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State Vocational Rehabilitation Services Program. Office of Special Education and Rehabilitative Services, Department of Education. Final regulations.

The Secretary amends the regulations governing the State Vocational Rehabilitation Services Program. These amendments implement changes to the Rehabilitation Act of 1973 made by the Rehabilitation Act Amendments of 1998 that were contained in Title IV of the Workforce Investment Act of 1998 (WIA), enacted on August 7, 1998, and as further amended in 1998 by technical amendments in the Reading Excellence Act and the Carl D. Perkins Vocational and Applied Technology Education Act Amendments of 1998 (hereinafter collectively referred to as the 1998 Amendments).

Persons with Disabilities↗

26th Kellersberger Memorial Lecture. Lessons from leprosy rehabilitation for general rehabilitation.

Leprosy is primarily a disease of skin and peripheral nerves. Because of nerve function impairment, leprosy patients may develop primary nerve related impairments such as, loss of sensation and weakness or paralysis. These primary impairments may lead to secondary impairments such as ulceration and contractures. Many other diseases and disorders present with similar impairments as seen in leprosy e.g. diabetes and peripheral nerve injuries. Nerve function assessment and ulcer prevention and treatment are areas that have been researched in leprosy but these research findings are not yet commonly known and adopted in diseases and disorders that 'relate' to leprosy. Rehabilitation is a relatively new field in medicine and not (well) developed in many developing countries. Rehabilitation requires an integrated approach from different disciplines and professionals. As for other medical specialty fields, rehabilitation demands evidence based practice.

Activities of Daily Living↗

Testing the Database of International Rehabilitation Research: using rehabilitation researchers to determine the usability of a bibliographic database.

OBJECTIVES: This study tested the usability of the Database of International Rehabilitation Research, a bibliographic database developed by the Center for International Rehabilitation Research Information and Exchange (CIRRIE). METHODS: Potential users, i.e., rehabilitation researchers, were asked to participate in a usability study. Test questions were designed to represent common tasks performed in a bibliographic database. Participants were asked to think aloud during the test so that both their actions and comments could be recorded. RESULTS: This study identified common problems that participants had while searching the database and aspects of the database that needed improvement. CONCLUSIONS: Usability testing proved to be an effective method for evaluating database effectiveness and user satisfaction. The method used provided valuable information about how the database searchers approached their searches as well as how they performed them.

Consumer Behavior↗

TRICARE Program; inclusion of anesthesiologist assistants as authorized providers; coverage of cardiac rehabilitation in freestanding cardiac rehabilitation facilities. Final rule.

This final rule establishes a new category of provider as an authorized TRICARE provider and it increases the settings where cardiac rehabilitation can be covered as a TRICARE benefit. It recognizes anesthesiologist assistants (AAs) as authorized providers under certain circumstances. It also authorizes cardiac rehabilitation services, which are already a covered TRICARE benefit when provided by hospitals, to be provided in freestanding cardiac rehabilitation facilities.

Accreditation↗

[Occupational rehabilitation of gynecologic tumor patients. Occupational rehabilitation].

After primary treatment due to genital and breast cancer we judged with a total of three hundred and sixty three (363) working women the reintegration into their former jobs. The rate of rehabilitation amounted to 37.2 per cent. The temporary prescription of sheltered jobs--i.e. of work which corresponds with the needs of rehabilitation--was for 56.1 per cent of the women, whereas 23 per cent of the women had to take up a job other that before. In the first place the after-care covers general and gynaecological examination aiming at uncovering recurrence and second tumours and the earliest possible phase, and in the second place special attention is given to the therapy of hormonal deficiency, post treatment effects and incidental cases. The results which the team of specialists from many fields had got from group as well as individual talks are the basis for a follow-up care, mainly done by the psychologists. As a result of this a classification into some possible intervention groups. Special attention has to be given to women where there has been a family history with oncological diseases. A thoroughly coordinated and well-balanced approach to the gynaecological tumour--after-care is indispensable, i.e. it has to integrate firmly the occupational rehabilitation and to bear in mind never to ask too much of the patient.

Adolescent↗

[Problems of occupational rehabilitation in the shipbuilding industry. II. Rehabilitation in a group of ship welders].

The causes of rehabilitation of welders employed in the Maritime Shipyard in Szczecin have been analysed for the period 1979-1984. The main causes were found to be diseases of the musculo-osseous system (18.9%) and respiratory tract (14.8%). Temporary rehabilitation covered 67.3% of welders (2/3 for respiratory tract diseases), whereas permanent rehabilitation--23.5% (2/3 for musculo-osseous diseases).

Adult↗

A geriatric assessment and rehabilitation unit in a rehabilitation hospital.

