Purpose: Japan is now the world's first ‘super-ageing’ society. We analysed the effect of occupational therapy (OT) sessions in addressing issues related to the elderly population, in comparison with other services.
Methods: We studied 136 elderly patients receiving at-home care. Seventy-four patients received weekly OT and 62 did not. We assessed quality of life (QOL) and its trajectory over 1 year using the Philadelphia Geriatric Center Morale Scale (PGC) to quantify changes in QOL and the Function Independence Measure (FIM) to measure changes in activities of daily living.
Results: Patient progress fell within five different trajectories, which was influenced by psychosocial factors. OT correlated with significantly greater improvement in PGC and FIM scores than other home care services.
Conclusion: There is a significant benefit associated with OT and is expected to become increasingly more important in the growing elderly population. Tailoring of OT will be required to benefit those trajectory groups that showed unsatisfactory outcomes.
Several studies have been implemented on home-visit occupational therapy based on activities or occupations for clients with dementia and their caregivers, but all have been conducted abroad; none have taken place in Japan. Therefore, we performed a pilot study of the effectiveness of an occupation-based home-visit program for clients with dementia and their caregivers using single cohort design. The results of our analysis of participants' (n = 9) data indicated that the home-visit program could improve the behavioral and psychological symptoms of dementia, particularly apathy, among clients with dementia, as well as caregivers' needs or what caregivers expected of clients. Additionally, the program tended to decrease caregivers' care burden. The implications of the study are discussed in light of further research on this program.
The hypothesis in this study was tested by conducting EMG experiments comparing the variability in muscle activity during repetitive reaching movements in hemiplegic patients and healthy subjects. The present study investigated the characteristics of reaching movements in hemiplegic patients using the variability in average electromyogram (EMG) value. We studied 21 right-handed stroke patients with left-sided hemiparesis and 14 right-handed healthy control subjects. Post-stroke patients (hemiplegic group) and normal subjects (control group) repeated a reaching movement 10 times. The variability in average EMG value of each muscle was defined as the average standard deviation of the average rectified values (nARV-SDave). During the reaching movements, the nARV-SDave values was significantly higher in the hemiparesis group than in the control group for the biceps and triceps brachii (P < 0.05). In the hemiparesis group, significant negative correlations between the variability in nARV-SDave values and the Fugl-Meyer assessment scores were observed in all muscle types (rs = −0.46 to −0.76; P < 0.05, P < 0.01). This study identified a direct relationship between the variability in muscle activity and the severity of motor function deficit in post-stroke patients. The selective impact on the biceps and triceps were related to the nature of the reaching task.
Objective: Amusement was introduced for one month and interaction among the elderly and its influence on their physiological function and sleep were investigated. Methods: The subjects were 9 elderly females (age: 89.0 ± 4.7 years old) who periodically visited a day care service center for the elderly. The survey was performed between October 2015 and December 2015. For the amusement, Blackjack was introduced. The survey period was comprised of 3 amusement introduction periods: pre-amusement, and one week and one month after amusement introduction. In each period, the heart rate (HR), sympathetic nerve activity (CSI), and parasympathetic nerve activity (CVI) were measured during amusement, and the difference in the salivary amylase level between before and after amusement was determined. The sleep efficiency and sleeping hours were measured at night of the days with amusement. Repeated measures one-way ANOVA was performed regarding the survey period as a factor and HR, CSI, CVI, sleep efficiency, sleeping hours, and difference in the amylase level as dependent variables. Results: Significant amusement-induced changes were noted in the CVI and salivary amylase level. These were significantly lower at one month after amusement introduction than those in pre-amusement. Conclusion: Amusement-induced laughing and regret or interaction through the amusement influenced their autonomic nerve system and they may have felt comfortable.
Background: Toilet activity is performed every day with a physiological phenomenon so called “excretion”, which is highly necessary. In this study, we used Eye Mark Recorder, a gaze analyzer, to analyze eye movement of elderly people during toilet activities. In addition, we compared the results with those obtained from a preceding study regarding toilet activities in young people.
Result: The toilet activity was divided into three phases: until they sit down, while they are sitting on the bowl, and until they leave the room. Until they sat down and until they left the room, they were looking at the entire environment in the toilet. While they were sitting on the bowl, however, they were mostly looking forward. A similar tendency was observed in young people as well. Furthermore, retention time, degree of dependence on the lower gaze, rate of recognition, as well as an association between the time required for movement and the degree of dependence on the lower gaze were investigated. The elderly people were far more likely to gaze toward the floor compared to the young people.
