Medicina Sportiva (2012), vol VIII, no 3, 1890 - 1896 Medicina Sportiva (2012), vol VIII, no 3, 1890 - 1896

Romanian Sports Medicine Society Romanian Sports Medicine Society

1890 1890

The role of occupational therapy within the complex functional rehabilitation The role of occupational therapy within the complex functional rehabilitation
program of the paraplegic patient program of the paraplegic patient

Mirela Dan, Ioan Cosmin Boca Mirela Dan, Ioan Cosmin Boca
Universitatea de Vest Vasile Goldis, Arad, Romania Universitatea de Vest Vasile Goldis, Arad, Romania

Abstract. Improving the quality of life of paraplegic patients is a common concern of all health care professionals. Abstract. Improving the quality of life of paraplegic patients is a common concern of all health care professionals.
Physical therapy has a variety of methods which can be used to prevent physical decompensation of paraplegic patients Physical therapy has a variety of methods which can be used to prevent physical decompensation of paraplegic patients
and to improve their quality of life. A complex functional rehabilitation program through physical therapy and and to improve their quality of life. A complex functional rehabilitation program through physical therapy and
occupational therapy will help the paraplegic patient to achieve the highest level of independence. occupational therapy will help the paraplegic patient to achieve the highest level of independence.
Key words: paraplegia, interdisciplinarity, occupational therapy, physical therapy. Key words: paraplegia, interdisciplinarity, occupational therapy, physical therapy.

Introduction Introduction
The technological explosion of the last decades him and that life can offer him a lot of The technological explosion of the last decades him and that life can offer him a lot of
has generated a directly proportional satisfactions even in these conditions in which his has generated a directly proportional satisfactions even in these conditions in which his
transformation of society, and the entry of the manner of movement is modified (3). transformation of society, and the entry of the manner of movement is modified (3).
modern techniques in our life has inevitably led to In the rehabilitation program of paraplegic modern techniques in our life has inevitably led to In the rehabilitation program of paraplegic
the increase of the number of accidents, to the patients the neuromotor reeducation represents the increase of the number of accidents, to the patients the neuromotor reeducation represents
enhancement of the vertebro-medullary only one aspect, the medical problems of these enhancement of the vertebro-medullary only one aspect, the medical problems of these
traumatisms, especially. Road accidents occupy a patients being extremely complex, belonging to traumatisms, especially. Road accidents occupy a patients being extremely complex, belonging to
first place in the genesis of the traumatic vertebral various neuro-surgical, neurological and first place in the genesis of the traumatic vertebral various neuro-surgical, neurological and
and medullary impairments. urological specialties, to physiotherapy, and medullary impairments. urological specialties, to physiotherapy,
The complex interdisciplinary approach, with occupational therapy and psychology. The complex interdisciplinary approach, with occupational therapy and psychology.
regard to the neuro-motor rehabilitation of the So the action of functional rehabilitation presumes regard to the neuro-motor rehabilitation of the So the action of functional rehabilitation presumes
paraplegic patient is especially delicate and a team activity in which every specialist must paraplegic patient is especially delicate and a team activity in which every specialist must
demands specialized units which are capable to bring his contribution for the achievement of the demands specialized units which are capable to bring his contribution for the achievement of the
solve the problems (1). The therapeutic program proposed objectives (4). The purpose is to create a solve the problems (1). The therapeutic program proposed objectives (4). The purpose is to create a
must be individualized according to the lifestyle for the patient and the family so that the must be individualized according to the lifestyle for the patient and the family so that the
particularities of every particular case, taking into disability may interfere as little as possible with particularities of every particular case, taking into disability may interfere as little as possible with
account the specific data of every patient, the the daily normal activities. The rehabilitation account the specific data of every patient, the the daily normal activities. The rehabilitation
associated impairments and personality, and program focuses on abilities rather than associated impairments and personality, and program focuses on abilities rather than
imposes the permanent reevaluation of the disabilities and facilitates the recuperation of the imposes the permanent reevaluation of the disabilities and facilitates the recuperation of the
functional level of the patient in order to complete individuals independence by exploiting the functional level of the patient in order to complete individuals independence by exploiting the
it according to the newly determined data. functional residual (5). it according to the newly determined data. functional residual (5).
The months in hospital after a spinal cord injury At the moment there are no medical solutions for The months in hospital after a spinal cord injury At the moment there are no medical solutions for
are an extremely difficult period for patients as the recovery of the area of injured medulla, are an extremely difficult period for patients as the recovery of the area of injured medulla,
they gradually adjust to what may be a lifetime of although there are medical teams who study the they gradually adjust to what may be a lifetime of although there are medical teams who study the
disability (2). The purpose of physiotherapy and possibility of nerve graft, stem cell implant, and disability (2). The purpose of physiotherapy and possibility of nerve graft, stem cell implant, and
of occupational therapy is to teach the patient to implant of electrostimulating devices at the level of occupational therapy is to teach the patient to implant of electrostimulating devices at the level
be independent, which means to make him benefit of the medulla. There are premises that such be independent, which means to make him benefit of the medulla. There are premises that such
from the maximum usage of the functional therapies will be possible in the following years. from the maximum usage of the functional therapies will be possible in the following years.
residual to compensate the paralyzed part and to The rehabilitation of a paraplegic person is a long residual to compensate the paralyzed part and to The rehabilitation of a paraplegic person is a long
accept his disability, stimulating the patient with process which demands the adjustment of almost accept his disability, stimulating the patient with process which demands the adjustment of almost
regard to the fact that he still has a lot of resources all aspects of life (6). So, the kinetic rehabilitation regard to the fact that he still has a lot of resources all aspects of life (6). So, the kinetic rehabilitation
for being useful to himself and to those around program of the paraplegic develops over a long for being useful to himself and to those around program of the paraplegic develops over a long
 The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient
Mirela Dan & all Mirela Dan & all

