[in Japanese]

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[in Japanese]

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Low vision is a concept that refers to a condition that interferes with activities of daily living because of visual impairment. A literature search was conducted of evaluation and intervention for low vision rehabilitation by occupational therapists. We searched for systematic reviews, randomized controlled trials, etc., using Japan Medical Abstracts Society and PubMed databases. Sixty six papers were extracted. Evaluations included assessment of visual function, driving aptitude, and home environment assessments. Interventions included problem solving strategies that focused on specific issues, home environment modifications, and use of low vision devices. Few studies have examined the effects of occupational therapy on low vision. In the future, it is necessary to enlighten occupational therapists about low vision and to scientifically verify the effects of occupational therapy.

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We carried out 2 weeks of repetitive transcranial magnetic stimulation and occupational therapy on chronic stroke patients with upper limb paralysis. The results showed a significant reduction in upper limb paralysis and an increase in frequency of use of the paralyzed side of the upper limb one month after the intervention. Factors associated with the Minimal Clinically Important Difference one month after the intervention were moderate pre-intervention paralysis and left-side paralysis in FMA, and low muscle tone in Motor Activity Log-Quality of movement. These results suggest that in the case of non-dominant moderate upper limb paralysis, it may be useful to increase the weight of interventions to reduce the paralysis, to pay attention to the degree of muscle tension in the fingers, and to provide interventions and guidance after the completion of interventions to reduce paralysis.

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The aim of this study was to examine the inter-examiner and intra-examiner reliability of the dual-task stepping test for determining the independence of toileting in stroke patients. The dual-task stepping test in 20 hospitalized stroke patients was evaluated by 4 examiners (years in clinical practice:1, 2, 3, and 13 years). One week later, 2 of the examiners (years in clinical practice:1 and 13 years) re-evaluated the same patients. The Fleiss κ coefficient and Cohen κ coefficient calculated from the results had high values, which indicated high reliability both between and within the examiners. The evaluation was carried out in 30 seconds and is considered a clinical evaluation that could be promoted for the purpose of determining toileting independence of stroke patients.

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The purpose of this study was to investigate the effectiveness of community-based occupational therapy programs in improving quality of life (QOL) for cancer survivors. This systematic review used the following procedure:(1) randomized controlled trials of occupational therapy aimed at improving QOL were searched from Pubmed, EBOSCOhost, and Igaku Chuo Zasshi databases, (2) papers that met the inclusion criteria were selected, and (3) the quality of the papers was assessed with revised Cochrane risk of bias tool for randomized trials. Four studies showed significant improvements in quality of life or health-related quality of life. These studies indicate the importance of cancer patients collaborating with each other as well as with professionals in improving QOL or health related QOL;these cancer survivors exhibited both a high level of motivation to maintain ADL, and enhanced spiritual well-being.

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Promoting activities and participation in home-visit occupational therapy (OT) is often based on the practical knowledge that individual occupational therapists (OTR) gain from their experiences. In order to systematize the OTR practical knowledge, we interviewed nine OTRs with more than five years of experience in home-visit OT and analyzed their narratives qualitatively. As a result, three central points emerged:intervention guidelines for home-visit OT;intervention guidelines in the context of the relationship between the patient and OTR;and introduction of tasks for activities and participation by the OTR. From these central points, we can conclude that intervention guidelines for home-visit OT and the context of the relationship between the patient and the OTR before introduction of work, are considered particularly important in the practice of home-visit OT.

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Aid for Decision-making in Occupation Choice for Hand (ADOC-H) is a decision-aid to promote the use of the affected hand in the real life;however, only a few studies have used the ADOC-H in clinical settings. This case study investigated the clinical utility of the ADOC-H in a male patient with upper limb palsy and mild aphasia. In this study, we provided him task-oriented training according to motor function, and promoted behavioral change using his affected hand in daily activities by ADOC-H. As a result, the function of his affected hand improved, and he could increase the frequency of the use of his affected hand in daily life. We speculate that the ADOC-H may help to facilitate communication regarding using the affected hand in real life.

