Holistic Rehabilitation Research Articles

Client experiences with holistic neuropsychological rehabilitation: “It is an ongoing process”

ABSTRACT The effectiveness of holistic neuropsychological rehabilitation for people with acquired brain injury has previously been demonstrated by means of standardized and routinely administered outcome measures. However, the most important outcomes from the perspective of former clients are largely unknown. This study explored the experience of participating in a holistic neuropsychological rehabilitation programme by conducting three focus groups with twelve former clients who had sustained a brain injury. Data were transcribed verbatim and analysed using thematic analysis. “It is an ongoing process” emerged as the overarching theme for the experience of recovery from brain injury. Four subthemes, or phases, were identified. Participants went through (1) a phase of confrontation, after which they (2) trained their skills and strategies, and (3) experimented with these in daily life. In the end, clients reached a phase of (4) coming to terms with their injury. Participants described increased levels of self-esteem, sense of competence, and adaptation as the most important outcomes of the programme, as these factors helped them regain a sense of identity. The results indicate that including these factors in outcome evaluations of complex interventions after brain injury may be important as they appear essential for capturing the client’s perspective on change.

Mixed methods evaluation of the impact of the COVID-19 ICU remote-learning rehabilitation course for frontline health professionals during the COVID-19 pandemic in the UK.

Optimising outcomes for critically ill patients with COVID-19 patients requires early interdisciplinary rehabilitation. As admission numbers soared through the pandemic, the redeployed workforce needed rapid, effective training to deliver these rehabilitation interventions. The COVID-19 ICU Remote-Learning Rehab Course (CIRLC-rehab) is a one-day interdisciplinary course developed after the success of CIRLC-acute. The aim of CIRLC-rehab was to rapidly train healthcare professionals to deliver physical, nutritional and psychological rehabilitation strategies in the ICU/acute setting. The course used blended learning with interactive tutorials delivered by shielding critical care professionals. CIRLC-rehab was evaluated through a mixed-methods approach, including questionnaires, and follow-up semi-structured interviews to evaluate perceived impact on clinical practice. Quantitative data are reported as n (%) and means (SD). Inductive descriptive thematic analysis with methodological triangulation was used to analyse the qualitative data from the questionnaires and interviews. 805 candidates completed CIRLC-rehab. 627 (78.8%) completed the post-course questionnaire. 95% (n = 596) found CIRLC-rehab extremely or very useful and 96.0% (n = 602) said they were very likely to recommend the course to colleagues. Overall confidence rose from 2.78/5 to 4.14/5. The course promoted holistic and humanised care, facilitated informal networks, promoted interdisciplinary working and equipped the candidates with practical rehabilitation strategies that they implemented into clinical practice. This pragmatic solution to educating redeployed staff during a pandemic increased candidates' confidence in the rehabilitation of critically ill patients. There was also evidence of modifications to clinical care utilising learning from the course that subjectively facilitated holistic and humanised rehabilitation, combined with the importance of recognising the humanity, of those working in ICU settings themselves. Whilst these data are self-reported, we believe that this work demonstrates the real-term benefits of remote, scalable and rapid educational delivery.

The impact of multimodal cognitive rehabilitation on executive functions in older adults with traumatic brain injury

This study evaluated the impact of a 12-week, 24-session multimodal group cognitive rehabilitation intervention, the Cognitive Enrichment Program (CEP), on executive functioning and resumption of daily activities after traumatic brain injury (TBI) in older individuals as compared with an active control group that received individual holistic rehabilitation as usual care. In total, 37 patients with a TBI and aged 57 to 90 years were assigned to experimental (n=23) and control (n=14) groups in a semi-randomized, controlled, before-after intervention trial with follow-up at 6 months, with blinded outcome measurement. The CEP's executive function module included planning, problem solving, and goal management training as well as strategies focusing on self-awareness. Efficacy was evaluated by neuropsychological tests (Six Elements Task-Adapted [SET-A], D-KEFS Sorting test and Stroop four-color version); generalization was measured by self-reporting questionnaires about daily functioning (Dysexecutive Functioning Questionnaire, forsaken daily activities). ANCOVA results showed significant group-by-time interactions; the experimental group showed a statistically significant improvement on Tackling the 6 subtasks and Avoiding rule-breaking measures of the SET-A, with medium effect sizes. The generalization measure, the Dysexecutive Functioning Questionnaire, showed a significant reduction in experimental patient-significant other difference on the Executive cognition subscale. The number of forsaken daily activities was reduced in the experimental versus control group, which was not significant immediately after the CEP but was significant 6 months later. Our study shows that older adults with TBI can improve their executive functioning, with a positive impact on everyday activities, after receiving multimodal cognitive training with the CEP. ClinicalTrials.gov Identifier: NCT04590911.

