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PubMed2005

Rehabilitation of orthopedic and rheumatologic disorders. 3. Total hip arthroplasty rehabilitation.

UNLABELLED: This self-directed learning module highlights a clinical vignette of a female patient who had a total hip arthroplasty. The module addresses the medical management and rehabilitation interventions necessary to direct the postacute care needs of this patient. It is part of the study guide on rehabilitation of the joint replacement patient in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes planning for discharge from the acute care hospital, postacute care medical complications, and rehabilitation program elements germane to the patient with hip joint replacement. OVERALL ARTICLE OBJECTIVE: To summarize the postacute care planning, medical complications, and rehabilitation needs of the patient with hip joint replacement.

Aged↗
PubMed2003

Characterization and correlates of medical and rehabilitation charges for traumatic brain injury during acute rehabilitation hospitalization.

OBJECTIVE: To identify factors associated with specific categories of charges during acute inpatient rehabilitation treatment after traumatic brain injury (TBI). DESIGN: Prospective observational study. SETTING: A single Traumatic Brain Injury Model Systems (TBIMS) center. PARTICIPANTS: Eighty-four consecutive TBIMS patients. One exploratory analysis also included all 350 patients with TBI admitted during 1999. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Average daily charges for specific categories of resource use (eg, room and board, rehabilitation therapies, functional labs). RESULTS: Room and board and rehabilitation therapy accounted for almost 90% of average daily charges. There was no linear component of change in average daily charges, but certain categories of charges were significantly higher during the first week than thereafter. Functional status at rehabilitation admission correlated with charges for respiratory, medical, and surgical supplies and with pharmacy and radiology, but not the other categories. Specific medical variables also correlated with specific charge categories. Focused chart reviews of patients with low and high charges in specific categories led to the formulation of additional predictive hypotheses. CONCLUSION: Certain categories of charges correlated with functional scores and acute medical variables that are known before admission to acute inpatient rehabilitation, allowing for better inpatient admission planning under prospective payment. Further research is needed to identify and correlate resource use that is bundled within the room and board category.

Brain Injuries↗
PubMed2002

[Rehabilitation score for patients with type 2 Diabetes mellitus: An instrument to standardize assessment of the need for rehabilitation].

Type 2 diabetes is considered a multidimensional health impairment which includes several components like risk factors, cofactors and complications. The early and consequent therapy of all of these components reduces secondary complications. Instead of simply applying drug treatment, a more holistic concept including behavioural medicine therapy and empowerment of patients has been found much more effective. The facilities required for such a multifactorial therapy by different health care professions could easily be provided by the medical rehabilitation services available under the German pension insurance scheme. However, this emphasizes the demand for standardized protocols to achieve an objective allocation of rehabilitation services to individuals in need. In an epidemiological study on 12 429 working insurants (age 41 - 60 years) of the pension insurance fund in the region of Luebeck, persons suffering from type 2 diabetes were identified and evaluated regarding a need for medical rehabilitation. Therefore, an algorithm was developed quantifying the multidimensional disturbances which accumulate in type 2 diabetes mellitus. The following indicators are taken into consideration: risk factors like eating behaviour, lack of physical activity, smoking and stress; metabolic parameters such as HbA1c and plasma lipids; cofactors like hypertension and depression and, additionally, the acute complication of hypoglycaemia. Based on this rehabilitation score, 19 % of cases in a preliminary evaluation of 79 patients with type 2 diabetes showed a need for medical rehabilitation therapy.

Adult↗
PubMedDate not supplied

Changes in exercise capacity following cardiac rehabilitation in patients stratified according to age and gender. Results of the Massachusetts Association of Cardiovascular and Pulmonary Rehabilitation Multicenter Database.

