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PubMed1988

Occupational hearing loss: an aural rehabilitation program for workers and their spouses, characteristics of the program and target group (participants and nonparticipants).

Until very recently, aural rehabilitation programs designed specifically for workers with occupational hearing loss were nonexistent in the Province of Quebec. A pilot study has been conducted to test and develop suitable services for these workers and their spouses, and to explore the factors causing them to seek (or on the other hand, avoid) professional assistance. A trial rehabilitation program was set up for this purpose. Results of a questionnaire conducted among program participants showed that the main factors leading to enrollment in the program were the acknowledgement of moderate or severe hearing handicap and the recognition of the need for help (particularly with problems such as tinnitus and stress, and in using strategies to facilitate communication). These results lend support to the idea of adopting a new approach to rehabilitation services for occupational hearing loss workers. According to the findings of the study, only a very small percentage of workers and spouses participated in the rehabilitation program, despite measures taken to adapt it to their needs. Low enrollment in the rehabilitation program suggests the need for: (1) a more well-defined target population, (2) strategies to promote greater understanding, awareness, and acceptance of hearing handicap on the part of occupational hearing loss workers and peoples surrounding them, (3) education at the work place and in society in general to increase motivation and awareness of the benefits of aural rehabilitation services, (4) integration of the program within the general health program in the work place, (5) measures to enhance the credibility of professionals in the rehabilitation services, (6) general and specific programs and follow-up services, and (7) more accessible services.

Combined Modality Therapy↗
PubMedDate not supplied

[Conceptual basis of rehabilitation of patients with stroke].

The authors describe the basis of the current concept of rehabilitation of patients with stroke. This concept is based on recent neurophysiological findings about the processes of information, learning, and memory. This indicates that the plasticity of cerebral structures depends especially on the possibilities either to rebuild or to compensate for destroyed structures with programs of rehabilitation. A comparison is given of 101 stroke patients rehabilitated according to a conventional program and the better results for 295 stroke victims rehabilitated according to a more modern rehabilitation program. Another investigation showed, as an example of the Babinsky phenomenon, that stroke patients can develop the ability to suppress. The results and dynamics of rehabilitation of stroke are an encouragement to continue researching new ways for more effective rehabilitation.

Aged↗
PubMed1988

Rehabilitative optometric services for survivors of acquired brain injury.

In a retrospective study of clinical management practices, we assessed the impact of offering rehabilitative optometric services to a group of severely head-injured residents of a long-term rehabilitation facility. Each testable patient admitted (n = 55) was screened for visual function, and more than half were identified as having visual problems in need of treatment. A few were sent to local practitioners, but most (n = 26) were referred to a rehabilitative optometrist (with a specialty in low vision). For all but two patients, optometric treatment recommendations were implemented. All of those who received treatment benefited; indeed, in most cases the impact on participation in the overall rehabilitation program was significant. For the severely brain-injured, the study emphasized the need for (1) careful screening of visual-sensory function, (2) referral for rehabilitative optometric evaluation and treatment, (3) taking the necessary time for evaluations, and (4) the value of having a cognitive rehabilitation therapist assist the rehabilitative optometrist.

Adult↗
PubMed1979

[Rehabilitation potential after myocardial infarction].

For determination of the individual rehabilitation potential in patients after myocardial infarction, factors were extracted which are of importance for exercise capacity and its influence upon rehabilitation measures. Further results of exercise tests were correlated with psychological tests (Freiburg-personality-inventory) and the results of a patients' questionnaire for individual self-assessment, with concerning restitution by means of rehabilitation measures. 147 patients were admitted to a controlled rehabilitation program 10 weeks after myocardial infarction or later. Mean increase of exercise capacity after one year of rehabilitation was 21.6% of the initial test. Significantly greater increases of exercise capacity were achieved in patients with regular attendance particularly in younger patients in comparison with older patients. As evidenced by ergometric test data initially low maximal heart rate, low increase of heart rate, low exercise capacity and low double product were correlated with greater increase of exercise capacity. Patients with anterior-wall myocardial infarction tended to increased exercise capacity more. A relation between "psychosomatic disturbance" at onset of rehabilitation and a greater increase of exercise capacity could be determined as a trend. Connections between psychosocial factors and determinants of exercise capacity in influencing the rehabilitation potential are discussed.

