence. 
14 Figure 11. Raking and hoeing provide exercise for secondarily involved areas 
such as the shoulder girdle. 
Figure 12. Light finger activity involved in making of toy animal by Army nurse.  
(No differentiation has been made between active and passive motion) 
Part involved 
Prescribed motion 
Activity indicated 
Thumb and fingers 
Flexion 
Clay modeling, carpentry with hand tools, radio and electricity construction, fly-tying, type 
setting, embossograph. 
Extension 
Pottery (coil method), furniture refinishing, weaving (braid, inverted), loom weaving (resis- 
tance of beater), folding paper stock, piano, typing, gardening (planting, weeding). 
Abduction 
Piano, typing, card weaving. 
Adduction 
Piano, typing, type setting, radio and electricity construction, leather tooling, embossograph. 
Opposition 
Cord knotting, radio repair, type setting, leather tooling, fly-tying, gardening (weeding), leather 
plaiting, cutting with shears, leather punching, feeding printing press, embossograph. 
Wrist 
Flexion 
Hammering (woodworking, metalry), weaving (roller type), chiseling with mallet, painting large 
surfaces, leather lacing. 
Extension 
Leather lacing, weaving (roller type), hand printing press, cord knotting, gardening (weeding, 
planting), painting large surfaces, chiseling with mallet, paper cutter. 
Ulnar deviation 
Hammering, card weaving, leather tooling, cord knotting, piano, typing. 
Radial deviation 
Card weaving, piano, leather tooling. 
Forearm 
Pronation 
Leather lacing, spading and shoveling, radio construction and repair, auto mechanics. 
Supination 
Leather lacing, shoveling, radio construction and repair, screw driving, auto mechanics. 
Elbow 
Flexion 
Weaving, carpentry (spoke shave, draw knife, drilling) hand printing press, painting, auto 
mechanics, gardening. 
Extension 
Carpentry (sawing, planing, sanding, filing, hammering, drilling), gardening (planting, hoeing), 
hand printing press, cord knotting, chiseling with mallet, paper cutter. 
Shoulder 
Flexion 
Carpentry (planing, sawing, sanding, drilling), auto mechanics, hand printing press, painting, 
gardening (planting, weeding, shoveling). 
CHART I. OCCUPATIONAL THERAPY ANALYSIS FOR JOINT LIMITATION 
16  
Extension 
Hand printing press, embossograph, paper cutter, gardening (hoeing, raking), painting and 
scraping, carpentry (spoke shave, draw knife). 
Abduction 
Weaving, painting large surfaces, printing, gardening (shoveling, spading, planting, weeding), 
cord knotting. 
Adduction 
Printing, carpentry (brace and bit). 
Internal rotation 
Cord knotting, chiseling with mallet. 
External rotation 
Cord knotting. 
Scapula 
Abduction 
Carpentry (planing, sanding), gardening (lawn mowing). 
Adduction 
Knotting, weaving, carpentry (draw knife, spoke shave). 
Hip 
Flexion 
Bike saw, bike sander, gardening (weeding, planting, etc.). 
Extension 
Bike saw, bike sander, treadle printing press, treadle loom, treadle stapler. 
Abduction 
Potter’s kick wheel, treadle loom. 
Adduction 
Potter’s kick wheel, treadle loom. 
Knee 
Flexion 
Treadle printing press, bicycle saw, bicycle sander, gardening (weeding, planting, etc.). 
Extension 
Bicycle saw, bicycle sander, potter’s kick wheel, treadle printing press, treadle stapling machine, 
gardening (spading). 
Ankle 
Flexion 
Treadle sander, treadle saw, treadle potter’s wheel. 
Extension 
Treadle sander, treadle saw, treadle potter's wheel. 
Neck 
Flexion 
Extension 
Lateral flexion 
Controlled by position of work] 
Controlled by position of work }• Knotting and netting 
Controlled by position of work] 
Trunk 
Flexion 
Carpentry controlled by position of work, gardening (planting, weeding, shoveling). 
Extension 
Gardening, painting, bicycle saw. 
Torsion 
Gardening (shoveling, weeding, planting), printing. 
17 Nerve involved 
Muscles involved 
Applied work 
UPPER EXTREMITY: 
1. Spinal Accessory 
Sternocleidomastoid 
Trapezius 
Controlled by position of work. 
2. Long Thoracic 
Serratus Anterior 
Weaving on rug loom. 
Raking. 
Sandpapering in antero-posterior plane. 
Long range planing. 
Sawing. 
3. Thoraco Dorsalis 
Latissmius Dorsi 
Cord knotting; with long strands. 
Weaving: use of beater. 
Carpentry: spoke shave, draw knife. Hand printing press. 
Paper cutter. 
4. Supra Scapular 
Supraspinatus 
Cord knotting. 
Infraspinatus 
Winding warp. 
Gardening: shoveling, spading. 
5. Musculo Cutaneous 
Biceps Brachi 
Cord knotting. 
Use of beater: weaving. 
Gardening: raking, spading. 
Carpentry: spoke shave, draw knife, sanding, drilling. 
6. Axillary 
Deltoid 
Square knotting. 
Weaving on large floor loom. 
Painting large surfaces. 
Carpentry: planing (anterior deltoid), spoke shave (posterior deltoid), sawing: (anterior 
and posterior deltoid). 
7. Radial 
Triceps 
Clay modeling on potter’s wheel. 
Brachio-Radialis 
Supinator 
Painting large surfaces, weaving. 
Extensor Communis 
Wood carving. 
CHART II. OCCUPATIONAL THERAPY ANALYSIS FOR MUSCLE WEAKNESS 
18  
Digitorum 
Extensor Carpi 
Metal tapping, screw driving. 
Radialis 
Abductor Pollicis 
Carpentry: sawing, planing, hammering, drilling. 
Longus 
Extensor Pollicis 
Longus 
Extensor Pollicis 
Gardening: hoeing, spading. 
8. Median 
Brevis 
Pronator Teres 
Leather lacing. 
Flexor Carpi Radialis 
Setting type. 
Flexor Digitorum 
Sublimis 
Clay modeling. 
Flexor Longus Pollicis 
Radio construction. 
Abductor Pollicis 
Brevis 
Piano playing. 
Opponens Pollicis 
Typing. 
Flexor Digitorum 
Profundus 
Grasping nails and hammering. 
Cutting with tin snips or shears 
9. Ulnar 
Flexor Carpi Ulnaris 
Clay modeling. 
Abductor Digiti 
Quinti 
Setting type. 
Dorsal and Palmar 
Typing. 
Interossei 
Adductor Pollicis 
Piano playing. 
Flexor Digitorum 
Weaving. 
Profundus 
Carving with built-up tools. 
Cutting leather or with tin snips. 
Hammering. 
19 Nerve involved 
Muscles involved 
Applied work 
LOWER EXTREMITY: 
1. Femoral 
Illiopsoas 
Foot power loom. 
Quadriceps Femoris 
Drill press—foot power. 
Adductors 
Bicycle saw. 
Gardening: spading. 
Kick wheel. 
2. Sciatic 
Gluteus Maximus 
Foot power loom weaving. 
Biceps Femoris 
Bicycle saw. 
SemLendinosus 
Treadle print press. 
3. Posterior tibial 
Gastrocnemius 
Bicycle saw—with ball of foot. 
Tibialis Posticus 
Lawn mowing. 
Flexor Digitorum 
Treadle sowing machine. 
Flexor Digitorum 
Treadle lathe, sander, and saw. 
4. Common Peroneal 
Hallucis 
Tibialis Anticus 
Treadle saw, sander, sewing machine. 
Extensor Longus 
Digitorum 
Extensor Hallucis 
Longus and Brevis 
Peroneus Longus and 
Bicycle saw. 
Brevis 
CHAPTER II. (Continued) OCCUPATIONAL THERAPY ANALYSIS FOR MUSCLE WEAKNESS Figure 13. Electrical construction involves forearm and upper arm motions. 
Figure 14. Ambulatory patients, prescribed to increased activity, potting greenhouse plants. CHART III. OCCUPATIONAL THERAPY ANALYSIS 
No concession is made in this chart to 
KEY 
THUMB AND FINGERS 
WRIST 
FOREARM 
ELBOW 
Flexion 
Extension 
Abduction 
Adduction 
Opposition 
Flexion 
Extension 
Ulnar deviation 
Radial deviation 
Pronation 
Supination 
Flexion 
Extension 
Degree: 
Mild x 
Moderate xx 
Intense xxx 
PLASTICS, WOOD, METAL 
SA WING: 
Coping 
xx 
XX 
Miter box 
xx 
XX 
Hack 
XXX 
XX 
Rip and cross-cut 
XX 
xx 
xxx 
Bicycle 
XX 
Treadle 
XX 
PLANING: 
Block 
XX 
X 
Jack 
XX 
XX 
Jointer 
cxx 
xxx 
Spoke Shave 
XX 
XX 
Draw knife 
xxx 
xxx 
FILING: 
File, fine 
X 
X 
File, coarse 
XX 
XX 
Rasp, wood 
xxx 
xxx 
SANDING: 
Block, extension 
XX 
XX 
Block, flexion 
XX 
XX 
Surfaces, concave 
XX 
XXX 
Surfaces, convex 
xx 
XX 
Bicycle 
Treadle 
22 FOR COMPARATIVE INTENSITY OF MOTION 
position change or equipment adaptation. 
X 
X 
X 
X 
X 
X 
X 
X 
X 
X 
Flexion 
1 I I 
X 
g 
X 
X 
1 
Extension 
C/i 
33 
1 
1 
1 
1 
I 1 
I i 
Abduction 
C 
r1 
a 
1 
. 
1 
Adduction 
1 1 1 1 1 1 
1 1 1 
! 1 1 1 1 
1 1 
1 1 1 
Internal rotation 
1 1 t 1 1 1 
1 1 
1 i -1 1 1 
1 1 
1 1 1 
1 
External rotation 
X 
X 
1 1 1 
1 8 
Flexion 
X 
X 
1 
X 
X 
Extension 
X 
j 
Abduction 
X 
i 
1 ! 