BACKGROUND: Using information collected prospectively from a multicenter cardiac rehabilitation database, this study was designed to evaluate baseline exercise tolerance and subsequent change in functional capacity among consecutive patients enrolled in supervised cardiac rehabilitation stratified according to age and gender. In addition, the study evaluated change in functional capacity among those with the lowest initial exercise tolerance (<5 METS) and assessed patient factors that correlate to the highest relative improvements in functional capacity after training. METHODS: A total of 778 patients performed an initial exercise test upon entry into cardiac rehabilitation, during which peak heart rate, blood pressure, and estimated peak MET levels were derived, and ischemic responses were evaluated. After 10 +/- 2 weeks of supervised prescribed exercise, 500 patients who completed the program performed follow-up exercise testing. RESULTS: The subjects included 558 men (72%) and 220 women (28%) of whom 492 (63%) were <65 years, 241 (31%) were 65 to 75 years, and 45 (6%) were >75 years. At baseline, the peak initial MET level for men was 8.6 +/- 3.4 METS and for women was 6.0 +/- 2.6 METs. The peak initial MET level declined with age: age <65 = 8.9 +/- 3.4 METS; age 65 to 75 = 6.6 +/- 2.6 METS; and age >75 = 5.7 +/- 2.9 METS. When stratified according to age and gender, the baseline exercise tolerance for men significantly (P <.0001) declined with age and was higher than that of women <65 and 65 to 75 years of age. After training, the relative improvement in exercise tolerance for each age and/or gender subgroup was: age <65: men 36%, women 41%; age 65 to 75: men 36%, women 50%; and age >75: men 36%, women 32%. Among 163 patients with an initial peak MET level <5, exercise tolerance rose from 4.1 +/- 0.7 to 8.3 +/- 3.5 METS (P <.0001). Multivariate analysis demonstrated that the greatest change in exercise tolerance with training was associated with those compliant patients with initial peak METS <5. No significant net change in the occurrence of exercise-induced ischemia was observed. CONCLUSIONS: Among consecutive patients enrolled in cardiac rehabilitation, baseline exercise tolerance differs relative to age and gender, with male gender and younger age demonstrating the highest functional capacity. Exercise training yielded significant improvements in exercise tolerance among men and women of every age group including those older than 75 years, and particularly among those with an initial peak MET level <5. Thus, referral to cardiac rehabilitation programs should be advocated for both men and women, and should not be limited by age.

Adult↗
PubMed2004

Virtual reality and physical rehabilitation: a new toy or a new research and rehabilitation tool?

Virtual reality (VR) technology is rapidly becoming a popular application for physical rehabilitation and motor control research. But questions remain about whether this technology really extends our ability to influence the nervous system or whether moving within a virtual environment just motivates the individual to perform. I served as guest editor of this month's issue of the Journal of NeuroEngineering and Rehabilitation (JNER) for a group of papers on augmented and virtual reality in rehabilitation. These papers demonstrate a variety of approaches taken for applying VR technology to physical rehabilitation. The papers by Kenyon et al. and Sparto et al. address critical questions about how this technology can be applied to physical rehabilitation and research. The papers by Sveistrup and Viau et al. explore whether action within a virtual environment is equivalent to motor performance within the physical environment. Finally, papers by Riva et al. and Weiss et al. discuss the important characteristics of a virtual environment that will be most effective for obtaining changes in the motor system.

Journal Article↗
PubMedDate not supplied

[Towards a comprehensive theory of the rehabilitation of cerebral function as a basis for programmes of rehabilitation in brain damaged patients].

INTRODUCTION: Definition of the programme on integral rehabilitation needed by each patient after a cerebral lesion is today a clinical challenge which still requires much investigation. The many advances in all fields of the neurosciences give a great stimulus and fresh hope in tackling these problems. For practical advances in treatment it is important that clinicians make an effort to explain which are the theoretical models used in this complex field of the CNS, or which models may be used to develop new programmes of treatment. DEVELOPMENT: In this paper we summarize some of the current models of rehabilitation of psychic and neuropsychological functions based on experience acquired in the rehabilitation of chronic psychiatric patients and the newer findings of neurophysiology, neuro-imaging, neuropharmacology, neuropsychology etc. We also offer suggestions for effective organization of the work of rehabilitation teams. The newer models to be developed in the future should be suitable for the determination of what should be rehabilitated? (altered functions), how? (substitution, restitution, integration, activation, etc.) and when? (in what chronological order should these interventions take place and at what point). CONCLUSION: Work with definite theoretical models on which to base diagnosis and treatment of psychic function would facilitate comparison of results and allow better understanding of the working of the normal brain.

Brain Injuries↗
PubMed2002

[Movement rehabilitation, psychotherapy and respiratory rehabilitation in patients with chronic obstructive pulmonary disease].

