Modified Rapid Emergency Medicine Score-Lactate (mREMS-L) performance to screen non-anticipated 30-day-related-mortality in emergency department.

BACKGROUND: The aim of this study was to compare the ability to predict 30-day in-hospital mortality of lactate versus the modified Rapid Emergency Medicine Score (mREMS) versus the arithmetic sum of the mREMS plus the numerical value of lactate (mREMS-L). METHODS: A prospective, multicentric, emergency department delivery, pragmatic study was conducted. To determine the predictive capacity of the scales, lactate was measured and the mREMS and mREMS-L were calculated in adult patients (aged>18 years) transferred with high priority by ambulance to the emergency department in five hospitals of Castilla y Leon between 1 January 2020 and 31 December 2021. The area under the receiver operating characteristic (ROC) curve of each of the scales was calculated in terms of mortality for 30 days. RESULTS: A total of 5371 participants were included, and the in-hospital mortality rate at 30 days was of 11.4% (615 cases). The best cut-off point determined in the mREMS was 7.0 points (sensitivity of 67% and specificity of 84%), and for lactate, the cut-off point was 1.4 mmol/L (sensitivity of 88% and specificity of 67%). Finally, the combined mREMS-L showed a cut-off point of 7.9 (sensitivity of 83% and a specificity of 83%). The area under the ROC curve of the mREMS, lactate and mREMS-L for 30-day mortality was 0.851, 0.853, and 0.903, respectively (p < 0.001 in all cases). CONCLUSIONS: The new score generated, mREMS-L, obtained better statistical results than its components (mREMS and lactate) separately.

Can specific virtual reality combined with conventional rehabilitation improve poststroke hand motor function? A randomized clinical trial.

TRIAL OBJECTIVE: To verify whether conventional rehabilitation combined with specific virtual reality is more effective than conventional therapy alone in restoring hand motor function and muscle tone after stroke. TRIAL DESIGN: This prospective single-blind randomized controlled trial compared conventional rehabilitation based on physiotherapy and occupational therapy (control group) with the combination of conventional rehabilitation and specific virtual reality technology (experimental group). Participants were allocated to these groups in a ratio of 1:1. The conventional rehabilitation therapists were blinded to the study, but neither the participants nor the therapist who applied the virtual reality-based therapy could be blinded to the intervention. PARTICIPANTS: Forty-six patients (43 of whom completed the intervention period and follow-up evaluation) were recruited from the Neurology and Rehabilitation units of the Hospital General Universitario of Talavera de la Reina, Spain. INTERVENTION: Each participant completed 15 treatment sessions lasting 150 min/session; the sessions took place five consecutive days/week over the course of three weeks. The experimental group received conventional upper-limb strength and motor training (100 min/session) combined with specific virtual reality technology devices (50 min/session); the control group received only conventional training (150 min/session). RESULTS: As measured by the Ashworth Scale, a decrease in wrist muscle tone was observed in both groups (control and experimental), with a notably larger decrease in the experimental group (baseline mean/postintervention mean: 1.22/0.39; difference between baseline and follow-up: 0.78; 95% confidence interval: 0.38-1.18; effect size = 0.206). Fugl-Meyer Assessment scores were observed to increase in both groups, with a notably larger increase in the experimental group (total motor function: effect size = 0.300; mean: - 35.5; 95% confidence interval: - 38.9 to - 32.0; wrist: effect size = 0.290; mean: - 5.6; 95% confidence interval: - 6.4 to - 4.8; hand: effect size = 0.299; mean: - -8.9; 95% confidence interval: - 10.1 to - 7.6). On the Action Research Arm Test, the experimental group quadrupled its score after the combined intervention (effect size = 0.321; mean: - 32.8; 95% confidence interval: - 40.1 to - 25.5). CONCLUSION: The outcomes of the study suggest that conventional rehabilitation combined with a specific virtual reality technology system can be more effective than conventional programs alone in improving hand motor function and voluntary movement and in normalizing muscle tone in subacute stroke patients. With combined treatment, hand and wrist functionality and motion increase; resistance to movement (spasticity) decreases and remains at a reduced level. TRIALS REGISTRY: International Clinical Trials Registry Platform: ISRCTN27760662 (15/06/2020; retrospectively registered).

