Movement repetitions in physical and occupational therapy during spinal cord injury rehabilitation.

STUDY DESIGN: Longitudinal observational study. OBJECTIVE: To quantify the amount of upper- and lower-extremity movement repetitions (that is, voluntary movements as part of a functional task or specific motion) occurring during inpatient spinal cord injury (SCI), physical (PT) and occupational therapy (OT), and examine changes over the inpatient rehabilitation stay. SETTING: Two stand-alone inpatient SCI rehabilitation centers. METHODS: Participants: A total of 103 patients were recruited through consecutive admissions to SCI rehabilitation. INTERVENTIONS: Trained assistants observed therapy sessions and obtained clinical outcome measures in the second week following admission and in the second to last week before discharge. MAIN OUTCOME MEASURES: PT and OT time, upper- and lower-extremity repetitions and changes in these outcomes over the course of rehabilitation stay. RESULTS: We observed 561 PT and 347 OT sessions. Therapeutic time comprised two-thirds of total therapy time. Summed over PT and OT, the median upper-extremity repetitions in patients with paraplegia were 7 repetitions and in patients with tetraplegia, 42 repetitions. Lower-extremity repetitions and steps primarily occurred in ambulatory patients and amounted to 218 and 115, respectively (summed over PT and OT sessions at discharge). Wilcoxon-signed rank tests revealed that most repetition variables did not change significantly over the inpatient rehabilitation stay. In contrast, clinical outcomes for the arm and leg improved over this time period. CONCLUSIONS: Repetitions of upper- and lower-extremity movements are markedly low during PT and OT sessions. Despite improvements in clinical outcomes, there was no significant increase in movement repetitions over the course of inpatient rehabilitation stay.

Tratamiento sintomático y del dolor en fibromialgia mediante abordaje multidisciplinar desde Atención Primaria / Symptomatic pain and fibromyalgia treatment through multidisciplinary approach for primary care

Introducción. La fibromialgia es una enfermedad crónica de etiología desconocida, caracterizada por dolor muscular generalizado, afectando al desempeño ocupacional, familiar, social, físico y psicológico. El abordaje multidisciplinar de la enfermedad aporta mejoría en la calidad de vida y sintomatología del paciente. Objetivos. Valorar la mejoría de actividades de la vida diaria (AVD) y calidad de vida tras una intervención multidisciplinar (Atención Primaria y Terapia Ocupacional). Material y método. Estudio pretest-postest, con muestreo aleatorio simple, en 21 pacientes con fibromialgia (rango 16-55 años). La medición se realiza con la escala de Barthel (ABVD), la escala de Lawton y Brody (AIVD), cuestionario FIQ y encuestas no estandarizadas para valorar situación pre y postintervención. Se realizó una intervención sobre psicomotricidad (psicomotricidad básica, ejercicio en piscina, ejercicio al aire libre, reestructuración, desempeño ocupacional y actividad graduada e intervención en ABVD), asociando control farmacológico de su sintomatología y tratamiento. Resultados y conclusiones. Los enfermos de fibromialgia no están totalmente conformes con el tratamiento que reciben, Atención Primaria recibe una valoración de 6,89, y la Atención Hospitalaria de 5,79, mejorando los índices de Barthel y de Lawton y Brody, y el cuestionario FIQ, de forma estadísticamente significativa (p < 0,05). Tras la intervención combinada, aumenta el número de mujeres independientes en ABVD y AIVD (AU)

Introduction. Fibromyalgia is a chronic disease of unknown etiology characterized by widespread muscle pain, with occupational, familial, social, physical and psychological performance involvement. The multidisciplinary approach to the disease leads to improvement in quality of life and symptomatology. Objectives. To evaluate the improvement of activities of daily living (ADL) and quality of life following a multidisciplinary intervention (Health Primary Care and Occupational Therapy). Materials and methods. Pretest–posttest study performed with a simple random sample of 21 patients with fibromyalgia (range 16–55 years). The measurement was performed with the Barthel scale (ADL), the scale of Lawton and Brody (IADL), the FIQ questionnaire, and no standardized surveys to assess the pre- and post-intervention situation. An intervention on motor skills (basic motor skills, pool exercise, outdoor exercise, restructuring, occupational performance and graded activity and intervention in ADL) was performed, combining pharmacological control of their symptoms and treatment. Results and conclusions. Fibromyalgia patients are not fully satisfied with their treatment; Primary Care receives a score of 6.89, and Hospital Care 5.79, improving the Barthel, Lawton and Brody and FIQ indexes, being statistically significant (P<.05). After the combined procedure the number of independent women in ADL and IADL increases (AU)

