Abstract

Occupational Therapy

SCHEDULE
Session 1 : 11 : 00 ~ 12 : 00
Session chair: Prof. Minoru Hoshiyama
1. Time orientation and orientation in the elderly persons.
Yuko Iwamoto
2. Communication with emotional materials with patients with dementia
Sayo Yamashita
3. Comparison of behavior in young and elderly drivers using the Safe Driving
Behavior Measure (SDBM)
Y. J. Jeong, M. Jung

Session 2 : 13 : 30 ~ 15:30
Session chair: Prof. Yuji Sawada
4. Analysis of the change of center of pressure sway during repeated dressing in
healthy subjects
Youta Obayashi
5. An influence of classroom furniture size on children's written test, pressure of the
pen and sitting posture
Go Igarashi
6. Current trends in occupational therapy assessment tools in Korean pediatricoccupational therapy
E. M. Jo, E. Y. Yoo- 15 minutes rest -Session chair: Prof. Ji-Hyuk Park
7. Assistive technology in Korea: Implications for occupational therapy
N. Y. Yang, B. M. Lee, M. Y. Jung
8. Brain response for awareness: A magneto-encephalographic study
Hitomi Yamakawa
9. A systematic review of the effects of occupational therapy for persons with dementia:
A meta-analysis of randomized controlled trials
S. Y. Kim, E. Y. Yoo, M. Y. Jung, S. H. Park, J. H. Park
10. Awareness of driving rehabilitation among occupational therapists in Korea
H. Y. Jung, M. Y. Jung

Time orientation and orientation in the elderly persons
Yuko Iwamoto
Department of Physical and Occupational Therapy
Graduate School of Medicine, Nagoya University, JAPANIntroduction
Recognition of time is an important cognitive
function in our daily lives. This relates to most of ourcognitive
attributes,
including
perception,
experience, memory, and every thought and feeling[1]. Recent studies have suggested that subjective timeperception is strongly linked to what occupies the timeand how one perceives it, pleasant or stressful [2, 3].
Since our life is a sequence of periods occupied withactivities, understanding of time recognition isimportant in the field of occupational therapy [3, 4].
In the present study, we investigated timeorientation to identify the perceived time of day ofelderly with dementia in a care facility. The objectiveof the present study was to clarify the ability andcharacteristics of time orientation in elderly withdementia.
MethodTwenty-six elderly participants with Alzheimer
type dementia (6 men and 20 women, mean age: 87.0
±7.0 (SD) years, range: 67-98) were involved in thepresent study. Participants were tested in 7 sessions
during a day (Wednesday) regarding their timeorientation. All data were collected by the same
examiner, by testing one or two participants on each
Wednesday. In each session, an examiner tested theirtime orientation by asking the time of day. Seven
sessions were performed just after every meal and tea
time (meal sessions), at 9:00, 12:30, 15:30, and 18:30,
and between each meal (interval sessions), at 10:30,
14:00, and 17:00. Since the time for meals and tea was
fixed every day in the care facility, the meal and tea
times could be cues based on oral intake in theparticipants. The time difference (ΔT) and absolute ΔT
in minutes between the true time and perceived timeof each participant was obtained in each session. For
example, when a participant responded that the time
was noon at 14:00, the ΔT and absolute ΔT values
were －120 and 120 min, respectively. Then, the ΔT
and absolute ΔT values underwent further analyses.
The ΔT values were compared by one-way(sessions) repeated measures analysis of variance(ANOVA) followed by Bonferroni-Dunn’s correction
for multiple comparisons among all sessions.
Relationships between the absolute ΔT value and
MMSE score were compared using Spearman’srank-correlation coefficient test. A p-value of less than

0.05 was considered significant. The absolute ΔT was
also compared among sessions using ANOVA
followed by Bonferroni-Dunn’s correction.
Results

All participants could answer during the sessions.
The main effect of the sessions on the mean ΔT value
was significant (F [6, 150] = 6.93, p< 0.0001,
ANOVA) (Fig. 1). Multiple comparisons revealed thatthe ΔT value was larger in the 9:00 session than in the
17:00 and 18:30 sessions, and the 10:30 session
showed a larger value than the 15:30, 17:00, and18:30 sessions. The values in the 14:00 sessions werelarger than in the 17:00 session. The correlation curve
between ΔT and the time of day (minutes) was: y =-0.2 x + 181.81.
There was a main effect of sessions on theabsolute ΔT value for all seven sessions (F [6, 150] =4.27, p = 0.0005, ANOVA). Multiple comparisons
showed that the absolute ΔT value at 10:30 was
significantly larger than those at 12:30, 14:00, 15:30,
17:00, and 18:30 (p < 0.01). For comparison between
after- and inter-meal sequences, there was nointeraction in the absolute ΔT change between thesequences, but there was a main effect of the three
sessions (F [2, 50] = 6.34, p< 0.0026, ANOVA),
although there was no difference in the value between
the sequences.
Discussion
The present results are summarized as: 1) timeorientation in patients with dementia was affected by
the time of day, more in the morning. They perceived
the time as later and earlier than the actual time in themorning and afternoon, respectively, 2) the MMSE
showed no significance but a tendency toward a
correlation with absolute ΔT at 14:00, 3) meals did not
significantly affect time orientation.
A major finding in the present study was that timeorientation depended on the time of day the examinerquestioned the participants. In the morning, disruptionof time orientation was evident at 10:30, and the timeperceived by participants shifted to later than theactual time, and, in the late afternoon, it shifted
oppositely to earlier than the actual time. The
correlation curve for the subjective time ofparticipants crossed the actual time at 15:09, whichsuggested that the participants gave a relatively

correct time at around 15:00, although this did notindicate that the participants correctly oriented
themselves to the real time. It was interesting thatelderly patients with dementia did not give the time of
day randomly, but tended to orient their time aroundearly-mid afternoon. Since the ΔT value linearlydecreased during the day, as shown in Figure 1, thevalue does not simply seem to relate to the sum ofcues during a day, such as meals or tea time.

dementia could be a kind of symptom of perseveration[5]. However, we considered another reason for the
disruption of time orientation in the patients. Without
information regarding time orientation due to memory
disturbance, or without a memory of cues in dailyliving, subjective time orientation in the patients might
become vague. They might then judge their subjective
time of day as a similar time during a day. Memory
loss regarding getting-up, meals, and experiences in a
day caused vague time orientation in patients.
There are few studies on intervention specificallyfor time disorientation. Intervention for timeorientation might be conducted partly during reality
orientation therapy for patients with dementia [6]. It
may not be practical to intensively apply cognitive
training for time orientation, but, since timeorientation is one of the basic aspects of cognition of
the environment, therapists may pay more attention toenhance time orientation during conventional
intervention. For example, therapists graduallypresenting information on time during intervention
with the aid of clocks may be effective for patients’cognition of time, especially in the morning when
their time orientation was disrupted more than at anyother time.
References[1] Jobst, K.A. (2011) Time, perception and the aging mind: the
National Alzheimer's Project Act 2011 enacted--is this the
beginning of a new era in health care research? Journal of
Alternative and Complementary Medicine, 17(1), 1-2.
[2] Chaston, A., & Kingstone, A. (2004) Time estimation: theeffect of cortically mediated attention. Brain andCognition, 55(2), 286-289.
[3] Larson, E., & von Eye, A. (2010) Beyond flow: temporality
and participation in everyday activities. American Journalof Occupational Therapy, 64(1), 152-163.
[4] Iwamoto, Y., & Hoshiyama, M. (2011) Alteration of timeperception in young and elderly people during jigsaw
puzzle tasks with different complexities. Occupational
Therapy International, 18(4), 194-200.
[5] Assal, F., & McNamara, P. (2007) Spatial perseveration indementia with Lewy bodies. Behavioral Neurology, 18(4),235-236.
[6] Zanetti, O., Oriani, M., Geroldi, C., Binetti, G., Frisoni,
G.B., Di Giovanni, G., & De Vreese, L.P. (2002)
Predictors of cognitive improvement after reality
orientation in Alzheimer's disease. Age and Ageing, 31(3),193-196.

Figur1.
The individual (top) and mean (bottom) values of timedifferences (ΔT) in all participants. Subjects perceived alater time in the morning and earlier time in the afternoon
than the actual time (** p<0.01. * p<0.02). Zero (0)indicates the actual time on each question. The verticalbars in the bottom graph indicate the standard deviation.
Correlation curve is: y = -0.2x + 181.8.

Form the results of the present study, there is apossibility that time orientation might not be randomly
disrupted in each patient but stereotyped. The
tendency to give a similar time of day in patients with

Author address
E-Mail: iwamoto.yuko@c.mbox.nagoya-u.ac.jp

Communication with emotional materials with patients with dementia
Sayo Yamashita
Department of Physical and Occupational Therapy
Graduate School of Medicine, Nagoya University, JAPANIntroduction
When patients with dementia have difficulty inverval communication with others, we, thrapists, try tocommunicate with them using a non-verbal way.
Emotinal expression could be non-verbal informationfrom patients as well as from therapists.
The implicit emotional processing in elderly patientswith Alzheimer type dementia (AD) was different fromthat in healthy aging [1]. It was suggested thatmulti-modal sensory cortex was affected in the earlystage of dementia, including memory system, and theemotional processes were also changed withpathological brain damages in the frontal and temporal
regions [1]. Such disturbance in emotional perception
was reported in another type of dementia,
frontotemporaldementia,
althoughunderlying
pathology might be different from AD [4].
On the other hand, people with severe dementia evenpreserve reactivity to facial expression [3].
Ourclinical experience may support their result, sinceemotional facial expression is potentially important tocommunicate with patients with dementia during
interventions.
It was suggested that patients and healthy elderly
easier to identify happy expressions than any otherbasic emotions; sad, fear, disgust, bore, anger, surprise[7.3]. Another previous study concluded that that theability to identify the basic emotional features of facial
expressions was largely preserved in patients with AD,even in a severe stage, but there was poor identificationof facial expression associated with non-verbal
cognitive impairment [5].
In the clinical fields, how we communicate with thepeople with dementia is especially important when
their ability in verbal communication is limited. The
relation
betweendisturbenceinnon-verbal
communication and degree of brain dysfunction indementia is still unclea, and only a small number of
researches
have
dealt
with
the
emotional
communication.
The aim of the present study was to clarify how we,therapists, could use emotinal materials, such as facial
expression, pictures of emotinal scene, and emotionalmusic, to communicate with patielts with dementia.
Method21 elderly patients (7 males and 14 females, mean

age: 85.5 ± 7.93 (years, SD)) in a care facility
participated in the study. The participants weredivided into two groups, dementia (10 subjects) andnon-dementia (11 subjects), based on the scores of the
Hasegawa Dementia Scale-Revised (HDS-R).
Experiment 1: Visual emotinal information
Illustrations with emotinal face, scene orinformation were preseted to the subjects, and they
were asked to answer their emotinal feeling. They
were asked to answer by indicating one of illustrationsof facial expression, as well as by verbal response.
Three cards of schematic emotinally neutral,
positive, and negative faces (10-cm square) wereprepared. Each face was drawn with eyes, nose,
mouth, ears, and eyebrows. The cards were used forthe subject’s answer. Subjects were asked to answere
regarding their feeling by indicating one of theemotinal faces; i.e., positive, neutral, and negative (Fig.
1). Eighteen cards (10-cm square) with illustration ofscenes incluidng 6 positive, 6 negative, and 6 neutral
emotional information were prepared (Fig. 2).
Each card of emotional scene was presented one byone, asking the subject’s emotinal feeling by the facecards. After the answer for one card, the following
card was presented. Eighteen cared of emotional
scenes were presented in random order.

