Asian Journal of Occupational Therapy Vol. 12(2016) No. 1

Type-1 diabetes results from cessation of endogenous insulin production. Self-management is essential for patients with type-1 diabetes to prevent secondary organ damage and premature death. Self-management may be inhibited by a vast array of psychosocial factors, and therapy is unlikely to be successful unless these factors are identified and addressed. A pilot study of seven patients from Norfolk in the United Kingdom was undertaken to investigate the psychosocial factors interfering with diabetes self-management. Occupational therapy assessments and interventions were provided in an outpatient clinic. Patients' capacities for diabetes self-management were adversely affected by physical and psychological comorbidities, financial hardship and family responsibilities. Health problems resulting from sub-optimal diabetes self-management included visual impairment, lower limb amputation, erectile dysfunction, hypoglycaemia and diabetic ketoacidosis. A combination of these problems impacted on patients' spiritual lives, interpersonal and intimate relationships, employment prospects, finances and personal power, pleasure and security.

There are some brain disease sufferers, who face difficulties in performing various tasks while maintaining standing posture. We examined how the difference in presentation modality and cognitive load affect information processing and the maintenance of standing posture. We assigned tasks based on the Paced Serial Addition Test (PSAT) to 11 healthy adults. More precisely, we presented digits auditorily or visually and analysed parameters, namely, the precision and the speed of processing as well as the center of pressure (COP). It was found that both the precision and the speed of processing were higher in visual presentation than in auditory presentation, and as cognitive load increased these parameters began to show poorer results. COP became unstable when cognitive load exceeded a certain degree.

Recent years, cases in which an occupational therapist is involved in the evaluation of patients' driving ability are rapidly increasing in Japan. One of the neuropsychological tests which are predictive of driving ability is a road sign recognition task (RSR). However, no RSR available in Japan has yet been reported. Hence, in this study, we developed a Japanese version of road sign recognition task (J-RSR). A total of 44 younger drivers and 43 older drivers living in the community took part in the study. We compared the number of correct answers and the total time taken to complete the task between the two groups. Results showed that there was no statistically significant differences for the number of correct answer (p = 0.43), while older drivers took significantly much longer than younger drivers to complete the task (p < 0.000001). Qualitative analysis on incorrect answer for each question revealed that older drivers chose the same incorrect road sign answer while younger drivers chose incorrect answer evenly among options. These results suggest that J-RSR is predictive of knowledge of road sign, non-verbal reasoning ability, mental speed, and might reflects subjects' driving experience.

In the present study, we report two cases of splinting therapy where favorable results were obtained using splinting of two types, consisting of a first step of fixation at PIP joint extension position and DIP joint extension position, followed by a second step of further fixation at DIP joint extension position, followed thereafter by hand therapy on mallet finger. As the first splint flexes the PIP joint, and, further, as the DIP joint is taken as the hyperextension position, it is thought that the ruptured tendon ends sufficiently entwined more than with the conventional splint at the DIP joint extension position. The splinting therapy we used, with its two-type splinting, is thought to have enabled fixation and ROM acquisition that were in tandem with the tendon healing process. This treatment hints at the effectiveness of conservative therapy in the treatment of swan neck deformities and bony mallet finger.

Objective/Background: In this study, we classified the psychological adjustments of family members of terminal cancer patients using a conceptual structure based on recurring cases. We hypothesised that it is possible to determine the need for intervention on the basis of the occupational performance patterns of the family members.

Methods: The subjects were bereaved family members of cancer patients who died more than a year ago. For our classification system, we adopted code matrix analysis using MAXQDA10 analysis software.

Results: We categorised the 9 cases into 3 types on the basis of functionality with regard to occupation: i) type of continued occupation; ii) type of resumed occupation; iii) type of interrupted occupation.

Conclusions: The categorisation of occupational types assumes that occupation has an effect on the family members' ability to progress through or alter mental states according to occupational performance patterns.

The purpose of this study is to clarify the patterns of 6-7-year-old children's pencil grip in Japan, and to clarify the relationship between grip pattern and gender. The participants were 80 first graders in the regular class of an elementary school (40 boys, 40 girls). Of the 80 children, 20 percent implemented a standard pencil grip. Additionally, 60 percent of the children held their pencil with three fingers, and 70 percent held their pencil near the tip. Analyses were conducted to determine factors related to gripping the pencil near the tip, and this practice was found to significantly differ with respect to thumb IP joint flexion. There was no significant difference regarding the position of the thumb, gender, and the number of fingers that touch the pencil. The data revealed that about 20 percent of 6- and 7-year-old children implemented an average pencil grasp.

