Client-Centred Occupational Therapy for Persons with Mental Retardation: Implementation of an Intervention Programme in Activities of Daily Living Tasks

The aim of this study was to implement a single-case design to evaluate the outcomes of a specified occupational therapy intervention programme. The intervention programme was based on a client-centred top-down approach and followed the Occupational Therapy Intervention Process Model. The interventions included both restorative and adaptive strategies to improve performance of the activities of daily living (ADL) tasks the participants defined as relevant and meaningful. Three women with moderate mental retardation living alone in apartments with support from professionals were included in the study. The Assessment of Motor and Process Skills was used to evaluate for changes in ADL motor and ADL process ability. The Assessment of Awareness of Disability was used to evaluate changes in the client's awareness of disability. The results showed improvements for all participants but patterns of changes were different between the participants and the outcome variables. ADL process ability was the only outcome variable that improved in all participants. The results are discussed in relation to the design used for evaluating intervention efficacy. Future improvements in the process of evaluating occupational therapy interventions are suggested.     

Assessment of Functional Ability of People with Alzheimer's Disease

The aim of this study was to examine the sensitivity of the Assessment of Motor and Process Skills (AMPS) in discriminating between independent people, those with dementia of the Alzheimer's type (DAT) requiring minimal assistance to live in the community (DAT-min) and those with DAT requiring moderate to maximal assistance (DAT-mod). The subjects comprised 329 non-disabled older adults, 167 people with DAT-min and 292 with DAT-mod. The AMPS was used to measure the subjects' ADL motor and ADL process abilities. Significant main effects were seen for ADL motor and ADL process abilities. All three groups differed significantly in both motor and process mean ability measures and the proportion of people with DAT with ability measures below AMPS cut-off measures increased significantly as the functional level decreased. The ADL process scale was a more discriminative measure of ability to function in the community than was the ADL motor scale.     

Effects of occupational therapy intervention on activities of daily living and awareness of disability in persons with intellectual disabilities

Aim:  The purpose of this study was to evaluate the effects of an occupational therapy intervention program on activities of daily living (ADL) ability and awareness of disability.
Methods:  Six persons with intellectual disabilities participated in the study, which was based on a single-case design. Assessment of Motor and Process Skills and Assessment of Awareness of Disability were used as evaluation tools.
Results:  Activities of daily living performance improved in five of the six participants after implementation of the program, with improvement across both motor and process skills. However, no clear improvement in awareness of disability was found following implementation of the program.
Conclusion:  It may be concluded from this study that persons with intellectual disabilities can benefit from occupational therapy interventions to improve ADL ability, even in the absence of any change in their awareness of disability.     

Occupational Performance of Persons Who Have Suffered a Stroke: a Follow-up Study

The main purpose of this study was to describe the progress made in terms of occupational performance during a two-year period by persons who had suffered a stroke and had been discharged to their home after their initial hospital stay. The population of the study consisted of 49 persons, 30 men and 19 women, with a mean age of 69 years. The Assessment of Motor and Process Skills (AMPS) was used to assess their occupational performance. Of the whole population at discharge, 66% showed increased effort and 29% showed decreased efficiency and independency. The results also showed that the persons who had decreased the most in their efficiency dropped out from the study. Twenty-nine persons participated in the study for 2 years. The best ADL ability was seen in the population at 3 months after discharge. A decrease was seen at 18 months after discharge in AMPS ADL process ability and at 24 months in AMPS ADL motor ability. The results suggest that persons who have suffered a stroke and live in their homes maintain their AMPS ADL ability performance for 1.5 to 2 years. A low AMPS ADL process ability measure in persons who have suffered a stroke signifies a reduced possibility of living at home.     