Adduction 
X 
X 
• ill 
III I 
1 1 1 
1 X I 
1 X 1 
1 1 1 
Flexion 
X 
A 
X 
X 
1 
i 1 
1 
X 
X 
1 1 1 
Extension 
W 
X 
X 
X 
1 
X | 1 i 
X 
X 1 1 
1 
1 
Flexion 
> 
2 
X 
X 
X 
1 
1 
X 
X 
X 
1 1 1 
1 1 
Extension 
X 
r 
w 
Flexion 
j 
Extension 
w 
n 
X 
1 1 
1 I 
1 I 
1 i 1 1 
1 1 1 
Lateral flexion 
X 
X 
1 
X 
X 
X 
X 
X 
1 
X 
X 1 
i 
1 
1 
Flexion 
X 
X 
1 1 
1 1 
X 
X 
1 
1 
Extension 
50 
a 
z 
I i 
1 II 1 1 1 1 
Torsion 
X 
X 
X 
i 
1 
X 1 
X 1 
X 
X 
X 
1 
Abduction 
n 
> 
1 
1 
i | 
1 i 
X 
X 
X 
X 
X 
i 
| 
Adduction 
G 
f 
> 
23 Chart III. (Continued) Occupational therapy analysis 
KEY 
THUMB AND FINGERS 
WRIST 
FOREARM 
ELBOW 
Flexion 
Extension 
Abduction 
Adduction 
Opposition 
Flexion 
Extension 
Ulnar deviation 
Radial deviation 
Pronation 
Supination 
1 Flexion 
Extension 
Degree: 
Mild x 
Moderate xx 
Intense xxx 
HA MMERING: 
Tack or ball pein, 7 oz. 
xx 
xx 
X 
Standard or planishing, 13 oz. 
XXX 
xxx 
XX 
Heavy or machinists, 20 oz. 
xxx 
xxx 
xxx 
DRILLING: 
Hand 
XX 
X 
X 
Breast 
XX 
XX 
XX 
Brace and bit 
XX 
XX 
XX 
SCREW DRIVING: 
Common 
xxx 
XXX 
Ratchet 
xxx 
X 
xxx 
Brace and bit 
XX 
XX 
XX 
FINISHING: 
Scraping 
:xx 
xxx 
Painting, decorative 
X 
Painting, furniture 
XX 
XX 
XX 
XX 
XX 
Painting wall and ceiling 
xxx 
xxx 
xxx 
XX 
XX 
Polishing 
x 
x 
xx 
XX 
CARVING 
LINOLEUM 
xx 
XX 
X 
GA UGING 
XX 
XX 
CHISEL AND MALLET 
xxx 
xxx 
XX 
XX 
PRINTING 
TYPE-SETTING 
X 
X 
X 
X 
X 
HAND PRESS: 
XXX 
Lever 
xxx 
x> 
xxx 
xxx 
Feeding 
X 
X 
X 
X 
X 
24 XXX 
X 
X 
XXX 
X 
i X 
X 
X 
X 
X 
X 
Flexion 
SHOULDER 
for comparative intensity of motion. 
X 
XXX 
X 
1 
X 
X 
X 
X 
1 
X 1 
x ! 
1 
x ! 
X 
1 
Extension 
3 
1 
1 
X 
X 
1 
Abduction 
1 
* 1 
X 
X 
i 
X 
X 
1 
1 
Adduction 
1 1- 
1 ! 
I ■ 
1 1 1 
1 
1 
| • 
Internal rotation 
1 1 
1 i 
I 
• 1 
1 
1 
1 
1 
External rotation 
i i i 
i 
i 1 1 
r i i 
Flexion 
X 
•c 
I I 1 
1 1 1 
1 
1 
1 
I 
Extension 
1 1 1 
1 1 1 
i 
i 
1 i 
1 1 
j j 
Abduction 
i i ! 
i i 1 i i 
1 1 1 
1 1 1 
1 1 1 
i i i i i 
1 1 I I t 
j Adduction 
i i i ! 
i 1 
1 1 1 1 1 1 1 1 .1 
1 1 1 1 1 1 1 1 1 1 I ' I--I- 1 1 1 
j Flexion 
KNEE 
I ! i ! 1 
1 1 1 
i i i i i i i i i i i i i i „, 
| Extension 
Mill 
1 
1 1 1 1 1 1 1 I I 
1 1 1 1 1 1 1 1 1 1 
1 i 
1 1 1 1 1 
j Flexion 
W 
X 
2 
< 
MM 
1 
1 ■ 1 
1 1 ! 1 1 1 1 1 
i 
i , i i i i i 
1 1 I i I | 1 
Extension 
i i M 
1 1 
1 1 
j Flexion 
z 
n 
X 
lit ill 
II III 
1 1 
i i i i i i i i i „ 
j Extension 
iiii 
iiil 
1 1 
1 1 
1 
M M 1 
1 1 1 1 1 
!■ 1 I 1 1 
j Eateral flexion 
ill i 
1 ! 1 1 
1 i i i I <!i 
1 1 1 1 1 I 1 ! 1 1 i 
Flexion 
TRUNK 
XXX 
1 _ 
1 
1 1 
1 
l 
1 
Extension 
i i 
v 1 
1 
X 
X 
X 
I 1 1 
1 1 j 1 
1 1 1 { 1 
j Torsion 
j | Abduction 
SCAPULA 
I j 
1 
1 
1 1 
1 
i I i 
1 Ml M 
Adduction 
25 Chart III. (Continued) Occupational therapy analysis 
KEY 
Degree; 
Mild x 
Moderate xx 
Intense xxx 
THUMB AND FINGERS 
WRIST 
FOREARM 
ELBOW 
Flexion 
Extension 
Abduction 
Adduction 
Opposition 
Flexion 
Extension 
Ulnar deviation 
Radial deviation 
Pronation 
Supination 
Flexion 
Extension 
FOOT PRESS: 
Treadle 
Feeding 
X 
X 
X 
X 
X 
STOCK PREPARATION: 
Catting 
XX 
XX 
xxx 
Folding 
XX 
XX 
Stapling, hand 
XX 
Stapling, foot 
EMBOSSOGRAPH 
SETTING TYPE 
XX 
XX 
XX 
x 
X 
PRINTING 
XX 
XX 
BOOKBINDING 
CUTTING: 
Scissors 
xxx 
xxx 
Knife 
xxx 
X 
Paper cutter 
XX 
XX 
xxx 
PASTING 
X 
ASSEMBLING 
X 
X 
X 
SEWING 
XX 
XX 
CLAY 
MODELLING 
X 
POTTERY: 
Coil 
XX 
Kick wheel 
Treadle 
1 
26 for comparative intensity of motion. 
X 
X 
X 
X 
Flexion 
X 
X 
X 
X 
X 
X 
X 
X 
1 
f 
X 
X 
X 
Extension 
i 
i 
\ 
X 
Abduction 
G 
O 
' 
X 
Adduction 
JO 
1 
1 • 
1 
1 
1 
Internal rotation 
X 
X 
1 
1 
External rotation 
X 
X 
Flexion 
X 
X 
X 
X 
Extension 
X 
X 
X 
Abduction 
ns 
X 
X 
1 
Adduction 
1 
X 
X 
Flexion 
X 
z 
X 
X 
X 
X 
X I 
s 
Extension 
m 
n 
X 
X 
X 
1 
Flexion 
> 
Z 
X 
X 
X 
i 
1 1 
1 1 1 
1 
Extension 
r 
w 
Flexion 
Extension 
w 
n 
X 
1 
Lateral flexion 
1 
Flexion 
h 
Extension 
JO 
G 
Z 
B 
Torsion 
Abduction 
o 
> 
Adduction 
G 
r 
> 
27 Chart III. {Continued) Occupational therapy analysis 
KEY 
Degree: 
Mild x 
Moderate xx 
Intense xxx 
THUMB AND FINGERS 
WRIST 
FOREARM 
ELBOW 
Flexion 
Extension 
Abduction 
Adduction 
Opposition 
Flexion 
Extension 
Ulnar deviation 
Radial deviation 
Pronation 
Supination 
Flexion 
Extension 
LLATHER 
CUTTING 
XXX 
x 
TOOLING 
xxx 
XXX 
XX 
XX 
PUNCHING 
OCX 
LA CING 
X 
X 
X 
X 
X 
X 
X 
BRAIDING 
XX 
KNOTTING 
XX 
X 
XX 
XX 
FLY TYING 
X 
X 
— 
X 
WEAVING 
CA RD 
XXX 
XX 
XX 
XX 
XX 
FRAME 
X 
X 
X 
x 
LOOM, TABLE: 
Lever 
XX 
XX 
XXX 
— 
X 
X 
X 
Roller 
XX 
XX 
X 
X 
X 
LOOM, FLOOR 
XX 
X 
X 
X 
XX 
GARDENING 
LAWN MOWING 
— 
— 
— 
PLANTING 
XX 
XX 
XX 
XX 
XX 
xxx 
WEEDING 
xxx 
XX 
XX 
XX 
xxx 
HOEING 
xxx 
xxx 
RAKING 
XX 
XX 
XX 
* 
SPADING 
xxx 
XX 
SHOVELING 
xxx 
xxx 
XXX 
xxx 
TYPING 
XX 
XX 
XX 
XX 
X 
PIANO 
XX 
XX 
XX 
XX 
XX 
X 
RADIO AND ELECTRICITY KITS 
XX 
XX 
x> 
XX 
XX 
AUTO MECHANICS 
xxx 
xxx 
xxx 
xxx 
28 for comparative intensity of motion. 
XXX 
X 
X 
XXX 
X 
X 
X 
X 
X 
X 
Flexion 
X 
X 
XXX 
X 
X 
X 
X 
X 
X 1 
X 
X 
X 
X 
Extension 
X 
X 
X 
X 
, 
X 
X 
Abduction 
G 
b 
Adduction 
ja 
1 1 
1 
X 
1 
Internal rotation 
1 
1 1 
1 
X 
1X 
External rotation 
1 
X 
X 
X 
X 
X 
Flexion 
1 
X 
X 
X 
X 
B 
X 
X 
Extension 
X 
1 
X 
Abduction 
1 1 
X 
Adduction 
1 
X 
X 
X 
X 
X 
X 
X 
1 1 
Flexion 
X 
z 
X 
X 
X 
1 
1 
Extension 
W 
1 
1 
, 
Flexion 
> 
z 
1 
Extension 
r 
w 
1 
1 
| Flexion 
1 1 
Extension 
w 
n 
* 
1 
1 1 1 
1 
1 
| Lateral flexion 
X 
X 
X 
1 1 X 
X 
X 
1 1 
Flexion 
H 
X 
X 
X 
X 
X 
X 
Extension 
G 
2 
1 
In 
1 
X 
X 
X 
X 
( Torsion 
XXX 
1 
Abduction 
C/5 
D 
> 
X 
X 
X 
Adduction 
G 
> 
29 CHAPTER 4 
TREATMENT OF AMPUTEES 
Section I. GENERAL REMARKS 
24. GENERAL REMARKS. The amputation case presents a problem and a 
challenge to occupational therapy, both of which are being met with increasing 
ingenuity today. Although there is a dearth of research material in this field 
available as a guide for work with the amputee, the new method of handling 
these patients in amputation centers and the increased number of cases treated 
in this war should correct this situation. The surgeon, the limb manufacturer, 
the limb fitter, the occupational therapist, the physical therapist, and the 
amputee, are all combining their knowledge, experience and resourcefulness to 
discover and develop new methods and improve appliances for the amputee. 
