Occupational Therapy for People Living With Human T-Lymphotropic Virus 1: Importance and Effectiveness of an Intervention Plan at the Level of Prevention and Rehabilitation.

Introduction: Human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy (HAM) restricts activities of daily living (ADLs), affecting health and quality of life. Occupational therapy is used to promote independence during ADL in people living with HTLV (PLHTLV). Objective: To quantify the clinical aspects, levels of functionality, performance in ADLs and occupational roles of PLHTLV and propose an occupational therapeutic intervention. Method: A cross-sectional, descriptive, observational study was designed with 40 PLHTLV monitored at two referral laboratories of the Federal University of Pará. The Evandro Chagas Research Institute Neurological Disability Scale (EIPEC-2), the Barthel Index and the Occupational Roles Identification List were applied. The G test and Fisher's exact test (to identify associations between qualitative variables), the Mann-Whitney test (to identify associations between quantitative variables) and Pearson correlation analysis (to identify associations between the total Barthel Index and EIPEC-2 scores) were performed with Microsoft Excel and BioEstat 5.0, and the significance level was set at p ≤ 0.05. Results: Motor aspects, the presence of spasticity, sensory aspects, and pain in the lumbar region and lower limbs were significantly (p = 0.0002) higher among symptomatic individuals, who also had more difficulties urinating, traveling up and down stairs and transferring from a chair to a bed. Being a worker, performing housework and socializing (with friends or family members) were the most affected activities among HAM patients. Conclusion: The impact of HAM on PLHTLV should include an intervention plan with occupational therapists in rehabilitation programs to create an important third-level prevention initiative, which may help achieve short-, medium-, and long-term goals. Asymptomatic PLHTLV should also be able to prevent future ADL impairment.

How chronic pain changes a person's life story in relation to participation in occupational roles: A narrative exploration.

BACKGROUND: Chronic pain (CP) affects a large part of the population worldwide, decreasing physical and mental health and causing a shift in occupational roles. This has created a need for a better understanding to address this problem. OBJECTIVES: To explore possible changes in occupational roles and the participation levels within among people diagnosed with CP over time. MATERIAL AND METHODS: The study used a qualitative, narrative methodology. Five people with CP were included in the study. They participated in a single-life story interview coupled with timeline drawings. Data analysis was conducted using a narrative analysis. RESULTS: The results revealed that occupational roles and the participation therein changed over time. Employee was considered the most important role, whereby the participants tried to maintain this role by sacrificing other roles within their lives. Moreover, CMP forced a change in their occupational identity. CONCLUSION: CP can disrupt a person's life and demand a change in occupational roles and the participation levels within. This process was accompanied by possible changes in their occupational identity.

Personas con discapacidad y sus roles ocupacionales: trabajo, familia, independencia y participación social / Occupational roles of people with disabilities: work, family, independence and social participation

Este estudio se propone describir las necesidades cotidianas y los roles ocupacionales de un grupo de personas adultas y ancianas con discapacidad en una ciudad de medio porto del Estado de São Paulo, Brasil. Metodológicamente, se seleccionaron dieciséis usuarios con una edad media de 61,7 años y desviación estándar de 17,2 años, con discapacidad física y/o sensorial, con excepción de personas con alteraciones en el lenguaje oral y/o alteraciones cognitivas. Los instrumentos utilizados para recolectar datos fueron el Mini Examen del Estado Mental (para seleccionar la muestra sin alteraciones cognitivas), el Listado de Roles y una guía de entrevista semiestructurada. Resultados: predominan ancianos de género femenino entre las personas con discapacidad física (n=10). Las entrevistas refieren que las relaciones de trabajo y funciones familiares son roles importantes, seguidos del deseo de independencia para realizar otras actividades como las de ocio, servicios domésticos y participación social. Conclusión: la investigación evidenció la importancia de mirar los roles ocupacionales en la vida cotidiana, entendiendo que la ampliación de protagonismo de las personas en su desempeño ocupacional puede favorecer su salud y el aumento de su vida social.

The objective of this study is to describe the everyday needs and occupational roles of adults and old adults with disabilities in a medium port city of the Sao Paulo provincy, Brazil. Method: sixteen adults and older adults age mean 61.7 an standard deviation 17.2 participated in this study. Those selected were people with physical and/ or sensory impairment, to the exclusion of people with alterations in verbal and / or cognitive impairments. The instruments used for data collection were the Mini Mental State Examination (as a criteria to exclude subjects with cognitive imnpairments), the Role Checklist and semi-structured interviews. The results revealed the predominance of elderly females among people with disabilities (n = 10). The interviews showed labor relations and family functions as important roles, followed by the desire for independence in carrying out other activities such as leisure, housework and greater social participation. Conclusion: The research highlighted the importance of looking at the occupational roles of people with disabilities in their daily lives, understanding that the expansion of the role of these people in their occupational performance can promote good health and increased participation in social life.

