Community-based Rehabilitation Facilities Research Articles

Insights into the deployment of a social robot-augmented telepresence robot in an elder care clinic – perspectives from patients and therapists: a pilot study

AbstractAs the proportion of the elderly population in the USA expands, so will the demand for rehabilitation and social care, which play an important role in maintaining function and mediating motor and cognitive decline in older adults. The use of social robotics and telemedicine are each potential solutions but each have limitations. To address challenges with classical telemedicine for rehabilitation, we propose to use a social robot-augmented telepresence (SRAT), Flo, which was deployed for long-term use in a community-based rehabilitation facility catering to older adults. Our goals were to explore how clinicians and patients would use and respond to the robot during rehab interactions. In this pilot study, three clinicians were recruited and asked to rate usability after receiving training for operating the robot and two of them conducted multiple rehab interactions with their patients using the robot (eleven patients with cognitive impairment and/or motor impairment and 23 rehab sessions delivered via SRAT in total). We report on the experience of both therapists and patients after the interactions.

COMMUNITY BASED REHABILITATION: PROVIDE BARRIER FREEENVIRONMENT AND DEVELOPMENTAL OPPORTUNITIES FOR DISABLED PEOPLE

Community-based rehabilitation approach providesrehabilitation reduce poverty, equal opportunities, and social insertion for differently abled people at community level. Objective of CBR is to meet the needs of people with disabilitieswith the respect to health, educat ion, employment, social and economic empowerment issues (WHO 2010). Statement of the problems: I am going to find out the barriers which affect the available facilities for disabled people. Society treats disabled people in a different way as pity, feelings of sympathy, isolated or rejected. People often maintain social distance and consider disabled as outsiders. Many disable people feel discriminated at various levels in the family as well as in the community. Sometimes their families strongly supported them and even sometimes they might be over-protected by the family members. At the same time they might be rejected and left out from normal community life because of society humiliation and discrimination. In that conditions disabled people have very restricted and limited opportunities and choices for their own development. Objectives: The main focus of the study to find out how community based rehabilitation programme strategies will be effective to remove barriers in all stages and createmultiple opportunities and choices for the betterment of life of disabled people. In this backdrop the paper aims to find out how CBR helpful to provide and strengthentheir mental and physical abilities so they can understand themselves as normal human being in the society. Methodology: The research paper envisioned to find out the exercise of CBR service facility to PWDs, regulate whether differently abled have access to community based rehabilitation facilities, and recognize the CBR implementation challenges from the opinion ofcaregiversand parents, service providers. This whole paper is based on theoretical and literary approach. Data is collected from secondary sources such as books, research papers, journals, and reports etc.

Fitness to drive practices among non-driver trained occupational therapists in an Australian community-based rehabilitation setting.

Driving is a valued occupation given the independence and freedom it provides. Safe driving performance can be impacted by medical conditions, change in functional status and ageing processes. Occupational therapy driver assessors (OTDAs) provide invaluable driving recommendations; however, this requires specialist training for the therapist and is costly for clients. The number of OTDAs is not expected to meet the growing demand for expert services in this area, and little is known about the practices that non- OTDAs use to assist clients with returning to driving. The aims of this study were to investigate the practices of non-OTDAs in a community-based rehabilitation setting in Australia with respect to knowledge, confidence and skills in assessments, recommendations and outcomes for clients as part of the return to driving process. A descriptive study including medical record audits between April and September 2019 and staff surveys were completed at a large metropolitan community-based rehabilitation facility. Descriptive statistics and thematic analysis were used to summarise data. A total of 102 client medical records were audited, and 13 clinician surveys were completed. Medical record audits identified that return to driving was not consistently addressed by occupational therapists. Clinician surveys outlined a lack of knowledge and confidence of return to driving processes and available assessment tools to guide this process. All occupational therapists have an ethical obligation to address driving as an activity of daily living; however, non-OTDAs report that they are not equipped for this role. This may negatively impact on driver safety, independence and overall health and well-being of clients in community-based rehabilitation. Further research is indicated to develop evidence-based driving resources to support best practice of non-OTDAs.

Partnership for the implementation of mental health policy in Nigeria: a case study of the Comprehensive Community Mental Health Programme in Benue State