Fig. 1: Three emotional face for answer.
(center), and negative (right) faces.

Positive (left), neutral

Experiment 2: Emotinal information by music
Two positive (bright or happy) and two negative(dark or fearful) pieces of music were presented to thesubjects, and their emotinal feeling was asked for eachpiece of music. The pieces of music were originallycreated by a professional musician. Prior to thepresent study, emotinal feelings for each pieces ofmusic were investigated using young subjects (meanage: 27.0±6.3), and the positive and negative feelings
were statistically confirmed. The intensity of soundwas adjusted to the level as each subject could hear thesound clearly. In a similar way to the experiment 1,
the subjects were asked regarding their emotinal

feeling by indicating one of the face cards.

Fig. 2: Example emotional scenes: Negative (left) and neutral(right).

Results
Regarding the cards of emotinal faces, all subjects
were correctly classified the three types of emotinal
faces as positive (or pleasant), negative (or unpleasant)and neutral.
Experiment 1: Visual emotinal information
First, the subjects were asked to answere verbally
their emotinal feeling on each emotinal scene. For
example, they answered on a positive scene as laughing,fun, happy, and pleased, and on a negative scene as
crying and angry.
In 10 subjects with dementia, there were fourincongruent answers in all 60 trials with negative
scenes (10 subjects × 6 cards). In the 11 non-demented
group, there was one incongruent anwere in 66 trials
with positive scene (11 subjects × 6 cards). On theother hand, 7 / 60 were incongruent for the positive
scene in the dementia group. The answeres for theneutral scenes varied in both groups.
Experiment 2: Emotinal information by music
Nine non-dementia subjects and eight dementia
subjects were involved in the experiments. Foursubjects could not be tested due to their hearling loss.
In non-demented group, for the negative music, in
4/18 trials (9 subjects × 2 pieces of music), the subjects
judged it as negative, and 9/18 were judged as neutral.
Five answered that it was positive. For the positive
music, in 7/18 and 11/18 trials, they judged it positive
and neutral, respectively.
In dementia group, in 3/18 trial, the negative music
was judged as negative, and in 5/18 trials, wereanswered as positive. For the positive music, in 3 and5 trials, congruent and incongruent answeres wereobtained, respectively.
There was signigicant difference in incongruency ofanswere on the emotinal information given between thegroups (p<0.05, Chi-squre test).
There was no
statistical relationship in the congruency of emotinal
feeling between visual and auditory emotinal
information.
Discussion
The results of the present study were summerized asthat visual and auditory emotinal information was
differently recognized in the patients with dementia
from young and healthy elderly people.
Seven core domains for emotional cognition weresuggested in the previous study: i.e., processing speed,
executive function, sustained attention, verbal memory,
capacity in working-memory, inhibition/impulsivity,and sensorimotor function [6]. Those factors may
facilitate the emotional process via amygdale function[2]. Degenerative change of responsible brain region
to those factors in the elderly and patients withdementia may cause amount of emotional response to
the emotional information, which leads a ‘neutral’judgment for the negative/positive information.
However, incongruent emotional judgment wassignificantly more in the patients with dementia,
compared to the healthy subjects. Origin of suchqualitative incongruence in the process of emotional
information remains unclear, although disturbance of
retrieve of emotional memory into working memory
might be one of the reasons [8].
Regarding the communication with patients withdementia, we, therapists, should carefully observe
whether emotional information was properly given to
the patients. Combinations of modalities of emotional
information could be tried to facilitate emotional
communication during interventions.
References[1] García-Rodríguez B et al. Differential patterns of implicit
emotional processing in Alzheimer's disease and healthy
aging. J Alzheimers Dis. 2009;18(3):541-551.
[2] de Gelder B. Towards the neurobiology of emotional bodylanguage. Nat Rev Neurosci. 2006;7(3):242-249.
[3] Guaita A, et al. Impaired facial emotion recognition andpreserved reactivity to facial expressions in people withsevere dementia. Arch Gerontol Geriatr. 2009;49 Suppl
1:135-146.
[4] Lavenu I, et al. Perception of emotion in frontotemporaldementia and Alzheimer disease. Alzheimer Dis Assoc
Disord. 1999;13(2):96-101.
[5] Luzzi S, Piccirilli M, Provinciali L. Perception of emotions
on happy/sad chimeric faces in Alzheimer disease:relationship with cognitive functions. Alzheimer Dis
AssocDisord. 2007 Apri-Jun;21(2):130-135.
[6] Mathersul D et al. Explicit identification and implicit
recognition of facial emotions: II. Core domains andrelationships with general cognition. J Clin Exp
Neuropsychol. 2009;31(3):278-291.
[7] McDowell et al. Is right hemisphere decline in theperception of emotion a function of aging? Int J Neurosci.
1994;79(1-2):1-11.
[8] Taylor JR and Olichney JM. From amnesia to dementia:
ERP studies of memory and language. Clin EEG Neurosci.
2007;38(1):8-17.

Author address
E-Mail: yamashita.sayo@a.mbox.nagoya-u.ac.jp

Comparison of behavior in young and elderly drivers
using the Safe Driving Behavior Measure (SDBM)
Y. J. Jeong1), M. Y. Jung1)
1)

Department of Occupational Therapy, College of Health Sciences, Yonsei University, Wonju, Korea

Introduction
In Korea, the population of people over the age of 65
will be more than 15.7% of the general population by theyear 2020 signaling an aged society. In addition, thenumber of people who hold driver’s license among theelderly will increase and it is expected that the driving
population will reach 18.4%.
However, with increasing age, decline in cognitive, visual,physical functioning in addition to reaction time is also
likely and this will make driving more difficult.
Impairments in driving skills brought about by aging andother health issues may lead to unsafe driving, vehicle
crashes, or driving cessation. In reality, compared withother drivers, older drivers have a higher fatality rate thanany other age group.
Despite what we know, research concerning driving
behaviors in the elderly population are insufficient. Only
few research have addressed the role of personality in agerelated assessment, driving performance, driving cessationand transitioning from driving to non-driving.
The Safe Driving Behavior Measure (SDBM) is a
precise and accurate measure for detecting safe driving
behaviors among the elderly. Respondent’s descriptions
provide a rich item set reflecting the complex nature ofdriving behavior and illustrating the theoretical concepts ofperson, vehicle, and environment.
Thus, the purpose of this pilot study was to develop a self –report driving measure for old people in Korea. We
compared driving behaviors between young drivers andelderly drivers and analyzed reliability by using the Safe
Driving Behavior Measure (SDBM).
Materials and Methods
Participants: : The participants were individuals who
visited the SENDEX Senior & People with Disabilities
Exposition from August 30th to September 2nd of 2012 witha driving experience of over 3 years. In this study, wecategorized participants over the age of 65 as the elderly
driver group and individuals between the ages of 40 to 50
as the young driver group.
Procedures: The SDBM was translated using thetranslation-back translation process as follows(1) Forward
translation from English to Korean; (2) Backward
translation : One bilingual who did not know about theoriginal English version of the SDBM translated the
Korean-to-English translated version of the SDBM into
English; (3) Review: One bilingual occupational therapy
professor who did not know about the original English
version of the SDBM compared the two English versionsof the questionnaire for accuracy and inconsistencies;(4)Finalization: After verifying the backward translation,
we revised some items in the Korean version of the SDBM
and proceeded with the survey.

Assessment of driving: We used demographic
characteristics (age, gender, education, employment status,
driving experience) and SDBM. SDBM is a 68-item selfreport measure to assess safe driving behaviors. The
measure score represents the reported level of difficulty forthe items given the participant’s ability level. It is scoredon a 5-point adjectival scale: Cannot do(1), very
difficult(2), somewhat difficult(3), a little difficult(4), nodifficult(5) with a total possible score of 340.
Data analysis: We used Cronbach’s α value to evaluate
the questionnaire’s internal consistency. We managed theparticipant demographic data using descriptive statistics of
SPSS Version 17.0. When comparing the SDBM total
scores of the two groups, we used independent t-test. The
correlation of SDBM total score by age were tested with
Pearson correlation.
Results
Demographics: Table 1 presents the young and elderly
drivers demographics. Young driver's average age was
51.76 years old (SD = 4.38), and all of the participants had
more than 10 years of driving experience. Elderly driver’s
average age was 69.89 years old (SD = 3.99), and 83.3% of
the elderly participants also had more than 10 years ofdriving experience.
Table 1 Demographics and Driving Characteristics ofYoung (N=21)and Elderly Drivers (N=18)
Characteristic
Age in years
mean(SD)
Gender, n(%)
Male
FemaleEducation
College or
University
High school
Middle school
Driving experience≥5years≥10years

Young Drivers(N=21)

Elderly Drivers(N=18)

51.76 (4.38)

69.89 (3.99)

13 (61.9)
8 (38.1)

16 (88.9)
2 (11.1)

12 (57.1)

10 (55.6)

8 (38.1)
1 (4.8)6 (33.3)
2 (11.1)

0 (0.0)21 (100.0)

3 (16.7)
15 (83.3)

Reliability: Internal consistency was measured in the twogroups to see the reliability of the Korean version of the
SBDM. As a result, both young driver group and elderly
driver group showed high reliability (Table 2).
Table 2 SDBM Internal Consistency by Age GroupInternal consistency (Cronbach’s α)
Item68Young driver.982

Elderly driver.977

SDBM total score: In SDBM score, young driver groupwas 316.05 (SD == 28.94) and elderly driver group was
302.22 (SD = 25.02). The young driver group reported
more safe driving behaviors compared to the elderly group.
However, there were no significant statistical difference
between the two groups (Table 3).
Table 3 SDBM total score

Young driver
Elderly drivers

Total score (SD)316.05 (28.94)
302.22 (25.02)

t

p

1.58

.87

Correlation between age and SDBM score: SDBM score
decreased as age increased but it was not statisticallysignificant.
Table 4 Correlation between age and SDBM score
Total score
Pearson correlation

-.283

p

.081

p>.05
Item comparison: 19 items showed significant difference(p= .00~.04) and those items are presented in Table 5.
Table 5 Items with significant difference between the
two age groups
Item
Item 3Item 7Item 8Item 9Item 14
Item 15
Item 16
Item 17
Item 21
Item 24
Item 25
Item 26

Item 28

Item 33
Item 42

Contents
Turn the steering wheel?
Stop for pedestrians crossing the roadway?
Drive in good weather?
Stay in the proper lane?
Press the gas or the brake when intended?
Use the car controls (such as the turn signals,
windshield wipers, or headlights)?
Place the car in the correct gear (such as driveor reverse)?
Operate the emergency brake?
Drive and hold a conversation with one or morepassengers?
Drive on a highway with two or more lanes ineach direction?
Keep up with the flow of traffic?
Keep distance from other vehicles whenchanging lanes?
Drive cautiously (to avoid collisions) insituations when others are driving erratically(such as speeding, road rage, crossing lanelines, or driving distracted)?
Share the road with vulnerable road users suchas bicyclists, scooter drivers, motorcyclists?
Keep distance between his or her car and others

Item 44
Item 45
Item 46
p>.05(allow time to react to hazards)
Look left and right before crossing anintersection
Drive in a construction zone?
Drive in dense traffic (such as rush hour)?