Adult↗
PubMed1995

Efficacy of outreach nutrition rehabilitation centres in reducing mortality and improving nutritional outcome of severely malnourished children in Guinea Bissau.

OBJECTIVE: There is still controversy about the efficacy and cost-effectiveness of outreach nutrition rehabilitation centres (NRCs) for severely malnourished children. We wanted to compare the mortality rates and nutritional status of severely malnourished children admitted to rural NRCs in Gabu region, Guinea Bissau, with other severely malnourished children who were not rehabilitated and stayed in their villages. DESIGN: Retrospective cohort study over a 3-year period. Mortality rates and nutritional outcome compared for children who were admitted to rural NRCs and those who were not rehabilitated. Selection for admission to the NRCs was based on availability of places only. SETTING: 19 health areas of the Gabu region, Guinea Bissau, West Africa. SUBJECTS: 1038 severely malnourished children (< 60% weight-for-age using NCHS standards) aged 6 to 47 months. 354 were rehabilitated in NRCs and 684 received no rehabilitation. RESULTS: Up to 36 months follow-up the relative risk of death in the rehabilitated group was 0.75 [95% confidence interval (c.i.) = 0.57-0.99], equivalent to a 25% reduction in mortality. The difference in mortality between the two groups was much higher during the first 3 months [P < 0.02, relative risk = 0.59 (95% c.i. = 0.39-0.91)]. Rehabilitated children had a higher mean weight gain in the first 3 months (1.63 compared to 0.56 weight-for-age standard deviation score, P < 0.001), and weight gain differences lasted up to 18 months (P < 0.01). CONCLUSIONS: Low-cost, outreach NRCs are effective both in the short term and in the mid-term to improve the nutritional situation and reduce the mortality of severely malnourished children.

Child, Preschool↗
PubMed1995

[Patient satisfaction as a criterion of quality assurance in inpatient psychosomatic rehabilitation].

The investigation of patient satisfaction with treatment by means of simple standardised self-rating instruments is a focal point of monitoring and improvement of treatment quality in the programme of quality assurance of rehabilitation within the statutory social insurance system. In the field of psychosomatic rehabilitation this criterion contains a number of problems due to the individual traits of patients, the treatment institutions, and the rehabilitation process. A structural discrepancy between the patients' attitudes and the requirements of the rehabilitation measure causes a systematic potential of dissatisfaction of the patients throughout the whole rehabilitation procedure. The specific quality of psychosomatic rehabilitation requires differentiation in the assessment and interpretation of patient satisfaction as a criterion of quality assurance as well as in the deduction of subsequent measures for improvement. Doubts are also raised as to the usefulness of a simple and global reference to patient satisfaction as a criterion of quality assurance even beyond the field of psychosomatic rehabilitation.

Humans↗
PubMed1994

Social and physical factors in the referral of people with traumatic brain injuries to rehabilitation.

Using standardized data abstracted from a representative sample of hospitals in north-central Alabama, we analyze significant social and physical factors in acute care discharge referral patterns for 756 people with traumatic brain injury (TBI). When a Physical Medicine and Rehabilitation specialist is involved in the referral, patients receive more formal rehabilitation care following discharge, even after controlling for the relevant social and physical characteristics of the patient. Other significant variables predicting the level of rehabilitation care include presence of injury-related complications, abnormal computed tomography scan, longer length of acute care stay, being unmarried, older, and having an unintentional injury. Patients not seen by rehabilitation medicine specialists and/or those whose injuries provide less clinical evidence (implying greater uncertainty of diagnosis) are less likely to be referred to more formal rehabilitation. Thus, social and demographic factors may be significant in referral patterns when diagnostic uncertainty is present. Results suggest the importance of increasing availability of rehabilitation medicine consultation for TBI patients, while informing acute care providers about formal rehabilitation as a management option.

Adult↗
PubMed1994

Prognosis of rehabilitation outcome in head injury using the Disability Rating Scale.

