全身心康复:作业疗法的首要精髓

Occupational therapy (OT) is one of the important rehabilitation disciplines.OT uses purposeful and/or meaningful activities to improve function in clients, and to help them gain or regain maximum independent abilities." Occupational therapy is the art and science of helping people do the day- to- day activities that are important to them despite impairment, disability, or handicap"[1] .OT does not simply refer to activities of daily living (ADL).In OT terminology,OT activities include all areas of ADL,work and productive activities, and play and leisure activities.The most important thing that occupational therapists should attempt to do in the practice setting is " to treat the whole person" .     

Effects of spaced retrieval training with errorless learning in the rehabilitation of patients with dementia

[Purpose] Among the non-pharmacological interventions for dementia, spaced retrieval training (SRT) is a good method for rehabilitating cognition. The purpose of this study was to examine effects of SRT with errorless learning (EL) in the rehabilitation of patients with dementia. [Subjects and Methods] Twenty-nine participants with vascular dementia (VD) and Alzheimer’s disease (AD) participated in the present study. The Korean version of the Consortium to Establish a Registry for Alzheimer’s disease (CERAD-K) and Modified Barthel Index (MBI) were performed to assess the changes in the neuropsychological performance and the independent activities of daily living after SRT with EL. All tests were administered both before and after SRT with EL. Each SRT with EL intervention was performed for 30 minutes per day for 5 weeks. SPSS for Windows version 18.0 was used for statistical analysis. [Results] All items of the CERAD-K score of the VD group except for constructional praxis increased significantly after the SRT with EL intervention, but no significant differences from the AD group were found. The Korean version of the geriatric depression scale (GDS-K) of the VD group increased significantly after the SRT with EL intervention. The mean MBI scores of each group showed no significant difference after the intervention. [Conclusion] SRT with EL is an effective intervention for memory training of patients with dementia. Future research using sufficient sample sizes will be needed to obtain strong evidence for comparing not only the before and after intervention data but also between the groups.Key words: Dementia, Errorless learning, Spaced retrieval training     

Cognitive training for elderly patients with early Alzheimer’s disease in the Qinghai-Tibet Plateau: A pilot study

BACKGROUNDAlzheimer’s disease (AD) influences the social and economic quality of life of older adult patients and their families.AIMTo explore the efficacy of cognitive training in clinical nursing for patients with early AD residing in the plateau area.METHODSThis pilot study was conducted in patients with early AD treated in the Geriatric Department of the Qinghai Provincial People’s Hospital between August 2019 and March 2021. The patients were divided into a cognitive training group and a conventional nursing group using the random number table method. Patients in the conventional nursing group received conventional nursing, whereas the patients in the cognitive training group received the new nursing intervention. The mini-mental state examination (MMSE) and activities of daily living (ADL) scales were used to compare the cognitive ability and daily activities, respectively, between the two groups before and after the intervention.RESULTSSixty patients were enrolled in this study, with 30 patients in the cognitive training group and conventional nursing group, respectively. The MMSE and ADL scores were significantly higher in the cognitive training group than in the conventional nursing group after the intervention (MMSE: 25.11 ± 2.02 vs 22.26 ± 1. 23, P = 0.032; ADL: 68.72 ± 4.86 vs 60.16 ± 2.27, P = 0.018).CONCLUSIONThe application of cognitive training in clinical nursing for patients with early AD could improve both their cognitive ability and ADL. This method could be applied in clinical practice to manage cognitive dysfunction in patients with early AD.     

针刺加当归芍药散治疗阿尔茨海默病对照性研究

目的比较、观察针刺加当归芍药散(针药组)、针刺、中药及尼莫地平对阿尔茨海默病的临床疗效及智能、认识能力、生活自理能力的影响。方法104例患者随机分成4组,针药组35例、针刺组37例、中药组18例、尼莫地平组14例,评定和比较各组长谷川智能量表(HDS)、简易精神状态(MMSE)、日常生活能力表(ADL)等神经量表,治疗8周前后及组间增分差异、临床疗效总评量表(CGI)的疗效。结果针药组CGI为74.3%(P<0.05);MMSE、ADL增分,均优于其他各组,尤其是时空定向、计算力、远记忆力改善更有显著意义(P<0.01或P<0.001),近记忆力也中药组有显著意义(P<0.05)。NM组HDS增分优于其他各组,ADL增分优于针刺组、中药组,尤其是近记忆力改善显著大于各组,P<0.05、P<0.01、P<0.001。针刺组HDS改善优于中药组。中药组远记忆力大于针刺组。结论针刺加当归芍药散治疗轻型或中型AD患者疗效胜于其他各组的治疗。     