Section II. PURPOSE OF OCCUPATIONAL 
THERAPY FOR AMPUTEES 
25. PSYCHOLOGICAL PURPOSES OF EARLY TREATMENT, a. The prin- 
ciple of maintaining mental as well as physical health should be applied to 
amputees during the period of their adjustment to usefulness. A well-healed 
stump with a correctly fitted prosthesis is of little value to a man whose mind 
and spirit have been warped by an attitude of cynicism, bitterness, or a feeling 
of uselessness and inadequacy. Amputations constitute a serious disability. It 
is therefore, of paramount importance that all possible effort be directed toward 
a program designed to treat the whole man and not just his physical injury. 
b. Immediately following traumatic or surgical amputation, there is a stage 
of convalescence characterized by a greater or lesser degree of mental shock. 
During this stage, there is opportunity for early psychological treatment. The 
patient is aided in his orientation to his disability through an association with 
those having a similar handicap. Treatment of amputation cases in all stages 
should be planned in such a way that the new patient, not yet fitted with his 
prosthesis, mingles with and observes the patient who is just learning as well 
as the patient already skilled in its use and ready for discharge. 
26. TREATMENT IN PRE-PROSTHETIC STAGE. During the early stage 
following amputation and before a prosthesis has been fitted, referral of arm 
amputation cases to occupational therapy is very important. Prescription should 
be for education of the remaining hand, with special emphasis cn writing if 
the dominant hand has been amputated. Writing may be taught for either the 
remaining hand or the stump as indicated by considerations such as length 
of stump, and preference of the patient. In addition, various craft and recrea- 
tional activities will help the recent amputee to develop skill and dexterity in 
30 the use of his hand and to reestablish confidence in his ability despite his 
handicap. 
27. TRAINING IN USE OF A PROSTHESIS, a. After the stump has been 
healed and hardened, a prosthesis is fitted and the amputee must be trained 
in its most efficient use. Work should be planned so that learning may come 
through doing, and that the patient may have every opportunity to find out 
for himself exactly how and why his prosthetic appliance works and what 
he may expect of it. Guidance, help, suggestions and a thorough explanation 
of the mechanics of its operation will all be necessary and helpful to the 
patient, but it is mainly through his own efforts and determination to learn 
that real proficiency will develop. Vocational training as such is the respon- 
sibility of the Veteran’s Administration, but any prevocational training that 
may be given during hospitalization is, of course, to be desired. 
b. The use of a prosthetic achievement chart (fig. 42) will be found help- 
ful in determining the time for discharge. In addition to providing a training 
ground for the use of the artificial limb, the various occupational therapy 
activities can act as a proving ground where the prosthesis may be tried oi t, 
observed and checked as to function under actual working conditions. Adjust- 
ments and changes are thereby facilitated since maximum use will be possible 
only if individual fittings are correct. 
28. CARE OF PROSTHESES. A final but none the less important considera- 
t;on in the treatment of amputees is thorough instruction in the care of pros- 
theses. The patient leaves the hospital with as nearly a perfect stump and as 
well fitting a prosthesis as can be obtained. The responsibility for this further 
care rests entirely with the patient when he has been discharged to civil life. 
War Department Pamphlet No. 8-7 should be made available to amputees 
through the Limb Shop. It includes such considerations as cleanliness, care of 
abrasions and blisters, stump shrinkage, care and maintenance of the moving 
parts of the artificial limb and the importance of care for the remaining sound 
limb. A list of Veteran’s Facilities where regular check-up, adjustments and 
repair may be obtained, is appended to the pamphlet. 
Section III. TREATMENT IN UPPER EXTREMITY 
AMPUTATIONS 
29. PARTIAL HAND. a. Thumb. 
b. One or more fingers. In cases where the thumb is lost, or all four 
fingers, a prosthesis may be supplied to permit opposition and grasp. If the 
thumb and at least one finger remain, so that grasp is possible, the use of 
a prosthesis is not usually indicated except for cosmetic effect. In these cases 
of partial hand amputation, flexibility and strength in what remains are essen- 
tials. The patient should work to increase mobility of the intrinsic muscles of 
his hand, and also to increase the power of his grip. If there is joint stiffness 
in any of the fingers, treatment should be given for this condition as indicated. 
Built-up handles for tools, shaped to fit the patient’s grasp, and gradually 
decreased in size as he progresses, are often useful. Clay modeling, leather 
tooling and lacing, type-setting, and fly-tying are also useful in promoting co- 
ordination and skill. (See fig. 15.) 
31 Figure 15. Patient tvith partial hand amputation, shown tying fishing flies for the 
development of skill and coordination. 
30. FOREARM, a. Dominant arm. That arm in which the handedness occurs. 
(1) PRE-PROSTHETIC STAGE, {a) Writing. In the pre-prosthetic stage, 
the most important consideration for this type of amputation is usually learning 
to write. Two methods may be used: 
1. Writing with the remaining hand. 
(a) Principles of treatment are: 
(1) Large sweeping arm motions and easy rhythm in the formation of fun- 
damental letters, alphabet and figure practice should be emphasized. 
(2) Progressive graduation from blackboard to writing table with large 
sheets of paper, at first ruled and later unruled, and from large sheets to 
ordinary stationery will be indicated as skill increases. (See fig. 16.) 
(3) Constant daily practice is essential to success. 
32 (b) Precautions should be observed as follows: 
(1) Practice should be interspersed with other more interesting activities. 
(2) Letter-writing should be encouraged to reestablish confidence as well 
as to increase time spent in practice. 
(3) Approved writing positions should be insisted upon at all times. 
2. Writing with the stump by the use of an adjustable leather cuff. (See 
% 17.) 
(a) Principles of treatment. 
(1) The cuff is buckled onto the forearm stump and the clip which holds 
the pencil is turned in such a direction as to give the writer the desired slant 
and position with relation to the paper. 
(2) Writing is done by a rotary motion of the whole arm from the shoulder. 
(See fig. 18.) In this way, writing becomes a skill of the arm instead of the 
hand, and since it was by this means—the Palmer method of school days— 
that many people learned writing originally, return to it is almost more 
natural than learning anew with the other hand. 
(3) When the prosthesis is fitted, the pencil is transferred from the cuff to 
the new hand or hook and writing is done as previously learned. (See fig. 
19.) 
Figure 16. Amputation upper one-third right arm. Practice in uniting as a part of the 
education of the left hand. Figure 17. Writing cuff used by amputees who will be able to ivrite with the prosthesis. 
Figure 18. Patient with bilateral arm amputation writing with cuff designed for amputees. Figure 19. Patient with bilateral arm amputation writing ivith prosthesis. 
(b) Advantages of the cuff. 
(1) The ease and speed of learning. 
(2) Naturalness. 
(3) The factor of encouragement to use of prosthesis when fitted. 
(v) The tendency to keep the patient thinking essentially in terms of being 
a two-handed person, which will make the next stage easier in many ways. 
(:) Disadvantages of this method. 
(!) A necessary delay in starting reeducation because of the precaution 
against using the cuff on a sensitive stump or because of injuries to the arm 
other than the amputation. 
(2) In short forearm and upper arm amputation, it is difficult and often 
unadvisable to use the cuff. 
(3) For disarticulations of the shoulder, this method is impossible. 
(h) Other activities. In addition to writing, other activities should ]be used 
to develop dexterity and skill in the untrained arm and hand. 
1. Ping-pong and darts are excellent for general coordination and skill and 
have high value from the points of view of recreation and socialization, and 
35 Figure 20. Patient with right arm amputation assembling model for dexterity and skill of left hand. 
offer welcome change from writing practice. The competitive nature of 
these activities is also wholesome, groups of amputees working out similar 
problems together and having fun in doing so. 
2. Type-setting requires finger dexterity and operation of the hand printing 
press will strengthen unused and undeveloped muscles. 
3. Leather work, clay modeling, typing, carpentry, model construction, and 
similar activities will help teach skill and impart a feeling of self-confidence 
and accomplishment to the recent amputee. (See fig. 20.) 
(2) TRAINING IN USE OF PROSTHESIS (a) Approximately 3 to 5 
weeks after amputation, a patient will be fitted with his prosthesis, and training 
in the use of this appliance should start immediately. 
(b) Principles of treatment: 
1. A thorough knowledge and understanding of the mechanics of operation 
is of prime importance in order that the patient may get the maximum use 
of his prosthesis. He must know what motions will initiate opening of the 
hook, and, conversely, how to close it; how to pick up objects near at hand 
36 and those at arm’s length, (fig. 21) how to regulate pressure, as for instance 
on a cigarette or drinking glass, and how to secure maximum holding power. 
2. Practice will develop efficiency and ease of use once these principles are 
understood. 
3. Work should be planned in such a way that learning will come through 
doing, and that the patient may have every opportunity to find out for him- 
self exactly how and why his arm works and what he may expect of it. 
4. Special practice in the common procedures met with in daily life should 
be stressed. Faucets, door knobs, shoe laces, handles, telephones, razors, tooth 
brushes, eating utensils (fig. 22) and many other simple objects will‘present 
real problems on first attempts to use the hook. 
3. Ease will replace awkwardness only as the patient pursues daily practice 
in the use of his appliance and engages in a sufficient variety of activities. 
Therefore, ingenuity in planning a program to cover every possible use of 
the prosthesis is of the utmost importance. 
6. The use of bilateral crafts and activities should be stressed because they 
teach a perfect coordination of normal hand and prosthesis. (See fig. 23.) 
At the same time a patient is learning to use his prosthesis efficiently, he will 
also increase the skill of his remaining hand to above average level. (See 
fig. 24.) 
Figure 21. Specially constructed checker board and checkers help 
teach fundamental mechanics of operation of the hook. Figure 22. The efficient handling of eating utensils is an important consideration 
for the arm amputee. 
h. Secondary arm. The alternate arm from that in which the handedness 
occurs. 
(1) TREATMENT IN THE PRO-PROSTHETIC STAGE. In cases of secon- 
dary arm amputation, the problem is not so complex. Referral to occupational 
therapy before the prosthesis is fitted is to be desired but is not as important 
as with the dominant arm amputations. For purposes of morale, diversion from 
worry, constructive use of leisure time (fig. 25) and an opportunity for the 
patient to become acquainted with prosthetics and their use, occupational 
therapy may prove very beneficial in this stage. Too great independence with 
one hand should not be stressed because of the tendency not to use the pros- 
thesis when fitted. 
