Prostheses,Equipment, Adapted Performance

As a member of the rehabilitation team with direct responsibility for a treatment program for the person with amputation(s), the occupational therapist has marked influence on the patient's adjustment to his disability. In addition, the occupational therapist can influence a patient's choices regarding use of adaptations or substitutions achieved by prostheses, equipment or body motion alone. The author, working in a comprehensive rehabilitation center, The Kessler Institute for Rehabilitation, where many amputees of all stages are treated, will outline basic principles in treatment planning for the person with amputation(s). In addition, treatment choices will be examined with the discussion focusing on different levels of amputations, and differing physical and psychological needs of the adult and child. Suggestions are offered for approaches to using protheses, equipment, or adapted performance in training persons with amputations. The author also explores why rejection of an upper limb prosthesis or equipment might not signify treatment failure. Therapists have responsibility for introducing all options for daily function to the patient and family as part of the occupational therapy treatment program, but must remember that final decisions are made by patients.     

Pre and Post Operative Occupational Therapy for a Toe to Hand Transplantation

Thumb loss is a significant disability for the hand. This paper describes a traumatic thumb injury and amputation after which the occupational therapist placed an orthotic device to substitute for the thumb. When the patient was undecided about a proposed toe-to-hand transplant, the occupational therapist fabricated a mold of the toe, and attached it to the patient's hand. After training with the mold, the patient was ready to accept the toe-to-hand transplant. The post transplant occupational therapy program and patient's return to work was described.     

The Schultz Structured Interview for Assessing Upper Extremity Pain

Trauma and disease processes in the upper extremity frequently cause pain as well as impairment in movement, strength and in function. While perception of pain occurs normally in response to bodily insult, prolonged or severe pain may interfere with attempts to maximize physical function and the return the involved person to optimal occupational role. Whether participating as a member on a medical or vocational rehabilitation team, the occupational therapist must adequately assess the area, nature and behavior of pain prior to providing appropriate intervention and recommendations to other team members. A structured interview to assess pain furnishes the therapist with a format for evaluation that is thorough and methodical. The structure and process of the interview allows the therapist to collect subjective information which can be coupled with objective findings from standard upper extremity evaluation and/or observation of task performance. Data gathered will assist the therapist in discovering the etiology of pain, in evaluating the appropriateness of complaints as they relate to pathology and in making appropriate recommendations about the patient's future work roles.     

The importance of inner transformation in the activity process

The importance of the inner world of the patients in occupational therapy has not been studied in recent occupational therapy literature. The activity process in this paper is seen as a complex mixture of internal and external transformations which occur as part of the patient's relationship with the therapist. Pertinent psychoanalytic theories are reviewed and their usefulness to occupational therapy is described. Specific sequences of therapy sessions in two case examples are presented to illustrate the dynamics of the relationship of patient, therapist and activity, and to start to identify inner transformations during activity participation. The authors consider basic research on the meaning of activity as a fundamental part of the profession.     

The quality of occupational therapy evaluated in six outpatients

The purpose of the study was to analyse the content and evaluate the quality of clinical occupational therapy in outpatients as reported by their respective therapists. An inductive and interpretive technique with special study protocols was developed in Sweden for the study of six patients. Each therapist kept a protocol of the patient's 2–3 months' participation in occupational therapy. The protocols were subsequently interpreted independently by another occupational therapist and a physician. At the end of the study, function and ability had improved in four cases and quality of life in five out of six cases as demonstrated by their ability in activities of daily living.     

Vulnerable,but strong: The spinal cord-injured patient during rehabilitation

A traumatic spinal cord injury affects the body to an extent that the patient requires the assistance of others to survive and recover. The rehabilitation phase puts the patient in a vulnerable position and involves a considerable amount of strength on the patient''s part. The aim of this paper is to explore the vulnerability of the spinal cord patient and how this vulnerability connects to the necessary strength, as the patient struggles to survive the injury and get through the rehabilitation.The circumstances of 12 traumatic spinal cord-injured patients were observed in the rehabilitation unit and after discharge.A phenomenological–hermeneutic narrative approach applying Ricoeur''s theory was used. Data were collected by field observation and interviews during the first 2 years after the spinal cord injury.The patient''s strength during the rehabilitation was portrayed by their endurance and from their narratives of how they handled difficult situations. The patient''s perception of vulnerability varied, and strength was mobilised as a response to the vulnerability to overcome the imbalance between demands and resources. Vulnerability should therefore refer to a person''s experience of the situation rather than the person, as it may hinder the professionals'' open, explorative approach towards the person.     

LIVING WITH DEMENTIA

Dementia is an illness profoundly affecting the patient's physical and emotional well-being. The impact of the disease extends far beyond the patient himself, touching each family member involved in the patient's care. Social workers and other mental health professionals can offer valuable assistance to the family as they experience each stage of the patient's illness. Several theoretical constructs aid in understanding the grieving process of the family. Clinical case examples are used to highlight individual and group therapeutic interventions.     

