Objective: Motor accidents caused by older drivers have been increasing and may result from a decline in cognitive functioning and delay in hazard perception. This study examined how brake operation and palmar perspiration indicate hazard predictive ability of older drivers in a driving simulation.
Method: We compared brake operation performance, palmar sweating response, and skin potential reflex responses in healthy older adults (n = 43) and healthy young adults (n = 36) during hazard and hazard prediction scenes in a driving simulator.
Results: In the hazard scene, both groups displayed rapid brake operation and skin potential reflex responses. In the hazard prediction scene, all young adults braked consistent with simulation footage, but 46.5% of older adults failed to brake. Palmar sweating response was greater (p < 0.01) in older adults who braked compared to older adults who did not. In those who failed to break, palmar sweating response was lower than the overall average observed in the older adult group, suggesting that non-operating group members lacked a sense of tension.
Conclusion: Cognitive processes of hazard perception and hazard prediction may facilitate the observed increase in palmar sweating response. Brake operation monitoring and palmar sweating response measurement appear to be useful for evaluating hazard perception ability in a driving simulator.
In Jordan, situated to the south of Syria, some 671,919 Syrians are registered as refugees with the UNHCR. Twenty-eight percent of the refugees have some kind of disorder. However, there are no studies regarding the Recognition and Intervention of Rehabilitation Professionals Handling the Health Conditions of Syrian Refugees with Disabilities (Person with Disabilities: PWDs) in Jordan. Therefore, the purpose of this study was to understand the challenges experienced by rehabilitation professionals who were providing rehabilitation services to Syrian refugee with disabilities through semi-structured interviews. The subjects of the study were Fifteen participants. Constant comparative analyses method was performed to assess them. As a result, the recognition and intervention of rehabilitation professionals who work with PWDs in Jordan were categorized under four main themes: 【Deterioration of PWDs' health conditions】, 【Lack of rehabilitation programs】, 【Difficulties in continuously providing rehabilitation to PWDs in urban areas】, and 【Forthcoming challenges facing rehabilitation programs by community-based organizations】. The study identified that rehabilitation professionals provided outpatient rehabilitation, home-visit rehabilitation and provision orthosis to PWDs. They also recognized the difficulties PWDs faced in accessing health care due to poverty, the spread of disuse syndrome, and the lack of caregivers in PWDs' families. However, the prevention of disuse syndrome, the provision of nursing care methods, and the intervention of Activities of Daily Living (ADL) were not mentioned as future challenges. Therefore, it is essential that rehabilitation professionals conduct prevention of disuse syndrome, provide intervention for ADL.
Purpose: This follow- up study by questionnaire aimed to identify factors associated with social activity levels of stroke patients by investigating their activities between 1 and 3 years after discharge.
Materials and Methods: Participants included 191 people with stroke who were living in their home. Their social activity levels at 1 and 3 years post-discharge were investigated using the Frenchay Activities Index (FAI: an index for evaluating social activities such as housework, leisure, and work). Factors associated with inactivity at 3 years post-discharge, and with a decline in activity levels from 1 to 3 years post-discharge were analyzed by logistic regression analysis.
Results: The median FAI was 23 points after 1 year; however, it declined significantly to 19 points after 3 years. Cognitive dysfunction [odds ratio (OR) = 11.61, p < .001] and dependency in activities of daily living (ADLs) [OR = 8.46, p < .001] were identified as factors associated with inactivity after 3 years. Moreover, dependence in ADLs (OR = 0.10, p = .027) was identified as a factor associated with a decline in activity level from 1 to 3 years post-discharge.
Conclusions: Patients with stroke living at home tend to be inactive in the long term; this could be attributed to cognitive dysfunction and ADL dependency. Therefore, occupational therapists need to pay more attention to the social activities of patients with stroke in the community; providing activities tailored to the patient's abilities is vital. Furthermore, interventions are needed to prevent long-term decline in social activities in patients with stroke living at home, who show independence in ADL.
Objective: To evaluate the cost-effectiveness of adding individualized occupational therapy (IOT) to group occupational therapy (GOT) as standard care versus GOT alone for prevention of rehospitalization for patients with schizophrenia.
Methods: Data were collected from our previous randomized controlled trial from baseline psychiatric discharge to 2-year follow-up. The effectiveness was measured as the number of patients who were not rehospitalized, and the cost outcome was defined as direct medical costs.
Results: A total of 109 patients were included: 53 in GOT + IOT and 56 in GOT alone. The number of patients who avoided rehospitalization was significantly higher in the GOT + IOT (n = 37) condition compared with the GOT alone condition (n = 16) (p < .001). Adding IOT to GOT was associated with a 56.76% probability of being more effective at reducing the rehospitalization rate and a 26.93% probability of being less costly than GOT alone. GOT + IOT had high outpatient costs, but lower inpatient costs due to the lower rehospitalization rate; as a result, total medical costs were lower than for GOT alone.
