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PubMed2004

Medicaid payment for telerehabilitation.

OBJECTIVE: To assess current payment practice for telerehabilitation in state Medicaid programs. DESIGN: Telephone survey. SETTING: State Medicaid programs. PARTICIPANTS: State Medicaid directors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Descriptive. RESULTS: Half of the 35 state Medicaid programs contacted reimbursed at least some telemedicine services other than radiology in 2002. The primary reason for reimbursing for telemedicine is to make services available when there is no local practitioner. Consultation and evaluation and management services were most likely to be reimbursed (12 states). Seven state programs reimbursed telepsychology, and 4 states reported reimbursing for telespeech and language pathology, physical therapy, or occupational therapy. CONCLUSIONS: Telemedicine helps Medicaid programs deliver specialized care to locations with provider shortages. Telerehabilitation is not yet widespread, despite its potential benefit to people with disabilities who cannot travel to a clinic for rehabilitation therapy. Most Medicaid programs calculate the financial costs and patient benefits when considering payment policies, and about half of states require a state law to allow payment for telerehabilitation. Minnesota, Hawaii, and Nebraska, among the responding states, currently reimburse for telerehabilitation. Research is needed to evaluate the appropriateness of telerehabilitation for Medicaid beneficiaries.

Current Procedural Terminology↗
PubMed1999

Measuring outcomes in children's rehabilitation: a decision protocol.

OBJECTIVE: To develop and test the feasibility and clinical utility of a computerized self-directed software program designed to enable service providers in children's rehabilitation to make decisions about the most appropriate outcome measures to use in client and program evaluation. DESIGN: A before-and-after design was used to test the feasibility and initial impact of the decision-making outcome software in improving knowledge and use of clinical outcome measures. SETTING: A children's rehabilitation center in a city of 50,000. PARTICIPANTS: All service providers in the children's rehabilitation center. Disciplines represented included early childhood education, occupational therapy, physical therapy, speech and language pathology, audiology, social work, and psychology. INTERVENTION: Using a conceptual framework based on the International Classification of Impairment, Disability, and Handicap (ICIDH), an outcome measurement decision-making protocol was developed. The decision-making protocol was computerized in an educational software program with an attached database of critically appraised measures. Participants learned about outcome measures through the program and selected outcome measures that met their specifications. The computer software was tested for feasibility in the children's rehabilitation center for 6 months. OUTCOME MEASURES: Knowledge and use of clinical outcome measures were determined before and after the feasibility testing using a survey of all service providers currently at the centre and audits of 30 randomly selected rehabilitation records (at pretest, posttest, and follow-up). RESULTS: Service providers indicated that the outcomes software was easy to follow and believed that the use of the ICIDH framework helped them in making decisions about selecting outcome measures. Results of the survey indicated that there were significant changes in the service providers' level of comfort with selecting measures and knowing what measures were available. Use of outcome measures as identified through the audit did not change. CONCLUSIONS: The "All About Outcomes" software is clinically useful. Further research should evaluate whether using the software affects the use of outcome measures in clinical practice.

Child↗
PubMed2003

Landau-Kleffner syndrome responsive to levetiracetam.

A 5-year-old girl with Landau-Kleffner syndrome is discussed. The child began having seizures at age 4 associated with language deterioration despite anticonvulsant therapy. With levetiracetam monotherapy to a dose of 60 mg/kg/day and discontinuation of carbamazepine and valproic acid, her language has improved and seizures are controlled. Levetiracetam should be considered as therapy for Landau-Kleffner syndrome.

Anticonvulsants↗
PubMed2006

[Which patients are (not) included in the DMP diabetes programme?].

