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PubMed2002

The role of rehabilitation specialists in Canadian NICUs: a national survey.

Rehabilitation specialists are an integral part of the team in the neonatal intensive care unit (NICU). A national survey was conducted to elucidate the current roles of rehabilitation specialists. Occupational therapy (OT), physical therapy (PT), and speech and language pathology (SLP) departments in all Canadian health care institutions with tertiary level NICUs (n = 38) were surveyed by telephone. Results indicate that 16% have no rehabilitation coverage, while 11% receive very limited external services (< 1/month). Over half of the OT and PT departments provide weekly services whereas only 5/38 provide SLP coverage. Service delivery includes assessment and a number of therapeutic interventions. Splinting and feeding are predominantly performed by OT, whereas chest physiotherapy and ROM are carried out primarily by PT. Rehabilitation specialists are actively involved in education and case management. The extent of involvement of rehabilitation specialists was discrepant, and highly associated with the type of facility. Rehabilitation services, when provided, are comprehensive and include evaluation, treatment, teaching, decision-making, and family support.

Allied Health Occupations↗
PubMed1975

[Organization of rehabilitative treatment of patients with myocardial infarct].

Purposeful continuous comprehensive rehabilitation of myocardial infarction patients is impossible without centralization. The authors share their long-term experience in arranging and running such a centralized stage-wise system of rehabilitation and secondary prophylaxis. All the stages (specialized hospital department -- post-hospital center -- sanatorium -- outpatient dispensary center) are manned with cardiologists, specialists in kinesitherapy and functional diagnosis, psychologists. All the measures are coordinated by persons responsible for the particular stages of rehabilitation. When the patients return to their professional activities, the state of their cardiovascular system is controlled at work, and ECG is recorded during the working hours. The well-coordinated work of all the links of this rehabilitation system permitted to achieve 91.7% restoration of the capacity for work in patients of a pre-retirement age who have survived myocardial infarction. In order to make scientifically substantiated conclusions on the effect of rehabilitation and secondary prophylaxis on the prognosis of the patients joint efforts of several centers are necessary, as well as standardizing all the studies, unification of the criteria of assessment of the patients' state and of the efficacy of the measures taken. This would serve as a foundation for the creation of a rehabilitation system suitable for the practical health services.

Adult↗
PubMedDate not supplied

[Cognitive rehabilitation. Theoretical and methodological aspects].

AIMS: The aim of this paper is to theoretically define some aspects related with cognitive rehabilitation, as well as the methodological principles needed to draw up a programme of rehabilitation for these functions. METHOD: We performed an analysis of the definitions developed by different contemporary authors, of the theoretical approaches to cognitive rehabilitation, and the modes and models of how the functions are organised within the brain. Lastly, we set out the fundamental methodological principles to be taken into account in the production of a cognitive intervention programme, and describe the advantages offered by computer aided procedures as compared to the conventional methods of rehabilitation. CONCLUSIONS: Cognitive rehabilitation is currently considered one of the most important tasks or directions in neuropsychology and a number of theoretical and methodological approaches have been developed to deal with it. Over the past few years there has been a notable increase in the number of studies carried out involving cognitive intervention, especially in patients who are carriers of brain injuries of a traumatic or vascular aetiology and which give rise to a collection of motor, sensory and cognitive disorders. The level of development achieved in the cognitive neurosciences and IT have contributed to the conventional methods being substituted by computer applications that allow greater effectiveness in the rehabilitating process

Brain↗
PubMed2003

[Effectiveness of three-stage rehabilitation of patients with chronic obstructive lung diseases].

AIM: To study the effectiveness of three-stage rehabilitation of patients with chronic obstructive lung disease (COLD). MATERIAL AND METHODS: An open randomized control trial included COLD patients divided into two groups. Group 1 patients have undergone three-stage rehabilitation: outpatient clinic-hospital-sanatorium, group 2 controls have undergone rehabilitation only in outpatient clinic. The condition of the patients was assessed by physical performance (bicycle exercise, 6-min walk test), external respiration function (spirography), tolerance to dyspnea (questionnaire) at the trial start and in 3, 6, 9, 12 and 18 months. Three-stage rehabilitation continued for 9 months. RESULTS: Positive changes in physical performance and dyspnea tolerance were more pronounced in three-stage rehabilitation. This trend persisted for 9 months and than positive results got worse. CONCLUSION: Three-stage rehabilitation of COLD patients is highly effective and should be an essential part of COLD treatment policy.

