Individual Rehabilitation Plan Research Articles

Assessing implementation, limited efficacy, and acceptability of the BEAST tool: A rehabilitation and return-to-sport decision tool for nonprofessional athletes with anterior cruciate ligament reconstruction

ObjectivesTo assess the implementation, limited efficacy, and acceptability of the BEAST (better and safer return to sport) tool – a rehabilitation and return-to-sport (RTS) decision tool after anterior cruciate ligament reconstruction (ACLR) in nonprofessional athletes. DesignProspective cohort. Participants43 nonprofessional pivoting sport athletes with ACLR. Main outcomeClinician- and athlete-experienced implementation challenges (implementation), changes in quadriceps power, side hop and triple hop performance from 6 to 8 months after ACLR (limited efficacy), athletes’ beliefs about the individual rehabilitation and RTS plans produced by the BEAST tool (acceptability). ResultsThe BEAST tool was developed and then implemented as planned for 39/43 (91%) athletes. Hop and quadriceps power performance improved significantly, with the largest improvement in involved quadriceps power (standardised response mean 1.4, 95% CI:1.1–1.8). Athletes believed the rehabilitation and RTS plan would facilitate RTS (8.2 [SD: 2.0]) and reduce injury risk (8.3 [SD: 1.2]; 0 = not likely at all, 10 = extremely likely). ConclusionThe BEAST tool was implemented with few challenges and adjustments were rarely necessary. Athletes had large improvements in quadriceps power and hop performance on the involved leg. Athletes believed that the individual rehabilitation and RTS plans produced by the tool would facilitate RTS and reduce injury risk.

Psychosocial rehabilitation for severe mental illness: A community project adjustable to the needs and resources of the population

IntroductionPsychosocial rehabilitation is a challenge in a society with demands unsuitable for those with severe mental illness (SMI). The Mental Health Department of Matosinhos Local Health Unity (MHD-MLHU) has developed a solidarity project aiming to evaluate and elaborate individualized rehabilitative responses with people with SMI, including people from the community motivated for solidarity initiatives.ObjectivesTo describe a psychosocial rehabilitation project focused on community integration of people with SMI, considering needs and resources of the population, and to present the individualized rehabilitation plans carried out for people with SMI.MethodsIn January 2019, we began the home evaluation of people with SMI monitored in the MHD-MLHU. To develop solidary based play-occupational groups, we interviewed people from the community and from the common mental pathology outpatient clinic willing to participate.ResultsWe present the description and evaluation of the psychosocial responses developed by the project. These responses include recreational-occupational groups, tailored to interests of each person with SMI, and using the community support group built for the purpose. These responses promote face-to-face activities, and enhance the destigmatization of SMI. The constraints resulting from the COVID-19 pandemic led to the creation of digital responses aimed at people with SMI and the community in general.ConclusionsThis experience has revealed the great potential of rehabilitating the community context of people with SMI, rather than just contemplating pre-existing structured responses. The pandemic created specific challenges but made the initiative even more relevant for SMI people and for promoting the mental health of the general population.

DIGITALIZATION OF THE MARKET OF REHABILITATION SERVICES, OCCUPATIONAL THERAPY AND SPORTS

Abstract. The intensive promotion of a healthy lifestyle in most countries of the world and the current situation with the global spread of viral and other infectious diseases clearly have the effect of changing patterns of human behavior. The study is based on the formation of appropriate mechanisms for managing the development of areas in the era of the fourth industrial revolution amid the globalization and the emergence of the digital economy. The real efficiency and social role of medical institutions can be ensured by increasing the availability of services to the population of complex areas, taking into account certain institutional aspects of this area. The practical importance of the achieved results is determined by the advantages of scaling the model of development of mechanisms that guide the development of health care and rehabilitation in the context of digitalization. The presented material will help to improve the quality of management decisions made by the heads of organizations from rehabilitation centers and regulatory authorities. This mechanism also helps to better meet the needs of new stakeholder groups, including customers, governments, manufacturers and healthcare professionals. The use of neo-modern technologies significantly enriches the opportunities for professionals around the world. The low price of mobile applications and personal electronic devices allows us to talk about the potential use of such comprehensive "IT-medical" solutions, even in rural and sparsely populated areas. This area is only at the initial stage of research, which will require scientists to obtain additional qualifications, and physicians the ability to work with modern high-tech solutions that are widely available to young people and all patients. Systematic research in this area is impossible without the use of big data processing technologies, as well as without a personalized approach to each patient. Based on the integrated use of the diagnostic potential of modern technologies, it is advisable to develop algorithms and use secure protocols for designing individual rehabilitation plans for people. The spread and development of digitalization in the field of occupational therapy and rehabilitation cannot be considered a refusal to participate in the human specialist, doctor and scientist in this area or diminish their role.

