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Occupational therapy and rehabilitation: an awkward alliance.

This article argues that although occupational therapy and rehabilitation are often considered synonymous, the latter is but one aspect of the former. Early influences on occupational therapy are briefly reviewed, and some philosophical ideas about activity are described. The rationale for the use of occupations as treatment in the early part of this century, both in Canada and in the United States, is examined and contrasted with the development of physical medicine and rehabilitation after World War II. This discussion demonstrates that the origins of occupational therapy and rehabilitation in North America had little in common. As occupational therapy became incorporated into rehabilitation, the profession's core values eroded, and although current definitions of rehabilitation offer a more appropriate fit for occupational therapy, rehabilitation continues to see engagement in occupations as a separate and subsequent step. The article concludes by considering future directions and the tasks that lie ahead.

Canada↗

Closed-chain rehabilitation for upper and lower extremities.

Closed-chain exercise protocols are used extensively in rehabilitation of knee injuries and are increasingly used in rehabilitation of shoulder injuries. They are felt to be preferable to other exercise programs in that they simulate normal physiologic and biomechanical functions, create little shear stress across injured or healing joints, and reproduce proprioceptive stimuli. Because of these advantages, they may be used early in rehabilitation and have been integral parts of "accelerated" rehabilitation programs. The authors review the important components of a closed-chain rehabilitation program and provide examples of specific exercises that are used for rehabilitation of knee and shoulder injuries.

Arm↗

Benefits of rehabilitation in the presence of advanced age or severe disability.

OBJECTIVE: To review the economic and psychosocial benefits of rehabilitation for patients with advanced age or severe disability. PATIENTS: Fifteen patients admitted to the Mount Royal rehabilitation unit who had been rejected by other rehabilitation services. OUTCOME MEASURES: Discharge destination; and the relative costs of rehabilitation with continuing community support and nursing home care. RESULTS: In 11 of 12 patients who were discharged home, the cost of rehabilitation was significantly less than the cost of nursing home care. The psychosocial implications are discussed. CONCLUSION: Rehabilitation for patients with advanced age or severe disability can be cost effective in economic and (by presumption) in psychosocial terms.

Aftercare↗

[Community rehabilitation systems--studies on physical training for the disabled in Kitakyushu].

We evaluated the personal profile, activities of daily living (ADL), and quality of life (QOL) of 52 disabled adults who participated in the community rehabilitation services of Kitakyushu Welfare Center for the Crippled to determine the appropriateness of the rehabilitation system in Kitakyushu City. It was found that most of the participants were satisfied with the community rehabilitation services: a high score in the ADL evaluation, and a moderate score in the QOL evaluation. In this paper we propose the problems regarding 1) proper connection and division of rehabilitation services between hospitals and community rehabilitation centers, 2) long-standing participants, and 3) rehabilitation programs that are different from those performed in hospitals.

Activities of Daily Living↗

The characteristics of physical exercise programs in rehabilitation: a means of analysis.

The relatively few number of articles available concerning the utility of physical exercise or physical sports activities within rehabilitation, according to a recent literature search, may reflect a general scarcity of such articles and/or programs. According to the 115 references located however, exercise appears potentially useful as a rehabilitation tool, in spite of various programmatic and methodological complications. It is apparent that all forms of exercise training are not suitable for all rehabilitation clients. However, based on the rehabilitation-related characteristics of the 15 different activities represented herein, there are certain forms of physical exercise which (1) are more congruent with normalization principles, (2) are more easily adapted to all disabilities, including the elderly, and (3) employ brief, high-intensity training principles, and therefore seem to be well suited for rehabilitation programming, in general. The anecdotal and empirical reports represented in this literature analysis should provide a base for continued investigation of the rehabilitative impact and relative efficiency of physical fitness/sports activities upon impaired individuals.

Humans↗

[Concept and measurement of need for rehabilitation--framework for a multidimensional investigational approach].

