Purpose: The purpose of this study was to investigate the psychological effects on health-related quality of life (HRQOL) of postoperative range of motion of the shoulder joint and subjective symptoms in patients with breast cancer who underwent rehabilitation.
Methods: In 79 patients with breast cancer surgery who underwent rehabilitation during hospitalization, we investigated temporal changes in the range of shoulder joint function (flexion of shoulder joint/abduction angle), postoperative subjective symptoms (surgical site pain, tightness, and anxiety regarding the disorder), and HRQOL scales (FACT-B and EQ-5D-5L) from before to 6 months after surgery and examined the factors relating to HRQOL.
Results: The range of shoulder joint movement was significantly decreased even from pre-operation to 1 month after surgery, but subjective symptoms had significantly improved at 6 months after surgery. Multivariable regression analysis showed that postoperative feelings of anxiety felt at 1, 3, and 6 months after surgery were a significant variable influencing the FACT-B and EQ-5D-5L scales. The path coefficients of the standard partial regression coefficients of breast cancer patients at 6 months postoperatively by covariance structure analysis were 0.66 for the EQ-5D-5L effective value, 0.94 for FACT-B, 0.47 for shoulder joint function, and −0.64 for postoperative subjective symptoms as the latent variables of HRQOL.
Conclusion: The results suggested the importance of interventions that focus on postoperative subjective symptoms to possibly improve not only patient function but also postoperative HRQOL.
The primary goal of occupational therapy is to enable people to participate in normal everyday activities. To understand and support a client's desired activities, it is necessary to share the meaning of occupation between the therapist and client. One concept that has been used to capture the psychological state for an activity is flow. Therefore, we devised a process of adjusting the challenge-skill balance for occupational therapy based on flow theory.
In this pilot study, we aimed to verify whether adjusting the challenge-skill balance for occupational therapy improved subjective quality of life in a recovery rehabilitation unit. To inform the future design of randomized controlled trials, we therefore compared standard occupational therapy with this new approach. Both interventions took place from recovery rehabilitation unit entry to discharge, and outcomes (continuous variables) were analyzed using a Bayesian approach explored with generalized linear mixed modeling.
Among a total of 22 patients, those receiving the new approach showed a significant improvement in Ikigai-9 (quality of life) compared with those receiving standard occupational therapy. The mean improvement was 4.44 ± 2.17 with a 95% credible interval of 0.104-8.713. The dependence factor, effective sample size, and autocorrelation time were 3.769, 8093, and 6.18, respectively. We conclude that adjusting the challenge-skill balance during occupational therapy could improve a client's subjective quality of life.
We aimed to clarify intervention processes for facilitating patients' living activities by understanding the practical structure of home-based occupational therapy (OT). Study participants were occupational therapists with at least three years of home-based OT experience. Data analysis was based on the grounded theory. For categorisation, MAXQDA 10 was used to conduct continuous comparative analysis. Analysis resulted in the following categories: 1,572 text segments, 195 labels, 40 small categories, 15 medium categories and 6 large categories. The large categories were (a) identifying unique living activities, (b) analysing and predicting living activities, (c) employing practices to confront living activities, (d) creating an environment that fosters living activities, (e) implementing independent living activities and (f) co-operating to realise living activities. Occupational therapists used patients' living spaces to support them in terms of independently performing living activities, accumulating living activity experience in familiar homes and communities.
Objective: The present study aimed to investigate the complex interaction of factors affecting discharge destination after the acute phase of stroke.
Methods: In 304 patients with stroke who required rehabilitation, we focused on three discharge destinations (i.e., home, convalescent rehabilitation ward, and other facility). Sociodemographic, medical, and acute symptoms data, within the first week of stroke onset and discharge destination, were collected from acute stroke wards. The complex interaction of factors relating to discharge destination from an acute stroke ward was investigated by classification and regression tree analysis.
Results: Patients with a total Functional Independence Measure (FIM) score > 35, a Brunnstrom recovery stage of the lower limb > V, and a comprehension FIM score > 5 had a 91.7% chance of home discharge. By contrast, patients with a total FIM score ≤ 35, age ≤ 79.5 years, and > 2.5 family members had an 80% chance of discharge to a convalescent rehabilitation ward. Finally, patients with a total FIM score ≤ 35, age > 79.5 years, and an expression FIM score ≤ 3 had a 78.6% chance of discharge to other facilities.
