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At least 181 records · Page 10Linked to original sources
PubMed2006

Sensorimotor training in a virtual reality environment: does it improve functional recovery poststroke?

OBJECTIVE: To investigate the effectiveness of computerized virtual reality (VR) training of the hemiparetic hand of patients poststroke using a system that provides repetitive motor reeducation and skill reacquisition. METHODS: Eight subjects in the chronic phase poststroke participated in a 3-week program using their hemiparetic hand in a series of interactive computer games for 13 days of training, weekend breaks, and pretests and posttests. Each subject trained for about 2 to 2.5 h per day. Outcome measures consisted of changes in the computerized measures of thumb and finger range of motion, thumb and finger velocity, fractionation (the ability to move fingers independently), thumb and finger strength, the Jebsen Test of Hand Function, and a Kinematic reach to grasp test. RESULTS: Subjects as a group improved in fractionation of the fingers, thumb and finger range of motion, and thumb and finger speed, retaining those gains at the 1-week retention test. Transfer of these improvements was demonstrated through changes in the Jebsen Test of Hand Function and a decrease after the therapy in the overall time from hand peak velocity to the moment when an object was lifted from the table. CONCLUSIONS: It is difficult in current service delivery models to provide the intensity of practice that appears to be needed to effect neural reorganization and functional changes poststroke. Computerized exercise systems may be a way to maximize both the patients' and the clinicians' time. The data in this study add support to the proposal to explore novel technologies for incorporation into current practice.

Aged↗
PubMed2005

General practice and the New Zealand health reforms--lessons for Australia?

New Zealand's health sector has undergone three significant restructures within 10 years. The most recent has involved a Primary Health Care Strategy, launched in 2001. Primary Health Organisations (PHOs), administered by 21 District Health Boards, are the local structures for implementing the Primary Health Care Strategy. Ninety-three percent of the New Zealand population is now enrolled within 79 PHOs, which pose a challenge to the well-established Independent Practitioner Associations (IPAs). Although there was initial widespread support for the philosophy underlying the Primary Health Care Strategy, there are concerns amongst general practitioners (GPs) and their professional organisations relating to its implementation. These centre around 6 main issues: 1. Loss of autonomy, 2. Inadequate management funding and support, 3. Inconsistency and variations in contracting processes, 4. Lack of publicity and advice around enrollment issues, 5. Workforce and workload issues, 6. Financial risks. On the other hand, many GPs are feeling positive regarding the opportunities for PHOs, particularly for being involved in the provision of a wider range of community health services. Australia has much to learn from New Zealand's latest health sector and primary health care reforms. The key lessons concern: The need for a national primary health care strategy, active engagement of general practitioners and their professional organisations, recognition of implementation costs, the need for infrastructural support, including information technology and quality systems, robust management and governance arrangements, issues related to critical mass and population/distance trade offs in service delivery models.

Journal Article↗
PubMed2003

An educational rationale for deaf students with multiple disabilities.

Deaf students with with multiple disabilities have a long history of limited opportunity, including limited access to educational opportunities available to their deaf peers. This article places the individual needs of deaf students with multiple disabilities in the context that guides much of deaf education--the importance of language acquisition. That emphasis provides a basis for placement and curriculum options for deaf students with multiple disabilities. The authors review the evolution of placement options, describe assumptions that should guide placement and curriculum decisions, and recommend practices for optimizing these students' education. Descriptions of three service delivery models--multidisciplinary, interdisciplinary, and transdisciplinary--are provided, as well as an overview of the effectiveness of person-centered planning for deaf students with multiple disabilities. Disability-specific resources are highlighted that relate to mental retardation, autism, visual impairments, learning disabilities, attention deficit hyperactivity disorder, emotional disorders, medical issues, and general resources.

Deafness↗
PubMed2005

Professional concerns of beginning teachers of deaf and hard of hearing students.