Discussion
This is a pilot study with the goal of examining thevalidity of a self-report driving measure for old people in
Korea. We compared driving behaviors between young
drivers and elderly drivers and analyzed reliability by using
SDBM. This study can be applied in the future as the basic
research for the development of self-report driving measure.
The results, while not statistically significant, suggestthat younger drivers reported more safe driving behaviors
compared to older drivers. Based on the results of SDBM
item comparison across the two age groups, the elderlygroup reported more difficulties in items regarding
properly driving in particular situations (e.g., keep up withthe flow, keep distance from other vehicles) than in the
manipulating car control systems (e.g., gear, wiper, brake).
This suggests that when providing education andassessment for elderly drivers, it may be important toconsider factors about keeping proper driving performancein different types of driving situations.
This study has several limitations. First, the small sample
size might limit the generalization of the researchconsequences. Second, the target of study included only
healthy individuals. Because most of the elderly experience
medical problems and/or or disability, it will be difficult toconclude that the results of the present study represents
driving behaviors of the elderly population in general.
Third, because, all participants had more than 5 years ofdriving experience, the results may not be applicable tothose with less driving experience.
The advantages of this study are as follows: The
relatively high internal consistency suggests that this tool
may provide a good opportunity to assess driving abilities
for elderly drivers who may exhibit unsafe driving
behaviors. As elderly drivers are used to their driving
method and driving situation, they may wrongfully thinktheir driving way is safe. Self-report measure such as the
SDBM may help them to know more objectively about
their problems. Second, occupational therapists canobserve problem factors related to driving behaviors
through the participants’ response to the questionnaire.
They may then offer consulting and intervention for elderly
drivers and their caregivers through driving assessment.
Future research studies are needed to compare thedriving behavior measure with various subjects.
Conclusion
This project was a pilot study for evaluating the driving
behavior of young and old healthy adults. We examined thereliability of the SDBM for use in Korea. The results
suggest good internal consistency of the questionnaire andpotential for further examination in future studies inassessing driving behaviors.
References[1] Anstey KJ, Wood, Joanne, Lord, Stephen, Walker,
Janine G. Cognitive, sensory and physical factors
enabling driving safety in older adults. Clin PsycholRev. 2005; 25(1): 45-65.

[2]Classen S, Winter SM, Velozo CA, Bédard M,
Lanford DN, Brumback B, Lutz BJ. Item
development and validity testing for a self- andproxy report: The Safe Driving Behavior Measure.
American J of Occul Therapy. 2010;64(2): 296-305.
[3] Classen S, Nichols, Austin L, McPeek, Robert,
Breiner, Judith F. Personality as a predictor ofdriving performance: An exploratory study.
Transportation Research Part F: Traffic Psychology
and Behaviour. 2011;14(5): 381-389.
[4]Classen S, Wen PS, Velozo CA, Bédard M, Winter,
SM, Brumback B, Lanford DN. Rater Reliability andRater Effects of the Safe Driving Behavior Measure.
Am J Occup Ther.2012; 66(1): 69-77.
[5]Gallo JJ, Rebok GW, Lesikar SE. The driving habitsof adults aged 60 years and older. J Am Geriatr
Soc.1999; 47(3): 335-341.
[6]Hunt LA, Arbesman M. Evidence-based andoccupational perspective of effective interventions
for older clients that remediate or support improved
driving performance. Am J Occup Ther.2008; 62(2):136-148.
[7]Jo HY, Oh YT, Lee SS. Investigation of the driving
characteristics of elderly drivers. J Korea ITS
Assoc .2008;7(6):121-132.
[8]Lee DH,Kim SP,Kim SJ,Jo SH,Jo NS. Factors
associated with the severity of injuries in older drivertrauma pateints.J Korean Soc Emerg Med.
2009;20(2):177-184.
[9]Minitry of Health and Welfare.2011 Senior survey.
Retreved october 4,2012, from http://www.mw.go.kr[10]Statistics korea. Population Projections. Retreved
october 4,2012, from http://kostat.go.kr[11]Winter SM, Classen S, dard, Michel B, Lutz BJ,
Velozo CA, Lanford DN, Brumback B. Focus groupfindings for the self-report Safe Driving Behaviour
Measure. Can J Occup Ther. 2011;78(2): 72-79.

Author address

E-Mail: estrella28@nate.com

Memo

ANALYSIS OF THE CENTER OF PRESSURE SWAY DURING REPEATED DRESSING
IN HEALTHY SUBJECTS
Youta Obayashi
Department of Physical and Occupational Therapy
Graduate School of Medicine, Nagoya University, JAPANIntroduction
Dressing is one of important activities of daily living(ADL).
In occupational therapy, CVA patients withhemiplegia are instructed how to dress with the affectedtrunk or upper and lower limbs dysfunction.
The
appropriate postural stability and the center of pressure(COP) shift during dressing are needed to dress well. Motorlearning is occurred by training repeatedly, and the dressing
skills such as postural stability and COP shift are influenced
by learning. There are many studies on motor learning. For
example, it was reported about neuronal mechanisms of
motor learning [1]. However, there are a few studies thatfocued on the COP sway have been reported. Thus, it is notclear that the COP sway during activity is changed byrepeated training.
On the other hand, there are some studies about theevaluation of dressing. Suzuki developed the Upper-body
dressing scale for stroke patients [4]. This dressing scale is a
useful tool to evaluate patient’s dressing performance.
However, there is no study about quantative evaluation
method for judgment whether continue or finish dressing
training. Clinically, therapists judged from the subjective
evaluation such as observation.
Because the dressing
activity accompanies COP shift, it might be possible thatmeasuring of the COP sway is usefull for the therapists tojudge whether continue or finish dressing training.
By dressing training repeatedly and motor learning,
patients with hemiplegia and disequilibrium must learn how
to balance their body appropriately to the unstability. In thegraduate study in 2010, Yokoyama reported about thedifference among dressing methods in the COP sway during
dressing, and the difference among trials in repeatedly.
Yokoyama revealed that the COP sway of healty subjects
during repeared dressing was changed within constant rangeof the COP sway in the usual method. But the COP sway
was changed in three trials in the unusual dressing method[5]. However, there is no study about the COP sway during
unusual dressing by still more repeating.
Therefore, the purpose of this study was to clarify the
COP sway during dressing in unusual method by repeating
15 trials from healthy subjects.
Materials and Methods
Subjects: Twenty-two healthy subjects participated in thisstudy (3 males and 19 females, age range: 21-28 years,
mean age: 21.5 ±1.6 years). No subjects had a history ofneurological disease or vestibular impairment. Each subject
was given informed consent prior to measurement. This
study was approved by the Ethical Committee of Nagoya
University, School of Health Sciences (10-624).
Experimental Procedures and Date acquisition: Subjects
sat on a chair and contacted both their feet on the exp.? board
during measurement. In the first measurement, the COP
sway was measured during a static sitting posture andlooking at the mark at eye level 30 seconds. Secondly, the

COP sway during dressing was measured.
Subjects were
instructed to dress in former opening shirts in the method of
doing in daily life. If one subject starts from passing the arm
through the right sleeve when wearing the shirts first, thecondition that starts from right sleeve is treated as usual and thecondition that starts from left sleeve is treated as unusual.
Subjects dressed it for 15 trials in the unusual way. The dataacquisition was started from telling subject to start to dress theshirt on thighs to fastening all buttons on a shirt.
Data processing and Analysis: 3 parameters were used forevaluation of the COP sway. In the first step, the center of
COP during just sitting (reference, COPr) were measured andcalculated in order to find the sitting zero points in each subject.
In next step, Maximal sways(the anterior - posterior (AP) andmedial - lateral (ML) directions) of the COP were measured andfound the differences from the COPr. When calculating the
ML direction of the COP, different calculating method was usedbecause subject dressed different ways(first passing the arm
through the sleeve (FPS: First Passing Side) and other side
(SPS: Second Passing Side)) In addition, track lengths of the
COP sway per second (TL/S) were calculated.
In 1st to 3rd trials of each subject, the COP Maximalsway in AP, ML, and TL/S were compared among trials, using
one-way (trials) repeated measures analysis of variance(ANOVA) with post hoc tests (Fisher’s PLSD). In addition, 15
trials were divided into five periods and the averages of eachperiod about the COP Maximal sway in AP, ML, TL/S, anddressing time were compared among periods, using one-way(periods) repeated measures analysis of variance (ANOVA)
with post-hoc tests (Fisher’s PLSD). The level of significant
was set at p <0.05.
Results
Differences from 1st to 3rd trial : There was nodifference in the COP Maximal sway in AP, FPS, and TL/S
among trials.
However, in SPS, there were significant
differences among 1st to 3rd trials (F (2.30) = 4.96 p <0.05),
and the post-hoc test revealed that the sway of 1st trial was
significantly larger than that of 2nd and 3rd (vs2, vs3 p <0.05)(Fig.1).
Differences from 1st to 5th period: There was nodifference in the COP Maximal sway in AP and ML among
periods. However, in TL/S, there was a significant difference(F (4.84) = 5.47 p <0.01), and the post-hoc test revealed that
TL/S of 4th period was the smallest of all periods (vs1, vs2, vs3,
vs5 p < 0.05) (Fig.2).
There was a significant difference
between 2nd and 3rd (p < 0.05). Thus, TL/S was smaller
gradually from 2nd to 4th period and got larger in 5th period.
In addition, in dressing time, there was a significant
difference (F (4.84) = 23.50 p < 0.01), and dressing time of 5th
period was significantly the shortest of all periods (vs1, vs2, vs3,

vs4 p < 0.05) (Fig.3). There were significant differencesamang period (p < 0.05). Thus, dressing time got shorter
gradually from 1st to 5th period.
＊＊

Fig1: The sway of 1st trial was significantly larger than that of 2nd
and 3rd (vs2,3 p < 0.05). There was no difference between 2nd and
3rd.

