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Introduction
Historically speaking, medicine
and practice of medicine has developed with art and religion. One of the
supreme physicians has been Sir William Osler, who was an eminent physician in
Canada. He became one of the big four great doctors at Johns Hopkins Hospital.
He emphasized the importance of bed side teaching and wrote down 2 famous
textbooks including “the principles and practice of medicine” and
“Aequanimitas”. His famous comment included “medicine is an art based on
science”. From the perspective of a variety of art in medicine, there have been
some changes in art in hospitals, practice of medicine and medical educations
in many facilities. The interactive appreciation can make force of the
sensibility of patients and medical staffs. Consequently, the ability to feel
and find various matters may be developed in such circumstances [1-5].
Recently, art therapy has been in
focus in the medical field. It can give positive influence to many patients not
only physically but also psychologically. Authors and collaborators have
continued the activity of art in hospitals for various opportunities. We have
already completed comfortable feeling artworks on the walls of corridors and
stairs at Tokushima University Hospital, in Japan. Furthermore, we have
performed four seasons’ artworks in Komatsushima Hospital, Komatsushima city,
Tokushima, including cherry blossom, flower, leaves, snowman and others. When
drawing these artworks, we use not oil or water color paints but masking tape.
It has become more widely used in recent years and is used for various purposes
such as decoration, wrapping, and crafts. As part of our activities, we have
already developed workshops for art in hospitals with masking tape. Among them,
we observed that elderly people with less power can handle masking tape easily,
associated with concentrating and working with interest [6-9].
The authors have long been
involved in the treatment and care of the elderly medical and welfare
facilities. Consequently, we presumed that masking tape could be used for
outpatient rehabilitation to improve finger dexterity and attention. In this
article, our trial for group rehabilitation using masking tape at day care
center will be reported.
Methods
The subjects are 12 elderly
patients who are regularly coming to our day care center for various
rehabilitation several times a week. Their background included male 3 and
female 9, with the age of 78-100 years old. According to the standard guideline
by the Ministry of Health and Welfare, Japan, their physical and psychological
care level was evaluated from 2 degree to 4 degree for requiring support for
daily life. Regarding the level of cognition, the rating of Mini-Mental State
Examination (MMSE) was from 15 to 23 points, which means mild and moderate
dementia [10].
Among them, target subjects were
selected who could use both hands freely and could tear off the masking tape in
the usual day service activities for aged people. The methods included were the
active use of various types of masking tapes, where the authors have continued
practice and research so far. The masking tapes are from Kamoi Company, Japan.
Masking tape has been known as Washi Tape (wa=Japanese and shi=paper), which is
adhesive tape easily to stick and peel off for decorative work [9].
The activity of masking tape
group was conducted for rehabilitation in day care center. The detail and order
content are shown in the following.
·
Elderly people usually visit the
facility 2-3 times a week. Among them, a small group of 3-5 people was formed,
and the training was conducted from November 1st to November 30th, about 30
minutes a day, 2-3 times a week.
·
As for the specific content of
the work, there was a rough sketch on a paper with an appropriate difficulty
level. The subjects were explained to tear up the roll of masking tape by both
hand and paste them onto the backing paper.
·
The subjects chose the masking
tapes of their favorite color and pattern from the masking tapes lined up on
the desk and finished the work within a month.
·
During the activity, there was an
important rule. When cutting the masking tape, they did not use tools such as
scissors, but used their own hands and fingers to tear up the tape.
·
The rehabilitation staffs and
care staffs around them were not able to participate the work. Only when the
subject was unable to perform the work, staff can just advice by words.
·
Before and after the above work,
the subject's grip strength, pinch strength, MMSE, and Kana (Japanese alphabet)
finding test (language word test) were conducted and compared. Their periods
evaluated were later October and early December.
Statistical Analysis
In this study, obtained data was
analyzed by Wilcoxon signed rank sum test for the evaluation of significant
difference. The calculation and analyze methods were performed using the
computerized standard statistical tool [11].
