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PubMed2004

Quality of life after community-based rehabilitation for blind persons in a rural population of South India.

This study aimed to determine the impact of community-based rehabilitation on the quality of life of blind persons in a rural south Indian population. We performed a population-based survey followed by clinical examinations to identify blind persons in a rural south Indian population. Pre-and-post rehabilitation quality of life of 159 blind persons aged 15 years or above was ascertained through a questionnaire previously validated for use in this population. Post-rehabilitation quality-of-life scales showed some improvement for 151 (95.0%) subjects. The additional benefit from rehabilitation was greatest for the self-care and mobility subscales, ranging from 24.6% to 30.0% for the self care subscale and 37.6% to 44.3% for the mobility subscale with effect sizes of 21.5 and 2.38 respectively. Overall quality of life scores were not significantly different between those who did and did not receive economic rehabilitation (P = 0.1). Blind persons in this rural population benefited considerably from rehabilitation services even if economic rehabilitation is not provided. Initiatives against blindness need to consider rehabilitation of the blind as a priority.

Adolescent↗
PubMed1993

Injured athletes' attitudes and judgments toward rehabilitation adherence.

In a follow-up study to certified athletic trainers' (ATCs') attitudes and judgments toward injury rehabilitation adherence, previously injured and rehabilitated athletes (n=36) were administered the Athletic Injury Rehabilitation Adherence Questionnaire. The purpose of the study was to compare the results collected from athletes with those collected previously from ATCs. The questionnaire consisted of 60 statements, categorized into seven scales: athletic trainers' influence, environmental influences, athlete's personality, pain tolerance, self-motivation, goals and incentives, and significant others. Four additional open-ended questions dealing with successful and unsuccessful rehabilitation strategies also were completed. Athletes' responses were generally similar to those of ATCs. Factors deemed significant to rehabilitation adherence were: (a) good rapport and communication between athletic trainers and injured athletes, (b) support from athletic trainers and coaches, (c) self-motivation on the part of athletes, and (d) convenience, accessibility, and flexibility of the rehabilitation facility and staff. The greatest deviations between athletes' and ATCs' responses were in the areas of self-motivation, pain tolerance, education about injury and rehabilitation exercises, and degree of realistic feedback. Analyses of open-ended question responses reinforced the aforementioned results. The strongest findings derived from these questions were the importance of rapport, communication, and support to rehabilitation adherence. Also, athletes' distastes for threats and scare tactics were quite evident.

Journal Article↗
PubMed2000

A kinetic chain approach for shoulder rehabilitation.

OBJECTIVE: To introduce an approach to shoulder rehabilitation that integrates the kinetic chain throughout the rehabilitation program while providing the theoretical rationale for this program. BACKGROUND: The focus of a typical rehabilitation program is to identify and treat the involved structures. However, in activities of sport and daily life, the body does not operate in isolated segments but rather works as a dynamic unit. Recently, rehabilitation programs have emphasized closed kinetic chain exercises, core-stabilization exercises, and functional programs. These components are implemented as distinct entities and are used toward the end of the rehabilitation program. DESCRIPTION: Kinetic chain shoulder rehabilitation incorporates the kinetic link biomechanical model and proximal-to-distal motor-activation patterns with proprioceptive neuromuscular facilitation and closed kinetic chain exercise techniques. This approach focuses on movement patterns rather than isolated muscle exercises. Patterns sequentially use the leg, trunk, and scapular musculature to activate weakened shoulder musculature, gain active range of motion, and increase strength. The paradigm of kinetic chain shoulder rehabilitation suggests that functional movement patterns and closed kinetic chain exercises should be incorporated throughout the rehabilitation process. CLINICAL ADVANTAGES: The exercises in this approach are consistent with biomechanical models, apply biomechanical and motor control theory, and work toward sport specificity. The exercises are designed to stimulate weakened tissue by motion and force production in the adjacent kinetic link segments.

Journal Article↗
PubMed2004

[Comparison of the first medical assessment for rehabilitation benefits and disability pension in Iceland September 1st 1999 to November 30th 2003.].

