The purpose of this study was to capture the features of writing skill in the non-dominant hand of the elderly, and to help the switching hand dominance training of stroke-related hemiplegic patients. Thirty-eight elderly (age:74.2 ± 5.5) and 15 youths (age:20.5 ± 0.9) participated in the study. Their task was to trace over the outline of 8 types of symbols presented over a tablet screen. The successive tracings of the 8 types of symbols were counted as 1 session, which was consecutively repeated 10 times. Acquired data were pen pressure during performance (pen pressure), and the force exerted by the fingers against the pen during writing (grip force). Results indicate no significant within-group differences in either group. Regarding comparisons between the groups, pen pressure was lower in the elderly than the youth in the first half of the drawing analysis, but the grip force was higher in elderly than in the youth group. Therefore, as motor and sensory function decline during aging, leading to a tendency among the elderly to grip the pen more forcefully, occupational therapists need to consider appropriate interventions.
The purpose of this study was to illustrate the reality and problems of occupational therapy in critical care centers in Japan. Questionnaires were submitted to 260 hospitals with critical care centers where occupational therapists worked. Ninety hospitals (34.6%) responded. Occupational therapy at critical care centers was conducted at 78 (86.7%) hospitals. However, the nature of the intervention was different in each hospital. In non-intervention hospitals, human factors were barriers. Recognition of the necessity of occupational therapy in critical care centers and intensive care unit areas was also high with the intervention and non- intervention hospitals. Future challenges include building an occupational therapy intervention system in the critical care centers, enhancing the education system of critical care medical knowledge and acknowledging the usefulness of occupational therapy in critical care centers.
Activities of daily living (ADL) performance among stroke patients after the convalescent period have been known to decrease gradually, indicating that stroke patients before discharge from the convalescent ward might have the highest ADL performance. ADL performance among chronic stroke patients is related to daily living space, instrumental ADL performance, and quality of life. However, the relationship between ADL performance and these factors among stroke patients before discharge from the convalescent ward is unclear. The aim of the present study was to compare and analyze FIM scores among stroke patients before and after discharge from the convalescent ward. Results indicate that FIM mobility items were significantly decreased (p<0.05), and the sole determinant factor of change in FIM score was daily living space. The present study demonstrated that encouraging an increase in daily living space might contribute to maintaining or improving ADL performance after discharge from the convalescent ward.
We examined subjective experiences using the paretic hand among stroke patients. Twelve subjects with some experience using a paretic hand in their daily living were interviewed, and the interview data were analyzed using Saiki's grounded theory approach. We found that stroke results in the “selection of scenes and means of using one's paretic hand”, and the “selection of scenes and means of non-use of one's paretic hand”. Subjects describe the experience of “a feeling of necessity to use the paretic hand”, “a sense of being able to live using only the non-paretic hand”, “an attempt to consciously use the paretic hand”, and “conscious of being watched by other persons”, while “living in a paralyzed body”. Our results suggest that when occupational therapists encourage the use of a paretic hand among stroke patients, it is important to consider the personal meaning of using one's paretic hand in relation to the characteristics of the engaged occupation(s).
The purpose of this research was to study the program development of Positive Occupation-Based Practice (POBP) based on occupations promoting well-being and to examine how to apply the POBP. Learning materials were created with three occupational therapists familiar with occupation-based practice. The examination was administered to 6 clients with mental disorders. We adopted Assessment of Positive Occupation 15 (APO-15), Equating Assessment of Positive Occupation (EAPO) and General Self-Efficacy Scale (GSES) as the effect indicators in this study. In addition, this study examined the intervention effects while using the generalized linear mixture model (GLMM) for data analysis, taking into account the random effect. As a result, 33 types of learning materials for occupation to promote well-being were created. The intervention effect of POBP was recognized in “engagement” of APO-15 and “positive occupation” of EAPO. POBP may contribute to the promotion of well-being among clients with mental disorders.
It has been reported that children with autism spectrum disorders (ASD) frequently suffer from abnormalities in sensory processing, clumsiness and problems of task performance skills. However, there have been few reports about those problems in high school-aged adolescents with ASD. We compared such adolescents' task performance skills with those of typically developed adolescents (TD), and studied the relationship between their skills and the level of abnormalities in sensory processing and clumsiness. Our study revealed that adolescents with ASD had more problems in task performance, and that the score of “sensory seeking” was significantly lower than that of TD adolescents. On the other hand, there was no correlation between task performance skills and self-efficacy, or between task performance skills and the level of abnormalities in sensory processing. However, there was a significant correlation between self-efficacy and “sensory sensitivity”. Our results suggest that the continuous assessment and support for task performance and for sensory processing might be necessary for the high school-aged adolescents.