Background71% of countries in the World Health Organisation’s (WHO’s) African Region have a stand-alone mental health policy or plan, but only 14% have fully implemented it. In Nigeria, integration of mental health into primary care has been a stumbling block to the implementation of the 1991 National Mental Health Policy, 2013 Policy on Mental Health Services Delivery and the National Mental, Neurological and Substance Use Programme and Action Plan. A partnership between public and private not-for-profits in Benue State, the Comprehensive Community Mental Health Programme (CCMHP) has successfully integrated mental health into primary care in alignment with the national mental health policy and the WHO’s mental health Gap Action Programme Intervention Guide (mhGAP-IG). There is a need to document such examples in order to inform policy implementation in Nigeria and other low- and middle-income countries (LMICs).MethodsWe followed the Case Study Methodology to Monitor and Evaluate Community Mental Health Programmes in LMICs. Four field visits were conducted between 2013 and 2017 to document the first phase of activities of CCMHP, covering the period of January 2011 through June 2016.ResultsIn its first phase, CCMHP trained 19 community psychiatric nurses and 48 community health extension workers in mhGAP-IG, establishing 45 new mental health clinics in primary care facilities across Benue, a state more populous than many countries. As a result, 13,785 clients (55% male, 45% female) were enrolled in mental health services either in primary care or in one of two pre-existing community-based rehabilitation facilities. Most are adults over age 18 (82.75%), and present to services with epilepsy (52.38%) or psychosis (38.41%).ConclusionThe case of CCMHP demonstrates it is possible to rapidly scale-up mental health services in line with national mental health policy using the mhGAP-IG, even in a challenging, low-resource setting. Multi-sectoral partnerships may help to overcome some of the barriers to successful integration of mental health into general healthcare by capitalising on the resources and expertise of both state and non-state actors. However, a difficult political context could threaten the sustainability of the programme if funder requirements force a rapid transition to full government ownership.

A Detoxification Intervention for Gulf War Illness: A Pilot Randomized Controlled Trial.

Approximately 30% of the 700,000 US veterans of the 1990–1991 Persian Gulf War developed multiple persistent symptoms called Gulf War illness. While the etiology is uncertain, several toxic exposures including pesticides and chemical warfare agents have shown associations. There is no effective medical treatment. An intervention to enhance detoxification developed by Hubbard has improved quality of life and/or reduced body burdens in other cohorts. We evaluated its feasibility and efficacy in ill Gulf War (GW) veterans in a randomized, waitlist-controlled, pilot study at a community-based rehabilitation facility in the United States. Eligible participants (n = 32) were randomly assigned to the intervention (n = 22) or a four-week waitlist control (n = 10). The daily 4–6 week intervention consisted of exercise, sauna-induced sweating, crystalline nicotinic acid and other supplements. Primary outcomes included recruitment, retention and safety; and efficacy was measured via Veteran’s Short Form-36 (SF-36) quality of life, McGill pain, multidimensional fatigue inventory questionnaires and neuropsychological batteries. Scoring of outcomes was blinded. All 32 completed the trial and 21 completed 3-month follow-up. Mean SF-36 physical component summary score after the intervention was 6.9 (95% CI; −0.3, 14.2) points higher compared to waitlist control and 11 of 16 quality of life, pain and fatigue measures improved, with no serious adverse events. Most improvements were retained after 3 months. The Hubbard regimen was feasible, safe and might offer relief for symptoms of GW illness.

A narrative exploration of an adapted physical activity space and its impact on persons with physical impairments

The Lakeshore Foundation is a community-based rehabilitation facility that claims to be fully adapted to support persons with physical impairments in exercise endeavors. The dominant narratives of ableism that can exclude persons with physical impairments from non-adapted exercise spaces supports research that explores narratives told in adapted exercise spaces. To explore the Lakeshore narrative and its effects, we conducted 35 semi-structured interviews with Lakeshore members and subjected these data to a dialogical narrative analysis. We crafted a story that reflected the participants’ journey from poor health to a sense of well-being. On this journey, participants discussed feeling included, that their body was accepted, like works in progress, part of a family, progression from story listeners to story-tellers and well-being. This journey to well-being highlights the important role that adapted exercise spaces can have on enhancing the well-being of individuals with physical impairments.

Secure services for patients should be needs based and locally available.

Dye et al's1 timely editorial on ‘locked rehabilitation’ highlights the need for a closer working relationship between local and specialist commissioners in order to achieve appropriate, least-restrictive local care provision. It also raises the question whether the emergence of locked rehabilitation units is caused by a reduction in open hospital or community-based rehabilitation facilities, combined with a difficulty in accessing low secure units. In our experience, the pathway into locked rehabilitation is usually via acute in-patient facilities where treatment focus is on stabilisation of mental state and early discharge. In the absence of appropriate open or community-based rehabilitation facilities available locally within the National Health Service (NHS), patients requiring longer periods of rehabilitation are referred for locked rehabilitation in the private sector, usually out of area. A significant minority of these patients have a history of violence, including serious physical assault and fire-setting, but have neither been charged nor convicted. Regardless of current or future risks, ‘gatekeeping assessment’ to low secure care on behalf of NHS England relies on the non-clinical requirement that the person has either serious offence charges pending or has been convicted of an offence. This becomes a barrier to accessing appropriate local secure care because in some areas police are reluctant to charge patients with long-term psychotic problems, as it may be clear that eventually they will receive a psychiatric disposal. Clearly defined criteria for gatekeeping assessment are not readily available for referrers, although the Joint Commissioning Panel for Mental Health refers to a guidance to improve assessment consistency.2 If the criteria set out by the Department of Health are taken as a reference,3 a substantial majority of patients undergoing locked rehabilitation would satisfy them. There is a need for clarity and transparency to ensure accessible, equitable and local care to this vulnerable group of patients. Local and specialist commissioners need to redefine secure rehabilitation care pathways with input from both general adult and forensic mental health professionals to make low secure care more needs based than based on legal charge. To improve patient care, a review of allocation of financial resources across the low secure/locked rehabilitation healthcare system involving both general adult and forensic mental health professionals is urgently required.