Does access to acute intensive trauma rehabilitation (AITR) programs affect the disposition of brain injury patients?

Early incorporation of rehabilitation services for severe traumatic brain injury (TBI) patients is expected to improve outcomes and quality of life. This study aimed to compare the outcomes regarding the discharge destination and length of hospital stay of selected TBI patients before and after launching an acute intensive trauma rehabilitation (AITR) program at King Saud Medical City. It was a retrospective observational before-and-after study of TBI patients who were selected and received AITR between December 2018 and December 2019. Participants' demographics, mechanisms of injury, baseline characteristics, and outcomes were compared with TBI patients who were selected for rehabilitation care in the pre-AITR period between August 2017 and November 2018. A total of 108 and 111 patients were managed before and after the introduction of the AITR program, respectively. In the pre-AITR period, 63 (58.3%) patients were discharged home, compared to 87 (78.4%) patients after AITR (p = 0.001, chi-squared 10.2). The pre-AITR group's time to discharge from hospital was 52.4 (SD 30.4) days, which improved to 38.7 (SD 23.2) days in the AITR (p < 0.001; 95% CI 6.6-20.9) group. The early integration of AITR significantly reduced the percentage of patients referred to another rehabilitation or long-term facility. We also emphasize the importance of physical medicine and rehabilitation (PM&R) specialists as the coordinators of structured, comprehensive, and holistic rehabilitation programs delivered by the multi-professional team working in an interdisciplinary way. The leadership and coordination of the PM&R physicians are likely to be effective, especially for those with severe disabilities after brain injury.

Holistic rehabilitation for children with cancer: The Chilean model.

The increasingly positive outcomes of childhood cancer treatments are among the most inspiring stories in modern medicine. Many of the children and adolescents surviving cancer will have a healthy life; however, many others will suffer from physical, cognitive, psychological, and social sequelae. During treatment, many children experience multiple temporary and permanent side effects which negatively impact their quality of life. Low‐ and middle‐income countries where childhood cancer treatment outcomes are improving are facing the reality of a growing population of teenagers and young adults suffering from long‐term disease‐ and treatment‐related consequences. In Chile, 500 children are diagnosed with cancer each year. Treatment is granted for all through public health policies and NGO collaboration. In order to address the complex problems from acute and long‐term consequences of disease and treatment, the Oncological Rehabilitation Center Fundación Nuestros Hijos (CROFNH) provides multidisciplinary attention to an extensive variety of rehabilitation needs for children and adolescents with cancer. With its integrated services in the medical treatment of children and adolescents with cancer, the CROFNH helps reduce the impact of treatment‐related side effects in children's daily lives, improves quality of life, and aims at contributing to these children becoming independent and functional adults to the maximum of their capacities. The aim of this article is to show the experience of the Chilean Oncological Rehabilitation Centre and its unique multidisciplinary approach. In addition, we discuss the successful telerehabilitation strategy implemented in response to the COVID‐19 pandemic in order to secure continuity of treatment.

Evaluation of an Advocacy Programme for Mental Health Care Users in South Africa: A Mixed Methods Study

This study evaluates the implementation of a national advocacy programme for mental health care users, conducted by the South African National Department of Health and the South African Federation for Mental Health. Semi-structured interviews were conducted with care users (n = 18), service providers (n = 9), support persons (n = 6), NGO directors (n = 4), and programme managers in the DoH (n = 4). Although informational benefits were highlighted from programmeempowerment sessions, very few advocacy groups were subsequentlyestablished. Barriers to establishing and conducting advocacy groups included a lack of follow-up support, pervasive stigma from communities and health care workers, low self-confidence, and a lack of financial resources. Facilitators for establishment of groups included conducting empowerment sessions and identifying 'mental health champions' at clinics, improving mental health training for health workers, dispensing psychiatric medication to patients on the same day, providing funding for non-governmental organisations, conducting national awareness campaigns, and establishing holistic rehabilitation centres for care users.