(2) TRAINING IN THE USE OF THE PROSTHESIS, (a) After a pros- 
thesis has been fitted, the problem is chiefly one of learning to use the new 
appliance as an efficient helpmate to the other hand. Bilateral activities, par- 
ticularly those requiring skill, are the most important in this type of retraining 
and should be strongly emphasized because of the tendency to use the good 
hand to the exclusion of the prosthesis. (See fig. 26.) 
38 (b) Length of stump will largely determine the degree of proficiency with 
which an amputee will be able to use his prosthesis. The patient with one long 
forearm stump and free elbow motion is not very much more handicapped than 
the man with a partial hand, except for his loss of wrist motion. Generally 
speaking, the shorter the stump, the greater the need for the development 
of skill in the remaining hand and the greater efficiency required with the 
prosthesis. Short forearm amputees will have difficulty with, and need more 
practice in, activities requiring skill because of decreased leverage. These 
cases will also have difficulty with activities requiring strength since the lifting 
power will have to come chiefly from the shoulder. Specific treatment will be 
indicated according to specific conditions and in each case should be planned 
with the needs of the individual patient always in mind. 
Figure 23. Billiards afford an excellent opportunity to learn coordination of normal 
hand and prosthesis. 31. UPPER ARM. Essentially the same treatment is indicated for all arm 
amputation cases with variations depending mainly on the handedness of the 
individual and the length of stump. The loss of an elbow is a serious handicap 
for although a joint is provided in the prosthesis its motion will usually be 
controlled by the other hand. Writing with the cuff and prosthesis will be 
much more difficult, although not impossible except for very short stumps 
or shoulder disarticulations. Treatment should therefore center on the develop- 
ment of skill in the remaining hand and the use of the prosthesis as a helpmate 
in holding things. (See fig. 27.) Difficulty will be experienced at first with 
such things as tying shoe laces, cutting meat and similar two-handed activities. 
However, the degree of success in the use of an upper arm prosthesis is 
largely dependent upon the amount of drive and intelligent practice the 
patient is willing to put into the learning process. Many achievements are 
possible through continued practice in control of the lead string, elbow and 
hook in various positions. The upper arm amputee who has initiative and 
patience, and above all, a desire to learn, can use his prosthesis for a great 
deal more than merely filling his sleeve. The cosmetic effect is important, 
particularly for a man whose work brings him into contact with strangers. 
But the cosmetic effect even for the upper arm amputee is only part of the 
advantage of the prosthesis. 
32. SHOULDER DISARTICULATION. This degree of amputation is fortu- 
nately not common. Beyond its value for cosmetic appearance, little can be 
done with the prosthesis fitted to a shoulder disarticulation. Treatment should 
stress skill and ability with the remaining hand by participation in as wide 
a variety of activities as possible. 
33. ONE ARM AND PARTIAL HAND. A number of cases of this type/ of 
amputation have occurred. Their treatment should be as intensive and complete 
Figure 24. In- learning to use his prosthesis as the helpmate, the patient will 
simultaneously increase the skill of bis normal hand. Figure 25. Patient makes a billfold while waiting for his stump to heal and prosthesis to be fitted. 
as that indicated for the bilateral amputee. Writing and personal care are 
among the most important abilities to be mastered at an early stage, and in 
addition, constant practice in bilateral activities will serve to reestablish confi- 
dence and increase independence. 
34. BILATERAL, a. Treatment in the pre-prosthetic stage. The first and most 
important consideration in the treatment of the bilateral arm amputee is the 
establishment of independence. As soon as the stump is sufficiently healed to 
permit strapping the cuff to it, treatment should commence. 
(1) PRIMARY ACTIVITIES. The cuff will make significant contribution to 
independence and in addition to its use for writing, adaptations for other 
activities can be made: 
{a) With pencil inverted, eraser end down, pages of a book, paper or maga- 
zine can be turned, thus enabling reading for the double amputee. 
41 (b) Equipped with a cuff on each arm, the pencil again inverted, the 
patient may become quite proficient in the "hunt and poke” system of typing 
(See fig. 28.) 
(c) The adjustable clip will also hold leather tools, paint brushes, and 
eating utensils, thus opening up other fields of accomplishment. 
(2) RECREATIONAL POSSIBILITIES. In addition to these activities, it is 
also desirable to provide an outlet for energy and recreation. 
(a) Leather straps tacked to the handles of ping-pong paddles and then 
strapped around the stumps have proven almost as adequate as hands in playing 
ping-pong (See fig. 29-) Two should be used in preference to one because 
of the opportunity for development of bilateral skill and also to enable the 
patient to pick up the ball and serve it himself. 
Figure 26. Patient uses hook as helpmate to other hand, Figure 27. With elbow joint locked in position of flexion, upper arm amputee can hold 
objects in position for work with normal hand. 
(b) Larger clips on the cuff to accommodate a cue handle will permit the 
addition of billiards as an activity for recreation and training in skill. 
(3) These activities will also do much toward maintaining general bodily 
health, circulation, and muscle tone which are often sluggish because of the 
very slight use of the arms after amputation and before the fitting of prostheses. 
b. Training in use of prostheses. When the patient is fitted with his pros- 
theses, there are certain things, such as typing (fig. 30) that he now finds 
quite simple to do. Having already learned how to get along without fingers, 
and with the hooks as a far more adequate means of holding utensils, skill 
in their use develops rapidly. 
(1) PRINCIPLES OF TREATMENT, (a) Ample opportunity should be 
given each patient to practice with eating utensils (fig. 31), dressing, shaving, 
and such common accoutrements of living as faucets, door knobs, keys, coins, 
43 Figure 28. Equipped with a cuff on each arm, the bilateral arm amputee is able to type. 
Figure 29. Ping-pong paddles may be used before prosthesis is fitted. Figure 30. Typing may be easily and quickly learned with bilateral prostheses. 
and papers. Most of these skills and abilities will be developed and perfected 
only through diligent application in constant practice. 
(b) A varied program of activity should be planned to insure change from 
practice with skills before a patient encounters discouragement through re- 
peated trial and failure. 
(c) Ping-pong (fig. 32) and billiards will be helpful in teaching coordina- 
tion and timing with relation to the interdependent function of the hooks, 
and are good socialization and recreation media. Other activities may be used 
as indicated by a patient’s willingness and desire to learn. (See fig. 33-) 
(2) PRECAUTIONS, (a) It has been found that the bilateral amputee can 
do many of the things that two-handed people can do, but he must be allowed 
to do it in his own way. 
(b) Angle of hook, direction of approach, control from the shoulder and 
back muscles are significant considerations and must be mastered by these 
patients before skill can be developed. 
(c) Special equipment and apparatus should be avoided since the main 
objective in treatment is to foster morale and independence in every day living. 
45 35. BILATERAL WITH ADDITIONAL LOSS OR HANDICAP. The condition 
of bilateral arm amputation may occasionally be accompanied by further dis- 
ability such as partial or total loss of sight. 
a. Writing with the cuff may be facilitated by outlining the paper with 
raised margins against which the pencil will be guided. 
b. Muscle retraining and development of coordination and skill should be 
emphasized. 
c. Training of these cases will necessarily be very specialized, depending on 
the individual factors involved and results will depend largely on the attitude 
and perseverance of the patient. 
Figure 31. Daily practice with eating utensils will lend confidence and self-assurance 
as well as develop skill in use. Figure 32. Ping-pong teaches coordination and timing with relation 
to the interdependent junction of the hooks. 
Figure 33• Patient with bilateral forearm amputation increases skill 
with prostbeses while printing pictures. 
47 Figure 34. The floor loom helps teach coordination and, placement in early training 
in use of lower extremity, prosthesis. 
Section IV. TREATMENT IN LOWER EXTREMITY AMPUTATIONS 
36. PRE-PROSTHETIC STAGE. Leg amputation cases are often confined to 
bed by traction for long periods of time following surgery and before treatment 
is begun to prepare the stump for a prosthesis. During this time, a planned 
program of diversion designed to decrease preoccupation with symptoms and 
general boredom from inactivity will contribute to the patient’s mental well- 
being and consequent adjustment to his handicap. These cases, although they 
do not come under the classification of functional work, are nevertheless 
48 worthy of consideration and should be given as much time as is in keeping 
with the over-all program. 
37. TRAINING IN USE OF PROSTHESIS. In the Army, the training of leg 
amputees is handled by the physical therapy department which teaches the 
fundamentals of correct use. Occupational therapy therefore will be called upon 
only to supplement their activities. It is important that the occupational 
therapist be familiar with the techniques of gait and balance taught in physical 
therapy so that she may employ the same techniques when the patient is 
engaged in activities under her supervision. Principles of treatment should be 
based on the following general procedures; 
a. Soon after the fitting of a prosthesis, and before extensive weight-bearing 
is attempted, the floor loom will help teach coordination and placement (See 
fig. 34.) 
b. The bicycle jig-saw (fig. 35) and treadle printing press (fig. 36) will 
Figure 35. The bicycle jig-saw provides exercise for long unused muscles 
without the strain of body weight. Figure 36. The treadle printing press is a step beyond the jig-saw in strength 
and coordination requirements. 
Figure 37. Patient with lower leg amputation engages in recreational activities 
for further skill with prosthesis. strengthen long-unused muscles without undue strain on the stump from 
the pressure of body weight. 
c. For establishing balance and a sense of security, shuffle-board, archery, 
horseshoes, and billiards are best in the early stages, with badminton, bowling 
(fig. 37), gardening (fig. 38) and similar activities being added as weight 
tolerance and proficency are increased. 
d. Swimming is valuable for general muscle tone unless contraindicated. 
e. Dancing will aid in the development of coordination and rhythm. 
f. Driving a car should be used as indicated by the facilities of the hospital 
(See fig. 39.) 
g. Other activities may be used as indicated by the facilities of the hospital 
(See fig. 40.) 
Figure 38. Patient spading in hospital garden increases weight tolerance 
and skill in use of prosthesis. 
51 Figure 39■ Other amputation cases go along for the ride as the driver t-ies out his new leg. 
Figure 40. Arm and leg amputation patients on horseback. Figure 41. One form of the prosthetic achievement chart for upper extremity amputations. 
