Interdisciplinary Rehabilitation Team Research Articles

Interorganizational Collaboration in Occupational Rehabilitation: Perceptions of an Interdisciplinary Rehabilitation Team

Various obstacles to and facilitators of collaboration between an interdisciplinary work rehabilitation team and the stakeholders (workers, insurers, physicians, and employers) exist, but are not well characterized. An observational study was conducted, using videotapes of interdisciplinary team discussions of ongoing cases involving 22 workers absent from work due to musculoskeletal disorders. The actions taken and strategies adopted by the team in an effort to overcome the obstacles to collaboration were studied. Various factors influence collaboration between the rehabilitation team and the stakeholders. In general, stakeholder endorsement of the team's therapeutic principles and confidence in their approach emerged as particularly important factors. Diverse strategies, most often, education and awareness-raising, were used by the team to foster collaboration among the parties. This study provides greater insight into the factors affecting collaboration among a rehabilitation team, an injured worker and other stakeholders. The results may improve understanding of the actions taken by rehabilitation teams and help to optimize their practices.

Case report: community rehabilitation for a patient with incomplete spinal cord lesion

This is a case report of Mr S, a 43-year-old man with a spinal cord lesion caused by tuberculosis resulting in incomplete paraplegia. He was discharged from hospital with significant residual disability. He received a major part of his rehabilitation in the community from an interdisciplinary neuro rehabilitation team with good results. Because Mr S was overweight, over 20 stones, the therapists had to use considerable creativity and imagination to facilitate his rehabilitation. Mr S's high level of motivation and courage was essential to the success achieved. The purpose of the case report is to demonstrate that a positive outcome can be achieved despite the many difficulties faced in the rehabilitation of an overweight patient with an incomplete spinal cord lesion in a community setting.

Patients with Severe Stroke Benefit Most by Interdisciplinary Rehabilitation Team Approach

Background: We evaluated the efficacy of a regular interdisciplinary stroke team approach on rehabilitation outcome. Methods: We compared a stroke rehabilitation unit (SRU) with regular interdisciplinary stroke team conferences with general rehabilitation ward (GRW) without such conferences in the same rehabilitation hospital. One hundred and seventy-eight patients within 3 months after stroke were allocated to SRU or GRW, based on bed availability. Main outcome measures were the Functional Independence Measure, Stroke Impairment Assessment Set, length of hospital stay, discharge disposition and cost of hospitalization. Results: The interval between stroke onset and admission to our hospital was significantly longer in the SRU (n = 91) group compared with the GRW group (n = 87, p < 0.05). Although comparable numbers of patients were discharged home (74.7% in the SRU vs. 71.3% in the GRW), significantly more patients (p < 0.0001) with severe disability were discharged home in the SRU group (47.4%) compared with the GRW group (0%). There were no significant differences in the increase in Functional Independence Measure score, Stroke Impairment Assessment Set score,length of hospital stay, or cost. Conclusion: Patients with severe stroke appeared to benefit most from regular interdisciplinary stroke team conferences in the SRU and had an improved discharge disposition.

The Effectiveness of a Sexuality Training Program for the Interdisciplinary Spinal Cord Injury Rehabilitation Team

While there is evidence to support consideration of client sexuality needs in the provision of rehabilitation services to people with spinal cord injury (SCI), the interdisciplinary team rarely receives training in this area. The current study aimed to examine the effectiveness of a consumer-driven sexuality training program in improving staff knowledge, comfort (general and personal) and attitudes. Using a local needs assessment to identify training needs and the Permission, Limited Information, Specific Suggestions and Intensive Therapy (PLISSIT) model as a training framework, a sexuality training program was developed in one Australian SCI service. A randomized controlled trial was conducted and significant improvement was found in all domains for the treatment group – Knowledge(χ2= 46.141, p< 0.001), Comfort (χ2= 23.338, p< 0.001), Approach(χ2= 23.925, p< 0.001) and Attitude (χ2= 15.235, p< 0.001) compared to the control group. Changes were found to be maintained at three month follow-up – Knowledge (Z=−5.116, p< 0.001), Comfort (Z=−3.953, p< 0.001), Approach (Z=−4.103, p< 0.001) and Attitudes (Z=−2.655, p< 0.001). These results support the use of an individualized needs-based sexuality training program in fostering staff knowledge, comfort and attitudinal change in an interdisciplinary SCI rehabilitation service.