AIMS: To evaluate the main characteristics which differentiate between those who are considered to benefit from rehabilitation and those for whom disability pension is thought more appropriate. MATERIAL AND METHODS: The study includes all those fulfilling the medical criteria for rehabilitation benefits or full disability pension in their first assessment at the State Social Security Institute of Iceland between September 1st 1999 and November 30th 2003. RESULTS: Rehabilitation benefits were mainly awarded in younger age groups; disability pension in older age groups. Mental and behavioural disorders were the most common medical reasons for granting rehabilitation benefits among both genders, followed by disorders of the musculoskeletal system and connective tissue, malignant neoplasms and injuries. Among females disorders of the musculoskeletal system and connective tissue were the most common medical reason for granting full disability pension, but this group of disorders was a less common reason for rehabilitation benefits. Those who fulfilled the medical criteria for rehabilitation benefits due to disorders of the musculoskeletal system and connective tissue were markedly older than those who fulfilled the medical criteria for rehabilitation benefits due to mental and behavioural disorders. CONCLUSION: In Iceland rehabilitation benefits are most likely to be awarded to relatively young claimants suffering from psychiatric disorders.

English Abstract↗
PubMed2002

[Opinions of clients on vocational rehabilitation organized by the State Social Security Institute of Iceland.].

OBJECTIVES: Evaluation of opinions of those evaluated by a multidisciplinary team on the evaluation, vocational rehabilitation they participated in and on the effect of the process on their self-confidence and self-reliance. MATERIAL AND METHOD: The Institute of Social Sciences carried out a telephone survey in October 2001, where it was attempted to contact the 109 individuals evaluated for rehabilitation potential by a multidisciplinary team in the year 2000. The data was analysed using descriptive statistics. RESULTS: 83 (76.1%) replied. After the evaluation 40 individuals were referred to vocational rehabilitation for approximately 2 months in a rehabilitation clinic; 19 were referred to a 6 week personal computer training at a vocational rehabilitation centre and 15 to a longer (usually 18 months) rehabilitation program in the same centre. Approximately 80% were content with the vocational rehabilitation offered. 54% of those evaluated by the multidisciplinary team said that it had been useful for them to meet the members of the team and 59% said that the team had informed them on resources they had not been aware of. Approximately half of the participants said that their self-confidence and self-reliance had increased. CONCLUSION: Approximately 80% of the participants were content with the vocational rehabilitation offered and approximately 50% had gained more self-confidence and self-reliance.

English Abstract↗
PubMed2006

Pain relief in early rehabilitation of rotator cuff tendinitis: any role for indirect suprascapular nerve block?

AIM: The purpose of the trial was to evaluate the efficacy of suprascapular nerve block (SSNB) to relieve the shoulder pain, ameliorate recovery after physiotherapy and reduce disability due to a rotator cuff tendinitis (RCT). A prospective, randomized, comparison cross over investigation was performed in the setting of a large inpatient rehabilitation unit with more than 200 admissions annually. METHODS: A total of 40 potential study subjects, who complained of shoulder pain from a RCT, were enrolled and randomly assigned to standard rehabilitation treatment plus SSNB (Group A) or to standard rehabilitation treatment alone (Group B). The UCLA shoulder rating scale was used to assess the shoulder mobility on admission and discharge, and to calculate the percentage of potential improvement achieved during rehabilitation (effectiveness). A pain visual analogic scale was used to serially assess pain. At the end of the trial, a self-report questionnaire evaluated whether patients could sleep and achieve activity of day life carry out everyday activities better than they could before treatment. RESULTS: Forty patients suffering from RCT entered the study. Those receiving nerve block from the beginning of the treatment in addition to standard rehabilitation therapy reported significantly less pain during physiotherapy and better final outcomes. During treatment with SSNBs, patients reported a more significant reduction in the intensity of pain and a better reduction of pain during sleep and rehabilitation exercises in comparison to with the standard therapy alone. A statistically significant inverse correlation was found between shoulder pain and mobility. CONCLUSIONS: The results indicate that combining nerve block with standard rehabilitative therapy may improve the final outcome of painful RCT. It decreased the severity and frequency of the perceived pain, improved the compliance with physiotherapy, restored more normal sleep patterns, and increased compliance with the rehabilitation program. This result proves to be an effective, safe and inexpensive therapeutic option for patients suffering from painful disabling shoulder tendinitis.