AIM: The disease management programme for diabetes mellitus type 2 (DMP) is joined by many General Practitioners. Aim of the study is to compare patients included in this programme with patients not included and to explore reasons for the selection. METHODS: 10 GPs in Hamburg participated. From each patient list 10 participants in the DMP and the same number of non-participants were randomly selected. HbA1c before start of the programme, presence of insulin therapy, comorbidity and language skills were documented. GPs reported their estimation of the compliance and their reasoning in the selection process. The hypothesis for the primary endpoint was: Diabetics not included have a worse HbA1c value than those included in the DMP. RESULTS: The hypothesis was not confirmed. In both groups similarly good HbA1c values were observed (7.0 in DMP participants, 7.3 in non-participants). The included participants differed from those not included with respect to age (statistically significantly younger) and a better compliance. In the subgroup of patients younger than 70 years the patients included have a better HbA1c and get insulin more frequently (both n. s.). CONCLUSIONS: One part of the patients seems to be not included into the DMP for good reasons. Two questions should be further evaluated: To what extent are patients included although they already have a good metabolic situation? And to what extent are patients with a poor compliance not included, although they might benefit from participation?

Adult↗
PubMed2005

Reflection as a means to foster client-centred practice.

BACKGROUND: Client-centred practice embraces important concepts about partnership and justice that promote client participation in meaningful occupations. It is important to understand how occupational therapists can engage in and continue to develop client-centred practice within the constraints of everyday settings. PURPOSE AND METHODS: An action research study was undertaken by a group of four occupational therapists to describe insights gained, and to show the effectiveness of participation in reflective education to help foster client-centred practice. RESULTS: The six main insights generated by the group involve: congruence, understanding the potential, environmental factors, personal factors, expectations, and lifelong learning. PRACTICE IMPLICATIONS: Although actual change to daily practice was limited, group members felt the reflective group discussion provided them with a launch pad to start a journey toward more client-centred practice. This may be the key to moving beyond simply changing the face and language of occupational therapy practice toward a deeper understanding and implementation of client-centred practice to improve client outcomes. Suggestions are provided for implementing reflection to help continue to develop your own practice.

Biomedical Research↗
PubMedDate not supplied

[Respiratory dynamics measurements in children with four to ten years of age].

BACKGROUND: respiratory dynamics measurements are frequently used in the speech-language pathology practice, but few are the scientific data for children. AIM: to study the respiratory dynamics in children with nasal breathing. METHOD: the study was performed with a stratified random sample of 106 nasal breathing children, male and female, from schools of the city of Marília-SP, with ages between four and ten years. The following measurements were obtained: vital capacity (VC) in both standing and sitting positions, with and without nasal occlusion; maximum phonation time (MPT) of sustained vowels and consonants and also of speech when counting numbers. RESULTS: the mean values for VC in the standing position with and without nasal occlusion were of 1515.56ml and 1538.67ml respectively and for the sitting position of 1524ml and 1539.15ml respectively. MPT of vowels in seconds were: /a/ = 8.32, /i/ = 8.61 and /ul = 8.42; of consonants: /s/ = 6.64 and /z/ = 7.65; and when counting numbers: 7.76. It was observed that the mean values of these measurements progressively increased according to age. There was a statistically significant difference (p<0.05) not only for the MPT of vowels but also for the MPT of consonants in older children, i.e. between 4 and 10 year olds, 4 and 9 year olds and 4 and 8 year olds. There was no significant statistical difference for the VC values in consecutive age groups. There was a strong association between VC and the child's physical development. CONCLUSION: this study presented respiratory dynamics measurements in children that can be used for the spech-language diagnosis and therapy. Other studies should be developed in order to bring additional information on the subject.

Age Distribution↗
PubMed1999

Low-molecular-weight heparins in pregnancy.

