Visual perception of objects: an approach to assessment and intervention

This paper proposes an alternative to the deficit-specific approach that has been used to guide the visual perceptual assessment and treatment of brain-injured adults. Recent theoretical advances in visual object perception are combined with a cognitive rehabilitation model to provide a framework for occupational therapy assessment and treatment of object-processing dysfunction. Assessment guidelines are presented that emphasize the analysis of residual function by specifying the task conditions that influence visual perception. A case study illustrates clinical application of this approach. Implications for research are discussed.     

A functional model of cognitive rehabilitation in occupational therapy

Persons who sustain cerebral injuries often have cognitive impairments. Occupational therapists are active in providing cognitive rehabilitation that aims to minimize the effects of cognitive deficits in their clients' lives. This paper presents a brief review of the literature in the area of cognitive rehabilitation including major characteristics of existing occupational therapy models related to the treatment of people who need cognitive rehabilitation. A model of cognitive rehabilitation is proposed that emphasizes functional components of occupational therapy in different rehabilitation settings. This model, called the Functional Model of Cognitive Rehabilitation, supports the use of activities in naturalistic settings in treatment, in order to enable those with cognitive impairments to fulfill their occupational roles.     

Position paper on the role of occupational therapy in adult physical dysfunction. The Canadian Association of Occupational Therapists

When an adult suffers from trauma or a condition that results in physical impairment or dysfunction, independence in daily living tasks may be affected. The occupational therapist's perspective and expertise lies in the assessment and treatment of the individual's function/dysfunction in the occupational performance areas of self-care, productivity and leisure. Assessment and treatment is carried out within the context of the individual's lifestage and environment. The occupational therapist facilitates the individual to assume a reasonable degree of responsibility for the rehabilitation process. Through the use of specific treatment approaches and techniques, occupational therapy intervention assists adults with physical dysfunction to restore function, develop new skills, develop adapted techniques, and maintain existing skills.     

Community care for the chronic mentally ill

The movement of chronic mentally ill patients from large mental hospitals into the community, seeks to liberate institutionalized clients and substitute a more humane environment. This article reviews the types of chronic mental patients now living in the community. The differences between a maintenance and a rehabilitation model for treating the chronic mental patient living in the community are discussed. Special treatment programs for the young adult chronic client are also considered. Three questions specific to occupational therapists working with chronic mentally ill patients in the community are then explored. These are: A. How can we increase the visibility of occupational therapy in community mental health?; B. Should occupational therapists be involved in programs which have a maintenance, rather than a rehabilitation focus?: and C. What has the occupational therapist to offer the young adult chronic client?     

认知障碍的康复治疗

认知障碍的康复是发展脑损伤患者的认知能力，以克服知觉、记忆和语言障碍的一种康复治疗方法。主要有作业疗法、电脑辅助和虚拟认知康复、远程认知康复治疗、内隐记忆康复、无错性学习、认知神经心理康复、电针疗法以及药物治疗。     

Effect of computerized cognitive rehabilitation program on cognitive function and activities of living in stroke patients

[Purpose] The objective of this study was to examine the effect of cognitive rehabilitation using a computer on cognitive function and activities of daily living in stroke patients presenting impairment of cognitive function. [Subjects] Forty-six stroke patients were divided into two groups (a training group and control group) through random assignment. [Methods] The training group received rehabilitation therapy and an additional computerized cognitive rehabilitation program using The RehaCom software 30 minutes/day, 5 times/week for 5 weeks. The control group received only rehabilitation therapy including physical and occupational therapy. A comparative analysis on all subjects was conducted before and after the experiment using a cognitive test and activities of daily living test. [Results] After 5 weeks of therapy, the training group presented statistically significant improvement in cognitive function assessment items of digit span, visual span, visual learning, auditory continuous performance, visual continuous performance, and others compared with the control group but did not present statistically significant improvement in activities of daily living. [Conclusion] It was revealed through this study that computerized cognitive rehabilitation with the RehaCom program results in improvement in cognitive function and can be used as a treatment tool beneficial to stroke patients presenting cognitive impairment.Key words: Computerized cognitive rehabilitation, Cognitive function, Activities of daily living     

An assessment of occupational therapists' roles and attitudes toward sexual rehabilitation of the disabled.

