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PubMed1991

Traumatic brain injury rehabilitation.

Improved survival from severe traumatic brain injury has prompted the development of dedicated rehabilitation programs. Ideally, rehabilitation should begin during acute care in order to prevent later complications. Medically stable patients should be referred from acute care to acute rehabilitation programs for evaluation and then treatment or transfer as appropriate. Dedicated brain injury rehabilitation programs follow a method in which treatment is adapted to the major physical and cognitive impairments at each stage of recovery. Specialized treatment protocols have been developed for unconscious or agitated patients, partly on the basis of advances in neuropharmacology. Because of the long recovery course after severe brain injury, many patients are appropriate for postacute rehabilitation programs directed at community reentry, including return to work. Newer program models for patients with traumatic brain injuries, especially programs using cognitive rehabilitation techniques, are controversial because of inadequate research support and uncertain cost-effectiveness.

Brain Damage, Chronic↗
PubMed1990

Ethical issues encountered in pediatric rehabilitation.

Ethical issues in pediatric rehabilitation should be viewed within the framework of the understanding of the terms of autonomy, nonmaleficence, beneficence and justice. In dealing with the pediatric patient, health professionals are most frequently treating the parents who have the decision-making authority. Normalization which underlies the concept of mainstreaming has become an important issue in pediatric rehabilitation. Normalization is based on the provision of opportunities for choosing, for independent decision making, and for autonomy. The right of the disabled child to have sexual information and to be acknowledged as a sexual individual is essential to the child's autonomy. More children are surviving catastrophic injuries and living with severe disabilities. Birth defects such as myelodysplasias point to the issues of treatment selection involving ethical, moral, philosophical, religious, financial and social values. The phrase 'quality of life' is often applied in these situations and is frequently understood as the 'best interests of the child' which should result in child-centered decisions. In this way, a decision to begin or to withhold treatment can be made in a more ethically considered manner. Resource allocation is of special concern in disabled children since they may consume significant resources in medical and rehabilitation costs spent throughout a lifetime. However, these costs may be justifiable when a disabled child matures into a productive adult. If maximum benefit of limited resources is to be achieved, these children should receive their care from rehabilitation professionals in established centers of rehabilitation expertise. However, we may soon need to accept the responsibility for rationing rehabilitative care as the number of disabled children grows beyond the dollars available to be spent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Program evaluation guidelines for the rehabilitation professional.

The overall purpose of the present chapter was to provide a set of guidelines to new rehabilitation investigators for conducting program evaluation in the burgeoning field of clinical rehabilitation. The specific objectives were to encourage investigators to develop a research consultation network, consider the benefits of utilizing a theoretical framework in specifying program objectives, assess program implementation, and to discuss the need and methods for ensuring high quality data. There is currently a widening gap in the United States and Canada between rehabilitation professionals who provide clinical services and those who conduct research on the effects of rehabilitation interventions. This is a matter of great concern and consequence. Without a firm commitment to evaluation, clinical rehabilitation practice may ultimately flounder in the mire of conjecture and ad hominem debate characteristic of therapeutic movements that have come and gone (e.g., the human potential movement). It is essential for the life of the discipline that rehabilitation programs be firmly grounded in both humanitarian and scientific principles.

Goals↗
PubMed1989

Trends in pediatric rehabilitation.