Effectiveness of virtual reality technology on functional mobility of older adults: systematic review and meta-analysis.

BACKGROUND: The accessibility, versatility and motivation provided by virtual reality technology (VRT) have fostered its rapid expansion as a rehabilitation technique to improve functional mobility. The aim of this study was to investigate the effectiveness of rehabilitation programmes using VRT, specific virtual reality technology (VRT-S) and non-specific virtual reality technology (VRT-NS), to improve functional mobility in individuals aged >60 years versus conventional treatment (CT) or no intervention. METHODS: Nine databases (Cochrane Library, Scopus, PEDro, Medline, CSIC, Web of Science, OT Seeker, NGCH and CINAHL) were searched to identify randomised trials up to December 2019. Results of clinical trials that used VRT-S and VRT-NS in rehabilitation were combined, using a random effects model with inverse variance weighting of the studies. GRADE was used to assess the quality of evidence. The protocol was registered in PROSPERO: CRD42019131630. Overall, there was moderate quality of evidence for the functional mobility results, which means that the estimate of effect is likely to change. RESULTS: Sixteen of the 18 studies selected (n = 568) provided data for the subgroup meta-analysis. VRT-NS was more effective in improving functional mobility than no intervention [standardised mean difference (SMD) = -1.02; 95% confidence interval (CI) -1,91 to -0,14). VRT-NS was also more effective than CT in improving resistance in ambulation (SMD = -1.20; 95% CI -1.93 to 0.46). No significant differences were found between VRT-S and CT or no intervention. Programmes in which >18 sessions were applied were more beneficial (SMD = -0.89; 95% CI -1.71 to -0.08; <0.001) than programmes with ≤18 sessions (SMD = 0.04; 95% CI -0.51 to 0.59) versus no intervention. CONCLUSIONS: Our results suggest that VRT is an effective intervention for improving functional mobility in older persons compared with CT. VRT-NS proved to be more effective than VRT-S. However, these results are still not conclusive due to the low methodological quality of the studies. Thus, new studies and analyses are required.

Degeneration of the cholinergic system in individuals with subjective cognitive decline: A systematic review.

BACKGROUND: Subjective cognitive decline (SCD) is a risk factor for future cognitive impairment and dementia. It is uncertain whether the neurodegeneration of the cholinergic system is already present in SCD individuals. We aimed to review the current evidence about the association between SCD and biomarkers of degeneration in the cholinergic system. METHOD: Original articles were extracted from three databases: Pubmed, Web of Sciences, and Scopus, in January 2023. Two researchers screened the studies independently. RESULTS: A total of 11 research articles were selected. SCD was mostly based on amnestic cognitive complaints. Cholinergic system biomarkers included neuroimaging markers of basal forebrain volume, functional connectivity, transcranial magnetic stimulation, or biofluid. The evidence showed associations between basal forebrain atrophy, poorer connectivity of the cholinergic system, and SCD CONCLUSIONS: Degenerative changes in the cholinergic system can be present in SCD. Subjective complaints may help when identifying individuals with brain changes that are associated with cognitive impairment. These findings may have important implications in targeting individuals that may benefit from cholinergic-target treatments at very early stages of neurodegenerative diseases.

Analysis of Occupational Balance and Its Relation to Problematic Internet Use in University Occupational Therapy Students.

(1) Objective: to explore and describe the relationship between the occupational balance of university students taking a Degree in Occupational Therapy and the problematic use of the Internet and how these, in turn, favour or not the appearance of phubbing behaviour which involves "a behaviour that happens when an individual looks at his mobile phone during a conversation with other individuals, escaping from interpersonal communication". (2) Methods: this is a quantitative descriptive study of an observational and cross-sectional nature, not experimental. The Spanish version of the Occupational Balance Questionnaire (OBQ-E), the Internet Addiction Test and the Phubbing Scale were used for data collection. 192 university students taking the Degree in Occupational Therapy of the University of Castilla-La Mancha participated (168 women and 24 men). (3) Results: the average score obtained in the OBQ-E was 38.7, indicating a moderate occupational balance; and (4) Conclusions: occupational therapy students from the Faculty of Health Sciences of the University of Castilla-La Mancha have a moderate occupational balance. Furthermore, this is negatively related to both problematic Internet use and phubbing, so a higher occupational balance indicates less Internet addiction and less phubbing.