We conducted a systematic review, with MEDLINE and Cochrane Library data base searches and bibliographic reviews, of English-language reports describing therapy with low-molecular-weight heparin (LMWH) in pregnancy. Altogether 40 citations, excluding abstracts, were identified. When the quality of evidence was categorized according to the method outlined by the U.S. Preventive Services Task Force, 2 articles were level I, 3 were level II-1, 3 were level II-2, 4 were level II-3, 9 were level III, and the remaining 19 were classified as other (i.e., below level III). Of the 728 pregnant women and 1 postpartum woman described in the 40 citations, 340 (47%) received dalteparin, 192 (26%) enoxaparin, 108 (15%) certoparin, 54 (7%) nadroparin, 30 (4%) other LMWH, and 6 (< 1%) unspecified. The indication for LMWH in most patients (606 pregnancies, 83%) was for thromboprophylaxis. Daily doses ranged from 2500-22,000 U for dalteparin, 20 mg (2000 U)-80 mg (8000 U) for enoxaparin, 3000 U for certoparin, and 2050-15,000 U for nadroparin. Regimens included fixed dosages, increasing dosages as pregnancy progressed, dosages based on body weight, and dosages titrated according to anti-Xa levels. Duration of therapy ranged from a single dose to 476 days. Maternal anti-Xa levels were reported for 255 pregnancies. Target anti-Xa levels ranged from 0.1-0.6 U/ml and measured values from 0.0-0.7 U/ml. Major maternal findings were 18 local and generalized skin reactions, 27 bleeding complications, 9 thromboembolic events, 8 deep vein thromboses, 1 bilateral renal vein thrombosis, 4 pulmonary emboli, 1 hepatic infarction, 4 cases of thrombophlebitis, 12 cases of preeclampsia, 1 placental abruption, and 2 osteoporotic vertebral fractures. A major fetal finding was lack of anti-Xa activity in fetal or cord blood. Published experience suggests that LMWHs are generally safe and effective when administered for thromboprophylaxis during pregnancy. Until prospective, randomized, controlled trials comparing them with unfractionated heparin are performed, their benefits in pregnancy will remain inconclusive.

Clinical Trials as Topic↗
PubMed1993

The Auditory Language Comprehension Programme: a description and case study.

The Auditory Language Comprehension Programme is a Dutch therapy programme at the word level, especially developed for severely aphasic patients. The programme consists of 420 items divided over three parts. Each item consists of a target word and three distractors. One spoken target word at a time is presented to the patient who has to choose one out of four pictures. The number of related distractors is varied: each part starts with items in which the distractors bear no resemblance to the target; later on, one, two and then all three distractors are related to the target. The nature of relatedness is dependent on the different levels in the programme. In part 1, the phonological level, there is a correspondence in sound; in part 2, the semantic level, a correspondence in meaning; in part 3, the complement, there is a phonological correspondence, a combination of phonological and semantic correspondence, or a lexical-morphological correspondence. The levels are hierarchically built, according to the principles of programmed instruction. In order to show how a therapist may apply this programme, a case study is presented. The patient, who developed aphasia after traumatic brain injury, was trained on the semantic level. Both his performance and our therapy methods will be described and evaluated.

Adult↗
PubMed2004

Development of a community-based medical rehabilitation programme in the Kivalliq Region of Nunavut, Canada.

OBJECTIVE: In 2000, the University of Manitoba and the Department of Health and Social Services of Nunavut, Canada, jointly embarked upon the development of a community-based medical rehabilitation programme in the Kivalliq Region of Canada's central Arctic. Two main objectives were identified in moving forward with the implementation of a rehabilitation programme. Firstly, to conduct a region wide community needs assessment for rehabilitation services for all age groups of all residents of the Kivalliq Region of Nunavut. Secondly, to provide information from which a community-based rehabilitation therapy programme could be developed. METHODS: A community needs assessment of the Kivalliq Region was carried out to guide the implementation of physiotherapy, occupational therapy and speech language pathology services. RESULTS: There are now two physiotherapists, one occupational therapist, and one speech language pathologist providing rehabilitation services to the residents of the Kivalliq Region of Nunavut. The results of this needs assessment, the challenges and successes of this medical rehabilitation programme are discussed. CONCLUSION: The total population of the service area is approximately 8,000 people, the significant majority of whom self-report as Inuit, and are widely dispersed over eight communities. Despite the challenges in terms of culture, geography and recruitment of introducing a rehabilitation program in Canada's north, the residents of the Kivalliq Region now have a viable model of receiving rehabilitative intervention in their home communities.