Ethical
Considerations
This research was basically
conducted along the Declaration of Helsinki, which was revised at the WMA
Fortaleza General Assembly in 2013. Moreover, a comment was added along the
ethical guidelines for human-based medical research. It was notified in Japan
by the Ministry of Education, Culture, Sports, Science and Technology (MEXT)
and also Ministry of Health, Labour and Welfare (MHLW). The detail study was
fully explained to the related patients in advance. Authors have got the
written document agreements from all patients. This investigation was discussed
for the ethical committee. It included some kinds of professionals such as
director, physicians, head nurses, pharmacists, nutritionists, and a person of
legal specialty.
Results
Artworks
The subjects visiting the day
care center and participating this project were working on masking tape (Figure 1). At that time, all the
subjects were having fun, choosing masking tapes of all colors and patterns
according to their own ideas, and sticking them freely.
Figure 1:Actual scenes of masking art-work.
Biomarker
Changes
The results of some tests before
and after the intervention were shown in Table
1. They included grasping power (left and right), MMSE, kana (Japanese
alphabet) finding test (Language word test), vitality test, Barthel index,
pinch strength (left and right). The former 5 markers were shown before and
after the intervention, and the latter 3 markers were shown only previous data.
Among these, correlations between before and after the intervention were
analyzed. Regarding the grasping power (right), it showed the increasing
tendency due to the intervention. However, the correlation coefficient showed
p=0.11, which was not enough for significant difference. In MMSE and word test,
they showed a little increase of average data, which did not show significant
difference. As to the vitality test, there was significant difference with
p=0.02, where the distribution of the data was narrow. Except these two
biomarkers, they did not show significant difference between before and after
the intervention.
Clinical
Effect
Among several biomarkers examined before and after the intervention, the changes in grasping power (right) were drawn in Figure 2. Out of 12 cases, 9 cases showed the stable and increased values of grasping power. Some of them showed remarkable elevation of grasping power. Their values of before and after the intervention were from 13.5±7.7 kg to 14.8±6.8 kg, where it was not enough to reveal significant difference statistically (p=0.11, n=12).
Figure 2:The changes is grasping power in the right hand after making art-work
Table 1:General data of the subjects.
Discussion
In this study, we planned to make
a work using masking tape for elderly people, and measured grip strength and
pinch strength before and after the intervention and compared them. As a
result, there was a tendency for increased grasping power the right hand and
improvement in the MMSE and language word tests. Regarding the intervention
method in this study, the operation of masking tape involves several processes.
Choose the color and pattern of the tape, pick it up, tear it up using both
hands and fingers to the appropriate size and shape, and stick it to the paper.
This process needs adequate judgments, hand and finger movements and
concentration some subjects felt confused and frustrated to judge how to do it
at first, but they got used to it and enjoyed it afterwards. This work seems to
be useful and attractive for the cognitive elderly from medical point of view [12].
According to the results after
intervention, there was a tendency to improve muscle strength such as grasping
power. This was suggested to be from the movement and skill of the hands and
fingers such as turning, tearing, sticking, and peeling off the masking tape.
In particular, it was observed with right hand. On the other hand, there was a
case in which the grip and pinch strength did not improve. The reason would be
that the case could not understand the work, continue, or complete the
artworks. When the cases can perform the work with enough comprehension and
concentration in addition to hand movements, they have tendency to maintain and
improve MMSE score. These seem to involve comprehensive cognitive functions
such as the favorite color and pattern of the tape and the imagination of the
background of the painting. In this study, subjects with mild to moderate
dementia showed a tendency to improve finger dexterity and attention.
Rehabilitation may be hindered due to decreased attention in patients with
dementia. Appropriate ADL is related to preserved attention and judgment in
addition to physical fitness. Current masking tape artwork may be beneficial
for ADL training in the future [13-15].
Historically speaking, the
diagnostic criteria for dementia were changed along the perspectives of medical
practice. In the ICD-10 classification of mental and behavioral disorders
(1993), dementia was described as a syndrome due to disease of the brain,
usually of a chronic or progressive nature, and so on. After that, National
Institute on Aging-Alzheimer’s Association (NIA-AA) (2011) proposed several
impaired abilities to acquire or remember new information, executive function,
language functions, etc. Successively, DMS-5 (2013) provided a new concept of
the criteria. They introduced a new perspective, and replaced the term dementia
with major neurocognitive disorder. DSM-5 includes six cognitive domains,
including i) complex attention, ii) executive function, iii) learning and
memory, iv) language, v) perceptual-motor function, and vi) social cognition [16-18].