Encouraging Digital Technology in Neuropsychology: The Theory of Visual Attention on Tablet Devices.

Visual attention helps us to selectively process relevant information and is crucial in our everyday interactions with the environment. Not surprisingly, it is one of the cognitive domains that is most frequently affected by acquired brain injury. Reliable assessment of attention deficits is pivotal to neuropsychological examination and helps to optimize individual rehabilitation plans. Compared with conventional pen-and-paper tests, computerized tasks borrowed from the field of experimental psychology bring many benefits, but lab-based experimental setups cannot be easily incorporated in clinical practice. Light-weight and portable mobile tablet devices may facilitate the translation of computerized tasks to clinical settings. One such task is based on the Theory of Visual Attention (TVA), a mathematical model of visual attention. TVA-based paradigms have been widely used to investigate several aspects of visual attention in both fundamental and clinical research, and include measures for general processing capacity as well as stimulus-specific attentional parameters. This article discusses the benefits of TVA-based assessments compared with frequently used neuropsychological tests of visual attention, and examines the reliability of a tablet-based TVA-based assessment in 59 neurologically healthy participants. Pearson's correlations indicate that the tablet-based TVA assessment and the conventional lab-based TVA assessment have a comparable parallel-form (range: .67-.93), test-retest (range: .61-.78), and internal reliability (range: .56-.97). Our results suggest that tablet-based TVA assessment may be a promising tool to acquire clinical measures of visual attention at low cost at the bedside of the patient.

Role of LCF scale as an outcome prognostic index in patients with traumatic brain injury.

Fifty-four patients with TBI with a mean age of 44.9years (SD 20.915) were enrolled in this retrospective study. Patients were evaluated at admission and at discharge using the Glasgow Outcome Scale, Functional Independence Measure, and Level of Cognitive Functioning Scale. The Glasgow Outcome Scale was also implemented at 6months after discharge (OUTCOME.GOS), whereas the LCF was used twice a week throughout hospitalization. For our purpose, we named LCF at admission LCFa, whereas permanence in the same LCF value (number of days), LCFaL. Δ.GOS, Δ.FIM (Δ = difference between value at discharge and at admission), and OUTCOME.GOS were significantly affected by age, length of stay, LCFa, and LCFaL. The LCF can give a valuable indication to the prognosis of patients with TBI besides monitoring changes in cognitive function. This allows for individual rehabilitation plan, and long-term management strategies could be developed more quickly upon patient's discharge. Consequently, valuable healthcare and social care resources could be assigned correctly.