Brokering Community Engagement: Proactive Strategies for Supporting Indigenous Australians with Mental Health Problems

This qualitative study explored the experiences of mental health employees working with Indigenous clients living with mental illness. Interviews were conducted with 20 mental health workers to identify strategies they adopt to facilitate community engagement with Indigenous clients. Using a thematic analysis approach, ‘Brokering community engagement’ was the umbrella theme from which two subthemes related to community engagement for the service and clients emerged (1) enabling connections –community and family; and (2) recovery and reconnecting with community. Participant insights enabled a deeper understanding of the role of community in the recovery process for Indigenous clients and highlight the importance of community engagement as a primary, yet multifaceted strategy used by mental health workers in the communities they serve.     

A randomized controlled trial of outpatient CAncer REhabilitation for older adults: The CARE Program

BackgroundLarge numbers of older adults (aged 65 years or older) are surviving cancer; however, many survivors report decreased quality of life (QOL) and limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) both during and after treatment [1–3]. Occupational and physical therapy (OT/PT) are services focused on improving functional status and QOL that are largely unexplored and underutilized in cancer survivorship care [4,5].Methods/DesignThis is a randomized, single-blind, two-arm, single institution pilot study. Eighty-two patients will be recruited from a university-affiliated outpatient oncology clinic. Inclusion criteria include the following: aged 65 years or older, diagnosis of cancer within 5 years, English speaking, has at least one functional deficit, and able to safely participate in an outpatient rehabilitation program. Exclusion criteria are: currently receiving rehabilitation or eligible for hospice. Consented patients will be randomized into two groups: (1) the CARE (CAncer REhabilitation) Program consisting of outpatient OT/PT and (2) standard of care. Primary outcome: change in Nottingham Extended Activities of Daily Living (NEADL) scores from baseline to 3 months between CARE and control.DiscussionThis study is one of the first RCTs aimed at examining the effect of OT/PT in older adults with cancer. If positive, findings from this study will suggest the potential for outpatient OT/PT to improve the functional ability and QOL of older adults with cancer.     

作业疗法在手烧伤整形术后康复护理中的作用

目的探讨作业疗法(OT)对手烧伤整形病人术后康复护理的作用.方法整形术后及时进行心态词理,侧重病人日常生活自理能力进行日常生活活动能力(ADL)训练,时间30d～1年以上.结果本组53例均获得满意效果.结论作业疗法是手烧伤病人整形术后走向社会前必不可少的锻炼阶段.     

Active learning of geriatric rehabilitation: deliberations of an undergraduate occupational therapy programme

Occupational therapists working in geriatric rehabilitation must possess skills of self-directed learning and critical thinking, but conventional teaching-learning strategies are limited in acquiring the said skills. This action research aimed at developing in students an ability for active learning and problem solving. An inquiry-based learning (IBL) methodology was introduced to two geriatric-related subjects of an undergraduate occupational therapy (OT) programme. Students worked on four real-life problems in tutorials and participated in service learning. Lectures were carefully structured to consolidate theoretical knowledge generated from the problems. This study was evaluated qualitatively through interviews of both students and clinical educators, and reflective journals. Students found the problems and service learning stimulating enough to encourage active learning and develop basic study skills. Likewise, clinical educators noted students to be more competent when working with geriatric clients than former students who learned through a conventional curriculum. However, the IBL methodology was stressful in areas related to consistency of teaching-learning strategies across curriculum, workload and time constraints. Curriculum review, development of resource files and provision of systematic support are some of the recommendations to the challenges encountered. To conclude, the IBL approach provides appropriate learning environments that foster in students a self-directed learning attitude in the study of geriatric rehabilitation.     