＊

＊

＊

sway in three times dressing. It is uncertain how changes inmore times repeated dressing.
Thus, this is the first study torevealed the COP sway during 15 times repeated dressing in
unusual method.
Differences from 1st to 5th period: From this result, dressing
time of 5th period was the shortest of all periods. Decreasingof dressing time indicates the increasing of TL/S, but the results
showed that TL/S of 4th period was the smallest of all periods.
This means that total track length during dressing was decreased
more than the decreasing of dressing time. However, there wasno difference in the COP Maximal sway in AP, ML.
Therefore, The COP Maximal sway in AP and ML weren’tchanged during repeated dressing, but the COP sway within therange of the COP Maximal sway was changed. By repeating
dressing, the subjects might unconsciously change how to use
their own body. I suppose that the subjects were getting betterto estimate next motion including motor speed, direction andstrengthen during repeating dressing. In addition to that, thesubjects were also getting better to adjust against the COP
perturbation following the next motion [2, 3]. I hypothesizethat these might cause changing of the COP sway, but of
Maximal sway.
Conclusions
In the present study, I recorded the COP sway by repeateddressing activity on a chair in the unusual way from healthy
subject. As a result, 1) the dressing time was getting shorterfrom 1st to 5th period. 2) The COP Maximal sway was notchanged. 3) The TL/S was getting smaller from 1st to 4th
period.

Fig2: There was a significant difference (F (4.84) = 5.47 p < 0.01),
and the post-hoc test revealed that TL/S of 4th period was thesmallest of all periods (p < 0.05).
There was a significant
difference between 2nd and 3rd (p < 0.05). Thus, TL/S was smaller
gradually from 2nd to 4th period and got larger in 5th period.

＊

＊

＊

＊

Fig3: There was a significant difference (F (4.84) = 23.50 p < 0.01),
and dressing time of 5th period was the shortest of all periods (p <0.05). There were significant differences in each period (p < 0.05).

Discussion
Differences from 1st to 3rd trial in SPS: In the graduate
study in 2010, Yokoyama revealed that the maximal sway in
ML of 3rd trial was significantly smaller than the 1st in theunusual dressing way [5]. This is consistent with my resultsthat the maximal sway to SPS in 1st was larger than in 2nd
and 3rd. The last study showed that there was the COP

References[1]Asanuma H, Keller A. Neuronal mechanisms of motor
learning in mammals. Neuroreport 1991;2(5):217-224.
[2]Bouisset S, Richardson J, Zattara M. Do anticipatory posturaladjustments occurring in different segments of the postural
chain follow the same organisational rule for different task
movement velocities, independently of the inertial load
value? Exp Brain Res 2000;132(1):79-86.
[3]Nouillot P, Do MC, Bouisset S. Are there anticipatory
segmental adjustments associated with lower limb flexions
when balance is poor in humans? Neurosci Lett
2000;279(2):77-80.
[4]Suzuki M, Yamada S, Omori M, Hatakeyama M, Sugimura
Y, Matsushita K, Tagawa Y. Development of the upper-body
dressing scale for a buttoned shirt: a preliminary correlational
study. Am J Phys Med Rehabil 2008;87(9):740-749.
[5]Yokoyama K. Analysis of center of pressure sway during
dressing in healthy young subjects. Graduate study
2010;10:147-155
Author address

E-Mail: oobayashi.youta@b.mbox.nagoya-u.ac.jp

An influence of classroom furniture size on children's written test, pressure of
the pen and sitting posture
Go Igarashi
Department of Physical and Occupational Therapy
Graduate School of Medicine, Nagoya University, JAPANIntroduction
Schoolchildren spend much of their day sitting inclassroom furniture. Although, recent study reports thatclassroom furniture is often too large or too small forschoolchildren [1] [2].
While many studies revealing the mismatch ofclassroom furniture, it is uncertain how these mismatch
influence the schoolchildren. To examine the influence ofclassroom furniture mismatch on schoolchildren could be
the important information for educators, and occupational
therapists who engaged in special needs education.
The purpose of this study is to compare the influence ofclassroom furniture on children’s written test, pressure of
the pen and sitting posture between two conditions:appropriate furniture size and inappropriate furniture size.
Methods
Subjects: A total of 110 second grade students, from anelementary school in Nagoya, Japan, participated in the
study (54 females and 56 males). All subjects obtained
the informed consent, and this research was approved by
the Ethics Committee of the school of Health Sciences,
Nagoya University.
Measurements: All anthropometric measurements weretaken with the subjects sitting on a seat with a horizontal
surface with knees bent at 90°. The human bodydimensions measured in this study are the following.
Elbow height: the vertical distance from the bottom of the
tip of the elbow (olecranon) to the subject’s seated surface.
Shoulder height: the vertical distance from the top of theshoulder at the acromion process to the subject’s sitting
surface. Popliteal height: the vertical distance from thefoot resting surface to the popliteal space, which is theposterior surface of the knee. Buttock–popliteal length(thigh length): the distance from the posterior surface ofthe buttock to the posterior surface of the knee.
Furniture measurements: Measured chairs and desks
are for daily use of each subject. The dimensions of theclassroom furniture that were measured are the following.
Seat height: the distance from the highest point on thefront of the seat to the floor. Seat depth: the distance fromthe back of the sitting surface of the seat to its front. Deskheight: the distance from the floor to the top of the frontedge of the desk.
All subjects’ body dimensions and the sizes of desks
and chairs were measured, and then subjects were divided
into two groups, appropriate group (who use appropriate
furniture) and inappropriate group (who use inappropriate

furniture). The definitions of “inappropriate” arefollowing.
Seat height mismatch: seat height that is either >95% or<88% of the popliteal height. Seat depth mismatch: seat
depth that is either <80% or >95% of the buttockpopliteal length. Desk height mismatch: the maximum
desk height is determined by 0.8517×elbow height ＋
0.1483×shoulder height＋seat height [3].
Assessments: All subjects took written test
(Developmental Test of Visual Perception: DTVP). In
this study, sub test 1. Eye-motor coordination test, 2.
Figure-ground test, and 5. Special relationships test weretaken. Test time was determined at 20min. Pressures ofthe pen and sitting postures were also assessed during
written test. Pressures of the pen were assessed by using
carbon papers as 1: weak to 5: strong [4]. Sitting postures
were recorded and assessed 1s each. The posturesclassified as “positive” or “negative”, and total negative
counts were adopted as postural score. Negative sitting
are absence of following: elbows or underarm resting on
desk, foot on floor, buttock in contact with at least half ofthe chair, contact with backrest when in listening position,
pelvis in neutral, trunk facing forwards [5].
Data analysis: DTVP scores and postural scores werecompared between appropriate group and inappropriategroup by unpaired t-test. Pressures of the pen werecompared between appropriate group and inappropriategroup by Mann-Whitney U test. For the pressure of the
pen analysis, Friedman’s test was used to compare thescores between DTVP sub tests. For multiple
comparisons, the Turkey-kramer test was used.
Significance was set at P<0.05.
Results
In seat height condition, appropriate subjects were 40
and inappropriate subjects were 70. In seat depth,
appropriate were 15 and inappropriate were 95. In deskheight, appropriate were 11 and inappropriate were 99.
None of the subjects were appropriate in all condition(Table. 1). There were no difference in DTVP scores,pressures of the pen and postural scores between
appropriate group and inappropriate group. But, both inappropriate and inappropriate groups, pressure of the pen
was significantly lower in Eye-Motor Coordination testcompared with Figure-Ground test and Spatial
Relationships test (p<0.01, Table. 2). About sitting
posture, as the mismatch between the furniture sizes andstudents’ body dimensions extend, student who could
keep good sitting posture tend to decrease (Fig. 1).

Table. 2: Pressures of the pen in each condition (Mean±SD).

Seat height
Seat depth
Desk heightappropriate
inappropriate
appropriate
inappropriate
appropriate
inappropriate

Eye-Motor Coordination
test
2.2±1.1**
2.6±1.2**
2.3±1.0**
2.5±1.2**
2.8±1.1**
2.4±1.2**

Figure-Ground test
3.8±1.1
3.7±1.2
3.6±1.3
3.7±1.2
4.0±1.0
3.7±1.2

Spatial Relationships
test
3.8±1.2
3.6±1.3
3.9±1.3
3.7±1.3
3.7±1.2
3.7±1.3**Significantly lower than Figure-Ground test and Spatial Relationships test (p<0.01).

Table. 1: Appropriate group and inappropriate group
numbers in each condition.
appropriate
inappropriate
Seat height
40
70
Seat depth
15
95
Desk height11
99
All conditions
0
110

Although in all conditions, Eye-Motor Coordination test
indicated significantly lower pressure than Figure-Groundtest and Spatial Relationships test. It is possible thatpressures of the pen were influenced by the test
characteristics.
There were no differences of postural scores between
appropriate group and inappropriate group. While themismatch between the furniture sizes and students’ bodydimensions extend, student who could keep good sitting
posture tend to decrease. Although appropriate size
furniture not necessarily promote the good sitting posture,
it is possible that inappropriate size furniture can press
schoolchildren to sit wrong posture.
Conclusions
In conclusion, this study compared the influence ofclassroom furniture on children’s written test, pressures ofthe pen and sitting posture. The results suggest thatclassroom furniture did not influence the result of written
test and pressures of the pen. Sitting posture tend to be
influenced by the classroom furniture sizes. Specifically,
inappropriate classroom furniture sizes can disturb goodsitting posture.
References[1] Panagiotopoulou G. Christoulas K. Papanckolaou A.
Mandroukas K: Classroom furniture dimensions andanthropometric measures in primary school. Applied
Ergonomics. 2004; 35: 121-128.
[2] Saarni L. Nygård CH. Kaukiainen A. Rimpelä A: Are theFig. 1: Relationships between postural scores andmismatch of furniture sizes. High postural scoreindicate wrong sitting posture.
Discussion
In this study, almost all the subjects used inappropriate
furniture. Especially only 15 subjects used appropriate
depth chair and 11 subjects used appropriate height desk.
These results are the same as previous reports in othercountry [1] [2]. It is possible that mismatch of classroom
furniture is widespread problem in Japan.
There were no differences of Pressures of the pen
between appropriate group and inappropriate group.

desks and chairs at school appropriate? Ergonomics. 2007;
50: 1561-1570.
[3] Parcells C. Stommel M. Hubbard RP: Mismatch ofClassroom Furniture and Student Body Dimensions Empirical Findings and Health Implications-. Journal ofadolescent health. 1999; 265-273.

[4] Parush S. Levanon EN. Weintraub N: Ergonomic
factors influencing handwriting performance. Work.
1998; 11: 295-305.
[5] Linton SJ. Hellsing AL. Halme T. Åkerstedt K: The
effects of ergonomically designed school furniture on
pupils' attitudes, symptoms and behaviour. Applied
Ergonomics. 1994; 25: 299-304.
Author address
E-Mail: go.igarashi@f.mbox.nagoya-u.ac.jp

CURRENT TRENDS IN OCCUPATIONAL THERAPY ASSESSMENT TOOLS IN
KOREAN PEDIATRIC OCCUPATIONAL THERAPY
E.M. Jo1) E.Y. Yoo1)
1) Department of Occupational Therapy, College of Health Sciences, Yonsei University, Wonju, Korea

Introduction
Pediatric occupational therapists work with children withdiverse diagnosis using various approaches (Mulligan, 2003).
Through a systematic approach based on evidence andprofessional clinical reasoning, occupational therapists use avariety of assessment tools for goal setting in intervention
and as outcome measures to determine if a client has shown
improvement after receiving therapy(Thorley & Lim, 2011). In
some practice settings assessment results are also used todetermine whether a client meets criteria for accessing
therapy services(Thorley & Lim , 2011).
However, it is unknown which assessment tools areprimarily used in which practice domain because extant
studies investigated just the frequency of use((Burtner et al.,
2002; Miller et al.,2001).
In a study by Yoo, Jeung, Park, and Choi(2006), 25.9% ofoccupational therapists worked as pediatric occupational
therapists in Korea. It is consequently hard to generalize theuse frequency of the assessment tools to other practice
domains.
The purpose of this study was hence to examine the current
state in the use of occupational therapy assessment tools by
Korean pediatric occupational therapists.