Effects of Virtual Reality-Based Therapy on Quality of Life of Patients with Subacute Stroke: A Three-Month Follow-Up Randomized Controlled Trial.

OBJECTIVE: To evaluate the influence of conventional rehabilitation combined with virtual reality on improving quality of life related to post-stroke health. DESIGN: Randomized controlled trial. SETTING: Rehabilitation and neurology departments of a general hospital (Talavera de la Reina, Spain). SUBJECTS: A total of 43 participants with subacute stroke. INTERVENTION: Participants were randomized into experimental group (conventional treatment + virtual reality) and control (conventional treatment). MAIN MEASURES: Health-related quality of life as measured by the EuroQoL-5 dimensions instrument (EQ-5D-5L) and EuroQoL visual analog scale (EQ-VAS). RESULTS: A total of 23 patients in the experimental group (62.6 ± 13.5 years) and 20 in the control (63.6 ± 12.2 years) completed the study. In the experimental group, EQ-VAS score was 29.1 ± 12.8 at baseline, 86.5 ± 7.1 post-intervention, and 78.3 ± 10.3 at the three-month follow-up. The control group obtained scores of 25.5 ± 5.1, 57.0 ± 4.7, and 58.5 ± 5.9, respectively. We identified significant differences at the post-intervention and follow-up timepoints (p = 0.000) and a partial η2 of 0.647. In EQ-5D-5L, the severity of issues decreased after intervention in the experimental group, while pain and anxiety dimensions increased between post-intervention and follow-up. CONCLUSIONS: The conventional rehabilitative approach combined with virtual reality appears to be more effective for improving the perceived health-related quality of life in stroke survivors.

Effects of Specific Virtual Reality-Based Therapy for the Rehabilitation of the Upper Limb Motor Function Post-Ictus: Randomized Controlled Trial.

This research analyzed the combined effect of conventional treatment and virtual reality exposure therapy on the motor function of the upper extremities in people with stroke. We designed a randomized controlled trial set in the rehabilitation and neurology departments of a hospital (Talavera de la Reina, Spain). The subjects included 43 participants, all randomized into experimental (conventional treatment + virtual reality exposure therapy) and control group (conventional treatment).; The main measures were Fugl-Meyer Assessment for upper extremity, Modified Ashworth Scale, and Stroke Impact Scale 3.0. The results included 23 patients in the experimental (62.6 ± 13.5 years) and 20 in the control group (63.6 ± 12.2 years) who completed the study. After the intervention, muscle tone diminished in both groups, more so in the experimental group (mean baseline/post-intervention: from 1.30 to 0.60; η2 = 0.237; p = 0.001). Difficulties in performing functional activities that implicate the upper limb also diminished. Regarding the global recovery from stroke, both groups improved scores, but the experimental group scored significantly higher than the controls (mean baseline/post-intervention: from 28.7 to 86.5; η2 = 0.633; p = 0.000). In conclusion, conventional rehabilitation combined with specific virtual reality seems to be more efficacious than conventional physiotherapy and occupational therapy alone in improving motor function of the upper extremities and the autonomy of survivors of stroke in activities of daily living.

Analysis of Fear Post COVID in First-Year Students after the Incorporation to the Classroom: Descriptive Study in University Students of Health Sciences.

BACKGROUND: After the onset of the COVID-19 pandemic, social restriction measures were implemented, among them, the adaptation of university teaching to online modality until the end of the 2019-2020 school year in order to stop the spread of the SARS-CoV-2 virus. At the beginning of the 2020-2021 school year, the Spanish universities opted for face-to-face teaching. To that end, different special measures and adaptations were implemented in higher education facilities, aimed at minimizing the risk of infection and ensuring safe face-to-face learning. The objective was to explore and describe the level of fear of first-year students after the start of in-person classes in the context of the COVID-19 pandemic. METHODS: The sample was 185 first-year students who were evaluated on the first day of class. For that purpose, an ad-hoc questionnaire was administered to collect demographic information and to find the level of fear and concern. The Fear of COVID-19 Scale was used to assess the severity of the participants' fear of the pandemic situation. RESULTS: The results indicate that participating university population does not report fear of the virus, but they describe various psychosomatic characteristics, such as increased pulse rate and heart palpitations (p = 0.008) and insomnia (p = 0.05) when they think about infection with coronavirus. Nevertheless, when data are disaggregated by gender, we observe differences specifically in women (83.2%), such as fear (p = 0.006) and sweaty hands when they think of the virus (p = 0.023). CONCLUSIONS: Incoming university freshmen do not express concern or fear of potential infection with COVID-19, but they are concerned about family transmission after beginning face-to-face classes.

