Purpose: This study aimed to examine the effects of driving cessation on the health-related quality of life (HRQOL) of older adults who do not have a driver's license.

Method: A cross-sectional study using a web-based questionnaire was conducted. Participants were 1,200 individuals aged 65 years or older who did not have a driver's license in Japan. Participants answered questions about their HRQOL (HUI3 and SF-8) and driving cessation using a self-administered questionnaire. Those who had surrendered their driver's license were also asked about their HRQOL before driving cessation.

Results: The HRQOL scores of the drivers who ceased driving were significantly lower than those of non-drivers. The HRQOL scores of the drivers who ceased driving were also significantly decreased—from −.816 to −.728 (< .001) for the HUI3 and from 51.5 to 49.5 (< .001) for the physical component summary of the SF-8—when comparing scores before and after driving cessation. The results of our multiple regression analysis showed that the number of years since driving cessation and incidence of major illness also affected HRQOL.

Conclusion: There is a clear relationship between driving cessation and a decrease in HRQOL. This confirms the necessity of implementing measures in the future to address this issue, such as securing means of transportation for older people who have ceased driving.

Background and Purpose: In patients with stroke, predictors of the use of paralyzed upper limbs in each activity of daily life, including eating and toileting, are not clear. Therefore, we aimed to identify factors that predict the use of paralyzed upper limbs in specific activities of daily life in patients with acute stroke.

Method: This prospective observational study enrolled 155 patients with acute stroke. We used the paralytic arm participation measure (PPM) to evaluate the use of the paralyzed upper limb in daily life. Eating and toileting were assessed at admission and discharge. Factors that predicted the use of the paralyzed upper limb at discharge were analyzed by binomial logistic regression analysis.

Results: The predictors of the use of paralyzed upper limbs for eating at discharge were age [odds ratio (OR)=0.93, p=.011], paralysis of the dominant hand (OR=3.75, p=.044), and motor function of the paralyzed upper limb (OR=2.16, p<.001). For toileting, the predictors were motor function of the paralyzed upper limb (OR=1.75, p<.001), sensory function of the paralyzed upper limb (OR=1.66, p=.004), and muscle strength of the quadriceps on the non-paralyzed side (OR=3.65, p=.005).

Conclusion: These identified predictors may provide clues to interventions promoting the use of paralyzed upper limbs in the daily life of hospitalized patients with acute stroke. Observation and evaluation of each activity by an occupational therapist using the PPM is potentially useful in encouraging patients to consciously use the paralyzed upper limbs in daily life.

Introduction: Peer support programs are mainly studied by hospitals and medical professionals, and further research is needed on their impact on quality of life (QOL). The purpose of this study was to investigate the type of community-based peer support program that is effective for improving the QOL of cancer survivors.

Method: A systematic review was performed using the following procedures: (1) randomized controlled trials aimed at improving QOL were searched from PubMed and Igaku Chuo Zasshi, (2) papers that met the inclusion criteria were selected, and (3) the papers were assessed for quality by using the revised Cochrane risk-of-bias tool for randomized trials.

Results: Results showed that four studies met the eligibility criteria, and three of them showed statistically significant improvements in QOL. The peers instructed in programs were breast cancer survivors who had been diagnosed one to three years earlier. Furthermore, peers received special training for approximately eight hours per session for a total of two to seven days before providing support to the participants.

Conclusion: Few programs have been fully applied in Japan. In terms of program effectiveness and risk of bias, programs that include obtaining support and managing activities that affect mood may be effective. Furthermore, the importance of taking enough time to help cancer survivors trust each other and provide support according to the patient's wishes and available community resources was demonstrated.

The purpose of this study is to identify how cognitive functions such as attention and cognitive processes, such as the retention process to maintain an image needed in the learning by imitation process, are related to the ability to convert this into action (imitation) in patients with schizophrenia. Many people with schizophrenia have a lower imitation ability compared to healthy persons. Those with low imitation ability had lower scores for cognitive functions such as MMSE and visuospatial cognitive functions such as the number of correct answers in MRT. As described above, reduced imitation ability in patients with schizophrenia is caused by problems in information processing which temporarily retains and manipulates visual information during the performance of a task.