1891 1891

period, changing together with the patients The basic criterion in selecting the 10 subjects period, changing together with the patients The basic criterion in selecting the 10 subjects
evolution. who participated in this study was paraplegia. evolution. who participated in this study was paraplegia.
The level of the injury dictates the limits of All subjects suffered a vertebro-medular The level of the injury dictates the limits of All subjects suffered a vertebro-medular
neuromotor rehabilitation, but functional traumatism, and half of them had an associated neuromotor rehabilitation, but functional traumatism, and half of them had an associated
rehabilitation is also dependent on the age of the diagnostic. None of the subjects was at the first rehabilitation is also dependent on the age of the diagnostic. None of the subjects was at the first
patient, his physical condition and the impact of stage of rehabilitation treatment. patient, his physical condition and the impact of stage of rehabilitation treatment.
the disability on the psychological balance of the During the entire period of this study, the subjects the disability on the psychological balance of the During the entire period of this study, the subjects
patient. of both lots followed a common functional patient. of both lots followed a common functional
Out of the multiple forms of disabilities which rehabilitation treatment which was based on a Out of the multiple forms of disabilities which rehabilitation treatment which was based on a
affect humankind, a severe traumatism or a physical therapy program comprising 30 exercises affect humankind, a severe traumatism or a physical therapy program comprising 30 exercises
disease of the medulla indubitably constitute one differently applied during the 4 weeks of study, disease of the medulla indubitably constitute one differently applied during the 4 weeks of study,
of the most devastating calamities of the human lasting 50 minutes, three times a week. of the most devastating calamities of the human lasting 50 minutes, three times a week.
being (7). The severity of the paraplegics In the case of the experimental lot the common being (7). The severity of the paraplegics In the case of the experimental lot the common
invalidity makes it a major objective of the great physical therapy program was supplemented by a invalidity makes it a major objective of the great physical therapy program was supplemented by a
rehabilitation services everywhere because this program of occupational therapy made on the rehabilitation services everywhere because this program of occupational therapy made on the
impairment demands considerable costs, both basis of the problems identified with regard to impairment demands considerable costs, both basis of the problems identified with regard to
medical-social and personal. performance in daily occupational activities, medical-social and personal. performance in daily occupational activities,
centered especially on exercising different centered especially on exercising different
Material and Method occupational activities with or without the help of Material and Method occupational activities with or without the help of
The selection of the subjects participating in this some adapted instruments. The selection of the subjects participating in this some adapted instruments.
research was made according to their own free research was made according to their own free
will. will.