Occupational Therapy with Children: Understanding Children's Occupations and Enabling Participation

When the occupational therapist meets the patient or client consumer of rehabilitation services, a therapeutic relationship is begun between persons who may have varying developmental backgrounds, value perspectives, social and physical environmental experiences, cultural ties, and lifestyle patterns. In order to develop significant evaluation and treatment strategies appropriate to the personal context of the consumer's life experience, it is the responslbility of the therapist to develop an understanding of the consumer's perspective. The following discussion describes a qualitative research project designed to explore the relationships of work, play, balance, and health in the life continuum of a 38-year-old woman who'suffered severe trauma at the age of 17 and regained control of her life through the development of a pattern of personal responsibility for her health. The study is discussed with regard to project procedures using tape-recorded interviews, outcomes, and applications to academic and clinical education.     

An Occupational Therapy Program for Patients With Swallowing Dysfunction Following Cancer Treatment

Eating, the intimate activity of daily living, carries with it many emotional, social and physical implications. Medical treatment of patients with cancers of the head and neck is frequently radical and almost certainly impacts on the patient's ability to eat. This paper outlines an occupational therapy program for patients with swallowing dysfunction following treatment for cancers of the head and neck. Discussed in this paper are the medical treatments particular to cancer treatment that directly affect swallowing function, along with evaluation and treatment by the occupational therapist. The paper concludes with a case study.     

社区脑卒中分级康复准入准出标准研究

摘 要 目的 构建上海市脑卒中分级康复准入准出标准,以指导社区脑卒中各级康复的有序开展。方法 于2018年8月通过小组会议筛选出脑卒中康复评价指标体系;于2018年10月—2019年5月通过对10位康复医院康复专家、社区卫生服务中心康复医师、家庭医生代表等的咨询,获得分级康复准入准出标准。结果 脑卒中分级康复包括康复医院、社区病房、社区门诊和居家病床4个康复等级,各级康复准入准出标准依据运动能力、失语症、吞咽功能障碍、家庭经济条件和患者自愿等设定。结论 脑卒中各级康复的重点是运动功能康复,患者选择哪级康复主要受患者自愿和家庭经济条件影响。     

The Home Visit

The home visit has become a integral part of treatment programs for a large number of patients at the Spaulding Rehabilitation Hospital. It is especially useful for elderly patients, who represent a considerable share of the caseload, and has proven to be most beneficial for those individuals who are returning home to live alone or be alone part of the day. At Spaulding the hyome visit is most often conducted by an occupational and physical therapist team who follow a specific evaluation protocol examining the patient's home environment vis-à-vis anticipated functional status at discharge. Recommendations and suggestions for both use patterns and possible structural changes follow. In order to both evaluate the process and the results of home visits a chart audit was conducted from which various ways have been discovered to improve the value of this treatment activity and thereby enhance a patient's quality of life after discharge.     

The impact of therapist gender on the treatment of bulimic women

A number of recent therapists and researchers have shown that the gender of the therapist can have a substantial effect on treatment. This is especially true in treating eating disorders, which involve many gender-related issues (such as body appearance and gender identity) and occur in primarily one sex (females). Here we discuss four areas in which transference and countertransference issues are greatly influenced, depending upon whether the therapist is male or female: (1) problems of body image; (2) the patient's overinvolvement with her mother; (3) the patient's ambivalence about gender identity; and (4) her need for a role model. The ways in which a female and male therapist work differently in these four areas are illustrated by two clinical vignettes with female bulimic patients.     

How do patients and health professionals perceive the role of family members in the decision-making process regarding the choice of a dialysis method? A qualitative study

BackgroundTherapeutic decisions often seem to be the product of interaction between health professionals and patients alone. However, some realities make it essential to consider family members when examining care of patients, especially in the construction of therapeutic choices. Implementation of measures such as therapeutic patient education to make the patient an actor in his own healthcare, and the impact of disease on the patient's social and professional activities mean there is an important place for family members in a patient's care pathway. This study aims to examine the role of family members and the family environment in decision-making on treatment for patients with chronic kidney disease. It also analyzes how they contribute to the construction of patients’ choices on dialysis methods through their involvement in a therapeutic patient education program.MethodsThis study involved thirty-six semi-structured interviews: sixteen with patients and twenty with health professionals. Therapeutic patient education sessions, interactions and information exchanges between patients and health professionals, as well as participant behaviours, were also observed. Analysis was thematic.ResultsResults indicate that the factors influencing the patient's choice of dialysis methods include the family environment as the place where the disease is experienced, the need to maintain family ties, the advice provided by family members and their active participation in therapeutic patient education sessions and partnership between family members and health professionals in the decision-making process.ConclusionThis study highlights the reality of decision-making processes that can start from a non-hospital setting. Furthermore, it argues for greater consideration of the needs, values, and preferences of family members in mechanisms designed to promote patient participation in therapeutic decisions.     

