Spirituality as a Neglected Core in Occupational Therapy Practice: An Iranian Exploratory Survey.

Spirituality has received more attention in recent decades from different health disciplines. Occupational Therapy (OT), as a health discipline, believes that all aspects of human experience, including physical, psychological, social, and spiritual, are considered essential aspects of health. OT supports the fact that incorporating spirituality can promote health, well-being, and quality of life. Various researchers have attempted to investigate and explain occupational therapists' views on spirituality. In Iran's OT curriculum, spirituality has not been incorporated directly. The purpose of this study is to acquire information about the knowledge and opinions of Iranian occupational therapists about spirituality. This is a cross-sectional exploratory descriptive survey study in which 125 occupational therapists participated through convenience sampling. Inclusion criteria were, namely (a) at least one-year clinical experience of OT, (b) being educated in Iran, and (c) working in Iran. The Occupational Therapy Assessment of Spirituality (OTAS) questionnaire was used for data collection. The answers to the quantitative questions were analyzed through descriptive statistics. Most of the participants believed that spirituality should be incorporated by occupational therapists, but more than half of the participants disagreed that formal education prepared them to pay any attention to spirituality in their practice. Analyzing qualitative data by frequencies of their repetitions, led to four categories and sixteen subcategories, accordingly. The four categories are (1) the barriers to applying spirituality in OT, (2) the need to acquire knowledge and apply spirituality in OT, (3) the benefits of incorporating spirituality for a client, and (4) the benefits of incorporating spirituality for the occupational therapist. The findings indicate that academic education has failed to prepare Iranian occupational therapists to meet spiritual needs of their clients. However, OTs tend to get information about spirituality from other sources and find it helpful for themselves and their clients. There are also barriers to applying spirituality; therefore, an educational package is needed to address these problems.

Electroencephalogram-based neurofeedback training in persons with stroke: A scoping review in occupational therapy.

BACKGROUND: Neurofeedback training targets the relevant brain response under minimal stress. It could be a promising approach for the treatment of patients with brain injury. OBJECTIVE: This review aimed to examine the existing literature to confirm the effectiveness of applied electroencephalogram (EEG)-based neurofeedback training in the area of occupational therapy for upper limb stroke rehabilitation. METHOD: All relevant literature published until July 1, 2020 in five prominent databases (PubMed, CINAHL, PsycINFO, MEDLINE Complete, and Web of Science) was reviewed, based on the five-step review framework proposed by Arksey and O'Malley. RESULTS: After a thorough review, a total of 14 studies were included in this review. Almost studies reported significant improvements as a result of EEG-based neurofeedback training, but this had not always account for the differences in effectiveness between groups. However, the results of these studies suggested that neurofeedback training was effective as compared to the traditional treatment and more effective in combination with EEG than that with simple equipment application. CONCLUSION: This review demonstrated the effectiveness of the combination of occupational therapy and EEG-based neurofeedback training. Most of these treatments are intended for inpatients, but they may be more effective for outpatients, especially if customized to their requirements. Also, such explorations to assess the suitability of the treatment for patient rehabilitation will help reduce barriers to effective interventions. An analysis of the opinions of participants and experts through satisfaction surveys will be helpful.

Impact of smart force feedback rehabilitation robot training on upper limb motor function in the subacute stage of stroke.

OBJECTIVE: To explore the impact of rehabilitation robot training (RRT) on upper limb motor function and daily activity ability in patients with stroke. METHODS: Forty patients meeting the inclusion criteria were randomly divided into the treatment group (TRE) and the control group (CON). Group TRE was trained with an upper limb rehabilitation robot and group CON was trained with traditional occupational therapy. The training time was six weeks, and the upper limb function and daily activities were then assessed. RESULTS: (1) There was no statistical significance in the Fugl-Meyer (FM) score, Wolf Motor Function Test (WMFT) score, and Modified Barthel Index (MBI) score between the two groups before treatment (P > 0.05). (2) After treatment, the FM score, WMFT score, and MBI score were significantly higher than before treatment (P < 0.01). (3) There was no significant significance between the two groups after treatment (P > 0.05). CONCLUSIONS: Both RRT and traditional occupational therapy training are useful for the recovery of upper limb motor function and daily life ability in the sub-acute stage of stroke.

Impact of the implementation of a therapy dog program on burn center patients and staff.

