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PubMed2003

The Stroke Rehabilitation Assessment of Movement (STREAM): a comparison with other measures used to evaluate effects of stroke and rehabilitation.

BACKGROUND AND PURPOSE: The Stroke Rehabilitation Assessment of Movement (STREAM) is a relatively new measure of voluntary movement and basic mobility. The main objectives of this study were: (1) to examine the relationship of the STREAM to other measures of impairment and disability and (2) to compare its usefulness for evaluating effects of stroke and rehabilitation and for assessing change over time with that of other measures of impairment and disability. SUBJECTS AND METHODS: The performance of 63 patients with acute stroke on the STREAM and other measures of impairment and disability was evaluated during the first week after stroke and 4 weeks and 3 months later. RESULTS: Scores on the STREAM were associated with scores on the Box and Block test, Balance Scale, Barthel Index, gait speed, and the Timed "Up Go" Test (with Pearson correlation coefficients ranging from .57 to .80) and were associated with categories of the Barthel Index and Balance Scale. The STREAM's ability to predict discharge destination from the acute care hospital, as well as to predict gait speed and Barthel Index scores at 3 months poststroke, was comparable to that of other commonly used measures. Standardized response mean estimates provided supporting evidence for the ability of the STREAM to reflect change over time. DISCUSSION AND CONCLUSION: The results obtained with the STREAM, as compared with other measures of impairment and disability in people with stroke, suggest that it may be useful in clinical practice and research.

Adult↗
PubMed1976

[Psychological rehabilitation as social learning process--on the application of the communication therapy in rehabilitation (author's transl)].

As, from the socio-psychological point of view, disability constitutes a communication problem, it was studied in how far the principles of communication therapy - originally developed for the treatment of marriage and family problems - can be applied to the psychological rehabilitation of the disabled. The author and her colleagues are of the opinion that the communication therapeutic approach can essentially improve the rehabilitation process, especially through the direct involvement of everyday social partners.

Communication↗
PubMed2006

[Rehabilitation as an integral part of the long-term management of bronchial asthma--what's new from the point of view of rehabilitation medicine].

Pulmonary rehabilitation is an integral and original part of the German National Disease Management Guideline for Asthma with clearly defined tasks within a comprehensive long-term management of asthma. The following short overview describes methods, indications for and effectiveness of pulmonary rehabilitation for adult patients with asthma.

Adult↗
PubMed1987

[Comparison of the efficacy of different programs of physical rehabilitation for myocardial infarct patients and possibilities of increasing it by incorporating physical training at the hospital stage of rehabilitation therapy].

The efficiency of rehabilitation can be improved through early activation of the patients and the beginning of exercise as early as the hospital stage of rehabilitation. The intensity of exercise should be rationed on a strictly individual basis, with regard to the patient's functional status. Hospital exercise in combination with purposeful psychotherapy are major prerequisites for the recovery of working capacity.

Adult↗
PubMed1986

[Vocational rehabilitation for psychologically handicapped patients: the Mannheim "starting help." On the creation of rehabilitative resources in industry].

A programme for rehabilitation of severely mentally impaired patients (mainly psychotic disorders) in local companies, industrial and municipal, is presented. Introduced in 1970 and extended since 1983, the programme is based on a theoretical model for social work practice, that centers around the concept of resources and interaction. Preliminary experiences with this on-the-job vocational rehabilitation approach are reported.

Germany, West↗
PubMed1982

Rehabilitation program evaluation using a revised level of rehabilitation scale (LORS-II).

The Level of Rehabilitation Scale (LORS) was prepared to aid in meeting program evaluation needs of rehabilitation facilities. Advantages of the original LORS-I, including economy of administration, behaviorally defined levels of function, multiple points of view, and concise presentation of findings were retained. Normative information concerning improvement levels for the activities of daily living subscale was developed for cerebrovascular accident inpatients. Data showed that expected improvement varies according to functional level at admission and patient age.

Activities of Daily Living↗
PubMed1995

[References for evaluation scales in quality assurance in rehabilitation--1. II. Measuring functional independence in rehabilitation with the Functional Independence Index].

Presented is an instrument assessing functional independence in rehabilitation. This instrument, the Functional Independence Measure (FIM), was developed in the USA and translated into German. Considerable experience and research has accumulated concerning its application, formal properties and function in interdisciplinary rehabilitation. Application and evaluation of the FIM is demonstrated in a case study. The FIM is shown to be a reliable and highly informative instrument measuring disability according to ICIDH criteria in clinical practice. It reflects reliably the amount of help and assistance required by the individual patient.

Activities of Daily Living↗
PubMed1994

[Prognostic importance of diagnostic functional and social parameters for occupational rehabilitation of heart patients. Results of studies and practical applications for rehabilitation counseling].

Vocational and social reintegration is one of the main targets of cardiac rehabilitation programs. As prognosis bases on objective pathophysiological data and psychosocial data, those data have to be used in the practice of cardiologists and rehabilitation workers. The relevant diagnostic parameters are demonstrated in this publication.