家庭随访干预对阿尔茨海默病早期患者康复的影响

目的:评价家庭随访干预对阿尔茨海默病(AD)早期患者康复的影响。方法:将确诊的83例社区居家AD早期患者分为试验组42例,对照组41例,对照组入组时开展一次有关AD知识教育与居家康复训练指导,此后由家庭照顾者督促患者按居家护理方案进行康复训练,试验组在此基础上采用家庭访视和电话随访相结合的干预方式。干预期1年。采用简易智力状态量表(MMSE)、日常生活能力量表(ADL)、汉密尔顿焦虑量表(HAMA)进行效果评定。结果:试验组患者干预前后ADL、HAMA得分及居家不安全事件发生率差异有统计学意义(P0.05),MMSE得分虽无统计学差异(P0.05),但干预后分数较干预前提高,且1年后无患者发展为中期痴呆;试验组与对照组干预后MMSE、HAMA得分差异有统计学意义(MMSE:P0.05;HAMA:P0.01),ADL得分虽无统计学差异(P0.05),但试验组分数较对照组降低;对照组患者干预前后MMSE、ADL、HAMA得分差异无统计学意义(P0.05),1年后有2例患者发展为中期痴呆。结论:仅依靠家庭照顾者督促患者开展居家康复训练是不够的,家庭随访干预可有效维持AD早期患者的认知水平,延缓病情进展,提高患者生活质量。     

Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing (TILDA)

Purpose: To identify the factors associated with disability across many domains using a large powered sample in the activities of daily living (ADL) and instrumental activities of daily living (IADL). Methods: Those aged?≥65 years from the Irish longitudinal study on ageing (TILDA) were included in this cross sectional analysis. Three logistic regression models were used to examine the relationships between 25 health, psychological and sociodemographic variables and difficulties in ADL, IADL and ADL/IADL combined. Results: The proportion of those reporting combined ADL/IADL difficulties was 18%. More individuals reported difficulty with ADLs (13%) than IADLS (11%). The main model showed that after age, the top three factors associated with difficulty in ADL/IADL combined were pain, taking five or more medications and depression. After age, the factors with the highest impact on ADL disability were pain, taking five or more medications and body mass index (BMI); the factors with the highest impact on IADL were being separated or divorced, living with others (non-spouse) and self-rated memory. Conclusions: Awareness of sociodemographics and early interventions for pain and cognitive deficits could reduce ADL/IADL disability and promote successful ageing. Identification of variables that influence ADL/IADLs can be used to inform policy and practice.

• Implications for rehabilitation

• After age, pain and taking five or more medications were the strongest factors associated with difficulty in ADL/IADL combined and ADL alone. Practice therefore needs to be cognizant that it is not the disease label but the symptoms of a disease that affect ADL and IADL activities.

• Given the strong influence of pain on difficulties with ADL and IADL, there is a need for early interventions from a multidisciplinary perspective for pain reduction, control, and self-management. These interventions should include development of pain-coping strategies and exercises to maintain mobility.

• After age, being separated/divorced or living with non-spouse others are the strongest factors associated with IADL difficulties. Awareness of these social factors can be used to inform support mechanisms, such as development of community services and suitable housing for those with these changing sociodemographics.

• Unsurprisingly, cognitive impairments were strongly associated with IADL difficulties. Simple cognitive screening assessments could be used for early detection of cognitive changes. In order to maintain optimal cognitive functioning, rehabilitation professionals should facilitate older adults’ engagement in activities that are cognitively demanding and socially interactive.

     

Repeated oxytocin prevents central sensitization by regulating synaptic plasticity via oxytocin receptor in a chronic migraine mouse model