Ocupação, bem-estar e satisfação de vida: a experiência de um modelo alternativo de estágio em terapia ocupacional na Austrália / Occupation, wellness and life-satisfaction: the experience of an alternative training model within occupational therapy in Australia / Ocupación, bienestar y satisfacción con la vida: la experiencia de un modelo alternativo de formación en terapia ocupacional en Australia

Apresenta-se um modelo alternativo de estágio em terapia ocupacional desenvolvido na Deakin University - Austrália, denominado Ocupação, bem-estar e satisfação de vida - Occupation, wellness and life-satisfaction (OWLS). O OWLS oferece, aos estudantes, a oportunidade de atuação em contextos não tradicionais, permitindo um aprendizado estratégico em ambientes não clínicos, incluindo o trabalho com outros profissionais não-terapeutas ocupacionais e com diferentes culturas de trabalho e práticas, em resposta a lacunas identificadas na comunidade. Favorece oportunidades para desenvolver habilidades, tais como: a promoção da saúde, avaliação e educação em saúde e intervenção em escolas, melhorando, assim, a saúde e o bem-estar da comunidade. O programa tem contribuído para o desenvolvimento de novos projetos, com resultados positivos alcançados pelos estudantes, representando uma importante estratégia de ensino para capacitação do profissional de terapia ocupacional, ampliando, assim, a área de atuação.

An alternative training model within occupational therapy developed at Deakin University, in Australia, named Occupation, Wellness and Life-Satisfaction (OWLS) is presented. OWLS provides students with opportunities to practice in nontraditional settings, thus enabling strategic learning in non-clinical settings, including working with professionals who are not occupational therapists and with different work cultures and practices, in response to gaps identified within the community. It promotes opportunities for developing skills such as health promotion, health education and assessment and interventions in schools, thus improving the health and wellbeing of the community. The program has contributed towards development of new projects, with positive results achieved by students, thereby representing an important educational strategy for professional occupational therapy training and expanding the field of activities.

La propuesta es presentar un modelo alternativo de formación en terapia ocupacional de la Universidad de Deakin - Australia, llamado Ocupación, bienestar y satisfacción con la vida - Occupation, Wellness and Life-Satisfaction (OWLS). OWLS ofrece a los estudiantes la oportunidad de practicar en lugares no que permite aprendizaje estratégico en entornos no clínicos, incluyendo el trabajo con profesionales no terapeutas ocupacionales, con culturas y prácticas diferentes, en respuesta a las lagunas identificadas en la comunidad. Promueve oportunidades para desarrollar habilidades, como promoción de la salud, educación sanitaria y evaluación e intervención en las escuelas, mejorando así la salud y el bienestar de la comunidad. El programa ha contribuído al desarrollo de nuevos proyectos, con resultados positivos, lo que representa una importante estratégia educativa para la formación profesional en terapia ocupacional, por lo tanto de aumento de la zona de actuacion.

Terapia ocupacional em reabilitação na atenção primária à saúde: possibilidades e desafios / Occupational therapy in rehabilitation in primary health care: challenges and opportunities

