Changes in brain morphometry after motor rehabilitation in chronic stroke.

PURPOSE: Recent studies have revealed structural changes after motor rehabilitation, but its morphological changes related to upper limb motor behaviours have not been studied exhaustively. Therefore, we aimed to map the grey matter (GM) changes associated with motor rehabilitation after stroke using voxel-based morphometry (VBM), deformation-based morphometry (DBM), and surface-based morphometry (SBM). METHODS: Forty-one patients with chronic stroke received twelve sessions of low-frequency repetitive transcranial magnetic stimulation plus intensive occupational therapy. MRI data were obtained before and after the intervention. Fugl-Meyer Assessment and Wolf Motor Function Test-Functional Ability Scale were assessed at the two-time points. We performed VBM, DBM, and SBM analyses using T1-weighted images. A correlation analysis was performed between cortical thickness in motor areas and clinical outcomes. RESULTS: Clinical outcomes significantly improved after the intervention. VBM showed significant GM volume changes in ipsilesional and contralesional primary motor regions. DBM results demonstrated GM changes contralesionally and ipsilesionally after the intervention. SBM results showed significant cortical thickness changes in posterior visuomotor coordination, precentral, postcentral gyri of the ipsilesional hemisphere and contralesional visuomotor area after the intervention. A combination of threshold p < .05, False Discovery Rate and p < .001 (uncorrected) were considered significant. In addition, cortical thickness changes of the ipsilesional motor areas were significantly correlated with the clinical outcome changes. CONCLUSIONS: We found GM structural changes in areas involved in motor, visuomotor and somatosensory functions after the intervention. Furthermore, our findings suggest that structural plasticity changes in chronic stroke could occur in the ipsilesional and contralesional hemispheres after motor rehabilitation.

Enabling Work: Occupational Therapy Interventions for Persons with Occupational Injuries and Diseases: A Scoping Review.

Purpose This review aims to map the scope of published research on occupational therapy (OT) interventions and pertinent work and work-related outcomes for persons with occupational injuries and diseases. Methods The scoping review adapted Arksey and O'Malley's framework. Six electronic databases were searched. Ancestral search was also done on five systematic reviews. The search was conducted from September 2015 to October 2015. Interventions and outcomes were coded using the International Classification of Functioning, Disability and Health Core Set for Vocational Rehabilitation to plot trends. Results Forty-six articles were included in the review. The top five intervention approaches included: acquiring skills (12.27%), health services, systems, and policies (10.43%), products and technology for employment (9.20%), handling stress and other psychological demands (7.98%), and apprenticeship (6.74%). The top five outcomes targeted included: remunerative employment (15.71%); sensation of pain (10.99%); emotional functions (5.76%); handling stress and other psychological demands (5.76%); economic self-sufficiency (4.71%); muscle endurance functions (4.71%); exercise tolerance functions (4.71%); undertaking multiple tasks (4.19%); acquiring, keeping, and terminating a job (4.19%); and looking after one's health (4.19%). Conclusion The trend in interventions show the use of activities and environment facilitators which are attuned to the conceptual nature of OT. Furthermore, the trend in outcomes show that there is substantial evidence that supports the use of OT to target work. This review may provide a platform for collaboration with other professionals and also help identify research directions to strengthen the evidence base for OT in work-related practice.

Unraveling the "Greener Pastures" Concept: The Phenomenology of Internationally Educated Occupational Therapists.

The Philippines is one of the major labor exporters for health care workers in the world and occupational therapists are the second most likely professionals behind nurses to work in "greener pastures" overseas. This phenomenological study describes the migration experiences of Philippine-trained occupational therapists working in high-income, Anglophone countries. Researchers conducted online interview for 15 participants who were previously/currently unemployed/underemployed. Following an inductive approach to qualitative data analysis, themes were drawn from the migrant therapists' lived experiences. Four themes describe the migration experiences of Filipino occupational therapists: (a) realities of being an occupational therapist in the Philippines, (b) contradictions faced by Filipino occupational therapists upon migration, (c) when the pastures overseas are not greener, and (d) when the pastures overseas are indeed greener. The study contributes to the labor migration discourse in occupational therapy and the critical examination of the idea of "greener pastures."

