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PubMed1977

Early protein malnutrition in the rat: behavioral changes during rehabilitation.

Behavioral development was studied in 2 groups of rats during the postweaning period. Pups were selected from litters nursed by dams fed either a standard protein (25% casein by weight) or a low protein diet (12% casein) during lactation. Two pups from each litter were housed together and fed the control diet throughout rehabilitation. Behavioral observations were made by repeated time-lapse photography at 5-day intervals. Differences in home cage behavior were observed at the onset of rehabilitation in the postnatally malnourished rats. Increased feeding behavior was observed during the 1st week of rehabilitation. Locomotor behavior was depressed during the rehabilitation period in the experimental animals. Climbing activity, however, was significantly greater. Self-grooming activity was elevated throughout rehabilitation in post-natally malnourished animals. During the course of rehabilitation, the behavioral differences between the 2 groups gradually disappeared.

Animals↗
PubMed1981

Home-orienting behavior in rat pups: the effect of 2 and 3 generations of rehabilitation following intergenerational malnutrition.

In an earlier study in this laboratory, we examined home-orienting ability in rats with histories of intergenerational malnutrition that were rehabilitated postnatally with an adequate protein diet (Galler, 1979). Despite increased size and activity, 1st-generation rehabilitated pups showed no improvement in homing ability when compared to malnourished pups. In the current study, offspring of rats with intergenerational malnutrition were rehabilitated for 2 additional generations and tested for homing ability from postnatal Day 4 through Day 12. The pups rehabilitated for 2 and 3 generations did not perform as well as control pups, even though growth and activity returned to normal levels. Furthermore, the rehabilitated pups failed to demonstrate any preference for the nest on all days of testing; in contrast, control pups favored the nest quadrant by Day 8 of life. No significant improvement was evident on any measure from the 2nd to the 3rd generation of rehabilitation.

Animals↗
PubMedDate not supplied

Disability and rehabilitation in head and neck cancer patients after treatment.

In an effort to obtain quantitative and qualitative information regarding the extent of disability sustained following definitive treatment for head and neck cancer, 51 patients--28 who had had laryngectomy and 23 who had had other major surgery--were interviewed. Also examined were the types of rehabilitation measures taken. In all cases, the following areas in which disability could occur were identified and explored: physical appearance, speech, deglutition, mastication, salivation, sensory deficits, cranial motor-nerve deficits, pain, nutrition, activities of daily living, psychosocial functioning, vocational status, environmental parameters, and delayed complications. Where appropriate, ratings and delineations of severity were compiled. Nine methods of rehabilitation were assessed with regard to frequency of utilization: surgical reconstruction, dental-maxillofacial prosthetics, speech therapy, physical therapy, rehabilitation nursing, occupational therapy, vocational rehabilitation, rehabilitation counseling, and social service. Our conclusions were that half of the patients studied had sustained significant disability in three to four areas, while 43% had moderate or severe disability in five to nine areas. Additionally, the head and neck surgeon was found to have used surgical reconstruction and dental-maxillofacial prosthetic measures, as well as the services of seven categories of allied health professionals, to provide rehabilitation.

Deglutition↗
PubMedDate not supplied

Cardiac rehabilitation program participation and outcomes after myocardial infarction.

Rehabilitation programs for myocardial infarction (MI) survivors are designed to alter survivors' self-care patterns and to improve long-term physical and psychological outcomes. The purpose of this study was to examine the relationship between participation in cardiac rehabilitation and health state; days of reduced activity; anxiety; depression; self-esteem; quality of life; and performance of exercise, diet, medication, stress-modification, and smoking-reduction self-care behaviors after MI. Interviews were conducted with 197 women and men 1 to 2 years after their initial MI to measure health state, mood, self-esteem, quality of life, and relevant self-care behaviors. Rehabilitation center records were reviewed to determine participation in rehabilitation programs. Rehabilitation participation was significantly associated with health state; days of reduced activity; self-esteem; quality of life; and performance of exercise, diet, and medication self-care. These findings suggest that participation in cardiac rehabilitation is a worthwhile intervention that facilitates recovery from myocardial infarction.

Adult↗
PubMedDate not supplied

Cardiac rehabilitation programs and the problem of patient dropout.