O objetivo deste artigo é contribuir com reflexões para consolidar ações que a Terapia Ocupacional (TO) pode desenvolver na Atenção Primária em Saúde (APS) no campo da reabilitação de pessoas com deficiências. Trata-se de uma proposição fundamentada em revisão bibliográfica da literatura e em experiências práticas do REATA- Laboratório de Estudos em Reabilitação e Tecnologia Assistiva no período de 1999/2010. Foram considerados os modelos assistenciais vigentes, a APS Seletiva e Ampliada, a constituição do conjunto dessas práticas no contexto histórico e prático-organizacional. Em seguida, são descritas as experiências desenvolvidas pelo REATA na APS, que motivaram a apresentação dessas reflexões em forma de proposição do trabalho da TO. Defendeu-se a necessidade de um deslocamento das intervenções terapêuticas ocupacionais instituídas sob vertentes normatizadoras, biomédicas, ou edificadas na concepção de saúde pública de base higienista, para a constituição de ações/estratégias que contemplem aspectos holísticos dos sujeitos e do território, com tecnologias leves e adequadas às demandas, como previstos na concepção de uma APS Ampliada. Finalmente, apresentaram-se possíveis contribuições da TO no que se refere às suas potencialidades tecnológicas a partir da premissa que as ações dessa profissão podem contribuir para a promoção do acesso e da longitudinalidade na assistência em saúde e dessa forma colaborar na efetivação da integralidade e equidade no SUS.

The goal of this paper is to contribute with ideas that may help to strengthen the actions Occupational Therapy (OT) has been able to develop in Primary Health Care (PHC) in the field of rehabilitation of people with disabilities. This proposition is based on both literature review and on the practical experience of REATA- Laboratory for Studies in Rehabilitation and Assistive Technology in the period from 1999 to 2010. We took into consideration the existing care models, Selective and Broad PHC, and the nature of these practices within the historical and practical-organizational context. Next, we describe the experiences developed by REATA in the PHC, which motivated the presentation of these ideas as an OT work proposition. We advocate the need for a shift from the occupational therapeutic interventions instituted under standardized, biomedical framework, or built within the public health hygienist design; towards the establishment of actions/strategies that address holistic aspects of the subjects and the territory, and with light technology adequate for the demands, as foreseen by the Broad PHC. Finally, we present possible OT contributions regarding their technological potential based on the premise that actions from this profession can contribute in promoting access and long-term health care and thus assist in the completeness and equity within the Basic Health System (SUS).

Considerations for occupational therapy assessment for Indigenous children in Australia.

BACKGROUND: To date, the literature specifically relating to occupational therapy assessment of Australian Indigenous children is lacking. This article aims to present occupational therapists with practice guidelines for conducting assessments with primary school-aged Indigenous children in Australia. It highlights key considerations to be made prior to assessment, reviews potentially culturally relevant assessment tools and discusses key principles to guide assessment practice. METHOD: A literature review was carried out with the aim of investigating: (i) Australian Indigenous culture in relation to health and paediatric development; (ii) current practices for assessment with Australian Indigenous children; and (c) paediatric assessment tools and their potential use with Australian Indigenous children. RESULTS: Research relating to specific assessments does highlight some pertinent points about their use with children from non-Western cultures. CONCLUSIONS: Conducting culturally relevant assessment requires a combination of the right tools, an adaptive approach to both understanding and conducting assessments and, above all, an appreciation that each child is unique.

Ação e criação na interface das artes e da saúde / Action and creation at the arts and healthcare interface

Este artigo apresenta a experiência de constituição e implantação do Laboratório de Estudos e Pesquisa Arte e Corpo em Terapia Ocupacional e do Programa Permanente Composições Artísticas e Terapia Ocupacional na Universidade de São Paulo, Brasil. Propõe-se a traçar um panorama das atividades de ensino, pesquisa e extensão à comunidade que configuram um novo campo de práticas de terapia ocupacional voltadas às complexas demandas da população atendida nesta área e à ampliação de sua participação sociocultural. Tem realizado pesquisas qualitativas através da metodologia da pesquisa-ação para a construção de um conhecimento local em terapia ocupacional orientado pela importância das ações criativas e por referenciais clínicos e artístico-culturais. As ações desenvolvidas ampliaram o acesso da população atendida às atividades artísticas e às experiências culturais, constituindo-se em estratégias de construção de projetos de vida, de formas de participação, de convivência e de trocas subjetivas, configurando modos inusitados de produção de valor social.