Materials and Methods
Subjects: The survey participants were 137 occupational
therapists with at least 6 months of clinical experience aspediatric occupational therapists in Korea.
Procedures : The survey content was based on
instruments employed in previous research(Park & Yoo,
2002; Yoo, Jeung, Park, and Choi, 2006). This survey packet
was updated with more comprehensive listing of current
assessments. A purpose-designed survey consisted ofquestions regarding the participants’ general information, useof particular assessment tools(16 questions), areas ofassessment tool(9 questions), assessment tool they would liketo study more(1 question). Areas of assessment tool consistedof developmental assessment, sensory integration assessment,
perceptual assessment, cognitive assessment, physicalassessment, upper motor assessment, daily activity
assessment, psychosocial·play assessment, and occupational
performance assessment. Data was obtained at the 2011
Congress of Korean Occupational Therapists by means of asurvey questionnaire packet, in addition to the use of e-mailand postal service mail to pediatric occupational therapists.

Data analysis: Descriptive statistics were calculated using
SPSS.

Results
A total of 290 packets were distributed with a final return rateof 47.2%. The vast majority of pediatric occupational therapists
who responded were female(90.5%), held a bachelor
degree(51.1%), and were between 26~30 years of age(44.1%).
Respondents had held a position in pediatrics for 3~5
years(27.5%) and one half of the respondent worked fulltime(52.9%), and 37.5% worked on a part-time basis. The
length of time for initial evaluation was 20~40 minutes(32.5%)
per one patient and reevaluation periods were every 6months(47.5%).
The difficulties reported in conducted evidenced-based
assessment included lake of accessibility to a wide range ofassessment tools(52.5%), lack of knowledge of accurate ways of
conducting assessment(30%).
Among the assessment tools the most frequently used tools
were: Denver Developmental Screening Test-Ⅱ(DDSTⅡ)(86.3%)
fordevelopment
assessment,
Sensory
Profile(76.3%)
forsensory
integrationassessment,
Developmental Test of Visual Perception(DTVP)(75%) for
perceptual assessment, Loewenstein Occupational Therapy
Cognitive Assessment (LOTCA)(15%) for cognitive assessment,
oral motor examination(53.8%) for physical assessment,
Grooved Pegboard Test(25%) for upper motor assessment, Wee
Functional Independence Measure (Wee FIM)(61.3%) for daily
activity assessment, Preschool Play Scale, Revised (PPS/PPSK)(22.5%) for psychosocial · play assessment, and Social
Maturity Scale(46.3%) for occupational performanceassessment(Table 1).
Korean pediatric occupational therapists also reported theywanted to study more about cognitive assessment (52.5%),
sensory integration assessment(50%), and development
assessment(47.3%).

Table 1 Assessments Tools Used in PediatricOccupational Therapy in Korea
Assessments tool

Frequency(N=139)Development assessment

Percentage(%)

Denver Developmental Screening TestⅡ(DDSTⅡ )

69

86.3

25

31.3

13

16.3

BruininksOseretsky Test of Motor Proficiency(B-OTest)Ⅱ
GesellDevelopmentalTest

Sensory Integration assessment

Sensory Profile
ClinicalObservation
Bruininks-

seretsky Test of Motor Proficiency

61

76.3

57

71.3

26

32.5

60

75.0

32

40.0

7

8.8

12

15.0

8

10.0

2

2.5

(B-O Test)Ⅱ

Perceptual Assessment

Developmental Test of Visual Perception(DTVP)
Motor-Free Visual Perception Test
(MVPT)
Visual Motor Integration (VMI)

Cognitive Assessment

Loewenstein Occupational Therapy
Cognitive Assessment (LOTCA)Good Enough-Harris Drawing Test

Dynamic Occupation Therapy Cognitive
Assessment for Children (DOTCA)

43

53.8

Reflex Test

41

51.3

Range of Motion( ROM)

28

30.5

Grooved Pegboard Test

Upper Motor Assessment
20

25.0

Box and Block Test

15

18.8

Purdue Pegboard

15

18.8

Daily Activity Assessment

Wee Functional Independence Measure(Wee FIM)

Assessment of Motor and Process Skills(AMPS) / School AMPS
Functional Independence Measure (FIM)

49

61.3

17

21.3

13

16.3

Psychosocial · Play Assessment

Preschool Play Scale, Revised (PPS) /

18

22.5

Childhood Autism Rating Scale (CARS)

15

18.8

Play History

7

8.8

PPS-K

Occupational Performance Assessment

Social Maturity Scale

Canadian Occupational Performance
Measure (COPM)
Pediatric Evaluation of disability Inventory(PEDI)

Pediatric occupational therapists were the DDST-Ⅱ, SP,
DTVP, LOTCA, oral motor examination, Grooved Pegboard
Test, Wee FIM, PPS-K, and Social Maturity Scale. Based on the
results, provisions of a more extensive educational opportunities
would promote the use of a greater variety of standardized andevidence-based assessment tools by Korean pediatricoccupational therapists. The results of this study indicate thatthe choice of evaluation tools may be dependent on theavailability of assessment tools, administration length of timeand degree of simplicity in administration procedure more sothan the awareness of evidence-based assessment tools for theparticular assessment domain.
References[1] Burtner P, McMain M, Crowe T. Survey of occupational therapy
practitioners in southwestern school: Assessments used andpreparation of students for school-based practice. Phys & Occup
Ther Pdeiatr.2002;22:25-38.
[2] G. Ted B, Sylvia R, Anita B, Carsten R, A Profile of Canadianpediatric occupational therapy practice. Occup Ther in health care.
2007;21(4):39-69.
[3] Miller L, Missiuna C, MacNab J, Mallory-Miller T, Polatajko H.
Clinical description of children with developmental coordination
disorder. C. Can J Occup Ther.2001;65:5-15.
[4] Park SY, Yoo EY. The use of occupational therapy assessment toolby Korean occupational therapist. Kor J Occup Ther.2002;10(2);9910.
[5] Thorley M, Lim SM. Considerations for occupational therapy
assessment for Indigenous children in Austrlia. Aust Occup Ther J.
2011;58:3-10.
[6] Yoo EY, Jeung MY, Park SY, Choi EH. Current trends ofoccupational therapy assessment tool by Koeran occupational
therapist. Kor J Occup Ther . 2006;14(3):27-37.
Author address

Physical Assessment

Oral motor examination

Conclusions

37

46.3

27

33.8

6

7.5

E-Mail: hopeotem@nate.com

ASSISTIVE TECHNOLOGY IN KOREA: IMPLICATION FOR OCCUPATIONAL THERAPY
N. Y. Yang1), B. M. Lee1), M. Y. JUNG1)
2) Department of Occupational Therapy, College of Health Sciences, Yonsei University, Wonju, Korea

Introduction
Assistive technology (AT) is a concept that includes
devices, services for selection and purchase of such devices
and strategies (e.g., service personnel and training methods)
facilitating delivery of services for individuals requiring thedevices, and is applied to maintain or improve functional
capacities of a disabled person. In the field of occupational
therapy, AT can be a powerful therapeutic tool that enables
optimal activities and social participation by overcoming thelimitations of functional training. In recent years, the field of
AT in Korea has shown rapid growth secondary to interestand support of the government and private enterprises, andhence, interest and utilization of AT services in the field ofoccupational therapy is expected to gradually increase [1].
Accordingly, the purpose of this study was to present
state of Korea's AT in the field of occupational therapy. In
order to do so, relevant statistics and studies must be
identified and considered to represent the current status andissues of Korea's AT service, and to examinate the degree ofawareness and utilization of AT services by occupational
therapists.

occupational therapists were aware of AT. Additionally, morethan 50.0% answered that they were aware of AT through their
university or college courses [5, 6]. However only 32.0% of
occupational therapists utilized AT in therapeutic setting, but
49.6% answered positively that they had plans to use AT intherapeutic intervention (Table 1) (Fig 1) [7].
Table 1 Studies on awareness and utilization and courses
among occupational therapists for AT
Study

Jang MY,et al.(2010)Materials and Methods
For this study, both the current status report and 7 studies
were analyzed. The current status report was provided by the
Ministry of Health and Welfare and 7 studies publishedbetween 2007 and 2012 were identified in the Korean
databawe system KERIS using the search terms 'assistive
technology' and 'occupational therapy'. In addition, thestudies' first author had to be certified occupational therapist.
Results
As of 2012, there are approximately 12 AT service
centers in Korea, and 1~2 centers are being open each year.
Each center has received supports from both the federal andlocal governments, and perform services such as rental,
support, development and custom-made fitting of the devices
for the disabled person. The service personnel in each centerare 5~10 people that are composed of physicians,
occupational therapists, physical therapists, assistive
technology practitioners, social workers and engineers, forexample [2].
According to the results of analyzing the studies, in 6
studies research topics were about the theoretical framework,
awareness and utilization, curriculum improvement andeligibility for AT in the field of occupational therapy. The
remaining 1 study was about effectiveness and satisfaction ofclinical interventions using AT [3].
A study about theoretical framework emphasized
importance of evidence-based AT interventions and researchthat main models are applied. The models were therehabilitation model, need-based model, Human Activity
Assistive Technology model(HAAT) and Matching Person
and Technology(MPT) model [4].
According to analysis of awareness and utilization,
76.8% of occupational therapy students and 89.8% ofJang MY,et al.(2007)

Participants

Outcome9 AT clinicians① Courses for OT students: AT,functional anatomy, splint, OT for
physical dysfunction, ergonomics,
ADL, therapeutic crafts, OT formusculoskeletal disorder,
augmentative and alternative
communication, rehabilitation
psychology, OT for children,
manual muscle testing, humananatomy② Advanced courses: House and work
place remodeling, wheelchairseating and positioning,mechatronics, AT devices, interface,
upper extremity prosthesis, theoryof seating and standing

30 Departments
of OT
256 OT
clinicians① 10.9 courses in a university, 9.3
courses in a college② 89.8% were aware of AT③ 53.1% were aware of AT in their
university or college courses④ Higher educational and vocational
experience showed a higher
awareness(p<.05)① 76.8% were aware of AT

Chae SY,et al.(2007)

312 OT students② 68.3% were dissatisfied withinformation related to AT③ 72.7% replied that AT introductionneeds into OT student curriculum① 32.0% had utilizations with AT

Jang MY,et al.(2007)

256 OT
clinicians② 64.4% replied that application was
low in therapeutic environment③ 49.6% had a plan to use a AT intherapeutic intervention④ Higher educational experience
showed a higher utilization(p<.01)