The Collaborative Role of the Psychologist and Physician on an Interdisciplinary Pain Rehabilitation Team

Pain is the most common reason individuals seek medical attention. Pain can be classified as either acute or chronic. Patients suffering from chronic pain deal with a mixture of physical, emotional, and social issues that makes the management of these patients very complex. Because of this complexity, a team treatment approach is imperative. One of these types of cases is described here, within the context of an interdisciplinary pain rehabilitation program. The collaborative role of the psychologist and physician in treatment planning is highlighted in this case presentation. The described case focuses on an individual dealing with a chronic painful condition, who also has a history of domestic abuse. Literature has shown that self-reported abuse may be an important prediction of chronic pain and supports the idea that abuse may indirectly or directly be implicated in the “chronification” of pain. Implications related to treatment are further explored in the case presentation and discussion.

Satisfaction of members of interdisciplinary rehabilitation teams with goal planning meetings

Sivaraman Nair KP, Wade DT. Satisfaction of members of interdisciplinary rehabilitation teams with goal planning meetings. Arch Phys Med Rehabil 2003;84:1710–3. Objective To study how satisfied members of interdisciplinary rehabilitation teams are with goal planning meetings. Design Survey. Setting A regional rehabilitation center for people with acute nonprogressive brain injuries in the United Kingdom. Participants Forty-four rehabilitation professionals who participated in 31 goal-planning meetings held between January 1, 2001, and March 30, 2001. Interventions Not applicable. Main outcome measure Responses to a questionnaire about staff satisfaction with rehabilitation team meetings. Results Forty-four of 46 members of 21 different rehabilitation teams completed the questionnaires. They included 12 occupational therapists, 7 physiotherapists, 7 physicians, 6 nurses, 5 clinical psychologists, 5 speech pathologists, and 2 social workers. Median scores of different domains were as follows: participation, 13; behavior, 20; outcome, 14; and process, 16. Correlations between the participation and outcome domains (ρ=.731, P=.01) and the process and outcome domains (ρ=.384, P=.05) were significant. None of the domain scores correlated with features of the meetings. Scores given by chairpersons for participation ( P=.001) and outcome ( P=.047) were significantly higher than those given by other participants. Conclusions Professionals were satisfied with the behavior of other participants and the process of goal-planning meetings. Satisfaction with outcome was related to satisfaction with the participation in and the process of the meetings. Chairpersons were more satisfied with the participation domain.

Neurorehabilitation after stroke

After stroke most patients need to undergo extensive neurological and neuropsychological rehabilitation (neurorehabilitation). It is important to have an individual treatment programme that takes into account that the stroke patient is impaired in terms of his receptive skills, his capacity to act and his personal integrity. Based on the "phase model" of the Austrian Society for Neurological Rehabilitation (OGNR) individual goals have to be agreed and measures have to be taken. After maintaining the vital functions and a stable vegetative state, the remaining abilities have to be stimulated, functions have to be regained and deficits have to be compensated. An interdisciplinary neurological rehabilitation team has, for example, the following responsibilities: treatment of impaired motor skills and balance, treatment of swallowing and breathing impairments, training of activities of daily living, and special concepts for the treatment of cognitive deficits and impaired behaviour. A decisive factor for rehabilitation success is the relationship between therapists and patients and their relatives/carers. Preparation for independent or care-managed life after inpatient rehabilitation is of paramount importance, this means organization of continuing out-patient treatment, out-patient care management, as well as measurement and documentation of rehabilitation success. Regaining quality of life is an active process of analysing and working on the remaining activity limitations and participation restrictions in society. The work of the interdisciplinary neurological rehabilitation team contributes decisively to this process.