Changes in Resilience in Students of Occupational Therapy After Their First Exposure to Practice Placement Education.

Introduction: Resilience is a multidimensional and dynamic construct associated with positive growth and the capacity to transform stressful and negative factors into opportunities of personal development and self-improvement when faced with difficult experiences. The resilience process of each individual integrates multiple analysis levels, which range from genetic-environmental interactions to a complex process of adaptation between the individual and his/her family, friends, co-workers, society, and culture. Objective: To determine whether resilience improves in students of occupational therapy when exposed for the first time to practice placement education. Methodology: Quasi-experimental, prospective, observational, multi-center study with a sample composed of students from the Degree of Occupational Therapy of the public universities of Málaga (UMA) and Castilla-La Mancha (UCLM) (Spain). Two weeks prior to the beginning of the practice education period, the participants completed a questionnaire that included sociodemographic data and the area of their internships. They were also given the Spanish version of the Connor-Davidson's resilience scale (CD-RISC). All these instruments were also completed 1 week after the end of the clinical practice. Results: There were statistically significant differences between the variables that make up resilience and the different internship areas. On the other hand, there was a significant improvement of global resilience after the clinical practice period, in both women (13.85 points; p < 0.001) and men (7.72 points; p < 0.035), when the internship area was not considered. Conclusions: The results show that resilient students are more optimistic and work to improve a situation beyond doing simply what is expected of them, knowing how to control their feelings. This is beneficial for students in practice education, since, during these, they face difficult situations that require a resilient pattern, which helps reduce stress and the burnout syndrome.

Eating Experiences of People with Disabilities: A Qualitative Study in Spain.

BACKGROUND: Disability causes changes in the eating process, which is central to the definition of each individual's social and psychological spaces. METHODS: This is a qualitative study based on grounded theory. Interviews were carried out in clinical hospital settings and headquarters of several disability organisations. The study included 27 individuals, aged between 18-75 years. All participants had a disability that caused a functional deficiency in the occupational aspects of the eating process. RESULTS: The respondents' narratives were analysed through observations made in different contexts, allowing us to describe and understand the significance attributed by the participants to their reality and experiences. Three key themes emerged from the analysis: (1) waning bodies (assumption of a diminished corporality); (2) redefinition of food-related social spaces; and (3) perceived burdensomeness, shame, and loneliness. CONCLUSIONS: Assisted feeding tends to prioritise the nutritional component of food ingestion. However, cultural, social, and contextual factors have a critical impact on an individual's well-being and quality of life. This study stresses the importance of re-addressing intervention models affecting differently-abled people and incorporating approaches that take into account the contextual aspects of occupational therapy.

Effectiveness of Virtual Reality Systems to Improve the Activities of Daily Life in Older People.

(1) This review aims to evaluate the effectiveness of treatments with virtual reality systems (VRSs) on the functional autonomy of older adults versus conventional treatment. (3) Methods: Systematic review and meta-analysis. An electronic data search was carried out, following the PRISMA statement, up to February 2020. We combined results from clinical trials using VRSs for the improvement of basic and instrumental activities of daily living. The guidelines of the Cochrane Handbook for Systematic Reviews of Interventions were followed for calculations and risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence. (4) Results: The final analysis included 23 studies with a population of 1595 participants. A moderate, but clinically significant, effect was found for basic activities of daily living (BADLs), (Standard Medium Deviation, SMD 0.61; 95% CI: -0.15-1.37; P < 0.001). A small effect was found for instrumental ADLs (Instrumental Activities of daily living, IADLs) (SMD -0.34; 95% CI: -0.82-0.15; P < 0.001). Functional ambulation was the BADL which improved the most (SMD -0.63; 95% CI: -0.86, -0.40; P < 0.001). (5) Conclusion: The use of VRSs is an innovative and feasible technique to support and improve the functional autonomy of community-dwelling older adults. Due to the very low quality of the evidence for our main outcomes, the effects of a VRS on the BADLs and IADLs are uncertain. Clinical trials of a higher methodological quality are necessary to increase the level of knowledge of its actual effectiveness.