Introduction: In racket sports, it is necessary to devise a gripping method that facilitates both the efficient transmission of power and injury prevention. This study quantified grip pressure distribution (PD) in the hand using various gripping methods and investigated the relationship between these distributions and muscle activation.

Methods: In a laboratory setting, a grip sensor was used to measure hand PD in 15 healthy adults during each task. Participants gripped the sensor device using three grip patterns with simultaneous electromyography (EMG) recordings from the extensor digitorum communis (EDC), extensor carpi radialis, flexor digitorum superficialis (FDS), and flexor carpi ulnaris (FCU). The device's hand-contact area was assigned anatomical regions, and the percentage PD of each region was calculated for each task. We compared the EMG in each grip pattern and analyzed the correlation between grip force and EMG.

Results: The main outcomes measured were EMG and PD. For radial and power grips, there was a significant relationship between EDC and grip force (r = 0.52, 0.47). For the ulnar grip, there was a significant relationship between FDS and grip force (r = 0.55). Furthermore, the ulnar grip's EDC activity was significantly lower than that of the power grip, and FCU activity was significantly higher than that of the radial grip (p < 0.05).

Discussion: The ulnar grip had significantly lower EDC activity than the power grip and higher FCU activity, which is involved in the elbow joint's stability, than the radial grip. The ulnar grip may be effective in preventing injuries.

Objective: The influence of myoelectric hand training on the ability of amputees to operate a prosthetic hand has not been fully verified. This study aimed to investigate the effects of single-handed and dual-handed tasks on the ability of amputees to use a myoelectric prosthetic hand in training.

Method: The subjects were unilateral transradial amputees (n = 12). The training effects of each task were measured by assigning the myoelectric hand prosthesis users to two groups and conducting a crossover study: one group performed the single-handed task first followed by the dual-handed task, and the other group did the opposite. The Southampton Hand Assessment Procedure (SHAP) score was used to assess the subjects' ability to control the myoelectric prosthetic hand.

Results: The training effect differed significantly between the single-handed task, SHAP score: 6.3 (5.8-8.5) points, and the dual-handed task, SHAP score: 10.3 (8.8-14.2) points; however, the effect was insufficient (p = 0.008, r = 0.20).

Conclusion: The dual-handed task improved the subjects' ability to accurately operate a myoelectric hand more effectively than the single-handed task. This suggests that the dual-handed task is more effective at developing control of opening/closing movements and object handling with a myoelectric hand than the single-handed task.

Background and Objectives: A knee–ankle–foot orthosis (KAFO) has been clinically used for individuals with stroke, but its effect is still unclear. This study was to evaluate the immediate effects of a KAFO on the standing reach of individuals with subacute stroke.

Method: This study adopted a cross-sectional experimental design. A total of 31 inpatients with subacute stroke (mean age, 66.5 ± 14.4 years; mean poststroke interval at admission, 26.2 ± 10.1 days) were enrolled in the study. The functional reach test (FRT) was used to measure the standing reach of the participants with or without a KAFO. The participants were divided into the following groups on the basis of the results of FRT without a KAFO: group 1 comprised patients who were unable to reach without a KAFO (n = 22), and group 2 comprised patients who had the ability to reach without a KAFO (n = 9).

Results: In group 1, the proportion of participants who could reach with a KAFO significantly increased (p = 0.002). In group 2, the mean standing reach with a KAFO (25.4 ± 6.7 cm) was significantly longer than that without a KAFO (20.3 ± 7.0 cm) (p = 0.021).

Conclusion: The use of a KAFO may immediately improve the standing reach of individuals with subacute stroke. Results show that a KAFO may be an effective device for improving standing reach and can be used to develop rehabilitation programs for individuals with subacute stroke.

Objective: In stroke patients with visual impairment, it is unclear which activities of daily living (ADL) are affected or how they are affected. This study aimed to determine the effect of the type and prevalence of visual impairments on ADL in acute stroke patients.

