Occupational Therapy in Cancer Survivorship—A Toolkit for Stimulating Rapid-Research on the Neglected Domain of “Participation” during COVID-19

COVID-19 has disrupted people’s occupational daily activities with detrimental impact on their daily living performances and quality of life. Occupational therapy contributes toward restoring health by remediating limitation in participation in meaningful occupation with lifestyle redesign interventions. However, the research gap on the area of “participation-limitation” for the field of Occupational Therapy in cancer survivorship during the COVID-19 is largely untapped and unknown. This commentary-review paper discussed the PEO-OT (person-environment-occupation) grid as a conceptual toolkit for stimulating research in the domain of occupational participation—an essential aspect in the field of occupational therapy, for cancer survivors. It applies the expertise finding from a large Delphi study on research priority in the fields and integrating these into evidenced methodology, to provide a structure to guide the novice researchers towards rapid reviews, by selecting evidence-based methods to ensure contextually-relevant enquiry to identify the “occupational-participation issues”—i.e., an emerging social determinant of health, affecting the daily self-management of cancer survivors with or without comorbidities.

An Occupational Perspective of Occupational Therapy and the Medical Hegemony System in Malaysia—Exploration for Further Research

Occupational Therapy is critically underdeveloped in many developing countries in Asia. There are many internal and external barriers to the growth of the profession, including lack of willpower and lack of professional representation in the government. This article aims to communicate the postulations for its stagnation across developing countries in Asia. An analytical reflection and historical review of the barriers to the growth of occupational therapy in Malaysia was conducted. Leaders in the field who met the inclusion criteria, collaborated to shape the reconstructions using an occupational reconstruction approach. The reconstruction guided key critical reflections on the roots of daily experiences to relive the cooperative action to problem solve the issues encountered by the profession in Malaysia. Medical hegemony was found as the active suppressor of the health professions, and can be seen as being beyond reproach in the Asian’s medical model that created occupational injustices. These occupational injustices hinder the growth of Occupational Therapy, do not serve the patients, science or the overall healthcare system. Autocratic governance has a debilitating impact on health sciences and its workforce especially around badly oppressed Asian countries. A greater systematic approach is needed to examine the extent, effect, problem solve and remediate the magnitude of injustices over the last decade—to make way for an inclusive and affordable care system.

Stakeholders Contribution in the Development of Occupational Therapy Profession and Impact of the Profession in Rwanda

Introduction: Africa was noted as a challenging place for allied health care professions including occupational therapy. Those challenges include promotion of occupational therapy and educational program. The University of Rwanda started the occupational therapy training program in 2014 with support of different stakeholders such as Humanity & Inclusion (HI), Rwanda. Aim: This study aimed to explore the contribution of different stakeholders in the development of occupational therapy programs and impact on the profession in Rwanda. Methods: A survey and mixed method of qualitative and quantitative approach was used. Client satisfaction questionnaire, semi-structured self-generated questionnaire were administered to the participants. Results: The majority of occupational therapists were between 20 and 30 years old and only half of the entire population were employed. Majority of the involved Universities excellently achieved their responsibilities. However, few of them reported to have achieved only 50% of their responsibilities. Other contributors like lecturers reported to have excellently achieved their duties while others reported to have achieved only 50%. Non-Governmental Organizations reported to contribute to enough level however there were some organizations contributed to the lowest level below 50%. The client receiving the Occupational Therapy services showed that they are very satisfied at the level of 73.5%, satisfied at 59% and not all satisfied at 20%. Conclusion: This study concluded that there is need for various stakeholders’ contributions, and a need for further study to explore the impact of occupational therapy profession in rehabilitation healthcare system of Rwanda.

Occupational Therapy Evaluation for Stroke Adults in the United States

Of the 700,000 people in the United States who experience a new or recurrent stroke each year,more than 500,000 survive(American Stroke Association,2007)[1]. Occupational therapy practitioners are critical rehabilitation professionals for stroke survivors.