Humans↗
PubMed2003

[Vocational rehabilitation, a descriptive follow-up study].

INTRODUCTION: Only few studies of the long-term occupational situation of clients after stay in a vocational rehabilitation clinic have been published. The aim of this study was to describe the clients in a specific vocational rehabilitation clinic, to investigate the employment situation 6-10 months after their stay, and to find out whether a doctor's estimate can point out the clients who are able to return to employment, and who are not. MATERIAL AND METHODS: All 254 clients that commenced a stay in the rehabilitation clinic from May 1996 to April 1998 were included. A doctor estimated whether he thought the client could return to employment or not. After 6-10 months the clients received a mailed questionnaire. A total of 210 persons (82.7%) answered the questionnaire. RESULTS: Eighty per cent of the clients were women. About two thirds of the clients were unskilled. Musculoskeletal disease was the reason of vocational disability in 63% of the clients. At the follow-up 50% were awarded disability pension, 20% were either employed or still in a rehabilitation process, whereas 30% still did receive passive support. If the doctor estimated that the person could not return to employment, the positive predictive value was 94.1-98-8%. If the doctor estimated that the person could return to employment the positive predictive value was 36.1-63.9%. DISCUSSION: Many of the clients that were later awarded disability pension could at an early time be pointed out by a doctor. These clients might not need to go through a stay in a vocational rehabilitation clinic. The methods used in vocational rehabilitation clinics should be evaluated and developed in order to make more clients return to employment.

Adult↗
PubMed1976

Health care utilization by persons with chronic disabilities who have been vocationally rehabilitated.

This investigation focuses on the effect of vocational rehabilitation on persons with chronic disabilities who have epilepsy, heart disease, spinal cord injury, arthritis, or emphysema. A thesis is proposed that such rehabilitants might be more vulnerable to unemployment than others, and it is also hypothesized that this frequently would be related to health care utilization. The study comprised 338 former clients of the State Rehabilitation Agency who had their cases successfully closed in the two-year period immediately prior to this study. All persons were sent a 12-page questionnaire dealing with matters of health, employment, social support, demography, medical economics, expressed needs, and relationship with the rehabilitation agency. Two-thirds (N = 213) of the clients responded. In addition, supplemental information was volunteered substantially by narrative and telephone. The primary thesis of the project was sustained; 43.7% were either unemployed or working less than full time six months after rehabilitation. However, few of the respondents reported having difficulties with health care utilization or availability. We propose a different rehabilitation services model to meet the needs of such clients. It should accentuate better diagnosis, careful selection of objectives, adequate vocational preparation, health care advisement, and more extensive job follow-up.

Adult↗
PubMed1992

[The rehabilitation of patients with neurological manifestations of lumbar osteochondrosis under outpatient conditions].

Computer was used to analyze the data on 226 patients with neurological manifestations of lumbar osteochondrosis, who completed the course of rehabilitation treatment at the outpatient center of industrial rehabilitation in Nizhni Novgorod. The authors provide the mean times, cost and outcomes of rehabilitation in groups of patients with different clinical syndromes. Specify indications for the rehabilitation course in a specialized institution for rehabilitation treatment. Analyze errors made in the referral of outpatients to the rehabilitation center.

Adult↗
PubMedDate not supplied

[The rehabilitation potential of the elderly].

This contribution points to the existence of potentials for rehabilitation in the elderly and underlines the necessity of rehabilitation in chronically ill patients. Especially important for the success of rehabilitation is a differential diagnosis and treatment. The potentials for rehabilitation differ among the several functions, abilities, and skills. For this reason, a differential profile of the rehabilitation potentials is necessary. Theoretical and empirical contributions to the plasticity, to developmental potentials, and to competence in the elderly form the basis for prognosis of rehabilitation potentials in old age. It is made clear that realizing these potentials is not only a task of the patient, but is also dependent on the ecological and social environment.

Activities of Daily Living↗
PubMed2003

The role of social worker in a team of rehabilitation: methodological approach.

This article introduces a new concept of a social worker role in rehabilitation team in Lithuania and presents a methodological approach for investigation of this role as well. THE GOAL of this study is to establish a standardized method for evaluation of social worker roles', significance for disabled people in a home-based rehabilitation setting, and to evaluate the most useful roles of social worker according to the needs of disabled people. The research method of this study was designed, based on a review of Lithuanian and foreign literature. Fifty (25 male, 25 female) disabled persons, who received home-based rehabilitation services, were observed and questioned according to this method. The results of the study show that the most important roles of a social worker in home-based rehabilitation are those of a broker, an enabler and a teacher. CONCLUSION. It was discovered that there is a need for follow-up qualification program of social workers in a rehabilitation team in order to develop additional skills that correspond to the roles of a teacher, an enabler and a broker, with application of this method for home-based rehabilitation of disabled people.

