Connections between the International Classification of Functioning and Disability domains of body systems, activity capabilities, and social participation were examined. Findings support the value of individualized, occupation-based therapy that addresses the mind and spirit as well as physical recovery in occupational therapy practice with hand injury clients.

A naturalistic, ethnographic, phenomenological study of adaptation to wheelchair use was conducted with one key informant, a 30-year-old white man with acquired paraplegia who was undergoing acute rehabilitation. Primary staff members served as additional informants. It was found that adaptation to wheelchair use had both pragmatic and emotional components. The latter appeared in alternating phases of resistance and neutrality or detente. Therapist and patient had conflicting goals relative to wheelchair use, which occasioned considerable friction. The patient's initial attitudes regarding wheelchairs were prejudicial, which hampered his ability to see the chair as a useful tool for mobility and independence. Successful pragmatic adaptation hinged in part on emotional acceptance of the wheelchair.

Relocation experience emerged as a major finding from two previous studies that tracked elders in the community after discharge from a transitional unit. This study involved follow-up of 5 elders from the two previous studies who relocated to a variety of new living arrangements. Purposes were (a) to identify how decisions were made to change living arrangements, (b) to describe the process of adaptation to relocation as it evolved over time including challenges and strategies used to address them, and (c) to identify indicators of effective adaptation. A phenomenological approach based on interviews, observations, and comparative analysis was used to capture the insiders' views of these elders. An account of each individual adaptive process was developed.Comparison across cases led to two major themes-sense of place and sense of self-which are proposed as indicators of effective adaptation. Implications of findings for service provision, public policy, and future research are examined.

Narratives are gaining recognition as important ways occupational therapists and other clinicians can think about the life stories of clients. The purpose of this article is to examine a conceptualization of how changes from one chapter to another occur in life stories, using the metaphor of an adaptive repertoire, and to consider how this notion can be useful in helping clients maintain continuity and a coherent life story in times of change. Three premises based on the concept of adaptation address (a) configurations of occupational forms embedded in particular local worlds, (b) cumulative development of an adaptive repertoire that allows one to perform both competently and appropriately, and (c) adaptive transitions and application of one's repertoire to new circumstances. Implications for research and clinical practice in occupational therapy also are examined.

A central theme was the patient's ongoing attempt to figure out how his future was related to his life before the injury and how he could use previous competencies in adapting to disability. Staff members seemed so intent on teaching the patient new skills that they often discounted the significance of his past experience and failed to engage in helping the patient connect his future life story to his past.