Chi-Square Distribution↗
PubMedDate not supplied

Rehabilitation potential of elderly patients with major amputations.

This study was undertaken to determine the rehabilitation potential of patients undergoing amputation for vascular disease. A total of 101 patients were studied with a mean age of 69 +/- 14 years, 26 of whom were over age 80. Operative indications were gangrene or ulceration in 80% with rest pain in 20%. Eighteen patients were bilateral amputees. Fifty per cent of the patient population had previous vascular operations. The operative mortality was 13% and was not affected by the age of the patients or the presence of diabetes. Most operative deaths were due to cardiac or septic respiratory complications. Twenty-four of 88 surviving patients were not considered candidates for rehabilitation and the major determining factor was the occurrence of a remote or perioperative stroke. None of these 24 patients was discharged from institutional care. Sixty-four patients were considered rehabilitation candidates with equal distribution in all age groups. Ninety-five per cent of these patients were discharged home with 80% of those patients over 80 being discharged. Eighty-seven per cent of the elderly rehabilitation candidates were fitted with prostheses which compares favourably to other age groups. Seventy-three per cent of the elderly reached their rehabilitation goals (most frequently ambulation with the aid of a walker) which is only slightly less than the younger amputation group. From this study we conclude that amputations which are done for ease of nursing care and patient comfort in debilitated patients have a high mortality rate and rehabilitation goals are unlikely to be met. We have demonstrated high success rates with rehabilitation including patients over age 80. The majority of these patients may be discharged home after a period of aggressive rehabilitation.

Activities of Daily Living↗
PubMed1991

[Rehabilitation of over 60-year-old stroke patients].

The rehabilitation processus in over 60-year-old patients is documented. History, clinical findings and progress of rehabilitation in 289 patients were evaluated. A pre- and post-comparison and a subgroup formation on the basis of rehabilitation success and finally the evaluation of possible predicting factors for the rehabilitation success are presented. "Successful rehabilitation" was defined, based on the clinical outcome, and judged by the responsible physician. This decision was subjected to thorough analysis. The outcome was judged to be 'very successful' in 18.3%, 'successful' in 51.2% and 'not successful' in only 30.5%. The costs per case were 16,000 DM. Highly significant relationships could be found between the expression 'successful rehabilitation', the discharge lacation, the stage of care at the time of discharge, the Barthel index and the in-house hemiplegic status at discharge. The following conditions resulted as highly significant predictors: stage of car, general condition, the numeric value of the Barthel index, presence of incontinence and presence of a psychoorganic syndrome. Age, sex and number of strokes revealed no relationship to the rehabilitation success in this work. In spite of multiple morbidity and in spite of mobility restrictions and prolonged reconvalescence time, the geriatric rehabilitation carried out in a trained team is successful.

Activities of Daily Living↗
PubMed1991

[Ten years neurologic follow up--part of the "Vorarlberg Rehabilitation Model"].

Within our framework of "comprehensive and permanent" rehabilitation, the follow-up neurological rehabilitation service is an important element. Based on the findings of an anterospective computerized documentation, a ten year survey is given concerning more than 600 patients and over 15,000 home visits. Aside general epidemiologic data, such as age, gender distribution, etc., our findings above all show that improvements in rehabilitation profiles can be achieved even after prolonged periods of time (i.e., 12 months and over) after onset. This, for one thing, may help in countering a widespread rehabilitation pessimism and, for another, serve in motivating the responsible cost-carrying agencies to pay increased attention to the field of neuro-rehabilitation. Literature concerning systematic assessment of long-term rehabilitation outcomes is sparse and fragmental. Available data to a large extent are in line with our findings. Further accompanying rehabilitation research into these respects is urgently needed. A number of important service delivery/organizational aspects have in addition been traced, which we are already trying to implement within our Vorarlberg rehabilitation model.

Activities of Daily Living↗
PubMed1990

[Psychiatric rehabilitation from the viewpoint of a large psychiatric facility].