Sexual adjustment is believed to be a fundamental aspect of the medical and psychosocial rehabilitation of the disabled and chronically ill. A sample of 26 occupational therapists involved in adult rehabilitation services were given a list of specific tasks identified in the literature to be related to medical (physical) aspects of sexual rehabilitation. The results indicated that a small percentage of occupational therapists participate in these tasks. The majority believed that the tasks were important in occupational therapy but that their preparation to perform the tasks was inadequate. The subjects, as a group, held positive attitudes toward sexual rehabilitation and considered it a legitimate aspect of health care for which an appropriate content should be integrated into the basic curricula in occupational therapy.     

Changing balance: environment and individual

The role of occupational therapy as a process for changing balance from dysfunction to function is discussed in this paper. The individual as the first level environment to be considered for balance in the occupational therapy process is emphasized. The role of purposeful activity as a change determinant and as a valued treatment modality is recognized as a practice factor that needs verification through research in conjunction with systematic study of the occupational therapy process.     

个体化作业疗法对老年脑卒中后认知障碍的影响

目的探讨个体化作业疗法对老年脑卒中认知障碍患者的康复疗效。方法60 例老年脑卒中认知障碍患者分为治疗组(n=30)和对照组(n=30),两组患者入院后均接受常规康复训练,治疗组在此基础上给予个体化作业治疗。治疗前后采用简易精神状态检查(MMSE)及改良Barthel 指数(MBI)进行评定。结果治疗后治疗组MMSE 评分显著高于治疗前(P<0.001),对照组治疗前后MMSE 评分无显著性差异(P>0.05)。治疗后,两组MBI 评分均高于治疗前(P<0.05),治疗组与对照组相比有非常高度显著性差异(P<0.001)。结论个体化作业疗法可明显改善老年脑卒中后认知障碍患者的认知功能,提高日常生活活动能力。     

A synthesis of occupational behavior and sensory integration concepts in theory and practice, part 2: clinical applications

This is the second of two papers addressing the occupational behavior and sensory integration approaches to occupational therapy for children. In the previous paper, basic concepts from these two approaches were discussed as presenting different, yet complementary, perspectives. The use of play was identified as central to occupational therapy practice from either perspective. Concepts from both approaches were integrated into a general systems model of play development in infancy and early childhood. This paper discusses play and sensory integration as interdependent developmental phenomena that are a function of interactions between the environment (input) and the child's internal processing (throughput). When input-throughput interactions do not permit the growth of competence, dysfunction occurs. Consideration of possible input and throughput deficits are suggested for assessment of individual children, and treatment guidelines are drawn from both the sensory integration and occupational behavior literature.     

Adjustment to severe disability: constructing and examining a cognitive and occupational performance model

Ninety adults with severe physical disabilities were tested with respect to their adjustment to severe disabilities in their adapted computerized work environment 1 year following occupational therapy consultation. The research goal was to examine a model that incorporates variables from the cognitive coping model (self-esteem, appraisal and social support) and variables from the occupational performance model (engagement in activities, involvement in work/study, time of typing performance and environmental adaptations). Findings showed goodness of fit between the observed and the proposed research models, although few changes in positions and relations were found. Self-esteem and time of performance were found to be core variables connecting cognitive and functional variables. Age and activities of daily living were the only background variables that contributed to the model. Research and rehabilitation clinical implications are discussed.     

呼吸训练联合作业治疗对脑卒中患者上肢功能恢复的影响

目的:观察呼吸训练联合作业治疗对脑卒中患者上肢功能恢复的影响。方法:采用随机数字表法将50例脑卒中患者分为观察组及对照组,每组25例。对照组患者给予常规康复干预(包括偏瘫肢体良肢位摆放、物理因子治疗及运功功能训练等),观察组患者在此基础上辅以呼吸训练(包括渐进性吸气肌抗阻训练和呼吸控制训练)及作业治疗,每天训练2次。于...     