The purpose of rehabilitation is to restore good physical, mental emotional, social condition and if at all possible efficiency at work in a patient with an obstructive pulmonary disease. The most important aspect of rehabilitation is an individual attitude to each patient. A patient with chronic disease and different degree of failure of the respiratory tract struggles with abnormal lung function i.e. with dyspnoea and general physical weakness. Obviously, a slight disturbance in the function of the respiratory system is almost imperceptible in daily activities, thus patients complain about slight fatigue that recedes after a short rest. The values of basic spirometric indexes FVC, FEV1 are within normal. Only disturbances of the function of peripheral air passages MEF50%VC, MEF25%VC indicate the onset of failure in the distribution of inspired gas and alveolar hypoventilation as well as violation of normal air flow in the peripheral bronchioles whose diameter is less than 2 mm. Anxiety and concern for health appear with increased dyspnoea while doing exercises and within years dyspnoea will accompany daily domestic routine activities. It is known that such factors as pollution of the environment, smoking tobacco, viral infections in childhood, bacterial infections of the respiratory system, prematurity, respiratory distress syndrome (RDS) and different degree of bronchi-pulmonary dysplasia favour the development of chronic obstructive pulmonary disease. The decrease of FEV1 more than 40 ml per year shows the increased respiratory failure. Ventilatory reserves of the respiratory system systematically diminished exceeding the predicted limit 80%. COPD is a chronic progressive disease causing irreparable obstruction of the bronchi. Then changes in the structure of the bronchial tree are seen as well as the increased tension of the smooth muscles which depend on the parasympathetic system. Does the progression of the disease indicate the lack of effective treatment? The sick patient starts doubting about the right diagnosis, medicines, rehabilitation and medical team. It is necessary to analyse and update again therapeutic treatment and rehabilitation. Movement and respiratory rehabilitation, regardless of the degree of COPD severity, has in principle five major tasks: 1. The control, alleviation, delay of pathological processes causing the increased pulmonary failure. 2. Improvement of physical condition. 3. The study of physiotherapy and coping with stress in patients with dyspnoea and progressive disease. 4. Improvement of the standard of life and prolonging lifespan. 5. The decrease of medical care expenses.

Activities of Daily Living↗
PubMed1990

Cardiovascular, pulmonary, and cancer rehabilitation. 3. Pulmonary rehabilitation.

This self-directed learning module highlights advances in pulmonary rehabilitation. It is a section of the chapter on cardiovascular, pulmonary, and cancer rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section reviews the anatomy and physiology, pathophysiology, and clinical and laboratory findings in pulmonary disorders. Therapeutic modalities for obstructive and restrictive pulmonary disorders are discussed. Advances covered in this section include the pulmonary rehabilitation of chronic obstructive pulmonary disease patients with elevated pCO2, techniques of respiratory muscle rest, pulmonary rehabilitation of the patient with paralytic restrictive respiratory disorders, and the use of noninvasive intermittent positive-airway-pressure-assisted ventilation for long-term assisted ventilation.

Bibliographies as Topic↗
PubMed1995

[Rehabilitation in rheumatoid arthritis (RA) patients--assessment of effects of rehabilitation based on activities of daily living (ADL)].

The 37 hospitalized RA patients undergoing rehabilitation (for 4 weeks) were evaluated on effects of rehabilitation by comparing scores of ADL at the time of admission and discharge. Items of ADL were composed of 32. Items of ADL which were likely to be disabled were related to those of ADL which were influenced by rehabilitation (r = 0.7412, p < 0.01). From this result, 11 items of ADL which were likely to be disabled and influenced by rehabilitation could be selected in order. Usefulness of these selected items of ADL on evaluation of rehabilitation was admitted.

Activities of Daily Living↗
PubMed2003

The Uniform Data System for Medical Rehabilitation report: patients discharged from subacute rehabilitation programs in 1999.

This is the third annual report describing patients discharged from subacute rehabilitation programs in the United States that subscribe to the Uniform Data System for Medical Rehabilitation (UDSmr). The analysis included 39,562 complete records of first admission cases discharged alive from 180 facilities in 1999. Sixty-five percent of the patients were women, and most patients (91%) were white. Sixty-two percent of the patients were 75 yr of age or older. Before the impairment onset, 55% lived with at least one other person. The average total FIM (motor and cognitive) score change for all patients was 21.1 points, and when stratified by rehabilitation impairment group, average scores ranged from 18.3 for patients with pulmonary conditions to 25.3 for patients with a joint replacement. The percentage of patients discharged to a community-based setting ranged from 67% for patients with stroke to 94% for patients with a joint replacement. These data show that patients receiving care in subacute rehabilitation programs show measurable functional improvement and that a high percentage of patients are discharged to community-based settings.

Activities of Daily Living↗
PubMed1983

[Experience with the rehabilitation of stroke patients in a specialized rehabilitation polyclinic].