BackgroundCentral sensitization is one of the characters of chronic migraine (CM). Aberrant synaptic plasticity can induce central sensitization. Oxytocin (OT), which is a hypothalamic hormone, plays an important antinociceptive role. However, the antinociceptive effect of OT and the underlying mechanism in CM remains unclear. Therefore, we explored the effect of OT on central sensitization in CM and its implying mechanism, focusing on synaptic plasticity.MethodsA CM mouse model was established by repeated intraperitoneal injection of nitroglycerin (NTG). Von Frey filaments and radiant heat were used to measure the nociceptive threshold. Repeated intranasal OT and intraperitoneal L368,899, an oxytocin receptor (OTR) antagonist, were administered to investigate the effect of OT and the role of OTR. The expression of calcitonin gene-related peptide (CGRP) and c-fos were measured to assess central sensitization. N-methyl D-aspartate receptor subtype 2B (NR2B)-regulated synaptic-associated proteins and synaptic plasticity were explored by western blot (WB), transmission electron microscope (TEM), and Golgi-Cox staining.ResultsOur results showed that the OTR expression in the trigeminal nucleus caudalis (TNC) of CM mouse was significantly increased, and OTR was colocalized with the postsynaptic density protein 95 (PSD-95) in neurons. Repeated intranasal OT alleviated the NTG-induced hyperalgesia and prevented central sensitization in CM mouse. Additionally, the OT treatment inhibited the overexpression of phosphorylated NR2B and synaptic-associated proteins including PSD-95, synaptophysin-1 (syt-1), and synaptosomal-associated protein 25 (snap25) in the TNC of CM mouse and restored the abnormal synaptic structure. The protective effect of OT was prevented by L368,899. Furthermore, the expression of adenylyl cyclase 1 (AC1)/ protein kinase A (PKA)/ phosphorylation of cyclic adenosine monophosphate response element-binding protein (pCREB) pathway was depressed by OT and restored by L368,899.ConclusionsOur findings demonstrate that repeated intranasal OT eliminates central sensitization by regulating synaptic plasticity via OTR in CM. The effect of OT has closely associated with the down-regulation of AC1/PKA/pCREB signaling pathway, which is activated in CM model. Repeated intranasal OT may be a potential candidate for CM prevention.     

Identifying undergraduate nurses´ learning requirements and teaching strategies in dementia care education: A nominal group technique

AimIdentify priorities and reach a consensus on student nurses´ learning requirements and the best-suited teaching strategies in dementia care.BackgroundDementia has become a global health priority. Nurses are primary service providers for people with dementia, but they may fall short on professional training. Nursing curricula still lacks a clear educational framework for dementia, meaning that nurse educators must make decisions amidst uncertainty.DesignNominal group technique based on the conceptual framework proposed by Van de Ven and Delbecq (1972).MethodsA structured face-to-face meeting convened in November 2021 involved nine participants who were directly involved in dementia care. The steps in the technique were (a) idea generation, (b) round-robin recording, (c) discussion, (d) voting and ranking, (e) discussion on the vote and (f) re-ranking. Participants answered two nominal questions. Consent, anonymity, feedback and iteration were guaranteed throughout the process.ResultsThe nominal group prioritized theoretical understanding of dementia, communication, caregivers´ needs, comprehensive assessment and ethical practice as learning requirements for nursing students. The outstanding teaching strategy discussed included various approaches to experiential learning.ConclusionsThe nominal group technique process explored learning requirement priorities for student nurses within a specific context. Participants discussed experiential learning as the best-suited teaching strategy. Findings could support nurse educators to design and deliver better dementia education.     

Intraventricular Electrogram Analysis for Ventricular Tachycardia Detection: Statistical Validation

THRONE, R.D., ET AL.: Intraventricular Electrogram Analysis for Ventricular Tachycardia Detection: Statistical Validation. Time-domain analysis of intraventricular electrogram morphology during ventricular tachycardia (VT) and sinus rhythm or atrial fibrillation (SR/AF) has been proposed as a method for increasing the specificity of pathological tachycardia detection by antitachycardia devices. However, few studies have validated the use of such analysis with statistical methods. When statistical methods have been utilized, it has been assumed that the distribution of the values derived from analysis of the intracardiac electrograms have had a normal (gaussian) distribution. In this study, we sought to determine whether: (1) the distribution of values derived from analysis of intracardiac electrogram during SR/AF and VT is gaussian or nongaussian; and (2) the discrimination of monomorphic VT from SR/AF using SR/AF templates can be validated statistically. Two previously proposed time-domain methods—correlation waveform analysis (CWA) and area of difference (AD)—were selected for evaluation of 29 patients with 33 distinct, sustained monomorphic VTs. An initial SR/AF template was used to analyze subsequent SR/AF and VT passages with a minimum of 50 consecutive depolarizations using a “best-fit” alignment. The values derived from each analysis were examined subsequently for skewness (asymmetry) and kurtosis (shape) using two-tailed tests (p < 0.02). For passages of SR/AF, a normal (gaussian) distribution was present in only 24% (CWA), and 45% (AD); for passages of VT, normal distribution was present in only 58% for both CWA and AD. Using appropriate statistical testing with nonparametric tolerance intervals, CWA and AD discriminated VT from SR/AF in 29 out of 33 (88%), and 30 out of 33 (91%) instances, respectively, with 95% confidence. Thus, the assumption of a gaussian distribution for values derived from time-domain analysis of intraventricular electrograms for VT detection is not uniformly valid. Both CWA, which is independent of both baseline and amplitude fluctuations, and AD, which is not independent of these fluctuations, have similar performance when validated with appropriate statistical methods.     