Community Health Services↗
PubMed1998

Accountability and competence: occupational therapy practitioner perceptions.

OBJECTIVE: Occupational therapy practitioners must meet ever-increasing accountability demands in all service delivery environments. Accountability is made possible through the ongoing development of continued competence throughout a practitioner's career. Behaviors that demonstrate accountability and reflect competence include commitment, leadership, and professional knowledge. This article discusses issues related to accountability and competence, presents findings from focus group discussions with occupational therapy practitioners regarding professional competence, and identifies actions that will bring about greater understanding of this topic. METHOD: Thirty-nine randomly selected occupational therapy practitioners attended one of two focus groups. Participants responded to a structured discussion guide, including questions addressing the definition, process for sustaining, and outcomes of continued competence. RESULTS: Several themes emerged from these discussions. Views about what constitutes and contributes to continued competence in occupational therapy were diverse, and perceptions of occupational therapy "practice" were broad. Participants believed that the "outcomes" of a practitioner's continued competence were best defined as autonomy in executing the occupational therapy process. CONCLUSIONS: Findings offer potential language to articulate competence in occupational therapy and facilitate a discipline-wide conversation. The findings likewise challenge practitioners to assume new professional behaviors that require both personal and interpersonal skills. Such behaviors are critical to demonstrating accountability and competence.

Attitude of Health Personnel↗
PubMed2000

Interprofessional learning modules at Dalhousie University.

Interprofessional education has been advocated to improve teamwork in the health sector. This paper reports on the first two years of operational experience by a School of Health Services Administration (SHSA) with three-hour interprofessional learning modules (IPLMs). SHSA students participated along with students from nursing, medicine, social work, physiotherapy, occupational therapy, pharmacy, speech language pathology, audiology, dental hygiene, dentistry, leisure studies, health education and kinesiology. The five IPLMs required for SHSA students were: professional roles and values, integrity in scholarly activity, disability, interpersonal violence and HIV/AIDS. This article describes the development, delivery and evaluation of these modules from an SHSA perspective. The IPLMs' evaluation findings indicated that IPLMs are worthwhile, but have taken years and ongoing senior management support to operationalize; inclusion of health services administration is worthwhile but challenging; vigilance is needed to retain an IP rather than module content focus; and faculty and facilitator development, along with student preparation and debriefing, is required. Student feedback was favourable; faculty members have gained by their involvement; and field practitioner support has been sustained. Evaluation and reflection are critical to IPLM evolution. The norms, strengths and constraints of the university must be taken into account, and thus IPLMs must be adapted for each educational setting. Schools of health services administration must decide whether they wish to be involved in interprofessional learning.

Allied Health Personnel↗
PubMed1961

The language-handicapped child. Coordinated evaluation by physicians and educators.

Seventy children were studied during 1959 in a special school program because of major language problems. A team of medical and educational personnel studied each child during a ten-day school enrollment. The results of the medical and educational studies were of great value in establishing the correct diagnosis and devising a suitable educational program for the children.

Cerebral Palsy↗
PubMed1985

[Primary reading epilepsy. 11 cases].

Eleven cases of primary reading epilepsy are reported. They confirm Bickford's description. These patients were otherwise normal. A family history of seizures was present in 6 cases. The first seizure occurred between 12 and 25 years. After a variable period of reading all patients developed a tightness and jerking in throat and jaw muscles. In 4 cases, occasionally, speaking could cause jaw or throat jerks. Whilst reading out loud or silently (exclusively in reading aloud in 1 patient) bilateral discharges were recorded in EEG, sometimes on the left hemisphere. The mechanisms are discussed. Seizures in primary reading epilepsy are facilitated by saccadic eye movements, impulse language muscles and mental concentration. The role of higher integrating systems of language is emphasized. Therapy is discussed.

Adolescent↗