In this correlational study, we investigated the prediction of functional status on discharge from head injury rehabilitation in 64 adults with traumatic closed head injury. Subjects were rated on Rappaport's Disability Rating Scale during rehabilitation to obtain the Disability Rating Score on admission to rehabilitation, recovery rate during the first month of rehabilitation, and discharge Disability Rating Score. Potential prognostic variables included demographic and social characteristics, severity of injury indicators, head injury deficits present on admission to rehabilitation, and initial Disability Rating Score, and recovery rate. Multiple regression analyses were performed to determine if discharge Disability Rating Score could be predicted from subsets of the potential prognostic variables. Significant contributions were made to the regression equations by initial Disability Rating Score, recovery rate, post-traumatic amnesia and cognitive deficits. A single multiple regression containing the four significant predictors retained initial Disability Rating Score and recovery rate as significant. The findings were cross-validated on a new sample of 30 head injury patients. Initial Disability Rating Score on admission to rehabilitation emerged as a useful predictor of rehabilitation outcome.

Adolescent↗
PubMed1996

A pilot study of rehabilitation at home after stroke: a health-economic appraisal.

This study aimed at describing the health-economic implications and organisational issues of rehabilitation at home in south-west Stockholm of 15 acute stroke patients, mean age 68.2, male:female ratio 9:6, independent in feeding and continent one week after their stroke. Average patient satisfaction with different dimensions of care was 92%. Perceived dysfunction, by means of the Sickness Impact Profile, 3 months after stroke was highest for Recreation-and-Pastime, Home Management and Ambulation. Between 3-12 months after stroke, functional improvement was particularly seen in Home Management, Recreation-and-Pastime and Emotional Behaviour. Three fourths of the patients received help with different ADL tasks from a family caregiver and 1/5 from home service assistants. According to the scores for subjective health of the spouses and time used to help the patient, the burden that the programme put on the patient's family was modest, temporary and in accordance with preferences reported by the elderly in Sweden. The mean duration of hospital stay for patients under rehabilitation at home was 14 days and for a selected comparison group with similar ADL-grade, 27 days. The mean number of therapy sessions at home was 11. Each home visit took 3.2 hours, 60% of which were direct patient time. In the selected comparison group, 1/3 was referred to other departments for rehabilitation and care, and 40% had contacts with day-care and paramedical professionals after discharge from the hospital. During the first year after stroke, the average, direct, per capita cost for rehabilitation at home amounted to SEK 127,730 divided between hospital care (50%), followed by contribution by family caregivers (18%), rehabilitation at home (10%), out-patient visits to physicians and nurses (8.8%), home-help service (7%), auxiliary equipment (2%), medication (1.5%), home adaptation (1%) and transportation service (0.3%). This organisational model of home-based rehabilitation of stroke patients constitutes a feasible, possibly less expensive alternative and complement to current rehabilitation in hospital and primary care, which could be further developed and evaluated.

Aged↗
PubMed1996

Rehabilitation after autogenous bone-patellar tendon-bone ACL reconstruction.

In the past decade, changes in the rehabilitation of patients with ACL injuries have made a dramatic impact on the management of the surgically treated ACL-deficient knee. Our rehabilitation program following the ACL reconstruction has been developed over the past 12 years. With close follow-up of our patients, we have modified the rehabilitation program in an attempt to eliminate postoperative complications, ensure long-term knee stability, and allow a safe and rapid return to athletic activities. Our present rehabilitation protocol is divided into four phases. The initial phase encompasses the preoperative period. The second phase involves the first 2 weeks after ACL reconstruction. The third phase extends from 2 to 5 weeks postoperation, and the final phase (> than 5 weeks postoperation) involves a safe return to athletic activities. An aggressive preoperative phase and close attention to full hyperextension, control of swelling, and good leg control during the first postoperative phase are the cornerstones of the rehabilitation program. We continue to evaluate our results closely and to advance our rehabilitation program guided by our patients and continuous follow-up evaluations. We propose that the avoidance of immediate surgery and appropriate preoperative patient preparation, along with postoperative rehabilitation program that emphasizes extension and closed chain function exercises, will optimize the final result.

Adult↗
PubMed1996

Functional outcome of vestibular rehabilitation in patients with abnormal sensory-organization testing.