Percepções sobre as mudanças nas atividades cotidianas e nos papéis ocupacionais de mulheres no climatério / Perceptions on daily activities changes and occupational roles of women in climacteric stage

O climatério é definido como o processo natural do ciclo de vida feminino, inerente à transição da fase reprodutiva para a fase não reprodutiva, e tem o seu marco principal com a menopausa. Durante esse período, a mulher perpassa por várias mudanças fisiológicas, emocionais, sociais e econômicas, que podem impactar negativamente nas atividades exercidas. Com o objetivo de analisar as percepções e os significados atribuídos pelas mulheres atendidas no Ambulatório de Climatério do HC-UFPR sobre o impacto nas atividades cotidianas e nos papéis ocupacionais, realizou-se uma pesquisa exploratória e qualitativa através de um questionário estruturado com dados socioeconômicos, contendo também um check-list autoaplicável e uma entrevista semiestruturada, com aferição dos dados através de técnicas de análise de conteúdo. Observou-se que o preconceito social e o desconhecimento pela mulher sobre as mudanças ocorridas nessa fase se constituem em barreiras para realização de diversas atividades, afetando os cuidados necessários com a saúde e, consequentemente, prejudicando a sua qualidade de vida. Em contrapartida, nesse período, muitas mulheres apresentam maior habilidade de adaptação, descobrindo novas atividades, realizando planos adiados e desempenhando novos papéis ocupacionais. Constata-se a importância da compreensão sobre as mudanças, as percepções e os significados do climatério pela própria mulher e pelos profissionais, para a formulação de uma assistência integral e na qual se valorize a sua individualidade.

Os papéis ocupacionais de pessoas com câncer de cabeça e pescoço / Occupational roles of people with head and neck cancer

INTRODUÇÃO: O câncer de cabeça e pescoço tem elevada incidência e alta mortalidade e seu diagnóstico etratamento influenciam a vida ocupacional da pessoa adoecida e de seus familiares. OBJETIVO: conhecer a configuração dos papéis ocupacionais de pessoas com este tipo de câncer,submetidas a laringectomia total ou parcial. MÉTODO: Estudo quantitativo, exploratório e transversal, aprovado pelo Comitê de Ética (Proc. nº 1102/2010). Foi utilizado o protocolo “Lista de Identificação dos Papéis Ocupacionais”, validada no Brasil; osdados quantitativos foram analisados pelo teste do Qui quadrado. Dados qualitativos complementares foram coletados por entrevista aberta e analisados pelo método de análise de conteúdo temático. CASUÍSTICA: Grupo de estudo com 30 pessoas atendidas pela Cirurgia de Cabeça e Pescoço (CCP), sendo 15 da enfermaria, no pós-cirúrgico imediato, e 15 do Ambulatório, (no mínimo um ano após a cirurgia). Grupo-controle compostopor 30 pessoas sem diagnóstico de câncer. Foram selecionadas 3 do ambulatório (20% do grupo de estudo) para as entrevistas. RESULTADOS: Demonstrou-se que ocorreram mudanças ou perdas de papéis ocupacionais, principalmente do papel de trabalhador. CONCLUSÃO: As consequências psicossociais e ocupacionais do câncer de cabeça e pescoço devem ser consideradas e cuidadas para um melhor e mais eficaz tratamento prestado a essa população.

The head and neck cancer has a high incidence and high mortality and its diagnosis and treatment influence the occupational life of the diseased personand their family. OBJECTIVE: To know the configuration of the occupational roles of people with this type of cancer,undergoing total or partial laryngectomy. METHODS: A quantitative, exploratory cross-sectional study approved by the Ethics Committee (Proc. No. 1102/2010). We used the protocol “List of Identifi cation of Occupational Roles”, validated in Brazil; quantitative data were analyzed by chi-square test. Additionalqualitative data were collected through open interviews and analyzed by the method of content analysis. PATIENTS: Study group with 30 persons served by Head and Neck Surgery (CCP), with 15 ward in the immediate post-surgical, outpatient and 15, (at least one year after surgery). Control group consisting of 30 people without cancer. Were selected from the outpatient clinic3 (20% of the study group) for interviews. RESULTS: It wasdemonstrated that there were changes or loss of occupational roles, especially the role of worker. CONCLUSION: The psychosocial and occupational consequences of head and neck cancer should be considered and cared for better and more effective treatmentprovided to this population.