Method: We interviewed stroke patients without severe movement disorder, aphasia, general inattention, or hemispatial neglect who were admitted to our hospital between September 2018 and May 2020 for lesions in the cortical and subcortical white matter posterior to the central sulcus. The patients were asked via a questionnaire whether they had ADL impairments related to 13 types of visual impairments, and to provide specific examples. We determined the types of visual impairments, the prevalence of each impairment, and what effect they exerted on daily life.

Results: Sixteen participants were included. Fifteen participants had defective visual search, 14 had hemianopic dyslexia, 9 had walking trajectory deviations, and 6 had difficulty in recalling the place where they were seeing right before. In addition, there were defective visual counting, difficulty in judging distance, and pure alexia.

Conclusion: Even in cases without severe movement disorder, aphasia, general inattention, and hemispatial neglect, cerebral infarction in the posterior half of the cerebrum causes problems in ADL due to visual impairment. It is important to interview patients from the acute stage with visual impairment in mind.

The purpose of this study was to examine the kinetics of the visual axis and pupil diameter during caregiver-assisted eating. The eating task was caregiver-assisted eating of twelve healthy volunteers. Visual axis position, spoon bowl motion, and pupil diameter were recorded using an eye tracker and a digital video camera. All participants indicated visual axis on a spoon or food during the motion of moving the spoon to the participant's mouth in caregiver-assisted eating. Critical visual point (CVP) disappeared completely in all trials of all participants. The min-to-max and max-to-min pupil diameters, differences and changing were divided to three patterns for caregiver-assisted eating in all participants. Most patterns showed decrease of pupil diameter. These data suggest that the participant looked carefully at the food or the spoon using an accommodation reflex and a convergence reflex. Caregiver-assisted eating is natural in non CVP. A participant does not have somatosensory information during eating motion in caregiver-assisted eating. Positional information of a spoon is obtained only from visual information. We speculated that participant anxiety was stronger with caregiver-assisted eating than with unassisted eating. However, the causes of an increase and lack of change in pupil diameter remain unclear. Occupational therapists, who understands biological responses during eating motion, must teach a caregiver-assistant methods that are suitable for a participant.

Objective: The number of children with special education needs (SEN) is on the rise in Japan. However, the behavior and sensory modulation functions of preschool-aged children with SEN have not been clarified. The purpose of this study was to examine the behavioral and sensory modulation characteristics of preschool-aged children with SEN compared with those of children without SEN.

Methods: We conducted a cross-sectional survey using a questionnaire on children's behavioral problems and sensory modulation, which was reported by nursery teachers who cared for children with and without SEN. Forty-two nursery teachers who were involved with the care of children with and without SEN were asked to complete the Japanese version of the Eyberg Child Behavior Inventory (ECBI) and the Japanese version of the Short Sensory Profile (SSP).

Results: The results showed that both ECBI and SSP scores were significantly higher in children with SEN than in children without SEN (p < 0.01), and that the SSP domain scores for underresponsive/seeks sensation and auditory filtering in children with SEN were significantly correlated with ECBI scores (p < 0.05).

Conclusion: Children with SEN had more sensory modulation bias and behavioral problems than children without SEN, and there was an association between sensory modulation bias and behavioral problems in children with SEN.

The Rey–Osterrieth complex figure test drawings of 68 children with learning disabilities who have difficulty acquiring kanji writing were evaluated using Osterrieth's scoring system (accuracy scale) and the organizational scoring system (drawing strategy scale) to understand the factors involved in their visual information processing. After 1 week or more, a second evaluation was performed with a color-coded setting for the components in the figure. The scores of each scale were normalized into z-scores. Using the z-scores as the dependent variables, a two-factor analysis of variance was performed for the color-coding and evaluation scale factors. Children with learning disabilities who have difficulty learning kanji writing had a problem with perceiving the components of the figure as a unit, which suggests that they found it difficult to recall the figure. It is considered that the factor involved in the visual information processing of children with learning disabilities who have difficulty acquiring kanji writing is largely influenced by the disability in using the composition strategy that promotes recall. A comparison of the evaluation results, based on the presence or absence of attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), suggests that children with ADHD and ASD tend to be more affected by the impaired use of composition strategies.