As before the concept and content regarding the need for rehabilitation have still not been sufficiently clarified. In particular, an operationalization of the underlying parameters, as the basis for their measurement is absent. Some exemplary research concepts have been introduced and their methodological implications have been put out. Resulting from this, up till now, in the most developed model, determining the need for rehabilitation has been developed as a latent multi-dimensional variable. A framework, as a starting point for a multi-dimensional investigation regarding the need for rehabilitation has been introduced. According to this, the need for rehabilitation is a multidimensional, qualitative construct, that can not be directly observed and measured. The empirical investigation, which is based on this, limits the description of the need for rehabilitation to the various patterns of determinants, (description by a set of requirement factors and arranged factors) which result in different effects. Therefore different samples regarding the qualitative aspect do not mean the lesser or greater need for rehabilitation based on a continuum of measurement, but different qualitative forms which are visible in different effects.

Germany↗

[Sex-specific predictors of utilization of cardiologic rehabilitation from the epidemiologic viewpoint].

Among men and women cardiovascular diseases are among the three main causes for early retirement and participation in rehabilitation programmes. Rehabilitation research has only recently taken notice of the potential effect of gender on the need and outcome of cardiac rehabilitation care. Findings from epidemiological studies suggest that sex differences exist at every stage of heart disease and therefore may also be important for the quality and quantity of gender specific rehabilitation needs. Based on results from epidemiological studies this article first describes some essential biomedical differences between men and women regarding coronary heart disease which should be taken into account when type and amount of rehabilitation programmes are discussed. Afterwards, some recent findings are presented which focus on gender specific aspects of the use and acceptance of rehabilitation procedures.

Adult↗

[Treatment dropout as failed utilization--development of a predictive model for inpatient psychosomatic rehabilitation].

Premature discontinuance of rehabilitative measures can be considered a revised decision by the patient concerning participation or a revised decision by the clinic concerning admittance. Such termination of therapy suggests that the individual need for rehabilitation (defined as the fit between the patient's need for rehabilitation and the treatment offered by the rehabilitation facility) is not (or no longer) present, at least at this point in time. Assuming that the individual need for rehabilitation actually existed when treatment was requested or approval for rehabilitative measures was granted, the question arises as to when and how the need changed in such a way that would prevent the treatment from continuing as planned and being concluded in a regular fashion. This question will be taken into focus in the present article by developing a model for the prediction and explanation of prematurely discontinued treatment. This model will give central significance to the intention to co-operate, which is considered a dependent variable by reference to individual symptoms and treatment related expectations. Furthermore, various factors of influence during the stay in the clinic are formulated, which, firstly, have a presumed effect on the intention to cooperate and, secondly, have an influence on whether the intention to prematurely terminate treatment develops from a specific intention to cooperate and whether this is then realized. The model is discussed with regard to its practicability and possibilities for operationalization.

Germany↗

The rehabilitation marketplace: economics, values, and proposals for reform.

This article examines whether the ideals, goals, and values of medical rehabilitation can be realized in a market-based health care system. The article observes that rehabilitation is greatly disadvantaged in today's health care marketplace, which violates virtually all the assumptions of a perfectly competitive one. Nevertheless, the authors argue that rehabilitation goals and market economics are not inherently incompatible and call for several market reforms that are congruent with both rehabilitation goals and market theory. These reforms will clarify and facilitate providers' fiduciary responsibilities to patients as well as their accountability to payers. The authors conclude that while the marketplace is an inevitable medium for realizing rehabilitation goals, the vision and value of rehabilitation will not derive from the internal workings of the marketplace but ultimately from committed individuals and socially responsible institutions outside the marketplace.

Health Care Reform↗

[Child neurology and rehabilitation].

The history of child neurology and the changing pattern of research methods in this field are reviewed with special reference to holoprosencephaly and recent technical advances in sleep research. This is followed by a discussion on the relationship between child neurology and rehabilitation. The majority of child neurologic disorders are developmental disabilities, but acquired child neurological diseases also show chronic progressive course in many cases. Therefore, child neurologist should understand the basis of rehabilitation approach and appreciate the three classes of disabilities; subsequently, a plan needs to be incorporating medical treatment and a program of rehabilitation for the disabled children. It is important that the role of the various rehabilitation specialists (rehabilitation doctor, physiotherapist, occupational therapist, and others) are understood in relation to the work of pediatric neurologist. Finally, a brief discussion is presented on the rehabilitation approach of patients with hypoxic encephalopathy and the information of welfare equipment.