This article presents the experience of constituting and establishing the Laboratory of Study and Research in Arts, Body and Occupational Therapy and the Artistic Composition and Occupational Therapy Permanent Program of USP, Brazil. To outline a scenario of teaching and researching activities and those involving the community composing a new field of occupational therapy practices focused on the complex demands of the population assisted in this area and on increasing their socio-cultural participation. This group have been done qualitative research conducted through an action-research methodology to build up local awareness of occupational therapy due to the importance of creative actions and clinical and cultural-artistic references. The actions taken have broadened the access of the population assisted to artistic activities and cultural experiences standing for strategies to build life projects, ways of participating in community life, networking and making subjective exchanges, which have resulted in unexpected production of social value.

Formação em terapia ocupacional na interface das artes e da saúde: a experiência do PACTO / Education in occupational therapy in the art & health interface: the PACTO experience

Este artigo apresenta o trabalho de formação oferecido na Graduação em Terapia Ocupacional desenvolvido pelo Laboratório de Estudos e Pesquisa Arte, Corpo e Terapia Ocupacional da FMUSP. O Laboratório realiza atividades de ensino e pesquisa, no campo didático-assistencial, nos atendimentos grupais e individuais para populações heterogêneas através do Programa Permanente Composições Artísticas e Terapia Ocupacional (PACTO) e em parcerias com projetos que se constituem na interface arte-saúde. As experiências dos estudantes são acolhidas e elaboradas em discussões de equipe, supervisões semanais, grupo de estudos e seminários de aprofundamento temático. A formação oferecida habilita os estudantes para: a compreensão e a construção de práticas na interface arte/saúde; a problematização das abordagens na interface arte/saúde nos espaços de assistência em saúde e nos espaços culturais; a compreensão das relações institucionais e sociais e dos processos de transformação das instituições; a reflexão sobre a participação do terapeuta ocupacional nas políticas culturais e nas políticas de humanização em saúde. Elegemos relatar e pontuar aspectos do trabalho efetuado nos últimos anos (2003-2008) no qual algumas estratégias de ensino foram consolidadas e evidenciaram seus efeitos na formação dos estudantes e no exercício profissional. No campo da Terapia Ocupacional verifica-se uma ampliação das possibilidades de atuação profissional vinculadas ao campo da produção cultural, em projetos transdisciplinares voltados para construção de redes sociais inclusivas, com a participação coletiva e a produção de subjetividade.

This paper presents the education work offered in the Occupational Therapy Program developed by the Laboratory of Studies and Research in Art, Body and Occupational Therapy of FMUSP. The Laboratory conducts teaching and research activities, in the didactic-assistancial field, with groups and individuals accompaniment for heterogeneous population through the Artistic Compositions and Occupational Therapy Permanent Program (PACTO) and through partnerships made with projects in the art/health interface. Students experiences are sheltered and elaborated in team discussion, weekly supervisions, study groups and theme-deepening seminars. The education qualifies students to: understand and build up practices in the art/health interface under an occupational therapy's perspective; questioning the approaches in the art/health interface in healthcare spaces and in cultural spaces; comprehend social and institutional relations and institutional transformation processes; understanding the occupational therapists' participation in cultural policies and health humanizing policies. We chose to report and scoring aspects of the work done in recent years (2003-2008) in which some teaching strategies were consolidated and showed its effects on students' education and professional exercise. In the Occupational Therapy field there is an increase in the possibilities for professional performance linked to the issues of cultural production, in trans-disciplinary projects dealing with constructing inclusive social networks, with collective participation and production of subjectivity.

PACTO adolescentes: arte e corpo na invenção de dispositivos em terapia ocupacional para produção de vida e saúde na adolescência / The youth group of PACTO: art and body on the invention of devices in occupational therapy to the production of life and health in adolescence

O artigo apresenta o trabalho desenvolvido no grupo de adolescentes do Programa Permanente de Composições Artísticas e Terapia Ocupacional (PACTO), que se constituiu em campo de experimentação e pesquisa em intervenção grupal com população heterogênea, com jovens advindos de realidades sócio-econômicas diversificadas e apresentando diferentes necessidades e problemáticas. A discussão focaliza a proposta desenvolvida nos anos de 2002 e 2003, numa parceria entre terapeutas ocupacionais e artistas plásticos e/ou arte-educadores, que participaram da concepção, planejamento e invenção de um dispositivo de acionamento de novos lugares sociais e de projetos de vida e saúde, permitindo uma ampliação da oferta de recursos no acompanhamento de trajetórias singulares. Os resultados deste trabalho apontam para a construção de uma metodologia de intervenção na interface da terapia ocupacional com as artes, que pressupõe um alinhamento rigoroso entre criação artística, produção de vida e de subjetividade. Através de um diálogo com a arte contemporânea, esta metodologia busca explorar modos particulares de relação com objetos do cotidiano e novas ordenações destes materiais, de modo a propor um novo sentido para o olhar da própria vida.