The 1980s have been declared the decade of the disabled. Surgeon General Koop has stated that "it is profoundly important for our own society that we tend to these issues of disabled children, that these children not be forgotten or pushed aside, and that we retain our belief in the strength of the American family". The field of pediatric rehabilitation, unheard of as recently as the late 1970s, has become a recognized specialty. The definition of pediatric rehabilitation has expanded to include the care and treatment of children with congenital and acquired disabilities. The pediatric rehabilitation nurse is challenged to keep abreast of new developments in the field while seeking and implementing innovative ways to assist the child and family in their adjustment to the child's disability. A knowledge base of normal growth and development is essential when assessing abnormal patterns in the child with a disability. Complete assessment of the child with a disability includes a parent-child interview and physical assessment, with particular focus on the child's developmental age, movement patterns, and functional activities of daily living. The reaction of the child and family to the disability is all too often viewed as lack of "acceptance" of the child's disability. A continuum of "adjustment" to the disability for both family and child describes normal coping mechanisms for living with and managing the needs of a disabled child. It is important for the pediatric rehabilitation nurse to develop a partnership with parents in which they serve as consultants to families, not as directors of the child's care. Cerebral palsy and spina bifida are the two most common childhood disabilities. With advanced technologic equipment and refined surgical procedures, the child's potential for independence is reaching new heights. Computerized technology has aided the motor-impaired child to progress through normal developmental processes of exploration and discovery. Specialized health procedures such as tube feedings and clean intermittent catherization have become routine for many children and their families. Advanced technology has also benefited the child who is ventilator dependent, although not without some limitations to the child, family, and society. Limited financial and psychosocial resources create a burden on both the family and society as the child continues to require high technology care. The relatively new field of head-injury rehabilitation provides an arena for pediatric rehabilitation nurses to define specific interventions for the child who is rapidly evolving through the stages of cognitive and motor recovery.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed1977

[Rehabilitation in various types of heart diseases].

The occasions on which reevaluation, re-establishment, readaptation, and rehabilitation in the true sense should be used are discussed, and the concept of both psychological and physical rehabilitation as an indivisible whole is underscored. It is also made clear that rehabilitation must not be limited to the heart patient himself, but be seen as the reintegration of the subject (and not the object) of rehabilitation in his family, social, occupational and recreational environment. Rehabilitation begins during hospitilisation and short- or long-term programmes are prepared. Full rehabilitation requires readjustment of the patient's surroundings and the removal of preconceptions and misunderstandings that may often make communication dramatically impossible.

Adolescent↗
PubMed1987

Neuropsycho-social rehabilitation of head injury.

The present article summarizes 10 years of experience in head injury rehabilitation at Loewenstein Rehabilitation Center. The goal of rehabilitation in head injured patients consists of returning to work and adaptation to: interpersonal consequences of disability; new affective needs; and capacity to attend to financial, legal and bureaucratic matters. The achievement of these goals goes far beyond neurological boundaries in the ordinary narrow sense and needs a neuropsycho-social approach. Neuropsycho-social rehabilitation in head injury has multidimensional clinical aspects. Two problems should be emphasised: a) gross neurological disability (mono, hemi, para and triplegia) found in the presence of good cognitive function (patients easy to rehabilitate) and b) minor neurological disability found in the presence of gross cognitive impairment (patients not easy to rehabilitate). Posttraumatic epilepsy needs general criteria for its management. It is preferable to wait for the first seizure in order to start anticonvulsant treatment, except for 3 at risk conditions: 1) diffuse bilateral injury 2) prolonged coma, and 3) intracerebral hematoma. The first 3 years is the maximum at risk period. The traumatic syndrome consisting of impaired insight and behaviour disturbances is underdiagnosed owing to the absence of neurological signs. The sleep disturbances accompanying head injury are usually underestimated.

Behavior↗
PubMed1987

[Rehabilitation of cerebral apoplexy--results based on 156 patients].

156 stroke patients were followed-up over a period of up to twelve months from the event. During that period they had participated repeatedly, or continually, in comprehensive inpatient rehabilitation programmes at the Bad Schallerbach rehabilitation centre, Austria. The services provided were characterized by a comprehensive medical, vocational and social orientation. Rehabilitation outcome assessment related to personal functioning levels (ADL performance, intellectual functioning, communication, social behaviour, etc.) as well as the basic working capacity. Based on medical findings, the results stated toward the end of our comprehensive rehabilitative efforts showed improvements of personal functioning by about 66 percent, and attainment of a basic working capacity in 22 percent of the patients. Outcomes varied for the different causes of stroke; three patients had died during the observation period due to renewed stroke. The principles to be observed in comprehensive rehabilitation are discussed, with special emphasis on those in stroke rehabilitation.

