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Sample records for nonoperative rehabilitation program

  1. Nonoperative Management, Rehabilitation, and Functional and Clinical Progression of Osteitis Pubis/Pubic Bone Stress in Professional Soccer Players: A Case Series.

    Science.gov (United States)

    McAleer, Stephen S; Lippie, Ed; Norman, Darcy; Riepenhof, Helge

    2017-09-01

    Study Design Case series. Background Pubic bone stress (PBS) is a common acute or chronic response of the pelvis in sports where sprinting, kicking, twisting, and cutting are the dominant movements. There are few nonoperative rehabilitation strategies for the condition reported in the literature, and the outcome of conservative treatment has not been documented. Case Description Five professional and academy soccer players complaining of pubic symphysis pain, confirmed as PBS on magnetic resonance imaging and objective assessment, were treated with a nonoperative rehabilitation program that featured functional and clinical objective markers as progression criteria. Interventions in the acute phase included pharmacological and physical therapeutic modalities to reduce pain initially. Rehabilitation management focused on improving range of motion at the hips and thorax, adductor strengthening, trunk and lumbopelvic stability, gym-based strength training, and field-based rehabilitation and conditioning. Clinical follow-up was performed at least 8 months following return to play. Outcomes All players demonstrated reduced or resolved pain, increased adductor squeeze strength, and return to pain-free training and match play. Return-to-training time averaged 40.6 days (range, 30-60 days) and return to play averaged 49.4 days (range, 38-72 days) within the 5 players. At final follow-up (mean, 29.6 months; range, 16-33 months), there had been no recurrences. Discussion This report of 5 cases suggests that a nonoperative protocol, using clinical and functional progression criteria, may be successful in rehabilitating athletes with PBS for return to sport within 11 weeks. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2017;47(9):683-690. Epub 3 Aug 2017. doi:10.2519/jospt.2017.7314.

  2. Comprehensive Outpatient Rehabilitation Program: Hospital-Based Stroke Outpatient Rehabilitation.

    Science.gov (United States)

    Rice, Danielle; Janzen, Shannon; McIntyre, Amanda; Vermeer, Julianne; Britt, Eileen; Teasell, Robert

    2016-05-01

    Few studies have considered the effectiveness of outpatient rehabilitation programs for stroke patients. The objective of this study was to assess the effectiveness of a hospital-based interdisciplinary outpatient stroke rehabilitation program with respect to physical functioning, mobility, and balance. The Comprehensive Outpatient Rehabilitation Program provides a hospital-based interdisciplinary approach to stroke rehabilitation in Southwestern Ontario. Outcome measures from physiotherapy and occupational therapy sessions were available at intake and discharge from the program. A series of paired sample t-tests were performed to assess patient changes between time points for each outcome measure. A total of 271 patients met the inclusion criteria for analysis (56.1% male; mean age = 62.9 ± 13.9 years). Significant improvements were found between admission and discharge for the Functional Independence Measure, grip strength, Chedoke-McMaster Stroke Assessment, two-minute walk test, maximum walk test, Timed Up and Go, Berg Balance Scale, and one-legged stance (P rehabilitation program was effective at improving the physical functioning, mobility, and balance of individuals after a stroke. A hospital-based, stroke-specific rehabilitation program should be considered when patients continue to experience deficits after inpatient rehabilitation. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Scoliosis Research Society (SRS) Criteria and Society of Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) 2008 Guidelines in Non-Operative Treatment of Idiopathic Scoliosis.

    Science.gov (United States)

    Korbel, Krzysztof; Kozinoga, Mateusz; Stoliński, Łukasz; Kotwicki, Tomasz

    2014-07-28

    According to the Scoliosis Research Society (SRS), idiopathic scoliosis (IS) is a curvature of more than 10° Cobb angle, affecting 2-3% of pediatric population. Idiopathic scoliosis accounts for 80% of all scoliosis cases. Non-operative principles in the therapy of idiopathic scoliosis, including Scoliosis Research Society (SRS) criteria and guidelines proposed by the experts of the Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORTS) were presented. The possibility to carry out quality of life assessments in a conservative procedure was also demonstrated. Based on the natural history of idiopathic scoliosis, SRS criteria, SOSORT 2008 experts' opinion and the knowledge of the possibilities of psychological assessment of conservative IS treatment, rules were proposed regarding nonsurgical IS therapy procedures, with special consideration being paid to the proper treatment start time (age, Risser test, biological maturity, Cobb angle), possibility of curvature progression, the importance of physiotherapy and psychological assessment. The knowledge of SRS criteria and SOSORT guidelines regarding the conservative treatment of IS are essential for proper treatment (the right time to start treatment), and supports establishment of interdisciplinary treatment teams, consisting of a physician, a physiotherapist, an orthopedic technician and a psychologist.

  4. EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE

    Science.gov (United States)

    Edwards, Peter; Ebert, Jay; Joss, Brendan; Bhabra, Gev; Ackland, Tim; Wang, Allan

    2016-01-01

    The incidence of rotator cuff tears increases with age, with full-thickness rotator cuff tears present in approximately 25% of individuals in their sixties, and more than 50% of those in their eighties. While surgery is considered an effective treatment, recurrent tears at the insertion site are common, especially with degenerative tears, which are frequent in the older population. More recently, there has been increasing interest in exercise rehabilitation and physical therapy as a means to manage partial and full thickness tears of the rotator cuff by addressing weakness and functional deficits. Recent studies have suggested that patients opting for physical therapy have demonstrated high satisfaction, an improvement in function, and success in avoiding surgery. When considering the increasing rate of shoulder surgery and the associated economic and social burden rotator cuff surgery places on both the patient and the health care system, non-surgical management such as physical therapy and exercise may, in selected cases, be a treatment alternative to surgical repair. The purpose of this clinical commentary is to provide an overview of rotator cuff pathology and pathogenesis, and to present an evidence-based case for the role of conservative rehabilitation in the management of rotator cuff injuries. Level of Evidence Level 5 PMID:27104061

  5. Business Enterprise Program | Division of Vocational Rehabilitation

    Science.gov (United States)

    About Us > Business Enterprise Program Business Enterprise Program The Division of Vocational Rehabilitation's (DVR) Business Enterprise Program (BEP) provides employment opportunities to people who experience contact their DVR counselor or the BEP coordinator. List of Business Enterprise Program Vendors BEP Policy

  6. Process of pulmonary rehabilitation and program organization.

    Science.gov (United States)

    Wouters, E F M; Augustin, I M L

    2011-09-01

    Pulmonary rehabilitation programs are highly directed to return patients suffering from chronic lung diseases to a state of self-help. These programs are largely organized as temporary interventions in a highly fragmented delivery care system for patients with chronic respiratory conditions. In an optimal health care organizational structure, pulmonary rehabilitation needs to be considered as an essential part of an individualized, integrated care process, organized from the vantage point of the patient and the patients'health continuum. Pulmonary rehabilitation programs need to become organized as patient-centered care, respectful of and responsive to individual patient preferences, needs and values. Partnering and communication skills are considered as drivers for successful rehabilitation. Assessment is considered as the cornerstone to evaluate the individual needs and problems in order to develop an individualized intervention. Pulmonary rehabilitation programs need to move away from a supply-driven functional organizational structure towards integrated structures, including the full range of medical expertise, technical skills and specialized facilities needed to compete on added value in the management of patients with chronic respiratory diseases.

  7. Integrating cognitive rehabilitation: A preliminary program description and theoretical review of an interdisciplinary cognitive rehabilitation program.

    Science.gov (United States)

    Fleeman, Jennifer A; Stavisky, Christopher; Carson, Simon; Dukelow, Nancy; Maier, Sheryl; Coles, Heather; Wager, John; Rice, Jordyn; Essaff, David; Scherer, Marcia

    2015-01-01

    Interdisciplinary cognitive rehabilitation is emerging as the expected standard of care for individuals with mild to moderate degrees of cognitive impairment for a variety of etiologies. There is a growing body of evidence in cognitive rehabilitation literature supporting the involvement of multiple disciplines, with the use of cognitive support technologies (CSTs), in delivering cognitive therapy to individuals who require cognitive rehabilitative therapies. This article provides an overview of the guiding theories related to traditional approaches of cognitive rehabilitation and the positive impact of current theoretical models of an interdisciplinary approach in clinical service delivery of this rehabilitation. A theoretical model of the Integrative Cognitive Rehabilitation Program (ICRP) will be described in detail along with the practical substrates of delivering specific interventions to individuals and caregivers who are living with mild to moderate cognitive impairment. The ultimate goal of this article is to provide a clinically useful resource for direct service providers. It will serve to further clinical knowledge and understanding of the evolution from traditional silo based treatment paradigms to the current implementation of multiple perspectives and disciplines in the pursuit of patient centered care. The article will discuss the theories that contributed to the development of the interdisciplinary team and the ICRP model, implemented with individuals with mild to moderate cognitive deficits, regardless of etiology. The development and implementation of specific assessment and intervention strategies in this cognitive rehabilitation program will also be discussed. The assessment and intervention strategies utilized as part of ICRP are applicable to multiple clinical settings in which individuals with cognitive impairment are served. This article has specific implications for rehabilitation which include: (a) An Interdisciplinary Approach is an

  8. 34 CFR 386.1 - What is the Rehabilitation Long-Term Training program?

    Science.gov (United States)

    2010-07-01

    ...; (5) Rehabilitation social work; (6) Rehabilitation psychiatry; (7) Rehabilitation psychology; (8...; (12) Physical education; (13) Therapeutic recreation; (14) Community rehabilitation program personnel...; (20) Independent living; (21) Client assistance; (22) Administration of community rehabilitation...

  9. The Rehabilitation Medicine Scientist Training Program

    Science.gov (United States)

    Whyte, John; Boninger, Michael; Helkowski, Wendy; Braddom-Ritzler, Carolyn

    2016-01-01

    Physician scientists are seen as important in healthcare research. However, the number of physician scientists and their success in obtaining NIH funding have been declining for many years. The shortage of physician scientists in Physical Medicine and Rehabilitation is particularly severe, and can be attributed to many of the same factors that affect physician scientists in general, as well as to the lack of well developed models for research training. In 1995, the Rehabilitation Medicine Scientist Training Program (RMSTP) was funded by a K12 grant from the National Center of Medical Rehabilitation Research (NCMRR), as one strategy for increasing the number of research-productive physiatrists. The RMSTP's structure was revised in 2001 to improve the level of preparation of incoming trainees, and to provide a stronger central mentorship support network. Here we describe the original and revised structure of the RMSTP and review subjective and objective data on the productivity of the trainees who have completed the program. These data suggest that RMSTP trainees are, in general, successful in obtaining and maintaining academic faculty positions and that the productivity of the cohort trained after the revision, in particular, shows impressive growth after about 3 years of training. PMID:19847126

  10. Multivisceral Transplantation Rehabilitation Program-Case Report.

    Science.gov (United States)

    Loschi, T M; Cinacchi, M P R G; Baccan, M D T A; Marques, F; Pedroso, P T; Meira Filho, S P; Scacchetti, T; Pavão, D N

    2018-04-01

    Multivisceral transplantation is the treatment for multiple abdominal organ failure. The patient experiences reduced food intake and absorption of nutrients, contributing to weight loss and decreased muscle mass, reducing functional capacity. A physical and nutritional rehabilitation program based on adequate caloric intake associated with supervised physical exercise seems to support a gain of muscle mass, re-establishing its capacity and functional independence. A rehabilitation program was carried out, consisting of low-intensity aerobic exercise on treadmill, exercises of global strengthening (50% of 1 maximum repetition [1RM], with progressive increase), and nutritional monitoring (oral hypercaloric diet, hyperproteic supplementation daily and after exercise). Initial and final evaluation included weight, muscle mass index, brachial circumference (BC), tricipital cutaneous fold (TCF), hand grip strength (HGS), 6-minute walk test (6MWT), 1RM, vital capacity (VC), and respiratory muscle strength. After the program, functional capacity was evaluated through the 6MWT (92%), 1RM test, VC (55%), respiratory muscle strength, HGS at 5 kg, weight gain (4.75%), increase of BC in 2 cm, and TCF in 2 mm. The program contributed to functional independence, improved quality of life, and social reintegration, suggesting the importance of a supervised physical activity program associated with adequate nutritional intake after multivisceral transplantation. Copyright © 2018 Elsevier Inc. All rights reserved.

  11. [Nutritional care in the cardiac rehabilitation program].

    Science.gov (United States)

    da Vico, Letizia; Biffi, Barbara; Masini, Maria Luisa; Fattirolli, Francesco

    2007-06-01

    There is some evidence of the efficacy of nutritional care in modifying eating habits and behavior in patients undergoing cardiac rehabilitation: nutritional care has a relevant role in the secondary prevention of cardiovascular disease. The dietitian is the qualified sanitary professional for nutritional care. The aim of this study was to define the role of dietitians within a health care team in programs of cardiac rehabilitation. In this setting, nutritional care starts with a dietary assessment, which includes a measurement of the anthropometric parameters, and a survey of the patient knowledge and eating habits. If there is no need for change in the patient lifestyle, the patient is addressed to the normal cardiac rehabilitation program with no further nutritional intervention except one session of counseling. When lifestyle changes are needed, the dietitian defines, together with the patient, therapeutic aims and expected results. The following phase is represented by group session with patients and their relatives during which nutritional topics are discussed and nutritional education is provided Afterwards, self-monitoring sheets of eating habits are individually discussed in one visit; a last individual visit is used for a final assessment of nutritional knowledge, dietary habits, and anthropometric parameters. In case of unsatisfactory results, patients are invited to participate to three group session to be held biweekly, during which they interact with the dietitian and take part to exercises and group discussions. When the established targets are reached, the nutritional program includes individual follow up visits at six and twelve months for further assessment of medium term results.

  12. THE PREVENTION PROGRAMS OF PHYSICAL REHABILITATION FOR CHERNOBYL DISASTER SURVIVORS

    OpenAIRE

    G.V. Korobeynikov; V.U. Drojjin

    2013-01-01

    The purpose of the study: approbation of the prevention program of physical rehabilitation for Chernobyl disaster survivors in lifestyle aspects. Sixty persons who were disaster survivors and workers of Chernobyl Nuclear Power Plant aged 32-60 have rehabilitation during 21 days. The complex of training prevention programs of physical and psycho-emotional rehabilitation methods was elaborated. The study of efficacy of training prevention programs among Chernobyl disaster survivors. The results...

  13. Ecological projects of Semipalatinsk region rehabilitation program

    International Nuclear Information System (INIS)

    Musataev, M.Kh.

    2000-01-01

    Number of radioecological investigations of Semipalatinsk region evident, that radiatively dangerous levels of contaminations remains only on test settlements of site, on traces of explosion dose-forming clouds, and on some sections where experiments with radioactive substances were carried out. Radiological problem includes necessity of clarification of boundaries between dirty and clean lands; study of plutonium contamination hazard and radionuclides migration with underground and surface waters; conducting of monitoring of both the water quality and the agricultural foodstuff. Today in the region the problem of psychological stress of population remains. The problem is arisen because of late consequences of nuclear tests and other factors related with insufficient well-informing of population and mistrust of population to official radiation assessments in the region. To this problem is devoted six ecological projects of Semipalatinsk site rehabilitation program proposed by 53 session of United Nation Assembly for financing by international financing organizations and by countries-donors

  14. Innovation in Rehabilitation Services and Clinical Programs for Health Care

    Directory of Open Access Journals (Sweden)

    Asghar Dadkhah

    2014-06-01

    Full Text Available Rehabilitation program is a critical piece of clinical care strategy in order to accelerate healing and improve quality of life to the fullest extent possible. An innovated program should have 3 inspiring concepts: Seek inspire and Advance. Seeking and evaluating is a breakthrough technology, innovative methodology and emerging trend in the healthcare industry. The program should inspire clinicians to critically evaluate and implement the highest standards of care. Also an innovated program should advance clinical program development to maximize opportunities for first to market positioning and community partnerships. The scope of program can be from psycho-rehabilitation to predictor in addiction (1-3, Cognitive and motor rehabilitation researchers are quite concerned about system wide biases that may impair development of innovative rehabilitation techniques. In this issue ....

  15. Progress in sensorimotor rehabilitative physical therapy programs for stroke patients

    Science.gov (United States)

    Chen, Jia-Ching; Shaw, Fu-Zen

    2014-01-01

    Impaired motor and functional activity following stroke often has negative impacts on the patient, the family and society. The available rehabilitation programs for stroke patients are reviewed. Conventional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, motor relearning and function-based principles) are the mainstream tactics in clinical practices. Numerous advanced strategies for sensory-motor functional enhancement, including electrical stimulation, electromyographic biofeedback, constraint-induced movement therapy, robotics-aided systems, virtual reality, intermittent compression, partial body weight supported treadmill training and thermal stimulation, are being developed and incorporated into conventional rehabilitation programs. The concept of combining valuable rehabilitative procedures into “a training package”, based on the patient’s functional status during different recovery phases after stroke is proposed. Integrated sensorimotor rehabilitation programs with appropriate temporal arrangements might provide great functional benefits for stroke patients. PMID:25133141

  16. Progress in sensorimotor rehabilitative physical therapy programs for stroke patients

    OpenAIRE

    Chen, Jia-Ching; Shaw, Fu-Zen

    2014-01-01

    Impaired motor and functional activity following stroke often has negative impacts on the patient, the family and society. The available rehabilitation programs for stroke patients are reviewed. Conventional rehabilitation strategies (Bobath, Brunnstrom, proprioception neuromuscular facilitation, motor relearning and function-based principles) are the mainstream tactics in clinical practices. Numerous advanced strategies for sensory-motor functional enhancement, including electrical stimulati...

  17. A virtual rehabilitation program after amputation: a phenomenological exploration

    NARCIS (Netherlands)

    Moraal, M.; Slatman, J.; Pieters, T.; Mert, A.; Widdershoven, G.

    2013-01-01

    Purpose: This study provides an analysis of bodily experiences of a man with a lower leg amputation who used a virtual rehabilitation program. Method: The study reports data from semi-structured interviews with a 32-year veteran who used a virtual environment during rehabilitation. The interviews

  18. Rehabilitation Counseling Information: Programmed Instruction for the Practitioner. Final Report.

    Science.gov (United States)

    Phelps, William R.

    This programmed instruction rehabilitation counseling information test attempts to cover six areas as follows: testing, psychological information, medical information, counseling concepts, history of rehabilitation, and counselor-agency functioning. The information may be utilized for research purposes and/or replicated by others. (Author)

  19. INCORPORATING KETTLEBELLS INTO A LOWER EXTREMITY SPORTS REHABILITATION PROGRAM

    OpenAIRE

    Brumitt, Jason; En Gilpin, Hui; Brunette, Meredith; Meira, Erik P.

    2010-01-01

    The primary goal of a sports rehabilitation program is to return the injured athlete back to competition as quickly and as safely as possible. Sports physical therapists utilize a variety of exercise equipment to help an athlete restore function after an injury. An injured athlete's therapeutic exercise program frequently includes the prescription of functional strengthening and power exercises during the later stages of rehabilitation. One piece of exercise equipment, the kettlebell, has gai...

  20. An Eccentrically Biased Rehabilitation Program Early after TKA Surgery

    Directory of Open Access Journals (Sweden)

    Robin L. Marcus

    2011-01-01

    Full Text Available Rehabilitation services are less-studied aspects of the management following total knee arthroplasty (TKA despite long-term suboptimal physical functioning and chronic deficits in muscle function. This paper describes the preliminary findings of a six-week (12 session eccentrically-biased rehabilitation program targeted at deficits in physical function and muscle function, initiated one month following surgery. A quasiexperimental, one group, pretest-posttest study with thirteen individuals (6 female, 7 male; mean age 57±7 years examined the effectiveness of an eccentrically-biased rehabilitation program. The program resulted in improvements in the primary physical function endpoints (SF-36 physical component summary and the six-minute walk test with increases of 59% and 47%, respectively. Muscle function endpoints (knee extension strength and power also increased 107% and 93%, respectively. Eccentrically-biased exercise used as an addition to rehabilitation may help amplify and accelerate physical function following TKA surgery.

  1. THE PREVENTION PROGRAMS OF PHYSICAL REHABILITATION FOR CHERNOBYL DISASTER SURVIVORS

    Directory of Open Access Journals (Sweden)

    G.V. Korobeynikov

    2013-02-01

    Full Text Available The purpose of the study: approbation of the prevention program of physical rehabilitation for Chernobyl disaster survivors in lifestyle aspects. Sixty persons who were disaster survivors and workers of Chernobyl Nuclear Power Plant aged 32-60 have rehabilitation during 21 days. The complex of training prevention programs of physical and psycho-emotional rehabilitation methods was elaborated. The study of efficacy of training prevention programs among Chernobyl disaster survivors. The results showed the improvement of psycho-emotional status and normalization of cardiovascular vegetative regulation after training prevention programs in Chernobyl disasters survivors. The studies show that the preventive programs for Chernobyl disaster survivors in lifestyle aspects had the high effect. This displays the decrease of tempo of aging and the improving of physical and psychological health status of Chernobyl disaster survivors during preventive course.

  2. ICU early physical rehabilitation programs: financial modeling of cost savings.

    Science.gov (United States)

    Lord, Robert K; Mayhew, Christopher R; Korupolu, Radha; Mantheiy, Earl C; Friedman, Michael A; Palmer, Jeffrey B; Needham, Dale M

    2013-03-01

    To evaluate the potential annual net cost savings of implementing an ICU early rehabilitation program. Using data from existing publications and actual experience with an early rehabilitation program in the Johns Hopkins Hospital Medical ICU, we developed a model of net financial savings/costs and presented results for ICUs with 200, 600, 900, and 2,000 annual admissions, accounting for both conservative- and best-case scenarios. Our example scenario provided a projected financial analysis of the Johns Hopkins Medical ICU early rehabilitation program, with 900 admissions per year, using actual reductions in length of stay achieved by this program. U.S.-based adult ICUs. Financial modeling of the introduction of an ICU early rehabilitation program. Net cost savings generated in our example scenario, with 900 annual admissions and actual length of stay reductions of 22% and 19% for the ICU and floor, respectively, were $817,836. Sensitivity analyses, which used conservative- and best-case scenarios for length of stay reductions and varied the per-day ICU and floor costs, across ICUs with 200-2,000 annual admissions, yielded financial projections ranging from -$87,611 (net cost) to $3,763,149 (net savings). Of the 24 scenarios included in these sensitivity analyses, 20 (83%) demonstrated net savings, with a relatively small net cost occurring in the remaining four scenarios, mostly when simultaneously combining the most conservative assumptions. A financial model, based on actual experience and published data, projects that investment in an ICU early rehabilitation program can generate net financial savings for U.S. hospitals. Even under the most conservative assumptions, the projected net cost of implementing such a program is modest relative to the substantial improvements in patient outcomes demonstrated by ICU early rehabilitation programs.

  3. Physical rehabilitation following polytrauma. The Canadian Forces Physical Rehabilitation Program 2008-2011.

    Science.gov (United States)

    Besemann, Markus

    2011-12-01

    As a consequence of Canada's involvement in the war in Afghanistan, many members of the Canadian Forces have experienced debilitating injuries. Despite the Canadian Forces Health Services (CFHS) having outstanding relationships with many civilian care providers for the rehabilitation of injured soldiers, it became apparent early on that the high-level goals and aspirations of these returning soldiers were sometimes beyond the capability of these centres to facilitate. From this reality grew the need to develop a Physical Rehabilitation Program within the CFHS. This article describes the lessons learned since the creation of the program and outlines the future vision in terms of unique challenges and opportunities. The primary purpose of this article is to describe a hybrid model of civilian-military rehabilitation for injured soldiers and discuss the benefits and challenges of such a model of care.

  4. Sex Offender Rehabilitation Programs in State Prisons: A Nationwide Survey.

    Science.gov (United States)

    Sapp, Allen D.; Vaughn, Michael S.

    1991-01-01

    Examined programs and strategies for rehabilitation used in adult sex offender treatment programs in state-operated adult correctional institutions. Questionnaires were completed by 73 adult sex offender treatment providers. The results revealed that incarcerated adult sex offenders were receiving comprehensive psychotherapy and behavior…

  5. National Institute on Disability and Rehabilitation Research Program Directory, 1999.

    Science.gov (United States)

    National Inst. on Disability and Rehabilitation Research (ED/OSERS), Washington, DC.

    This directory lists all projects funded by the National Institute of Disability and Rehabilitation Research (NIDRR) during the 1999 fiscal year. It includes summaries, funding data, and contact information for a broad range of programs. Programs are grouped into the following research priorities: (1) employment outcomes; (2) health and function;…

  6. Nonoperative treatment of symptomatic spondylolysis.

    Science.gov (United States)

    Kurd, Mark F; Patel, Deepan; Norton, Robert; Picetti, George; Friel, Brian; Vaccaro, Alexander R

    2007-12-01

    Symptomatic spondylolysis resulting from a stress fracture of the pars interarticularis is a cause of low back pain in the juvenile and adolescent patient. Treatment is conservative in the majority of cases. To analyze the outcome of patients with symptomatic isthmic spondylolysis treated nonoperatively with a custom fit thoracolumbar orthosis and activity cessation for 3 months followed by an organized physical therapy program. Retrospective case series. Four hundred thirty-six juvenile and adolescent patients with spondylolysis. Pain improvement, hamstring flexibility, range of motion, resolution of back spasms, and return to previous activities. Retrospective review of 436 juvenile and adolescent patients with symptomatic spondylolysis confirmed by single-photon emission computed tomography or computed tomography. Clinical outcomes were assessed through patient history and physical examination. Ninety-five percent of patients achieved excellent results according to a modified Odom's Criteria. The remaining 5% of patients achieved good results as they required occasional nonsteroidal anti-inflammatory drugs to relieve pain. Back spasms were resolved and hamstring tightness and range of motion returned to normal in all patients. All patients returned to their preinjury activity level. No patients went on to surgery. Symptomatic juvenile and adolescent patients with an isthmus spondylolysis may be effectively managed with a custom fit thoracolumbar orthosis brace and activity cessation for approximately 3 months followed by an organized physical therapy program.

  7. Incorporating kettlebells into a lower extremity sports rehabilitation program.

    Science.gov (United States)

    Brumitt, Jason; En Gilpin, Hui; Brunette, Meredith; Meira, Erik P

    2010-12-01

    The primary goal of a sports rehabilitation program is to return the injured athlete back to competition as quickly and as safely as possible. Sports physical therapists utilize a variety of exercise equipment to help an athlete restore function after an injury. An injured athlete's therapeutic exercise program frequently includes the prescription of functional strengthening and power exercises during the later stages of rehabilitation. One piece of exercise equipment, the kettlebell, has gained popularity for its ability to allow the user to perform functional power exercises. The unique exercises that can be performed with kettlebells may have utility in sports physical therapy practice. This clinical suggestion outlines the clinical rationale for the inclusion of kettlebell exercises when rehabilitating an athlete with a lower extremity injury.

  8. Social support and subjective health complaints among patients participating in an occupational rehabilitation program

    OpenAIRE

    Øyeflaten, Irene; Gabriele, Jeanne M.; Fisher, Edwin B.; Eriksen, Hege R.

    2010-01-01

    Objectives: To examine differences in rehabilitation patients' social support received from rehabilitation staff and from support providers outside rehabilitation, and to examine the relationships between social support and the patients' reports of subjective health complaints (SHC). Methods: 131 patients (68 % females, mean age 45 years) participating in a 4-week, inpatient, occupational rehabilitation program were included. All patients completed questionnaires on demographic variables, SHC...

  9. Initial Efficacy of a Cardiac Rehabilitation Transition Program: Cardiac TRUST

    Science.gov (United States)

    Zullo, Melissa; Boxer, Rebecca; Moore, Shirley M.

    2012-01-01

    Patients recovering from cardiac events are increasingly using postacute care, such as home health care and skilled nursing facility services. The purpose of this pilot study was to test the initial efficacy, feasibility, and safety of a specially designed postacute care transitional rehabilitation intervention for cardiac patients. Cardiac Transitional Rehabilitation Using Self- Management Techniques (Cardiac TRUST) is a family-focused intervention that includes progressive low-intensity walking and education in self-management skills to facilitate recovery following a cardiac event. Using a randomized two-group design, exercise self-efficacy, steps walked, and participation in an outpatient cardiac rehabilitation program were compared in a sample of 38 older adults; 17 who received the Cardiac TRUST program and 21 who received usual care only. At discharge from postacute care, the intervention group had a trend for higher levels of self-efficacy for exercise outcomes (X=39.1, SD=7.4) than the usual care group (X=34.5; SD=7.0) (t-test 1.9, p=.06). During the 6 weeks following discharge, compared with the usual care group, the intervention group had more attendance in out-patient cardiac rehabilitation (33% compared to 11.8%, F=7.1, p=.03) and a trend toward more steps walked during the first week (X=1,307, SD=652 compared to X=782, SD=544, t-test 1.8, p=.07). The feasibility of the intervention was better for the home health participants than for those in the skilled nursing facility and there were no safety concerns. The provision of cardiac-focused rehabilitation during postacute care has the potential to bridge the gap in transitional services from hospitalization to outpatient cardiac rehabilitation for these patients at high risk for future cardiac events. Further evidence of the efficacy of Cardiac TRUST is warranted. PMID:22084960

  10. Final priority; National Institute on Disability and Rehabilitation Research--Disability and Rehabilitation Projects and Centers Program--Rehabilitation Engineering Research Centers. Final priority.

    Science.gov (United States)

    2013-06-19

    The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for a Rehabilitation Engineering Research Center (RERC) on Technologies to Support Successful Aging with Disability under the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). The Assistant Secretary may use this priority for a competition in fiscal year (FY) 2013 and later years. We take this action to focus research attention on areas of national need. We intend to use this priority to improve outcomes for individuals with disabilities.

  11. Final priority; National Institute on Disability and Rehabilitation Research--Disability and Rehabilitation Research Projects and Centers Program--Rehabilitation Engineering Research Centers. Final priority.

    Science.gov (United States)

    2013-06-14

    The Assistant Secretary for Special Education and Rehabilitative Services announces a priority for a Rehabilitation Engineering Research Center (RERC) on Universal Interfaces and Information Technology Access under the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). The Assistant Secretary may use this priority for a competition in fiscal year (FY) 2013 and later years. We take this action to focus research attention on areas of national need. We intend to use this priority to improve outcomes for individuals with disabilities.

  12. 42 CFR 410.49 - Cardiac rehabilitation program and intensive cardiac rehabilitation program: Conditions of coverage.

    Science.gov (United States)

    2010-10-01

    ... of the items and services furnished under the plan. (iii) The goals set for the individual under the... prescribed exercise, cardiac risk factor modification, psychosocial assessment, and outcomes assessment... section. Intensive cardiac rehabilitation site means a hospital outpatient setting or physician's office...

  13. Developing a Rehabilitation Model of Breast Cancer Patients Through Literature Review and Hospital Rehabilitation Programs

    Directory of Open Access Journals (Sweden)

    Bok-Yae Chung, PhD, RN, APN

    2008-03-01

    Conclusion: Rehabilitation of breast cancer patients deserves special attention to achieve optimal quality of life. Health care professionals need to be educated about rehabilitation as an effective intervention.

  14. 77 FR 66959 - Request for Information on the Future Direction of the Rehabilitation Training Program

    Science.gov (United States)

    2012-11-08

    ... Individuals 10 1 0 10 3 with Mental Illnesses (H129H).. Rehabilitation Psychology 2 1 0 1 1 (H129J... State VR agencies and in community rehabilitation programs. The following questions are designed to...

  15. 34 CFR 369.44 - What wage and hour standards apply to community rehabilitation programs?

    Science.gov (United States)

    2010-07-01

    ... VOCATIONAL REHABILITATION SERVICE PROJECTS What Conditions Must Be Met by a Grantee? § 369.44 What wage and... hour standards must be observed in projects carried out in community rehabilitation programs...

  16. 77 FR 33729 - Disability and Rehabilitation Research Projects and Centers Program-National Data and Statistical...

    Science.gov (United States)

    2012-06-07

    ... inclusion and integration of individuals with disabilities into society, and promote the employment... DEPARTMENT OF EDUCATION Disability and Rehabilitation Research Projects and Centers Program.... Final priority; National Institute on Disability and Rehabilitation Research (NIDRR)--Disability and...

  17. 75 FR 70013 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

    Science.gov (United States)

    2010-11-16

    ... 0938-AP89 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal... the July 22, 2010 Federal Register entitled, ``Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2011.'' DATES: Effective Date. This correction is effective for IRF...

  18. The Performance Enhancement Group Program: Integrating Sport Psychology and Rehabilitation

    Science.gov (United States)

    Granito, Vincent J.; Hogan, Jeffery B.; Varnum, Lisa K.

    1995-01-01

    In an effort to improve the psychological health of the athlete who has sustained an injury, the Performance Enhancement Group program for injured athletes was created. This paper will offer a model for the Performance Enhancement Group program as a way to: 1) support the athlete, both mentally and physically; 2) deal with the demands of rehabilitation; and 3) facilitate the adjustments the athlete has to make while being out of the competitive arena. The program consists of responsibilities for professionals in sport psychology (ie, assessment/orientation, support, education, individual counseling, and evaluation) and athletic training (ie, organization/administration, recruitment and screening, support, application of techniques, and program compliance). The paper will emphasize that the success of the program is dependent on collaboration between professionals at all levels. PMID:16558357

  19. Late postacute neurologic rehabilitation: neuroscience, engineering, and clinical programs.

    Science.gov (United States)

    Bach-y-Rita, Paul

    2003-08-01

    This lecture highlights my career in rehabilitation research. My principal efforts in rehabilitation have been to study (1) mechanisms of brain plasticity related to reorganization of the brain and recovery of function; (2) late postacute rehabilitation; (3) sensory substitution; and (4) rehabilitation engineering. A principal goal has been to aid in the development of a strong scientific base in rehabilitation.

  20. Original article Rehabilitation model program for seriously ill patients

    Directory of Open Access Journals (Sweden)

    Adrienne Kegye

    2014-10-01

    Full Text Available Background Patients receiving cancer treatment start lifestyle changes mostly at the end of the treatment during the rehabilitation period. Most often, the first step is a dietary change and physical exercises built into the daily routine. Patients who do this in groups led by qualified therapists and based on professional counseling can build more effective and more permanent changes into their life. To develop a complex rehabilitation program which, in the short term, aims to familiarize patients with a lifestyle which harmonizes the physical, mental, spiritual and social spheres of life and, in the long term, to build it into their everyday life in order to ameliorate the physical and mental state and reduce the psychological symptoms and the isolation of patients. The physical component focuses on diet and exercise. The psycho-social-spiritual support focuses on discovering inner sources of strength, developing active coping mechanisms and helping to achieve more open communication. Participants and procedure In February and March 2011, 8 patients treated for malignant tumors participated in the model program. The components of the model program were psychotherapy, physiotherapy, cancer consultation, nutrition counseling, creative activities and walking. Results During the period of the model program the isolation of the patients decreased and their social support and ability of coping with the illness ameliorated. They reported an ease in anxiety and depression in their everyday activities. According to feedback, their communication with each other, with the staff and with their relatives became more open. Altogether this had advantageous effects on the functioning of the ward and the mood of the staff. Conclusions The rehabilitation program confirmed that beside individual psycho-social support, beneficial and economic psycho-social support can be provided for the patients in group form along with the most effective assignment of the

  1. A multifaceted rehabilitation program for women with cancer.

    Science.gov (United States)

    Johnson, J B; Kelly, A W

    1990-01-01

    A multifaceted rehabilitation program for women diagnosed with cancer includes a personal fitness plan, aerobic exercise classes, journaling, and a six-day environmental wilderness experience. The program's purpose is for participants to learn how to cope with uncertainties in life and to promote a wellness concept for living with cancer. This is achieved through successfully meeting the challenges of the program. A descriptive study, using journal entries of the pilot group's 12 women with breast cancer, provides insight into participants' views of the program. Their responses described: personal growth through succeeding at new and difficult experiences; normalization engendered by communicating with others having cancer; exhilaration at focusing on challenging events external to personal health problems; and courage that overrode their fears of facing what seemed impossible.

  2. Effectiveness of a Multidisciplinary Rehabilitation Program Following Shoulder Injury

    Directory of Open Access Journals (Sweden)

    Andrea Bean

    2017-07-01

    Full Text Available Background: Shoulder injuries in working age adults result in a major cost to the health care system. The purpose of this study was to examine the effectiveness of a new multidisciplinary rehabilitation program and to explore factors that affected a successful return to work (RTW in injured workers with shoulder problems who received this program. Methods: This was a prospective longitudinal study. The patient-oriented outcome measures were the Numeric Pain Rating Scale (NPRS and the Disabilities of the Arm, Shoulder, and Hand (DASH. Range of motion (ROM in flexion, abduction, and external rotation and strength in lifting and push/pull were documented. All outcomes were measured before and at the completion of the program. Results: Data of 68 patients were used for analysis. All outcomes showed a statistically significant improvement over time. Conclusions: Multidisciplinary rehabilitation programs help to improve pain, disability, ROM, strength, and facilitate RTW. Higher stress and a fast-paced work environment increased the risk of not progressing in work status.

  3. Final priorities; National Institute on Disability and Rehabilitation Research--Disability and Rehabilitation Research Projects and Centers Program--Rehabilitation Engineering Research Centers. Final priorities.

    Science.gov (United States)

    2013-06-11

    The Assistant Secretary for Special Education and Rehabilitative Services announces priorities under the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce priorities for a Rehabilitation Engineering Research Center (RERC) on Rehabilitation Strategies, Techniques, and Interventions (Priority 1), Information and Communication Technologies Access (Priority 2), Individual Mobility and Manipulation (Priority 3), and Physical Access and Transportation (Priority 4). The Assistant Secretary may use one or more of these priorities for competitions in fiscal year (FY) 2013 and later years. We take this action to focus research attention on areas of national need. We intend these priorities to improve community living and participation, health and function, and employment outcomes of individuals with disabilities.

  4. 34 CFR 350.1 - What is the Disability and Rehabilitation Research Projects and Centers Program?

    Science.gov (United States)

    2010-07-01

    ...) Rehabilitation Engineering Research Centers. (Authority: Sec. 204; 29 U.S.C. 762) ... 34 Education 2 2010-07-01 2010-07-01 false What is the Disability and Rehabilitation Research... DISABILITY AND REHABILITATION RESEARCH PROJECTS AND CENTERS PROGRAM General § 350.1 What is the Disability...

  5. 76 FR 59256 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

    Science.gov (United States)

    2011-09-26

    ...; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size... [CMS-1349-CN] RIN 0938-AQ28 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2012; Changes in Size and Square Footage of Inpatient Rehabilitation Units...

  6. Vocational Rehabilitation and Employment program--self-employment. Final rule.

    Science.gov (United States)

    2010-01-20

    This document amends the vocational rehabilitation and employment regulations of the Department of Veterans Affairs (VA) concerning self-employment for individuals with qualifying disabilities. We are making changes to conform VA's regulations for self-employment programs for veterans, and for servicemembers awaiting discharge, to statutory provisions, including provisions limiting eligibility for certain supplies, equipment, stock, and license fees to individuals with the most severe service-connected disabilities. We are also making related changes in VA's regulations affecting eligibility for such assistance for certain veterans' children with birth defects in self-employment programs. In addition, we are amending our regulations regarding the approval authority for self-employment plans to make certain requirements less restrictive and less burdensome, to remove a vague and overly broad requirement, to make changes to reflect longstanding VA policy, and to make nonsubstantive clarifying changes.

  7. Making an APPropriate Care Program for Indigenous Cardiac Disease: Customization of an Existing Cardiac Rehabilitation Program.

    Science.gov (United States)

    Bradford, DanaKai; Hansen, David; Karunanithi, Mohan

    2015-01-01

    Cardiovascular disease is a major health problem for all Australians and is the leading cause of death in Aboriginal and Torres Strait Islanders. In 2010, more then 50% of all heart attack deaths were due to repeated events. Cardiac rehabilitation programs have been proven to be effective in preventing the recurrence of cardiac events and readmission to hospitals. There are however, many barriers to the use of these programs. To address these barriers, CSIRO developed an IT enabled cardiac rehabilitation program delivered by mobile phone through a smartphone app and succesfully trialed it in an urban general population. If these results can be replicated in Indigenous populations, the program has the potential to significantly improve life expectancy and help close the gap in health outcomes. The challenge described in this paper is customizing the existing cardiac health program to make it culturally relevant and suitable for Indigenous Australians living in urban and remote communities.

  8. Is nonoperative management of adhesive intestinal obstruction ...

    African Journals Online (AJOL)

    Background: Nonoperative management of adhesive intestinal obstruction gives good results in adults but there are scant studies on its outcome in children. This study reports outcomes and experiences with nonoperative and operative management of adhesive intestinal obstruction in children in a resource-poor country.

  9. Strategies For Being A Successful Physician Administrator Of A Rehabilitation Program

    Institute of Scientific and Technical Information of China (English)

    John L.Melvin; MD,MMSc

    2008-01-01

    @@ INTRODUCTION Purpose: The purpose of this paper is to provide rehabili-tation physicians with suggestions that will assist themin becoming successful program leaders/managers/ad-ministrators. The content of this paper is based uponthe experiences and observations of the author whohas had extensive experience in developing, leadingand managing rehabilitation programs.

  10. 48 CFR 853.271 - Loan Guaranty, Education and Vocational Rehabilitation and Counseling Programs.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Loan Guaranty, Education and Vocational Rehabilitation and Counseling Programs. 853.271 Section 853.271 Federal Acquisition... Guaranty, Education and Vocational Rehabilitation and Counseling Programs. ...

  11. Rehabilitation through the Arts: Impact on Participants' Engagement in Educational Programs

    Science.gov (United States)

    Halperin, Ronnie; Kessler, Suzanne; Braunschweiger, Dana

    2012-01-01

    Educational achievement has been shown to be negatively correlated with recidivism among those released from prison (Nuttall, Hollmen, and Staley, 2003). The purpose of this study was to examine the impact of a prison art rehabilitation program, Rehabilitation Through the Arts (RTA), on inmate participation in voluntary educational programs. RTA…

  12. Donkey-assisted rehabilitation program for children: a pilot study

    Directory of Open Access Journals (Sweden)

    Paola De Rose

    2011-12-01

    Full Text Available Bonding with animals grants access to the sphere of affectivity and facilitates therapeutic engagement. The methodological approach of donkey-assisted programs is based on mediation, which is characterized by multidirectional relationships (patient-donkey-therapist. The donkey is an excellent facilitator in the motivation-building process, being able to stimulate the child's development by way of active and positive forces that foster psycho-affective and psycho-cognitive development processes. Results of this study, which focused on the child's approach to the donkey, indicate that while communicating with the animal, children rely more on physical expressions than on verbal language. Donkey-assisted rehabilitative sessions can help in identifying children's strong points, on which motivation could be built.

  13. 77 FR 37022 - Disability and Rehabilitation Research Projects and Centers Program; Rehabilitation Engineering...

    Science.gov (United States)

    2012-06-20

    ... training to facilitate the advancement of knowledge and understanding of the unique needs of traditionally... opportunities for early-career rehabilitation engineers. RERCs seek to solve rehabilitation problems and remove... sector of the economy, productivity, competition, jobs, the environment, public health or safety, or...

  14. Rehabilitering

    DEFF Research Database (Denmark)

    Caswell, Dorte; Høybye-Mortensen, Matilde; Dall, Tanja

    2013-01-01

    Rehabilitering som både begreb og indsats har været genstand for stigende fokus i de seneste år, på både politisk, organisatorisk og praksis-niveau. Fra januar 2013 træder en større reform af førtidspension og fleksjob i kraft, og med reformen etableres ’rehabilitering’ som både mål og middel i...

  15. Potential role of a cognitive rehabilitation program following left temporal lobe epilepsy surgery

    Directory of Open Access Journals (Sweden)

    Camila de Vasconcelos Geraldi

    Full Text Available ABSTRACT Research into memory and epilepsy has focused on measuring problems and exploring causes with limited attention directed at the role of neuropsychological rehabilitation in alleviating post-operative memory difficulties. Objectives To assess the effects of a memory rehabilitation program in patients with left temporal lobe epilepsy following surgery. Methods Twenty-four patients agreed to participate and 18 completed the study; nine received memory rehabilitation while nine had no input and were designated as controls. Verbal learning efficiency, naming abilities, memory subjective ratings, ecological activity measures and a language fMRI paradigm were used as outcome measures. Results Improved verbal learning and naming test performance, increase in memory strategy use and improved self-perception were observed following the rehabilitation. Changes in fMRI activation patterns were seen in the rehabilitation group over the long term. Conclusion The findings support the potential role of a cognitive rehabilitation program following left temporal lobe surgery.

  16. Nonoperative modalities to treat symptomatic cervical spondylosis.

    LENUS (Irish Health Repository)

    Hirpara, Kieran Michael

    2012-01-01

    Cervical spondylosis is a common and disabling condition. It is generally felt that the initial management should be nonoperative, and these modalities include physiotherapy, analgesia and selective nerve root injections. Surgery should be reserved for moderate to severe myelopathy patients who have failed a period of conservative treatment and patients whose symptoms are not adequately controlled by nonoperative means. A review of the literature supporting various modalities of conservative management is presented, and it is concluded that although effective, nonoperative treatment is labour intensive, requiring regular review and careful selection of medications and physical therapy on a case by case basis.

  17. Smartphone-Based Cardiac Rehabilitation Program: Feasibility Study.

    Science.gov (United States)

    Chung, Heewon; Ko, Hoon; Thap, Tharoeun; Jeong, Changwon; Noh, Se-Eung; Yoon, Kwon-Ha; Lee, Jinseok

    2016-01-01

    We introduce a cardiac rehabilitation program (CRP) that utilizes only a smartphone, with no external devices. As an efficient guide for cardiac rehabilitation exercise, we developed an application to automatically indicate the exercise intensity by comparing the estimated heart rate (HR) with the target heart rate zone (THZ). The HR is estimated using video images of a fingertip taken by the smartphone's built-in camera. The introduced CRP app includes pre-exercise, exercise with intensity guidance, and post-exercise. In the pre-exercise period, information such as THZ, exercise type, exercise stage order, and duration of each stage are set up. In the exercise with intensity guidance, the app estimates HR from the pulse obtained using the smartphone's built-in camera and compares the estimated HR with the THZ. Based on this comparison, the app adjusts the exercise intensity to shift the patient's HR to the THZ during exercise. In the post-exercise period, the app manages the ratio of the estimated HR to the THZ and provides a questionnaire on factors such as chest pain, shortness of breath, and leg pain during exercise, as objective and subjective evaluation indicators. As a key issue, HR estimation upon signal corruption due to motion artifacts is also considered. Through the smartphone-based CRP, we estimated the HR accuracy as mean absolute error and root mean squared error of 6.16 and 4.30bpm, respectively, with signal corruption due to motion artifacts being detected by combining the turning point ratio and kurtosis.

  18. Smartphone-Based Cardiac Rehabilitation Program: Feasibility Study.

    Directory of Open Access Journals (Sweden)

    Heewon Chung

    Full Text Available We introduce a cardiac rehabilitation program (CRP that utilizes only a smartphone, with no external devices. As an efficient guide for cardiac rehabilitation exercise, we developed an application to automatically indicate the exercise intensity by comparing the estimated heart rate (HR with the target heart rate zone (THZ. The HR is estimated using video images of a fingertip taken by the smartphone's built-in camera. The introduced CRP app includes pre-exercise, exercise with intensity guidance, and post-exercise. In the pre-exercise period, information such as THZ, exercise type, exercise stage order, and duration of each stage are set up. In the exercise with intensity guidance, the app estimates HR from the pulse obtained using the smartphone's built-in camera and compares the estimated HR with the THZ. Based on this comparison, the app adjusts the exercise intensity to shift the patient's HR to the THZ during exercise. In the post-exercise period, the app manages the ratio of the estimated HR to the THZ and provides a questionnaire on factors such as chest pain, shortness of breath, and leg pain during exercise, as objective and subjective evaluation indicators. As a key issue, HR estimation upon signal corruption due to motion artifacts is also considered. Through the smartphone-based CRP, we estimated the HR accuracy as mean absolute error and root mean squared error of 6.16 and 4.30bpm, respectively, with signal corruption due to motion artifacts being detected by combining the turning point ratio and kurtosis.

  19. Effect of computerized cognitive rehabilitation program on cognitive function and activities of living in stroke patients

    OpenAIRE

    Yoo, Chanuk; Yong, Mi-hyun; Chung, Jaeyeop; Yang, Yeongae

    2015-01-01

    [Purpose] The objective of this study was to examine the effect of cognitive rehabilitation using a computer on cognitive function and activities of daily living in stroke patients presenting impairment of cognitive function. [Subjects] Forty-six stroke patients were divided into two groups (a training group and control group) through random assignment. [Methods] The training group received rehabilitation therapy and an additional computerized cognitive rehabilitation program using The RehaCo...

  20. Building a Knowledge to Action Program in Stroke Rehabilitation.

    Science.gov (United States)

    Janzen, Shannon; McIntyre, Amanda; Richardson, Marina; Britt, Eileen; Teasell, Robert

    2016-09-01

    The knowledge to action (KTA) process proposed by Graham et al (2006) is a framework to facilitate the development and application of research evidence into clinical practice. The KTA process consists of the knowledge creation cycle and the action cycle. The Evidence Based Review of Stroke Rehabilitation is a foundational part of the knowledge creation cycle and has helped guide the development of best practice recommendations in stroke. The Rehabilitation Knowledge to Action Project is an audit-feedback process for the clinical implementation of best practice guidelines, which follows the action cycle. The objective of this review was to: (1) contextualize the Evidence Based Review of Stroke Rehabilitation and Rehabilitation Knowledge to Action Project within the KTA model and (2) show how this process led to improved evidence-based practice in stroke rehabilitation. Through this process, a single centre was able to change clinical practice and promote a culture that supports the use of evidence-based practices in stroke rehabilitation.

  1. A rehabilitation program for lung cancer patients during postthoracotomy chemotherapy

    Directory of Open Access Journals (Sweden)

    Hoffman AJ

    2014-03-01

    Full Text Available Amy J Hoffman,1 Ruth Ann Brintnall,2 Alexander von Eye,3 Lee W Jones,4 Gordon Alderink,5 Lawrence H Patzelt,6 Jean K Brown7 1College of Nursing, Michigan State University, East Lansing, MI, USA; 2Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA; 3Psychology Department, Michigan State University, East Lansing, MI, USA; 4Duke Center for Cancer Survivorship Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA; 5Frederik Meijer Honors College, Grand Valley State University, Grand Rapids, MI, USA; 6Spectrum Health, Grand Rapids, MI, USA and College of Human Medicine, Michigan State University, East Lansing, MI, USA; 7School of Nursing, University at Buffalo, the State University of New York, Buffalo, NY, USA Objective: The objective of this pilot study was to describe the effects of a 16-week home-based rehabilitative exercise program on cancer-related fatigue (CRF, other symptoms, functional status, and quality of life (QOL for patients with non-small cell lung cancer (NSCLC after thoracotomy starting within days after hospital discharge and continuing through the initiation and completion of chemotherapy. Materials and methods: Five patients with NSCLC completed the Brief Fatigue Inventory (measuring CRF severity and the MD Anderson Symptom Inventory (measuring symptom severity before and after thoractomy, and at the end of each week of the 16-week exercise program. Additionally, the Medical Outcomes Study Short Form-36 (measuring physical and mental functional status and the Quality of Life Index (measuring QOL were completed before and after thoracotomy, after weeks 3, 6, 12, and 16 (the end of the exercise program. Further, the 6-minute walk test (measuring functional capacity was administered before thoracotomy, prior to the initiation of chemotherapy and/or radiation therapy, and at the end of the 16-week exercise program, after completion of chemotherapy. Results: Participants had a

  2. Pulmonary rehabilitation programs in lung transplant: a literature review

    Directory of Open Access Journals (Sweden)

    Juliana Maria de Sousa Pinto

    2015-09-01

    Full Text Available Objective: To analyze, using a literature review, Pulmonary Rehabilitation (RP Programs in lung transplant. Methods: A literature review in July 2014 in Ebsco Host, Periódicos Capes, BVS and Science Direct data bases using descriptors in English (“lung transplantation”, “lung transplant” AND/OR “rehabilitation” and Portuguese (“reabilitação” AND/OR “transplante pulmonar”. The eligibility criterions were interventional studies of PR before and/or after lung transplant; participants who were candidates to lung transplant or lung transplant recipients; studies that applied any kind of PR program (hospital-based, homebased or outpatient and articles published in English, Spanish or Portuguese. Literature reviews, guidelines and case reports were excluded. The search process yielded 46 articles of which two were duplicated. After title and abstract screening 13 articles remained for full text reading. Six studies met the inclusion eligibility and were included in the review. Results: The studies involved patients with Chronic Obstructive Pulmonary Disease, Cystic Fibrosis, Pulmonary Hypertension, Interstitial Lung Disease and Pulmonary Fibrosis. Pulmonary function, exercise capacity, quality of life (QoL and quadriceps force were evaluated. Most interventions were outpatient programs with three months duration, three times a week and session with at least one hour. Protocols included physical training, educational approach and just one included nutritional, psychiatric and social assistant follow-up. The studies presented significant change in the six-minute walking distance, QoL and quadriceps force after PR programs. Conclusion: This review showed the benefits of the PR in the QoL and exercise capacity contributing to the Health Promotion of the patients.

  3. Expanding the Haitian rehabilitation workforce: employment situation and perceptions of graduates from three rehabilitation technician training programs.

    Science.gov (United States)

    Descôteaux, Nancy; Chagnon, Valérie; Di Dong, Xin; Ellemo, Eric; Hamelin, Alessandra; Juste, Evans; Laplante, Xavier; Miron, Allison; Morency, Philippe; Samuel, Katherine; Charles, David; Hunt, Matthew

    2018-05-01

    This article examines the employment situation and perceptions of graduates from three rehabilitation technician (RT) programs in Haiti. In this mixed method study, 74 of 93 recent graduates completed a questionnaire, and 20 graduates participated in an in-depth qualitative interview. We analyzed survey results using descriptive statistics. We used a qualitative description approach and analyzed the interviews using constant comparative techniques. Of the 48 survey respondents who had completed their training more than six months prior to completing the questionnaire, 30 had found work in the rehabilitation sector. Most of these technicians were working in hospitals in urban settings and the patient population they treated most frequently were patients with neurological conditions. Through the interviews, we explored the participants' motivations for becoming a RT, reflections on the training program, process of finding work, current employment, and plans for the future. An analysis of qualitative and quantitative findings provides insights regarding challenges, including availability of supervision for graduated RTs and the process of seeking remunerated work. This study highlights the need for stakeholders to further engage with issues related to formal recognition of RT training, expectations for supervision of RTs, concerns for the precariousness of their employment, and uncertainty about their professional futures. Implications for Rehabilitation The availability of human resources in the rehabilitation field in Haiti has increased with the implementation of three RT training programs over the past 10 years. RTs who found work in the rehabilitation sector were more likely to work in a hospital setting, in the province where their training had taken place, to treat a diverse patient clientele, and to be employed by a non-governmental organization. The study underlines challenges related to the long-term sustainability of RT training programs, as well as the

  4. Treatment Plans in Psychiatric Community Housing Programs : Do They Reflect Rehabilitation Principles?

    NARCIS (Netherlands)

    de Heer-Wunderink, Charlotte; Visser, Ellen; Caro-Nienhuis, Annemarie D.; van Weeghel, Jaap; Sytema, Sjoerd; Wiersma, Durk

    2012-01-01

    Objective: This study examined the extent to which treatment plans of service users of community housing programs measure up to rehabilitation principles according to the Choose-Get-Keep model of psychiatric rehabilitation. The study evaluates whether these plans correspond with service-user and

  5. 40 CFR 35.935-16 - Sewer use ordinance and evaluation/rehabilitation program.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Sewer use ordinance and evaluation...-Clean Water Act § 35.935-16 Sewer use ordinance and evaluation/rehabilitation program. (a) The grantee... sewer use ordinance, and the grantee is complying with the sewer system evaluation and rehabilitation...

  6. Cardiac Rehabilitation Enhancing Programs in Patients with Myocardial Infarction: A literature Review

    Directory of Open Access Journals (Sweden)

    Ahyana Ahyana

    2013-01-01

    Full Text Available Background: Cardiac rehabilitation (CR is a process that involves a multidisciplinary team of health professionals in order to optimize the status of patients’ physical, psychological, social, and vocational well being. The CR program has been proven to influence health outcomes in patients with cardiac diseases, particularly myocardial infarction (MI and stable angina. However, patients’ compliance with cardiac rehabilitation programs remains a challenge.Purpose: The purpose of this study is to review and identify interventions that enhance cardiac rehabilitation behaviors in MI patients.Method: A literature review was conducted by analyzing related research reports published since 2000 to 2012. Only English language articles were included.Result: There were 10 experimental studies and 2 meta-analysis studies. Interventions widely used to enhance cardiac rehabilitation behaviors in MI patients were self-efficacy and self management derived programs. These programs involved interventions that enhance cardiac rehabilitation behaviors, including training exercise, behavioral change, education and psychological support, and lifestyle changing strategies. None have reported the use of culturally tailored intervention. Four phases of cardiac rehabilitation were accepted as each phase represents a different aspect of care: inpatient care, early post discharge period, exercise training, and long term follow up. Critical factors for patients in maintaining an optimum health condition after a cardiac event are, in order, status of patient’s physical, psychological, social, and vocational well being.Conclusion: Cardiac Rehabilitation program has been shown to improve quality of life and decrease mortality in MI patients. The development of culturally specific interventions to increase cardiac rehabilitation behaviors will provide a significant improvement for cardiac patient’s care that ultimately results in better health outcomes. Health care

  7. POST-OPERATIVE REHABILITATION PROGRAM AFTER SURGERY ACL RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Zoran Đokić

    2013-07-01

    Full Text Available ACL (anterior cruciate ligament are small ligaments inside the knee capsule that connect the femur tibia, main function is to prevent movement of the femur in front of tibia and to provide stability, it also helps in controlling the movement of the knee, in direction back-forward. Injuries of ACL appear in an increasing number of athletes. Per year, from 100,000 people who have an injury of the knee joint, 30% have the reconstruction surgery of ACL. ACL injury accounts about 40% of all sports injuries. The greatest number of injuries just happens in the most popular sports, such as: basketball, football and handball, often in female athlete. After the injury, about 25% of athletes fail to return to the sport. Recovery time after surgery is usually 6-12 months, depending on individual characteristics, as well as technical and tactical demands of specific sports activities. Choosing an appropriate and efficient rehabilitation protocols, and training is of great importance. The aim of this paper is to present training protocol of 60 days, 3 months after ACL reconstruction surgery, of top handball female athletes. In the first 30 days, a total of 74 training sessions were done, 39 trainings and 21 EMS (Electrical Muscle Stimulation treatments, at the end of each workout. Functional abilities and morphological status were measured at the beginning and end of the treatment program. After the training protocol athlete got individual exercise program of 26 days (30 training sessions. After 20 days began with normal training, the 26th day of the first game played. The applied protocol has proven successful, as the third competition season there is no problem with an injury.

  8. Athletic pubalgia and associated rehabilitation.

    Science.gov (United States)

    Ellsworth, Abigail A; Zoland, Mark P; Tyler, Timothy F

    2014-11-01

    Evaluation and treatment of groin pain in athletes is challenging. The anatomy is complex, and multiple pathologies often coexist. Different pathologies may cause similar symptoms, and many systems can refer pain to the groin. Many athletes with groin pain have tried prolonged rest and various treatment regimens, and received differing opinions as to the cause of their pain. The rehabilitation specialist is often given a non-specific referral of "groin pain" or "sports hernia." The cause of pain could be as simple as the effects of an adductor strain, or as complex as athletic pubalgia or inguinal disruption. The term "sports hernia" is starting to be replaced with more specific terms that better describe the injury. Inguinal disruption is used to describe the syndromes related to the injury of the inguinal canal soft tissue environs ultimately causing the pain syndrome. The term athletic pubalgia is used to describe the disruption and/or separation of the more medial common aponeurosis from the pubis, usually with some degree of adductor tendon pathology. Both non-operative and post-operative treatment options share the goal of returning the athlete back to pain free activity. There is little research available to reference for rehabilitation guidelines and creation of a plan of care. Although each surgeon has their own specific set of post-operative guidelines, some common concepts are consistent among most surgeons. Effective rehabilitation of the high level athlete to pain free return to play requires addressing the differences in the biomechanics of the dysfunction when comparing athletic pubalgia and inguinal disruption. Proper evaluation and diagnostic skills for identifying and specifying the difference between athletic pubalgia and inguinal disruption allows for an excellent and efficient rehabilitative plan of care. Progression through the rehabilitative stages whether non-operative or post-operative allows for a focused rehabilitative program. As more

  9. Complex exercise rehabilitation program for women of the II period of age with metabolic syndrome

    OpenAIRE

    Lee, Eun-Ok; Olga, Kozyreva

    2013-01-01

    The purpose of this study was to develop a complex exercise program integrating Eastern and Western complex exercise rehabilitation programs in order to examine the effects of it on the human body with the subjects for women of the II period of mature age with metabolic syndrome. The subjects of this study are 60 II period of mature aged women with metabolic syndrome living in G City, and the experimental group conducted Taekwon-aerobic exercise, European rehabilitation gymnastics, gym ball e...

  10. 78 FR 66271 - Final Priority; Rehabilitation Training: Rehabilitation Long-Term Training Program-Vocational...

    Science.gov (United States)

    2013-11-05

    ... social and electronic media, especially as it relates to confidentiality and appropriateness of the use... Counselor Certification Code of Professional Ethics; (2) VR services to transition-age youth; (3... Rehabilitation Act, as amended, and the Social Security Act and their accompanying regulations; (5) basic...

  11. Information and communication technology-based cardiac rehabilitation homecare programs

    Directory of Open Access Journals (Sweden)

    Varnfield M

    2015-04-01

    Full Text Available Marlien Varnfield, Mohanraj KarunanithiAustralian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organization, Royal Brisbane and Women's Hospital, Brisbane, AustraliaAbstract: Cardiac rehabilitation (CR has, for many years, been a highly recommended approach to secondary prevention for patients recovering after a heart attack or heart surgery. These programs are traditionally delivered from a hospital outpatient center. Despite demonstrated benefits and guideline recommendations, CR utilization has been poor, particularly in women, older patients, and ethnic minority groups. To overcome some of the barriers to the traditional delivery of CR, different delivery platforms and approaches have been developed in recent years. In general, Telehealth solutions which have been used to address the delivery of CR services remotely include: 1 patient–provider contact delivered by telephone systems; 2 the Internet, with the majority of patient–provider contact for risk factor management taking place online; and 3 interventions using Smartphones as tools to deliver CR through (independently or in combination with short message service messaging, journaling applications, connected measurement devices, and remote coaching. These solutions have been shown to overcome some of the barriers in CR participation and show potential as alternative or complementary options for individuals that find traditional center-based CR programs difficult to commit to. The major benefits of remote platforms for CR delivery are the ability to deliver these interventions without ongoing face-to-face contact, which provides an opportunity to reach large numbers of people, and the convenience of selecting the timing of cardiovascular disease management sessions. Furthermore, technologies have the potential to deliver long-term follow-up, which programs delivered by health professionals cannot afford to do due to staff shortages and budget restrictions

  12. Nonoperative dynamic treatment of acute achilles tendon rupture

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Bloch Lauridsen, Hanne

    2014-01-01

    BACKGROUND: Dynamic rehabilitation has been suggested to be an important part of nonoperative treatment of acute Achilles tendon rupture that results in functional outcome and rerupture rates comparable with those of operative treatment. However, the optimal role of weight-bearing during early re...... Score (ATRS) after one year. Secondary outcomes included heel-rise work, health-related quality of life, and the rerupture rate. Outcome assessors were blinded to the intervention. RESULTS: Thirty patients were randomized to each group; twenty-nine in the weight-bearing group and twenty......, the total heel-rise work performed by the injured limb relative to that by the uninjured limb was 53% in the weight-bearing group and 58% in the control group (p = 0.37). There were three reruptures in the weight-bearing group and two in the control group (p = 1.0). CONCLUSIONS: The ATRS and heel-rise work...

  13. An interprofessional palliative care oncology rehabilitation program: effects on function and predictors of program completion.

    Science.gov (United States)

    Chasen, M R; Feldstain, A; Gravelle, D; Macdonald, N; Pereira, J

    2013-12-01

    After treatment, patients with active cancer face a considerable burden from the effects of both the disease and its treatment. The Palliative Rehabilitation Program (prp) is designed to ameliorate disease effects and to improve the patient's functioning. The present study evaluated predictors of program completion and changes in functioning, symptoms, and well-being after the program. The program received referrals for 173 patients who had finished anticancer therapy. Of those 173 patients, 116 with advanced cancer were eligible and enrolled in the 8-week interprofessional prp; 67 completed it. Measures of physical, nutritional, social, and psychological functioning were evaluated at entry to the program and at completion. Participants experienced significant improvements in physical performance (p program not challenging enough), death, and personal or unknown reasons. A normal level of C-reactive protein (program completion. Patients living with advanced cancers who underwent the interprofessional prp experienced significant improvement in functioning across several domains. Program completion can be predicted by a normal level of C-reactive protein.

  14. Do Cardiac Rehabilitation Programs Offer Cardiopulmonary Resuscitation Training in Australia and New Zealand?

    Science.gov (United States)

    Cartledge, Susie H; Bray, Janet E; Stub, Dion; Krum, Henry; Finn, Judith

    2016-06-01

    Cardiac rehabilitation may provide an ideal environment to train high-risk cardiac patients and their families in cardiopulmonary resuscitation (CPR). However, whether this training is currently offered is unknown. The aims of this study were to: 1) describe the prevalence of CPR training in cardiac rehabilitation programs in Australia and New Zealand (NZ); and 2) examine perceived barriers and attitudes of cardiac rehabilitation coordinators towards providing CPR training. We conducted a cross-sectional online survey of Australian and NZ cardiac rehabilitation coordinators. We received 253 completed surveys (46.7% response rate) (Australia n=208, NZ n=45). Cardiopulmonary resuscitation training was included in 23.9% of Australian programs and 56.6% in NZ. Common barriers to CPR training included lack of resources (49.7%) and a lack of awareness to provide CPR training for this high-risk group (33.7%). The majority of coordinators believed that lay people should be trained in CPR (96.3%) and were comfortable with recommending CPR training to this high-risk group (89.4%). While cardiac rehabilitation coordinators have positive attitudes towards CPR training, it is not currently part of most programs - particularly in Australia. Organisations formulating cardiac rehabilitation recommendations and guidelines should give consideration to include the provision of CPR training. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  15. Anglo-Saxon experience in the implementation of correctional treatment and the Polish individual rehabilitation program

    Directory of Open Access Journals (Sweden)

    Maciej Bernasiewicz

    2012-12-01

    Full Text Available The authors cite American and British research on the effectiveness of correctional treatment. On that basis, they describe several crucial factors that affect the success of rehabilitation (e.g., educators’ skills, working with families of juvenile offenders. The article broadly discusses the specific juvenile residential treatment program that has been implemented in Florida. The conclusions of this program are drawn from the research conducted through interviews with juvenile offenders (young adults who have effectively completed the process of rehabilitation in correctional facilities. Furthermore, the authors discuss an individual program of rehabilitation (IPR implemented in Polish correctional facilities. Using the experience and the impact of correctional treatment in the West, it is proposed to introduce certain modifications in the planning and implementation of Polish correctional treatment programs (IPR s.

  16. Program of complex rehabilitation of pregnant with alimentary-constitutional obesity in the third trimester.

    Directory of Open Access Journals (Sweden)

    Kovalenko T.N.

    2011-03-01

    Full Text Available In the article is presented the complex rehabilitation program for pregnant with alimentary-constitutional obesity in the third trimester. The program is directed on the decline of bodyweight, with the purpose of increase of scray-protective reactions of organism of pregnant and to the decline of obstetric traumatism in births. In an experiment took part 90 pregnant of the third trimester with obesity of I-III degree, middle genesial age. The developed and inculcated program foresaw the use of physical, psychological and medical rehabilitation.

  17. Cooperative Work-Study Programs in Vocational Rehabilitation: Results of a National Survey.

    Science.gov (United States)

    Bullis, Michael; Foss, Gilbert

    1983-01-01

    Conducted a national survey of vocational rehabilitation agencies (N=42) to determine the present status of cooperative work study programs serving mentally retarded secondary students. Results documented a decrease both in formal programs and number of students served. (Author/JAC)

  18. 75 FR 55786 - Office of Special Education Programs, Office of Special Education and Rehabilitative Services...

    Science.gov (United States)

    2010-09-14

    ... DEPARTMENT OF EDUCATION Office of Special Education Programs, Office of Special Education and Rehabilitative Services, Department of Education; Notice of Final Extension of Project Period and Waiver for the... Transition Technical Assistance Center (NSTTAC). Currently, the Office of Special Education Programs (OSEP...

  19. 75 FR 55785 - Office of Special Education Programs, Office of Special Education and Rehabilitative Services...