The paper makes the reader familiar with the results of activities of the central rehabilitation department in the Psychiatric Sanatorium in Kromĕríz. It postulates views regarding the technique of work with patients and pays special attention to the rehabilitation of patients with schizophrenic psychosis. In these patients the results of rehabilitation care at different rating levels were evaluated. In the field of ergotherapy the schizophrenic patients were evaluated by the therapists and instructors of occupational therapy on entry of and departure from the workshop or class, using the Engelsman--Hájek scale. Based on the results the hypothesis was confirmed of a lower working performance of patients with schizophrenic psychosis, as compared with other diagnostic groups. In the field of remedial exercise and special forms of psychiatric rehabilitation, such as educational and recreational activities, patients with schizophrenic psychosis were evaluated by a doctor and psychologist of the rehabilitation department of the psychiatric sanatorium for after--treatment of psychoses. The patients were evaluated by Wing's scale for chronic schizophrenia and by means of the Scale for Evaluation of Working Performance and Behaviour. According to the results of both scales no significant differences were found between the experimental groups where different forms of rehabilitation were accentuated, as compared with the control group engaged only in occupational therapy. Both scales revealed in both experimental groups highly significant improvement as regards resocialization within a very short period during which the patients were subjected to intense rehabilitation. Based on these results the author recommends further rehabilitation provisions.

Hospitals, Psychiatric↗
PubMed1988

[Stroke. Status and general practice of conservative treatment and rehabilitation].

Adequate help for the apoplectic patient according to recent standards can be given only by simultaneous and equivalent orientation towards both acute therapy and rehabilitation, which should merge smoothly into each other. This can be achieved only by specialised hospitalisation. The idea of totally domestic treatment, as advocated in times past, has to be abandoned for good. In the foreground of acute therapy are treatment of edema, cardiac output and blood pressure, rheological factors: blood viscosity, thrombocyte aggregation, erythrocyte elasticity. In the foreground of rehabilitation efforts we place the principle of "totality and permanence" regardless of prognostic selectivity. The principle of permanence refers to rehabilitative efforts from the very beginning to long-term rehabilitation for months and years with the help of our special rehabilitation service and systematic training of relatives. At least, it has to be stressed that the rehabilitation patient is not a medical waste product and not a symbol of medical surrender either. It would be unfair and senseless to help him through the acute phase and leave him alone during his rehabilitation period. Permanent attention for the apoplectic patient is essential within a system of social medicine. Much is lacking in this respect, as far as academic institutions, advanced training, and information is concerned. We hope that we herewith demonstrate that not only the acute therapy, but also the rehabilitation of the apoplectic patient is a field of scientific fascination, still being in consequent further development. It is intended to give an additional stimulus for the optimal after-care of the apoplectic.

Cerebrovascular Disorders↗
PubMed1985

Knee rehabilitation following arthroscopic meniscectomy.

Guidelines for knee rehabilitation after conventional open meniscectomy are generally well known. Less agreement exists on rehabilitation following arthroscopic meniscectomy. The program is sometimes arbitrary. Rehabilitation should follow a logical progression regardless of the type of surgery performed. Rehabilitation following knee surgery can be divided into four phases: immediate post-operative period, early healing phase, late healing phase, and conditioning for return to preinjury activity. Following arthroscopic surgery, the overall recovery time can be significantly shortened compared to conventional arthrotomy, primarily by decreasing the length of the early postoperative phases. A smaller incision causes less soft-tissue injury to skin, capsule, synovium, and other periarticular structures, resulting in less quadriceps inhibition and a more rapid recovery. The rate of tissue healing is not altered, however, and the knee must still heal completely before the patient can return to a full functional level. Not all patients are rehabilitated uniformly, and a great deal of variability exists following arthroscopic surgery. Factors that affect the speed of rehabilitation and return to normal function are the extent of meniscectomy performed, the coexistence of additional intra- or extra-articular pathology, and individual patient differences. Therefore, an arbitrary time frame for rehabilitation following arthroscopic meniscectomy is not recommended. Rather, each patient should progress from one stage of rehabilitation to the next, based on objective knee findings.

Arthroscopy↗
PubMed1983

[Early complex rehabilitation of children with cerebral palsy].