Ability in daily activities after early supported discharge models of stroke rehabilitation

More knowledge is needed about how different rehabilitation models in the municipality influence stroke survivors’ ability in activities of daily living (ADL). Objectives: To compare three models of outpatient rehabilitation; early supported discharge (ESD) in a day unit, ESD at home and traditional treatment in the municipality (control group), regarding change in ADL ability during the first three months after stroke. Methods: A group comparison study was designed within a randomized controlled trial. Included participants were tested with the Assessment of Motor and Process Skills (AMPS) at baseline and discharged directly home. Primary and secondary outcomes were the AMPS and the modified Rankin Scale (mRS). Results and conclusions: Included were 154 participants (57% men, median age 73 years), and 103 participants completed the study. There were no significant group differences in pre–post changed ADL ability measured by the AMPS. To find the best rehabilitation model to improve the quality of stroke survivors’ motor and process skills needs further research. Patients participating in the ESD rehabilitation models were, compared with traditional treatment, significantly associated with improved ADL ability measured by the mRS when controlling for confounding factors, indicating that patients with social needs and physical impairment after stroke may benefit from ESD rehabilitation models.     

Utilizing AMPS ability measures to predict level of community dependence

The aim of the study was to examine the efficacy of utilizing Assessment of Motor and Process Skills (AMPS) ability measures as evidence for determining level of community dependence. The sample for the study was drawn from existing data from the AMPS International Project database, and consisted of adults from numerous world regions, with varying diagnoses and levels of ability (n=64,466). Findings support using ADL motor and process ability measures as evidence of a client's level of community dependence. When using ADL motor or process ability measures to identify the need for moderate to maximal assistance, the areas under the ROC curves were 0.74 (fair discrimination power) and 0.82 (good discrimination power), respectively. New ADL motor and process cutoff measures demarcating maximum assistance were set at 1.00 logit (sensitivity=0.70, specificity=0.66) and 0.70 logit (sensitivity=0.79, specificity=0.69), respectively. While ADL process ability continues to be the better predictor, the highest accuracy estimates occurred when motor and process decisions matched (n=30,835). For the first time, multiple AMPS cutoff measures, demarcating independent in the community and in need of maximal assistance, have been proposed.     

The Assessment of Motor and Process Skills as a measure of ADL ability in schizophrenia

Background: Functional impairments in schizophrenia are substantial, complex, and persistent. Objective measurement of ADL ability, functional capacity and performance is needed for effective intervention planning and outcome evaluation. Objective: To evaluate ADL ability in people with schizophrenia using the Assessment of Motor and Process Skills (AMPS) and to determine the utility of using the AMPS to predict levels of assistance required for successful community living. Method: In a retrospective audit, AMPS ADL measures of a consecutive sample of 64 people with schizophrenia admitted to a mental health facility were compared with normative data and with recommended “cut-off” measures for competency to live independently in the community. Results: Substantial difficulties were measured in both ADL motor (mean z = –1.5) and ADL process ability (mean z = –2.1). AMPS ability measures did not predict problems with independent living for 62.5% of the patients. Conclusion: People with schizophrenia admitted to an inpatient rehabilitation facility experienced significant difficulty performing ADL tasks. AMPS is a useful measure of ADL ability but should be used in conjunction with measures of functional performance in order to plan interventions and supports for people with schizophrenia that reflect the complexity of factors affecting community functioning.     

Test–retest reproducibility of the Assessment of Motor and Process Skills for school-aged children with acquired brain injuries

Background Persistent impairments resulting from childhood acquired brain injury (ABI) can impact performance of activities of daily living (ADL). Objective and reliable measures of ADL skills are required for treatment planning and research. Aim To evaluate test–retest reproducibility of the Assessment of Motor and Process Skills (AMPS) for children with ABI. Methods Twenty-eight children with ABI (mean age 11 years 7 months, SD 2 years 4 months; males?=?11) were recruited. Two AMPS tasks were performed over two consecutive days, as per standardized AMPS procedures. Intraclass correlation coefficients (ICC; 2,1), standard error of measurement (SEM), smallest detectable difference (SDD), and 95% limits of agreement (Bland–Altman) were calculated. Results Test–retest reliability was fair to good for AMPS ADL motor (ICC 0.55) and ADL process (ICC 0.58) measures. The SEM was 0.36 and 0.34 logits for AMPS ADL motor and ADL process measures respectively. The SDD was 1.0 (motor) and 0.93 logits (process) measures. A learning effect was evident. Conclusion Test–retest reproducibility of the AMPS was fair to good for children with ABI, which is poorer than previously published data. Administration of the AMPS in an unfamiliar environment, fatigue, and the small time interval between testing sessions may have contributed to poorer results. The AMPS remains a useful measure of ADL, contributing to our understanding of task execution processes.     