STAFF ATTITUDES TOWARDS INDIVIDUALS WITH LEARNING DISABILITIES AND AIDS: THE ROLE OF ATTITUDES TOWARDS CLIENT SEXUALITY AND THE ISSUE OF MANDATORY TESTING FOR HIV INFECTION

This study investigated staff attitudes towards individuals with learning disabilities and AIDS in combination with staff attitudes towards client sexuality. Two hundred and forty-six respondents (55% of those invited to participate) from one organisation in Scotland voluntarily and anonymously returned the nine-item Staff Attitudes Towards persons with Learning Disabilities and AIDS (LDAIDS) scale (Murray & Minnes, 1994b) and the Sexuality and Persons with Learning Disabilities Attitude Inventory (SPLDAI; Brantlinger, 1983; Murray & Minnes 1994a). Results indicated that staff held moderately positive attitudes towards individuals with a learning disability and AIDS. Regression analysis showed that while controlling for staff demographic and contact variables, attitudes towards client sexuality (SPLDAI) predicted 22% of the variance in scores of attitudes towards clients with learning disabilities and AIDS., Forty-four percent of participants employed in a direct residential care capacity agreed with mandatory testing of clients for HIV infection. The implications of these findings are discussed with relevance to issues raised by Cambridge (1994) who explored the informed consent/mandatory testing issue. Directions for future research and limitations of the study are also discussed.     

What Spouse Caregivers Know About Communication in Alzheimer's Disease: Development of the AD Communication Knowledge Test

Most individuals with Alzheimer's disease are cared for at home by family members, particularly spouses. As language impairment progresses, communication between spouses becomes difficult and caregivers are likely to be unprepared for this challenge. The purpose of this study is to describe spouse caregivers’ knowledge of communication in AD and to determine their learning needs regarding effective communication strategies. A measure of knowledge about declining language skills and appropriate communication strategies was developed and pilot tested. Participants included 16 spouses caring for a partner with AD at home. Care recipients were generally mildly impaired. Caregivers were aware of at least some of the decline in language but were less knowledgeable about communication strategies. They were experiencing numerous communication problems, but reported minimal difficulty in communicating. Nurses in acute and long-term care settings are challenged to assess spouses’ knowledge and awareness about communication in AD and provide information about effective communication strategies to decrease misunderstandings and frustration, which often lead to behavior problems. Recommendations for further development of the AD Communication Knowledge Test are offered.     

A longitudinal mixed methods study describing 4th year baccalaureate nursing students' perceptions of inclusive pedagogical strategies

BackgroundCreating inclusive learning environments—those in which all students thrive—is a priority as nursing educators are charged with preparing a diverse workforce to care for a diverse patient population. Yet, faculty are hindered by a dearth of evidence-based pedagogical strategies to promote inclusion.PurposeThis longitudinal mixed methods study uniquely addresses this evidence gap by describing relationships among inclusive pedagogical strategies and student outcomes in 81 4th-year baccalaureate nursing students.MethodsAcross the academic year, students participated in two focus groups and completed surveys at three timepoints on classroom and clinical belongingness, self-confidence and satisfaction with learning, and self-efficacy in the clinical setting.ResultsStudents' reports of satisfaction and confidence in learning, clinical self-efficacy, and clinical belongingness were significantly higher when they characterized their learning environment as inclusive. Underrepresented students, however, reported significantly lower classroom and clinical belongingness at all three survey timepoints and shared examples of unaddressed breaches in inclusivity which undermined confidence and belongingness. Focus group participants evaluated pedagogical strategies and highlighted faculty's pivotal role in creating inclusive learning environments.ConclusionInclusive pedagogical strategies may increase students' sense of belongingness, satisfaction and confidence in learning, and self-efficacy. Study results may assist faculty and inform future interventions.     