The Migration and Deskilling of Filipino Occupational TherapistsThis study provides stories of Filipino occupational therapists who were underemployed as they migrated to developed and English-speaking countries. We interviewed 15 people online to explore their experiences of migration, being underemployed, and working in a foreign country with a different culture of working. Results of the study revealed four ideas: (a) reality of being an occupational therapist in the Philippines, (b) contradictions faced by Filipino occupational therapists upon migration, (c) barriers faced by migrant occupational therapists, and (d) successes experienced by migrant occupational therapists. This study contributes to the ongoing research on occupational therapy, labor migration, and overseas Filipino workers.

Promoting Sports Engagement during the COVID-19 Pandemic via Virtual Reality Games.

OBJECTIVE: To examine sports engagement and health changes of young adults when utilizing a VR sports game and investigate the relationship between sports engagement and health. METHOD: This study used a single-group design with 20 participants, aged 19-29 years, with no preexisting health conditions. The VR game "Sports Scramble" was used thrice within a span of one week. Outcomes sought include sports engagement and health, measured through the Sports Engagement Scale (SES) and Short Form 36 (SF-36), respectively. RESULTS: A significant difference (p < 0.001) was found between the pre-posttest scores of the SES. Moreover, a positive trend was observed in terms of health with a significant difference (p < 0.05) between pre-posttest scores of the SF-36's vitality dimension. There were positive correlations among the dedication and vigor subscales of the SES with the dimensions of health. CONCLUSION: This study showed the potential of VR sports games in positively influencing sports engagement and health among participants with the vigor and dedication positively influencing health. Future studies may involve the exploration of the effectiveness of VR to promote engagement and health through a randomized controlled trial with a longer timeframe and across various populations.

Experience of Filipinos with Spinal Cord Injury in the Use of Assistive Technology: An Occupational Justice Perspective.

Assistive technology (AT) is often required to facilitate the performance of occupations and promote inclusion and reduction of dependency among persons with spinal cord injury (SCI). However, only 5-15% of individuals in developing countries have access to AT. This study is aimed at exploring the experience of Filipinos with SCI as they use AT and understand these from an occupational justice (OJ) perspective. This study utilised a hermeneutic phenomenological approach to explore the participants' experiences with AT usage. Ten participants were recruited from a hospital and communities within Metro Manila, Philippines, and interviewed last January 2020. Hermeneutic analysis was done to interpret the shared meaning embedded within their experiences and was informed by an occupational justice perspective. Exploring the experience of the participants in using AT yielded four themes, namely, (1) engaging in occupations despite limited opportunities, (2) going to various locations amidst an inaccessible environment, (3) striving towards inclusion in spite of attitudinal barriers, and (4) securing needs in light of unfavourable life conditions. Filipinos with SCI deal with numerous structural and contextual factors in daily life. There has been partial enablement of OJ as they incorporate AT in their daily lives as occupational rights are far from being recognised and respected. In infusing an OJ perspective to understanding AT use, OT practitioners are bound to identify problems and courses of action that go beyond traditional service delivery.

Is occupational therapy an ableist health profession? A critical reflection on ableism and occupational therapy / Terapia ocupacional é uma profissão da saúde capacitista? Uma reflexão crítica sobre capacitismo e terapia ocupacional

Abstract Introduction There is a need to engage in critical reflection and reflexivity to deconstruct ableist conceptualisations and practices in occupational therapy. Objectives: 1) to discuss ableism as a social construction within a practice system, 2) to deconstruct ableist mechanisms employed within occupational therapy practice, and 3) to propose inclusive and justice-oriented practices that can improve patterns of practices within the occupational therapy profession. Method Online discussions and reflective writing, producing critical reflections, were done to curate our experiences and insights based on our personal and professional experiences, thoughts, and observations as Filipino occupational therapy practitioners. Critical reflexivity was seen both as process and output to address the research objectives. Findings Despite the efforts of scholars, educators, and practitioners in employing inclusive and justice-oriented occupational therapy practices, ableism continues to proliferate through overt and covert mechanisms within professional practices. Conclusion As the occupational therapy profession continues to evolve, practitioners are expected to be critically reflective and reflexive to mitigate discriminatory practices and promote inclusive and participatory practices today and beyond. This article hopes to serve as an eye-opener for occupational therapy practitioners and reconsider their doings, knowings, and sayings in their present and future practice.