    Science.gov (United States)

    2010-09-14

    ... DEPARTMENT OF EDUCATION Office of Special Education Programs, Office of Special Education and Rehabilitative Services, Department of Education; Notice of Final Extension of Project Period and Waiver for the... this award, the Office of Special Education Programs (OSEP) funds NCEO to address national, State, and...

  20. Healthcare Professionals' Attitudes to Rehabilitation Programming for Male Cancer Survivors

    DEFF Research Database (Denmark)

    Handberg, Charlotte; Midtgaard, Julie; Nielsen, Claus Vinther

    2016-01-01

    observation and 9 semi-structured focus group interviews with 58 hospital HCPs. Methods: Using interpretive description methodology with symbolic interaction as a theoretical framework, data were collected through fieldwork in three oncology wards in Denmark. Findings: Attitudes about both gender...... be compromised by HCP attitudes and conduct. Clinical Relevance: These findings provide insight into approaches to guide HCPs to take responsibility for rehabilitation and to take gender into account in their work....

  1. Outcomes of Nonoperative Management of Uncomplicated Appendicitis.

    Science.gov (United States)

    Bachur, Richard G; Lipsett, Susan C; Monuteaux, Michael C

    2017-07-01

    Nonoperative management (NOM) of uncomplicated pediatric appendicitis has promise but remains poorly studied. NOM may lead to an increase in resource utilization. Our objective was to investigate the trends in NOM for uncomplicated appendicitis and study the relevant clinical outcomes including subsequent appendectomy, complications, and resource utilization. Retrospective analysis of administrative data from 45 US pediatric hospitals. Patients appendicitis between 2010 and 2016 were studied. NOM was defined by an ED visit for uncomplicated appendicitis treated with antibiotics and the absence of appendectomy at the index encounter. The main outcomes included trends in NOM among children with uncomplicated appendicitis and frequency of subsequent diagnostic imaging, ED visits, hospitalizations, and appendectomy during 12-month follow-up. 99 001 children with appendicitis were identified, with a median age of 10.9 years. Sixty-six percent were diagnosed with nonperforated appendicitis, of which 4190 (6%) were managed nonoperatively. An increasing number of nonoperative cases were observed over 6 years (absolute difference, +20.4%). During the 12-month follow-up period, NOM patients were more likely to have the following: advanced imaging (+8.9% [95% confidence interval (CI) 7.6% to 10.3%]), ED visits (+11.2% [95% CI 9.3% to 13.2%]), and hospitalizations (+43.7% [95% CI 41.7% to 45.8%]). Among patients managed nonoperatively, 46% had a subsequent appendectomy. A significant increase in NOM of nonperforated appendicitis was observed over 6 years. Patients with NOM had more subsequent ED visits and hospitalizations compared with those managed operatively at the index visit. A substantial proportion of patients initially managed nonoperatively eventually had an appendectomy. Copyright © 2017 by the American Academy of Pediatrics.

  2. Final priority; Rehabilitation Services Administration--Assistive Technology Alternative Financing Program. Final priority.

    Science.gov (United States)

    2014-08-14

    The Assistant Secretary for Special Education and Rehabilitative Services announces a priority under the Assistive Technology Alternative Financing Program administered by the Rehabilitation Services Administration (RSA). The Assistant Secretary may use this priority for competitions in fiscal year (FY) 2014 and later years. This priority is designed to ensure that the Department funds high-quality assistive technology (AT) alternative financing programs (AFPs) that meet rigorous standards in order to enable individuals with disabilities to access and acquire assistive technology devices and services necessary to achieve education, community living, and employment goals.

  3. LESSON LEARNED FROM MANGROVE REHABILITATION PROGRAM IN INDONESIA

    Directory of Open Access Journals (Sweden)

    Cecep Kusmana

    2017-07-01

    Full Text Available Indonesia as an archipelagic country more than 17,504 islands with the length of coastline estimated at 95,181 km bears mangroves from several meters to several kilometers. They grow extensively in the five big islands (Jawa, Sumatra, Kalimantan, Sulawesi, Papua. At the year of 2009, Agency of Survey Coordination and National Mapping (Bakosurtanal of Indonesia reported the existing mangrove forest area in Indonesia of about 3,244,018 ha, however Directorate General of Land Rehabilitation and Social Forestry, Ministry of Forestry (Ditjen RLPS MoF of Indonesia at 2007 reported about 7,758,411 ha of mangrove area in Indonesia (including existing vegetated mangrove area. It was further reported that those mangroves were 30.7% in good condition, 27.4% moderate-destroyed, and 41.9% heavy-destroyed. In order to rehabilitate destroyed mangrove ecosystems, Indonesia applies at least three type of planting designs (square planting design, zig zag planting design, and cluster planting design and eight planting techniques (“banjar harian” technique, bamboo pole technique, guludan technique, water break technique, huge polybag technique, ditch muddy technique, huge mole technique, cluster technique. Generally, in Indonesia Rhizophora spp. are used for mangrove rehabilitation and/or restoration with the spacing of 1x1 m spending varied planting cost based on the site local condition and planting technique used. The mangrove planting ranged from about Rp. 14.2 million using propagules to Rp. 18.5 million using cultured seedlings. Recently, local community used to utilizing associated mangrove aquatic fauna for supporting their daily life as well as utilizing mangrove habitat for multipurpose uses through agroforestry techniques (silvofishery, agrosilvofishery, agrosilvopastoralfishery systems. So that, the good mangrove ecosystem serves luxurious both flora and fauna species (biodiversity as well as their abundance for significantly

  4. Pediatric pancreatic trauma: trending toward nonoperative management?

    Science.gov (United States)

    Cuenca, Alex G; Islam, Saleem

    2012-11-01

    Pancreatic trauma is rare in children and optimal care has not been defined. We undertook this study to review the cumulative experience from three centers. After obtaining Institutional Review Board approval at each site, the trauma registries of three institutions were searched for pancreatic injuries. The charts were reviewed and data pertaining to demographics, hospital course, and outcome were obtained and analyzed. During the study period, a total of 79 pancreatic injuries were noted. The most common mechanism of injury was motor vehicle crash (44%) followed by child abuse (11%) and bicycle crashes (11%). Computed tomographic (CT) scans were obtained in 95 per cent with peripancreatic fluid the most common finding. Median Injury Severity Score (ISS) was 9, whereas median organ injury score was 2, and a higher grade correlated with need for operation (P = 0.001). Pancreatic operations were performed in 32 patients, whereas nonoperative management was noted in 47 cases. We noted no differences in length of stay, age, ISS, or initial blood pressure in operative versus nonoperatively managed cases. Pancreatic injuries were rare in children with trauma. CT scans were the most common method of diagnosis. Nonoperative management appeared to be safe and was more common, especially for the lower grade injuries.

  5. 77 FR 43560 - American Indian Vocational Rehabilitation Services Program; Proposed Waivers and Extensions of...

    Science.gov (United States)

    2012-07-25

    ... Program; Proposed Waivers and Extensions of the Project Periods AGENCY: Office of Special Education and... rehabilitation services to American Indians with disabilities who reside on or near Federal or State reservations... documents published by the Department. Dated: July 19, 2012. Alexa Posny, Assistant Secretary for Special...

  6. A Meta-Analysis of Skills Training Programs for Rehabilitation Clients.

    Science.gov (United States)

    Bolton, Brian; Akridge, Robert L.

    1995-01-01

    Summarized the results of 15 experimental studies of 10 small-group skills training interventions developed for use with vocational rehabilitation clients. Concluded that the typical participant in skills training interventions received substantial benefit from the activity. Skills training programs should be implemented more widely with clients…

  7. An Annotated Bibliography of Current Literature Dealing with Stroke Education Programs in a Physical Rehabilitation Setting.

    Science.gov (United States)

    Donohue, Ann Teresa

    This study makes available to nurses and other rehabilitation team members pertinent information to meet stroke patients' educational needs. The study was conducted to support the theory that those patients and families who actively participate in a stroke education program will more positively cope with the losses resulting from the disability…

  8. 75 FR 3163 - Vocational Rehabilitation and Employment Program-Basic Entitlement; Effective Date of Induction...

    Science.gov (United States)

    2010-01-20

    ... is retroactively inducted into a rehabilitation program, VA may authorize payment of tuition, fees... aggregate, or by the private sector, of $100 million or more (adjusted annually for inflation) in any year. This final rule will have no such effect on State, local, and Tribal governments, or on the private...

  9. 78 FR 26879 - Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal...

    Science.gov (United States)

    2013-05-08

    ... Prospective Payment System for Federal Fiscal Year 2014; Proposed Rule #0;#0;Federal Register / Vol. 78, No... Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2014 AGENCY... IRF prospective payment system's (PPS) case-mix groups and a description of the methodology and data...

  10. 75 FR 3168 - Vocational Rehabilitation and Employment Program-Self-Employment

    Science.gov (United States)

    2010-01-20

    ... Employment Program--Self-Employment AGENCY: Department of Veterans Affairs. ACTION: Final rule. SUMMARY: This document amends the vocational rehabilitation and employment regulations of the Department of Veterans Affairs (VA) concerning self-employment for individuals with qualifying disabilities. We are making...

  11. Public estimation of the program of the rehabilitation of the east Urals territory of radioactive contamination

    International Nuclear Information System (INIS)

    Ishutina, T.A.; Korobejnikova, T.A.; Pavlov, B.S.; Suslo, A.F.; Sharova, A.F.

    1996-01-01

    The state of public opinion at the East Urals territory of radioactive contamination of the moment of the adoption of a number of govement acts on rehabilitation may be considered as transitory from the state of actually complete neglect of the problem on the part of the government (1950-70) to that of publicity and taking first practical steps towards development and implementation of rehabilitation policies (1990 s). A primary goal for a program for such territories should be achieving their overall revival on the basis of modern requirements of the population

  12. Disability and employee benefits receipt: evidence from the U.S. Vocational Rehabilitation Services Program.

    Science.gov (United States)

    Sosulski, Marya R; Donnell, Chandra; Kim, Woo Jong

    2012-01-01

    Studies indicate positive effects of the U.S. Vocational Rehabilitation Services (VRS) in assisting people with disabilities to find independent employment. Underemployment continues to impact access to adequate health care and other benefits. Workers with disabilities receive fewer benefits, overall. With data from the Longitudinal Study of Vocational Rehabilitation Services Program (LSVRSP), the authors compare the rates of receipt of 6 types of benefits for people with physical, mental, and sensory impairments. Although those with physical disabilities are most likely to receive benefits, all groups lack adequate access to health care, sick leave, and vacation. The authors discuss implications for services provision in the current job market.

  13. Participant and service provider perceptions of an outpatient rehabilitation program for people with acquired brain injury.

    Science.gov (United States)

    Poncet, Frédérique; Pradat-Diehl, Pascale; Lamontagne, Marie-Eve; Alifax, Anne; Fradelizi, Pascaline; Barette, Maude; Swaine, Bonnie

    2017-09-01

    A holistic, intensive and interdisciplinary rehabilitation program for people with acquired brain injury (ABI) was developed at the Pitié-Salpêtrière Hospital, France (5 days/week for 7 weeks). This program, recently demonstrated effective, aimed to optimize the ability of people with ABI to perform activities and improve their participation by using individual and group interventions involving ecologically valid activities inside (e.g., in the gym and kitchen) and outside the hospital. However, the perception of the quality of the program by participants and service providers has not yet been reported. This study had 3 objectives: (1) report the perception of participants (adults with ABI) in terms of service quality of the program, (2) report the strengths, weaknesses, opportunities, and threats (SWOT analysis) of the program as perceived by service providers, and (3) triangulate findings to draw conclusions about the program's quality and provide recommendations for quality improvement. We used a mixed-methods design with a validated questionnaire (Perception of Quality of Rehabilitation Services [PQRS-Montreal]) and interviews (structured around a SWOT analysis) involving program participants and service providers. We included 33 program participants (mean age 43.6 years) and 12 service providers (mean years with program 7.6 years). In general, study participants showed a convergence of opinion about the high quality of the program, particularly regarding the team and its participant-focused approach. Specific aspects of the program were viewed more negatively by both participants and service providers (i.e., addressing sexuality, family involvement and return to work/volunteer work/school). Participant and service provider perceptions of the rehabilitation program under study were generally positive. A reliable and valid questionnaire and interviews helped identify aspects of the program that worked well and those that could be targeted for future quality

  14. A Contest without a Loser: the Development of the Navy’s Alcohol Rehabilitation Program.

    Science.gov (United States)

    1981-06-01

    entire HRM Program could have been cost supported on the success of the Alcohol Rehabilitation Program alone. More importantly, these figures were...later the startling results were that the use of alcohol led to 25,000 automobile related deaths and at least 800,000 automobile collisions in this...treatment of automobile accident cases, spouse or child abuse, chronic illness, etc. It was necessary to gain the support of the Medical Department to

  15. The development of an expressionistic program in the rehabilitation of juvenile delinquents

    OpenAIRE

    2012-01-01

    M.A. The aim of the thesis is to illustrate the process of developing a psychoeducational program as part of the rehabilitation and development of juvenile delinquents, through the effective use of music, art and dancing in a therapeutic context. The rationale of the program is to give delinquents the psychological freedom to express emotions in a functional and constructive way. Delinquents are described by Thorpe, Smith, Green, & Paley (1980) as socially and emotionally deprived. Art, mu...

  16. An evidence-based rehabilitation program for tracheoesophageal speakers

    NARCIS (Netherlands)

    Jongmans, P.; Rossum, M.; As-Brooks, C.; Hilgers, F.; Pols, L.; Hilgers, F.J.M.; Pols, L.C.W.; van Rossum, M.; van den Brekel, M.W.M.

    2008-01-01

    Objectives: to develop an evidence-based therapy program aimed at improving tracheoesophageal speech intelligibility. The therapy program is based on particular problems found for TE speakers in a previous study as performed by the authors. Patients/Materials and Methods: 9 male laryngectomized

  17. Restructuring rehabilitation for women: programs for the female drug addict.

    Science.gov (United States)

    Doyle, K M; Quinones, M A; Tracy, G; Young, D; Hughes, J

    1977-12-01

    Two residential therapeutic communities for female addicts--one coeducational and the other all female--encountered serious problems shortly after their formation. The authors found that the male and female staff of the coeducational program had quite different perceptions of the purposes and characteristics of the women's part of the program. In both programs the female staff held such strongly ambivalent feeling toward their roles as women and authority figures that they had difficulty functioning effectively. The authors suggest the need for research that will identify the female addict's special needs, and a restructuring of programs to meet those needs. Further, training programs for female staff must enable them to distinguish between their own ideals and their clients' needs.

  18. Compliance of patients with chronic obstructive pulmonary disease to a pulmonary rehabilitation program

    Directory of Open Access Journals (Sweden)

    Janaina Schafer

    2012-04-01

    Full Text Available Background and Objectives: The lack of adherent and non-adherent to recommended treatment is a very common problem that interferes with the successful care and assistance to people with Chronic Obstructive Pulmonary Disease-COPD. This study compared the profi le of COPD patients that were adherent with non-adherent to a pulmonary rehabilitation program. Methods: was done an exploratory prospective observational study involving 24 patients with COPD Pulmonary Rehabilitation Program, divided into two groups according to full participation of the proposed treatment: Adhesive Group (GA = 18 subjects and non-adherent (GN = 06 subjects. The treatment occurred in 08 weeks, 3 times a week, lasting 1 hour and 30 minutes, assisted by a multidisciplinary team composed by physiotherapist, physical education professional, nutritionist, pharmacist, psychologist and pneumologist. Results: The GA did not differ from GN about the situation sociodemographic, anthropometric, cardiopulmonary exercise capacity and respiratory function. GN had more comorbidities when compared to GA and higher average amount of drugs used. All patients were characterized with reduced quality of life and correlation between cardiac function and quality of life was seen for both groups. Conclusion: Our results show that the advanced stage of disease and worsening of symptoms were determinants for the adherence of patients with COPD in the Pulmonary Rehabilitation Program. KEYWORDS: COPD. Pulmonary Rehabilition. Interdisciplinary Health Team.

  19. Low-educated women with chronic pain were less often selected to multidisciplinary rehabilitation programs.

    Directory of Open Access Journals (Sweden)

    Anne Hammarström

    Full Text Available BACKGROUND: There is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education. METHODS: The population consisted of consecutive patients (n = 595 women, 266 men referred during a three-year period from mainly primary health care centers for a multidisciplinary team assessment at a pain rehabilitation clinic at a university hospital in Northern Sweden. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation National Pain Register. The outcome variable was being selected by the multidisciplinary team assessment to a multidisciplinary rehabilitation program. The independent variables were: sex, age, born outside Sweden, education, pain severity as well as the hospital, anxiety and depression scale (HADS. RESULTS: Low-educated women were less often selected to multidisciplinary rehabilitation programs than high-educated women (OR 0.55, CI 0.30-0.98, even after control for age, being born outside Sweden, pain intensity and HADS. No significant findings were found when comparing the results between high- and low-educated men. CONCLUSION: Our findings can be interpreted as possible discrimination against low-educated women with chronic pain in hospital referrals to pain rehabilitation. There is a need for more gender-theoretical research emphasizing the importance of taking several power dimensions into account when analyzing possible bias in health care.

  20. Non-operative management of adult blunt splenic injuries

    Institute of Scientific and Technical Information of China (English)

    YANG Jun; GAO Jin-mou; Jean-Claude Baste

    2006-01-01

    Objective: To investigate the indication of nonoperative management of adult blunt splenic injuries.Methods: A retrospective review was performed on all adult patients (age > 15 years ) with blunt splenic injuries admitted to the department of vascular surgery of Pellegrin hospital in France from 1999 to 2003. We managed splenic injuries non-operatively in all appropriate patients without regard to age.Results: During the 4 years, 54 consecutive adult patients with blunt splenic injuries were treated in the hospital. A total of 27 patients with stable hemodynamic status were treated non-operatively at first, of which 2 patients were failed to non-operative treatment. The successful percentage of non-operative management was 92.6 %. In the 54 patients, 7 of 8 patients older than 55 years were treated with non-operative management. Two cases developing postoperatively subphrenic infection were healed by proper treatment. In the series, there was no death.Conclusions: Non-operative management of low-grade splenic injuries can be accomplished with an acceptable low-failure rate. If the clinical and laboratory parameters difficult for surgeons to make decisions, they can depend on Resciniti' s CT (computed tomography)scoring system to select a subset of adults with splenic trauma who are excellent candidates for a trial of nonoperative management. The patients older than 55 years are not absolutely inhibited to receive non-operative management.

  1. The Transcendental Meditation Program and Rehabilitation at Folsom State Prison

    Science.gov (United States)

    Abrams, Allan I.; Siegel, Larry M.

    1978-01-01

    Effects of the Transcendental Meditation program in a maximum security prison were studied via cross-validation design. Meditation and control groups indicated reduction in anxiety, neuroticism, hostility, and insomnia as a function of the treatment. (Author)

  2. Patients' pretreatment beliefs about recovery influence outcome of a pain rehabilitation program

    DEFF Research Database (Denmark)

    Merrick, D; Sjölund, B H

    2009-01-01

    hospital setting. Demographic data and patient beliefs about recovery recorded on a five-category scale were collected before the program. Pain intensity (VAS), Disability Rating Index (DRI) and life satisfaction (LiSat-11) were collected before, immediately after and one year after the program. Partial....../sports'' improved significantly after rehabilitation (Wilcoxon's test; P=0.0009), and remained improved one year later (P=0.0144). Life satisfaction in the physical and psychological domains increased after the program. A clinically meaningful reduction in pain intensity (10 mm) was reported by 43% of patients...... at the one-year follow-up. This group had significant increases in life satisfaction. Only patients with positive beliefs about recovery before rehabilitation showed a decrease in pain intensity at the one-year follow-up (Plife satisfaction and...

  3. Psychological changes in alcohol-dependent patients during a residential rehabilitation program

    Directory of Open Access Journals (Sweden)

    Giorgi I

    2015-12-01

    Full Text Available Ines Giorgi,1 Marcella Ottonello,2,3 Giovanni Vittadini,4 Giorgio Bertolotti5 1Psychology Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Pavia, 2Department of Physical & Rehabilitation Medicine, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Genoa, 3Department of Medicine, PhD Program in Advanced Sciences and Technologies in Rehabilitation Medicine and Sport, Università di Tor Vergata, Rome, 4Alcohol Rehabilitation Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Pavia, 5Psychology Unit, Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Tradate, Italy Background: Alcohol-dependent patients usually experience negative affects under the influence of alcohol, and these affective symptoms have been shown to decrease as a result of alcohol-withdrawal treatment. A recent cognitive–affective model suggests an interaction between drug motivation and affective symptoms. The aim of this multicenter study was to evaluate the psychological changes in subjects undergoing a residential rehabilitation program specifically designed for alcohol addiction, and to identify at discharge patients with greater affective symptoms and therefore more at risk of relapse.Materials and methods: The sample included 560 subjects (mean age 46.91±10.2 years who completed 28-day rehabilitation programs for alcohol addiction, following a tailored routine characterized by short duration and high intensity of medical and psychotherapeutic treatment. The psychological clinical profiles of anxiety, depression, psychological distress, psychological well-being, and self-perception of a positive change were assessed using the Cognitive Behavioral Assessment – Outcome Evaluation questionnaire at the beginning and at the end of the program. The changes in the psychological variables of the questionnaire were identified and considered as outcome

  4. Towards the integration of mental practice in rehabilitation programs. A critical review

    Directory of Open Access Journals (Sweden)

    Francine eMalouin

    2013-09-01

    Full Text Available Many clinical studies have investigated the use of mental practice (MP through motor imagery (MI to enhance functional recovery of patients with diverse physical disabilities. Although beneficial effects have been generally reported for training motor functions in persons with chronic stroke (e.g. reaching, writing, walking, attempts to integrate MP within rehabilitation programs have been met with mitigated results. These findings have stirred further questioning about the value of MP in neurological rehabilitation. In fact, despite abundant systematic reviews, which customarily focused on the methodological merits of selected studies, several questions about factors underlying observed effects remain to be addressed. This review discusses these issues in an attempt to identify factors likely to hamper the integration of MP within rehabilitation programs. First, the rationale underlying the use of MP for training motor function is briefly reviewed. Second, three modes of MI delivery are proposed based on the analysis of the research protocols from 27 studies in persons with stroke and Parkinson’s disease. Third, for each mode of MI delivery, a general description of MI training is provided. Fourth, the review discusses factors influencing MI training outcomes such as: the adherence to MI training, the amount of training and the interaction between physical and mental rehearsal; the use of relaxation, the selection of reliable, valid and sensitive outcome measures, the heterogeneity of the patient groups, the selection of patients and the mental rehearsal procedures. To conclude, the review proposes a framework for integrating MP in rehabilitation programs and suggests research targets for steering the implementation of MP in the early stages of the rehabilitation process. The challenge has now shifted towards the demonstration that MI training can enhance the effects of regular therapy in persons with subacute stroke during the period of

  5. A disease of frozen feelings: ethically working on emotional worlds in a Russian Orthodox Church drug rehabilitation program

    NARCIS (Netherlands)

    Zigon, J.

    2010-01-01

    In a Russian Orthodox Church drug rehabilitation program in St. Petersburg, drug addiction was often described as a disease of frozen feelings. This image suggests that rehabilitation is a process of thawing emotional worlds and, thus, allows the emotions to flow once again. In this article I argue

  6. Should Family and Friends Be Involved in Group-Based Rehabilitation Programs for Adults with Low Vision?

    Science.gov (United States)

    Rees, G.; Saw, C.; Larizza, M.; Lamoureux, E.; Keeffe, J.

    2007-01-01

    This qualitative study investigates the views of clients with low vision and vision rehabilitation professionals on the involvement of family and friends in group-based rehabilitation programs. Both groups outlined advantages and disadvantages to involving significant others, and it is essential that clients are given the choice. Future work is…

  7. Evaluation of a four month rehabilitation program for stroke patients with balance problems and binocular visual dysfunction

    DEFF Research Database (Denmark)

    Schow, Trine; Harris, Paul; Teasdale, Thomas William

    2016-01-01

    Trine Schow, Paul Harris, Thomas William Teasdale, Morten Arendt Rasmussen. Evaluation of a four month rehabilitation program for stroke patients with balance problems and binocular visual dysfunction. NeuroRehabilitation. 2016 Apr 6;38(4):331-41. doi: 10.3233/NRE-161324....

  8. Safety of Nonoperative Management After Acute Diverticulitis

    Science.gov (United States)

    Amoza Pais, Sonia; Batlle Marin, Xavi; Oronoz Martinez, Begoña; Balen Ribera, Enrique; Yarnoz Irazabal, Concepción

    2014-01-01

    Purpose The role of surgery in the management of diverticular disease after an episode of acute diverticulitis (AD) managed in a conservative form is evolving. Age, number of episodes of AD, type of episode, and symptoms after the episodes are factors related to the need for elective surgery. The aim of this study is to evaluate the safety of conservative management and the risk factors for emergency surgery after a first episode of AD managed without surgery. Methods We retrospectively evaluated 405 patients diagnosed as having had a first episode of AD. Sixty-nine patients underwent emergency surgery on the first admission, and 69 patients had an elective operation in the follow-up (group A). The remaining 267 patients were managed initially without surgery (group B). Thirteen of these 267 patients needed a further urgent surgical procedure. Factors involved in the decision of elective surgery and the probability of emergency surgery after the first episode of AD managed without surgery were evaluated in relation to demographic factors, risk factors, presence of recurrences, and type of the first episode. Results Patients, mean age was 62.7 years, 71 were aged less than 51, and 151 were males. The mean follow-up for patients with nonoperative management was 91.2 months. An elective operation was performed in 69 patients. Compared to patients in group B, those in group A more frequently had a first episode of complicated acute diverticulitis (CAD) (37.1% vs. 16.4%; P = 0.000) and were more likely to be smokers (46.3% vs. 19.3%; P = 0.000) and to suffer more than one episode of AD (42% vs. 26.9%; P = 0.027). Nonoperative management was chosen for 267 patients, but 13 patients needed an emergency operation later. In the multivariate analysis, we found a significant relation between the presence of CAD in the first episode and the need for emergency surgery. There were no differences in surgical mortality between the patients in the two groups, but patients treated

  9. National Registry of Cardiac Rehabilitation Programs in Mexico II (RENAPREC II).

    Science.gov (United States)

    Ilarraza-Lomelí, Hermes; García-Saldivia, Marianna; Rojano-Castillo, Jessica; Justiniano, Samuel; Cerón, Norma; Aranda-Ayala, Zulema-L; Rodríguez, Azucena; Hernández, Alejandro; Cassaigne, María-Elena; Cantero, Raúl; Gasca, Pablo; Hinojosa, Tania; Alonso, Jesús; Romo, Ricardo; Lara, Jorge; Pimentel, Elizabeth; Zavala, Juana; Rius-Suárez, María-Dolores; Cherebetiu, Gabriel; Cortés, Othniel; Almaraz, Alejandro; Mendoza, Pedro; Silva, Jesús; Tirado, Enrique; Martínez, Leonel

    The aim of this paper is to compare the state of Cardiac Rehabilitation Programs (CRP) in 2009 with 2015. Focus is directed on health care, training of health-providers, research, and the barriers to their implementation. All authors of RENAPREC-2009, and other cardiac rehabilitation leaders in Mexico were requested to participate. These centres were distributed into two groups: RENAPREC-2009 centres that participated in 2015, and the new CRP units. In 2009 there were 14 centres, two of which disappeared and another two did not respond. CRP-units increased by 71% (n=24), and their geographic distribution shows a centripetal pattern. The coverage of CRP-units was 0.02 centres per 100,000 inhabitants. Only 4.4% of eligible patients were referred to CRP, with a rate of 10.4 patients/100,000 inhabitants in 2015. The ratio of Clinical Cardiologists to Cardiac Rehabilitation Specialists was 94:1, and the ratio of Intervention Specialists to cardiac rehabilitation experts was 16:1. Cardiac rehabilitation activities and costs varied widely. Patient dropout rate in phase II was 12%. Several barriers were identified: financial crisis (83%), lack of skilled personnel (67%), deficient equipment (46%), inadequate areas (42%), and a reduced number of operating centres (38%). CRPs in Mexico are still in the process of maturing. Mexican CRP-centres have several strengths, like the quality of the education of the professionals and the multidisciplinary programs. However, the lack of referral of patients and the heterogeneity of procedures are still their main weaknesses. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  10. A nutritional intervention to reduce the calorie content of meals served at psychiatric rehabilitation programs.

    Science.gov (United States)

    Casagrande, Sarah Stark; Dalcin, Arlene; McCarron, Phyllis; Appel, Lawrence J; Gayles, Debra; Hayes, Jennifer; Daumit, Gail

    2011-12-01

    To assess the effectiveness of an intervention to reduce the calorie content of meals served at two psychiatric rehabilitation programs. Intervention staff assisted kitchen staff with ways to reduce calories and improve the nutritional quality of meals. Breakfast and lunch menus were collected before and after a 6-month intervention period. ESHA software was used to determine total energy and nutrient profiles of meals. Total energy of served meals significantly decreased by 28% at breakfast and 29% at lunch for site 1 (P breakfast for site 2 (P = 0.018). Total sugars significantly decreased at breakfast for both sites (P ≤ 0.001). In general, sodium levels were high before and after the intervention period. The nutrition intervention was effective in decreasing the total energy and altering the composition of macro-nutrients of meals. These results highlight an unappreciated opportunity to improve diet quality in patients attending psychiatric rehabilitation programs.

  11. Early Uncomplicated Appendicitis-Who Can We Treat Nonoperatively?

    Science.gov (United States)

    Horattas, Mark C; Horattas, Ileana K; Vasiliou, Elya M

    2018-02-01

    This study evaluated nonoperative treatment for mild appendicitis and reviewed selection criteria to be used in introducing this option into clinical practice. A retrospective review of 73 consecutive cases of appendicitis treated by a single surgeon from 2011 to 2013 was completed. Patients who were diagnosed with mild appendicitis meeting the criteria of an APPENDICITIS scoring algorithm proposed in this manuscript were considered for nonoperative management. An additional 17 patients with mild appendicitis were offered and successfully treated nonoperatively between 2014 and 2016 and reviewed. Of these original 73 patients, 37 had moderate to severe appendicitis and directly underwent appendectomy. The remaining patients were diagnosed with mild appendicitis and considered eligible for nonoperative management. Of these, 14 patients were offered nonoperative therapy. Thirteen responded successfully; one patient responded partially, but later opted for surgery. In 2014, this scoring system and preliminary results were shared with the other surgeons in our department. Nonoperative management was then selectively adopted by a few of the surgeons from 2014 to 2016 with another 17 patients (APPENDICITIS score of 0 or 1) being offered and successfully managed nonoperatively. Patients with mild or early appendicitis can be successfully managed nonoperatively. A proposed APPENDICITIS scoring system may provide a helpful mnemonic for successfully selecting patients for this option.

  12. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement

    OpenAIRE

    ?yp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; W?ostowska, Ewa; Stanis?awska, Iwona; Szypu?a, Jan; Tomaszewski, Wies?aw

    2016-01-01

    Background Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. Material/Methods A total of 192 patients (the mean age 61.03?10.89) suffering from hip osteoarthritis (OA) were evaluated before an...

  13. Fatigue in patients with COPD participating in a pulmonary rehabilitation program

    Directory of Open Access Journals (Sweden)

    Cindy J Wong

    2010-09-01

    Full Text Available Cindy J Wong1, Donna Goodridge1, Darcy D Marciniuk2, Donna Rennie1,31College of Nursing, 2College of Medicine, 3Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, CanadaBackground: Fatigue is a distressing, complex, multidimensional sensation common in individuals with chronic obstructive pulmonary disease (COPD. While fatigue negatively impacts functional performance and quality of life, there has been little study of the fatigue that affects participants in pulmonary rehabilitation programs. The purpose of this study was to examine the emotional, behavioral, cognitive, and physical dimensions of fatigue and their relationships to dyspnea, mental health, sleep, and physiologic factors.Patients and methods: A convenience sample of 42 pulmonary rehabilitation participants with COPD completed self-report questionnaires which measured dimensions of fatigue using the Multidimensional Fatigue Inventory, anxiety and depression using the Hospital Anxiety and Depression Scale, and sleep quality using the Pittsburgh Sleep Quality Index. Data on other clinical variables were abstracted from pulmonary rehabilitation program health records.Results: Almost all (95.3% participants experienced high levels of physical fatigue. High levels of fatigue were also reported for the dimensions of reduced activity (88.1%, reduced motivation (83.3%, mental fatigue (69.9%, and general fatigue (54.5%. Close to half (42.9% of participants reported symptoms of anxiety, while almost one quarter (21.4% reported depressive symptoms. Age was related to the fatigue dimensions of reduced activity (ρ = 0.43, P < 0.01 and reduced motivation (ρ = 0.31, P < 0.05. Anxiety was related to reduced motivation (ρ = -0.47, P < 0.01. Fatigue was not associated with symptoms of depression, sleep quality, gender, supplemental oxygen use, smoking status, or Medical Research Council dyspnea scores.Conclusions: Fatigue (particularly the physical and

  14. A Multimodal Communication Program for Aphasia during Inpatient Rehabilitation: A Case Study

    Science.gov (United States)

    Wallace, Sarah E.; Purdy, Mary; Skidmore, Elizabeth

    2014-01-01

    BACKGROUND Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. OBJECTIVE The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns. METHODS Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy. RESULTS Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant. CONCLUSIONS Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting. PMID:25227547

  15. A multimodal communication program for aphasia during inpatient rehabilitation: A case study.

    Science.gov (United States)

    Wallace, Sarah E; Purdy, Mary; Skidmore, Elizabeth

    2014-01-01

    Communication is essential for successful rehabilitation, yet few aphasia treatments have been investigated during the acute stroke phase. Alternative modality use including gesturing, writing, or drawing has been shown to increase communicative effectiveness in people with chronic aphasia. Instruction in alternative modality use during acute stroke may increase patient communication and participation, therefore resulting in fewer adverse situations and improved rehabilitation outcomes. The study purpose was to explore a multimodal communication program for aphasia (MCPA) implemented during acute stroke rehabilitation. MCPA aims to improve communication modality production, and to facilitate switching among modalities to resolve communication breakdowns. Two adults with severe aphasia completed MCPA beginning at 2 and 3 weeks post onset a single left-hemisphere stroke. Probes completed during each session allowed for evaluation of modality production and modality switching accuracy. Participants completed MCPA (10 and 14 treatment sessions respectively) and their performance on probes suggested increased accuracy in the production of various alternate communication modalities. However, increased switching to an alternate modality was noted for only one participant. Further investigation of multimodal treatment during inpatient rehabilitation is warranted. In particular, comparisons between multimodal and standard treatments would help determine appropriate interventions for this setting.

  16. Patients' perceptions of their roles in goal setting in a spinal cord injury regional rehabilitation program.

    Science.gov (United States)

    Draaistra, Harriett; Singh, Mina D; Ireland, Sandra; Harper, Theresa

    2012-01-01

    Goal setting is a common practice in rehabilitation, yet there is a paucity of literature exploring patients' perceptions of their roles in this process. This study was conducted using a qualitative descriptive methodology to explore patients' perceptions of their roles in setting goals in a spinal cord injury regional rehabilitation program. Imogene King's theory of goal attainment was used to frame the study. Data were collected through interviews and analyzed using a content analysis. The results revealed four themes: Visioning, Redefining, Brainstorming, and Rebuilding Participants (n = 13) envisioned their roles as setting an overarching priority goal, defining detailed rehabilitation goals, sharing knowledge with the team, and rebuilding skills to attain goals. Implications for nursing practice include the need to understand patients' experiences and perceptions, share knowledge, and support effective communication to promote collaborative goal setting. A need to enhance health professionals' education to fully understand factors influencing patients' abilities to set rehabilitation goals, and future research in methods to promote patients' engagement in goal setting was also clearly indicated.

  17. Effects of a sexual rehabilitation intervention program on stroke patients and their spouses.

    Science.gov (United States)

    Song, HoSook; Oh, HyunSoo; Kim, HwaSoon; Seo, WhaSook

    2011-01-01

    The present study was conducted to examine whether a sexual rehabilitation intervention program, which was developed during the present study and designed for stroke patients and their spouses, was effective in terms of sexual knowledge and satisfaction and frequency of sexual activity at 1 month after intervention. The study subjects were conveniently selected from stroke patients admitted to the neurology department at a university hospital located in Incheon, South Korea. A total of 46 subjects (12 couples for the experimental group and 11 couples for the control group) were included. Sexual knowledge, sexual satisfaction, frequency of sexual activity, level of cognitive function, and performance with respect to daily living activities were measured. The results obtained demonstrated that the devised sexual rehabilitation intervention program significantly increased sexual satisfaction and frequency of sexual activity, but that it did not promote sexual knowledge. The present study has meaning because the intervention program could be used as a practical guideline for post-stroke sexual rehabilitation. In addition, the findings of this study provide evidence regarding the usefulness of sexual education and counseling on the sexual health of post-stroke patients and their spouses.

  18. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement.

    Science.gov (United States)

    Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

    2016-07-25

    BACKGROUND Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. MATERIAL AND METHODS A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. RESULTS A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (pwater exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR.

  19. Rehabilitation Program Integrating Virtual Environment to Improve Orientation and Mobility Skills for People Who Are Blind.

    Science.gov (United States)

    Lahav, Orly; Schloerb, David W; Srinivasan, Mandayam A

    2015-01-01

    This paper presents the integration of a virtual environment (BlindAid) in an orientation and mobility rehabilitation program as a training aid for people who are blind. BlindAid allows the users to interact with different virtual structures and objects through auditory and haptic feedback. This research explores if and how use of the BlindAid in conjunction with a rehabilitation program can help people who are blind train themselves in familiar and unfamiliar spaces. The study, focused on nine participants who were congenitally, adventitiously, and newly blind, during their orientation and mobility rehabilitation program at the Carroll Center for the Blind (Newton, Massachusetts, USA). The research was implemented using virtual environment (VE) exploration tasks and orientation tasks in virtual environments and real spaces. The methodology encompassed both qualitative and quantitative methods, including interviews, a questionnaire, videotape recording, and user computer logs. The results demonstrated that the BlindAid training gave participants additional time to explore the virtual environment systematically. Secondly, it helped elucidate several issues concerning the potential strengths of the BlindAid system as a training aid for orientation and mobility for both adults and teenagers who are congenitally, adventitiously, and newly blind.

  20. Effects of a Pulmonary Rehabilitation Program for Several Asthme. Case Presentation

    Directory of Open Access Journals (Sweden)

    Gómez V

    2012-05-01

    Full Text Available Objective: to present the effectiveness of pulmonary rehabilitation programs in the treatment of a patient with asthma. Case: this is the case of a young Caucasian girl —17 years old— with severe asthma diagnosis, with symptoms since she was eight years old, 10th grade student. She was referred to the program of Pulmonary Rehabilitation after three hospitalizations during the last year due to asthmatic crises, dyspnoea in activities of daily living, and intolerance to physical exercise. In the initial evaluation, a patient with non-controlled asthma was found; she was receiving short-acting medication admitting that she was not complying with regular use and with a prescribed dose of the pharmacological treatment and that she ignored the importance of this commitment for optimal evolution. The patient expressed concern about the progressive deterioration at her respiratory and functional level during the last year and her fear and anxiety for not being able to breathe during activities befitting her age. One month after receiving bronchodilators and long-acting steroids permanently and complying with recommendations about regular use and adequate inhalatory technique, the patient was included in a three-timesa-week program of pulmonary rehabilitation during eight weeks for upper and lower extremity endurance and resistance training. This intervention showed significant changes in the patient at functional level and a greater social participation.

  1. Comparing Faculty and Students Perceptions on Clinical Competency Achievement in Rehabilitation Programs

    Directory of Open Access Journals (Sweden)

    Foroozan Shokooh

    2009-10-01

    Full Text Available Objectives: Clinical competencies are learning outcomes the student should display by the end of the program and competency based instruction measures what participants have learned as opposed to what instructors think they have thought. Objective of this study was to compare student and faculty perceptions of the importance and achievement of clinical competencies in rehabilitation programs. Methods: The survey instrument was a dual-response 5-point Likert-type questionnaire consisting of 29 competencies based on content and skill areas in the management of patient with chronic illnesses. The instrument was administered to all faculty members and final year undergraduate students of three rehabilitation programs including Speech therapy, physiotherapy and occupational therapy at the University of Rehabilitation and Social Welfare in Iran. Results: 45 students and 19 faculty members participated in the study. Overall, most of the students (81% rated themselves as moderately competent (mean between 2 to 4. Perceived self-efficacy of male students was significantly higher than female students. (P=0.014 Differences between perceived importance and perceived achievement were statistically significant in each subject group. (P=0.000. Discussion: Faculty members and students shared very similar perceptions on the importance & achievement of competencies. Difference between importance and achievement of competencies may suggest a failure in consideration of required competencies or successful implementation of them in the current curriculum.

  2. Impact of activities in self-esteem of patients in a pulmonary rehabilitation program.

    Science.gov (United States)

    Oliveira, Juliana Nascimento de; Tavares, Cecilia Melo Rosa; Squassoni, Selma Denis; Machado, Nadine Cristina; Cordoni, Priscila Kessar; Bortolassi, Luciene Costa; Lapa, Mônica Silveira; Fiss, Elie

    2015-01-01

    To evaluate self-esteem and self-image of respiratory diseases patients in a Pulmonary Rehabilitation Program, who participated in socialization and physical fitness activities, and of patients who participated only in physical fitness sessions. A descriptive cross-sectional exploratory study. Out of a total of 60 patients analyzed, all enrolled in the Pulmonary Rehabilitation Program, 42 participated in at least one of the proposed activities, 10 did not participate in any activity and 8 were excluded (7 were discharged and 1 died). When the two groups were compared, despite the fact that both demonstrated low self-esteem and self-image, the difference between them was relevant (pself-esteem, indicating that those who participated in the proposed socialization activities had better self-esteem than the individuals who only did the physical fitness sessions. Regarding self-image, the difference between the groups was not relevant (p>0.05). The Pulmonary Rehabilitation Program patients evaluated presented low self-esteem and self-image; however, those carrying out some socialization activity proposed had better self-esteem as compared to the individuals who did only the physical fitness sessions.

  3. Does a Nintendo Wii exercise program provide similar exercise demands as a traditional pulmonary rehabilitation program in adults with COPD?

    Science.gov (United States)

    LeGear, Tyler; LeGear, Mark; Preradovic, Dejan; Wilson, Geoffrey; Kirkham, Ashley; Camp, Pat G

    2016-05-01

    The chronic obstructive pulmonary disease (COPD) population can experience lower activity and fitness levels than the non-COPD population. The Nintendo Wii may be an appropriate at-home training device for the COPD population, which could be used as a supplement for a pulmonary rehabilitation program. This study was a randomized, within-subject, cross-over study involving 10 adults with COPD previously enrolled in St Paul's Hospital's pulmonary rehabilitation program. This study attempted to determine if specific Wii activities resulted in similar energy expenditures to that of a more traditional pulmonary rehabilitation activity. Participants completed two 15-min exercise interventions in a single session, with a washout period of 30 min in-between. The interventions were an experimental Wii intervention and a traditional treadmill intervention. There was no significant difference in total energy expenditure between the two 15-min exercise interventions [mean difference 36.3 joules; 95% confidence interval (CI): 31.4, 104]. There was no significant difference in heart rate (mean difference -0.167 beats per minute; 95% CI: -4.83, 4.50), rating of perceived exertion (mean difference 0.100; 95% CI: -0.416, 0.616) and Borg dyspnea scale (mean difference 0.267; 95% CI: -0.004, 0.537) between the two 15-min exercise interventions. There was a significant difference in SpO2 between the two 15-min exercise interventions (Wii intervention mean difference 2.33% > treadmill intervention; 95% CI: 1.52, 3.15). Gaming technology can provide an exercise program that has similar cardiovascular demands to traditional pulmonary rehabilitation programs for patients with COPD. Further research is necessary to address feasibility and long-term adherence. © 2014 John Wiley & Sons Ltd.

  4. The Effectiveness of a Multidisciplinary Group Rehabilitation Program on the Psychosocial Functioning of Elderly People Who Are Visually Impaired

    NARCIS (Netherlands)

    Alma, Manna A.; Groothoff, Johan W.; Melis-Dankers, Bart J. M.; Suurmeijer, Theodorus; van der Mei, Sijrike F.

    2013-01-01

    Introduction: The pilot study reported here determined the effectiveness of a multidisciplinary group rehabilitation program, Visually Impaired Elderly Persons Participating (VIPP), on psychosocial functioning. Methods: The single-group pretest-posttest pilot study included 29 persons with visual

  5. Functional rehabilitation of patients with acute Achilles tendon rupture

    DEFF Research Database (Denmark)

    Mark-Christensen, Troels; Troelsen, Anders; Kallemose, Thomas

    2014-01-01

    PURPOSE: The optimal treatment for acute Achilles tendon rupture (ATR) is continuously debated. Recent studies have proposed that the choice of either operative or non-operative treatment may not be as important as rehabilitation, suggesting that functional rehabilitation should be preferred over...

  6. Rehabilitation in COPD: the long-term effect of a supervised 7-week program succeeded by a self-monitored walking program

    DEFF Research Database (Denmark)

    Ringbaek, T; Brøndum, E; Martinez, G

    2008-01-01

    rehabilitation program combined with daily self-monitored training at home on exercise tolerance and health status. Two hundred and nine consecutive COPD patients who had completed a 7-week pulmonary rehabilitation program were assessed with endurance shuttle walk test (ESWT) and the St George's Respiratory...... change in SGRQ +2.0 (p = 0.40). A relative simple and inexpensive 7-week supervised rehabilitation program combined with daily self-monitored training at home was able to maintain significant improvement in exercise tolerance and health status throughout 1 year. Death and hospital admissions due to acute...

  7. A manual-based vocational rehabilitation program for patients with an acquired brain injury

    DEFF Research Database (Denmark)

    Høffding, Louise.K.Enggaard; Nielsen, Maria Haahr; Rasmussen, Morten Arendt

    2017-01-01

    as a work placement program including supported employment. Furthermore, the intervention will include a family intervention program followed up by support to one individual family caregiver. The primary outcomes are increased work or study rate at six-month follow-up. Moreover, a budget impact analysis...... and possibly a cost-utility analysis of the intervention will be performed. DISCUSSION: This study consists of a comprehensive multidiciplinary VR intervention involving several parties such as the municipalities, a specialized rehabilitation team, and patients' own family caregivers. If this intervention...

  8. Rehabilitation in COPD: the long-term effect of a supervised 7-week program succeeded by a self-monitored walking program

    DEFF Research Database (Denmark)

    Ringbaek, T; Brøndum, E; Martinez, G

    2008-01-01

    Questionnaire (SGRQ) at baseline, 0, 3, and 12 months after the program. Sixty-eight (32.5%) patients did not attend the 1-year follow-up. Among the 141 patients who competed the 1-year evaluation, the initial improvement after the 7-week program in the ESWT time was 180 s or 101% (p = 0.001) and in SGRQ 3......Pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) improves exercise tolerance and health status, however, these effects have been shown to decline after termination of the rehabilitation program. This study has examined the long-term effect of a 7-week supervised...... rehabilitation program combined with daily self-monitored training at home on exercise tolerance and health status. Two hundred and nine consecutive COPD patients who had completed a 7-week pulmonary rehabilitation program were assessed with endurance shuttle walk test (ESWT) and the St George's Respiratory...

  9. Effect of a rehabilitation program using virtual reality for balance and functionality of chronic stroke patients

    Directory of Open Access Journals (Sweden)

    Wagner Henrique Souza Silva

    2015-09-01

    Full Text Available AbstractThis study aimed to investigate the effect of a rehabilitation program using virtual reality (VR in addition to conventional therapy for improvement of balance (BERG scale and functional independence (FIM scale in chronic stroke patients. Ten individuals, mean age of 51.4 (± 6.7 years, participated of eight 60-minute sessions comprising kinesiotherapy (15min, Nintendo Wii (30min and Learning transfer (15min exercises. After training, nonparametric statistical analysis showed significant improvement in total FIM (p= .01 and BERG scores (p= .00, and in some of their subitems: FIM - dressing lower body (p= .01, transfer to bathtub/shower (p= .02 and locomotion: stairs (p= .03; BERG - reaching forward with outstretched arm (p= .01, retrieving object from the floor (p= .04, turning 360º (p= .01, placing alternate foot on step (p≤ .01, standing with one foot in front (p= .01, and one leg stand (p= .03. These findings suggest a positive influence of virtual reality exercises adjunct to conventional therapy on rehabilitation of balance and functionality post stroke, and indicate the feasibility of the proposed VR-based rehabilitation program.

  10. Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol

    Directory of Open Access Journals (Sweden)

    Tarnanen Sami

    2012-07-01

    Full Text Available Abstract Background Lumbar spine fusion (LSF effectively decreases pain and disability in specific spinal disorders; however, the disability rate following surgery remains high. This, combined with the fact that in Western countries the number of LSF surgeries is increasing rapidly it is important to develop rehabilitation interventions that improve outcomes. Methods/design In the present RCT-study we aim to assess the effectiveness of a combined back-specific and aerobic exercise intervention for patients after LSF surgery. One hundred patients will be randomly allocated to a 12-month exercise intervention arm or a usual care arm. The exercise intervention will start three months after surgery and consist of six individual guidance sessions with a physiotherapist and a home-based exercise program. The primary outcome measures are low back pain, lower extremity pain, disability and quality of life. Secondary outcomes are back function and kinesiophobia. Exercise adherence will also be evaluated. The outcome measurements will be assessed at baseline (3 months postoperatively, at the end of the exercise intervention period (15 months postoperatively, and after a 1-year follow-up. Discussion The present RCT will evaluate the effectiveness of a long-term rehabilitation program after LSF. To our knowledge this will be the first study to evaluate a combination of strength training, control of the neutral lumbar spine position and aerobic training principles in rehabilitation after LSF. Trial registration ClinicalTrials.gov Identifier NCT00834015

  11. Effect of a physiotherapy rehabilitation program on knee osteoarthritis in patients with different pain intensities.

    Science.gov (United States)

    Abdel-Aziem, Amr Almaz; Soliman, Elsadat Saad; Mosaad, Dalia Mohammed; Draz, Amira Hussin

    2018-02-01

    [Purpose] To examine the effect of physiotherapy rehabilitation program on moderate knee osteoarthritis in patients with different pain intensities. [Subjects and Methods] Sixty subjects (37 men and 23 women) with moderate knee osteoarthritis participated in the current study. Randomization software was used to select the participating subjects' numbers from the clinic records. They were classified into three groups according to pain intensity: mild, moderate, and severe pain groups. All groups underwent a standard set of pulsed electromagnetic field, ultrasound, stretching exercises, and strengthening exercises. Pain intensity, knee range of motion, knee function, and isometric quadriceps strength were evaluated using the visual analogue scale, universal goniometer, Western Ontario and McMaster Universities osteoarthritis index, and Jamar hydraulic dynamometer, respectively. The evaluation was performed before and after a 4-week rehabilitation program. [Results] All groups showed significant differences in pain intensity, knee range of motion, isometric quadriceps strength, and knee function. The score change in moderate pain group was significantly greater than those in mild and severe pain groups. [Conclusion] Pain intensity is one of the prominent factors that are responsible for the improvement of knee osteoarthritis. Consequently, pain intensity should be considered during rehabilitation of knee osteoarthritis.

  12. Transforming cardiac rehabilitation into broad-based healthy lifestyle programs to combat noncommunicable disease.

    Science.gov (United States)

    Arena, Ross; Lavie, Carl J; Cahalin, Lawrence P; Briggs, Paige D; Guizilini, Solange; Daugherty, John; Chan, Wai-Man; Borghi-Silva, Audrey

    2016-01-01

    The current incidence and prevalence of noncommunicable diseases (NCDs) is currently a cause for great concern on a global scale; future projections are no less disconcerting. Unhealthy lifestyle patterns are at the core of the NCD crisis; physical inactivity, excess body mass, poor nutrition and tobacco use are the primary lifestyle factors that substantially increase the risk of developing one or more NCDs. We have now come to recognize that healthy lifestyle interventions are a medical necessity that should be prescribed to all individuals. Perhaps the most well-established model for healthy lifestyle interventions in the current healthcare model is cardiac rehabilitation. To have any hope of improving the outlook for NCDs on a global scale, what is currently known as cardiac rehabilitation must transform into broad-based healthy lifestyle programing, with a shifted focus on primordial and primary prevention.

  13. [Reflections on community-based rehabilitation strategy (CBR): the experience of a CBR program in Bolivia].

    Science.gov (United States)

    Díaz-Aristizabal, Urko; Sanz-Victoria, Silvia; Sahonero-Daza, Milton; Ledesma-Ocampo, Sandra; Cachimuel-Vinueza, Mesías; Torrico, Marisabel

    2012-01-01

    Community-Based Rehabilitation (CBR) is a strategy for community development endorsed by the World Health Organization (WHO), the International Labor Office (ILO) and the United Nations Educational, Scientific and Cultural Organization (UNESCO). It is designed to promote rehabilitation, equal opportunity and social inclusion of Disabled Persons (DP) in their home communities by fostering cooperation among disabled individuals, their families, and other concerned social actors, it encourages community leadership and full social participation by DP through multi-sector cooperation. This article explores the historical antecedents and basic features of CBR strategy through an analysis of a directed culture change initiative developed by a foundation in the Cochabamba administrative region of Bolivia. Especially in intercultural environments, certain aspects of the socio-cultural context may determine whether CBR programs succeed or fail.

  14. Rehabilitation program for children with brachial plexus and peripheral nerve injury.

    Science.gov (United States)

    Ramos, L E; Zell, J P

    2000-03-01

    An aggressive and integrated physical and occupational therapy program is essential in the treatment of congenital brachial plexus injuries and other severe upper extremity nerve injuries. This article addresses the evaluation, identification of needs, establishment of goals, and the approaches to rehabilitation treatment for patients with brachial plexus palsy and other peripheral nerve injuries. Rehabilitative therapy can preserve and build on gains made possible by medical or surgical interventions; however, therapy is vital to these children regardless of whether surgery is indicated. The therapist uses a problem-solving approach to evaluate the patient and select appropriate occupational and physical therapy treatment modalities. Therapy is continually adjusted based on each child's unique needs. An understanding of the therapy principles aids in making appropriate referrals and prescriptions, and helps to coordinate care between the therapist, pediatrician, neurologist, and surgeon.

  15. Benefits of a 7-week outpatient pulmonary rehabilitation program in COPD patients.

    Science.gov (United States)

    Croitoru, Alina; Ioniţă, Diana; Stroescu, Carmen; Pele, Irina; Gologanu, Daniela; Dumitrescu, Andreea; Marinescu, Lucia; Anghelescu, Dana; Alexandru, Miron; Bogdan

    2013-01-01

    Respiratory rehabilitation programs (RR) are essential tools in the management of COPD. We present the results of a 7-week outpatient rehabilitation program in terms of dyspnea, exercise tolerance and quality of life. The following parameters were evaluated before and after RR: dyspnea (mMRC scale), pulmonary function (FEVI, RV- residual volume), exercise tolerance (6MWT- 6 minutes walk test, CPET - cardiopulmonary exercise test), quality of life (SGROQ questionnaire). The RR program was outpatient, hospital based (7 weeks, 3 sessions/ week) and included: exercise training, therapeutic education, and psychological support. 25 patients, COPD stage II-IV GOLD (mean FEVI 44.5 +/-13% predicted), mean age 60.4 +/-12 years, 7 females, average BMI 27.14+/-4 kg/m2, average RV residual volume 221.55+/-86% predicted. Mean 6MWTdistance: 407.48 +/- 84 m and mean maximum power (Pmax) obtained on CPET: 75.67+/-30 Watts. All patients were symptomatic with significant dyspnea (3.06+/-0.7 on mMRC scale) and showed a significant impairment of quality of life: SGRO score 46.23+/- 14. At the end of RR program: dyspnea decreased with 0.67points on mMRC scale (p = 0.000), 6MWT distance increased with 58.5 m (p = 0.0071), Pmax obtained during CPET increased with 11.2 W, without reaching statistical significance (p> 0.05). SGRO score decreased by 5.59 points (p = 0.02). There were no significant improvements in FEV1 and RV values (p> 0.05). In our COPD patients, the 7 week outpatient rehabilitation program was effective, leading to improvement ofsymptoms, exercise tolerance and quality of life.

  16. Conceptual bases of Christian, faith-based substance abuse rehabilitation programs: qualitative analysis of staff interviews.

    Science.gov (United States)

    McCoy, Lisa K; Hermos, John A; Bokhour, Barbara G; Frayne, Susan M

    2004-09-01

    Faith-based substance abuse rehabilitation programs provide residential treatment for many substance abusers. To determine key governing concepts of such programs, we conducted semi-structured interviews with sample of eleven clinical and administrative staff referred to us by program directors at six, Evangelical Christian, faith-based, residential rehabilitation programs representing two large, nationwide networks. Qualitative analysis using grounded theory methods examined how spirituality is incorporated into treatment and elicited key theories of addiction and recovery. Although containing comprehensive secular components, the core activities are strongly rooted in a Christian belief system that informs their understanding of addiction and recovery and drives the treatment format. These governing conceptions, that addiction stems from attempts to fill a spiritual void through substance use and recovery through salvation and a long-term relationship with God, provide an explicit, theory-driven model upon which they base their core treatment activities. Knowledge of these core concepts and practices should be helpful to clinicians in considering referrals to faith-based recovery programs.

  17. Gender differences in the use of transportation services to community rehabilitation programs

    Directory of Open Access Journals (Sweden)

    Kaneda Mariko

    2009-06-01

    Full Text Available Abstract Background Prevention and reduction of disability among community-dwelling older adults have been an important health policy concern in Japan. Moreover, it has also become a gendered issue due to the recent rapid growth in older females than males with disability living in their own homes. The aim of this study is to examine whether there is a gender difference in the use of community rehabilitation programs in Japan, and if so, whether the lack of transportation services and accompanying caregivers are the reasons for the gender difference. Methods This study was based on surveys of the program administrators and the primary caregivers of the program participants from 55 randomly selected community rehabilitation programs (CRP in the Tokyo metropolitan area. Questions included sociodemographic characteristics of program participants, types of transportation services provided by the CRP, caregiver's relationship to participant, and the nature of family support. Bivariate statistical analysis was conducted. Results Although there were more females than males with disability residing in communities, our findings showed that females were less likely to use CRP than males (1.3% and 2.3%, respectively; X2 = 93.0, p Conclusion This study builds on previous research findings, which suggest gender inequality in access to CRP.

  18. [Gait, balance and independence rehabilitation program in elderly adults in a primary care unit].

    Science.gov (United States)

    Espinosa-Cuervo, Gisela; López-Roldán, Verónica Miriam; Escobar-Rodríguez, David Alvaro; Conde-Embarcadero, Margarita; Trejo-León, Gerardo; González-Carmona, Beatriz

    2013-01-01

    to evaluate the effect of a supervised rehabilitation program to improve gait, balance and independence in elderly patients attending a family medicine unit. we conducted a quasi-experimental study over a period of four weeks in a group of 72 patients older than 65 years. a supervised program regarding the risk factors for falling, and balance, gait, coordination and oculovestibular system, the modalities to be done two or three times a week in the primary care unit or at home. An analysis of both tests was performed by "up and go," Tinetti scale and the Katz index. "intention to treat" and "by protocol." mean age was 72 ± 5 years, 67.8% were female and 81.9% of the patients completed the program. A significant clinical improvement with statistical level were evident for gait and balance (p = 0.001), independence showed only clinical improvement (p = 0.083). The efficacy for periodicity (two or three times/week) and performance place showed same clinical improvement and statistical level for gait and balance (p = 0.001 to 0.003) and independence showed only clinical improvement (p = 0.317 to 0.991). an integral rehabilitation program improved gait, balance and clinical independence significantly. The supervised program is applicable and can be reproduced at primary care unit or home for geriatric care and preventive actions.

  19. Health-Improving Rehabilitation Program of Pysical Education at Higher School

    Directory of Open Access Journals (Sweden)

    V. M. Naskalov

    2013-01-01

    Full Text Available The research is aimed to explore the efficiency of innovative technologies and increase the health-improving effect as a result of physical training in ecologically unfavorable conditions. A health-improving rehabilitation program, containing a set of modern means of physical rehabilitation and recreation in combination with physical exercises, was worked out to carry out the pedagogical experiment. The program includes the hydromassage, stretching exercises with biomechanical stimulation and exercises for developing weightlifting abilities. Apart from this, the interval hypoxic training was used in ‘artificially created’ favorable ecological conditions for detoxication. The students at Polotsk State University took part in the experiment. Among the assessment criteria applied by the author, there are generally acknowledged methods identifying the development of physical qualities, external respiration functions, body fat and other components composition. The experiment revealed that the innovative program had enhanced the health-improving effect compared to the traditional training programs, which was expressed by the statistically valid increase of the students’ speed- strength characteristics, flexibility, external respiration functions as well as the body fat decrease. Therefore, in order to increase a health-improving effect of physical training, the author recommends considering the specific ecological and hygienic conditions of a particular region to create the corresponding programs for group and individual health protection and recovery. The research findings can be used in physical education process at universities situated in the regions with unfavorable ecological conditions. 

  20. [The effectiveness of physical therapy methods (Bobath and motor relearning program) in rehabilitation of stroke patients].

    Science.gov (United States)

    Krutulyte, Grazina; Kimtys, Algimantas; Krisciūnas, Aleksandras

    2003-01-01

    The purpose of this study was to examine whether two different physiotherapy regimes caused any differences in outcome in the rehabilitation after stroke. We examined 240 patients with stroke. Examination was carried out at the Rehabilitation Center of Kaunas Second Clinical Hospital. Patients were divided into 2 groups: Bobath method was applied to the first (I) group (n=147), motor relearning program (MRP) method was applied to the second (II) group (n=93). In every group of patients we established samples according to sex, age, hospitalization to rehab unit as occurrence of CVA degree of disorder (hemiplegia, hemiparesis). The mobility of patients was evaluated according to European Federation for Research in Rehabilitation (EFRR) scale. Activities of daily living were evaluated by Barthel index. Analyzed groups were evaluated before physical therapy. When preliminary analysis was carried out it proved no statically reliable differences between analyzed groups (reliability 95%). The same statistical analysis was carried out after physical therapy. The results of differences between patient groups were compared using chi(2) method. Bobath method was applied working with the first group of patients. The aim of the method is to improve quality of the affected body side's movements in order to keep both sides working as harmoniously as possible. While applying this method at work, physical therapist guides patient's body on key-points, stimulating normal postural reactions, and training normal movement pattern. MRP method was used while working with the second group patients. This method is based on movement science, biomechanics and training of functional movement. Program is based on idea that movement pattern shouldn't be trained; it must be relearned. CONCLUSION. This study indicates that physiotherapy with task-oriented strategies represented by MRP, is preferable to physiotherapy with facilitation/inhibition strategies, such the Bobath programme, in the

  1. Factors associated with failure of nonoperative treatment in lateral epicondylitis.

    Science.gov (United States)

    Knutsen, Elisa J; Calfee, Ryan P; Chen, Raymond E; Goldfarb, Charles A; Park, Kevin W; Osei, Daniel A

    2015-09-01

    Lateral epicondylitis is a common cause of elbow pain that is treated with a variety of nonoperative measures and often improves with time. Minimal research is available on patients in whom these nonoperative treatments fail. To identify baseline patient and disease factors associated with the failure of nonoperative treatment of lateral epicondylitis, defined as surgery after a period of nonoperative treatment. Case control study; Level of evidence, 3. A total of 580 patients treated for lateral epicondylitis at a tertiary center between 2007 and 2012 were analyzed. Disease-specific and patient demographic characteristics were compared between patient groups (nonoperative vs surgical treatment). A multivariable logistic regression model was created based on preliminary univariate testing to determine which characteristics were associated with failure of nonoperative treatment. Of the 580 patients, 92 (16%) underwent surgical treatment at a mean of 6 months (range, 0-31 months) from their initial visit. Univariate analysis demonstrated a potential association (P 12 months (OR, 2.5) remained significant independent predictors of surgical treatment. This study identifies risk factors for surgical treatment for lateral epicondylitis. While these findings do not provide information regarding causal factors associated with surgery, these patient and disease-specific considerations may be helpful when counseling patients regarding treatment options and the likelihood of the success of continued nonoperative treatment. © 2015 The Author(s).

  2. Systematic review of nonoperative versus operative treatment of uncomplicated appendicitis.

    Science.gov (United States)

    Gorter, Ramon R; The, Sarah-May M L; Gorter-Stam, Marguerite A W; Eker, Hasan H; Bakx, Roel; van der Lee, Johanna H; Heij, Hugo A

    2017-08-01

    To compare the risk of complications between initial nonoperative treatment and appendectomy of uncomplicated (simple) appendicitis in children. Systematic literature search. Eligible for inclusion were both and randomized controlled trials and cohort studies including children in which the outcome of nonoperative treatment of uncomplicated appendicitis was reported with a minimum follow-up period of one year. Two authors extracted data independently and assessed quality. Primary outcome parameter was the percentage of children experiencing complications. Secondary outcomes were early failures, recurrent appendicitis and appendectomies, for all indications and on request. Five of the 2051 articles screened were eligible for inclusion, including 147 children (nonoperative treatment) and 173 children (appendectomy) with one year follow-up. Percentage of children experiencing complications ranged from 0 to 13% versus 0-17% for nonoperative and appendectomy, respectively. Nonoperative treatment avoided an appendectomy in 62-81% of the children after one year follow-up. The evidence base for initial nonoperative treatment of acute uncomplicated appendicitis in children is by far insufficient. It suggests that the percentage of patients experiencing complications in the initial nonoperative treatment group is comparable to the appendectomy group, and it may avoid an appendectomy in the large majority of children after one year follow-up. Systematic review. 1. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Study of High Sensitive C-Reactive Protein (HS-CRP) After Cardiac Rehabilitation Program in Patients Undergoing Isolated CABG.

    Science.gov (United States)

    Johari Moghadam, Adel; Azizinejad, Saied

    2016-12-01

    Although cardiac rehabilitation is known as a tool to reduce the overall risk of cardiovascular complications, its specific role in the reduction of hs-CRP as a marker of inflammation and a proven marker of cardiovascular risk needs further investigation. The present study aims at elucidating the effects of a full course of conventional cardiac rehabilitation program for the period of eight weeks, on the levels of hs-CRP in patients who underwent isolated coronary artery bypass surgery. In this case study, 30 consecutive patients who underwent isolated coronary artery bypass surgery (isolated CABGS), and a full 8-week cardiac rehabilitation program in Tehran Heart Center, were investigated. A group of 30 similar patients, who enrolled in the same period of rehabilitation program but did not participate in practice, was considered as a control group. Serum levels of hs-CRP in both groups were measured retrospectively and in similar days before the start of rehabilitation program and at the end of it (or 8 weeks after initial registration for the control group). Levels of hs-CRP in the rehabilitation group and control group were 5.9 7.7 and 6.3 6.9 respectively before start of the program which was not statistically meaningful ( P -Value = 0.833). However, after the program, level of hs-CRP in the two tested groups changed to 2.3 5.1 and 5.7 6.1 respectively which showed a meaningful correlation ( P -Value = 0.023). These results also showed that decrease in hs-CRP level in the rehabilitated group but not in the control group was statistically meaningful (with P -Value of 0.037 and 0.0723 respectively). In patients undergoing coronary bypass surgery, participating in a full course of cardiac rehabilitation for 8 weeks has resulted in a significant reduction in hs-CRP levels as a marker of cardiovascular risk.

  4. Outcomes in a Community-Based Intensive Cardiac Rehabilitation Program: Comparison with Hospital-Based and Academic Programs.

    Science.gov (United States)

    Katzenberg, Charles; Silva, Edna; Young, M Jean; Gilles, Greg

    2018-04-13

    The purpose of this study was to test the hypothesis that a community-based intensive cardiac rehabilitation program could produce positive changes in risk factor profile and outcomes in an at-risk population. Participants seeking either primary or secondary coronary artery disease prevention voluntarily enrolled in the 12-week intensive cardiac rehabilitation program. Data were obtained at baseline and 6-12 months after completion of the program. A total of 142 individuals, mean age 69 years, completed the Heart Series between 2012 and 2016. Follow-up data were available in 105 participants (74%). Participants showed statistically significant improvements in mean weight (165 to 162 lbs, P = .0005), body mass index (26 to 25 kg/m 2 , P = .001), systolic blood pressure (126 to 122 mm Hg, P = .01), diastolic blood pressure (73 to 70 mm Hg, P = .0005), total cholesterol (175 to 168 mg/dL, P = .03), low-density lipoprotein cholesterol (LDL-C) (100 to 93 mg/dL, P = .005), LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio (1.8 to 1.6, P = .005), and cholesterol/HDL-C ratio (3.2 to 3.0, P = .003). Changes in HDL-C, triglycerides, and fasting blood glucose did not reach statistical significance, but all trended in favorable directions. Adverse cardiovascular disease outcomes were rare (one stent placement, no deaths). A total of 105 participants completed our 12-week community-based intensive cardiac rehabilitation program and showed significant positive changes in several measures of cardiac risk, with only 1 adverse event. These results compare favorably with those of hospital-based and academic institutional programs. Copyright © 2018 Elsevier Inc. All rights reserved.