The aim of a study was to evaluate health, psychological and social problems related to rehabilitation of cerebral palsy children (c.p. children). The study was based on 30 children c.p. who after diagnosis underwent systematic complex rehabilitation. Half of the children was under observation in outpatient clinics and their parents played the role of physiotherapeutists another half of the children apart from ambulatory kind of rehabilitation was hospitalized periodically in rehabilitation centres. Each half year all the children underwent control examinations of physical and motor development (including evaluation of postural and righting reflexes) as well as of psycho-motor development. Environmental conditions, parental attitudes towards examined children taking into consideration their evolution were also evaluated. The therapeutic team consisting of a paediatrician, neurologist, psychologist, physiotheraupeutist and psychiatrist took advantage of these examinations in psychotherapy of parents. Observation period of children was from 1:6 to 3 years. Age when rehabilitation was initiated was below 20 months of life. It was observed that result are influenced mainly by the degree of neurological disorders not by the conditions of rehabilitation. There are differences with regard to motor efficiency between rehabilitation at home and in rehabilitation center. Treatment at home has a better effect upon psychomotor development of children with more serious developmental disorders. Infections of upper respiratory tract are more rare in this group of children. There are two reasons why children in preschool age should be recommended for sanatorium treatment: medical indication e.g. operation and social indications.

Cerebral Palsy↗
PubMed1995

[The cost-benefit of cardiac rehabilitation programs].

In the past 20 years there has been a steady improvement in the short-term prognosis of patients with myocardial infarction, following the introduction of beta blockers, thrombolysis, and aspirin. Cardiac rehabilitation and secondary prevention also has contributed to this improvement. However, the development cardiac rehabilitation is limited and not fully developed in Europe. Multiple reasons are related to the underuse of rehabilitation, between then the increase of economical cost associated rehabilitation services. The participation in comprehensive cardiac rehabilitation show and lower cardiac rehospitalization costs. Also, earlier return to work and less pension cost in patients included in cardiac rehabilitation. Several studies had confirmed rehabilitation programs are more cost-effective, in QALYs terms, that some drugs. Then, cardiac rehabilitation is an efficient health-care resource, and may be economically justified.

Cost-Benefit Analysis↗
PubMed1996

Rehabilitation after meniscal repair.

Meniscal repair as an isolated procedure should be considered for patients who present with clinically symptomatic meniscal tears and who have large, unstable, peripheral, bucket-handle meniscal tears at arthroscopy. Successful repair relieves meniscal symptoms and allows the patient to return to full function. In the authors' study population, patients with adequate repair of the meniscal tears followed a rehabilitation program that allowed immediate ROM and weight bearing as tolerated. They achieved a clinical result comparable to patients who followed a restrictive rehabilitation program. By using a less restrictive rehabilitation program, surgeons may offer patients who require meniscal repairs a program with a shorter interval between the surgical procedure and full return to the activities of daily living and athletics than was offered by previous regimens. From the evidence obtained from the study population using the authors' selection criteria and surgical technique, the accelerated rehabilitation program does not compromise the clinical result. The follow-up period is too short to determine if repair will be successful in protecting the knee joint from the known degenerative changes that follow meniscectomy. It is certain, however, that surgical repair that preserves meniscal tissue can relieve symptoms and allow patients to return to activities at their own pace. Many questions remain to be answered, all of which need to be addressed in the future: What is the natural history of an untreated meniscal tear in an ACL-stable and in an ACL-injured knee? Is suturing necessary for meniscal tears? If so, what type of suturing technique should be used? Is some type of meniscal abrasion or stimulation of the meniscal tear needed to obtain healing? What is the likelihood of a healed, repaired meniscus to retear in the future, even if the initial repair has been successful, especially on the medial side? At present, there is no universal agreement as to what rehabilitation protocol is best. For the past 8 years, the authors have undertaken an accelerated rehabilitation program following isolated meniscal repairs and also following repairs performed in conjunction with ACL reconstructions. With constant patient evaluation and follow-up, clinically successful results have been achieved. A well-designed, prospective, multicenter study of isolated meniscal repair comparing different rehabilitation protocols is desirable to resolve the existing controversial issue of rehabilitation after meniscal repair.

Anterior Cruciate Ligament Injuries↗
PubMed1996

[Cardiologic rehabilitation. An orienting overview].