A goal of vestibular rehabilitation is to improve the functional status of patients with balance disorders. Despite the focus of vestibular rehabilitation on function, few objective data describe the outcome of vestibular rehabilitation in terms of balance function. In this prospective observational study, we tested a well-defined patient cohort (n = 67) with abnormal pretreatment sensory-organization testing who were undergoing vestibular rehabilitation. Patient outcomes were determined by using objective and subjective measures of function before and after rehabilitation. Overall, 60% of patients showed objective improvement of balance function; 25% of patients improved to normal. Analysis of success and failure of vestibular rehabilitation is important as an aid to appropriate patient counseling and efficient use of rehabilitation resources.

Adult↗
PubMed1996

Rehabilitation of neck/shoulder patients in primary health care clinics.

OBJECTIVE: To review the literature pertaining to neck/shoulder pain and its treatment primarily through rehabilitation. A discussion regarding the theoretical basis for clinical rehabilitation is presented. DATA SOURCE: A Medline literature search was performed. English and Scandinavian language articles were reviewed. Key words included neck/shoulder pain, neck pain, rehabilitation and exercise. STUDY SELECTION: The studies included used rehabilitation of the cervical musculature as the main treatment therapy on patients suffering from neck/shoulder pain as defined by the Standardized Nordic Questionnaires. DATA SYNTHESIS: The relatively new concept of neck/shoulder rehabilitation seems to result in pain reduction, restoration of functional values and psychological benefit for patients suffering from chronic, recurrent, post-traumatic or postoperative neck/shoulder pain. Successful protocols seem to be dependent upon sufficient dosage, duration and a relative disregard of pain. Side effects seem to be rare. CONCLUSIONS: Rehabilitation of patients with neck/shoulder pain offers great promise; sufficient documentation exists to warrant serious consideration from all practitioners in the primary health sector. Future studies will be necessary to further clarify which rehabilitative procedures are most suitable for different patient types.

Arthralgia↗
PubMed1996

[Gastroenterologic and hepatologic rehabilitation today--on changes in indications and contents].

The rehabilitation in gastrointestinal diseases has experienced the introduction of new concepts. Regional health resorts (i.e., mineral springs, climate or mud baths) do not play a role anymore. Today, rehabilitation cliniques are teaching and training centers for chronic patients with multiprofessional teams. The need for rehabilitation cannot be derived from the diagnosis alone or the duration of the illness but from the severity of the symptoms and/or additional psychosocial problems. The order of the application of different techniques during medical rehabilitation differs from patient to patient and necessitates a definition of the rehabilitation goal. Chronic inflammatory bowel disease, chronic pancreatitis, and chronic liver diseases are explained as an example. "Rehabilitation of gastrointestinal or metabolic diseases' is often better described with a model of progression than with the traditional model of disablement. Therefore, a network of clinical and ambulant rehabilitation as well as an entanglement of institutions providing hospital care and after-care is required.

Aftercare↗
PubMedDate not supplied

The development and testing of a cardiac rehabilitation audit tool.

Cardiac rehabilitation is a multidisciplinary activity and as such necessitates the development of audit systems that cut across professional boundaries. The objective of this paper is to describe the development and testing of an audit tool for cardiac rehabilitation. The tool, based on published guidelines, comprised three proformas: one for each patient entering a cardiac rehabilitation programme, one for a summary of a series of patients and one for the facilities available. The proformas were tested in three centres that were assessed as either 'high', 'moderate' or 'low' providers of cardiac rehabilitation. The cardiac rehabilitation programme coordinator of each centre examined a consecutive series of 30 patients' case notes and completed the proformas. The proformas were found to be clear and easy to use. Information was obtained that informed users of current practice and provided pointers to improvements in the provision of care. In conclusion, the cardiac rehabilitation audit tool proved to be effective in determining the documented evidence of practice, was better for determining the level of provision than a purely subjective judgement and provided information indicating an individual programme's strengths and weaknesses. This is the first attempt at producing an audit tool for cardiac rehabilitation. However, further work may be required in its refinement.

Heart Diseases↗
PubMed1997

The effect of cognitive status on outcomes following rehabilitation.