Conclusion: The interaction of independence on FIM, function of the paralyzed lower limb, age, number of family members, and comprehension or expression function affect the choice of discharge destination from acute stroke wards.
Background: Children with developmental disorders who require occupational therapy often show clumsiness in handwriting (hereafter referred to as clumsy children). The quality of handwriting has been reported to be deteriorated in children who had physical function-related issues for using handwriting tools. However, to date there has not been any clinical research to investigate the types and severity of deficits in physical function that influence the using handwriting tools. Similarly, how the trends and the severity of problems in physical function affect the characteristics of the results of handwriting task was previously unaddressed.
Objective: This study investigated the influence of characteristics of physical function on drawing performance and drawing motion in clumsy children.
Method: Participants were healthy children and clumsy children enrolled in grades 2-6 of elementary school. The participants' drawing performance was evaluated using the triangle drawing task on a tablet personal computer. The participants' drawing motion was evaluated using the two-dimensional movement analysis device. The physical function of clumsy children was evaluated using the clinical observational assessment.
Results: The largest stray distance, the range of speed and the difference of speed for the healthy child group by grade and each clumsy child. The sway length ratio of the clumsy children differed from those of the healthy children group. Clumsy children who exhibited poor drawing skills also had problems in posture maintenance, muscle condition, upper limb coordination, and eye movement.
Conclusion: We found the influence of poor physical function on poor drawing and drawing motion in clumsy children.
Background: Depression causes mothers to experience difficulties in child care and increases stress, which can influence the development of the child. Japan currently has insufficient support for mothers with depression.
Objectives: We aimed to reveal the difficulties in child care and related factors of three Japanese mothers with depression by examining their narratives.
Methods: A mixed method design was applied. We conducted in-depth, semi-structured interviews with mothers with depression and analyzed the data using both the grounded theory approach and text mining software (KH Coder).
Results: As a result of focus coding, 11 focus codes were extracted. In addition, as a result of multi-dimensional scaling, two codes (“Physical burden caused by family and child care” and “The mother coping with difficulties by herself”) were in close proximity and formed a unit. Another two codes (“Anxiety over not having complete control over child care” and “One-sided coping methods”) were in close proximity, creating a second unit.
Conclusion: This study suggested the following: 1) in spite of being aware of their excessive burden, mothers with depression believed that they should take care of their children by themselves; 2) because of the desire to be a perfect mother, mothers with depression tended to have extremes in their child care. We need further research based this result for the developing support systems.
Background: Children with neuropsychiatric disorders may have a limited participation in everyday activities. It is common that they tend to avoid engaging in activities due to a decreased ability to interpret sensory information. To increase these children's' activity performance ball vests are provided and prescribed as an intervention. The aim of this study was to explore the use of a ball vest in everyday activities from the perspective of adolescents with neuropsychiatric disorders, their parents and teachers.
Method: A qualitative method, where six adolescents with neuropsychiatric disorders, their parents and teachers were interviewed concerning experiences of the adolescents' use of a ball vest for eight weeks. A qualitative content analysis approach was used.
Results: The analysis identified four themes. The adolescents with neuropsychiatric disorders, their parents and teachers portrayed different aspects of the use of the vest which all were mainly positive. The adolescents experienced that their high activity level was influenced by using the ball vest in activities. A slightly delayed calming effect was also described which influenced the adolescents plan when to use of the ball vest during the day.
Conclusion: This study identifies a positive though limited hypothesis regarding how a ball vest can be experienced in relation to everyday activities at home and in the school setting for adolescents with high activity levels and neuropsychiatric disorders.
Everyday technology (ET) has become central to modern life, but its use poses challenges to those with cognitive impairments. We sought to describe the level of perceived difficulties in using ET by people with Acquired Brain Injury (ABI) and to assess the correlation between perceived level of difficulty and cognitive impairment. The Everyday Technology Use Questionnaire revised Japanese version (ETUQ-Japan) was used to assess perceived difficulties in ET use for twenty-two participants with ABI. A trend of negative correlation was observed between the ratio of ET used with assistance of someone else and all neuropsychological test results. In particular, strong negative correlation was observed between the executive function (Behavioral Assessment of the Dysexecutive Syndrome, BADS) and the use of ET with assistance. It is likely that impairments to executive function are associated with difficulties in using ET use and patients with ABI living at home will require aid to address these problems.