Persons with Disabilities↗
PubMed2003

Utilization of community-based rehabilitation services for incurably blind persons in a rural population of southern India.

PURPOSE: To identify barriers in utilisation of community based rehabilitation (CBR) services for incurably blind persons in rural South India. METHODS: A community-based rehabilitation programme for incurably blind persons was initiated in Theni district of southern Tamil Nadu in south India. After door-to-door enumeration and preliminary ocular screening by trained workers at the village, identified blind persons were categorised as either curable or incurable by an ophthalmologist. Trained workers provided rehabilitation, including mobility training (OM), training to perform activities of daily living (ADL), and economic rehabilitation for the incurably blind in their respective villages. RESULTS: Of the 460,984 persons surveyed, 400 (0.09%) were certified as incurably blind including 156 (39.00%) persons blind from birth. Social rehabilitation was provided for 268 (67.00%) incurably blind persons. Economic rehabilitation was provided to 96 persons, and integrated education to 22 children. Nearly one-fifth (n=68, 17.00%) of incurably blind persons refused the services provided. The major reasons for refusal included old age and other illnesses (41.18%), and multiple handicaps (19.12%). Twenty-seven (6.75%) persons had either migrated or died, and 29 (7.25%) persons were already able to function independently. CONCLUSION: Although CBR programmes provide useful services to the incurably blind, a better understanding of barriers is required to improve service utilisation. Developing a standardised data collection format for every CBR programme can result in the creation of a national database of ophthalmic diseases.

Adolescent↗
PubMed1992

Cardiac rehabilitation. Current status and future directions.

Comprehensive cardiac rehabilitation is more than exercise training for patients with coronary artery disease and now includes all aspects of secondary prevention. Exercise training is individually prescribed based on clinical status and therapeutic goals. Smoking cessation and abstinence and the treatment of hypercholesterolemia are integral to the rehabilitation process. Education and counseling are important adjuncts to treatment, especially soon after a coronary event. Vocational rehabilitation can be included simply and effectively in the rehabilitation process. Efficient and cost-effective cardiac rehabilitation is tailored to a patient's medical condition, risk factor evaluation, and vocational status. The future of cardiac rehabilitation will be linked to the success of training nonphysician health professionals to provide preventive services.

Ambulatory Care↗
PubMed2004

[Relationship between tunnel widening and different rehabilitation procedures after ACL reconstruction with quadrupled hamstring tendons].

OBJECTIVE: To find out the relationship between different rehabilitation procedures and the tibial tunnel widening after ACL reconstruction. METHODS: Sixty-five patients undergone ACL reconstructions by using quadrupled semitendinosus and gracilis tendons were divided into two groups. Group A had 33 patients, 19 male, 14 female, average age (31.2 +/- 12.4) years, only ACL reconstruction was performed with Germanic Professor Paessler's technique, and aggressive rehabilitation procedure was used for functional recovery. Group B had 32 patients, 20 male, 12 female, average age (30.3 +/- 10.3) years. Besides ACL reconstruction, every patient in Group B accepted meniscus repair or cartilage repair with microfracture technique, then postoperative conservative rehabilitation procedure was used. Six months after operation, standard posterior-anterior radiographic plates were taken for each patient, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification of X-ray plates was taken out after measurement. Statistic analysis was done by t-test. RESULTS: Six months after ACL reconstruction, on both the posterior-anterior and lateral X-ray plates the tibial tunnel widening of the upper, middle and lower parts in Group B with aggressive rehabilitation procedure was significantly serious than in Group A with conservative rehabilitation. CONCLUSIONS: Rehabilitation procedure after ACL reconstruction is one of the reasons for tunnel widening. It perhaps influences the functional recovery and long-term clinical result of the operated knee by affecting the tunnel widening.

Adolescent↗
PubMed2005

[Can routine data on in-patient rehabilitation of musculoskeletal diseases replace the physicians' judgement in quality management? --an investigation on 12,014 observations].

