Association of Driving Fitness and Driving Efficacy in the Elderly with Generalized Anxiety Disorder.

Purpose: The purpose of this study was to investigate the relationship between driving fitness and driving efficacy in elderly patients with generalized anxiety disorder and identify factors influencing anxiety. Methods: The anxiety level, driving efficacy, and driving performance were assessed for 45 elderly drivers who had been diagnosed with or were suspected of having an anxiety disorder in the past. The Korean-Self-rating Anxiety Scale (K-SAS), Korean-Adelaide Driving Self-Efficacy Scale (K-ADSES), and Korean-Drivers 65 Plus (K-D65+) were used as test tools. Factors affecting anxiety and the differences between the groups with high anxiety symptoms and anxiety in the normal range were analyzed. Results: There were differences in driving efficiency and driving performance between elderly drivers with anxiety scores in the normal range and those with mild-to-moderate anxiety (p < 0.05). Significant factors (p < 0.001) influencing driving anxiety in the high anxiety group were GAD duration (ß = 0.170), driving difficulty (ß = 10.648), drug use (ß = 0.656), traffic sign/signal awareness (ß = -0.870). Conclusion: Our results suggest that a combination of a driving rehabilitation approach and interventions that can provide emotional support and reduce mental health anxiety, as well as exposure treatment for driving performance training, may be necessary for driving rehabilitation of the elderly with generalized anxiety disorder.

Development of a Web-Based Mini-Driving Scene Screening Test (MDSST) for Clinical Practice in Driving Rehabilitation.

(1) Background: For the elderly and disabled, self-driving is very important for social participation. An understanding of changing driving conditions is essential in order to drive safely. This study aimed to develop a web-based Korean Mini-Driving Scene Screening Test (MDSST) and to verify its reliability and validity for clinical application. (2) Methods: We developed a web-based MDSST, and its content validity was verified by an expert group. The tests were conducted with 102 elderly drivers to verify the internal consistency and reliability of items, and the validity of convergence with the existing Korean-Safe Driving Behavior Measure (K-SDBM) and the Korean-Adelaide Driving Self-Efficacy Scale (K-ADSES) driving tests was also verified. The test-retest reliability was verified using 54 individuals who participated in the initial test. (3) Results: The average content validity index of MDSST was 0.90, and the average internal consistency of all items was 0.822, indicating high content validity and internal consistency. The exploratory factor analysis for construct validity, the KOM value of the data, was 0.658, and Bartlett's sphericity test also showed a strongly significant result. The four factors were road traffic and signal perception, situation understanding, risk factor recognition, and situation prediction. The explanatory power was reliable at 61.27%. For the convergence validation, MDSST and K-SDBM showed r = 0.435 and K-ADSES showed r = 0.346, showing a moderate correlation. In the evaluation-reevaluation reliability verification, the reliability increased to r = 0.952. (4) Conclusions: The web-based MDSST test developed in this study is a useful tool for detecting and understanding real-world driving situations faced by elderly drivers. It is hoped that the MDSST test can be applied more widely as a driving ability test that can be used in the clinical field of driving rehabilitation.

Role Value, Occupational Balance, and Quality of Life: A Cross-Sectional Study on Exploring the Urban Older People Perspective in South Korea.

The purpose of this study was to investigate the role value, occupational balance, and quality of life among urban older adults in South Korea. We recruited 90 urban older adults in Seoul, Gyeonggi-do and Chungcheong-do. Assessments used (1) Role Checklist, (2) Life Balance Inventory (LBI), and (3) WHO Quality of Life Scale abbreviated version (WHOQOL-BREF). Our results showed that the roles that were perceived as very valuable were as family members, housekeepers, and guardians (in descending order). The roles that were perceived as less valuable were students, volunteers, and organizational members (in descending order). The activities that individuals were actively pursuing were hygiene management, rest, and healthy eating (in descending order). By contrast, the activities that were not being actively pursued were composing (music, poetry), preparing for event planning, dancing, yoga, and taekwondo. The total score of the Role Checklist and WHOQOL-BREF total (r = 0.343, p < 0.01), K-LBI total and WHOQOL-BREF total (r = 0.386, p < 0.01), and role value total and K-LBI (r = 323, p < 0.01) showed a statistically significant correlation. As a result of the regression analysis, the sub-item of work balance that affected the quality of life was managing appearance (R2 = 51.7, p < 0.001). These data showed that the role of urban older adults in Korea was mainly played within the family. The level of participation was low in the areas of instrumental daily life activities, work, leisure, and social participation. We propose that this population needs to be provided with opportunities for active aging through broader professional participation.