Adaptation and Ability in Daily Occupations in People with Poliomyelitis Sequelae

The aims of these studies were to explore the adaptive process from an occupational perspective by revealing strategies used to manage daily occupations, to examine factors influencing the development of strategies, to investigate ability and perceived difficulty in ADL, use of assistive devices and to investigate the prevalence of distress in aspects of perceived health. Methods. Both qualitative and quantitative analyses were used. The adaptive process was explored by tape-recorded interviews, observations in the subjects' own homes and analysis according to grounded theory. Structured interviews regarding demographic data, use of assistive devices and housing adaptations were also included. Assessments used in the studies were: the NRH postpolio limb classification for the progress and degree of polio; the staircase of ADL (an extension of Katz' index) supplemented with self-ratings of perceived difficulty; walking speed for 30 m indoors and the Nottingham Health Profile (NHP). Subjects. In the qualitative analysis, 22 persons were selected according to theoretical sampling from a longitudinal study of volunteers with poliomyelitis sequelae. In the quantitative analysis, 133 participants with polio were obtained from a consecutive clinical group. Results. Six broad groups of strategies were used to keep some kind of balance among goals, abilities and environmental demands in daily occupations. One group of strategies was emotion-focused, while five groups were problem-focused: utilising physical capability, promoting concrete problem-solving, altering the pattern of occupations, influencing relations and facilitating future activities. The examination of factors influencing the development and choice of everyday life strategies resulted in identification of the concept conception of occupational self, which comprised the participant's body image, sense of competence, values and goals in interaction with the environment. Coming to a new approach towards the shift in one's capabilities revealed two integrated processes: one dealing with the process of realisation and reorganisation, the other six patterns of behaviour in daily occupations. The participants had a high degree of independence in personal ADL, whereas more than 50% were dependent in cleaning, shopping and transportation. However, a great number of independent persons reported difficulties in some activities. Most distress was found in the dimensions of physical mobility, pain and energy according to NHP and most health-related problems were reported in housework, employment and leisure. Fifty-nine percent of the participants were in gainful employment. Conclusions. The results showed that the persons with poliomyelitis sequelae tried to maintain their independence despite perceived difficulties in ADL and might be reluctant to use assistive devices. Signs of overload indicate that balance among goals, abilities and environmental demands might be difficult to achieve. Flexibility in the use of strategies facilitated participation in daily occupations. Requirements for this adaptive pattern seemed to be time to realise and modify behaviour; energy and ability to solve problems; access to information and support and being ready to compensate with assistive devices. The results suggest that late effects of polio interfere with many areas of daily activities and that there is a need for multidisciplinary support.     

针灸结合运动再学习训练对中风偏瘫患者的日常生活活动和步行能力的影响

目的探讨针灸运动再学习训练对脑梗死中风偏瘫患者的日常生活活动(ADL)能力和步行能力的临床疗效。方法将80例脑中风偏瘫患者随机分为两组,治疗组40例,采用针灸加运动再学习治疗;对照组40例,采用常规康复治疗。两组患者分别在治疗前和治疗6周后采用Barthel指数量表(BI)测评ADL,Fugl-Meyer下肢运动功能评分(FMA)和步行分级(FAC)评测步行能力。结果治疗组患者的BI、FMA积分、步行分级(FAC)均明显优于对照组,差异有显著性(P<0.01)。结论针灸结合运动再学习训练对脑梗死偏瘫患者的ADL能力、步行能力有明显改善,可显著提高脑梗死患者的临床疗效,降低致残率。     