From six cognitive domains, the
results of the research would be considered. The artwork of masking tape can
lead satisfactory activation of the ability of instruction comprehension,
ability to maintain attention, working memory, and selective concentration. The
special aspect that we focused on was social cognition. By the active group
work, participants increased their conversations about masking tape color,
scheme, background, sticking method, and so on. Social exchanges and interrelationships
have begun associated with their artworks. Even if there are some mistakes of
sticking the masking tape, it can be repaired immediately. Such kind of working
behavior may lead to a satisfying and successful experience for the patients
with dementia. Concerning the brain function, this research includes the
following aspects: i) By taking advantages of masking tape, the complex
movements of hand and finger were conducted, which could stimulate the
interrelationship of learning and perception-motor function, ii) By
concentrating and working enthusiastically, the subjects had attended the
artwork workshop more times than expected, which could stimulate the executive
function and caution for complexity, iii) By continuing the learning the minute
artwork, they can use their hand and finger better, which could stimulate the
learning ability, memory and executive function [7,8, 19].
In this study, grasping power
(right) and MMSE showed a tendency to improve after the intervention, but there
was no significant difference. The main reason is considered to be that the
number of subjects is small (n=12). At present, the P value is p=0.11 for
grasping power, and p=0.18 for MMSE, and then it is expected that a significant
difference will be observed as the number of cases increases. The masking tape
artwork showed a tendency to improve in (i) physical aspect including finger
movements and (ii) psychiatry aspect including cognitive function. The former
(i) has complex actions of hand and finger such as flipping, pulling, tearing,
pasting, and peeling, and the latter (ii) has functions such as selecting,
thinking, deciding, executing, learning, and concentrating on colors and
patterns. Consequently, it is expected that the skill of movement and the improvement
of cognitive function would be expected and continued in the future [20].
Masking tape work has the
potential to improve cognitive function. The factors are related to the work
process. The following points can be considered: i) choose the color and
pattern of the tape, which involves complexity attention, executive and
perception-motor function, ii) continue group work while considering the
surrounding situation, which involves social cognition and language function,
iii) tear off and paste each tape with always thinking a better method, which
involves learning and memory, complexity attention, executive and
perception-motor function, iv) consider the size and shape of the tape so that
it fits inside the frame, which involves complexity attention, learning and
memory, executive and perception-motor.
As a matter of fact, the former
and the latter have already been reported to show relationship each other. A
correlation has been found between finger dexterity and cognitive function. As
a quantitative method, a magnetic sensing finger-tap device can be used. For
suggesting the onset of future neurodegenerative diseases, the application of
simple test of manuals dexterity would be useful. Consequently, the study of
manual dexterity may contribute to the evaluation of cognition at present and
the prediction of deterioration of cognitive function in the future. Regarding
this study, there are some limitations for the protocol of the investigation.
The backgrounds of the subjects are patients with cognitive elderly people who
are attending day service centers. The level of the cognition is heterogeneous.
Then, it seems to set another study with patients with similar level of
dementia in the future research. The number of the subjects was as small as 12
with wider range of ages. Consequently, current study is a pilot cohort study,
and future study will be with enough number with similar quality of the
subjects, the adoption of other markers, evaluation methods and comparison
methods [21-25].
In summary, this study suggested beneficial
positive effects of grasping power and cognitive situation by masking tape
artwork for elder patients with dementia. Furthermore, the artwork may
contribute various cognitive domains, especially social cognition.
Consequently, authors would continue and develop the research of masking tape
from physical and psychological points of view.
Acknowledgement
Authors would like to express our
gratitude for related all people concerning this research.
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*Corresponding author
Hiroshi Bando, Tokushima
University/Medical Research, Nakashowa 1-61, Tokushima 770-0943, Japan Tel:
+81-90-3187-2485, E-mail: pianomed@bronze.ocn.ne.jp
Citation
Nagahiro S, Tanaka K, Bando H, Bando
M, Nishizaki M, et al.
Masking tape art-work may provide beneficial positive effects (2021) Edel
J Biomed Res Rev 3: 5-8.
Keywords
Masking tape art, Washi tape, Art in hospitals, Dementia,
Grasping power, Elderly.