Activities of Daily Living↗
PubMed1985

[The need and actually successful work-related rehabilitation measures for first-admission psychiatric patients].

Presented are the findings of a follow-up study of 258 psychiatric patients who had for the first time been admitted to inpatient psychiatric treatment in 1979. Using standardized forecasting instruments, the patients themselves, their treating physician, and a member of the care staff were asked to give their views of the patient's occupational outlook, his chances for resettlement, and the need for vocational rehabilitation services following discharge. The needs statements made at discharge are contrasted with the vocational and job-related rehabilitation measures actually initiated and carried out in the year following discharge; additionally, the patients' vocational situation at discharge is compared with their situation twelve months later, and the course of the rehabilitation measures provided is described. Along with the discrepancies between needs statements and amount of vocational rehabilitation services actually initiated and carried out, the empirical findings point to a non-specific, dispersive approach to providing rehabilitation services. The possible causes for this discrepancy between needs and service provision, with its rather serious implications, as well as the doubtful effectiveness of the rehabilitation services provided are discussed, practice-related consequences are outlined.

Adult↗
PubMed1978

Oral health services for adult rehabilitation patients: three illustrative cases.

Recent research has shown that the actual capability of physical medicine and rehabilitation units to provide oral health services is less than the need as perceived by rehabilitation administrators. Three cases have been selected to illustrate the nature and diversity of health benefits that can be provided by a complete oral health service which focuses on rehabilitation patients. The advantages of offering a comprehensive oral health service include not only improvement of the oral health of the patient but also often directly aids the patients' achievement of overall rehabilitation goals. Furthermore, by synergistic interaction with the other rehabilitation disciplines, an oral health service can appreciably enhance the quality and the scope of the rehabilitation program itself. Additionally, a new adaptive device for oral grasping, designed for use by patients who lack the use of their upper extremities, is illustrated. The device is intended to provide the patient with a range of functions including recreational participation in board games as well as vocational activities which require the lifting or grasping of objects.

Adolescent↗
PubMed1981

Evaluation of disability insurance savings due to beneficiary rehabilitation.

This article uses individual vocational rehabilitation case data and disability insurance (DI) benefit histories from the master beneficiary record file to compare the costs and savings to the DI trust fund associated with the beneficiary rehabilitation program. Using cost-benefit procedures and varying assumptions as to the impact of vocational rehabilitation services, the savings to the trust fund were found to range between $1.39 and $2.72 per $1.00 of cost for DI beneficiaries who completed their vocational rehabilitation service period in fiscal year 1975. Calculating savings according to the length of the savings period revealed that expenditures for vocational rehabilitation services to these beneficiaries would be fully repaid within 10 years after closure. It was also discovered that the loss of savings due to return to the DI rolls substantially exceeds the increased payroll tax revenue accruing to the trust fund from post-vocational rehabilitation employment.

Age Factors↗
PubMed1995

[Different phases in neurologic rehabilitation. Association of German Pension Insurance Carriers].

Elaborated by the project subgroup for "Neurological Rehabilitation" of the Federation of German Pension Insurance Institutes, the phase model presented describes the phases of neurological care and rehabilitation for patients with neurological conditions (notably stroke, craniocerebral trauma, and multiple sclerosis). It deals with acute and intensive care, inpatient medical rehabilitation, as well as the phase of aftercare and the care/rehabilitation phase where long-term support, attendant and/or maintenance measures are required (outpatient or partial-hospitalization medical rehabilitation modalities are not included as yet). Based on patient characteristics, care and rehabilitation goals are specified along with the care and rehabilitation tasks that can be derived from these, with great diversity of individual management course being possible.

Brain Injuries↗
PubMed1995

The CARE Program: a nurse-managed collaborative outpatient program to improve function of frail older people. Collaborative Assessment and Rehabilitation for Elders.