Animal-assisted interventions have been implemented in both inpatient and outpatient settings and have demonstrated positive outcomes on patients and hospital staff. Animal-assisted interventions have not been previously reported in any burn center. A therapy dog program was established at our burn center with the intent of improving duration and quality of rehabilitation sessions and physical therapy. Satisfaction surveys were distributed to patients and staff. After one year, 14 patient surveys and 23 staff surveys were collected. Implementation of this program was feasible and patients worked with the therapy dogs in all environments of the burn center: outpatient, ward, and ICU. Most patients reported improved pain and anxiety after working with the therapy dogs. All patients reported that they would like more sessions with the therapy dogs. All staff members were satisfied or very satisfied with their therapy dog visit and all enjoyed having the therapy dogs present. Most reported an improved mood after seeing the therapy dogs and wanted that additional therapy dog visits. One year after the implementation of the therapy dog program, we have demonstrated feasibility, acceptability, and desirability of this type of program at our burn center. Given the paramount importance of rehabilitation in the recovery of burn patients, further investigation into therapy should be performed and longer term outcomes assessed.

[Beyond suffering, schizophrenic improvisation and therapeutic challenges]. / Au-delà des maux, improvisation schizophrénique et (en)jeux thérapeutiques.

Led jointly by an actress and an occupational therapist, an 'improvisation' activity has been set up within the Sainte-Anne University Hospital SHU Sector 14 for hospitalised patients, on medical prescription. This containing environment provides psychological support and encourages patients with schizophrenia to explore their creativity and to 'let go' so as to discover new physical possibilities. The group thereby becomes a support for the relationship and the development of verbal and non-verbal communication.

Práctica mental en la rehabilitación de pacientes con ictus. Una revisión sistemática / Mental practice in the rehabilitation of stroke patients. A systematic review

Objetivo. Realizar una revisión sistemática de la literatura para conocer la efectividad de la imaginería motora o práctica mental como tratamiento de pacientes con ictus en la recuperación motora del miembro superior e inferior. Estrategia de búsqueda. Se realizó una búsqueda sistemática de artículos científicos publicados, tanto en inglés como en castellano, desde octubre del 2012 hasta diciembre del 2014. Se evaluó la calidad metodológica mediante la escala de Jadad. Selección de los estudios. Se incluyeron un total de 12 artículos. La calidad metodológica de los estudios fue muy pobre en general. Solo cuatro artículos superaron la puntuación 3/5 en la escala Jadad. Síntesis de resultados. Se observó una gran heterogeneidad en la duración y en el número de participantes. El tiempo de tratamiento osciló entre los 5 y las 54 semanas. El tamaño muestral de los estudios estuvo comprendido de media entre 9 y 42 individuos. Los individuos incluidos en los trabajos presentaban hemiparesia, pudiendo afectar esta tanto a miembro superior como inferior, en una fase subaguda o crónica de la enfermedad. Conclusiones. La mayoría de los trabajos incluidos apenas detallaron los parámetros de las intervenciones. En aquellas publicaciones en las que se especificaron, el tiempo de duración por sesión osciló entre 15-20 minutos; con una frecuencia de tratamiento de tres días a la semana durante una media de cuatro semanas; en relación con el tipo de instrucciones, estas fueron principalmente auditivas y visuales; finalmente, el orden de aplicación de la terapia fue variable en relación con la terapia física convencional. Existieron elementos que no se especificaron como el número de ensayos por sesión, el tipo de imaginería empleada, el contexto o la localización de las sesiones (AU)

Objective. To conduct a systematic review of the literature to determine the effectiveness of motor imagery and mental practice as a treatment of patients with stroke for motor recovery of the upper and lower limb. Search strategy. We conducted a systematic search of scientific articles published in both English and Spanish from October 2012 to December 2014. Methodological quality was evaluated using the Jadad scale. Study selection. A total of 12 items were included. The methodological quality of the studies was generally poor. Only four articles exceeded a score of 3/5 on the Jadad scale. Synthesis of the results. There was wide heterogeneity in treatment duration and the number of participants. The treatment time ranged from 5 to 54 weeks. The average sample size of the studies included was between 9 and 42 individuals. Included individuals had hemiparesis, which could affect both the upper and lower limbs in the subacute and chronic phases. Conclusions. Most of the included studies did not describe the parameters of the interventions. In those that did specify them, the duration of each session was between 15 and 20 minutes, with a treatment frequency of three days per week for an average of four weeks. Instructions were auditory and visual. The order of application of the therapy varied in relation to conventional physical therapy. Numerous elements were not specified, such as the number of trials per session, the kind of imagery, and the context or location of the sessions (AU)

A phenomenology of occupation-based hand therapy.