This paper presents process and outcome data for a geriatric assessment unit in a rehabilitation hospital whose focus is on short-term rehabilitation. While the results presented here are positive, they are descriptive and do not prove a cause and effect relationship between the geriatric assessment and rehabilitation unit care and the outcomes described. This unit is currently being evaluated by a prospective randomized controlled clinical trial.

Aged↗

[Neurologic rehabilitation in Bavaria. Study of the development of admission capacity of rehabilitation clinics 1992 to 1994].

In order to get information about capacities of neurorehabilitation for patients with acquired brain injuries or stroke in Bavaria, a survey concerning the time interval between registration and admission of the patient (waiting period) was carried out. Structured interviews by telephone were performed and all departments of neurorehabilitation and neurosurgery in Bavaria were included. The waiting period was calculated for the last 3 years and for each phase of rehabilitation using rehabilitation phase model A-D, which was proposed by the Deutscher Verband Rentenversicherungsträger (Association of German social pension Insurancies). As a result, a significant shortening of the waiting period over the last 3 years for almost all phases of rehabilitation has been demonstrated. We therefore conclude that an over capacity may develop in Bavarian neurorehabilitation, at least in certain regions. Quantity seems to be obtained. Next goal required is control of quality.

Brain Damage, Chronic↗

[Rehabilitation from the economic viewpoint--how is geriatric rehabilitation positioned in the German health care system?].

The paper summarizes the answers to given questions and the lecture held on the occasion of a hearing of the Enquete-Kommission "Demographic change" of the German Parliament. The subject was the problem of cost-effectiveness of rehabilitation measures. The position of geriatric rehabilitation in Germany as an established and efficient method is described. The indication for rehabilitation must be correctly and individually determined, and the treatment should be available to patients in all communities.

Activities of Daily Living↗

[Assessment of long-term needs and expenditures development for rehabilitation services of the BfA with reference to the growth and occupational rehabilitation regulation (WFG)].

Based on a Prognos Model projection (1998 to 2040), the number of medical and occupational rehabilitation service treatments required will increase by about 70,000 between 1998 and 2015, reaching 500,000. Thereafter, the situation improves and the number drops to between 370,000 and 430,000. The WFG law provides a 2.7 billion DM budget for the entire time period which results in a growing deficit, reaching 1.7 billion DM by 2015, and enabling the provision of only 50% of the treatments required in the western states, if it is assumed that a reduction of treatment in the eastern states is precluded. This service deficit makes an increase in early retirements probable, thereby, generating costs on balance which exceed any potential savings in the areas of rehabilitation. It is, therefore, necessary to adapt the WFG law to the demands of real needs so that the BfA may continue to fulfill its legal obligation, "rehabilitation before retirement" to the accustomed and necessary extent.

Aged↗

[Cost-benefit evaluation of medical rehabilitation by social security pensions and effects of the growth and occupational rehabilitation regulation (WFG)].

The retirement insurers, within the scope of their responsibility for health care, have already adopted the standard that calls for quality control, cost-efficiency, and outcome-focusing. For a start, the BfA (Federal Insurance Agency for Salaried Employees) has compiled a pilot evaluation presented here, based solely on its own costs and returns on costs. This evaluation demonstrates that rehabilitation "pays off". With regard to the WFG, this means that cost-saving in rehabilitation generates significant cost increases through loss of premium payments and necessary early-retirement outlays. The analysis presented shows that future investment in rehabilitation is required to ensure positive returns for the RV.

Aged↗

[Conditions and results of medico-social rehabilitation at the rehabilitation centre of Cologne University (author's transl)].

From its establishment in 1966 the Rehabilitation Center of Cologne University has documented its medical, social and prevocational evaluation findings, and subjected the prognoses given to periodical follow-up verifications. A statistical overview of the years 1971 through 1978 describes the numerical development of in- and outpatient rehabilitees, diagnostic groupings, and follow-up results. Development, organisational patterns, and working approaches at the centre as well as the importance of integrated prevocational training are underlined, as is the need for more medical rehabilitation facilities.

Female↗

CAncer Rehabilitation Evaluation System--short form (CARES-SF). A cancer specific rehabilitation and quality of life instrument.

The CAncer Rehabilitation Evaluation System (CARES) (CARES Consultants, Santa Monica, CA) a rehabilitation and quality of life instrument with well-documented reliability and validity, has been shortened. This report describes the development and psychometric properties of the new instrument, the CAncer Rehabilitation Evaluation System--Short Form (CARES-SF). The data from four existing samples of cancer patients demonstrate that the CARES-SF is highly related to the CARES (r = 0.98), has excellent test-retest reliability (86% agreement), concurrent validity with related measures, and acceptable internal consistency of summary scales (alpha = 0.85 to 0.61). In a new sample of breast cancer patients evaluated at three points in time (1 month, 7 months, and 13 months after diagnosis) the instrument appears to be sensitive to change and is highly related to the Functional Living Index--Cancer (FLIC), an existing quality of life instrument. The authors conclude that the CARES-SF has excellent potential as a quality of life instrument for use in clinical trials.