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This study attempts to validate the assessment of the sensorial properties in occupational therapy to improve inappropriate behaviors in children with autism spectrum disorder (ASD). Two ASD cases with similar developmental and environmental factors but presenting different sensorial properties were investigated. Occupational therapy was performed once a week for 10 weeks based on the clinical reasoning of the occupational therapist, and the changes in behavior before and after the intervention were analyzed and compared. The results showed that preliminary categorization of the causes of the inappropriate behavior was essential, since for case A, it was inadequate sensory modulation related, while for case B, it was sensory processing related. Consequently, those differences affected how to set the objectives, and the suitable interventions. This paper hints at the necessity of assessing the sensorial properties along with a well-defined strategy for supporting ASD children in improving their inappropriate behaviors.

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Background:Stroke patients with chronic kidney disfunction are prone to malnutrition. Method:Stroke patients with chronic kidney disfunction treated with intensive rehabilitation approaches have high reliability with managing risk factors and nutrition. Results:In in-patient settings, our approaches failed to improve prolonged muscle output, but we were able to improve temporary muscle output. In the outpatient setting, to improve nutrition, the patient received intensive approaches with newly prescribed medications for renal chronic kidney disfunction. Consequently, improved endurance muscle output resulted in the real-world use of the affected arm use in activities daily living. Conclusions:In stroke patients with chronic kidney disfunction, the long-term functional improvement of the affected arm might be improved by both appropriate nutrition guidance and intensive training.

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A male patient in his 60s suffered from Collagen Vascular Disease-Associated Interstitial Pneumonia（CVD-IP）resulting in dyspnea. The patient experienced inefficient ventilation resulting in respiratory difficulty. Occupational therapy (OT) intervention was performed on the patient’s household behavior. To alleviate the dyspnea, OT intervention included modifying his working style, adjusting the workload, conducting environmental studies, and coaching in the breathing methods appropriate for this case. As a result, dyspnea was reduced, and behavior improved to a significant degree. Understanding the pathophysiology of CVD-IP, as well as both respiratory and work performance analyses were effective in reducing dyspnea.

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We report the results of two staggered sessions of CI therapy in five patients with upper limb paralysis after recovery from stroke. The Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL) were conducted before and after the first and second sessions. The first session focused on shaping tasks, and the second session incorporated important household and occupational activities and hobbies, etc. Incorporating CI therapy into an occupational therapy program at a time when ADLs have improved and post-discharge life is in mind may affect the use of the paralyzed hand and acquisition of specific work activities.

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Progression of amyotrophic lateral sclerosis (ALS) reduces muscular limb strength, and is followed by the repression of quality of life (QOL)．Therefore, it is important to utilize every opportunity to maintain body function to maximize the integrity of daily life. Herein, we utilized the two types of HAL^® to improve residual motor function in a 54-year-old female patient with ALS. We verified the clinical efficacy of HAL^® for lower limbs and HAL^® for single joints along with occupational therapy. As a result, we found immediate improvements in the muscle strength of the upper limbs, gait function, and QOL. We propose that a multimodal rehabilitation approach comprising robotics and authentic rehabilitation results in further improvements in residual function and QOL in patients with ALS.

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The effects of Visual Feedback (VF) using a tablet was examined for phantom limb pain after upper limb bilateral amputation. VF was carried out by inserting remaining limbs in a box connected to a tablet. The images on the tablet were movements of the forearm, wrist joints, and fingers. The subject visualized the movements of the amputated limbs in sync with the video. The results indicate that VF provides immediate and sustained pain relief, as well as relief from catastrophic thought of pain. VF may be an effective method because it is easy and convenient for upper limb bilateral amputees who have difficulty intervening with intact hand movements such as mirror therapy.