Insights into the Cultured Bacterial Fraction of Corals.

ABSTRACTBacteria associated with coral hosts are diverse and abundant, with recent studies suggesting involvement of these symbionts in host resilience to anthropogenic stress. Despite their putative importance, the work dedicated to culturing coral-associated bacteria has received little attention. Combining published and unpublished data, here we report a comprehensive overview of the diversity and function of culturable bacteria isolated from corals originating from tropical, temperate, and cold-water habitats. A total of 3,055 isolates from 52 studies were considered by our metasurvey. Of these, 1,045 had full-length 16S rRNA gene sequences, spanning 138 formally described and 12 putatively novel bacterial genera across the Proteobacteria, Firmicutes, Bacteroidetes, and Actinobacteria phyla. We performed comparative genomic analysis using the available genomes of 74 strains and identified potential signatures of beneficial bacterium-coral symbioses among the strains. Our analysis revealed >400 biosynthetic gene clusters that underlie the biosynthesis of antioxidant, antimicrobial, cytotoxic, and other secondary metabolites. Moreover, we uncovered genomic features—not previously described for coral-bacterium symbioses—potentially involved in host colonization and host-symbiont recognition, antiviral defense mechanisms, and/or integrated metabolic interactions, which we suggest as novel targets for the screening of coral probiotics. Our results highlight the importance of bacterial cultures to elucidate coral holobiont functioning and guide the selection of probiotic candidates to promote coral resilience and improve holistic and customized reef restoration and rehabilitation efforts.IMPORTANCE Our paper is the first study to synthesize currently available but decentralized data of cultured microbes associated with corals. We were able to collate 3,055 isolates across a number of published studies and unpublished collections from various laboratories and researchers around the world. This equated to 1,045 individual isolates which had full-length 16S rRNA gene sequences, after filtering of the original 3,055. We also explored which of these had genomes available. Originally, only 36 were available, and as part of this study, we added a further 38—equating to 74 in total. From this, we investigated potential genetic signatures that may facilitate a host-associated lifestyle. Further, such a resource is an important step in the selection of probiotic candidates, which are being investigated for promoting coral resilience and potentially applied as a novel strategy in reef restoration and rehabilitation efforts. In the spirit of open access, we have ensured this collection is available to the wider research community through the web site http://isolates.reefgenomics.org/ with the hope many scientists across the globe will ask for access to these cultures for future studies.

Increasing participation in the 2019 UK general election amongst patients on a high intensity rehabilitation ward

AimsTo increase participation in the 2019 UK general election amongst inpatients on a high intensity rehabilitation ward, by supporting patients to both register to vote (RTV) and vote.BackgroundIn 2000, the franchise was extended to those under section 2 or 3 as well as informal inpatients. Unfortunately, voting rates remain low: studies of the 2010 general election show voting rates amongst psychiatric inpatients to be 14%, compared to 65% for the general population. Engaging patients in the democratic process is not only just, it has been shown to be an effective avenue for rehabilitation through increasing social capital. The 2019 UK general election represents a singular opportunity for biopsychosocial rehabilitation.MethodIn the three weeks up until 26/11/19 – the deadline to RTV – visual displays and verbal information were used to notify patients of: The electionTheir eligibilityThe need to RTV before casting a ballotThe registration deadlineVoting methods (in person, by post, by proxy)We gathered patients’ intention to RTV and offered impartial, personalised support to register online or by paper, and to apply for a postal or proxy ballot if wished. Patients with no fixed abode were supported to use the ward as their declared place of residence.ResultOf the 17 patients on the ward there were:Four informal patients11 patients under section 3One patient each under a section 37 and a section 37/41, both ineligible to voteOf the 15 eligible patients, one (6.7%) had already registered, six patients (40%) wanted to register and eight (53.3%) stated they did not want to register. Those wanting to register were supported according to individual patient preference. Of the registered seven, five (33.3%) reported voting, one (6.7%) reported not having voted and one (6.7%) declined to say. Two (13.3%) voted in person and five (33.3%) voted by postal ballot.ConclusionOur intervention corresponded with an increase in number of patients registering – from one patient (6.7%) to seven (46.7%), with 5-6 (33.3-40%) casting their ballot. While the causal relationship should not be overstated, the uptake of assistance supports the intervention's efficacy.Good rehabilitation increases a person's social capital, empowering them to actively participate in societal life. Registering to vote is a tacit assertion of this principle. Our study shows that brief interventions that are easily incorporated into everyday care are a simple, effective and ultimately necessary tool in holistic mental health rehabilitation.