Effects of occupational balance and client-centered occupational management in a patient with schizophrenia.

BACKGROUND: Occupational balance is an essential element for social participation and quality of life. However, it is difficult for patients with schizophrenia to participate in occupation and achieve occupational balance in daily life due to physical and mental symptoms. OBJECTIVE: This study investigated the form of time use and occupational balance in a schizophrenic patient, and examined the effect of client-centered occupation-based case management. METHODS: The research was conducted at a private center visited using one-on-one weekly client interactions for 10 weeks from September 1, 2020, and time use was analyzed using the Occupational Questionnaire (OQ) and the 2019 Life Time Survey Table of the National Statistical Office. In addition, data on work performance and satisfaction were collected using Canadian Occupational Performance Measure (COPM), and client-centered occupation-based interventions were conducted. RESULTS: As a result of identifying the balance of work of clients, 38.46% of rest and sleep during the day, 30.77% of IADL, 17.94% of Work, 10.26% of BADL, and 2.57% of leisure. Through occupation-based case management for child care and work, which are the main goals of the client, the COPM score increased on average by 2 or more points per item, showing a positive effect. CONCLUSION: In order to resolve the occupation imbalance of schizophrenic patients, it is necessary to closely understand the type of time use and actively intervene in client-centered occupation-based interventions. DATA AVAILABILITY STATEMENT: Data pertinent to this report will be made available upon reasonable request to the author.

Effects of a cognitive rehabilitation programme on cognitive function, self-management and quality of life in patients with chronic obstructive pulmonary disease.

AIM: The study purpose was to investigate effects of a cognitive rehabilitation programme on cognitive function, self-management and quality of life in patients with chronic obstructive pulmonary disease. BACKGROUND: Cognitive impairment is frequently observed in chronic obstructive pulmonary disease patients, and it interferes with many aspects of self-management, which is fundamental to disease management and quality of life. DESIGN: The design is quasi-experimental. METHODS: Data collection was performed between June 2018 and March 2019. Study participants were 60 in- or out-patients with chronic obstructive pulmonary disease. The cognitive rehabilitation programme involved six 30-min sessions administered over a period of 2 weeks and consisted of six areas: attention, memory, language, visuospatial perception, executive function and problem solving. Cognitive function, self-management and quality of life were measured at three times (preintervention and immediately and 4 weeks after intervention). RESULTS: Cognitive function, self-management and quality of life were found to be significantly improved over time after administration of the cognitive rehabilitation programme. However, no significant improvement was observed in the control group. CONCLUSIONS: Our findings support the potential usefulness of cognitive intervention to promote cognitive function, self-management ability and quality of life in patients with chronic obstructive pulmonary disease.

The Relationship between Single Task, Dual Task Performance and Impulsiveness Personality Traits of Young Adults in the Community.

(1) Background: The aim of this study was to investigate the association between single, dual task performance and impulsiveness personality traits of young adults in the community. (2) Methods: As a cross-sectional study, the Korean version of the Barratt Impulsiveness Scale-11-Revised test, which is an impulsiveness indicator test tool, was conducted on a total of 62 healthy young adults in the community. In order to assess the task performance ability, single task, motor dual task, and cognitive-motor dual task of Timed up and go (TUG) test were conducted. (3) Results: In order to identify the mean difference of the three types of TUG task performance according to the total score of impulsiveness test of all subjects, one-way ANOVA analysis was performed. As a result, there was no statistically significant difference by each task type. Upon investigating the correlation between the three subtypes (cognitive impulsiveness, motor impulsiveness, non-planned impulsiveness) of impulsiveness and total score and TUG task performance, cognitive impulsiveness and TUG-cognitive task performance showed statistically significant correlation. (4) Conclusions: There was an association with the degree of cognitive impulsiveness when performing motor task and cognitive task simultaneously.

Relationship between Basic Neurological Cognition and Social Cognition among Allen Cognitive Disability Levels of Acquired Brain Injury.