The acceptance of quality management is strongly influenced by the additional work-load necessary to obtain data. "Quality management questionnaire? Do we really need it? In rehabilitation, we must deliver a long and detailed discharge report anyway...". This frequent comment from the physician side has prompted us to investigate whether compilation of quality-management questionnaires really provides new information, or if a prediction model (for example similar to that predicting early retirement based on routine data in a discharge report) could be used to replace the physician judgement. If the prediction accuracy of the model is sufficiently high, the compilation of quality-management questionnaires might become obsolete, sparing the paperwork load of the physician. A central issue in the quality-management system of the LVA Baden-Wuerttemberg (a regional pension insurance institute) is the mutual agreement on a certain rehabilitation goal by patient and physician at the beginning of therapy. At the end of the rehabilitation program, the achievement of the goal is discussed with the patient in a discharge interview. In addition, patient and physician fill out a structured questionnaire with specification on three rehabilitation dimensions (WHO standard ICF: Body function and structure, activity, and participation). However, the results of multivariate modelling of 10 routinely observed parameters on more than 12,000 observations in patients with musculoskeletal diseases demonstrate that the agreement between the prediction model and the physician judgement of rehabilitation success is far away from optimal values. Thus, in this case the physician judgement can not be replaced by a forecast model solely based on routine data. Accordingly, the evaluation of rehabilitation success within the framework of a quality-management system based on currently valid standards must directly rely on the physician judgement.

Germany↗
PubMedDate not supplied

Parental perceptions of oral health-related quality of life for children with special needs: impact of oral rehabilitation under general anesthesia.

PURPOSE: The purposes of this study were to: (1) describe the symptoms, daily life problems and parental concerns related to oral health for children with special health care needs; and (2) examine the effectiveness of oral rehabilitation under general anesthesia at improving quality of life (QOL). METHODS: A single-group design measuring change over time was used. Family caregivers of 107 children with special needs, for whom oral rehabilitation under general anesthesia was recommended, completed a QOL survey upon dental examination. RESULTS: Seventy-three children underwent oral rehabilitation, and 50 completed a follow-up survey. The most frequent survey responses before oral rehabilitation were: (1) spontaneous toothache and pain with hot/cold temperatures (oral symptoms); (2) difficulty eating and sleeping (daily life problems); and (3) worrying about eating and nutrition (parental concerns). Severity ratings for oral symptoms, daily life problems, and parental concerns were significantly lower (P<.001), and scores for oral well-being were significantly higher (P<.001) following oral rehabilitation. CONCLUSIONS: Family caregivers of special health care needs patients report a variety of oral symptoms, daily life problems, and concerns attributable to their child's oral health that impact QOL. Oral rehabilitation under general anesthesia is effective at improving QOL for special health care needs children and their families.

Activities of Daily Living↗
PubMedDate not supplied

[Functional recovery in post-acute rehabilitation: patient characteristics and treatment effect].

OBJECTIVE: Most studies on the effectiveness of rehabilitation consider only particular rehabilitation treatments for particular conditions, and do not give a global vision of the issue. This study evaluated the effectiveness of various types of post acute rehabilitative care in patients with different diagnoses by investigating the association between treatments and functional gain by type of impairment and severity on admission. DESIGN, SETTING AND PARTICIPANTS: Information on the characteristics of patients and the rehabilitative treatments was collected using an Italian version of the Minimum Data Set-Post Acute Care. The questionnaire was created and validated by the Centers for Medicare and Medicaid Services, it is divided in various section and was filled in at regular intervals throughout the hospital stay. Patients included in the study were 1918. MAIN OUTCOME MEASURES: We used factor analysis to summarize each section in a single continuous variable. The observed functional gain was calculated as the difference between functional status at the beginning and at the end of the admission. A multiple linear regression analysis was performed to evaluate the association between rehabilitation treatments and functional gain, adjusting for patient characteristics and severity at admission. The effectiveness of the treatments were obtained by calculating the difference between the overall functional gain of the hospital stay and the predicted functional gain of the stay in the absence of rehabilitation treatments. RESULTS AND CONCLUSION: The effectiveness of treatments differs across diagnostic class and it is associated directly with severity of functional status at admission. In most cases, the positive effect of treatments combines with the spontaneous functional gain; in other cases the positive effect of treatments opposes the spontaneous deterioration of patient functional status.

Comorbidity↗
PubMed2005

[Influence of factors on independence of patients after stroke in early rehabilitation stage].

