Foy Teresa, Perritt Ginger, Thimmaiah Deepa, Heisler Lauren, Offutt Jennifer Lookingbill, Cantoni Kara, Hseih Ching-Hui, Gassaway Julie, Ozelie Rebecca, Backus Deborah
Shepherd Center, Atlanta, Georgia, USA.
J Spinal Cord Med. 2011;34(2):162-75. doi: 10.1179/107902611X12971826988093.
Occupational therapy (OT) is a critical component of the rehabilitation process after spinal cord injury (SCI), the constitution of which has not been studied or documented in full detail previously.
To describe the type and distribution of SCI rehabilitation OT activities, including the amount of time spent on evaluation and treatment, and to discuss predictors (patient and injury characteristics) of the amount of time dedicated to OT treatment activities.
Six inpatient rehabilitation centers enrolled 600 patients with traumatic SCI in the first year of the SCIRehab. Occupational therapists documented 32 512 therapy sessions including time spent and specifics of each therapeutic activity. Analysis of variance and contingency tables/chi-square tests were used to test differences across neurologic injury groups for continuous and categorical variables.
SCIRehab patients received a mean total of 52 hours of OT over the course of their rehabilitation stay. Statistically significant differences among four neurologic injury groups were seen in time spent on each OT activity. The activities that consumed the most OT time (individual and group sessions combined) were strengthening/endurance exercises, activities of daily living (ADLs), range of motion (ROM)/stretching, education, and a grouping of 'therapeutic activities' that included tenodesis training, fine motor activities, manual therapy, vestibular training, edema management, breathing exercise, cognitive retraining, visual/perceptual training desensitization, and don/doff adaptive equipment. Seventy-seven percent of OT work occurred in individual treatment sessions, with the most frequent OT activity involving ADLs. The variation in time (mean minutes per week) spent on OT ROM/stretching, ADLs, transfer training, assessment, and therapeutic activities can be explained in part by patient and injury characteristics, such as admission Functional Independence Measure (FIM) score, neurologic injury group, and the medical severity of illness score.
OT treatment patterns for patients with traumatic SCI show much variation in activity selection and time spent on activities, within and among neurologic level of injury groups. Some of the variation can be explained by patient and injury characteristics. Almost all patients with SCI participated in strengthening/ endurance and ROM/stretching exercises during OT treatment and these two activities are where the most time was spent when therapy provided in individual and group settings was combined. ADL work consumed the most time in individual therapy sessions.
职业治疗（OT）是脊髓损伤（SCI）后康复过程的关键组成部分，其构成此前尚未得到充分研究或记录。
描述SCI康复OT活动的类型和分布，包括评估和治疗所花费的时间，并讨论OT治疗活动时间的预测因素（患者和损伤特征）。
在SCIRehab的第一年，六个住院康复中心招募了600例创伤性SCI患者。职业治疗师记录了32512次治疗会话，包括每次治疗活动所花费的时间和具体情况。方差分析和列联表/卡方检验用于检验神经损伤组之间连续变量和分类变量的差异。
SCIRehab患者在康复住院期间平均接受了52小时的OT治疗。四个神经损伤组在每项OT活动所花费的时间上存在统计学显著差异。OT时间消耗最多的活动（个体和团体治疗会话合计）是强化/耐力训练、日常生活活动（ADL）、关节活动度（ROM）/伸展训练、教育以及一组“治疗活动”，其中包括肌腱固定训练、精细运动活动、手法治疗、前庭训练、水肿管理、呼吸训练、认知再训练、视觉/感知训练脱敏以及穿脱适应性设备。77%的OT工作发生在个体治疗会话中，最常见的OT活动涉及ADL。OT ROM/伸展训练、ADL、转移训练、评估和治疗活动所花费时间（每周平均分钟数）的差异部分可由患者和损伤特征解释，如入院时的功能独立性测量（FIM）评分、神经损伤组以及疾病的医疗严重程度评分。
创伤性SCI患者的OT治疗模式在活动选择和活动时间上，在损伤神经水平组内和组间都有很大差异。部分差异可由患者和损伤特征解释。几乎所有SCI患者在OT治疗期间都参与了强化/耐力训练和ROM/伸展训练，当个体和团体治疗相结合时，这两项活动花费的时间最多。ADL工作在个体治疗会话中消耗的时间最多。