Transplante de células-tronco hematopoéticas - um estudo controlado sobre papéis ocupacionais / Hematopoietic stem-cells transplants - a controlled study on the occupational roles

O Transplante de Células-Tronco Hematopoiéticas é um procedimento que gera múltiplos sofrimentos ao paciente e seus familiares. Este estudo analisa as mudanças ocorridas nos papéis ocupacionais de pacientes submetidos ao transplante, na sua fase tardia (a partir de um ano pós-transplante), atendidos em um hospital universitário terciário, de grande porte, localizado no interior de São Paulo. Trata-se de um estudo quantitativo, baseado na aplicação de um protocolo internacional validado no Brasil - Lista de Identificação de Papéis Ocupacionais. A casuística é composta por 52 sujeitos, sendo 26 do grupo de estudo e 26 do grupo-controle. Através da análise comparativa entre os grupos, constataram-se diferenças estatisticamente significativas entre os papéis ocupacionais de trabalhador, voluntário, amigo e participante em organizações. Concluiu-se que, passada a fase crítica pós-transplante, embora tenham ocorrido perdas, as pessoas transplantadas de medula óssea mudaram sua vida ocupacional, tendo resgatado ou mudado seus papéis ocupacionais

The transplant of hematopoietic stem-cells is a procedure that causes a lot of distress to the patient and family. This study analyses the changes occurred in the occupational roles of patients that have undergone transplants, in the late stage, assisted in a considerable university hospital located in the interior of the State of Sao Paulo. It is a quantitative research based on the use of an international protocol validated in Brazil: The Occupational Role Checklist. The survey consists of 52 subjects: 26 of the experimental group and 26 of the control group. Through the comparative analysis between the groups, statistically significant differences were observed between the occupational roles of workers, volunteers, friends and participants in organizations. It was possible to conclude that, after the critic stage right after transplant, although they have experienced some losses, the bone marrow transplanted subjects changed their occupational lives, having resumed or changed their occupational roles

Transplante de células-tronco hematopoéticas - um estudo controlado sobre papéis ocupacionais / Hematopoietic stem-cells transplants - a controlled study on the occupational roles

O Transplante de Células-Tronco Hematopoiéticas é um procedimento que gera múltiplos sofrimentos ao paciente e seus familiares. Este estudo analisa as mudanças ocorridas nos papéis ocupacionais de pacientes submetidos ao transplante, na sua fase tardia (a partir de um ano pós-transplante), atendidos em um hospital universitário terciário, de grande porte, localizado no interior de São Paulo. Trata-se de um estudo quantitativo, baseado na aplicação de um protocolo internacional validado no Brasil - Lista de Identificação de Papéis Ocupacionais. A casuística é composta por 52 sujeitos, sendo 26 do grupo de estudo e 26 do grupo-controle. Através da análise comparativa entre os grupos, constataram-se diferenças estatisticamente significativas entre os papéis ocupacionais de trabalhador, voluntário, amigo e participante em organizações. Concluiu-se que, passada a fase crítica pós-transplante, embora tenham ocorrido perdas, as pessoas transplantadas de medula óssea mudaram sua vida ocupacional, tendo resgatado ou mudado seus papéis ocupacionais.(AU)

The transplant of hematopoietic stem-cells is a procedure that causes a lot of distress to the patient and family. This study analyses the changes occurred in the occupational roles of patients that have undergone transplants, in the late stage, assisted in a considerable university hospital located in the interior of the State of Sao Paulo. It is a quantitative research based on the use of an international protocol validated in Brazil: The Occupational Role Checklist. The survey consists of 52 subjects: 26 of the experimental group and 26 of the control group. Through the comparative analysis between the groups, statistically significant differences were observed between the occupational roles of workers, volunteers, friends and participants in organizations. It was possible to conclude that, after the critic stage right after transplant, although they have experienced some losses, the bone marrow transplanted subjects changed their occupational lives, having resumed or changed their occupational roles.(AU)

A percepção de adolescentes gestantes acerca dos papéis ocupacionais e do futuro papel materno / The perception of pregnant adolescent about the occupational roles and future maternal role