Figure 1 Awareness and utilization of occupational
therapists for AT

Most of the studies offered realistic problems inpropagating AT services by occupational therapists such ashortage of qualidied personnel and a lack of specialty. The
solutions offered included setting up more university
education courses, launching advanced placement courses
and introducing a certification system. In a study on a groupof 9 AT clinicians using the Delphi method, it was reported
that to train AT specialists the university education
curriculum should include 14 courses such as assistive
technology, functional anatomy and activities of daily living(ADL), for example. Also it was shown that the advanced
placement program should include 7 courses that relate toclinical interventions such as house and work place
remodeling [8].
Discussion
Through this study, it was identified that the awarenessof Korea's occupational therapy students and therapists for
AT was high, while the actual utilization was low. Thus, asemphasized in the studies, to establish a more active AT in
the field of occupational therapy, practical training ofspecialists is essential.
In Korea, there is no a legal criteria on qualifications of a
AT specialist. For this reason, in the past two to three years
social and legal requirements has been offered by thegovernment to establish [9].
The Korean Society of Assistive Technology (KSAT),
consisting mainly of Members of The Korean Association of
Occupational Therapists (KAOT) was founded in 2009. The
KSAT is providing an education program for training of AT
specialists. The program embraces a diverse range of courses
such as understanding of AT, counseling and evaluation,interface and delivery system, funding management, splint
fabrication and application, seating and positioning anddriving rehabilitation. Certifications on AT specialist are
given to KAOT members through completion of the courses
and passing of qualifying examinations. Besides the 50
departments of occupational therapy in korea are making
every effort to improve awareness and develop knowledge of
AT by setting up courses such as assistive technology, ADL
and splint.
These program and courses can be used as the basis in
the near future when the legal ground is enacted by thegovernment. In this regard, occupational therapists are
expected to enhance the opportunity to play a pivotal role as
specialists in the field of AT.

Conclusions
This study summarized the current status of AT service
centers and conditions of service personnel in Korea as well as
the awareness and utilization for AT among occupational
therapists and students. In addition it was identified that the
problems of Korea's AT are a shortage of the personnel and alack of specialty, and the solutions are to set up courses, launchadvanced placement programs and introduce the certification
system.
As the field of AT grows rapidly in Korea, the role andproportion of occupational therapists are now recognized to play
an important role. On this account academic association andsocieties in relation to occupational therapy are carrying out
continuing educational and research activities.
The results of this study are expected to be utilized as thebasic materials for research and educational activities in the
future, which can present a systematic direction to Korea's AT
and contribute to enhancement of occupational therapists's
capabilities.
References[1]An NY, Yook JH. Deveoping assistive thchnology service
process and factors for persons with disabilities. Korean J
Phys Mult Disab. 2011;54(2):45-73.
[2]Ministry of Health and Welfare. 2012 Guidance of welfare
service on disabled person. Retrieved September 24. 2012,
from http://www.mw.go.kr[3]Yoo YM. Case report on the application of assistive
thchnology to pediatric occupational therapy. J Korean Soc
Ass Tech. 2009;1(1):11-17.
[4]Lee HK, Kwon HC, Kong JY, Jo SJ, Chae SY. A study on
the theoretical framework for assistive technology service ofoccupational therapises: centering on mating person andtechnology(MPT).
J
Korean
Soc
Occup
Ther.
2012;20(1):95-107.
[5]Chae SY, Lee HK, Yoo EY. A pilot study to incorporate
assistive thchnology into occupational therapy curriculum inkorea. J Korean Soc Occup Ther. 2007;15(1):91-103.
[6]Chang MY, Kwon HC, Kim KM, An DH. The study on
education and perception of occupational therapists towardassistive thechnology. J Korean Soc Occup Ther.
2007;15(1):105-115.
[7]Chang MY, Kwon HC, Kim KM, An DH. A study on thepractical degree of use toward assistive thchnology foroccupational therapists. J Korean Soc Occup Ther.
2007;16(1):99-107.
[8]Chang MY, Jung HY. Delphi method on course subjects foroccupational therapists as assistive technology practitioner:
assistive technology services in general and for the aged. J
Korean Soc Occup Ther. 2010;18(2):39-62.
[9]Hong SP, Cha YJ. A study of occupational therapists’ roleon laws and regulations related to the services of assistive
technology in foreign countries. J Korean Soc Ass Tech.
2009;1(1):1-9.
Author address

E-Mail: nofever@nate.com

BRAIN RESPONSE FOR AWARENESS:
A MAGNETO-ENCEPHALOGRAPHIC STUDY
Hitomi Yamakawa
Department of Physical and Occupational Therapy
Graduate School of Medicine, Nagoya University, JAPANIntroduction
Awareness of an object is the starting point of abehavior. The awareness may be not only a cue foran action, but also a sign of consciousness. Since
every conscious activity of us accompanies withawareness of something, brain processes forawareness, as a fundamental brain activity, havebeen investigated (Koivisto and Revonsuo, 2010).
Brain processes for awareness should involve
those for categorization and discrimination, and we
finally aware what was presented. Previous study
suggested that our brain select a target andsuppressed irrelevant information to the target
information through interaction between the target
and irrelevant information detection processes(Conci et al., 2006). Occupational therapy, which
supports meaningful activities occupying client’stime, it may be important to know what clients areaware of through an intervention. Therefore, tounderstand brain mechanisms for awareness, as wellas cognitive process, has been especially importantfor OT, with knowledge of neuroscience (Katz et al.,
2002; Carey, 2010).
I conducted a basic research for awareness of facein the present study. Since recognition of face is
one of the most fundamental and important activities
at the beginning of intervention to communicate face
to face with the client. I considered that brain
responses before awareness should be clarified toknow the brain process leading awareness. A
magneto-encephalographic system (MEG) has been
a powerful tool to investigate when and where a
response of brain was activated following
stimulation/information.
Materials and Method
Ten healthy volunteers participated in thepresent study (2 males and 8 females, mean age:
24.9 ±7.62 (SD) years). Schematic pictures were
presented on the center of a screen in front of thesubjects (Fig. 1). The visual stimulation included
three categories of pictures; i.e., two faces of lateraland oblique views, two non-face and intermediate
pictures (Fig. 2). For example, a white dot wasplaced at the center of a large circle, and, by adding
a small white dot, the picture was presented as face,non-face or, or intermediate schema. Therefore,
The face, non-face and intermediate pictures weredifferent in position of a small dot (Fig. 1).
Presented period for each picture was 1 sec, andmagnetic signals were recorded for 2 sec after the
onset of the visual stimulation.
Sampling
frequency was 2k Hz, and the initial bandpass filter
was between 1 to 100 Hz. Each picture waspresented 50 times during one session in random
order, thus 50 evoked brain responses following
each face, non-face and intermediate picture wereobtained. The subjects asked to judge whether apictures seemed to be face or not, by pressing buttonin their right hand, just after the offset of the visualpresentation.
The brain response recorded as magnetic fields,
were averaged for each category of visual
stimulation. We analysed the initial response, atapproximately 150 ms after the onset of the visual
stimulation, since the response differ in magnetic
fields among the categories of the stimulation.
Peak latency and strength of the global field power,
which were obtained as a root-mean square (RMS)
of intensity of magnetic signals at each sampling
point, were compared among the categories.

Fig. 1: Visual stimulation: Initial schema was a small dot
in a large black area (left-center), and another small dot
was added to change the initial schema to face,non-face or intermediate picture (right-center, face andnon-face were presented). This presentation enabled
to evoke brain response for different categories byadding a small white circle. The MEG signal wasrecorded from the onset of the right-center picture.

Results
The MEG waveforms recorded from a
representative subject were shown in Fig. 2. The
brain responses after the onset of adding a small dot
were obviously different among the picturesuggested that awareness for face, at least for face asa familiar stimulation, might be preceded by absent
of brain responses for “ambiguousness” or“unusualness”.

Fig. 2: The MEG waveforms obtained from the righthemisphere following visual stimulation of each category.
Fifty waveforms were superimposed (left), and patterns
of magnetic fields at150 ms after the onset of visual
stimulation by adding the second dot were shown (right).
The arrow indicate the onset of the stimulation; i.e., theonset of adding small circle.

categories (Fig. 2).Statistical analysis showed large
brain response following the intermediate pictures
than that after face pictures (Bonferroni-Dunn’s test,
p<0.05, Fig. 3). Latency of the response was notchanged among the categories. The generator
source for the response at 150 ms after the visual
stimulation was estimated in the inferior temporal
area in each hemisphere.

Fig. 3: The global field power at the peak of thecomponents at 150 ms after the visual stimulation.
Significantly larger response (gray bar) was obtained
after the Intermediate simulation.

References
Conci M, Gramann K, Müller HJ, Elliott MA.
Electrophysiological correlates of similarity-based
interference during detection of visual forms. J Cogn
Neurosci. 2006 Jun;18(6):880-888.
Carey L. Neuroscience makes sense for occupational therapy.
Aust Occup Ther J. 2010 Jun;57(3):197-199.
Katz N, Fleming J, Keren N, Lightbody S, Hartman-Maeir A.
Unawareness and/or denial of disability: implications foroccupational therapy intervention. Can J Occup Ther.
2002 Dec;69(5):281-292.
Koivisto M, Revonsuo A. Event-related brain potential
correlates of visual awareness. Neurosci Biobehav Rev.
2010 May;34(6):922-934.

Discussion
The present results showed a large brain response
following the intermediate pictures, which were
ambiguous, and the face picture evoked smaller
response than that for intermediate picture. The
brain response for the intermediate and non-faceresponse might include responses for non-familiar
stimulation, since those pictures were relatively
unusual than the face pictures. I considered that thelarge response following the intermediate ambiguous
pictures needed more brain activity to identify what
was the picture. The brain activity might involved
suppressive response that resulted in “this was not
face nor non-face”, as Conci et al. (2006) indicatedas a detection process.
The present results

Author address
E-Mail: yamakawa.hitomi@b.mbox.nagoya-u.ac.jp

A SYSTEMATIC REVIEW OF THE EFFECTS OF OCCUPATIONAL THERAPY FORPERSONS WITH DEMENTIA: A META-ANALYSIS OF RANDOMIZED CONTROLLED
TRIALS
1)

1)