Factors associated to functional outcome after total hip and knee arthroplasty

Abstract Background An individual rehabilitation plan should guarantee a personalized approach to each patient. Identifying patients at risk of slower progression could help to implement a targeted approach. Aim of this study was to analyse patients characteristics associated to worse Functional Outcome (FO). Methods A cross sectional study of patients after Total Hip Arthoplasty (THA) or Total Knee Artroplasty (TKA) recovered in a Rehabilitation Clinic from January 2017 to December 2018 was performed. Patients characteristic: Age, Gender, Body Mass Index (BMI), Pain at admission (expressed in Numeric Pain Rating Scale: NRS), Cumulative Illness Rating Scale (CIRS) and Length of Stay in surgical facility (SLOS). Outcome tested: Active Flexion (AF), Barthel index (BI), Tinetti scale (TS), Pain at Discharge (PD). Patients were divided into two groups in relation to the achievement of target values in eight day of rehabilitation (AF = 84°, BI = 90, TS = 19 and PD ≥ 5). Statistical analysis was realized using Stata12. Results In total 1857 patients, 58% females, 56% after THA. Average age was 70.5±10.4, higher for females (72±9.7 vs. 68.3±11), average BMI 27.2±4.3, average SLOS 5.2±2.8. Regarding AF: 48% did not reach target value (38%THA; 55%TKA), for THA more likely older (OR 1.01) and females (OR 1.5) and for both THA and TKA higher NRS (OR 1.2). As for the BI target value was not reached by 24% patients (24.4%THA; 23.4%TKA); more likely older patients (OR 1.05), females (THA OR 2.1; TKA OR1.5), those with higher NRS (OR 1.13) and higher SLOS (THA OR 1.16; TKA OR 1.14). As for TS, 7% did not reached target (6.5%THA; 6.8%TKA), association with age (TKA OR 1.08; THA OR 1.04) and for THA also with SLOS (OR 1.13), pain (OR 1.16) and female sex (OR 2.16) was observed. As for the PD 17% not reached target (9.78%THA; 25.59%TKA), for TKA an association with BMI was observed (OR 1.08). Conclusions Worse FO was associated to not modifiable variables as age and gender but also with NRS, BMI and SLOS. Key messages Analysing patients characteristics associated to worse Functional Outcome allow to identify patients at risk of slower progression. The aim is to implement a targeted and personalized approach. The worse FO was associated to not modifiable variables as age and sex but also to higher NRS, prolonged SLOS and high BMI. Those conclusions help to manage an Individual Rehabilitation plan.

Current problems of medical and social expertise

This article analyses legal framework of medical and social expertise. We have assessed and identified negative aspects of the existing order of interaction between health facilities and bureaus of medical and social expertise during disability determination. We have established the key role of health facilities in determination of persons that need social protection and rehabilitation because of persistent impairments of health. The article reflects significant gaps in the Classifications and Criteria, that are used in practice of bureaus of medical and social expertise, during development and implementation of individual rehabilitation and habilitation plan of a person with disabilities.

Systematic screening as a tool for individualized rehabilitation following primary breast cancer treatment: study protocol for the ReScreen randomized controlled trial

BackgroundIt is well known that women suffer from negative consequences following breast cancer (BC) treatment and that their largely varying needs for rehabilitation are often unmet. Up to 43% of these women are at risk of developing chronic distress requiring complex interventions; however, how to early identify and meet these women’s needs is unknown, leaving them with suboptimal chances of rehabilitation. The aim of the ReScreen study is to develop a model for and evaluate the effect of screening-based, individualized rehabilitation following primary BC treatment.MethodsThe ReScreen study is designed as a complex intervention. Women with newly diagnosed BC are consecutively included in a three-armed randomized controlled trial. At inclusion, patients score their distress level on the Distress Thermometer (scale of 0–10) aiming to identify patients with extended rehabilitation needs. Patients scoring ≥5 are randomized to the intervention or control group while patients scoring ≤4 are followed longitudinally as an observational group. Patients in the intervention group, in conjunction with a dedicated research nurse, create an individualized rehabilitation plan based on an evidence-based decision support tool that was developed to create a solid base for the intervention. The research nurse will act as a continuous health care contact and be responsible for proactively and systematically evaluating patients’ needs to ensure that potential new problems or changed rehabilitation needs are identified throughout the 1-year follow-up period. The intervention will be evaluated through self-reported data focusing on physical and psychological outcomes as well as evaluation of satisfaction with care at baseline, 2 weeks and 3, 6, 9 and 12 months. Evaluation will also include health economic aspects based on register data and patients’ and relatives’ experiences of the rehabilitation process. In addition, optimal cut-off levels for distress as an indicator for extended rehabilitation needs will be investigated.DiscussionThis study will provide important knowledge related to effectiveness of screening-based identification of rehabilitation needs and standardized evidence-based, individualized rehabilitation after primary BC treatment. With a complex intervention design, this study has the potential to form a comprehensive knowledge base which includes tools and guidelines for implementation into clinical practice.Trial registrationClinicalTrials.gov NCT03434717. Registered February 15, 2018.

Cognitive Status and Outcomes of Older People in Orthopedic Rehabilitation? A Retrospective-Cohort Study.

