Japan’s serious problems as a super-aging society has resulted in a predicted shortfall in the number of available care workers. One of the causes of a lack of care workers is work-related lower back pain. Preventive strategies for dealing with lower back pain include restricting transfer and movement of patients by physical force through adopting welfare equipment utilized in overseas developed countries. However, widespread utilization of such welfare equipment has not yet caught on in Japan due to inadequate environments and lack of training in operating the equipment. To alleviate these factors, we focused on Behavior Analysis which is based on the viewpoint that behavior is a function of the environment. In this paper, current issues associated with work-related lower back pain in care workers are introduced. Furthermore, applying the framework of Behavior Analysis to the educational method aimed at acquiring assistance techniques utilizing welfare equipment is discussed.
The purpose of this study was to investigate the effect of low frequency repetitive transcranial magnetic stimulation (rTMS) combined with occupational therapy (OT) on the evaluation of motor function;Fugl-Meyer Assessment, 10-second tests, Passive-Range of Motion (P-ROM), Modified Ashworth Scale (MAS) and Motor Activity Log (MAL), evoked potential improvement in patients of stroke hemiplegia. The analysis included a severe hemiplegia group and a mild hemiplegia group. This therapy showed improvement of statistical significance in all measures in patients with mild motor dysfunction. It showed improvement of statistical significance on MAS, P-ROM and MAL in patients of severe motor dysfunction. We found that MAL was improved because of improvement of MAS and P-ROM. These results indicate that rTMS combined with OT has therapeutic effect in patients with severe symptoms.
This qualitative study suggests methods for home support of mild care recipients towards social participation. We conducted a semi-structured interview using the Sense of Coherence (SOC) scale, which is an index of stress coping ability and health maintenance targeting required Support Levels 1, 2, and Nursing Care 1. The analysis was performed using a modified grounded theory approach．As a result, 【Understanding mental and physical conditions】, 【Predicting behavior according to the situation】, and 【Reflecting upon the experience to find a solution】 appeared only in the high SOC group. 【Don’t ask for help from family and friends】, and 【Don’t find meaning in participation】 appeared only in the low SOC group. The possibility that supporting an increase in SOC promotes social participation suggests the usefulness SOC in support activities.
This research focused on the practical use of chopsticks among patients with right hemiparesis after first onset brain disease in a convalescent rehabilitation hospital and investigated the relationship between clinical evaluations and practicality of chopsticks. We checked basic information and evaluated clinical tests. Patients did a speed test with chopsticks to pick up kidney beans. If patients successfully carried out this test, they attempted to eat a meal with regular chopsticks. The practicality of chopsticks was defined that patients could eat more than 80% of meals within 30 minutes with regular chopsticks. The patients were divided into two groups based on the practicality of chopsticks, and discriminant analysis was carried out by comparing the practicality of chopsticks with factors in which there were significant differences between the two groups by univariate analysis. The results indicated that STEF and speed tests are useful for predicting the practical use of chopsticks.
This study attempted to clarify the process of re-acquiring occupation by hemiplegic patients hospitalized in the recovery rehabilitation ward based on subjective experience. Semi-structured interviews were conducted on the daily work performance of five hemiplegic patients and were analyzed using a modified grounded theory approach. As a result, seven categories were generated:“Understanding the status of occupation”, “Hierarchy occurring in the performance of occupation in real life”, “Testing own potential through occupation”, “Learning through occupation”, “Challenging occupation”, “Avoiding occupation”, and “Choosing new occupation”. Results indicate that the subjects were going through a process of testing their potential through their work and selecting new work based on experiential learning.
The purpose of this study was to calculate the cutoff value in lower limb function evaluation for occupational therapists determining the independent use of ward toilets in acute care hospitals. A survey was undertaken on 56 patients with pneumonia, using the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) test, and quadriceps strength. The results revealed TUG as a factor related to the usability of ward toilets, with a cutoff value of 11.8 seconds (AUC:0.807;sensitivity:69.4%;specificity:89.5%). Occupational therapists can thus use the TUG cutoff value of 11.8 seconds for not only subjective observations, but also objective evaluations;moreover, the independent use of ward toilets can be determined by typical evaluation criteria.
This study aimed to examine whether the interpersonal relationship subordinate item of the Life Assessment Scale for the Mentally Ill (LASMI) is related to the Brief Negative Symptom Scale (BNSS) and whether the BNSS predicts disorder and non-disorder in the subordinate items of the LASMI subdomains. An ordinal logistic regression analysis and ROC curves were used to calculate the BNSS score cutoff values for patients with schizophrenia who were hospitalized at a psychiatric hospital for more than 1 year. Fifty-three participants were analyzed. The BNSS revealed the following LASMI items:Voluntary relationships had a cutoff value of 20 or less;spontaneity and association with friends ranged from 30 to 40;and self-assertion, response, and voice volume, ranged from 40 to 50. Furthermore, functions of interpersonal relationship functions were predicted.