Conclusions: The results showed which areas the subjects had to look at during 3 toilet-activity phases in order to understand the spatial relation. In toilet activities of the elderly, the rate of gaze toward the floor increased probably due to aging, posture and decreased balancing ability. We will need to further investigate associations between the subjects' age, posture, balancing ability and the gaze during the toilet activities.
Background: Physical activity (PA) has been found to affect the fear of falling (FOF). Although objective measures can improve the accuracy of measurement compared with subjective measures, previous studies have primarily used self-report measures to assess PA. The relationship between FOF, PA, and health-related quality of life (HRQOL) in elderly people who need long-term care has therefore not been sufficiently clarified.
Purpose: The purpose of this study was to investigate the relationship between FOF, PA, and HRQOL in elderly daycare service users.
Methods: The participants were 39 frail elderly people living at home who regularly used daycare facilities (13 men, 26 women; mean age, 75.1 ± 6.7 years). A cross-sectional study design was used. FOF was assessed using the Japanese version of the Falls Efficacy Scale (FES), PA was measured using a triaxial accelerometer, and HRQOL was assessed using the Japanese version of the Short Form-8 Health Survey. Based on median FES scores, participants were divided into two groups, High FES and Low FES, and then the PA and HRQOL values were compared.
Results: Patients in the Low FES group had significantly less PA (p = 0.019) and lower physical component scores in regard to HRQOL (p = 0.006).
Conclusions: The results of this study suggest the presence of a relationship between low FES scores in elderly daycare service users and less PA and low physical component scores in regard to HRQOL.
We are developing tasks on a laptop computer to enable cheaper and easier driving assessments at medical institutions. The aim of this preliminary study is to characterize the performance of young drivers in the developed tasks. The participants were 42 young licensed drivers who performed a video-based hazard detection task and a visual searching task (Trail Making Test). In the hazard detection task, they were instructed to touch the hazardous events on the computer screen that was likely to become involved in a traffic conflict during a driving video. Results showed that the video included 11 hazards and young drivers detected hazardous events during a particular period of time. For the visual searching tasks, our computer-based TMT had proper cognitive load, which was not found in existing paper-based TMT. Further investigations recruiting subjects from other age groups should be necessary to validate our driving assessment programs.
Background: Continuous stretching is an effective treatment for contractures, and its efficacy can be improved with a dynamic orthosis. Dynamic orthotic positioning is expected to achieve greater clinical results in joints with less pretreatment stiffness and in those with a short window between injury and treatment. Here we studied the effect of dynamic orthotic positioning on the metacarpophalangeal (MCP) joint using computed tomography (CT).
Methods: The MCP joints of 10 human index fingers were examined using CT in healthy subjects who wore flexion- or traction-type orthoses versus those who wore no orthoses.
Results: The palmar joint distance between the traction-type and no orthosis group was not significantly different; however, the distance was shorter with the flexion-type than the traction-type orthosis (p < 0.05). Compared to healthy subjects without orthoses, the palmar joint space decreased in patients with flexion-type orthoses (p < 0.05) and increased in healthy subjects with traction-type orthoses (p < 0.05).
Conclusions: The traction-type dynamic orthosis was designed to correct flexion while achieving joint traction to enhance MCP joint area spacing and minimize damage caused by articular surface collision. Our findings show that the traction-type dynamic orthosis causes joint space widening and may reduce the risk of articular surface collision compared with the flexion-type orthosis.
Background: Occupational therapy (OT) in South Korea suffers from ambiguous legislation and lack of institutional support.
Aim: To identify the current state and prospects of psychiatric OT in South Korea.
Methods: We introduced the concept of Japanese psychiatric OT to Korean occupational therapists (OTRs). In-depth semi-structured interviews were conducted with participating OTRs. All interview data were analyzed using thematic analysis and NVivo10.
Results: Interview data were divided into two themes: (1) [Current state of Psychiatric OT in South Korea] and (2) [Impressions on Psychiatric OT in Japan]. Furthermore, [Current state of Psychiatric OT in South Korea] was divided into three nodes: (a) [clinical psychiatry], (b) [legal system], and (c) [psychiatric OT]. In addition, we identified that psychiatric OT in Korea had four major problems related to clinical psychiatry, the legal system, psychiatric OT, and education. Although the treatment structure of OT for acute phase, referred to as “parallel place,” is difficult to apply in South Korea, opinions on OT in Japan by practitioners were generally positive.