Clinical accuracy of point-of-care urine culture in general practice

Objective: To assess the clinical accuracy (sensitivity (SEN), specificity (SPE), positive predictive value and negative predictive value) of two point-of-care (POC) urine culture tests for the identification of urinary tract infection (UTI) in general practice.

Design: Prospective diagnostic accuracy study comparing two index tests (Flexicult? SSI-Urinary Kit or ID Flexicult?) with a reference standard (urine culture performed in the microbiological department).

Setting: General practice in the Copenhagen area patients. Adult female patients consulting their general practitioner with suspected uncomplicated, symptomatic UTI.

Main outcome measures: (1) Overall accuracy of POC urine culture in general practice. (2) Individual accuracy of each of the two POC tests in this study. (3) Accuracy of POC urine culture in general practice with enterococci excluded, since enterococci are known to multiply in boric acid used for transportation for the reference standard. (4) Accuracy based on expert reading of photographs of POC urine cultures performed in general practice. Standard culture performed in the microbiological department was used as reference standard for all four measures.

Results: Twenty general practices recruited 341 patients with suspected uncomplicated UTI. The overall agreement between index test and reference was 0.76 (CI: 0.71–0.80), SEN 0.88 (CI: 0.83–0.92) and SPE 0.55 (CI: 0.46–0.64). The two POC tests produced similar results individually. Overall agreement with enterococci excluded was 0.82 (0.77–0.86) and agreement between expert readings of photographs and reference results was 0.81 (CI: 0.76–0.85).

Conclusions: POC culture used in general practice has high SEN but low SPE. Low SPE could be due to both misinterpretation in general practice and an imperfect reference standard.

Registration number: ClinicalTrials.gov NCT02323087.     

Face-name memory in Alzheimer's disease

Alzheimer's disease (AD) affects face-name memory, the ability to recognize faces and recall names. Remembering face and name requires a sophisticated cognitive process because of the complexity and similarity among faces and also because of their arbitrary association with names. Assessments of face-name memory can measure episodic and semantic memory performance and are useful for early detection of AD. Improving face-name memory is possible through cognitive interventions targeted to promote procedural memory, which is often preserved until the late stage of AD. This article describes a conceptual model, assessment tools, and strategies for improving face-name memory in persons with AD.     

The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities

OBJECTIVE: To examine the relation between therapy intensity, including physical therapy (PT), occupational therapy (OT), and speech and language therapy (SLT), provided in a skilled nursing facility (SNF) setting and patients' outcomes as measured by length of stay (LOS) and stage of functional independence as measured by the FIM instrument. DESIGN: A retrospective analysis of secondary data from an administrative dataset compiled and owned by SeniorMetrix Inc. SETTING: Seventy SNFs under contract with SeniorMetrix health plan clients. PARTICIPANTS: Patients with stroke, orthopedic conditions, and cardiovascular and pulmonary conditions (N=4988) covered by Medicare+Choice plans, and admitted to an SNF in 2002. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: LOS and improvement in stage of independence in the mobility, activities of daily living (ADLs), and executive control domains of function as determined by the FIM instrument. RESULTS: Higher therapy intensity was associated with shorter LOS ( P <.05). Higher PT and OT intensities were associated with greater odds of improving by at least 1 stage in mobility and ADL functional independence across each condition ( P <.05). The OT intensity was associated with an improved executive control stage for patients with stroke, and PT and OT intensities were associated with improved executive control stage for patients with cardiovascular and pulmonary conditions ( P <.05). The SLT intensity was associated with improved motor and executive control functional stages for patients with stroke ( P <.05). Therapy intensities accounted for small proportions of model variances in all outcomes. CONCLUSIONS: Higher therapy intensity was associated with better outcomes as they relate to LOS and functional improvement for patients who have stroke, orthopedic conditions, and cardiovascular and pulmonary conditions and are receiving rehabilitation in the SNF setting.