Aftercare↗
PubMed1993

[Medical and occupational rehabilitation of psychiatric patients. Results of concomitant research of rehabilitation facilities for psychiatric and handicapped patients].

The Rehabilitation facilities for mentally ill and disabled (RPK) are designed to enable clients with chronic mental illness to (re)acquire the skills needed for their reintegration in occupational and/or social respects. The peculiar feature of the RPKs is their holistic approach integrating medical-psychiatric care, vocational preparation and training services, as well as sociotherapeutic measures. Accompanying research findings clearly prove that, once they have gained a firm foothold in the RPK, the great majority of the rehabilitees will achieve successful and lasting rehabilitation. The medical phase is completed by some two thirds of the clients admitted. Drop-out usually occurs in the initial three months period. The medical phase is followed by medical-vocational services in approx. 60% of the rehabilitees, and the majority of these achieve successful reintegration, with a drop-out rate of 15-20% in this phase clearly below the rate during the medical service provision phase. RPKs operating along a cooperative model have proven their worth within a dense service provider network, while the advantages of the integrative model lie in its concentration of services under one roof. Recommendations given in particular pertain to simplification of admission procedures and to ensuring follow-up services after programme completion.

Adult↗
PubMed1997

[Medical rehabilitation between politics and demographic development--consequences for quality management in rehabilitation clinics].

Drastic changes are ahead for medical rehabilitation in the wake of austreity measures in the pension insurance domain. This paper presents consequences for rehabilitation hospitals and their current strategies of coping in the German health care system. Quality management now needs long and medium term planning, rather than short-term reactions. Demographic trends and a changing spectrum of morbidity indicate possible survival strategies. These societal developments are already incorporated in Total Quality Management.

Chronic Disease↗
PubMed1999

A randomised controlled trial of home-based rehabilitation versus outpatient-based rehabilitation for patients suffering from chronic schizophrenia.

BACKGROUND: Outpatient-based treatments for patients suffering from chronic schizophrenia inadvertently exclude a significant proportion of subjects because they are often too poorly motivated to attend for treatment. In addition there are also concerns about whether the skills that are learnt in a hospital setting will generalize to situations when the individuals are at home. This study attempted to redress some of these potential deficiencies and followed on from an earlier local study which found that a community-based team met more of the needs of patients suffering from chronic schizophrenia. METHOD: Seventy-five patients suffering from chronic schizophrenia were allocated randomly to receive traditional outpatient-based or home-based rehabilitation from a clinical psychologist and an occupational therapist. They were assessed before and after 9 months of treatment on a range of clinical, social and quality of life outcomes. Distress to carers was also assessed. Readmission to hospital was recorded for each subject. RESULTS: There were significant reductions in socially embarrassing behaviour (SBS), increases in interpersonal functioning and recreational activities and a trend for quality of life to improve in the home-based group. There were fewer admissions in the home-based group but the differences, although financially substantial, were not statistically significant. CONCLUSIONS: The home-based rehabilitation service was well received by the majority of patients suffering from chronic schizophrenia and led to some improvement in social behaviour, interpersonal functioning, recreational activities and quality of life.

Adult↗
PubMed2005

Rehabilitation of orthopedic and rheumatologic disorders. 2. Osteoarthritis assessment, treatment, and rehabilitation.

UNLABELLED: This self-directed learning module discusses a patient with knee osteoarthritis and addresses the clinical presentation, assessment, medical management, rehabilitation approaches, and surgical options. It is part of the chapter on osteoarthritis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes the differential diagnosis, clinical diagnostic considerations, current pharmacology, orthotics, exercise interventions, and surgical procedure options for a patient with knee osteoarthritis. OVERALL ARTICLE OBJECTIVE: To summarize diagnostic considerations and management of knee osteoarthritis.

Acute Kidney Injury↗
PubMed2007

Critical illness VR rehabilitation device (X-VR-D): evaluation of the potential use for early clinical rehabilitation.

We present a new critical illness VR rehabilitation device (X-VR-D) that enables diversified self-training and is applicable early in the rehabilitation of severely injured or ill patients. The X-VR-D consists of a VR program delivering a virtual scene on a flat screen and simultaneously processing commands to a moving chair mounted on a motion system. Sitting in the moving chair and exposed to a virtual reality environment the device evokes anticipatory and reactive muscle contractions in trunk and extremities for postural control. In this study we tested the device in 10 healthy subjects to evaluate whether the enforced perturbations indeed evoke sufficient and reproducible EMG muscle activations. We found that particular fast roll and pitch movements evoke adequate trunk and leg muscle activity. Higher angular velocities and higher angles of inclination elicited broader EMG bursts and larger amplitudes. The muscle activation pattern was highly consistent between different subjects and although we found some habituation of EMG responses in consecutive training sessions, the general pattern was maintained and was predictable for specific movements. The habituation was characterized by more efficient muscle contractions and better muscle relaxation during the rest positions of the device. Furthermore we found that the addition of a virtual environment to the training session evoked more preparatory and anticipatory muscle activation than sessions without a virtual environment. We conclude that the X-VR-D is safe and effective to elicit consistent and reproducible muscle activity in trunk and leg muscles in healthy subjects and thus can be used as a training method.