  5. 75 FR 11553 - Final Fair Market Rents for the Housing Choice Voucher Program and Moderate Rehabilitation Single...

    Science.gov (United States)

    2010-03-11

    ... provided on the same website noted above. Any questions related to use of FMRs or voucher payment standards... the Housing Choice Voucher Program and Moderate Rehabilitation Single Room Occupancy Program for... County, ND. Both areas were having significant problems administering the Housing Choice Voucher program...

  6. How Prospective Physical Medicine and Rehabilitation Trainees Rank Residency Training Programs.

    Science.gov (United States)

    Auriemma, Michael J; Whitehair, Curtis L

    2018-03-01

    Since the inception of the National Resident Matching Program, multiple studies have investigated the factors applicants consider important to ranking prospective residency programs. However, only 2 previous studies focused on prospective physical medicine and rehabilitation (PM&R) trainees, and the most recent of these studies was published in 1993. It is unknown whether these previous studies are reflective of current prospective PM&R residents. To assess various factors that contribute to prospective PM&R residents' decision making in choosing a residency program and compare these findings with previous studies. An anonymous, voluntary questionnaire. A single PM&R residency program. All applicants to a single PM&R residency program. All applicants to our PM&R residency program were invited to participate in a 44-item, 5-point Likert-based questionnaire. Applicants were asked to rate the importance of various factors as they related to constructing their residency rank list. Means and standard deviations were calculated for items included in the survey. A response rate of 26% was obtained, with the responses of 98 applicants (20%) ultimately analyzed. The highest rated factors included "perceived happiness of current residents," "opportunities for hands-on procedure training," "perceived camaraderie among current residents," "perceived camaraderie among faculty and current residents," "perceived quality of current residents," and "perceived work/life balance among current residents." Although male and female respondents demonstrated similar ranking preferences, an apparent difference was detected between how genders rated the importance of "whether the program projects a favorable environment for women" and "whether the program projects a favorable environment for minorities." As compared with previous PM&R applicants, current prospective trainees seem to place greater importance on skill acquisition over didactic teaching. Prospective PM&R residents highly value

  7. 75 FR 14582 - Office of Special Education and Rehabilitative Services-Special Demonstration Programs-Model...

    Science.gov (United States)

    2010-03-26

    ... DEPARTMENT OF EDUCATION Office of Special Education and Rehabilitative Services--Special... of Special Education and Rehabilitative Services, Department of Education. ACTION: Notice of proposed... for Special Education and Rehabilitative Services proposes a priority under the Special Demonstration...

  8. 75 FR 47798 - Office of Special Education and Rehabilitative Services-Special Demonstration Programs-Model...

    Science.gov (United States)

    2010-08-09

    ... DEPARTMENT OF EDUCATION Office of Special Education and Rehabilitative Services--Special... of Special Education and Rehabilitative Services, Department of Education. ACTION: Notice of final... for Special Education and Rehabilitative Services establishes a priority under the Special...

  9. Active LifestyLe Rehabilitation interventions in aging spinal cord injury (ALLRISC): a multicentre research program.

    Science.gov (United States)

    van der Woude, L H V; de Groot, S; Postema, K; Bussmann, J B J; Janssen, T W J; Post, M W M

    2013-06-01

    With today's specialized medical care, life expectancy of persons with a spinal cord injury (SCI) has considerably improved. With increasing age and time since injury, many individuals with SCI, however, show a serious inactive lifestyle, associated with deconditioning and secondary health conditions (SHCs) (e.g. pressure sores, urinary and respiratory tract infections, osteoporosis, upper-extremity pain, obesity, diabetes, cardiovascular disease) and resulting in reduced participation and quality of life (QoL). Avoiding this downward spiral, is crucial. To understand possible deconditioning and SHCs in persons aging with a SCI in the context of active lifestyle, fitness, participation and QoL and to examine interventions that enhance active lifestyle, fitness, participation and QoL and help prevent some of the SHCs. A multicentre multidisciplinary research program (Active LifestyLe Rehabilitation Interventions in aging Spinal Cord injury, ALLRISC) in the setting of the long-standing Dutch SCI-rehabilitation clinical research network. ALLRISC is a four-study research program addressing inactive lifestyle, deconditioning, and SHCs and their associations in people aging with SCI. The program consists of a cross-sectional study (n = 300) and three randomized clinical trials. All studies share a focus on fitness, active lifestyle, SHCs and deconditioning and outcome measures on these and other (participation, QoL) domains. It is hypothesized that a self-management program, low-intensity wheelchair exercise and hybrid functional electrical stimulation-supported leg and handcycling are effective interventions to enhance active life style and fitness, help to prevent some of the important SHCs in chronic SCI and improve participation and QoL. ALLRISC aims to provide evidence-based preventive components of a rehabilitation aftercare system that preserves functioning in aging persons with SCI.

  10. Effectiveness of individualized fall prevention program in geriatric rehabilitation hospital setting: a cluster randomized trial.

    Science.gov (United States)

    Aizen, Efraim; Lutsyk, Galina; Wainer, Lea; Carmeli, Sarit

    2015-10-01

    There is no conclusive evidence that hospital fall prevention programs can reduce the number of falls. We aimed to investigate the effect of a targeted individualized falls prevention program in a geriatric rehabilitation hospital. This was a two-stage cluster-controlled trial carried out in five geriatric rehabilitation wards. Participants were 752 patients with mean age 83.2 years. The intervention was a two-phase targeted intervention falls prevention program. The intervention included an assessment of patient's risk by a risk assessment tool and an individual management that includes medical, behavioral, cognitive and environmental modifications. Patients with moderate risk received additionally orientation guidance, and mobility restriction. Patients determined as high risk were additionally placed under permanent personal supervision. Outcome measures were falls during hospital stay. In both stages of the trial, intervention and control wards were almost similar at baseline for individual patient characteristics. Overall, 37 falls occurred during the study. No significant difference was found in fall rates during follow-up between intervention and control wards: 1.306 falls per 1000 bed days in the intervention groups and 1.763-1.826 falls per 1000 bed days in the control groups. The adjusted hazard ratio for falls in the intervention groups was 1.36 (95 % confidence interval 0.89-1.77) (P = 0.08) in the first stage and 1.27 (95 % confidence interval 0.92-1.67) (P = 0.12) in the second stage. These results suggest that in a geriatric rehabilitation hospital a targeted individualized intervention falls prevention program is not effective in reducing falls.

  11. Fee-for-service cancer rehabilitation programs improve health-related quality of life.

    Science.gov (United States)

    Kirkham, A A; Neil-Sztramko, S E; Morgan, J; Hodson, S; Weller, S; McRae, T; Campbell, K L

    2016-08-01

    Rigorously applied exercise interventions undertaken in a research setting result in improved health-related quality of life (hrqol) in cancer survivors, but research to demonstrate effective translation of that research to practice is needed. The objective of the present study was to determine the effect of fee-for-service cancer rehabilitation programs in the community on hrqol and on self-reported physical activity and its correlates. After enrolment and 17 ± 4 weeks later, new clients (n = 48) to two fee-for-service cancer rehabilitation programs completed the 36-Item Short Form Health Survey (rand-36: rand Corporation, Santa Monica, CA, U.S.A.), the Godin Leisure-Time Exercise Questionnaire, and questions about physical activity correlates. Normal fee-for-service operations were maintained, including a fitness assessment and individualized exercise programs supervised in a group or one-on-one setting, with no minimum attendance required. Fees were associated with the assessment and with each exercise session. Of the 48 participants, 36 (75%) completed both questionnaires. Improvements in the physical functioning, role physical, pain, and energy/fatigue scales on the rand-36 exceeded minimally important differences and were of a magnitude similar to improvements reported in structured, rigorously applied, and free research interventions. Self-reported levels of vigorous-intensity (p = 0.021), but not moderate-intensity (p = 0.831) physical activity increased. The number of perceived barriers to exercise (p = 0.035) and the prevalence of fatigue as a barrier (p = 0.003) decreased. Exercise self-efficacy improved only in participants who attended 11 or more sessions (p = 0.002). Exercise enjoyment did not change (p = 0.629). Enrolment in fee-for-service cancer rehabilitation programs results in meaningful improvements in hrqol comparable to those reported by research interventions, among other benefits. The fee-for-service model could be an effective model for

  12. Mobile game-based virtual reality rehabilitation program for upper limb dysfunction after ischemic stroke.

    Science.gov (United States)

    Choi, Yoon-Hee; Ku, Jeonghun; Lim, Hyunmi; Kim, Yeo Hyung; Paik, Nam-Jong

    2016-05-02

    Virtual reality (VR) has the potential to provide intensive, repetitive, and task-oriented training, and game-based therapy can enhance patients' motivation and enjoyment. The objective of the present study was to develop a mobile game-based upper extremity VR program for patients who have experienced stroke, and to evaluate the feasibility and effectiveness of the program. This randomized, double-blind, controlled trial included 24 patients with ischemic stroke. The intervention group (n = 12) received 30 min of conventional occupational therapy (OT) and 30 min of the mobile upper extremity rehabilitation program using a smartphone and a tablet PC (MoU-Rehab). The controls (n = 12) received conventional OT alone for 1 h per day. Rehabilitation consisted of 10 sessions of therapy, 5 days per week, for 2 weeks. The outcome measures (Fugl-Meyer Assessment of the upper extremity [FMA-UE], Brunnström stage [B-stage] for the arm and the hand, manual muscle testing [MMT], modified Barthel index [MBI], EuroQol-5 Dimension [EQ-5D], and Beck Depression Inventory [BDI]) were assessed at the beginning and end of treatment, and at 1 month. User satisfaction was evaluated by a questionnaire. A greater improvement in the FMA-UE, B-stage, and MMT was found after treatment with the MoU-Rehab than with conventional therapy. The extent of improvements in the MBI, EQ-5D, and BDI was not significantly different between the two groups. Patients in the experimental group completed the 2-weeks treatment without adverse effects, and they were generally satisfied with MoU-Rehab. This mobile game-based VR rehabilitation program appears to be feasible and effective for promoting upper limb recovery after ischemic stroke.

  13. Attitude toward the out-patient cardiac rehabilitation program and facilitators for maintenance of exercise behavior.

    Science.gov (United States)

    Wong, Eliza M L; Zhong, Xue Bing; Sit, Janet W H; Chair, Sek Ying; Leung, Doris Y P; Leung, Carmen; Leung, K C

    2016-09-01

    This study examined the attitudes of Chinese patients with coronary heart disease (CHD) toward the outpatient cardiac rehabilitation program (OCRP), as well as their exercise behavior, intention, maintenance and related factors. A qualitative descriptive study design was used, and 22 CHD patients were recruited in Hong Kong in 2014. In-depth interviews and content analyses were conducted. The tripartite model of attitudes was adopted as research framework. Two themes were identified: (1) informant attitude (perception, affection, and practice) toward the OCRP and (2) Exercise Behavior - intention, maintenance and its related factors. Most informants showed positive perception and affection regarding the outpatient rehabilitation program, leading to regular practice of exercise in the program and at home. Peer, group dynamic, social support and Chinese culture influences on exercise behavior may serve as major facilitators to maintain exercise behavior. Positive attitude toward the OCRP enhanced the participation rate, whereas peer and social support from the family and workplace were useful to improve the maintenance of exercise behavior. Overall, this study provides insights into strategic planning for the OCRP and continual support for CHD patients in the community.

  14. The benefits of a comprehensive rehabilitation program in patients diagnosed with spastic quadriplegia.

    Science.gov (United States)

    Rogoveanu, O C; Tuțescu, N C; Kamal, D; Alexandru, D O; Kamal, C; Streba, C T; Trăistaru, M R

    2016-01-01

    Spastic quadriplegia has as an etiopathogenic substrate, a non-progressive brain lesion; however, the clinical manifestations of the disease evolve over time. Children diagnosed with spastic quadriplegia show a variety of symptoms in different areas: sensorimotor, emotional, cognitive, and social. The purpose of this study was to assess the functional status in patients diagnosed with spastic quadriplegia, who followed a complex medical rehabilitation program, during a year, and highlight the importance of using physical and kinetic techniques in improving their status. A total of 10 children diagnosed with spastic quadriplegia were included in the study and the Gross Motor Function Classification System (GMFCS) and manual ability classification system (MACS) were used to evaluate the functionality status of each patient. Every patient was evaluated initially (T1), after six months of program (T2), and after they completed the study. All the children were originally monitored daily, for 5 days per week for a period of one month, then two times a week for a year. A statistically significant difference regarding the modification of the GMFCS and MACS stage was found, which occurred between the first and the third evaluation. The inverse correlation of the statistical significance between the ages of patients and the decrease in GMFCS or MACS stage was highlighted; the younger the patient, the more the scale decreased. A direct link between the gross motor function and the manual ability was noticed. Applying a complex rehabilitation program has proven efficient by improving both the gross motor functionality and the manual ability.

  15. The Recovery Process When Participating in Cancer Support and Rehabilitation Programs in Sweden

    Directory of Open Access Journals (Sweden)

    Christina Melin-Johansson

    2015-07-01

    Full Text Available The aim was to illuminate the meaning of participating in support and rehabilitation programs described by people diagnosed with cancer. Nineteen persons were interviewed in focus groups and face-to-face. Data were analyzed with a qualitative phenomenological hermeneutical method for researching lived experiences. Interpretation proceeded through three phases: naïve reading, structural analysis, and comprehensive understanding. Three themes were disclosed: receiving support for recovery when being most vulnerable, recapturing capabilities through supportive activities, and searching to find stability and well-being in a changed life situation. Participating in the programs was an existential transition from living in an unpredictable situation that was turned into something meaningful. Recovery did not mean the return to a state of normality; rather, it meant a continuing recovery from cancer treatments and symptoms involving recapturing capabilities and searching for a balance in a forever changed life. This study provides new insights about the experiences of participating in cancer support and rehabilitation programs.

  16. Treatment of short bowel syndrome in children. Value of the Intestinal Rehabilitation Program

    Directory of Open Access Journals (Sweden)

    Uenis Tannuri

    Full Text Available Summary The main cause of acute intestinal failure is short bowel syndrome, generally as a result of resection of extensive segments of small intestine. As a result, the main symptoms are watery diarrhea, malabsorption syndrome, chronic malnutrition, and death, if the patient is not properly treated. If the length of the remaining intestine is greater than 30 cm, complete adaptation is possible and the patient may not require parenteral nutrition. The currently recommended treatment includes the use of prolonged parenteral nutrition and enteral nutrition, always aimed at constant weight gain, in conjunction with surgeries aimed at elongating the dilated bowel. This set of procedures constitutes what is called an Intestinal Rehabilitation Program. This therapy was used in 16 children in periods ranging from 8 months to 7.5 years, with survival in 75% of the cases. Finally, the last resort to be used in children with complete resection of the small bowel is an intestinal transplant. However, to date there is no record of a Brazilian child that has survived this procedure, despite it being attempted in seven patients. We conclude that the results of the intestinal rehabilitation program are encouraging for the continuation of this type of treatment and stimulate the creation of the program in other pediatric care institutions.

  17. Do supervised weekly exercise programs maintain functional exercise capacity and quality of life, twelve months after pulmonary rehabilitation in COPD?

    Directory of Open Access Journals (Sweden)

    Alison Jennifer A

    2007-05-01

    Full Text Available Abstract Background Pulmonary rehabilitation programs have been shown to increase functional exercise capacity and quality of life in COPD patients. However, following the completion of pulmonary rehabilitation the benefits begin to decline unless the program is of longer duration or ongoing maintenance exercise is followed. Therefore, the aim of this study is to determine if supervised, weekly, hospital-based exercise compared to home exercise will maintain the benefits gained from an eight-week pulmonary rehabilitation program in COPD subjects to twelve months. Methods Following completion of an eight-week pulmonary rehabilitation program, COPD subjects will be recruited and randomised (using concealed allocation in numbered envelopes into either the maintenance exercise group (supervised, weekly, hospital-based exercise or the control group (unsupervised home exercise and followed for twelve months. Measurements will be taken at baseline (post an eight-week pulmonary rehabilitation program, three, six and twelve months. The exercise measurements will include two six-minute walk tests, two incremental shuttle walk tests, and two endurance shuttle walk tests. Oxygen saturation, heart rate and dyspnoea will be monitored during all these tests. Quality of life will be measured using the St George's Respiratory Questionnaire and the Hospital Anxiety and Depression Scale. Participants will be excluded if they require supplemental oxygen or have neurological or musculoskeletal co-morbidities that will prevent them from exercising independently. Discussion Pulmonary rehabilitation plays an important part in the management of COPD and the results from this study will help determine if supervised, weekly, hospital-based exercise can successfully maintain functional exercise capacity and quality of life following an eight-week pulmonary rehabilitation program in COPD subjects in Australia.

  18. MAIN CONTROVERSIES IN THE NONOPERATIVE MANAGEMENT OF BLUNT SPLENIC INJURIES.

    Science.gov (United States)

    Carlotto, Jorge Roberto Marcante; Lopes-Filho, Gaspar de Jesus; Colleoni-Neto, Ramiro

    2016-03-01

    The nonoperative management of traumatic spleen injuries is the modality of choice in patients with blunt abdominal trauma and hemodynamic stability. However, there are still questions about the treatment indication in some groups of patients, as well as its follow-up. Update knowledge about the spleen injury. Was performed review of the literature on the nonoperative management of blunt injuries of the spleen in databases: Cochrane Library, Medline and SciELO. Were evaluated articles in English and Portuguese, between 1955 and 2014, using the headings "splenic injury, nonoperative management and blunt abdominal trauma". Were selected 35 articles. Most of them were recommendation grade B and C. The spleen traumatic injuries are frequent and its nonoperative management is a worldwide trend. The available literature does not explain all aspects on treatment. The authors developed a systematization of care based on the best available scientific evidence to better treat this condition.

  19. Factors for failure of nonoperative management of blunt ...

    African Journals Online (AJOL)

    Factors for failure of nonoperative management of blunt hepatosplenic trauma in children. ... Annals of Pediatric Surgery ... However, other than hemodynamic instability, the other factors mentioned above deserve further evaluation to ...

  20. Exercise through a cardiac rehabilitation program attenuates oxidative stress in patients submitted to coronary artery bypass grafting.

    Science.gov (United States)

    Taty Zau, José Francisco; Costa Zeferino, Rodrigo; Sandrine Mota, Nádia; Fernandes Martins, Gerez; Manoel Serra, Salvador; Bonates da Cunha, Therezil; Medeiros Lima, Daniel; Bragança Pereira, Basilio de; Matos do Nascimento, Emília; Filho, Danilo Wilhelm; Curi Pedrosa, Rozangela; Pedrosa, Roberto Coury

    2018-12-01

    Cardiovascular disease is the main cause of morbidity and mortality in the world and oxidative stress has been implicated in the pathogenesis. Cardiac rehabilitation in patients with coronary artery disease submitted to coronary artery bypass grafting may prevent cardiovascular events probably through the attenuation of oxidative stress. The aim of this study was to evaluate the benefits of a cardiac rehabilitation program in the control of the systemic oxidative stress. The studied population consisted of 40 patients, with chronic stable coronary artery disease submitted to coronary artery bypass grafting, who attended a cardiac rehabilitation program. Biomarkers of oxidative stress were evaluated in the blood of these patients at different moments. After the onset of cardiac rehabilitation, there was a significant and progressive decrease in thiobarbituric acid reactive substances levels and protein carbonyls, an initial increase and subsequent decrease in superoxide dismutase, catalase and glutathione peroxidase activities. Also, a progressive increase of uric acid, while ferric reducing antioxidant power levels increased only at the end of the cardiac rehabilitation and a tendency to increase of glutathione contents. The results suggest that regular exercise through a cardiac rehabilitation program can attenuate oxidative stress in chronic coronary artery disease patients submitted to coronary artery bypass grafting.

  1. An individual rehabilitation program: evaluation by Parkinsonian patients and their physiotherapists.

    Science.gov (United States)

    Ory Magne, F; Fabre, N; Gu, C; Pastorelli, C; Tardez, S; Marchat, J-C; Marque, P; Brefel Courbon, C

    2014-11-01

    The purpose of this work was to study the feasibility of an individual Parkinson disease (PD) rehabilitation program based on each patient's prevalent symptoms and to determine the effects of this program on patient's quality of life as well as the level of patient's and physiotherapist's satisfaction with the program. In association with physiotherapists with expertise in PD, a physical medicine and rehabilitation physician, we elaborated a physical therapy program based on the core areas for physical therapy in PD: transfers; posture; balance and falls; physical capacity and inactivity. Within this program, we selected exercises tailored to each patient's main impairment and proposed this selection to their local physiotherapist for three months. Quality of life was evaluated with PDQ-39 at baseline and after three months of the individualized physical therapy program. We built an anonymous satisfaction questionnaire for patients and physiotherapists that was filled out at the end of the program. One hundred and three individuals with moderately advanced but clinically stable idiopathic PD were included. Significant improvement was found for the emotional well-being, bodily discomfort and stigma domain (P ≤ 0.05). No significant improvement was found for the other PDQ-39 domains. The mean global satisfaction figures for this program were 6.0 ± 2.4 and 7.2 ± 2.1 for patients and physiotherapists respectively. Most of the patients felt improved by the physiotherapy program and especially for transfer, balance, gait, and mobility. Our study found evidence of the potential benefits of a patient-tailored physiotherapy program. Such a program was feasible and had a favorable impact on patients' quality of life and on physiotherapists' practices for PD patients. Specific physiotherapy may be effective to limit physical mobility impairment. Our results also pointed out that physiotherapy may be efficient to confine the negative impact of social isolation, pain and

  2. A pair-matched comparison of return to pivoting sports at 1 year in ACL-injured patients after a nonoperative versus operative treatment course

    Science.gov (United States)

    Grindem, Hege; Eitzen, Ingrid; Moksnes, Håvard; Snyder-Mackler, Lynn; Risberg, May Arna

    2013-01-01

    significantly higher knee joint laxity, but significantly better hop test limb symmetry indexes, KOS-ADLS scores, and IKDC 2000 scores. None of the functional differences were larger than the smallest detectable difference. Conclusion ACL-injured patients following a nonoperative treatment course, including recommendations of activity modifications, and operatively treated patients did not have significantly different rates of returning to pivoting sports after 1 year in this pair-matched cohort study. Clinicians should be aware of a potentially high level of noncompliance to recommendations of activity modifications. While these results show that it is possible for nonoperatively treated patients to return to sport after rehabilitation, future follow-ups are needed to examine whether these patients maintain sports participation over time, and what long-term consequences they may suffer regarding subsequent injuries and knee osteoarthritis. PMID:22962290

  3. Adherence to a Maintenance Exercise Program 1 Year After Pulmonary Rehabilitation WHAT ARE THE PREDICTORS OF DROPOUT?

    NARCIS (Netherlands)

    Heerema-Poelman, Ankie; Stuive, Ilse; Wempe, Johan B.

    2013-01-01

    PURPOSE: To evaluate adherence to a maintenance exercise program in patients with chronic obstructive pulmonary disease (COPD) and explore predictors for adherence. METHODS: Seventy patients with COPD were referred to a home-care maintenance exercise program after completing pulmonary rehabilitation

  4. Patient Profile of Drop-Outs From a Pulmonary Rehabilitation Program.

    Science.gov (United States)

    Almadana Pacheco, Virginia; Pavón Masa, María; Gómez-Bastero Fernández, Ana Paulina; Muñiz Rodríguez, Ana Mirian; Tallón Moreno, Rodrigo; Montemayor Rubio, Teodoro

    2017-05-01

    While the benefits of pulmonary rehabilitation programs (PR) in COPD have been demonstrated, poor adherence, related with worse clinical outcomes, is common. The purpose of this study was to examine causes for drop-out during a 12-week multidisciplinary pulmonary rehabilitation program and to investigate the characteristics of patients with poor adherence, with special emphasis on functional and clinical characteristics. A prospective study was performed between February and November 2015in 83 COPD patients enrolled in an outpatient program of 36 strength +resistance training sessions. Ambulances were provided to facilitate access to the clinic. Patients were divided into: adherent (A) (attended at least 70% of the program) or non-adherent (NA) (at least one session). A total of 83 patients were evaluated and 26 excluded; 15.7% refused to participate. The drop-out rate was 38.5%. The main causes were low motivation and transport problems. Lower forced vital capacity (NA, 58.9% vs A, 67.8%; P=.03), worse results on submaximal exercise test (NA, 6.2minutes vs A, 9.2minutes; P=.02), in total distance walked (NA, 42.6 vs A, 56.5; P=.03) and VO 2 in ml/min/kg (NA, 11.4 vs A, 13.6; P=.03) and in ml/min (NA, 839 vs A, 1020; P=.04) were found in the non-adherent group. This group also showed higher use of oral steroids (NA, 23.8% vs A, 2.9%; P=.01). More than 1/3 of patients leave programs. The main causes are related to motivation and transport. The patients who dropout are those with worse functional tests, more exacerbations, steroids and smoking habit. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. A neuropsychological rehabilitation program for patients with Multiple Sclerosis based on the model of the ICF.

    Science.gov (United States)

    Pusswald, Gisela; Mildner, Christa; Zebenholzer, Karin; Auff, Eduard; Lehrner, Johann

    2014-01-01

    Forty to sixty percent of MS patients suffer from cognitive impairments. Cognitive deficits are a great burden for patients affected. In particular they may lead to a reduced quality of life, loss of work and problems with the social environment. The aim of this study was to evaluate a specific neuropsychological rehabilitation program for MS patients according to the ICF to be able to meet more properly individual requirements on the therapy level of function as well as of activities and participation. Forty patients with MS were randomised in an intervention (IG) - and a control group (CG). The outcome measure of the IG, who started an intensive computer based home training of attention and attended psychological counselling was compared to the untrained CG. In specific domains of attention (simple and cued alertness and divided attention) significant group differences between CG and IG could be found. The IG reported an improvement of mental fatigue and retardation. These findings support the idea that a neuropsychological rehabilitation program, which based on the model of ICF, could improve cognitive impairment and could also have a positive influence of activities and participation.

  6. Women's experiences accessing a women-centered cardiac rehabilitation program: a qualitative study.

    Science.gov (United States)

    Rolfe, Danielle E; Sutton, Erica J; Landry, Mireille; Sternberg, Len; Price, Jennifer A D

    2010-01-01

    The health benefits of cardiac rehabilitation (CR) for women living with heart disease are well documented, yet women remain underrepresented in traditionally structured CR programs. This health service delivery gap has been attributed to a number of sex-related factors experienced by women, including lower rates of physician referral, travel-related barriers, competing work and caregiving responsibilities, greater cardiovascular disease severity, and number of comorbid health conditions. Whether a program specifically designed for women is able to address these barriers and facilitate women's participation is a question that has seldom been explored in the CR literature. As part of a larger study exploring whether 6 predefined principles of women's health (empowerment of women, accessible programs, broad definition of health care, high-quality of care, collaborative planning, and innovative and creative approaches) are reflected in the practices of the Women's Cardiovascular Health Initiative (WCHI) (a comprehensive CR and primary prevention program designed for women), the objective of this analysis was to explore how the principle of "accessible programs" is experienced by women participating in the WCHI. Fourteen women previously enrolled in the WCHI program participated in a single, in-person qualitative interview. Transcripts were analyzed using a constant-comparative approach to identify relevant themes related to program accessibility. Key themes identified included participants' experiences with acquiring physician referral, negotiating transportation issues, and navigating program schedules. Women discussed how peer support and staff members' willingness to address their health-related concerns facilitated their participation. While a women-centered CR/primary prevention program may facilitate and encourage women's participation by providing flexible program schedules as well as peer and professional support, efforts are still required to address

  7. [The Effect of a Movie-Based Nursing Intervention Program on Rehabilitation Motivation and Depression in Stroke Patients].

    Science.gov (United States)

    Kwon, Hye Kyung; Lee, Sook Ja

    2017-06-01

    The aim of this study was to develop and measure the effect of a movie-based-nursing intervention program designed to enhance motivation for rehabilitation and reduce depression levels in stroke patients. The study used a quasi-experimental, nonequivalent control group and a pretest-posttest design. The 60 research subjects were assigned to the experimental (n=30) or control group (n=30). The moviebased nursing intervention program was provided for the experimental group during 60-minute sessions held once per week for 10 weeks. The program consisted of patient education to strengthen motivation for rehabilitation and reduce depression, watching movies to identify role models, and group discussion to facilitate therapeutic interaction. After 10 weeks of participation in the movie-based nursing intervention program, the experimental group's rehabilitation motivation score was significantly higher, F=1161.54 (within groups df=49, between groups df=1), pmotivation for rehabilitation and increased depression during the rehabilitation process. © 2017 Korean Society of Nursing Science

  8. Physical activity and health-related quality of life in pediatric cancer patients following a 4-week inpatient rehabilitation program.

    Science.gov (United States)

    Müller, Carsten; Krauth, Konstantin A; Gerß, Joachim; Rosenbaum, Dieter

    2016-09-01

    Chronic health conditions and impaired quality of life are commonly experienced in childhood cancer survivors. While rehabilitation clinics support patients in coping with the disease, studies evaluating an inpatient rehabilitation program on promoting physical activity (PA) and health-related quality of life (HRQoL) are missing. A 4-week inpatient rehabilitation program was prospectively evaluated. One hundred fifty patients with leukemia or lymphoma (N = 86), brain tumors (N = 38), and sarcomas (N = 26) were enrolled on average 17 months after cessation of acute medical treatment. PA amount and cadence (indicating the intensity of walking activity) using the StepWatch™ 3 Activity Monitor and HRQoL global and physical well-being scores using the KINDL(®) questionnaire were assessed before, immediately after, and 6 and 12 months following the program and analyzed using multiple linear mixed models. Significant effects on PA were only found at 12-month follow-up for amount and cadence variables (all p patients revealed the highest PA level throughout the study, rehabilitation effects were more pronounced for cadence variables in brain tumor and sarcoma patients. The rehabilitation program had immediate (t = 4.56, p cancer patients.

  9. Life Values as an Intrinsic Guide for Cardiopulmonary Rehabilitation Program Engagement: A QUALITATIVE ANALYSIS.

    Science.gov (United States)

    Ellis, Jordan M; Whited, Matthew C; Freeman, John Taylor; Corson, Ansley T; Jameson, John Paul; Greenway, Stacey; Sager, David M; Midgette, Emily P; Varju, Eliza V

    2017-11-08

    Participation in cardiovascular and pulmonary rehabilitation (CVPR) programs can lead to improved functional abilities and improved quality of life, but attendance and adherence to these programs remain suboptimal. Behavioral therapies have emphasized the importance of life value identification as a guide for goal setting and behavior change for both psychological and physical health conditions. Individuals who choose to engage in behaviors that align with their life values are thought to be intrinsically reinforced. The purpose of the following qualitative study was to interview patients enrolled in CVPR about their own life values and motivating factors related to healthy behavior changes. Thirty cardiac or pulmonary patients were recruited from a CVPR program and participated in a semistructured interview about their life values and motivating factors related to program engagement. The data were transcribed and analyzed thematically. Participants identified a wide range of values related to program engagement, and only half of the participants endorsed health as a value. The most frequently endorsed life values included being active, family, and independence. The interviews indicated that, although patients make lifestyle changes in the program to improve their physical health, there are often other values that primarily guide their choice to engage in and maintain lifestyle behaviors. Life values can serve as a powerful guide for individual behavior change. The present study suggests that the piloting of brief values interventions early in CVPR treatment is warranted and has the potential to improve patient outcomes.

  10. Change indicators of miotonometry under the influence of physical rehabilitation programs for football players with anterior cruciate ligament damage

    Directory of Open Access Journals (Sweden)

    Parish Mohammadreza.

    2012-12-01

    Full Text Available The question of the effectiveness of physical rehabilitation program designed to include physiotherapy, special proprioceptive exercises and functional training, aimed at restoring stability and mobility in the joint, muscle tone, intermuscular coordination, proprioception of the knee joint and the prevention of recurrent injuries in football players after ACL reconstruction. The data miotonometry quadriceps injured extremity surveyed 58 players. Found that decreasing physical activity leads to trophic changes and decrease in muscle tone of the injured extremity. The use of the physical rehabilitation program possible to state its high efficiency.

  11. Is nonoperative management of partial distal biceps tears really successful?

    Science.gov (United States)

    Bauer, Tyler M; Wong, Justin C; Lazarus, Mark D

    2018-04-01

    The current treatment of partial distal biceps tears is a period of nonoperative management, followed by surgery, if symptoms persist. Little is known about the success rate and outcomes of nonoperative management of this illness. We identified 132 patients with partial distal biceps tears through an International Classification of Diseases, Ninth Revision code query of our institution's database. Patient records were reviewed to abstract demographic information and confirm partial tears of the distal biceps tendon based on clinical examination findings and confirmatory magnetic resonance imaging (MRI). Seventy-four patients completed an outcome survey. In our study, 55.7% of the contacted patients who tried a nonoperative course (34 of 61 patients) ultimately underwent surgery, and 13 patients underwent immediate surgery. High-need patients, as defined by occupation, were more likely to report that they recovered ideally if they underwent surgery, as compared with those who did not undergo surgery (odds ratio, 11.58; P = .0138). For low-need patients, the same analysis was not statistically significant (P = .139). There was no difference in satisfaction scores between patients who tried a nonoperative course before surgery and those who underwent immediate surgery (P = .854). An MRI-diagnosed tear of greater than 50% was a predictor of needing surgery (odds ratio, 3.0; P = .006). This study has identified clinically relevant information for the treatment of partial distal biceps tears, including the following: the failure rate of nonoperative treatment, the establishment of MRI percent tear as a predictor of failing nonoperative management, the benefit of surgery for the high-need occupational group, and the finding that nonoperative management does not negatively affect outcome if subsequent surgery is necessary. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  12. Participation of children with neurodevelopmental risk factors in the early rehabilitation program in relation to the level of parental education.

    Science.gov (United States)

    Mikelić, Valentina Matijević; Kosicek, Tena; Crnković, Maja; Radanović, Branko

    2011-12-01

    Many factors that have an adverse effect on fetal growth and development can manifest later in the child's development. Because of the biological basis, children born under the influence of these factors belong to the group of neurorisk children. They need special attention and prompt participation in the early rehabilitation program to encourage the use of brain plasticity. In addition to the biological influences, socioeconomic status affects a wide array of medical, cognitive and socio-emotional consequences in children, which begin before birth and continue into adulthood. This retrospective study included 50 children aged one to three years, hospitalized at Department of Pediatric Rehabilitation, University Department of Rheumatology, Physical Medicine and Rehabilitation, Sestre milosrdnice University Hospital Center in Zagreb. The aim was to determine the frequency of inclusion of children with neurodevelopmental risks in the early rehabilitation program according to the level of parental education. The results showed the highest percentage of parents of neurorisk children to have high school education, while the smallest number of parents had elementary school education. These data pointed to the lack of public awareness of the importance of the early period of life. However, they also indicated the lack of parental knowledge of their rights and opportunities for involvement of their neurorisk children in the early rehabilitation programs.

  13. Evolution of patients with heart disease after cardiopulmonary rehabilitation program: case report

    Directory of Open Access Journals (Sweden)

    Saulo Fabrin

    Full Text Available Abstract Introduction: Recovery and maintenance of patients suffering from heart and respiratory diseases using the cardiopulmonary rehabilitation program (CPRP help maintain their functionality and improve the activities of daily living (ADLs carried out according to their functional limitations. Objective: To investigate the efficacy of a CPRP in a patient with cardiopulmonary disease, following a 5-month training program. Methods: A 66-year-old female patient, body weight 78 kg, height 1.55 m, diagnosed with acute myocardial infarction and bronchial asthma underwent a six-minute walk test (6MWT to measure exercise tolerance; the Wells Bench was used to measure the flexibility of the posterior chain and lower limbs (LL, and a hand-held dynamometer (HHD was used to measure upper limb strength (ULS.Vital sign measurements include blood pressure (BP, heart rate (HR, respiratory rate (RR, oxygen saturation (SpO2 as well as dyspnea and LL fatigue (modified Borg scale at rest, during and after 5-month CPRP. Results: An increase of 145 meters during the cardiopulmonary rehabilitation program i.e. 30% of walk distance (WD in the 6MWT (pre = 345, post = 490m. There was an increase of 32% in flexibility (pre = 13, post = 19cm; in right upper limb (pre = 26, post = 60 kgf and left lower limb strength (pre = 28, post = 72kgf, there was an increase of 57% and 61%, respectively. Conclusion: The CPRP proved to be effective in increasing exercise capacity, upper limb strength and flexibility of the posterior chain and lower limbs.

  14. Effects of a multidisciplinar cognitive rehabilitation program for patients with mild Alzheimer's disease

    Directory of Open Access Journals (Sweden)

    Luciane F. Viola

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate the effects of a multidisciplinary rehabilitation program on cognition, quality of life, and neuropsychiatry symptoms in patients with mild Alzheimer's disease. METHOD: The present study was a single-blind, controlled study that was conducted at a university-based day-hospital memory facility. The study included 25 Alzheimer's patients and their caregivers and involved a 12-week stimulation and psychoeducational program. The comparison group consisted of 16 Alzheimer's patients in waiting lists for future intervention. INTERVENTION: Group sessions were provided by a multiprofessional team and included memory training, computer-assisted cognitive stimulation, expressive activities (painting, verbal expression, writing, physiotherapy, and physical training. Treatment was administered twice a week during 6.5-h gatherings. MEASUREMENTS: The assessment battery comprised the following tests: Mini-Mental State Examination, Short Cognitive Test, Quality of Life in Alzheimer's disease, Neuropsychiatric Inventory, and Geriatric Depression Scale. Test scores were evaluated at baseline and the end of the study by raters who were blinded to the group assignments. RESULTS: Measurements of global cognitive function and performance on attention tasks indicated that patients in the experimental group remained stable, whereas controls displayed mild but significant worsening. The intervention was associated with reduced depression symptoms for patients and caregivers and decreased neuropsychiatric symptoms in Alzheimer's subjects. The treatment was also beneficial for the patients' quality of life. CONCLUSION: This multimodal rehabilitation program was associated with cognitive stability and significant improvements in the quality of life for Alzheimer's patients. We also observed a significant decrease in depressive symptoms and caregiver burden. These results support the notion that structured nonpharmacological interventions can yield

  15. Body Image and quality of life of senior citizens included in a cardiac rehabilitation program

    Directory of Open Access Journals (Sweden)

    Fernanda Vargas Amaral

    2013-12-01

    Full Text Available Most people who have to live with some kind of disease tend to adopt healthy habits and create new ways of seeing themselves. The aim of this study is to explore the relationship between the index of quality of life and self perception of patients included in a cardiovascular rehabilitation program in Florianopolis/Brazil. The sample consists of 24 subjects of 62 ± 1.3 years of age, who have coronary artery disease. The Minnesota Living With Heart Failure Questionnaire (MLHFQ was used to assess the quality of life, and to identify the degree of body image discontentment the Stunkard and Sorensen questionnaire (1993 was applied. Statistical analysis was made through statistics programs and the software SPSS 11.0. The degree of association between variables was studied with Kendall test. It was verified that the higher the BMI and the current body shape, the greatest the degree of body image dissatisfaction. The emotional symptoms also appear to be significantly correlated with a desire for a smaller body shape and with indicators of lower quality of life (r = 0474 = 0735, p major 0.05. The physical symptoms were also considerably associated with the emotional symptoms. These results suggest that the variables concerning the quality of life are meaningful to significant body image and satisfaction, which seems to correlate with fewer emotional problems and better facing of the disease. Cardiovascular Rehabilitation Programs that implement physical activity in daily habits proves to be a suitable tool for improving these ailments in this post-acute phase

  16. The association between rehabilitation programs and metabolic syndrome in chronic inpatients with schizophrenia.

    Science.gov (United States)

    Lin, Yi-Chun; Lai, Chien-Liang; Chan, Hung-Yu

    2017-12-02

    The correlation between different rehabilitation programs and the prevalence of metabolic syndrome in people with schizophrenia is unclear. We tested the association in chronic inpatients with schizophrenia of a psychiatric hospital in Taiwan. Patients with schizophrenia and age from 20 to 65 years old were included. The criteria of metabolic syndrome were according to the adapted Adult Treatment Protocol for Asians. According to different types of rehabilitations, patients were divided into work group, occupational therapy group and daily activities group. A total of 359 chronic inpatients with schizophrenia were recruited. Participants had a mean age of 45.9 years and the prevalence of metabolic syndrome was 37.3%. There was a significantly higher prevalence of metabolic syndrome in the work group than in the daily activity group (adjusted odds ratio (aOR) = 1.91, 95% CI = 1.019-3.564, p metabolic syndrome included old age, female gender, low psychotic symptoms severity and clozapine user. This study identified a high prevalence of metabolic syndrome in chronic inpatients with schizophrenia especially in patients with good occupational function. Further investigation of the relationship between the occupational function and metabolic syndrome is necessary for chronic inpatients with schizophrenia. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. [Effectiveness of Self-efficacy Promoting Vestibular Rehabilitation Program for Patients with Vestibular Hypofunction].

    Science.gov (United States)

    Lee, Hyun Jung; Choi-Kwon, Smi

    2016-10-01

    In this study an examination was done of the effect of self-efficacy promoting vestibular rehabilitation (S-VR) on dizziness, exercise selfefficacy, adherence to vestibular rehabilitation (VR), subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness in patients with vestibular hypofunction. This was a randomized controlled study. Data were collected 3 times at baseline, 4 and 8 weeks after beginning the intervention. Outcome measures were level of dizziness, exercise self-efficacy, and level of adherence to VR. Subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness were also obtained. Data were analyzed using Windows SPSS 21.0 program. After 4 weeks of S-VR, there was no difference between the groups for dizziness, subjective and objective vestibular functions. However, exercise self-efficacy and adherence to VR were higher in the experimental group than in the control group. After 8 weeks of S-VR, dizziness (p=.018) exercise self-efficacy (pexercise self-efficacy, subjective vestibular function and adherence to VR. Objective vestibular function and vestibular compensation were also improved in the experimental group at the end of 8 weeks of S-VR.

  18. Rehabilitation of radioactive objects of Kirovo-Chepetsky chemical plant preliminary program of works

    International Nuclear Information System (INIS)

    Chesnokov, F.V.; Ivanov, O.P.; Pavlenko, V.I.; Semenov, S.G.; Stepanov, V.E.; Volkov, V.G.; Volkovich, A.G.; Zverkov, Yu.A.

    2008-01-01

    In 2007, the specialists of RRC Kurchatov Institute, jointly with MosNPO Radon, launched works on the radiation survey of radiation-contaminated objects and areas on the site of Kirovo-Chetetsky Chemical Plant (KCCP). This survey was launched with the object of subsequent development of the rehabilitation program and concept for buildings and storage sites left from shutdown uranium-processing facilities, as well as for sludge storage facilities and repositories of radioactive waste produced as a result of these facilities operation. Besides, radioactive contamination caused by the preceding operations involving radwaste and equipment contaminated at early stages of uranium hexafluoride (UHF) and tetrafluoride (UTF) processing technology mastering was detected in some spots at KCCP site. The radiation survey was performed in order to assess the amount of rehabilitation works, to identify the most critical objects and areas at KCCP site, and to develop the sequence of measures to be implemented in order to enhance the radiation safety of people living in the Kirov Region. (author)

  19. Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2018. Final rule.

    Science.gov (United States)

    2017-08-03

    This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2018 as required by the statute. As required by section 1886(j)(5) of the Social Security Act (the Act), this rule includes the classification and weighting factors for the IRF prospective payment system's (IRF PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2018. This final rule also revises the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes that are used to determine presumptive compliance under the "60 percent rule," removes the 25 percent payment penalty for inpatient rehabilitation facility patient assessment instrument (IRF-PAI) late transmissions, removes the voluntary swallowing status item (Item 27) from the IRF-PAI, summarizes comments regarding the criteria used to classify facilities for payment under the IRF PPS, provides for a subregulatory process for certain annual updates to the presumptive methodology diagnosis code lists, adopts the use of height/weight items on the IRF-PAI to determine patient body mass index (BMI) greater than 50 for cases of single-joint replacement under the presumptive methodology, and revises and updates measures and reporting requirements under the IRF quality reporting program (QRP).

  20. An ICF-Based Model for Implementing and Standardizing Multidisciplinary Obesity Rehabilitation Programs within the Healthcare System

    Directory of Open Access Journals (Sweden)

    Amelia Brunani

    2015-05-01

    Full Text Available Introduction/Objective: In this study, we aimed to design an ICF-based individual rehabilitation project for obese patients with comorbidities (IRPOb integrated into the Rehab-CYCLE to standardize rehabilitative programs. This might facilitate the different health professionals involved in the continuum of care of obese patients to standardize rehabilitation interventions. Methods: After training on the ICF and based on the relevant studies, ICF categories were identified in a formal consensus process by our multidisciplinary team. Thereafter, we defined an individual rehabilitation project based on a structured multi-disciplinary approach to obesity. Results: the proposed IRPOb model identified the specific intervention areas (nutritional, physiotherapy, psychology, nursing, the short-term goals, the intervention modalities, the professionals involved and the assessment of the outcomes. Information was shared with the patient who signed informed consent. Conclusions: The model proposed provides the following advantages: (1 standardizes rehabilitative procedures; (2 facilitates the flow of congruent and updated information from the hospital to outpatient facilities, relatives, and care givers; (3 addresses organizational issues; (4 might serve as a benchmark for professionals who have limited specific expertise in rehabilitation of comorbid obese patients.

  1. Technology of wellness aerobics in the structure of personality-oriented program of physical rehabilitation of women with postmastectomy syndrome

    Directory of Open Access Journals (Sweden)

    Tatiana Odynets

    2015-10-01

    Full Text Available Purpose: to develop and substantiate technology of wellness aerobics in the structure of personality-oriented program of physical rehabilitation of women with postmastectomy syndrome on the dispensary stage of rehabilitation. Material and Methods: theoretical analysis and compilation of scientific and methodical literature and internet providers; induction and comparison. The study involved 115 women with postmastectomy syndrome on the dispensary stage of rehabilitation. Results: the developed program of wellness aerobics includes elements of basic aerobics, fitball aerobics, step-aerobics, strength training and stretching and their rational combination, which was implemented in accordance with the adaptation and training period of follow steps. Customization means of wellness aerobics depended on cardiorespiratory disorders, autonomic systems, limiting range of motion of the shoulder joint, degree of lymphostasis of women with postmastectomy syndrome

  2. Shuttle Walking Test as Predictor of Survival in Chronic Obstructive Pulmonary Disease Patients Enrolled in a Rehabilitation Program

    DEFF Research Database (Denmark)

    Ringbæk, Thomas; Martinez, Gerd; Brøndum, Eva

    2010-01-01

    BACKGROUND: The Incremental Shuttle Walking Test (ISWT) is used to assess exercise capacity in chronic obstructive pulmonary disease (COPD) and is employed as an outcome measure for pulmonary rehabilitation. We studied the value of this test in predicting survival in COPD patients enrolled...... in a rehabilitation program. METHODS: A total of 416 patients performed an ISWT before entering a 7-week outpatient pulmonary rehabilitation program. Their survival was observed over a mean period of 4.5 years (range = 1.2-7.2 years). RESULTS: During the observation period, 169 (40.6%) patients died. Univariate...... analyses showed that the ISWT as well as age, gender, present and previous tobacco smoking, forced expiratory volume in 1 second, body mass index, oxygen saturation at rest, long-term oxygen therapy, Medical Research Council dyspnea score, and treatment with oral corticosteroids were significantly...

  3. 76 FR 45697 - Vocational Rehabilitation and Employment Program-Changes to Subsistence Allowance

    Science.gov (United States)

    2011-08-01

    ... we do for veterans pursuing institutional training or rehabilitation. Thus, veterans pursuing... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 21 RIN 2900-AO10 Vocational Rehabilitation and... August 1, 2011, that affect payment of vocational rehabilitation benefits for certain service-disabled...

  4. 78 FR 35890 - Applications for New Awards; National Institute on Disability and Rehabilitation Research...

    Science.gov (United States)

    2013-06-14

    ... (NIDRR)--Disability and Rehabilitation Research Projects and Centers Program--Rehabilitation Engineering... Rehabilitation Act of 1973, as amended (Rehabilitation Act). Rehabilitation Engineering Research Centers Program... Rehabilitation Act. It does so by conducting advanced engineering research, developing and evaluating innovative...

  5. Nonoperative management for perforated peptic ulcer: who can benefit?

    Science.gov (United States)

    Cao, Feng; Li, Jia; Li, Ang; Fang, Yu; Wang, Ya-Jun; Li, Fei

    2014-07-01

    Although nonoperative management for perforated peptic ulcer (PPU) has been used for several decades, the indication is still unclear. A clinicoradiological score was sought to predict who can benefit from it. A clinicoradiological protocol for the assessment of patients presenting with PPU was used. A logistic regression model was applied to identify determinant variables and construct a clinical score that would identify patients who can be successfully treated with nonoperative management. Of 241 consecutive patients with PPU, 107 successfully received nonoperative management, and 134 required surgery. In multivariable analysis, the following four variables correlated with surgery and were given one point each toward the clinical score: age ≥70 years, fluid collection detection by ultrasound, contrast extravasation detection by water-soluble contrast examination, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥8. Eighty-five percent of patients with a score of 1 or less were successfully treated with nonoperative management, whereas 23 of 29 patients with a score of 3 or more required surgery. The area under the receiver operating characteristic curve was 0.804 (95% confidence interval = 0.717-0.891). By combining clinical, radiological parameters, and APACHE II score, the clinical score allowed early identification of PPU patients who can benefit from nonoperative management. Copyright © 2013. Published by Elsevier B.V.

  6. Research Paper: Effect of Navayesh Parent-Based Comprehensive Rehabilitation Program on the Development of Early Language and Communication Skills in Deaf Children Aged 0-2 Years

    Directory of Open Access Journals (Sweden)

    Saeid Hassanzadeh

    2017-02-01

    Conclusion The results are indicative of the effect of the Navayesh parent-based comprehensive rehabilitation program on the development of early language and communication skills of deaf children. Therefore, it is recommended that this program should be used at rehabilitation centers for deaf children, aiming at training parents as the primary therapists of deaf children.

  7. The effect of pulmonary rehabilitation program on quality of life of elderly patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Neda Mirbagher-Ajorpaz

    2011-03-01

    Full Text Available Background: Considering the prevalence of chronic obstructive pulmonary disease (COPD and its well-known complications; different studies indicate the success of rehabilitation techniques to improve quality of life for those patients. The present study was conducted to determine the effect of the implementation of pulmonary rehabilitation techniques on quality of life in patients with COPD.Materials and Method: This quasi-experimental research was performed in the selected teaching hospitals in Isfahan on 80 elderly patients with COPD with moderate intensity during their 85-86 years. The patients divided randomly into two groups (40 patients in case group and 40 patients in control group. The disease severity was evaluated based on spirometry results. Data were collected by using quality of life questionnaire (SF-12. First, the quality of life of patients in both groups was evaluated by SF-12 and then the 20 minutes pulmonary rehabilitation programs in the case group were performed every morning and evening for two months. At the end of two months, the qualities of life in both groups were measured again. The results were analyzed using SPSS-10 software. Results: The results showed that there is a significant direct relationship between some demographic characteristics and their quality of life score (p=0.03. Pulmonary rehabilitation program enhanced the quality of life in those patients (p=0.01. Conclusion: Regarding these findings, it should be consider that demographic characteristics of patients and their rehabilitation programs should be included the pulmonary rehabilitation program to improve quality of life

  8. Functional improvements following the use of the NVT Vision Rehabilitation program for patients with hemianopia following stroke.

    Science.gov (United States)

    Hayes, Allison; Chen, Celia S; Clarke, Gayle; Thompson, Annette

    2012-01-01

    The incidence of visual deficits following stroke ranges from 20%-68% and has significant impact on activities of daily living. The NVT system is a compensatory visual scanning training program that consists of combined static and mobility training and transfer to activities of daily living. The study aims to evaluate functional changes following the NVT program for people who have homonymous hemianopia (HH) following stroke. Interventional case series of 13 consecutive participants with HH undergoing NVT vision rehabilitation. The primary outcome measure was the number of targets missed on a standardized Mobility Assessment Course (MAC). Other outcome measures included assessment of visual scanning, vision specific Quality of Life questionnaires and reading performance. The average number of targets (sd) missed on the MAC course was 39.6 ± 20.9% before intervention, 27.5 ± 16.3% immediately post intervention and 20.8 ± 15.5% at 3 months post rehabilitation. The study showed a statistically significant trend in improvement in mobility related subscales of National Eye Institute Visual Function Questionnaire-NEI VFQ-25 (p=0.003) and the Veteran Affairs Low Vision Visual Function Questionnaire-VA LVFQ-48 (p=0.036) at 3 months post rehabilitation. The NVT intervention resulted in functional improvements in mobility post rehabilitation. The NVT training showed improvement in vision specific quality of life. There is a need for standardised vision therapy intervention, in conjunction with existing rehabilitation services, for patients with stroke and traumatic brain injury.

  9. Effects of a Multidisciplinary Rehabilitation Program on Pediatric Obesity: The CEMHaVi Program

    Science.gov (United States)

    Vanhelst, Jeremy; Mikulovic, Jacques; Fardy, Paul; Bui-Xuan, Gilles; Marchand, Frederic; Beghin, Laurent; Theunynck, Denis

    2011-01-01

    The objective of this study is to assess the effects of the unique 1-year health-wellness program of exercise and health education for obese youth on body mass index (BMI) and blood pressure. The CEMHaVi program included 74 obese children. Participants, 19 girls and 18 boys, and controls, 17 girls and 20 boys, were assigned to treatment. The…

  10. Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: a pilot study.

    Science.gov (United States)

    Spruit, Martijn A; Janssen, Paul P; Willemsen, Sonja C P; Hochstenbag, Monique M H; Wouters, Emiel F M

    2006-05-01

    Although lung cancer is a highly prevalent type of cancer, the effects of an inpatient multidisciplinary rehabilitation program on pulmonary function and exercise capacity have never been studied in these patients. Pulmonary function, 6-min walking distance and peak exercise capacity of 10 patients with a severely impaired pulmonary function following treatment of lung cancer were assessed in this pilot study before and after an 8-week inpatient multidisciplinary rehabilitation program. At baseline, patients had a restrictive pulmonary function and an apparent exercise intolerance (median 6-min walking distance: 63.6% predicted; median peak cycling load: 58.5% predicted). Despite the lack of change in median pulmonary function [FEV1: -0.01L, p = 0.5469], functional exercise capacity [145 m; 43.2% of the initial values, p=0.0020] and peak exercise capacity [26 W; 34.4% of the initial values, p = 0.0078] improved significantly compared to baseline. Future trials have to corroborate the present findings. Nevertheless, patients with lung cancer have a clear indication to start a comprehensive rehabilitation program following intensive treatment of their disease. In fact, based on the results of the present pilot study it appears that these patients are good candidates for pulmonary rehabilitation programs.

  11. Very short/short-term benefit of inpatient/outpatient cardiac rehabilitation programs after coronary artery bypass grafting surgery.

    Science.gov (United States)

    Spiroski, Dejan; Andjić, Mojsije; Stojanović, Olivera Ilić; Lazović, Milica; Dikić, Ana Djordjević; Ostojić, Miodrag; Beleslin, Branko; Kostić, Snežana; Zdravković, Marija; Lović, Dragan

    2017-05-01

    Exercise-based rehabilitation is an important part of treatment patients following coronary artery bypass graft (CABG) surgery. To evaluate effect of very short/short-term exercise training on cardiopulmonary exercise testing (CPET) parameters. We studied 54 consecutive patients with myocardial infarction (MI) treated with CABG surgery referred for rehabilitation. The study population consisted of 50 men and 4 women (age 57.72 ± 7.61 years, left ventricular ejection fraction 55% ± 5.81%), who participated in a 3-week clinical and 6-month outpatient cardiac rehabilitation program. The Inpatient program consisted of cycling 7 times/week and daily walking for 45 minutes. The outpatient program consisted mainly of walking 5 times/week for 45 minutes and cycling 3 times/week. All patients performed symptom-limited CPET on a bicycle ergometer with a ramp protocol of 10 W/minute at the start, for 3 weeks, and for 6 months. After 3 weeks of an exercise-based cardiac rehabilitation program, exercise tolerance improved as compared to baseline, as well as peak respiratory exchange ratio. Most importantly, peak VO 2 (16.35 ± 3.83 vs 17.88 ± 4.25 mL/kg/min, respectively, P exercise training in patients with MI treated with CABG surgery is safe and improves functional capacity. © 2017 Wiley Periodicals, Inc.

  12. Effects of Comprehensive Risk Management Program on the Preparedness of Rofeide Rehabilitation Hospital in Disasters and Incidents

    Directory of Open Access Journals (Sweden)

    Samira Rajabi

    2017-07-01

    Conclusion: Considering the positive impact of the implementation of the risk management program on the preparedness of Rofeide Rehabilitation Hospital and promotion of its preparedness level from poor to moderate, as well as relatively high vulnerability of hospitals against internal and external risks, national hospitals are recommended to use the comprehensive hospital risk management model to be more prepared for disasters.

  13. Effectiveness of Written Materials in a Rehabilitative Program for Female Offenders: A Case Study at the Montana Women's Prison

    Science.gov (United States)

    Dillon, Laura; Colling, Kyle

    2010-01-01

    This case study of the Therapeutic Community Program at Montana Women's Prison investigates the relationship between inmate reading levels and the self-help materials used for rehabilitative purposes within prison settings. The Therapeutic Community Handbook, published by the Montana Department of Corrections, is used as the primary method of…

  14. Nonoperative treatment of adult splenic trauma: Role of CT

    International Nuclear Information System (INIS)

    Raptopoulos, V.; Fink, M.; Resciniti, A.; Davidoff, A.; Silva, W.E.

    1987-01-01

    Of 27 adult patients with known splenic injuries admitted to a regional referral trauma center and who were initially treated nonoperatively, ten (37%) ultimately required splenectomy. A CT scoring system was developed based on the degree of splenic parenchymal injury and the presence of fluid in the perisplenic region, the upper abdomen, and the pelvis. Adult patients who were successfully treated nonoperatively had a significantly (P=.011) lower total CT score than did patients who required delayed celiotomy. No patient older than 17 years with a total CT score less than 2.5 required delayed operative intervention. CT can be used to select a subset of adults with splenic trauma who are excellent candidates for a trail of nonoperative management

  15. Development and Implementation of a Mental Health Work Rehabilitation Program: Results of a Developmental Evaluation.

    Science.gov (United States)

    Sylvain, Chantal; Durand, Marie-José; Velasquez Sanchez, Astrid; Lessard, Nathalie; Maillette, Pascale

    2018-05-23

    Purpose Long-term work disability due to common mental disorders (CMDs) is a growing problem. Yet optimal interventions remain unclear and little is known about implementation challenges in everyday practice. This study aimed to support and evaluate, in real time, the development and implementation of a work rehabilitation program (WRP) designed to promote post-CMD return-to-work (RTW). Methods A 2-year developmental evaluation was performed using a participatory approach. At program outset, the researchers held five work meetings to revise the program's logic model and discuss its underlying change theory with clinicians. Data collection tools used throughout the study period were structured charts of activities conducted with workers (n = 41); in-depth interviews with program clinicians and managers (n = 9); and participant observation during work meetings. Quantitative data were analyzed using descriptive statistics. Qualitative data underwent thematic analysis using a processual approach. Results Three types of activity were developed and implemented: individual and group interventions targeting workers, and joint activities targeting partners (physicians, employers, others). While worker-targeted activities were generally implemented as planned, joint activities were sporadic. Analysis of the implementation process revealed five challenges faced by clinicians. Determinants included clinicians, host organization, sociopolitical context and resources provided by the evaluation. Conclusion The program studied is original in that it is based on the best available scientific knowledge, yet adapted to contextual particularities. The identified implementation challenges highlight the need for greater importance to be placed on the external, non-program context to ensure sustainable implementation in everyday practice.

  16. Barriers for Nonparticipation and Dropout of Women in Cardiac Rehabilitation Programs: A Systematic Review.

    Science.gov (United States)

    Resurrección, Davinia M; Motrico, Emma; Rigabert, Alina; Rubio-Valera, Maria; Conejo-Cerón, Sonia; Pastor, Luis; Moreno-Peral, Patricia

    2017-08-01

    Cardiovascular disease (CVD) is a major health problem worldwide. Cardiac rehabilitation (CR) programs are effective in reducing mortality and improving the quality of life of patients with CVD. Women are under-represented in CR and have a higher dropout rate than men. We aimed to systematically review the literature on barriers perceived by women with CVD affecting their nonparticipation in and/or dropping out from CR programs. Systematic review was done using MEDLINE, Embase, Scopus, Open Grey, and Cochrane Database from inception to September 2016. Search terms included (1) heart disease and other cardiac conditions, (2) CR and secondary prevention, and (3) nonparticipation in and/or dropout. Databases were searched following the "participants, interventions, comparisons, outcomes, and study design" method. A total of 24 studies (17 descriptive, 6 qualitative, and 1 randomized controlled trial) reporting several barriers were grouped into five broad categories: intrapersonal barriers (self-reported health, health beliefs, lack of time, motivation, and religious reasons); interpersonal barriers (lack of family/social support and work conflicts); logistical barriers (transport, distance, and availability of personal/community resources); CR program barriers (services offered, group format, exercise component, and CR sessions); and health system barriers (lack of referral, cost, negative experiences with the health system, and language). We found differences between the barriers related to nonparticipation in and dropout from CR programs. Women reported multilevel barriers for nonparticipation in and dropout from CR programs. Future clinical guidelines should evaluate and eliminate these barriers to improve adherence to CR programs in women. In addition, understanding the barriers for nonparticipation and dropout may be beneficial for future intervention trials.

  17. A Surgical Perspective of the Outcome of a Multidisciplinary Intestinal Rehabilitation Program for Children With Short Bowel Syndrome in the Netherlands

    NARCIS (Netherlands)

    Schurink, M.; Hulscher, J. B. F.; Nieuwenhuijs, V. B.; Heineman, E.; Rings, E. H. H. M.

    2014-01-01

    Aim. In 2001, a multidisciplinary intestinal rehabilitation program, prompted by a nationwide collaboration on intestinal failure (Dutch Registry for Intestinal Failure and Intestinal Transplantation), was started for children who have short bowel syndrome (SBS). This study evaluates this program,

  18. Nonoperative management for patients with grade IV blunt hepatic trauma

    Directory of Open Access Journals (Sweden)

    Zago Thiago

    2012-08-01

    Full Text Available Abstract Introduction The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications. Methods This is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessed Results Eighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5% who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%; one patient developed a tracheal stenosis (secondary to tracheal intubation; one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days. Conclusions In our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.

  19. Nonoperative management for patients with grade IV blunt hepatic trauma.

    Science.gov (United States)

    Zago, Thiago Messias; Tavares Pereira, Bruno Monteiro; Araujo Calderan, Thiago Rodrigues; Godinho, Mauricio; Nascimento, Bartolomeu; Fraga, Gustavo Pereira

    2012-08-22

    The treatment of complex liver injuries remains a challenge. Nonoperative treatment for such injuries is increasingly being adopted as the initial management strategy. We reviewed our experience, at a University teaching hospital, in the nonoperative management of grade IV liver injuries with the intent to evaluate failure rates; need for angioembolization and blood transfusions; and in-hospital mortality and complications. This is a retrospective analysis conducted at a single large trauma centre in Brazil. All consecutive, hemodynamically stable, blunt trauma patients with grade IV hepatic injury, between 1996 and 2011, were analyzed. Demographics and baseline characteristics were recorded. Failure of nonoperative management was defined by the need for surgical intervention. Need for angioembolization and transfusions, in-hospital death, and complications were also assessed Eighteen patients with grade IV hepatic injury treated nonoperatively during the study period were included. The nonoperative treatment failed in only one patient (5.5%) who had refractory abdominal pain. However, no missed injuries and/or worsening of bleeding were observed during the operation. None of the patients died nor need angioembolization. No complications directly related to the liver were observed. Unrelated complications to the liver occurred in three patients (16.7%); one patient developed a tracheal stenosis (secondary to tracheal intubation); one had pleural effusion; and one developed an abscess in the pleural cavity. The hospital length of stay was on average 11.56 days. In our experience, nonoperative management of grade IV liver injury for stable blunt trauma patients is associated with high success rates without significant complications.

  20. Presentation of the RESSAC research program (REhabilitation of Soils and Surfaces after an ACcident)

    International Nuclear Information System (INIS)

    L'Homme, A.; Parmentier, N.; Legrand, B.; Fache, P.

    1992-01-01

    If, despite all the precautions taken in nuclear power plants, a severe accident were to occur in France involving extensive release of radioactive materials to the environment, existing emergency plans would be implemented enabling urgent decisions to be made with regard to the immediate protection of the population: confinement indoors, evacuation, distribution of stable iodine, etc. But, at a later stage, mean and long term actions would have to be carried out to decontaminate the polluted areas and limit subsequent contamination of the food chain, with a view to enabling the populations concerned to return to normal life. These actions would concern, in decreasing order of priority and using the WHO and IAEA definitions, the near field, closest to the accident site, and the far field, subjected to the direct impact of fallout. They should be aimed at reducing external exposure due to deposition and internal exposure by inhalation of radioactive products re-suspended in the atmosphere and by ingestion of products for human consumption. In the context of IPSN research and development programs on severe accidents, the RESSAC program was defined in 1985 for the purpose of studying methods and means of rehabilitating the near field and controlling problems related to the far field. Elaboration of the program is presently proceeding at the Nuclear Research Center of Cadarache, focussed on the following main topics: assessment of what happens to the radionuclides deposited on the soil and vegetation, determination of priorities and how to intervene, management of the waste produced. (author). 4 refs

  1. Non-operative management of perforated peptic ulcer

    International Nuclear Information System (INIS)

    Rahman, M.M.; Ahsan, H.N.; Hossain, M.D.

    2003-01-01

    Objective: The aim of this study was to see the morbidity and mortality in peptic ulcer perforation cases by non-operative management in selected cases. Results: In the selected 54 patients, male: female were 49:05. Nine had history of NSAID intake. There was no mortality. Morbidity analysis showed that three had hepatic abscess, four had pelvic abscess, six took prolonged time for improvement, in two cases conservative treatment had to be abandoned and laparotomy was done in the same hospital admission. Conclusion: Non-operative procedure is a safe and effective measure for the management of perforated peptic ulcer in selected cases. (author)

  2. Motivational factors for initiating, implementing, and maintaining physical activity behavior following a rehabilitation program for patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Walker, Karen Christina; Valentiner, Laura Staun; Langberg, Henning

    2018-01-01

    conducted at three separate occasions; at initiation of the rehabilitation program, at completion of the 12-week program, and 52 weeks after enrolment. Interviews were audio-recorded, transcribed, and analyzed according to Systematic Text Condensation. The framework of Self-Determination Theory was applied......Aim: To explore motivational factors for initiating, implementing, and maintaining physical activity following a rehabilitation program for patients with type 2 diabetes mellitus. Methods: Semi-structured, individual, qualitative interviews with five informants from the InterWalk trial were...... to guide analysis after identification of preliminary themes. Results: Commitment and obligation were emphasized as being motivational in initiating physical activity. Toward the termination of the program, this was challenged by an expressed need for autonomy. Successful behavioral change...

  3. Mandatory criteria for cardiac rehabilitation programs: 2018 guidelines from the Portuguese Society of Cardiology.

    Science.gov (United States)

    Abreu, Ana; Mendes, Miguel; Dores, Hélder; Silveira, Conceição; Fontes, Paulo; Teixeira, Madalena; Santa Clara, Helena; Morais, João

    2018-04-30

    Cardiac rehabilitation (CR) is a multidisciplinary process for patients recovering after an acute cardiac event or with chronic cardiovascular disease that reduces mortality and morbidity and improves quality of life. It is considered a cost-effective intervention and is expressly indicated in the guidelines of the major medical societies. In Portugal, only 8% of patients discharged from hospital after myocardial infarction are included in CR programs. In Europe overall, the percentage admitted to CR programs is 30%, while in the USA it is 20-30%. In view of the underuse of CR in Portugal, we call the attention of the health authorities to the need to increase the number and national coverage of CR programs, while maintaining high quality standards. The aim is for all patients resident in Portugal who are eligible for CR programs to have the same opportunities for access and attendance. In order to preserve the benefits and safety of this intervention, CR needs to be performed according to international guidelines. The fact that various initiatives in this field have been developed by different professional groups, some of them non-medical, that do not follow the European guidelines, has prompted us to prepare a series of norms defining mandatory criteria for CR, based on current knowledge and evidence. In this way we aim to ensure that the required increase in the number of CR programs, linked in a national network of CR centers, does not detract from the need to maintain their efficacy and quality. These criteria should serve as the basis for the future accreditation of CR centers in Portugal. Copyright © 2018. Publicado por Elsevier España, S.L.U.