This article's aim is to present the work developed on the youth group of PACTO - Artistic Compositions and Occupational Therapy Program -, a field of experimentation and research in group intervention with people coming from different social and economic realities, and presenting multiple problematic. The analysis focus on the proposal developed in 2002 and 2003, when occupational therapists, visual artists and art-educators were involved on generating the concept, planning and inventing a device that could improve life and health projects for the people assisted, bringing a wider vision to the accompaniment of singular trajectories. The result of this work point out the construction of aim of the research developed with this group was to construct a methodology of intervention in the art and occupational therapy interface that presupposes a rigorous articulation between artistic creation and production of subjectivity. Trough a dialogue with contemporary art, this methodology explores particulars ways of relating with every-day objects in the search to experiment news meanings to look life itself.

["Work hardening" for chonic back pain. An integral component of multimodal therapy programs]. / "Work hardening" bei chronischen Rückenschmerzen. Ein integraler Bestandteil multimodaler Therapieprogramme.

Work hardening is aimed at a reestablishment of the potentials needed in occupational everyday life. Fundamental motor abilities, such as strength, stability, flexibility and persistence, are restored and merged into the everyday life so that psychological contents, such as fear avoidance behavior will be positively affected. The design of work hardening is interdisciplinary in the sense of a holistic approach to back pain. Handling the pain under load requires sophisticated treatment and the training demands a high degree of individual design. A trusting and mutual agreement between therapist and patient is essential. Work hardening represents an important part of the therapy of chronic back pain and greatly supports regaining confidence in the physical efficiency and the ability to control the body.

O dispositivo grupal como intervenção em reabilitação: reflexões a partir da prática em Terapia Ocupacional / The group device as intervention in tehabilitation: reflections from the practical one in Occupational Therapy

As abordagens grupais têm sido, cada vez mais, fonte de investigação e intervenção na prática da terapia ocupacional. Este artigo busca discutir a utilização do dispositivo grupal como intervenção em reabilitação, levantando alguns elementos teóricos que fundamentam essa proposição. Um grupo terapêutico de atividades pode configurar-se como importante espaço para a explicitação e troca de diversos conteúdos relativos à reabilitação, como dificuldades, limites e potencialidades, vivenciados a partir de diferentes necessidades e demandas. Pode também, através dos processos vinculares, configurar-se em espaço para a construção de novos projetos de vida, singulares e coletivos...

The group boardings have been, each time more, source of inquiry and intervention in the practical one of the occupational therapy. This article searchs to argue the use of the group device as intervention in rehabilitation, raising some theoretical elements that base this proposal. A therapeutical group of activities can be configured as important space for the revelation and changes of diverse relative contents to the rehabilitation, as difficulties, limits and potentialities, lived deeply from different necessities and demands. It also can, through the processes to tie, to configure themselves in space for the construction of new projects of life, singulars and collective...

The use of craft activities as an occupational therapy treatment modality in Norway during 1952-1960.

The purpose of the present study was to explore the use of craft activities as occupational therapy treatment modalities in Norway during the period 1952-1960. Data were obtained through in-depth interviews with six retired occupational therapists on their experiences in using crafts. Data were analysed through textual analysis and this resulted in four themes: craft activities identified as a therapeutic tool; ambivalence in how to frame the intervention; practice relative to power relationships; and occupational therapists and patients as equals. A limitation of the present study was that participants drew on their screened memories in the context of contemporary practice, which may omit or distort the historical truth. Further research is needed to document the effect of contemporary therapeutic use of craft activities, and to bring forward how occupational therapists and clients value the craft activities of today in the context of their lives.