The professional concerns of beginning teachers of students who are deaf or hard of hearing were examined. Five first-year teachers of deaf and hard of hearing students served as participants. Two of the participants were itinerant teachers; three taught in self-contained classrooms. Participants were selected from programs serving deaf and hard of hearing students in rural and urban areas of the midwestern and southwestern United States. To interview the study participants, the researcher used an in-depth phenomenological method employing semi-structured questions and guided by a constructivist paradigm. Data were analyzed using qualitative analysis strategies (Bogdan & Biklen, 1992; Miles & Huberman, 1994). Results showed that concerns of beginning teachers of deaf and hard of hearing students are specific to service delivery models and geography. Participants provided specific recommendations for addressing the concerns of beginning teachers of deaf and hard of hearing students.

Adolescent↗
PubMed1994

Itinerant teachers. Responsibilities, perceptions, preparation, and students served.

Increased numbers of deaf and hard of hearing students live at home, attend their neighborhood schools, and receive major portions of their educations from general education teachers with support from itinerant teachers of deaf and hard of hearing students. Although the itinerant service-delivery model is used extensively, there is a paucity both of information about itinerant teaching and of research that has examined its effectiveness. The purpose of this study was to begin a database of information about the job responsibilities, perceptions, and preparation of itinerant teachers, as well as about the characteristics of the students they serve. Data from surveys returned by 319 itinerant teachers was analyzed. The responses indicate that itinerant teaching differs in numerous ways from more-traditional approaches to educating deaf and hard of hearing students. Results, implications, concerns, and suggestions for future research are discussed.

Adult↗
PubMed1999

An examination of two coteaching classrooms.

The present study presents data on two classrooms that used a coteaching approach to provide services to students who were deaf, hard of hearing, and hearing. The author conducted extensive observations, as well as interviews with teachers, students, administrators, and parents. The resulting qualitative data supported coteaching's effectiveness as a service delivery model. However, the research also identified important and specific challenges. Seven subthemes about coteaching are presented, and quotes from various stakeholders are provided to support and illustrate the information reported. Suggestions for future research are provided. The author makes recommendations on how to establish coteaching teams and describes issues surrounding communication, staff development, and family involvement.

Child↗
PubMed1989

Overview of supported employment.

This article traces the emergence of supported employment as a result of philosophical changes in expectations for persons with disabilities, based on scientific developments that challenged traditional service-delivery models. Supported employment program characteristics also are reviewed, and the influence of applied behavior analysis is outlined. Finally, areas for future research in supported employment are discussed.

Employment↗
PubMed1996

Perceptions and experiences of occupational therapists in rural schools.

Occupational therapy practice in rural schools is influenced by a number of factors unique to rural settings, such as geographic barriers, cultural diversity, limited access to external resources, and lack of personnel with specialist skills. The purpose of this ethnographic study was to identify the unique experiences of occupational therapists who practice in rural schools and to explore how they perceived their roles in rural schools. Six occupational therapists were interviewed and observed in the field. Analysis of interview data revealed five themes: (a) jack-of-all-trades, which described how the participants viewed themselves as generalists; (b) bridging the span between services, which described their roles in coordinating the students' medical services, which tended to be disjointed; (c) the world can get kind of lonely out there, which described the sources of support seen as reducing their sense of isolation; (d) trust and teaming, which described their attempts to provide an integrated intervention service and the challenges they faced; and (e) I cannot do it all, but I wish I could, which described how they selected their service delivery models to meet the demands of their practice. The participants believed that their work in rural schools required creativity, resourcefulness, and self-reliance. These characteristics, as well as support from their colleagues, were important to coping with the challenges of practice in rural schools.

Data Collection↗
PubMedDate not supplied

Outcomes associated with a summer handwriting course for elementary students.

OBJECTIVE: The purpose of this study was to examine the benefits of a summer handwriting instruction course offered to community elementary-age students. METHODS: Twenty-six students participated in the study and attended instruction for 1 hour per day for 2 weeks. Pre- and posttesting with the Evaluation Tool of Children's Handwriting (ETCH) were conducted. Parents were also asked to rate their child's handwriting at pretest, posttest, and 3 months posttest. RESULTS: Participants made significant improvement in two subtests of the ETCH and in parent ratings between pretest and posttest. Parent ratings remained significantly improved 3 months posttesting. Additional results suggest that children who received special education during the previous school year improved their handwriting scores on the ETCH to a greater degree than those who did not receive special education. CONCLUSION: A new service delivery model for handwriting instruction has the potential to benefit students. Occupational therapists should consider offering handwriting training to students in the summer especially if deterioration of performance is anticipated.