To investigate the features associated with the mastery of neat and speedy handwriting, 23 healthy volunteers practiced writing with their non-dominant hand. The participants were randomly divided into two groups. One group (n = 12) started writing simple symbols such as dashes, circles, and triangles (-, ○, and △) and then after 1 week, advanced to writing individual characters. The other group (n = 11) started by copying entire sentences. The practice period lasted 4 weeks (7 days/week). Results showed no major differences between the groups in terms of handwriting learning effectiveness; however, there was a trade-off between the speed at which the participants wrote and the neatness of their writing. These findings suggest that the process of learning to master handwriting is consistent with the Fitts's law.

Objective: In Asia, chopsticks are popular eating utensils, and the use of chopsticks is closely related to food culture. Therefore, the type in which children grasp chopsticks and the functionality of these grasping patterns are important for occupational therapists. The purpose of this study was to investigate the various types of grasping chopsticks in typically developing preschool children and compare the functionalities of these types.

Methods: We investigated various types of grasping chopsticks in 102 typically developing preschool children. There were 72 preschool children who performed four types of chopstick operation tasks: two pick-up and carry tasks, a scoop-up and carry task, and a cut task. These task scores were compared between the traditional and untraditional grasping types.

Results: Within the 102 participants, we found the traditional and four untraditional grasping types. There was no significant difference between the traditional and untraditional grasping types in the “pick-up and carry” and “scoop-up and carry” task scores (p > 0.05). For all grasping types, the “cut task” score was low.

Conclusion: There were no differences in functionality between traditional and untraditional grasping types. Furthermore, we found that functionality was affected by food shape. These results may provide insights on interventions during meals, especially for children who are learning how to use chopsticks.

Objective: The perfect O sign is often evaluated in carpal tunnel syndrome but there are no clear criteria. The purpose of this study is to develop a tool for quantifying the perfect O sign and to investigate the values of the perfect O sign in healthy subjects using this method.

Methods: Participants are healthy 20- to 30-year-old volunteers (n = 13) without any clinical symptoms of carpal tunnel syndrome. Surface electromyogram was used to measure the amplitude of the abductor pollicis brevis (APB), first dorsal interosseous muscle (FDI), flexor digitorum superficialis (FDS), and extensor digitorum communis (EDC) while performing the perfect O sign in three different wrist positions: neutral, dorsiflexion, and palmar flexion. The roundness of the perfect O sign in healthy subjects was measured by approximating a circle using 7 points in the photo captured by a smartphone and imported to a personal computer.

Results: The FDI/APB ratio was significantly lower in the dorsiflexion position than that in the palmar flexion position, and the FDS/APB ratio had a significantly lower dorsiflexion position than that of the other two wrist positions. Based on these results, a device was developed that holds the wrist in the dorsiflexion position. The mean roundness of the perfect O sign using the device in 13 healthy volunteers was 80.46 ± 9.47%.

Conclusions: Dorsiflexion of the wrist can minimize the effect of other muscles while performing the perfect O sign. The perfect O sign can be quantified by calculating the roundness.

Introduction: Functional use of a paralyzed upper extremity in patients with hemiparesis after stroke depends on the specificity of the task. Further, task specificity-dependent upper extremity use is an important factor in the recovery of upper extremity function. The purpose of this study was to investigate the usefulness of a perceptive exploration activity in consideration of the specificity of the task for Japanese male patient in his 70s and monitor its effect on spoon manipulation using the affected arm.

Methods: A single-subject research design was implemented in the ABAB trial. The facilitation of selective movement of the paralyzed upper extremity and self-care skill training were provided during baseline A and A’ as occupational therapy (OT). In addition to the OT, 10 minutes of perceptive exploration activity was added during the interventions B and B’. The required time (RT) and number of errors (NOE) in task performance were monitored as the outcome of the therapeutic effect. Goal Attainment Scaling (GAS) and Fugl-Meyer Assessment (FMA) were also adopted to evaluate individual goals and changes in upper extremity function.