Child↗

New directions in pediatric rehabilitation measurement: the growing challenge.

The Center on Rehabilitation Effectiveness (CRE) was created in 1998 at Boston University's Sargent College of Health and Rehabilitation Sciences. An important reason for the creation of the Center was demand by purchasers of health services and patients for high quality yet cost-effective rehabilitation programs, particularly with respect to pediatric services. This demand for accountability has created many pressures and challenges for the psychometric community. These challenges include: pediatric rehabilitation assessments that are conceptually grounded in rehabilitation theory; new instruments that are short yet sensitive enough to detect meaningful disability restrictions and that are sensitive enough to measure meaningful change; and new scales that offer real meaningful comparisons across patients. The purpose of this paper is to explain how the Center for Rehabilitation Effectiveness will meet these growing challenges.

Academies and Institutes↗

Rehabilitation while standing.

Paraplegia caused by traumatic vertebrospinal lesions too often signifies paralyzing motor injury, and the rehabilitator is attributed the task of activating all of the rehabilitation procedures aimed at restoring an acceptable level of independence for the patient in terms of self-management and transferral. Traditional rehabilitation protocols have as a maximum objective the strengthening of the districts located above the injury, and their use in motori compensation operations aimed at maintaining the paralyzed region located below the injury. The main aim is that of training the patient to use the wheelchair and to adapt to his or her disability. Still today, many famous foreign spinal centers substitute the term "rehabilitation center" with "adaptation center." Today, we wish to bring the patient back to an erect physiological posture and walking, aided by his or her own limbs. New proposals for rehabilitation are observed that may be defined "rehabilitation while standing."

Humans↗

[Strategies to follow in the design of neuropsychological rehabilitation programs for brain injured people].

INTRODUCTION: Before initiating the planning of the neuropsychological rehabilitation program for a brain injured patient, it is necessary to make and comprehensive neuropsychological evaluation. This evaluation has to be oriented, not only to the scores obtained, but how cognitive processes are deteriorated. In this sense, it is very important to pay attention to the strategies used by the subject to carry out each one of the tasks that we present to him, and the emotional factors that can influence in the success of the rehabilitation program like, for example, awareness of the deficits or familiar and social pressures. DEVELOPMENT: The neuropsychological rehabilitation program must take care of several fundamental issues: 1. The treatment of the altered cognitive functions (cognitive rehabilitation): the use of different principles like the restoration, the compensation or the substitution will be determined. 2. The modification of the dysadaptative behaviors (irritability, aggressiveness, etc.) by means of different operating techniques. 3. The professional readaptation or reintegration: one of the final objectives of the rehabilitation is the reintegration of the brain injured person in the work or studies that did before or in those for which is enabled. 4. The psychosocial support: it is impo0rtant to work with the relatives and the social surroundings, specially the paper of the associations and the support groups. The design of the rehabilitation program must be focused to the specific necessities of each individual patient. It is also advisable to combine the individual and group treatment sessions.

Behavior Therapy↗

Does a delay in transfer to a rehabilitation unit for older people affect outcome after fracture of the proximal femur?

AIMS: To detemine the relationship between delay in transfer to rehabilitation wards and outcome for patients aged over 75 years with fracture of the proximal femur. METHODS: An observational study in a district general hospital of all patients admitted to hospital aged over 75 years with fracture of the proximal femur over 3 1/2 years. Outcome data collected included the number of patients discharged back to their usual residence and total hospital length of stay related to age, gender, usual residence and delay in transfer to a rehabilitation ward. RESULTS: 58% of 455 patients were transferred to a rehabilitation ward. For those patients who were transferred to a rehabilitation ward only age predicted discharge to a more dependent residence. The relative risk for discharge to a more dependent residence for people aged over 85 years compared to younger people was 1.47 (95% CI 1.15-1.88). Delay in transfer to rehabilitation was associated with a longer total hospital length of stay of 0.64 (95% CI 0.23-1.05) days per day of delay in transfer. CONCLUSIONS: Delay in transfer to a rehabilitation ward was associated with a disproportionate increase in total hospital length of stay for patients aged over 75 with fracture of the proximal femur.

Aged↗

Pulmonary rehabilitation after acute COPD exacerbation.

