In this study, a spirituality rating scale related to health in the elderly was developed and its validity and reliability were studied. In the survey, a questionnaire was distributed to the elderly living in two regions in prefecture A. Among 764 responses, there were 532 without missing data for spirituality/QOL-related questions that were considered valid responses for a statistical analysis. As an 18-item spirituality health scale for the elderly, we created a 6 factor and a second-order factor model assuming "meaning and purpose of living, " "attitudes toward death and dying, " "self-transcendence, " "accordance with others, " "spiritual support, " and "harmony with nature" as first order factors and "spirituality" as a second-order factor. We employed confirmatory factor analysis to investigate the fit of the model to the data, which supported the construct validity of the scale. Then, we examined the fit of the causal model, where spirituality and a sense of well-being measured by the Philadelphia Geriatric Center (PGC) Morale Scale was used as the external criterion, to the data, using structural equation modeling. It was demonstrated that spirituality is significantly related to "loneliness and dissatisfaction, " "mental turmoil, " and "attitudes toward aging, " or lower conceptions of the QOL. Also, the reliability of this scale was shown to have adequate value. The results indicate the importance of a spirituality measurement in developing intervention strategies to maintain and promote QOL in the elderly.

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Objectives : To evaluate the intensities of an exercise for healthy elderly (HE) and an another for frail elderly (FE) using an elastic band performed in the sitting position, which have already been shown to be effective in helping elderly persons avoid requiring care and in preventing worsening of disabilities, and to profile, by age and general health, the people in a community-dwelling who had performed these exercises for three months. Method : To evaluate the intensity of each exercise, average and peak metabolic equivalent (METs) in 9 healthy women aged 62 to 80 as they performed each exercise twice. Metabolic equivalent was measured using a portable metabolic measurement system (Cosmed K4b2) . The ages of all 1307 healthy elderly participants were recorded, while the ages, degree of care required, and the general health of all 127 frail elderly participants were recorded. Results : The average peak METs was 3.4 and 4.3 for the exercise for the healthy and 2.0 and 3.1 for the exercise for the frail. Of those who performed the exercise for the healthy, 48.7% were in their 70s and 10.7% were in their 80s, while of those who performed the exercise for the frail, 17.3% were in their 70s and 65.4% were in their 80s. Of the FE participants, 82.7% had disabilities, and 96.9% had significant diseases. Conclusion : Healthy elderly were able to perform an exercise of 3.4 and 4.3 METs, while frail elderly with diseases and requiring some care were able to perform an exercise of 2.0 and 3.1 METs.

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This article examined the relationship between a sympathetic relationship in the group and caregivers' adjustment in order to explore the adjusting process in the caregivers' group. Self-administered instruments were mailed to 375 members of caregivers' group, and 112 usable responses were analyzed. A model of the adjusting process was structured with latent-valuables "sympathy" and "adjusting". "Sympathy" was defined as caregivers feeling positive regard from others, and positive regard to others, acceptance of others in the group. "Adjusting" was defined as caregivers understanding family members with dementia, and feeling positive self-regard to their own care, coping with various situations with a perspective for care. "Sympathy" was structured with "positive regard from others", "positive regard to others", "acceptance of others" "Adjusting" was structured with "understanding family members with dementia", "congruence between self and experience", "perspective for care". This hypothesis model was examined using Structural Equation Modeling (SEM). A hypothesis model performed well in terms of CFI=0.921, RMSEA=0.070. Coefficient from "sympathy" to "adjusting" was plus 0.79. Coefficient from "sex", "age", and "participating period" to "sympathy" and "adjusting" were not higher than the former coefficient. Support was found for the hypothesis that a sympathetic relationship in the group was related to caregivers' adjustment. In the caregivers' group, feeling positive regard from others and positive regard to others, and acceptance of others affected the adjustment that caregivers are able to understand family members with dementia, feel congruence between self and experience, and have a perspective for care. Caregivers' adjustment was affected by "sympathy" more than "sex", "age", or "period of participation".

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We reviewed research on the subjective lifestyle and mental health and welfare needs of individuals with mental illness in Japan. A total of 45 articles published from 1994 to 2005 were selected for review from the Japana Centra Revuo Medicina database using 6 keywords. The needs identified in the literature were categorized using an approach based on the KJ method. The classification method used in the present research extracted items and organized them into subcategories based on similarity. Subsequently, the subcategories were combined in order to establish core categories. A total of 819 labels were extracted as needs of individuals with mental illness. These labels were categorized into 17 categories and the following core categories : 'I can live my life as I want, ' 'my involvement with the mental health and welfare system is finished, ' 'the environment I live in has been adjusted for me, ' and 'my interaction with the human environment is finished.' The needs of the individuals that were categorized into the above categories and core categories are rich in detail. If professionals continue to support individuals with mental illness, the needs of the individuals will serve as a useful reference for supporting others. These categories identified in the present research are thought to correspond with the mind-brain-body performance subsystem, volition subsystem, habituation subsystem, physical environment, social environment, and occupational behavior setting concept of the model of human occupation, which is the model of occupational therapy practice. Based on the present findings, occupational therapists should provide support for individuals with mental illness in accordance with the established model of occupational therapy practice.

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It was clarified that a little research was done on clinical reasoning especially in the field of occupational therapy for developmental disorders as a result of the literature review. Then clinical reasoning of occupational therapy for cerebral palsy was researched by the participant observation, video image and interview with the agreement of the research of five occupational therapists with clinical experience of ten years or more, and five occupational therapists with clinical experience of less than four years. Corresponding reasoning to the basic classification of clinical reasoning presented in foreign countries was used through the analysis. Reasoning attached importance to most in the occupational therapy for cerebral palsy children was scientific reasoning, and the deductive scientific thinking process had decided treatment goals for the motor skill problems. Narrative reasoning contains understanding and an insight of the future of cerebral palsy children living with the chronic disease. Pragmatic reasoning is frequently used in the occupational therapy scene of the preparation for apparatus, notes in correspondence, the selections of the place and the play equipment, and the influences on the object person, etc. In the ethical reasoning, there is a conflict between the sense of ethics to put importance on functional recovery and the sense of ethics to put importance on life recognizing the limitation of functional recovery. Moreover, there is a script in a clinical scene, and the correction of the script has been done by the occupational therapist. The atmosphere of a clinical scene plays an important part in reasoning. To sustain and encourage clients' occupational performance and development, it was shown that to maintenance and change the atmosphere of the clinical scene was important typology of clinical reasoning in occupational therapy.

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Pneumatosis cystoids intestinalis (PCI) is characterized by the presence of gas retention within the submucosal or subserosal layer of the intestinal wall. An 18-year-old female with anorexia nervosa had severe abdominal distension without tenderness. She had suffered from an eating disorder attended with self-induced vomiting and secondary amenorrhea. In addition, she had suffered from obstinate constipation and hypothyroidism. Abdominal radiography and abdominal computed tomography showed intra-abdominal free air and lineal gas within the intestinal wall from the ascending colon to the hepatic flexure. She was diagnosed as having PCI at a neighborhood hospital and was admitted to our hospital for hyperbaric oxygen therapy (HBO) . We treated her with HBO (2 atm absolute) five days per week, 170 minutes each day, during bed rest and fasting. Her general condition improved, and diet was started on day 5 after admission. On abdominal radiography her PCI improved, and she was discharged on day 16 after admission. Following discharge, we continued to treat her with HBO five days per week, but reduced the sessions to 85 minutes each day. A month after the first HBO treatment her PCI had healed. The etiology of the PCI in this case seems to have been luminal pressure caused by obstinate constipation and self-induced vomiting.

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