Results: RT and NOE in task performance were decreased with interventions B and B’ compared to baselines A and A’. GAS score improved in interventions B and B’, and FMA showed a gradual improvement within each phase.

Conclusion: Spoon manipulation using the paralyzed upper extremity with sensory disturbance was improved by perceptive exploration activity. Current therapy suggests that perceptive exploration activity may be effective in improving movement skills in the manipulation of tools.

Problem Statement: There is a need to determine whether a brain-injured person can return to driving from the viewpoint of a healthy individual's driving abilities and characteristics. Accordingly, this study investigated the attention function and driving characteristics of healthy middle-aged and older female drivers in a region with a high level of automobile dependence, and examined their relationship with traffic violations and accidents.

Methodology: Participants were 81 healthy female drivers, with a mean age of 64.4 ± 8.4 years, whose incidences of traffic violations and accidents, attention function, and driving characteristics were examined. Attention function was evaluated using Trail Making Test Part A, Trail Making Test Part B, and Symbol Digit Modalities Test. Participants were divided into two groups according to whether they had been involved in traffic violations or accidents. Statistical comparisons were performed.

Results: Drivers who experienced violations and accidents exhibited reduced attention function in the Trail Making Test Part A assessments. Trail Making Test Part B and Symbol Digit Modalities Test were unrelated to driving risk. Driving characteristics showed differences between the two groups.

Conclusion: In addition to attention function, potential personality changes and awareness of disease after brain damage may affect the driving function of people with brain damage, in addition to their driving characteristics and personality traits from before the brain damage. In the future, we aim to conduct a survey of drivers with brain diseases to help determine criteria for whether a person with a brain injury can return to driving.

Introduction: Few reports describe the occupational therapy practice of reinforcing the daily life behaviors hoped for by clients with schizophrenia in community mental health services. We outline a therapeutic process to enable bathing hoped for by a client with schizophrenia through the combined use of the Canadian Occupational Performance Measure (COPM) and a checklist as a cognitive aid.

Methods: The study was divided into a baseline phase and intervention phase based on the single-system design. The interventions were focused on occupation based on the COPM and positive feedback by using the checklist. Assisted bathing, advice, suggestions and prompting of voluntary activities were conducted in the baseline phase.

Results: The frequency of bathing per week increased significantly in the intervention phase compared to baseline phase by binomial test (p = 0.03). Although bathing performance score and satisfaction score in the COPM assessment decreased from 10 and 9 (20th week) to 6 and 4 (34th week), respectively, the assessment was influenced by the client's further positive inquiries into ways of bathing.

Conclusion: Bathing hoped for by a client with schizophrenia was enhanced, and further positive inquiries into activities of daily life in a personal context were initiated. The findings suggest that in community-dwelling clients with schizophrenia, a client-centered approach combining COPM and a checklist as a behavioral reinforcement-based cognitive aid is sufficiently appropriate for promoting client participation in activities.

Statement of the problem: We conducted a systematic review on oculomotor rehabilitation for patients with brain injuries; however, an appropriate study design was not used and was inadequate for the evaluation of effect. Thus, in this study, we aimed to verify the benefits of our previously developed oculomotor rehabilitation program for patients with brain injury hospitalized in an acute care hospital.

Methods: This report presents the case of a 50-year-old female patient hospitalized in an acute care hospital for disturbed consciousness and limb dysfunction due to subarachnoid hemorrhage and cerebral stroke. The patient showed abducens nerve palsy of the right eye and right-sided gaze palsy. She received our oculomotor rehabilitation program. An ABAB design was used: Phase A involved basic rehabilitation only, and Phase B involved basic rehabilitation plus the oculomotor rehabilitation program. The program comprised training to promote pursuit, fixation, saccade, and vergence. Starting from day 40 of admission, the patient completed five 20-min sessions per week for 4 weeks forming Phases A1, B1, A2, and B2. The oculomotor range of the right eye was measured during each phase.