Background: Cognitive function of older people is not routinely assessed in orthopedic rehabilitation, after elective and non-elective surgery. The aim of this study was to assess cognitive impairment and its impact on both length of stay and functional outcomes, of older people admitted to orthopedic rehabilitation. Methods: Retrospective audit, inclusion criteria: aged >65 years, orthopedic diagnosis, discharged from hospital. Results: 116 files were audited, mean age of 82.3 (SD = 7.5) years. Diagnostic groups: fractured neck of femur, (n = 44, 37.98%); elective surgery (n = 42, 36.21%); and other orthopedic conditions (n = 30, 25.86%). Overall 71.55% (n = 83) had cognitive impairment, with a median of mild cognitive impairment across all diagnoses. Both measures of cognition (MoCA/FIM Cognitive) were significantly associated with length of stay (p < 0.01), function (p < 0.05), and discharge destination (p = 0.01). Conclusions: A high percentage of older orthopedic patients in rehabilitation with both elective and non-elective diagnoses have cognitive impairment. Cognitive screening is recommended for all older orthopedic patients in rehabilitation, to inform an individualized rehabilitation plan to improve outcomes and length of stay. Further research is required to explore cognitive strategies to maximize rehabilitation outcomes in the geriatric orthopedic population.

Adapted physical activity and therapeutic exercise in late-onset Pompe disease (LOPD): a two-step rehabilitative approach.

Aerobic exercise, training to sustain motor ability, and respiratory rehabilitation may improve general functioning and quality of life (QoL) in neuromuscular disorders. Patients with late-onset Pompe disease (LOPD) typically show progressive muscle weakness, respiratory dysfunction and minor cardiac involvement. Characteristics and modalities of motor and respiratory rehabilitation in LOPD are not well defined and specific guidelines are lacking. Therefore, we evaluated the role of physical activity, therapeutic exercise, and pulmonary rehabilitation programs in order to promote an appropriate management of motor and respiratory dysfunctions and improve QoL in patients with LOPD. We propose two operational protocols: one for an adapted physical activity (APA) plan and the other for an individual rehabilitation plan, particularly focused on therapeutic exercise (TE) and respiratory rehabilitation.

Employing Neural Network Methods to Label Sleep EEG Micro-Arousals in Obstructive Sleep Apnea Syndrome

Well-designed studies are essential to screen suspected cases of Obstructive Sleep Apnea Syndrome (OSAS) using the widely-referenced questionnaires and then to confirm the diagnosis by means of full Polysomnography (PSG), and finally to assess various variables of treatment efficacy and safety. Defining the severity index of OSAS based on the Apnea-Hypopnea Index (AHI), sleep marco- and micro-structural features (i.e. hypnogram and cyclic alternating patterns or CAPs), and neurocognitive functions would help better explain the treatment outcome. Using the neural network models on sleep data in OSAS sufferers is potentially expected to help the above goals. Determination of neurocognitive impairments in OSAS subjects in relation with disease severity indices and subsequent changes in microstructural changes (i.e. CAPs) in sleep Electroencephalography (EEG), would therefore be useful in defining individualized care and cognitive rehabilitation plans. The present methodology paper has attempted to address the above hypothesis in a clinical population from a hospital-based sleep disorders laboratory.

Prevention of Dangerous Acts of Persons with Mental Disorders: Organization, Statistics, Trends

Dangerous and violent acts of mentally disordered persons that pose a threat to the health and lives of people around them frequently attract the media attention and become a subject of public debates. Prevention of such actions is one of the most important tasks of the psychiatric care system. This article describes the organization of psychiatric prevention at federal and regional levels, involving all medical organizations that provide outpatient and inpatient psychiatric care. The primary focus is on forensic psychiatric prevention of dangerous behavior of the mentally ill. One of the forms of preventive measures is active dispensary observation of patients prone to dangerous acts due to their mental condition. This observation is carried out by medical organizations together with the internal affairs’ agencies. However, the key issue of forensic psychiatric prevention is the execution of the compulsory medical measures imposed by the court and provided for by the Criminal Code of the Russian Federation. Besides, the measures aimed at preventing repeat crimes also include psychiatric care of convicts as a separate branch of forensic psychiatric prevention. The authors present the data of ten-year monitoring of medical services that make it possible to assess the scope, main directions and effectiveness of prevention. This investigation uses the data from the state statistical reports for the Russian Federation and the subjects of the Russian Federation from 2008 to 2017. On this basis, the authors identify the trends in prevention of the dangerous acts of mentally disordered offenders in the psychiatric care system and formulate the main directions for the improvement. In this connection, the authors pay special attention to the use of standardized risk assessment tools to predict dangerous behavior of the mentally ill as one of the ways to increase the effectiveness of psychiatric prevention. Such tools are widely used in foreign forensic psychiatric practice, as well as in criminal justice institutions. The authors describe principal methodological approaches to the development of such tools in foreign and domestic research. According to the authors, the use of such techniques for the risk assessment of dangerous behavior in mentally disordered persons and the development of individual medical and rehabilitation plans on their basis would expand the possibilities for forensic psychiatric prevention.