Can exergames contribute to improving walking capacity in older adults? A systematic review and meta-analysis.

BACKGROUND: The accessibility, low cost and motivation generated by exergames has fostered its rapid expansion as a rehabilitation technique. OBJECTIVE: To estimate the effectiveness of rehabilitation programs using IVGT in improving walking capacity of people aged 60 years and over. MATERIALS AND METHODS: The electronic data research following the PRISMA Statement (Scopus, Cochrane, Web of Science, OT Seeker, National Guideline Clearinghouse, Trip Database, CSIC Spanish National Research Council) was completed in September 2018. The results of randomized clinical trials using exergames for rehabilitation of walking capacity were combined. The calculations have followed the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The Grading of Recommendations Assessment, Development and Evaluation system was used to evaluate the quality of the evidence. RESULTS: We obtained data from 14 trials, including 11 meta-analysis studies. The size of exergames effects on walking capacity is moderate, but significant (SMD -0.56; 95 % CI: -0.90, -0.21; p = 0.002). Effectiveness was greater to recover the ability to transfer from one position or place to another (SMD -1.02; CI 95 %: -1.70, -0.35; P = 0.003). The intervention protocols, their duration and intensity varied considerably. The lack of masking, the allocation concealment, the absence of assessor blinding were the main causes of bias so the final grade of evidence has been low for walking and very low for transfers. CONCLUSIONS: Positive clinical effects of exergames have been found to improve walking capacity, but the quality of evidence to refute its effectiveness is weak with risk of bias. Further research is needed in order to know the actual magnitude of its effect.

Anatomical prosection practices in the Occupational Therapy degree. Student anxiety levels and academic effectiveness.

CONTEXT: The practice of anatomical dissection and/or prosection on human cadavers is an essential component of human anatomy training programmes. However, this activity can be stressful for inexperienced students when exposed to cadavers for the first time, and it may generate high anxiety levels. The aims of this study are threefold: 1) to analyse the thoughts and feelings of first-year students of the Occupational Therapy degree about prosection practices; 2) to examine their anxiety levels in relation to these practices; and 3) to evaluate how useful and effective they are as an educational tool for anatomy training. METHODS: This is a before-and-after cross-sectional study of first-year students of the Occupational Therapy degree at the Universidad de Castilla-La Mancha, Spain. These students had not previously participated in prosection practices. An anonymous questionnaire was distributed among the students before and after the practice, in order to examine their feelings and perceptions during the practice. To examine their anxiety levels, we used a State-Trait Anxiety Inventory (STAI) questionnaire. To assess their learning outcomes the students had to complete two practical tests of recognition of anatomical structures, one before attending the practice and one immediately afterwards. RESULTS: Basal anxiety levels, measured as trait anxiety (TA), remained stable and did not show significant differences during the practice (p>0.05). Their emotional anxiety, measured as state anxiety (SA), dropped from 14.7 to 10 points (p<0.05) after the practice. Before the start of the practice 11 students (19%) showed signs of anxiety, and these remained so at the end of the practical session (p>0.05). As for their academic performance, we observed that the number of students able to pass the test after attending the prosection practice increased notably (by more than 60%). Additionally, 100% of the students recommended that the practice be retained for future courses, giving it an approval rate of 9.1 out of 10. CONCLUSION: Although anatomy is usually an attractive subject for Occupational Therapy students and they value prosection practices positively, they remain a potentially complex and stressful experience. Some students find that their experiences in the dissecting room can upset their emotional balance, however, the implementation of coping mechanisms could be a very effective strategy to reduce their anxiety and also to improve their learning outcomes, helping to strengthen their practical knowledge of anatomy as we have observed in this study. The students not only value positively these practices, they also believe that they are an extremely useful tool for both teaching and learning anatomy, and they recommend their routine use as part of the training process.