As one of the leading causes of death in the United States, coronary atherosclerotic heart disease (CAHD) has been shown to have a reduced incidence if the principles of primary prevention are instituted to reduce cardiac risk factors. In people who already suffer from CAHD, employing secondary prevention such as controlling hypertension, reducing serum lipid levels, eliminating nicotine intake, reducing stress, losing weight, and increasing exercise habits can decrease recurrence of problems related to CAHD. Cardiac rehabilitation programs are a way to help CAHD patients restore optimal medical, physiological, psychological, social, and vocational performance following an acute cardiac event. A major problem in cardiac rehabilitation programs is patient dropout. For any cardiac rehabilitation program to be a success, the CAHD patient must become invested in the maintenance of health and, therefore, committed to participation in the program. The author reviews the current literature, including discussions of the history of cardiac rehabilitation, current trends in cardiac rehabilitation programs, factors that influence patients' investment in these programs, and ways in which the cardiac rehabilitation nurse might intervene to make an impact on patients' participation.

Coronary Disease↗
PubMedDate not supplied

Painting a mural and writing an article: creative rehabilitation strategies.

In this article, the authors describe a creative rehabilitation process that used painting a mural and writing for publication as interventions. The successful rehabilitation process is described from the perspective of the patient as well as the rehabilitation nurse. Creative strategies often are needed when a patient does not readily respond to traditional rehabilitation methods. A patient's interests, talents, and concerns often can be creatively aligned with the rehabilitation goals of the nurse and can result in unique interventions that have successful outcomes. Painting a mural and coauthoring this article became the primary rehabilitation interventions for a patient with expressive aphasia and impaired mobility, secondary to his stroke in 1987.

Aged↗
PubMed2006

Relative contributions of muscle activation and muscle size to plantarflexor torque during rehabilitation after immobilization.

Muscle atrophy is clearly related to a loss of muscle torque, but the reduction in muscle size cannot entirely account for the decrease in muscle torque. Reduced neural input to muscle has been proposed to account for much of the remaining torque deficits after disuse or immobilization. The purpose of this investigation was to assess the relative contributions of voluntary muscle activation failure and muscle atrophy to loss of plantarflexor muscle torque after immobilization. Nine subjects (ages 19-23) years with unilateral ankle malleolar fractures were treated by open reduction-internal fixation and 7 weeks of cast immobilization. Subjects participated in 10 weeks of rehabilitation that focused on both strength and endurance of the plantarflexors. Magnetic resonance imaging, isometric plantarflexor muscle torque and activation (interpolated twitch technique) measurements were performed at 0, 5, and 10 weeks of rehabilitation. Following immobilization, voluntary muscle activation (56.8 +/- 16.3%), maximal cross-sectional area (CSA) (35.3 +/- 7.6 cm(2)), and peak torque (26.2 +/- 12.7 N-m) were all significantly decreased ( p < 0.0056) compared to the uninvolved limb (98.0 +/- 2.3%, 48.0 +/- 6.8 cm(2), and 105.2 +/- 27.0 N-m, respectively). During 10 weeks of rehabilitation, muscle activation alone accounted for 56.1% of the variance in torque ( p < 0.01) and muscle CSA alone accounted for 35.5% of the variance in torque ( p < 0.01). Together, CSA and muscle activation accounted for 61.5% of the variance in torque ( p < 0.01). The greatest gains in muscle activation were made during the first 5 weeks of rehabilitation. Both increases in voluntary muscle activation and muscle hypertrophy contributed to the recovery in muscle strength following immobilization, with large gains in activation during the first 5 weeks of rehabilitation. In contrast, muscle CSA showed fairly comparable gains throughout both the early and later phase of rehabilitation.

Adult↗
PubMed1999

[Experiences with ambulatory cardiologic rehabilitation].

Since the founding of the Düsseldorf Outpatient Cardiologic Rehabilitation Center (Berliner Allee) in 1990 approximately 500 outpatient rehabilitation measures were performed, predominantly as follow-up treatment. The Center is currently participating in 2 pilot programs in outpatient cardiologic rehabilitation initiated by pension scheme providers and health insurance companies. A holistic approach to the concept of therapy is fundamental to an intensive rehabilitation of the heart patients. In conjunction with physiotherapeutic exercise, a health education program and extensive psychological care form the basis of the broader therapy program. An on-going implementation of measures designed to assure the maintenance of structural and procedural quality is fundamental to the creation of a positive subjective experience on the part of the person undergoing rehabilitation as well as the attainment of the individual's specified rehabilitation goals.

Ambulatory Care↗
PubMed2002

The influence of early speech rehabilitation with voice prostheses on the psychological state of laryngectomized patients.