  4. Dietary resilience in patients with severe COPD at the start of a pulmonary rehabilitation program

    Directory of Open Access Journals (Sweden)

    ter Beek L

    2018-04-01

    Full Text Available Lies ter Beek,1–3 Hester van der Vaart,2 Johan B Wempe,2 Aliaksandra O Dzialendzik,4 Jan LN Roodenburg,3 Cees P van der Schans,1,5,6 Heather H Keller,7,8 Harriët Jager-Wittenaar1,3 1Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen, the Netherlands; 2University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Center for Rehabilitation, Groningen, the Netherlands; 3University of Groningen, University Medical Center Groningen, Department of Maxillofacial Surgery, Groningen, the Netherlands; 4Hanze University of Applied Sciences, Department of Applied Psychology, Groningen, the Netherlands; 5University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands; 6University of Groningen, University Medical Center Groningen, Health Psychology Research, Groningen, the Netherlands; 7University of Waterloo, Schlegel Research Institute for Aging, Waterloo, ON, Canada; 8University of Waterloo, Department of Kinesiology, Waterloo, ON, Canada Background: COPD may impact food-related activities, such as grocery shopping, cooking, and eating. Decreased food intake may result in an unhealthy diet, and in malnutrition, which is highly prevalent in patients with COPD. Malnutrition is known to negatively impact clinical outcome and quality of life. Aims: In this qualitative study, we aimed to explore strategies used to overcome food-related challenges, ie, dietary resilience, and whether these led to a healthy diet. Furthermore, we aimed to identify the key themes of motivation for dietary resilience in patients with severe COPD. Methods: In October 2015 to April 2016, 12 patients with severe COPD starting a pulmonary rehabilitation program were interviewed. Qualitative description and thematic analysis were performed. Results: All participants mentioned the use of strategies to overcome

  5. Comparing Effectiveness of New Training Program of Local Trainers of Community-Based Rehabilitation Program with the Current Program: A Knowledge, Attitude and Skills Study

    Directory of Open Access Journals (Sweden)

    Mohsen Iravani

    2011-10-01

    Full Text Available Objective: This research aimed at comparison effects of a new and current "training program for community rehabilitation workers of Community Based Rehabilitation", in enhancing their knowledge, attitude and skills. Materials & Methods: In this experimental field trial, a total number of 34 newly engaged local trainers in Lorestan province were divided randomly in two (16 and 18 peoplesinterventional groups based on geographical location of their work places Teaching methods were roll playing, problem solving, and learning by doing in new program and the booklets were revised in terms of fluency and a guideline booklet for trainers were added in this program but the teaching method was reading booklets and demonstration of the skills in current program. Knowledge, Attitude and Skills of trainees assessed just before and after the training course based on the material which were used for the training course. K.A.P. changes of two groups were compared by independent t-test, Mann Whitney, Wilcoxon & Chi square. Results: Mean knowledge and skills scores increments were remarkably more significant after attending new course than after passing the current course (P<0.001 and more rehabilitation workers who attending new course use practical guides in addition to verbal instructions to train disabled people and their families (P=0.028. There were no significant differences in attitude changes among the two groups. Conclusion: As trainees learned more by means of the new training course and the two courses were not so different in the resource allocation, substituting the new method to the current one should get consideration.

  6. [Development of an integrative cognitive rehabilitation program for brain injured patients in the post-acute stage].

    Science.gov (United States)

    Oh, Hyun Soo; Kim, Young Ran; Seo, Wha Sook; Seo, Yeon Ok

    2005-04-01

    This study was conducted to develop a comprehensive cognitive rehabilitation program that can be easily applied to brain injured patients by family members or nurses in community or hospital settings. A Systemic literature review design was used. Thirty-three related studies were reviewed. Based on the results of the literature review, the training tasks for attention were designated to enhancing 4 hierarchical areas, i.e., focused, selective, alternating, and divided attention. On the other hand, the memory rehabilitation tasks mainly consisted of mnemonic skills, such as the association method which helps patients memorize given information by linking together common attributes, the visual imagery method, and self-instruction method. The problem solving rehabilitation program included a task of games or plays which stimulated the patients' curiosity and interest. The training tasks for problem solving were to encourage the process of deriving reasonable solutions for a problematic situation resembling real problems that the patients were faced with in their everyday life. It is expected that the cognitive rehabilitation program developed from this study could help patients having difficulty in their every day life, due to a reduced cognitive ability resulting from brain injury, to effectively adapt to every day life.

  7. Description of a multifaceted rehabilitation program including overground gait training for a child with cerebral palsy: A case report.

    Science.gov (United States)

    Farrell, Elizabeth; Naber, Erin; Geigle, Paula

    2010-01-01

    This case describes the outcomes of a multifaceted rehabilitation program including body weight-supported overground gait training (BWSOGT) in a nonambulatory child with cerebral palsy (CP) and the impact of this treatment on the child's functional mobility. The patient is a nonambulatory 10-year-old female with CP who during an inpatient rehabilitation stay participated in direct, physical therapy 6 days per week for 5 weeks. Physical therapy interventions included stretching of her bilateral lower extremities, transfer training, bed mobility training, balance training, kinesiotaping, supported standing in a prone stander, two trials of partial weight-supported treadmill training, and for 4 weeks, three to five times per week, engaged in 30 minutes of BWSOGT using the Up n' go gait trainer, Lite Gait Walkable, and Rifton Pacer gait trainer. Following the multifaceted rehabilitation program, the patient demonstrated increased step initiation, increased weight bearing through bilateral lower extremities, improved bed mobility, and increased participation in transfers. The child's Gross Motor Functional Measure (GMFM) scores increased across four dimensions and her Physical Abilities and Mobility Scale (PAMS) increased significantly. This case report illustrates that a multifaceted rehabilitation program including BWSOGT was an effective intervention strategy to improve functional mobility in this nonambulatory child with CP.

  8. Evaluation of an audiological rehabilitation program for spouses of people with hearing loss.

    Science.gov (United States)

    Preminger, Jill E; Meeks, Suzanne

    2010-05-01

    Since the psychosocial effects of hearing loss are different in the spouse (SP) than in the person with hearing loss (PHL), it seems reasonable that rehabilitation programs designed for PHLs may need to be adapted to benefit SPs. To evaluate the effectiveness of training in communication strategies and psychosocial exercises for SPs of PHLs by determining whether SPs who completed the group class had improved mood, reduced stress, improved marital communication, and greater awareness of their partners' hearing loss-related quality of life (HL-QOL) in comparison with SPs who did not participate in a group class. Additionally, to determine whether PHLs of SPs who participated in a group audiological rehabilitation (AR) class had significantly improved mood, reduced stress, improved marital communication, and better HL-QOL scores in comparison with PHLs whose SPs did not participate in a group class. A randomized controlled study. A total of 72 individuals participated in the study, 36 PHLs and 36 SPs. The PHLs were hearing aid users or cochlear implant users; the SPs had normal or near normal hearing. PHLs in the control group participated in a traditional group AR program while their SPs received no treatment. PHLs in the experimental group also participated in a traditional group AR program while their SPs participated in a treatment program designed for SPs of PHLs. Classes consisted of 90 min sessions meeting once a week for four weeks. All participants completed questionnaires measuring HL-QOL (the SPs filled out third-party reports of HL-QOL), stress, mood (positive affect and negative affect), and communication in the marriage. Scales were completed three times: prior to the AR program, within two weeks after completing the AR program, and 6 mo later. SP awareness of their PHL's HL-QOL was measured by comparing preclass and 6 mo scores with reported critical difference values. Preclass, postclass and 6 mo data were examined with repeated measures ANOVAs. All

  9. Basic life support training into cardiac rehabilitation programs: A chance to give back. A community intervention controlled manikin study.

    Science.gov (United States)

    González-Salvado, Violeta; Abelairas-Gómez, Cristian; Peña-Gil, Carlos; Neiro-Rey, Carmen; Barcala-Furelos, Roberto; González-Juanatey, José Ramón; Rodríguez-Núñez, Antonio

    2018-03-12

    Early basic life support is crucial to enhance survival from out-of-hospital cardiac arrest but rates remain low, especially in households. High-risk groups' training has been advocated, but the optimal method is unclear. The CArdiac REhabilitation and BAsic life Support (CAREBAS) project aims to compare the effectiveness of two basic life support educational strategies implemented in a cardiac rehabilitation program. A community intervention study including consecutive patients enrolled on an exercise-based cardiac rehabilitation program after acute coronary syndrome or revascularization was conducted. A standard basic life support training (G-Stan) and a novel approach integrating cardiopulmonary resuscitation hands-on rolling refreshers (G-CPR) were randomly assigned to each group and compared. Basic life support performance was assessed by means of simulation at baseline, following brief instruction and after the 2-month program. 114 participants were included and 108 completed the final evaluation (G-Stan:58, G-CPR:50). Basic life support performance was equally poor at baseline and significantly improved following a brief instruction. A better skill retention was found after the 2-month program in G-CPR, significantly superior for safety and sending for an automated external defibrillator. Confidence and self-perceived preparation were also significantly greater in G-CPR after the program. Integrating cardiopulmonary resuscitation hands-on rolling refreshers in the training of an exercise-based cardiac rehabilitation program is feasible and improves patients' skill retention and confidence to perform a basic life support sequence, compared to conventional training. Exporting this formula to other programs may result in increased numbers of trained citizens, enhanced social awareness and bystander resuscitation. Copyright © 2018 Elsevier B.V. All rights reserved.

  10. Features of Designing the Criterion-Based Rehabilitation Program for Patients after Arthroscopic Reconstruction of the Anterior Cruciate Ligament

    Directory of Open Access Journals (Sweden)

    I.V. Roy

    2016-04-01

    Full Text Available The article presents an innovative criterion-based rehabilitation program for patients, who underwent arthroscopic reconstruction of the anterior cruciate ligament. The features of the program are described, methodological foundations to perform permissible exercises are presented for each periods of the program, which correspond to a specific motor mode. The degree of preparedness of the patient is determined by the criterion of performance of the test exercises that will permit him to the loads of a new, higher level of trainings. The effectiveness of the developed program is confirmed clinically.

  11. Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care.

    Science.gov (United States)

    Hoekstra, Femke; van Offenbeek, Marjolein A G; Dekker, Rienk; Hettinga, Florentina J; Hoekstra, Trynke; van der Woude, Lucas H V; van der Schans, Cees P

    2017-12-01

    Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients' health behavior. This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n = ± 70). Higher fidelity scores indicate a more complete implementation of the program's core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes. Three trajectories were identified as the following: 'stable high fidelity' (n = 9), 'moderate and improving fidelity' (n = 6), and 'unstable fidelity' (n = 2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period's start and end, support from physicians and physiotherapists, professionals' appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients' self-reported physical activity outcomes (adjusted model β = - 651.6, t(613)

  12. Rehabilitation of children and infants with osteogenesis imperfecta. A program for ambulation.

    Science.gov (United States)

    Gerber, L H; Binder, H; Weintrob, J; Grange, D K; Shapiro, J; Fromherz, W; Berry, R; Conway, A; Nason, S; Marini, J

    1990-02-01

    Management of children and infants with osteogenesis imperfecta (OI) poses difficult decisions for pediatricians, orthopedists, and physiatrists. These children are frequently frail with disabling bone and joint deformities and fractures. In an eight-year cumulative management of 12 children with OI, a comprehensive program included strengthening exercises to the pelvic girdle and lower extremity muscles, in addition to pool exercises and molded seating to support upright posture. Long leg braces were fitted when the children were able to sit unsupported. All 12 were fitted with braces; nine were functional ambulators, and three were home ambulators. Six children required femoral plating or rodding, two of whom subsequently had the metal removed. Lower extremity fractures averaged one and one-half per year prior to bracing for nine children who had fractures. There was 0.83 fracture per year for the ten children who had fractures after bracing. The degree of femoral bowing increased in four, decreased in four, and remained unchanged in four, while the degree of tibial bowing increased in two, decreased in nine, and remained unchanged in one during the observation period. A comprehensive rehabilitation program and long leg bracing with surgical operations on the femur result in a high level of functional activity for children with OI with an acceptable level of risk for fracture.

  13. PRR1 rehabilitation and the current and future neutron beam utilization program

    International Nuclear Information System (INIS)

    Calix, Virginia S.

    2003-01-01

    The PRR1 research reactor is the center for nuclear science R and D in the Philippines. It is located in Metro Manila inside the campus of the University of the Philippines. It is a General Electric designed reactor and was commissioned in 1963 with a rated thermal power of 1 MW. It was operated for 20 years enabling the Institute to pursue activities in radioisotope production, neutron scattering, activation analyses and other R and D activities requiring neutron beams. In 1984 it was converted to a 3 MW TRIGA Type reactor. Conversion was completed and test run was successfully accomplished in 1988. In the same year the reactor was shut down due to a leak in the aluminum linear of the reactor pool. During the repair deterioration of the other parts of the reactor was discovered that could affect the safety of its operation. A rehabilitation program is made that include the reactor core box and all the other peripherals that could affect its safety operation and to address present regulatory concerns. Modification of the core box and its position in the pool opens opportunities and possibilities to suit specific neutron beam application for the users. Plans for this will be presented as well as the strategy of the Institute to satisfy the current need for reactor based facilities to enhanced implementation of the Country's S and T Program. (author)

  14. The Effect of a Program Using Some Therapeutic Methods to Rehabilitate Patients Suffering from Neck Pain

    Directory of Open Access Journals (Sweden)

    Ayad O MAR

    2015-09-01

    Full Text Available Neck pain is one of the common physical problems of the adults which needs to be taken seriously in order to prevent further health problems. As the daily life of the modern people leads physical in activity, and the use of electronic devices causes imprope r effect on certain parts of the body, specials programs have to be developed as preventive treatment. Therapeutic methods can also be listed through such preventive methods. The purpose of this study was to i dentify the impact of the proposed program usin g some natural methods of treatment for the rehabilitation of people with neck pain , to i dentify the improved range of motion in all directions to the neck area , and also t o identify the extent of improvement in muscle strength for the neck and back. Twelv e patients in Ain Zara Physiotherapy Center and Tripoli Clinic (in Tripoli city were chosen as voluntarily whose age ranged from 30 to 50 years, and the subjects were divided into two groups , as experimental and control groups. This study proved that pro posed therapeutic methods help the treatment of neck pain.

  15. Primary care provider perceptions of intake transition records and shared care with outpatient cardiac rehabilitation programs

    Directory of Open Access Journals (Sweden)

    Jamnik Veronica

    2011-09-01

    Full Text Available Abstract Background While it is recommended that records are kept between primary care providers (PCPs and specialists during patient transitions from hospital to community care, this communication is not currently standardized. We aimed to assess the transmission of cardiac rehabilitation (CR program intake transition records to PCPs and to explore PCPs' needs in communication with CR programs and for intake transition record content. Method 144 PCPs of consenting enrollees from 8 regional and urban Ontario CR programs participated in this cross-sectional study. Intake transition records were tracked from the CR program to the PCP's office. Sixty-six PCPs participated in structured telephone interviews. Results Sixty-eight (47.6% PCPs received a CR intake transition record. Fifty-eight (87.9% PCPs desired intake transition records, with most wanting it transmitted via fax (n = 52, 78.8%. On a 5-point Likert scale, PCPs strongly agreed that the CR transition record met their needs for providing patient care (4.32 ± 0.61, with 48 (76.2% reporting that it improved their management of patients' cardiac risk. PCPs rated the following elements as most important to include in an intake transition record: clinical status (4.67 ± 0.64, exercise test results (4.61 ± 0.52, and the proposed patient care plan (4.59 ± 0.71. Conclusions Less than half of intake transition records are reaching PCPs, revealing a large gap in continuity of patient care. PCP responses should be used to develop an evidence-based intake transition record, and procedures should be implemented to ensure high-quality transitional care.

  16. Exploring how prison-based drug rehabilitation programming shapes racial disparities in substance use disorder recovery.

    Science.gov (United States)

    Kerrison, Erin M

    2018-02-01

    Prison-based therapeutic community (TC) programming is derived from the perspective that drug addiction is primarily symptomatic of cognitive dysfunction, poor emotional management, and underdeveloped self-reliance skills, and can be addressed in a collaborative space where a strong ideological commitment to moral reform and personal responsibility is required of its members. In this space, evidence of rehabilitation is largely centered on the client's relationship to language and the public adoption of a "broken self" narrative. Failure to master these linguistic performances can result in the denial of material and symbolic resources, thus participants learn how to use TC language to present themselves in ways that support existing institutionalized hierarchies, even if that surrender spells their self-denigration. This research examines the interview narratives of 300 former prisoners who participated in a minimum of 12 months of prison-based TC programming, and described how programming rhetoric impacted their substance abuse treatment experiences. While many of the respondents described distressing experiences as TC participants, White respondents were more likely to eventually embrace the "addict" label and speak of privileges and reintegrative support subsequently received. Black respondents were more likely to defy the treatment rhetoric, and either fail to complete the program or simulate a deficit-based self-narrative without investing in the content of those stories. The following explores the significance of language and identity construction in these carceral spaces, and how treatment providers as well as agency agendas are implicated in the reproduction of racial disparities in substance abuse recovery. Published by Elsevier Ltd.

  17. 76 FR 37085 - Applications for New Awards; Rehabilitation Engineering Research Centers (RERCs)

    Science.gov (United States)

    2011-06-24

    ... DEPARTMENT OF EDUCATION Applications for New Awards; Rehabilitation Engineering Research Centers...)--Disability and Rehabilitation Research Projects and Centers Program--Rehabilitation Engineering Research... (Rehabilitation Act). Rehabilitation Engineering Research Centers Program (RERCs) The purpose of the RERC program...

  18. Pancreatic injury in children: good outcome of nonoperative treatment.

    NARCIS (Netherlands)

    Blaauw, I. de; Winkelhorst, J.T.; Rieu, P.N.M.A.; Staak, F.H.J.M. van der; Wijnen, M.H.W.A.; Severijnen, R.S.V.M.; Vugt, A.B. van; Wijnen, R.M.H.

    2008-01-01

    PURPOSE: Treatment of blunt injury of the pancreas in children remains controversial. Some prefer nonoperative treatment, whereas others prefer operative management in selected cases. This report reviews the treatment of patients with blunt pancreatic trauma admitted to a level I pediatric trauma

  19. Factors predicting the outcome of non-operative management of ...

    African Journals Online (AJOL)

    A.M. Maarouf

    Predictors of non-operative management failure of high-grade blunt renal trauma. 45 and computed .... perform univariate and multivariate analyses of the risk factors. The .... possible. At our institutions, renal trauma management decisions were based on the ... gency nephrectomy and thus limits the possibility of preserving.

  20. Blunt hepatic trauma: comparison between surgical and nonoperative treatment.

    Science.gov (United States)

    Zago, Thiago Messias; Pereira, Bruno Monteiro; Calderan, Thiago Rodrigues Araujo; Hirano, Elcio Shiyoiti; Rizoli, Sandro; Fraga, Gustavo Pereira

    2012-01-01

    To examine the outcomes of blunt hepatic trauma, and compare surgical and non-surgical treatment in patients admitted with hemodynamic stability and with no obvious indications of laparotomy. This is a retrospective study of cases admitted to a university teaching hospital between the years 2000 and 2010. Patients undergoing surgical treatment were divided into two groups: (a) all patients undergoing surgical treatment, and (b) patients with obvious need for surgery. In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients treated non-operatively had better physiologic conditions on admission, demonstrated less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality than the patients operated upon. Patients who underwent non-operative treatment had a lower need for blood transfusion but higher rates of complications and mortality than the patients operated upon. Patients who were operated upon, with no obvious indications for surgery, had higher rates of complication and mortality than patients not operated upon. A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.

  1. Selective Nonoperative Management of Penetrating Abdominal Solid Organ Injuries

    Science.gov (United States)

    Demetriades, Demetrios; Hadjizacharia, Pantelis; Constantinou, Costas; Brown, Carlos; Inaba, Kenji; Rhee, Peter; Salim, Ali

    2006-01-01

    Objective: To assess the feasibility and safety of selective nonoperative management in penetrating abdominal solid organ injuries. Background: Nonoperative management of blunt abdominal solid organ injuries has become the standard of care. However, routine surgical exploration remains the standard practice for all penetrating solid organ injuries. The present study examines the role of nonoperative management in selected patients with penetrating injuries to abdominal solid organs. Patients and Methods: Prospective, protocol-driven study, which included all penetrating abdominal solid organ (liver, spleen, kidney) injuries admitted to a level I trauma center, over a 20-month period. Patients with hemodynamic instability, peritonitis, or an unevaluable abdomen underwent an immediate laparotomy. Patients who were hemodynamically stable and had no signs of peritonitis were selected for further CT scan evaluation. In the absence of CT scan findings suggestive of hollow viscus injury, the patients were observed with serial clinical examinations, hemoglobin levels, and white cell counts. Patients with left thoracoabdominal injuries underwent elective laparoscopy to rule out diaphragmatic injury. Outcome parameters included survival, complications, need for delayed laparotomy in observed patients, and length of hospital stay. Results: During the study period, there were 152 patients with 185 penetrating solid organ injuries. Gunshot wounds accounted for 70.4% and stab wounds for 29.6% of injuries. Ninety-one patients (59.9%) met the criteria for immediate operation. The remaining 61 (40.1%) patients were selected for CT scan evaluation. Forty-three patients (28.3% of all patients) with 47 solid organ injuries who had no CT scan findings suspicious of hollow viscus injury were selected for clinical observation and additional laparoscopy in 2. Four patients with a “blush” on CT scan underwent angiographic embolization of the liver. Overall, 41 patients (27

  2. The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD : A pilot study

    NARCIS (Netherlands)

    Flokstra-de Blok, Bertine; de Greef, Mathieu; ten Hacken, Nicolaas; Sprenger, S.; Postema, Klaas; Wempe, Johan

    Objective: To study the effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation. Methods: Twenty-one chronic obstructive pulmonary disease (COPD) patients were randomized to an experimental group that followed a regular rehabilitation

  3. The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: A pilot study

    NARCIS (Netherlands)

    de Blok, B.M.J.; De Greef, M.H.G.; ten Hacken, N.H.T.; Sprenger, S.R.; Postema, K; Wempe, J.B.

    2006-01-01

    Objective: To study the effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation. Methods: Twenty-one chronic obstructive pulmonary disease (COPD) patients were randomized to an experimental group that followed a regular rehabilitation

  4. 77 FR 34363 - Disability and Rehabilitation Research Projects and Centers Program; Traumatic Brain Injury Model...

    Science.gov (United States)

    2012-06-11

    ... outcomes in the vocational rehabilitation process. Section 21 of the Rehabilitation Act specifically... priorities, we designate the type of each priority as absolute, competitive preference, or invitational...)). Competitive preference priority: Under a competitive preference priority, we give competitive preference to an...

  5. Can a chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization?

    Science.gov (United States)

    Rasekaba, T M; Williams, E; Hsu-Hage, B

    2009-01-01

    Chronic obstructive pulmonary disease (COPD) imposes a costly burden on healthcare. Pulmonary rehabilitation (PR) is the best practice to better manage COPD to improve patient outcomes and reduce acute hospital care utilization. To evaluate the impact of a once-weekly, eight-week multidisciplinary PR program as an integral part of the COPD chronic disease management (CDM) Program at Kyabram District Health Services. The study compared two cohorts of COPD patients: CDM-PR Cohort (4-8 weeks) and Opt-out Cohort (0-3 weeks) between February 2006 and March 2007. The CDM-PR Program involved multidisciplinary patient education and group exercise training. Nonparametric statistical tests were used to compare acute hospital care utilization 12 months before and after the introduction of CDM-PR. The number of patients involved in the CDM-PR Cohort was 29 (n = 29), and that in the Opt-out Cohort was 24 (n = 24). The CDM-PR Cohort showed significant reductions in cumulative acute hospital care utilization indicators (95% emergency department presentations, 95% inpatient admissions, 99% length of stay; effect sizes = 0.62-0.66, P 0.05). Total costs associated with the hospital care utilization decreased from $130,000 to $7,500 for the CDM-PR Cohort and increased from $77,700 to $101,200 for the Opt-out Cohort. Participation in the CDM-PR for COPD patients can significantly reduce acute hospital care utilization and associated costs in a small rural health service.

  6. Presentation of the ressac research program (rehabilitation of soils and surfaces after an accident)

    International Nuclear Information System (INIS)

    L'Homme, A.

    1989-11-01

    If, despite all the precautions taken in nuclear power plants, a severe accident was to occur in France involving extensive release of radioactive materials to the environment, existing emergency plans would be implemented enabling urgent decisions to be made with regard to the immediate protection of the population: confinement indoors, evacuation, distribution of stable iodine, etc. But, at a later stage, mean and long term actions would have to be carried out to decontaminate the polluted areas and limit subsequent contamination of the food chain, with a view to enabling the populations concerned to return to normal life. These actions would concern, in decreasing order of priority and using the WHO and IAEA definitions, the near field, closest to the accident site, and the far field, subjected to the direct impact of fallout. They should be aimed at reducing external exposure due to deposition and internal exposure by inhalation of radioactive products re-suspended in the atmosphere and by ingestion of products for human consumption. In the context of IPSN (Institute of Protection and Nuclear Safety) research and development programs on severe accidents, the RESSAC program was defined in 1985 for the purpose of studying methods and means of rehabilitating the near field and controlling problems related to the far field. Elaboration of the program is presently proceeding at the Nuclear Research Center of CADARACHE, focussed on the following main topics: assessment of what happens to the radionuclides deposited on the soil and vegetation, determination of priorities and how to intervene, management of the waste produced

  7. Evaluation of the effectiveness of a phonoaudiology program for the rehabilitation of dysphagia in the elderly.

    Science.gov (United States)

    Santoro, P; e Silva, I L; Cardoso, F; Dias, E; Beresford, H

    2011-01-01

    The object of this study was to evaluate the effectiveness of a phonoaudiology rehabilitation program directed towards the degenerative changes of the neurophysiological mechanisms responsible for the upper digestive system compromised by the age between 80 and 90 years, in a regime of internment in a long permanence institution in the city of Rio de Janeiro, which express, bodily, their difficulty in swallowing food of liquid or pasty consistency. To achieve such an object, the current study was developed in an experimental format or design, comprised of a sample group of 23 elderly subjects, of both genders, undergoing evaluation by the phonoaudiology protocol for evaluating the risk of dysphagia (abbreviated from the Portuguese name: Protocolo de Avaliação do Risco para Disfagia=PARD), pre- and post-intervention procedure. The developed program used the indirect therapy approach based on the adaptive myotherapeutic and myofunctional stimulation, contemplating two isometric and isokinetic orofacial active myotherapeutic exercises, two passive myotherapeutic manipulations for the supra-hyoidal musculature, as well as adaptive cephalic postural maneuvres, associated to the intra-oral olfactive and gustative sensory stimulation. The evolution of the individuals was analyzed before and after the therapy by estimating the capacity of swallowing food in the liquid fluid (LF) consistency, by the paired Student t-test, giving a p=0.01, making the difference of 2.31 between the 2 evaluations statistically significant. The changes produced by the PARD program in the capacity of individuals in swallowing food of a pasty consistency were also significant when analyzing the variance of the results on the 2 instances by using the F-test (pre- and post-intervention difference=4.47, p=0.039). Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  8. 78 FR 35758 - Final Priority; National Institute on Disability and Rehabilitation Research-Rehabilitation...

    Science.gov (United States)

    2013-06-14

    ... Institute on Disability and Rehabilitation Research--Rehabilitation Research and Training Centers AGENCY... for the Disability and Rehabilitation Research Projects and Centers Program administered by the National Institute on Disability and Rehabilitation Research (NIDRR). Specifically, we announce a priority...

  9. Stroke Rehabilitation.

    Science.gov (United States)

    Belagaje, Samir R

    2017-02-01

    Rehabilitation is an important aspect of the continuum of care in stroke. With advances in the acute treatment of stroke, more patients will survive stroke with varying degrees of disability. Research in the past decade has expanded our understanding of the mechanisms underlying stroke recovery and has led to the development of new treatment modalities. This article reviews and summarizes the key concepts related to poststroke recovery. Good data now exist by which one can predict recovery, especially motor recovery, very soon after stroke onset. Recent trials have not demonstrated a clear benefit associated with very early initiation of rehabilitative therapy after stroke in terms of improvement in poststroke outcomes. However, growing evidence suggests that shorter and more frequent sessions of therapy can be safely started in the first 24 to 48 hours after a stroke. The optimal amount or dose of therapy for stroke remains undetermined, as more intensive treatments have not been associated with better outcomes compared to standard intensities of therapy. Poststroke depression adversely affects recovery across a variety of measures and is an important target for therapy. Additionally, the use of selective serotonin reuptake inhibitors (SSRIs) appears to benefit motor recovery through pleiotropic mechanisms beyond their antidepressant effect. Other pharmacologic approaches also appear to have a benefit in stroke rehabilitation. A comprehensive rehabilitation program is essential to optimize poststroke outcomes. Rehabilitation is a process that uses three major principles of recovery: adaptation, restitution, and neuroplasticity. Based on these principles, multiple different approaches, both pharmacologic and nonpharmacologic, exist to enhance rehabilitation. In addition to neurologists, a variety of health care professionals are involved in stroke rehabilitation. Successful rehabilitation involves understanding the natural history of stroke recovery and a

  10. 78 FR 35009 - Applications for New Awards; National Institute on Disability and Rehabilitation Research...

    Science.gov (United States)

    2013-06-11

    ... (NIDRR)--Disability and Rehabilitation Research Projects and Centers Program--Rehabilitation Engineering... authorized under the Rehabilitation Act of 1973, as amended (Rehabilitation Act). Rehabilitation Engineering... under the Rehabilitation Act. It does so by conducting advanced engineering research, developing and...

  11. Inpatient cardiac rehabilitation programs' exercise therapy for patients undergoing cardiac surgery: National Korean Questionnaire Survey.

    Science.gov (United States)

    Seo, Yong Gon; Jang, Mi Ja; Park, Won Hah; Hong, Kyung Pyo; Sung, Jidong

    2017-02-01

    Inpatient cardiac rehabilitation (ICR) has been commonly conducted after cardiac surgery in many countries, and has been reported a lots of results. However, until now, there is inadequacy of data on the status of ICR in Korea. This study described the current status of exercise therapy in ICR that is performed after cardiac surgery in Korean hospitals. Questionnaires modified by previous studies were sent to the departments of thoracic surgery of 10 hospitals in Korea. Nine replies (response rate 90%) were received. Eight nurses and one physiotherapist completed the questionnaire. Most of the education on wards after cardiac surgery was conducted by nurses. On postoperative day 1, four sites performed sitting on the edge of bed, sit to stand, up to chair, and walking in the ward. Only one site performed that exercise on postoperative day 2. One activity (stairs up and down) was performed on different days at only two sites. Patients received education preoperatively and predischarge for preventing complications and reducing muscle weakness through physical inactivity. The results of the study demonstrate that there are small variations in the general care provided by nurses after cardiac surgery. Based on the results of this research, we recommended that exercise therapy programs have to conduct by exercise specialists like exercise physiologists or physiotherapists for patients in hospitalization period.

  12. Effectiveness of a family-oriented rehabilitation program on the quality of life of parents of chronically ill children.

    Science.gov (United States)

    West, C A; Besier, T; Borth-Bruhns, T; Goldbeck, L

    2009-01-01

    Parents of chronically ill children face numerous burdens in daily life, which can impair their quality of life (QoL) significantly. Therefore in family-oriented rehabilitation, not only the children themselves, but also their parents receive interventions. These aim at stabilizing parents both mentally and physically to enable them to support their children in the best possible way. This study investigates the effects of an inpatient family-oriented rehabilitation program on the QoL of parents of chronically ill children. A consecutive sample of 231 mothers and 155 fathers of children suffering from cancer, cardiac diseases or cystic fibrosis participated in the study. In a prospective longitudinal study, parental QoL was repeatedly assessed using the Ulm Quality of Life Inventory for Parents (ULQIE) at three different time points: admission to the rehabilitation clinic, discharge after four weeks of inpatient treatment, and at a six-month follow-up. Parental QoL increased markedly during rehabilitation treatment (mothers eta (2)=.326, fathers eta (2)=.249). Moreover, six months after the intervention, parental quality of life was still markedly improved compared to baseline assessment (mothers eta (2)=.259, fathers eta (2)=.069). The child's diagnosis had no effect on the level and course of parental QoL. Taking part in family-oriented rehabilitation can improve the QoL of parents of children suffering from cancer, cardiac diseases or cystic fibrosis. Such programs could be expected to affect the way chronically ill children cope with their condition and this should be examined in future studies.

  13. Development of a program for tele-rehabilitation of COPD patients across sectors: co-innovation in a network

    Directory of Open Access Journals (Sweden)

    Birthe Dinesen

    2011-03-01

    Full Text Available Introduction: The aim of the Telekat project is to prevent re-admissions of patients with chronic obstructive pulmonary disease (COPD by developing a preventive programof tele-rehabilitation across sectors for COPD patients. The development of the program is based on a co-innovation process between COPD patients, relatives, healthcare professionals and representatives from private firms and universities. This paper discusses theobstacles that arise in the co-innovation process of developing an integrated technique for tele-rehabilitation of COPD patients.Theory: Network and innovation theory.Methods: The casestudy was applied. A triangulation of data collection techniques was used: documents, observations (123 hours, qualitative interviews (n=32 and action research.Findings: Obstacles were identified in the network context; these obstacles included the mindset of the healthcare professionals, inter-professionals relations, views of technology as a tool and competing visions for the goals of tele-rehabilitation.Conclusion: We have identified obstacles that emerge in the co-innovation process when developing a programme for tele-rehabilitation of COPD patients in an inter-organizational context. Action research has been carried out and can have helped to facilitate the co-innovation process.

  14. "The Whole Is Greater Than the Sum of the Parts": Prison Staff Perceptions of Domestic Violence Rehabilitation Programs.

    Science.gov (United States)

    Shoham, Efrat; Zelig, Anat; Hasisi, Badi; Weisburd, David; Haviv, Noam

    2017-11-01

    This qualitative study is part of a mixed methods research project that examined the effectiveness of the primary rehabilitation program for domestic violence offenders in the Israeli Prison Services-the "House of Hope." The quantitative part of the study showed that the "House of Hope" program was effective in reducing recidivism among participating inmates. The purpose of this qualitative study was to describe the rehabilitation program according to the perspectives of the program staff. For this purpose, semistructured interviews were conducted with the department staff during the study as well as with past directors. The qualitative findings suggested that the success of the program probably stemmed from a synergistic combination of several components, for example, identifying the characteristics of domestic violence offenders and adjusting treatment programs to their needs, along with exposure to psychological treatment in varied therapies (cognitive behavioral therapy, psychoeducational, and psychodynamic) and formats (group therapy and individual therapy) during a 1-year stay in a hierarchical therapeutic community. Other components mentioned are staff professionalism, stability, and the program's location in a therapeutic-oriented prison that is architecturally designed and built to create a less stressful environment for the inmates and the staff.

  15. Multidisciplinary rehabilitation program: effects of a multimodal intervention for patients with Alzheimer’s disease and cognitive impairment without dementia

    Directory of Open Access Journals (Sweden)

    Glenda Dias Santos

    2015-12-01

    Full Text Available Abstract Background Non-pharmalogical interventions represent an important complement to standard pharmalogical treatment in dementia. Objective This study aims to evaluate the effects of a multidisciplinary rehabilitation program on cognitive ability, quality of life and depression symptoms in patients with Alzheimer’s disease (AD and cognitive impairment without dementia (CIND. Methods Ninety-seven older adults were recruited to the present study. Of these, 70 patients had mild AD and were allocated into experimental (n = 54 or control (n = 16 groups. Two additional active comparison groups were constituted with patients with moderate AD (n = 13 or with CIND (n = 14 who also received the intervention. The multidisciplinary rehabilitation program lasted for 12 weeks and was composed by sessions of memory training, recreational activities, verbal expression and writing, physical therapy and physical training, delivered in two weekly 6-hour sessions. Results As compared to controls, mild AD patients who received the intervention had improvements in cognition (p = 0.021 and quality of life (p = 0.003, along with a reduction in depressive symptoms (p < 0.001. As compared to baseline, CIND patients displayed at the end of the intervention improvements in cognition (p = 0.005 and depressive symptoms (p = 0.011. No such benefits were found among patients with moderate AD.Discussion: This multidisciplinary rehabilitation program was beneficial for patients with mild AD and CIND. However, patients with moderate dementia did not benefit from the intervention.

  16. Correlation between changes in diastolic dysfunction and health-related quality of life after cardiac rehabilitation program in dilated cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Sherin H.M. Mehani

    2013-03-01

    Full Text Available Chronic heart failure (CHF is a complex syndrome characterized by progressive decline in left ventricular function, low exercise tolerance and raised mortality and morbidity. Left ventricular diastolic dysfunction plays a major role in CHF and progression of most cardiac diseases. The current recommended goals can theoretically be accomplished via exercise and pharmacological therapy so the aim of the present study was to evaluate the impact of cardiac rehabilitation program on diastolic dysfunction and health related quality of life and to determine the correlation between changes in left ventricular diastolic dysfunction and domains of health-related quality of life (HRQoL. Forty patients with chronic heart failure were diagnosed as having dilated cardiomyopathy (DCM with systolic and diastolic dysfunction. The patients were equally and randomly divided into training and control groups. Only 30 of them completed the study duration. The training group participated in rehabilitation program in the form of circuit-interval aerobic training adjusted according to 55–80% of heart rate reserve for a period of 7 months. Circuit training improved both diastolic and systolic dysfunction in the training group. On the other hand, only a significant correlation was found between improvement in diastolic dysfunction and health related quality of life measured by Kansas City Cardiomyopathy Questionnaire. It was concluded that improvement in diastolic dysfunction as a result of rehabilitation program is one of the important underlying mechanisms responsible for improvement in health-related quality of life in DCM patients.

  17. Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review

    Directory of Open Access Journals (Sweden)

    Andrea M Bruder

    2017-10-01

    Registration: CRD42016041818. [Bruder AM, Shields N, Dodd KJ, Taylor NF (2017 Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review. Journal of Physiotherapy 63: 205–220

  18. Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program.

    Science.gov (United States)

    Güngen, Belma Doğan; Tunç, Abdulkadir; Aras, Yeşim Güzey; Gündoğdu, Aslı Aksoy; Güngen, Adil Can; Bal, Serdar

    2017-07-11

    The aim of this study was to investigate the predictors of intensive care unit (ICU) admission and mortality among stroke patients and the effects of a pulmonary rehabilitation program on stroke patients. This prospective study enrolled 181 acute ischemic stroke patients aged between 40 and 90 years. Demographical characteristics, laboratory tests, diffusion-weighed magnetic resonance imaging (DWI-MRI) time, nutritional status, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin scale (MRS) scores were recorded for all patients. One-hundred patients participated in the pulmonary rehabilitation program, 81 of whom served as a control group. Statistically, one- and three-month mortality was associated with NIHSS and MRS scores at admission and three months (pstroke patients. We believe that a pulmonary rehabilitation program, in addition to general stroke rehabilitation programs, can play a critical role in improving survival and functional outcomes. NCT03195907 . Trial registration date: 21.06.2017 'Retrospectively registered'.

  19. Structures, processes and outcomes of the Aussie Heart Guide Program: A nurse mentor supported, home based cardiac rehabilitation program for rural patients with acute coronary syndrome.

    Science.gov (United States)

    Frohmader, Terence J; Lin, Frances; Chaboyer, Wendy P

    2018-03-01

    Cardiac rehabilitation has a number of benefits for patients, yet participation in it is sub-optimal, especially in regional Australia. Innovative models of cardiac rehabilitation are needed to improve participation. Providing nurse mentors to support patients transitioning from hospital to home represents a new model of service delivery in Australia. To explore the impact of a home-based cardiac rehabilitation program in assisting patients to recover from Acute Coronary Syndrome and meeting the expectations of nurse mentors delivering the program. This case study was underpinned by the structure, process and outcomes model and occurred in three Australian hospitals 2008-2011. Thirteen patients recovering from acute coronary syndrome were interviewed by telephone and seven nurse mentors completed a survey after completing the program. Mentor perceptions concerning the structures of the home-based CR program included the timely recruitment of patients, mentor training to operationalise the program, commitment to development of the mentor role, and the acquisition of knowledge and skills about cognitive behavioural therapy and patient centred care. Processes included the therapeutic relationship between mentors and patients, suitability of the program and the promotion of healthier lifestyle behaviours. Outcomes identified that patients were satisfied with the program's audiovisual resources, and the level of support and guidance provided by their nurse mentors. Mentors believed that the program was easy to use in terms of its delivery. Patients believed the program assisted their recovery and were satisfied with the information, guidance and support received from mentors. There were positive signs that the program influenced patients' decisions to change unhealthy lifestyle behaviours. Outcomes highlighted both rewards and barriers associated with mentoring patients in their homes by telephone. Experience gained from developing a therapeutic relationship with

  20. 77 FR 33725 - Applications for New Awards; Disability and Rehabilitation Research Projects and Centers Program...

    Science.gov (United States)

    2012-06-07

    ...-funded research and development activities in refereed journals. The percentage of new NIDRR grants that... DEPARTMENT OF EDUCATION Applications for New Awards; Disability and Rehabilitation Research... institutions of higher education (IHEs) only. II. Award Information Type of Award: Discretionary grants...

  1. [Development and short-term effects of a standardized patient education program for in-patient cardiologic rehabilitation].

    Science.gov (United States)

    Seekatz, B; Haug, G; Mosler, G; Schwaab, B; Altstidl, R; Worringen, U; Faller, H; Meng, K

    2013-10-01

    Patient education is an essential part in the treatment of coronary heart disease in medical rehabilitation. In the German-speaking area, no standardized and evaluated patient education program for coronary heart disease is available so far. In this paper, we demonstrate the development of a quality assured patient education program based on a health-education program of the German statutory pension insurance scheme. In a multi-level approach, an existing program was modified concerning treatment evidence, practical guidelines, theories of health and illness behavior and quality criteria for patient education as well as clinical experience and thereafter manualized. In a formative evaluation, feasibility and patient acceptance of this modified program were assessed using evaluation questionnaires of patients and trainers. Afterwards, effects of the patient education program as compared to a traditional education program were assessed on a short-term (at discharge), medium-term (6-month follow-up) and long-term (12-month follow-up) basis in a multicenter quasi-experimental control group study of patients with coronary heart disease (n=434). Results of the formative evaluation demonstrate an overall good acceptance and a good feasibility of the manualized program. Short-term results show a significant small treatment effect in the primary outcome variable patients' knowledge (p=0.001, η2 =0.028). Furthermore, small effects were also observed among some secondary outcomes, such as attitude towards medication, planning of physical activity, psychological quality of life and satisfaction with the education program. A standardized education program for patients with coronary heart disease has been developed in a systematic process based on established quality standards. Depending on the outstanding medium and long-term effects, the program may be recommended for general use in medical rehabilitation. The manual provides the prerequisites allowing for a successful

  2. Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial.

    Science.gov (United States)

    Nordin, Catharina A; Michaelson, Peter; Gard, Gunvor; Eriksson, Margareta K

    2016-10-05

    Web-based interventions with a focus on behavior change have been used for pain management, but studies of Web-based interventions integrated in clinical practice are lacking. To emphasize the development of cognitive skills and behavior, and to increase activity and self-care in rehabilitation, the Web Behavior Change Program for Activity (Web-BCPA) was developed and added to multimodal pain rehabilitation (MMR). The objective of our study was to evaluate the effects of MMR in combination with the Web-BCPA compared with MMR among persons with persistent musculoskeletal pain in primary health care on pain intensity, self-efficacy, and copying, as part of a larger collection of data. Web-BCPA adherence and feasibility, as well as treatment satisfaction, were also investigated. A total of 109 participants, mean age 43 (SD 11) years, with persistent pain in the back, neck, shoulder, and/or generalized pain were recruited to a randomized controlled trial with two intervention arms: (1) MMR+WEB (n=60) and (2) MMR (n=49). Participants in the MMR+WEB group self-guided through the eight modules of the Web-BCPA: pain, activity, behavior, stress and thoughts, sleep and negative thoughts, communication and self-esteem, solutions, and maintenance and progress. Data were collected with a questionnaire at baseline and at 4 and 12 months. Outcome measures were pain intensity (Visual Analog Scale), self-efficacy to control pain and to control other symptoms (Arthritis Self-Efficacy Scale), general self-efficacy (General Self-Efficacy Scale), and coping (two-item Coping Strategies Questionnaire; CSQ). Web-BCPA adherence was measured as minutes spent in the program. Satisfaction and Web-BCPA feasibility were assessed by a set of items. Of 109 participants, 99 received the allocated intervention (MMR+WEB: n=55; MMR: n=44); 88 of 99 (82%) completed the baseline and follow-up questionnaires. Intention-to-treat analyses were performed with a sample size of 99. The MMR+WEB intervention

  3. Nonoperative management for perforated peptic ulcer: Who can benefit?

    OpenAIRE

    Cao, Feng; Li, Jia; Li, Ang; Fang, Yu; Ya-jun Wang, Ya-jun Wang; Li, Fei

    2017-01-01

    Background: Although nonoperative management for perforated peptic ulcer (PPU) has been used for several decades, the indication is still unclear. A clinicoradiological score was sought to predict who can benefit from it. Methods: A clinicoradiological protocol for the assessment of patients presenting with PPU was used. A logistic regression model was applied to identify determinant variables and construct a clinical score that would identify patients who can be successfully treated with ...

  4. Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged.

    Science.gov (United States)

    Altman, Irwin M; Swick, Shannon; Parrot, Devan; Malec, James F

    2010-11-01

    To evaluate outcomes of home- and community-based postacute brain injury rehabilitation (PABIR). Retrospective analysis of program evaluation data for treatment completers and noncompleters. Home- and community-based PABIR conducted in 7 geographically distinct U.S. cities. Patients (N=489) with traumatic brain injury who completed the prescribed course of rehabilitation (completed-course-of-treatment [CCT] group) compared with 114 who were discharged precipitously before program completion (precipitous-discharge [PD] group). PABIR delivered in home and community settings by certified professional staff on an individualized basis. Mayo-Portland Adaptability Inventory (MPAI-4) completed by means of professional consensus on admission and at discharge; MPAI-4 Participation Index at 3- and 12-month follow-up through telephone contact. Analysis of covariance (CCT vs PD group as between-subjects variable, admission MPAI-4 score as covariate) showed significant differences between groups at discharge on the full MPAI-4 (F=82.25; P<.001), Ability Index (F=50.24; P<.001), Adjustment Index (F=81.20; P<.001), and Participation Index (F=59.48; P<.001). A large portion of the sample was lost to follow-up; however, available data showed that group differences remained statistically significant at follow-up. Results provided evidence of the effectiveness of home- and community-based PABIR and that treatment effects were maintained at follow-up. Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  5. Computed tomography and nonoperative treatment for blunt abdominal trauma

    International Nuclear Information System (INIS)

    Watanabe, Shinsuke; Ishi, Takashi; Kamachi, Masahiro; Takahashi, Toshio.

    1990-01-01

    Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries. (author)

  6. Computed tomography and nonoperative treatment for blunt abdominal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Shinsuke; Ishi, Takashi; Kamachi, Masahiro [Saiseikai Shiga Hospital, Shiga (Japan); Takahashi, Toshio

    1990-01-01

    Studies were undertaken to determine if computed tomography (CT) could reliably assist physical examination in the initial assessment of blunt abdominal trauma, and also to examine how various abdominal injuries were managed with the guidance of CT. A total of 255 patients underwent emergency abdominal CT following blunt abdominal trauma over a period of seven years. One hundred and fifty two patients had abnormal CT scans, including 58 hepatic, 36 renal, 25 splenic and 9 pancreatic injuries as well as 67 patients with intra-abdominal hemorrhage and 21 patients with free abdominal air. A comparative study on the detection of pneumoperitoneum revealed CT to be far superior to plain radiography. One hundred and three patients had normal CT scans, all of whom were managed nonoperatively, except for three false-negative cases and two nontherapeutic cases. The patients with injury to the parenchymal organs were given nonoperative treatment if they had stable vital signs and no evidence of associated injuries demanding immediate surgery and the majority of these patients were managed well nonoperatively. CT was thus found to be a useful adjunct in the management of victims of blunt abdominal trauma, since in a rapid and noninvasive fashion, CT accurately defined the extent of parenchymal organ injury and also disclosed any other abdominal injuries. (author).

  7. Pipeline rehabilitation planning

    Energy Technology Data Exchange (ETDEWEB)

    Palmer-Jones, Roland; Hopkins, Phil; Eyre, David [PENSPEN (United Kingdom)

    2005-07-01

    An operator faced with an onshore pipeline that has extensive damage must consider the need for rehabilitation, the sort of rehabilitation to be used, and the rehabilitation schedule. This paper will consider pipeline rehabilitation based on the authors' experiences from recent projects, and recommend a simple strategy for planning pipeline rehabilitation. It will also consider rehabilitation options: external re-coating; internal lining; internal painting; programmed repairs. The main focus will be external re-coating. Consideration will be given to rehabilitation coating types, including tape wraps, epoxy, and polyurethane. Finally it will discuss different options for scheduling the rehabilitation of corrosion damage including: the statistical comparison of signals from inspection pigs; statistical comparison of selected measurements from inspection pigs and other inspections; the use of corrosion rates estimated for the mechanisms and conditions; expert judgement. (author)

  8. Traumatic brain injury rehabilitation, the programs applied in French UEROS units, and the specificity of the Limoges experience.

    Science.gov (United States)

    Hamonet-Torny, J; Fayol, P; Faure, P; Carrière, H; Dumond, J-J

    2013-04-01

    First created in 1996, the French evaluation, retraining, social and vocational orientation units (UEROS) now play a fundamental role in the social and vocational rehabilitation of patients with brain injury. As of today, there exist 30 UEROS centers in France. While their care and treatment objectives are shared, their means of assessment and retraining differ according to the experience of each one. The objective of this article is to describe the specific programs and the different tools put to work in the UEROS of Limoges. The UEROS of Limoges would appear to offer a form of holistic rehabilitation management characterized by the importance of psycho-education and its type of approach towards vocational reintegration. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  9. Effects of horticultural therapy on mood and heart rate in patients participating in an inpatient cardiopulmonary rehabilitation program.

    Science.gov (United States)

    Wichrowski, Matthew; Whiteson, Jonathan; Haas, François; Mola, Ana; Rey, Mariano J

    2005-01-01

    To assess the effects of horticultural therapy (HT) on mood state and heart rate (HR) in patients participating in an inpatient cardiac rehabilitation program. Cardiac rehabilitation inpatients (n = 107) participated in the study. The HT group consisted of 59 subjects (34 males, 25 females). The control group, which participated in patient education classes (PECs), consisted of 48 subjects (31 males, 17 females). Both HT sessions and PEC are components of the inpatient rehabilitation program. Each group was evaluated before and after a class in their respective modality. Evaluation consisted of the completion of a Profile of Mood States (POMS) inventory, and an HR obtained by pulse oximetry. Changes in the POMS total mood disturbance (TMD) score and HR between preintervention and postintervention were compared between groups. There was no presession difference in either TMD score (16 +/- 3.6 and 19.0 +/- 3.2, PEC and HT, respectively) or HR (73.5 +/- 2.5 and 79 +/- 1.8, PEC and HT, respectively). Immediately following the intervention, the HT TMD was significantly reduced (post-TMD = 1.6 +/- 3.2, P < .001), while PEC TMD was not significantly changed (TMD = 17.0 +/- 28.5). After intervention, HR fell in HT by 4 +/- 9.6 bpm (P < .001) but was unchanged in PEC. These findings indicate that HT improves mood state, suggesting that it may be a useful tool in reducing stress. Therefore, to the extent that stress contributes to coronary heart disease, these findings support the role of HT as an effective component of cardiac rehabilitation.

  10. Spitting in the Ocean: Realistic Expectations of the Impact of Driver Alcohol Education and Rehabilitation Programs on the Problem of Drunk Driving.

    Science.gov (United States)

    Waller, Patricia F.

    Alcohol education and rehabilitation programs are widely accepted as an integral part of the enforcement of drunk driving laws; however, careful evaluations of these programs generally fail to show subsequent beneficial effects on traffic crashes. This fact is due in part to the many barriers to conducting sound program evaluations and in part to…

  11. Adherence to a maintenance exercise program 1 year after pulmonary rehabilitation: what are the predictors of dropout?

    Science.gov (United States)

    Heerema-Poelman, Ankie; Stuive, Ilse; Wempe, Johan B

    2013-01-01

    To evaluate adherence to a maintenance exercise program in patients with chronic obstructive pulmonary disease (COPD) and explore predictors for adherence. Seventy patients with COPD were referred to a home-care maintenance exercise program after completing pulmonary rehabilitation (PR) in the rehabilitation center. Adherence (yes/no) to the maintenance program was assessed by a self-reported questionnaire, where adherence was defined as attending the maintenance program 1 year after PR. Early dropouts received a self-reported questionnaire after 6 months and the remaining patients after 12 months. Lung function, exercise capacity, exercise self-efficacy, illness perceptions, health-related quality of life, levels of anxiety and depression, duration of PR, and the number of exacerbations were studied as possible predictors of adherence. Ten patients died or were lost to followup. Of the remaining 60 patients, 73.3% and 63.3% were adherent to the maintenance exercise program after 6 and 12 months, respectively. Forced expiratory volume in 1 second (FEV1) (P = .021), Hospital Anxiety and Depression Scale depression score (P = .025), and duration of PR (P = .018) were significant predictors of adherence to the maintenance program. Adherence to the maintenance exercise program included a 36.7% drop-out rate during the first year after completing PR. Experiencing exacerbations was the most reported reason for dropout. Poorer lung function, shorter initial PR course measured by reviewing patient records, and higher level of depressive symptoms were predictive of drop-out to the maintenance program. Adherence to the maintenance program needs to be improved for patients with lower FEV1, with signs of depression, or with a shorter initial PR course.

  12. Nonoperative management of penetrating kidney injuries: a prospective audit.

    Science.gov (United States)

    Moolman, C; Navsaria, P H; Lazarus, J; Pontin, A; Nicol, A J

    2012-07-01

    The role of nonoperative management for penetrating kidney injuries is unknown. Therefore, we review the management and outcome of penetrating kidney injuries at a center with a high incidence of penetrating trauma. Data from all patients presenting with hematuria and/or kidney injury discovered on imaging or at surgery admitted to the trauma center at Groote Schuur Hospital in Cape Town, South Africa during a 19-month period (January 2007 to July 2008) were prospectively collected and reviewed. These data were analyzed for demographics, injury mechanism, perioperative management, nephrectomy rate and nonoperative success. Patients presenting with hematuria and with an acute abdomen underwent a single shot excretory urogram. Those presenting with hematuria without an indication for laparotomy underwent computerized tomography with contrast material. A total of 92 patients presented with hematuria following penetrating abdominal trauma. There were 75 (80.4%) proven renal injuries. Of the patients 84 were men and the median age was 26 years (range 14 to 51). There were 50 stab wounds and 42 gunshot renal injuries. Imaging modalities included computerized tomography in 60 cases and single shot excretory urography in 18. There were 9 patients brought directly to the operating room without further imaging. A total of 47 patients with 49 proven renal injuries were treated nonoperatively. In this group 4 patients presented with delayed hematuria, of whom 1 had a normal angiogram and 3 underwent successful angioembolization of arteriovenous fistula (2) and false aneurysm (1). All nonoperatively managed renal injuries were successfully treated without surgery. There were 18 nephrectomies performed for uncontrollable bleeding (11), hilar injuries (2) and shattered kidney (3). Post-nephrectomy complications included 1 infected renal bed hematoma requiring percutaneous drainage. Of the injuries found at laparotomy 12 were not explored, 2 were drained and 5 were treated with

  13. The Process of Motivating Inmates to Participate in Individual Programming System-Reflections on Prison Rehabilitation

    Directory of Open Access Journals (Sweden)

    Justyna Siemionow

    2013-12-01

    Full Text Available The rehabilitation process is a continuum of actions, changes obtained on its individual stages are the key to the success of the next step, a prisoner’s commitment in the process of changing is a very important part of rehabilitation. The prisoners may choose whether they actively participate in the rehabilitation process or not. If they decide, the completed tasks are evaluated by the staff. Currently it is still being looked for effective work with prisoners, how to change their behavior and the way of thinking. The stuff should build a specific interpersonal relationships with the prisoners because it creates opportunities to motivate the prisoners and let them see their strong points.

  14. Effects of a multifactorial falls prevention program for people with stroke returning home after rehabilitation: a randomized controlled trial.

    Science.gov (United States)

    Batchelor, Frances A; Hill, Keith D; Mackintosh, Shylie F; Said, Catherine M; Whitehead, Craig H

    2012-09-01

    To determine whether a multifactorial falls prevention program reduces falls in people with stroke at risk of recurrent falls and whether this program leads to improvements in gait, balance, strength, and fall-related efficacy. A single blind, multicenter, randomized controlled trial with 12-month follow-up. Participants were recruited after discharge from rehabilitation and followed up in the community. Participants (N=156) were people with stroke at risk of recurrent falls being discharged home from rehabilitation. Tailored multifactorial falls prevention program and usual care (n=71) or control (usual care, n=85). Primary outcomes were rate of falls and proportion of fallers. Secondary outcomes included injurious falls, falls risk, participation, activity, leg strength, gait speed, balance, and falls efficacy. There was no significant difference in fall rate (intervention: 1.89 falls/person-year, control: 1.76 falls/person-year, incidence rate ratio=1.10, P=.74) or the proportion of fallers between the groups (risk ratio=.83, 95% confidence interval=.60-1.14). There was no significant difference in injurious fall rate (intervention: .74 injurious falls/person-year, control: .49 injurious falls/person-year, incidence rate ratio=1.57, P=.25), and there were no significant differences between groups on any other secondary outcome. This multifactorial falls prevention program was not effective in reducing falls in people with stroke who are at risk of falls nor was it more effective than usual care in improving gait, balance, and strength in people with stroke. Further research is required to identify effective interventions for this high-risk group. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  15. Development and feasibility of an evidence-informed self-management education program in pediatric concussion rehabilitation.

    Science.gov (United States)

    Hunt, Anne W; De Feo, Luciano; Macintyre, Jennifer; Greenspoon, Dayna; Dick, Talia; Mah, Katherine; Paniccia, Melissa; Provvidenza, Christine; Reed, Nick

    2016-08-17

    Concussion is a considerable public health problem in youth. However, identifying, understanding and implementing best evidence informed recovery guidelines may be challenging for families given the vast amount of information available in the public domains (e.g. Internet). The objective of this study was to develop, implement and evaluate the feasibility of an evidence-informed self-management education program for concussion recovery in youth. Synthesis of best evidence, principles of knowledge translation and exchange, and expert opinion were integrated within a self-management program framework to develop a comprehensive curriculum. The program was implemented and evaluated in a children's rehabilitation hospital within a universal health care system. A retrospective secondary analysis of anonymous data from a program evaluation survey was used to evaluate program feasibility, to identify features of importance to program participants and to assess changes in participants' knowledge. The program, "Concussion & You" includes a comprehensive, evidence informed, population specific curriculum that teaches participants practical strategies for management of return to school and play, sleep, nutrition, relaxation and energy conservation. A 'wheel of health' is used to facilitate participants' self-management action plan. Results from eighty-seven participant surveys indicate that the program is feasible and participant knowledge increased in all areas of the program with the highest changes reported in knowledge about sleep hygiene, rest and energy conservation. Findings indicate that "Concussion & You" is a feasible program that is acceptable to youth and their families, and fills a health system service gap.

  16. Evaluation of a four month rehabilitation program for stroke patients with balance problems and binocular visual dysfunction.

    Science.gov (United States)

    Schow, Trine; Harris, Paul; Teasdale, Thomas William; Rasmussen, Morten Arendt

    2016-04-06

    Balance problems and binocular visual dysfunction (BVD) are common problems after stroke, however evidence of an effective rehabilitation method are limited. To evaluate the effect of a four-month rehabilitation program for individuals with balance problems and BVD after a stroke. About 40 sessions of 1.5 hours duration over four months with visual therapy and balance rehabilitation, was provided to all 29 participants, aged 18-67 years, in groups of 7-8 individuals. Several measures for BVD, balance, gait, Health Related Quality Of Life (HRQoL) and functional recovery were used at baseline, at the end of training and at a six-month follow up (FU). We found significant improvements in stereopsis, vergence, saccadic movements, burden of binocular visual symptoms, balance and gait speed, fatigue, HRQoL and functional recovery. Moreover, 60% of the participants were in employment at the six-month FU, compared to only 23% before training. All improvements were sustained at the six-month FU. Although a control group is lacking, the evidence suggests that the positive improvement is a result of the combined visual and balance training. The combination of balance and visual training appears to facilitate changes at a multimodal level affecting several functions important in daily life.

  17. The application of implementation science for pressure ulcer prevention best practices in an inpatient spinal cord injury rehabilitation program.

    Science.gov (United States)

    Scovil, Carol Y; Flett, Heather M; McMillan, Lan T; Delparte, Jude J; Leber, Diane J; Brown, Jacquie; Burns, Anthony S

    2014-09-01

    To implement pressure ulcer (PU) prevention best practices in spinal cord injury (SCI) rehabilitation using implementation science frameworks. Quality improvement. SCI Rehabilitation Center. Inpatients admitted January 2012 to July 2013. Implementation of two PU best practices were targeted: (1) completing a comprehensive PU risk assessment and individualized interprofessional PU prevention plan (PUPP); and (2) providing patient education for PU prevention; as part of the pan-Canadian SCI Knowledge Mobilization Network. At our center, the SCI Pressure Ulcer Scale replaced the Braden risk assessment scale and an interprofessional PUPP form was implemented. Comprehensive educational programing existed, so efforts focused on improving documentation. Implementation science frameworks provided structure for a systematic approach to best practice implementation (BPI): (1) site implementation team, (2) implementation drivers, (3) stages of implementation, and (4) improvement cycles. Strategies were developed to address key implementation drivers (staff competency, organizational supports, and leadership) through the four stages of implementation: exploration, installation, initial implementation, and full implementation. Improvement cycles were used to address BPI challenges. Implementation processes (e.g. staff training) and BPI outcomes (completion rates). Following BPI, risk assessment completion rates improved from 29 to 82%. The PUPP completion rate was 89%. PU education was documented for 45% of patients (vs. 21% pre-implementation). Implementation science provided a framework and effective tools for successful pressure ulcer BPI in SCI rehabilitation. Ongoing improvement cycles will target timeliness of tool completion and documentation of patient education.

  18. Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan.

    Science.gov (United States)

    Shamim, Muhammad Shahzad; Ali, Syed Faizan; Enam, Syed Ather

    2011-01-01

    Surgical stabilization of injured spine in patients with complete spinal cord injury is a common practice despite the lack of strong evidence supporting it. The aim of this study is to compare clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in patients with complete deficits, essentially from a developing country's point of view. A detailed analysis of patients with traumatic spine injury and complete deficits admitted at the Aga Khan University Hospital, Pakistan, from January 2004 till January 2010 was carried out. All patients presenting within 14 days of injury were divided in two groups, those who underwent stabilization procedures and those who were managed non-operatively. The two groups were compared with the endpoints being time to rehabilitation, length of hospital stay, 30 day morbidity/mortality, cost of treatment, and status at follow up. Fifty-four patients fulfilled the inclusion criteria and half of these were operated. On comparing endpoints, patients in the operative group took longer time to rehabilitation (P-value = 0.002); had longer hospital stay (P-value = 0.006) which included longer length of stay in special care unit (P-value = 0.002) as well as intensive care unit (P-value = 0.004); and were associated with more complications, especially those related to infections (P-value = 0.002). The mean cost of treatment was also significantly higher in the operative group (USD 6,500) as compared to non-operative group (USD 1490) (P-value managed non-operatively with a provision of surgery only if their rehabilitation is impeded due to pain or deformity.

  19. Childhood Craniopharyngioma with Hypothalamic Obesity - No Long-term Weight Reduction due to Rehabilitation Programs

    NARCIS (Netherlands)

    Sterkenburg, A. S.; Hoffmann, A.; Gebhardt, U.; Waldeck, E.; Springer, S.; Mueller, H. L.

    2014-01-01

    Background: Severe obesity due to hypothalamic involvement has major impact on prognosis in long-term survivors of childhood craniopharyngioma. The long-term effects of rehabilitation efforts on weight development and obesity in these patients are not analyzed up to now. Patients and Methods: 108

  20. Childhood Craniopharyngioma with Hypothalamic Obesity - No Long-term Weight Reduction due to Rehabilitation Programs

    NARCIS (Netherlands)

    Sterkenburg, A. S.; Hoffmann, A.; Gebhardt, U.; Waldeck, E.; Springer, S.; Mueller, H. L.

    Background: Severe obesity due to hypothalamic involvement has major impact on prognosis in long-term survivors of childhood craniopharyngioma. The long-term effects of rehabilitation efforts on weight development and obesity in these patients are not analyzed up to now. Patients and Methods: 108

  1. 77 FR 21547 - Proposed Priorities; Disability and Rehabilitation Research Projects and Centers Program

    Science.gov (United States)

    2012-04-10

    ... recreational technologies that need to be tested for use by individuals with disabilities. For example, virtual reality (VR) and body movement tracking video-game technologies offer an emerging and highly promising...). Currently, therapy robots are found only in large medical and rehabilitation centers. There is a need to...

  2. Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Remedios López-Liria

    2015-01-01

    Full Text Available Objectives. To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. Materials and Methods. A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients’ functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC. Results. The groups did not significantly differ in the leg side (right/left or clinical characteristics (P>0.05. After the intervention, both groups showed significant improvements (P<0.001 from the baseline values in the level of pain (visual analogue scale, the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices, balance, and walking. Conclusions. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective.

  3. 78 FR 28949 - Fund Availability Under VA's Homeless Providers Grant and Per Diem Program (Rehabilitation)

    Science.gov (United States)

    2013-05-16

    ...--Utilities and Features (e.g., electrical, heating, ventilation, air conditioning (HVAC), boiler, roof... Rehabilitations (e.g., minor repairs or improvements such as painting, flooring, or other aesthetical enhancements... creation of plans, i.e., changing or installing locks or painting. Items (i) and (ii) are not required. If...

  4. Differential Effects of 2 Rehabilitation Programs Following Anterior Cruciate Ligament Reconstruction

    DEFF Research Database (Denmark)

    Setuain, Igor; Izquierdo, Mikel; Idoate, Fernando

    2017-01-01

    in their recovery according to the current evidence-based principles. UCR group followed the national conventional approach for ACL rehabilitation. Main Outcome Measures- Concentric isokinetic knee joint flexor-extension torque assessments at 180º/s and Magnetic Resonance Imaging (MRI) evaluations were performed...

  5. The Effect of Vestibular Rehabilitation Therapy Program on Sensory Organization of Deaf Children With Bilateral Vestibular Dysfunction

    Directory of Open Access Journals (Sweden)

    Amir Abbas Ebrahimi

    2018-01-01

    Full Text Available The purpose of this study was to determine the effect of vestibular rehabilitation therapy program on the sensory organization of deaf children with bilateral vestibular dysfunction. This cross-sectional and analytic study was conducted on 24 students between the age of 7 and 12 years (6 girls and 18 boys with the profound sensorineural hearing loss (PTA>90 dB. They were assessed through the balance subtest in Bruininks-Oseretsky test of motor proficiency (BOTMP. For children which the total score of the balance subtest was 3 standard deviation lower than their peers with typical development, vestibular function testing was completed pre-intervention. Posturography Sensory organization testing (SOT was completed pre- and post-intervention with SPS (Synapsys, Marseille, France. Children with bilateral vestibular impairment were randomly assigned to either the exercise or control group. Exercise intervention consisted of compensatory training, emphasizing enhancement of visual and somatosensory function, and balance training. The exercise group entered in vestibular rehabilitation therapy program for 8 weeks. The children initially participating in the control group were provided the exercise intervention following the post-test. Based on the results there was significant difference in condition 5 and 6, areas of limits of stability (LOS, vestibular ratio and global score in posturography at the end of the intervention, but there was no significant difference in the control group in posturography (P<0.05. The results indicated that testing of vestibular, and postural control function, as well as intervention for deficiencies identified, should be included in deaf children rehabilitation program.

