Effective rehabilitation for upper limb motor paralysis after cervical myelopathy of adult cerebral palsy has yet to be established. An eight-week crossover study compared the therapeutic effects of repetitive facilitative exercise under continuous neuromuscular electrical stimulation (RFE under cNMES) and the upper limb rehabilitation device (CoCoroe AR2). Facilitation function on the proximal upper limb was examined twice a day for two weeks on cervical myelopathy in an adult with cerebral palsy. As a result, there was a greater change in STEF with reaching robot training on the proximal right upper limb than in RFE under cNMES. For other items, similar changes were seen in both types of training.
Acute cranial nerve disease causes hyperactive delirium. This may be affected by changing toileting habits. Twenty-six patients with hyperactive delirium caused by acute cranial nerve disease were taken to the toilet, and the relationship between delirium and toileting was examined, resulting in a reduction of delirium. However, the effect was temporary, and delirium increased again. Furthermore, introducing clients to toilets ahead of time tends to reduce the period of delirum. This study suggests that toilet intervention is effective in mitigating delirium.
The purpose of this study was to consider factors influencing the professional identity development of young psychiatric occupational therapists. The survey was mailed to 202 occupational therapists under the age of 35 working at psychiatric occupational therapy facilities in Aichi, Gifu, and Mie prefectures. The survey questionnaire was comprised of three sections:(a) individual attributes;(b) employment environments;and (c) the professional identity scale. The response rate was 36% (72 respondents). We examined the relationship between the professional identity scale and individual attributes or employment environments. Results indicate a weak correlation among age, the number of years of clinical experience, and the professional identity scale. The professional identity scales of occupational therapists who have experience instructing their subordinates, participating in multi-job conferences, and no target number of patient to treat were significantly higher than those of other OTs. According to multiple regression analysis, it was found that the number of years of clinical experience, not having a target number of patients to treat, and participation in multi-job conference mostly affected the professional identity scale.
The purpose of this study was to examine the relationship between depression and changes in social roles among 708 elderly people living in an agricultural area in Japan. Depression and past and present changes in roles were investigated using the Role checklist. Logistic regression analysis revealed the following results:“student role reduction (OR:6.25, 95%CI:2.43-7.42)”, “no hobbyist role (OR:5.54, 95%CI:3.02-10.18)”, “family member role reduction (OR:4.23, 95%CI:2.82-6.35)”, “hobbyist role sustentation (OR:2.77, 95%CI:1.40-5.49)”, “religious participant role reduction (OR:2.75, 95%CI:1.06-7.09)”, “worker role reduction (OR:2.32, 95%CI:1.43-3.75)”, “gender (OR:3.41, 95%CI:2.10-5.53)”, and “age group (OR:2.11, 95%CI:1.34-3.34)” had a strong relationship with depression. These findings suggest that depression among the elderly could be clarified through evaluation of such role changes.
This study examined the efficacy of accelerometry for monitoring real-world arm activity (ActiGraph Link GT9X) in stroke patients, and whether the monitoring by 2-accelerometers or 3-accelerometers is more appropriate. The study design was a cross-sectional single-center study. Thirty-seven subjects wore 3-accelerometers (left hand, right hand and chest) and were monitored for 24 consecutive hours, and the activity ratio of the paretic hand was calculated using the value of each hand minus the value of the chest. Regardless of monitoring method, a moderate to strong correlation was shown between the activity ratio of the paretic hand and functional assessment. The 3-accelerometer monitoring was not shown to be superior to the 2-accelerometer monitoring. Which method best reflects real-world arm activity of stroke patients should be investigated.
This study investigated the influence of auditory interference stimuli on short-term rhythm memory and reproduction of healthy subjects and Parkinson's disease patients (PD patients) through the 1.0 Hz rhythm reproduction task. Task performance with two types of auditory interference stimuli, either meaningless or meaningful, was compared with performance in the absence of interference stimuli. The results of the rhythm reproduction task showed that the accuracy of rhythm reproduction decreased significantly in PD patients in the absence of interference stimuli. Regarding the effect of auditory interference stimuli, no difference was observed in any of the groups in the presence of a meaningless interference stimulus. In contrast, PD patients were significantly affected by the presence of a meaningful interference stimulus. These results suggest that PD patients experience difficulty in reproducing accurate rhythm in their daily lives where various meaningful stimuli are present.
For the elderly with disabilities to continuously live at home after discharge from hospital and rehabilitation, various factors must be considered. These factors include physical and mental function, socio-economics, and housing performance. We investigated the elderly with disabilities who spent at least six months at home upon discharge from the hospital in urban areas. A self-administered survey was conducted through registered mail, and there were 214 responses. The answers were categorized and analyzed according to the duration of living at home. The results indicated that a perception of environmental barriers in the house, emotional attachment to the house, and the surrounding community influence the subjects' desire to continuously live at home. In order improve the living environment so that the elderly may continue to live at home, OTs need to address not only the physical aspects of the home environment but also the cognitive/emotional attachments to the person's own house and community.