S.Y. Kim , E.Y. Yoo , M.Y. Jung1) , S.H. Park1), J.H. Park1).
1) Department of Occupational Therapy, School of Health Sciences, Yonsei University, Wonju, Korea
Introduction
With population aging, the number of elderly people whoare being diagnosed with dementia, which is a representative
disease for the elderly, is continuously increasing. As thenumber of persons with dementia is increasing, studies on
effective occupational therapy(OT) intervention need to beorganized to be used in evidence-based practice and will
provide useful information for clinicians providing therapy for
persons with dementia. However, no systematic studies to
examine the degree of effectiveness across OT interventions for
persons with dementia have been conducted recently, and theeffect of various OT interventions for persons with dementia
has not been sufficiently demonstrated. Therefore, there is aneed for a systematic study on the effectiveness of OT
interventions to provide clinically effective OT to persons withdementia.
Meta-analysis was conducted to examine the effects of OT
interventions based on sensory stimulation, environmental
modification and functional task activity on the behavioral
problems and depressive symptoms of individuals withdementia.
Materials and Methods
Search strategy: An extensive search in databases such as
MEDLINE, CINAHL, ProQuest Medical Library, andCochrane in addition to 11 OT-related journals was performed.
Selection criteria: Potential studies were idenfied throughthe following keywords: dementia or Alzheimer, randomized
controlled trials (RCTs) and occupational therapy or
occupational therapist or ADL or sensory stimulation or
Snoezelen or environmental modification or education for
caregivers.
Data collection and analysis: Two reviewers independently
identified studies, extracted data, and assessed methodologicalquality of the studies. Effect size was estimated using
standardized mean difference with 95% confidence intervals.
Significant heterogeneity and publication bias were
investigated.
Results
The characteristics of the 9 studies included for meta
analysis are shown in Table 1. Nine studies identified were
RCTs and showed random assignment and a low dropout rate.
The methodological quality of the primary data was assessedby PEDro. The quality of seven out of nine studies was high.
The results of Funnel Plot analysis found that there was no
publication bias. In the homogeneity test, no statisticallysignificant heterogeneity .
The OT intervention in four of the nine studies was sensory
stimulation [1,2,3,4], intervention of three studies wasfunctional task activity [5,6,7] and intervention of two studies
was environmental modification [8,9]. The intervention
duration was from four weeks to six months. We reviewed 9
RCT studies and failed to find one common outcome. The
common dependent variable of OT interventions based on
sensory stimulation and environmental modification was
behavioral problems(agitation, disruptive behavior, memory
related problems) and that of OT intervention based onfunctional task activity was depression(apathy, sadness,depressive symptoms).
Effects of OT intervention based on sensory stimulation on
behavioral problems: A total of 250 subjects were included infour studies [1,2,3,4], and all studies compared sensory
stimulation therapy and general treatment. The range of effectsize in this meta analysis was from 0.11 to 1.14. The overall
effect size was statistically significant at 0.32 (95% CI, 0.04 to
0.59, p < 0.05) (Fig.1) and can be interpreted as small.
Effects of OT intervention based on envrionmental
modification on behavioral problems: A total of two studies[8,9] involving 298 participants were included to examine theeffects of OT intervention based on environmental modification.
Meta analysis found that the range of effect size was from 0.13
to 0.14. The overall effect size was not statistically significant
at 0.13 (95% CI, -0.09 to 0.36, p > 0.05) (Fig.2).
Effects of OT intervention based on functional task activity
on depression: Three studies [5,6,7] involving 203 people wereanalyzed to examine the effect of OT intervention based onfunctional task activity. The range of effect size of meta
analysis was from 0.08 to 0.25. The overall effect size was notstatistically significant at 0.15 (95% CI, -0.17 to 0.47, p > 0.05)(Fig.3).
Figure 1 Forest plot of the effect of OT intervention basedon sensory stimulation on behavioral problems
Study name

Statistics for each study

Std diff in means and 95% CI

Std diff Standard
Lower Upper
in means error Variance limit limit Z-Value p-Value

Robichaud(1994)

0.303

0.320

0.102 -0.323 0.930

0.948

0.343

Baker(2001)

0.383

0.285

0.081 -0.177 0.942

1.340

0.180

Baker(2003)

0.105

0.208

0.043 -0.303 0.512

0.503

0.615

Staal(2007)

1.139

0.440

0.194 0.277 2.002

2.589

0.010

0.317

0.141

0.020 0.041 0.593

2.250

0.024
-2.00

-1.00

0.00

Favours A

1.00

2.00

Favours B

Figure 2 Forest plot of the effect of OT intervention basedon environmental
modification on behavioral
Meta Analysis
problems
Meta Analysis

opy
c
n
atio

lu
a
v
E

Study name

Statistics for each study

Std diff in means and 95%CI

Std diff Standard
Lower Upper
in means error Variance limit limit Z-Value p-Value

Gitlin(2001)

0.126

0.154

0.024 -0.175 0.428 0.823 0.410

Gitlin(2005)

0.143

0.176

0.031 -0.202 0.487 0.812 0.417

0.134

0.116

0.013 -0.093 0.360 1.154 0.248
-1.00

-0.50

0.00

0.50

1.00

Favours A
Favours
B
Figure 3 Forest plot of the effect of OT intervention
based
on functional task activity on depression

Meta Analysis

lua
a
v
E

tio

opy
c
n

Meta Analysis
Study name

Statistics for each study

Conclusions
The result of meta analysis indicated that OT interventions
based on sensory stimulation have a small but significant effecton improving behavioral problems for persons with dementia.
However, since these conclusions were draw from 2 to 4 RCTs,
it should be treated with caution until replicated in future
research.

Std diff in means and 95%CI

Std diff Standard
Lower Upper
in means error Variance limit limit Z-Value p-Value

Gitlin(2008)

0.147

0.268

0.072 -0.378 0.672 0.550 0.582

Lam(2010)

0.084

0.266

0.071 -0.438 0.605 0.314 0.753

Clare(2010)

0.246

0.314

0.098 -0.369 0.860 0.783 0.434

0.150

0.162

0.026 -0.167 0.467 0.927 0.354
-1.00

-0.50

0.00

0.50

1.00

Discussion
Favours B OT
This review explored the efficacy Favours
of A several
interventions on behavioral problems and depression for
dementia. The overall effect size of OT interventions based on
sensory
Meta Analysisstimulation, environmental modification and functional
task activity was 0.32, 0.13, 0.15. The available evidence
suggests that sensory stimulation is an effective intervention to
improve behavioral problems while OT interventions based on
environmental modification and functional task activity are noteffective to improve behavioral problemsand depression.
The overall effect size of OT interventions based on
sensory stimulation was 0.32 that revealed small but
statistically significant effects in improving behavioral
problems of persons of dementia. Although the effect size issmall, sensory stimulation was found to be effective in
improving behavioral problems based on our meta analysis.
Dementia is the result of degenerative changes in the central
nervous system [10]. The onset of dementia leads to gradual
deterioration, with multiple cognitive deficits and a significant
decline from previous levels of functioning [11]. Therefore, asmall effect size in dementia studies can be interpreted asmeaningful and OT intervention based on sensory stimulation
can be used to improve behavioral problems that is a common
symptom in dementia patients and contribute to the distress of
their caregivers.
There are several limitations of this meta analysis thatshould be considered in interpreting the findings. First, thisreview sought only RCT of OT interventions and this resulted
in only a small number of studies being found. As such, thisreview included studies that did not classify type and severityof dementia clearly. Therefore, there is a limitation to
generalizability of the present findings as different types(Alzheimer’s type dementia and vascular dementia) andseverity of dementia were represented in our analysis. It isarguable whether intervention effect in people with Alzheimer
dementia is sufficiently similar to that in people with vasculardementia to justify inclusion in the same study population orwhether intervention effect between different stages ofdementia is same, or whether the inclusion of such a mixed
population would have a confounding effect. Therefore, theresult of this review should be considered cautiously. Lastly, as
this review included only studies published in English, studies
published in other languages may have been missed. Suchlimitations suggest an urgent need for more RCT studies
evaluating specific categories of OT intervention for specific
type and severity of dementia.
This study is meaningful in that a meta analysis was
performed for the first time to assess the overall effect byintegrating the results of independent studies to examine theeffects of OT interventions on behavioral problems anddepression for persons with dementia. In conclusion, sensory
stimulation provided by occupational therapist is an effective
clinical intervention that can be used for dementia. For
scientific studies in the future, further studies are needed byclassifying type and severity of dementia since thecharacteristics can be different depending on type and severityof dementia.

Eva

io
t
a
lu

op
nc

y

Note: To cite this abstract, please refer to
Kim SY, Yoo EY, Jung MY, Park SH, Park JH. A systematic
review of the effects of occupational therapy for persons withdementia: A meta-analysis of randomized controlled trials.
NeuroRehabilitation. 2012;31(2):107-115.
References[1] Baker R, Bell S, Baker E, Gibson S, Holloway J, Pearce R,
Dowling Z, Thomas P, Assay J, Wareing LA. A randomized
controlled trial of the effects of multi-sensory
stimulation(MSS) with people with dementia. Brit J Clin
Psychol. 2001;40:81-96.
[2] Baker R, Holloway J, Holtkamp CCM, Larsson A, Hartman
LC, Pearce R, Scherman B, Johansson S, Thomas PW,
Wareing LA, Owens M. Effects of multi-sensory stimulation
for people with dementia. J Adv Nurs. 2003;43:465-477.
[3] Robichaud L, Hebert R, Desrosiers J. Efficacy of a sensory
integration program on behaviors of inpatients with dementia.
Am J Occup Ther.1994;48:355-360.
[4] Staal JA, Sacks A, Matheis R, Collier L, Calia T, Hanif H,
Kofman ES. The effects of snoezelen(multi-sensory behavior
therapy) and psychiatric care on agitation, apathy, andactivities of daily living in dementia patients on a short term
geriatric psychiatric inpatient unit. Int J Psychiat Med. 2007;
37:357-370.
[5] Clare L, Linden DEJ, Woods RT, Whitaker R, Evans SJ,
Parkinson CH, van Paasschen J, Nelis SM, Hoare Z, Yuen K,
Rugg MD. Goal-oriented cognitive rehabilitation for people
with early-stage Alzheimer’s disease: A single-blind
randomized controlled trial of clinical efficacy. Am J Geriatr
Psychiatry.2010;18: 928-939.
[6] Gitlin LN, Winter L, Burke J, Chernett N, Dennis MP,
Hauck WW. Tailored activities to manage neuropsychiatricbehaviors in persons with dementia and reduce caregiverburden: a randomized pilot study. Am J Geriatr Psychiatry.
2008;16:229-239.
[7] Lam LCW, Lui VWC, Luk DNY, Chau R, So C, Poon V,
Tam P, Ching R, Lo H, Chiu J, Fung A, Ko FSL.
Effectiveness of an individualized functional training
program on affective disturbances and functional skills inmild and moderate dementia-a randomized control trial. Int
J Geriatr Psychiatry. 2010;25:133-141.
[8] Gitlin LN, Corcoran M, Winter L, Boyce A, Hauck WW. A
randomized controlled trial of a home environmental
intervention: Effect on efficacy and upset in caregivers andon daily function of persons with dementia. Gerontologis.
2001;41:4-14.
[9]Gitlin LN, Hauck WW, Dennis MP, Winter L. Maintenanceof effects of the home environmental skill-building programfor family caregivers and individuals with Alzheimer's
disease and related disorders. J Gerontol A Biol Sci Med Sci.
2005;60:368-374.
[10]Schneider LS. Cholinergic deficiency in Alzheimer’s
disease: Pathogenic model. Am J Geriatr Psychiatry.1998
Spring;6(2 Suppl 1):S49-55.
[11]Glogoski C. Alzheimer's disease, In: Pendleton H, SchultzKrohn W, Pedretti's occupational therapy: Practice skills forphysical dysfunction, 6th ed., St. Louis: Mosby. 2006;880886.