The implementation of the 'International Classification of Functioning, Disability and Health' (ICF) in daily practice of neurorehabilitation: an interdisciplinary project at the Kantonsspital of Lucerne, Switzerland

Purpose : The current paper describes the implementation of ICF as a standard language and framework for description of human functioning and disability for common use in every day work by the multiprofessional team. Method : An interdisciplinary project team involving all rehabilitation specialities was constituted. The extensive original document of ICF was broken down to a simplified raster for body functions and structures, activities and participation, as well as for contextual factors. These rasters had to cover the most important aspects concerning the patients treated on our unit. Checklists on the basis of these rasters were worked out for use by the different specialized teams. Using these checklists, rehabilitation conferences, form and language of interdisciplinary communication, goal setting and documentation were introduced newly in every day work for the interdisciplinary rehabilitation team, structured strictly based on the ICF-criteria. Results : Since April 2002 the ICF-based processes are implemented in routine work for all members of the rehabilitation staff. First experiences show good acceptance by the team members, improvements in communication and documentation as well as substantial gains in content and handling of rehabilitation conferences. As a result of the implementation we observed, that participation, context and domiciliary interventions gained quite more influence in every day work at the unit. Conclusion : Implementation improved considerably the quality of interdisciplinary work processes and contributed to a more systematic approach to rehabilitation tasks by the team members.

Loewenstein communication scale for the minimally responsive patient

Primary objective : Any sign of communicative ability in patients in vegetative state can provide information about regain of consciousness and conservation of cognitive abilities. The aim of this study was to test the reliability and validity of an instrument designed to measure the degree of communication in minimally responsive patients. Materials : The Loewenstein Communication Scale (LCS) measures five hierarchical functions - mobility, respiration, visual responsiveness, auditory comprehension and linguistic skills (verbal or alternative) - which are divided into five parameters and rated in developmental order on a 5-point scale by level of difficulty. Scores for each function are summed to obtain a quantitative communication profile. Methods : Forty-two adult patients in vegetative state, as a result of acquired brain injury, were examined with the proposed LCS for the minimally responsive patients by two speech and language clinicians at admission to the Intensive Care Unit (ICU) for brain injured patients and, thereafter, at least once weekly. At the end of the ICU stay, 27 patients who showed signs of recovery and were referred for continued rehabilitation were compared to a group of 15 patients who were not referred for continued rehabilitation, for functional and general LCS scores. The predictive power of the LCS in differentiating between these groups was tested. Results : The LCS was found to have very good reliability with good inter-rater agreement. Patients who eventually continued rehabilitation had significantly higher total scores as well as in the motor, visual and auditory sub-scales. Logistic regression results indicated that these parameters successfully differentiated between the two groups of patients, even after adjusting for age and for scores on the Glasgow Coma Scale. Conclusion : The LCS for the minimally responsive patients proved to be reliable and predictive of rehabilitation progress of minimally responsive patients. It may be useful for the interdisciplinary rehabilitation team in planning early individually targeted therapeutic programmes.

Neurologic Recovery and Neurologic Decline After Spinal Cord Injury

Physicians caring for patients with spinal cord injury facilitate neurologic recovery by optimizing nutrition and general health, by coordinating active exercise and functional training to enhance the underlying synapse growth, reversal of muscle atrophy, and motor learning, and by controlling interfering spasticity. SCI physicians also must monitor for neurologic decline during initial rehabilitation and later in life, diagnose promptly and accurately such decline, and orchestrate the appropriate intervention.

The roles of the pastor in the interdisciplinary rehabilitation team.