Item-Level Analysis of the Revised Occupational Therapy Fieldwork Performance Evaluation Applied in Practice

Competency-based assessments for healthcare professionals are critical for safe and effective client outcomes. Rehabilitation clinical skill competency assessments must be validated and revised to produce safe and skilled practitioners. The revised American Occupational Therapy Association (AOTA) Fieldwork Performance Evaluation (FWPE) instrument measures occupational therapy student performance to determine readiness for practice. The assessment includes thirty-seven competencies that address both profession specific clinical skills and general professional behavior skills. The objective of this study was to use Rasch methods to explore the use of the revised FWPE in actual fieldwork practice and to determine the instrument’s psychometric properties when separating the item components into two distinct subdomains: General Health Professions Competences and Occupational Therapy-Specific Competencies. Internal construct validity and test reliability were analyzed using data from 149 occupational therapy students after completing their initial Level II A fieldwork clinical internship. This study examined the item difficulty hierarchy, item fit, person-fit to model, person separation index, person separation reliability coefficient, strata, ceiling and floor effect, and unidimensionality of the FWPE instrument as a whole and as two separate domains. With the exception of not meeting the criteria for unidimensionality, the full FWPE instrument and the Occupational Therapy-Specific Competencies subdomain showed acceptable item-level psychometrics for reliability and precision. While the General Health Professions Competencies subdomain showed good item-level psychometrics, it was below the criterion for reliability and only separated the sample into two strata. Results support the validity, reliability, and clinical use of the revised FWPE full instrument and the Occupational Therapy-Specific Competencies subdomain to measure entry-level clinical skill competencies in practice.

Effectiveness of sensory integration therapy in children,focusing on Korean children:A systematic review and meta-analysis

BACKGROUND Sensory integration intervention is highly related to the child's effective interaction with the environment and the child's development.Currently,various sensory integration interventions are being applied,but research methodological problems are arising due to unsystematic protocols.This study aims to present the optimal intervention protocol by presenting scientific standards for sensory integration intervention through meta-analysis.AIM To prove the effectiveness of sensory integration therapy,examine the latest trend of sensory integration studies in Korea,and provide clinical evidence for sensory integration therapies.METHODS The database of Korean search engines,including RISS,KISS,and DBpia,was used to search for related literature published from 2001 to October 2020.The keywords,“Children”,“Sensory integration”,“Integrated sensory”,“Sensorymotor”,and“Sensory stimulation”were used in this search.Then,a meta-analysis was conducted on 24 selected studiesRISS,KISS,and DBpia,was used to search for related literature published from 2001 to October 2020.The keywords,“Children”,“Sensory integration”,“Integrated sensory”,“Sensorymotor”,and“Sensory stimulation”were used in this search.Then,a meta-analysis was conducted on 24 selected studies.RESULTS Sensory integration intervention has been proven effective in children with cerebral palsy,autism spectrum disorder,attention deficit/hyperactivity disorder,developmental disorder,and intellectual disability in relation to the diagnosis of children.Regarding sensory integration therapies,1:1 individual treatment with a therapist or a therapy session lasting for 40 min was most effective.In terms of dependent variables,sensory integration therapy effectively promoted social skills,adaptive behavior,sensory processing,and gross motor and fine motor skills.CONCLUSION The results of this study may be used as therapeutic evidence for sensory integration intervention in the clinical field of occupational therapy for children,and can help to present standards for sensory integration intervention protocols.

Application of intelligent rehabilitation equipment in occupational therapy for enhancing upper limb function of patients in the whole phase of stroke

Stroke was one of the leading causes of death in the Chinese population in 2017.Most stroke survivors may suffer from different levels of disabilities,which prevents them from returning to their daily activities.The decreased upper limb function is considered as the principal factor that makes the patients have less access to their activities of daily livings.Occupational therapy(OT),aiming to enhance patients'functional performances and improve the participation in daily activities is usually applied from the onset of stroke.However,conventional OT intervention still has several problems that need to be solved,such as the inefficient use of human resources,inadequate upper limb functional training and non-continuous OT services.To address these difficulties and improve the patients'functional outcomes,intelligent rehabilitation equipment is combined with OT through evaluation and intervention.Based on this combination,OT can be provided in health care facilities,home,and community for patients with all phases of stroke.This combination promotes the transition of OT to digitization,intelligence and homogenization.

