WHAT ARE YOU LOOKING AT? INVESTIGATING VISUAL OBSERVATIONAL BEHAVIOUR OF OCCUPATIONAL THERAPISTS AND UNTRAINED OBSERVERS

Abstract

Assessments within occupational therapy frequently are dominated by observation-based information gathering. However, it remains unknown how therapists gather and interpret visual information, and there have been few systematic attempts to explore what the therapist is “seeing” or how this contributes to decision-making.

Three experiments were designed to track the eye movements (fixations, fixation durations, saccades and saccade amplitudes) of Occupational Therapists (OT) and control participants (NonOT). The studies investigated eye movement differences between groups while viewing different stimuli content (stroke versus not-stroke), stimuli image presentation (both static image and dynamic video), and task demands (either with instructions and task requirements, or without). Ten licensed occupational therapists, and ten age, gender, and education-level matched participants completed the experiments. It was predicted that differences in eye movements would be seen between groups for stroke content but not necessarily non-stroke content, given the different knowledge and experience about stroke between groups.

The overall results did not consistently demonstrate differences between groups with regard to eye movement across all three studies. Where differences were found, there was evidence to suggest it was due to top-down influences of content and task instructions. In the absence of differences for eye movement, the groups did differ in ratings of image safety, providing reason to suspect covert attention may play a key role in information gathering for decision-making tasks. There were no differences between groups for eye measures within key safety regions of interest as identified by an ad-hoc expert OT panel. The lack of overt visual fixations by OT to these regions of interest, even when the overall safety rating was in agreement with the expert panel, challenges the concept of what it means to ‘look at something’.

The results of the three studies point to a complex relationship between decision-making and observational behaviour in occupational assessment, and highlight the need to explore more than simply “what” therapists look at but also what they “see”. Observation is the gateway to therapeutic intervention, and is a foundational skill for Occupational Therapy. Attempts to study and understand characteristics of observation can therefore provide valuable information relating to therapy practice.