Reflexões sobre as possíveis contribuições da terapia ocupacional nos processos de inclusão escolar / Considerations about the possible contributions of occupational therapy in the school inclusion process

O Objetivo deste artigo é apresentar e problematizar as possibilidades das ações da Terapia Ocupacional no processo de inserção de crianças com deficiências na rede regular de ensino, a partir de um posicionamento epistemológico e ético diante dos conceitos que permeiamos discursos e as práticas atuais da Inclusão Escolar.As autoras discutem, primeiramente, os conceitos de integração...

Arte, corpo e terapia ocupacional: aproximacoes, interseccoes e desdobramentos / Art, body and occupational therapy: approaches, intersections and unfoldings

Um dos desafios dos terapeutas ocupacionais, a partir de meados dos anos 80, foi apresentar uma melhora real na qualidade de oferta as pessoas que vivenciam o processo de reabilitacao. Este artigo busca discutir a importancia da arte e do corpo sob a optica da necessidade de propiciar a invencao de novas praticas. Sao temas que proporcionam aos pacientes as mesmas oportunidades que sao oferecidas a outros cidadaos, pois configuram-se como instrumentos de...

What can be done about home health fieldwork?

The literature indicates that health care is moving away from institutional care and specialization to the community and home where providers need generalist competencies. As educators strive to prepare students for this environment, fieldwork experiences in the community and home are opportunities for students to develop generalist competencies. Because of the current scarcity of fieldwork sites, in general, scheduling placements is difficult. As educators seek new sites, home health settings and therapists who provide home health care as a component of their service need to be considered. Home health occupational therapy requires a practitioner to adopt a holistic perspective in order to assist clients to function optimally in their home environment. Because a large number of students work in addition to taking classes, they can be encouraged to find jobs as home health aides or chore providers as part-time employment before and during their didactic education. This work experience can help them to acculturate to the home setting. By encouraging students' participation in home health experiences, educators are helping to facilitate generalist competencies.

Occupational therapists' beliefs and practices with regard to spirituality and therapy.

OBJECTIVE: What is the role of occupational therapists with regard to clients' spirituality? What activities address spirituality in occupational therapy? Whom do practitioners think should be responsible for helping clients with their spiritual needs? The objectives of this study were to address these and other related questions by validating a previously used questionnaire and establishing a baseline of occupational therapists' opinions and practices about spirituality and therapy on which future research can be built. METHOD: A previously piloted questionnaire was revised to investigate the opinions of 500 U.S. registered occupational therapists about spirituality and therapy. The 54% return rate yielded a sample of 270 respondents. RESULTS: Nearly 79% of the respondents agreed that the questionnaire accurately measured their opinions about therapy and spirituality. Spirituality is an important part of life for 89% of the respondents, helps 79% with daily job responsibilities, and is viewed as a very important dimension of health and rehabilitation by 84%. However, 63% were either undecided or disagreed that addressing spirituality was within the scope of occupational therapy practice. CONCLUSION: In general, the respondents reported that spirituality is important and helpful in their personal lives and a very important dimension of the health and rehabilitation of their clients. However, less than 40% of the respondents indicated that addressing clients' spiritual needs was within the scope of their professional practice, and the majority (82%) reported that their academic training did not prepare them to address the spiritual needs of clients. The questionnaire, now validated with a national sample, may be used for follow-up studies to further investigate the role of spirituality in health and rehabilitation.

Geriatric occupational therapy: the uncertain ideology of long-term care.

The search for the good life is used as a framework for understanding the meaning of geriatric practice to occupational therapists. Data consisted of a subset of phenomenological interviews drawn from a nationwide study of 148 occupational therapists in all areas of practice. Narratives of satisfying and dissatisfying experiences with older clients were analyzed to understand the uniqueness of therapists' lived experiences in geriatrics. The realities of practice with older clients--the settings, the meanings and symbols of continuity in old age, and the older client's uncertain future--merge to create an uncertain ideology in geriatric occupational therapy. We suggest that a fundamental task of occupational therapists in geriatrics, as they seek the good life for themselves and their older clients, is to reconcile the realities of practice with traditional rehabilitation ideologies by redefining themselves and their roles in practice.