BACKGROUND/AIM: The existing tension between holistic, occupation focused approaches and the medical model in occupational therapy is most evident in the area of hand therapy. Occupation-based hand therapy has been proposed as a means to alleviate this tension. However, there is a lack of research on occupation-based hand therapy. Clearly describing and defining what constitutes occupation-based hand therapy can facilitate efficacy research and help promote occupation-based practice in keeping with the philosophy of the profession. METHODS: The qualitative approach of phenomenology as described by Moustakas was used. Participants who were occupational therapists with more than 5 years of experience who self -identified as occupation-based practitioners were recruited to the point of saturation using criterion and chain sampling for a final total of 10 participants. Data were collected through audio recorded telephone interviews and electronic mail. The data were reduced and distilled into a description of the experience of providing occupation-based hand therapy. RESULTS: Participants described the experience of providing occupation-based hand therapy around the concepts of influences, psychosocial benefits, procedural elements of practice and challenges. CONCLUSION: Findings of this study can assist occupational therapists to develop a more occupation-based intervention program through focusing on occupation-based theory, being intentional, using occupation-focused interventions and building an occupation focused context. Findings can also inform future research into the efficacy of occupation-based hand therapy, appropriate timing for balancing occupation with tissue protection, and the effects of therapist experience on their ability to use an occupation-based approach in hand therapy.

Estrategia para el bienestar emocional en niños escolares hospitalizados: Villa Clara: 2013 / Strategy for the emotional well-being in hospitalized school children

Los niños hospitalizados sufren un cambio abrupto, desaparece el hogar, la escuela, el barrio, los hermanos, amigos, las actividades que solía desarrollar y aparece aburrimiento por pobre estimulación y monotonía de las rutinas, condiciones pésimas para la recuperación. La atención sicológica a estos niños enfermos ingresados es insuficiente, por lo que es necesario resolver la situación emocional negativa que genera la hospitalización, la enfermedad y los tratamientos, y así restablecer su salud y su bienestar sicológico. Objetivo: Evaluar el diseño de una estrategia con enfoque intersectorial para mejorar el bienestar emocional en niños hospitalizados. Metodología: Matriz DAFO, método Delphy, criterio de especialistas, encuestas. Intervinieron en el diseño cinco prestadores; muestra para la evaluación, 15 especialistas, seleccionados en “Bola de nieve”. Resultados: Se describió la estrategia diseñada, conformada por cinco dimensiones, nueve programas, veintisiete subprogramas y más de ochenta acciones y se obtuvo un criterio positivo de especialistas sobre el diseño. Conclusiones: Se diseñó una estrategia para mejorar el bienestar emocional en niños escolares hospitalizados con enfoque salubrista. A juicio de especialistas la estrategia es pertinente y apropiada, es factible su aplicación y puede ser eficaz para mejorar el bienestar emocional en niños hospitalizados.(AU)

Background: Hospitalized children suffer an abrupt change. Home, school, neighborhood, siblings, friends and usual activities disappear besides boredom due to poor stimulation and monotony of the routines and all of these make recovery very poor. Objective: To assess the design of a strategy with an intersectorial approach to enhance emotional well-being in hospitalized children. Methodology: Delphy method, SWOT matrix, specialists criteria and interviews. Five providers intervened in the design and 15 specialists were taken as samples for evaluation by using the Snow Ball method. Results: The designed strategy was described, consisting of five dimensions, nine programs, 27 subprograms and more than eighty actions and a positive criterion of experts is taken. Conclusions: A strategy was designed to improve the emotional well-being in hospitalized school children with a health approach. The strategy isrelevant and appropriate, feasible to be applied and can be very effective to improve the emotional well-being in hospitalized school children.(AU)

"Running Water Won't Freeze": How people with advanced Parkinson's disease experience occupation.