Clinical application of the ICF core set for cerebral palsy children

Objective To compare the effectiveness of cerebral palsy rehabilitation patterned on the children and youth version of the international classification of functioning, disability and health (ICF-CY) with traditional patterns. Methods Two children′s rehabilitation wards were selected as the ICF-CY group and the control group. The children in the former group were evaluated using the ICF-CY and provided with individual rehabilitation plans according to their evaluation results, while those in the latter group were given traditional rehabilitation without any evaluation. Before and after 3 courses of treatment, both groups were assessed using the pediatric evaluation of disability inventory (PEDI) and the gross motor function measure (GMFM), and their use of assistant devices was assessed. Results After three courses of treatment the ICF-CY group′s average PEDI score had improved significantly and was superior to that of the control group. Significant improvement was observed in the GMFM scores in both groups after the treatment, with no significant inter-group differences. Significantly more of the children in the ICF-CY group used the assistive devices (except the lower limb orthoses) compared to the control group. Conclusion Therapy based on the ICF-CY is obviously superior to traditional rehabilitation planning. Key words: International classification of functioning, disability and health; Cerebral palsy; Pediatric Evaluation of Disability Inventory; Gross motor function

Limitations of Long-Standing Non-Malignant Pain in Functioning, Activity and Quality of Life

Background: Long-standing non-malignant pain (LSNMP) leads to limitations of function and activity as well as decreased quality of life (QoL). Aim: The aim of this study is to describe the subjective experience and to compare the gender differences of functional, activity, and QoL limitations in patients with LSNMP. Methods: Three hundred patients, 207 women and 93 men, with a median duration of pain of 49 months referred to a Pain Management Centre filled out the Functional Barometer questionnaire, adapted to the International Classification of Functioning, Disability and Health (ICF). Results: All patients reported that pain was a moderate, major or total problem. In the ICF item variables, lifting/carrying things, endurance, keeping posture, muscle strength, leisure time, sleeping and energy were indicated as major or total limitations due to pain. Women had significantly more limitations in comparison to men regarding concentration, ordinary housework stress and psychological demands, keeping posture, lifting/carrying things, gastrointestinal functions and contact with friends. Conclusion: Targeting limitations and possibilities in function, activity and QoL are of importance when tailoring an individual treatment and rehabilitation plan. Gender differences are of importance to recognize.

Multiple sclerosis and rehabilitation: an overview of the different rehabilitation settings.

To date, a lack of accurate information about how the different rehabilitation settings are actually delivered to people with multiple sclerosis (PwMS) is still present. Here, we described how PwMS use the different rehabilitation settings in Italy. An observational retrospective study was designed and data collected through an anonymous questionnaire distributed attending MS clinical centers, rehabilitation units, or among PwMS affiliated to the Italian MS Society. We considered as settings: out-patient ambulatory therapy (OUT), hospitalized therapy (HOSP, in-patient and out-patient hospitalized therapy), and home-based therapy (HOME). One thousand six hundred eighty-six subjects at all disability levels were included in the analysis. A high number (53%, n=890) did not receive rehabilitation care in the last 3months before the interview. Main causes were probably due to organizational aspects and poor transports and road networks especially in Center and the Islands. The rehabilitation setting profile of the 796 subjects obtaining rehabilitation care consisted in 58.3% (n=464) receiving only OUT setting, 9.4% (n=75) only HOSP setting, and 21.7% (n=173) only HOME setting. We observed a percentage of overlap among different rehabilitation settings: 3.9% (n=31) OUT-HOME, 3.6% (n=29) OUT-HOSP, 2.6% (n=21) HOSP-HOME, and 0.4% (n=3) OUT-HOME-HOSP. The physiotherapy was the treatment more common among different rehabilitation settings. Only in the in-patient hospitalized therapy setting, the patient received more frequently diversified treatment. Considering the results, the admission to rehabilitation care in Italy is still far from the standards outlined by the recent guidelines that hypothesize a multidisciplinary evaluation and a more individualized rehabilitation plan.