The success of treating 549 patients who had survived cerebral stroke and received a course of therapy at a specialized rehabilitation outpatient clinic has demonstrated the feasibility and efficacy of rehabilitation in outpatient conditions. Comparison of the results of treatment in the study (139 patients) and the control (100 patients) groups offers a good idea as to the social significance of such rehabilitation. 75.8% of the study patients admitted for treatment immediately after the acute stage of the disease were found capable of working (including subjects with minimal disability), whereas the corresponding figure in the control group was only 16%. A new organizational structure, a neurologic outpatient rehabilitation department, providing combined biological and psychosocial methods of treatment is discussed. The principles of the design of the therapeutic and restorative process including psycho- and physiotherapy, as well as special methods of exercise therapy and occupational therapy are presented.

Adult↗
PubMed2005

Interorganizational collaboration in occupational rehabilitation: perceptions of an interdisciplinary rehabilitation team.

INTRODUCTION: Various obstacles to and facilitators of collaboration between an interdisciplinary work rehabilitation team and the stakeholders (workers, insurers, physicians, and employers) exist, but are not well characterized. METHODS: An observational study was conducted, using videotapes of interdisciplinary team discussions of ongoing cases involving 22 workers absent from work due to musculoskeletal disorders. The actions taken and strategies adopted by the team in an effort to overcome the obstacles to collaboration were studied. RESULTS: Various factors influence collaboration between the rehabilitation team and the stakeholders. In general, stakeholder endorsement of the team's therapeutic principles and confidence in their approach emerged as particularly important factors. Diverse strategies, most often, education and awareness-raising, were used by the team to foster collaboration among the parties. CONCLUSIONS: This study provides greater insight into the factors affecting collaboration among a rehabilitation team, an injured worker and other stakeholders. The results may improve understanding of the actions taken by rehabilitation teams and help to optimize their practices.

Decision Making↗
PubMed2005

The further development and validation of the Liverpool Oral Rehabilitation Questionnaire: a cross-sectional survey of patients attending for oral rehabilitation and general dental practice.

BACKGROUND: Since the first version of the Liverpool Oral Rehabilitation Questionnaire (LORQ) was first published in 2004, the questionnaire has been modified to include more detail on chewing and appearance, and also details of denture, dental and implant status. AIM: The aim of this study is to report the ongoing development and validation of the LORQ version3. METHODS: A postal survey of the LORQv3 and OHIP-14 questionnaires was performed in April 2004 of 164 patients who had attended the oral rehabilitation clinic from February 2000. In addition The LORQv3 was administered to 349 patients attending six General Dental Practices, based in Liverpool, attending for routine care. RESULTS: Patients attending GDP scored appreciably better on most items in the LORQv3. The questionnaire discriminated between cancer and non-cancer oral rehabilitation patients in items such as swallowing, chewing, trismus, drooling and food clearance. There was no significant difference between rehabilitation groups for any of the seven OHIP-14 domains. The LORQv3 demonstrated good criterion validity when compared to the OHIP-14 with social items in the LORQv3 correlating well with items of the OHIP-14. Conversely various LORQv3 items did not have strong correlates within the OHIP-14 thus endorsing the additional items in the LORQv3.

Adolescent↗
PubMed1996

Cardiovascular, pulmonary, and cancer rehabilitation. 1. Cardiac rehabilitation.

This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of cardiac patients and other rehabilitation patients with cardiac diseases. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. New advances covered in this article include the management of patients who have undergone cardiac surgery, including transplantation, and gender differences in evaluation, therapy, and outcome.

Persons with Disabilities↗
PubMed2006

Rehabilitation is compromised by arousal and sleep disorders: results of a survey of rehabilitation centres.

PRIMARY OBJECTIVE: To investigate the impact of disorders of arousal and sleep disturbance on everyday living and participation in rehabilitation. RESEARCH DESIGN: Survey of rehabilitation centres based on naturalistic observation. METHOD: One hundred and thirty-five adults with acquired brain injury were reported by rehabilitation staff in seven centres across the UK for presence of arousal and/or sleep disturbance, the impact on rehabilitation and daily living and treatment strategies in use. OUTCOMES: Disturbance of arousal or sleep patterns was reported in 47% of the sample, with significant adverse effect on activity evident in two-thirds of such cases. Prevalence of disordered arousal was consistent over time for up to 10 years post-injury. Concurrent psychiatric illness, but not epilepsy, was associated with arousal and sleep disorder. Non-pharmacological interventions and benzodiazepine/hypnotic drugs were in use in 34% and 20% of cases respectively. In all cases of prescribed hypnotic drugs, period of use exceeded recommended UK guidelines. CONCLUSIONS: Long-term outcome from severe brain injury can be compromised by enduring disturbance of arousal, most commonly evidenced as sleep disorder. Treatment should be based on judicious use of medication (beyond hypnotic drugs) and greater emphasis on non-pharmacological management.