Abdominal Muscles↗
PubMed2004

Responsiveness of health-related quality of life outcome measures in cardiac rehabilitation: comparison of cardiac rehabilitation outcome measures.

Assessment instruments that are not responsive to change are unsuitable as outcome tools in cardiac rehabilitation because they underestimate the psychosocial benefits of program attendance. Nine questionnaires were assessed for responsiveness with the standardized response mean (SRM). Questionnaires were allocated into 3 batteries, and each battery was completed by cardiac rehabilitation and comparison participants at 2 time points (411 and 375 participants in total, respectively). There was a high degree of variability in the responsiveness of instrument subscales. The positive affect subscale of the Global Mood Scale (J. Denollet, 1993a) was the most responsive (SRM = 0.62). Further information on the comparative responsiveness of psychosocial scales is important to optimize instrument selection for outcome studies.

Female↗
PubMed2005

A rehabilitation robot with force-position hybrid fuzzy controller: hybrid fuzzy control of rehabilitation robot.

The goal of this study was to design a robot system for assisting in the rehabilitation of patients with neuromuscular disorders by performing various facilitation movements. The robot should be able to guide patient's wrist to move along planned linear or circular trajectories. A hybrid position/force controller incorporating fuzzy logic was developed to constrain the movement in the desired direction and to maintain a constant force along the moving direction. The controller was stable in the application range of movements and forces. Offline analyses of data were used to quantitatively assess the progress of rehabilitation. The results show that the robot could guide the upper limbs of subjects in linear and circular movements under predefined external force levels and apply a desired force along the tangential direction of the movements.

Computer-Aided Design↗
PubMed2000

Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study).

OBJECTIVES: 1. To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases (myocardial infarction, acute coronary syndrome, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). 2. To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group, in comparison with similar changes in the conventional care group. DESIGN: Randomized, controlled, parallel-group design (intervention/conventional care). SETTING: Akershus County, southeast of Oslo City, Norway. PARTICIPANTS: 500 patients, men and women, aged 40-85 years, who have sustained at least one of the above-mentioned cardiovascular diseases. INTERVENTIONS: 8 weeks of supervised, structured physical training of three periods of 20 min per week, targeting a heart rate of 60-70% of the individual's maximum; home-based physical exercise training with the same basic schedule as in the supervised period; quantification of patients' compliance with the exercise programme by the use of wristwatches, information stored in the watch memory being retrieved once a month during the 3-year follow-up period; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control.

Journal Article↗
PubMed1996

The Work Rehabilitation Impact Quotient: a tool to assess the effectiveness of early rehabilitation of injured workers.

The Work Rehabilitation Impact Quotient (WRIQ) compares the percentage of long term claimants in a classification group with the percentage of long term claimants overall in the scheme, a value greater than one indicating that more people than expected remain on compensation. We studied the Accident Rehabilitation and Compensation Insurance Corporation of New Zealand (ACC) claims from 1988 to 1994 and data from the 1986 and 1991 census. High WRIQs were found in workers over the age of 50, people injured in motor vehicle crashes, those with head and multiple location injuries, and those with amputations, dislocations, injuries to internal organs, and OOS (Overuse syndromes). Analysis by occupation and industry identified certain groups with high and very high WRIQs. The WRIQ value was not related to the rate of injury or to job availability, but was related to mean claim cost. Thirty six percent of claim costs paid in 1994 were in groups with high or very high WRIQs. Reduction of the WRIQ in these groups to low levels would produce savings of over $100 million in 1994 dollars.

Accidents, Occupational↗
PubMed1998

["Direct" indirect training approach to rehabilitation of dysphagia patients--a new method for rehabilitation with a feeding-tube].

The rehabilitation approaches for training patients with dysphagia consist of both direct approaches (eating training) and indirect approaches (basic training for dysphagia patients without food). On the other side, some recent reports revealed that some patients who had had severe dysphagia were improved while the feeding approach was with a naso-gastic tube and an oral-esophago feeding tube. So we thought that stimulation of these feeding tubes for the pharynx and the larynx would produce some useful reactions for dysphagia patients. We developed a new method for the rehabilitation of such patients. The technique is the repeated insertion of the naso-gastric tube at the time of the swallowing motion, which we called the "direct" indirect training approach. Sometimes, other basic training procedures for dysphagia patients are admissible. We treated 26 patients by this method. The patients included those with disorders of the corticobulbar tract (n = 11), a disorder of the medulla (n = 5), a disorder of the peripheral nerve (n = 7), and a long-lasting disused state (n = 3). Twenty-four patients were improved and could eat orally without major problems. Laryngeal elevation curves of this approach in the pre- and post-therapeutic states revealed that the threshold of the swallowing reflux was lower, and the swallowing actions were changed dynamically, and became more useful.

Adult↗