Research indicates that the addiction to fantasy among children with autism spectrum disorder negatively affects interpersonal communication. We provided occupational support to externalize the fantasy for a male child with a pervasive developmental disorder. This child was having difficulty executing activities of daily living due to immersive fantasy activities, which consisted of mentally forming a fictional card game as a diversional fantasy. For that reason, we externalized his fictional card game by writing out his imagined characters on actual cards and encouraged him to communicate with hospital staff and school friends using these cards. This support enabled him to mentally organize the fantasy, allowing him to use it as a communication tool. Moreover, he alleviated his troubles in daily living by reflecting on his fantasy and building a connection with reality.
Previous research indicates that poor finger mobility one month after stroke onset may indicate poor upper-extremity function. Current treatment consisted of robotic therapy for severe upper-extremity paresis related to inactive finger extension one month after stroke onset. After improving upper extremity function, we used the brief version of transfer package of the constraint-induced movement therapy to transfer functional gain in training into real-world use. Consequently, upper-extremity and real-world functions improved. Thus, combination therapy incorporating robotic therapy might be an effective treatment for stroke patients with severe upper-extremity paresis.
This article examined the importance of home-visit occupational therapy for an adult with ADHD and comorbid disorders. The patient was in her 40s, and was frequently admitted to the hospital due to difficulties with housework and childrearing. During home-visit occupational therapy, the OTR intervened in daily occupations and adjusted the environment accordingly, while considering characteristics of disabilities associated with ADHD, for example, simplifying the cleaning process by taking into account attention deficit and enhancing visual cues. In addition, family psychoeducation and multidisciplinary support was provided. Consequently, the patient became able to perform housework and raise her children. She continued to live at home without admission for two years since this OT intervention. Therefore, the significance of occupational therapy for adult ADHD patients suggests that occupational therapists rebuild patients' life by utilizing medical knowledge of disability characteristics and expert knowledge of their occupation.
A man in his 40s with schizophrenia experienced a shift in community support through occupational therapy and the Management Tool for Daily Life Performance (MTDLP). The Assessment of Motor and Process Skills were used as supporting tools of MTDLP, focusing on necessary occupations, valuable steps he can follow upon discharge, and the management of integrated care by collaborating with several types of jobs. He received occupational therapy for meal preparation and psycho-education for preventing illness recurrence. Thus, his life competency improved along with his cognitive function. MTDLP may be a useful management tool in shifting the community support for persons with schizophrenia.
A case of schizophrenia was admitted to psychiatric acute period ward due to poor understanding of the disease and compliance with taking medication. It was discovered during intervention that ceramics was a meaningful occupation prior to the onset of the illness. Awareness of schizophrenia, compliance with taking medication and recognition of the importance maintaining health improved by continuing ceramics. Thus, focusing on ‘healthy parts' which center on the subject engaging in meaningful occupations is in line with the ‘recovery model' and ‘strength model', making it important in the acute phase of occupational therapy for patients with schizophrenia.
The present case involves long-term hospitalization under the Medical Treatment and Supervision Act due to serious psychotic symptoms and impulsive violence resulting in a diagnosis of schizophrenia. A lack of improvement in negative symptoms resulted in OT intervention, which revealed the meaningfulness of playing the guitar. Through playing the guitar, the case increased motivation for treatment and resumed community life. Focusing on the meaningful occupation of the client is useful in establishing the relationship with the client, and suggests that it could be a useful means for promoting care, and reducing long-term hospitalization through the framework of the Medical Treatment and Supervision Act.
This case study investigated the pain intensity and psychological condition throughout the day of a patient suffering from chronic pain due to accident-induced physical brachial right plexus damage, resulting in spontaneous pain to the right arm. A 14-day investigation found that various mild intensity physical activities such as housework or light walking resulted in a decrease in pain intensity. Specifically, “taking a walk” or “using a day service” was important in daily life and may contribute to a decrease in the pain intensity. This may highlight the importance of said activities to the client, resulting in continuation of the activities independently.