Action observation therapy (AOT), which involves observing target motions with a monitor before physical practice, has been focused on recently as an approach for upper limb hemiparesis after stroke. The effectiveness of AOT has been shown in previous studies;however, they did not show details such as subjects’ characteristics, and the procedures were insufficient for clinical application. This paper reviews previous studies, from March 2007, focusing on clinical application of AOT. Twelve papers were extracted and the effects of AOT were proved in moderate hemiparesis in convalescent phase and mild to moderate hemiparesis in chronic phase. The common procedures of AOT in the twelve studies, were “performing graded task-oriented training every day”. However, the procedures of AOT were diverse in terms of treatment period, time structure, and so on. AOT could be a potential treatment in occupational therapy because it has a low burden on patients, and its instruments and procedures are simple. Observing videos prior to physical practice in occupational therapy could enhance the treatment effect. Further studies on the AOT protocol are necessary for more effective clinical application.
Objective:To evaluate the effects of reach training with Arm Rehabilitation Robot on functions and daily use of hemiplegic upper limbs. The robot utilized computer controlled Motor-load-relieving and facilitation functions using electrical/vibratory stimulation (AR2 robot). Subjects:The sample consisted of 15 stroke patients (age:61±12 years, time after onset:76±22 days, Brunnstrom Recovery Stage:upper limb Ⅲ to Ⅴ, hand Ⅲ to Ⅵ, affected side:right 8/left 7, left handed 1). They were selected from stroke patients who were admitted to our rehabilitation center between 2016 and 2018. Method:A crossover design (A1-B-A2:A, reach training with AR2 robot for 15 min, B, reach training with sanding block for 15 min) across individuals was used. Basic rehabilitation included the repetitive facilitative exercise (RFE) for hemiplegia and task-specific training with Transfer package. Fugl-Mayer Assessment (FMA) for upper limb and hand, Motor Activity Log (MAL), Amount of Use (AOU), and Quality of Movement (QOM) were evaluated at 2-week intervals. Results:Except for the second AR2 robot reach, significant improvements in FMA of upper limb and hand were seen after the first AR2 robot reach and SB reach, and some improvements of MAL (AOU and QOM) were seen in the second AR2 reach. Regarding MAL (AOU and QOM), improvements were associated with AR2 reach, and deteriorations were associated with sanding block reach in patients with failure of the dominant hand. Conclusions:AR2 robot reach might be effective to improve everyday use of hemiplegic upper limbs.
The purpose of this research was to preliminary examine whether the Positive Occupation-Based Practice (POBP) for salon of elderly can improve individual well-being. Twenty-one elderly salon users participated in the program for 5 weeks. We examined the effects of POBP through a pre-post study using the Philadelphia Geriatric Center Morale Scale (PGC-MS), and Assessment of Positive Occupation (APO-15). Taking into consideration the random influences of the Generalized linear mixed model, results showed that POBP improved the PGC-MS (total score). POBP may contribute to improving the well-being of elderly salon users.
This study aimed to investigate the actual means of occupational therapy for school adaptation of children with neurodevelopmental disorders in Japan. The study took place from April 1st, 2017 to March 31st, 2018, and the subjects were occupational therapists for elementary students with neurodevelopmental disorders in a regular class and who received special needs education in Japan. An original questionnaire was mailed to 1,594 Japanese occupational therapists specializing in “Clinical” and “Neurodevelopmental” Disorders who were registered with the Japanese Association of Occupational Therapists. The responses were analyzed by quantitative textual analysis. As a result, both preschool- and school-age children were frequently practicing “sensory -motor play”, “manipulation of the goods, tools, and toys”, “writing” and “self-care”, etc. In particular, “consultation, guidance, and coordination” for environmental resources were also significant for school-age children. When considering such an intervention for school-age children with neurodevelopmental disorders, further study of occupational therapy for school adaptation in Japan is necessary.
In this study, 47 patients after distal radius fractures were combined in a 6-week Home Exercise program and occupational therapy based on previous studies. The purpose of the study was to determine whether the amount of Home Exercise is related to the treatment results after distal radius fracture, and to clarify the characteristics of patients who do much Home Exercise. The treatment results were evaluated for PRWE (Patient-Rated Wrist Evaluation), wrist joint range of motion, and grip strength at 6 and 12 weeks after surgery. There was an association between amount of Home Exercise and treatment outcomes based on forearm supination range of six weeks after surgery of patients 70 years old or older. However, the correlation with other treatment results was not clear. The patient factor which markedly increased Home Exercise was work injury. The Home Exercise program is considered an effective means to obtain good treatment results even for the elderly with poor understanding of Home Exercise by combining the instruction with occupational therapy.
Robotic therapy has shown promise for improving arm function after stroke. However, it is difficult to improve the behavior of the affected arm in daily life. This study provided modified forms of original Constraint-induced movement therapy (modified CIMT) which is effective for the affected arm and self-training using ReoGoⓇ-J (Robotic therapy) during six weeks for subacute patients with moderate to severe upper limb paralysis after stroke. We examined whether this approach could improve the movement of the affected arm by comparing with previous studies. As a result, this approach improved not only arm function but also affected arm behavior in daily life compared with previous studies. These results suggest that combining modified CIMT with robotic therapy helps patients regain upper limb function in their daily lives.