Child↗
PubMed2001

Palliative care by family physicians in the 1990s. Resilience amid reform.

OBJECTIVE: To explore issues family physicians face in providing community-based palliative care to their patients in the context of a changing health care system. DESIGN: Focus groups. SETTING: Small (< 10,000 population), medium-sized (10,000 to 50,000), and large (> 50,000) communities in Nova Scotia. PARTICIPANTS: Twenty-five men and women physicians with varying years of practice experience in both solo and group practices. METHOD: A semistructured approach was used, asking physicians to reflect on recent palliative care experiences in order to explore issues of care. MAIN FINDINGS: Five themes emerged from the discussions: resources needed, availability of family support, time and money supporting physicians' activities, symptom control for patients, and physicians' emotional reactions to caring for dying patients. CONCLUSION: With downsizing of hospitals and greater emphasis on community-based care, the issues identified in this study will need attention, particularly in designing an integrated service delivery model for palliative care.

Adult↗
PubMed1999

Enhancing parental power and flexibility in the transition from welfare to work.

Recent welfare reforms in the United States shifted the emphasis from income maintenance to preparation for employment. Many families receiving welfare benefits have members with disabilities, which can complicate the process of transition into the workforce. Rehabilitation professionals have a unique set of skills, expertise and experiences which could enhance work transition outcomes for welfare recipients. This purpose of this article is to (a) familiarize rehabilitation professionals with welfare reform changes in the United States, (b) summarize the experiences of families affected by those changes who participated in a recent study, and (c) present a service delivery model to enhance parental power and flexibility based on rehabilitation principles.

Journal Article↗
PubMed1992

Guidelines for meeting the communication needs of persons with severe disabilities. National Joint Committee for the Communicative Needs of Persons with Severe Disabilities.

In summary, the current best practices in the facilitation and enhancement of communication among persons with severe disabilities reflect six major tenets: (a) communication is social behavior; (b) effective communicative acts can be produced in a variety of modes; (c) appropriate communicative functions are those that are useful in enabling individuals with disabilities to participate productively in interactions with other people; (d) effective intervention must also include efforts to modify the physical and social elements of environments in ways that ensure that these environments will invite, accept, and respond to the communicative acts of persons with severe disabilities; (e) effective intervention must fully utilize the naturally occurring interactive contexts (e.g., educational, living, leisure, and work) that are experienced by persons with severe disabilities; and (f) service delivery must involve family members or guardians and professional and paraprofessional personnel. These six tenets have resulted in assessment, intervention, and service delivery models that offer maximum responsiveness to the need to establish communicative repertoires that will allow persons with severe disabilities to function effectively in least restrictive environments--in productive interactions with others.

American Speech-Language-Hearing Association↗
PubMed1994

Effects of a school for pregnant students on the incidence of low-birthweight deliveries.

To evaluate effects of an alternative public school for pregnant teenagers in New Haven, CT, medical and school records were reviewed for a 1-year birth cohort of 230 adolescent mothers. Nearly three-quarters of all school-aged primiparas who were enrolled in the city's public schools when they became pregnant attended the alternative school. Because of summer vacation, however, students who conceived in January through April began attending later in pregnancy than did those who conceived in May through December; these mothers were significantly more likely to deliver a preterm, low-birthweight infant. No such seasonal effects were found for other teenagers in the city who were not enrolled in public school at conception. Positive birth outcomes for early program attenders are similar to those reported for a nurse-home-visitation program. The results suggest that school programs have considerable potential to be an effective service delivery model for providing prenatal intervention to adolescents.

Adolescent↗
PubMed1996

Communication intervention in an adolescent with profound cognitive impairment and autistic features.