Table I. The subjects of the experimental lot (data taken from their individual charts) Table I. The subjects of the experimental lot (data taken from their individual charts)
Level of Associated Level of Associated
Name Sex Age Diagnostic TVM Cause Name Sex Age Diagnostic TVM Cause
injury diagnostic injury diagnostic
Spastic paraparesis, after TVM, Spastic paraparesis, after TVM,
P.E. F 24 T4-T5 Road accident P.E. F 24 T4-T5 Road accident
non- operated; non- operated;
Flaccid Paraplegia, after TVM, Flaccid Paraplegia, after TVM,
L.C. M 31 T11-T12 Fall from height L.C. M 31 T11-T12 Fall from height
operated T11-T12 operated T11-T12
Spastic paraplegia after TVM, 2nd degree Spastic paraplegia after TVM, 2nd degree
L.M. F 27 T6-T7 Road accident L.M. F 27 T6-T7 Road accident
operated T5-T7 Obesity operated T5-T7 Obesity
Spastic paraplegia after TVM, Spastic paraplegia after TVM,
B.C. F 32 T10-T11 Fall from height B.C. F 32 T10-T11 Fall from height
operated T9-T11 operated T9-T11
Flaccid Paraplegia after TVM, Urinary Flaccid Paraplegia after TVM, Urinary
F.P. M 24 T6-T7 Road accident F.P. M 24 T6-T7 Road accident
operated T5-T8 Infection operated T5-T8 Infection

Table II. The subjects of the witness lot (data taken from their individual charts) Table II. The subjects of the witness lot (data taken from their individual charts)
Level of Associated Level of Associated
Name Sex Age Diagnostic TVM Cause Name Sex Age Diagnostic TVM Cause
injury diagnostic injury diagnostic
Spastic paraparesis after TVM, Urinary Spastic paraparesis after TVM, Urinary
D.M. F 22 T11-T12 Fall from height D.M. F 22 T11-T12 Fall from height
operated T11-L1 Infection operated T11-L1 Infection
Flaccid Paraplegia after TVM, Flaccid Paraplegia after TVM,
C.S. F 32 T11-T12 Road accident C.S. F 32 T11-T12 Road accident
operated T11-L1 operated T11-L1
Flaccid Paraplegia after TVM, Malformation Flaccid Paraplegia after TVM, Malformation
D.B. M 38 T11-T12 Road accident D.B. M 38 T11-T12 Road accident
operated T11-L1 gr. IV operated T11-L1 gr. IV
Spastic Paraplegia after TVM, Neurogenic Spastic Paraplegia after TVM, Neurogenic
T.B. M 32 T6-T7 Road accident T.B. M 32 T6-T7 Road accident
operated T6-T8 bladder operated T6-T8 bladder
Spastic paraparesis after TVM, Spastic paraparesis after TVM,
M.A. M 24 T6-T7 Dive M.A. M 24 T6-T7 Dive
operated T6-T7 operated T6-T7

Medicina Sportiva Medicina Sportiva

 The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient
Mirela Dan & all Mirela Dan & all

