[in Japanese]

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This study uses a latent class analysis to identify occupational challenges among the elderly living in the community and the relationship among occupational participation, depression and personality characteristics. The data collected was analyzed using latent class analysis and multinomial logistic regression analysis. Three types of occupational challenges for the elderly emerged from the analysis:positive occupational challenge, unstable occupational challenge, and negative occupational challenge. The positive occupational challenge was affected by the degree productivity, self-care of occupational participation, the degree somatic symptoms, positive emotions, and the degree of agreeableness and conscientiousness. This study will contribute to occupational therapy interventions for the elderly living in the community.

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Elucidating the relationship between brain function and performance leads to the presentation of basic data for examining the motor task intervention period from the viewpoint of brain function. Therefore, we examined the relationships among cerebral blood flow dynamics, the brain network, and performance by measuring activity in the prefrontal and sensory-motor cortices during motor learning in 18 healthy subjects. Consequently, activation of the prefrontal cortex decreased while brain network efficiency increased as motor learning progressed. In contrast, when motor learning plateaued some areas of the prefrontal cortex were reactivated, and brain network efficiency decreased. Continuous change of brain function and continually performing the same exercise task may also be a means of improving performance.

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We investigated the effects of seat tilting and anterior movement during forward reaching movements in the sitting position. The subjects reached for a target placed in the forward position under 2 seat conditions:a forward-tilting and back-tilting seat that could move anteriorly. Movement was measured using kinematic analysis and muscle activities. Three time phases of muscle activities were analyzed:entire reach task time, initial reach task time, later reach task time. The trunk inclination angle and the upper trunk rotation angle in the “forward-tilting seat that moved anteriorly” were less acute than that of the seat tilted back. The left external oblique muscle activities during the first phase and the left erector spinae muscle activities during the third phase in the “forward-tilting seat that moved anteriorly” were smaller than with the seat tilted back. The “forward-tilting seat that moved anteriorly” condition may have supported body movements to reduce forward trunk inclination and trunk muscles activity during forward reaching movements.

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This study analyzed the relational structure of occupational participation, prefrailty and its elements, and psychosocial states for the elderly participating in voluntary activities in the community. The subjects were 146 people living in Tokyo, and the analysis was performed by the One-way analysis of variance, Kruskal-Wallis test, multiple comparisons of robust, prefrail, and frail people, and structural equation modeling. The results showed that those with prefrailty tended not to adequately participate in occupations. There was a structural link between prefrailty and occupational participation, indicating that physical and sociological conditions promote occupational participation, while occupational participation promotes psychological states.

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We have developed a tablet version of the cognitive rehabilitation program “Ikiiki-Rihabiri”, which incorporates various non-pharmacological therapies, to expand its range of use. This study clarifies the effectiveness of the tablet version on the elderly with cognitive impairment by quantitative and qualitative evaluations and comparison with previous studies. As a result, no improvement in cognitive function over the original version was observed. However, there was improvement in the QOL evaluation “Restlessness”. These results indicate that the tablet version of “Ikiiki-Rihabiri” is effective in improving the QOL of the elderly with cognitive impairment similar to the original version, suggesting the possibility of using the tablet version.

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The purpose of this study was to clarify the environmental factors associated with out-of-bed states in older adults with severe disabilities living at home. Survey items included the attributes of the participants, out-of-bed states, and environmental factors related to transfer. Each survey item was analyzed after classifying participants into four groups according to their out-of-bed states. The results showed that out-of-bed states were significantly related to environmental factors, such as medical management and/or treatment, the use of assistive devices, the number of caregiver types, the use of services, and motivation for getting out of bed. Thus, support for out-of-bed patients by focusing on environmental factors such as disseminating assistive devices for transfer, expanding daycare services for older adults with severe disabilities, and setting the goal of out-of-bed activities and participation should be encouraged to promote activity and participation among older adults with severe disabilities.

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In occupational therapy, it is important to support motivation so that clients can complete their daily life performance. We report on an intervention procedure that improved the client’s motivation toward goals and participation in daily life performance. The intervention utilized a semi-structured interview and a self-rating scale to improve the motivation of a female patient after total hip arthroplasty. Using the Scale for Achievement Motive in Rehabilitation total and subscale scores, and the interview method, we assessed the patient’s achievement motive and agreed with her about the goals, action plans, and support from people around her, which led to her occupational participation. As a result, her achievement motive and behavior improved by making her visually aware of the content of the interview and modifying it appropriately. Thus, from the viewpoint of achievement motive, combining the interview method with the Scale for Achievement Motive in Rehabilitation can clarify the support content to the patient.