In this report, we examined the clinical usefulness of Scale for Achievement Motive in Rehabilitation (SAMR) through the support of home-visit occupational therapy in the field of long-term care insurance. SAMR measures a client’s motivation to achieve goals. Initial evaluation and intervention using SAMR revealed a “slightly low” motivation, and a goal was set to actualize important activities through interviews. In addition, setting up step-by-step tasks towards the goal, visualizing the number of steps, and increasing self-conscious improved the client’s motivation to achieve (“slightly high”), leading to the termination of home-visit occupational therapy. Evaluation and intervention using SAMR may provide valuable support according to the characteristics of the client’s motivation.
We studied life review therapy using collage as a psychological approach on 2 patients suffering from depression and dementia at a convalescent rehabilitation ward. We structured and analyzed the effects of the psychological approach and psychological change with the KJ method. Patients recalled their past through life review, they realized their thoughts through collage, and they achieved self-consistency over time. Then psychology has changed to patient role, the emergence of goals, willingness to act, and desire for the future. These approaches resulted in their leaving the hospital, mainly as a result of behavioral change due to psychological adaptation.
The occupational therapist (OT) provided school consultation for a child with clumsiness and learning disabilities in a regular classroom. The OT visited the school seven times over a period of approximately 7 months and consulted with either the teaching staff or parents. Regarding the chief complaints from parents and teaching staff, the OT explained the circumstances of this child and obtained agreements to apply supporting methods. By adopting teaching methods that made the most of the child’s individual qualities and devising easy-to-write teaching materials, the child learned how to read and write while improving his motivation toward the course work. The parents’ training also decreased problematic behaviors by the child at home.
Comprehensive rehabilitation was performed for the patient with unilateral cerebellum and lateral medullary infarction who had severe bulbar paralysis, ataxia, and central hypoventilation. We collaborated with the primary physician and the respiratory support team to wean the patient off mechanical ventilation and improve activities of daily living (ADL). Furthermore, we determined a nutrition program in cooperation with the nutrition support team and performed active dysphagia rehabilitation by evaluating a videofluorography. After hospitalization for approximately a year, the patient’s ADL improved, including oral intake, resulting in the patient being discharged to home. We inferred that comprehensive rehabilitation is effective for severe multiple disability cases such as mechanical ventilation and has a positive effect on the functional prognosis of patients.
A housewife suffering from semantic dementia received occupational therapy to offer shopping support. When the patient started to use the day-care center, she had difficulty understanding and expressing language because of dysfunctional listening comprehension, spontaneous speech, writing, and reading. However, she could go shopping with a shopping list, and occupational therapy consisted of drawing pictures and practicing understanding and expressing words needed for shopping with pictures that she drew. We also gathered information from her family and taught them how to cope with the situation. As a result, one year after the initial assessment, language symptoms worsened. Nevertheless, she could continue shopping with a shopping list and pictures. Finding compensatory strategies and holding rehabilitation conferences may have a positive effect on cases of semantic dementia.
As a member of a multi-professional team, I intervened in a client with schizophrenia and autism spectrum disorder who was admitted to our psychiatric acute ward after violently attacking police officers in a hallucinatory state. Through individual occupational therapy I established a relationship with the client and tried to stop the violence. The client progressed to group occupational therapy and psychological education for schizophrenia, which eventually led to discharge from the hospital. The intervention indicates that involvement of occupational therapists in multidisciplinary teams for inpatients can lead to building a relationship through patient empathy. In addition, by providing information such as client characteristics and thoughts that they value, to the multidisciplinary team, it is possible to assist the clients in their return to normal life.
Occupational therapy was provided to a prisoner (A) with a developmental disorder and disabilities in interpersonal interaction by considering A’s “thoughts.” Therapy was conducted at the prison, which is a unique environment with many restrictions. The treatment resulted in A being able to undergo job training and guidance reform before being released, and his attitudes and motivation for reform changed remarkably. The factors that facilitated A’s treatment included the occupational therapists’ (OT) individualized and flexible interactions with A as a medical professional, the OT’s search for ways by which A could easily express his thoughts, and the timely sharing of information between OT and the staff in charge of job training and reform guidance through improving recording methods. The factors were facilitated because the OT worked in a section that supported collaboration between staff members.
In this case, psychological factors such as pain catastrophizing and anxiety were recognized for pain after high tibial osteotomy. These factors increased disability, and hindered lifestyle, self-efficacy, and coping skills. Occupational therapy introduced coping strategies to reduce pain and anxiety. The combined occupational therapy practice program resulted in improving performance measures and reducing disability. Combining occupational therapy with coping skills reduces psychological factors (catastrophizing and anxiety), postoperative pain, and disability leading to improvement of goal achievement.