Purpose: This study aimed to compare adjustability of grasping force (AGF) between people belonging to young and elderly age-groups.
Methods: Twenty young people and 20 elderly people, with no previous pathology involving the hands and fingers, were included in the study, and an AGF assessment was performed for all the subjects using an iWakka. Subjects adjusted the grasping force according to the target value displayed on the monitor by opening or closing the iWakka.
Results: The assessment of AGF was performed separately from that of the gripping force, and the latter was found to be comparable between the two groups. The mean AGF was found to be 8.9 ± 4.0 g and 7.6 ± 2.8 g for the dominant and the non-dominant hand, respectively, in the elderly group, as compared to the mean AGF for the dominant and the non-dominant hand of 4.4 ± 1.2 g and 4.4 ± 0.6 g, respectively estimated in the young age-group. A t-test conducted after controlling the disparate factors (sex, handedness, gripping force) between the subjects of the two groups, showed that there was a significant difference in AGF between the young and the elderly groups for both the dominant (p = 0.03) and the non-dominant hand (p = 0.02), indicating that the AGF of the elderly people was significantly lower than that of the young study-subjects.
Conclusions: Our findings suggest that AGF decreases with aging and that it is necessary to assess AGF separately from the gripping force, to make a precise comparison.
It is well known that children with autism spectrum disorder show handwriting difficulty. Although it is considered that not only cognitive but also motor impairments affect the difficulty, remarkably little is known about the motor characteristics of handwriting in autistic children. Therefore, the purpose of this study is to investigate: 1) peculiarities of hand and finger functions; and 2) characteristics of handwriting movement in preschool children with ASD during the chrysalis stage of handwriting. Participants were children with ASD and age- and partially IQ-matched controls. We conducted assessment of muscle strength, motor coordination, separate finger movement, dexterity, grasp posture and line drawing movement. We compared data between ASD and control groups. Significant differences were observed in repetitive hand tapping, pronation and supination, sequential finger tapping, finger lifting and pegboard. Considering components of handwriting, there seems to be no prominent difference between the two groups in grasp posture, although ASD showed poorer motor coordination on the drawing line task compared to that of controls. The present results also showed atypical characteristics of hand and finger motor functions and line drawing movement in ASD. These findings provide further insight into the motor aspects of handwriting and suggest investigating correlation between hand and finger functions, especially separate finger movement and manual dexterity and motor aspect of handwriting may be important to clarify effective bottom up training for acquisition of handwriting skills.
This study investigated the effects of seat cushion material during a reaching task. Ten healthy adults and three individuals with cerebral palsy participated. All subjects performed the reaching task on two urethane cushions and one silicone cushion. Anterior/posterior and medial/lateral displacement of the center of pressure and straight rate were assessed. In addition, the movement trajectory of the hand was recorded. No differences among seat cushions were observed in healthy adults. However, all of individuals with cerebral palsy were able to perform the task more efficiency while seated on the silicone cushion than the others. These findings suggest that seat cushion design may improve movement in individuals with cerebral palsy who have postural control disabilities.
Introduction: Few reports describe interventions combining the Canadian Occupational Performance Measure (COPM) with cognitive behavioral therapy (CBT) although both are important in enabling occupation for a client with depression. We outline the therapy process conducted by an occupational therapist combining the COPM with CBT to enable occupation for a client with depression.
Methods: A single-system research design was implemented. The intervention was based on behavioral activation, and the cognitive restructuring was divided into three phases: baseline (Phase I), intervention 1 (Phase II), and intervention 2 (Phase III). Baseline consisted of behavioral activation only. In intervention 1, the COPM was used in addition to the baseline action. In intervention 2, cognitive restructuring was conducted in addition to intervention 1.
Results: There was no significant difference in the client's frequency per week of going out in Phase II compared with Phase I (p = 0.062), but the rate increased significantly in Phase III compared with Phase II by binomial test (p = 0.002). As assessed by the COPM, the performance and satisfaction scores for going out were 4 and 3 at the 5th week, but they improved to 7 and 6 at the 17th week.
Conclusion: Combining the COPM with CBT significantly increased the frequency of going out that a client with depression hoped to attain. The present intervention might facilitate enabling occupation for clients with depression. Our findings suggested that in clients with depressive symptoms, enabling occupation is possible by combining the COPM with CBT.