Improving Self-Perceived Emotional Intelligence in Occupational Therapy Students Through Practical Training.

Background: In the field of healthcare, higher skills in emotional intelligence (EI) have been proven to have a positive impact on healthcare professionals in general and occupational therapists in particular and also on teamwork and patient care. The purpose of this research was to determine whether performing practical work included in the undergraduate Occupational Therapy program improves students' self-perceived EI, and whether there are any differences in the latter depending on the area in which this practical training is performed. Methods: It was conducted a multicenter, quasi-experimental, pre-post study with Occupational Therapy undergraduate students in the 2016-2017 academic year. A total of 184 students met the inclusion criteria. Of these, 10 (5.40%) declined to participate; therefore, the participation rate was 94.60% and the initial sample comprised 174 students. Mean age was 21.34 years (SD = 2.54) and 84.50% (n = 147) were women. Students' self-perceived EI was measured with the Trait Meta-Mood Scale-24 (TMMS-24). This measure was completed in the two weeks prior to the start of the practical training period and one week after the end of it. McNemar-Bowker and McNemar tests were used to analyze the differences in self-perceived EI between these two points in time. Results: After the practical training, an improvement in self-perceived EI was observed in women (Emotional Attention, Emotional Clarity, and Emotional Regulation dimensions). Regarding areas of practical training, results showed an improvement in EI in women who had received practical training in the areas of Physical Rehabilitation, Mental Health and Geriatrics and Gerontology. Conclusions: The findings contribute to a better understanding of the relation between practical training and an improvement in self-perceived EI. This insight can help make changes in the teaching methodology to enhance the emotional skills needed for a better professional performance.

Construyendo y entendiendo la ocupación en contextos privados de libertad: experiencias de familias con hijos en situación de discapacidad en campamentos de refugiados / Construindo e compreendendo a ocupação em contextos privados de liberdade: experiências de famílias com crianças em situação de deficiência em campos de refugiados / Building and understanding occupation in contexts deprived of freedom: experiences of families with children in a situation of disability in refugee camps

Resumen Introducción Desde la Terapia Ocupacional se ha prestado una especial atención a la descripción y el análisis de las ocupaciones que tienen lugar en contextos de mayor vulnerabilidad y precariedad social en los que el desempeño y la participación ocupacional en condiciones de salud, bienestar y sentido personal pueden verse comprometidos de forma significativa. Objetivo Describir y explicar la ocupación desde un enfoque cultural en familias con hijos en situación de discapacidad que residen en un contexto privado de libertad como son los campamentos de refugiados saharauis. Método Estudio descriptivo transversal, de naturaleza etnográfica, realizado en los campamentos de refugiados saharauis de Tindouf (Argelia). Resultados En los campamentos, el tiempo invertido en el desarrollo de las actividades de la vida diaria dista mucho de occidente, partiendo de que el propio concepto 'tiempo' presenta un significado muy distinto. Los quehaceres diarios de los saharauis están marcados por tres "tiempos": (1) la luz del sol, (2) el rezo y (3) la hora del té, siendo las dos últimas las ocupaciones más significativas de la población refugiada. El significado de la cultura parecía ser una parte integral de la práctica profesional, así como las circunstancias vitales con las que convivían las familias con miembros en situación de discapacidad. Conclusión La Terapia Ocupacional debe verse interpelada a ofrecer oportunidades de vida cotidiana más digna para todas las personas, apoyando y protegiendo los derechos de participación ocupacional de todos los sujetos, especialmente de aquellos que experimentan situaciones de mayor vulnerabilidad.