This survey assessed how early speech rehabilitation influences the emotional state and psychological adjustment of 43 male laryngectomy patients, at three different chronological stages. The first assessment occurred 2-3 days before the operation. The patients filled out a stress questionnaire (SVF) which assessed coping strategies. Exactly 2 weeks after the operation the patients were given a list of adjectives (EWL) which measured their actual emotional state. One day before leaving the hospital the patients were given the Post-laryngectomy Telephone Test (PLTT) which ascertained the quality of speech intelligibility. In addition, patients filled out a questionnaire on postoperative stress and anticipated stigmatisation with regard to their changed voice. Results demonstrated that patients who had early speech rehabilitation felt significantly more active and, in general, felt considerably better than patients who had not received speech rehabilitation training. Patients assessed voice loss as extremely distressing. The postoperative stress and the anticipated stigmatisation on the basis of the changed voice was significantly higher in those patients with good speech intelligibility than in patients with poor speech articulation at hospital discharge. The coping strategies "Giving up and resignation" and "Need for social support" correlated positively with postoperative stress and anticipated stigmatisation. Results show that early speech rehabilitation with voice prostheses had a positive effect on the emotional state of laryngectomy patients. However, the early speech rehabilitation leads to distress in the initial phase in laryngectomy patients. Moreover, patients who habitually tend towards resignation, or need lots of social support should receive psychological support during the early phase of speech rehabilitation training.

Adult↗
PubMed2004

[Improvement of health-related quality of life in breast cancer patients by inpatient rehabilitation].

PURPOSE: Improvement of health-related quality of life in women with breast cancer after primary therapy by standardized inpatient rehabilitation. PATIENTS AND METHODS: 129 women with breast cancer, 25-75 years old, and 42 healthy women were interviewed about their health-related quality of life by using the EORTC-QLQ-C30. This questionnaire assesses different aspects of quality of life as well as overall quality of life. Quality of life of breast cancer patients was assessed before and after inpatient rehabilitation, considering especially their age and the interval between diagnosis and rehabilitation. RESULTS: Compared with healthy women, the breast cancer patients had distinctly reduced values in the beginning of rehabilitation. By specific therapy, the overall quality of life as well as physical, emotional and role function could be improved significantly (p < 0.0001). Concerning cognitive and social function, there were also significant changes after rehabilitation (p < 0.0001), but only in 50% of the women an improvement could be shown. There was no evidence of correlation between quality of life after the end of primary therapy and the patients' age or the interval between diagnosis and rehabilitation. CONCLUSION: Up to 3 years after the end of primary therapy, the health-related quality of life is noticeably reduced in breast cancer patients, without showing a tendency toward spontaneous improvement. By an intensive therapy with psychooncologic measures and activating physiotherapy, the quality of life can be improved in these patients. Whether this improvement leads to a long-term effect must be shown by a presently conducted randomized, prospective study.

Adult↗
PubMed2006

Impact of a rehabilitation legislation on the survival in the community of long-term patients discharged from psychiatric hospitals in Israel.

BACKGROUND: The aim of the present study was to examine the impact of the Rehabilitation Law 2000 in Israel (which provides a basket of rehabilitation services for every mentally disabled patient) on the survival in the community of a population of long-stay psychiatric patients released from psychiatric hospitals. METHODS: A naturalistic follow-up study was performed on long-stay patients discharged ("key discharge") from two Israel psychiatric hospitals closed before (in 1997) and after (in 2000) introduction of the Rehabilitation Law 2000. The data source was the National Psychiatric Hospitalization Registry. RESULTS: The study population consisted of 611 patients. The percentage of patients who, at closure of hospital, were discharged directly into the community was eightfold higher following the Rehabilitation Law 2000 than before. There was also a trend for a lower readmission rate for those patients who were discharged into the community in the post-law period, both for those whose key discharge was directly to the community and for those who were later discharged after being transferred to another hospital at key discharge. Concerning the mean duration of inpatient stay, there was no difference between the two cohorts, whether hospitalizations followed transfer to another hospital from key discharge or rehospitalization from the community. Interestingly, the Rehabilitation Law did not have a significant effect on patients' mortality after key discharge. CONCLUSION: The Rehabilitation Law 2000 has a beneficial effect on the opportunities of long-stay psychiatric patients to resettle in the community without increasing risk of death.

Adult↗
PubMed2003

Cognitive rehabilitation in schizophrenia: a quantitative analysis of controlled studies.