Effects of Mirror Therapy on the upper Limb Functionality:A study on the perception of Occupational Therapists

With the visual illusion of the mirror,Mirror Therapy,models the primary somatosensory cortex,cortical and muscular excitability,stimulating cortical reorganization and sensorimotor recovery.Studies have shown to be effective in improving motor function in short and medium term,in activities of daily living,in visuospatial neglect and in reducing pain,especially in patients with complex regional pain syndrome.Objective:To report the perception of Occupational Therapists regarding the application of Mirror Therapy in professional practice.Specifically,what factors lead to its application,what are the effects and benefits of the technique,what are its advantages and limitations.Results:In the perception of Occupational Therapists,the Mirror Therapy technique has the following benefits:significant decrease in pain,improved sensitivity and functionality of the upper limb,unblocking movements in the affected limb,decreased phantom pain;as negative aspects:difficulties in spatial/environmental control,patient's perceptual/cognitive skills,high level of concentration/attention,absence of scientific evidence in neurological conditions.Conclusion:For the interviewed Occupational Therapists,the Mirror Therapy is a safe and useful technique to be applied in your professional practice that has been showing positive results in the functional recovery of patients,however,it lacks studies that identify the appropriate time to start its application and the explanation of an intervention protocol.

Occupational Performance of Women with Chronic Pelvic Pain and the Potential of Coping as an Unassisted Intervention

Objective: To assess the satisfaction and occupational performance of women with chronic pelvic pain and to discuss unassisted intervention strategies by the occupational therapist for the care of these patients. Methods: A case-control study was conducted on 75 women with chronic pelvic pain and 75 apparently healthy women. The study was approved by the Research Ethics Committee of the institution and all subjects gave written informed consent to participate. Pain intensity was determined using a visual analogue scale and each patient was submitted to psycho-metric assessment using the Patient Health Questionnaire, the Self-Reporting Questionnaire of Psychiatric Screening and the Tampa Scale of Kinesiophofobia in their Brazilian version. The main outcomes regarding occupational performance and satisfaction were evaluated using the Canadian Measure of Occupational Performance. Results: The performance and satisfaction scores of women with chronic pelvic pain were significantly lower than those of healthy women. The presence of pain and kinesophobia was directly and independently correlated with low performance and satisfaction scores regardless of ethnicity, marital status, schooling, or psychometric scores. Conclusion: women with chronic pelvic pain present significant impairment of satisfaction and occupational performance. Coping is a potential unassisted intervention strategy to be applied to this population by occupational therapists.

Analysis of the effectiveness of cognitive rehabilitation for patients with chronic mental illness:A meta-analysis

BACKGROUND People suffering from chronic mental illness are sensitive to stressful stimuli,lack coping skills,and have low self-esteem due to problems such as social situations.They also experience depression,isolation,fear,and frustration.Due to cognitive dysfunction,people suffering from chronic mental illness have inadequate cognitive processes that lead to distorted thinking.AIM To confirm the effectiveness of cognitive rehabilitation therapy in improving cognitive function and alleviating behavioral and psychological symptoms in patients with chronic mental illness,and to identify the cognitive function that had the main effect.METHODS The quality of the studies was evaluated using the Assessment of Multiple Systematic Reviews criteria,and data published from 2011 to December 2022 were searched using PubMed,Cochrane,RISS,KISS,and DBpia.The keywords used in the search were“mental illness,”“cognitive rehabilitation,”“cognition,”and“mental.”A meta-analysis was conducted on the 12 selected papers.RESULTS The level of evidence for the 12 documents was that of a randomized experimental study.Intervention types in cognitive rehabilitation can be divided into cognitive behavior,cognitive training,cognitive rehabilitation,and computerized cognitive programs.Most of the studies were on schizophrenia,and the measurement areas were cognitive functions(e.g.,concentration,memory,and executive function)as well as depression,sociability,and quality of life.As a result of the meta-analysis of each variable,the effect size for cognitive rehabilitation treatment was in the following order:Sociability,memory,concentration,executive function,quality of life,and depression.Particularly,sociability and memory exhibited significant effects.CONCLUSION Cognitive rehabilitation aids cognitive function and sociability in patients with chronic mental illness and can be used as evidence for cognitive rehabilitation in mental health and occupational therapy.