Estudo descritivo-exploratório de abordagem qualitativa desenvolvido mediante pesquisa participante no período de 2010 a 2011. Abordou-se o tema gravidez na adolescência, considerada uma etapa do desenvolvimento humano com suas peculiaridades e permeada por uma série de transformações que envolvem fatores biológicos e culturais. Muitas adolescentes podem vivenciar conflitos em relação a suas escolhas e desempenho de papéis em relação à futura maternidade. Sendo assim, o Terapeuta Ocupacional pode atuar junto às adolescentes gestantes abordando a gestação e a maternidade, tendo como foco de investigação o desempenho ocupacional. O cenário da pesquisa foi o Sistema Único de Saúde - SUS, especificamente a Atenção Básica à Saúde, identificado na atuação do Terapeuta Ocupacional neste contexto. Neste estudo, utiliza-se o termo papel ocupacional na perspectiva do Modelo de Ocupação Humana - MOHO. A questão norteadora foi: Como em um processo grupal adolescentes gestantes percebem os seus papéis ocupacionais na gestação e o desenvolvimento futuro do papel materno? Buscou-se identificar os papéis ocupacionais desempenhados pelas adolescentes no segundo e terceiro trimestres da gestação, mediante a Lista de identificação de papéis ocupacionais, e favorecer a reflexão de um grupo de adolescentes gestantes acerca de a percepção dos futuros papéis ocupacionais e sua relação com a maternidade. Aplicou-se a técnica de Grupo em Terapia Ocupacional a um grupo de sete participantes, associada à metodologia problematizadora segundo o Método do Arco de Charlez Maguerez. Destaca-se entre os resultados a perda dos papéis de amigo e estudante, considerados pertinentes a essa fase de vida. Constatou-se também a incorporação do papel de cuidador, membro de família e o papel materno, alicerçados ao momento da gestação. A participação de adolescentes no grupo no contexto de uma Unidade Básica de Saúde, tendo como facilitadoras as dinâmicas grupais, problematizadas a partir da própria realidade e interesse das adolescentes promoveu a identificação e reflexão de seus papéis ocupacionais no período da gestação, bem como daqueles relacionados à perspectiva futura do papel materno. Conseguiu-se mobilizar um processo de mudança para as adolescentes visando favorecer o seu fortalecimento, a adaptação ativa à realidade, o rompimento de estereótipos, a redistribuição de papéis e uma atitude positiva em relação às mudanças sofridas. Esta proposta contribui também para a prática profissional e à ciência da Terapia Ocupacional, oferecendo uma possibilidade de aplicação do MOHO no trabalho em grupo com a população-alvo.

It is a descriptive-exploratory study conducted through a qualitative approach developed during the years of 2010 and 2011. The main theme is adolescent pregnancy, which is considered as a phase of human development with its peculiarities, permeated by a sequence of changes that involve biological and cultural factors. Some adolescents may pass through conflicts related to their choices and performance roles related to the future maternity. Therefore, the occupational therapist may approach pregnancy and maternity, focusing its investigation and practice on occupational performance. The research field is the Sistema Único de Saúde (SUS), concentrated on Health Primary Care and the occupational therapist practice in this context. The term occupational role is used in the Model of Human Occupation (MOHO) perspective. Research main question is: How may pregnant adolescents in a group process perceive their occupational roles during the pregnancy period and the development of the future maternal role? The research goals are: to indentify the occupational roles performed by the adolescents throughout the second and third trimesters of gestation (according the Occupational Role Checklist) and to facilitate a group reflection of pregnant adolescents about the perception of their future occupational roles and their relation to maternity. The Occupational Therapy group technique was applied whit seven participants. That was associated to the problem-centered methodology, according to the Method of the Arc, proposed by Charles Maguerez. The results show the loss of the roles of friend and student considered relevants to this phase of the life. They also demonstrate the incorporation of the role of caregiver, family member and the maternal role associated to the time of pregnancy. Participation of adolescents in groups held on Primary Health Care context facilitated the identification and reflection of their occupational roles during the gestation period and also those roles related to the future maternity. A change process was promoted pursuing empowerment, active sense of adaptation to reality, stereotypes breaking, roles redistribution and positive attitude towards the suffered changes. Moreover the methodological proposal contributes to professional practice and science, offering a possibility of the application of the MOHO in work groups with the target population.

Occupational therapy: current practice and training issues in the treatment of cognitive dysfunction.

A significant relationship exists between cognitive abilities and functional performance in activities of daily living. Occupational therapists are involved in providing cognitive rehabilitation to individuals with brain damage by assisting them in fulfilling self-care, work and leisure roles. Since occupational therapists specialize in functioning in the real world, they should have a primary role on the interdisciplinary team in assessing and treating cognition as it relates to function. Particular areas of expertise include assessment and intervention in daily living tasks, safety issues and cognitive/perceptual dysfunction. Treatment strategies in occupational therapy are classified into two approaches: remedial and compensatory. A combination of the two approaches has been found to be the most beneficial method of intervention. Though current training guidelines for occupational therapists in cognitive rehabilitation are vague, the major focus has been on evaluating functional status and intervening when cognitive/perceptual deficits are present. Future training for practitioners in this area will require more specialized experiences and education. Additional research will need to be conducted by therapists to document treatment efficacy. Despite current health care constraints, occupational therapists must not lose sight of delivering quality care in an individualized and holistic manner.

Preparing the young stroke survivor for return to work.

Preparing the young stroke survivor for work is an essential aspect of the rehabilitation process. This unique prevocational program, the Functional Occupations Program (FOP), is designed to provide outpatient, interdisciplinary group services to those who want to return to work or an occupation after cerebrovascular accident (CVA) or other devastating injuries. In the past 3.5 years of the program, 39 CVAs were seen. Preliminary outcome measures indicate that 20% of the CVAs served in year 3 and beginning of year 4 returned to work, with 58% of those individuals in blue collar jobs.