Actual Rehabilitation Research Articles

Causal Attributions of Patients, Their Spouses and Physicians, The Rehabilitation of the Patients After Their First Myocardial Infarction and Physicians, and the Rehabilitation of the Patients After Their First Myocardial Infarction

The possibility that coping with a first myocardial infarction (MI) is mediated by the patient's subjective interpretation of the event was tested in steps. Eighty-nine male patients under the age of sixty, admitted after their first MI to the intensive care unit of the Soroka Medical Center, were interviewed on different occasions within a six-month period. Wives and physicians were similarly interviewed on the same occasions. Five causal patterns were identified among subjects' interpretations of the MI, and were found to be consistent over time and modes of questioning. Patients who attributed the MI and its possible outcomes to external, uncontrollable causes returned to work and to regular physical and sexual functioning after six months at a significantly lower rate than did patients who cited a more complex causal pattern. Wives' attributions and predictions were similar to those of the patients. However, the physicians foresaw the patients' rehabilitation by ascertaining the risk factors (smoking, obesity, hypertension, heredity, etc.), which turned out to be poor indicators of the actual rehabilitation six months later. Theoretic and practical implications of these findings are discussed.

The De-Politicization of Gustave Courbet: Transformation and Rehabilitation under the Third Republic

Two quite different pursuits lead to place from which to contemplate late nineteenth-century of Gustave Courbet. The first is my ongoing investigation of Courbet within framework of those issues of realism that were his concern. The second is a meditation on questions feminism poses for art history and theory: pair, of which one part is have there been no great women artists? and other, its corollary, have there been great male ones? Why has this entity, great artist, existed at all, in short? And more specifically, what configuration will notion of great have at given moments in history? How is this entity the great artist constructed? And to what purposes? What political needs, what psychological yearnings, what ideological functions, does such a notion serve? And more concretely, how was a former Communard, an exile, a stillcontroversial and prickly painter like Courbet transformed, during decade between 1879 and 1889, into something approaching a cultural hero of Third French Republic? The steps in Courbet's actual rehabilitation are easy enough to follow and have been succinctly outlined in current literature.1 In 1877, a year before his death, Courbet was still in official disfavor, in exile in Switzerland, as a result of his participation in Commune, and more to point, his supposed responsibility for destruction of Vend6me Column. As late as November 26, 1877, a little more than a month before artist's death, courtordered sale of his works for payment of reconstruction of column brought in, altogether, derisory sum of 10,000 francs. Courbet died on New Year's Eve of 1877, on uneasy brink of Republic of Opportunists, a year before MacMahon was replaced by Jules Grevy, a veteran of 1848, a year before republic was actually controlled by republicans. In 1878 Courbet made a minor showing at Exposition Universelle

32. The rehabilitation of patients with apallic syndrome in the therapeutic community.

One of the main principles in the rehabilitation of apallic patients is that rehabilitation has to be started in every case as soon as possible. More precisely, the rehabilitation of an apallic syndrome has to be started in the acute phase of a severe brain damage which corresponds to the acute midbrain syndrome. During this phase, which was termed “preparatory phase” (Gerstenbrand, 1968), all precautions should be taken to provide the most favorable basis for the actual rehabilitation. The main precautions taken should concentrate on the prevention of cachexia, decubitus, contraction of joints, and periarticular ossifications. Thus a favorable basis for rehabilitation could be obtained. In this phase the application of hyper-caloric nutrition and a special physicotherapy using the tonus-regulating reflexes are of special importance. While the enormous consumption of energy is compensated by the hypercaloric nutrition, the physicotherapy effects an indirect training of the motoric functions and causes a simultaneous activation of the reticular system leading to a reactivation of vigilance.

The Physical Aspects of Industrial Rehabilitation

The physical aspects of rehabilitation should be considered on the basis of the organization and service of a rehabilitation center, even though the principles rather than actual rehabilitation center facilities would be used. It is recognized that every patient presenting himself to the doctor's office and every industrial disability requires rehabilitation to some degree. A rehabilitation center basically is a simultaneous Integration of physical, emotional, social and vocational evaluation and treatment. The physical is further subdivided into the indicated medical and surgical specialties and related paramedical therapies, the total personnel comprising a rehabilitation team. It should be emphasized that physical rehabilitation is not the province of one medical specialty, but is a philosophy imparting a logical dynamic aspect to medicine and surgery. Added to these, but not replacing them is physical medicine which, in addition to diagnostic aspects offers: A. Conservative measures to control muscle spasm and pain, which often begin a vicious cycle of contracture and debility. B. Progressive resistive exercise techniques to strengthen muscles and muscle groups. C. Exercises to maintain normal joint ranges or to restore restricted joints. D. Retraining for physical coordination and dexterity, including gait training. E. Activities to integrate the patient's abilities with the demands of self care and employment.