Exploring the factors that influence the perceptions of disability: a qualitative study of mothers of children with disabilities at a community-based rehabilitation centre in Sri Lanka.

The prevalence of disability is growing worldwide; however, perceptions regarding disability are not well understood. The aim of this study was to explore factors that influence the perception of disability among mothers of children with disabilities who were attending a community-based rehabilitation facility in Sri Lanka. A descriptive qualitative research design was employed. Thirteen semi-structured interviews were conducted with participants receiving rehabilitation services at a community-based facility. Interviews were recorded, transcribed and coded using software for qualitative data. Three major themes emerged from the analysis: (i) level of family and community support; (ii) spiritual and cultural interpretations of disability; and (iii) outcomes of rehabilitation services. Perceptions of disability appeared to be strongly influenced by the social, community and spiritual/cultural support structure in which the mothers lived. In particular, the support from the participant's spouse emerged as a primary factor exerting strong influence on perception, and future outlook, among the participants. Engagement in community-based rehabilitation programming also reinforced positive perceptions, created a sense of hope among participants regarding their child's future, and established aspirations for future education and employment opportunities alongside social integration. Knowledge of factors that influence the perception of disability can inform future implementation of public-health and community-based initiatives, and may improve social integration of children with disabilities in lower-resource settings.

Service utilisation in a public post-acute rehabilitation unit following traumatic brain injury

Traumatic brain injury (TBI) causes disability in a proportion of survivors across the spectrum of injury severity. Previous research suggests physical changes are the primary focus of rehabilitation, although cognitive, emotional and behavioural difficulties cause greater concern in the long-term. There is little information about services accessed by those with mild injuries, who often have no physical disabilities. This study investigated factors determining service utilisation in a population-based sample which included 52% mild injuries (PTA ≤ 24 hours). Chi-squares and t-tests were used to examine the impact of demographic, clinical, psychological and physical variables on referral of 175 TBI patients to clinical disciplines in a public, community-based rehabilitation facility in Hobart, Tasmania. Increased service intensity (total disciplines referred to), was associated with greater injury severity (p = .006) and previous TBI (p = .041). Less traditional rehabilitation services (nursing, psychology) received more referrals than traditional disciplines (physiotherapy, occupational therapy, social work). Referral to physiotherapy and occupational therapy was associated with greater injury severity, functional dependence, hospitalisation and older age. Referral to nursing, psychology and social work was associated with more post-concussion symptoms, younger age, anxiety, depression and assault-related injury. The large number of referrals to psychology strengthens the case for including it as a core rehabilitation discipline.

Social functioning and quality of life of people with schizophrenia in the northern region of Malaysia

This is an explorative study on the quality of life of 258 people with schizophrenia living in the northern region of Malaysia. The study samples were selected from the Outpatient Department of the Departments of Psychiatry attached to the General Hospitals located in Northern Malaysia. Details on background and illness characteristics of the respondents were collected through a questionnaire prepared by the researcher. The Disability Assessment Schedule (WHO/DAS) was used to collect information related to respondents' social functioning. The Quality of Life Interview (QOLI) was used to collect the information about quality of life (QOL). Results of the present study indicated serious deficits in the areas of social functioning and quality of home environment and these deficits were found to have a significant association with low QOL. Based on these findings, the present research argues that policy makers must focus more on creating rehabilitation resources within communities which will complement the level of success achieved in reducing psychotic symptoms. Results of the study highlight an urgent need for the creation of community-based rehabilitation facilities for the successful care of people with a mental illness in Malaysia. This is necessary for other countries in the region as well.

Needs and problems related to mental health services in Beijing

Abstract Accounts in the literature show that our understanding of the current needs and problems of mental health services in Mainland China is based on unsystematic observations and theoretical extrapolation. There has not been a survey of practitioners on its current status. This paper describes a small-scale survey conducted in a large psychiatric hospital in Beijing in 1998, which addressed the issues and problems hindering the community integration of people with mental illness, the current concerns of practitioners, and the difficulties hindering the further development of mental health services in Beijing. A specially designed questionnaire was distributed to eligible staff members of the hospital through the chief psychiatrist. Thirty-four questionnaires were returned and analyzed using descriptive and cross-tab statistics. Social discrimination, unsatisfactory social networks, unsatisfactory social skills and lack of community-based rehabilitation facilities were regarded as the most significant problems faced by individuals with severe mental illness returning to the community. Medication, relapse prevention, and family intervention were the issues that attracted the current attention of most respondents. Reservations about the development of vocational rehabilitation were noted. The major difficulties hindering further development of psychiatric rehabilitation include lack of funding, rehabilitation professionals, and physical resources. As the needs and circumstances in China are different from those in Western countries, social and cultural differences must be considered before Western models of rehabilitation can be modified and adopted in China.