Results: The patient did not exhibit fluctuation of vital signs or any adverse events following the oculomotor rehabilitation program. The mean expanded mobility ranges were 1.49 mm in Phase A and 4.91 mm in Phase B (p < 0.05).

Conclusion: Implementation of the oculomotor rehabilitation program promoted shortening of the extraocular muscles, resulting in improvement of the oculomotor mobility range.

Purpose: Folding socks can be difficult for patients who rely on only one hand. We hypothesized that through the following procedure, patients could easily fold their socks even with just one hand. First, place the rounded part of a ladle between the leg and the chair. Then, stack the pair of socks on top of each other. Put your finger through the opening of the upper sock and hold up the lower sock. Finally, place the sock on the tip of the handle, and pull your fingers down. The aim of this study was to compare how hemiplegic patients fold socks using the flip and tuck method through the folding motion with and without a ladle, to demonstrate the effectiveness of this technique in folding socks.

Method: Forty hemiplegic patients participated in this study. After being instructed on how to fold a sock with and without a ladle, participants performed the folding motion using the flip and tuck method with one hand. After the experiment, it was determined whether the participants had successfully folded the socks, and the ease of folding was subjectively evaluated. Moreover, the folding time was measured using the captured video footage.

Results: When the ladle was used, all participants succeeded in folding the socks. The motion was easier and the folding time was significantly shorter when using a ladle than when not using a ladle.

Discussion: Using a ladle to fold socks is a practical method for hemiplegic patients.

Objective: This study aimed to clarify the influence of the coronavirus disease (COVID-19) pandemic on occupational therapy (OT), including changes in assessment and treatment, along with other restrictions and measures in long-term care insurance service facilities.

Methods: We conducted a questionnaire survey from representatives of OT departments in long-term care insurance service facilities in Hokkaido and obtained responses from 89 participants.

Results: More than half of the facilities remained unchanged in their assessments and treatments following the first emergency declaration, after which their responses gradually decreased. As for the content of assessment, there were increased needs, such as body temperature, health condition, and physical/cognitive changes due to disuse syndrome, while reduced opportunities were available to assess in areas, such as home environment, mobility outdoors, and instrumental activities of daily living outdoors. As for the content of treatment, while outings and group training had been discontinued, prevention of disuse syndrome had been added. The treatment also incorporated changes in methods, such as fixing the location and time. Restrictions related to OT were reported, including client participation, OT operations, and discontinuation of services. On the other hand, measures related to OT, such as thorough standard precautions, management of health conditions of the clients and housemates, and infection control measures by occupational therapists, were also mentioned.

Conclusions: Despite various restrictions, OT was provided by thoroughly implementing standard precautions, managing the physical conditions of the clients and housemates, providing new means of participant support and infection control for the influences of the COVID-19 pandemic.

Objective: In Japan, the introduction of a project aimed at providing support for individuals with higher brain dysfunction has resulted in a substantial increase in their employment rate. While this shows positive effects, many such individuals still have difficulty finding employment and may face various difficulties in cases where employment is secured. This study aimed to clarify the factors that affect the performance of employment support for people with higher brain dysfunction, with a focus on the conditions at medical institutions and employment support organizations in Japan.

Methodology: This study measures scores on the competency scale (WSC-HB) required for employment support for people with higher brain dysfunction. An anonymous self-administered paper-based questionnaire was circulated among a total of 1,384 occupational therapists, speech therapists, social workers, and employment support workers. Factors affecting job performance were processed by hierarchical multiple regression analysis.

Results: The factors of “transdisciplinary learning (ΔR² = 0.105, F(311) = 7.699, p < 0.01)” and “amount of knowledge (ΔR² = 0.056, F(305) = 6.854, p < 0.01)” about employment support influenced the performance of employment support for people with higher brain dysfunction.