UNLABELLED: Brain stroke is the main cause of disability starting from age of 40 years. Due to this disability, a person loses his ability to work because of long-lasting disorders of biosocial functions. According to literature, occupational therapy for such patients, taking regard to their social, cultural and economic background, significantly increases their self-care and independence and helps to educate working skills. OBJECTIVE. To evaluate conditional disorders of patients with stroke under rehabilitation and to establish the influence of extent of brain damage, localization, age and gender on effectiveness of occupational therapy. MATERIAL AND METHODS: Study included 47 men and 53 women diagnosed with brain ischemia or hemorrhage (ischemic or hemorrhagic stroke). Out of them, 30 were of working age (18-59 years old) and 70 of non-working age (more than 60 years old). The mean age was 63.4+/-1.2 years. In order to assess the functional status of patients, they were tested using the Functional Independence Measure (FIM). RESULTS AND CONCLUSIONS: At the start of rehabilitation, the mean FIM score was 47.4+/-16.1 (48.9+/-15.6 for men and 46.3+/-16.6 for women, p>0.05). At the end of early rehabilitation, the mean FIM score reached up to 89.9+/-22.3 (94.7+/-18.9 for men and 85.7+/-24.3 for women, p<0.05). Evaluation of functional status showed that at the start of rehabilitation functional status was worse in women than men, nevertheless, women's functional status improved during rehabilitation, though the difference between men and women still remained. Occupational therapy was less effective for patients who suffered from hemiplegia than for patients with hemiparesis (p<0.01). Older patients (more than 60 years) had more expressed functional disorders, and worse functional recovery comparing with younger, working age patients (18-59 years old). Evaluation of occupational therapy effectiveness at the end of early rehabilitation showed that extent of brain damage influences independence of patients suffering from brain stroke (p<0.01).

Activities of Daily Living↗
PubMed2005

[Cardiac rehabilitation in the elderly].

Cardiac rehabilitation is an integral component of secondary prevention, and is indicated for patients with a wide variety of cardiac conditions, ranging from coronary artery disease to chronic heart failure. Best results are obtained with integrated, multicomponent cardiac rehabilitation programs, which include exercise training together with counseling and psychosocial measures that may help patients maintain sustained changes toward a more healthy lifestyle. Evidence from randomized controlled trials and meta-analyses supports the efficacy of cardiac rehabilitation on clinically relevant outcomes such as reduced long-term morbidity and mortality, enhanced functional profile and improved control of cardiovascular risk factors. However, the vast majority of this evidence derives from trials with only small numbers of patients > 70 years of age. In elderly patients the goal of cardiac rehabilitation may differ from those of younger patients, and include the preservation of mobility, self-sufficiency and mental function. Cardiac rehabilitation my represent an opportunity to provide effective health care and achieve a high quality of life for older patients. Future research programs should therefore be aimed at specifically investigating the efficacy and effectiveness of cardiac rehabilitation in older, frail cardiac patients.

Aged↗
PubMed2006

Discharge of respiratory-compromised children after respiratory rehabilitation.

BACKGROUND: There is a growing demand for respiratory rehabilitation services for children dependent on tracheostomy and/or chronic mechanical ventilation. Discharging these patients home following their rehabilitation can be an arduous process. OBJECTIVES: To define the length of time required to rehabilitate and discharge these patients, and to identify predictors of a prolonged or failed discharge process. METHODS: We conducted a retrospective chart review of patients admitted to the Respiratory Rehabilitation Unit at Alyn Hospital, Jerusalem, over a 4 year period. RESULTS: Of the 48 patients identified, 31 (64.7%) were eventually discharged, 13 (27.1%) remained hospitalized long-term, and 4 (8.3%) died during their hospitalization. The median length of hospitalization was 10 months: 6 months for purposes of rehabilitation therapy, and 4 months thereafter to resolve the logistics of discharge. Specific family characteristics--an unemployed father (odds ratio = 4.6, P = 0.02) and an additional family member with a disability (OR = 5.8, P = 0.03)--as well as ongoing mechanical ventilation at the time of discharge (OR = 5.5, P < 0.01) were found to positively correlate with a prolonged or failed discharge process. CONCLUSIONS: Hospitalization in a pediatric respiratory rehabilitation unit may be prolonged for both medical and non-medical reasons, with the process of discharge home being particularly difficult in certain subsets of patients. A proactive discharge policy by hospitals, improved community support services, and legislation defining the rights of home-ventilated children may facilitate more efficient discharge home of these patients.

Adolescent↗