(1) Background: There are various cognitive, perceptual, and social problems associated with acquired brain injury (ABI). The Allen cognitive impairment level indicates the degree of cognitive function required for everyday activities. Until recently, there have been no studies on the relationship between basic neurological cognition and social cognitive function according to the Allen cognitive level (ACL). The aim of this study is to identify the relationship between basic neurological and social cognition among Allen cognitive disability levels of ABI. (2) Methods: Thirty-four patients with ABI were identified. Cartoon Intention Inference Task (CIIT), Social Behavior Sequence Task (SBST), Korean version Mimi-Mental Status Examination (K-MMSE), and Lowenstein Occupational Therapy Cognitive Assessment (LOTCA)-tests were administered to examine the differences in neurological and social cognitive functions according to each participant's Allen Cognitive Level Screening (ACLS). (3) Results: There were significant differences between K-MMSE, LOTCA, CIIT and SBST results among Allen cognitive levels (p < 0.05). There was a linear correlation between K-MMSE (r = 0.778, p < 0.01), LOTCA-total score (r = 0.627, p < 0.01), LOTCA-orientation (r = 0.470, p = 0.01), LOTCA-thinking operation (r = 0.341, p < 0.05), CIIT (r = 0.817, p < 0.05), and SBST (r = 0.376, p < 0.05) and ACL. Stepwise multivariate regression showed that the subscales affecting the ACLS score were SBST (ß = 0.239, p = 0.000) and K-MMSE (ß = 0.068, p = 0.001). The explanatory power of this regression equation, R2, was 0.767. (4) Conclusions: A significant difference was found in neurological and social cognitive function according to the ACL level of the ABI patient. In addition, there was a linear correlation between the ACLS scores of the ABI patients and the underlying neurological cognitive function and social cognition. The higher the overall functional cognitive level (i.e., the group with higher ACLS scores), and the lower the degree of help required in daily life, the higher both the neurological cognition level and social cognitive level were determined to be.

Driving scene-based driving errors in brain injury patients and their relevance to cognitive-perceptual function and functional activity level: A cross-sectional study.

Driving is an essential activity for community engagement in patients with brain injury. However, brain injury patients have cognitive-perceptual deficits and low independence in daily activities. The aims of this study were to identify the driving errors of brain injury patients and determine their relevance to cognitive-perception function and daily activity level. This study was conducted at a single rehabilitation hospital. Thirty-one brain injury patients were included in the study. The patients underwent a driving-scene-based simulator evaluation in the rehabilitation clinic. Driving errors were checked using automatic software. Perceptual ability was measured using Motor-free Visual Perceptual Test (MVPT) and Cognitive-perceptual Assessment for Driving (CPAD). A linear relationship was found between the driving aptitude score, steering wheel and judgment, simultaneous operation items, total score of road course test, and cognitive-perceptual functions and daily activity levels of the participants (P <.05). The general factors that affected driving errors included driving experience, age, part of the hemispheric affected, and presence of vascular injury (P <.05). In addition, the Korean version of Mini-Mental State Examination (K-MMSE) score and the CPAD score correlated with driving errors (P <.05). The total error score of the participants correlated with the Korean version of the Modified Barthel Index (K-MBI) score (P <.05).These findings suggest that driving experience and age have more influence on driving error than perceptual level due to brain damage. In addition, it was found that the basic level of daily living influences overall operating errors.

Effect of a dual-task program with different cognitive tasks applied to stroke patients: A pilot randomized controlled trial.

BACKGROUND: Dual-task training using one walking and one cognitive task is effective in improving post-stroke motor functions. OBJECTIVE: We aimed to investigate the effectiveness of dual-task training using various cognitive tasks for the assessment of attention, executive function, and motor function in stroke patients. METHODS: This was a single-center, randomized trial involving 30 stroke patients who were divided into a dual-task (test) group (n = 15) using different cognitive tests, and a conventional occupational therapy (control) group (n = 15). In both groups, interventions were conducted 18 times, at 30 minutes per session, 3 sessions per week, for 6 weeks. Primary outcome measures were the Trail Making Test A&B, the Digit Span Test (DST) Forward and Backward, and the Stroop (ST) Color and Word test. Secondary outcome measures were the Fugl-Meyer Assessment, the Modified Functional Reach Test, and the Berg Balance Scale. Each test was applied pre-and post- intervention. RESULTS: Post-intervention, the dual-task group showed a significantly stronger effect than the occupational therapy group in the DST-Forward (p = 0.04), DST-Backward (p = 0.001), ST-Color (p = 0.023), and Berg Balance Scale (p = 0.009) assessments. CONCLUSIONS: Dual-task training using various cognitive tasks had a greater positive effect than conventional occupational therapy on auditory attention, memory span, executive function, and balance.