Rehabilitation of the frail older adults in primary healthcare in rural areas: a scoping review protocol

IntroductionFrail older adults are particularly vulnerable to functional decline and adverse outcomes because they lack the necessary resistance and ability to cope. Rehabilitation services for the frail older adults are...

Quality of life and occupational performance of children with cancer in the era of the COVID-19 pandemic in terms of rehabilitation.

PurposeThis study was designed to determine the changes in the quality of life (QOL) and occupational performance of children with cancer and to examine their rehabilitation needs during the pandemic period in Turkey.Methods60 children with cancer and their families participated in the study. The first and second assessments were carried out in April and September 2020, respectively. The pediatric quality of life inventory parent proxy-report was used to evaluate the QOL, and the Canadian occupational performance measurement was used to evaluate children’s occupational performance and satisfaction. A qualitative interview was planned to determine the impact of the pandemic on children with cancer alongside their families and therefore determining the rehabilitation needs of the children.ResultsWhile there is no statistically significant change in the pain-related conditions of the children in the first six months of the pandemic (p > 0.05), procedural and treatment anxieties of the children increased during the treatment. Their QOL including cognitive state, perceived physical appearance and communication skills also showed a statistically significant decrease (p < 0.05). Both the occupational performance and satisfaction scores decreased significantly, covering the pre-pandemic and pandemic era (p < 0.01). In the qualitative interview parents expressed their children's need for physical, psychological and social participation support. Also, they emphasized the need for time management.ConclusionsDuring the COVID-19 pandemic, the QOL and occupational performance level of children with cancer decreased significantly. Holistic rehabilitation approaches complying with pandemic conditions are likely to benefit these children.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11136-021-02857-7.

The Road Less Traveled: Integrating Neurotherapy with Holistic Neuropsychological Rehabilitation After Severe Head Injury

Introduction: Traumatic brain injury (TBI) is associated with physical, cognitive, emotional, and behavioral disturbances. The cognitive deficits are common after TBI, and a holistic approach to neuropsychological rehabilitation is recommended in these patients. EEG neurofeedback training (EEG-NFT) is a state-of-the-art technique for neuropsychological rehabilitation. There is a paucity of studies exploring the use of EEG-NFT integrated with holistic neuropsychological rehabilitation. Method: Single case design was adopted for the present study. A 25-year-old single male, diagnosed with severe TBI, presented with physical, cognitive, and emotional-behavioral disturbances after 17 months of injury. A comprehensive neuropsychological assessment was carried out. The neuropsychological rehabilitation using EEG-NFT along with psychosocial interventions with the patient and the parents was carried out for 9 months. Results: The patient showed significant improvement in cognitive deficits such as attention, executive functions, and visuospatial ability. Emotional-behavioral problems such as irritability, sadness, and overall dysfunction also improved significantly. Conclusion: The present case study highlights that integrating EEG-NFT along with holistic neuropsychological rehabilitation helps to improve cognitive, emotional, and behavioral disturbances after TBI.

Psychological Aspects in Early Adjustment After Severe Burn Injury.

Burn injury is one of the most serious traumatic events with possible psychological and psychosocial consequences. Health status perception is one of the main health outcomes. The severity of psychological symptoms does not always correlate with that of the burn injury, suggesting that early screening for psychological vulnerabilities may be beneficial. The aim of our study was to identify the personality, clinical, and sociodemographic characteristics related to patient's subjective perception of health, depression, and anxiety in a sample of 52 adult patients with severe burn injury shortly before discharge from specialty burn clinic. Subjective health perception was predicted by depression (β = -.143, t(47) = -3.94, P < .001) and neuroticism (β = -.106, t(43) = -4.83, P < .001), and it correlated positively with extraversion (r = .2858, P = .0465) and conscientiousness (r = .3663, P = .0096). Depression was predicted by neuroticism (F(1,49) = 18.4; P < .001) and correlated with attachment avoidance (r = .29, P = .0383) and negatively with extraversion (r = -.32, P = .0220). Anxiety was related to attachment anxiety (F(1,49) = 4.25; P = .045), neuroticism (F(1,49) = 15.75; P < .001), and agreeableness (r = -.36, P = .0101). Unemployed patients experienced higher levels of depression and anxiety. This research suggests that personality traits and adult attachment may play an important role in the acute phase of the recovery from a severe burn injury. These findings can be relevant for early intervention and holistic rehabilitation.