Conclusions: Our results demonstrate that adding IOT to GOT is likely to reduce costs and the rehospitalization rate; thus, GOT + IOT is more cost-effective than GOT alone.
Occupational therapy has a pivotal role in the organization of health care, and has important role to improve the health and quality of life of women by facilitating participation in meaningful occupations. The aim of this paper is to present a summary of occupational therapy role for health of women, and an analytical perspective of the current issues eroding its professional autonomy and contributing to a critical lack of progress in Malaysia. Three key root-causes – with an emerging summative theme of “triple whammy”, was identified using root cause analyses technique. The root causes were related to two internal and 1 external root-source:- (1) Low numbers of occupational therapists, (2) Low university- education occupational therapy programs, and (3) Entrenched medical governance hindering the progress of therapy professionals. These interrelated key issues (roots) play a detrimental role in the advancement of a cost-effective, evidence-based best practice of the profession, and reduces its significant contributions towards the healthcare of all, including the issues of women health care. As a young profession compared to many other health disciplines, occupational therapy needs a mandate to protect its role autonomy, with enhance visionary pathway for growth, and to expand its roles, including for the underserved area of women health, in Asia's male dominated world.
Background: Only 20% of the hospitals in Japan currently provide work support services for patients with acquired brain injury (ABI). Since the new employment quota system in Japan requires private companies to hire individuals with psychiatric disabilities as of April 2018, the number of employees with ABI is expected to increase. This social background would encourage medical staff to rely more on neuropsychological assessment test scores to understand the cognitive abilities of those patients who need vocational support to transition from hospital to work.
Purpose: The purpose of the study was to clarify the subcategories of the Wechsler Adult Intelligence Scale that would predict the work ability of individuals with ABI.
Methodology: A systematic review and meta-analysis were conducted to identify specific cognitive functions related to work ability. Four original articles from MEDLINE, CINAHL, ERIC, CiNii, and the ICHUSHI database that met study inclusion criteria were analyzed.
Results: Results showed that there were four tasks under the verbal test—“vocabulary,” “digit span,” “arithmetic,” and “similarities”—and two tasks under the performance test—“block design” and “coding”—that were predictive variables of work ability.
Conclusion: Assessing cognitive functions of individuals with ABI, such as “working memory,” “continuous attention,” “abstract thinking,” “vocabulary and expression,” and “time series processing,” could more effectively predict work ability.
Introduction: This study aimed to identify the usefulness of the dual-task stepping test to determine the independent toileting ability of patients with stroke.
Method: Sixty-seven stroke in-patients who were able to perform stepping in a seated position were enrolled in the study and underwent the dual-task stepping test. The relationships of the test results with other assessments (Berg Balance Scale, Mini-Mental State Examination, and the Attentional Rating Scale) with toileting ability, and with factors affecting toileting ability were investigated by regression analysis.
Results: Patients with low dual-task performance tended to have poorer balance, attentional, and cognitive abilities. The results of the dual-task stepping test and rates of independent toileting were distributed as follows: severe dual-task disability, 15.6% (5/32), mild dual-task disability, 64.7% (11/17); and normal dual-task ability, 94.4% (17/18). The dual-task stepping test results revealed a significant relationship between dual-task disability and toileting ability (p < 0.01). Logistic regression analysis showed that the dual-task stepping test had the highest odds ratio for toileting ability (p = 0.00; odds ratio, 14.50).
Conclusion: The dual-task stepping test was useful for determining independent toileting ability. This assessment is rapid and does not require special equipment or infrastructure, and has the potential for wide application in clinical practice.
Background: Parents of children with gross motor dysfunction often face obstacles when performing out-of-home activities with their children. However, little is known concerning their situation.
Objective: This study aimed to develop an out-of-home activity accessibility checklist for parents of children with gross motor dysfunction that clarifies their situation during these activities.
Method: Parents of children with gross motor dysfunction participated in semi-structured interviews to generate a tentative accessibility checklist. Then, Delphi questionnaire survey was conducted to determine appropriate checklist items.
Result: Fifteen participants involved in the semi-structured interview and 124 tentative checklist items were generated. Then, 56 participants involved in Delphi questionnaire survey and tentative checklist items was reduced to 39. These checklist items were grouped under the domains of obstacles, coping strategies, and required assistance and resources. Most obstacles were caused by the lack of equipped infrastructures.
Discussion: Most obstacles faced by parents of children with gross motor dysfunction were caused by the lack of infrastructures that were barrier-free. The parents had to collect extensive information prior to outings as coping strategies. Therefore, parents require society level environment improvement in order to participate in out-of-home activities. The checklist may provide local communities with valuable information to construct more accessible environments and inclusive communities.