针灸结合运动再学习训练对中风偏瘫患者的日常生活活动和步行能力的影响

目的探讨针灸运动再学习训练对脑梗死中风偏瘫患者的日常生活活动（ADL）能力和步行能力的临床疗效。方法将80例脑中风偏瘫患者随机分为两组,治疗组40例,采用针灸加运动再学习治疗;对照组40例,采用常规康复治疗。两组患者分别在治疗前和治疗6周后采用Barthel指数量表（BI）测评ADL,Fugl—Meyer下肢运动功能评分（FMA）和步行分级（FAC）评测步行能力。结果治疗组患者的BI、FMA积分、步行分级（FAC）均明显优于对照组,差异有显著性（P〈0．01）。结论针灸结合运动再学习训练对脑梗死偏瘫患者的ADL能力、步行能力有明显改善,可显著提高脑梗死患者的临床疗效,降低致残率。     

2011年济宁市城区部分老年人日常生活活动能力评价

[目的]了解济宁市老年人基本日常生活活动能力和工具性日常生活活动能力,为社区及乡镇卫生服务机构有效开展老年卫生服务和健康维护提供参考。[方法]2011年3～4月,采用多阶段随机抽样方法,在济宁市城区抽取≥65岁常住户口的老年504人应用Katz日常生活活动量表(Katz-ADL)和工具性日常生活活动量表(Lawton-IADL)进行调查。[结果]测评人504人,Katz-ADL得分为5.66±0.91分。6项功能均保持的占80.95%,6项功能均丧失的占0.79%。6项功能均保持者所占比例,男性为86.67%,女性为74.36%(P<0.01)。测试的504人中,Lawton-IADL得分:男性为3.72±1.59分,女性为5.06±2.83分。其中,男女相同的5项功能均保持者所占比例为33.53%,男性为44.08%,女性为21.37%(P<0.01);5项功能均丧失者所占比例为11.31%,男性为7.78%,女性为15.38%(P<0.01)。[结论]济宁市城区老年人日常生活活动能力和工具使用生活能力较高,多项生活活动能力保持率男性高于女性。     

Relationship between Nutritional Status,Body Composition,Muscle Strength,and Functional Recovery in Patients with Proximal Femur Fracture

Sarcopenia is a major issue among the elderly. However, the effects of nutritional status and body composition on functional recovery in patients with proximal femur fractures (PFF) remain unclear. Hence, this study aimed to investigate the effects of nutritional status, body composition (skeletal muscle mass and muscle quality measured by phase angle [PhA] values), and muscle strength on the improvement in activities of daily living (ADL) in patients with PFF. We enrolled patients with PFF admitted to a rehabilitation unit. Nutritional status, body composition, grip strength, and motor Functional Independence Measure (FIM) score were assessed on admission day and at 4 weeks thereafter. Of 148 patients, 84 had femoral neck fractures, and 64 had trochanteric fractures. The mean motor FIM score was 49.2 points at admission and 64.9 points after 4 weeks. In multivariate analysis, higher geriatric nutritional risk index and PhA measured by anthropometry were associated with a significantly higher FIM score after 4 weeks. Muscle strength and quality changes significantly correlated with ADL improvement. Poor nutritional status and decreased muscle strength and quality interfered with ADL recovery. Nutritional management before injury and from the acute phase, and rehabilitation to maintain skeletal muscle status, are important for ADL recovery.     