1892 1892

In order to make this study we resorted to the asking the subject to think about an ordinary day. In order to make this study we resorted to the asking the subject to think about an ordinary day.
following research methods: the bibliographic Then the subject was asked to identify which of following research methods: the bibliographic Then the subject was asked to identify which of
study method, the interview method, the these activities are satisfied with difficulty now study method, the interview method, the these activities are satisfied with difficulty now
observation method, the experiment method, the for him. The recording of these activities- observation method, the experiment method, the for him. The recording of these activities-
functional evaluation method, the graphic and problems was made at Step 1 - 1A, 1B or 1C. At functional evaluation method, the graphic and problems was made at Step 1 - 1A, 1B or 1C. At
imagistic method, the statistic analysis method. Step 2 the subject was asked to give a value on a 1 imagistic method, the statistic analysis method. Step 2 the subject was asked to give a value on a 1
The first and the last act of the physiotherapist, to 10 scale for the importance of every activity- The first and the last act of the physiotherapist, to 10 scale for the importance of every activity-
necessary for the application of a functional problem from Step 1. Steps 3 and 4 consist of the necessary for the application of a functional problem from Step 1. Steps 3 and 4 consist of the
rehabilitation program, is evaluation. The confirmation by the patient of the five most rehabilitation program, is evaluation. The confirmation by the patient of the five most
exactness of the evaluation depends on the quality important problems which will be recorded by the exactness of the evaluation depends on the quality important problems which will be recorded by the
of the measuring instruments (tests, evaluator. Using the scoring card, the subject is of the measuring instruments (tests, evaluator. Using the scoring card, the subject is
questionnaires) and on the correctness of their asked to record every problem under the aspects questionnaires) and on the correctness of their asked to record every problem under the aspects
usage, to which is added the observance of some of performance and satisfaction. The total score is usage, to which is added the observance of some of performance and satisfaction. The total score is
compulsory conditions on which the exactness calculated summing the value for all the problems compulsory conditions on which the exactness calculated summing the value for all the problems
and the validity of the results depend. Evaluation both for performance and for satisfaction and and the validity of the results depend. Evaluation both for performance and for satisfaction and
is extremely important, initially for the assessment which is then divided by the number of confirmed is extremely important, initially for the assessment which is then divided by the number of confirmed
of the functional deficit and of the functional problems. At the final evaluation the subject of the functional deficit and of the functional problems. At the final evaluation the subject
residual, and finally for the assessment of the recorded again every problem both for residual, and finally for the assessment of the recorded again every problem both for
results obtained after the implementation of the performance and for satisfaction, then calculating results obtained after the implementation of the performance and for satisfaction, then calculating
rehabilitation program. An important part of the the modified ion/change in performance. rehabilitation program. An important part of the the modified ion/change in performance.
rehabilitation process is the evaluation of the The Functional Independence Measure (FIM) is rehabilitation process is the evaluation of the The Functional Independence Measure (FIM) is
patients functional deficit. the most widely accepted functional assessment patients functional deficit. the most widely accepted functional assessment
It is essential to evaluate the consequences of the measure in use in the rehabilitation community It is essential to evaluate the consequences of the measure in use in the rehabilitation community
infirmity in order to assist the patient in adapting (10); can be used to assess the impact that the infirmity in order to assist the patient in adapting (10); can be used to assess the impact that the
to daily life and to reduce, if possible, both the medullary injury has on the functionality of the to daily life and to reduce, if possible, both the medullary injury has on the functionality of the
disability limitation of activity and the handicap paraplegic patient; that assessment was made disability limitation of activity and the handicap paraplegic patient; that assessment was made
the restriction of participation. twice during research, before beginning the the restriction of participation. twice during research, before beginning the
For the functional evaluation of the subjects we rehabilitation program and at its end. For the functional evaluation of the subjects we rehabilitation program and at its end.
used the Canadian Occupational Performance FIM verifies 18 functions, grouped in 6 subscales, used the Canadian Occupational Performance FIM verifies 18 functions, grouped in 6 subscales,
Measure (COPM) and the Functional every function being quantified from 1 to 7, and Measure (COPM) and the Functional every function being quantified from 1 to 7, and
Independence Measure (FIM). assess two dimensions: physical (eating, Independence Measure (FIM). assess two dimensions: physical (eating,
The Canadian Occupational Performance Measure grooming, bathing, dressing, toiletry, bowel and The Canadian Occupational Performance Measure grooming, bathing, dressing, toiletry, bowel and
(COPM) is an individualized outcome measure bladder control, transffering, and ambulation) and (COPM) is an individualized outcome measure bladder control, transffering, and ambulation) and
designed for use by occupational therapists. The cognitive (communication, social interaction, designed for use by occupational therapists. The cognitive (communication, social interaction,
measure is designed to detect changes in a client's problem solving, and memory) (11). The highest measure is designed to detect changes in a client's problem solving, and memory) (11). The highest
self-perception of occupational performance over possible functional level is 126 (18x7). self-perception of occupational performance over possible functional level is 126 (18x7).
time (8). COPM represents a questionnaire of In describing the evaluation manner for every time (8). COPM represents a questionnaire of In describing the evaluation manner for every
individualized evaluation used for the assessment function only specific aspects were highlighted. individualized evaluation used for the assessment function only specific aspects were highlighted.
of changes with regard to the performance and The seven degrees awarded for each function of changes with regard to the performance and The seven degrees awarded for each function
satisfaction in problems of daily occupational were: satisfaction in problems of daily occupational were:
activities. Degree 1 (complete help) patient performs less activities. Degree 1 (complete help) patient performs less
The COPM has a semi-structured interview than 25% of the respective activity, being The COPM has a semi-structured interview than 25% of the respective activity, being
format and it is usually first completed as an completely dependent on another person due to format and it is usually first completed as an completely dependent on another person due to
initial assessment so that therapy objectives can physical or cognitive limits; needs the assistance initial assessment so that therapy objectives can physical or cognitive limits; needs the assistance
be based upon problems selected by the client (9). of two persons; presents risk of injury during be based upon problems selected by the client (9). of two persons; presents risk of injury during
During the research, this questionnaire was testing; During the research, this questionnaire was testing;
applied twice, before starting the rehabilitation Degree 2 (maximal help) performs between applied twice, before starting the rehabilitation Degree 2 (maximal help) performs between
program and at its end. 25% and 49% of the respective activity, being program and at its end. 25% and 49% of the respective activity, being
For the identification of the problems maximally dependent on another person; For the identification of the problems maximally dependent on another person;
occupational performance, of the aspects and Degree 3 (moderate help) performs between occupational performance, of the aspects and Degree 3 (moderate help) performs between
results of the intervention, the subject was 50% and 74% of the respective activity, being results of the intervention, the subject was 50% and 74% of the respective activity, being
interviewed about the daily activities of self-help, moderately dependent on another person; interviewed about the daily activities of self-help, moderately dependent on another person;
of work and during their spare time. The subject of work and during their spare time. The subject
was asked to identify the daily activities which he was asked to identify the daily activities which he