The European Society of Cardiology has dealt in detail with concepts of cardiological rehabilitation in 1992 and has published guidelines. According to the opinion of this society, the organization of cardiological rehabilitation can differ among the European countries considering the socio-economic structures, legal and insurance regulations as well as national traditions. Guidelines for the standards of cardiological rehabilitation have to be flexible and adaptable to the organization of each European country. According to the opinion of Müller-Fahrnow, the beginning of modern medical rehabilitation in the Federal Republic of Germany is clearly linked to the development of concepts for cardiological rehabilitation at the end of the sixties and beginning of the seventies with a holistic approach under consideration of a kinetotherapeutic and psychosocial focus. A countrywide introduction of the concept of the following curative treatment at the end of the seventies by the insurances contributed to a significant stabilization of the new qualities of rehabilitation and, again the cardiological rehabilitation played an important role (Müller-Fahrnow W., 1994). This paper demonstrates basic elements and structures of the cardiological rehabilitation in an orientating manner and contains conclusions about the future development.

Combined Modality Therapy↗
PubMedDate not supplied

[Evaluation of a project for nutritional rehabilitation at home in Benin].

Childhood malnutrition is a public health problem in most developing countries and the rehabilitation of malnourished children is a real challenge for health services. The main aim of this study was to evaluate the implementation of a community-based strategy for nutritional rehabilitation at home (NRH). This strategy was assessed in two districts of Benin. We also evaluated its effects on the nutrition status of the children involved in the study. Screening and rehabilitation protocols were developed for the project and were defined before the study began. The implementation process was evaluated by checking whether the children registered for NRH had received adequate treatment from the health agencies. Intervention was judged to be adequate if it was consistent with that previously set out in the rehabilitation protocol. The variables studied concerned whether the health workers had adequately implemented NRH and had applied UNICEF's three. "A" (Assessment, Analysis and Action). The results of the rehabilitation process were recorded. The weight and age of the children were determined to evaluate changes in their nutrition status. The study population was a group of 452 children aged 0 to 35 months old. The frequency of NRH sessions was adequate in 259 cases (57.9%), the quality of observations and advice was adequate in 284 cases (63.1%) and the protocol was followed properly in 151 cases (34.1%). At inclusion, 191 children (42.3%) were suffering from mild malnutrition and 146 (32.3%) were suffering from severe malnutrition. Seventy children (15.5%) were rehabilitated as defined in the protocol standards. One hundred and fifty nine children (35.2%) were lost to follow-up, 83 (18.4%) stopped the treatment and 83 (18.4%) were declared rehabilitated when they were not. The nutrition status of 69 of the 70 children who completed NRH had improved. Thus, there are flaws in the implementation process, with the three "A" not being reliably applied by health workers, particularly in terms of analysis and action. However, NRH does seem to be effective for the rehabilitation of children suffering from malnutrition, improving their nutrition status at least.

Benin↗
PubMed1998

[One year follow-up of pulmonary rehabilitation in patients with pulmonary emphysema--physiological outcome].

To evaluate the long-term effects of pulmonary rehabilitation on physiological outcome, 12 patients with pulmonary emphysema were enrolled in an inpatient pulmonary rehabilitation program for 6 weeks. After discharge from the hospital, they were followed up for 1 year. The pulmonary rehabilitation program consisted of breathing retraining, thoracic mobilization, exercise training, and patient education. Although the subjects did not participate in outpatient maintenance group sessions after their discharge, they continued breathing retraining and exercise training at home. Their vital capacity improved significantly, and was sustained over the course of the year; other pulmonary functions, however, did not change significantly. Maximum exercise load increased 31% after the rehabilitation program; although it was 18% higher than baseline at follow-up one year later, that was not a significant change. The follow-up data on exercise traming had generally deteriorated 1 year after the rehabilitation program. The change in maximum exercise load from baseline before and after the inpatient pulmonary rehabilitation program correlated closely with the change in maximum exercise load thereafter to follow-up one year later (R = 0.62). We conclude that it is pessible to estimate long-term change in exercise capacity on the basis of short-term changes achieved during inpatient pulmonary rehabilitation. It may be necessary to develop maintenance programs of some kind to help pulmonary emphysema patients retain the benefits of pulmonary rehabilitation over the longer term.

Aged↗