Section V. PROSTHETIC ACHIEVEMENT CHART 
38. PURPOSE, a. It is felt that every amputee should remain under treat- 
ment until he has demonstrated a satisfactory ability to use his prosthesis. To 
do this, he should be kept occupied by a planned program of activity. The 
number of weeks that he must be so occupied will vary with the individual, 
but should never be less than 3 weeks. Patients should not be promised, a 
definite date of discharge until this has been accomplished. 
b. Patients should be encouraged to wear their prostheses at all times. If 
it becomes obvious that a patient is wearing it only for treatment periods, he 
should be warned that he is only holding up his own discharge. Upper 
extremity amputations should be encouraged to wear the hook and not the 
hand. 
53 PROSTHETIC ACHIEVEMENT CHART 
Upper Extremity 
Name Grade Ward 
f 
Site of amputation 
Single Left Date first visit. 
Double Right Date Prosthesis received 
Any other physical disability Date discharged from O. T._ 
1. Pingpong with cuff 
2. Writing and typing with cuff 
3. Writing with left hand 
4. Writing with prosthesis 
5. Pingpong with prosthesis 
6. Typing with prosthesis 
7. Dial and answer phone and 
messages 
8. Fold business letter and put in 
envelope 
9. Open sealed envelope and take 
letter out 
13. Operate pencil sharpener 
11. Open and close windows and 
drawers 
12. Open door with double lock 
13. Use knife and fork 
14. Pick up cups and glasses 
15. Tie shoe laces 
16. Tie necktie 
17. Comb hair and shave 
18. Button buttons 
19. Light cigarette safely with 
match or lighter 
20. Turn types of light switches on 
and off 
21. Turn faucets on and off 
22. Leather project 
23. Woodwork project 
24. Project in weaving or cord 
knotting 
25. Play checkers 
26. Throw darts or horseshoes 
27. Additional skills 
Figure 42. Suggested activities for consideration in the prosthetic achievement chart 
for upper extremity. 
39. APPLICATION. In order to provide objective measurement for the demon- 
strated satisfactory ability to use his prosthesis, the prosthetic achievement 
chart (fig. 4l) has been advised. The form for this chart will necessarily be 
determined by the type of prosthesis being tested and the type of equipment 
available. Essentials to be included for the arm amputee are the common skills 
such as eating, dressing, and writing, which every amputee must master before 
discharge. (See fig. 42.) A similar form, with activities suited to test proficiency 
of use for lower extremity amputee may be used. Ratings of accomplishment 
will naturally depend largely on the site of amputation and therefore the 
maximum proficiency possible for a given condition. Use of this type of 
chart will prove of real benefit in determining when an amputee is ready for 
discharge. 
54 CHAPTER 5 
OCCUPATIONAL THERAPY IN 
NEUROPSYCHIATRIC DISORDERS 
Section I. OVERVIEW 
40. OVERVIEW OF PROBLEM. Nearly everyone recognizes that even the most 
distressing situations in life are easier to face if one has a job to do that seems 
important.1 Work, play, or relaxation and rest must find a part in the activity 
of everyone each day in the interest of mental health. Work has long been 
recognized as a useful means of diverting the mind from its troubles and 
anxieties. Occupational therapy employs this age-old concept in the treatment 
of nervous and mental disorders. "We find almost regularly in psychiatric 
patients that they cannot work, they cannot play, and they cannot rest. They 
have to be taught to do all three of these things. Fortunately, in most cases it 
proves possible to grade assignments so that the patient may be taught to 
play and taught to work and thus taught to divert available energy toward the 
construction of patterns of creativeness.”2 
41. PURPOSE. Occupational therapy is of increased importance in the treat- 
ment of neuropsychiatric disorders because it is practical, promotes a desire 
to want to get well, and assists in socialization. It is also an effective aid in 
restoring self-confidence and a sense of security. Absorption in interesting, 
useful tasks, or in hobby interests, denied expression during the war, are a 
means of putting in order disorganized thoughts. Occupational therapy substi- 
tutes constructive habits and outlets for tensions and may facilitate sublimation. 
42. ADMINISTRATION. Participation in occupational therapy will be re- 
quired, if the psychiatrist so directs, with freedom given the neuropsychiatric 
patient in the choice of purposeful tasks he would select by his own will. 
a. Division according +o types of cases. Psychiatric patients attending the 
occupational therapy department will be organized into social groups in similar 
stages of recovery. The patient who is very sick needs to be separated from 
the slightly ill. It will be found that closed ward patients should have their 
own shop or shop period. Some open ward patients also still require individual 
handling. The majority of open ward nervous and mental cases may, however, 
be intermingled to advantage with other patient groups. This avoids the 
hazards of belief that they are different from others as well as exaggeration 
of stigmatization. 
b. Division according +o types of activities. If all crafts are taught in one 
room, it is often noisy and confusing. A solution to the problem of different 
W. E., M.C., "Occupational Therapy;” Manual of Military Neuropsychiatry, 
edited by Harry C. Solomon; W. B. Saunders Co., pp 604-610, 1944. 
2Menninger, Karl, "The Abuse of Rest in Psychiatry,” J.A.M.A., 125:1080-1090, 19 
August 1944. 
55 patient needs is in the establishment of two sections of the shop. One shop 
room features the noisier, more robust projects such as carpentry, metal work, 
and graphic arts. In it useful articles are made for the hospital, such as file 
boxes, bookcases, cabinets, ash trays, medicine trays, or printed letterheads 
or a newspaper. The other shop is a quiet restful place—even the color motif 
differs from the active shop—where creative arts and crafts are featured. 
Efficient shop practice calls for a carefully planned detailed schedule. Work 
standards should be high in order to approximate normal work situations. 
c. A greater variety of occupational activities should be provided for neuro- 
psychiatric cases in order to meet the varied interests of patients. In addition 
to the usual arts and crafts, the following will indicate the range: wood 
working, graphic arts, radio and electricity, motor mechanics, photography, 
gardening, model plane building, and industrial (work) assignments about the 
hospital or camp. Even such hobbies as collecting stamps or nature study 
materials have a place in occupational therapy in selected cases for they may 
arouse the patient’s interest. Recently, small manufacturing assembly processes 
have been successfully introduced into the hospital ward occupational program. 
43. PRESCRIPTION. The psychiatrist must accept the responsibility for indi- 
cating when the patient is ready for occupational therapy and must indicate 
the desired objectives. The more complete the understanding of the individual 
patient’s problems and psychological needs, the more skillfully may occupa- 
tional therapy be prescribed. The therapist, if acquainted with the essential 
facts and precautions in the case will then be able to more intelligently treat 
these special types of patients through the selection of particular activities 
designed to meet a particular problem. No patient should be accepted without 
a prescription by the medical officer. Observation made by therapists on the 
behavior and attitudes of patients in the informal atmosphere of the shop 
have value to the psychiatrist in the management of the patient and should 
therefore be transmitted to him at regular intervals. 
44. TECHNIQUE OF APPLICATION OF OCCUPATIONAL THERAPY. 
a. The vast majority of neuropsychiatric cases encountered in military hospitals 
are psychoneuroses. Most of the cases occurring in combat and being returned 
from overseas represent the psychoneuroses. Most frequent type by far are 
the anxiety states, followed by the gastro-intenstinal and cardiac neuroses, 
hypochondriasis, neurasthenia, and conversion hysteria. The situational stress 
of battle has been found more important than personality weakness in a large 
proportion of the combat cases. It is the threat of danger in return to duty 
that makes it necessary for the combat soldier to cling to his neurosis, cr 
the return to the overwhelming situation again that makes the neurotic 
continue ill. 
b. Essential factors in therapy are immediate treatment while symptoms are 
amorphous and avoidance of prolonged hospitalization which tends to aggra- 
vate the symptoms through exaggeration of the concept of illness. As soon 
as the necessary investigative procedures have been completed, therefore, all 
patients who do not require closed ward care with intensive individual therapy 
are assigned to convalescent facilities or convalescent hospitals or to the 
advanced reconditioning section where they are housed apart from hospital 
wards. Here they are exposed to an active program of physical and educational 
reconditioning and occupational therapy. The expectancy of recovery must 
permeate the atmosnhere. Greater benefits will accrue if the patient is aware 
56 that the planned reconditioning program, which includes occupational therapy, 
is the prescribed treatment for his disorder and that he has a share in the 
responsibility for getting well. Patients must also be impressed with their 
continuing responsibility to the group. Even though incapable of combat, 
they must still perform service consistent with their abilities. A strong program 
of motivation is an essential part of the therapy. 
Section II. PSYCHONEUROSES 
45. TECHNIQUE OF APPLICATION OF OCCUPATIONAL THERAPY IN 
PSYCHONEUROSES, a. About 2 hours daily should be planned as a mini- 
mum of time to be devoted to occupational therapy. All of the various types 
of occupational activities apply in the psychoneuroses. The choice of the 
type of work project for a particular patient should be determined by an 
understanding of the dynamics of the illness which the ward officer will 
interpret to the therapist. The work selected should meet a specific psychological 
need. An example might be cited to illustrate the use of occupational therapy 
based upon an understanding of a patient problem. Sgt. E. M., an instrument 
maker in civilian life, was left with severe anxiety after recovery from an 
attack of arthritis. His fears were linked with the invalidism and complete 
economic dependency suffered by his father after an attack of arthritis that 
crippled the father’s hands. Sgt. E. M. regained his confidence in himself and 
demonstrated to his satisfaction that he could still perform fine skillful move- 
ments in an occupational therapy project in which he made a minute casting 
of a sculptored crucifix and a tiny model house which he designed and 
constructed. 
b. Correlation of occupational therapy with study interests in the educa- 
cational reconditioning program offers much advantage. Such projects as 
electrical, radio work, wood and metal work, printing, motor repair and 
maintenance, and business administration, will fit a patient for further military 
service or will prepare the way for his return to civilian life. Grouping patients 
with similar interests in a class such as motor mechanics may serve as purpose- 
ful occupational therapy and as a form of psychotherapy. The problem-solving 
attitude necessary to the acquisition of new skills may be turned to develop 
group interaction when the opportunity affords. Similar projects can be organ- 
ized with electrical equipment, gardening, landscaping, carpentry, photography, 
and hobby interests. Selective industrial (work) assignments around the 
hospital or post also are of great value in the treatment of the psychoneurotic 
patient. He gains security in a job situation which provides recognition and 
which was previously denied in a misassignment. 
c. Hysterica! paralysis. (1) CAUSE. The cause of hysterical paralysis is 
difficult to elicit and may often be obscure. The functional approach, as out- 
lined below, is one of the methods of treatment. 
(2) RESULTS. The condition resulting from this diagnosis is an impairment 
of function manifested by joint limitation and muscle weakness. Restoration 
of function occurs only when the original cause is ameliorated or removed. 
(3) TREATMENT. The principle of occupational therapy for hysterical 
paralysis is a correlation of the psychiatric and functional approach. 