Functional recovery in cancer rehabilitation

OBJECTIVE: To assess the impact of inpatient rehabilitation on the motor and cognitive functional status of cancer patients, and to determine whether cancer diagnosis, rehabilitation impairment, physician-determined rehabilitation goals, and active cytotoxic treatment affect the magnitude of functional improvement. DESIGN AND SETTING: A retrospective, case series of patients with an oncology diagnosis undergoing inpatient rehabilitation at a rehabilitation hospital. PARTICIPANTS: A sample of 200 patients admitted for rehabilitation services due to disability resulting from impairments caused by cancer or its treatment. INTERVENTION: Comprehensive multidisciplinary inpatient rehabilitation. OUTCOME MEASURES: Function status was measured using the motor and cognitive measures of the Functional Independence Measure. RESULTS: All patients made significant gains in motor function regardless of diagnostic group, rehabilitation impairment group, rehabilitation goal group, and cytotoxic treatment status. The magnitude of motor function gain was not equivalent across all impairments and rehabilitation goals. Significant gains in cognitive function were made by all patients except those with intracranial neoplasms, central nervous system dysfunction, and palliative rehabilitation goals. CONCLUSION: Inpatient rehabilitation can improve both motor and cognitive function in patients with disability resulting from impairments caused by cancer or its treatment.     

帕金森病的认知障碍及康复治疗

帕金森病是一个运动系统的疾病 ,但也有认知功能的障碍 ,研究发现帕金森病患者的认知障碍主要表现为 :言语流畅性障碍、视空间障碍、额叶功能记忆障碍、智能障碍等。其中最引起人们关注和最引起病人丧失生活能力的是智能障碍 ,即痴呆。病人的认知功能障碍尤其是痴呆对其生活造成了极大的影响 ,因此有必要对帕金森病患者的认知障碍进行康复治疗。本文在总结了国内外的文献的基础上 ,对帕金森病的认知障碍及其康复治疗做一简单综述     

小组模式作业治疗对伴有情绪障碍脑卒中患者的康复疗效观察

目的 研究小组作业治疗对伴有情绪障碍脑卒中患者的康复疗效。方法 选择72例脑卒中患者,采用随机数字表随机分为小组作业治疗组(研究组)和常规作业治疗组(对照组),于治疗前、治疗4周后分别采用汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评测焦虑及抑郁情况;采用蒙特利尔认知评估量表(MoCA)评测认知情况;采用简化Fugl-Meyer量表(FMA)评定运动功能;采用改良Barthel指数量表(MBI)评定日常生活活动能力。结果 治疗4周后,两组患者HAMA、HAMD、MoCA、FMA、MBI评分较治疗前明显改善(P <0.05),且研究组HAMA (10.80±2.39)分、HAMD (15.34±3.96)分、MoCA (24.61±4.72)分、FMA(74.16±8.12)分、MBI (75.6±12.11)分均显著优于对照组HAMA (14.79±3.42)分、HAMD (20.77±3.85)分、MoCA(20.83±4.90)分、FMA(62.34±7.91)分、MBI(64.14±10.71)分,组间差异均具有统计学意义(P <0.05)。结论 小组作...     

高压氧治疗联合重复经颅磁刺激对脑梗死后认知功能障碍的疗效

目的 研究高压氧治疗联合重复经颅磁刺激（rTMS）对脑梗死后认知功能障碍的影响。 方法 将纳入的81例脑梗死后认知功能障碍患者经知情同意并签署知情同意书后按随机数字表法分为对照组、高压氧组和联合治疗组,每组27例,各组均接受基本药物和常规康复训练,高压氧组增加高压氧治疗,联合治疗组增加高压氧和rTMS治疗,分别于治疗前和治疗4周后(治疗后),采用简易精神状态（MMSE）量表和蒙特利尔认知评估（MoCA）量表对各组患者进行认知功能评定,并进行统计学分析比较。 结果 治疗后,高压氧组和联合治疗组的MMSE评分分别为（22.65±5.79）和（24.84±5.88）分,均明显高于对照组［（18.84±4.11）分］,差异有统计学意义（P<0.05）,且联合治疗组的MMSE评分较高压氧组有明显改善（P<0.05）;治疗后,高压氧组和联合治疗组的MoCA评分分别为（21.31±6.25）和（23.17±7.51）分,均明显高于对照组（18.31±4.81）,且差异有统计学意义（P<0.05）,而联合治疗组的MoCA评分较高压氧组亦有明显改善（P<0.05）。 结论 高压氧治疗联合rTMS能更有效地改善脑梗死后认知障碍患者的认知功能。     

Emotional dysfunction in a geriatric population: staff observations and patients' reports.