Medicina Sportiva Medicina Sportiva

 The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient
Mirela Dan & all Mirela Dan & all

1893 1893

Degree 4 (minimum help) performs more than Results and Discussion Degree 4 (minimum help) performs more than Results and Discussion
75% of the respective activity, needing only a The recorded results after evaluation according to 75% of the respective activity, needing only a The recorded results after evaluation according to
minimal and occasional contact from another The Canadian Occupational Performance Measure minimal and occasional contact from another The Canadian Occupational Performance Measure
person; (COPM) reflect the fact that with regard to person; (COPM) reflect the fact that with regard to
Degree 5 needs only monitoring, verbal occupational performance, the subjects of the Degree 5 needs only monitoring, verbal occupational performance, the subjects of the
impulse, indications or the preparation of the experimental lot made, at the end of the study, an impulse, indications or the preparation of the experimental lot made, at the end of the study, an
ambient for the performance of activity, by that average progress of 0,8 points, starting from a ambient for the performance of activity, by that average progress of 0,8 points, starting from a
the patient having a modified dependence; (the initial value of 2,22 points and reaching at the the patient having a modified dependence; (the initial value of 2,22 points and reaching at the
examiner is always prepared to intervene); final evaluation an average of 3,02 points. examiner is always prepared to intervene); final evaluation an average of 3,02 points.
Degree 6 (modified independence) requires The satisfaction felt by the subjects of the Degree 6 (modified independence) requires The satisfaction felt by the subjects of the
support devices or specialized equipment experimental lot in performing activities support devices or specialized equipment experimental lot in performing activities
(modified instruments, orthosis, prostheses), considered problematic recorded, between the two (modified instruments, orthosis, prostheses), considered problematic recorded, between the two
activity is performed independently but in a evaluations, an average increase of 1 point, from activity is performed independently but in a evaluations, an average increase of 1 point, from
longer than reasonable time or the activity an initial average of 3,08 points to a final average longer than reasonable time or the activity an initial average of 3,08 points to a final average
presents risks of injury; of 4,08 points, which denotes a favorable presents risks of injury; of 4,08 points, which denotes a favorable
Degree 7 (independent) - activity is usually modification in the sense of increased satisfaction Degree 7 (independent) - activity is usually modification in the sense of increased satisfaction
performed safely, without modifications, devices in performing the activities. performed safely, without modifications, devices in performing the activities.
or support devices and in a reasonable interval of or support devices and in a reasonable interval of
time. time.

Table III. The recorded results according to the Canadian Occupational Performance Measure (COPM) Table III. The recorded results according to the Canadian Occupational Performance Measure (COPM)
with the experimental lot with the experimental lot
Experimental Lot P.E. L.C. L.M. B.C. F.P. Average Experimental Lot P.E. L.C. L.M. B.C. F.P. Average
Initially 2 2,4 2,2 2,3 2,2 2,22 Initially 2 2,4 2,2 2,3 2,2 2,22
C Performance C Performance
Finally 2,6 3,2 3 3,3 3 3,02 Finally 2,6 3,2 3 3,3 3 3,02
O O
P Difference 0,6 0,8 0,8 1 0,8 0,8 P Difference 0,6 0,8 0,8 1 0,8 0,8
M Initially 2,8 3,2 3,4 3 3 3,08 M Initially 2,8 3,2 3,4 3 3 3,08
Satisfaction Satisfaction
Finally 3,6 4,2 4,4 4,2 4 4,08 Finally 3,6 4,2 4,4 4,2 4 4,08
Difference 0,8 1 1 1,2 1 1 Difference 0,8 1 1 1,2 1 1

Initially Initially
Finally Finally
Difference Difference

Performance Satisfaction Performance Satisfaction

Figure 1. Recorded results according to the Canadian Occupational Performance Measure (COPM) Figure 1. Recorded results according to the Canadian Occupational Performance Measure (COPM)
by the subjects of the experimental lot by the subjects of the experimental lot

Medicina Sportiva Medicina Sportiva

 The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient
Mirela Dan & all Mirela Dan & all