RATIONALE: Cognitive rehabilitation is now recognized as an important tool in the treatment of schizophrenia, and findings in this area are emerging rapidly. There is a need for a systematic review of the effects of the different training programs. OBJECTIVES: To review quantitatively the controlled studies on cognitive rehabilitation in schizophrenia for the effect of training on performance on tasks other than those practiced in the training procedure. METHODS: A meta-analysis was conducted on 12 controlled studies of cognitive rehabilitation in schizophrenia taking into account the effects of type of rehabilitation approach (rehearsal or strategy learning) and duration of training. RESULTS: The mean weighted effect size was 0.45, with a 95% confidence interval from 0.26 to 0.64. Effect sizes differed slightly, depending on rehabilitation approach, in favor of strategy learning, but this difference did not reach statistical significance. Duration of training did not influence effect size. CONCLUSIONS: Cognitive rehabilitation can improve task performance in patients with schizophrenia and this effect is apparent on tasks outside those practiced during the training procedure. Future studies should include more real-world outcomes and perform longitudinal evaluations.

Brief Psychiatric Rating Scale↗
PubMed2001

Effective planning and implementation of ecological rehabilitation projects: a case study of the regional municipality of Waterloo (Ontario, Canada).

The literature guides environmental planning and, specifically, how to use ecological rehabilitation projects to achieve long-term planning goals and landscape-scale environmental sustainability. There is, however, a perceived gap between principles in the literature and the use of them by practitioners involved in smaller-scale ecological rehabilitation projects. Using interviews with practitioners involved in 11 projects within the Regional Municipality of Waterloo, Ontario, Canada, we tested whether practitioners used five principles for effective planning and implementation of ecological rehabilitation that we derived from the literature. These five principles were: establishing political and ecological context, using ecologically appropriate objectives and practices, using comparative multidisciplinary and cross-scale approaches, using adaptive planning and implementation, and establishing good communication within and external to projects. Few projects followed all five principles, and practitioners indicated that they used three more project-specific principles: obtaining political/social support, promoting projects and changing attitudes about projects, and securing sufficient and persistent funding to maintain a project's life. While the literature emphasizes that ecological rehabilitation is only effective if projects are coordinated on a watershed basis, most practitioners focused solely on the goals of their specific project. The gap between literature and practice may arise because most practitioners are new to the field of ecological rehabilitation and still are focused on the methods involved. Time pressures force practitioners to obviate the literature and get projects started quickly, lest support evaporate. Complicating these difficulties is decreased support from federal and provincial governments for large-scale environmental planning. It is unclear whether ecological rehabilitation projects in Waterloo Region (at least) will ever become effective at promoting landscape-scale ecological goals or remain smaller-scale stop-gaps.

Animals↗
PubMed2006

What I have learned about the ACL: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction.

Anterior cruciate ligament surgery and rehabilitation have changed drastically during the past 30 years. The patellar tendon autograft fixed with buttons provides tight bone-to-bone placement of the graft and quick bony healing, which allows accelerated rehabilitation to obtain full range of motion and strength. Although surgical stability is easily reproducible, long-term patient satisfaction is difficult to guarantee. Full knee range of motion should be compared to that of the contralateral normal knee, including full hyperextension. We followed the progress of all patients to gauge the utility of our rehabilitation program. In order of importance, the lack of normal knee range of motion (within 2 degrees extension and 5 degrees of flexion compared with that of the normal knee), partial or total medial meniscectomy, partial or total lateral meniscectomy, and articular cartilage damage were related to lower subjective scores. Rehabilitation after ACL reconstruction must first strive to achieve full symmetrical knee range of motion before aggressive strengthening can begin. Our current perioperative rehabilitation starts at the time of injury and preoperatively includes aggressive swelling reduction, hyperextension exercises, gait training, and mental preparation. Goals after surgery are to control swelling while regaining full knee range of motion. After quadriceps strengthening goals are reached, patients can shift to sport-specific exercises. When using a graft from the contralateral knee, the conflicting goals of strengthening the donor site and achieving full knee range of motion are divided between the knees. Thus, normal range of motion and strength can be achieved more easily and more quickly than when using an ipsilateral graft. Regardless of the graft source, a systematic rehabilitation program that emphasizes the return to symmetrical knee motion, including hyperextension, is necessary to achieve the optimum result.

Anterior Cruciate Ligament↗
PubMed2006

Gender differences in psychosocial influence and rehabilitation outcomes for work-disabled individuals with chronic musculoskeletal pain.

INTRODUCTION: This study aimed to investigate gender differences in rehabilitation outcomes and how psychosocial factors may interact to influence rehabilitation outcome in work-disabled with chronic musculoskeletal pain. METHODS: One hundred and sixty eight (n=168) persons (mean age = 45.5/SD=9.0) participating in a multidisciplinary rehabilitation program, were included. Data on pain, functional health and psychosocial factors were collected previous to treatment, after 5 week intensive training and after 52 week follow-up period. Demographics, socio-economics and data on personal characteristics were also collected. RESULTS: Significant (p<.05) gender differences were found on sleeplessness, meaningfulness and manageability. No significant gender differences were found on pain or functional health status variables. Gender differences (p<.001) were found in how socio-demographic and psychosocial factors influence rehabilitation outcomes in terms of functional health status. CONCLUSIONS: These data suggests that knowledge of gender differences and the way psychosocial factors influence rehabilitation outcomes must be taken into account in designing rehabilitation intervention.