Children with Auditory Brainstem Implant: How Do They Perform in Motor and Language Skills?

Background: Young children are able to explore new objects and practice language through the acquisition of motor skills that lead to their overall development. Congenital hearing loss and total vestibular loss may contribute to the delay in speech and motor skill development. Objectives: To investigate the relationship between motor development performance, speech perception, and language performance in children with auditory brainstem implant (ABI). Method: Ten children, aged 4–17 years (mean age 9.76 ± 4.03), fitted with unilateral ABI for at least 2 years due to the presence of labyrinthine aplasia and rudimentary otocyst at least 1 side were included in the study. Several standardized tests, such as Bruininks-Oseretsky Motor Proficiency Test-2 (BOT-2), Children’s Auditory Perception Test Battery, Meaningful Auditory Integration Scale (MAIS), and Test of Early Language Development-3, were performed to evaluate their skills of fine motor control, balance, manual dexterity, language, and auditory perception. Results: A significant correlation was established between the BOT-2 manual dexterity and MAIS scores (r = 0.827, p < 0.05) and between the manual dexterity and language skills (for expressive language, r = 0.762, p < 0.05; for receptive language, r = 0.650, p < 0.05). Some of the BOT-2 balance tasks, such as standing on 1 leg on a line with eyes closed, standing on 1 leg on a balance beam with eyes open, standing heel-to-toe on a balance beam, and walking forward heel-to-toe on a line, showed a strong correlation with their receptive and expressive language performance (p < 0.05). Conclusion: The current study has indicated that significantly poor manual and balance performances are associated with poor speech perception and language skills in children with ABI. The authors recommend performing a vestibular assessment before and after ABI surgery and the use of a holistic rehabilitation approach, including auditory and vestibular rehabilitation, to support development of the children with ABI.

Mine completion criteria defined by best-practice: A global meta-analysis and Western Australian case studies

In many mining-intensive areas around the world, knowledge-sharing among companies is critical to advance best-practices in mine rehabilitation and closure. The academic literature documents innovative, best-practices options, yet these are often not accessible to field practitioners. Published mine closure plans provide relevant examples of standards accepted by regulators, however, regulations vary with jurisdiction and can change over time, limiting the utility of these plans. There is, therefore, a need for greater transparency and accessibility of practical knowledge to inform the definition of achievable completion criteria. The purpose of this study is to provide an overview of best-practices for the purpose of defining mine completion criteria. The methods comprise: i) a qualitative meta-analysis of the global peer-reviewed literature; and ii) three in-depth case studies in Western Australia. The research identifies ten key best-practices that could be potentially applied by mining proponents to guide the definition of successful completion criteria. These include: multiple references, monitoring and corrective actions, science-informed completion criteria, holistic rehabilitation, dynamic targets, leading indicators, integration of rehabilitation with mine operations, innovation-guided completion criteria, specific objectives and indicators and risk-based completion criteria. These best-practices are further examined through recent mine rehabilitation and closure programs of mid-to-large mining operators in Western Australia. Our findings provide the first comprehensive review of best-practices towards the definition of mine completion criteria, which are relevant to industries requiring rehabilitation of disturbed lands across Australian and international jurisdictions.

The cross-cutting psychosocial and systemic barriers to holistic rehabilitation, including educational re-engagement, of incarcerated adolescents: Realities in and perspectives from Africa

The present study identifies the potential barriers to holistic rehabilitation, including educational re-engagement, of justice-involved youth in Africa. This was done using quantitative data on the educational and other psychosocial problems presented by a cohort of justice-involved youth and qualitative data on the realities on ground in the correctional school within a youth correctional facility in Lagos, Nigeria, as an illustrative example. Findings showed a lot of cross-cutting psycho-social and systemic barriers to holistic psycho-social rehabilitation of justice-involved adolescents. These include pre-existing psychosocial problems such as, educational disengagement prior to incarceration, high prevalence rates of untreated intercurrent behavioral disorders such as conduct disorders and attention-deficit/ hyperactivity disorder among detained youth, and lack of community- or school-based pre-emptive interventions for school-related indicators of delinquency within the juvenile justice system. Others are lack of non-incarcerating correctional system with focus on psychosocial and educational rehabilitation, poor standard of human/ infrastructural resource-capacity within the facilities, and low level of school-engagement occasioned by poor mental and behavioral health among those enrolled in correctional schools. Context-appropriate pre-emptive and responsive strategies to address cross-cutting psycho-social and rehabilitative needs of justice-involved youth were discussed.