(a) Recognition of the disability from a functional point of view, applying 
activity within the limitation. 
57 (b) Raising of the achievement level in correlation with psychiatric treat- 
ment or progress. 
(c) Encouragement of extensive use of the affected part through graded 
exercise for joint limitation and muscle weakness. 
(4) SPECIAL PRECAUTIONS. The same precautions which apply to the 
treatment of joint limitation and muscle weakness will pertain. 
Section III. PSYCHOSES 
46. TECHNIQUE OF APPLICATION OF OCCUPATIONAL THERAPY IN 
PSYCHOSES.1 a. The depressed patient is overwhelmed by a sense of per- 
sonal failure and ideas of guilt. Retardation in thought and activity are fre- 
quent symptoms as are easy frustrations and a low level of work tolerance. 
One must reestablish feelings of personal value and of achievement and 
stimulate interests outside the patient, or provide, at times, a means of expiation 
of guilt. Previous hobbies and work interests of the patient must be explored 
and work prepared in small units that can easily be achieved within the 
allotted time. If simple tasks are chosen at the start, there is less chance for 
bewilderment or lack of concentration and interest. Arts and crafts usually 
are most acceptable, but industrial (work) therapy is also helpful. Occasionally 
menial tasks may assist the individual in punishing himself and in atoning 
for his "sinful” ideas. The need for an ever constant guard against suicide 
when working with depressed patients is mandatpry. 
b. Excited patients are aided in clinging to rational behavior through an 
opportunity to discharge tension in work. Patients with extreme over activity 
seldom work well within the close confinement of the occupational therapy 
shop. Frictions and irritations inevitably result from too intimate contacts with 
other patients. Industrial (work) therapy is usually the best for this group. 
Work that requires fatiguing vigorous bodily action is desirable in a place 
that provides enough room to move about freely without coming closely in 
contact with others. Gardening, outdoor labor, "rough” salvage, and construc- 
tion are jobs suited to the needs of excited patients. 
c. Schizophrenic patients suffer from a loss of interest and initiative. They 
lack the capacity for forming attachments with others and are beset with 
notions of inferiority and insecurity. Living as they do in a dream world, it is 
often difficult to penetrate through their wall of fantasy. The therapist must 
know how to captivate the interest of such an individual. The abrupt onset 
and the importance of situational factors in military cases of schizophrenia 
or dementia praecox combine to effect a more favorable prognosis. Stimulating 
group activities, with an opportunity for socialization and with some work 
pressure forcing group interaction are sometimes most helpful. The organized 
activities of patients engaged in printing a news sheet in the shop is an 
example of group work. Typesetting, press operation, cutting and folding 
demand cooperation if the task is to be smoothly done. Industrial (work) 
therapy also offers many opportunities. Gardening is one of the best of such 
means. Many will find ego satisfaction in creative art and the first signs of 
renewed interest in the world of reality may come through painting or music. 
d. The Paranoid individual, who is suspicious and distrustful, often responds 
best if given an individual work assignment of trust. The assigned task must 
iBarton, W. E., op. cit. 
58 satisfy the cravings for self-importance. They work best alone. Satisfactory 
examples are: work in the finance office, medical supply offices or warehouses, 
in the library, or as an operator of the hospital public address system. Indi- 
vidual job assignments or hobby interests or art projects that are established 
should encourage a standard of excellence that may recreate a true sense 
of self-importance. 
Section IV. OTHER NEUROPSYCHIATRIC CONDITIONS 
47. TECHNIQUE OF OCCUPATIONAL THERAPY IN OTHER PSYCHI- 
ATRIC DISORDERS.1 a. Psychopathic personalities adjust poorly to the regi- 
mentation and team play required in the Army. They seek to avoid group 
responsibility and constitute behavior problems. In occupational therapy they 
require impartial military discipline, that minimizes the opportunity for seek- 
ing self gain. Any project to which they are assigned demands a close super- 
vision. Interests and aptitudes, if carefully explored, may reveal a basis upon 
which to build. The psychopathic patient usually adjusts readily in the occupa- 
tional therapy shop. Suggested activities in occupational therapy are carpentry, 
radio, electricity, automotive mechanics, printing and graphic arts. 
b. Mental defectives must be assigned tasks commensurate with their ability 
to accomplish and complete them. They must have assurance that they, too, are 
valuable members of the military group. A short time project with an immedi- 
ately perceivable result serves the purpose best. Liberal praise, consistent with 
achievement, may restore to society by this means a useful but limited mem- 
ber. Suggested activities in occupational therapy are leather work, plastic 
crafts, metal work, weaving, and simple carpentry. 
c. Psychosomatic disorders are prevalent in military medical practice. Studies 
have shown that in military hospitals, on medical and surgical wards, as many 
as one-third of the patients may have severe and unrecognized psychosomatic 
concomitants to their physical disability. Powerful unconscious factors operate 
as a result of exposure to death or the rigors of military service that tend to 
prolong disability and extend symptoms from somatic illnesses. For example, it 
is important to take the mind of a patient suffering with back pain or head- 
ache from over-concern with his complaint and to motivate the person toward 
normal interests and recovery. A person with a stiff knee, although surgically 
recovered, may continue to be disabled. Occupational therapy, while primarily 
diversional in its application to general somatic problems, may perform a 
service in removal of psychic barriers to recovery. The general techniques stated 
in chapter 2 on functional occupational therapy will apply as will diversional 
activities in many instances. 
d. Neurological problems most prevalent in military hospitals are: 
(1) Post-traumatic conditions, either central, spinal, or peripheral. 
(2) The complications of infections of the nervous system, such as poly- 
neuritis, encephalitis, or meningitis. 
(3) THE CONVULSIVE DISORDERS. The occupational treatment of 
convulsive disorders offers no particular problem. The only care necessary is the 
avoidance of hazardous occupations that might cause personal injury. Pcst- 
traumatic disorders may involve the personality and so necessitate individual- 
■Barton, op. cit. 
59 ized approaches. They often involve motor areas. Regeneration of nerves is a 
slow process. Occupational therapy helps relieve the mental factors that serve as 
inhibitors to the return of function. Patient guidance in the performance of 
handicrafts may improve motor coordination. Even severe handicaps, such as 
paraplegia, will be benefited by graduated occupational therapy and will aid 
in restoration of greater activity. It is helpful to restore their confidence in 
their ability to perform useful work. See chart 2 for suggestions of activities 
applicable to nerve injuries. 
48. PRECAUTIONS. Several enlisted men assigned to the shop may insure 
security in the handling of neuropsychiatric patients as well as assisting with 
teaching and cleaning. When closed ward patients are brought to the shop 
there must be a strict observance of certain protective measures. Patients must 
be brought to and from the ward safely. The occupational therapy shop door 
should be locked during the work period. Constant, unobtrusive supervision 
must be provided at all times. Tools will be kept in locked shadow-board 
cabinets that reveal missing articles at a glance. Before any patients are per- 
mitted to leave the shop, all tools must be returned and checked. Depressed 
patients require constant surveillance. Tools, potentially dangerous, may be 
used only if personal supervision is constant during the period of use. 
60 CHAPTER 6 
DIVERSIONAL HANDICRAFT ACTIVITIES 
49. DEFINITION AND PURPOSE. Diversional activities comprise those rec- 
reational interests such as arts and crafts, music, dramatics, games, special 
interest projects, and hobbies which are applied for their mental and social 
values. They serve chiefly to divert the mind from thoughts of illness and 
invalidism, and they constructively utilize leisure time. The learning and 
acquisition of new skills stimulates the interest and sustains morale. Participa- 
tion in group activities encourages socialization. The use of diversional activities 
on the ward aids administration of medical care and furnishes the opportunity 
for self expression, thereby maintaining initiative and conserving good work 
habits. 
50. ORGANIZATION AND ADMINISTRATION. All art and recreation will 
be under medical supervision and coordinated by the chief reconditioning 
officer. Art and handicraft activities will be arranged and supervised by the 
Occupational Therapy Department whether prescribed or offered as a diver- 
sion. In those hospitals which do not have an occupational therapy department, 
the Red Cross will be responsible for conducting the art, craft, and hobby 
activities as one phase of its hospital program of social service. 
51. COORDINATION OF RED CROSS ACTIVITIES WITH OCCUPA- 
TIONAL THERAPY, The Red Cross upon request will recruit volunteer assis- 
tants to work in the occupational therapy department. 
a. The Red Cross hospital executive will maintain administrative responsi- 
bility for all volunteers including recruitment and the keeping of records. 
b. "Gray Ladies” procured and trained by the Red Cross may be assigned 
to the Occupational Therapy Department as one of their services. Additional 
training in the craft activities may be given to this group by the Occupational 
Therapy Department. With such training these workers become valuable assis- 
tants under the technical direction of the therapist. 
c. The volunteers of the Arts and Skills Corps are assigned as a group to 
the Occupational Therapy Department. Hospitals located near large centers of 
population will have the advantage of this service. Skilled artists and craftsmen 
are available in these localities and may be secured to instruct the patients 
referred for diversional activities. They will render valuable expert instruction 
and assistance. Such a plan makes it possible to reach large groups of patients 
that otherwise might not have the opportunity for participation in the Occupa- 
tional Therapy program due to the scarcity of professional personnel. These 
instructors may work directly on the Wards or in a studio shop, teaching large 
groups of patients with special interests or creative talents. 
d. Close cooperation with the Red Cross hospital executive is important to 
the occupational therapy program. The social worker and recreational worker 
are in frequent contact with many patients and will transmit the expressed 
desires concerning arts and crafts to the occupational therapist. 
61 Figure 43. Patient painting in hobby shop. 
Figure 44. Patient modeling with clay in diversional shop. Figure 43. Patient assembling model boat. 
52. TYPES OF ACTIVITIES. All of the arts and crafts provide satisfactory 
diversional therapy. Therefore all allied handicrafts, painting (fig. 43), car- 
tooning, light metalry, clay modeling (fig. 44), wood carving, and model 
construction (fig. 45) are popular. Photography with developing and printing 
of pictures interests many patients. Music offers an excellent outlet for repressed 
energies through choral singing, playing of instruments (fig. 46) and orches- 
tral or handwork. Dramatics afford opportunity for leadership, ingenuity, and 
objective work activity. 
53. PRECAUTIONS. General precautions should be observed as follows: 
a. Maintain good posture and working positions for ambulatory patients. 
Work benches and chairs or stools should be of correct working height. 
b. Maintain good posture with bed patients providing proper support for 
back, arms or legs where necessary. 
c. Provide good lighting. 
d. Avoid any adjustment of casts, braces, traction weights, or other ortho- 
pedic apparatus. 