Epidemiology of electrical burns and its impact on quality of life-the developing world scenario

BACKGROUND Electrical burns are devastating injuries and can cause deep burns with significant morbidity and delayed sequelae.Epidemiological data regarding the etiology,socioeconomic differences and geographic variation are necessary to assess the disease burden and plan an effective preventive strategy.These severe injuries often lead to amputations and thus hamper quality of life in the long term AIM To identify the population at maximum risk of sustaining electrical burns.We also studied the impact of electrical burns on these patients in terms of quality of life as well as return to work.METHODS The study was conducted at a tertiary referral teaching hospital over a period of eighteen months.All patients with a history of sustaining electrical burns and satisfying the inclusion criteria were included in the study.All relevant epidemiological parameters and treatment details were recorded.The patients were subsequently followed up at 3 mo,6 mo and 9 mo.The standardized Brief Version of the Burn Speci
c Health Scale(BSHS-B)was adopted to assess quality of life.Statistical analysis was conducted using IBM SPSS statistics(version 22.0).A P value of<0.05 was considered statistically significant.RESULTS A total of 103 patients were included in the study.The mean age of the patients was 31.83 years(range 18-75 years).A significant majority(91.3%)of patients were male.The mean total body surface area(TBSA)in these patients was 21.1%.In most of the patients(67%),the injury was occupation-related.High voltage injuries were implicated in 72.8%of patients.Among the 75 high voltage burn patients,31(41%)required amputation.The mean number of surgeries the patients underwent in hospital was 2.03(range 1 to 4).The quality of life parameters amongst the patients sustaining high voltage electrical burns were poorer when compared to low voltage injuries at all follow-up intervals across nine domains.In eight of these domains,the difference was statistically significant.Similarly,the scores among the amputees were poorer when compared to non-amputees.The difference was statistically significant in six domains.CONCLUSION Electrical burns remain a problem in the developing world.Most injuries are occupation-related.The quality of life in patients with high voltage burns and amputees remains poor.Work resumption was almost impossible for amputees.These patients could not regain pre-injury status.Steps should be taken to create awareness and to implement an effective preventive strategy to safeguard against electrical injuries.

Design of Human Adaptive Mechatronics Controller for Upper Limb Motion Intention Prediction

Human Adaptive Mechatronics(HAM)includes human and computer system in a closed loop.Elderly person with disabilities,normally carry out their daily routines with some assistance to move their limbs.With the short fall of human care takers,mechatronics devices are used with the likes of exoskeleton and exosuits to assist them.The rehabilitation and occupational therapy equipments utilize the electromyography(EMG)signals to measure the muscle activity potential.This paper focuses on optimizing the HAM model in prediction of intended motion of upper limb with high accuracy and to increase the response time of the system.Limb characteristics extraction from EMG signal and prediction of optimal controller parameters are modeled.Time and frequency based approach of EMG signal are considered for feature extraction.The models used for estimating motion and muscle parameters from EMG signal for carrying out limb movement predictions are validated.Based on the extracted features,optimal parameters are selected by Modified Lion Optimization(MLO)for controlling the HAM system.Finally,supervised machine learning makes predictions at different points in time for individual sensing using Support Vector Neural Network(SVNN).This model is also evaluated based on optimal parameters of motion estimation and the accuracy level along with different optimization models for various upper limb movements.The proposed model of human adaptive controller predicts the limb movement by 96%accuracy.