This study was designed to determine the following about a geriatric rehabilitation population: (1) the relationship between patients' self-reports of depression and anxiety and staff observations of compromised participation in treatment secondary to emotional dysfunction; (2) the relationship of observations among different disciplines; and (3) changes that may occur to staff observations during the patient's hospitalization. The Geriatric Depression Scale, the depression and anxiety subtests of the Brief Symptom Inventory, and the Modified Mini-Mental State Exam were administered to geriatric patients on admission to and discharge from two DRG-exempt acute rehabilitation units. In addition, day nurses, evening nurses, occupational therapists, and physical therapists rated the same geriatric patients on how frequently their emotional functioning interfered with rehabilitation. Significant correlations were obtained between staff observations and patients' reports of emotional dysfunction, with occupational therapists' ratings generally the most highly correlated with patients' reports. At admission, day and evening nurses reported significantly greater patient emotional dysfunction than did occupational therapists, who reported significantly greater emotional dysfunction than did physical therapists. These differences, however, were not evident by time of discharge. Thus, staff members can provide reliable information to mental health professionals in determining the effect of emotional functioning on rehabilitation participation. However, level of compromised participation secondary to emotional dysfunction reported by staff appears to be contingent on which rehabilitation discipline is asked and when during the patient's hospitalization the inquiry is made. Also, patients who generally participated less in treatment tended to be older, depressed women with less education and greater cognitive impairment.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Relationship between Rehabilitation and Changes in Depression in Stroke Patients

[Purpose] This study investigated the primary factors behind changes in depressive symptoms among stroke patients after 8 weeks of rehabilitation (physical, occupational, and cognitive therapy). [Methods] This study was conducted using a literature review, and electronic medical records from January, 2008 to December, 2009. Data were collected for 120 subjects with chronic stroke. [Results] Cardiac disorder, left-brain lesion, early-stage depression, activities of daily living, and cognitive function were significant predictors of the changes in depression in chronic stroke patients. [Conclusion] Post-stroke depression can be controlled by rehabilitation. Also, clinicians should comprehend and share the psychological and physical affliction, develop back-up programs, and make them comprehensively available to support the psychological and physical health of subjects with chronic stroke.Key words: Stroke, Rehabilitation, Depression     

An application of the Occupation Competence Model to organizing factors associated with return to work

The variations in return to work outcomes for ill or injured persons experiencing health leaves are complex. However, it is important to comprehend these variations in order to develop evidenced-based practice in work rehabilitation. Currently, a plethora of studies exist in the literature that have attempted to explain the variations in work outcomes. A 20-year review of the literature on work outcomes has revealed several limitations in using this knowledge in occupational therapy. The study of return to work outcomes is, for the most part, atheoretical and the knowledge base is fragmented and disorganized. In addition, the literature does not reflect a consistent understanding of the multidimensional nature of either work disability or the facilitators for return to work. In this paper, the Occupational Competence Model is presented as a framework for filling this gap. This model is used here to organize and synthesize the factors previously studied on work outcomes to foster an understanding of this literature from an occupational therapy perspective and the future study of work outcomes and work rehabilitation.     

From ancient Greece to the cognitive revolution: A comprehensive view of physical rehabilitation sciences

The development of rehabilitation has traditionally focused on measurements of motor disorders and measurements of the improvements produced during the therapeutic process; however, physical rehabilitation sciences have not focused on understanding the philosophical and scientific principles in clinical intervention and how they are interrelated. The main aim of this paper is to explain the foundation stones of the disciplines of physical therapy, occupational therapy, and speech/language therapy in recovery from motor disorder. To reach our goals, the mechanistic view and how it is integrated into physical rehabilitation will first be explained. Next, a classification into mechanistic therapy based on an old version (automaton model) and a technological version (cyborg model) will be shown. Then, it will be shown how physical rehabilitation sciences found a new perspective in motor recovery, which is based on functionalism, during the cognitive revolution in the 1960s. Through this cognitive theory, physical rehabilitation incorporated into motor recovery of those therapeutic strategies that solicit the activation of the brain and/or symbolic processing; aspects that were not taken into account in mechanistic therapy. In addition, a classification into functionalist rehabilitation based on a computational therapy and a brain therapy will be shown. At the end of the article, the methodological principles in physical rehabilitation sciences will be explained. It will allow us to go deeper into the differences and similarities between therapeutic mechanism and therapeutic functionalism.