BACKGROUND AND OBJECTIVES: Frail older adults are especially vulnerable in a health system that is fragmented and fails to focus on preservation or restoration of function. The School of Nursing at the University of Pennsylvania, together with the School of Medicine and the Hospital of the University of Pennsylvania, established the Collaborative Assessment and Rehabilitation for Elders (CARE) Program to meet the needs of this population. We used the British Day Hospital as a model because it provides a comprehensive approach to care and a bridge between acute, home-based, and institutional long-term care. We have designed our program to provide innovative, interdisciplinary care as well as to be reimbursable under current and future payment structures. This nurse-managed, collaborative practice seeks to maximize independent functioning, promote health, and enhance quality of life for chronically ill, frail older adults living in the community whose needs are left unmet by existing services. The program was certified as a Comprehensive Outpatient Rehabilitation Facility (CORF) in December 1993 to maximize reimbursement of services through Medicare and other third party payers. With a Gerontological Nurse Practitioner as care manager, clients receive an intensive, individualized, time-limited program of nursing, rehabilitation, mental health, social, and medical services in one setting several days each week. Additional geriatric services, such as primary care, are available in the same location when needed. SETTING: The program is housed in renovated space devoted to the care of older people. The academic and clinical offices of the University of Pennsylvania's nursing and medical gerontologic and geriatric faculty are in the same building. PARTICIPANTS: We have targeted those persons older than age 65 who have complex health problems and are living at home. Individuals must need multiple services, including at least one rehabilitation therapy, and they must be unsuitable-for inpatient rehabilitation. DESCRIPTION OF THE POPULATION: In its first 8 months of operation, the program received 97 referrals and admitted 53 clients. Clients were, on average, 78 years of age. Over three-fourths (77%) were women and 58% were black. The average stay in the program was 6 weeks. FIM scores, which improved a mean of 2.4 points, were found to lack sensitivity to the functional improvements achieved by clients. CONCLUSION: Under existing Medicare and third party reimbursement policies, it is feasible to establish a nurse-managed comprehensive outpatient rehabilitation program designed to meet the needs of frail older persons. Preliminary data support the beneficial effects of the program as well as the economic feasibility of this approach.

Academic Medical Centers↗
PubMed1995

Post-stroke rehabilitation: assessment, referral, and patient management. U.S. Department of Health and Human Services Public Health Service. Agency for Health Care Policy and Research.

This Quick Reference Guide for Clinicians contains highlights from Post-Stroke Rehabilitation, Clinical Practice Guideline No. 16, which was developed by a multidisciplinary, private-sector panel comprised of health care professionals and a consumer representative. The Quick Reference Guide for Clinicians is an example of how a clinician might implement the panel's findings and recommendations on the overall management of stroke patients who need post-stroke rehabilitation programs or services before returning to a family or other living environment. Topics include medical management of patients, systematic assessment and evaluation of patients throughout acute care and rehabilitation, referring patients to appropriate rehabilitation programs, managing the rehabilitation process, discharging patients from rehabilitation programs, and reintegrating patients into family and community environments.

Cerebrovascular Disorders↗
PubMed1995

Rehabilitation services in the health sector: the perspectives of providers and consumers: Part 1.

AIMS: To establish the degree of implementation of the Strategic Planning Guidelines for Area Health Boards--Services for Adults with Physical Disability, published by the Department of Health in 1989, the services being provided, and the priorities for future service provision. METHODS: Two postal surveys of area health boards (AHB's) were carried out in 1991. The first asked about the terminology of rehabilitation, administrative structure, advocacy, service audit, inventory of services, regional service delivery, and consultation processes. The second asked about the rehabilitation services provided, the type of disability of the consumers of the service, the reasons why services were or were not provided, the service gaps that existed, and the priorities that existed to fill those service gaps. RESULTS: The major finding was that while all area health boards adopted the rehabilitation concepts in principle, service development was impeded in many cases by the failure to provide resources to plan and develop the service. Some were providing comprehensive services. Most AHB's provided services for people with physical or multiple disabilities. All provided statutory services such as district nursing and home help, while most provided regular medical reviews, physiotherapy, occupational therapy, speech therapy, etc. Only about half provided attendant care, driving assessment, and swimming for people with disabilities, while less than half supported disability information services (DIS). Attendant care was seen as high priority to fill gaps in service, but was seen as the funding responsibility of the Department of Social Welfare. CONCLUSIONS: Service provision reflected a traditional approach to the provision of rehabilitation services. The development of innovative service delivery will require crown health enterprises to reevaluate their present level of commitment to rehabilitation services and to assess the effectiveness of reallocating some funds from acute services into rehabilitation.