  6. Comparison of self-reported and register data on sickness absence among Norwegian patients participating in an occupational rehabilitation program

    Directory of Open Access Journals (Sweden)

    Irene Øyeflaten

    2010-01-01

    Full Text Available Background: Sick leave and return to work are common outcome variables in studies where the aim is to measure the effect of targeted interventions for individuals that are on sick leave benefits or other allowances. Use of official register data is often restricted, and research on sick leave and return to work are often based on the participants self-reports. However, there is insufficient documentation that there is agreement between self-reports and register data on sick leave benefits and allowances.Aims: The aim of this study was to analyse the individuals' knowledge about states of sick leave benefits or allowances compared with register data from The Labour and Welfare Administration (NAV in Norway.Method: 153 individuals, sick-listed or on allowances, participated in a 4-week inpatient occupational rehabilitation program. 132 (86% answered a questionnaire on assessments of work, sick leave, and allowances three months after completed rehabilitation. Self-reported data were compared with register data from NAV according to four categories: working, sick-listed, on medical/vocational rehabilitation allowance or disability pension. Agreement between self-reported and register data was evaluated in cross-tabulations and reported with kappa values. Stratified analyses were done for gender, age, education, medical diagnosis and length of sick leave/allowances at baseline.Results: Good agreement was found for medical/vocational rehabilitation allowance (kappa=.70 and disability pension (kappa=.65. Moderate agreement was found for working (kappa=.49 and fair agreement for sick-listed (kappa=.36. Stratified analyses showed significant better kappa values for individuals that had been sick-listed less than 12 months before entering the rehabilitation program.Conclusions: Agreements from good to fair were found between self-reported and official register data on sick leave. However, official register data is preferred in research because this will

  7. The effect of the cardiac rehabilitation program on obese and non-obese females with coronary heart disease

    Directory of Open Access Journals (Sweden)

    Fatemeh Esteki Ghashghaei

    2012-01-01

    Full Text Available Introduction: Obesity is strongly associated with coronary heart disease and it is known as an independent risk factor. So, the aim of this study was to investigate the effects of phase II comprehensive cardiac rehabilitation program on obesity indexes, functional capacity, lipid profiles, and fasting blood sugar in obese and non-obese female patients with coronary heart disease and to compare changes in these groups. Materials and Methods: Two hundred and five women with coronary heart disease participated in our study. At the beginning of study, body mass index, functional capacity, and lipid profiles and fasting blood sugar were evaluated; then, these patients were divided into two groups, patients who had BMI≥30 were known as obese and who had BMI<30 were known as non-obese patients. All of them completed the period of cardiac rehabilitation program, and 2 months later, all risk factors were examined for the second time in each group. Data were analyzed with SPSS software version 15. For comparing the mean of outcomes, independent t-tests and paired t-tests were used. Results: Data revealed that unless in weight (P=0.00 and functional capacity (P=0.001, there were no significant differences in obese and non-obese female patients, at baseline. As a result of the cardiac rehabilitation program, both groups had significant improvement in functional capacity (P=0.00, weight reduction (P=0.00, triglyceride (P=0.01 and P=0.02, respectively, low-density lipoprotein cholesterol (P=0.01, and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (P=0.00 and P=0.003, respectively. As well, significant improvement was observed in high-density lipoprotein (P=0.01 only in obese female, and non-obese female had significant differences in total cholesterol (P=0.003. However, there were not significant changes in total cholesterol (P=0.05 and fasting blood sugar (P=0.09 in obese female. Also, non-obese females didn′t have

  8. Impact of symptom burden on health related quality of life of cancer survivors in a Danish cancer rehabilitation program

    DEFF Research Database (Denmark)

    Kjaer, Trille Kristina; Johansen, Christoffer; Ibfelt, Else

    2011-01-01

    to QoL measurements. Material and methods. A questionnaire including the EORTC QLQ-C30 and an empirically derived symptom check-list was completed by 2 486 cancer survivors participating in a rehabilitation program at baseline and at 1, 6 and 12 months' follow-up. We used multivariate linear regression......Abstract Introduction. Little research has been conducted on the effect of self-reported rating of symptom severity on quality of life (QoL) among cancer survivors. The aim of the study was to examine the prevalence of symptoms and whether information about self-reported symptom severity adds value...

  9. Treatment Readiness as a Determinant of Treatment Participation in a Prison-Based Rehabilitation Program: An Exploratory Study.

    Science.gov (United States)

    Bosma, Anouk Q; Kunst, Maarten J J; Dirkzwager, Anja J E; Nieuwbeerta, Paul

    2017-06-01

    The current study had three aims. First, it measured treatment readiness among offenders who entered the Prevention of Recidivism program. This is a prison-based rehabilitation program in the Netherlands that aims to lower re-offending rates among offenders with a prison sentence of at least for months and that is carried out during the final months of incarceration. Second, the study evaluated whether treatment readiness was associated with treatment participation. Third, the study examined whether treatment readiness measured with a validated instrument predicted treatment participation above and beyond a clinical assessment of treatment readiness, currently used as a criterion to include offenders in rehabilitation programs. To address these aims, data were used from the fourth wave of a research project studying the effects of imprisonment on the life of detainees in the Netherlands. Results indicated that treatment readiness as measured with a validated instrument was a significant predictor of treatment participation. Also, the current study showed that treatment readiness measured with a validated instrument improved the prediction of treatment participation above and beyond a clinical assessment of treatment readiness. Outcomes were discussed in light of study limitations and implications.

  10. What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears.

    Science.gov (United States)

    Boorman, Richard S; More, Kristie D; Hollinshead, Robert M; Wiley, James P; Mohtadi, Nicholas G; Lo, Ian K Y; Brett, Kelly R

    2018-03-01

    The purpose of this study was to examine 5-year outcomes in a prospective cohort of patients previously enrolled in a nonoperative rotator cuff tear treatment program. Patients with chronic (>3 months), full-thickness rotator cuff tears (demonstrated on imaging) who were referred to 1 of 2 senior shoulder surgeons were enrolled in the study between October 2008 and September 2010. They participated in a comprehensive, nonoperative, home-based treatment program. After 3 months, the outcome in these patients was defined as "successful" or "failed." Patients in the successful group were essentially asymptomatic and did not require surgery. Patients in the failed group were symptomatic and consented to undergo surgical repair. All patients were followed up at 1 year, 2 years, and 5 or more years. At 5 or more years, all patients were contacted for follow-up; the response rate was 84%. Approximately 75% of patients remained successfully treated with nonoperative treatment at 5 years and reported a mean rotator cuff quality-of-life index score of 83 of 100 (SD, 16). Furthermore, between 2 and 5 years, only 3 patients who had previously been defined as having a successful outcome became more symptomatic and underwent surgical rotator cuff repair. Those in whom nonoperative treatment had failed and who underwent surgical repair had a mean rotator cuff quality-of-life index score of 89 (SD, 11) at 5-year follow-up. The operative and nonoperative groups at 5-year follow-up were not significantly different (P = .11). Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  11. Does different duration of non-operative immobilization have an effect on the redislocation rate of primary patellar dislocation?

    DEFF Research Database (Denmark)

    Kaewkongnok, Bo; Bøvling, Anders; Milandt, Nikolaj

    2018-01-01

    BACKGROUND: Immobilization devices such as plaster splints, casts and braces have been used for first time patellar dislocation (FTPD) in order to prevent redislocation. This study evaluates different non-operative immobilization regimes upon rates of redislocation. METHODS: A retrospective cohort...... study with a study population of 1366 in which 601 subjects under 30years with FTPD were included from three hospitals. Exclusion criteria were osteochondral fracture, ligament injury and subluxation. Subjects were divided into five groups; unknown/none, two weeks of brace, two weeks of brace followed...... by bandage, four weeks of brace and six weeks of brace with increasing of range of motion. Radiographs were evaluated for trochlear dysplasia (TD), patella alta, trochlear depth and growth zone. Crude analysis and logistic regression adjusted for radiographic assessments, age, gender and rehabilitation...

  12. A retrospective observational study of functional outcomes, length of stay, and discharge disposition after an inpatient stroke rehabilitation program in Saudi Arabia.

    Science.gov (United States)

    Bindawas, Saad M; Mawajdeh, Hussam; Vennu, Vishal; Alhaidary, Hisham

    2016-08-01

    Functional outcomes, length of stay (LOS), and discharge disposition have become frequent outcome measures among stroke patients after rehabilitation programs. To examine the trends of changes in functional outcomes, LOS, and discharge disposition in stroke patients discharged from an inpatient rehabilitation facility.All patients (n = 432) were admitted to a tertiary inpatient rehabilitation hospital in Riyadh, Saudi Arabia with stroke diagnoses from November 2008 to December 2014. The functional independence measure (FIM) instrument used to assess the patient's functional status. The LOS was measured as the number of days the patients spent in the hospital from the day of admission to the day of discharge. The FIM efficiency was used to measure the patient's rehabilitation progress. All of the variables of the prospectively collected data were retrospectively analyzed.There were significant changes by years in the total FIM ranging from 23 to 29 (P stroke have improved after an inpatient stroke rehabilitation program between 2008 and 2014 even with a constant LOS. Discharge disposition has remained unstable over this period. To improve the efficiency of the stroke rehabilitation program in Saudi Arabia, there is a need to decrease the LOS and emphasize a comprehensive interdisciplinary approach.

  13. Experiences of an Internet-based aural rehabilitation (IAR) program for hearing aid users: a qualitative study.

    Science.gov (United States)

    Malmberg, Milijana; Sundewall Thorén, Elisabet; Öberg, Marie; Lunner, Thomas; Andersson, Gerhard; Kähäri, Kim

    2018-04-24

    Internet interventions for hearing aid (HA) users have been shown to be effective in helping persons with hearing problems. As earlier research refers to objective data on these effects, little is known about how participants experience the Internet interventions subjectively. The aim of the present study was to explore participants' experiences of an Internet-based aural rehabilitation (IAR) program for HA-users, and to explore the possible subjective benefits of such a program. A qualitative exploratory design was implemented involving semi-structured telephone interviews. The interviews were transcribed and analysed using content analysis. Interviews were conducted with 20 participants (9 men and 11 women) who had completed an IAR program for HA-users. The participants were 57-81 years old and had used HAs for 2-25 years. The results are organised in three main categories: general experiences associated with participating in the program, knowledge obtained from the program and perceived impact of taking part in the program. The overall results indicate positive experiences of the IAR program, and an overreaching theme of increased self-esteem was identified. The findings provide some valuable information for developers of future IAR programs.

  14. Referral to Cardiac Rehabilitation After Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery, and Valve Surgery: Data From the Clinical Outcomes Assessment Program.

    Science.gov (United States)

    Beatty, Alexis L; Bradley, Steven M; Maynard, Charles; McCabe, James M

    2017-06-01

    Despite guideline recommendations that patients undergoing percutaneous coronary intervention (PCI), coronary artery bypass surgery, or valve surgery be referred to cardiac rehabilitation, cardiac rehabilitation is underused. The objective of this study was to examine hospital-level variation in cardiac rehabilitation referral after PCI, coronary artery bypass surgery, and valve surgery. We analyzed data from the Clinical Outcomes Assessment Program, a registry of all nonfederal hospitals performing PCI and cardiac surgery in Washington State. We included eligible PCI, coronary artery bypass surgery, and valve surgery patients from 2010 to 2015. We analyzed PCI and cardiac surgery separately by performing multivariable hierarchical logistic regression for the outcome of cardiac rehabilitation referral at discharge, clustered by hospital. Patient-level covariates included age, sex, race/ethnicity, comorbidities, and procedure indication/status. Cardiac rehabilitation referral was reported in 48% (34 047/71 556) of PCI patients and 91% (21 831/23 972) of cardiac surgery patients. The hospital performing the procedure was a stronger predictor of referral than any individual patient characteristic for PCI (hospital referral range 3%-97%; median odds ratio, 5.94; 95% confidence interval, 4.10-9.49) and cardiac surgery (range 54%-100%; median odds ratio, 7.09; 95% confidence interval, 3.79-17.80). Hospitals having an outpatient cardiac rehabilitation program explained only 10% of PCI variation and 0% of cardiac surgery variation. Cardiac rehabilitation referral at discharge was less prevalent after PCI than cardiac surgery. The strongest predictor of cardiac rehabilitation referral was the hospital performing the procedure. Efforts to improve cardiac rehabilitation referral should focus on increasing referral after PCI, especially in low referral hospitals. © 2017 American Heart Association, Inc.

  15. Principles of developing a well-rounded program of physical rehabilitation for female students in the special medical group with consideration of physical activity impairment

    Directory of Open Access Journals (Sweden)

    N. R. Golod

    2015-05-01

    Full Text Available Purpose : to highlight the main provisions of a comprehensive physical rehabilitation program for students of special medical group based on violations of the motor capacity. Material : testing 24 students of special medical group and the same number of their healthy peers on standardized tests of physical qualities. To reflect the movement disorders applied functional movement screen. Results : a program of rehabilitation of the students included: lifestyle modification; morning hygienic gymnastics; kinesitherapy (using yoga fitness, functional training; aerobic exercise (swimming, Nordic Walking, jogging, aerobics wellness; massage. First presented a unified approach to working with students of special medical groups - selection based on load capacity motor disorders according to the results of tests of functional movement screen. The complexity of the impact of the program involves the impact on the physical, social and mental health components. Conclusions : the author's program of physical rehabilitation of students of special medical group is complex.

  16. Criteria for nonoperative management of blunt splenic trauma

    Directory of Open Access Journals (Sweden)

    Sarmast Shoushtary MH

    2009-02-01

    Full Text Available "nBackground: Although nonoperative management is as an alternative method for surgery in the management of blunt splenic trauma, there are many contraversies in criteria for appropriate selection of the best method of management in patients. This study was conducted to find clinical and diagnostic criteria for selection of patients for surgery. "nMethods: One hundred and one patients with blunt splenic injury entered in our prospective observational and cross sectional study. Patients with unstable hemodyna-mics and obvious abdominal symptoms underwent emergency splenectomy was performed. In stable patients, abdominal and pelvic CT scan with IV contrast was performed. Patients with stable hemodynamics who lack obvious abdominal symptoms, admitted in ICU ward. Patients' demographics, blood pressure changes, hemoglobin concertration, severity of trauma with injury severity score (ISS scoring system, CT scan findings, amount of blood transfusion; Hospitalization time and mechanism of injury were recorded. "nResults: From 101 patients, 61(60.3% underwent early laparotomy. 40 patients were planned for conservative management. In 30 patients (29.7% nonoperative management was successful. In 10 patients (9.9% This management failed and they underwent surgery. Hypotension, hemoglobin concentration dropping more than one episode and blood transfusion requirement more than one time, increased the risk of operation. Higher ISS number and ISS≥16 had a direct relation with operative management. In patients who underwent early laparotomy CT grade of injury was higher. CT findings correlated well with laparotomy findings. "nConclusion: Nonoperative management was successful in 75% of selected patients. With correct selection of patients and concerning to homodynamic status, hemoglobin concentration changes and injury severity score in conjunction with CT findings, we can use this management in greater number of patients.

  17. Nonoperative management of pancreatic injuries in pediatric patients

    International Nuclear Information System (INIS)

    Cigdem, M.K.; Senturk, S.; Onen, A.; Siga, M.; Akay, H.; Otcu, S.

    2011-01-01

    Nonoperative management of minor pancreatic injury is the generally accepted approach. However, the management of major pancreatic injury remains controversial in pediatric patients. The aim of the present study was to determine the safety and efficacy of nonoperative management of pancreatic injury in pediatric patients. Between 2003 and 2009, 31 patients, 28 male and 3 female, with pancreatic injury due to blunt abdominal trauma were treated in our clinic. All patients were evaluated by ultrasonography, computed tomography (CT), and evaluation of serum amylase levels. Patients with ongoing hemodynamic instability after resuscitation or signs of bowel perforation underwent immediate laparotomy, and the remaining patients were conservatively treated. Conservative treatment consisted of nasogastric tube replacement, total parenteral nutrition, monitoring of amylase levels, and serial clinical examination. The most common mechanism of injury was a fall (35.4%). Ten patients (32.2%) had associated extraabdominal injuries, and 18 patients (58.1%) had associated abdominal injuries. The spleen was the most common site of intra-abdominal injury that was associated with pancreatic trauma. Initial amylase levels were normal in 5 patients, whose CT scans revealed pancreatic injury. Twenty-five patients (80.6%) were conservatively treated. Six patients (19.4%) required surgical intervention because of a hollow viscus or diaphragmatic injury and hemodynamic instability. A pseudocyst developed in 11 of the 25 patients who were nonoperatively treated; 6 patients required intervention for the pseudocyst (percutaneous drainage and cystogastrostomy). No patient succumbed to injury. The majority of the pancreatic injuries in pediatric patients can be successfully treated conservatively, unless there is hemodynamic instability and a hollow viscus injury. The most common complication is a pseudocyst. (author)

  18. The NHV rehabilitation services program improves long-term physical functioning in survivors of the 2008 Sichuan earthquake: a longitudinal quasi experiment.

    Directory of Open Access Journals (Sweden)

    Xia Zhang

    Full Text Available BACKGROUND: Long-term disability following natural disasters significantly burdens survivors and the impacted society. Nevertheless, medical rehabilitation programming has been historically neglected in disaster relief planning. 'NHV' is a rehabilitation services program comprised of non-governmental organizations (NGOs (N, local health departments (H, and professional rehabilitation volunteers (V which aims to improve long-term physical functioning in survivors of the 2008 Sichuan earthquake. We aimed to evaluate the effectiveness of the NHV program. METHODS/FINDINGS: 510 of 591 enrolled earthquake survivors participated in this longitudinal quasi-experimental study (86.3%. The early intervention group (NHV-E consisted of 298 survivors who received institutional-based rehabilitation (IBR followed by community-based rehabilitation (CBR; the late intervention group (NHV-L was comprised of 101 survivors who began rehabilitation one year later. The control group of 111 earthquake survivors did not receive IBR/CBR. Physical functioning was assessed using the Barthel Index (BI. Data were analyzed with a mixed-effects Tobit regression model. Physical functioning was significantly increased in the NHV-E and NHV-L groups at follow-up but not in the control group after adjustment for gender, age, type of injury, and time to measurement. We found significant effects of both NHV (11.14, 95% CI 9.0-13.3 and sponaneaous recovery (5.03; 95% CI 1.73-8.34. The effect of NHV-E (11.3, 95% CI 9.0-13.7 was marginally greater than that of NHV-L (10.7, 95% CI 7.9-13.6. It could, however, not be determined whether specific IBR or CBR program components were effective since individual component exposures were not evaluated. CONCLUSION: Our analysis shows that the NHV improved the long-term physical functioning of Sichuan earthquake survivors with disabling injuries. The comprehensive rehabilitation program benefitted the individual and society, rehabilitation services

  19. The NHV rehabilitation services program improves long-term physical functioning in survivors of the 2008 Sichuan earthquake: a longitudinal quasi experiment.

    Science.gov (United States)

    Zhang, Xia; Reinhardt, Jan D; Gosney, James E; Li, Jianan

    2013-01-01

    Long-term disability following natural disasters significantly burdens survivors and the impacted society. Nevertheless, medical rehabilitation programming has been historically neglected in disaster relief planning. 'NHV' is a rehabilitation services program comprised of non-governmental organizations (NGOs) (N), local health departments (H), and professional rehabilitation volunteers (V) which aims to improve long-term physical functioning in survivors of the 2008 Sichuan earthquake. We aimed to evaluate the effectiveness of the NHV program. 510 of 591 enrolled earthquake survivors participated in this longitudinal quasi-experimental study (86.3%). The early intervention group (NHV-E) consisted of 298 survivors who received institutional-based rehabilitation (IBR) followed by community-based rehabilitation (CBR); the late intervention group (NHV-L) was comprised of 101 survivors who began rehabilitation one year later. The control group of 111 earthquake survivors did not receive IBR/CBR. Physical functioning was assessed using the Barthel Index (BI). Data were analyzed with a mixed-effects Tobit regression model. Physical functioning was significantly increased in the NHV-E and NHV-L groups at follow-up but not in the control group after adjustment for gender, age, type of injury, and time to measurement. We found significant effects of both NHV (11.14, 95% CI 9.0-13.3) and sponaneaous recovery (5.03; 95% CI 1.73-8.34). The effect of NHV-E (11.3, 95% CI 9.0-13.7) was marginally greater than that of NHV-L (10.7, 95% CI 7.9-13.6). It could, however, not be determined whether specific IBR or CBR program components were effective since individual component exposures were not evaluated. Our analysis shows that the NHV improved the long-term physical functioning of Sichuan earthquake survivors with disabling injuries. The comprehensive rehabilitation program benefitted the individual and society, rehabilitation services in China, and international rehabilitation

  20. Effect of a rehabilitation-based chronic disease management program targeting severe COPD exacerbations on readmission patterns

    Directory of Open Access Journals (Sweden)

    Lalmolda C

    2017-08-01

    Full Text Available C Lalmolda,1–3 R Coll-Fernández,4 N Martínez,1 M Baré,5 M Teixidó Colet,5 F Epelde,6 E Monsó1–3 On behalf of the COPD Multidisciplinary Management Group 1Respiratory Diseases Department, Hospital Universitari Parc Tauli, 2Ciber de Enfermedades Respiratorias – Ciberes, 3Universitat Autònoma de Barcelona – UAB, 4Rehabilitation Department, Hospital Universitari Parc Tauli, 5Primary Care Unit Vallés Occidental, Institut Català de la Salut, 6Short Stay Unit, Emergency Service, Hospital Universitari Parc Taulí, Barcelona, Spain Background: Pulmonary rehabilitation (PR is recommended after a severe COPD exacerbation, but its short- and long-term effects on health care utilization have not been fully established. Aims: The aims of this study were to evaluate patient compliance with a chronic disease management (CDM program incorporating home-based exercise training as the main component after a severe COPD exacerbation and to determine its effects on health care utilization in the following year. Materials and methods: COPD patients with a severe exacerbation were included in a case-cohort study at admission. An intervention group participated in a nurse-supervised CDM program during the 2 months after discharge, comprising of home-based PR with exercise components directly supervised by a physiotherapist, while the remaining patients followed usual care.Results: Nineteen of the twenty-one participants (90.5% were compliant with the CDM program and were compared with 29 usual-care patients. Compliance with the program was associated with statistically significant reductions in admissions due to respiratory disease in the following year (median [interquartile range]: 0 [0–1] vs 1 [0–2.5]; P=0.022 and in days of admission (0 [0–7] vs 7 [0–12]; P=0.034, and multiple linear regression analysis confirmed the protective effect of the CDM program (β coefficient -0.785, P=0.014, and R2=0.219.Conclusion: A CDM program incorporating

  1. Short-Term and Long-Term Outcomes of a Vocational Rehabilitation Program for Patients with Acquired Brain Injury in The Netherlands

    NARCIS (Netherlands)

    van Dongen, Caroline H.; Goossens, Paulien H.; van Zee, Inge E.; Verpoort, Kirsten N.; Vliet Vlieland, Thea P. M.; van Velzen, Judith M.

    2017-01-01

    Purpose To describe short-term and long-term work status after a vocational rehabilitation (VR) program in patients with acquired brain injury (ABI) in the Netherlands. Methods Patients with ABI who participated in a VR program between 2007 and 2010 were included in this study. The 4-month VR

  2. Acute cognitive dysfunction after hip fracture: frequency and risk factors in an optimized, multimodal, rehabilitation program

    DEFF Research Database (Denmark)

    Bitsch, Martin; Foss, Nicolai Bang; Kristensen, Billy Bjarne

    2006-01-01

    hip fracture surgery in an optimized, multimodal, peri-operative rehabilitation regimen. METHODS: One hundred unselected hip fracture patients treated in a well-defined, optimized, multimodal, peri-operative rehabilitation regimen were included. Patients were tested upon admission and on the second......BACKGROUND: Patients undergoing hip fracture surgery often experience acute post-operative cognitive dysfunction (APOCD). The pathogenesis of APOCD is probably multifactorial, and no single intervention has been successful in its prevention. No studies have investigated the incidence of APOCD after......, fourth and seventh post-operative days with the Mini Mental State Examination (MMSE) score. RESULTS: Thirty-two per cent of patients developed a significant post-operative cognitive decline, which was associated with several pre-fracture patient characteristics, including age and cognitive function...

  3. Progress assessed with the Mayo-Portland Adaptability Inventory in 604 participants in 4 types of post-inpatient rehabilitation brain injury programs.

    Science.gov (United States)

    Eicher, Vicki; Murphy, Mary Pat; Murphy, Thomas F; Malec, James F

    2012-01-01

    To compare progress in 4 types of post-inpatient rehabilitation brain injury programs. Quasiexperimental observational cohort study. Community and residential. Individuals (N=604) with acquired brain injury. Four program types within the Pennsylvania Association of Rehabilitation Facilities were compared: intensive outpatient and community-based rehabilitation (IRC; n=235), intensive residential rehabilitation (IRR; n=78), long-term residential supported living (SLR; n=246), and long-term community-based supported living (SLC; n=45). With the use of a commercial web-based data management system developed with federal grant support, progress was examined on 2 consecutive assessments. Mayo-Portland Adaptability Inventory (MPAI-4). Program types differed in participant age (F=10.69, PMPAI-4 score (F=6.89, PMPAI-4 score and chronicity were significantly associated with the second MPAI-4 rating. On average, SLR participants were 9.1 years postinjury compared with 5.1 years for IRR, 6.0 years for IRC, and 6.8 years for SLC programs. IRR participants were more severely disabled per MPAI-4 total score on admission than the other groups. Controlling for these variables, program types varied significantly on second MPAI-4 total score (F=5.14, P=.002). Both the IRR and IRC programs resulted in significant functional improvement across assessments. In contrast, both the SLR and SLC programs demonstrated relatively stable MPAI-4 scores. Results are consistent with stated goals of the programs; that is, intensive programs resulted in functional improvements, whereas supported living programs produced stable functioning. Further studies using data from this large, multiprovider measurement collaboration will potentially provide the foundation for developing outcome expectations for various types of postacute brain injury programs. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  4. Does a Rehabilitation Program of Aerobic and Progressive Resisted Exercises Influence HIV-Induced Distal Neuropathic Pain?

    Science.gov (United States)

    Maharaj, Sonill S; Yakasai, Abdulsalam M

    2018-05-01

    Distal symmetrical polyneuropathy is a common neurological sequela after HIV, which leads to neuropathic pain and functional limitations. Rehabilitation programs with exercises are used to augment pharmacological therapy to relieve pain but appropriate and effective exercises are unknown. This study explored the safety and effect of moderate-intensity aerobic exercises and progressive resisted exercises for HIV-induced distal symmetrical polyneuropathy neuropathic pain. A randomized pretest, posttest of 12 wks of aerobic exercise or progressive resisted exercise compared with a control. Outcome measures were assessed using the subjective periphery neuropathy, brief peripheral neuropathy screening, and numeric pain rating scale. Pain was assessed at baseline, 6 and 12 wks. Data between groups were compared using Kruskal-Wallis, Mann-Whitney U test, and within-groups Friedman and Wilcoxon signed rank tests. There were 136 participants (mean [SD] age = 36.79 [8.23] yrs) and the exercise groups completed the protocols without any adverse effects. Pain scores within and between aerobic exercise and progressive resisted exercise groups showed significant improvement (P 0.05). This study supports a rehabilitation program of moderate-intensity aerobic exercise and progressive resisted exercise being safe and effective for reducing neuropathic pain and is beneficial with analgesics for HIV-induced distal symmetrical polyneuropathy.

  5. Short-term results of a 5-week comprehensive cardiac rehabilitation program after first-time myocardial infarction.

    Science.gov (United States)

    Fallavollita, Luca; Marsili, Bruno; Castelli, Sandro; Cucchi, Francesca; Santillo, Elpidio; Marini, Luciano; Balestrini, Fabrizio

    2016-03-01

    A prospective single-center interventional cohort study was conducted to evaluate the effects of a 5-week comprehensive cardiac rehabilitation program on terms exercise capacity, quality of life, echocardiographic findings and autonomic modulation after first-time myocardial infarction. We studied 37 consecutive post-myocardial infartion patients (mean age 66 years). All patients began a 5-week cardiac rehabilitation supervised training. The exercise program consisted of 40 minutes of training, three times a week, on a cycle ergometer at 60-80% of the maximal heart rate. At baseline and after training program we analyzed: the distance walked after the Six-Minutes Walking Test (6MWT); quality of life (QoL) assesed using the Psychological General Well-Being Inventory (PGWBI) questionnaire; echocardiographic finding and autonomic balance assesed heart rate variability (HRV). We observed statistically significant improvement in exercise capacity (from 423±94 to 496±13 m; P<0.05). Also we observed statistically significant improvements in the many PGWBI dimensions; particularly, anxiety +5.8% (from 18.11±5.2 to 19.12±4.4); depression +6.0% (from 12.00±3.0 to 12.73±2.4); positive well-being +6% (from 11.55±3.5 to 12.23±4.0); general health +10.3% (from 9.48±3.5 to 10.46±2.87); vitality +6.8% (from 12.96±4.2 to 13.85±4.2). Finally, we observed changes in HRV indices after training program: RR (from 903±169 ms to 952±163 ms; P<0.05), pNN50% (from 4.74±4.89 to 6.23±5.53; P<0.05), in time-domain; LF (from 274±169 to 362±233 ms2; P<0,05); HF (from 214±154 to 314±194 ms2; P<0.05) and LF/HF (from 1.53±0.54 to 1.24±0.47; P<0.05) in frequency-domain. The study suggest that a cardiac rehabilitation program in postmyocardial infarction improves exercise capacity, QoL and autonomic modulation.

  6. Operative versus nonoperative treatment of displaced midshaft clavicle fractures in adults

    DEFF Research Database (Denmark)

    Rehn, Carl-Henrik; Kirkegaard, Martin; Viberg, Bjarke

    2013-01-01

    Intervention studies of clavicle fracture treatment are numerous, but only a few high quality studies prospectively compare operative and nonoperative treatment. The objective of this study was to review evidence from randomized controlled trials on operative versus nonoperative treatment of disp...

  7. Dynamics of cardiovascular parameters in combined aortic malformations under the influence of a physical therapy program during the rehabilitation process

    Directory of Open Access Journals (Sweden)

    Serhii Kalmykov

    2017-12-01

    Full Text Available Purpose: to study hemodynamic parameters and the reaction of the cardiovascular system to the dosed physical load of patients combined aortic defect with heart failure of the I degree under the influence of the complex physical therapy program developed by us during the rehabilitation process. Material & Methods: the study involved 26 middle-aged men with a diagnosis: combined aortic valve disease, HF I st. Result: dynamics of functional parameters of the cardiovascular system of patients under the influence of the physical therapy program is analyzed. Conclusion: the combination of morning hygienic gymnastics, therapeutic gymnastics, independent activities and dosed walking with a therapeutic massage contributes to the normalization of vascular tone, motor-vascular reflexes and blood pressure, increasing the tolerance of the cardiovascular system to physical activity.

  8. Nonoperative management for major blunt hepatic trauma. A case report.

    Science.gov (United States)

    Mingoli, Andrea; Saracino, Andrea; Brachini, Gioia; Mariotta, Giovanni; Migliori, Emanuele; Silvestri, Vania

    2015-03-16

    Over the past 20 years the management of blunt liver trauma has evolved from a primary operative approach to a nonoperative one, for both low and high grade injuries, only on the basis of hemodynamic stability. However, in spite of a high success rate of non operative management, it is frequently observed, also in our country, an old fashioned way to approach these patients, based on habit more than observation and evidence based medicine. We present a case of successful nonoperative treatment of a grade IV blunt liver trauma (lacero-contusive injury of V, VI and VII segments) in a 34-year-old woman. Nowadays more than 85% of liver injuries are managed without operative intervention, irrespective of the injury grade. Success rate of the conservative approach ranges from 82% to 100% and almost all complications (14% in high grade injuries) can be managed with interventional radiology procedures, still avoiding major surgery. Today, in the absence of other abdominal injuries requiring surgical exploration, hemodynamic instability from ongoing hemorrhage after primary evaluation and resuscitative treatment, is the only indication to an operative management of traumatic liver injuries.

  9. Nonoperative management of blunt hepatic trauma: A systematic review.

    Science.gov (United States)

    Boese, Christoph Kolja; Hackl, Michael; Müller, Lars Peter; Ruchholtz, Steffen; Frink, Michael; Lechler, Philipp

    2015-10-01

    Nonoperative management (NOM) has become the standard treatment in hemodynamically stable patients with blunt hepatic injuries. While the reported overall success rates of NOM are excellent, there is a lack of consensus regarding the risk factors predicting the failure of NOM. The aim of this systematic review was to identify the incidence and prognostic factors for failure of NOM in adult patients with blunt hepatic trauma. Prospective studies reporting prognostic factors for the failure of nonoperative treatment of blunt liver injuries were identified by searching MEDLINE and the Cochrane Central Register of Controlled Trials. We screened 798 titles and abstracts, of which 8 single-center prospective observational studies, reporting 410 patients, were included in the qualitative and quantitative synthesis. No randomized controlled trials were found. The pooled failure rate of NOM was 9.5% (0-24%). Twenty-six prognostic factors predicting the failure of NOM were reported, of which six reached statistical significance in one or more studies: blood pressure (p hepatic injuries. Systematic review, level III.

  10. Early rehabilitation exercise program for inpatients during an acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial.

    Science.gov (United States)

    Tang, Clarice Y; Blackstock, Felicity C; Clarence, Michael; Taylor, Nicholas F

    2012-01-01

    To determine whether an early rehabilitation program was safe and feasible for patients during an acute exacerbation of chronic obstructive pulmonary disease (COPD). In this phase 1 randomized controlled trial, patients with an acute exacerbation of COPD admitted to the hospital were randomly allocated to a low-intensity exercise group, a moderate- to high-intensity exercise group, or a control group, who received routine physical therapy. In addition to routine physical therapy, patients in the exercise group had to participate in an exercise program. The program consisted of twice-daily aerobic and resistance exercise sessions. Primary outcomes were the number and classification of adverse events and program adherence. In 174 exercise sessions, there was 1 serious adverse event of arrhythmia in the low-intensity exercise group that resolved within 1 hour. There were 12 other minor adverse events involving 5 patients with no significant differences between groups. Patients completed an average of 80% of their scheduled sessions with no significant between-group differences. The exercise groups improved significantly in walking distance; however, no significant between-group differences were observed. There was preliminary evidence that it was safe and feasible to implement an exercise program for patients during an acute exacerbation of COPD. Additional studies with larger sample sizes are required to accurately evaluate program effectiveness.

  11. A bio-psycho-social exercise program (RÜCKGEWINN for chronic low back pain in rehabilitation aftercare - Study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Pfeifer Klaus

    2010-11-01

    Full Text Available Abstract Background There is strong, internationally confirmed evidence for the short-term effectiveness of multimodal interdisciplinary specific treatment programs for chronic back pain. However, the verification of long-term sustainability of achieved effects is missing so far. For long-term improvement of pain and functional ability high intervention intensity or high volume seems to be necessary (> 100 therapy hours. Especially in chronic back pain rehabilitation, purposefully refined aftercare treatments offer the possibility to intensify positive effects or to increase their sustainability. However, quality assured goal-conscious specific aftercare programs for the rehabilitation of chronic back pain are absent. Methods/Design This study aims to examine the efficacy of a specially developed bio-psycho-social chronic back pain specific aftercare intervention (RÜCKGEWINN in comparison to the current usual aftercare (IRENA and a control group that is given an educational booklet addressing pain-conditioned functional ability and back pain episodes. Overall rehabilitation effects as well as predictors for compliance to the aftercare programs are analysed. Therefore, a multicenter prospective 3-armed randomised controlled trial is conducted. 456 participants will be consecutively enrolled in inpatient and outpatient rehabilitation and assigned to either one of the three study arms. Outcomes are measured before and after rehabilitation. Aftercare programs are assessed at ten month follow up after dismissal form rehabilitation. Discussion Special methodological and logistic challenges are to be mastered in this trial, which accrue from the interconnection of aftercare interventions to their residential district and the fact that the proportion of patients who take part in aftercare programs is low. The usability of the aftercare program is based on the transference into the routine care and is also reinforced by developed manuals with structured

  12. Assessing the effectiveness of Malaysia's drug prevention education and rehabilitation programs.

    Science.gov (United States)

    Scorzelli, J F

    1988-01-01

    The multifaceted drug prevention education and rehabilitation system of Malaysia appears to have contributed to the steady decrease of the number of identified drug abusers in the country. In this article, those components of the Malaysian system that would be most applicable to the American effort were examined. In the same manner, because the fastest growing minority group in the United States are Asian Americans, in which a significant proportion involve persons from Southeast Asia, those components in the Malaysian system that are applicable to Southeast Asian Americans were examined.

  13. Developing Community-Based Rehabilitation Programs for Musculoskeletal Diseases in Low-Income Areas of Mexico: The Community-Based Rehabilitation for Low-Income Communities Living With Rheumatic Diseases (CONCORD) Protocol

    Science.gov (United States)

    2014-01-01

    Background The negative impact of musculoskeletal diseases on the physical function and quality of life of people living in developing countries is considerable. This disabling effect is even more marked in low-socioeconomic communities within developing countries. In Mexico, there is a need to create community-based rehabilitation programs for people living with musculoskeletal diseases in low-socioeconomic areas. These programs should be directed to prevent and decrease disability, accommodating the specific local culture of communities. Objective The objective of this paper is to describe a research protocol designed to develop, implement, and evaluate culturally sensitive community-based rehabilitation programs aiming to decrease disability of people living with musculoskeletal diseases in two low-income Mexican communities. Methods A community-based participatory research approach is proposed, including multi and transdisciplinary efforts among the community, medical anthropology, and the health sciences. The project is structured in 4 main stages: (1) situation analysis, (2) program development, (3) program implementation, and (4) program evaluation. Each stage includes the use of quantitative and qualitative methods (mixed method program). Results So far, we obtained resources from a Mexican federal agency and completed stage one of the project at Chankom, Yucatán. We are currently receiving funding from an international agency to complete stage two at this same location. We expect that the project at Chankom will be concluded by December of 2017. On the other hand, we just started the execution of stage one at Nuevo León with funding from a Mexican federal agency. We expect to conclude the project at this site by September of 2018. Conclusions Using a community-based participatory research approach and a mixed method program could result in the creation of culturally sensitive community-based rehabilitation programs that promote community development and

  14. Impact of a cardiac rehabilitation program and inflammatory state on endothelial progenitor cells in acute coronary syndrome patients.

    Science.gov (United States)

    Cesari, Francesca; Marcucci, Rossella; Gori, Anna Maria; Burgisser, Costanza; Francini, Sara; Sofi, Francesco; Gensini, Gian Franco; Abbate, Rosanna; Fattirolli, Francesco

    2013-09-01

    Among the benefits of a cardiac rehabilitation (CR) program for patients after an acute coronary syndrome (ACS) is the mobilization of endothelial progenitor cells (EPCs). However not all patients respond to CR with an increase of EPC. We performed this study to identify the characteristics of patients who will not benefit from an increase of EPCs at the end of a CR program. 112 ACS patients were admitted to a four-week CR program. EPCs, high sensitivity C-reactive protein (hsCRP) and NT-ProBNP levels were determined at the beginning (T1) and at the end (T2) of the CR program. All patients performed a cardiopulmonary exercise test at T1 and at T2. EPCs were defined as CD34+KDR+, CD133+KDR+ and CD34+CD133+KDR+. hsCRP and NT-ProBNP were measured by nephelometric and immunometric method, respectively. At T2, we observed a significant increase of EPCs (p=0.001), VO2 peak, Watt max HDL-cholesterol (pprogram. A CR program determines an increase of EPCs with a decrease of CRP and NT-ProBNP. A different trend for EPCs can be detected among patients correlated to CRP levels and exercise tolerance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  15. Gender Differences in Patients' Beliefs About Biological, Environmental, Behavioral, and Psychological Risk Factors in a Cardiac Rehabilitation Program

    Directory of Open Access Journals (Sweden)

    Mozhgan Saeidi

    2014-11-01

    Full Text Available Introduction: There are significant gender differences in the epidemiology and presentation of cardiovascular diseases (CVDs, physiological aspects of CVDs, response to diagnostic tests or interventions, and prevalence or incidence of the associated risk factors. Considering the independent influence of gender on early dire consequences of such diseases, this study was conducted to investigate gender differences in patients' beliefs about biological, environmental, behavioral, and psychological risk factors in a cardiac rehabilitation program. Materials and Methods: This study has cross sectional design. The sample was composed of 775 patients referred to cardiac rehabilitation unit in Imam Ali Hospital in Kermanshah, Iran. The data were collected using clinical interview and patients’ medical records. The data were analyzed using descriptive statistics such as mean, standard deviation, and chi-square test​​. To do the statistical analysis, SPSS version 20 was utilized. Results: As the results indicated, there was a significant difference between the beliefs of men and women about risk factors of heart disease (X2= 48.36; P

  16. To the Issue of Application of L. Ron Hubbard Detoxication Method Under the Program of Semipalatinsk Region Population Rehabilitation

    International Nuclear Information System (INIS)

    Apusheva, B.K.; Nurumbetova, R.M.; Tuleubaev, B.A.

    1998-01-01

    The detoxification is one of the most acute problems of the population rehabilitation program of Semipalatinsk region suffered from the nuclear tests in 1949 - 1989. It is known that a Humanitarian Detoxification Service is success-fully functioning in Russia and facilitates the creation of improving centers for the removal of toxic chemical deposits, radiation decay products, and drugs out of the human organism. A method, which permits the successful removal of chemical deposits from the organism, consists of a number of procedures including the intake of a balanced amount of vitamins and minerals, physical exercises and sauna. It is based on the developments of an American scientist L. Ron Hubbard and analytical results of different biologists, physicians and pharmacologists. The effectiveness of the method was confirmed with the numerous clinical tests and examination of over 20,000 patients. The positive results were also obtained during the application of method to the people suffered from the Chernobyl accident. It is proposed to establish such detoxification centre in Kurchatov in order to perform similar investigations among the population of Semipalatinsk region affected by the nuclear testing. It will be created under the auspices of the Kazakh Detoxification Centre and the Pavlodar Centre of the Dianetika International Public Movement. The stable and successive functioning of the Centre is entirely dependent on the financing from the different funds and contract works. This paper proposes the ways of practical solution of man detoxification problem and the introduction of the method into the existing system of population rehabilitation

  17. HISTORY OF NEUROPSYCHOLOGICAL REHABILITATION

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    N. A. Varako

    2014-01-01

    Full Text Available ABSTRACT. The article reviews the history of neuropsychological rehabilitation. It begins with the description of first rehabilitation programs developed by Paul Broca and Shepherd Franz. Franz’s experimental work for motor recovery in monkeys and correlation between active movement or affected limb immobilization and rehabilitation outcomes are described in further details. Special focus is given on ideas of famous German neurologist and psychiatrist Kurt Goldstein, who laid the foundation for modern approach in rehabilitation. Goldstein developed the idea of connection between rehabilitation and patient’s daily life. He also pointed out the necessity of psychological care of patients with brain damage.Russian neuropsychological approach is presented by its founders L.S. Vygotskiy and A.R. Luriya. Aspects of higher mental processes structure and options of its correction such as “cognitive prosthesis” are described in the sense of the approach.Y. Ben-Yishay, G. Prigatano, B. Wilson represent neuropsychological rehabilitation of the second half of the 20th century. The idea of a holistic approach for rehabilitation consists of such important principles as patient’s active involvement in a process of rehabilitation, work of a special team of rehabilitation professionals, inclusion of patient’s family members. The short review of a new rehabilitation approach for patients in coma, vegetative states and critical patients under resuscitation is given. 

  18. The effects of cardiac rehabilitation program on exercise capacity and coronary risk factors in CABG Patients aged 45-65

    Directory of Open Access Journals (Sweden)

    rahim Mirnasuri

    2014-03-01

    Full Text Available Background : Cardiovascular diseases (CVD are the most common cause of mortalily and inability. In Iran, one third of mortality causes are coronary heart diseases. So, the aim of the present study was to evaluate the effects of a Cardiac Rehabilitation program (CR on exercise capacity (VO2max and coronary risk factors in CABG patients aged 45-65 . Materials and Methods: Of 36 CABG patients randomly selected from Hamadan Shahid Beheshti hospital, 18 subjects as experimental group (with mean age 54.57±6.26 years and weight 72.14±10.83 kg participated in CR program, and 18 subjects as control group (with mean age 57.64±4.75 years and weight 76.5±12 kg without participation in any exercise and CR program participated in this study based on inclusion and exclusion criteria. CR program was an eight-week involving warm-up, aerobic exercises and cool-down. Variables including: anthropometrics measurements and exercise capacity (VO2max, and also coronary risk factors such as body mass index (BMI, waist-hip ratio (WHR, systolic blood pressure (SBP, diastolic blood pressure (DBP, fasting blood sugar (FBS, total cholesterol (TC, triglyceride (TG, low-density lipoprotein (LDL, high-density lipoprotein (HDL, LDL-HDL ratio (LHR, body fat percent (BFP were determined at the first and the last week of CR program in both groups. Results: Statistical analysis by independent t-test indicated that after program, there was a significant difference between 2 groups in VO2max, BMI, WHR, SBP, DBP, TC, TG, LDL, LHR (P<0.05, but there was no significant difference between the 2 groups in FBS, HDL, BFP. Conclusion: The CR program of the present study indicated a significant effect on exercise capacity and some coronary risk factors profile in CABG patients of 45-65 and can it be considered as a suitable program for CABG patients.

  19. THE CONSTRUCTION OF PHYSICAL REHABILITATION PROGRAMS IN THE PREOPERATIVE PERIOD FOR PATIENTS THAT WILL REMOVE OF INTERVERTEBRAL DISC’ PROLAPSE IN THE LUMBAR SPINE

    Directory of Open Access Journals (Sweden)

    E.B. Lazarieva

    2014-06-01

    Full Text Available The ineffectiveness of conservative treatment will make the need for surgery in 4-5% of patients suffering from low back pain with hernias of the lumbar and sacral spine. Despite the surgical removal of the source of compressed roots, nerves and blood vessels, require a comprehensive system of rehabilitation therapy in order to eliminate manifestations of disease and relief of disease progression. The aim of the work is to substantiate the general approaches for the using of physical rehabilitation and diagnostics static component of the dynamic stereotype in the preoperative period in patients to remove intervertebral disc prolapse. The materials and methods. There was examined 96 with low back pain. Methods are applied in this research: analysis of a literature, observation methods. Results. In conjunction with the physician was determined "diagnosis for rehabilitation" and "prognosis of the rehabilitation". The formulation of the basis of the diagnosis for rehabilitation was performed through the examination during the rehabilitation (as a taking an anamnestic data, examination and palpation, studies of intact sensory and motor functions, the results of objective research tool. Conclusions. The identification of preserved anatomical and functional entities, the definition of the initial level of compensation for lost functions and forecast further recovery is a fundamental approach to program development in the preoperative period in patients with low back pain aimed at the removal of intervertebral disc herniations.

  20. Animal assisted therapy (AAT program as a useful adjunct to conventional psychosocial rehabilitation for patients with schizophrenia: results of a small-scale randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Paula eCalvo

    2016-05-01

    Full Text Available Currently, one of the main objectives of human-animal interaction research is to demonstrate the benefits of animal-assisted therapy (AAT for specific profiles of patients or participants.The aim of this study is to assess the effect of an AAT program as an adjunct to a conventional 6-month psychosocial rehabilitation program for people with schizophrenia. Our hypothesis is that the inclusion of AAT into psychosocial rehabilitation would contribute positively to the impact of the overall program on symptomology and quality of life, and that AAT would be a positive experience for patients. To test these hypotheses, we compared pre-program with post-program scores for the Positive and Negative Syndrome Scale (PANSS and the EuroQoL-5 dimensions questionnaire (EuroQol-5D, pre-session with post-session salivary cortisol and alpha-amylase for the last four AAT sessions, and adherence rates between different elements of the program.We conducted a randomized, controlled study in a psychiatric care center in Spain. Twenty-two institutionalized patients with chronic schizophrenia completed the 6-month rehabilitation program, which included individual psychotherapy, group therapy, a functional program (intended to improve daily functioning, a community program (intended to facilitate community reintegration and a family program. Each member of the control group (n=8 participated in one activity from a range of therapeutic activities that were part of the functional program. In place of this functional program activity, the AAT-treatment group (n=14 participated in twice-weekly 1-hour sessions of AAT. All participants received the same weekly total number of hours of rehabilitation. At the end of the program, both groups (control and AAT-treatment showed significant improvements in positive and overall symptomatology, as measured with PANSS, but only the AAT-treatment group showed a significant improvement in negative symptomatology. Adherence to the AAT

  1. Animal Assisted Therapy (AAT) Program As a Useful Adjunct to Conventional Psychosocial Rehabilitation for Patients with Schizophrenia: Results of a Small-scale Randomized Controlled Trial.

    Science.gov (United States)

    Calvo, Paula; Fortuny, Joan R; Guzmán, Sergio; Macías, Cristina; Bowen, Jonathan; García, María L; Orejas, Olivia; Molins, Ferran; Tvarijonaviciute, Asta; Cerón, José J; Bulbena, Antoni; Fatjó, Jaume

    2016-01-01

    Currently, one of the main objectives of human-animal interaction research is to demonstrate the benefits of animal assisted therapy (AAT) for specific profiles of patients or participants. The aim of this study is to assess the effect of an AAT program as an adjunct to a conventional 6-month psychosocial rehabilitation program for people with schizophrenia. Our hypothesis is that the inclusion of AAT into psychosocial rehabilitation would contribute positively to the impact of the overall program on symptomology and quality of life, and that AAT would be a positive experience for patients. To test these hypotheses, we compared pre-program with post-program scores for the Positive and Negative Syndrome Scale (PANSS) and the EuroQoL-5 dimensions questionnaire (EuroQol-5D), pre-session with post-session salivary cortisol and alpha-amylase for the last four AAT sessions, and adherence rates between different elements of the program. We conducted a randomized, controlled study in a psychiatric care center in Spain. Twenty-two institutionalized patients with chronic schizophrenia completed the 6-month rehabilitation program, which included individual psychotherapy, group therapy, a functional program (intended to improve daily functioning), a community program (intended to facilitate community reintegration) and a family program. Each member of the control group (n = 8) participated in one activity from a range of therapeutic activities that were part of the functional program. In place of this functional program activity, the AAT-treatment group (n = 14) participated in twice-weekly 1-h sessions of AAT. All participants received the same weekly total number of hours of rehabilitation. At the end of the program, both groups (control and AAT-treatment) showed significant improvements in positive and overall symptomatology, as measured with PANSS, but only the AAT-treatment group showed a significant improvement in negative symptomatology. Adherence to the AAT

  2. [Effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life for patients with chronic lung disease].

    Science.gov (United States)

    Lee, Chang Kwan

    2007-04-01

    The purpose of this study was to examine the effects of an inpatient pulmonary rehabilitation program on dyspnea, exercise capacity, and health related quality of life in inpatients with chronic lung disease. This quasi experimental study was designed with a nonequivalent control group pre-post test time series. Twenty three patients were assigned to the experimental group and nineteen to the control group. The inpatient pulmonary rehabilitation program was composed of upper and lower extremity exercise, breathing retraining, inspiratory muscle training, education, relaxation and telephone contacts. This program consisted of 4 sessions with inpatients and 4 weeks at home after discharge. The control group was given a home based pulmonary rehabilitation program at the time of discharge. The outcomes were measured by the Borg score, 6MWD and the Chronic Respiratory Disease Questionnaire(CRQ). There was a statistically significant difference in dyspnea between the experimental group and control group, but not among time sequence, or interaction between groups and time sequence. Also significant improvements in exercise capacity and health related quality of life were found only in the experimental group. An Inpatient pulmonary rehabilitation program may be a useful intervention to reduce dyspnea, and increase exercise capacity and health related quality of life for chronic lung disease patients.

  3. Comparing the effects of a cardiac rehabilitation program on functional capacity of obese and non-obese women with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Masoumeh Sadeghi

    2012-06-01

    Full Text Available    BACKGROUND: Obesity and sedentary lifestyle are known as important risk factors of coronary artery disease. The prevalence of obesity has increased among both men and women in the world. Therefore, the present study tried to evaluate the effectiveness of a cardiac rehabilitation program on functional capacity and body mass index (BMI in obese and non-obese women with coronary artery disease.    METHODS: In an observational study during 2000-11, we evaluated a total of 205 women with coronary artery disease who referred to the cardiac rehabilitation unit of Isfahan Cardiovascular Research Institute, Isfahan, Iran. BMI and functional capacity of each patient were assessed before and after the program. The patients were categorized as obese or non-obese based on their BMI. All participants completed the full course of the program. Data was analyzed by independent t-test and paired t-test in SPSS15.    RESULTS: Our finding showed that an 8-week cardiac rehabilitation program had significant effects on functional capacity in obese and non-obese female patients (P < 0.01 for both. The program also resulted in BMI improvements in both groups (P < 0.01 for both. Comparing the changes in the two groups did not reveal any significant differences in functional capacity. However, the two groups were significantly different in terms of BMI changes.    CONCLUSION: Cardiac rehabilitation programs are a major step in restoration of functional capacity and improvement of BMI in obese and non-obese women with coronary artery disease.         Keywords: Cardiac Rehabilitation Program, Coronary Artery Disease, Obesity, Functional Capacity, Body Mass Index.

  4. Evaluation of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation: study protocol of a cluster randomized controlled trial.

    Science.gov (United States)

    Meng, Karin; Musekamp, Gunda; Seekatz, Bettina; Glatz, Johannes; Karger, Gabriele; Kiwus, Ulrich; Knoglinger, Ernst; Schubmann, Rainer; Westphal, Ronja; Faller, Hermann

    2013-08-23

    Chronic heart failure requires a complex treatment regimen on a life-long basis. Therefore, self-care/self-management is an essential part of successful treatment and comprehensive patient education is warranted. However, specific information on program features and educational strategies enhancing treatment success is lacking. This trial aims to evaluate a patient-oriented and theory-based self-management educational group program as compared to usual care education during inpatient cardiac rehabilitation in Germany. The study is a multicenter cluster randomized controlled trial in four cardiac rehabilitation clinics. Clusters are patient education groups that comprise HF patients recruited within 2 weeks after commencement of inpatient cardiac rehabilitation. Cluster randomization was chosen for pragmatic reasons, i.e. to ensure a sufficient number of eligible patients to build large-enough educational groups and to prevent contamination by interaction of patients from different treatment allocations during rehabilitation. Rehabilitants with chronic systolic heart failure (n = 540) will be consecutively recruited for the study at the beginning of inpatient rehabilitation. Data will be assessed at admission, at discharge and after 6 and 12 months using patient questionnaires. In the intervention condition, patients receive the new patient-oriented self-management educational program, whereas in the control condition, patients receive a short lecture-based educational program (usual care). The primary outcome is patients' self-reported self-management competence. Secondary outcomes include behavioral determinants and self-management health behavior (symptom monitoring, physical activity, medication adherence), health-related quality of life, and treatment satisfaction. Treatment effects will be evaluated separately for each follow-up time point using multilevel regression analysis, and adjusting for baseline values. This study evaluates the effectiveness of a

  5. Association of a Proactive Swallowing Rehabilitation Program With Feeding Tube Placement in Patients Treated for Pharyngeal Cancer.

    Science.gov (United States)

    Ajmani, Gaurav S; Nocon, Cheryl C; Brockstein, Bruce E; Campbell, Nicholas P; Kelly, Amy B; Allison, Jamie; Bhayani, Mihir K

    2018-04-19

    A proactive speech and language pathology (SLP) program is an important component of the multidisciplinary care of patients with head and neck squamous cell carcinoma (HNSCC). Swallowing rehabilitation can reduce the rate of feeding tube placement, thereby significantly improving quality of life. To evaluate the initiation of a proactive SLP rehabilitation program at a single institution and its association with rates of feeding tube placement and dietary intake in patients with HNSCC. Cohort study at a tertiary care and referral center for patients with HNSCC serving the northern Chicago region. Patients were treated for squamous cell carcinomas of the hypopharynx, oropharynx, and nasopharynx from 2004 to 2015 with radiation or chemoradiation therapy in the definitive or adjuvant setting. Patients who received less than 5000 cGy radiation or underwent reirradiation were excluded. A proactive SLP program for patients with HNSCC was initiated in 2011. Study cohorts were divided into 2 groups: 2004 through 2010 and 2011 through 2015. Primary outcome variables were SLP referral placement and timing of the referral. Secondary outcomes were feeding tube placement and ability to tolerate any oral intake. A total of 254 patients met inclusion criteria (135 before and 119 after implementation of SLP program; median age, 60 years [range, 14-94 years]; 77% male). With the initiation of a proactive SLP program, pretreatment evaluations increased from 29 (21.5%) to 70 (58.8%; risk ratio [RR], 2.74; 95% CI, 1.92-3.91), and rate of referral overall at any time increased from 60.0% to 79.8% (RR, 1.33; 95% CI, 1.13-1.57). Feeding tube placement rates decreased from 45.9% (n = 62) to 29.4% (n = 35; RR, 0.64; 95% CI, 0.46-0.89). Among patients receiving a swallow evaluation, feeding tube requirements were less frequent for those receiving a pretreatment evaluation (31 of 99 [31%]) than for those referred during (11 of 18 [61%]) or after (38 of 59 [64%]) treatment. The rate

  6. 77 FR 1872 - Vocational Rehabilitation and Employment Program-Changes to Subsistence Allowance

    Science.gov (United States)

    2012-01-12

    ... Order 13563 (Improving Regulation and Regulatory Review) emphasizes the importance of quantifying both... Part 21 Administrative practice and procedure, Armed forces, Civil rights, Claims, Colleges and universities, Conflict of interests, Education, Employment, Grant programs--education, Grant programs--veterans...

  7. EFFECTIVENESS OF SECRETOLYTIC THERAPY IN REHABILITATION PROGRAM IN FREQUENTLY AILING CHILDREN

    Directory of Open Access Journals (Sweden)

    V.V. Kiselev

    2008-01-01

    Full Text Available A problem of rehabilitation of frequently ailing children (FAC is one of the actual problems in pediatrics. Disorders of mucosal immunity, depending on different factors including the state of mucociliary transport, play important role in formation of FAC group including patients with recurrent episodes of obstructive bronchitis. Morphological and functional unity of mucous tunic of respiratory tract allows determining the state of mucociliary clearance and effectiveness of secretolytic therapy by the state of mucosal tunic of nose and nasopharynx (it is the most accessible mucosal tunic for the objective examination. Specified rates of time of mucociliary transport in different groups of FAC are presented in this article. An effectiveness of mucoregulatory medication ambroxol in complex treatment of FAC with adenoids and recurrent episodes of obstructive bronchitis, and advisability of its prolonged (14–18 days use for the recovery of disturbed system of mucociliary transport were described in this article.Key words: frequently ailing children, somatotype, mucociliary clearance, treatment.

  8. CHANGES IN LIPOPROTEIN INDICATOR AND INDICATOR OF ENDOTHELIAL FUNCTION AFTER IMPLEMENTED CARDIOVASCULAR REHABILITATION PROGRAM

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    Jasmina Ranković

    2012-09-01

    Full Text Available Insufficient physical activity in the world annually is the cause of death of 1.9 million people. According to the data from the World Health Report, physical inactivity is about to become the global problem. Regular physical activity and good physical shape raise the functional capacity and the quality of patient’s life. With physical activity it is possible to improve metabolic, endothelial, lateral-muscular, pulmonary and cardiovascular functions of an organism, but also the function of the autonomous nervous system. The endothelium has the important role in maintaining the normal cardiovascular tonus and blood fluidity by reducing the platelet activity and the adhesion of leukocytes, and also by restricting the reaction of vascular inflammation. The aim of this paper was to present the recent data about effects of cardiovascular rehabilitation and physical training on lipoproteins’ status and markers of endothelial function. The impact of physical activity on the lipid status is accomplished by affecting the enzymes of lipoprotein metabolism, including the lipoprotein and the liver lipase and the movable protein of cholesterol ester (11. The studies point out that aerobic physical activity result in increasing of HDL concentration and the decrease of the triglycerides value, total and LDL cholesterol. The connection, which is dose-dependant, exists between physical activity and the lipid level, as the arguments which suggest that the duration of physical activity is the key parameter in modification of the lipid metabolism. Physical activity leads to the beneficial changes in the cardiovascular and lipid indicators and improves the endothelial function in the secondary prevention of coronary disease. Reduction of the lipid parameters by introducing physical rehabilitation and dietetic regime lie in the basis of secondary prevention of coronary disease. Furthermore, there is a constant improvement in NO biodisposability and therewith the

  9. Outcomes of nonoperatively treated displaced scapular body fractures.

    Science.gov (United States)

    Dimitroulias, Apostolos; Molinero, Kenneth G; Krenk, Daniel E; Muffly, Matthew T; Altman, Daniel T; Altman, Gregory T

    2011-05-01

    Displaced scapular body fractures most commonly are treated conservatively. However there is conflicting evidence in the literature regarding the outcomes owing to retrospective design of studies, different classification systems, and diverse outcome tools. The functional outcome after nonoperative management of displaced scapular body fractures was assessed by change in the DASH (Disability of Arm, Shoulder and Hand) score; (2) the radiographic outcome was assessed by the change of the glenopolar angle (GPA); and (3) associated scapular and extrascapular injuries that may affect outcome were identified. Forty-nine consecutive patients were treated with early passive and active ROM exercises for a displaced scapular body fracture. We followed 32 of these patients (65.3%) for a minimum of 6 months (mean, 15 months; range, 6-33 months). Mean age of the patients was 46.9 years (range, 21-84 years) and the mean Injury Severity Score (ISS) was 21.5 (range, 5-50). Subjective functional results (DASH score) and radiographic assessment (fracture union, glenopolar angle) were measured. All fractures healed uneventfully. The mean change of glenopolar angle was 9° (range, 0°-20°). The mean change of the DASH score was 10.2, which is a change with minimal clinical importance. There was a correlation between the change in this score with the ISS and presence of rib fractures. Satisfactory outcomes are reported with nonoperative treatment of displaced scapular body fractures. We have shown that the severity of ISS and the presence of rib fractures adversely affect the clinical outcome.

  10. A 12-week rehabilitation program improves body composition, pain sensation, and internal/external torques of baseball pitchers with shoulder impingement symptom.

    Science.gov (United States)

    Cha, Jun-Youl; Kim, Jae-Hak; Hong, Ju; Choi, Young-Tae; Kim, Min-Ho; Cho, Ji-Hyun; Ko, Il-Gyu; Jee, Yong-Seok

    2014-02-01

    The aim of this study was to investigate the effects of a 12-week rehabilitation program on body composition, shoulder pain, and isokinetic internal/external torques of pitchers with impingement syndrome. A total of 30 pitchers were divided into 2 groups: experimental group (EG, n = 16) and control group (CG, n= 14). The rehabilitation program consisted of physical therapy, warm-up, work-out, and cool-down. As results, body weight and fat mass of EG were decreased whereas muscle mass of EG was significantly increased after the experiment. The pain degrees in resting, normal daily activity, and strenuous activity on the numeric pain rating scale were significantly decreased in the EG. The internal and external peak torques (PTs) of uninvolved and involved sides of EG were increased in EG after 12 weeks. Such results provide a deficit ratio of both sides in EG close to normal values. The ratios of internal/external PTs in EG were also close to the reference values. The internal and external total works of both sides in EG were similar to the values of PT. The fatigue indices of internal and external rotators of both sides in EG were decreased. As a conclusion, a 12-week rehabilitation program reduced the shoulder pain, improved the body composition and enhanced the isokinetic shoulder internal/external rotators in EG with impingement symptoms. Also the study suggested that the rehabilitation program evened out the ratio between internal and external rotators and lowered the fatigue level after the experiment.

  11. Treatment of the Aged Patients at a Large Cardiac Rehabilitation Center in the Southern Brazil and Some Aspects of Their Dropout from the Therapeutic Programs

    Directory of Open Access Journals (Sweden)

    Pietro Felice Tomazini Nesello

    2016-11-01

    CONCLUSION: The Non-Old and the Middle-Old patients showed higher dropout rates compared to Young-Old. To ensure the best possible rehabilitation and to improve patients´ participation in CR, these programs should be adjusted to the needs of patients in terms of their age.

  12. Effect of a home-based exercise program on functional recovery following rehabilitation after hip fracture: a randomized clinical trial.

    Science.gov (United States)

    Latham, Nancy K; Harris, Bette Ann; Bean, Jonathan F; Heeren, Timothy; Goodyear, Christine; Zawacki, Stacey; Heislein, Diane M; Mustafa, Jabed; Pardasaney, Poonam; Giorgetti, Marie; Holt, Nicole; Goehring, Lori; Jette, Alan M

    2014-02-19

    For many older people, long-term functional limitations persist after a hip fracture. The efficacy of a home exercise program with minimal supervision after formal hip fracture rehabilitation ends has not been established. To determine whether a home exercise program with minimal contact with a physical therapist improved function after formal hip fracture rehabilitation ended. Randomized clinical trial conducted from September 2008 to October 2012 in the homes of 232 functionally limited older adults who had completed traditional rehabilitation after a hip fracture. The intervention group (n = 120) received functionally oriented exercises (such as standing from a chair, climbing a step) taught by a physical therapist and performed independently by the participants in their homes for 6 months. The attention control group (n = 112) received in-home and telephone-based cardiovascular nutrition education. Physical function assessed at baseline, 6 months (ie, at completion of the intervention), and 9 months by blinded assessors. The primary outcome was change in function at 6 months measured by the Short Physical Performance Battery (SPPB; range 0-12, higher score indicates better function) and the Activity Measure for Post-Acute Care (AM-PAC) mobility and daily activity (range, 23-85 and 9-101, higher score indicates better function). Among the 232 randomized patients, 195 were followed up at 6 months and included in the primary analysis. The intervention group (n=100) showed significant improvement relative to the control group (n=95) in functional mobility (mean SPPB scores for intervention group: 6.2 [SD, 2.7] at baseline, 7.2 [SD, 3] at 6 months; control group: 6.0 [SD, 2.8] at baseline, 6.2 [SD, 3] at 6 months; and between-group differences: 0.8 [95% CI, 0.4 to 1.2], P daily activity scores for intervention group: 57.4 [SD, 13.7] at baseline, 61.3 [SD, 15.7] at 6 months; control group: 58.2 [SD, 15.2] at baseline, 58.6 [SD, 15.3] at 6 months; and

  13. Sick-listed persons' experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy: a qualitative focus group interview study.

    Science.gov (United States)

    Rise, Marit B; Gismervik, Sigmund Ø; Johnsen, Roar; Fimland, Marius S

    2015-11-27

    Occupational medicine has shifted emphasis from disease treatment to disability rehabilitation and management. Hence, newly developed occupational rehabilitation programs are often generic and multicomponent, aiming to influence the sick-listed persons' perception on return to work, and thereby support the return to work process. The aim of this study was to explore sick-listed persons' experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy. Twenty-nine adults on sickness benefit or work assessment allowance due to musculoskeletal and/or common mental health disorders participated in this study. They were interviewed in focus groups at the beginning and at the end of a 3.5 week inpatient group-based occupational rehabilitation program in Central Norway. Key elements in the program were Acceptance and Commitment Therapy (ACT), physical exercise and creating a work-participation plan. The program was mainly group-based including participants with different diagnoses. Data was analyzed according to a phenomenological approach. At the start of the program most participants expressed frustration regarding being sick-listed, external anticipations as well as hindrances towards returning to work, and described hope that the program would provide them with the skills and techniques necessary to cope with health problems and being able to return to work. At the end of the program the participants described that they had embarked upon a long process of increased awareness. This process encompassed four areas; an increased awareness of what was important in life, realizing the strain from external expectations and demands, a need to balance different aspects of life, and return to work as part of a long and complex process. The occupational rehabilitation program induced a perceived meaningful reorientation encompassing several aspects of life. However, the return to work process was described as diffuse

  14. Alberta Environment's weir safety program : options for rehabilitation to improve public safety : a case study of the Calgary weir

    Energy Technology Data Exchange (ETDEWEB)

    Blakely, D [Alberta Environment, Edmonton, AB (Canada)

    2009-07-01

    Alberta Environment Water Management Operations (WMO) owns and operates 46 dams and 800 kilometres of canals in Alberta. The WMO consists of 120 staff and several contract operators to take care of this infrastructure. Most of the infrastructure supplies water for irrigation use, which adds 5 billion dollars to the provincial economy annually. Other water uses include stock watering, domestic use, municipal use, recreational use and habitat. Alberta Environment's weir safety program was also discussed along with options for rehabilitation to improve public safety. A case study of Calgary's Weir Dam on the Bow River was highlighted. A brief history of the dam was offered and safety programs around provincially-owned weirs were discussed. Photographs were included to illustrate some of the additional safety measures at the Calgary weir, such as suspended safety buoys upstream of the boom directing paddlers to the portage trail, and signage on the river that can be activated when the boom is out. Typical river users on the Calgary Bow River and safety history at the Calgary Weir were discussed along with other topics such as the Calgary Bow River weir project criteria; project design progress; pre-feasibility options; scale modelling; final design analysis; construction funding; and proposed changes to the safety program for the new weir configuration. figs.

  15. Student perspectives of a Student-Led Groups Program model of professional practice education in a brain injury rehabilitation unit.

    Science.gov (United States)

    Patterson, Freyr; Fleming, Jennifer; Marshall, Kathryn; Ninness, Nadine

    2017-10-01

    Professional practice education is a core and essential component of occupational therapy training. With increasing numbers of education programmes and more students requiring professional practice placements, development of innovative models of professional practice education has emerged, but these require investigation. The aim of this study was to investigate student experiences and perceptions of the Student-Led Groups Program model of professional practice education in an inpatient brain injury rehabilitation unit. A qualitative approach, guided by phenomenological theory was used. Participants were 15 students who had completed a professional practice placement in the Student-Led Groups Program. Data were collected using in-depth semi-structured interviews and analysed thematically. Three over-arching themes emerged from the data; balance of support and freedom, development of clinical skills and missed opportunities. Students described how the structure of the placement facilitated independent learning and autonomy that was balanced with support from clinicians and student peers. Students perceived that they had developed a breadth of clinical skills and also had missed some learning opportunities in this professional practice placement structure. Overall student perceptions of the Student-Led Groups Program were positive, supporting the continued use of this model of professional practice education in this setting. The results highlight the value of structured and consistent approaches for supervision, including the use of formal approaches to peer supervision in the initial stages of learning. © 2017 Occupational Therapy Australia.