Factors Affecting Early Single Heel Raise after Repair of Achilles Tendon Rupture

Category: Sports Introduction/Purpose: No physical exam or clinical test can clearly predict a final course of acute Achilles tendon rupture after surgical treatment. But, in recent studies, ability to perform single-heel-raise during the early postoperative period was considered as a significant prognostic factor. Therefore, analysis of the relationship between preoperative factors and timing of the single heel raise might help to predict the prognosis and aid to establish an individualized rehabilitation plan. The purpose of this study was to analyze the factors affecting early single heel raise after surgical treatment of acute Achilles tendon rupture. Methods: From January 2012 to August 2015, a retrospective analysis was performed for 68 patients who met the inclusion criteria among 98 cases of surgically treated acute Achilles tendon rupture. Operative technique and rehabilitation protocol were same in all cases. The patients who were able to perform a single heel raise within 3 months postoperatively were classified into the study group and the rest was determined as the control group. During periodic outpatient observation, we evaluated Achilles tendon total rupture score (ATRS), Visual Analog Scale (VAS), and timing capable of a single heel raise. We also preoperatively measured defect size and distance between calcaneal osteotendinous junction and rupture site by ultrasound image in all cases. Results: No difference was found in demographic factors between the study group (23 cases) and the control group (45 cases) who performed a single heel raise later than 3 months postoperatively. There were no significant difference in defect size and distance between calcaneal osteotendinous junction to the rupture site (P=0.38, P=0.63). However, when the rupture site was divided into hyporvascular zone (from calcaneal osteotendinous junction to the rupture site: 4~7 cm) and hypervascular zone, the study group showed a significantly low hyporvascular zone rupture rate. (14/23, 41/45, P=0.003). Also, in the logistic regression analysis that included age, BMI, smoking, hyporvascular zone rupture, defect size, and operation delay, patients with hypervascular region rupture showed odds ratio of 5.3 (P=0.017) in performing a single heel raise within postoperative 3 month. ATRS score at postoperative 3 months and last f/u were significantly higher in the study group. (p&lt;0.01) Conclusion: Achilles tendon rupture at hypovascular zone is a poor prognostic factor for the early single heel raise and might significantly affect the prognosis after acute Achilles tendon rupture operation.

Postural Control in Young People with Visual Impairments and Various Risks of Falls

Introduction Early diagnosis of postural control deficiencies facilitates implementation of an individual rehabilitation plan to prevent falls. The aim of the study was to assess the risk of falling in individuals with visual impairments, and to compare performance-based and theoretical limits of stability in subjects with various risks of falling. Methods The study was comprised of 23 participants with severe visual impairments. The risk of fall was assessed with the Step Test. Performance-based limits of stability were measured with the Advanced Mechanical Technology, Inc. (AMTI) platform, and theoretical limits of stability were calculated based on the height of the center of mass (COM) and maximum body sway leaning angles. Results COM displacement values, corresponding to performance-based limits of stability, in individuals with visual impairments whose risk of falling was classified as high were significantly lower than the theoretical values (p ≤ .05). Similar differences were not observed in participants with visual impairments whose risk of falling was assessed as low. Individuals from the low-risk group showed significantly higher values of performance-based limits of stability than the participants from the high-risk group (p ≤ .01 for medio-lateral direction and p ≤ .05 for forward-backward direction). Discussion Nearly half of young people with visual impairments are at increased risk of falling. Such persons showed lower performance-based limits of stability than participants with visual impairments with a low risk of falling. Performance-based limits of stability in individuals with visual impairments with a high risk of falling are lower than their theoretical limits of stability. Implications for practitioners The fact that nearly half of young people with visual impairments are at an increased risk of falling necessitates implementation of preventive measures in this group, as well as among individuals who are blind.