Acute COPD exacerbation provides a window of opportunity for providing teaching, supportive care, and rehabilitation to a group of patients at high risk for complications and re-admissions. This article has attempted to make a case for the unique needs of this group of patients. Treatment of exacerbation is often viewed as "routine" by hospital staff and generally has focused upon the pharmacologic regimen of oxygen therapy, bronchodilators, antibiotics, and steroids. Within a few days, the patient is usually less dyspneic and is discharged with a combination of MDIs and a plan for steroid taper. All too often, the patient returns home with no idea of how to regain lost function or prevent future exacerbations. The use of the MAC provides a more complete picture of the unique needs and capabilities of COPD patients and brings together the collective expertise of the entire health team in designing a plan of rehabilitative care. Planned monitoring of the patient after discharge is an integral component to the success of the rehabilitation approach and the ability of the patient and family to move toward self-management of this chronic disease. Transitional care programs, community nurse referrals, telephone contacts, and outpatient visits are all appropriate methods for providing the type of support required to sustain rehabilitation. Traditionally, nurse researchers have examined psychosocial and functional performance outcomes of rehabilitation, however, nurses are in an ideal position to explore the methods of rehabilitation that yield the most positive outcomes over time and are sustainable over the course of the disease. Nursing can and should assume a leadership role in such initiatives.

Exercise Therapy↗

[External quality assurance of medical rehabilitation in statutory health insurance].

Medical rehabilitation and the statutory health insurance companies (SHI) are increasingly coming into conflict due, on the one hand, to the current shortage of resources in the health care system and, on the other hand, the increasing need for rehabilitation measures. This makes it necessary to base the planning and management of rehabilitation treatments on economic and qualitative considerations equally. Quality assurance procedures play an important role in guaranteeing that rehabilitation is effective and efficient. This article discusses the expectations of the SHI companies regarding quality assurance (QS), explains the demands made by the legislator and reports on the activities of the SHI companies aimed at implementing a common external QS-program. As rehabilitation units are treating patients for various health insurance companies it is imperative that these agencies--in spite of competing with each other--agree on a common QS-program in order to avoid a situation in which a rehabilitation unit would have to provide different (and perhaps conflicting) proofs of its quality.

Germany↗

Staff and administration perspectives in a one-year geriatric rehabilitation developmental process.

A health care reform for senior citizens took effect in 1992 in Sweden. Shortcomings as regards geriatric rehabilitation were identified and, in 1995, governmental grants were assigned to local developmental projects. The aim of this study was to report the staff and administration perspectives in a geriatric rehabilitation developmental process over a 1-year period. In all, 782 staff and 45 administration respondents took part. The investigation was based on questionnaires and series of interviews. Significant positive changes with respect to collaboration between the authorities involved were demonstrated at the administrative level, while the most positive results at staff level concerned competence development in the group of employees without college education. A positive process as regards geriatric rehabilitation has started in the study district, indicating that governmental grants assigned for the stimulation of developmental activities are beneficial. Official goals for geriatric rehabilitation, points of departure for the organization of rehabilitation services and the content of general and specialized rehabilitation programmes are pinpointed as some of the areas deserving further attention.

Aged↗

[Current view of rehabilitation].

The study selects some changing and developing aspects of the contemporary considerations of rehabilitation and relates them closely to neurological rehabilitation. Functional diagnostics aims at the assessment of impairments and functioning. Several internationally recognized methods of neurological rehabilitation have already been adapted in Hungary. Author emphasises the use of International classification of functioning, disability and health, officially accepted by the Assembly of the World Health Organization in 2001. Its use for functional diagnostics is also possible. The everyday practice of teamwork is still problematic. Its implementation in rehabilitation is inevitable. The neurological rehabilitation is a special field where the cooperation of many teammembers is needed. The attitude to human beings in rehabilitation is different from medicine at large. It considers man not only as biological but also as social beings with own life history, thus helping to achieve compliance and increasing autonomy. The author mentions the possibility for the cooperation with organizers of the independent living movement. The separation of quality of life and health status assessments is suggested. Attention is called to the requirements of the adaptation of assessment methods and an initial account of own experiences is given.

Chronic Disease↗