OBJECTIVE: Parkinson's disease (PD) is a progressive neurodegenerative condition often resulting in significant disability and impacting on one's ability to participate in an occupation. The present study aimed to explore how people with advanced Parkinson's disease experience the phenomenon of occupation in their daily lives in order to inform the practice of occupational therapy in palliative care. METHOD: Using a phenomenological approach, in-depth interviews were undertaken with a purposive sample of 10 people in the advanced stages of Parkinson's disease. These interviews were audiotaped, transcribed verbatim, and subsequently analyzed using a thematic content analysis approach. The study received approval from the relevant university ethics committee, as well as the research network of Parkinson's UK. RESULTS: The experience of occupation emerged as being physical, psychological, social, and spiritual with related subthemes. Within each of these themes, participants described their experience of occupation that they valued and that were important to their daily lives. They also identified the strategies they employed to continue participating in certain occupations and described others they were no longer able to engage in and the impact of that loss. SIGNIFICANCE OF RESULTS: Participants' experiences crossed the domains of palliative care and suggest that adopting a palliative care approach would enhance an enhanced quality of life, experienced in terms of meaningful and valuable occupation. Disruption to participation in occupation caused them distress and frustration, suggesting that access to occupation-focused therapy would significantly improve quality of life for people with PD. As there is a strong link between the ethos of occupational therapy and palliative care, it is proposed that there is a valuable role for occupational therapy intervention to play within palliative care.

Occupational Therapy Students' Perceptions of Spirituality in Training.

Spirituality is recognized as an essential and integral component of a holistic approach in occupational therapy practice. However, little is known about occupational therapy students' perceptions regarding spirituality in learning context. This study used qualitative exploratory, descriptive design to explore the occupational therapy students' perceptions about spirituality in training. Using purposive sampling, four semi-structured interviews were conducted with two students, a lecturer and an occupational therapist. In addition, two focus groups were conducted with students in order to collect data. Data collected were audio-taped; transcribed and thematic analysis was used to identify themes. The analysis resulted in emergence of four themes: "Unique to every individual," "Spirituality in occupational therapy," "To be or not to be taught," and "The Real world." Participants perceived spirituality as an individually experienced. The study contributes to the body of knowledge base of occupational therapy education regarding spirituality. However, there is a need for guidelines to integrate spirituality in occupational therapy training.

Positive and cost-effectiveness effect of spa therapy on the resumption of occupational and non-occupational activities in women in breast cancer remission: a French multicentre randomised controlled trial.

PURPOSE OF THE RESEARCH: The main aim was to assess the effects of a spa treatment on the resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission. A cost-effectiveness analysis (CEA) was also performed. METHODS AND SAMPLE: A multicentre randomised controlled trial was carried out between 2008 and 2010 in the University Hospital of Auvergne and two private hospitals in Clermont-Ferrand, France. Eligible patients were women in complete breast cancer remission without contraindication for physical activities or cognitive disorders and a body mass index between 18.5 and 40 kg/m(2). The intervention group underwent spa treatment combined with consultation with dietician whereas the control underwent consultations with the dietician only. Of the 181 patients randomised, 92 and 89 were included in the intervention and the control groups, respectively. The CEA involved 90 patients, 42 from the intervention group and 48 from the control group. KEY RESULTS: The main results showed a higher rate of resumption of occupational activities in the intervention group (p = 0.0025) and a positive effect of the intervention on the women's ability to perform occupational activities 12 months after the beginning of the study (p = 0.0014), and on their ability to perform family activities (p = 0.033). The stay in a thermal centre was cost-effective at 12 months. CONCLUSIONS: Spa treatment is a cost-effective strategy to improve resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission.

Spirituality in occupational therapy: do we practice what we teach?

This mixed-method study examined the responses of 97 occupational therapists on the subject of spirituality in occupational therapy practice. The inclusion of spirituality into the Occupational Therapy Practice Framework (2008) implies that clinicians address spirituality as a component of client-centered practice. This research revealed a gap between education, theory, and practice as evidenced in the quantitative and qualitative data. Although occupational therapy is intended to be holistic, therapists require a more complete understanding of what spirituality is and what the role of the occupational therapist is when addressing spirituality in evaluation or treatment. The discussion of this research provides information for future occupational therapy educators and educational programs as they seek to incorporate the construct of spirituality into curricula.

Contemporary psychological approaches to life at the end of life.

When people have a serious life-limiting illness, physical symptoms are often prominent, both in the experience of the illness and in its treatment. No less important, however, are psychological symptoms. A holistic, bio-psycho-social-spiritual approach to quality of life near the end of life must address psychological distress of all types, including frank psychopathology, more moderate problems with living, and existential distress. Responding to mental health issues at the end of life requires (1) systematic and careful assessment, and (2) deployment of evidence-based treatments. In recent years, standardized assessment tools have been adapted or developed for use with people who have serious illness, and the same has happened with psychological treatments. Practitioners have several resources available to them. Given their practice orientation centered on meaningful engagement, occupational therapists can play an important role in responding to mental distress in patients with serious illness whose lives are becoming more circumscribed because of their medical condition or because of the mental distress itself. High-quality end-of-life care depends on scrupulous attention to the full spectrum of thoughts, feelings, and behaviors that unfold as death draws near.