1894 1894

By analyzing the problems of occupational With regard to the satisfaction felt by the subjects By analyzing the problems of occupational With regard to the satisfaction felt by the subjects
performance it stands out that the subjects of the of the witness lot about performing the activities performance it stands out that the subjects of the of the witness lot about performing the activities
witness lot started from an initial value of the considered problematic, they recorded, between witness lot started from an initial value of the considered problematic, they recorded, between
average performance of 2,22 points and reached, the two evaluations, an average increase of 0,6 average performance of 2,22 points and reached, the two evaluations, an average increase of 0,6
at the final evaluation, an average of 2,82 points, points, from an initial average of 3 points to a at the final evaluation, an average of 2,82 points, points, from an initial average of 3 points to a
that is an increase of 0,6 points after intervention final average of 3,6 points. that is an increase of 0,6 points after intervention final average of 3,6 points.
by physiotherapy and occupational therapy. by physiotherapy and occupational therapy.

Table IV. Recorded results according to the Canadian Occupational Performance Measure (COPM) Table IV. Recorded results according to the Canadian Occupational Performance Measure (COPM)
with the witness lot with the witness lot
Witness Lot D.M. C.S. D.B. T.B. M.A. Average Witness Lot D.M. C.S. D.B. T.B. M.A. Average
Initially 2 2,2 2,4 2,3 2,2 2,22 Initially 2 2,2 2,4 2,3 2,2 2,22
C Performance C Performance
Finally 2,5 3 3 3 2,8 2,82 Finally 2,5 3 3 3 2,8 2,82
O O
P Difference 0,5 0,8 0,6 0,7 0,6 0,6 P Difference 0,5 0,8 0,6 0,7 0,6 0,6
M M
Initially 2,8 3 3,2 3 3 3 Initially 2,8 3 3,2 3 3 3
Satisfaction Satisfaction
Finally 3,4 3,6 3,8 3,8 3,6 3,6 Finally 3,4 3,6 3,8 3,8 3,6 3,6
Difference 0,6 0,6 0,6 0,8 0,6 0,6 Difference 0,6 0,6 0,6 0,8 0,6 0,6

Difference Difference
0.6 Finally 0.6 Finally
0.6 Initially
0.6 Initially

2.82 3.6 2.82 3.6

2.22 3 2.22 3

Performance Satisfaction Performance Satisfaction

Figure 2. Recorded results according to the Canadian Occupational Performance Measure (COPM) by the subjects of Figure 2. Recorded results according to the Canadian Occupational Performance Measure (COPM) by the subjects of
the witness lot the witness lot

If we analyze comparatively the results obtained witness lot ; the same good evolution can also be If we analyze comparatively the results obtained witness lot ; the same good evolution can also be
by the subjects of both lots, after the evaluation of noticed with regard to satisfaction, with an by the subjects of both lots, after the evaluation of noticed with regard to satisfaction, with an
performance in daily activities (ADL) according average of 1 point, with the experimental lot, performance in daily activities (ADL) according average of 1 point, with the experimental lot,
to The Canadian Occupational Performance compared to an average of 0,6 points with the to The Canadian Occupational Performance compared to an average of 0,6 points with the
Measure (COPM), we notice a better evolution of witness lot, which denotes the fact that the Measure (COPM), we notice a better evolution of witness lot, which denotes the fact that the
the experimental lot, with an average of 0,8 improvement of the performance determines a the experimental lot, with an average of 0,8 improvement of the performance determines a
points, with regard to performance, as compared more significant favorable modification of the points, with regard to performance, as compared more significant favorable modification of the
to an average of 0,6 points, obtained by the satisfaction in the performance of activities. to an average of 0,6 points, obtained by the satisfaction in the performance of activities.

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 The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient
Mirela Dan & all Mirela Dan & all

1895 1895

Performance Performance
Satisfaction Satisfaction

1 1

0,8 0,8
0,6 0,6 0,6 0,6

> t> > t>

Figure 3. Recorded results obtained according to the Canadian Occupational Performance Measure (COPM) Figure 3. Recorded results obtained according to the Canadian Occupational Performance Measure (COPM)
by both lots of subjects by both lots of subjects