Learning to Manage a Patient's Erotic Feelings in Psychotherapy

Abstract

Beginning therapists are often ill-prepared when faced with sexual and loving feelings in their work with patients. Using psychody-namic theory as a basis, erotic feelings between therapist and patient are discussed not as obstacles to treatment, but as valuable opportunities to better understand a patient's dynamics, the therapeutic relationship, and the treatment process. Sexual feelings of patient toward therapist are specifically addressed in context of the case example of a psychotic man. Recommendations are offered to beginning therapists for managing these feelings that are both ethically sound and therapeutically meaningful.     

Occupational Therapy Management of Tendon Transfers in Persons with Spinal Cord Injury Quadriplegia

Upper extremity surgical reconstruction can play an important role In helping the spinal cord injured quadriplegic patient achieve maximum independence in a variety of activities of daily living. The transfer of the brachioradialis to the extensor carpi radialis brevis, the brachioradialis to the flexor pollicis longus, and the posterior deltoid to the triceps each provide opportunities for functional improvement in this patient group. The occupational therapist's understanding of functional potentials and problems unique to spinal cord injury provides a realistic perspective to the team on potential benefits of each surgery. The occupational therapist also plays a critical role in identifying appropriate surgical candidates, in establishing treatment goals with the patient, and in administering a carefully planned post-operative treatment program.     

The Gardia Experience: Implications for Occupational Therapists Working with Australia's Indigenous People in the Kimberley Region

Working with Australia's indigenous people as an occupational therapist requires an understanding of Aboriginal culture. Non-Aboriginal (gardia) therapists, in the Kimberley region of Western Australia, have been challenged to revise their use of conventional therapy to work effectively with their traditional Aboriginal clients. Some of the cultural aspects which impact on the therapists' work include language differences, explanations of illness and death, complex laws governing family relationships, and attitudes to ageing and disabilities.     

The Forensic Model of Occupational Therapy

In the past decade attorneys have increasingly sought the services of occupational therapists to serve as experts in legal and quasi-legal personal injury proceedings. This emerging specialty area of forensic practice is rapidly developing. The unique qualifications of the therapist enables him to assess and document functional assets and deficits of the individual and relate them to daily life tasks. This ability makes the occupational therapist an important expert on the forensic panel. The therapist provides reports and information to persons who are responsible for applying the law, but who are without medical backgrounds and therefore do not understand the problems or lack of problems which an injured person has in meeting the physical demands of work and daily life. Common proceedings in which the occupational therapist's expertise is called for include Social Security disability and Workman's Compensation hearings and personal injury litigation. The complementary group of forensic experts, of which the occupational therapist is one, frequently consists of physician, psychologist, vocational expert and economist. Information is provided through verbal and written reports as well as through testimony.     

The Occupational Therapist's Role in Employee Health Promotion Programs

The first challenge in developing an effective health promotion program for employees is the performance of a health needs assessment on the target population. In an effort to meet this challenge, 600 corporate employees were surveyed and compared with respect to the allotment of time to work, leisure, and self/family care activities; health risk factors; perceived health; and activity satisfaction. The results of the study indicated that the employees participating in the corporate health and fitness programs were not the high risk individuals who consume the majority of the corporate medical dollar. The role of the occupational therapist in meeting the needs of high risk employees is discussed. A brief review of the literature addresses research efforts in the area of health promotion in industry and the role of the occupational therapist in disease prevention. The appropriateness of occupational therapy education, training and theory in relation to health promotion programs and the utilization of the five occupational performance components in the evaluation of employee populations is outlined. Finally, the role of the occupational therapist working in specific areas of health promotion is reviewed, including: back pain reduction, substance abuse treatment, cardiac fitness/rehabilitation and hypertension control, smoking cessation, weight reduction, stress management, industrial accident and injury prevention, and self-responsibility for health instruction.     

Pilot study of the inpatient rehabilitation – scales of therapeutic occupation

The IR – SOTO is a self-help instrument that assists the occupational therapist in evaluating the adherence of an inpatient rehabilitation facility to an occupational approach to therapy. The IR – SOTO focuses on individualization of therapy, holism, naturalistic occupations, documentation of occupation and communication of occupational therapy principles. A series of practitioner panels provided feedback on the content validity of early versions of the instrument. Pilot testing of the revised instrument (a 62-item survey using seven-point Likert scales) was carried out using a mailed survey (n = 138) to nine inpatient rehabilitation facilities in different areas of the United States. The pilot version of the IR–SOTO was internally consistent, with alpha = 0.91. The overall mean score across items and across subjects of 5.48 on a seven-point scale (sd = 0.52) indicates some adherence to an occupational approach to therapy. The scores of one facility were significantly lower than five of the other facilities. Continued revision of the instrument to enhance reliability and validity is recommended, with testing of test–retest reliability as a priority. The IR–SOTO holds promise for measuring a facility's approach to the use of occupation as therapy in inpatient rehabilitation. Copyright © 1998 Whurr Publishers Ltd.