BACKGROUND AND OBJECTIVES: Impaired cognition is a determinant of poor recovery following a hip fracture. Because of the risk of poorer outcomes, individuals with impaired cognitive function may be refused admission into a rehabilitation program. This study considered the impact of cognitive status on functional ability over time for older adults who participate in a rehabilitation program. METHODS: We studied a convenience sample of 200 consecutive patients who participated in an inpatient rehabilitation program following an orthopedic event. We obtained complete follow-up data on 181 participants. Baseline data were collected within 48 hours of admission and included demographics, rehabilitation diagnosis, living location prior to admission, the Mini-mental State Examination, and the Barthel Index (BI). Telephone follow-up was made at 3, 6, and 12 months after discharge from rehabilitation, and we obtained information about demographic data and functional status (BI). RESULTS: There were no differences in the demographic characteristics of the two groups except for race; a larger percentage of African-Americans were in the impaired group. There was a statistically significant main effect of time with functional ability of all participants, increasing over the 12-month follow-up period. CONCLUSIONS: This study suggests that rehabilitation of the older adult, both with and without cognitive impairment, can result in improvement in functional ability that is sustained over a 12-month period. Although the findings indicate that those with cognitive impairment have lower functional performance at each testing period, these individuals improved functionally during the course of rehabilitation and maintained their discharge level of functioning for 1 year after discharge.

Aged↗
PubMed1998

[Partial inpatient treatment as a responsibility in psychosomatic rehabilitation].

Day clinic rehabilitation is part of the development of the medical rehabilitation system. Psychosomatic rehabilitation faces the task of developing a concept of day treatment and of collecting experiences with such models in clinical practice. The basis of this task consists in regulations laid down by the social security insurance authorities which serve as a frame for the development. The main points of these regulations are presented and their relevance for psychosomatic rehabilitation is outlined. The institutional and conceptual establishment of day treatment presents psychosomatic rehabilitation with a number of problems that are particular in this area and which are discussed in detail. Besides that, consequent elaboration of day treatment could stimulate further development of psychosomatic rehabilitation in general and help to overcome prevailing shortcomings of this part of the rehabilitation system.

Day Care, Medical↗
PubMed1998

Interventional cardiology in perspective: impact on cardiac rehabilitation.

Exponential evolution of percutaneous, catheter-based revascularization has modified traditional premises of cardiac rehabilitation. With increasing numbers of percutaneous transluminal angioplasty (PTCA) procedures relative to coronary artery bypass grafting interventions, the need for in-patient rehabilitation is declining; on the other hand, the need for life-style counselling within the framework of out-patient rehabilitation is increasing. Risk factor interventions are important to minimize and to retard the progression of the disease. Rehabilitation programmes offer exercise training, stress modification and life style counselling to reduce cardiovascular risk factors and to increase exercise capability. Since costs of out-patient rehabilitation seem to be lower than those of in-patient rehabilitation, a case may be made in favour of directing limited funds to additional interventions and to saving money by replacing in-patient rehabilitation with outpatient programmes after PTCA. The budget-holder has to make the choice.

Angioplasty, Balloon, Coronary↗
PubMed2004

Impact of a viral respiratory epidemic on the practice of medicine and rehabilitation: severe acute respiratory syndrome.

Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in China but has affected many parts of the world, with devastating impact on economies and the practice of medicine and rehabilitation. A novel coronavirus has been implicated, with transmission through respiratory droplets. Rehabilitation was significantly affected by SARS, because strict infection control measures run counter to principles such as multidisciplinary interactions, patients encouraging and learning from each other, and close physical contact during therapy. Immunocompromised patients who may silently carry SARS are common in rehabilitation and include those with renal failure, diabetes, and cancer. Routine procedures such as management of feces and respiratory secretions (eg, airway suctioning, tracheotomy care) have been classified as high risk. Personal protection equipment presented not only a physical but also a psychologic barrier to therapeutic human contact. Visitor restriction to decrease chances of disease transmission are particularly difficult for long-staying rehabilitation patients. At the height of the epidemic, curtailment of patient movement stopped all transfers for rehabilitation, and physiatrists had to function as general internists. Our experiences strongly suggest that rehabilitation institutions should have emergency preparedness plans because such epidemics may recur, whether as a result of nature or of bioterrorism.

Communicable Diseases, Emerging↗