The purpose of this study is to identify factors affecting the duration to achieve independence of upper-body dressing in 56 first stroke patients who had become independent during hospitalization in a convalescent rehabilitation ward. Patients were divided into three groups according to the duration to achieve independence:group A within one month, group B more than one month and less than two months, and group C over two months. Basic characteristics, stroke impairment assessment set (SIAS), and functional independence measure (FIM) were compared from the beginning of training the among groups. In group A, the score of FIM upper-body dressing, problem solving, memory, and SIAS lower limb motor function and sensory function were higher than those of the other groups. Characteristics of Group B were unclear. In group C, the score of FIM social interaction and SIAS visuospatial recognition were lower than in other two groups. Factors affecting the duration to independence are mainly cognitive functions and lower limb function of the affected side.
To examine the effects of home-visit rehabilitation with the Management Tool for Daily Life Performance (MTDLP) on the fear of falling and life activities, 36 home-visit rehabilitation users were divided into intervention and control groups. Both groups underwent MTDLP and routine home-visit rehabilitation interventions, respectively. As a result, specific goals to improve activities and participation were set in the intervention group:facilitating exercise practices in real situations, cooperating with family members and related businesses, and supporting the environment in a well-balanced manner. Three months later, significant improvement was achieved in the intervention group. Thus, the MTDLP reduced the fear of falling by improving the feeling of self-efficacy, and enhanced life activities, suggesting the usefulness of the MTDLP in promoting activities and participation and supporting independence.
Much of the research in upper limb dysfunction has targeted the chronic phase. However, studies with robust results in the acute phase are lacking. Due to the difficulty in conducting comparative studies during the acute phase we periodically extracted the evaluation data of stroke-related upper limb paralysis and constructed a data pool from the calculations of the propensity scores. This data pool enabled the creation of a control group in the acute phase that is normally difficult to establish. The data pool also granted the ability of many institutions to share the data, resulting in verification of new interventions. In addition, as an example of how this data could be utilized, we report the results of propensity score matching using the intervention group during the current period.
To conduct high-level intervention studies, it is necessary to set up a control group, which presents ethical difficulties. Therefore, in this study, we decided to construct a data pool for calculating the propensity score of the recovery period in 214 upper limb paralysis after stroke by retrospectively extracting data that was conducted as an evaluation in general clinical practice. We also report the results of propensity score matching in which data from previous and subsequent comparative studies that did not use control groups performed by the author as an intervention group was used as an example of data usage. By sharing the data of this study with many researchers and clinicians and using it as a control group, we can improve the accuracy of clinical studies.
Psychiatric occupational therapy includes practices rooted in Positive Occupation-Based Practice (POBP) as intervention methods that promote client well-being. POBP has been found to be useful for the well-being of people with mental disorders. On the other hand, individual differences affecting the intervention have not been investigated. Therefore, the purpose of this study was to examine the factors of individual differences influencing POBP intervention. The subjects were 19 individuals suffering from mental disorders and had previous experience in POBP clinical studies. The analysis was performed through a latent curve model on longitudinal data (baseline, post-intervention, post-follow-up) collected during POBP participation. As a result, the number of hospitalizations met the criteria that influenced POBP intervention. These results suggest that POBP can be applicable to a wide range of clients except for those who are hospitalized frequently.
The purpose of this study is to clarify the educational effect of fieldwork. Sixteen second-year occupational therapy university students investigated the environment of toilets in Ako-city as part of their fieldwork. The subjects participated in a pre-post questionnaire asking what were the necessary skills that occupational therapists need to able to do in community. The data were analyzed using KH Coder. The results indicate that after the fieldwork, most of students changed their recognition of 【experiential knowledge】, 【occupational therapy skill】, and 【occupational therapy field】. Some students showed no change in their recognition of 【basic knowledge】, but it was possible to examine the factors. The study made it possible to examine the factors leading to a clarification of the educational effect of fieldwork.