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It is important to share the details and progress of specific interventions performed on severe hemiplegic patients in the chronic phase of stroke in facilities ill-equipped with advanced equipment. The case involved a stroke patient with severe upper extremity paralysis 13 years after the onset of stroke. This study utilized a combination of target setting using ADOC and interventions using electrical stimulation therapy, orthotic therapy, repetitive facilitation exercises, and constraint-induced movement therapy. The functioning of the paralyzed hand did not change significantly after the intervention, but meaningful tasks were acquired, and subjective evaluations were improved. Such interventions are feasible even in a limited facility environment. Improving paralytic hand function and encouraging the use of the paralytic hand in daily life may contribute to meaningful work among patients with severe hemiplegia.

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Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) therapy has been effective as a treatment for stroke-related hemiplegia. However, the treatment is often difficult for patients with severe upper-extremity spastic paresis. We implemented HANDS therapy after injection of botulinum toxin type A (BTX-A) for subacute stroke with severe upper-extremity spastic paresis. As a result, upper-extremity function and real-world arm use improved. The improvement lasted up to two months after the end of HANDS therapy. Thus, injection of BTX-A in conjunction with HANDS therapy might reduce spasticity in patients with severe upper-extremity spastic paresis.

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This study investigated valuable occupation-based practice for three cases in a convalescent rehabilitation ward. We focused on the severity of occupational dysfunction using Classification and Assessment of Occupational Dysfunction (CAOD). Although the three cases had different courses, the severity of occupational dysfunction was reduced in all cases. Comparing the progress of the three cases indicated that the severity of occupational dysfunction tends to fluctuate according to both the occupational environment and characteristics. Therefore, it is important to consider those factors when providing occupations for the subjects. In addition, our findings suggest that estimating the severity of occupational dysfunction using CAOD for clients in a convalescent rehabilitation ward and utilizing those outcomes may encourage interprofessional cooperation.

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An occupational therapist consulted with a parent and teachers 10 times over a year for a student with behavioral problems in a regular class. In response to the parent’s and teachers’ needs, the OT explained the child’s situation using characteristic factor diagrams and discussed the goals to be focused on. In addition, the OT analyzed the function of the behavioral problems based on the applied behavioral analysis and advised specific coping methods. As a result, behavioral problems such as rule-breaking, attention deficit, and thought problems were reduced in school life. In aggressive behavior, verbal resistance and rejection remained, but violent behavior largely disappeared. In addition, the time spent in the classroom and the frequency of working on tasks increased.

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The effectiveness of occupational therapy on the daily life performance of an adolescent with spina bifida was investigated during a 24-day short-term hospitalization. The following method was implemented with reference to the Occupational Therapy Intervention Process Model. Daily life performance and goal setting was verified by the Canadian Occupational Performance Measure (COPM), and analysis of a daily life performance was verified by the Assessment of Motor and Process Skills (AMPS). As a result, the COPM performance score improved from 3.0 points to 6.8 points, and the satisfaction score from 2.0 points to 8.2 points. Also, the AMPS motor skills improved from 0.2 logits to 1.4 logits and the process skills from 0.3 logits to 0.9 logits. In conclusion, short-term hospitalized occupational therapy in the convalescent rehabilitation ward for adolescents with spina bifida improved the occupational performance and satisfaction level of daily life performance.

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Although MOMO, an arm support, has been mainly used as a living support device for patients with intractable neurological diseases, there are few reports of its use in recovery-phase rehabilitation wards. Therefore, we investigated the use of MOMO as a living support device for daily life and rehabilitation for training in a recovery-phase rehabilitation ward. Subjects were 4 patients with upper extremity dysfunction resulting from stroke and spinal cord injury. As a result, MOMO was used successfully in daily activities such as manipulating a spoon while eating and operating personal computer. Furthermore, it was used as an assistive device for upper extremity training and was contributed to improving upper extremity function. These results suggest that MOMO is effective as both a living support and a rehabilitation device in recovery-phase rehabilitation wards.

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Occupational therapy was carried out for a patient who received conscious surgery to resect a brain tumor in the right supplementary motor cortex and premotor cortex. Upon resection of the tumor, motor dysfunction of the left ring and little fingers appeared, and the surgery resulted in decreased skilled movement including pinching. Brain magnetic resonance images revealed edema surrounding the area of resection. However, the corticospinal tract including the primary motor area in the right hemisphere was spared, indicating improvement in movement. Occupational therapy included specific training programs which focused on finger function resulting in a significant improvement in skilled movement. The functional assessment during and after the conscious surgery, and occupational therapy based on previous studies could lead to predicted functional improvement.

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This patient presented with diagonistic dyspraxia and intermittent difficulty initiating actions due to subarachnoid hemorrhage, resulting in decreased arm use, and inability to independently perform activities of daily living. Occupational therapy intervention included motor imagery, as well as intervention that does not increase intention of movements. Consequently, the patient’s condition improved, and the intermittent difficulty in initiating actions was reduced. When the symptoms appeared, the patient responded well independently. The amount of arm use increased, as did the ability to independently perform activities of daily living. Furthermore, improvement in satisfaction with arm use and post-stroke depression were also noted. The findings suggest that occupational therapy including both methods are effective for treating diagonistic dyspraxia and intermittent difficulty to initiating actions.

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