The impacts of outpatient vs inpatient holistic management based on exercise training on cardiac rehabilitation efficacy among patients with chronic heart failure

Objective: To evaluate the impacts of outpatient vs inpatient exercise training (ET) on cardiac rehabilitation efficacy among patients with chronic heart failure (CHF). Methods: Thirty six patients who were diagnosed with CHF in Beijing Rehabilitation Hospital from September 2015 to September 2018, were randomly divided into three groups: control group (n=12), outpatient ET group (n=12) and inpatient ET group (n=12). Patients in control group were treated with conventional cardiac rehabilitation without ET, patients in outpatient and inpatient ET groups were treated with holistic cardiac rehabilitation with the core of ET according to individualized exercise prescription based on cardiopulmonary exercise testing (CPET). Exercise intensity of cycle ergometer was Δ50% power above anaerobic threshold (AT), 30 min/d, 5 d/week, for 12 weeks. General information, CPET parameters, echocardiogram, 6 minute walking distance (6MWD) and quality of life (QoL) score of three groups of patients before and after treatment were recorded. Results: All patients in 3 groups finished symptom-limited CPET and patients in ET groups finished 12 weeks - ET safely without complications. Before treatment, there were no significant differences in CPET parameters, echocardiogram results, 6MWD and QoL score among 3 groups (P>0.05). After treatment, AT (ml/min, ml/(min·kg), %pred), peak oxygen uptake (VO2) (ml/min, ml/(min·kg), %pred), peak oxygen pulse(ml/beat), peak workload(W/min, %pred), left ventricular ejection fraction (LVEF) and 6MWD of patients in outpatient and inpatient ET groups were significantly higher than those of patients in control group (P<0.05), QoL score of patients in outpatient and inpatient ET groups was lower than that of patients in control group(P<0.05). To be noted, there were no obvious differences in CPET indexes, echocardiogram results, 6MWD and QoL score in patients between outpatient ET group and inpatient ET group (P>0.05). For patients in control group, there were no significant differences in above parameters before and after treatment (P>0.05). AT(ml/min, ml/(min·kg)), Peak VO2 (ml/min, ml/(min·kg), %pred), peak oxygen pulse(ml/beat, %pred), peak workload(W/min, %pred), LVEF and 6MWD of patients in outpatient and inpatient ET groups were significantly higher than those before treatment (P<0.05), QoL score of patients in outpatient and inpatient ET groups after treatment was significantly lower than that before treatment (P<0.05). Conclusion: Outpatient ET can improve the cardiopulmonary function, exercise tolerance and QoL of CHF patients, which has no significant difference compared with inpatient ET, indicating that outpatient cardiac rehabilitation, as an effective rehabilitation mode, is deserved to be applied widely.

Long-term perceived disabilities up to 10 years after transient ischaemic attack.