The purpose of this study was to clarify the focus of interventions, technology, and role of occupational therapists in the practice of inpatient occupational therapy for mentally ill offenders under the Medical Treatment and Supervision Act. We conducted a semi-structured interview with an occupational therapist specializing in the above-mentioned medical treatment;qualitative analyses indicated a conceptual structure of occupational therapy that aims at the “regional life that patients want to maintain”. As a member of a multi-disciplinary team in this medical treatment, occupational therapists focus on the regional life desired by patients, and collaborate with patients so that they can stably perform daily life occupations. By doing so, occupational therapists indirectly prevent patients from harming others again.
The purpose of this systematic review was to explore the current state of research in motivation for rehabilitation. A total of 1,930 articles were identified through a search of databases including PubMed, CENTRAL, and ICHUSHI web;13 articles were retrieved with the inclusion/exclusion criteria and included for the review. Regarding the evaluation scale for motivation, the non-specific scales for motivation and the observational evaluation by medical staff were used. These studies reported that the interaction between motivation and rehabilitation, such as the effects of motivation on function and activities, and the factors influencing motivation for rehabilitation. This review, however, reveals a lack of both quality and quantity of research regarding motivation for rehabilitation. Further studies are required to develop a specific evaluation scale of motivation for rehabilitation, and to establish the concept of motivation for rehabilitation.
Purpose:This trial aimed to determine the efficacy of standard modified CI therapy (mCI therapy) with self-training in hospital wards (ward-based mCI therapy) on upper-extremity function and behavior. Method:Through comparing the standard mCI therapy, which focuses on one extremity, with the ward-based mCI therapy using retrospective cohort design for acute stroke patients, we investigated upper-extremity motor function and behavior. Results:Post hoc analysis revealed that both groups significantly exhibited improved upper-extremity function and behavior. However, comparison between groups revealed that the ward-based mCI therapy significantly improved the affected upper-extremity behavior more than the standard mCI therapy. Conclusion:The ward-based CI therapy might have a greater effect on the behavior of the affected upper-extremity in real life.
Hybrid Assistive Neuromuscular Dynamic Stimulation therapy (HANDS therapy) has been shown to improve the function of the peripheral area of paretic upper limb after stroke. However, the issues related to HANDS therapy remain, including lack of improvement of the paretic arm use in real world, and the limited function of the central area of the paretic upper limb. Simplified Transfer Package (TP) is a therapy effective for improving function of paralyzed hands using task-oriented training aimed at enhancing the skills of specific tasks. Robot therapy is considered effective for the central nervous system. TP, Robot Therapy, and HANDS therapy were combined to improve the affected arm function and behavior of the stroke patient. Fugl-Meyer Assessment (FMA) and Motor Active Log (MAL) showed clinically meaningful improvements. Additionally, the patient was able to use the chopsticks that was the patient’s goal illustrating the efficacy of the combined upper limb approach.
Auditory agnosia refers to impairments in auditory recognition of verbal and environmental sounds, caused by injury of the transverse temporal gyrus or acoustic radiation. We experienced a case of a woman in her 60s who presented with auditory agnosia. Originally a sociable person, the case began to have difficulty in communicating with others due to the problem with listening. Occupational therapy included alternative methods using visual modalities, like lipreading. The case overcame the communication difficulty and regained the relationships, while no improvement was seen in auditory agnosia itself. Occupational therapists have to participate in rehabilitation for the patients with difficulty in communication, regarding it as a handicap in daily life, not as an verbal impairment.
Rework support for a client with adaptation disorders who wished to be reinstated in psychiatric daycare was provided. The client would be dismissed if she could not return within the rest period. For this reason, the rehabilitation team set an agreement goal with the client which included setting an achievement period. OT intervention focused on the Management Tool for Daily Life Performance (MTDLP) that provided multi-skills support to achieve that goal. As a result, the client was successfully reinstated within the time limit. This intervention shows the usefulness of the MTDLP in the rework support of the client within a limited period, suggesting that collaboration between the client and her family, work place, and the rehabilitation team was promoted.
We investigated the occupational therapy for a case of spaghetti wrist due to a work-related contusion accident. Early post-operative OT interventions included splinting, graded tendon exercises for independent flexor digits, and perceptual and functional training. Although improvement in both grasping ability and sensory function of the median nerve area were observed until 19 months after the operation, ulnar nerve palsy remained. Therefore, by confirming the tension of the suture tendon and vasculature, early nerve mobilization and perceptual training can improve motor and sensory function. Therapy should include exercise of the flexor digit tendons independently 4 weeks after surgery. However, it is important to confirm the degree of nervous and vascular injury.