Data Collection↗

[Need for ambulatory cardiology after-care rehabilitation in the metropolitan area of a large city. Results of the Cologne model of ambulatory cardiologic rehabilitation--phase II].

Within the Cologne Model (CM) of outdoor cardiac rehabilitation (OCR), phase II investigations about the demand for this form of cardiac rehabilitation (CR) after acute cardiac diseases were carried out in three general hospitals, the cardiological and cardiosurgical university hospitals of Cologne. The subsequent questions were investigated: total number of coronary or cardiac operated patients, number of patients with indication for CR, and number of patients corresponding to the restricted indications of CM (age below 65, low risk patient, no cardiac operation). For these groups the acceptance or refusal of CR was checked. Subsequently a sample of patients corresponding to the criteria of CM or of operated patients were confronted with the additional offer of an OCR. The motivation for the acceptance of rehabilitation in specialized hospitals (ICR), OCR or refusal of each kind of CR was inquired. The acceptance of CR in the different groups varied widely. Whereas operated patients in Cologne accept CR in nearly 100% of cases, this is the case in patients after acute myocardial infarction (AMI) in only 50% and in patients after PTCA without AMI in only 5-6%. The analysis of predictors for acceptance brings about that younger patients prefer CR, and if they do, OCR. Patients with the more serious form of disease prefer ICR. Women accept CR more rarely than men, and if they do, they prefer the hospital form. However, this is less gender specific but consequence of the generally more serious form and later onset of CAD in females. Higher educational as well as occupational status favors acceptance of CR and specially OCR. The suspicions that unmarried people prefer OCR and foreigners ICR could not be generally confirmed. Crucial reasons for the form of CR which is accepted or refused are individual ones. ICR is favored by the wish for more safety and better recuperation. For OCR, the comfortable conditions at home with high social support and/or antipathy against hospitals after long clinical treatment are named. Analysis of demand for OCR demonstrates that between 40% in low risk patients (corresponding to CM criteria) and 20% in more serious cases (operated patients) prefer the outhospital form. From these data an estimation of demand for OCR in areas with high population was carried out.

Aftercare↗

Working within the law: guidelines for veterinary surgeons and wildlife rehabilitators on the rehabilitation of wild mammals.

In recent years there has been a considerable increase in the numbers of both veterinary surgeons and wildlife rehabilitators involved in the care and rescue of wildlife. Several publications are available offering practical advice on what to do, but many of the people working in this field are unclear as to which laws apply to wildlife rehabilitation. This paper provides a summary of the legal position as it relates to the rehabilitation of wild mammals in Britain.

Animal Welfare↗

A mobile rehabilitation team program to assist patients in nursing homes rehabilitate and return to their homes.

A slow-stream rehabilitation program for frail elderly patients was developed utilising nursing homes visited by a mobile rehabilitation team (MRT) based at the hospital from which these patients had been discharged following major illness. The nursing homes were able to provide physiotherapy and the MRT contributed medical, nursing, occupational therapy and social work support through weekly visits. The supported group and a control group (also discharged to nursing homes from the same hospital but unsupported) were matched for age, sex and ADL level. Outcomes for the two groups were compared and were significantly different. Of the supported group (N = 33), 64% (N = 21) were discharged home compared with only 9% (N = 2) of the 23 control subjects (chi2 = 15.6, df. = 1, P < 0.05). The potential for patient rehabilitation in a modestly supported nursing home was realised.

Journal Article↗

Geriatric rehabilitation. 3. Physical medicine and rehabilitation interventions for common disabling disorders.

UNLABELLED: This self-directed learning module highlights physical medicine and rehabilitation (PM and R) interventions for common disorders that cause disability in older adults. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in PM and R and geriatric medicine. This article specifically focuses on PM and R interventions for arthritides, fractures, cardiovascular disorders, peripheral vascular disease, amputations, pulmonary disorders, cancer, stroke, traumatic brain injury, Parkinson's disease, spinal cord injury, peripheral neuropathies, and diabetic complications. OVERALL ARTICLE OBJECTIVE: To summarize the physical medicine and rehabilitation interventions for commonly disabling conditions of older adults.

Aged↗

Geriatric rehabilitation. 4. Physical medicine and rehabilitation interventions for common age-related disorders and geriatric syndromes.

UNLABELLED: This self-directed learning module highlights physical medicine and rehabilitation (PM and R) interventions for age-related physiologic changes. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in PM and R and geriatric medicine. This article specifically focuses on PM and R interventions (including exercise) for mobility alterations, activities of daily living alterations, osteoporosis, cognitive and behavioral changes, bladder changes, and bowel changes. OVERALL ARTICLE OBJECTIVE: To summarize the physical medicine and rehabilitation interventions for age-related physiologic changes.

Aged↗