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当前位置：国际临床研究杂志 > 2025年 9卷 (6)期

Open Access Article

International Journal of Clinical Research. 2025; 9: (6) ; 1-8 ; DOI: 10.12208/j.ijcr.20250272.

A new perspective -The Kawa Model in occupational therapy and its application in the long-term care facilities of elderly with sight and memory loss
作业治疗的新视角——河川模式（Kawa Model）视力和记忆力减退患者小区长期照护机构中的应用

作者： 赵达燊¹ *, 叶智斌² *, 黄家强³, 叶志刚², 鄭楚雯⁴, 周祈臻⁴, 施永昌¹, 张丽明¹, 郭志谦², 岩間建工⁵

1 中国香港盲人辅导会院舍服务香港

2 中国香港东华学院医疗及健康科学学院（作业治疗）香港

3 中国香港理工大学康复治疗科学系香港

4 中国香港注册职业治疗师香港

5 美国杜克大学医学院美国

*通讯作者：赵达燊,单位：中国香港盲人辅导会院舍服务香港；叶智斌,单位：中国香港东华学院医疗及健康科学学院（作业治疗）香港；

发布时间: 2025-06-25 总浏览量: 74

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摘要

中国香港正面临人口老龄化的挑战，对住宅服务的需求也不断增长。本文旨在介绍河川模式（Kawa Model）及其在老年视力及记忆力缺失患者作业治疗中的应用。河川模式（Iwama, 2006）由日本作业治疗师开发，以"河流"隐喻人生流程。不是使用被认为是以自我为中心或主流使用的西方医学模式，而契合中国传统文化对和谐的重视，这一特性使其对香港长者群体尤为适用。河川模式可以作为实践的概念模型、参考框架、评估工具和模式，旨在帮助治疗师和视力和记忆力缺失的老年人以更具文化相关性的方式看待他们的问题和生活。案例研究“生活在黑暗中”（一位90岁视力及记忆力缺失的焦虑长者）中，治疗师协作长者绘制"生命河流"识别障碍（如未解决创伤、睡眠困扰）与优势（如信仰、社交参与）。在治疗过程中，行动干预整合了适应性策略、职能重建（如烹饪小组）及文化元素（禅宗思想、成语"海纳百川"［图1］）。协作长者重新连接到职业和归属，积极和消极的意义归因于他们的职业，提升职能平衡与自我效能，减轻焦虑。透过生命河流的横切面，进一步探讨自我、生命流动与“当下”、“时刻”意义和关系。中国传统文化心态对社会和复康有着深刻的影响，尤其是在作业治疗中。河川模式是一种符合文化背景的临床实践模式，对生命之河的隐喻和象征意义易于老年视力缺失患者理解。融合中国哲学中的一些元素，如“禅”和“成语”的融合，这一新的视角为香港长期照护机构提供文化适配的作业治疗框架，通过和谐协作强化治疗关系。

关键词： 作业治疗；老年人；视力缺失；河川模式；理论

Abstract

The Hong Kong Special Administration Region(HKSAR) of China’s rapidly aging population, particularly those with sight and memory loss in long-term care facilities, faces significant occupational dysfunction and psychosocial challenges. This article explores the application of the Kawa Model, a culturally responsive occupational therapy framework originating from Japan, which employs the metaphor of a river to conceptualize life flow, obstacles, and environmental influences. Emphasizing harmony and collective cultural values, the model aligns with traditional Chinese philosophies, making it particularly relevant for elderly clients in Hong Kong. A case study of a 90-year-old woman with visual impairment and anxiety ("Living in the Darkness") demonstrates the model’s utility. Through collaborative narrative exploration, her "life river" was mapped, identifying obstacles (e.g., unresolved trauma, sleep disturbances) and strengths (e.g., faith, social engagement). Interventions integrated adaptive coping strategies, occupational re-engagement (e.g., cooking groups), and cultural elements such as Zen principles and Chinese idioms (e.g., "海纳百川" [Figure 1]— inclusivity). Outcomes highlighted enhanced occupational balance, self-efficacy, and reduced anxiety, underscoring client empowerment through culturally resonant metaphors. The discussion posits that the Kawa Model’s flexibility and emphasis on client-therapist collaboration foster therapeutic relationships while bridging Western clinical practices with Eastern cultural values. By incorporating Chinese philosophical concepts, the model offers a holistic, person-centered approach to address the complex needs of elderly individuals with sensory and cognitive impairments. This study advocates for culturally adapted models in occupational therapy to improve well-being in aging populations within multicultural contexts.

Key words： Occupational therapy; Older adult; Visual impairment; Kawa Model; Ethical practice

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引用本文

赵达燊, 叶智斌, 黄家强, 叶志刚, 鄭楚雯, 周祈臻, 施永昌, 张丽明, 郭志谦, 岩間建工, 作业治疗的新视角——河川模式（Kawa Model）视力和记忆力减退患者小区长期照护机构中的应用[J]. 国际临床研究杂志, 2025; 9: (6) : 1-8.

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