The service delivery model currently used with a large proportion of profoundly cognitively impaired (PCI) persons, results in the under-utilization of their potential and often contributes to social isolation. By providing communication and independence training the self-actualisation potential and the right to power and control, is recognised. This single case study describes the implementation of a communication intervention model with a PCI adolescent. His mother was trained in the use of picture symbol task analysis as well as positive reinforcement to promote change in the adolescent's communication skills and independence. Results indicated significant changes in the skills of both participants and highlighted the mother's need for support to meet the demands of change.

Activities of Daily Living↗
PubMed2004

Targeting community-dwelling urinary incontinence sufferers: a multi-disciplinary community based model for conservative continence services.

This paper presents an argument that there is a need to provide services that target community-dwelling incontinence sufferers, and presents a demonstration case study of a multi-disciplinary, community-based conservative model of service delivery: The Waterworx Model. Rationale for approaches taken, implementation of the model, evaluation and lessons learned are discussed. In this paper community-dwelling sufferers of urinary incontinence are identified as an underserved group, and useful information is provided for those wishing to establish services for them. The Waterworx Model of continence service delivery incorporates three interrelated approaches. Firstly, client access is achieved by using community-based services via clinic and home visits, creating referral pathways and active promotion of services. Secondly, multi-disciplinary client care is provided by targeting a specific client group, multi-disciplinary assessment, promoting client self-management and developing client knowledge and health literacy. Finally, interdisciplinary collaboration and linkages is facilitated by developing multidisciplinary assessment tools, using interdisciplinary referrals, staff development, multi-disciplinary management and providing professional education. Implementation of the model achieved greater client access, improvement in urinary incontinence and client satisfaction. Our experiences suggest that those suffering urinary incontinence and living in the community are an underserved group and that continence services should be community focussed, multi-disciplinary, generalist in nature.

Adult↗
PubMed2002

Geographic delivery models for radiotherapy services.

The study described here was undertaken to quantify the societal cost of radiotherapy in idealized urban and rural populations and, hence, to generate a measure of impediment to access. The costs of centralized, distributed comprehensive and satellite radiotherapy delivery formats were examined by decomposing them into institutional, productivity and geographical components. Our results indicate that centralized radiotherapy imposes the greatest financial burden on the patient population in both urban and rural scenarios. The financial burden faced by patients who must travel for radiotherapy can be interpreted as one component of the overall impediment to access. With advances in remote-monitoring systems, it is possible to maintain technical quality while enhancing patient access. However, the maintenance of professional competence will remain a challenge with a distributed service-delivery format.

Catchment Area, Health↗
PubMed2004

The Ontario Cardiac Rehabilitation Pilot Project: Recommendations for health planning and policy.

BACKGROUND: Expansion of cardiac rehabilitation (CR) could save both lives and costs by reducing illness and use of health care services. In February 2001, the Ontario Ministry of Health and Long-Term Care (the Ministry) announced a pilot project (the Pilot) to implement and evaluate a comprehensive, multifactoral model of CR service delivery at 17 centres across Ontario. OBJECTIVES: To design, coordinate and evaluate a coordinated model of CR service delivery, and to collect and evaluate an extensive set of clinical and administrative data. METHODS AND RESULTS: The Pilot was a large, province-wide observational investigation of a health service delivery model for CR and secondary prevention care. The present paper is the third in a three-part, policy-related series. In the present paper, the results of the evaluation of the service delivery model and the final health policy recommendations that were made to the Ministry in September 2002 are presented. CONCLUSIONS: Within approximately one year, 4922 patients were enrolled in the Pilot at participating sites throughout Ontario; 88% of sites implemented all elements of the comprehensive services model, either on-site or through internal/external partnerships, and 94% of sites implemented the multidisciplinary Pilot staffing model. Based on this rapid and near-total implementation of the Pilot model, it was concluded that the Pilot model of care was generalizable. Furthermore, regional coordination was achieved through operationalization of the coordinating centres' roles in quality management, regional planning and program development, education and outreach.

Cardiac Rehabilitation↗