63 Figure 46. Ocarina class of ambulatory patients on the ward. 
Figure 47. Bed patient making wall plaque with wood-burning tool. Figure 48. Knotting belt with multi-colored strings. 
e. Avoid materials that may aggravate the patient’s condition, that is plastic 
surgery cases should work with clay or some such nonirritating medium rather 
than wood or metal. 
f. Care should be exercised to plan projects for the patients that are suffi- 
ciently simple to make (fig. 47), highly colorful (fig. 48), and purposeful 
(fig. 49). 
g. Analysis of activities should be made to insure the use of the diversional 
occupations which are within the capabilities of the patient and those in which 
he will take an active interest. 
h. Avoid assignment of volunteer workers to wards in which there is any 
element of danger. 
i. Maintain interest in service in order that instruction may be enthusiastic 
and continuous. 
65 Figure 49. Leather work is a purposeful, leisure time activity. 
54. SUGGESTED WARD ACTIVITIES. A list of suggested art and craft ac- 
tivities, suitable for use on the ward, is appended by chart IV. 
CHART IV. SUGGESTED WARD ACTIVITIES 
Individual work: 
All types of leather work 
Gimp belt and bracelets 
Knotted belts and purses 
Airplane models 
Jeep models 
Tank models 
Ship models 
Chip carving 
Inlaying wood work 
Plastic work—bracelets, boxes, etc. 
Sketching and painting 
Modeling clay 
Block printing 
Stenciling 
Weaving—small looms 
Weaving—card 
Group Work: 
Folding bulletins 
Folding hospital newspaper 
Bandage makin/ 
Kits: 
Radio—assembly and repair 
Electric construction 
Mineralogy—types and geography of rocks 
Clocks and watches—assembly and repair 
Field telephone—dismantling and reassembling 
Pinhole cameras—construction and use 
Electric motors—assembly and learning parts 
Carburetors—assembly and learning parts 
Generators—assembly and learning parts 
Chemical sets 
Chemical gardening sets 
55. RED CROSS RECREATION PROGRAM, The Red Cross recreation pro- 
gram in the Army hospitals embraces such activities as social recreation, music, 
special interest projects, games and entertainment. 
66 CHAPTER 7 
INDUSTRIAL THERAPY 
56. DEFINITION. Industrial Therapy is the use of an industrial assignment or 
work project for its therapeutic effect. 
57, PURPOSE. When used as part of the Reconditioning Program, it is ap- 
plied to medical, surgical or neuropsychiatric patients for their physical or 
mental needs. Under medical supervision, industrial resources of a hospital 
are utilized for the following treatment purposes: 
a. General effect on muscle tone. 
b. Specific effect on injuries. 
c. Combat the effects of prolonged hospitalization. 
d. Increase work tolerance. 
e. Reestablish work habits and allay periods of mental and physical idleness. 
f. Stimulate mental alertness. 
58. SCOPE. Many opportunities exist for the employment of convalescent 
patients in hospital maintenance and management, such as the utility shops 
(figs. 50 and 51), motor pool, warehouses (fig. 52), laboratories, supply, 
offices (fig. 53), landscaping and gardening (fig. 54). As the patient progresses 
through the stages of convalescence, he experiences a corresponding increase 
in energy. Energy can be more effectively used and absorbed by such activities 
as building trades (fig. 55), use of power tools (fig. 56), drafting (fig. 57), 
and clerical assignments (fig. 58) having more of an industrial nature than 
the less active arts and crafts. A man given an opportunity to contribute to 
the maintenance of his own community takes the first step toward the resump- 
tion of normal life. 
59. PRECAUTIONS, a. Proper placement in job assignments must be bene- 
ficial to the patient in order to maintain the therapeutic value. "Industrial 
Therapy is viewed with approval as long as the assignment of each individual 
to a project is made only with a clearly defined purpose. The relationship of 
the work to be done to the recovery of the patient should be clear to him. 
Above all, work projects should not be allowed to deteriorate into a source of 
cheap labor.”i 
b. Patients on job assignments should be readily accessible to ward officers 
at all times. Clinical appointments and consultations take precedence over 
industrial assignments. 
60. CORRELATION WITH RECONDITIONING PROGRAM, a. All classes 
of patients in the Reconditioning Program are eligible for industrial therapy. 
Reconditioning Conference, Hammond General Hospital, Modesto, Calif., 16 June 
1944, Brig. Gen. C. C. Hillman. 
67 Figure 50. Reconditioning patients with plumbing experience work 
in the plumbing shop and around the hospital. 
Figure 51. Patients assigned to utility shops. Figure 52. Patients working in the medical supply warehouse. 
Figure 53. Sorting mail in the hospital post office. Those patients of classes 3 and 4 who are prescribed to activity for functional 
or neuropsychiatric treatment, will be under direct supervision of the occupa- 
tional therapist. Industrial therapy meets the work needs of that large group 
of patients who have progressed beyond the need for specific therapy. In this 
instance a patient may be prescribed for an extension of treatment. In cases 
v/here the patient is in the acute stage of functional treatment, he may be 
assigned to a job that does not involve the injured part. All other patients are 
assigned as a general toughening process. 
b. The Educational and Physical Reconditioning sections apply similar and 
additional activities for the further treatment of patients in classes 1 and 2. 
(See TM 8-290 and 8-292.) 
c. The supervisor of the industrial therapy program, who may be a medical 
officer of the reconditioning service, is responsible for checking the patient’s 
physical condition with the demands of a job assignment, determining the time 
of day the patient works, the length of working time, and the reassignment of 
patients on change in classification. 
Figure 54. The Victory garden, a popular assignment. Figure 55. Patients working in the reconditioning shop. 
61. JOB PLACEMENT, a. The reconditioning officer places a patient in in- 
dustrial (work) therapy on a request from the ward officer. This request should 
contain a statement of the patient’s physical and mental needs. The occupational 
therapist will supply the reconditioning officer with such details as: 
b. Factors to be considered in proper placement in work therapy. 
(1) Patient’s interests. 
(2) Past occupational experience and classification, WD, AGO Form 20 
(Soldier’s qualification card). 
(3) Placement possibilities within the hospital. Upon the written prescrip- 
tion of the supervising reconditioning officer, the occupational therapist will 
interpret each patient’s physical limitations in a particular assignment. Special 
needs for physical development or precautions will be explained to the job 
supervisor and frequent industrial rounds will be made to insure proper 
understanding of the assignment. 
71 62. MECHANICS OF INDUSTRIAL THERAPY, a. Job survey and job 
standards. The hospital must be surveyed for the number and kinds of jobs 
available. There must be specifically planned duties with definite work stand- 
ards for the patients assigned. 
Figure 56. Group of patients in woodworking shop. 
b. Job analysis. Each job is analyzed as to the use or avoidance of the 
following: 
(1) Position—sitting, standing, walking. 
(2) Use of one hand, both hands. 
(3) Reaching, bending, stooping, lifting, pushing. 
(4) Solitary or group work. 
(5) Indoors or outdoors. 
(6) Degree of supervision. 
(7) Concentration. 
(8) Responsibility, 
72 Figure 57. Patient with leg injury utilizes his drafting skill in the Engineer's office. 
73 Figure 58. Army clerk assigned to the mess office to test work tolerance. 
c. Quotas. Quotas of patients on a specific work therapy detail should be 
higher than the number necessary to carry the work in order to maintain the 
required attendance. Treatments, consultations, conferences, and passes which 
are of primary importance to the welfare of patients take precedence over 
their work assignments and render their attendance uncertain. However, careful 
planning and cooperation in all departments as to appointments will allow 
for general covering of allotted patient quotas in the respective jobs. A patient 
should not be placed until the initial work-up has been completed nor before 
he can be expected to work with reasonable regularity. 
d. Unit supervision. The personality, interest, and cooperation of the super- 
vising personnel is of great importance in a program of this type. When the 
personnel understand the treatment idea back of patient help, plan work for 
the patients, tolerate limitations in work abilities, and know daily who is on 
the job, the assignment has value. 
74 63. PREVOCATIONAL ACTIVITIES IN CONVALESCENT HOSPITALS. 
There may be additional opportunities for industrial assignments in connec- 
tion with the educational program. Here courses in business administration, 
motor mechanics, electronics, wood and metal shop practice are given. The 
exploratory shop work will be coordinated with classroom instruction. This 
offers an opportunity to explore aptitudes and interests. These may later be 
used as the basis for vocational assignment as to possible employment activities 
or may serve as a basis for referral to the Veterans’ Administration. The latter 
organization provides vocational training for those who have acquired a handi- 
cap in the course of their military service which necessitates retraining in a new 
vocation. 
CHART V. 
SUGGESTED ACTIVITY ACCORDING TO DISABILITY 
Part involved 
Activity indicated 
Fingers 
Writing letters for patients, charting temperatures for nurses, carrying 
trays, radio and electrical repair, typing in offices, clerical work, motor 
repair. 
Hand 
Motor repair, painting, furniture repair, carpentry shop, gardening (spad- 
ing, hoeing, raking, weeding), construction work. 
Wrist 
Cleaning food carts, carrying food trays, moving beds, cleaning floors, 
pushing wheel chairs, spading, masonry, carpentry, electrical and radio 
repair, motor mechanics, painting. 
Forearm 
Carpentry, motor mechanics, painting, gardening, digging on construc- 
tion jobs. 
Elbow 
Sweeping and dusting on the ward, digging on construction work, land- 
scaping, sawing wood. 
Upper arm 
Moving furniture about the ward, policing the grounds, gardening, con- 
struction projects, salvage, moving stock. 
Shoulder 
Dusting ward woodwork, care of information bulletin boards, painting, 
sawing, gardening, construction. 
Back 
General ward and barracks duty, messenger service, counter service, 
gardening, construction projects. 
Chest 
Care of information bulletin boards, painting, care of motorized equip- 
ment, such as washing cars. 
Heart 
Clerical work, office administration, reception or information desk, an- 
swering telephone, dispatcher. 
Abdomen 
Policing the ward and barracks, clerical work, moving stock, driver in a 
motor pool, carpenter, gardener. 
Hip 
Messenger service, physical education instructor, gardening, motor me- 
chanics, bicycle messenger, supervisor of recreational games. 
Knee 
Ward service, messenger service, bicycle messenger, gardening, construc- 
tion projects, supervisor of military drills. 
Foot 
General ward duty, pushing wheel chairs and carts, motor pool driver, 
printing press operator (foot treadle), physical education instructor, 
gardening. 