Conclusions: There are few opportunities to acquire knowledge about employment support for people with higher brain dysfunction. Going forward, systematic professional training should, therefore, be implemented to cover issues such as welfare, employment, and the medical features of higher brain dysfunction. This will help establish a system for providing quality employment support.

Background: Eye movement disorders of amyotrophic lateral sclerosis are unlikely to occur. For this reason, an increasing number of occupational therapists are have started introduction gaze-based AACDs. Although it is desirable to introduce AACDs as early as possible, the optimal method for introducing such devices remains unclear.

Objectives: This study aimed to clarify the initial practice for the introduction of a gaze-based AACD from an operational perspective.

Methods: The study participants were 16 healthy adults (12 males and 4 females; 30.9 ± 6.28 years). The following three aspects were measured according to the two operation methods (gaze groups and switch groups): “physical function”, “mental function”, “computer operation”.

Results: No significant differences in physical or mental functioning were found between the gaze and switch groups. The switch group input significantly more characters in the computer operation than did the gaze group (P = 0.02, mean number of characters ± SD: 425.7 ± 156.5 vs. 234.9 ± 84.7, respectively). Furthermore, the switch group became accustomed to the operation significantly faster than the gaze group (P = 0.01, 9.1 ± 4.0 vs. 15.1 ± 2.7 minutes, respectively).

Conclusion: The initial training points for the introduction of gaze-based AACDs are as follows: The operating posture may affect the ease of operation. Therefore, always check the operating environment. If you want to input many characters quickly or communicate your intentions in a timely manner, switch input is recommended. Give the patient at least 10-15 minutes per session of continuous practice to become comfortable with the operation.

Background: Outcome of motor practice is influenced by focus of attention. Paying attention to the environment (external focus) has been reported to be more effective than paying attention to body movements (internal focus). On the other hand, internal focus was reported to be more effective for novice sports players, indicating that the optimal focus differs among individuals. Outcome of motor practice is also reported to be influenced by motor imagery ability, where subjects with higher motor imagery ability show better outcomes. However, the possible relation between optimal focus of attention and motor imagery ability is not yet known.

Methods: In this study, we evaluated the motor imagery ability of healthy young students using a mental rotation task, and divided the subjects into low-motor-imagery and high-motor-imagery groups. The subjects performed the Functional Reach Test, which reflects balance ability, and performance was examined during and after repeated practice with different focuses of attention.

Results: Internal focus was more effective than external focus for the low-motor-imagery groups, while internal focus and external focus were similarly effective for high-motor-imagery groups.

Conclusion: These results indicate the relation between optimal focus of attention and motor imagery ability, and suggest the importance of evaluating motor imagery ability in choosing optimal focus of attention for motor practice.

Objective: Few intervention studies have focused on upper limb function in patients with cerebellar ataxia. This study aimed to evaluate the influence of upper limb target-tracking task training on upper limb coordination in patients with cerebellar ataxia.

Methods: Six patients with cerebellar-type multiple system atrophy underwent training (20 min/day for 10 days), which involved using the left and right index fingers to track a target that moved at a constant speed on several kinds of simple figures. The evaluation was conducted using the iPad® Application for Evaluating Ataxia (iPatax), Scale for the Assessment and Rating of Ataxia (SARA), and Simple Test for Evaluating Hand Function (STEF).

Results: The coefficient of variation of the velocity of iPatax showed a tendency to decrease after training with the straight line and circle test, indicating the stability of upper limb movement speed. However, the SARA score did not change after training. The total time of STEF was shortened for the left and right hand after training in all cases, indicating improvements in the accuracy of motion and motor performance of the upper limbs.

Conclusion: Upper limb target-tracking task training may be useful for improving upper limb coordination in patients with cerebellar ataxia. In addition, iPatax can be used to detect smaller changes in symptoms that are not reflected in SARA.

Introduction: The perceptive exploration approach is a therapy for upper extremity movement disorders in patients with acute stroke hemiparesis. It facilitates the organization of actions in terms of perceptual information exploration and motor control, and may help develop the functional use of the upper extremities. The purpose of this study was to determine whether the perceptive exploration approach is effective in improving upper extremity movement disorders in patients with acute stroke hemiparesis.