Rehabilitation for stroke patients requires a large amount of high-quality, intensive training. However, for most patients, use of the paralyzed upper limb is avoided in daily life outside of rehabilitation therapy. The purpose of this study was to devise a menu of tasks for improving upper limb function in patients with hemiplegia after stroke. Participants included 39 occupational therapists with experience in treating patients with hemiplegia after stroke. The tasks were organized and rewritten as 26 items on a questionnaire. Participants were asked to consider the tasks for inclusion in the upper limb function task menu. The participants identified the lowest possible Brunnstrom recovery stage (BRS) for the upper limb and fingers required to complete each task. In accordance with the Delphi method, this study was conducted in three rounds. The final round included 32 occupational therapists with an average of 4.40 ± 3.00 years of experience. The mean score (±SD) for evaluation of the tasks in this round was 3.85 ± 0.63 and the median value was 3.85. The same mean value of 3.0 was chosen to represent recommendation to adopt a task. In the final round, 100.0% (26/26) of the tasks were selected for adoption. The mean value (±SD) for the lowest BRS for the paralyzed upper limb was 4.26 ± 0.41 (median, 4.15) and that for the fingers was 4.57 ± 0.46 (median, 4.62). Results indicated that these tasks would be useful for upper limb functional training for stroke patients. The most important aim of occupational therapy is to make patients aware of what movement is possible. The role of occupational therapists is to provide task-specific training by using a feasible upper limb function task menu that demonstrates ability to improve upper limb function in patients undergoing occupational therapy after a stroke.

Aim: To clarify the characteristics of desktop dual tasks that cause dorsolateral prefrontal cortex (DLPFC) activation. Methods: Subjects (29 young adults and 22 middle-aged adults) performed three different combinations of dual tasks composed of a pencil and paper task (copying numbers or calculation) and a hand-shape changing task (in response to visual hints or self judgment). We measured brain activation using near-infrared spectroscopy. Results: Right DLPFC activation was significantly higher for the simplest dual task than the complex dual task with the younger group, whereas there was no significant difference between tasks with the middle-aged group. Task performance was higher in the younger group than the middle-aged group, whereas there was no difference in brain activation between the two age groups. Conclusion: A dual task including two of each task performed automatically could be used for training frontal lobe functions, and the difficulty level should be adjusted depending on age.

Neuropsychological, off-road, and on-road testing were used to assess the driving skill of a stroke patient to determine whether he could drive safely. Driving risk could not be detected by neuropsychological testing, but was detected with the Useful Field of View (UFOV) test and a driving simulator and confirmed with on-road testing. Although it may be more effective to use on-road testing or a driving simulator to assess whether a stroke patient is competent to drive, our results suggest that UFOV may be more a more accessible and cost-effective method for detecting driving risk due to mild cognitive dysfunction.

Using public transportation is crucial for people living in urban communities. However, a previous study suggested that approximately one-third of sub-acute rehabilitation hospitals in Japan could not practice using public transportation. Here we aimed to quantitatively and qualitatively examine why these hospitals did not practice. Managerial occupational therapists working in sub-acute rehabilitation hospitals in urban Japan were enrolled. Using a postal survey, some questions regarding the practice of using public transportation were asked. Two hundred and twenty-eight responses were analyzed. The frequency of practicing the use of public transportation was weakly correlated with the hospital bed number, therapist number, and average therapy duration. The qualitative data concerning reasons for not practicing were integrated into four categories: barriers of social system, specific factors of the task, existence of complementary method, and lack of necessity and awareness. It may be important to improve these inhibiting factors for providing appropriate occupational therapy.

Using functional near infrared spectroscopy (fNIRS), we have been researching the effect of musical attention control training (MACT) on the prefrontal lobe, which is involved in attention control. We detected significant dorsolateral prefrontal cortex (DLPFC) activation during music-based tasks that included “dual task” elements. In this study, to elucidate which musical elements influence DLPFC activation, we focused on the effects of tempo of both handed Rhythmic tapping tasks (RTT), which including “dual task” elements. RTT with 3 different tempos, the easy (E) (slow tempo), intermediate (I) (moderate tempo), and difficult (D) (fast tempo) tasks, were developed. Then, the activation of the DLPFC was measured during each task. Our results detected a significantly stronger DLPFC activation during the (D) task than during the (E) task (p < 0.01) or the (I) task (p < 0.01). These results indicate that the difficulty of RTT can be adjusted by altering the tempo. Music-based tasks could be useful for cognitive training programs, even those for poorly motivated people with severe attention deficits through changing the difficulty level by changing the tempo.

Collateral ligament shortening causes extension contractures of the metacarpophalangeal (MCP) joint, and dynamic flexion splinting (DFS) has been widely used to treat these contractures; however, there are various problems with these approaches. We developed a novel, pneumatic-type dynamic traction and flexion (DTF) splint to solve these problems. Twenty-one patients were treated with either the DTF or DFS for 8 weeks. Every 2 weeks, the average MCP joint flexion angle, total active motion (TAM), grasp strength, and pain scores were assessed. The flexion angle, in the DTF, was significantly greater than that in the DFS, starting after 6 weeks of treatment (p < 0.05). Similarly, the TAM results were significantly better following DTF treatment. Compared to treatment with DFS, our results showed that DTF treatment promoted earlier recovery of joint flexion angle and whole finger function in patients.

The present study examined the effects of tasks involving different numbers of processes on working memory (WM) by conducting cognitive function tests and using NIRS (near-infrared spectroscopy). The subjects were asked to perform two types of task involving varying numbers of processes. After the subjects performed both tasks involving one and multiple processes: drawing and the creation of a box, respectively, the oxygen hemoglobin concentration in the DLPFC was higher. However, there was no significant difference between the two tasks. The results of cognitive function tests following the production of boxes were also compared, and the PASAT 2 sec and SDMT scores were significantly higher. These results suggested that the efficient implementation of the task involving multiple processes generated an appropriate level of cognitive load required to promote the active functioning of WM and, as a result, the subjects achieved higher cognitive function test scores after completing the tasks.