Building up Systematic Client-Centred Data as a Base for Clinical Outcome within Outpatient Neurorehabilitation

Objective: This study describes the development and use of a specific database supporting personnel within outpatient neurological rehabilitation to reflect on existing interventions and improve future rehabilitation. Methods: Five outpatient rehabilitation centres in one county council in Sweden were involved in developing and implementing a systematic data collection template within the existing digital medical record system. Data were collected to get more information on the effects of outpatient stroke rehabilitation in patients who received rehabilitation the first year after a stroke (ICD-I64) and patients who received further rehabilitation 1 year or more after a stroke (ICD-I69). Data analysis included evaluation of balance, movement, activity/participation, health-related quality of life, and self-rated health. Results: The ICD-I64 group had positive results after treatment (p < 0.05) for all variables and the ICD-I69 group had positive results for balance and activity/participation. Conclusions: The use of systematic data collection provided a platform for employees and managers to discuss and use clinical results to improve the type and quality of rehabilitation interventions.

作业疗法合并或不合并针刺对痉挛型偏瘫脑瘫患儿上肢疼痛及手功能的干预研究:一个三臂随机安慰对照临床试验

Objective:This study is conducted to investigate the effects of occupational therapy(OT) with or without combined acupuncture for upper limb pain and hand functions among children with spastic hemiplegic cerebral palsy.Methods:A total of 90 patients who met the inclusion criteria were enrolled in a three-arm randomized,placebo-controlled trial,and were allocated to mono-occupational therapy(OT) group(patients=30),OT combined with real-acupuncture(ORA) group(patients=30),and OT combined with placeboacupuncture(OPA) group(patients=30),respectively.In addition to receiving the conventional OT program as the basic treatment for total 8 weeks,patients in ORA and OPA group also received corresponding acupuncture treatment 5 days per week for the first two weeks,3 days per week for the next two weeks,2 days per week for another two weeks,and 1 day per week for the last two weeks.Non-communicating children’s pain checklist-revised scale(NCCPC-R) was used for assessing the upper limb pain among patients.Squeeze dynamometry,modified Ashworth scale(MAS),manual muscle testing(MMT),JebsenTaylor hand function test(JTHFT) and box and block test(BBT) were used for assessing various aspects of upper limb and hand functions among patients.Meanwhile,adverse effects were monitored and recorded.Results:After 8-week treatment,NCCPC-R global scores witnessed a dramatic decline in ORA group(P<0.05),but not in either OPA(P> 0.05) or OT group(P> 0.05).Dramatic increases were identified in both squeeze dynamometry scores and MMT scores in all three groups(all P <0.05).Furthermore,the increases of ORA group were more significant than those of another two groups(both P <0.05).There were no significant changes in MAS global scores in each group(all P> 0.05).The BBT global scores of all three groups significantly increased(all P <0.05) after treatment.Among them,the increase of the ORA group was more than that of the other two groups(P <0.05).The 8-week treatment also had a significant impact on several sub-tests of JTFHT in each group.No significant adverse event was reported.Conclusion:ORA is a potential and promising alternative therapy for mitigating upper limb pain as well as improving both upper limb and hand functions among children with spastic hemiplegic cerebral palsy.

Guidelines for burn rehabilitation in China

Quality of life and functional recovery after burn injury is the final goal of burn care,especially as most of burn patients survive the injury due to advanced medical science.However,dysfunction,disfigurement,contractures,psychological problems and other discomforts due to burns and the consequent scars are common,and physical therapy and occupational therapy provide alternative treatments for these problems of burn patients.This guideline,organized by the Chinese Burn Association and Chinese Association of Burn Surgeons aims to emphasize the importance of team work in burn care and provide a brief introduction of the outlines of physical and occupational therapies during burn treatment,which is suitable for the current medical circumstances of China.It can be used as the start of the tools for burn rehabilitation.