Guidelines as Topic↗
PubMed1976

Time and money for vocational rehabilitation of clients with mild, moderate, and severe mental retardation.

Mildly, moderately, and severely mentally retarded vocational rehabilitation clients comprised a random national sample of 600 clients. One-half of the sample had been closed (services completed) "rehabilitated", and half had been closed "nonrehabilitated." Variables selected for analyses were time in referral, training, and rehabilitation process; dollars in evaluation, facilities, all services, and earnings. Rehabilitated clients tended to require more time in referral, less moneys for extended evaluation and rehabilitation facilities, and earned more per week than the nonrehabilitated clients. Severely mentally retarded clients required more time in training and higher costs for extended evaluation, rehabilitation facilities, and all services than the moderately or mildly retarded groups. A consistent interaction across five variables indicated that the greatest amounts of service in time and money went to the nonrehabilitated severely retarded group.

Cost-Benefit Analysis↗
PubMed1993

Rehabilitation in the outpatient setting.

A working familiarity with rehabilitation techniques is absent from most primary care settings. Primary care clinicians can benefit greatly from better knowledge of the principles of geriatric rehabilitation. Physiatrists and geriatricians can have a greater impact if future research also explores the practical barriers to providing rehabilitation services outside institutional settings. An active, collaborative search for new models of care is needed. If more elderly citizens are to benefit from effective rehabilitation services, established geriatric rehabilitation programs must learn how to select from the many patients referred for evaluation those who will most benefit from outpatient rehabilitation services. Impending national health care reform creates a window of opportunity to establish rational systems to deliver health services designed for our aging population.

Aged↗
PubMed1993

Educating primary care physicians in geriatric rehabilitation.

This article has reviewed the current status of primary care physician education in rehabilitation and the potential effects of current educational inadequacies on use of rehabilitation. The epidemiologic data regarding disease, development of disability, resource utilization, and its relevance to curriculum selection for rehabilitation were examined. Health care resources are limited, and given the increasingly important role the rehabilitation will play in health care, it is important that our educational efforts promote optimal use of those resources. A variety of teaching methods and their potential utility were discussed. Educating primary care physicians in the proper use of rehabilitation is of immediate importance for the large and growing older population. The use of available data on disease prevalence and impact to direct educational efforts will maximize the beneficial effects of our educational investments. The improved use of geriatric rehabilitation can make a significant impact on the health and quality of life for millions of older Americans.

Activities of Daily Living↗
PubMedDate not supplied

Recent advances in rehabilitation medicine.

Rehabilitation is aimed at minimising the disadvantage experienced by an individual as a result of functional impairment or disability following disease. It also addresses the impact of the social and environmental consequences of disease. Rehabilitation medicine is a new specialty although the concept of rehabilitation is not. Previously this work was undertaken within the fields of rheumatology, physical medicine, neurology, and orthopaedic, general medical and limb fitting services. In some patients, primarily those with neurological and musculoskeletal disease, the interaction of impairments with social and environmental dimensions can be complex. Effective management requires coordination between the patient, carers, and the medical, therapy, nursing, psychology and social services. The management of patients with complex disabilities is undergoing change with the introduction of new treatments, awareness of needs of patients and carers, and new models of care. This conference, entitled 'Medical priorities in the rehabilitation of adults with complex disabilities' given at the Royal College of Physicians on 2 February 1995, reviewed these changes. It dealt with medical priorities in rehabilitation for patients with specific diseases, and recent advances in areas pertinent to rehabilitation medicine.

Adult↗