Effects of seating education and cushion management for adaptive sitting posture in spinal cord injury: Two case reports.

RATIONALE: Pressure ulcers can frequently occur in spinal cord injured patients living in wheelchairs. Therefore, to manage the cushion in sitting posture is important for preventing ulcers. PATIENT CONCERNS: The patients visited seating clinic in rehabilitation hospital for uncomfortable sitting posture. The patients were asked for posture control and cushion air management training in a sitting posture to prevent sores. DIAGNOSIS: The diagnosis was spinal cord injury. INTERVENTIONS: Two patients with spinal cord injury were subjected to posture training while the quantity of air in the cushion was being modulated to minimize gluteal pressure by measuring the pressure in the sitting position in the driver's seat using an X-sensor. OUTCOMES: In Case 1, as a result of air control, contact area showed 1108.06 cm, average pressure 45.20 mmHg, contact area increased, and mean pressure decreased. In Case 2, the contact area 974.19 cm and the average area 41.00 mmHg were measured by applying the change to the ROHO low-Quardro type, showing a decrease in the average body pressure from the initial stage. LESSONS: From the results of this study, it was found that measurement of body pressure and posture training using a sensor that provides visual feedback is effective in preventing pressure ulcer. Therefore, it is necessary to perform routine control of the sitting pressure in the clinic and management training of the air cell cushion.

Effects of cognitive-motor dual-task training combined with auditory motor synchronization training on cognitive functioning in individuals with chronic stroke: A pilot randomized controlled trial.

BACKGROUND: Preservation and enhancement of cognitive function are essential for the restoration of functional abilities and independence following stroke. While cognitive-motor dual-task training (CMDT) has been utilized in rehabilitation settings, many patients with stroke experience impairments in cognitive function that can interfere with dual-task performance. In the present study, we investigated the effects of CMDT combined with auditory motor synchronization training (AMST) utilizing rhythmic cues on cognitive function in patients with stroke. METHODS: The present randomized controlled trial was conducted at a single rehabilitation hospital. Thirty patients with chronic stroke were randomly divided an experimental group (n = 15) and a control group (n = 15). The experimental group received 3 CMDT + AMST sessions per week for 6 weeks, whereas the control group received CMDT only 3 times per week for 6 weeks. Changes in cognitive function were evaluated using the trail making test (TMT), digit span test (DST), and stroop test (ST). RESULTS: Significant differences in TMT-A and B (P = .001, P = .001), DST-forward (P = .001, P = .001), DST-backward (P = .000, P = .001), ST-word (P = .001, P = .001), and ST-color (P = .002, P = .001) scores were observed in both the control and experimental groups, respectively. Significant differences in TMT-A (P = .001), DST-forward (P = .027), DST-backward (P = .002), and ST-word (P = .025) scores were observed between the 2 groups. Performance speed on the TMT-A was faster in the CMDT + AMST group than in the CMDT group. Moreover, DST-forward and DST-backward scores were higher in the CMDT + AMST group than in the CDMT group. Although ST-color results were similar in the 2 groups, ST-word scores were higher in the CMDT + AMST group than in the CMDT group. CONCLUSION: This finding indicates that the combined therapy CMDT and AMST can be used to increase attention, memory, and executive function for people with stroke.

Effects of gross motor function and manual function levels on performance-based ADL motor skills of children with spastic cerebral palsy.

[Purpose] The purpose of this study was to determine effects of Gross Motor Function Classification System and Manual Ability Classification System levels on performance-based motor skills of children with spastic cerebral palsy. [Subjects and Methods] Twenty-three children with cerebral palsy were included. The Assessment of Motor and Process Skills was used to evaluate performance-based motor skills in daily life. Gross motor function was assessed using Gross Motor Function Classification Systems, and manual function was measured using the Manual Ability Classification System. [Results] Motor skills in daily activities were significantly different on Gross Motor Function Classification System level and Manual Ability Classification System level. According to the results of multiple regression analysis, children categorized as Gross Motor Function Classification System level III scored lower in terms of performance based motor skills than Gross Motor Function Classification System level I children. Also, when analyzed with respect to Manual Ability Classification System level, level II was lower than level I, and level III was lower than level II in terms of performance based motor skills. [Conclusion] The results of this study indicate that performance-based motor skills differ among children categorized based on Gross Motor Function Classification System and Manual Ability Classification System levels of cerebral palsy.