Functional decline and nutritional status in a hospitalized geriatric population: sequential study

We analyzed the relations between nutritional status and several measures of the ability to perform the normal activities of daily living (ADL) in a long-term institutionalized geriatric population and also studied whether changes in this ability, as found ten months later, were associated with changes in the nutritional status. Nutritional status was assessed using objective anthropometric measurements (triceps skinfold, mid upper-arm circumference, midarm muscle area [AMA], midarm fat area [AFA]) and subjective clinical features (temporal muscle atrophy [TMA] and Bichat's fat atrophy [BFA]). The capacity to perform ADL was analyzed considering ability to eat and to walk, dental status, and mental performance status. Patients with total absence or loss of more than 50% of the teeth showed less AMA and AFA and greater degrees of TMA and BFA; the same happened with regard to deterioration of mental performance status. Those patients fed through a nasogastric tube showed less AFA and serum albumin and also a greater degree of TMA and BFA. Patients unable to walk without aid showed less AMA and AFA. Patients whose capacity to walk improved or whose mental performance status ameliorated showed an increase of their AMA, whereas AFA slightly decreased in those patients whose abilities to eat and to walk deteriorated. Long-term hospitalization in our center led to improvement and to deterioration of ADL in approximately the same number of patients, and similar changes were seen in the nutritional measures.     

Constructions of masculinity following prostatectomy-induced impotence

Large numbers of Australian men are diagnosed and treated for prostate cancer each year. The incidence is exceeding mortality, and men are living longer with prostate cancer and the common treatment[s] side effect of impotence. Despite these epidemiological trends there is little research about men's experiences of impotence following treatment. An ethnographic study of Anglo-Australian men with localized prostate cancer explored participants' experiences of impotence following prostatectomy. In-depth semi-structured interviews with 15 men were analyzed using a social constructionist gendered framework. In particular, the effect of impotence on participants' masculinity, sexuality and intimate relationships was explored. The findings show that participants rationalized forgoing potency prior to surgery as a way of living longer. However, diverse complex reactions accompanied impotence. Whilst most participants redefined masculine ideals of phallocentric sex, the way in which this occurred varied greatly. The findings disrupt essentialist constructions of male sexuality and impotence, and provide valuable insight for clinical practice.     

高血压自我管理方法(高血压俱乐部)初探

[目的 ]　了解高血压自我管理健康教育课程的近期效果 ,预试验慢性病自我管理方法在上海的可行性。 [方法 ]　在某社区成立一个高血压自我管理小组 ,由 2名小组长按照指导手册指导组员一起学习高血压自我管理。每月活动一次 ,每次 1.5小时。采用定性、定量研究方法综合评价其 6个月后的近期效果 ,并收集参与者对该课程的看法、意见、建议。 [结果 ]　高血压自我管理近期效果明显 ,提高了参加者自我管理高血压的技能、信心 ,高血压管理和控制情况得到了改善。用非药物措施控制血压的比例增加了 10 %～ 40 % ,6个月后 ,收缩压平均降低了 15mmHg ,舒张压平均降低了 8mmHg。[结论 ]　慢性病自我管理方法在上海社区完全可行 ;该种病人教育形式适合我国的文化传统。     

云南傣族生活习惯对饮水砷健康危害的影响

目的了解云南傣族人喝生水、吃生菜、生肉对砷健康危害保护作用的原理,为地砷病的防治提供理论依据。方法采用定性到定量的研究方法:将高砷饮水健康危害影响的多因素条件logisitic回归分析研究中发现的2个保护因素:喝生水、吃生菜做实验室定量检测分析。结果经加热后,水、蔬菜、肉中的砷含量增加,并且随着加热时间的增加,砷含量也在增加,用砷含量高的水煮沸后的蔬菜、肉,砷含量增加的速度更快。结论傣族喝生水、吃生菜、生肉的生活习惯,对砷的机体损伤的保护作用,是因为生水、生菜、生肉中的砷含量低,从而减少了砷的摄入量。因此,在其他高砷地区,如不能及时改水,采取减少加热时间,提倡急火快炒的烹调方法,可能是一条经济实惠的地砷病防治措施;我国现行的水砷标准被修订为0.01 mg/L是科学合理的。