It has been pointed out that behavioral observation may be more useful than psychological tests in understanding the characteristics of developmental disorders when autism spectrum disorders (ASD) are diagnosed after adolescence. Therefore, this research verified the kinds of daily behavioral characteristics peculiar to ASD that were identifiable from direct observation, as well as the observational perspectives of registered occupational therapists (OTR) during the evaluation. The research method included interviews with five OTRs regarding the identifying characteristics of ASD after they evaluated the social life skills of ASD patients. As a result, we extracted 36 characteristics and problematic issues from 7 entries. The characteristics related to the difficulty with transitions between activities might be particular to ASD.
We describe the case of a male patient suffering from stroke induced right hemiplegia, who received behavioral training with activity monitoring of the affected arm to improve real-world use of the paretic arm and hand. The intervention was administered in an outpatient unit for 2 hour intervals, 3 times a week for a total of 10 times. The training conformed to the behavioral strategies (transfer package) in constraint-induced movement therapy. Paretic arm activity in daily life was monitored every week, and the results were reported to the patient. Following training, the function of the paretic upper limb and real-world arm use improved. The effect was maintained even 2 months after completion of the training. Both the patient and occupational therapist were able to objectively review the degree of functioning of the paretic hand via arm activity monitoring. We concluded that real-world arm activity monitoring can be a useful tool to enhance the effectiveness of transfer package.
Constraint-induced movement therapy (CI therapy) is a representative approach for stroke patients that aims not only to improve the function of the paralyzed arm, but also to change the behavior of actual use of the arm in activities of daily living. This study employed the modified CI therapy for 2 stroke patients with arm paresis in the subacute phase. Consequently, the affected arm functions and real-world behaviors of the patients improved immediately, and maintained the improvement one-year after the modified CI therapy. Furthermore, the two patients refused the rehabilitation service covered by the medical and nursing-care insurance and were able self-manage their care. Therefore, implementing modified CI therapy in the subacute phase may promote rehabilitative self-management.
Purpose:To illustrate the treatment of a sub-acute patient with bilateral upper-limb paresis using several approaches. Method:Constraint-induced movement therapy (CIMT) combined with the orthosis and neuro-muscular electrical stimulation therapy for one to two hours per day was used. In addition, to treat the more affected left upper-limb, robotic therapy was used as a self-training for 0.5 hours per day. These approaches were tailored to the improve the function of the upper-limb disorder for 34 days. Results:Several upper-limb outcomes of bilateral upper limb function improved beyond the minimal clinical important difference. Conclusion:Combining several evidence-based approaches of the stroke-induced hemiparetic arm might benefit sub-acute multi-focal stroke patients with bilateral upper-limb paresis.
Constraint-induced movement therapy (CIMT) has successfully treated upper-extremity movement disorders after stroke, with mid- to long-term results after recovery. However, there are few reports on approaches in the acute phase in Japan, and the long-term prognosis of subjects who underwent intensive exercise including CIMT in the acute phase is unclear. In this study, we performed a complex upper-extremity intensive exercise for two hours a day for acute stroke patients and analyzed the long-term effects. As a result, the upper-extremity function was maintained or improved over a period of one year after the intervention. Intensive exercise of the upper-extremity could have a positive effect on upper-extremity function and use behavior in the even in the acute phase.
Patient-based outcomes used in employment support have been needed in Japan. This study aimed at translating the Work Rehabilitation Questionnaire and examining its linguistic validity. The Beaton protocol for cross-cultural adaptation of self-reported measures was used. With the author’s permission, two persons separately translated the questionnaire, and then integrated their translations. After performing a reverse translation, the author was contacted and corrected the translation. Next, we held meeting among experts, corrected the translation, and created the Japanese draft version. The preliminary test was administered on 27 subjects, and an interview was conducted regarding the ease of answering. Based on the interview results, the final translated edition was created and reported to the author. Finally, the Japanese version was released on the homepage.