Comparison of motor and process skills among children with different developmental disabilities.

[Purpose] The purpose of the present study was to compare the motor and process skills of children with different developmental disabilities. [Subjects] Thirty-nine children with developmental disabilities participated in this study which was conducted at N hospital in South Korea. [Methods] The motor and process skills of the participants were compared among three different disabilities: pervasive developmental disorder, cerebral palsy, and intellectual disorder. The data were analyzed using descriptive statistics and one-way ANOVA. [Results] Significant differences in motor skills were found among the diagnoses. The cerebral palsy group showed poorer motor skills than the pervasive developmental disability and intellectual disability groups. [Conclusion] The findings have clinical implications for strategies of rehabilitation for children with developmental disabilities.

A comparison of driving errors in patients with left or right hemispheric lesions after stroke.

[Purpose] The aim of this study was to compare the incidence of driving errors among patients with left or right hemispheric lesions due to stroke. [Subjects and Methods] Thirty stroke patients participated in the study. Driving errors were assessed using a virtual reality driving simulator. [Results] Significant differences were shown in center line crossing frequency, accident rate, brake reaction time, total driving error scores, and overall driving safety between participants with left or right hemispheric lesions. [Conclusion] Driving rehabilitation specialists should consider hemispheric function when teaching driving skills to stroke survivors, because patients with lesions in the left or right hemispheres after stroke show differences in driving skills.

Effect of activities of daily living status on resuming driving after stroke.

[Purpose] This study aimed to investigate the effect of the activities of daily living status on resuming driving after stroke. [Subjects] Thirty-one participants with stroke, who visited in Korean national rehabilitation centers, were included in this study. [Methods] The activities of daily living performance and the driving ability of the participants were assessed with the Korean-Modified Barthel Index in combination with the results obtained by using a driving simulator. [Results] Significant correlations were noted among the Korean-Modified Barthel Index, on-road driving total score, reaction time, speed anticipation tests, judgment tests, and steering wheel-pedal operation tests. Results of Stepwise multiple regression also revealed that the Korean-Modified Barthel Index total score and speed anticipation, with an R(2) of 52.9%. In other words, as the Korean-Modified Barthel Index total score and speed anticipation score increased and the driving performance score also increased in patients who had suffered a stroke. [Conclusion] The activities of daily living status was positively correlated with the patients' post stroke driving ability.

Nonalcoholic fatty liver disease is associated with coronary artery disease in Koreans.

AIM: To investigate whether nonalcoholic fatty liver disease (NAFLD) affects coronary artery disease (CAD) and identify candidate mediators. METHODS: Patients who underwent coronary angiography were consecutively recruited. The patients were classified into four groups by coronary artery stenosis: A, insignificant; B, one-vessel disease; C, two-vessel disease; and D, three-vessel disease. Abdominal ultrasonography was performed to determine the presence of a fatty liver and categorize by grade: 0, no evidence; 1, mild; 2, moderate; and 3, severe. We measured not only known CAD risk factors, but also serum insulin, HOMA-index, adiponectin, interleukin-6, tumor necrosis factor-α and high-sensitivity C-reactive protein levels. RESULTS: Of the 134 patients who met the inclusion criteria, 82 (61.2%) had ultrasonographically diagnosed NAFLD. Among the 46 patients with CAD, 37 (80.4%) had evidence of a fatty liver. The two groups (A vs B-D) were significantly different in terms of age, total cholesterol, triglycerides, low-density lipoprotein levels and fatty liver. Coronary artery stenosis was strongly associated with fatty liver in a grade-dependent manner (P = 0.025). In binary logistic regression, NAFLD was a significant independent predictor of CAD (P = 0.03, OR = 1.685; 95%CI: 1.051-2.702). Among the candidate mediators, the serum adiponectin level showed a trend toward lowering based on CAD progression (P = 0.071). CONCLUSION: NAFLD is an independent risk factor for CAD in a grade-dependent manner. Moreover, adiponectin might be related to the pathogenesis of NAFLD.