  16. The effect of Sub-maximal exercise-rehabilitation program on cardio-respiratory endurance indexes and oxygen pulse in patients with spastic cerebral palsy

    Directory of Open Access Journals (Sweden)

    M Izadi

    2006-05-01

    Full Text Available Background: Physical or cardio-respiratory fitness are of the best important physiological variables in children with cerebral palsy (CP, but the researches on exercise response of individuals with CP are limited. Our aim was to determine the effect of sub-maximal rehabilitation program (aerobic exercise on maximal oxygen uptake, oxygen pulse and cardio- respiratory physiological variables of children with moderate to severe spastic cerebral palsy diplegia and compare with able-bodied children. Methods: In a controlled clinical trial study, 15 children with diplegia spastic cerebral palsy, were recruited on a voluntarily basis (experimental group and 18 subjects without neurological impairments selected as control group. In CP group, aerobic exercise program performed on the average of exercise intensity (144 beat per minute of heart rate, 3 times a week for 3 months. The time of each exercise session was 20-25 minutes. Dependent variables were measured in before (pretest and after (post test of rehabilitation program through Mac Master Protocol on Tantories cycle ergometer in CP group and compared with the control group. Results: The oxygen pulse (VO2/HR during ergometery protocol was significantly lower in CP group than normal group (P<0.05. No significant statistical difference in maximal oxygen uptake (VO2 max was found between groups. The rehabilitation program leads to little increase of this variable in CP group. After sub-maximal exercise in pretest and post test, the heart rate of patient group was greater than control group, and aerobic exercise leads to significant decrease in heart rate in CP patients(P<0.05. Conclusion: The patients with spastic cerebral palsy, because of high muscle tone, severe spasticity and involuntarily movements have higher energy cost and lower aerobic fitness than normal people. The rehabilitation exercise program can improve physiological function of muscle and cardio-respiratory endurance in these

  17. Humanoid assessing rehabilitative exercises.

    Science.gov (United States)

    Simonov, M; Delconte, G

    2015-01-01

    This article is part of the Focus Theme of Methods of Information in Medicine on "New Methodologies for Patients Rehabilitation". The article presents the approach in which the rehabilitative exercise prepared by healthcare professional is encoded as formal knowledge and used by humanoid robot to assist patients without involving other care actors. The main objective is the use of humanoids in rehabilitative care. An example is pulmonary rehabilitation in COPD patients. Another goal is the automated judgment functionality to determine how the rehabilitation exercise matches the pre-programmed correct sequence. We use the Aldebaran Robotics' NAO humanoid to set up artificial cognitive application. Pre-programmed NAO induces elderly patient to undertake humanoid-driven rehabilitation exercise, but needs to evaluate the human actions against the correct template. Patient is observed using NAO's eyes. We use the Microsoft Kinect SDK to extract motion path from the humanoid's recorded video. We compare human- and humanoid-operated process sequences by using the Dynamic Time Warping (DTW) and test the prototype. This artificial cognitive software showcases the use of DTW algorithm to enable humanoids to judge in near real-time about the correctness of rehabilitative exercises performed by patients following the robot's indications. One could enable better sustainable rehabilitative care services in remote residential settings by combining intelligent applications piloting humanoids with the DTW pattern matching algorithm applied at run time to compare humanoid- and human-operated process sequences. In turn, it will lower the need of human care.

  18. The effects of a Korean computer-based cognitive rehabilitation program on cognitive function and visual perception ability of patients with acute stroke

    OpenAIRE

    Park, Jin-Hyuck; Park, Ji-Hyuk

    2015-01-01

    [Purpose] The purpose of this study is to investigate the effects of a Korean computer-based cognitive rehabilitation program (CBCR) on the cognitive function and visual perception ability of patients with acute stroke. [Subjects] The subjects were 30 patients with acute stroke. [Methods] The subjects were randomly assigned to either the experimental group (EG) or the control group (CG). The EG subjects received CBCR with the CoTras program. The CG subjects received conventional cognitive reh...

  19. 42 CFR 410.47 - Pulmonary rehabilitation program: Conditions for coverage.

    Science.gov (United States)

    2010-10-01

    ... program. (ii) Objective clinical measures of effectiveness of the PR program for the individual patient, including exercise performance and self-reported measures of shortness of breath and behavior. Physician... certification including basic life support. (4) Is licensed to practice medicine in the State in which the...

  20. Efficiency in Vocational Rehabilitation Program Service Delivery: The Impact of Socioeconomic Context

    Science.gov (United States)

    Gere, Bryan O.; Burnett, Royce D.; Flowers, Carl R.; Akaaboune, Ouadie

    2017-01-01

    Background: State-federal (VR) program efficiency is the focus of empirical research because of increases in the magnitude and types of program requests, possibly funding cuts and class for models to more appropriately measure and evaluate performance. Objective: The purpose of this study was to examine the impact socioeconomic diversity has on…

  1. Measurement of Functional Capacity Requirements of Farmers: IMPLICATIONS FOR A CARDIAC REHABILITATION TRAINING PROGRAM.

    Science.gov (United States)

    Jordan, Shannon; Karcher, Justin; Rogers, Rebecca; Kennedy, Kathleen; Lawrence, Anne; Adams, Jenny

    2017-03-01

    Updated cardiac rehabilitation (CR) and return-to-work guidelines from the American College of Sports Medicine (ACSM) now include specificity of training for industrial athletes (exercise training that involves the muscle groups, movements, and energy systems that these patients use during occupational tasks). However, many CR facilities do not apply this principle, relying instead on the traditional protocol that consists primarily of aerobic exercise. This study was conducted to measure the metabolic cost of typical farming tasks and to compare 2 methods of calculating training intensities. Metabolic data were collected from 28 participants (23 men and 5 women, aged 18 to 57 years) while they loaded 10 hay bales, dug a fence posthole, filled 8 seed hoppers, and shoveled grain. Mean metabolic equivalent levels during these activities were 5.9 to 7.6 and participants reached 60% to 70% of heart rate reserve (HRR). By comparison, their mean resting heart rate + 30 beats per minute (RHR+30, a traditional CR intensity level) represented only 28% of HRR. Participants in the current study performed farming tasks within the ACSM's recommended range of 40% to 80% of HRR, and the results suggest that training at RHR+30 would have been inadequate for helping a farmer return to work after a cardiac event. Using the study tasks as a basis, we described exercises that would be appropriate for the supervised resistance training of farmers in a CR setting.

  2. Mental Distress Factors and Exercise Capacity in Patients with Coronary Artery Disease Attending Cardiac Rehabilitation Program.

    Science.gov (United States)

    Kazukauskiene, Nijole; Burkauskas, Julius; Macijauskiene, Jurate; Duoneliene, Inga; Gelziniene, Vaidute; Jakumaite, Vilija; Brozaitiene, Julija

    2018-02-01

    There is still insufficient data on mental distress factors contributing to exercise capacity (EC) improvement before and after cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). The aim of our study was to evaluate the associations between various mental distress factors and EC before and after exercise-based CR (EBCR). Over 12 months, 223 CAD patients (70% men, mean age 58 ± 9 years) were evaluated for socio-demographic, clinical, and mental distress symptoms as measured by the Hospital Anxiety and Depression scale (HADS), Beck Depression Inventory-II (BDI-II), and Spielberger State-Trait Anxiety Inventory (STAI). Patients were tested for EC at baseline and after EBCR. In a multivariate linear regression model, EC before EBCR was associated with HADS anxiety subscale (β = -.186, p = .002) and BDI-II somatic/affective subscale (β = -.249, p Mental distress and somatic/affective symptoms of depression are strongly associated with EC both at the beginning and after EBCR. Analysis of possible mediating or moderating factors was beyond the scope of our study. Future studies should focus on comprehensive evaluation of EC risk factors including other mental distress characteristics, subjectively experienced fatigue, and post-operative CAD symptoms.

  3. The Relation between Deterministic Thinking and Mental Health among Substance Abusers Involved in a Rehabilitation Program

    Directory of Open Access Journals (Sweden)

    Seyed Jalal Younesi

    2015-06-01

    Full Text Available Objective: The current research is to investigate the relation between deterministic thinking and mental health among drug abusers, in which the role of  cognitive distortions is considered and clarified by focusing on deterministic thinking. Methods: The present study is descriptive and correlative. All individuals with experience of drug abuse who had been referred to the Shafagh Rehabilitation center (Kahrizak were considered as the statistical population. 110 individuals who were addicted to drugs (stimulants and Methamphetamine were selected from this population by purposeful sampling to answer questionnaires about deterministic thinking and general health. For data analysis Pearson coefficient correlation and regression analysis was used. Results: The results showed that there is a positive and significant relationship between deterministic thinking and the lack of mental health at the statistical level [r=%22, P<0.05], which had the closest relation to deterministic thinking among the factors of mental health, such as anxiety and depression. It was found that the two factors of deterministic thinking which function as the strongest variables that predict the lack of mental health are: definitiveness in predicting tragic events and future anticipation. Discussion: It seems that drug abusers suffer from deterministic thinking when they are confronted with difficult situations, so they are more affected by depression and anxiety. This way of thinking may play a major role in impelling or restraining drug addiction.

  4. Improvement of upper limb’s condition of women with post mastectomy syndrome with the help of problem-oriented program of physical rehabilitation

    Directory of Open Access Journals (Sweden)

    Y.A. Briskin

    2015-11-01

    Full Text Available Purpose: to determine effectiveness of problem-oriented program of women’s physical rehabilitation with post mastectomy syndrome in improvement of upper limb’s functional state. Material: 50 women with early symptoms of post mastectomy syndrome at stationary rehabilitation stage, who underwent radical mastectomy by Madden were involved in the research. Testing of movement amplitude in shoulder joint, swelling of upper limb and muscular strength of hand’s flexors was conducted on 2 nd day after surgery and at the end of stationary rehabilitation period (12-14 th day. Results: Main means of the authors’ program were: general and special physical exercises; static and dynamic breathing exercises; breathing through preloaded lips, controlled coughing, autogenic drainage, manual pressing, manual vibration; post-isometric relaxation; elements of labor therapy; lymphatic drainage massage and self massage; topical talks; consultations; auto training. The trainings were conducted individually 2-3 times a day; 20-30 minutes every session. The patients’ independent trainings included: fulfillment of therapeutic positions, self-massage, relaxation exercises and auto-training. Conclusions: application of problem-oriented physical rehabilitation program facilitates improvement of upper limb’s functional potentials of women with post mastectomy syndrome.

  5. Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Objective: To evaluate the safety and efficacy of early rehabilitation after surgery program (ERAS in patients undergoing laparoscopic assisted total gastrectomy. Materials And Methods: This is a study where 47 patients who are undergoing lap assisted total gastrectomy are selected. Twenty-two (n = 22 patients received enhanced recovery programme (ERAS management and rest twenty-five (n = 25 conventional management during the perioperative period. The length of postoperative hospital stay, time to passage of first flatus, intraoperative and postoperative complications, readmission rate and 30 day mortality is compared. Serum levels of C-reactive protein pre-operatively and also on post-op day 1 and 3 are compared. Results: Postoperative hospital stay is shorter in ERAS group (78 ± 26 h when compared to conventional group (140 ± 28 h. ERAS group passed flatus earlier than conventional group (37 ± 9 h vs. 74 ± 16 h. There is no significant difference in complications between the two groups. Serum levels of CRP are significantly low in ERAS group in comparison to conventional group. [d1 (52.40 ± 10.43 g/L vs. (73.07 ± 19.32 g/L, d3 (126.10 ± 18.62 g/L vs. (160.72 ± 26.18 g/L]. Conclusion: ERAS in lap-assisted total gastrectomy is safe, feasible and efficient and it can ameliorate post-operative stress and accelerate postoperative rehabilitation in patients with gastric cancer. Short term follow up results are encouraging but we need long term studies to know its long term benefits.

  6. Lasting effect of an oral hygiene care program for patients with stroke during in-hospital rehabilitation: a randomized single-center clinical trial.

    Science.gov (United States)

    Kim, Eun-Kyong; Park, Eun Young; Sa Gong, Jung-Whan; Jang, Sung-Ho; Choi, Youn-Hee; Lee, Hee-Kyung

    2017-11-01

    Because the oral hygiene is poorly prioritized in the immediate post-stroke period, we implemented an oral hygiene care program (OHCP) for stroke in-patients and evaluated its persistence after discharge. In all, 62 patients with stroke who were admitted to the rehabilitation ward were randomly assigned to two groups: 33 patients to the intervention group and 29 to the control group. The OHCP, including tooth brushing education and professional tooth cleaning, was administered to the intervention group twice a week six times during in-hospital rehabilitation. Oral health status was examined both at baseline and three months after discharge from the hospital. Oral hygiene status was examined at three- to four-day intervals five times during the hospitalization period. After OHCP, oral hygiene status including the plaque index, calculus index, and O'Leary plaque index improved significantly in the intervention group, compared to the control group (p < 0.05). In the intervention group, after administration of the OHCP for the fourth time, the O'Leary index improved significantly, and remained high when checked three months after discharge (p < 0.001). An OHCP conducted during in-hospital rehabilitation was effective in improving oral health and plaque control performance among patients with stroke, with effects still seen three months after discharge from the hospital. Implications for Rehabilitation Initial oral hygiene status and plaque control performance were poor in stroke patients who were in rehabilitation center. An oral hygiene care program during in-hospital rehabilitation was effective in improving oral hygiene status and plaque control performance among stroke patients at three months after discharge. Repeated tooth brushing education and professional tooth cleaning were necessary to improve plaque control performance of stroke patients.

  7. Implementation fidelity trajectories of a health promotion program in multidisciplinary settings : Managing tensions in rehabilitation care

    NARCIS (Netherlands)

    Hoekstra, Femke; van Offenbeek, Marjolein A. G.; Dekker, Rienk; Hettinga, Florentina J.; Hoekstra, Trynke; van der Woude, Lucas H. V.; van der Schans, Cees P.

    2017-01-01

    Background: Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary

  8. Programming and Process in Prisoner Rehabilitation: A Prison Mental Health Center.

    Science.gov (United States)

    Smith, James A., III; Faubert, Marie

    1990-01-01

    Reviews literature concerning men in prisons. Describes specific program at a prison mental health center which prepares men for reentry into society. Closes with reflections on one man's struggle to grow and prepare for the outside. (CM)

  9. Medical cannabis use among patients with chronic pain in an interdisciplinary pain rehabilitation program: Characterization and treatment outcomes.

    Science.gov (United States)

    Shah, Arya; Craner, Julia; Cunningham, Julie L

    2017-06-01

    Cannabis is increasingly being used in the treatment of chronic pain. However, there is a lack of available research in the population of patients with chronic pain who are using cannabis. The current study examines clinical and treatment characteristics for patients who are admitted to a 3-week outpatient interdisciplinary chronic pain rehabilitation program. Participants (N=48) included patients with a positive urine drug screen for 9-carboxy-tetrahydrocannabinol (THC(+); n=24) and a matched comparison sample of patients with a negative screen (THC(-); n=24). Participants were matched for age, gender, race, education, and current prescription opioid use. Measures of pain, functioning, and quality of life were completed at admission and discharge. Medical chart review was conducted to assess medication and substance use history. Participants with a positive screen for THC were more likely to report a past history of illicit substance use, alcohol abuse, and current tobacco use. Cannabis use was not associated with a significantly lower morphine equivalence level for participants using prescription opioids (n=14). Both groups of participants reported significant improvement in pain severity, pain interference, depressive symptoms, and pain catastrophizing. There were no group- or treatment-related differences in these outcome variables. Results provide preliminary evidence that patients with chronic pain using cannabis may benefit from an interdisciplinary chronic pain program. Patients with chronic pain using cannabis may be at higher risk for substance-related negative outcomes, although more research is needed to understand this relationship. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Nonoperative care for hip fracture in the elderly: the influence of race, income, and comorbidities.

    Science.gov (United States)

    Neuman, Mark D; Fleisher, Lee A; Even-Shoshan, Orit; Mi, Lanyu; Silber, Jeffrey H

    2010-04-01

    Hip fracture occurs in 340,000 older adults each year. Operative repair is the standard of care, maximizing the chances of functional recovery. Not receiving operative care may condemn patients to a lifetime of pain and potential immobility. To measure the incidence of nonoperative treatment for first-time hip fracture in a population-based cohort and to measure the odds of nonoperative treatment of hip fracture among patients of differing race and income. Retrospective cohort study of 165,861 Medicare beneficiaries admitted for hip fracture between March 31, 2002 and December 31, 2006 to hospitals in New York, Illinois, and Texas. Odds of nonoperative management of hip fracture, adjusted for fracture characteristics, comorbidities, source of admission, age, sex, race, income, and individual hospital effects. Nonoperative management occurred in 6.2% of patients (N = 10,283). After adjustment, black patients had a 79% increase in the odds of nonoperative management as compared with whites (OR 1.79, 95% CI 1.64-1.95). Low income itself was not associated with a change in the odds of nonoperative care. Among patients not receiving operative repair, blacks demonstrated lower mortality than whites at 7 days (7.96% vs. 20.17%, P < 0.0001) and 30 days (24.14% vs. 38.22%, P < 0.0001). Black race predicts an increased odds of nonoperative care for hip fracture. Among patients receiving nonoperative care, black patients demonstrated increased survival compared with whites. These results are consistent with differential selection of operative candidates by patient race.

  11. 34 CFR 371.1 - What is the Vocational Rehabilitation Services Program for American Indians with Disabilities?

    Science.gov (United States)

    2010-07-01

    ... the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES... disabilities who reside on Federal or State reservations, consistent with their individual strengths, resources...

  12. A rehabilitation program based on music practice for patients with unilateral spatial neglect: a single-case study.

    Science.gov (United States)

    Guilbert, Alma; Clément, Sylvain; Moroni, Christine

    2017-02-01

    Two major limitations of unilateral spatial neglect (USN) rehabilitation methods are actually reported: a lack of long-term efficiency and a lack of generalization to daily life. The aim of our case study was to underline how a multisensory method-music practice-could avoid these limitations. Mrs BV suffered from a chronic severe USN. She had rehabilitation sessions of music practice over 8 weeks. An improvement of her USN was found on paper-pencil tests but also in daily activities. Benefits subsisted 4 months after rehabilitation. Music practice seemed to avoid the major limitations of USN rehabilitations and could represent a promising tool.

  13. Nonoperative management of perforated appendicitis in children: can CT predict outcome?

    International Nuclear Information System (INIS)

    Levin, Terry; Whyte, Christine; Harris, Burton; Borzykowski, Ross; Han, Bokyung; Blitman, Netta

    2007-01-01

    The optimal treatment of perforated appendicitis remains controversial, but there is a trend toward nonoperative management. CT scanning might be helpful in determining which patients could benefit from this treatment option. To determine the value of CT imaging in predicting clinical success or failure in children with nonoperative management of perforated appendicitis. Admission CT scans of 34 children with perforated appendicitis treated nonoperatively between January 2003 and June 2006 were retrospectively reviewed. All children were given intravenous antibiotics. Clinical outcome was correlated with imaging findings including the maximal area, number and complexity of collections, presence of an appendicolith or extraluminal air, and extent of intra-abdominal disease outside the right lower quadrant. Patients with an accessible simple collection were drained if their clinical condition did not improve. Successful nonoperative management was achieved in 20 patients; 14 patients failed nonoperative therapy. The presence of collections in three or more sectors (defined as the pelvis and four abdominal quadrants) correlated strongly with clinical failure (P < 0.05), while there was no correlation found between clinical outcome and the presence of an appendicolith, extraluminal air, distant ascites, and collection size or complexity. In the nonoperative management of children with perforated appendicitis, admission CT findings demonstrating disease beyond the right lower quadrant correlate with treatment failure. (orig.)

  14. Overview of Nonoperative Blunt Splenic Injury Management with Associated Splenic Artery Pseudoaneurysm.

    Science.gov (United States)

    Morrison, Chet A; Gross, Brian W; Kauffman, Matthew; Rittenhouse, Katelyn J; Rogers, Frederick B

    2017-06-01

    The delayed development of splenic artery pseudoaneurysm (SAP) can complicate the nonoperative management of splenic injuries. We sought to determine the utility of repeat imaging in diagnosing SAP in patients managed nonoperatively without angioembolization. We hypothesized that a significant rate of SAPs would be found in this population on repeat imaging. Patients undergoing nonoperative splenic injury management from January 2011 to June 2015 were queried from the trauma registry. Rates of repeat imaging, angioembolization, readmission, and SAP development were analyzed. Further, subanalyses investigating the incidence of SAP in patients managed nonoperatively without angioembolization were conducted. A total of 133 patients met inclusion criteria. Repeat imaging rate was 40 per cent, angioembolization rate was 26 per cent, and readmission rate was 6 per cent. Within the study population, nine SAPs were found (8/9 in patients with splenic injury grade ≥III). Of these nine SAPs, three (33%) were identified on initial scans and embolized, whereas six (67%) were found on repeat imaging in patients not initially receiving angioembolization. Splenic injuries are typically managed nonoperatively without serious complications. Our results suggest patients with splenic injuries grade ≥III managed nonoperatively without angioembolization should have repeat imaging within 48 hours to rule out the possibility of SAP.

  15. Successful return to sports in athletes following non-operative management of acute isolated posterior cruciate ligament injuries: medium-term follow-up.

    Science.gov (United States)

    Agolley, D; Gabr, A; Benjamin-Laing, H; Haddad, F S

    2017-06-01

    The aim of this study was to report the outcome of the non-operative treatment of high-grade posterior cruciate ligament (PCL) injuries, particularly Hughston grade III injuries, which have not previously been described. This was a prospective study involving 46 consecutive patients who were athletes with MRI-confirmed isolated PCL injuries presenting within four weeks of injury. All had Hughston grade II (25 athletes) or III (21 athletes) injuries. Our non-operative treatment regimen involved initial bracing, followed by an individualised rehabilitation programme determined by the symptoms and physical signs. The patients were reviewed until they had returned to sports-specific training, and were reviewed again at a mean of 5.2 years (3 to 9). The mean time to return to sports-specific training was 10.6 weeks and the mean time to return to full competitive sport was 16.4 weeks (10 to 40). A total of 42 patients (91.3%) were playing at the same or higher level of sport two years after the injury, with a mean Tegner activity score of 9 (5 to 10). At five years, 32 patients (69.5%) were playing at the same or higher level of sport, and 38 patients (82.6%) were playing at a competitive level, with a mean Tegner activity score of 9 (5 to 10). Medium-term review of a series of athletes suggests that commencing the non-operative management of isolated, Hughston grade II and III PCL injuries within four weeks of injury gives excellent functional outcomes with a high proportion returning to the same or higher level of sport. Cite this article: Bone Joint J 2017;99-B:774-8. ©2017 The British Editorial Society of Bone & Joint Surgery.

  16. Daily functioning of dyspnea, self-esteem and physical self in patients with moderate COPD before, during and after a first inpatient rehabilitation program.

    Science.gov (United States)

    Ninot, Gregory; Moullec, Gregory; Desplan, Jacques; Prefaut, Christian; Varray, Alain

    2007-11-30

    Inpatient rehabilitation improves dyspnea and increases self-esteem between admission and discharge in patients with moderate chronic obstructive pulmonary disease (COPD). Some researchers nevertheless argue that the changes may be due to nursing effects and thus that scores will decrease quickly at home after discharge. This study assessed the change in dyspnea, self-esteem and physical self mean scores and stability in patients with moderate COPD during three consecutive four-week periods: at home, during an inpatient rehabilitation program, and again at home post-discharge. Twenty-three consecutive patients [63.9 years (SD 6.6)] with moderate COPD [FEV1 = 55.8% (SD 13.2)] were included. The participants responded to the Physical Self Inventory and rated dyspnea using a visual analogue scale twice a day. Exercise tolerance was assessed with the six-minute walk test (6MWT) at admission and discharge. 6MWT performance improved between admission and discharge [452.3 m. (SD 74.0) vs. 503.3 m. (SD 80.4), p self-esteem and physical self scores between the two home periods (p self-worth at home post-discharge compared to pre-admission (p self-esteem, the perceptions of physical condition and attractive body were all significant. After rehabilitation, the coefficients between dyspnea, and perceived physical condition, physical strength and sport competence were significant (p self scores in patients with moderate COPD and decreases their instability; the program also improves dyspnea. However, the impact of rehabilitation was greater on specific perceptions of physical abilities than on the global self-esteem. Randomized controlled trials are needed to confirm these changes, which were probably due to rehabilitation program.

  17. A personalized, intense physical rehabilitation program improves walking in people with multiple sclerosis presenting with different levels of disability: a retrospective cohort.

    Science.gov (United States)

    Kalron, Alon; Nitzani, Dalia; Magalashvili, David; Dolev, Mark; Menascu, Shay; Stern, Yael; Rosenblum, Uri; Pasitselsky, Diana; Frid, Lior; Zeilig, Gabi; Barmatz, Caroline; Givon, Uri; Achiron, Anat

    2015-03-04

    People with multiple sclerosis (PwMS) endure walking limitations. To address this restriction, various physical rehabilitation programs have been implemented with no consensus regarding their efficacy. Our objective was to report on the efficacy of an integrated tailored physical rehabilitation program on walking in people with multiple sclerosis categorized according to their level of neurological disability. Retrospective data were examined and analyzed. Specifically, data obtained from all patients who participated in the Multiple Sclerosis Center's 3 week rehabilitation program were extracted for in depth exploration. The personalized rehabilitation program included three major components modified according to the patient's specific impairments and functional needs: (a) goal directed physical therapy (b) moderately intense aerobic exercise training on a bicycle ergometer and (c) aquatic therapy chiefly oriented to body structures appropriate to movement. Gait outcome measurements included the 10 meter, 20 meter, Timed up and go and 2 minute walking tests measured pre and post the rehabilitation program. Three hundred and twelve people with relapsing-remitting multiple sclerosis were included in the final analysis. Patients were categorized into mild (n = 87), moderate (n = 104) and severely (n = 121) disabled groups. All clinical walking outcome measurements demonstrated statistically significant improvements, however, only an increase in the 2 minute walking test was above the minimal clinical difference value. The moderate and severe groups considerably improved compared to the mild gait disability group. Mean change scores (%) of the pre-post intervention period of the 2 minute walking test were 19.0 (S.E. = 3.4) in the moderate group, 16.2 (S.E. = 5.4) in the severe group and 10.9 (S.E. = 2.3) in the mild gait disability group. We presented comprehensive evidence verifying the effects of an intense goal-directed physical

  18. Nonoperative treatment of splenic trauma: usefulness of computed tomography

    International Nuclear Information System (INIS)

    Resende, Vivian; Tavares Junior, Wilson Campos; Vieira, Jose Nelson Mendes; Drumond, Domingos Andre Fernandes

    2005-01-01

    Objective: to report the results of use of conservative treatment in patients with splenic trauma and to emphasize the usefulness of computed tomography in these cases. Material and method: sixty-nine cases of pediatric patients with blunt abdominal trauma seen from from January 2001 to June 2004 at the level I trauma center were retrospectively studied. Forty-four of these patients were submitted to nonoperative treatment and the clinical follow-up was performed by computerized tomography. All patients had been diagnosed with splenic injury by computerized tomography.Results: the causes of the injuries were motor vehicle accident in 12 (27.2%) patients, bicycle accident in nine (20.4%) patients, and falls in 23 (52.2%) patients. Two (3.7%) patients died from associated injuries. The mean duration of hospital stay was six days. The mean age of the patients was nine years. Conclusion: conservative treatment for blunt splenic trauma is performed with the aim of reducing costs and risks for the patients, and computerized tomography should be routinely used. No posterior complications were observed in this approach. (author)

  19. Adolescent idiopathic scoliosis: Indications and efficacy of nonoperative treatment

    Directory of Open Access Journals (Sweden)

    Federico Canavese

    2011-01-01

    Full Text Available The strategy for the treatment of idiopathic scoliosis depends essentially upon the magnitude and pattern of the deformity, and its potential for progression. Treatment options include observation, bracing and/or surgery. During the past decade, several studies have demonstrated that the natural history of adolescent idiopathic scoliosis can be positively affected by nonoperative treatment, especially bracing. Other forms of conservative treatment, such as chiropractic or osteopathic manipulation, acupuncture, exercise or other manual treatments, or diet and nutrition, have not yet been proven to be effective in controlling spinal deformity progression, and those with a natural history that is favorable at the completion of growth. Observation is appropriate treatment for small curves, curves that are at low risk of progression, and those with a natural history that is favorable at the completion of growth. Indications for brace treatment are a growing child presenting with a curve of 25°-40° or a curve less than 25° with documented progression. Curves of 20°-25° in patients with pronounced skeletal immaturity should also be treated. The purpose of this review is to provide information about conservative treatment of adolescent idiopathic scoliosis. Indications for conservative treatment, hours daily wear and complications of brace treatment as well as brace types are discussed.

  20. Non-operative management of isolated liver trauma.

    Science.gov (United States)

    Li, Min; Yu, Wen-Kui; Wang, Xin-Bo; Ji, Wu; Li, Jie-Shou; Li, Ning

    2014-10-01

    Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, non-operative management (NOM) is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma. Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2% (70/72). The success rates of NOM in the patients with grade I-III, IV and V liver trauma were 100%, 94.4% and 83.3%. The complication rates were 10.0% and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived. NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.

  1. [Cognitive rehabilitation in multiple sclerosis: preliminary results and presentation of a new program, PROCOG-SEP].

    Science.gov (United States)

    Brissart, H; Leroy, M; Debouverie, M

    2010-04-01

    Although cognitive disorders are well-known in multiple sclerosis (MS), even in earlier stages of the disease, their management may be overlooked. Our objective was to elaborate and evaluate the efficiency of a remedial program (PROCOG-SEP) designed for MS patients. The evidence-based program proposes exercises to both stimulate preserved functions and develop new abilities compensating for cognitive disabilities. Twenty-four patients with MS participated in 10/2-hour PROCOG-SEP sessions over a 6-month period. A neuropsychologist recorded BCcog-SEP performances before and after the PROCOG-SEP program. In addition, the same neuropsychologist conducted psychoclinical interviews to complete the before and after cognitive evaluations. The statistical analysis used the t-test performed with Excel. Compared with the initial levels, subtests of BCcog-SEP showing improvement after PROCOG-SEP were: verbal memory (SRT), visuospatial memory (10/36), verbal fluency (animal categories) and response to conflicting orders. Also, individual psychological interviews tended to be in favor of a general improvement in quality of life (more social interactions for instance). To our knowledge, the management program we have elaborated is the first designed to improve cognitive deficits in MS. These encouraging results suggest possibilities for improving cognition and thus quality-of-life in MS patients. 2009 Elsevier Masson SAS. All rights reserved.

  2. Beyond Rehabilitation: The Federal City College Lorton Project--A Model Prison Higher Education Program

    Science.gov (United States)

    Taylor, Andress

    1974-01-01

    A description and evaluation of the Federal City College (the first Urban Land Grant institution in the nation) higher education program offered in association with a group of Washington, D.C., penal institutions located in Lorton, Virginia. This Lorton Project has been adopted as a National Model by the Department of Health, Education, and…

  3. 77 FR 480 - Applications for New Awards; Disability and Rehabilitation Research Projects and Centers Program...

    Science.gov (United States)

    2012-01-05

    ... maximum amount includes direct and indirect costs. Estimated Number of Awards: 20. Note: The Department is... activities will support new intervention approaches and strategies. Submission of the information identified... (e.g., new or improved tools, methods, discoveries, standards, interventions, programs, or devices...

  4. 38 CFR 21.310 - Rate of pursuit of a rehabilitation program.

    Science.gov (United States)

    2010-07-01

    ...) Programs offered at educational institutions. This section provides policy for determining the full-time... subjects and subjects requiring class attendance on the basis of the combined training load when the number... veteran must have a disability or circumstances which preclude regular attendance at an institution of...

  5. Burned area emergency watershed rehabilitation: Program goals, techniques, effectiveness, and future directions in the 21st Century

    Science.gov (United States)

    Daniel G. Neary; Peter R. Robichaud; Jan L. Beyers

    2000-01-01

    Following wildfires, burned areas are assessed by special teams to determine if emergency watershed rehabilitation measures are required to restore watershed function and minimize damage to soil resources. The objective of burned area emergency rehabilitation (BAER) treatments is to restore watershed condition and reduce erosional losses on hillslopes, in channels, and...

  6. Improved functional capacity evaluation performance predicts successful return to work one year after completing a functional restoration rehabilitation program.

    Science.gov (United States)

    Fore, Lisa; Perez, Yoheli; Neblett, Randy; Asih, Sali; Mayer, Tom G; Gatchel, Robert J

    2015-04-01

    To evaluate whether functional capacity evaluation (FCE) scores are responsive to functional restoration treatment, and to assess the ability of FCEs at program discharge to predict work outcomes. An interdisciplinary cohort study of prospectively collected data. A functional restoration center. A consecutive sample of 354 patients with chronic disabling occupational musculoskeletal disorders (CDOMDs) completed a functional restoration program consisting of quantitatively directed exercise progression and multi-modal disability management with interdisciplinary medical supervision. Each patient participated in an FCE at admission and discharge from treatment. The results of each FCE yielded the physical demand level (PDL) at which patients were functioning. Patients were initially divided into 5 PDL groups, based on job-of-injury lifting, carrying, and pushing/pulling requirements, for the pre- to posttreatment responsiveness analyses. Patients were subsequently divided into 5 PDL groups, based on their performance on the FCE upon program completion. Outcome measures included admission-to-discharge changes in PDLs and 2 specific FCE lifting tasks: isokinetic lifting; and the Progressive Isoinertial Lifting Evaluation (PILE). Socioeconomic outcomes were also evaluated, including post-discharge work return and work retention 1-year after treatment completion. Overall, 96% of the patients demonstrated improvement in their PDLs from admission to discharge. A majority of patients (56%) were able to achieve a discharge PDL that was comparable to their estimated job-of-injury lifting requirement or higher (P work return (P work retention (P work return after treatment completion and work retention 1 year later. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  7. What is role of sex and age differences in marital conflict and stress of patients under Cardiac Rehabilitation Program?

    Directory of Open Access Journals (Sweden)

    Saeid Komasi

    2016-05-01

    Full Text Available BACKGROUND: To investigate the role of sex and age differences in marital conflict and stress of patients who were under cardiac rehabilitation (CR program. METHODS: The data of this cross-sectional study were collected from the database of the CR Department of Imam Ali Hospital, Kermanshah, Iran. The demographics and medical data of 683 persons were collected from January 2003 and January 2010 using medical records, the Beck Anxiety Inventory, the Beck Depression Inventory, the Hudson’s Index of Marital Stress, and the Structured Clinical Interview for axis I disorders. Data were analyzed through Analysis of Covariance and Bonferroni test. RESULTS: About 74.8% of the subjects were male. After adjustment for age, educational level, anxiety, and depression-the findings showed that women in CR program had a higher level of marital stress compared to men (54.75 ± 2.52 vs. 49.30 ± 0.89; P = 0.042. Furthermore, it was revealed that women who aged 56-65 years and more experienced higher level of marital stress compared to younger patients (P < 0.050; however, no significant difference was observed between different age groups in male patients (P > 0.050. CONCLUSION: Marital conflict and stress threaten healthiness of women who aged 56-65 years more prominently than does in males or younger patients. Regarding the effect of marital stress on recurrence of the disease and cardiac-related morbidity and mortality in women, providing effective education and interventions to this group of patients, especially older women and even their spouses could be one of the useful objectives of CR programs

  8. What is role of sex and age differences in marital conflict and stress of patients under Cardiac Rehabilitation Program?

    Science.gov (United States)

    Komasi, Saeid; Saeidi, Mozhgan

    2016-05-01

    To investigate the role of sex and age differences in marital conflict and stress of patients who were under cardiac rehabilitation (CR) program. The data of this cross-sectional study were collected from the database of the CR Department of Imam Ali Hospital, Kermanshah, Iran. The demographics and medical data of 683 persons were collected from January 2003 and January 2010 using medical records, the Beck Anxiety Inventory, the Beck Depression Inventory, the Hudson's Index of Marital Stress, and the Structured Clinical Interview for axis I disorders. Data were analyzed through Analysis of Covariance and Bonferroni test. About 74.8% of the subjects were male. After adjustment for age, educational level, anxiety, and depression-the findings showed that women in CR program had a higher level of marital stress compared to men (54.75 ± 2.52 vs. 49.30 ± 0.89; P = 0.042). Furthermore, it was revealed that women who aged 56-65 years and more experienced higher level of marital stress compared to younger patients (P age groups in male patients (P > 0.050). Marital conflict and stress threaten healthiness of women who aged 56-65 years more prominently than does in males or younger patients. Regarding the effect of marital stress on recurrence of the disease and cardiac-related morbidity and mortality in women, providing effective education and interventions to this group of patients, especially older women and even their spouses could be one of the useful objectives of CR programs.

  9. An Extended Exercise-Based Cardiac Rehabilitation Program reduces Key Inflammatory Biomarkers in Atherosclerosis

    DEFF Research Database (Denmark)

    Jørgensen, Malene Munk; Petersen, Annemette Krintel; Mølby Nielsen, Mette

    2018-01-01

    ECR program was more successful in reducing low-grade vascular inflammation, compared to a conventional 8-week ECR program. A total of 110 patients treated for IHD, and referred to ECR, were randomized to a 12-week or 8-week ECR intervention. We measured the concentration of soluble vascular cell...... adhesion molecule 1 (sVCAM-1), interleukin-6 (IL-6), highsensitivity C-reactive protein (hsCRP), before and after participation in either of the two ECRs and at 6-month and one year follow-up. Additionally, we determined the absolute White Blood Cell count (WBC), the absolute monocyte count...... at the end of ECR (IL-6: p=0.002; hsCRP: pprogram. However, this effect was not sustained on a long...

  10. "The feasibility of implementing cognitive remediation for work in community based psychiatric rehabilitation programs": Correction to McGurk et al. (2017).

    Science.gov (United States)

    2017-06-01

    Reports an error in "The feasibility of implementing cognitive remediation for work in community based psychiatric rehabilitation programs" by Susan R. McGurk, Kim T. Mueser, Melanie A. Watkins, Carline M. Dalton and Heather Deutsch ( Psychiatric Rehabilitation Journal , 2017[Mar], Vol 40[1], 79-86). In the article, the author order was incorrect due to a printer error. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2017-13255-004.) Objective: Adding cognitive remediation to vocational rehabilitation services improves cognitive and work functioning in people with serious mental illness, but despite interest, the uptake of cognitive programs into community services has been slow. This study evaluated the feasibility of implementing an empirically supported cognitive remediation program in routine rehabilitation services at 2 sites. The Thinking Skills for Work (TSW) program was adapted for implementation at 2 sites of a large psychiatric rehabilitation agency providing prevocational services, but not community-based vocational services, which were provided off-site. Agency staff were trained to deliver TSW to clients with work or educational goals. Cognitive assessments were conducted at baseline and posttreatment, with work and school activity tracked for 2 years. Eighty-three participants enrolled in TSW, of whom 79.5% completed at least 6 of the 24 computer cognitive exercise sessions (M = 16.7) over an average of 18 weeks. Participants improved significantly from baseline to posttreatment in verbal learning and memory, speed of processing, and overall cognitive functioning. Over the follow-up, 25.3% of participants worked and 47.0% were involved in work or school activity. Higher work rates were observed at the site where participants had easier access to vocational services. The results support the feasibility of implementing the TSW program by frontline staff in agencies providing

  11. A standardized motor imagery introduction program (MIIP) for neuro-rehabilitation: development and evaluation

    OpenAIRE

    Wondrusch, C.; Schuster-Amft, C.

    2013-01-01

    Background: For patients with central nervous system (CNS) lesions and sensorimotor impairments a solid motor imagery (MI) introduction is crucial to understand and use MI to improve motor performance. The study's aim was to develop and evaluate a standardized MI group introduction program (MIIP) for patients after stroke, multiple sclerosis (MS), Parkinson's disease (PD), and traumatic brain injury (TBI). Methods: Phase 1: Based on literature a MIIP was developed comprising MI theory (def...

  12. A standardized motor imagery introduction program (MIIP) for neuro-rehabilitation: development and evaluation

    OpenAIRE

    Christine eWondrusch; Corina eSchuster; Corina eSchuster

    2013-01-01

    Background: For patients with central nervous system lesions and sensorimotor impairments a solid motor imagery (MI) introduction is crucial to understand and use MI to improve motor performance. The study’s aim was to develop and evaluate a standardized MI group introduction program (MIIP) for patients after stroke, multiple sclerosis, Parkinson’s disease, and traumatic brain injury. Methods:Phase 1: Based on literature a MIIP was developed comprising MI theory (definition, type, mode, persp...

  13. Evaluation of a Web-Based Cognitive Rehabilitation Program in Cancer Survivors Reporting Cognitive Symptoms After Chemotherapy.

    Science.gov (United States)

    Bray, Victoria J; Dhillon, Haryana M; Bell, Melanie L; Kabourakis, Michael; Fiero, Mallorie H; Yip, Desmond; Boyle, Frances; Price, Melanie A; Vardy, Janette L

    2017-01-10

    Purpose Cognitive impairment is reported frequently by cancer survivors. There are no proven treatments. We evaluated a cognitive rehabilitation program (Insight) and compared it with standard care in cancer survivors self-reporting cognitive symptoms. Patients and Methods We recruited adult cancer survivors with a primary malignancy (excluding central nervous system malignancies) who had completed three or more cycles of adjuvant chemotherapy in the previous 6 to 60 months and reported persistent cognitive symptoms. All participants received a 30-minute telephone consultation and were then randomly assigned to the 15-week, home-based intervention or to standard care. Primary outcome was self-reported cognitive function (Functional Assessment of Cancer Therapy Cognitive Function [FACT-COG] perceived cognitive impairment [PCI] subscale): difference between groups after intervention (T2) and 6 months later (T3). Results A total of 242 participants were randomly assigned: median age, 53 years; 95% female. The primary outcome of difference in FACT-COG PCI was significant, with less PCI in the intervention group at T2 ( P cognitive symptoms compared with standard care. To our knowledge, this is the first large randomized controlled trial showing an improvement in self-reported cognitive function in cancer survivors, indicating that this intervention is a feasible treatment.

  14. Measurement of physical performance by field tests in programs of cardiac rehabilitation: a systematic review and meta-analysis.

    Science.gov (United States)

    Travensolo, Cristiane; Goessler, Karla; Poton, Roberto; Pinto, Roberta Ramos; Polito, Marcos Doederlein

    2018-04-13

    The literature concerning the effects of cardiac rehabilitation (CR) on field tests results is inconsistent. To perform a systematic review with meta-analysis on field tests results after programs of CR. Studies published in PubMed and Web of Science databases until May 2016 were analyzed. The standard difference in means correct by bias (Hedges' g) was used as effect size (g) to measure que amount of modifications in performance of field tests after CR period. Potential differences between subgroups were analyzed by Q-test based on ANOVA. Fifteen studies published between 1996 e 2016 were included in the review, 932 patients and age ranged 54,4 - 75,3 years old. Fourteen studies used the six-minutes walking test to evaluate the exercise capacity and one study used the Shuttle Walk Test. The random Hedges's g was 0.617 (P<0.001), representing a drop of 20% in the performance of field test after CR. The meta-regression showed significantly association (P=0.01) to aerobic exercise duration, i.e., for each 1-min increase in aerobic exercise duration, there is a 0.02 increase in effect size for performance in the field test. Field tests can detect physical modification after CR, and the large duration of aerobic exercise during CR was associated with a better result. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Symptoms of Depression and Anxiety as Barriers to Participation in Cardiac Rehabilitation Programs Among Arab and Jewish Patients in Israel.

    Science.gov (United States)

    Vilchinsky, Noa; Reges, Orna; Leibowitz, Morton; Khaskia, Abdulrahim; Mosseri, Morris; Kark, Jeremy D

    2018-05-01

    Despite its proven efficacy, low participation rates in cardiac prevention and rehabilitation programs (CPRPs) prevail worldwide, especially among ethnic minorities. This is strongly evident in Israel's Arab minority. Since psychological distress has been found to be associated with CPRP participation and minorities are subjected to higher levels of distress, it is plausible that distress may be an important barrier for CPRP participation among minority patients. The current prospective study assessed the contribution of depression and anxiety symptoms to participation in a CPRP after acute coronary syndrome, both in the enrollment phase and when considering adherence over time, among Jewish (majority) and Arab (minority) patients in Israel. Patients were interviewed during hospitalization about their emotional status and at a 6-mo follow-up concerning participation in a CPRP. Analyses were performed on 397 patients. The Brief Symptom Inventory was used. Logistic regression modeling was applied. Symptoms of depression, but not anxiety, were frequently observed among Arab patients compared with their Jewish counterparts. In analyses adjusted for age, sex, ethnicity, and sociodemographic and clinical characteristics, having symptoms of anxiety was associated with less participation in a CPRP, evident for both Jews and Arabs; this association was less evident for symptoms of depression. Multivariable adjusted models did not show a significant association of symptoms of anxiety or depression with adherence in a CPRP. Accounting for psychological distress did not reduce the sharp difference between Jews and Arabs in CPRP participation. Symptoms of distress may serve as barriers to CPRP participation, regardless of ethnic origin.

  16. Therapist-Assisted Rehabilitation of Visual Function and Hemianopia after Brain Injury: Intervention Study on the Effect of the Neuro Vision Technology Rehabilitation Program.

    Science.gov (United States)

    Rasmussen, Rune Skovgaard; Schaarup, Anne Marie Heltoft; Overgaard, Karsten

    2018-02-27

    Serious and often lasting vision impairments affect 30% to 35% of people following stroke. Vision may be considered the most important sense in humans, and even smaller permanent injuries can drastically reduce quality of life. Restoration of visual field impairments occur only to a small extent during the first month after brain damage, and therefore the time window for spontaneous improvements is limited. One month after brain injury causing visual impairment, patients usually will experience chronically impaired vision and the need for compensatory vision rehabilitation is substantial. The purpose of this study is to investigate whether rehabilitation with Neuro Vision Technology will result in a significant and lasting improvement in functional capacity in persons with chronic visual impairments after brain injury. Improving eyesight is expected to increase both physical and mental functioning, thus improving the quality of life. This is a prospective open label trial in which participants with chronic visual field impairments are examined before and after the intervention. Participants typically suffer from stroke or traumatic brain injury and will be recruited from hospitals and The Institute for the Blind and Partially Sighted. Treatment is based on Neuro Vision Technology, which is a supervised training course, where participants are trained in compensatory techniques using specially designed equipment. Through the Neuro Vision Technology procedure, the vision problems of each individual are carefully investigated, and personal data is used to organize individual training sessions. Cognitive face-to-face assessments and self-assessed questionnaires about both life and vision quality are also applied before and after the training. Funding was provided in June 2017. Results are expected to be available in 2020. Sample size is calculated to 23 participants. Due to age, difficulty in transport, and the time-consuming intervention, up to 25% dropouts are

  17. EFFECT OF SUPERVISED MODERATE INTENSITY EXERCISE PROGRAM IN PHASE ONE CARDIAC REHABILITATION OF POST OPERATIVE CABG PATIENTS - A RANDOMIZED CONTROLLED TRAIL

    Directory of Open Access Journals (Sweden)

    Rajan Modi

    2014-10-01

    Full Text Available Background: With the increasing number of cases for CABG, the cardiac rehabilitation has gained importance. The trends in rehabilitation of a coronary artery disease patient are changing by incorporating a variety of aerobic exercises and resisted training in to their rehabilitation program. The outcome of any exercise chiefly depends on the training parameters like intensity, frequency and duration. Hence the present study focused to know the effects of supervised moderate intensity exercises on patients during hospital discharge following CABG. The objective of is to study the effectiveness of supervised moderate intensity exercise on distance walked and Quality of Life at hospital discharge following CABG. Methods: Study recruited randomly 46 patients between age group 40-65 years who were posted for non-emergency CABG for the first time. Pre-operative assessment was done thoroughly and was divided in to two groups, Group A conventional treatment and Group B Moderate intensity exercise group. The patients were treated using different protocols in terms of intensity for 8-10 days immediate post CABG. Then the outcome parameters of 6MWT and sf-36 were compared for analysis. Results: Both groups individually showed extremely significant results for two outcome measures. 6 MWD difference between two treatment groups showed significant results with unpaired t test (t = 8.5720,p<0.001. Quality of life score difference within group showed very significant results but there is no difference found between both groups. Conclusion: Moderate intensity exercises can also be included in the immediate post-operative phase of CABG, as they reduce the length of hospital stay and quicken the cardiac rehabilitation process. But there need to be a lot of randomized control trails to confirm the benefits of moderate intensity exercises in phase one rehabilitation program after CABG.

  18. Non-operative management of abdominal gunshot injuries: Is it safe in all cases?

    Science.gov (United States)

    İflazoğlu, Nidal; Üreyen, Orhan; Öner, Osman Zekai; Meral, Ulvi Mehmet; Yülüklü, Murat

    2018-01-01

    In line with advances in diagnostic methods and expectation of a decrease in the number of negative laparotomies, selective non-operative management of abdominal gunshot wounds has been increasingly used over the last three decades. We aim to detect the possibility of treatment without surgery and present our experience in selected cases referred from Syria to a hospital at the Turkish-Syrian border. Between February 2012 and June 2014, patients admitted with abdominal gunshot wounds were analyzed. Computed tomography was performed for all patients on admission. Patients who were hemodynamically stable and did not have symptoms of peritonitis at the time of presentation were included in the study. The primary outcome parameters were mortality and morbidity. Successful selective non-operative management (Group 1) and unsuccessful selective non-operative management (Group 2) groups were compared in terms of complications, blood transfusion, injury site, injury severity score (ISS), and hospital stay. Of 158 truncal injury patients, 18 were considered feasible for selective non-operative management. Of these, 14 (78%) patients were treated without surgery. Other Four patients were operated upon progressively increasing abdominal pain and tenderness during follow-up. On diagnostic exploration, all of these cases had intestinal perforations. No mortality was observed in selective non-operative management. There was no statistically significant difference between Group 1 and Group 2, in terms of length of hospital stay (96 and 127 h, respectively). Also, there was no difference between groups in terms of blood transfusion necessity, injury site, complication rate, and injury severity score (p>0.05). Decision making on patient selection for selective non-operative management is critical to ensure favorable outcomes. It is not possible to predict the success of selective non-operative management in advance. Cautious clinical examination and close monitoring of these

  19. Physical and Psychological Effects of a 12-Session Cancer Rehabilitation Exercise Program.

    Science.gov (United States)

    Smith, Tricia M; Broomhall, Christine N; Crecelius, Anne R

    2016-12-01

    The positive effects of regular exercise for cancer survivors are becoming increasingly apparent. However, comprehensive examination of the benefits of modest levels of physical activity is somewhat lacking. This study aimed to test the hypothesis that participating in a 12-session exercise program will improve depression, fatigue, aerobic endurance, muscular strength, and quality of life (QOL) in patients with cancer. A group of 20 older adult women with a prior cancer diagnosis were evaluated during a 6- to 10-week exercise program that occurred twice weekly. The majority of patients had breast cancer (n = 14), but treatment status varied (11 were currently undergoing treatment, and 9 were post-treatment). Each patient completed initial and exit assessments, which consisted of three physical function tests and three psychosocial questionnaires. Patient charts contained the initial and final assessment scores and personal demographics. Analyses of pre- and postprogram data using paired t tests revealed that 12 exercise sessions (each lasting about an hour) significantly improved six-minute walk test, 30-second sit-and-stand test, hand grip strength test (dominant and nondominant hand), and overall QOL scores in patients. As a result, moderate levels of exercise have a beneficial effect in this population.

  20. The impact of a rehabilitation day centre program for persons suffering from schizophrenia on quality of life, social functioning and self-esteem.

    Science.gov (United States)

    Štrkalj-Ivezić, Slađana; Vrdoljak, Marijo; Mužinić, Lana; Agius, Mark

    2013-09-01

    Presently few studies demonstrate improved outcomes in patients with schizophrenia treated in day rehabilitation centres. One reason is the absence of an evidence based protocol for rehabilitation in such centres. Hence further research is required to assess whether such a protocol will improve psychosocial outcomes. We performed a controlled evaluation study of a protocol based rehabilitation day program (RDC) for persons suffering from schizophrenia. Patients from the experimental group (N=50) were treated within the RDC for a 6 month period. The control group were patients on the waiting list for the RDC. Quality of life (MANSA), social functioning (OSA) and self-esteem (Rosenberg) were measured before and after the intervention. Statistically significant improvement was shown in social functioning measured by OSA (F(1,96)=33.7; pself esteem measured by Rosenberg scale (F(1,96)=84.5; pcompared with the control group, conversely, the control group outcomes deteriorated. An evidence based protocol for rehabilitation within the RDC lead to improved social outcomes and recovery for persons suffering from schizophrenia.

  1. Measurement of functional capacity requirements of police officers to aid in development of an occupation-specific cardiac rehabilitation training program.

    Science.gov (United States)

    Adams, Jenny; Schneider, Jonna; Hubbard, Matthew; McCullough-Shock, Tiffany; Cheng, Dunlei; Simms, Kay; Hartman, Julie; Hinton, Paul; Strauss, Danielle

    2010-01-01

    This study was designed to measure the functional capacity of healthy subjects during strenuous simulated police tasks, with the goal of developing occupation-specific training for cardiac rehabilitation of police officers. A calibrated metabolic instrument and an oxygen consumption data collection mask were used to measure the oxygen consumption and heart rates of 30 Dallas Police Academy officers and cadets as they completed an 8-event obstacle course that simulated chasing, subduing, and handcuffing a suspect. Standard target heart rates (85% of age-predicted maximum heart rate, or 0.85 x [220 - age]) and metabolic equivalents (METs) were calculated; a matched-sample t test based on differences between target and achieved heart rate and MET level was used for statistical analysis. Peak heart rates during the obstacle course simulation were significantly higher than the standard target heart rates (those at which treadmill stress tests in physicians' offices are typically stopped) (t(29) = 12.81, P requires a functional capacity greater than that typically attained in traditional cardiac rehabilitation programs. Rehabilitation professionals should consider performing maximal stress tests and increasing the intensity of cardiac rehabilitation workouts to effectively train police officers who have had a cardiac event.

  2. Changing patterns in the management of splenic trauma: the impact of nonoperative management.

    Science.gov (United States)

    Pachter, H L; Guth, A A; Hofstetter, S R; Spencer, F C

    1998-01-01

    OBJECTIVE: The recognition that splenectomy renders patients susceptible to lifelong risks of septic complications has led to routine attempts at splenic conservation after trauma. In 1990, the authors reported that over an 11-year study period involving 193 patients, splenorrhaphy was the most common splenic salvage method (66% overall) noted, with nonoperative management employed in only 13% of blunt splenic injuries. This report describes changing patterns of therapy in 190 consecutive patients with splenic injuries seen during a subsequent 6-year period (1990 to 1996). An algorithmic approach for patient management and pitfalls to be avoided to ensure safe nonoperative management are detailed. METHODS: Nonoperative management criteria included hemodynamic stability and computed tomographic examination without shattered spleen or other injuries requiring celiotomy. RESULTS: Of 190 consecutive patients, 102 (54%) were managed nonoperatively: 96 (65%) of 147 patients with blunt splenic injuries, which included 15 patients with intrinsic splenic pathology, and 6 hemodynamically stable patients with isolated stab wounds (24% of all splenic stab wounds). Fifty-six patients underwent splenectomy (29%) and 32 splenorrhaphy (17%). The mean transfusion requirement was 6 units for splenectomy survivors and 0.8 units for nonoperative therapy (85% received no transfusions). Fifteen of the 16 major infectious complications that occurred followed splenectomy. Two patients failed nonoperative therapy (2%) and underwent splenectomy, and one patient required splenectomy after partial splenic resection. There no missed enteric injuries in patients managed nonoperatively. The overall mortality rate was 5.2%, with no deaths following nonoperative management. CONCLUSIONS: Nonoperative management of blunt splenic injuries has replaced splenorrhaphy as the most common method of splenic conservation. The criteria have been extended to include patients previously excluded from this form

  3. Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial.

    Science.gov (United States)

    Sanders, David W; Tieszer, Christina; Corbett, Bradley

    2012-03-01

    To compare clinical and functional outcomes after operative and nonoperative treatment of undisplaced, unstable, isolated fibula fractures. Randomized multicenter clinical trial. Six level 1 trauma centers. Eighty-one patients with undisplaced, unstable, isolated fibula fractures as confirmed by an external rotation stress examination demonstrating an increase in medial clear space to 5 mm or greater were followed for 12 months after treatment. Forty-one patients were treated operatively by open reduction and internal fixation of the fibula. Forty patients underwent nonoperative treatment, which included the use of a short leg cast or brace and protected weight bearing for 6 weeks. Functional outcomes determined using the Olerud-Molander Ankle Score and the Short Form 36. Radiographic outcomes included measurement of union and displacement at each visit. There were no statistically significant differences in functional outcome scores or pace of recovery between the operative and nonoperative groups at any time interval (β = -0.28, 3.49; P = 0.936). Complications in the nonoperative group included 8 patients with a medial clear space ≥5 mm and 8 patients with delayed union or nonunion. In the operative group, 5 patients had a surgical site infection and 5 patients required hardware removal. Patients managed operatively had equivalent functional outcomes compared with nonoperative treatment; however, the risk of displacement and problems with union was substantially lower in patients managed with surgery.

  4. Outcomes of a multimodal cognitive and physical rehabilitation program for persons with mild dementia and their caregivers: a goal-oriented approach

    Directory of Open Access Journals (Sweden)

    Chew J

    2015-10-01

    Full Text Available Justin Chew, Mei-Sian Chong, Yoke-Leng Fong, Laura Tay Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore Background: Nonpharmacological interventions such as exercise and cognitive rehabilitation programs have shown promise in reducing the impact of dementia on the individual and the caregiver. In this study, we examine the effect of a multimodal cognitive and physical rehabilitation program for persons with mild dementia and their caregivers using conventional measures of cognition, behavior, quality of life (QoL, and caregiver burden together with goal attainment scaling (GAS, an individualized outcome measure.Methods: Goals were set at baseline, and GAS score was calculated at the end of the program. Participants were also assessed with the Chinese Mini-Mental State Examination, functional and behavioral scales (Barthel Index, Instrumental Activities of Daily Living, Neuropsychiatric Inventory Questionnaire, QoL, and caregiver burden using EuroQol-five dimension questionnaire and Zarit Burden Interview (ZBI. Differences in median scores postintervention were obtained. Further analysis of caregiver burden was undertaken utilizing the multidimensional classification of burden on the ZBI.Results: Thirty-four (61.8% patients were assessed to have met their goals (GAS score ≥50. Mean (standard deviation GAS score was 48.6 (6.5. Cognition goals were set in only 20.6%, followed by goals to improve engagement and socialization; reduce caregiver stress; and improve physical function, behavior, and mood. Median scores in the cognitive, functional, and QoL measures did not differ significantly pre- and postintervention. The intervention had a positive impact on role strain, a unique dimension of caregiver burden.Conclusion: This study provides evidence that a multimodal approach combining physical exercise and cognitive rehabilitation improves goal attainment and caregiver burden

  5. Study of environmental contamination of Semipalatinsk region and development of rehabilitation program

    International Nuclear Information System (INIS)

    Artemev, O.I.; Akhmetov, M.A.; Ptitskaya, L.D.

    1998-01-01

    The obtained and analyzed results of the researches showed the following. 1) The exposure dose rate does not exceed the level admitted - 0.3 μSv/h. 2) Beta contamination level is below the 55 counts per minute per sq. cm, the level admitted is 200 counts per minute per sq. cm. 3) alpha contamination level is below the 2 counts per minute per sq. cm for the most part of the territory. The sites with the higher level have been detailed examined, their boundaries have been laid out. 4) 1 37C s contamination is below the level admitted. However, several points showed the values higher than those of the global fallout. 5) 9 0S r contamination is below the level admitted for the most part of the territory. The elevation observed is within the total error of the radiochemical analysis. 6) 2 39P u was detected in the majority of samples. It was detected on both the radioactive plums and outside of them. It is too early to conclude anything about Pu due to the lack of materials. It is necessary to examine the territory more detailed as the step of sampling is larger than the size of Pu contaminated sites. 7) There is no elevation of alpha, beta and gamma levels in places of people temporary living as well as no high radionuclide content. Analysis for 2 39P u was not made. 48 settlements have been investigated totally. The program developed for the environment remediation at STS is planned for many years and will be implemented stage-by-stage

  6. A standardized motor imagery introduction program (MIIP for neuro-rehabilitation: development and evaluation

    Directory of Open Access Journals (Sweden)

    Christine eWondrusch

    2013-08-01

    Full Text Available Background: For patients with central nervous system lesions and sensorimotor impairments a solid motor imagery (MI introduction is crucial to understand and use MI to improve motor performance. The study’s aim was to develop and evaluate a standardized MI group introduction program (MIIP for patients after stroke, multiple sclerosis, Parkinson’s disease, and traumatic brain injury. Methods:Phase 1: Based on literature a MIIP was developed comprising MI theory (definition, type, mode, perspective, planning and MI practice (performance, control. Phase 2: Development of a 27-item self-administered MIIP evaluation questionnaire, assessing MI knowledge self-evaluation of the ability to perform MI and patient satisfaction with the MIIP. Phase 3: Evaluation of MIIP and MI questionnaire by 2 independent MI experts based on predefined criteria and 2 patients using semi-structured interviews.Phase 4: Case series with a pre-post design to evaluate MIIP (3x30minutes using the MI questionnaire, Imaprax, Kinaesthetic and Visual Imagery Questionnaire, and Mental Chronometry. The paired t-test and the Wilcoxon signed-rank test were used to determine significant changes.Results: Data of eleven patients were analysed (5 females; age 62.3±14.1 years. Declarative MI knowledge improved significantly from 5.4±2.2 to 8.8±2.9 (p=0.010. Patients demonstrated good satisfaction with MIIP (mean satisfaction score: 83.2±11.4 %. MI ability remained on a high level but showed no significant change, except a significant decrease in the Kinaesthetic and Visual Imagery Questionnaire score.Conclusion: The presented MIIP seems to be valid and feasible for patients with central nervous system lesions and sensorimotor impairments resulting in improved MI knowledge. MIIP sessions can be held in groups of four or less. MI ability and Mental Chronometry remained unchanged after 3 training sessions.

  7. A standardized motor imagery introduction program (MIIP) for neuro-rehabilitation: development and evaluation.

    Science.gov (United States)

    Wondrusch, C; Schuster-Amft, C

    2013-01-01

    For patients with central nervous system (CNS) lesions and sensorimotor impairments a solid motor imagery (MI) introduction is crucial to understand and use MI to improve motor performance. The study's aim was to develop and evaluate a standardized MI group introduction program (MIIP) for patients after stroke, multiple sclerosis (MS), Parkinson's disease (PD), and traumatic brain injury (TBI). Phase 1: Based on literature a MIIP was developed comprising MI theory (definition, type, mode, perspective, planning) and MI practice (performance, control). Phase 2: Development of a 27-item self-administered MIIP evaluation questionnaire, assessing MI knowledge self-evaluation of the ability to perform MI and patient satisfaction with the MIIP. Phase 3: Evaluation of MIIP and MI questionnaire by 2 independent MI experts based on predefined criteria and 2 patients using semi-structured interviews. Phase 4: Case series with a pre-post design to evaluate MIIP (3 × 30 min) using the MI questionnaire, Imaprax, Kinaesthetic and Visual Imagery Questionnaire, and Mental Chronometry. The paired t-test and the Wilcoxon signed-rank test were used to determine significant changes. Data of eleven patients were analysed (5 females; age 62.3 ± 14.1 years). Declarative MI knowledge improved significantly from 5.4 ± 2.2 to 8.8 ± 2.9 (p = 0.010). Patients demonstrated good satisfaction with MIIP (mean satisfaction score: 83.2 ± 11.4%). MI ability remained on a high level but showed no significant change, except a significant decrease in the Kinaesthetic and Visual Imagery Questionnaire score. The presented MIIP seems to be valid and feasible for patients with CNS lesions and sensorimotor impairments resulting in improved MI knowledge. MIIP sessions can be held in groups of four or less. MI ability and Mental Chronometry remained unchanged after 3 training sessions.

  8. Rehabilitation time before disability pension

    Directory of Open Access Journals (Sweden)

    Støver Morten

    2012-10-01

    Full Text Available Abstract Background The decision to grant a disability pension is usually the end of a long process of medical examinations, treatment and rehabilitation attempts. This study investigates to what extent the time spent on rehabilitation time prior to disability pension is associated with characteristics of the individual or the local employment and welfare office, measured as municipality variance. Methods A study of 2,533 40 to 42 year olds who received disability pension over a period of 18 years. The logarithm of the rehabilitation time before granting a disability pension was analysed with multilevel regression. Results The rehabilitation time before a disability pension was granted ranged from 30 to 5,508 days. Baseline health characteristics were only moderately associated with rehabilitation time. Younger people and people with unemployment periods had longer rehabilitation time before a disability pension was granted. There were only minor differences in rehabilitation time between men and women and between different levels of education. Approximately 2% of the total variance in rehabilitation time could be attributed to the municipality of residence. Conclusions There is a higher threshold for granting a disability pension to younger persons and those who are expecting periods of unemployment, which is reflected in the extended rehabilitation requirements for these groups. The longer rehabilitation period for persons with psychiatric disorders might reflect a lack of common knowledge on the working capacity of and the fitted rehabilitation programs for people with psychiatric disorders.

  9. Rehabilitation time before disability pension.

    Science.gov (United States)

    Støver, Morten; Pape, Kristine; Johnsen, Roar; Fleten, Nils; Sund, Erik R; Claussen, Bjørgulf; Ose, Solveig Osborg; Bjørngaard, Johan Håkon

    2012-10-30

    The decision to grant a disability pension is usually the end of a long process of medical examinations, treatment and rehabilitation attempts. This study investigates to what extent the time spent on rehabilitation time prior to disability pension is associated with characteristics of the individual or the local employment and welfare office, measured as municipality variance. A study of 2,533 40 to 42 year olds who received disability pension over a period of 18 years. The logarithm of the rehabilitation time before granting a disability pension was analysed with multilevel regression. The rehabilitation time before a disability pension was granted ranged from 30 to 5,508 days. Baseline health characteristics were only moderately associated with rehabilitation time. Younger people and people with unemployment periods had longer rehabilitation time before a disability pension was granted. There were only minor differences in rehabilitation time between men and women and between different levels of education. Approximately 2% of the total variance in rehabilitation time could be attributed to the municipality of residence. There is a higher threshold for granting a disability pension to younger persons and those who are expecting periods of unemployment, which is reflected in the extended rehabilitation requirements for these groups. The longer rehabilitation period for persons with psychiatric disorders might reflect a lack of common knowledge on the working capacity of and the fitted rehabilitation programs for people with psychiatric disorders.

  10. Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform

    Directory of Open Access Journals (Sweden)

    Carrie Alice Des Roches

    2015-01-01

    Full Text Available The delivery of tablet-based rehabilitation for individuals with post-stroke aphasia is relatively new, therefore, this study examined the effectiveness of an iPad-based therapy to demonstrate improvement in specific therapy tasks and how the tasks affect overall language and cognitive skills. Fifty-one individuals with aphasia due to a stroke or traumatic brain injury were recruited to use an iPad-based software platform, Constant Therapy, for a 10 week therapy program. Participants were split into an experimental (N=42 and control (N=9 group. Both experimental and control participants received a one hour clinic session with a clinician once a week, the experimental participants additionally practiced the therapy at home. Participants did not differ in the duration of the therapy and both groups of participants showed improvement over time in the tasks used for the therapy. However, experimental participants used the application more often and showed greater changes in accuracy and latency on the tasks than the control participants; experimental participants’ severity level at baseline as measured by standardized tests of language and cognitive skills were a factor in improvement on the tasks. Subgroups of task co-improvement appear to occur between different language tasks, between different cognitive tasks, and across both domains. Finally, experimental participants showed more significant and positive changes due to therapy in their standardized tests than control participants. These results provide preliminary evidence for the usefulness of a tablet-based platform to deliver tailored language and cognitive therapy to individuals with aphasia.

  11. Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform.