BackgroundThe long-term impact of transient ischaemic attack is largely unknown.ObjectivesTo assess the long-term perceived impact of transient ischaemic attack and explore the influence of sex and age on these perceptions; and to evaluate the relationships between activities of daily living, participation and overall recovery, and the other domains of the Stroke Impact Scale 3.0 (SIS).MethodsA retrospective study among adult community-dwelling individuals from 6 months up to 10 years after onset of transient ischaemic attack. A total of 299 survivors of transient ischaemic attack responded to the SIS.ResultsMost self-reported disabilities involved emotion, strength, and participation domains of SIS and remained stable until 10 years post-transient ischaemic attack. Women reported significantly more disabilities for emotion and hand function. Elderly subjects (age > 65 years) reported more disabilities for strength, mobility, hand function, activities of daily living/instrumental activities of daily living, and participation. The activities of daily living/instrumental activities of daily living, participation, and overall recovery demonstrated significant, although low-to-moderate, associations with other SIS domains after transient ischaemic attack.ConclusionThe broadly perceived disabilities were demonstrated consistently and played a significant meaningful role in everyday life and recovery among community-dwelling individuals up to 10 years after a transient ischaemic attack. These findings indicate the need for long-term multi-professional follow-up with holistic rehabilitation to improve overall recovery among survivors of transient ischaemic attack.LAY ABSTRACTThe long-term impact of transient ischaemic attack is largely unknown. The aims of this study were to assess the long-term patient-reported impact of transient ischaemic attack and explore the influence of sex and age on these perceptions. A further aim was to evaluate the relationships between activities of daily living, participation, and overall recovery with the other domains of the Stroke Impact Scale 3.0 (SIS). This study assessed various patient-reported disabilities among 299 survivors of transient ischaemic attack, from 6 months until 10 years after onset of transient ischaemic attack, using patient-reported SIS outcome measures. The results showed that most self-reported disabilities involved the emotion, strength, and participation domains of SIS and remained stable until 10 years post-transient ischaemic attack. Women reported higher levels of disabilities than men. There was a correlation between increased age and levels of self-reported disabilities for both men and women. These patient-reported disabilities showed significant, although low-to-moderate, associations with activities of daily living, participation, and overall recovery. The findings suggest a long-term need for general follow-up and rehabilitation among individuals after transient ischaemic attack.

Double Jeopardy-A dyadic case reports of Acne vulgaris with COVID 19 and its psychosocial turbulance

Acne vulgaris is among the commonest inflammatory skin diseases affecting pilosebaceous units whereas COVID 19 pandemic is taking its toll on humanity and both effecting psychological aspects in a manner that inspite of the huge number of physical recoveries a holistic rehabilitation of the sufferer is contemplated.

Addressing the elephant in the room: integrating sexual health practice in spinal cord injury rehabilitation

Purpose Sexual health, a basic human right, maybe disrupted after a spinal cord injury (SCI) and is often not addressed in rehabilitation. This quality improvement initiative embedded sexual health education and support for patients with SCI into clinical practice. Materials and methods In 2017–2018 a team of clinicians, researchers and persons with SCI developed and implemented a new sexual health practice in SCI rehabilitation. A systematic process was undertaken which included implementation science principles; the PLISSIT model and Sexual Rehabilitation Framework were foundational to the new practice. Results Adult inpatients with SCI began receiving the sexual health practice in June 2018. After 6 months, patient and health care provider surveys were conducted. Patients reported increased awareness of sexual health resources and increased satisfaction with sexual health concerns being addressed. Clinicians reported increased comfort in addressing patients’ sexual health concerns and increased awareness of sexual health resources. Conclusions Embedding the new sexual health practice facilitates the reintegration of sexual health into the daily lives of SCI patients and supports a more comprehensive and holistic rehabilitation. It normalizes sexual health concerns and questions in an SCI rehabilitation facility. IMPLICATIONS FOR REHABILITATION Sexual health is noted to be a top priority among persons with spinal cord injury, however, this area of care is often overlooked by healthcare providers across the rehabilitation continuum. A team of clinicians, researchers, and persons with SCI used a systematic process to address this gap by developing and implementing a new sexual health practice in the SCI rehabilitation program. This quality improvement initiative resulted in increased clinician knowledge and confidence in this domain of practice and greater patient satisfaction in having their sexual health needs to be addressed during rehabilitation.

Pranayama Yoga and Music Therapy: A Holistic Rehabilitation Therapy Combination for Chronic Obstructive Pulmonary Disease Patient

The management of certain health disorder can be done through a combination of conventional methods, namely with medicine, as well as traditional in a holistic (comprehensive) manner. The same also can be done for people with chronic obstructive pulmonary disease (COPD). Breath training technique and self-relaxation can be used as a complement, in addition to the consumption of drugs. Yoga pranayama combined with music therapy is a new rehabilitation therapy combination that can be implemented. This study was a narrative literature review composed by original articles and reviews written in English, aims to determine the potential of a combination of yoga pranayama and music therapy as a holistic rehabilitation therapy in patients with COPD. That therapy combination has been proven capable by some literatures in reducing dyspnea, increasing lung capacity and oxygen saturation, improving fitness and minimizing anxiety level, however, there were not any studies that ensure the potency of this therapy combination in COPD patients, therefore further research should be addressed.