Working with transgender clients: learning from physicians and nurses to improve occupational therapy practice.

BACKGROUND: Gender identity disorder and the process of transitioning involve both mental and physical health, yet there is virtually no discussion of transgender health care in occupational therapy. PURPOSE: This study draws on interviews with primary-care nurses and physicians about their experience with transgender health care, extending the insights gleaned there to make suggestions for occupational therapy practice with this population. METHOD: Semi-structured interviews were conducted with 12 primary care nurses and 9 physicians who had clinical experience with lesbian, gay, and bisexual patients. FINDINGS: Participants felt uncertain about transgender care, wanting more specialized knowledge. Collaborating with patients, acknowledging stigma, ensuring inclusive systems and procedures, navigating health care, and providing holistic care emerged as key elements for best practice. Advocacy was a crucial part of care provision. IMPLICATIONS: Suggestions are provided for therapists to ensure that space and interactions are welcoming to transgender clients as well as suggestions for occupational therapy intervention in the transitioning process.

Clinical experiences to promote student education of psychological and social aspects of mental health: a case report.

OBJECTIVES: This case study describes and reports one university's occupational therapy (OT) curriculum design regarding the utilization of clinical fieldwork level II experiences to promote mental health as a core to the education of occupational therapists. PARTICIPANTS AND METHODS: Graduates (190) of a Connecticut University were queried through a survey to determine the influence of OT fieldwork level II on student development of knowledge pertaining to psychological and social aspects of mental health. The respondents also provided feedback on the efficacy of such an experience in preparing for practice across all practice settings. RESULTS: Quantitative and qualitative themes indicate that University alumni recognize significant educational benefits acquired through the experience of a mental health/psychological-social fieldwork level II experience. CONCLUSIONS: Mental health concepts as represented by psychological and social aspects are embedded in all domains of occupational therapy. Beginning with its strong foundational influence to the profession, there has been of late, a recent resurgence of knowledge and practice implications as noted by various official professional publications. The major finding of the study was that graduates indicated that a clinical experience in mental health did contribute significantly to their holistic practice skills. Recognizing the potential benefits of a psychosocial fieldwork level II experience with new, accentuated methods for student learning, may foster the development of mental health skills for utilization across all practice settings.

Perceptions of self-esteem in a welfare-to-wellness-to-work program.

OBJECTIVE: The study investigates welfare recipients' perceptions of personal self-esteem in relationship with their participation in a welfare-to-wellness-to-work program. DESIGN AND SAMPLE: The cross-sectional, mixed-methods design examined a convenience sample of 33 participants who attended a welfare-to-wellness-to-work program called Work Wellness: The Basics that is based in an agency called Wellness Works!. MEASURES: A demographic survey, Rosenberg's Self-Esteem scale, and qualitative interviews were used. RESULTS: Even with normal self-esteem scores, the participants credited the program with decreasing negative thoughts and improving self-esteem. The themes identified include program, self-esteem, mental health, and domestic violence. CONCLUSION: Information about the benefits of a holistic wellness program and its relationship with self-reported enhanced self-esteem can be used to assist with health promotion, policy, and the development of innovative programs that assist with transition from public assistance.

Mindfulness and flow in occupational engagement: presence in doing.

BACKGROUND: Flow is a psychological state that might be viewed as desirable, and it occurs when a person is aware of his or her actions but is not being aware of his or her awareness. Mindfulness is viewed not as the achievement of any particular state, but as intentional awareness of what is, being aware of awareness. PURPOSE: To examine theoretical perspectives and empirical research on flow and mindfulness, and offer suggestions about the relevance of these concepts to occupational engagement. KEY ISSUES: Both flow and mindfulness involve being present, actively engaged, and attentive. The experience and practice of flow and mindfulness are relevant to the experience of occupational engagement. IMPLICATIONS: Understanding flow and mindfulness may help occupational therapists improve the therapeutic occupational engagement process with their clients through enhancing depth and meaning of occupational experiences, as well as health and well-being.