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We observed a male who suffered from severe somatosensory anesthesia that continued for six months after a stroke. He received an active sensory relearning program for 1 hour, twice a week, for 8 weeks. He repeatedly performed various tactile discrimination and identification tasks (Carey, 1993, 2012), in which the clinician asked him to visually confirm the correctness of the task and to compare it with the sensation of the affected hand by touching the non-affected hand. The difficulty of each task was adjusted for differences in the number of choices and stimuli. As a result, the affected arm use in daily life and somatosensory functions were improved, and accompanying changes in daily life were also reported. The active, sensory re-learning may have facilitated conscious compensation that uses residual function. Such compensation may have contributed to the improvement of the patient’s somatosensory function and activities of daily living.

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We treated a female in her nineties who sustained a distal radius fracture. Regarding patient progress, although post-fracture pain decreased, sensory differences between left and right sides were present during object manipulations. In particular, the patient had difficulty using chopsticks. For these reasons, we hypothesized that plastic transformation of the central region due to peripheral receptor damage and immobilization occurred. Thus, we attempted peripheral nerve sensory stimulation, which was reported to promote reorganization of the central region. As a result, although motor function improved, object manipulation exhibited little improvement. Therefore, Mental Practice (MP) was added to improve object manipulation, and the patient was able to use chopsticks at meals. These results suggest that combined intervention of peripheral nerve sensory stimulation and MP contribute to functional recovery after distal radius fracture.

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Previous studies have demonstrated that impaired self-awareness after acquired brain injury can result in limitations in activities of daily living and rehabilitation. However, the effectiveness of intervention for impaired self-awareness is uncertain. We provided task practice using behavioral strategy training to improve self-awareness for a subacute stroke patient with higher brain dysfunction. We found that she exhibited a significant improvement in self-awareness and performance on activity, although there was no significant change in physical functions and neuropsychological assessments. These findings suggest that this intervention for a subacute stroke patient with higher brain dysfunction may be useful for improving self-awareness as well as performance on activity.

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This report reviews the course of an intervention in which an elderly woman confined to bed in despair over her own health who was unable to express what she wanted to do regained independence and came to value her relationships with others. In light of the value she placed on “relationships with others,” as revealed in an interview on her occupational history, the intervention set up an environment that encouraged her to choose and interact with her peers in co-occupations and situations of daily life to afford her the chance for experiences similar to past ones, with the goal of supporting her in building relationships that she valued in a piecemeal fashion. As a result, her relationships have expanded from a two-way relationship with her significant other to include other inpatients. Even when a patient cannot express what they want to do, it is important to identify experiences they value and support them with a focus on occupations.

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Purpose:In addition to a multifaceted approach combined with a highly evidence-based approach, we encouraged the use of the paralyzed hand in real life under orthotic conditions in patients with sub-acute stroke who presented with severe upper limb paralysis. Methods:CI therapy combined with the orthosis, electrical stimulation, and robotics therapy for one to two hours per day. In addition, two types of orthoses were made for different purposes, such as suppressing muscle tone and using a paralyzed hand in real life, to encourage the use of the orthosis in real life. Results:Upper extremity limb outcomes improved beyond the minimum clinically meaningful change (MCID), and there were increased opportunities for paralytic hand use under orthotics. Conclusion:The use of a paralyzed hand with an orthosis in real life may improve function and expand the use of the paralyzed hand for sub-acute stroke patients with severe upper limb paralysis and inadequate finger extension.

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This case presented with severe COVID-19 pneumonia, with prolonged endotracheal intubation, and deep sedation, causing ICU-Acquired Weakness (ICU-AW) and ADL decline. We organized a rehabilitation team for COVID-19 and conducted intensive rehabilitation and infection control, resulting in the patient resuming normal ADL. This article reports the occupational therapy for a patient with severe COVID-19 pneumonia in the acute phase. Occupational therapy with a transdisciplinary team approach mitigated the severity of Post Intensive Care Syndrome (PICS) and contributed to resumption of the patient’s daily life.

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