Objective: Handwriting, which consists of multiple joint movements in the upper extremity, is a suitable model to investigate motor control after hemiplegic stroke. We analyzed pen tip movement during handwriting in relation to the finger and wrist to reveal tightening and joint linkage that control writing movements done by a hemiplegic hand.
Methods: Thirteen right-handed individuals with right-sided mild hemiplegia after a stroke and 14 age-matched, right-handed controls were included. Movements of the pen tip, finger, and wrist were recorded using a three-dimensional movement analyzer. We investigated their writing performance by measuring writing time, variabilities of pen tip kinematics and trajectory. Movement linkage of the joints during writing was quantified by calculating the ratio of the trajectory size at the finger or wrist to that at the pen tip.
Results: The time needed for writing and the kinematic variability did not differ between the hemiplegic and control groups. The tight linkage of the pen tip with the finger and wrist joint movement was found in hemiplegic handwriting, which was similar to nondominant hand use in the controls. The linkage parameter of hemiplegic handwriting significantly correlated with writing time and kinematic variability of the pen tip movement.
Conclusion: Individuals with dominant-hand hemiplegia, in an attempt to produce consistently legible writing, may tighten the joint linkage of the finger and wrist to reduce the freedom of motion to control writing and simultaneously slow their writing speed, potentially resulting in increased kinematic variability of the pen tip movement.
Background: Paralysis of the upper limb after stroke affects daily life. Our objective was to examine the clinical effects of our newly developed finger extension splint, which was made by specially processing a shape memory alloy, in a chronic stroke patient.
Design: Comparison of the clinical effects of the splint use pre- and post-treatment.
Patient: A 70-year-old man who developed right thalamus hemorrhage 15 years previously presented with right hemiplegia.
Intervention: Training was performed 30 minutes/day for 10 weekdays for the fingers on the paralyzed side. Task-oriented training, such as block stacking, was performed.
Results: Upper limb function evaluation results (pre vs post-treatment): grip strength, 9.3 vs 12.1 kg; upper-extremity subtest of the Fugl-Meyer Assessment of Motor Function, 42 vs 54 points; Wolf Motor Function Test (functional ability scale), 47 vs 50 points; time, 389.2 vs 308.2 seconds, and the Box and Block Test: 11 vs 15 and 8 vs 15 with and without the splint, respectively.
Conclusion: When training was conducted using this splint, improvement of upper limb function was observed.
Objectives: There are only a few functional evaluations that non-medical personnel can perform and interpret without guidance. Here, we have created a questionnaire that focused on eating activities, which can be used to evaluate motor function easily because most people could relate to eating activities. This study aimed to verify the reliability and validity of the developed questionnaire by comparing it with clinical evaluations for upper extremity function.
Methods: This was a cross-sectional study. Patients who have cerebrovascular disease history with disabilities in the upper limb were included in the study. The questionnaire on eating activities was answered by the patients themselves. Upper extremity function was evaluated with the Fugl-Meyer Assessment (FMA). Work efficiency was evaluated with the General Aptitude Test Battery. Reliability of the questionnaire was assessed by test-retest reliability. Validity was evaluated using a correlation analysis.
Results: The study included 16 participants. The results indicated that all items had sufficient reliability. The correlation between the questionnaire score of the hand and the FMA score of the wrist, hand, and arm was statistically significant.
Conclusions: The developed questionnaire was reliable and significantly related to clinical evaluation of upper extremity functions. This questionnaire is of great value to patients with stroke to understand their functions.
Purpose: Hanging washed pullover garments to dry with one hand poses a challenge in daily life for patients who are forced to use their unilateral upper extremity. We hypothesized that a hanger hooked onto the backrest of a chair (backrest hanger) would facilitate easy hanging of pullover garments that need to be dried with one hand; in particular, one can place a pullover garment on the backrest hanger and then pull the hanger along with the garment upward to separate them from the backrest. The present study aimed to demonstrate the practical usefulness of a backrest hanger for patients with hemiplegia.
Methods: This study included 20 healthy volunteers and 16 patients with hemiplegia. Participants were requested to hang a sweatshirt to dry with one hand only (the non-dominant hand for healthy volunteers and the non-paralytic hand for patients with hemiplegia) using a backrest hanger, pinch hanger, and a bath towel rack. Patients with hemiplegia performed the task after being instructed regarding how the greatest number of healthy individuals used each tool. Participants were requested to rate their level of ease in hanging the sweatshirts, and the total time required to complete the task was measured.
Results: Both healthy volunteers and patients with hemiplegia reported the backrest hanger to be the easiest mode of hanging sweatshirts, and it required significantly shorter amount of time as compared to the other two tools.
Discussion: The findings indicate the high practical usefulness of the backrest hanger method.