People with chronic illnesses and functional limitations may face a lifetime of changes and adjustments. Often, the onset of a long-term illness or disease requires a person to rethink values and develop new coping strategies in order to adapt to a life-changing event. At such times, people may draw on sources of spiritual support, finding comfort from a pastor or other clergy. This article describes key roles taken by the clergy who provide these services. Patients discharged from inpatient rehabilitation units have reported using faith and prayer as effective coping strategies. Religious faith can have a positive influence on emotions and may be directly related to improved functional ability. Disciplines of faith, such as solitude, silence, and meditation, may promote mental health. Although this article presents information from a Christian church perspective, readers should note that services should be considered from a wide range of spiritual representatives.

Rehabilitation of the Geriatric Orthopaedic Patient

Older patients who are referred for rehabilitation after undergoing orthopaedic procedures have numerous age-related conditions that may interfere with physical performance and safety. The general rehabilitation goals are to return each patient to the premorbid functional level of mobility and self-care, teach the exercises that are to be performed after hospital discharge, reduce the risk of falls, and ensure that the patient is discharged to a safe environment. Before elective surgery, the elderly orthopaedic patient should be instructed to perform breathing exercises to prevent pulmonary complications and active lower limb exercises to maintain good circulation and joint mobility, and be instructed in functional activities for mobilization in and out of bed. Postoperatively, the interdisciplinary rehabilitation team must facilitate early resumption of active exercises and self-care tasks and discourage prolonged bed rest and dependency on nursing staff and family members. Physical and occupational therapy should be provided to restore mobility and self-care functions. If discharge to home is planned, the home environment should be assessed and modifications recommended to reduce the risk of falls and ensure independent functioning to the extent possible. When the rehabilitation goals have been obtained, the patient should be discharged from the hospital, but additional therapy may be required, either at home or at an outpatient facility.

An interdisciplinary approach to the rehabilitation of people with brain injury

Reducing handicap in clients with complex needs requires input from a variety of disciplines. This input must be coordinated in order to prevent duplicated or conflicting goals that are not relevant to the reduction of handicap. Also, clients should be heavily involved in choosing their goals. Methods that help to ensure clear communication between professionals and facilitate the functioning of the interdisciplinary rehabilitation team are described.

Return to Work Following Spinal Cord Injury

Return to work following spinal cord injury is achievable for many individuals. Interdisciplinary rehabilitation teams are ideally suited to facilitate an individual's efforts at overcoming the numerous barriers involved in returning to gainful, competitive employment. Many of these barriers are person-specific (i.e., education level), and multifaceted assessment and comprehensive vocational planning are suggested. Other barriers, such as economic disincentives and poor access to needed services, are less easily overcome. Rehabilitation professionals are encouraged to become familiar with recent health and disability policy (i.e., Americans with Disabilities Act) and become proactive in policy formation. There is a significant need for development and testing of model programs to enhance return to work for individuals with spinal cord injury.

An Industrial Pain and Stress Program

Chronic low back pain in the industrial worker is an expensive enigma. Successful management of this problem, culminating in return of the injured worker to work, often requires the expertise of an interdisciplinary rehabilitation team. A state-run, vocationally oriented, functional restoration pain and stress management industrial rehabilitation program is described in this article.

Development of an Assessment Unit: An Australian Experience

This article describes an interdisciplinary rehabilitation team that was developed to assess and provide orientation and mobility training to handicapped people who have additional impairments.

Prevocational programming in the rehabilitation of the head-injured patient. A summary.

The purpose of this paper is to discuss the success and relevance of prevocational and transitional programming, as components of reentry for the head-injured patient, to the treatment continuum of the interdisciplinary rehabilitation team. Prevocational and transitional programming are particularly applicable to the young adult with head injury because they combine conditioning and instruction in a societal, thus a developmental, context. The societal context is described and distinguished from a purely medical or clinical model. The specific features, problems, and prerequisites of prevocational and transitional programming are discussed.