Table 1 Characteristics of included RCTs
Duration/
Frequency
30 min/session,
2 times/week for 4
weeks

Outcome
Measures
BMD
BRS

Exp group: sensory stimulation
Con group: usual activity

30 min/session,
2 times/week for 4
weeks

BMD
BRS

6

Exp group: sensory stimulation; sensory integration programactivities emphasizing
physical response, sensory
stimulations, cognitive
stimulations
Con group: usual activities

30~45 min/session,
3 times/week for 10
weeks

RMBPC

6

Exp group: sensory stimulation(Snoezelen)
Con group: standard care

25~30 min/session,
6 times

PAS
SANS

6

Exp group: performing functional
task activity; goal-oriented activity using
practical aids and strategies
Con group: no treatment
Exp group: performing functional
task activity; tailored activity programtarget activity based
cognition, interest and role
Con group: routine care

60 min/session,
1 time/week for 8
weeks

HADS

6

90 min/session, 6home visits, 15
min/session, 2
telephone contacts;
8 times for over 4
months

CSDD

8Exp group: performing functional
task activity; functional enhancement
program- tailored functional
activity and skills training
Con group: general care

45 min/session,
2 times/week for 8
weeks

CSDD
NPI

8

Exp group: environmental
modification; physical, social environmental
modifications
Con group: routine care

90 min/session,
approximately 1time/every otherweek for over 3
months

MBPC

6

Study

Participants

Intervention

Baker(2001) [1]

N = 50(Exp: Con = 25:25)
Mean age: 78.0
Gender: 25M, 25F
N = 136(Exp: Con = 65:71)
Mean age(Exp: Con=81.0: 83.0)

Exp group: sensory stimulation
Con group: usual activity

N = 40(Exp:Con = 22:18)
Exp group
Mean age: 76.6
Gender: 8M, 14F
Con group
Mean age: 80.1
Gender: 4M, 14F
N = 24(Exp:Con = 12:12)
Mean age(Exp:Con =80.3:72.0)
N = 69Mean age: 77.78
Gender: 28M, 41F

Baker(2003) [2]

Robichaud(1994) [3]

Staal(2007) [4]Clare(2010) [5]

Gitlin(2008) [6]Lam(2010) [7]

Gitlin(2001) [8]Gitlin(2005) [9]N = 60(Exp:Con = 30:30)
Exp group
Mean age: 78.0
Gender: 15M, 15F
Con group
Mean age: 80.8
Gender: 19M, 11F
N = 74(Exp:Con = 37:37)
Exp group
Mean age: 83.1
Gender: 12M, 25F
Con group
Mean age: 83.8
Gender: 7M, 30F
N = 171(Exp: Con = 93:78)
Exp group;
Mean age: 77.78
Gender: 31M, 62F
Con group
Mean age: 78.36
Gender: 27M, 51F
N = 127
Mean age(Exp:Con = 79.2:82.9)
Gender: 38M, 89F

Methodologicalquality5

Exp group: environmental
90 min/session,
RMBPC
4
modification
5 home visits, 1; home environmental skill
telephone contact; 6building program- problem
times for over 6
solving, simple homemonthsmodification
Con group: routine care
Exp: experimental; Con: control; M: male; F: female; BMD: Behavior and Mood Disturbance Scale; BRS: Behavior Rating Scale; HADS: Hospital
Anxiety and Depression Scale; MBPC: Memory and Behavior Problems Checklist; RMBPC: Revised Memory and Problem Behavior Checklist;
CSDD: Cornell Scale for Depression in Dementia; NPI: Neuropsychiatric Inventory; PAS: Pittsburgh Agitation Scale; SANS: Scale for theAssessment of Negative Symptoms

Author address
E-Mail: 9685071@hanmail.net

MemoAwareness of Driving Rehabilitation among Occupational Therapists in Korea
H. Y. Jung1), M. Y. Jung1)
1) Department of Occupational Therapy, College of Health Sciences, Yonsei University, Wonju, Korea

Introduction
Mobility within the community has been recognized as a uniquearea of occupational therapy as an instrumental activity of dailyliving. Community mobility through public transportation such as abus or a taxi or driving constitutes "independent movement" [1].
Driving is the most basic method of mobility for both nondisabledindividuals and people with disability and is the most important
method of transportation in instrumental activities of daily living at
the same time. Driving requires interaction of considerable
perceptual, visual, and cognitive abilities [2]. Individuals requiring
assistance such as those with disabilities may be able to use public
transportation such as bus and subway but they may not have easy
access because of the lack of facility. In addition, many taxi drivers
oftentimes refuse to take individuals with disability as passengers. As
such, individuals with disability often prefer to drive their own car[3]. Especially given the growing proportion of the elderly, theirexpressed need for driving in order to actively participate in social
activities is also increasing. Furthermore, to evaluate individuals
post-accident or injury who have acquired physical impairment isanother important part of driving rehabilitation [4]. The occupationof driving is thus one of the newly emerging social issue in Korea as
the elderly population grows. In fact, 12.2% of the elderly population
drive their own cars while 21.3% report they also experience
difficulty in driving [5].
This age group is also at a greater risk for motor vehicle crashes
due to medical conditions, medication use, and functional
impairments that are common in the older population than thegeneral adult age group [6]. In Korea, vehicle accident fatalities inolder drivers is increasing gradually at 11.6% [7]. Similar numbers
are being reported in the United States and Canada. To solve suchproblems, there is a greater demand for governments interventions,
including mandating physical and cognitive evaluation to renew thedriver's license [8].
Therefore, the need for driving assessment and driving
rehabilitation is rising. This study was based on examining mobility
within the community and collecting basic data for future research byinvestigating the awareness and the necessity of driving rehabilitation
among occupational therapists.
Materials and Methods
A total of 209 occupational therapists with 3.1 years of clinicalexperience who are members of the Korean Association of
Occupational Therapists (KAOT) completed the survey (Table 1).
There were 8 questions pertaining to driving rehabilitation and 14
questions regarding utilization of driving rehabilitation in clinicalpractice.
Table 1 General characteristic
Characteristic
Frequency(N=209)%Age distribution
20~29 years

175

83.7

30~39 years

29

13.9

40 years and up

5

2.4

3 years Bachelor'

114

54.5

Bachelor's degree

90

45.4

Rehabilitation hospital

87

41.6

Nursing home

52

24.9

University hospital

54

25.8

Place of Employment

Results
180 of the participants reported the need for driving rehabilitationintervention. 116 participants (55.5%) had taken a driving
rehabilitation course during undergraduate education, and if
continuing education course in driving rehabilitation is open
following licensure, 188 (90%) occupational therapists indicated theywould enroll in such education programs (Table 2).
Table 2 Awareness of driving rehabilitation amongoccupational therapists(N=209)
Questions
Frequency%
Driving rehabilitation intervention necessity
Necessary
Not necessary

180
29

86.1
13.9

Enrollment in driving rehabilitation course
during undergraduate education
Yes
No

116
91

55.5
21.0

Willingness to participation in driving rehab
continuing education
Yes
No

188
21

90.0
10.0

In regards to questions regarding ways to enhance accessibility todriving rehabilitation related courses, 86.1% reported that it isnecessary to have more courses made available through professional
associations, while 82.3% responded that certification may not benecessary (Table 3).
Table3 Means to increase accessibility to driving rehabilitation
courses(N=209)
Questions
Frequency%
Additional education
Necessary

180

86.1

Not necessary

29

13.9

Require Certification

Gender
Male

53

25.4

Necessary

91

43.5

Female156

74.6

Not necessary

116

55.5

Highest level of education

On questions regarding actual experience of applying driving
rehabilitation in clinical settings, 197 participants (94.3%) indicatedthat they did not have experience in providing driving rehabilitationin clinical practice. However, 125 participants (59.8%) reported thatclients express the need for driving rehabilitation (Table 4).
Table 4 Application of driving rehabilitation in clinical practice(N=209)
Questions
Frequency%
Driving rehabilitation provided in clinicalsetting
Implemented

12

5.7

Not implemented

197

94.3

Demanded

125

86.1

Not Demanded

84

13.9

Client desire for driving rehabilitation

To questions concerning the degree of applicability of driving
rehabilitation in the current place of employment, 143 participants(68.4%) reported that there is a difficulty in immediate application ofdriving rehabilitation. When inquired about future plans of
implementing driving rehabilitation, 125 occupational therapists(59.8%) indicated that they plan to provide driving rehabilitation in
the future when systematic and physical set-up is finalized,
suggesting that there is a desire to provide driving rehabilitation.
Some of the interfering factors in implementing driving rehabilitation
currently included absence of necessary equipment and facilities(87.9%) (Table 5).
Table 5 Applicability of driving rehabilitation
Frequency(N=209)
%

63

31.1

143

68.4

Yes

125

59.8

No

80

38.3

Absence of facilities, equipment,
space, vehicle for practice

157

87.9

Absence of experts

53

19.6

Lack of insurance coverage

50

18.5

QuestionsApplicability of driving rehabilitation incurrent work environment
Possible
Not possible
Plan to apply driving rehabilitation in the
futureObstacles to providing driving
rehabilitation (multiple responses)

Discussion
This study was conducted across 209 occupational therapists inorder to examine the awareness and the perceived need for driving
rehabilitation in the current clinical practice setting.
The results are consistent with studies conducted through theAmerican Occupational Therapist Association (AOTA). Participants
reported the need for driving rehabilitation, as well as more
specialized driving rehabilitation specialists. Such results indicate
greater need for continuing education for occupational therapists inthis area.
Clinical experience through hands-on training for therapists
working in the area of driving rehabilitation is needed, and there is a
desire to be trained by driving rehabilitation specialists to enhancetheir therapy experience. However, too much focus has been on
curriculum-based education in driving rehabilitation, with relativelack of exposure to actual clinical application of driving

rehabilitation.
Driver-trained occupational therapists (DTOTs) are qualified
occupational therapists who specializes in the rehabilitation ofdriving in Australia, even if issued through a variety of assessment
and the actual highway rating (On-Road Driving Test) is parallel [10].
In Korea, such driving rehabilitation certification system with awide range of professional training programs targeting impaired
drivers are lacking, with deficiency in professional training orpractice facilities, and the need is urgent to expand the compositionof the environment, provide more sufficient and safe driving
education and training that can be provided by professionals.
The results of this study will assist the efforts made by qualified
occupational therapist striving to broaden the field of driving
rehabilitation .
Especially given the growing proportion of the elderly and disabled,
it is essential to make the foundation for driving rehabilitation within
the curriculum and active interest and participation of occupational
therapist are also required.
The limitations of this study are that this research was conductedwith a proportionate number of occupational therapists. Moreover,further studies are necessary regarding specific and systematic means
to examine the effectiveness of driving rehabilitation.
Conclusion
The preesent study demonstrated there is still a significant needfor education and clinical training in the clinical field of driving
rehabilitation in occupational therapy. Thus, it will be essential to
implement more education in driving rehabilitation and training
support.
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Author address

E-Mail: othaeyoun@yonsei.ac.kr.