Activities of Daily Living↗
PubMed1988

Return to work after rehabilitation in coronary bypass patients. Role of the occupational medicine specialist during rehabilitation.

The aim of the study was to assess the role of the occupational medicine specialist in improving return to work (RTW) after coronary bypass graft (CABG) surgery, with an early intervention in the rehabilitation programme of the patients. There were 57 patients (56 male, 1 female, mean age was 50.7 years), sent for rehabilitation 22 days after surgery (49% of them had a prior myocardial infarction, and the ejection fraction (EF) was greater than or equal to 0.55 in 67%, 0.30 less than EF less than 0.55 in 25%, or less than or equal to 0.30 in 8%; myocardial revascularization was complete in 47% of the patients). Jobs required a high level of physical activity in 52.5% of the patients, a medium or low level in 44% and 3.5% of the patients were unemployed. At 7 months follow-up, 73.2% out of the 56 alive patients had returned to work with a mean delay of 109.9 +/- 84 days after surgery. The causes of non-return to work were social and economical factors (46.6%), psychological factors (40%) and medical reasons (13.4%). No clinical data were correlated with return to work (age, EF, extent of revascularization, or results of the stress tests), but return to work varied with the energy requirement in jobs with 97.3% return to work in case of low physical level, and 46.7% in case of high physical level (P less than 0.001). The comparison with a previous study performed in 1984 in 45 rehabilitation patients (with non-systematic vocational counselling), showed an increase in return to work in cardiac patients from 51% to 78% (P less than 0.05) after intervention of the occupational physician. So, the different ways of improving return to work in post-CABG patients are complementary: exercise training and secondary prevention are important, but must be completed with individual vocational counselling that should be included in every rehabilitation programme.

Adult↗
PubMed2006

Pathophysiology of stroke rehabilitation: the natural course of clinical recovery, use-dependent plasticity and rehabilitative outcome.

Even though the disruption of motor activity and function caused by stroke is at times severe, recovery is often highly dynamic. Recuperation reflects the ability of the neuronal network to adapt. Next to an unmasking of latent network representations, other adaptive processes, such as excitatory metabolic stress, an imbalance in activating and inhibiting transmission, leading to salient hyperexcitability, or the consolidation of novel connections, prime the plastic capabilities of the system. Rehabilitative interventions may modulate mechanisms of neurofunctional plasticity and influence the natural course after stroke, both positively, but potentially also acting detrimentally. Though routine rehabilitative procedures are an integral part of stroke care, evidence as to their effectiveness remains equivocal. The present review describes the natural course of motor recovery, focusing on ischemic stroke, and discusses use- and training-dependent adaptive effects. It complements a prior article which highlighted the pathophysiology of plasticity. Though the interaction between rehabilitation and plasticity remains elusive, an attempt is made to clarify how and to what extent rehabilitative therapy shapes motor recovery.

Brain↗
PubMed2002

Development and implementation of the Rehabilitation Activities Profile for children: impact on the rehabilitation team.

OBJECTIVE: To describe the changes in functioning of the rehabilitation team induced by the Rehabilitation Activities Profile for children (Children's RAP), an instrument designed to improve interdisciplinary communication in paediatric rehabilitation. DESIGN: Multiple case-study design. SUBJECTS: Seven paediatric rehabilitation teams. INTERVENTION: A two-year project to develop and implement the Children's RAP. DATA COLLECTION: During the project, data were gathered from observations, documents and informal interviews. After the project, formal interviews were held with team members and parents, and a focus group meeting with representatives of the teams was organized. DATA ANALYSIS: Data were analysed by the method of analytic induction. The analysis was checked by an independent researcher. The preliminary results and conclusions were discussed in detail with participating teams. RESULTS: Development and implementation, as well as the changes induced by the project, varied between teams. Changes were observed for individual team members, for the team as a whole and for the children and their parents. However, changes for individual team members occurred relatively quickly, in comparison with the other changes. To achieve an optimal interdisciplinary team approach all changes are necessary. Therefore, we postulated four hierarchical steps in the development of an interdisciplinary team approach: (1) process-oriented approach, (2) result-oriented approach, (3) problem-oriented approach, and (4) interdisciplinary team approach. CONCLUSION: It took a considerable amount of time to achieve the interdisciplinary team approach by implementing the Children's RAP. However, the first steps are not only rewarding in themselves, but also prerequisites for further improvement.

Adolescent↗