    Science.gov (United States)

    Des Roches, Carrie A; Balachandran, Isabel; Ascenso, Elsa M; Tripodis, Yorghos; Kiran, Swathi

    2014-01-01

    The delivery of tablet-based rehabilitation for individuals with post-stroke aphasia is relatively new, therefore, this study examined the effectiveness of an iPad-based therapy to demonstrate improvement in specific therapy tasks and how the tasks affect overall language and cognitive skills. Fifty-one individuals with aphasia due to a stroke or traumatic brain injury (TBI) were recruited to use an iPad-based software platform, Constant Therapy, for a 10 week therapy program. Participants were split into an experimental (N = 42) and control (N = 9) group. Both experimental and control participants received a 1 h clinic session with a clinician once a week, the experimental participants additionally practiced the therapy at home. Participants did not differ in the duration of the therapy and both groups of participants showed improvement over time in the tasks used for the therapy. However, experimental participants used the application more often and showed greater changes in accuracy and latency on the tasks than the control participants; experimental participants' severity level at baseline as measured by standardized tests of language and cognitive skills were a factor in improvement on the tasks. Subgroups of task co-improvement appear to occur between different language tasks, between different cognitive tasks, and across both domains. Finally, experimental participants showed more significant and positive changes due to therapy in their standardized tests than control participants. These results provide preliminary evidence for the usefulness of a tablet-based platform to deliver tailored language and cognitive therapy to individuals with aphasia.

  12. Measurement of functional capacity requirements to aid in development of an occupation-specific rehabilitation training program to help firefighters with cardiac disease safely return to work.

    Science.gov (United States)

    Adams, Jenny; Roberts, Joanne; Simms, Kay; Cheng, Dunlei; Hartman, Julie; Bartlett, Charles

    2009-03-15

    We designed a study to measure the functional capacity requirements of firefighters to aid in the development of an occupation-specific training program in cardiac rehabilitation; 23 healthy male firefighters with no history of heart disease completed a fire and rescue obstacle course that simulated 7 common firefighting tasks. They wore complete personal protective equipment and portable metabolic instruments that included a data collection mask. We monitored each subject's oxygen consumption (VO(2)) and working heart rate, then calculated age-predicted maximum heart rates (220 - age) and training target heart rates (85% of age-predicted maximum heart rate). During performance of the obstacle course, the subjects' mean working heart rates and peak heart rates were higher than the calculated training target heart rates (t(22) = 5.69 [working vs target, p functional capacity greatly exceeded that typically attained by patients in traditional cardiac rehabilitation programs (5 to 8 METs). In conclusion, our results indicate the need for intense, occupation-specific cardiac rehabilitation training that will help firefighters safely return to work after a cardiac event.

  13. Compiling standardized information from clinical practice: using content analysis and ICF Linking Rules in a goal-oriented youth rehabilitation program.

    Science.gov (United States)

    Lustenberger, Nadia A; Prodinger, Birgit; Dorjbal, Delgerjargal; Rubinelli, Sara; Schmitt, Klaus; Scheel-Sailer, Anke

    2017-09-23

    To illustrate how routinely written narrative admission and discharge reports of a rehabilitation program for eight youths with chronic neurological health conditions can be transformed to the International Classification of Functioning, Disability and Health. First, a qualitative content analysis was conducted by building meaningful units with text segments assigned of the reports to the five elements of the Rehab-Cycle ® : goal; assessment; assignment; intervention; evaluation. Second, the meaningful units were then linked to the ICF using the refined ICF Linking Rules. With the first step of transformation, the emphasis of the narrative reports changed to a process oriented interdisciplinary layout, revealing three thematic blocks of goals: mobility, self-care, mental, and social functions. The linked 95 unique ICF codes could be grouped in clinically meaningful goal-centered ICF codes. Between the two independent linkers, the agreement rate was improved after complementing the rules with additional agreements. The ICF Linking Rules can be used to compile standardized health information from narrative reports if prior structured. The process requires time and expertise. To implement the ICF into common practice, the findings provide the starting point for reporting rehabilitation that builds upon existing practice and adheres to international standards. Implications for Rehabilitation This study provides evidence that routinely collected health information from rehabilitation practice can be transformed to the International Classification of Functioning, Disability and Health by using the "ICF Linking Rules", however, this requires time and expertise. The Rehab-Cycle ® , including assessments, assignments, goal setting, interventions and goal evaluation, serves as feasible framework for structuring this rehabilitation program and ensures that the complexity of local practice is appropriately reflected. The refined "ICF Linking Rules" lead to a standardized

  14. Non-operative management of blunt abdominal trauma: positive predictors

    Directory of Open Access Journals (Sweden)

    A. A. Pankratov

    2017-01-01

    Full Text Available Background: Over the last years a non-operative management (NOM of blunt  abdominal  trauma has been included into the standard treatment guidelines  in leading  trauma  centers  all over the world.  The  success  of NOM is based  on  careful patient  selection. Nevertheless, the selection  criteria have not been clearly determined up to now.Aim: To identify predictors of successful NOM and to  create  a diagnostic  and  treatment algorithm for its implementation.Materials and methods: 209 patients  with abdominal  trauma  who underwent  laparoscopy  or NOM from January 2006 to September 2015 were included  in the  study. The hemoperitoneum volume  and  organ  injury rate evaluated   by  using  ultrasonography  and  computed  tomography scan, as well as hemoglobin level, blood  pressure,  and  peripheral  pulse  were analyzed. We performed  comparative  analysis of prognostic  values of various selection  criteria for NOM, such as: 1 Huang and McKenney ultrasound scoring systems for hemoperitoneum quantification; 2 hemodynamic parameters; 3 hemoglobin levels;  4 various combinations  of the  above mentioned factors; 5 Sonographic  Scoring for Operating  Room Triage in Trauma (SSORTT scoring system.Results: Positive prognostic  values of parameters included into the study varied from 88 to 91.7% when used separately or in combination with other scored factors. Furthermore, there was no  significant  difference  between positive  predictive value  of all combinations of factors  and McKenney ultrasound hemoperitoneum scoring system used alone.Conclusion: The proposed predictors  as  well as  diagnostic  and  treatment algorithm are easy-to-use  and available in clinical practice.

  15. Are Virtual Rehabilitation Technologies Feasible Models to Scale an Evidence-Based Fall Prevention Program? A Pilot Study Using the Kinect Camera.

    Science.gov (United States)

    Shubert, Tiffany E; Basnett, Jeanna; Chokshi, Anang; Barrett, Mark; Komatireddy, Ravi

    2015-11-05

    Falls in older adults are a significant public health issue. Interventions have been developed and proven effective to reduce falls in older adults, but these programs typically last several months and can be resource intensive. Virtual rehabilitation technologies may offer a solution to bring these programs to scale. Off-the-shelf and custom exergames have demonstrated to be a feasible adjunct to rehabilitation with older adults. However, it is not known if older adults will be able or willing to use a virtual rehabilitation technology to participate in an evidence-based fall prevention program. To have the greatest impact, virtual rehabilitation technologies need to be acceptable to older adults from different backgrounds and level of fall risk. If these technologies prove to be a feasible option, they offer a new distribution channel to disseminate fall prevention programs. Stand Tall (ST) is a virtual translation of the Otago Exercise Program (OEP), an evidence-based fall prevention program. Stand Tall was developed using the Virtual Exercise Rehabilitation Assistant (VERA) software, which uses a Kinect camera and a laptop to deliver physical therapy exercise programs. Our purpose in this pilot study was to explore if ST could be a feasible platform to deliver the OEP to older adults from a variety of fall risk levels, education backgrounds, and self-described level of computer expertise. Adults age 60 and over were recruited to participate in a one-time usability study. The study included orientation to the program, navigation to exercises, and completion of a series of strength and balance exercises. Quantitative analysis described participants and the user experience. A diverse group of individuals participated in the study. Twenty-one potential participants (14 women, 7 men) met the inclusion criteria. The mean age was 69.2 (± 5.8) years, 38% had a high school education, 24% had a graduate degree, and 66% classified as "at risk for falls". Eighteen

  16. Patient Outcomes in the Operative and Nonoperative Management of High-Grade Spondylolisthesis in Children

    DEFF Research Database (Denmark)

    Lundine, K. M.; Lewis, S. J.; Al-Aubaidi, Zaid

    2014-01-01

    Background:The optimal management of high-grade spondylolisthesis in the growing child is controversial. Some authors have advocated for surgery in all cases regardless of symptoms. Surgical intervention results in a >10% risk of complications with increased risk of neurological injury associated...... with slip reduction maneuvers. There is a paucity of literature regarding nonoperative management in this setting. This study sought to obtain outcome measures in pediatric patients with high-grade spondylolisthesis managed either operatively or nonoperatively.Methods:Database review was performed...

  17. Results of Operative and Nonoperative Treatment of Rockwood Types III and V Acromioclavicular Joint Dislocation

    Science.gov (United States)

    Joukainen, Antti; Kröger, Heikki; Niemitukia, Lea; Mäkelä, E. Antero; Väätäinen, Urho

    2014-01-01

    Background: The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved. Purpose: To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed. Results: Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in

  18. Justification inclusion of physiotherapy and self-reflexotherapy program physical rehabilitation of adolescents with short-sightedness

    Directory of Open Access Journals (Sweden)

    T.G. Redkovets

    2014-02-01

    Full Text Available Purpose : To substantiate the combined use of therapeutic exercises and Onnuri therapy to restore vision in teenagers with myopia. Material: analysis of more than 80 sources of literature on the subject to study the prevalence of myopia in adolescents and the impact of physical rehabilitation for restoration of view. Results : It was established that the increase in the prevalence of myopia in adolescents with greater visual load, requires the development of new approaches to rehabilitation. Data on the impact kinesotherapy and reflexology on the body. Presents the rationale of their use in rehabilitation, with the principles of conduct, with myopia. Conclusions : kinesis therapy, compliance with recommendations for the application of different directivity exercises limited power voltage, over- load of a physical and jumping, should be combined with the methods of self-reflection therapy (self-massage, application of seed, color effects for more high effect of restoring vision.

  19. Telehealth, Wearable Sensors, and the Internet: Will They Improve Stroke Outcomes Through Increased Intensity of Therapy, Motivation, and Adherence to Rehabilitation Programs?

    Science.gov (United States)

    Burridge, Jane H; Lee, Alan Chong W; Turk, Ruth; Stokes, Maria; Whitall, Jill; Vaidyanathan, Ravi; Clatworthy, Phil; Hughes, Ann-Marie; Meagher, Claire; Franco, Enrico; Yardley, Lucy

    2017-07-01

    Stroke, predominantly a condition of older age, is a major cause of acquired disability in the global population and puts an increasing burden on health care resources. Clear evidence for the importance of intensity of therapy in optimizing functional outcomes is found in animal models, supported by neuroimaging and behavioral research, and strengthened by recent meta-analyses from multiple clinical trials. However, providing intensive therapy using conventional treatment paradigms is expensive and sometimes not feasible because of social and environmental factors. This article addresses the need for cost-effective increased intensity of practice and suggests potential benefits of telehealth (TH) as an innovative model of care in physical therapy. We provide an overview of TH and present evidence that a web-supported program, used in conjunction with constraint-induced therapy (CIT), can increase intensity and adherence to a rehabilitation regimen. The design and feasibility testing of this web-based program, "LifeCIT," is presented. We describe how wearable sensors can monitor activity and provide feedback to patients and therapists. The methodology for the development of a wearable device with embedded inertial and mechanomyographic sensors, algorithms to classify functional movement, and a graphical user interface to present meaningful data to patients to support a home exercise program is explained. We propose that wearable sensor technologies and TH programs have the potential to provide most-effective, intensive, home-based stroke rehabilitation.

  20. Guidelines for postdoctoral training in rehabilitation psychology.

    Science.gov (United States)

    Stiers, William; Hanson, Stephanie; Turner, Aaron P; Stucky, Kirk; Barisa, Mark; Brownsberger, Mary; Van Tubbergen, Marie; Ashman, Teresa; Kuemmel, Angela

    2012-11-01

    This article describes the methods and results of a national conference that was held to (1) develop consensus guidelines about the structure and process of rehabilitation psychology postdoctoral training programs and (2) create a Council of Rehabilitation Psychology Postdoctoral Training Programs to promote training programs' abilities to implement the guidelines and to formally recognize programs in compliance with the guidelines. Forty-six conference participants were chosen to include important stakeholders in rehabilitation psychology, representatives of rehabilitation psychology training and practice communities, representatives of psychology accreditation and certification bodies, and persons involved in medical education practice and research. Consensus guidelines were developed for rehabilitation psychology postdoctoral training program structure and process and for establishing the Council of Rehabilitation Psychology Postdoctoral Training Programs. The Conference developed aspirational guidelines for postdoctoral education and training programs in applied rehabilitation psychology and established a Council of Rehabilitation Psychology Postdoctoral Training Programs as a means of promoting their adoption by training programs. These efforts are designed to promote quality, consistency, and excellence in the education and training of rehabilitation psychology practitioners and to promote competence in their practice. It is hoped that these efforts will stimulate discussion, assist in the development of improved teaching and evaluation methods, lead to interesting research questions, and generally facilitate the continued systematic development of the profession of rehabilitation psychology. PsycINFO Database Record (c) 2012 APA, all rights reserved

  1. It's About Me: Patients' Experiences of Patient Participation in the Web Behavior Change Program for Activity in Combination With Multimodal Pain Rehabilitation.

    Science.gov (United States)

    Nordin, Catharina; Michaelson, Peter; Eriksson, Margareta K; Gard, Gunvor

    2017-01-18

    Patients' participation in their health care is recognized as a key component in high-quality health care. Persons with persistent pain are recommended treatments with a cognitive approach from a biopsychosocial explanation of pain, in which a patient's active participation in their rehabilitation is in focus. Web-based interventions for pain management have the potential to increase patient participation by enabling persons to play a more active role in rehabilitation. However, little is known about patients' experiences of patient participation in Web-based interventions in clinical practice. The objective of our study was to explore patients' experiences of patient participation in a Web Behavior Change Program for Activity (Web-BCPA) in combination with multimodal rehabilitation (MMR) among patients with persistent pain in primary health care. Qualitative interviews were conducted with 15 women and 4 men, with a mean age of 45 years. Data were analyzed with qualitative content analysis. One theme, "It's about me," and 4 categories, "Take part in a flexible framework of own priority," "Acquire knowledge and insights," "Ways toward change," and "Personal and environmental conditions influencing participation," were developed. Patient participation was depicted as being confirmed in an individualized and structured rehabilitation framework of one's own choice. Being confirmed was fundamental to patient participation in the interaction with the Web-BCPA and with the health care professionals in MMR. To acquire knowledge and insights about pain and their life situation, through self-reflection in the solitary work in the Web-BCPA and through feedback from the health care professionals in MMR, was experienced as patient participation by the participants. Patient participation was described as structured ways to reach their goals of behavior change, which included analyzing resources and restrictions, problem solving, and evaluation. The individual's emotional and

  2. Twenty-six years of post-release monitoring of Florida manatees (Trichechus manatus latirostris): evaluation of a cooperative rehabilitation program

    Science.gov (United States)

    Adimey, Nicole M.; Ross, Monica; Hall, Madison; Reid, James P.; Barlas, Margie E.; Keith Diagne, Lucy W; Bonde, Robert K.

    2016-01-01

    The rescue, rehabilitation, and release of Florida manatees (Trichechus manatus latirostris) into the wild has occurred since 1974; however, a comprehensive evaluation of the outcomes of the releases has never been conducted. Herein, we examined data for 136 Florida manatees that were rehabilitated and released with telemetry tags between 1988 and 2013 to determine release outcome of each individual as either success (acclimation) or failure after at least 1 y. Ten predictor variables were statistically evaluated for potential relationships to release outcome. To assess the contribution of each predictor variable to release outcome, each variable was tested for significance in univariate analyses. Manatees born in captivity experienced poor success after release (14%), whereas the overall success of wild-born individuals was higher (72%). When compared with other variables in our dataset, number of days in captivity was the strongest predictor for determining success. Manatees rescued as calves and held in captivity for more than 5 y had a high likelihood of failure, while subadults and adults had a high likelihood of success, regardless of the amount of time spent in captivity. Ensuring the success of individual manatees after release is critical for evaluating the contribution of the manatee rehabilitation program to the growth of the wild population.

  3. Research Productivity in Rehabilitation, Disability, and Allied Health Programs: A Focus Group Perspective on Minority-Serving Institutions

    Science.gov (United States)

    Aref, Fariborz; Manyibe, Edward O.; Washington, Andre L.; Johnson, Jean; Davis, Dytisha; Eugene-Cross, Kenyotta; Moore, Cayla A.

    2017-01-01

    Purpose: The article outlines select individual and institutional factors that could contribute to rehabilitation, disability, and health research productivity among minority-serving institutions (MSIs; i.e., historically Black colleges/universities, Hispanic-serving institutions, and American Indian tribal colleges/universities). Method: We…

  4. Enhancing Your Public Relations. A Guide for Designing Effective Communication Strategies for Community-Based Vocational Rehabilitation Programs.

    Science.gov (United States)

    DePoint, Beth

    This document is intended to assist agencies in formulating and initiating a financially realistic public relations plan specifically designed for their community-based vocational rehabilitation organizations. The document consists of 6 chapters, a 43-item bibliography, a glossary, and information about the author. Chapter 1 defines public…

  5. Rehabilitation in multiple sclerosis.

    Science.gov (United States)

    Kubsik-Gidlewska, Anna M; Klimkiewicz, Paulina; Klimkiewicz, Robert; Janczewska, Katarzyna; Woldańska-Okońska, Marta

    2017-07-01

    The aim of the study is to present a strategy of rehabilitation in multiple sclerosis on the basis of the latest developments in the field of physiotherapy. The publications on the problem discuss a wide range of methods of physiotherapy that can be used in order to reduce the degree of disability and alleviate the symptoms associated with the disease. The complexity of the disease, the difficulty in determining the appropriate treatment and a wide range of symptoms require a comprehensive approach to the patient, which would include both pharmacology and neurorehabilitation. Rehabilitation, which includes psychotherapy and symptomatic therapy, is regarded nowadays as the best form of treatment for multiple sclerosis. An indepth diagnostic assessment of functional status and prognosis should be carried out before the start of the rehabilitation process. The prognosis should take into account the mental state, the neurological status and the awareness of the patient. The kinesiotherapy program in multiple sclerosis is based on a gradation of physiotherapy which assumes a gradual transition from basic movements to more complex ones till global functions are obtained. The most appropriate form of treatment is functional rehabilitation combined with physical procedures. Recent reports indicate the need for aerobic training to be included in the rehabilitation program. The introduction of physical activities, regardless of the severity of the disease, will reduce the negative effects of akinesia, and thus increase the functional capabilities of all body systems.

  6. Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: A systematic review

    NARCIS (Netherlands)

    Olthof, Dominique C.; Joosse, Pieter; van der Vlies, Cornelis H.; de Haan, Rob J.; Goslings, J. Carel

    2013-01-01

    BACKGROUND: Contradictory findings are reported in the literature concerning prognostic factors for failure of nonoperative management (NOM) in the treatment of adults with blunt splenic injury. The objective of this systematic review was to identify prognostic factors for failure of NOM, with or

  7. Impact of Splenic Artery Embolization on the Success Rate of Nonoperative Management for Blunt Splenic Injury

    NARCIS (Netherlands)

    van der Vlies, C. H.; Hoekstra, J.; Ponsen, K. J.; Reekers, J. A.; van Delden, O. M.; Goslings, J. C.

    2012-01-01

    Introduction Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to

  8. Consensus strategies for the nonoperative management of patients with blunt splenic injury: A Delphi study

    NARCIS (Netherlands)

    Olthof, Dominique C.; van der Vlies, Cornelius H.; Joosse, Pieter; van Delden, Otto M.; Jurkovich, Gregory J.; Goslings, J. C.; Angle, J. F.; Chakraverty, S.; Coimbra, R.; Demetriades, D.; Denys, A.; Duchesne, J. C.; Fabian, T. C.; Feliciano, D. V.; Fingerhut, A.; Gaarder, C.; Haan, J. M.; Hanks, S. E.; Hauser, C. J.; Heuer, M.; Hoffer, E. K.; Hoyt, D. B.; Ivatury, R. R.; Jurkovich, G. J.; Leenen, L. P.; Leppaniemi, A.; Maegele, M.; Michel, L. A.; Moore, E. E.; Peitzman, A. B.; Reekers, J. A.; Scalea, T. M.; Velmahos, G. C.; de Waele, J. J.; Wisner, D. H.

    2013-01-01

    BACKGROUND: Nonoperative management is the standard of care in hemodynamically stable patients with blunt splenic injury. However, a number of issues regarding the management of these patients are still unresolved. The aim of this study was to reach consensus among experts concerning optimal

  9. Is non-operative management still justified in the treatment of ...

    African Journals Online (AJOL)

    Abstract. Background: Adhesive small bowel obstruction (ASBO) is a feared complication after abdominal operations in both children and adults. The optimal ... Followup data were available for 29 patients. Demographic ... required surgery. Key words: Adhesive small bowel obstruction, children, non-operative management ...

  10. Trauma surgery in the era of nonoperative management: the Dutch model

    NARCIS (Netherlands)

    Goslings, J. Carel; Ponsen, Kees Jan; Luitse, Jan S. K.; Jurkovich, Gregory J.

    2006-01-01

    BACKGROUND: Falling operative experience and diminished job satisfaction of trauma surgeons appears to be in part the result of nonoperative management of many blunt injuries. In The Netherlands, the responsibility of trauma surgeons includes the operative treatment of most pelvic and extremity

  11. Evaluation of a protocol for the non-operative management of perforated peptic ulcer.

    Science.gov (United States)

    Marshall, C; Ramaswamy, P; Bergin, F G; Rosenberg, I L; Leaper, D J

    1999-01-01

    The non-operative management of perforated peptic ulcer has previously been shown to be both safe and effective although it remains controversial. A protocol for non-operative management was set up in this hospital in 1989. Adherence to the guidelines in the protocol has been audited over a 6-year period with a review of outcome. The case-notes of patients with a diagnosis of perforated peptic ulcer were reviewed. Twelve guidelines from the protocol were selected for evaluation of compliance to the protocol. Forty-nine patients underwent non-operative treatment initially. Eight patients failed to respond and underwent operation. Complications included abscess formation (seven patients), renal failure (one), gastric ileus (one), chest infection (two), and cardiac failure and stroke (one). Four deaths occurred in this group. Adherence to certain protocol guidelines was poor, notably those concerning prevention of thromboembolism, use of antibiotics, use of contrast examination to confirm the diagnosis and referral for follow-up endoscopy. Two gastric cancers were detected on subsequent endoscopy. This experience demonstrates that non-operative treatment can be used successfully in a general hospital. Adherence to protocol guidelines was found to be variable and the protocol has therefore been simplified. This study highlights the need for an accurate diagnosis and the importance of follow-up endoscopy.

  12. [Non-operative treatment for severe forms of infantile idiopathic scoliosis].

    Science.gov (United States)

    Trobisch, P D; Samdani, A; O'Neil, C; Betz, R; Cahill, P

    2012-02-01

    Infantile idiopathic scoliosis (IIS) is a rare orthopaedic condition. Braces and casts are popular options in the treatment of IIS but there is a paucity of studies commenting on the outcome of non-operative treatment. The purpose of this study was to analyse failure and success after non-operative treatment for severe forms of IIS. We retrospectively reviewed the data of all children who had been treated for IIS between 2003 and 2009 at a single institution. After calculating the failure and success rates, we additionally performed a risk factor analysis for patients who failed non-operative treatment. Chi (2) and T tests were used for statistical analysis with significance set at p failure (55 versus 42) while neither age, gender, nor RVAD seem to influence the outcome. In children who were considered as successfully treated, the Cobb angle decreased from 42 to 18 degrees. Non-operative treatment for IIS is successful in 3 out of 4 patients. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Anterolateral ankle impingement in adolescents: outcomes of nonoperative and operative treatment.

    Science.gov (United States)

    Edmonds, Eric W; Chambers, Reid; Kaufman, Elizabeth; Chambers, Henry G

    2010-03-01

    Ankle sprains in adolescents usually resolve with conservative management but a few patients may develop ankle impingement syndrome. There have been adult studies addressing surgical treatment of this pathology, but our study evaluated the surgical management of anterolateral ankle impingement in adolescents by comparing their outcomes after nonoperative treatment and subsequent surgical intervention. Thirteen patients (children and adolescents) diagnosed with ankle impingement by history, physical examination, and magnetic resonance imaging during a 9-year period at our institution underwent eventual arthroscopic debridement. A retrospective chart review of these patients was performed and they were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) functional rating scale on 3 separate occasions: (1) initial presentation, (2) termination of nonoperative management, and (3) final postoperative follow-up visit. Thirteen adolescents (11 girls and 2 boys; 14 ankles) with a mean age of 15.6 (11.9-18.3) years met the inclusion criteria; of these, all had arthroscopic surgery. Mean duration of reported symptoms was 9.6 (4-15) months and mean duration of nonoperative management (physical therapy, activity modifications) was 6.9 (2-12) months. The mean AOFAS rating (out of 100 total) at initial presentation was 68.4 (40-84) and after nonoperative management was no better with a mean of 68.2 (63-76). The mean AOFAS rating at final follow-up was 90.6 (52-100), which was statistically significant (Pankle impingement in the adolescent population.

  14. Progression of carpal tunnel syndrome according to electrodiagnostic testing in nonoperatively treated patients

    NARCIS (Netherlands)

    van Suchtelen, Mark; Becker, Stéphanie J. E.; Gruber, Jillian S.; Ring, David

    2014-01-01

    This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS) over time according to median nerve distal motor latency (DML) on two electrodiagnostic tests. This retrospective study analyzed sixty-two adult

  15. A novel nonoperative approach to abdominal compartment syndrome after abdominal wall reconstruction.

    Science.gov (United States)

    Hasan, Zeenat R; Sorensen, G Brent

    2013-01-01

    Intraabdominal hypertension and abdominal compartment syndrome have been increasingly recognized as significant causes of morbidity and mortality in both medical and surgical patients. The gold standard remains surgical intervention; however, nonoperative approaches have been investigated less. Here, we describe the successful treatment of a severe acute case by intubation, nasogastric decompression, and paralysis--a novel approach not previously described in the literature. After the patient underwent laparoscopic bilateral component separation and repair of a large recurrent ventral hernia with a 20 30-cm Strattice mesh (LifeCell Corp, Branchburg, NJ), acute renal failure developed within 12 hours postoperatively, and was associated with oliguria, hyperkalemia, and elevated peak airway and bladder pressures. The patient was treated nonoperatively with intubation, nasogastric tube decompression, and paralysis with a vecuronium drip. Rapid reversal was seen, avoiding further surgery. Within 2 hours after intubation and paralysis, our patient's urine output improved dramatically with an initial diuresis of approximately 1 L, his bladder pressures decreased, and within 12 hours his creatinine level had normalized. Although surgical intervention has traditionally been thought of as the most effective--and thus the gold standard--for abdominal compartment syndrome, this preliminary experience demonstrates nonoperative management as highly efficacious, with the added benefit of decreased morbidity. Therefore, nonoperative management could be considered first-line therapy, with laparotomy reserved for refractory cases only. This suggests a more complex pathology than the traditional teaching of congestion and edema alone.

  16. Nonoperative Treatment of Thoracic and Lumbar Spine Fractures : A Prospective Randomized Study of Different Treatment Options

    NARCIS (Netherlands)

    Stadhouder, Agnita; Buskens, Erik; Vergroesen, Diederik A.; Fidler, Malcolm W.; de Nies, Frank; Oner, F. C.

    Objectives: To evaluate and compare nonoperative treatment methods for traumatic thoracic and lumbar compression fractures and burst fractures. Design: Prospective randomized controlled trial with long-term follow-up. Setting: Two general hospitals in the Netherlands. Patients/Participants: Patients

  17. Second date appendectomy: Operating for failure of nonoperative treatment in perforated appendicitis.

    Science.gov (United States)

    Lotti, Marco

    2017-06-01

    Nonoperative treatment of acute appendicitis is embraced by many surgical teams, driven by low to moderate quality randomized studies that support noninferiority of antibiotics versus appendectomy for treatment of acute uncomplicated appendicitis. Several flaws of these studies have emerged, especially in the recruitment strategy and in the diagnostic criteria that were used. The growing confidence given to antibiotics, together with the lack of reliable criteria to distinguish between uncomplicated and perforated appendicitis, exposes patients with perforated appendicitis to the likelihood to be treated with antibiotics instead of surgery. Among them, those patients who experience a temporary relief of symptoms due to antibiotics, followed by early recurrence of disease when antibiotics are discontinued, are likely to undergo appendectomy at their second date. Second date appendectomy, i.e. the removal of the appendix when acute inflammation relapses within the scar of a previously unhealed perforated appendicitis, is the unwanted child of the nonoperative treatment and a new challenge for both the surgeon and the patient. Between June and July 2016, two patients were readmitted and operated for failure of nonoperative treatment with antibiotics. A video is presented, which focuses on the different anatomic presentation and technical challenges between prompt and second date laparoscopic appendectomy. When proposing nonoperative treatment for acute appendicitis, surgeons should be aware and inform their patients that if the appendix is perforated and an incomplete healing and early recurrence occur, a second date appendectomy could be a more challenging operation compared to a prompt appendectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. A review on the nonoperative removal of necrotic tissue from burn wounds

    NARCIS (Netherlands)

    Klasen, HJ

    The study of nonoperative debridement of burns got underway during:thr Second World War. A large number of substances such as enzymes of plant origin, acids and proteolytic enzymes:of bacterial origin were examined since. The proteolytic enzymes derived from filtrates of C, histolyticum and B,

  19. The Effectiveness of the Comprehensive Voice Rehabilitation Program Compared With the Vocal Function Exercises Method in Behavioral Dysphonia: A Randomized Clinical Trial.

    Science.gov (United States)

    Pedrosa, Vanessa; Pontes, Antônio; Pontes, Paulo; Behlau, Mara; Peccin, Stella Maria

    2016-05-01

    To evaluate the effectiveness of the Comprehensive Voice Rehabilitation Program (CVRP) compared with Vocal Function Exercises (VFEs) to treat functional dysphonia. This is a randomized blinded clinical trial. Eighty voice professionals presented with voice complaints for more than 6 months with a functional dysphonia diagnosis. Subjects were randomized into two voice treatment groups: CVRP and VFE. The rehabilitation program consisted of six voice treatment sessions and three assessment sessions performed before, immediately after, and 1 month after treatment. The outcome measures were self-assessment protocols (Voice-Related Quality of Life [V-RQOL] and Voice Handicap Index [VHI]), perceptual evaluation of vocal quality, and a visual examination of the larynx, both blinded. The randomization process produced comparable groups in terms of age, gender, signs, and symptoms. Both groups had positive outcome measures. The CVRP effect size was 1.09 for the V-RQOL, 1.17 for the VHI, 0.79 for vocal perceptual evaluation, and 1.01 for larynx visual examination. The VFE effect size was 0.86 for the V-RQOL, 0.62 for the VHI, 0.48 for the vocal perceptual evaluation, and 0.51 for larynx visual examination. Only 10% of the patients were lost over the study. Both treatment programs were effective. The probability of a patient improving because of the CVRP treatment was similar to that of the VFE treatment. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  20. Shock Incarceration: Rehabilitation or Retribution?

    Science.gov (United States)

    MacKenzie, Doris Layton; And Others

    1989-01-01

    Reviews Louisiana's shock incarceration program used as alternative to standard prison incarceration. Program involves short period of imprisonment in a "boot camp" type atmosphere followed by three phases of intensive parole supervision. Examines the program in regard to its rehabilitative potential and compares program elements to…

  1. Intrinsic and extrinsic risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures.

    Science.gov (United States)

    Liu, W; Xiao, J; Ji, F; Xie, Y; Hao, Y

    2015-04-01

    The optimal treatment of midshaft clavicle fractures remains controversial. Nonunion is usually considered to be an uncommon complication following a nonoperatively treated clavicle fracture. Not every midshaft clavicular fractures shares the same risk of developing nonunion after nonoperative treatment. The present study was performed to identify the intrinsic and extrinsic independent factors that are independently predictive of nonunion in patients with midshaft clavicular fractures after nonoperative treatment. We performed a retrospective study of a series of 804 patients (391 men and 413 women with a median age of 51.3 years) with a radiographically confirmed midshaft clavicle fracture, which was treated nonoperatively. There were 96 patients who underwent nonunion. Putative intrinsic (patient-related) and extrinsic (injured-related) risk factors associated with nonunion were determined with the use of bivariate and multivariate statistical analyses. By bivariate analysis, the risk of nonunion was significantly increased by several intrinsic risk factors including age, sex, and smoking and extrinsic risk factors including displacement of the fracture and the presence of comminution (P<0.05 for all). On multivariate analysis, smoking (OR=4.16, 95% CI: 1.01-14.16), fracture displacement (OR=7.81, 95% CI: 2.27-25.38) and comminution of fracture (OR=3.86, 95% CI: 1.16-13.46) were identified as independent predictive factors. The risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures are multifactorial. Smoking, fracture displacement and comminution of fracture are independent predictors for an individual likelihood of nonunion. Further studies are still required to evaluate these factors in the future. Level III, case-control study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  2. Non-operative diagnosis - effect on repeat-operation rates in the UK breast screening programme

    International Nuclear Information System (INIS)

    Wallis, M.G.; Cheung, S.; Kearins, O.; Lawrence, G.M.

    2009-01-01

    Non-operative diagnosis rates in the UK breast screening programme have improved dramatically from 48.8% in 1994/95 (only nine units achieved the then minimum standard of 70%) to 94% in 2005/06 (only seven units failed to achieve the target of 90%). Preoperative and operative history of all 120,550 women diagnosed with screen-detected breast cancer in the UK between April 1994 and March 2006 was derived from different national databases. In 2005/06, 2,790 (17.8%) of the 15,688 women having surgery needed two or more operations. In 2001/02 (non-operative diagnosis rate 87%), the re-operation rate was 23.8% (2,377 of 9,969). Extrapolation backwards to 1994/95 (non-operative diagnosis rate 48.8%) suggests a re-operation rate of 62%. Analysis over the 4 years from April 2002 (n=34,198) demonstrates that 4,089 (12%) women with a correct non-operative diagnosis of invasive disease required additional surgery compared to 1,166 (48%) of women who were under-staged (diagnosed as non-invasive based on core biopsy, but actually suffering from invasive disease). Failure to achieve a non-operative diagnosis of invasive disease (n=1,542) or non-invasive disease (n=2,247) resulted in re-operation rates of 65 and 43% respectively. Given the impact of not having a diagnosis pre-operatively, or of under-staging invasive carcinoma, it seems timely to introduce more sophisticated standards. (orig.)

  3. Is nonoperative management of adhesive intestinal obstruction applicable to children in a resource-poor country?

    Directory of Open Access Journals (Sweden)

    Osifo Osarumwense

    2010-01-01

    Full Text Available Background: Nonoperative management of adhesive intestinal obstruction gives good results in adults but there are scant studies on its outcome in children. This study reports outcomes and experiences with nonoperative and operative management of adhesive intestinal obstruction in children in a resource-poor country. Patients and Methods: This is a retrospective analysis of records of children who were managed with adhesive intestinal obstruction at the University of Benin Teaching Hospital between January 2002 and December 2008. Results: Adhesive intestinal obstruction accounted for 21 (8.8% of 238 children managed with intestinal obstruction. They were aged between 7 weeks and 16 years (mean 3 ± 6.4 years, comprising 13 males and eight females (ratio 1.6:1. Prior laparotomy for gangrenous/perforated intussusception (seven, 33.3%, perforated appendix (five, 23.8%, perforated volvulus (three, 14.3%, penetrating abdominal trauma (two, 9.5% and perforated typhoid (two, 9.5% were major aetiologies. Adhesive obstruction occurred between 6 weeks and 7 years after the index laparotomies. All the 21 children had initial nonoperative management without success, owing to lack of total parenteral nutrition and monitoring facilities. Outcomes of open adhesiolysis performed between 26 and 48 h in six (28.6% children due to poor response to nonoperative management, 11-13 days in 12 (57.1% who responded minimally and 2-5 weeks in three (14.3% who had relapse of symptoms were encouraging. Exploration of the 21 adhesive obstructions confirmed small bowel obstruction due to solitary bands (two, 9.5%, multiple bands/adhesions (13, 61.9% and encasement, including one bowel gangrene (six, 28.6%. Postoperatively, the only child who had recurrence during 1-6 years of follow-up did well after a repeat adhesiolysis. Conclusion: Nonoperative management was unsuccessful in this setting. Open adhesiolysis may be adopted in children to prevent avoidable morbidities and

  4. Complications of nonoperative management of high-grade blunt hepatic injuries.

    Science.gov (United States)

    Kozar, Rosemary A; Moore, John B; Niles, Sarah E; Holcomb, John B; Moore, Ernest E; Cothren, C Clay; Hartwell, Elizabeth; Moore, Frederick A

    2005-11-01

    Nonoperative management of blunt hepatic injuries is highly successful. Complications associated with high-grade injuries, however, have not been well characterized. The purpose of the present study was therefore to define hepatic-related complications and associated treatment modalities in patients undergoing nonoperative management of high-grade blunt hepatic injuries. Three hundred thirty-seven patients from two regional Level I trauma centers with grade 3 to 5 blunt hepatic injuries during a 40-month period were reviewed. Complications and treatment of hepatic-related complications in patients not requiring laparotomy in the first 24 hours were identified. Of 337 patients with a grade 3 to 5 injury, 230 (68%) were managed nonoperatively. There were 37 hepatic-related complications in 25 patients (11%); 63% (5 of 8) of patients with grade 5 injuries developed complications, 21% (19 of 92) of patients with grade 4 injuries, but only 1% (1 of 130) of patients with grade 3 injuries. Complications included bleeding in 13 patients managed by angioembolization (n = 12) and laparotomy (n = 1), liver abscesses in 2 patients managed with computed tomography-guided drainage (n = 2) and subsequent laparotomy (n = 1). In one patient with bleeding, hepatic necrosis followed surgical ligation of the right hepatic artery and required delayed hepatic lobectomy. Sixteen biliary complications were managed with endoscopic retrograde cholangiopancreatography and stenting (n = 7), drainage (n = 5), and laparoscopy (n = 4). Three patients had suspected abdominal sepsis and underwent a negative laparotomy, whereas an additional three patients underwent laparotomy for abdominal compartment syndrome. Nonoperative management of high-grade liver injuries can be safely accomplished. Mortality is low; however, complications in grade 4 and 5 injuries should be anticipated and may require a combination of operative and nonoperative management strategies.

  5. Severe hepatic trauma: nonoperative management, definitive repair, or damage control surgery?

    Science.gov (United States)

    Leppäniemi, Ari K; Mentula, Panu J; Streng, Mari H; Koivikko, Mika P; Handolin, Lauri E

    2011-12-01

    Management of severe liver injuries has evolved to include the options for nonoperative management and damage control surgery. The present study analyzes the criteria for choosing between nonoperative management and early surgery, and definitive repair versus damage control strategy during early surgery. In a retrospective analysis of 144 patients with severe (AAST grade III-V) liver injuries (94% blunt trauma), early laparotomy was performed in 50 patients. Initial management was nonoperative in 94 blunt trauma patients with 8 failures. Uni- and multivariate analyses were used to calculate predictor odds ratios (OR) with 95% confidence intervals (CI). Factors associated with early laparotomy in blunt trauma included shock on admission, associated grade IV-V splenic injury, grade IV-V head injury, and grade V liver injury. Only shock was an independent predictor (OR, 26.1; 95% CI, 8.9-77.1; P < 0.001). The presence of a grade IV-V splenic injury predicted damage control strategy (OR infinite; P = 0.021). Failed nonoperative management was associated with grade IV-V splenic injury (OR, 14.00; 95% CI, 1.67-117.55), and shock (OR, 6.82; 95% CI, 1.49-31.29). The hospital mortality rate was 15%; 8 of 21 deaths were liver-related. Shock (OR, 9.3; 95% CI, 2.4-35.8; P = 0.001) and severe head injury (OR, 9.25; 95% CI, 3.0-28.9; P = 0.000) were independent predictors for mortality. In patients with severe liver injury, associated severe splenic injury favors early laparotomy and damage control strategy. Patients who arrive in shock or have an associated severe splenic injury should not be managed nonoperatively. In addition to severe head injury, uncontrollable bleeding from the liver injury is still a major cause of early death.

  6. Stroke rehabilitation.

    Science.gov (United States)

    Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert

    2011-05-14

    Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Cardiac rehabilitation

    Science.gov (United States)

    ... rehab; Heart failure - cardiac rehab References Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: ... of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed ...

  8. Yoga-based postoperative cardiac rehabilitation program for improving quality of life and stress levels: Fifth-year follow-up through a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Eraballi Amaravathi

    2018-01-01

    Full Text Available Objectives: This study was aimed to assess the efficacy of yoga-based lifestyle program (YLSP in improving quality of life (QOL and stress levels in patients after 5 years of coronary artery bypass graft (CABG. Methodology: Three hundred patients posted for elective CABG in Narayana Hrudayalaya Super Speciality Hospital, Bengaluru, were randomized into two groups: YLSP and conventional lifestyle program (CLSP, and follow-up was done for 5 years. Intervention: In YLSP group, all practices of integrative approach of yoga therapy such as yama, niyama, asana, pranayama, and meditation were used as an add-on to conventional cardiac rehabilitation. The control group (CLSP continued conventional cardiac rehabilitation only. Outcome Measures: World Health Organization (WHO-QOL BREF Questionnaire, Perceived Stress Scale, Positive and Negative Affect Scale (PANAS, and Hospital Anxiety and Depression Scale (HADS were assessed before surgery and at the end of the 5th year after CABG. As data were not normally distributed, Mann–Whitney U-test was used for between-group comparisons and Wilcoxon's signed-rank test was used for within-group comparisons. Results: At the end of 5 years, mental health (P = 0.05, perceived stress (P = 0.01, and negative affect (NA (P = 0.05 have shown significant improvements. WHO-QOL BREF score has shown improvements in physical health (P = 0.046, environmental health (P = 0.04, perceived stress (P = 0.001, and NA (P = 0.02 in YLSP than CLSP. Positive affect has significantly improved in CLSP than YLSP. Other domains of WHO-QOL-BREF, PANAS, and HADS did not reveal any significant between-group differences. Conclusion: Addition of long-term YLSP to conventional cardiac rehabilitation brings better improvements in QOL and reduction in stress levels at the end of 5 years after CABG.

  9. Rehabilitation robotics.

    Science.gov (United States)

    Krebs, H I; Volpe, B T

    2013-01-01

    This chapter focuses on rehabilitation robotics which can be used to augment the clinician's toolbox in order to deliver meaningful restorative therapy for an aging population, as well as on advances in orthotics to augment an individual's functional abilities beyond neurorestoration potential. The interest in rehabilitation robotics and orthotics is increasing steadily with marked growth in the last 10 years. This growth is understandable in view of the increased demand for caregivers and rehabilitation services escalating apace with the graying of the population. We provide an overview on improving function in people with a weak limb due to a neurological disorder who cannot properly control it to interact with the environment (orthotics); we then focus on tools to assist the clinician in promoting rehabilitation of an individual so that s/he can interact with the environment unassisted (rehabilitation robotics). We present a few clinical results occurring immediately poststroke as well as during the chronic phase that demonstrate superior gains for the upper extremity when employing rehabilitation robotics instead of usual care. These include the landmark VA-ROBOTICS multisite, randomized clinical study which demonstrates clinical gains for chronic stroke that go beyond usual care at no additional cost. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. Rehabilitation program based on sensorimotor recovery improves the static and dynamic balance and modifies the basal ganglia neurochemistry: A pilot 1H-MRS study on Parkinson's disease patients.

    Science.gov (United States)

    Delli Pizzi, Stefano; Bellomo, Rosa Grazia; Carmignano, Simona Maria; Ancona, Emilio; Franciotti, Raffaella; Supplizi, Marco; Barassi, Giovanni; Onofrj, Marco; Bonanni, Laura; Saggini, Raoul

    2017-12-01

    Rehabilitation interventions represent an alternative strategy to pharmacological treatment in order to slow or reverse some functional aspects of disability in Parkinson's disease (PD). To date, the neurophysiological mechanisms underlying rehabilitation-mediated improvement in PD patients are still poorly understood. Interestingly, growing evidence has highlighted a key role of the glutamate in neurogenesis and brain plasticity. The brain levels of glutamate, and of its precursor glutamine, can be detected in vivo and noninvasively as "Glx" by means of proton magnetic resonance spectroscopy (H-MRS). In the present pilot study, 7 PD patients with frequent falls and axial dystonia underwent 8-week rehabilitative protocol focused on sensorimotor improvement. Clinical evaluation and Glx quantification were performed before and after rehabilitation. The Glx assessment was focused on the basal ganglia in agreement with their key role in the motor functions. We found that the rehabilitation program improves the static and dynamic balance in PD patients, promoting a better global motor performance. Moreover, we observed that the levels of Glx within the left basal ganglia were higher after rehabilitation as compared with baseline. Thus, we posit that our sensorimotor rehabilitative protocol could stimulate the glutamate metabolism in basal ganglia and, in turn, neuroplasticity processes. We also hypothesize that these mechanisms could prepare the ground to restore the functional interaction among brain areas deputed to motor controls, which are affected in PD. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  11. Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; electronic reporting pilot; Inpatient Rehabilitation Facilities Quality Reporting Program; revision to Quality Improvement Organization regulations. Final rule with comment period.

    Science.gov (United States)

    2012-11-15

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2013 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program. We are continuing the electronic reporting pilot for the Electronic Health Record (EHR) Incentive Program, and revising the various regulations governing Quality Improvement Organizations (QIOs), including the secure transmittal of electronic medical information, beneficiary complaint resolution and notification processes, and technical changes. The technical changes to the QIO regulations reflect CMS' commitment to the general principles of the President's Executive Order on Regulatory Reform, Executive Order 13563 (January 18, 2011).

  12. Evaluation of Rehabilitation Strategies and Management Schemes for the Improvement of Mangrove Management Programs in Lingayen Gulf

    OpenAIRE

    Severino Salmo III; Dante Torio; Janalezza Morvenna Esteban

    2007-01-01

    We evaluated the mangrove rehabilitation strategies and management schemes in five municipalities in Lingayen Gulf (Bolinao, Anda, Bani, Alaminos and San Fernando). Mangrove planting appears to be the first and only option used in the area, ignoring other recommended management strategies, e.g. conservation, landscaping, and sustainable production. All planting sites were located in coastal fringes and are mostly monospeficic stands of the species Rhizophora mucronata. The planted mangroves w...

  13. Newly blind persons using virtual environment system in a traditional orientation and mobility rehabilitation program: a case study.

    Science.gov (United States)

    Lahav, Orly; Schloerb, David W; Srinivasan, Mandayam A

    2012-09-01

    This paper presents a virtual reality system (the BlindAid) developed for orientation and mobility training of people who are newly blind. The BlindAid allows users to interact with different virtual structures and objects via auditory and haptic feedback. This case study aims to examine if and how the BlindAid, in conjunction with a traditional rehabilitation programme, can help people who are newly blind develop new orientation and mobility methods. Follow-up research based on this study, with a large experiment and control group, could contribute to the area of orientation and mobility rehabilitation training for the newly blind. The case study research focused on A., a woman who is newly blind, for 17 virtual sessions spanning ten weeks, during the 12 weeks of her traditional orientation and mobility rehabilitation programme. The research was implemented by using virtual environment (VE) exploration and orientation tasks in VE and physical spaces. The research methodology used both qualitative and quantitative methods, including interviews, questionnaire, videotape recording, and user computer logs. The results of this study helped elucidate several issues concerning the contribution of the BlindAid system to the exploration strategies and learning processes experienced by the participant in her encounters with familiar and unfamiliar physical surroundings. [Box: see text].

  14. A Participatory Design Approach to Develop a Web-Based Self-Care Program Supporting Early Rehabilitation among Patients after Total Laryngectomy.

    Science.gov (United States)

    Cnossen, Ingrid C; van Uden-Kraan, Cornelia F; Eerenstein, Simone E J; Rinkel, Rico N P M; Aalders, Ijke J; van den Berg, Klaske; de Goede, Cees J T; van Stijgeren, Ans J; Cruijff-Bijl, Yvonne; de Bree, Remco; Leemans, C René; Verdonck-de Leeuw, Irma M

    2015-01-01

    To develop a Web-based self-care program for patients after total laryngectomy according to a participatory design approach. We conducted a needs assessment with laryngectomees (n = 9) and their partners (n = 3) by means of a focus group interview. In 4 focus group sessions, a requirement plan was formulated by a team of health care professionals (n = 10) and translated into a prototype. An e-health application was built including illustrated information on functional changes after total laryngectomy as well as video demonstrations of skills and exercises. Usability of the prototype was tested by end users (n = 4) and expert users (n = 10). Interviews were held to elicit the intention to use and the desired implementation strategy. Six main self-care topics were identified: (1) nutrition, (2) tracheostomy care, (3) voice prosthesis care, (4) speech rehabilitation, (5) smell rehabilitation, and (6) mobility of head, neck, and shoulder muscles. Expert users expressed concerns regarding tailored exercises, indicated a positive intent to implement the intervention in routine care, and expressed a need for guidance when implementing the intervention. End users and expert users appreciated the content completeness and multimedia-based information built into the application. The participatory design is a valuable approach to develop a self-care program to help meet users' needs. © 2016 S. Karger AG, Basel.

  15. Hospital-based versus hybrid cardiac rehabilitation program in coronary bypass surgery patients in western Iran: effects on exercise capacity, risk factors, psychological factors, and quality of life.

    Science.gov (United States)

    Najafi, Farid; Nalini, Mahdi

    2015-01-01

    The efficacy of alternative delivery models for a cardiac rehabilitation program (CRP) in low- and middle-income countries is not well documented. This study compared the traditional hospital-based CRP with a hybrid CRP in western Iran. This observational study was conducted with postcoronary surgery patients in Imam-Ali Hospital in Kermanshah, Iran. Both program models included 2 phases: (1) a common preliminary phase (2-4 weeks) involving exercise training and a plan to control cardiac risk factors; and (2) a complementary phase (8 weeks) consisting of group educational classes and exercise training conducted 3 times a week in the hospital or once a week accompanied by phone calls in the hybrid program. Changes in exercise capacity, blood pressure, lipids, resting heart rate, body mass index, waist circumference, smoking, depression, anxiety, and quality of life as well as differences in attendance at hospital sessions were investigated. From a total of 887 patients, 780 (87.9%) completed the programs. There was no association between course completion and type of CRP. Mean age of patients completing the programs was 55.6 ± 8.7 years and 23.8% were female. The hospital-based (n = 585) and hybrid (n = 195) programs resulted in a significant increase in exercise capacity (P countries where there are no appropriate health facilities in remote areas.

  16. Evaluation of a standardized patient education program for inpatient asthma rehabilitation: Impact on patient-reported health outcomes up to one year.

    Science.gov (United States)

    Bäuerle, Kathrin; Feicke, Janine; Scherer, Wolfgang; Spörhase, Ulrike; Bitzer, Eva-Maria

    2017-05-01

    To modify and evaluate a patient education program for adult asthma patients in consideration of quality criteria for teaching. This was a prospective single-center controlled trial in an inpatient rehabilitation center. The control group (n=215) received the usual lecture-based education program, and the intervention group (n=209) the modified patient education program. Data were assessed at admission, discharge, 6 and 12 months post discharge. The primary outcome was asthma control, the secondary outcomes were asthma knowledge, quality of life, and program acceptance. Analysis of change was performed by ANCOVA for each follow-up, adjusting for baseline values. Statistically significant increases in all health outcomes and in asthma control were maintained in both groups at 12 months: CG: +1.9 (95%-CI 1.3-2.6) IG: +1.6 (95%-CI 0.8-2.3). We observed no significant differences between the programs for asthma control and quality of life. Regarding practical asthma knowledge, after 12 months, a group*time interaction emerged with a small effect size (P=0.06, η2=0.01). The modified program was not superior to traditional patient education concerning asthma control. It permanently increased self-management knowledge. Structured and behavioral patient education fosters patient's disease management ability. Possible ways of improving asthma control need to be explored. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Nurse mentor perceptions in the delivery of a home-based cardiac rehabilitation program to support patients living in rural areas: An interpretive study.

    Science.gov (United States)

    Frohmader, Terence J; Lin, Frances; Chaboyer, Wendy P

    2017-05-01

    Home-based cardiac rehabilitation (CR) programs improve health outcomes for people diagnosed with heart disease. Mentoring of patients by nurses trained in CR has been proposed as an innovative model of cardiac care. Little is known however, about the experience of mentors facilitating such programs and adapting to this new role. The aim of this qualitative study was to explore nurse mentor perceptions of their role in the delivery of a home-based CR program for rural patients unable to attend a hospital or outpatient CR program. Seven nurses mentored patients by telephone providing patients with education, psychosocial support and lifestyle advice during their recovery. An open-ended survey was administered to mentors by email and findings revealed mentors perceived their role to be integral to the success of the program. Nurses were satisfied with the development of their new role as patient mentors. They believed their collaborative skills, knowledge and experience in coronary care, timely support and guidance of patients during their recovery and use of innovative audiovisual resources improved the health outcomes of patients not able to attend traditional programs. Cardiac nurses in this study perceived that they were able to successfully transition from their normal work practices in hospital to mentoring patients in their homes. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  18. Motivational factors for initiating, implementing, and maintaining physical activity behavior following a rehabilitation program for patients with type 2 diabetes: a longitudinal, qualitative, interview study

    Directory of Open Access Journals (Sweden)

    Walker KC

    2018-01-01

    Full Text Available Karen Christina Walker,1 Laura Staun Valentiner,1,2 Henning Langberg1 1CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health, 2Center for Physical Activity Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Aim: To explore motivational factors for initiating, implementing, and maintaining physical activity following a rehabilitation program for patients with type 2 diabetes mellitus.Methods: Semi-structured, individual, qualitative interviews with five informants from the InterWalk trial were conducted at three separate occasions; at initiation of the rehabilitation program, at completion of the 12-week program, and 52 weeks after enrolment. Interviews were audio-recorded, transcribed, and analyzed according to Systematic Text Condensation. The framework of Self-Determination Theory was applied to guide analysis after identification of preliminary themes.Results: Commitment and obligation were emphasized as being motivational in initiating physical activity. Toward the termination of the program, this was challenged by an expressed need for autonomy. Successful behavioral change was characterized by transfer of commitment to a new structure in everyday life, which also honored the request for autonomy. Feeling capable of participating in physical activity was facilitated through knowledge, practical experience, and progress and considered motivational, whereas lack of progress extinguished motivation. Finally, enjoyment of the activity was determining for long-term maintenance of physical activity behavior.Conclusion: Satisfaction of innate psychological needs leads to more autonomous regulation of behavior and, through this study, we investigated determining factors for extrinsically motivated behavior and factors of importance to the internalization process. Keywords: self-determination theory, type 2 diabetes mellitus, adherence, behavioral change

  19. Non-operative management versus operative management in high-grade blunt hepatic injury.

    Science.gov (United States)

    Cirocchi, Roberto; Trastulli, Stefano; Pressi, Eleonora; Farinella, Eriberto; Avenia, Stefano; Morales Uribe, Carlos Hernando; Botero, Ana Maria; Barrera, Luis M

    2015-08-24

    Surgery used to be the treatment of choice in cases of blunt hepatic injury, but this approach gradually changed over the last two decades as increasing non-operative management (NOM) of splenic injury led to its use for hepatic injury. The improvement in critical care monitoring and computed tomographic scanning, as well as the more frequent use of interventional radiology techniques, has helped to bring about this change to non-operative management. Liver trauma ranges from a small capsular tear, without parenchymal laceration, to massive parenchymal injury with major hepatic vein/retrohepatic vena cava lesions. In 1994, the Organ Injury Scaling Committee of the American Association for the Surgery of Trauma (AAST) revised the Hepatic Injury Scale to have a range from grade I to VI. Minor injuries (grade I or II) are the most frequent liver injuries (80% to 90% of all cases); severe injuries are grade III-V lesions; grade VI lesions are frequently incompatible with survival. In the medical literature, the majority of patients who have undergone NOM have low-grade liver injuries. The safety of NOM in high-grade liver lesions, AAST grade IV and V, remains a subject of debate as a high incidence of liver and collateral extra-abdominal complications are still described. To assess the effects of non-operative management compared to operative management in high-grade (grade III-V) blunt hepatic injury. The search for studies was run on 14 April 2014. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), Embase Classic+Embase (Ovid), PubMed, ISI WOS (SCI-EXPANDED, SSCI, CPCI-S & CPSI-SSH), clinical trials registries, conference proceedings, and we screened reference lists. All randomised trials that compare non-operative management versus operative management in high-grade blunt hepatic injury. Two authors independently

  20. OARSI Clinical Trials Recommendations: Design and conduct of clinical trials of rehabilitation interventions for osteoarthritis.

    Science.gov (United States)

    Fitzgerald, G K; Hinman, R S; Zeni, J; Risberg, M A; Snyder-Mackler, L; Bennell, K L

    2015-05-01

    A Task Force of the Osteoarthritis Research Society International (OARSI) has previously published a set of guidelines for the conduct of clinical trials in osteoarthritis (OA) of the hip and knee. Limited material available on clinical trials of rehabilitation in people with OA has prompted OARSI to establish a separate Task Force to elaborate guidelines encompassing special issues relating to rehabilitation of OA. The Task Force identified three main categories of rehabilitation clinical trials. The categories included non-operative rehabilitation trials, post-operative rehabilitation trials, and trials examining the effectiveness of devices (e.g., assistive devices, bracing, physical agents, electrical stimulation, etc.) that are used in rehabilitation of people with OA. In addition, the Task Force identified two main categories of outcomes in rehabilitation clinical trials, which include outcomes related to symptoms and function, and outcomes related to disease modification. The guidelines for rehabilitation clinical trials provided in this report encompass these main categories. The report provides guidelines for conducting and reporting on randomized clinical trials. The topics include considerations for entering patients into trials, issues related to conducting trials, considerations for selecting outcome measures, and recommendations for statistical analyses and reporting of results. The focus of the report is on rehabilitation trials for hip, knee and hand OA, however, we believe the content is broad enough that it could be applied to rehabilitation trials for other regions as well. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  1. Locally Available Dietary Menus Promote Weight Gain among Acutely Malnourished Children Undergoing a Community-Based Nutrition Rehabilitation Program in Uganda

    International Nuclear Information System (INIS)

    Mugisha, Jennifer; Kakande, Celia

    2014-01-01

    Full text: Background: A significant proportion of Uganda’s children still suffer from acute malnutrition, despite decades of government, donor and agency investment in basic health services. The demand for the WHO recommended Ready to Use Therapeutic Foods (RUTF) for community based nutrition rehabilitation programs (CMAM) and costs involved have been overwhelming, thus prompting the need for alternative, sustainable, local solutions. Methods The Management Sciences for Health STRIDES for Family Health Project (MSH-STRIDES), funded by USAID, implemented a community-based nutritional rehabilitation intervention using the principles of Positive Deviance. The approach identified solutions (practices) already being used by community members with well-nourished children despite not having access to special resources (positive deviants). Community volunteers encouraged children to be assessed for nutrition during special growth monitoring sessions. Children found malnourished were enrolled into a nutrition rehabilitation program also known as a hearth cycle, in a volunteer’s home. Project staff and trained volunteers followed-up with malnourished children in their homes and invited the caregivers to bring them to participate in hearth cycles over 26 days. Caregivers were taught to recognize malnutrition and to treat it with supervised supplemental feedings of menu-mixtures of locally prepared, nutrient-dense foods. Weight gain was used as an outcome measure. Children were linked to health centers within the locality for curative services. MSH-STRIDES provided training to staff in the facilities and equipped them to serve as referral points for the children identified from the community. Results: Hearth cycles were conducted in 230 villages from 34 sub-counties in 11 out of 15 project districts. A total of 1336 health workers and 283 caregivers were trained and involved in the implementation of the community model. Overall, 2525 children with moderate and severe

  2. REHABILITATION IN CARDIOLOGY AND CARDIOSURGERY

    Directory of Open Access Journals (Sweden)

    N. V. Galtseva

    2015-01-01

    Full Text Available At the present time effectiveness of rehabilitation programs after heart surgery, myocardial infarction, and in some cases for coronary artery disease (CAD is undeniable. According to the researches, physical exercises, which underlie cardio rehabilitation of patients with CAD, reduce cardiac mortality. In the review accumulated scientific data about modern approaches to cardio rehabilitation is discussed: goals, indications, contraindications, its organization, advantages. Controlled training in patients with CAD, making a complex program of cardio rehabilitation, kinds of control during cardio training are described in details. In this review the second phase of physical rehabilitation after cardiac surgery – a stationary phase, protocols of which are subjective and often contested, is considered. More frequently physical rehabilitation after coronary artery bypass surgery is doing breathing exercises, as there is data that physical exercises, in which tangential force vector in or around the sternum appears, should be avoided for at least 3 months after surgery. On the other hand, avoiding of heaving during the first weeks after surgery leads to more pronounced atrophy of the chest muscles. But there is data, according to which, early beginning of an adapted program of cardio rehabilitation (1–2 weeks after surgery is safely, it accelerates recovery and does not increase problems with the sternum. In this review the following idea is suggested: in order to follow the stages of rehabilitation after cardiac surgery it is necessary to start it on the stationary stage, and control of load rehabilitation programs must be carried out using hemodynamic changes during exercises, energy, SF-36 questionnaire. 

  3. Rehabilitation Traumatology: A Narrative Review.

    Science.gov (United States)

    Bloodworth, Donna; Pandit, Sindhu; Mullan, Patrick; Chiou-Tan, Faye

    2017-09-01

    Rehabilitation traumatology has developed within the field of physical medicine and rehabilitation as a specialized area of knowledge in which the physiatrist works with the traumatology team to enhance the functional outcome of trauma patients. Based on the definition of traumatology in the American Heritage Dictionary, the authors propose rehabilitation traumatology be "the branch of medicine that deals with the treatment of serious wounds, injuries, and disabilities," "to restore [the patient] to good health or useful life." This article reviews the history of traumatology, special considerations of the traumatology patient through the continuum of care, and concepts toward the creation of a rehabilitation traumatology program. V. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  4. Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

    Science.gov (United States)

    Zhao, Ting; Mejaddam, Ali Y; Chang, Yuchiao; DeMoya, Marc A; King, David R; Yeh, Daniel D; Kaafarani, Haytham M A; Alam, Hasan B; Velmahos, George C

    2016-10-01

    Isolated nonoperative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge, and rehabilitation issues, which far exceed the acute component of their care. This study was aimed to compare the outcomes of patients with INOMHI admitted to three services: trauma surgery, neurosurgery, and neurology. Retrospective case series (January 1, 2009 to August 31, 2013) at an academic Level I trauma center. According to an institutional protocol, INOMHI patients with Glasgow Coma Scale (GCS) of 13 to 15 were admitted on a weekly rotational basis to trauma surgery, neurosurgery, and neurology. The three populations were compared, and the primary outcomes were survival rate to discharge, neurological status at hospital discharge as measured by the Glasgow Outcome Score (GOS), and discharge disposition. Four hundred eighty-eight INOMHI patients were admitted (trauma surgery, 172; neurosurgery, 131; neurology, 185). The mean age of the study population was 65.3 years, and 58.8% of patients were male. Seventy-seven percent of patients has a GCS score of 15. Age, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, Abbreviated Injury Scale in head and neck, and GCS were similar among the three groups. Patients who were admitted to trauma surgery, neurosurgery and neurology services had similar proportions of survivors (98.8% vs 95.7% vs 94.7%), and discharge disposition (home, 57.0% vs 61.6% vs 55.7%). The proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma (97.7% vs 93.0% vs 92.4%). In a logistic regression model adjusting for Charlson Comorbidity Index CCI and Abbreviated Injury Scale head and neck scores, patients who were admitted to neurology or neurosurgery had significantly lower odds being discharged with GOS 4 or 5. While the trauma group had the lowest proportion of repeats of brain computed tomography (61

  5. A randomized controlled trial on rehabilitation through caregiver-delivered nurse-organized service programs for disabled stroke patients in rural china (the RECOVER trial): design and rationale.

    Science.gov (United States)

    Yan, Lijing L; Chen, Shu; Zhou, Bo; Zhang, Jing; Xie, Bin; Luo, Rong; Wang, Ninghua; Lindley, Richard; Zhang, Yuhong; Zhao, Yi; Li, Xian; Liu, Xiao; Peoples, Nicholas; Bettger, Janet Prvu; Anderson, Craig; Lamb, Sarah E; Wu, Yangfeng; Shi, Jingpu

    2016-10-01

    Stroke is the leading cause of death and disability in rural China. For stroke patients residing in resource-limited rural areas, secondary prevention and rehabilitation are largely unavailable, and where present, are far below evidence-based standards. This study aims to develop and implement a simplified stroke rehabilitation program that utilizes nurses and family caregivers for service delivery, and evaluate its feasibility and effectiveness in rural China. This 2-year randomized controlled trial is being conducted in 2-3 county hospitals located in northwest, northeast, and southwest China. Eligible and consenting stroke inpatients (200 in total) have been recruited and randomized into either a control or intervention group. Nurses in the county hospital are trained by rehabilitation specialists and in turn train the family caregivers in the intervention group. They also provide telephone follow-up care three times post discharge. The recruitment, baseline, intervention, follow-up care, and evaluation are guided by the RECOVER mobile phone app specifically designed for this study. The primary outcome is patients' Barthel Index (activities of daily living: mobility, self-care, and toileting) at 6 months. Process and economic evaluation will also be conducted. The results of our study will generate initial high-quality evidence to improve stroke care in resource-scarce settings. If proven effective, this innovative care delivery model has the potential to improve the health and function of stroke patients, relieve caregiver burden, guide policy-making, and advance translational research in the field of stroke care. © 2016 World Stroke Organization.

  6. Early rehabilitation after total knee replacement surgery: a multicenter, noninferiority, randomized clinical trial comparing a home exercise program with usual outpatient care.

    Science.gov (United States)

    Han, Annie S Y; Nairn, Lillias; Harmer, Alison R; Crosbie, Jack; March, Lyn; Parker, David; Crawford, Ross; Fransen, Marlene

    2015-02-01

    To determine, at 6 weeks postsurgery, if a monitored home exercise program (HEP) is not inferior to usual care rehabilitation for patients undergoing primary unilateral total knee replacement (TKR) surgery for osteoarthritis. We conducted a multicenter, randomized clinical trial. Patients ages 45-75 years were allocated at the time of hospital discharge to usual care rehabilitation (n = 196) or the HEP (n = 194). Outcomes assessed 6 weeks after surgery included the Western Ontario and McMaster Universities Osteoarthritis Index pain and physical function subscales, knee range of motion, and the 50-foot walk time. The upper bound of the 95% confidence interval (95% CI) mean difference favoring usual care was used to determine noninferiority. At 6 weeks after surgery there were no significant differences between usual care and HEP, respectively, for pain (7.4 and 7.2; 95% CI mean difference [MD] -0.7, 0.9), physical function (22.5 and 22.4; 95% CI MD -2.5, 2.6), knee flexion (96° and 97°; 95% CI MD -4°, 2°), knee extension (-7° and -6°; 95% CI MD -2°, 1°), or the 50-foot walk time (12.9 and 12.9 seconds; 95% CI MD -0.8, 0.7 seconds). At 6 weeks, 18 patients (9%) allocated to usual care and 11 (6%) to the HEP did not achieve 80° knee flexion. There was no difference between the treatment allocations in the number of hospital readmissions. The HEP was not inferior to usual care as an early rehabilitation protocol after primary TKR. Copyright © 2015 by the American College of Rheumatology.

  7. Effect of Rehabilitation Technology Services on Vocational Rehabilitation Outcomes of Individuals with Multiple Sclerosis

    Science.gov (United States)

    Chiu, Chung-Yi; Tansey, Timothy N.; Chan, Fong; Strauser, David; Frain, Michael P.; Arora, Simran

    2015-01-01

    Objectives: To examine the effect of rehabilitation technology interventions on the employment or job retention outcomes of individuals with multiple sclerosis (MS) served by the state-federal vocational rehabilitation program using a case-control study design. Participants: Data for this study were extracted from the Rehabilitation Services…

  8. Initial non-operative management of uncomplicated appendicitis in children: a protocol for a multicentre randomised controlled trial (APAC trial)

    NARCIS (Netherlands)

    Knaapen, Max; van der Lee, Johanna H.; Bakx, Roel; The, Sarah-May L.; van Heurn, Ernst W. E.; Heij, Hugo A.; Gorter, Ramon R.; Rippen, H.; Bet, P. M.; Kazemier, G.; Kneepkens, C. M. F.; Wijnen, R.; Offringa, M.; Ahmadi, N.; Bonjer, H. J.; van Rijn, R. R.; Benninga, M. A.; Bemelman, W. A.; Hilarius, D. L.; van Veen, S. A. J. M.; Go, P. M. N. Y. H.; Cense, H. A.; de Vries, A.; Straatman, J.; in ’t Hof, K. H.; van Beek, E. J. A. H.; Bender, M. H. M.; van den Hill, L. C. L.; Bolhuis, H. W.; Treskes, K.; Bijlsma, T. S.; Geubbels, N.; de Blaauw, I.; Botden, S. M. B. I.; Leijdekkers, V. J.; Boonstra, M. C.; Rongen, L. H.; Boerma, E. J. G.; Luyer, M. D. P.; Vugts, G.; Copper, T.; Garssen, F. P.; Hulsker, C.; Visschers, R. G. J.

