As a practicing psychologist, Leonard N. Matheson, PhD, observed that when his clients could do useful work, they felt better. “I came to believe the best thing you can do for a person is get them a good job,” he says.

Matheson, associate professor of occupational therapy and of neurology, directs the School of Medicine’s Occupational Performance Center, where he is developing a new type of program to help people who are recovering from accident or illness return to work. Traditional programs, he believes, take a simplistic approach that does not prepare people for workplace challenges.

His laboratory, housed in the Rehabilitation Institute of St. Louis, is designing and testing sets of activities called Structured Work Activity Groups (SWAGs). Developed in consultation with employers, they provide clients with detailed and realistic preparation for particular types of jobs. One SWAG that uses a library as a “virtual employer” asks the client to perform such tasks as transcribing phone messages from an answering machine, tracking overdue books and calculating fines, working up a spreadsheet of patron information for a federal grant, and scheduling meeting rooms. The activities rise in difficulty, and the last one includes an irresolvable conflict.

“We set up a meaningful challenge—meaning there’s a possibility of failure,” Matheson says. “You don’t give a person self-confidence just by bucking them up.”

Traditionally, therapists believed that what clients needed was endless encouragement. Facing them with failure is a novel idea, but Matheson wants them to encounter it first in a clinical setting, not on the job. He explains that too often, people recovering from brain injuries react to failure by becoming depressed or angry—responses that can get them fired. So, in his lab as in real life, clients are judged on their work.

After the client completes a task, both client and therapist fill out an evaluation. Then they compare notes. “We want to correct inaccurate self-perceptions,” Matheson says. Many clients think they are ready to return to work when they have not yet adjusted to the effects of their injury or illness. An accurate evaluation keeps them from setting themselves up for disappointment.

In another SWAG, called Gepetto’s Work-shop after the puppet-maker in Pinocchio, clients take on more physical tasks, like cutting out wooden puzzle pieces with a power saw. Other activities exercise particular parts of the body. People whose injury or illness affected their hands put together a baby-changing table that has many screws and washers. People with shoulder or back problems have to bend and stretch as they build a bunk bed. All can benefit from the fact that these tasks require motor control and focusing of attention.

Matheson and his occupational therapy colleagues plan to develop a total of eight SWAGs. Assisted by other collaborators—physical therapists, speech pathologists, neuropsychologists —they evaluate activities, looking for consistent results in the clinic. The researchers also will follow clients back to the workplace to ensure that activities are relevant.

“We want to help therapists make the link to what’s expected in the real world,” he says.

(Exerpted from Outlook, an online publication of Washington University in St. Louis, Missouri School of Medicine. Retrieved July 20, 2009 from http://outlook.wustl.edu/summer2003/occupationaltherapy.html)