Activities of Daily Living↗
PubMed1992

Referral patterns and exercise response in the rehabilitation of female coronary patients aged greater than or equal to 62 years.

Gender-related differences in cardiac rehabilitation referral patterns and response to an aerobic conditioning program were examined in 226 hospitalized older coronary patients (aged greater than or equal to 62 years). Overall, the outpatient cardiac rehabilitation participation rate in this population was 21%. Older women were less likely to enter cardiac rehabilitation than were older men (15 vs 25%; p = 0.06), despite similar clinical profiles. This was explained primarily by a greater likelihood of primary physicians to strongly recommend cardiac rehabilitation to men. Before conditioning, women who entered cardiac rehabilitation were less fit than were men; peak oxygen consumption was 18% lower in women (16 +/- 5 vs 20 +/- 5 ml/kg/min; p = 0.02). However, both groups improved aerobic capacity similarly in response to a 12-week aerobic conditioning program, with maximal oxygen consumption increasing by 17% in women and by 19% in men. Thus, older female coronary patients are less likely to be referred for cardiac rehabilitation, despite a similar clinical profile and improvement in functional capacity from the training component.

Age Factors↗
PubMed1984

Current concepts in cardiac rehabilitation.

This article has presented the historical basis for cardiac rehabilitation and the available data related to the four most important questions that remain: (1) Does exercise increase survival after myocardial infarction? Although it is generally thought that clinical trials have failed to demonstrate that cardiac rehabilitation prolongs life after a myocardial infarction, analysis of pooled data from all published studies shows that this conclusion is unjustified. (2) Can each individual patient's risk for a future cardiac event be determined? We have developed a method using serial application of Baye 's theorem to determine each patient's risk. By so doing, we can stratify patient groups by previous risk and then assess the effect of cardiac rehabilitation on altering risk without limiting the analysis to subsequent myocardial infarction and cardiac death. (3) Can regression of atherosclerosis be demonstrated? Regression of atherosclerosis has been clearly demonstrated in animal models, but new evidence suggests that it can also occur in human subjects. (4) Do all patients require monitored exercise after a myocardial infarction? Evidence documenting the safety of exercise in patients recovering from a myocardial infarction has resulted in inclusion of sick patients in cardiac rehabilitation programs and exercise of the healthier patients in unmonitored settings. Major changes in cardiac rehabilitation programs are now taking place, with the emphasis moving away from prolongation of life toward improvement in the quality of life. As a result, cardiac rehabilitation is no longer confined to exercise alone; equal emphasis is placed on dietary and psychologic aspects of patient recovery.

Arteries↗
PubMed1994

Impact of nutritional rehabilitation on gastroesophageal reflux in neurologically impaired children.

The impact of nutritional rehabilitation on gastroesophageal reflux (GER) in 10 malnourished neurologically impaired children (NIC) was studied (mean age, 9.1 +/- 3.1 years). None of the children had an antireflux procedure (ARP), and all were fed exclusively through a percutaneous endoscopic gastrostomy (PEG). Malnutrition was defined as triceps skin fold thickness (TSF) below the fifth percentile for age and sex. GER was established using standard criteria for a 24-hour pH probe study. All children were treated with an H2 antagonist and a prokinetic agent, along with aggressive nutritional rehabilitation. When TSF was > or = 50th percentile, medications were stopped, and the 24-hour pH probe study was repeated. The mean weight gain was 8.8 +/- 3.7 kg over 8.4 +/- 2.3 months. The 24-hour pH probe study showed marked improvement after nutritional rehabilitation in six of 10 children. These children remained asymptomatic throughout long-term follow-up, without the use of medications. Two children had abnormal pH probe results and worsening clinical symptoms when taken off medications after nutritional rehabilitation. They were reexamined after reinstituting the prokinetic drug; results of the pH probe study were normal, and there was no clinical symptomatology. The patients were then given long-term medication. Two children (one with erosive esophagitis and one with persistent symptoms) underwent ARP. We conclude that despite accompanying GER, successful nutritional rehabilitation can be achieved in malnourished NIC, using PEG feeding and antireflux medication. Although some NIC with GER may need an ARP or long-term medication, in most malnourished NIC nutritional rehabilitation is associated with resolution of GER.

Adolescent↗