Abstract Introduction From Occupational Therapy, special attention has been paid to the description and analysis of the occupations that take place in contexts of greater vulnerability and social precariousness in which occupational performance and participation in conditions of health, well-being, and personal sense can be significantly compromised. Objective To describe and explain the occupation from a cultural approach in families with children with disabilities living in a context deprived of freedom such as the Sahrawi refugee camps. Method Cross-sectional descriptive study, of an ethnographic nature, carried out in the Saharan refugee camps of Tindouf (Algeria). Results In the camps, the time invested in the development of daily life activities is far from the West, since the very concept of 'time' has a very different meaning. The daily chores of the Saharawis are marked by three "times": (1) sunlight, (2) prayer, and (3) tea time, the last two being the most significant occupations of the refugee population. The meaning of culture seemed to be an integral part of professional practice, as well as the life circumstances with which families with disabled members lived. Conclusion Occupational Therapy must be challenged to offer opportunities for a more dignified daily life for all people, supporting and protecting the rights of occupational participation of all subjects, especially those who experience situations of greater vulnerability.

Resumo Introdução Do ponto de vista da Terapia Ocupacional, foi dada atenção especial à descrição e análise das ocupações que ocorrem em contextos de maior vulnerabilidade e precariedade social nos quais o desempenho ocupacional e a participação em condições de saúde, bem-estar e senso pessoal podem ser significativamente comprometidos. Objetivo Descrever e explicar a ocupação a partir de uma abordagem cultural em famílias com crianças deficientes que vivem em um contexto privado de liberdade, como os campos de refugiados saharauis. Método: Estudo descritivo transversal, de natureza etnográfica, realizado nos campos de refugiados saarianos de Tindouf (Argélia). Resultados Nos campos, o tempo gasto no desenvolvimento das atividades da vida diária está longe do Ocidente, uma vez que o próprio conceito de "tempo" tem um significado muito diferente. As tarefas diárias dos saharauis são marcadas por três "tempos": (1) luz solar, (2) oração, e (3) hora do chá, sendo as duas últimas as ocupações mais significativas da população refugiada. O significado da cultura parecia ser parte integrante da prática profissional, assim como as circunstâncias de vida com as quais as famílias com membros deficientes viviam. Conclusão : A terapia ocupacional deve ser desafiada a oferecer oportunidades para uma vida diária mais digna para todas as pessoas, apoiando e protegendo os direitos de participação ocupacional de todos os sujeitos, especialmente aqueles que vivenciam situações de maior vulnerabilidade.

[Effectiveness of a programme based on a virtual reality game for cognitive enhancement in schizophrenia]. / Efectividad de un programa de juego basado en realidad virtual para la mejora cognitiva en la esquizofrenia.

OBJECTIVE: To evaluate the effectiveness of a programme based on a virtual reality game to improve cognitive domains in patients with schizophrenia. METHOD: A randomized controlled trial was conducted in 40 patients with schizophrenia, 20 in the experimental group and 20 in the control group. The experimental group received 10 sessions with Nintendo Wii(®) for 5 weeks, 50 minutes/session, 2 days/week in addition to conventional treatment. The control group received conventional treatment only. RESULTS: Statistically significant differences in the T-Score were found in 5 of the 6 cognitive domains assessed: processing speed (F=12.04, p=0.001), attention/vigilance (F=12.75, p=0.001), working memory (F=18.86, p <0.01), verbal learning (F=7.6, p=0.009), visual learning (F=3.6, p=0.064), and reasoning and problem solving (F=11.08, p=0.002). CONCLUSIONS: Participation in virtual reality interventions aimed at cognitive training have great potential for significant gains in different cognitive domains assessed in patients with schizophrenia.

Descripción de los factores que determinan la elección de prácticas clínicas de los estudiantes en el grado en terapia ocupacional / Descrição dos fatores que determinam a escolha das práticas clínicas dos estudantes de graduação em terapia ocupacional / Description of the factors that determine the choice of clinical practices of unfergraduation occupattional therapy students