Conclusion: We suggest three approaches that could be used in the future in South Korea. Considering the differences in culture and therapeutic systems between South Korea and Japan, this study proposes solutions to improve the quality and status of psychiatric OTRs in South Korea.
This cross-sectional study investigated the factors associated with recovery in patients with schizophrenia. One-hundred and three patients with schizophrenia participated in this study. Measures included the Japanese version of the Recovery Assessment Scale (RAS-J), Japanese version of the Beck Cognitive Insight Scale (BCIS-J), Wechsler Adult Intelligence Scale-III (WAIS-III) similarities and symbol search subtests, Life Assessment Scale for the Mentally Ill (LASMI), and Brief Psychiatric Rating Scale (BPRS). Stepwise multiple regression analyses were performed to investigate relationship between recovery and other clinical variables, including cognitive insight, neurocognition, social functioning, and symptoms. Goal/success orientation and hope in the RAS-J was significantly associated with self-reflectiveness (β = 0.42) in the BCIS-J and self-recognition (β = 0.59) in the LASMI. Reliance on others in the RAS-J was significantly associated with self-certainty (β = 0.49) and self-reflectiveness (β = 0.49) in the BCIS-J. Personal confidence in the RAS-J was significantly associated with self-certainty (β = 0.22) in the BCIS-J and endurance and stability (β = 0.78) in the LASMI. No domination by symptoms in the RAS-J was significantly associated with self-certainty (β = 0.69) and self-reflectiveness (β = 0.28) in the BCIS-J. Willingness to ask for help in the RAS-J was significantly associated with self-certainty (β = 0.41) in the BCIS-J and belligerence (β = 0.59) in the BPRS. RAS-J total score was significantly associated with self-certainty (β = 0.20) and self-reflectiveness (β = 0.12) in the BCIS-J and endurance and stability (β = 0.69) in the LASMI. Our findings provide encouraging evidence for the relationship between recovery and cognitive insight and contribute to developing tailored interventions to improve cognitive insight with the aim of achieving recovery in patients with schizophrenia.
Collaboration between medical care and long-term care professionals is very important in cases of stroke rehabilitation in Japan. This study aimed to explore whether collaboration between occupational therapists and care managers using the Management Tool for Daily Life Performance (MTDLP) supports the daily life performance at 1 month after discharge in stroke patients. Participants were 15 patients [77.3 ± 7.9 years (mean ± SD)] in the acute care ward and 22 patients (71.7 ± 9.6 years) in the convalescent rehabilitation ward. Patients were assessed using the Barthel Index, Lawton and Brody Instrumental Activities of Daily Living Scale, and a measure of self-rated health at discharge and 1-month follow-up to investigate the effects of collaboration between occupational therapists and care managers using MTDLP. Collaboration tasks performed by occupational therapists using MTDLP prior to discharge included creating and delivering the daily life performance transfer sheet, conducting patient home visits with care manager, and attending the care service conference. In acute care ward patients, the Barthel Index was significantly increased at 1 month after discharge compared with that at discharge (p = 0.044). Furthermore, self-rated health was significantly improved in both the acute care and convalescent rehabilitation ward patients at 1 month after discharge compared with that at discharge (p = 0.035 and p = 0.019, respectively). These results suggest that the collaboration between occupational therapists and care managers using MTDLP contributed to a positive effect in promoting independent daily living after discharge in stroke patients.
Introduction: The conflict in the Syrian Arab Republic has been ongoing since 2011. Since the war broke out, many Syrians have evacuated Jordan as refugees. 28% of refugees have some kind of functional disorder. We conducted the present study to identify the health conditions of Syrian refugee with disabilities (Person With Disabilities: PWDs) in urban area of Jordan and the situations of their and their families' social participation. Methods: The subjects of the study were twelve participants of PWDs and their families in Jordan. We conducted semi-structured interview between August 2014 and December 2016. Qualitative Content Analysis Method was performed to assess the social participation of them. Results: The social participation of PWDs were categorized under five main themes: 【Lack of health care for PWDs in urban areas】, 【Insufficient health literacy of PWDs and their family members】, 【Restriction of social participation of PWDs and their family members】, 【Spreading of disuse syndrome】 and 【Care burden on family members】. Conclusion: The study identified that the social participation of PWDs and their families in urban area could be often restricted, and that insufficient health care services, health literacy, disuse syndrome, and burdens of nursing care be correlated to the level of social participation of PWDs and their families. Therefore, It is essential that health professionals including occupational therapists provide knowledge and health services concerning the prevention of disuse syndrome and support for the empowerment of PWDs.