We consider that the most important improvement on the functionality of the paraplegic patient, We consider that the most important improvement on the functionality of the paraplegic patient,
of the performance and satisfaction of the through the evaluation of the 18 functions of the of the performance and satisfaction of the through the evaluation of the 18 functions of the
identified problems was due to the intervention FIM scale, we can notice that at the initial identified problems was due to the intervention FIM scale, we can notice that at the initial
through occupational therapy, by providing evaluation the obtained score was of 90 points for through occupational therapy, by providing evaluation the obtained score was of 90 points for
instruments adapted for the achievement of the experimental lot, and 90,2 points for the instruments adapted for the achievement of the experimental lot, and 90,2 points for the
independence in performing problematic activities witness lot, from a maximum total of 126 points. independence in performing problematic activities witness lot, from a maximum total of 126 points.
identified by every subject (multifunctional At the end of the study, the experimental lot, as a identified by every subject (multifunctional At the end of the study, the experimental lot, as a
instrument rod with a handle for taking and consequence of applying kinetic treatment and of instrument rod with a handle for taking and consequence of applying kinetic treatment and of
putting clothes on the peg, on the hanger, for the intervention of the occupational therapy putting clothes on the peg, on the hanger, for the intervention of the occupational therapy
lifting objects/shoe from the floor, the possibility obtained an increase of the score to 108,6 points, lifting objects/shoe from the floor, the possibility obtained an increase of the score to 108,6 points,
to reach items of clothing in higher or deeper more important than in the case of the witness lot, to reach items of clothing in higher or deeper more important than in the case of the witness lot,
sections of the closet). who obtained at the final evaluation a score of 106 sections of the closet). who obtained at the final evaluation a score of 106
With regard to the impact of the medullary injury points. With regard to the impact of the medullary injury points.

Table V. The results obtained by the subjects of both lots according to the evaluation Table V. The results obtained by the subjects of both lots according to the evaluation
of the Functional Independence Measure (FIM) of the Functional Independence Measure (FIM)
Experimental Lot Crt. Witness Lot Experimental Lot Crt. Witness Lot
Subjects Initially Finally Difference Nr. Subjects Initially Finally Difference Subjects Initially Finally Difference Nr. Subjects Initially Finally Difference
P.E. 80 105 25 1 D.M. 98 110 12 P.E. 80 105 25 1 D.M. 98 110 12
L.C. 98 111 13 2 C.S. 87 107 20 L.C. 98 111 13 2 C.S. 87 107 20
L.M. 90 110 20 3 D.B. 86 100 14 L.M. 90 110 20 3 D.B. 86 100 14
B.C. 82 105 23 4 T.B. 90 105 15 B.C. 82 105 23 4 T.B. 90 105 15
F.P. 100 112 12 5 M.A. 90 108 18 F.P. 100 112 12 5 M.A. 90 108 18
Average 90 108,6 18,6 Average 90,2 106 15,8 Average 90 108,6 18,6 Average 90,2 106 15,8
FIM 5 6,03 1,03 Average/18 FIM 5,01 5,88 0,87 FIM 5 6,03 1,03 Average/18 FIM 5,01 5,88 0,87

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 The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient The role of occupational therapy within the complex functional rehabilitation program of the paraplegic patient
Mirela Dan & all Mirela Dan & all

1896 1896

Initially Initially
Finally Finally
Difference Difference

Experimental Lot Witness Lot Experimental Lot Witness Lot

Figure 4. The results obtained according to FIM by both lots of subjects Figure 4. The results obtained according to FIM by both lots of subjects