The characteristics of stroke units in Ontario: a pan-provincial survey

BackgroundPrevious studies have demonstrated that organized, multidisciplinary care is the cornerstone of current strategies to reduce the death and disability caused by stroke. Identification of stroke units and an understanding of their composition and operation would provide insight for the further actions required to improve stroke care. The objective of this study was to identify and survey stroke units in Canada’s largest province, Ontario (population of 13 million) in order to describe availability, structure, staffing, processes of care, and type of population stroke units serve.MethodsThe Ontario Stroke Network (2011) list of stroke units and snowball sampling was used to identify all stroke units. During 2013 – 2014 an interviewer conducted telephone surveys with the stroke unit managers using closed and semi-open ended questions. Descriptive statistics were used to summarize survey responses.ResultsThe survey identified 32 stroke units, and a respondent from every stroke unit (100% response rate) was interviewed. Twenty one were acute stroke units, 10 were integrated stroke units and one was classified as a rehabilitation stroke unit. Stroke units were available in all 14 Local Health Integration Networks except Central West. The estimated average number of stroke patients served per stroke unit was 604 with six-fold variation (242 to 1480) across the province. The typical population served in stroke units were patients with either ischemic or hemorrhagic stroke. Data consistently reported on the processes of stroke care, including the availability of multidisciplinary staff, specific diagnostic imaging, use of validated assessment tools, and the delivery of patient education. Details about the core components of stoke care were provided by 16 stroke units (50%).ConclusionsThis study demonstrates the heterogeneous structure of stroke units in Ontario and signaled potential disparity in access to stroke units. Many core components are in place, but half of the stroke units in Ontario do not meet all criteria. Areas for potential improvement include stroke care training for the multidisciplinary team, provision of individualized rehabilitation plans, and early discharge assessment.

Patients' experiences of their everyday life 14 months after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy - a qualitative follow-up study.

Patients with peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy have a long recovery process. To describe patients' experiences of their everyday lives after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A follow-up study with a qualitative, descriptive design. Data were collected by individual, in-depth telephone interviews with 16 patients who had been treated for peritoneal carcinomatosis 14months earlier at a university hospital in Sweden. The interviews were performed between May and June 2013 and analysed using systematic text condensation. Five themes were identified: (i) finding one's new self and relating to the new situation; (ii) the disease making its presence felt through bodily complications or mental fatigue; (iii) worrying about the return of the disease and passing it on to one's children; (iv) experiencing difficulties contacting various care facilities, not having a clear plan for ongoing rehabilitation; and (v) the need for online support through the Internet and counselling for both patients and their family members. Despite bodily complications, mental fatigue and worries about the return of the disease, the patient's everyday life was focused on finding his/her new self and adapting to the new circumstances. Difficulties in contacting care facilities and the lack of an ongoing medical and nursing rehabilitation plan called for a need for network support for patients and their families. After advanced surgery, patients require a continuous medical and nursing rehabilitation plan, and a platform of support such as meetings via social media and Internet which would connect former patients and their families with future patients and their family members. A contact nurse with specific expertise should design an individual rehabilitation plan and continuously identify the individual needs for long-term support.

Jean Itard en clave de educación inclusiva

Jean Itard ha sido valorado tradicionalmente como el padre de la Educación Especial. Un análisis de sus Informes de 1801 y 1807 sobre la educación de Víctor, el joven salvaje de L’Aveyron desde la perspectiva de la Educación Inclusiva permite descubrir en él algunos rasgos significativos que ayudan a considerarlo como un claro precursor de ésta. Tales son: su reivindicación del derecho a la educación de los más desfavorecidos y la aplicación de un programa de formación integral, así como de un plan de rehabilitación individualizado a partir de las capacidades, limitaciones, necesidades y aspiraciones del alumno. Sus aportaciones metodológicas adelantan algunas de las propuestas actuales de la educación inclusiva: importancia de la atención temprana, valor del trabajo interdisciplinar, la integración social del individuo como última meta de la educación.Pese al fracaso en su intento de ofrecer el habla a Víctor, las propuestas y reivindicaciones de Itard acerca del derecho de un joven salvaje a una educación atendida por administradores y científicos, y auspiciada por el propio gobierno son un claro precedente de algunas propuestas básicas de la Educación Inclusiva que orienta en la actualidad las principales Declaraciones Internacionales.