Methods: I used pretest-posttest data to examine the therapeutic effects of the perceptive exploration approach in eight hemiparesis patients. In addition to a standard occupational therapy program, the therapy included a tailored perceptive exploration activity based on the assessment of patient-specific upper extremity function. I examined three main outcome measurements: Fugl-Meyer Assessment (FMA), and amount of use (AOU) and quality of movement (QOM) in the motor activity log (MAL).

Results: Outcome data measured before and after therapy showed improvement in all patients. FMA scores for motor function (p = 0.01, Δ = 0.55) and sensory function (p = 0.02, Δ = 0.59) assessment were significantly improved, and the effect size was moderate. AOU (p = 0.01, Δ = 0.81) and QOM (p = 0.01, Δ = 0.80) in the MAL were also significantly improved, and the effect size showed a large change.

Conclusion: The present results suggest that the perceptive exploration approach may be useful for the recovery of upper extremity movement in patients with acute stroke hemiparesis.

Introduction: Ultrasound (US) has been used to improve range of motion; however, there is no consensus on its therapeutic effects. This study aimed to explore the therapeutic effects of US in combination with exercise and mobilization on range of motion based on a single-case design.

Methods: The patient was a 40-year-old man who had a fracture of the greater tuberosity of the right humerus and presented with limited shoulder range of motion in flexion postoperatively. In addition to standard treatment (exercise and mobilization), US was performed as an additional intervention. The therapeutic effect of US was examined using Tau-U.

Results: The range of motion of the shoulder flexion significantly increased in the period when standard treatment and US were combined compared to that in the period when only standard treatment was administered (p < 0.001). The effect size was high (tau-U = 0.758).

Conclusion: The use of US improved shoulder range of motion during flexion. The Tau-U analysis can be useful to indicate the effect of intervention in a single-case design.

Introduction: Occupation-based practice (OBP) is seldom performed for people with severe acute cerebrovascular accidents (CVA). This study aimed to explore the conditions and situations in which occupational therapists (OTs) provide OBP to patients with severe acute CVA.

Methods: Semi-structured interviews with eight OTs were conducted to determine OBP for patients with severe acute CVA. The participants were OTs who had conducted OBP for patients with CVA in an acute care setting. Data were analyzed using inductive analysis. The procedures were: (i) to create verbatim records, (ii) to separate the verbatim records by context and to code while comparing the differences and commonalities of each code, (iii) to create subcategories, and (iv) to create categories by grouping together the subcategories with concepts that have similarities.

Results: The participants (OTs) reported that they have performed OBP for patients with severe acute CVA patients when (1) environments are available to perform occupations, (2) OTs establish good quality teamwork with multi-disciplinary professionals, (3) OTs emphasize patient-centered practice, (4) patients express their wishes to do occupations, (5) patients and families are getting to ready to resume occupation, (6) patients' occupations are actionable and meaningful.

Conclusion: The OTs' belief, the supportive environment, the client and family oriented toward occupations, and the identification of actionable and meaningful occupations were critical for the OTs to implement OBP for the severe acute CVA patients. These results could provide OTs with insights for promoting OBP in acute settings, especially working with patients with severe acute CVA.

Objective: This study aimed to identify the difficulties experienced by occupational therapists during cancer rehabilitation, and explore potential solutions.

Methods: Eighteen occupational therapists with experience in cancer rehabilitation were interviewed, and the interviews were analyzed and synthesized using qualitative research methods.

Results: A total of 206 primary, 60 secondary, and 12 tertiary category themes were identified. These themes were discussed from three perspectives: “Related to the practice of occupational therapy,” “Related to occupational therapists themselves,” and “The environment surrounding the occupational therapist.”

Conclusions: Occupational therapists in Japan have multiple difficulties in cancer rehabilitation because few of them specialize in cancer. Therefore, their sense of difficulties could be reduced by improving their pre and post graduate education as well as for nurses who had similar problems.