Conclusions Conclusions
In the case of the paraplegic persons the 2. Grundy D, Swin A, (2002). ABC of Spinal Cord In the case of the paraplegic persons the 2. Grundy D, Swin A, (2002). ABC of Spinal Cord
Injury, 4th edition, BMJ Publishing Group, London, Injury, 4th edition, BMJ Publishing Group, London,
occupational therapy has as a main objective their occupational therapy has as a main objective their
pp.53. pp.53.
full integration, integration on all plans: personal, 3. Dan M (2005). Introducere n terapia ocupaional, full integration, integration on all plans: personal, 3. Dan M (2005). Introducere n terapia ocupaional,
familial and socio-economic. A high degree of Editura Universitatii, Oradea, pp.7-8. familial and socio-economic. A high degree of Editura Universitatii, Oradea, pp.7-8.
independence, as close as possible to normal is 4. Kiss I (2007). Fiziokinetoterapia i recuperarea independence, as close as possible to normal is 4. Kiss I (2007). Fiziokinetoterapia i recuperarea
possible to reach especially for the paraplegic medical, Editura Medicala, Bucureti, pp.270. possible to reach especially for the paraplegic medical, Editura Medicala, Bucureti, pp.270.
with a low injury, but only after he accepted the 5. Coppard BM, Lohman H (1996). Introduction to with a low injury, but only after he accepted the 5. Coppard BM, Lohman H (1996). Introduction to
situation and took the decision to use all his Splinting: A Clinical Reasoning and Problem-Solving situation and took the decision to use all his Splinting: A Clinical Reasoning and Problem-Solving
resources for that purpose. Approach, C.V. Mosby, St. Louis, pp.3. resources for that purpose. Approach, C.V. Mosby, St. Louis, pp.3.
By combining programs of physiotherapy with the 6. Williams PL, Early BM, (2001). Occupational By combining programs of physiotherapy with the 6. Williams PL, Early BM, (2001). Occupational
individualized ones of occupational therapy we therapy Practice Skills for Physical Dysfunction, 5th individualized ones of occupational therapy we therapy Practice Skills for Physical Dysfunction, 5th
edition, Mosby, Elsevier Health Sciences Company, edition, Mosby, Elsevier Health Sciences Company,
can emphasize the progress of rehabilitation, by can emphasize the progress of rehabilitation, by
Maryland Heights, pp.767 Maryland Heights, pp.767
improving the functional level of the paraplegic, 7. Guttmann L (2003). Spinal Cord Injury Review, improving the functional level of the paraplegic, 7. Guttmann L (2003). Spinal Cord Injury Review,
of the degree of functional independence and Pioneer in 20th Century Management of Spinal Cord of the degree of functional independence and Pioneer in 20th Century Management of Spinal Cord
implicitly of the quality of his life. Injury, FA Davis Company, Philadelphia, pp.112. implicitly of the quality of his life. Injury, FA Davis Company, Philadelphia, pp.112.
The increase of the level of independence and a 8. http://www.caot.ca/copm/index.htm (accessed The increase of the level of independence and a 8. http://www.caot.ca/copm/index.htm (accessed
total social integration of the persons with motor December, 2010). total social integration of the persons with motor December, 2010).
disabilities still remain some desiderata. 9. Fawcett AL (2007). Principles of assessment and disabilities still remain some desiderata. 9. Fawcett AL (2007). Principles of assessment and
Unfortunately, in the absence of a completely outcome measurement for occupational therapists and Unfortunately, in the absence of a completely outcome measurement for occupational therapists and
accessible physical environment and of the physiotherapists - Theory, skills and application, John accessible physical environment and of the physiotherapists - Theory, skills and application, John
efficient implementation of legislation adopted by Wiley & Sons Ltd, West Sussex, pp.56 efficient implementation of legislation adopted by Wiley & Sons Ltd, West Sussex, pp.56
10.Wright, J (2000). The FIM (TM): The Center for 10.Wright, J (2000). The FIM (TM): The Center for
the Romanian state, and also of the non- the Romanian state, and also of the non-
Outcome Measurement in Brain Injury, Outcome Measurement in Brain Injury,
involvement of the civil society in supporting the http://www.tbims.org/combi/FIM (accessed December, involvement of the civil society in supporting the http://www.tbims.org/combi/FIM (accessed December,
causes of the persons with physical disabilities, 2010) causes of the persons with physical disabilities, 2010)
there may appear the failure of social integration 11. Herndon RM (2006). Handbook of neurologic there may appear the failure of social integration 11. Herndon RM (2006). Handbook of neurologic
which attracts after it the emergence, in such rating scales, 2nd edition, Demos Medical Publishing, which attracts after it the emergence, in such rating scales, 2nd edition, Demos Medical Publishing,
persons, of the feelings of uselessness, frustration, New York, pp.279 persons, of the feelings of uselessness, frustration, New York, pp.279
powerlessness, marginalization. powerlessness, marginalization.
Coressponding author Coressponding author
References Mirela Dan References Mirela Dan
1. Burlu, M, Hin, S, Vidican, L, Dune, AM, (2008). Universitatea de Vest Vasile Goldi din Arad 1. Burlu, M, Hin, S, Vidican, L, Dune, AM, (2008). Universitatea de Vest Vasile Goldi din Arad
Persoana cu disAbilitate din perspectiva Terapiei E-mail: [email protected], [email protected] Persoana cu disAbilitate din perspectiva Terapiei E-mail: [email protected], [email protected]
Ocupaionale, Conferina Furnizorilor de Servicii Ocupaionale, Conferina Furnizorilor de Servicii
pentru Persoanele cu Disabiliti, Oradea, pp.22 Received: 25 April, 2011 pentru Persoanele cu Disabiliti, Oradea, pp.22 Received: 25 April, 2011
Accepted: 30 July, 2012 Accepted: 30 July, 2012

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