75 Civilian skill 
Military skill 
Disability 
Assignment 
desired by patient 
Assignment 
Grade 
Chain store manager 
Ship fitter 
Paratrooper 
Fractured tibia 
Carpentry 
Carpentry 
A 
Student-electricity 
Rifleman 
Allergy 
Electrical work 
Electrical shop 
A 
Spot welder 
Heavy truck driving— 
Warehouse foreman 
Joint mice knee 
Plumbing 
Plumbing 
A 
Sign painter 
Basic 
Fractured left 
elbow-tender 
Sign painting 
Sign painting 
Quartermaster 
A 
Clerical work 
Coast Artillery office clerk 
Allergy 
Any job 
Warehouse checker 
B 
Truck driver 
Pick and tfaovel job 
Military Police 
Gun shot wound 
left leg 
No preference 
Outside detail for leg 
exercises 
C 
Bartender 
Cook 
Litter bearer 
Fracture 
lower extremity 
No preference 
Outside detail for 
muscle strengthening 
of leg 
C 
Selling and appraising 
jewelry 
Code and dispatching 
messenger service 
Dermatitis 
No preference 
Messenger dispatcher 
B 
Auto mechanic 
Personnel work 
Clerk 
T. B. Arrested 
Malaria 
No preference 
Assistant to Public 
Relation Officer 
B 
Orthopedic mechanic 
Orthopedic mechanic 
Neuro circulatory 
Asthenia 
Orthopedic mechanic shop 
Orthopedic mechanic 
shop 
B 
Typist and student 
Construction crew with 
Engineers 
Fracture of 
vertebrae 
Sitting job 
Typist in EENT clinic 
B 
Butcher 
Mess 
Butcher shop 
Mess; Butcher shop 
A 
Motor repair 
British Army: 
Infantry 
Laceration—right hand: 
secondary infection 
Outdoor work 
Something to strengthen 
right hand and arm 
Victory gardening 
A 
Radio repair 
Radio repair 
Rheumatic fever 
Radio repair 
Radio repair 
A 
DrilleCoil fields 
Coast Artillery 
Sciatic nerve 
No preference 
Ward supervision of 
linen rooms. 
Reconditioning ward 
B 
Farmer 
Infantry 
Mental deficient 
Outdoor work 
Victory garden 
B 
CHART VI. TABULATION SHOWING INTERPLAY OF FACTORS 
COMPOSING AN INDUSTRIAL PLACEMENT 
76  
— 
Foreman of auto repair 
A 
Storage battery electrician 
Auto mechanic 
Fractured 
Job to exercise hip 
detail 
Editor of patient’s 
College student 
Clerical work 
Semilunar cartilege 
Newspaper work 
hospital paper 
Baker 
Cavalry 
Lower extremity 
Bakery 
Bakery 
B 
Drafting—Post 
Draftsman 
Antiaircraft 
Arthrotomy 
Drafting 
Engineer’s Office 
B 
Clerk 
Medical supply 
Soda dispenser 
Antiaircraft 
Fracture left fibula 
Warehouse job 
warehouse-clerk 
A 
Ground crew mechanic 
Light carpentry 
Lathe operator 
A. T. Command 
Chronic arthritis 
Convalescing from 
No preference 
C 
cataract scars of cornea. 
* 
B 
Garage mechanic 
Infantry 
Defective hearing 
Garage mechanic 
Garage mechanic 
Orthopedic mechanic 
Driver—Caterpillar 
tractor—trucks 
Blacksmith demolition 
Sinus trouble 
Orthopedic shop 
shop—forging, 
bending steel braces 
B 
Drawing injection finger 
Electrical work 
Electrical shop 
Electrical work 
Electrical repair 
third finger right hand 
A 
Engineer warehouse 
Engineer warehouse 
Grocery clerk 
supply 
Jaw infection 
Gun shot wound 
Warehouse 
A 
Carpenter 
Company carpenter 
left leg 
Carpentry 
Carpentry 
A 
Mill worker 
Signal Corps 
Fractured elbow wired 
Garden 
Garden 
C 
Short order cook 
Defense artillery 
Psychoneurosis 
Mess-kitchen 
Mess-kitchen 
Truck driver for outside 
D 
Truck driver 
Machine combat 
Fracture 
Driving 
detail 
C 
Carnival worker: 
Electrical work with 
Owned ferris wheel 
Cook 
Clerical work: 
Bookkeeping, 
Pulmonary tuberculosis 
Electrical work 
electrician 
Finance Office: 
Accounting 
A 
Bookkeeper accountant 
accounting, etc. 
Malaria 
Office job 
Bookkeeping 
A 
Assigned to hospital 
painter—painting 
House painter 
Infantry 
Fracture fibia and fibula 
Painting 
wards, etc. 
A INDEX 
Paragraph Page 
Achievement chart: prosthetic 27,38,39 .31, 53,54 
Activities: 
For amputees 29-37 31 
Industrial therapy, according to disability Chart V 75 
For neuropsychiatric disorders 42 55 
Prevocational 63 75 
Adaptation: equipment 17 6 
Amputations, treatment in— 
Bilateral arm 34, 35 41, 46 
Dominant arm 30 32 
Fingers 29 .31 
Forearm 30 32 
Lower etremity 36, 37 48, 49 
One arm and partial hand 33 40 
Partial hand 29 31 
Secondary arm 30 32 
Shoulder disarticulation 32 40 
Thumb . . 29 31 
Upper arm 31 40 
Upper extremity 29-35 31 
Amputees: 
Activities for 29-37 31 
Care of prostheses 28 31 
Early treatment purposes 25 30 
Special equipment for 34 41 
Training in the use of a prosthesis 27, 30, 31, 32, 
34, 37 41, 49 
Treatment, general 24 30 
Treatment in the pre-prosthetic stage 26, 30, 30, 32, 
34, 36 41, 48 
Writing for 30 32 
Arts and skills: Red Cross 51 61 
Blindness 23 14 
Cardiac disorders 22 14 
Chart: prosthetic achievement 27,38,39 31,53,54 
Closed ward cases: neuropsychiatric 42 55 
Compensation: functional occupational therapy 16 5 
Cuff, writing: for amputees 30, fig. 17 32, 34 
Depression: psychosis 46 58 
Diversionai activities: 
Administration of 50 61 
Precautions 53 63 
Purpose of 49 61 
Suggestions for Chart IV 66 
Types of 52 63 
Educational reconditioning: correlation with 45, 63 57, 75 
Equipment; adaptation 17 6 
Equipment and supply 10 3 
Excitement: psychosis 46 58 
Facilities 9 3 
78 Paragraph Page 
Fatigue; 
Joint limitation 16 5 
Muscle weakness 19 8 
Functional occupational therapy 12-23 5 
Definition 12 5 
Precautions, general 16 5 
Scope 13 5 
Treatment principles 14 5 
Gray Ladies; Red Cross 51 61 
Hysterical paralysis 45 57 
Incoordination 20 9 
Industrial therapy; 
Correlation with reconditioning 60 67 
Definition 56 67 
Job analysis 62 72 
Job placement 61 71 
Job survey 62 72 
Mechanics of 62 72 
Precautions 59 67 
For psychoneurotics 45 57 
For psychoses 46 58 
Purpose 57 67 
Scope 58 67 
Inflammation: indication 16 5 
Job analysis: industrial therapy 62 72 
Job placement: industrial therapy 61, Chart VI 71,76 
Job survey; industrial therapy 62 72 
Joint limitation 18 7 
Analysis for Chart! 16 
Joint measurement 18 7 
Mental defective 47 59 
Motion, loss of; indication 16 5 
Muscle testing 19 8 
Muscle weakness 19 8 
Analysis for Chart II 18 
Neurological problems 47 59 
Neuropsychiatric disorders: 
Administration, for treatment 42 55 
Precautions 48 60 
Prescription for 43 56 
Problem of 40 55 
Occupational therapy for 41 55 
Technique of occupational therapy for 44 56 
Occupational therapy: 
Administration 7-11 3 
Definition 3 2 
Purpose 4 2 
Scope 5 2 
Supervision of 7 3 
Values resulting from 6 2 
Pain: indications 16 5 
Paralysis: hysterical 45 57 
Paranoid: psychosis 46 58 
Personnel, occupational therapy 8 3 
Physical therapy: 
Coordination with 15,37 5,49 
Training leg amputees 37 49 
Placement, industrial: factors in ChartVI 76 
Posture: 
Cardiac disorders 22 14 
Functional occupational therapy 16 5 
79 Paragraph Page 
Precautions: 
For amputees 30,34,37 32,41,49 
In blindness 23 14 
In cardiac disorders 22 14 
In diversional activities 53 63 
General: in functional occupational therapy 16 5 
For incoordination 20 9 
Industrial therapy 59 67 
For joint limitation 18 
For muscle weakness 19 8 
For neuropsychiatric cases 42,43,45, 55,56,57, 
46,47,48 58,59,60 
In thoracic disorders 21 10 
Pre-prosthetic stage: treatment in 26, 30, 30, 32, 
34, 36 41, 48 
Prescription: 
For amputees 26 30 
For functional occupational therapy 16 5 
For industrial therapy 6l 71 
For neuropsychiatric disorders 43 56 
Prevocational activities 63 ' 75 
Prevocational therapy 5 2 
Prostheses: 
Care of - . 28 31 
Cosmetic effect of 29, 31, 32 31, 40 
Training in the use of 27, 30, 31, 32, 
34,37 41,49 
Prosthetic Achievement Chart 27,38,39 31,53,54 
Psychoneuroses: 
Industrial therapy for 45 57 
Technique of occupational therapy 45 57 
Psychopathic personality 47 59 
Psychosis 46 58 
Psychiatric disorders 47 59 
Psychosomatic disorders 47 59 
Reconditioning: 
Classes , , 11 4 
Purpose 2 1 
Recreation; Red Cross program 55 66 
Red Cross: 
Activities: coordination with occupational therapy 51 61 
Activities: types of 52 63 
Arts and skills 51 61 
Gray Ladies . 51 61 
Recreation program 55 66 
Schizophrenia; psychosis ; 46 58 
Staff Organization ... 7 3 
Stump, amputation; writing with 30 32 
Supervision; of occupational therapy 7 3 
Supply and equipment 10 3 
Swelling: indication 16 5 
Temperature: thoracic disorders 21 10 
Thoracic Disorders 21 10 
Treatment in upper extremities amputations 29-35 31 
Treatment in lower extremity amputations 36 48 
Vocational training: 
For amputees 27 31 
Veterans’ Administration 63 75 
Work Therapy. (See Industrial therapy.) 
Writing: for arm amputee 30 32 
U. S. GOVERNMENT PRINTING OFFICE: 1943—620575