Resumo Introdução Há uma necessidade de se engajar em uma reflexão crítica e em reflexividade para desconstruir conceituações e práticas capacitistas em terapia ocupacional. Objetivos 1) discutir o capacitismo como uma construção social dentro de um sistema de prática, 2) desconstruir mecanismos capacitistas empregados na prática em terapia ocupacional e 3) propor práticas inclusivas e orientadas para a justiça que possam melhorar os padrões de práticas dentro da profissão de terapia ocupacional. Método Foram feitas discussões online e escrita reflexiva, produzindo reflexões críticas, para selecionar nossas experiências e insights, pensamentos e observações pessoais e profissionais como praticantes de terapia ocupacional nas Filipinas. A reflexividade crítica foi vista tanto como processo quanto como saída para abordar os objetivos da pesquisa. Resultados Apesar dos esforços de acadêmicos, educadores e profissionais em empregar práticas de terapia ocupacional inclusivas e orientadas para a justiça, o capacitismo continua a proliferar por meio de mecanismos abertos e encobertos nas práticas profissionais. Conclusão À medida que a profissão de terapia ocupacional continua a evoluir, espera-se que os profissionais sejam criticamente reflexivos para mitigar práticas discriminatórias e promover práticas inclusivas e participativas hoje e além. Este artigo espera contribuir como um alerta para terapeutas ocupacionais reconsiderarem seus fazeres, saberes e dizeres em sua prática presente e futura.

Occupational justice health questionnaire: reflections on its application / Questionário de saúde e justiça ocupacional: reflexões em sua aplicação

ABSTRACT Introduction Occupational justice concept is defined as the equal access and participation in all occupations, including the resources required for participation and opportunities for social inclusion. Occupational justice not only remains conceptually ambiguous for occupational therapy practice but also lacks critical examination of its applicability to non-Western cultures. Objective This article describes the reflexive process exercised by the researchers during and after using the Occupational Justice Health Questionnaire (OJHQ) as an occupational therapy tool in a substance addiction rehabilitation setting in the Philippines. Method This qualitative study gathered transcriptions from field notes and focus group discussions of the authors. These transcriptions were characterized by the authors' reflections on their experiences using the OJHQ on four distinct periods: 1) OJHQ translation, 2) pilot testing, 3) OJHQ-Filipino version administration, and 4) project conclusion. Data were analyzed through thematic analysis. Results Qualitative data revealed four themes: tool usefulness; administration guidelines; contextualized use of the tool; and nuances of occupational injustices in substance addiction and rehabilitation setting. Conclusion Findings expanded OJHQ's purpose to enhance clinical reasoning, promote justice-oriented health care, activate reflective practice, and recognize the interweaving and evolving nature of injustices. This article offers an understanding of how reflections can facilitate cultural adaptation of practice tools used in occupational therapy and justice practice.

RESUMO Introdução O conceito de justiça ocupacional é definido como a igualdade de acesso e participação em todas as ocupações, incluindo os recursos necessários para a participação e oportunidades de inclusão social. A justiça ocupacional não apenas permanece conceitualmente ambígua para a prática, mas também carece de um exame crítico de sua aplicabilidade a culturas não ocidentais. Objetivo Descrever o processo reflexivo dos pesquisadores durante e após o uso do Questionário de Saúde e Justiça Ocupacional (OJHQ), como uma ferramenta em terapia ocupacional em um ambiente de reabilitação para pessoas com dependência de substâncias psicoativas nas Filipinas. Método Estudo qualitativo baseado em notas reflexivas e grupos focais. As transcrições foram caracterizadas pelas reflexões dos autores sobre suas experiências usando o OJHQ em quatro períodos distintos: 1) Tradução do OJHQ, 2) teste piloto, 3) Administração da versão OJHQ-Filipino e 4) conclusão do projeto. Os dados foram analisados por meio de análise temática. Resultados Os dados qualitativos revelaram quatro temas: utilidade da ferramenta; diretrizes de administração; uso contextualizado da ferramenta; e nuances de injustiças ocupacionais no contexto de dependência de substâncias psicoativas e reabilitação. Conclusão Houve a expansão do propósito do OJHQ para aprimorar o raciocínio clínico, promover cuidados em saúde orientados para a justiça, ativar a prática reflexiva e reconhecer a natureza entrelaçada e evolutiva das injustiças. Compreende-se como as reflexões podem facilitar a adaptação cultural das ferramentas práticas utilizadas na terapia ocupacional com base em práticas de justiça.