We investigated the improvement of affected upper-extremity function in stroke patients in the subacute phase who received robotic therapy for 15 days. Participants:36 subjects who received the robotic therapy for 15 days (the intervention group), and 62 subjects who received standard rehabilitation for one month (the control group) from June 2015 to August 2018. Method:We compared the proximal upper-extremity scores of Fugl-Meyer Assessment (FMA) using propensity score matching of the intervention group and control group. Results:44 patients in both groups were matched by propensity score matching. Consequently, the proximal upper-extremity score of Fugl-Meyer Assessment (FMA) in the intervention group improved significantly more than the control group. Conclusion:Intervention using robotic therapy might efficiently improve the affected upper-extremity deficits for subacute stroke patients.
This systematic review was carried out to investigate occupational therapy research for respiratory disease 10 years after revision of medical fee remuneration in Japan. The method extracted reports from occupational therapy for respiratory disease patients from 8 databases and hand search. As a result, 5 papers in Japanese were extracted. The content of occupational therapy papers for patients with respiratory diseases was evaluation of higher brain dysfunction, ADL/IADL training, and survey of social life. In the future, it is necessary to increase the number of occupational therapy research on respiratory disease patients and to verify their usefulness.
A stroke patient who displayed frontal lobe dysfunction, and lacked ability to self-monitor, received task-oriented training and transfer package with family participatory transfer package(12 weeks, 0.5 hours per day, 5-7 days per week). Consequently, this intervention facilitated self-monitoring and changed the behavior of affected arm in the real world. Previous studies showed the caregiver deeply understanding the key training points and participating in the training with therapists. In our case report, facilitating participating in the transfer package promoted change in the monitoring and arm use in real world function of the affected arm. Intervention by the patient's family might be one of factor to facilitate the behavioral learning.
In task-oriented training (i.e., shaping and task practice approaches) for acute stroke patients, clearly defined roles exist for the primary occupational therapist (OT) and ward placement OT. The ward placement OT provides task practice in the patient's hospital room, whereas the primary OT provides shaping practice in a rehabilitation setting. Taken together, these two roles may improve the affected upper extremity function and use in everyday activities for acute stroke patients. In addition, this type of collaboration may lead to the effective transfer of positive patient outcomes from the rehabilitation setting into the real world.
We gradually introduced several treatments according to an improvement of upper extremity function in an acute stroke patient. From the early stage of stroke onset, we combined the following approaches, which improved the affected upper extremity function:Finger Equipped Electrode electrical stimulation (FEE-ES), repetitive facilitation exercise therapy (RFE), and neuromuscular electrical stimulation (NMES). Then, we use the combined approaches with the modified constraint-induced movement therapy (mCIMT), electrical stimulation, and orthosis, and adapted these to the upper extremity function in a stroke patient. As a result, the upper extremity function and amount of use in daily life improved in the stroke patient. In addition, affected upper extremity function in the stroke patient showed further improvement two months post intervention. This case study showed that evidence-based combined approaches might improve arm function in the acute phase.
Occupational therapy puts much value on the occupation which is based on the client's interests and their sense of values. It is especially important for the reconstruction of vital life to provide support reflecting patients' sense of values. However, this is difficult in cases of severe aphasia. This is a practical report about occupational therapy evaluations to understand meaningful occupations of a severe aphasia client. In home-visit occupational therapy, re-evaluation of the client's interests, sense of values and past experiences through a “notebook” from the client was very useful in making an appropriate intervention plan.
The purpose of this study was to examine the dual benefits of Management Tool for Daily Life Performance (MTDLP) and the role of OT for a case where MTDLP was used for craniopharyngioma after reinstatement. Through the use of MTDLP, an appropriate OT program was established, the roles of various occupations were specified, and choosing the meaningful occupation enabled the patient to joint active training. As a result, the quality of life improved, and the patient successfully returned to work after daily life rehabilitation. We think that it is important to carefully observe the functions that change daily, establish appropriate goals through consensus, and conduct OT intervention. In addition, even if the OT cannot fully intervene during the recovery period of the client, the OT still has an important role to play through daily rehabilitation and leading the client to the final goal.
Occupational therapy was applied under adverse circumstances to a schizophrenic inmate suffering from hallucinations, delusions, and other symptoms of mental illness upon entering prison. Early stages of occupational therapy involved active listening to prison staff in order to build a relationship of trust, which resulted in opening a factory and developing a tailored OT regime involving both prison staff and prisoners. As the client's medical condition worsened, a mutual understanding between the prison staff and the OT was fostered on the importance drug treatment, and drug treatment could commence as a result. After that, the client was able to participate in the plant regularly with the OT intervention matched to his medical condition, and the client also received special improvement instructions. Furthermore, the client was able to continue to take medicine after being released from prison and visiting the hospital. This OT intervention focused on taking advantage of the special prison environment and collaborating with the prison staff, which previously had few opportunities to interact with occupational therapists.