    2017-01-01

    Introduction Based on epidemiological, immunological and pathology data, the idea that appendicitis is not necessarily a progressive disease is gaining ground. Two types are distinguished: simple and complicated appendicitis. Non-operative treatment (NOT) of children with simple appendicitis has

  9. Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the

    Science.gov (United States)

    2017-05-19

    This final rule finalizes May 20, 2017 as the effective date of the final rule titled "Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR)" originally published in the January 3, 2017 Federal Register. This final rule also finalizes a delay of the applicability date of the regulations at 42 CFR part 512 from July 1, 2017 to January 1, 2018 and delays the effective date of the specific CJR regulations listed in the DATES section from July 1, 2017 to January 1, 2018.

  10. Critical review on non-operative management of adolescent idiopathic scoliosis.

    Science.gov (United States)

    Wong, M S; Liu, W C

    2003-12-01

    There are a number of different non-operative interventions which aim to control moderate adolescent idiopathic scoliosis (AIS) from progression. Clinicians may find difficulties in the selection of appropriate interventions for AIS. A comprehensive literature review was carried out to study all contemporary non-operative interventions, it was noted that rigid spinal orthoses apparently give more curve control; however, it would compromise the patient's quality of life via those inevitable factors--physical constraint, poor acceptance and psychological disturbance. There is a trend to develop more effective, acceptable and user-friendly interventions. Under such an aspiration, the theories and clinical evidence of different interventions should be developed along the clinical pathway of early intervention with reliable indicators/predictors, patient's active participation, dynamic control mechanism, holistic psychological and psychosocial considerations, and effective and long-lasting outcome.

  11. Non-Operative Management of Isolated Pneumoperitoneum Due to Severe Blunt Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    Murat Kilic

    2016-02-01

    Full Text Available Nonoperative management of blunt abdominal trauma is the treatment of choice for hemodynamically stable patients. The results of nonoperative management are more successful in isolated solid organ injuries such as the liver and spleen than hollow viscus injury. In this approach, both the clinical course of the patient and the computed tomography findings play an important role. Isolated pneumoperitoneum in blunt abdominal trauma may be a surgical challenge for clinicians because it is usually a significant radiological sign for hallow viscus perforations. Here, we report a case of isolated pneumoperitoneum detected on computed tomography and managed non-surgically, in a young man suffered from a severe blunt abdominal trauma. Our aim is to attract the attention of surgeons to the management problems of the presence of pneumoperitoneum in the absence of other radiological findings in blunt abdominal trauma.

  12. COPD online-rehabilitation versus conventional COPD rehabilitation

    DEFF Research Database (Denmark)

    Hansen, Henrik; Bieler, Theresa; Beyer, Nina

    2017-01-01

    BACKGROUND: Rehabilitation of patients with chronic obstructive pulmonary disease (COPD) is a key treatment in COPD. However, despite the existing evidence and a strong recommendation from lung associations worldwide, 50% of patients with COPD decline to participate in COPD rehabilitation program......, symptoms, anxiety and depression symptoms, disease specific and generic quality of life. Primary endpoint is 10/12 weeks from baseline, while secondary endpoints are 22, 36, 62 weeks from baseline assessments. DISCUSSION: The study will likely contribute to knowledge regarding COPD tele...... accessibility and compliance. The aim of this multicenter RCT study is to compare the potential benefits of a 10-week online COPD rehabilitation program (CORe) with conventional outpatient COPD rehabilitation (CCRe). METHODS: This study is a randomized assessor- and statistician blinded superiority multicenter...

  13. Treatment of the Aged Patients at a Large Cardiac Rehabilitation Center in the Southern Brazil and Some Aspects of Their Dropout from the Therapeutic Programs.

    Science.gov (United States)

    Nesello, Pietro Felice Tomazini; Tairova, Olga; Tairova, Maria; Graciolli, Lucas; Baroni, Allan; Comparsi, Eduardo; Marchi, Thiago De

    2016-12-15

    This paper aims to assess the dropout rate in different age groups through the example of the large cardiac rehabilitation centre affiliated with the Institute of Sports Medicine, University of Caxias do Sul. A historic cohort study comprising the following groups: Non-Old dropout was defined as attendance of 50% of sessions or less. Logistic binominal regression was performed to assess the risk of dropout. For all analyses, a two-tailed P value of dropout rate was 38.6%. The Young-Old and Middle-Old groups showed lower dropouts compared to Non-Old patients (p = 0.01). Young-Old has 96% less risk for dropout compared to Non-Old group (adjusted odds ratios = 1.96 [1.16-3.29]). Furthermore, patients underwent the Coronary Artery Bypass Graft showed a lower rate of dropout (p = 0.001). The absence of CABG involved three times more risk of dropout (p = 0.001). The Non-Old and the Middle-Old patients showed higher dropout rates compared to Young-Old. To ensure the best possible rehabilitation and to improve patients´ participation in CR, these programs should be adjusted to the needs of patients in terms of their age.

  14. The cost-effectiveness of nonoperative management versus laparoscopic appendectomy for the treatment of acute, uncomplicated appendicitis in children.

    Science.gov (United States)

    Wu, James X; Sacks, Greg D; Dawes, Aaron J; DeUgarte, Daniel; Lee, Steven L

    2017-07-01

    Several studies have demonstrated the safety and short-term success of nonoperative management in children with acute, uncomplicated appendicitis. Nonoperative management spares the patients and their family the upfront cost and discomfort of surgery, but also risks recurrent appendicitis. Using decision-tree software, we evaluated the cost-effectiveness of nonoperative management versus routine laparoscopic appendectomy. Model variables were abstracted from a review of the literature, Healthcare Cost and Utilization Project, and Medicare Physician Fee schedule. Model uncertainty was assessed using both one-way and probabilistic sensitivity analyses. We used a $100,000 per quality adjusted life year (QALY) threshold for cost-effectiveness. Operative management cost $11,119 and yielded 23.56 quality-adjusted life months (QALMs). Nonoperative management cost $2277 less than operative management, but yielded 0.03 fewer QALMs. The incremental cost-to-effectiveness ratio of routine laparoscopic appendectomy was $910,800 per QALY gained. This greatly exceeds the $100,000/QALY threshold and was not cost-effective. One-way sensitivity analysis found that operative management would become cost-effective if the 1-year recurrence rate of acute appendicitis exceeded 39.8%. Probabilistic sensitivity analysis indicated that nonoperative management was cost-effective in 92% of simulations. Based on our model, nonoperative management is more cost-effective than routine laparoscopic appendectomy for children with acute, uncomplicated appendicitis. Cost-Effectiveness Study: Level II. Published by Elsevier Inc.

  15. Turning whine into wine: the fiscal impact of comprehensive documentation and billing for nonoperative pediatric surgical services.

    Science.gov (United States)

    Gollin, Gerald; Moores, Donald

    2006-06-01

    Some pediatric surgeons rarely document nonoperative services, believing that the reimbursement provided for such care is negligible. We evaluated the impact of comprehensive documentation and billing for nonoperative, pediatric surgical care. All bills submitted for inpatient, nonoperative care for 1 year were reviewed. Total receipts for documented admissions, consultations, critical care, and daily care were determined. The Evaluation and Management code billed for each service was recorded, and the total and average payments attributable to each Evaluation and Management code were calculated. Fifty-six percent of services were covered by Medicaid and 26% by a commercial insurer. There were 607 billed admission history and physical exams for which reimbursement totaled 43,493 dollars. Critical care services were provided to 49 patients and yielded 8964 dollars in payments. Six hundred thirty-nine inpatient consultations were performed with a reimbursement of 42,830 dollars. Daily care services were billed 1044 times and produced 71,579 dollars in payments. Overall reimbursement for documented, nonoperative services was 166,866 dollars. This represented 16.2% of total, noncontracted income for the practice. Despite a payer mix heavily weighted toward Medicaid, comprehensive documentation and billing for nonoperative services increased total, noncontracted reimbursement by almost 20% over what it would have been had only operative services been billed. The yield from properly documented, nonoperative care can be substantial.

  16. A patient education tool for nonoperative management of blunt abdominal trauma.

    Science.gov (United States)

    Budinger, Julie Marie

    2007-01-01

    Blunt trauma is the primary mechanism of injury seen at Charleston Area Medical Center, a rural level I trauma center. Blunt abdominal trauma occurs as a result of various mechanisms. It can be safely managed nonoperatively and is considered to be the standard of care in hemodynamically stable patients. Appropriate patient education before discharge will enable patients to identify complications early and seek appropriate medical care.

  17. Nonoperative options for management of residual stones after cholecystostomy in high-risk patients

    Science.gov (United States)

    Reed, David M.; Daye, S. S.; Lincer, R. M.

    1993-05-01

    Cholecystostomy is frequently performed to obtain control of sepsis in high risk patients with acute cholecystitis. Retained stones in the gallbladder may cause future clinical problems. We present two patients with cholecystostomy tubes managed non-operatively. A review of other reported methods for stone extraction or destruction is also presented. Knowledge of safe and effective techniques for removal of these stones, using minimally invasive techniques is useful to the general surgeon.

  18. Success of nonoperative management of adductor longus tendon ruptures in National Football League athletes.

    Science.gov (United States)

    Schlegel, Theodore F; Bushnell, Brandon D; Godfrey, Jenna; Boublik, Martin

    2009-07-01

    Acute complete ruptures of the proximal adductor longus tendon are rare but challenging injuries to treat. The limited literature supports operative treatment, but data from management of chronic groin pain in athletes indicate that anatomical attachment of the tendon to the pubis may not be required for high-level function. Nonoperative management of complete adductor rupture can provide equal results to surgical repair in terms of return to play in the National Football League. Case series; Level of evidence, 4. Using the National Football League Injury Surveillance System, adductor tendon ruptures documented by magnetic resonance imaging were identified in 19 National Football League players from 1992 to 2004. The team physician for each respective player completed a survey with information about history, physical examination, magnetic resonance imaging findings, treatment, and outcomes. Statistics were analyzed with a Student unpaired t test. Fourteen players were treated nonoperatively, and 5 players were treated with surgical repair using suture anchors. In both groups, all players eventually returned to play in the National Football League. Mean time for return to play was 6.1 +/- 3.1 weeks (range, 3-12 weeks) for the nonoperative group and 12.0 +/- 2.5 weeks (range, 10-16 weeks) for the operative group (P = .001). One player in the operative group suffered the complication of a draining wound and heterotopic ossification. Players represented a variety of positions, and 12 of 19 (63%) had experienced prior symptoms or events. Nonoperative treatment of proximal adductor tendon rupture results in a statistically significantly faster return to play than does operative treatment in athletes competing in the National Football League and avoids the risks associated with surgery while providing an equal likelihood of return to play at the professional level.

  19. Rehabilitation in Justice: The Prisoner's Perspective.

    Science.gov (United States)

    Erez, Edna

    1987-01-01

    Surveyed 348 prison inmates about their needs or interests in rehabilitation programs, reasons for their needs, whether they deserved treatment, and why. Results suggest that prisoners view rehabilitation and reform as the major purpose of punishment or prison sentence. Need was endorsed most often as fairest criterion for program participation.…

  20. Rehabilitation costs

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Arthur S [BDM Corp., VA (United States); [Bikini Atoll Rehabilitation Committee, Berkeley, CA (United States)

    1986-07-01

    The costs of radioactivity contamination control and other matters relating to the resettlement of Bikin atoll were reviewed for Bikini Atoll Rehabilitation Committee by a panel of engineers which met in Berkeley, California on January 22-24, 1986. This Appendix presents the cost estimates.

  1. Rehabilitation costs

    International Nuclear Information System (INIS)

    Kubo, Arthur S.

    1986-01-01

    The costs of radioactivity contamination control and other matters relating to the resettlement of Bikin atoll were reviewed for Bikini Atoll Rehabilitation Committee by a panel of engineers which met in Berkeley, California on January 22-24, 1986. This Appendix presents the cost estimates

  2. Review: The Necessity of Producing/Normalizing Adaptive Behavior Scales in Diagnosing Training Treatment Rehabilitation of Peop e and Assessment of the Programs

    Directory of Open Access Journals (Sweden)

    Seyyed Jalal Sadrosadat

    2000-10-01

    Full Text Available Adaptive behavior is defined as the manner in which people cope with the natural and social demands of their environments. Impairments in adaptive behavior are described as significant limitations in an individual's effectiveness in meeting the standards of maturation, learning, personal independence, and/or social responsibility that are expected for one's age level and cultural group, as determined by clinical assessment, and usually, standardized scales. The definitions of adaptive deficiencies imply an individual's ability to cope with demands of his or her environment. Some scholars support this notion when describing adaptive behavior's relationship to mental retardation. Despite the fact that adaptive behavior scales are the necessary tools in diagnosing training: treatment. Rehabilitation of people (Particularly with developmental disorders and the assessment of programs, those are not available to professionals. This article tries to explain the necessity of producing/normalizing such scales, and introduces one of the most famous scales named as "Adaptive Behavior Scale-Residential and Community".

  3. Rehabilitation of the contaminated territories

    International Nuclear Information System (INIS)

    Lych, G.M.; Babosov, E.M.; Firsakova, S.K.

    1997-01-01

    In the chapter the system of management of socio economical development of contaminated territories in conditions of transition of the republic to market economy is described. The scientific substantiation of the complex programs of rehabilitation of both Bragin and Vetka areas of the Gomel Region is given. The methods of social support and socio psychological rehabilitation of the population having suffered after the Chernobyl accident are offered

  4. 77 FR 9731 - Rehabilitation Research and Development Service Scientific Merit Review Board; Notice of Meeting

    Science.gov (United States)

    2012-02-17

    ...--Rehabilitation Engineering and Prosthetics/Orthotics. March 7--Career Development Award Program. March 13--Spinal... DEPARTMENT OF VETERANS AFFAIRS Rehabilitation Research and Development Service Scientific Merit...-463 (Federal Advisory Committee Act) that a meeting of the Rehabilitation Research and Development...

  5. Graduate students' self assessment of competency in grief education and training in core accredited rehabilitation counseling programs

    Science.gov (United States)

    Cicchetti, Richard Jude

    The study examined whether 93 master's level rehabilitation counselor trainees from select Midwestern CORE-accredited schools report having been adequately trained to identify and work with clients who are having grief-related issues from a loss or disability. Using the Grief Counseling Competency Scale (GCCS), participants showed a wide range of scores regarding personal competency related to grief; however, scores tended to be low when examining skills and knowledge relating to grief, with most respondents scoring between "this barely describes me" and "this somewhat describes me." Although presence or history of a disability was found to be related to personal competency, a number of variables were not related, including: gender, age, race/ethnicity, course work in grief theories and grief interventions, practica/internship setting, and attitudes toward people with disabilities. Implications for further research are discussed.

  6. COMPLEX TREATMENT OF DECUBITAL ULCERS AS THE MAIN COMPONENT OF THE PROGRAM OF EARLY REHABILITATION FOR PATIENTS WITH BRAIN DAMAGE

    Directory of Open Access Journals (Sweden)

    A. A. Iakovlev

    2017-10-01

    Full Text Available The proposed treatment of ulcus decubitalis ulcers III (an area of more than 2 cm2 and stage IV in 31 patients with consequences of severe traumatic brain injury (TBI and cerebral stroke during their rehabilitation in Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology. Used has developed a unique technique and customary for this category of patients treatment. In the control group of 34 patients with ulcus decubitalis II and III (area less than 2 cm2 stages were treated in accordance with medical standards. In the study group, consisting of 31 patients, the use of the methodology obtained good and satisfactory results in 100% of the study group (compared with 31.6% of patients had complete healing of ulcers, 35% of patients healing 70–90% by volume of the wound, 33.4% of the healing of 30–70% by volume of the wound.

  7. Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART I: PATIENTS AFTER ACUTE CORONARY SYNDROMES AND HEART FAILURE.

    Science.gov (United States)

    Compostella, Leonida; Compostella, Caterina; Russo, Nicola; Setzu, Tiziana; Iliceto, Sabino; Bellotto, Fabio

    2017-09-01

    During outpatient cardiac rehabilitation after an acute coronary syndrome or after an episode of congestive heart failure, a careful, periodic evaluation of patients' clinical and hemodynamic status is essential. Simple and traditional cardiac auscultation could play a role in providing useful prognostic information.Reduced intensity of the first heart sound (S1), especially when associated with prolonged apical impulse and the appearance of added sounds, may help identify left ventricular (LV) dysfunction or conduction disturbances, sometimes associated with transient myocardial ischemia. If both S1 and second heart sound (S2) are reduced in intensity, a pericardial effusion may be suspected, whereas an increased intensity of S2 may indicate increased pulmonary artery pressure. The persistence of a protodiastolic sound (S3) after an acute coronary syndrome is an indicator of severe LV dysfunction and a poor prognosis. In patients with congestive heart failure, the association of an S3 and elevated heart rate may indicate impending decompensation. A presystolic sound (S4) is often associated with S3 in patients with LV failure, although it could also be present in hypertensive patients and in patients with an LV aneurysm. Careful evaluation of apical systolic murmurs could help identifying possible LV dysfunction or mitral valve pathology, and differentiate them from a ruptured papillary muscle or ventricular septal rupture. Friction rubs after an acute myocardial infarction, due to reactive pericarditis or Dressler syndrome, are often associated with a complicated clinical course.During cardiac rehabilitation, periodic cardiac auscultation may provide useful information about the clinical-hemodynamic status of patients and allow timely detection of signs, heralding possible complications in an efficient and low-cost manner.

  8. Evaluation of Rehabilitation Strategies and Management Schemes for the Improvement of Mangrove Management Programs in Lingayen Gulf

    Directory of Open Access Journals (Sweden)

    Severino Salmo III

    2007-06-01

    Full Text Available We evaluated the mangrove rehabilitation strategies and management schemes in five municipalities in Lingayen Gulf (Bolinao, Anda, Bani, Alaminos and San Fernando. Mangrove planting appears to be the first and only option used in the area, ignoring other recommended management strategies, e.g. conservation, landscaping, and sustainable production. All planting sites were located in coastal fringes and are mostly monospeficic stands of the species Rhizophora mucronata. The planted mangroves were constrained by low seedling survival and stunted growth as probably caused by poor species-substrate matching, mono-species planting and pest infestations. Three management schemes were noted: community-managed (Bolinao and Anda, local government unit (LGU-managed (Alaminos and San Fernando, and co-managed between the LGU and the community (Bani. The community-managed mangrove areas have the benefits of voluntary efforts from community-based organizations in conducting daily management activities but were constrained with budgetary and logistical concerns. In contrast, both LGU-managed and co-managed areas received institutional and logistical supports from their respective municipal governments, but lacking community participation made mangrove management difficult. Almost two decades of mangrove management indeed helped improved the mangrove forest condition, at least in terms of forest structure. These projects demonstrated some level of success but also encountered several setbacks. Several lessons can be derived from these areas that can help improve the mangrove rehabilitation and management approaches in Lingayen Gulf. Among the recommendations are: (1 provide ordinance enacting the remaining natural secondary growth mangroves as marine protected areas, (2 promote planting in former mangrove areas by reverting abandoned, idled and unproductive aquaculture ponds to mangroves; (3 improve management schemes by formulating resource management plan

  9. The ritualization of rehabilitation

    DEFF Research Database (Denmark)

    Tjørnhøj-Thomsen, Tine; Hansen, Helle Ploug

    2013-01-01

    There is widespread and increasing political interest in devising plans to support people who have or have had cancer to recover and recommence 'normal' lives. Educating cancer patients for this purpose is a central element in cancer rehabilitation in both Europe and the United States. One of the...... highlight the significance of the ritual site, its aesthetics, its exaggerations, and the social and temporal organization of the program....

  10. Subtypes in clinical burnout patients enrolled in an employee rehabilitation program: differences in burnout profiles, depression, and recovery/resources-stress balance.

    Science.gov (United States)

    Bauernhofer, Kathrin; Bassa, Daniela; Canazei, Markus; Jiménez, Paulino; Paechter, Manuela; Papousek, Ilona; Fink, Andreas; Weiss, Elisabeth M

    2018-01-17

    Burnout is generally perceived a unified disorder with homogeneous symptomatology across people (exhaustion, cynicism, and reduced professional efficacy). However, increasing evidence points to intra-individual patterns of burnout symptoms in non-clinical samples such as students, athletes, healthy, and burned-out employees. Different burnout subtypes might therefore exist. Yet, burnout subtypes based on burnout profiles have hardly been explored in clinical patients, and the samples investigated in previous studies were rather heterogeneous including patients with various physical, psychological, and social limitations, symptoms, and disabilities. Therefore, the aim of this study is to explore burnout subtypes based on burnout profiles in clinically diagnosed burnout patients enrolled in an employee rehabilitation program, and to investigate whether the subtypes differ in depression, recovery/resources-stress balance, and sociodemographic characteristics. One hundred three patients (66 women, 37 men) with a clinical burnout diagnosis, who were enrolled in a 5 week employee rehabilitation program in two specialized psychosomatic clinics in Austria, completed a series of questionnaires including the Maslach Burnout Inventory - General Survey (MBI-GS), the Beck Depression Inventory, and the Recovery-Stress-Questionnaire for Work. Cluster analyses with the three MBI-GS subscales as clustering variables were used to identify the burnout subtypes. Subsequent multivariate/univariate analysis of variance and Pearson chi-square tests were performed to investigate differences in depression, recovery/resources-stress balance, and sociodemographic characteristics. Three different burnout subtypes were discovered: the exhausted subtype, the exhausted/cynical subtype, and the burned-out subtype. The burned-out subtype and the exhausted/cynical subtype showed both more severe depression symptoms and a worse recovery/resources-stress balance than the exhausted subtype

  11. Behavioral Contributions to Rehabilitation and Childhood Asthma

    Science.gov (United States)

    Creer, Thomas L.; And Others

    1976-01-01

    Described is the 12- to 18-month residential treatment program at the Children's Asthma Research Institute and Hospital, a behaviorally oriented rehabilitation program for children who suffer from chronic bronchial asthma. (IM)

  12. [Effectiveness of an educational program for respiratory rehabilitation of Chronic Obstructive Pulmonary Disease patients in Primary Care in improving the quality of life, symptoms, and clinical risk].

    Science.gov (United States)

    Blánquez Moreno, Cristina; Colungo Francia, Cristina; Alvira Balada, M Carme; Kostov, Belchin; González-de Paz, Luis; Sisó-Almirall, Antoni

    2017-10-04

    To determine the impact of an educational program to improve the management of chronic obstructive pulmonary disease (COPD) that contributes to an increase of the quality of life, exercise capacity, level of dyspnoea, and clinical risk. Intervention study without controls. Primary Healthcare Centre. 193 patients with COPD were invited, 73 accepted and 55 participated in the educational program. Respiratory rehabilitation educational program with basic concepts of pulmonary and respiratory pathophysiology, respiratory physiotherapy exercises, practical workshop on the use of the most frequent inhalation devices, understanding of chronic disease and self-care measures in case of exacerbation. The quality of life (the COPD assessment test), exercise tolerance (the Six-Minute Walk Test), rating of perceived exertion (Borg Dyspnoea Score) and clinical risk (BODE index) were assessed by means of validated questionnaires in Spanish. A total of 43 (78.2%) participants completed the program. An improvement in the quality of life by a mean of 3.3 points was observed (95%CI; 1.76-4.84). Just over half (53.5%) of the participants obtained a clinically relevant improvement. Participants also improved their physical exercise capacity at post-intervention by increasing the distance that they walked in 6min by a mean of 20.76m (95%CI; 2.57-38.95). Improvements in the level of dyspnoea and clinical risk were also observed. The educational program shows a statistically significant and clinically relevant improvement in the quality of life, fatigue, symptomatology, exercise capacity, level of dyspnoea, and clinical risk. The program is adaptable to the health care routine of healthcare centres. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  13. Randomized comparison of a multidisciplinary job-retention vocational rehabilitation program with usual outpatient care in patients with chronic arthritis at risk for job loss.

    Science.gov (United States)

    de Buck, Petronella D M; le Cessie, Saskia; van den Hout, Wilbert B; Peeters, Andreas J; Ronday, Herman K; Westedt, Marie-Louise; Breedveld, Ferdinand C; Vliet Vlieland, Theodora P M

    2005-10-15

    Work disability is a major consequence of inflammatory rheumatic conditions. Evidence regarding the effectiveness of interventions aimed at the prevention or reduction of work disability in rheumatic diseases is limited. We conducted a randomized controlled trial to investigate the effectiveness of a multidisciplinary job-retention vocational rehabilitation (VR) program in patients with a rheumatic condition who were at risk for job loss. A total of 140 patients with a chronic rheumatic condition were randomly assigned to either a multidisciplinary job-retention VR program (n = 74) or usual outpatient care (UC) (n = 66). Patients in the VR group were assessed and guided by a multidisciplinary team, whereas patients in the UC group received care as initiated by their rheumatologist, supplemented with written information. The main outcome measure was the occurrence of job loss (complete work disability or unemployment); additional outcome measures included job satisfaction, pain, functional status, emotional status, and quality of life. There was no difference between the 2 groups regarding the proportion of patients having lost their job at any time point, with 24% and 23% of the patients in the VR and UC groups, respectively, having lost their job after 24 months. Over the total period of 24 months, patients in the VR group had a significantly greater improvement of the fatigue visual analog scale and of emotional status (all P values job-retention VR program did not reduce the risk of job loss but improved fatigue and mental health in patients with chronic rheumatic diseases at risk for job loss.

  14. Alberta Environment's weir safety program : options for rehabilitation to improve public safety : a case study of the Calgary weir

    Energy Technology Data Exchange (ETDEWEB)

    Blakely, D. [Alberta Environment, Edmonton, AB (Canada)

    2009-07-01

    Alberta Environment Water Management Operations (WMO) owns and operates 46 dams and 800 kilometres of canals in Alberta. The WMO consists of 120 staff and several contract operators to take care of this infrastructure. Most of the infrastructure supplies water for irrigation use, which adds 5 billion dollars to the provincial economy annually. Other water uses include stock watering, domestic use, municipal use, recreational use and habitat. Alberta Environment's weir safety program was also discussed along with options for rehabilitation to improve public safety. A case study of Calgary's Weir Dam on the Bow River was highlighted. A brief history of the dam was offered and safety programs around provincially-owned weirs were discussed. Photographs were included to illustrate some of the additional safety measures at the Calgary weir, such as suspended safety buoys upstream of the boom directing paddlers to the portage trail, and signage on the river that can be activated when the boom is out. Typical river users on the Calgary Bow River and safety history at the Calgary Weir were discussed along with other topics such as the Calgary Bow River weir project criteria; project design progress; pre-feasibility options; scale modelling; final design analysis; construction funding; and proposed changes to the safety program for the new weir configuration. figs.

  15. Psychological well-being in obese in-patients with ischemic heart disease at entry and at discharge from a four-week cardiac rehabilitation program

    Directory of Open Access Journals (Sweden)

    Gian Mauro Manzoni

    2010-08-01

    Full Text Available The purposes of this observational pre-post study were twofold: 1- to evaluate psychological health in obese patients with ischemic heart disease (IHD at admission to cardiac rehabilitation (CR and 2 - to examine the effectiveness of a four-week CR residential program in improving obese patients’ psychological well-being at discharge from CR. A sample of 177 obese patients completed the Psychological General Well-Being Inventory (PGWBI at admission to the CR program and at discharge. The equivalence testing method with normative comparisons was used to determine the clinical significance of improvements after having established that baseline mean scores on the PGWBI scales were significantly lower than normal means. Results show that patients scored equally or better than norms on many PGWBI dimensions at admission to CR but scored significantly worse on Global Score, Vitality and Self-control. At discharge, mean scores that were impaired at baseline returned to normal levels at the more conservative equivalence interval. A four-week CR program was thus effective in improving obese patients’ psychological well-being. The equivalence testing method allowed to establish the clinical significance of such improvement.

  16. Short-term effects of exercise and music on cognitive performance among participants in a cardiac rehabilitation program.

    Science.gov (United States)

    Emery, Charles F; Hsiao, Evana T; Hill, Scott M; Frid, David J

    2003-01-01

    Exercise has been associated with improved cognitive performance among patients with coronary artery disease. Music listening has been associated with enhanced cognitive functioning among healthy adults. This study evaluated the combined influence of exercise and music listening on cognitive performance among patients in cardiac rehabilitation (CR). Using a within-subjects repeated measures design, this study was conducted in an outpatient University-based CR facility. Thirty-three men and women (mean age = 62.6 +/- 10.5 years) participated in this study. Participants completed 1 exercise session accompanied by music and a second exercise session without music. Order of conditions was assigned randomly. Before and after each exercise session, participants completed a brief assessment of depression and anxiety, and a cognitive test of verbal fluency. The music condition was associated with significant improvements in verbal fluency, but the no-music control condition was not associated with cognitive change. The study provides preliminary evidence of the combined benefit of exercise and music listening for cognitive performance among patients in CR.

  17. The Untreated Addiction: Going Tobacco-Free in a VA Substance Abuse Residential Rehabilitation Treatment Program (SARRTP).

    Science.gov (United States)

    Conrad, Megan; Bolte, Teri; Gaines, Leigh; Avery, Zackery; Bodie, Linda

    2018-05-02

    Despite negative effects of tobacco on the human body and the high prevalence of smoking among those who enter treatment for substance use, few residential programs endorse a tobacco-free policy. Conventional wisdom suggests that it is overwhelming to quit more than one substance at a time, and as a result, many clinicians believe that a shift to a tobacco-free treatment environment is unfeasible. However, the most recent scientific literature suggests the opposite: targeting tobacco use during substance use treatment can increase abstinence rates from both smoking and substances of choice. Therefore, the purpose of the current project is to outline the process by which a residential substance use treatment program within a Veterans Affairs (VA) medical center implemented a tobacco-free policy. In addition, preliminary program evaluation data dispels the myth that eliminating tobacco use in a residential treatment program leads to a decline in patient interest and program utilization.

  18. Rehabilitation and older people.

    OpenAIRE

    Young, J.

    1996-01-01

    Rehabilitation is concerned with lessening the impact of disabling conditions. These are particularly common in older people and considerable health gain can be achieved by successful rehabilitation. Hospital doctors and general practitioners should be aware of the core principles of rehabilitation, be able to recognise rehabilitation need in their patients, and have sufficient knowledge of their local rehabilitation services to trigger the referral process.

  19. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence.

    Science.gov (United States)

    Mark-Christensen, Troels; Troelsen, Anders; Kallemose, Thomas; Barfod, Kristoffer Weisskirchner

    2016-06-01

    The optimal treatment for acute Achilles tendon rupture (ATR) is continuously debated. Recent studies have proposed that the choice of either operative or non-operative treatment may not be as important as rehabilitation, suggesting that functional rehabilitation should be preferred over traditional immobilization. The purpose of this meta-analysis of randomized controlled trials (RCTs) was to compare functional rehabilitation to immobilization in the treatment of ATR. This meta-analysis was conducted using the databases: PubMed, EMBASE, Rehabilitation and Sports Medicine Source, AMED, CINAHL, Cochrane Library and PEDro using the search terms: "Achilles tendon," "rupture," "mobilization" and "immobilization". Seven RCTs involving 427 participants were eligible for inclusion, with a total of 211 participants treated with functional rehabilitation and 216 treated with immobilization. Re-rupture rate, other complications, strength, range of motion, duration of sick leave, return to sport and patient satisfaction were examined. There were no statistically significant differences between groups. A trend favoring functional rehabilitation was seen regarding the examined outcomes. Functional rehabilitation after acute Achilles tendon rupture does not increase the rate of re-rupture or other complications. A trend toward earlier return to work and sport, and increased patient satisfaction was found when functional rehabilitation was used. The present literature is of low-to-average quality, and the basic constructs of the examined treatment and study protocols vary considerably. Larger, randomized controlled trials using validated outcome measures are needed to confirm the findings. II.

  20. The Use of Computer-Assisted Home Exercises to Preserve Physical Function after a Vestibular Rehabilitation Program: A Randomized Controlled Study

    Directory of Open Access Journals (Sweden)

    Michael Smaerup

    2016-01-01

    Full Text Available Objective. The purpose of this study was to evaluate whether elderly patients with vestibular dysfunction are able to preserve physical functional level, reduction in dizziness, and the patient’s quality of life when assistive computer technology is used in comparison with printed instructions. Materials and Methods. Single-blind, randomized, controlled follow-up study. Fifty-seven elderly patients with chronic dizziness were randomly assigned to a computer-assisted home exercise program or to home exercises as described in printed instructions and followed for tree month after discharge from an outpatient clinic. Results. Both groups had maintained their high functional levels three months after finishing the outpatient rehabilitation. No statistically significant difference was found in outcome scores between the two groups. In spite of moderate compliance levels, the patients maintained their high functional level indicating that the elderly should not necessarily exercise for the first three months after termination of the training in the outpatient clinic. Conclusion. Elderly vestibular dysfunction patients exercising at home seem to maintain their functional level, level of dizziness, and quality of life three months following discharge from hospital. In this specific setup, no greater effect was found by introducing a computer-assisted training program, when compared to standard home training guided by printed instructions. This trial is registered with NCT01344408.

  1. MRI evaluation of anterior knee pain: predicting response to nonoperative treatment

    International Nuclear Information System (INIS)

    Wittstein, Jocelyn R.; Garrett, William E.; O'Brien, Seth D.; Vinson, Emily N.

    2009-01-01

    Tibial tubercle lateral deviation and patellofemoral chondromalacia are associated with anterior knee pain (AKP). We hypothesized that increased tibial tubercle lateral deviation and patellofemoral chondromalacia on magnetic resonance imaging correlates with the presence of AKP and with failure of nonoperative management. In this retrospective comparative study, a blinded musculoskeletal radiologist measured tibial tubercle lateral deviation relative to the trochlear groove in 15 controls, 15 physical therapy responders with AKP, and 15 physical therapy nonresponders with AKP. Patellar and trochlear cartilage was assessed for signal abnormality, irregularity, and defects. The mean tibial tubercle lateral deviation in controls, physical therapy responders, and physical therapy nonresponders were 9.32 ± 0.68, 13.01 ± 0.82, and 16.07 ± 1.16 mm, respectively (data are mean ± standard deviation). The correlation coefficients for tubercle deviation, chondromalacia patellae, and trochlear chondromalacia were 0.51 (P < 0.01), 0.44 (P < 0.01), and 0.28 (P < 0.05), respectively. On analysis of variance, tubercle deviation and chondromalacia patellae contributed significantly to prediction of AKP and response to physical therapy. The presence of chondromalacia patellae and a tubercle deviation greater than 14.6 mm is 100% specific and 67% sensitive with a positive predictive value of 100% and negative predictive value of 75% for failure of nonoperative management. Subjects with AKP have more laterally positioned tibial tubercles and are more likely to have patellar chondromalacia. Patients with AKP, chondromalacia patellae, and a tubercle deviation greater than 14.6 mm are unlikely to respond to nonoperative treatment. Knowledge of tibial tubercle lateralization and presence of chondromalacia patellae may assist clinicians in determining patient prognosis and selecting treatment options. (orig.)

  2. Plantar Pressures After Nonoperative Treatment for Clubfoot: Intermediate Follow-up at Age 5 Years.

    Science.gov (United States)

    Jeans, Kelly A; Erdman, Ashley L; Karol, Lori A

    2017-01-01

    Worldwide, a nonoperative approach in the treatment of idiopathic clubfoot has been taken in an attempt to reduce the incidence of surgical outcomes. Although both the Ponseti casting (Ponseti) and the French physiotherapy (PT) methods have shown gait and pedobarograph differences at age 2 years, improved gait results have been reported by age 5 years. The purpose of this study was to assess plantar pressures in feet treated with the Ponseti versus the PT methods at this intermediate stage. Clubfoot patients treated nonoperatively (Ponseti or PT) underwent pedobarograph data collection at age 5 years. The foot was subdivided into the medial/lateral hindfoot, midfoot, and forefoot regions. Variables included Peak Pressure, Maximum Force, Contact Area%, Contact Time%, Pressure Time Integral, the hindfoot-forefoot angle, and displacement of the center of pressure (COP) line. Twenty controls were used for comparison. Pedobarograph data from 164 patients (238 feet; 122 Ponseti and 116 PT) showed no significant differences between the Ponseti and the PT feet, except the PT feet had a significantly less medial movement of the COP than the Ponseti feet (P=0.0379). Compared with controls, both groups had decreased plantar pressures in the hindfoot and first metatarsal regions, whereas the midfoot and lateral forefoot experienced significant increases compared with controls. This lateralization was also reflected in the hindfoot-forefoot angle and the COP. Feet that remain nonoperative and avoid surgical intervention are considered a good clinical result. However, pedobarograph results indicate mild residual deformity in these feet despite clinically successful outcomes. Level II-therapeutic.

  3. "Stiction Syndrome": Non-Operative Management of Patients With Difficult AMS 700 Series Inflation.

    Science.gov (United States)

    Kavoussi, Nicholas L; Viers, Boyd R; VanDyke, Maia E; Pagliara, Travis J; Morey, Allen F

    2017-09-01

    Static friction (stiction) is a mechanical phenomenon in which a state of increased resistance exists across a control valve mechanism. To present a strategy for non-operative management of inflatable penile prosthesis (IPP) cases with pump malfunction from pump valve stiction. All patients had American Medical Systems (AMS; Minnetonka, MN, USA) 700 series Momentary Squeeze IPPs with transient pump malfunction owing to pump valve stiction after extended periods of device inactivity. Our evolving non-operative management experience with the "forced deflation" maneuver is described. This technique has successfully prevented the need for surgical pump replacement. Of patients with IPP who were instructed to inflate and deflate daily to prevent stiction recurrence, none have re-presented with difficult inflation. Of 306 patients receiving the AMS 700 series IPP at our institution from 2007 through 2015, 6 (1.9%) presented with difficulty activating the Momentary Squeeze pump (from 2011 through 2015). Four additional patients were referred from outside institutions with the same complaint. All patients (10 of 10, 100%) presented after a prolonged period of inactivity (minimum = 6 weeks) during which the IPP was not cycled and remained stagnant. Although the initial four patients (40%) underwent surgical exploration with pump mobilization and replacement, the six most recent patients (60%) were successfully instructed in the forced deflation maneuver in the office, which enabled the device to cycle normally thereafter. Device inactivity, for as little as 6 weeks, can predispose to Momentary Squeeze pump valve malfunction; and a regimen of daily IPP cycling could prevent stiction-related malfunction. Our findings should encourage practitioners to attempt conservative management of patients with "stiction syndrome" whenever possible, thereby avoiding unnecessary surgery. Kavoussi NL, Viers BR, VanDyke ME, et al. "Stiction Syndrome": Non-Operative Management of Patients

  4. MRI evaluation of anterior knee pain: predicting response to nonoperative treatment

    Energy Technology Data Exchange (ETDEWEB)

    Wittstein, Jocelyn R.; Garrett, William E. [Duke University Medical Center, Division of Orthopaedic Surgery, Durham, NC (United States); O' Brien, Seth D. [Brooke Army Medical Center, Department of Radiology, San Antonio, TX (United States); Vinson, Emily N. [Duke University Medical Center, Department of Radiology, Durham, NC (United States)

    2009-09-15

    Tibial tubercle lateral deviation and patellofemoral chondromalacia are associated with anterior knee pain (AKP). We hypothesized that increased tibial tubercle lateral deviation and patellofemoral chondromalacia on magnetic resonance imaging correlates with the presence of AKP and with failure of nonoperative management. In this retrospective comparative study, a blinded musculoskeletal radiologist measured tibial tubercle lateral deviation relative to the trochlear groove in 15 controls, 15 physical therapy responders with AKP, and 15 physical therapy nonresponders with AKP. Patellar and trochlear cartilage was assessed for signal abnormality, irregularity, and defects. The mean tibial tubercle lateral deviation in controls, physical therapy responders, and physical therapy nonresponders were 9.32 {+-} 0.68, 13.01 {+-} 0.82, and 16.07 {+-} 1.16 mm, respectively (data are mean {+-} standard deviation). The correlation coefficients for tubercle deviation, chondromalacia patellae, and trochlear chondromalacia were 0.51 (P < 0.01), 0.44 (P < 0.01), and 0.28 (P < 0.05), respectively. On analysis of variance, tubercle deviation and chondromalacia patellae contributed significantly to prediction of AKP and response to physical therapy. The presence of chondromalacia patellae and a tubercle deviation greater than 14.6 mm is 100% specific and 67% sensitive with a positive predictive value of 100% and negative predictive value of 75% for failure of nonoperative management. Subjects with AKP have more laterally positioned tibial tubercles and are more likely to have patellar chondromalacia. Patients with AKP, chondromalacia patellae, and a tubercle deviation greater than 14.6 mm are unlikely to respond to nonoperative treatment. Knowledge of tibial tubercle lateralization and presence of chondromalacia patellae may assist clinicians in determining patient prognosis and selecting treatment options. (orig.)

  5. Outcome of non-operative management of femoral shaft fractures in children

    Directory of Open Access Journals (Sweden)

    Akinyoola A

    2011-01-01

    Full Text Available Background: Femoral shaft fractures are common injuries in childhood. There is paucity of information on their presentation and outcome of the available treatment methods in the African population. This study evaluated the outcome of non-operative methods of treatment of femoral shaft fractures in our centre. Patients and Methods: A retrospective review of the database of children aged 14 years and below with femoral shaft fractures treated non-operatively over a 10-year period. Results: A total of 134 patients with 138 fractures met the study criteria. This consisted of 71 boys (mean age = 6.1 years ± SD and 63 girls (mean age = 6.5 years ± SD. Pedestrian vehicular accident was the most common cause of femoral shaft fractures in the study population. The midshaft was the most common site of fractures. There were associated injuries to other parts of the body (especially head injury in 34.3% of the patients. The commonest mode of treatment was skin traction only (87.7%. The mean time to fracture union was 4.9 weeks ± SD (range = 3-15 weeks. The mean length of hospitalisation was 6.7 weeks ± SD (range = 5 days-11 weeks. There was a fairly strong positive correlation between the length of hospitalisation and the presence of associated injuries, especially head injury, upper limb fractures and bilaterality of the fractures. The mean total cost of treatment was #7685 (Naira or $51.2 (range = $14.2-$190. At the last follow up, 97.8% of the fractures united without significant angulation or shortening. Conclusion: The outcome of non-operative treatment of femoral shaft fractures in our setting is comparable to the results of other workers. Methods of treatment that shorten the length of hospitalisation without unduly increasing cost should be encouraged.

  6. The emerging trend of non-operative treatment in paediatric type I open forearm fractures.

    Science.gov (United States)

    Zhang, H; Fanelli, M; Adams, C; Graham, J; Seeley, M

    2017-08-01

    Open fractures are considered an orthopaedic emergency and are generally an indication for operative debridement. Recent studies have questioned this approach for the management of Gustilo-Anderson Type I open fractures in the paediatric population. This meta-analysis studies the non-operative management of Type I open paediatric forearm fractures. An Ovid MEDLINE and PubMed database literature search was performed for studies that involved a quantified number of Gustilo-Anderson Type I open forearm fractures in the paediatric population, which were treated without operative intervention. A fixed-effect meta-analysis, weighting each study based on the number of patients, and a pooled estimate of infection risk (with 95% confidence interval (CI)) was performed. The search results yielded five studies that were eligible for inclusion. No included patients had operative debridement and all were treated with antibiotics. The number of patients in each study ranged from 3 to 45, with a total of 127 paediatric patients in the meta-analysis. The infection rate was 0% for all patients included. The meta-analysis estimated a pooled infection risk of 0% (95% CI 0 to 2.9). The five included studies had a total of 127 patients with no cases of infection after non-operative management of Type I open paediatric forearm fractures. The infection rate of Type I fractures among operatively managed patients is 1.9%. The trend in literature towards non-operative treatment of paediatric Type I open fractures holds true in this meta-analysis.

  7. Non-operative management of blunt hepatic trauma: Does angioembolization have a major impact?

    Science.gov (United States)

    Bertens, K A; Vogt, K N; Hernandez-Alejandro, R; Gray, D K

    2015-02-01

    A paradigm shift toward non-operative management (NOM) of blunt hepatic trauma has occurred. With advances in percutaneous interventions, even severe liver injuries are being managed non-operatively. However, although overall mortality is decreased with NOM, liver-related morbidity remains high. This study was undertaken to explore the morbidity and mortality of blunt hepatic trauma in the era of angioembolization (AE). A retrospective cohort of trauma patients with blunt hepatic injury who were assessed at our centre between 1999 and 2011 were identified. Logistic regression was undertaken to identify factors increasing the likelihood of operative management (OM) and mortality. We identified 396 patients with a mean ISS of 33 (± 14). Sixty-two (18%) patients had severe liver injuries (≥ AAST grade IV). OM occurred in 109 (27%) patients. Logistic regression revealed high ISS (OR 1.07; 95% CI 1.05-1.10), and lower systolic blood pressure on arrival (OR 0.98; 95% CI 0.97-0.99) to be associated with OM. The overall mortality was 17%. Older patients (OR 1.05; 95% CI 1.03-1.07), those with high ISS (OR 1.11; 95% CI 1.08-1.14) and those requiring OM (OR 2.89; 95% CI 1.47-5.69) were more likely to die. Liver-related morbidities occurred in equal frequency in the OM (23%) and AE (29%) groups (p = 0.32). Only 3% of those with NOM experienced morbidity. The majority of patients with blunt hepatic trauma can be successfully managed non-operatively. Morbidity associated with NOM was low. Patients requiring AE had morbidity similar to OM.

  8. The one repetition maximum test and the sit-to-stand test in the assessment of a specific pulmonary rehabilitation program on peripheral muscle strength in COPD patients.

    Science.gov (United States)

    Zanini, Andrea; Aiello, Marina; Cherubino, Francesca; Zampogna, Elisabetta; Azzola, Andrea; Chetta, Alfredo; Spanevello, Antonio

    2015-01-01

    Individuals with COPD may present reduced peripheral muscle strength, leading to impaired mobility. Comprehensive pulmonary rehabilitation (PR) should include strength training, in particular to lower limbs. Furthermore, simple tools for the assessment of peripheral muscle performance are required. To assess the peripheral muscle performance of COPD patients by the sit-to-stand test (STST), as compared to the one-repetition maximum (1-RM), considered as the gold standard for assessing muscle strength in non-laboratory situations, and to evaluate the responsiveness of STST to a PR program. Sixty moderate-to-severe COPD inpatients were randomly included into either the specific strength training group or into the usual PR program group. Patients were assessed on a 30-second STST and 1-minute STST, 1-RM, and 6-minute walking test (6MWT), before and after PR. Bland-Altman plots were used to evaluate the agreement between 1-RM and STST. The two groups were not different at baseline. In all patients, 1-RM was significantly related to the 30-second STST (r=0.48, Ptest. In the specific strength training group significant improvements were observed in the 30-second STST (P<0.001), 1-minute STST (P=0.005), 1-RM (P<0.001), and in the 6MWT (P=0.001). In the usual PR program group, significant improvement was observed in the 30-second STST (P=0.042) and in the 6MWT (P=0.001). Our study shows that in stable moderate-to-severe inpatients with COPD, STST is a valid and reliable tool to assess peripheral muscle performance of lower limbs, and is sensitive to a specific PR program.

  9. CT grading systems as a predictor of successful nonoperative treatment of splenic trauma

    International Nuclear Information System (INIS)

    Umlas, S.L.; Cronan, J.J.

    1990-01-01

    PURPOSE: Selective nonoperative management of splenic trauma yields benefits with regard to preservation of the body's defense systems. This paper evaluates the capability of CT grading systems to predict successful non- operative management of splenic trauma in children and adults. Fifty-six patients with documented splenic injury were assessed with CT following standard trauma protocols. Each of these CT scans were graded according to the three recently proposed splenic trauma systems. The charts of these patients were then reviewed, and correlations between the CT grade and the clinical outcome were determined for each of these three grading systems

  10. Wandering spleen associated with omphalocele in a neonate: An unusual case with non-operative management

    Directory of Open Access Journals (Sweden)

    Daisuke Masui

    2017-09-01

    Full Text Available Wandering spleen with a history of omphalocele is extremely rare. We encountered a male baby with wandering spleen associated with omphalocele. This case of wandering spleen in a neonate was diagnosed by ultrasound and computed tomography scans after surgery for omphalocele. Our case was able to be managed non-operatively due to the lack of any findings suggesting torsion of the spleen and its asymptomatic status. We herein report the clinical presentation as well as the treatment options regarding wandering spleen associated with omphalocele.

  11. Rehabilitative bodywork

    DEFF Research Database (Denmark)

    Hansen, Agnete Meldgaard

    2016-01-01

    Care work for elderly people has been characterised as dirty work, owing to its proximity to the (dys)functions and discharges of aged bodies and the notions of disease, decay and death associated with the idea of ‘old age’. However, a wave of reform programmes in Danish municipalities promoting...... units, this article analyses how rehabilitative care practices, drawing on a narrative of the third age, provide an optimistic and anti-ageist framing of homecare work that informs the development of new occupational identities for care workers as coaches rather than carers in relation to citizens...

  12. Program of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack (PREVENT Trial: a multi-centred, randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Thompson Kara

    2010-12-01

    Full Text Available Abstract Background Despite lack of outward signs, most individuals after non-disabling stroke (NDS and transient ischemic attack (TIA have significant cardiovascular and cerebrovascular disease and are at high risk of a major stroke, hospitalization for other vascular events, or death. Most have multiple modifiable risk factors (e.g., hypertension, physical inactivity, hyperlipidaemia, diabetes, tobacco consumption, psychological stress. In addition, accelerated rates of depression, cognitive decline, and poor quality of sleep have been reported following TIA, which correlate with poor functional outcomes and reduced quality of life. Thus, NSD and TIA are important warning signs that should not be overlooked. The challenge is not unlike that facing other 'silent' conditions - to identify a model of care that is effective in changing people's current behaviors in order to avert further morbidity. Methods/Design A single blind, randomized controlled trial will be conducted at two sites to compare the effectiveness of a program of rehabilitative exercise and education versus usual care in modifying vascular risk factors in adults after NDS/TIA. 250 adults within 90 days of being diagnosed with NDS/TIA will be randomly allocated to a 12-week program of exercise and education (PREVENT or to an outpatient clinic assessment and discussion of secondary prevention recommendations with return clinic visits as indicated (USUAL CARE. Primary outcome measures will include blood pressure, waist circumference, 12-hour fasting lipid profile, and 12-hour fasting glucose/hemoglobin A1c. Secondary measures will include exercise capacity, walking endurance, physical activity, cognitive function, depression, goal attainment and health-related quality of life. Outcome assessment will be conducted at baseline, post-intervention, and 6- and 12-month follow-ups. Direct health care costs incurred over one year by PREVENT versus USUAL CARE participants will also be

  13. Validation of two scales for measuring participation and perceived stigma in Chinese community-based rehabilitation programs.

    Science.gov (United States)

    Chung, Eva Yin-Han; Lam, Gigi

    2018-05-29

    The World Health Organization has asserted the importance of enhancing participation of people with disabilities within the International Classification of Functioning, Disability and Health framework. Participation is regarded as a vital outcome in community-based rehabilitation. The actualization of the right to participate is limited by social stigma and discrimination. To date, there is no validated instrument for use in Chinese communities to measure participation restriction or self-perceived stigma. This study aimed to translate and validate the Participation Scale and the Explanatory Model Interview Catalogue (EMIC) Stigma Scale for use in Chinese communities with people with physical disabilities. The Chinese versions of the Participation Scale and the EMIC stigma scale were administered to 264 adults with physical disabilities. The two scales were examined separately. The reliability analysis was studied in conjunction with the construct validity. Reliability analysis was conducted to assess the internal consistency and item-total correlation. Exploratory factor analysis was conducted to investigate the latent patterns of relationships among variables. A Rasch model analysis was conducted to test the dimensionality, internal validity, item hierarchy, and scoring category structure of the two scales. Both the Participation Scale and the EMIC stigma scale were confirmed to have good internal consistency and high item-total correlation. Exploratory factor analysis revealed the factor structure of the two scales, which demonstrated the fitting of a pattern of variables within the studied construct. The Participation Scale was found to be multidimensional, whereas the EMIC stigma scale was confirmed to be unidimensional. The item hierarchies of the Participation Scale and the EMIC stigma scale were discussed and were regarded as compatible with the cultural characteristics of Chinese communities. The Chinese versions of the Participation Scale and the EMIC

  14. Utilidad de un programa de rehabilitación neuropsicológica de la memoria en daño cerebral adquirido (Usefulness of a Program of Neuropsychological Rehabilitation of Memory in Acquired Brain Damage

    Directory of Open Access Journals (Sweden)

    Carlos José De los Reyes-Aragón

    2013-12-01

    Full Text Available RESUMEN: Este estudio evaluó la utilidad de un programa de rehabilitación cognitiva y funcional de memoria para pacientes con daño cerebral adquirido. Diez participantes con deterioro cognitivo leve o moderado participaron en el estudio, cinco de ellos asistieron durante cuatro meses a un programa semanal de rehabilitación, mientras que los otros cinco no recibieron intervención neuropsicológica. Los resultados mostraron que el grupo de rehabilitación mejoró la puntuación en la Escala de Memoria de Wechsler III. De igual forma, se encontró que la puntuación en la escala de fallos de memoria de la vida diaria solo mejoró en el grupo que recibió rehabilitación. Los resultados sugieren que el programa de rehabilitación de la memoria resulta útil en el tratamiento de las secuelas tanto cognitivas como funcionales resultantes del daño cerebral adquirido. ABSTRACT: This study evaluated the usefulness of a cognitive and functional rehabilitation of memory program for patients with acquired brain injury. Ten participants with mild- to -moderate cognitive impairment participated in the study; five of them for four months attended a weekly rehabilitation program, while the other five did not receive any neuropsychological intervention. The results showed that the rehabilitation group improved the score in the Wechsler III Memory Scale. Similarly, it was found that the score on the memory scale of failure of the daily life only improved in the group that received rehabilitation. The results suggest that memory rehabilitation program is useful in the treatment of both cognitive and functional sequels resulting from acquired brain damage.

  15. Design of a study evaluating the effects, health economics, and stakeholder perspectives of a multi-component occupational rehabilitation program with an added workplace intervention - a  study protocol.

    Science.gov (United States)

    Rise, Marit B; Skagseth, Martin; Klevanger, Nina E; Aasdahl, Lene; Borchgrevink, Petter; Jensen, Chris; Tenggren, Hanne; Halsteinli, Vidar; Jacobsen, Trym N; Løland, Svein B; Johnsen, Roar; Fimland, Marius S

    2018-02-05

    Recent research has suggested that interventions at the workplace might be the most potent ingredient in return to work interventions, but few studies have investigated the different effects of workplace interventions as part of occupational rehabilitation programs. The comprehensive design described in this article includes effect (on return to work and health outcomes), and health economic evaluations of a workplace intervention added to a multicomponent rehabilitation program. Qualitative and mixed method studies will investigate sick-listed persons', rehabilitation therapists' and employers' perspectives on the usability and outcomes of the rehabilitation program and the workplace intervention. The program and intervention are provided to patients with musculoskeletal, psychological or general and unspecified diagnoses. The program is multi-component and includes Acceptance and Commitment Therapy, physical exercise, patient education and creating a plan for increased work participation. Persons who are employed, aged from 18 to 60 years, with a current sick leave status of 50% or more and a diagnosis within the musculoskeletal, psychological or general and unspecified chapters of International Classification of Primary Care-2 (ICPC-2) will be recruited to a researcher-blinded parallel-group randomized controlled trial. All participants take part in an in-patient occupational rehabilitation program, while the intervention group also takes part in an intervention at the workplace. The effect and economic evaluation will investigate the effect of the added workplace intervention. The primary outcome measures will be time until full sustainable return to work and total number of sickness absence days in the 12 months after inclusion. Health economic evaluations will investigate the cost-effectiveness and cost-utility. Qualitative studies will investigate rehabilitation therapists' experiences with working towards return to work within an ACT-approach and

  16. Non-operative management of right side thoracoabdominal penetrating injuries--the value of testing chest tube effluent for bile.

    Science.gov (United States)

    De Rezende Neto, João Baptista; Guimarães, Tiago Nunes; Madureira, João Lopo; Drumond, Domingos André Fernandes; Leal, Juliana Campos; Rocha, Aroldo; Oliveira, Rodrigo Guimarães; Rizoli, Sandro B

    2009-05-01

    While mandatory surgery for all thoracoabdominal penetrating injuries is advocated by some, the high rate of unnecessary operations challenges this approach. However, the consequences of intrathoracic bile remains poorly investigated. We sought to evaluate the outcome of patients who underwent non-operative management of right side thoracoabdominal (RST) penetrating trauma, and the levels of bilirubin obtained from those patients' chest tube effluent. We managed non-operatively all stable patients with a single RST penetrating injury. Chest tube effluent samples were obtained six times within (4-8 h; 12-16 h; 20-24 h; 28-32 h; 36-40 h; 48 h and 72 h) of admission for bilirubin measurement and blood for complete blood count, bilirubin, alanine (ALT) and aspartate aminotransferases (AST) assays. For comparison we studied patients with single left thoracic penetrating injury. Forty-two patients with RST injuries were included. All had liver and lung injuries confirmed by CT scans. Only one patient failed non-operative management. Chest tube bilirubin peaked at 48 h post-trauma (mean 3.3+/-4.1 mg/dL) and was always higher than both serum bilirubin (pchest tube effluent from control group (27 patients with left side thoracic trauma). Serum ALT and AST were higher in RST injury patients (ptrauma appears to be safe. Bile originating from the liver injury reaches the right thoracic cavity but does not reflect the severity of that injury. The highest concentration was found in the patient failing non-operative management. The presence of intrathoracic bile in selected patients who sustain RST penetrating trauma, with liver injury, does not preclude non-operative management. Our study suggests that monitoring chest tube effluent bilirubin may provide helpful information when managing a patient non-operatively.

  17. Effectiveness of the "Transcendental Medication" Program in Criminal Rehabilitation and Substance Abuse Recovery: A Review of the Research.

    Science.gov (United States)

    Hawkins, Mark A.

    2003-01-01

    Reviews research on the Transcendental Meditation (TM) program relevant to the treatment and prevention of criminal behavior and substance abuse. Incarcerated offenders show rapid positive changes in risk factors associated with criminal behavior, including anxiety, aggression, hostility, moral judgment, in-prison rule infractions, and substance…

  18. 78 FR 61667 - Final Fair Market Rents for the Housing Choice Voucher Program and Moderate Rehabilitation Single...

    Science.gov (United States)

    2013-10-03

    ... Metro FMR Area 2016 Area. Las Vegas-Paradise, NV MSA 2015 New Haven-Meriden, CT HUD Metro FMR 2016 Area...) in the Low-Income Housing Tax Credit program is outside of the scope of this notice. However, HUD...

  19. ENVIRONMENTAL TECHNOLOGY VERIFICATION PROGRAM: PROTOCOL FOR THE VERIFICATION OF GROUTING MATERIALS FOR INFRASTRUCTURE REHABILITATION AT THE UNIVERSITY OF HOUSTON - CIGMAT

    Science.gov (United States)

    This protocol was developed under the Environmental Protection Agency's Environmental Technology Verification (ETV) Program, and is intended to be used as a guide in preparing laboratory test plans for the purpose of verifying the performance of grouting materials used for infra...

  20. Diabetes rehabilitation : development and first results of a Multidisciplinary Intensive Education Program for patients with prolonged self-management difficulties

    NARCIS (Netherlands)

    Keers, JC; Blaauwwiekel, EE; Hania, M; Bouma, J; Scholten-Jaegers, SMHJ; Sanderman, R; Links, TP

    For a number of diabetes patients regular care may be insufficient. A Multidisciplinary Intensive Education Program (MIEP), based on the empowerment approach, has been developed to help patients obtain their treatment goals (adequate self-management, glycemic control and quality of life). The aim of

  1. Detection of systemic inflammation in severely impaired chronic pain patients, and effects of a CBT-ACT-based multi-modal pain rehabilitation program.

    Science.gov (United States)

    Hysing, E-B; Smith, L; Thulin, M; Karlsten, R; Gordh, T

    2017-12-29

    Aims A few previous studies indicate an ongoing of low-grade systemic inflammation in chronic pain patients (CPP) [1, 2]. In the present study we investigated the plasma inflammatory profile in severely impaired chronic pain patients. In addition we studied if there were any alterations in inflammation patterns at one-year follow up, after the patients had taken part in a CBT-ACT based 4 weeks in-hospital pain rehabilitation program (PRP). Methods Blood samples were collected from 52 well characterized chronic pain patients. Plasma from matched healthy blood donors were used as controls. At one year after the treatment program, 28 of the patients were available for follow up. Instead of only analyzing single inflammation-related substances, we used a new multiplex panel enabling the simultaneous analysis of 92 inflammation-related proteins, mainly cytokines and chemokines (Proseek Inflammation, Olink, Uppsala, Sweden). Multivariate statistics were used for analysis. Results Clear signs of increased inflammatory activity were detected in the pain patients. Accepting a false discovery rate (FDR) of 5%, there were significant differences in 43 of the 92 inflammatory biomarkers. The expression of 8 biomarkers were 4 times higher in patients compared to controls. Three biomarkers, CXCL5, SIRT2, AXIN1 were more than 8 times higher. The conventional marker for inflammation, CRP, did not differ. Of the 28 patients available for follow up one year after the intervention, all showed lower levels of the inflammatory biomarker initially raised. Conclusions The results indicate that CPP suffer from a low grade of chronic systemic inflammation, not detectable by CRP analysis. This may have implications for the general pain hypersensitivity, and other symptoms, often described in this group of patients. We conclude that inflammatory plasma proteins may be measureable molecular markers to distinguishes CPP from pain free controls, and that a CBT-ACT pain rehab program seem to

  2. Study protocol for the FITR Heart Study: Feasibility, safety, adherence, and efficacy of high intensity interval training in a hospital-initiated rehabilitation program for coronary heart disease.

    Science.gov (United States)

    Taylor, Jenna; Keating, Shelley E; Leveritt, Michael D; Holland, David J; Gomersall, Sjaan R; Coombes, Jeff S

    2017-12-01

    For decades, moderate intensity continuous training (MICT) has been the cornerstone of exercise prescription for cardiac rehabilitation (CR). High intensity interval training (HIIT) is now recognized in CR exercise guidelines as an appropriate and efficient modality for improving cardiorespiratory fitness, a strong predictor of mortality. However, the clinical application of HIIT in a real world CR setting, in terms of feasibility, safety, and long-term adherence, needs further investigation to address ongoing reservations. Furthermore, studies using objective measures of exercise intensity (such as heart rate; HR) have produced variable outcomes. Therefore we propose investigating the use of subjective measures (such as rating of perceived exertion (RPE)) for prescribing exercise intensity. One hundred adults with coronary artery disease (CAD) attending a hospital-initiated CR program will be randomized to 1) HIIT: 4 × 4 min high intensity intervals at 15-18 RPE interspersed with 3-min active recovery periods or 2) MICT: usual care exercise including 40 min continuous exercise at a moderate intensity corresponding to 11-13 RPE. Primary outcome is change in exercise capacity (peak VO 2 ) following 4 weeks of exercise training. Secondary outcome measures are: feasibility, safety, exercise adherence, body composition, vascular function, inflammatory markers, intrahepatic lipid, energy intake, and dietary behavior over 12-months; and visceral adipose tissue (VAT) following 12 weeks of exercise training. This study aims to address the ongoing concerns regarding the practicality and safety of HIIT in CR programs. We anticipate study findings will lead to the development of a standardized protocol to facilitate CR programs to incorporate HIIT as a standard exercise option for appropriate patients.

  3. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline.

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    Stassen, Nicole A; Bhullar, Indermeet; Cheng, Julius D; Crandall, Marie L; Friese, Randall S; Guillamondegui, Oscar D; Jawa, Randeep S; Maung, Adrian A; Rohs, Thomas J; Sangosanya, Ayodele; Schuster, Kevin M; Seamon, Mark J; Tchorz, Kathryn M; Zarzuar, Ben L; Kerwin, Andrew J

    2012-11-01

    During the last century, the management of blunt force trauma to the spleen has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the Practice Management Guidelines for Non-operative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the current EAST guideline. The National Library of Medicine and the National Institute of Health MEDLINE database was searched using Pub Med (www.pubmed.gov). The search was designed to identify English-language citations published after 1996 (the last year included in the previous guideline) using the keywords splenic injury and blunt abdominal trauma. One hundred seventy-six articles were reviewed, of which 125 were used to create the current practice management guideline for the selective nonoperative management of blunt splenic injury. There has been a plethora of literature regarding nonoperative management of blunt splenic injuries published since the original EAST practice management guideline was written. Nonoperative management of blunt splenic injuries is now the treatment modality of choice in hemodynamically stable patients, irrespective of the grade of injury, patient age, or the presence of associated injuries. Its use is associated with a low overall morbidity and mortality when applied to an appropriate patient population. Nonoperative management of blunt splenic injuries should only be considered in an environment that provides capabilities for monitoring, serial clinical evaluations, and has an operating room available for urgent laparotomy. Patients presenting with hemodynamic instability and peritonitis still warrant emergent operative intervention

  4. Progression of Carpal Tunnel Syndrome According to Electrodiagnostic Testing in Nonoperatively Treated Patients

    Directory of Open Access Journals (Sweden)

    Mark van Suchtelen

    2014-09-01

    Full Text Available Background:  This study tested the null hypothesis that nonoperatively treated patients would not show disease progression of carpal tunnel syndrome (CTS over time according to median nerve distal motor latency (DML on two electrodiagnostic tests.   Methods:  This retrospective study analyzed sixty-two adult nonoperatively treated patients who were diagnosed with CTS confirmed by a minimum of two electrodiagnostic tests at our institution between December 2006 and  tober 2012. A Wilcoxon signed-rank test was conducted to test the difference between electrodiagnostic measurements between the first and last test. Results: The mean time between the first and last electrodiagnostic test was 26±12 months (range, 12 to 55 months. The only electrodiagnostic measurement that increased significantly was the difference between median and ulnar DML on the same side (r=0.19, P =0.038. The time between the electrodiagnostic tests was significantly longer for patients with at least 10% worsening of the DML at the second test compared to cases of which the DML did not worsen or improve a minimum of 10% (P =0.015.  Conclusions: There is evidence that—on average—idiopathic median neuropathy at the carpal tunnel slowly progresses over time, and this can be measured with electrodiagnostics, but studies with a much longer interval between lectrodiagnostic tests may be needed to determine if it always progresses.

  5. Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment

    Directory of Open Access Journals (Sweden)

    Ioannis Polyzois

    2016-04-01

    Full Text Available Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (OA, the effects of delaying surgery and the optimal method of immobilisation. Extensive literature review was performed looking for previous publication addressing 4 points. i Natural history of primary shoulder dislocation ii Effect of surgical intervention on natural history iii Risk of long term osteoarthritis with and without surgical intervention iv Immobilisation techniques post reduction. Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces. Defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity.

  6. Use of multiple-site performance-contingent SEMG reward programming in pediatric rehabilitation: a retrospective review.

    Science.gov (United States)

    Bolek, Jeffrey E

    2006-09-01

    We completed a retrospective review of the effectiveness of multi-site, performance-contingent reward programming on functional change in motor performance of 16 treatment resistant children. Patients were previously treated in physical or occupational therapy for head control, standing balance training, sitting and upper extremity use (brachial plexus injury). They then participated in a program that utilized multiple surface electromyography sites the use of which was rewarded with videos for performing the correct constellation of recruitment pattern (e.g., contracting some muscles while relaxing others). Onset of reward was calibrated for each patient and transfer of skill to outside the clinic was encouraged by linking a verbal cue to the correct motor plan. Fourteen of the 16 patients improved. The implications of the use of this technique in the treatment of motor dysfunction is discussed.

  7. Effect of a dedicated oral care program on periodontal status of medically compromised patients at the Toronto Rehabilitation Institute Dental Clinic.

    Science.gov (United States)

    Schlosser, Robert; Hebbes, Trudy

    2016-01-01

    Medically compromised patients attending the dental clinic at the Toronto Rehabilitation Institute have considerable gingival inflammation and breath odor. The objective of this study was to evaluate the effect of toothbrushing on the periodontal status of these patients and to determine if there were any additional benefit in combining brushing with an application of an antibiotic rinse. During the first 7 days of the study, the teeth of 11 participants were brushed twice a day by a dental hygienist using a soft-bristle suction toothbrush without toothpaste. Soft interproximal brushes were used to clean interproximal surfaces from the facial aspect. During the second week, facial and interproximal cleaning were repeated in the same patients, but the toothbrush and interproximal brush were dipped in 10-mL of a solution consisting of water and 40 mg/mL of metronidazole with nystatin. Each patient underwent an oral examination and biofilm sampling at baseline, after brushing without toothpaste (week 1), and after brushing with antibiotic solution (week 2). After week 1, tissues improved substantially, and there was a notable change in the biofilm on the teeth. The addition of an antibiotic solution increased healing and resulted in a further decrease in oral biofilm. Medically compromised patients would benefit considerably from a treatment regimen of antibiotic solution to decrease oral infection followed by a daily oral care program of brushing and interdental cleaning to maintain healthy oral tissues.