Resumen Introducción La realización de prácticas en los contextos reales de trabajo supone uno de los aspectos clave en la organización, desarrollo y evaluación de los programas universitarios, tales como el Grado en Terapia Ocupacional. Además, permiten adquirir habilidades personales y profesionales, favoreciendo la integración de la teoría con la práctica, así como la identidad profesional. Método Estudio descriptivo transversal. 164 estudiantes de 2º, 3º y 4º curso del Grado en Terapia Ocupacional de la Universidad de Castilla-La Mancha fueron evaluados mediante un cuestionario online, tras el proceso de asignación de recursos. Se exploró la importancia que los estudiantes del Grado en Terapia Ocupacional atribuyen a su aprendizaje en recursos de prácticas y se identificaron los factores que determinan la elección de los dispositivos en los que realizarán su formación práctica. El reclutamiento de los estudiantes se llevó a cabo en el curso 2017-2018, siendo su participación voluntaria. Resultados Se obtuvieron diferencias estadísticamente significativas en función del curso académico (2º, 3º y 4º) entre las variables dependientes vinculadas con la valoración de las prácticas en el currículum académico: ayudan a solucionar problemas prácticos (p= 0,007) y enseñan habilidades interpersonales (p = 0,025). Más de la mitad de la muestra de estudiantes encuestados (51,2%) señaló la cercanía del centro de prácticas a su domicilio familiar como el factor más importante a la hora de seleccionar el dispositivo en el que realizará su formación práctica. Conclusiones Este trabajo contribuye a comprender el impacto de la toma de decisiones, así como a facilitar la mejora de dicho proceso por parte de los estudiantes, promoviendo experiencias en recursos de prácticas que resulten exitosas, así como un futuro desarrollo profesional satisfactorio.

Resumo Introdução A realização de ensino prático nos contextos reais de trabalho supõe um dos aspectos-chave na organização, desenvolvimento e avaliação dos programas universitários, como o Curso de Graduação em Terapia Ocupacional. Além disso, permite adquirir habilidades pessoais e profissionais, favorecendo a integração da teoria com a prática, assim como a identidade profissional. Método Estudo descritivo transversal. 164 alunos do 2º, 3º e 4º anos do Curso de Graduação em Terapia Ocupacional da Universidade de Castilla-La Mancha foram avaliados por meio de questionário on-line, após o processo de alocação de recursos. Foi explorada a importância que os alunos do curso de graduação em Terapia Ocupacional atribuem aos recursos de aprendizagem na prática e foram identificados os fatores que determinam a escolha dos dispositivos nos quais eles realizaram sua formação prática. O recrutamento dos alunos foi realizado no ano letivo 2017-2018, sendo sua participação voluntária. Resultados Foram obtidas diferenças estatisticamente significantes, dependendo do ano acadêmico (2º, 3º e 4º), entre as variáveis ​​dependentes vinculadas à avaliação de práticas no currículo acadêmico: ajudam a resolver problemas práticos (p = 0,007) e ensinam habilidades interpessoais (p = 0,025). Mais da metade da amostra de estudantes pesquisados ​​(51,2%) indicou a proximidade do centro de prática à casa da família como o fator mais importante na seleção do dispositivo no qual eles realizaram o estágio prático. Conclusão Este trabalho contribui para a compreensão do impacto da tomada de decisão, além de facilitar a melhoria do processo por parte dos alunos, promovendo experiências em recursos práticos bem-sucedidos, bem como o desenvolvimento profissional satisfatório futuro.

Abstract Introduction Carrying out internships within a real work context is one of the key aspects for the organisation, development and evaluation of university programmes such as the Degree in Occupational Therapy. In addition, it allows acquiring personal and professional skills, favouring this way the integration between theory and practice as well as the sense of a professional identity. Method This is a cross-sectional descriptive study. 164 students of 2nd, 3rd and 4th year of the Degree in Occupational Therapy of the University of Castilla-La Mancha were assessed by an online questionnaire after the process of allocation of resources. We explored the importance that students of the Occupational Therapy Degree attribute to their learning in practice resources and identified the factors that determine the choice of devices in which they will carry out their practical training. The selection of students was made during the 2017-2018 academic year and all of them participated voluntarily. Results Statistically significant differences were obtained depending on the academic year (2nd, 3rd and 4th) among the dependent variables linked to the assessment of the internship in the academic curriculum: it helps to solve practical problems (p = 0.007) and teach interpersonal skills (p = 0.025). More than half of the sample of students surveyed (51.2%) pointed out the proximity of the internship centre to their family home as the most important factor when selecting the device in which place where they would carry out their practical training. Conclusions This work helps to understand the impact of decision making as well as to facilitate the improvement of this process for students, promoting experiences in practical resources that are successful as well as a satisfactory future professional development.