Multidisciplinary Rehabilitation Team Research Articles

The COVID-19 Sequelae: A Cross-Sectional Evaluation of Post-recovery Symptoms and the Need for Rehabilitation of COVID-19 Survivors.

Background As of January 19, 2021, around two million fatalities and 68 million recoveries from coronavirus disease 2019 (COVID-19) have been reported around the globe. The past pandemics of severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) hint toward a risk of occurrence of "Long-COVID" syndrome, i.e., the persistence of post-discharge symptoms among COVID-19 survivors. With the scarcity of literature addressing post-COVID-19 manifestations and little regard for the stigma associated with this disease, survivors' rehabilitation remains widely neglected. The current study aims to assess the prevalence and characteristics of post-COVID-19 manifestations and their effect on the quality of life (QoL) of COVID-19 recovered individuals. We have also analyzed the relationship of time since the recovery of COVID-19 and its severity with the post-discharge symptoms. The stigma affiliated with the infection of SARS coronavirus-2 (SARS-CoV-2) has also been highlighted.MethodologyA descriptive, cross-sectional, questionnaire-based study was conducted from September 2020 to December 2020 among 158 COVID-19 recovered patients, whose information was obtained from Dow Diagnostic Laboratory, Ojha Campus, Karachi, Pakistan. The questionnaire consisted of four sections: sociodemographic data, post-COVID-19 manifestations, questions relating to the stigma, and the QoL of the recovered COVID-19 patients. We used the EuroQol five-dimension five-level questionnaire to assess the QoL, while the modified BG Prasad Socioeconomic Classification updated for 2019 was employed to determine the socioeconomic status of the participants. Data were analyzed using SPSS version 24.0 (IBM Corp., Armonk, NY, USA). Data were presented in the form of frequencies and percentages.ResultsAn overwhelming majority (94.9%) experienced at least one post-COVID-19 symptom, with fatigue (82.9%) being the most prevalent post-discharge manifestation. We observed a significant correlation of post-COVID-19 symptoms with gender, age, and time since recovery. COVID-19 severity was found to be significantly related to the five dimensions of the QoL. A significant difference in EuroQol Visual Analog Scale health score was observed between the participants with mild, moderate, and severe COVID-19 infection (p < 0.001). Besides, the associated stigma with SARS-CoV-2 infection was found to be more prevalent in the participants belonging to the upper class as compared to the other classes (p < 0.05). Nonetheless, we also observed a significant association of disease severity with post-COVID-19 manifestations and pre-existing comorbidities.ConclusionsThe long-COVID syndrome is similar to the post-discharge manifestations of the survivors of prior pandemics of SARS and MERS. Multi-disciplinary rehabilitation teams, healthcare workers, and the general population should recognize the need for systematic assessment of their recovery and further rehabilitation.

Медицинский логопед в мультидисциплинарной реабилитационной команде. Практический опыт Клиники Института Мозга

Background. In domestic and foreign publications, there are no descriptions of the principles of interaction between a medical speech therapist (MST) and other members of a multidisciplinary rehabilitation team (MDRT). Aim. To analyze our own experience in organizing the work of the speech therapy service of the regional neurorehabilitation Center. Materials and methods. We conducted a retrospective analysis of the activities of the division of MST of the interterritorial Center for Neurorehabilitation “Clinic of the Brain Institute“ (CBI) for the period 2015–2019. In the structure of the CBI, there is a 24-hour hospital with 45 beds, including a 9-bed intensive care unit, an 8-bed day hospital, a polyclinic with 50 visits per shift, and a telemedicine center. The speech therapy team of the MDRT consists of 8 specialists with higher education in the specialty “speech pathologist-defectologist“. Speech therapy examination consists of key blocks of clinical diagnosis of speech therapy syndromes: dysphagia, dysarthria, aphasia and prosoparesis. Each block represents a complex of a basic score scale and additional instrumental, including neurophysiological methods. The basis of speech therapy is voice training, articulation and probe massage and other standard procedures, combined in the concept of “basic techniques” for speech therapy syndromes. Drug and non-drug modulations are used to enhance the basic techniques. Results. In the period from 2015 to 2019, 5243 patients were treated in CBI after acute cerebral circulatory disorders and traumatic brain injuries, of which 4273 (81%) needed the help of clinical speech therapists. The most common problem was dysarthria – 55%. Speech breakdown in the framework of aphasia syndrome was noted in 26% of all hospitalized patients. Dysphagia was diagnosed in 30% of all hospitalized patients. During the hospitalization period of 14 days, each patient receives at least 45 minutes of daily individual training with a specialist and group articulation exercises, including weekends. The lesson is preceded by a modulating drug or non-drug procedure. For 5 years, 4273 patients were treated with speech therapy team. In 154 (11.6%) patients, speech therapy syndromes completely regressed, in 28% the severity of their manifestations decreased by 1–2 levels. Conclusion. At the early stage of rehabilitation, the speech therapist is called upon to solve priority tasks: achieving the maximum possible level of independence of the patient, at least staying at home with a minimum level of dependence on the help of a guardian. This is a prerequisite for the implementation of an individual comprehensive rehabilitation program. Despite many methodological and organizational problems, the MST is a key member of the MDRT, without which an effective rehabilitation process is impossible.

Back2Work: a new model of early vocational rehabilitation for people with spinal cord injury.

Objective The aim of this article is to describe the development of a novel evidence-based model of early intervention vocational rehabilitation (EIVR) for people with spinal cord injury (SCI). Methods An extensive literature review and background study guided the collaboration of experienced practitioners and researchers in developing and evaluating the innovative Back2Work model of EIVR for people with SCI in Queensland, Australia. The program is undergoing longitudinal mixed-methods evaluation to the end of 2023. Results The model is central to the successful implementation of the EIVR program, delivered by rehabilitation counsellors in the Queensland Spinal Injuries Unit. Back2Work includes a strong focus on maintaining and nurturing the pre-injury occupational bond between injured workers and employers, and aims to create a positive expectation for return to work (RTW) and increase the rate and timeliness of RTW after SCI. Conclusions The Back2Work program has become an integrated component of the multidisciplinary rehabilitation team, with positive early results in RTW outcomes and additional benefits in participants' sense of well-being and hope. What is known about the topic? Vocational intervention after SCI has traditionally been delivered after hospital discharge and considered outside the scope of early intervention approaches. Emerging evidence suggests EIVR, commencing before hospital discharge, can encourage hope and a positive expectancy for employment after SCI, and is showing promising outcomes in supporting people's quality of life and vocational goals. What does this paper add? This article details the process and product of developing and evaluating a novel EIVR model for people with SCI. The model underpins the Back2Work EIVR program being trialled in the Queensland Spinal Injuries Unit, an example of this emerging field of practice within the primary rehabilitation setting. What are the implications for practitioners? The Back2Work program is based on an innovative and evidence-based model of EIVR for people with SCI. The collaborative and empirically driven process of developing, implementing and evaluating the model will be of interest to researchers and practitioners looking to advance practices in vocational rehabilitation after serious injury.

QOL-21. DEVELOPMENT AND UTILISATION OF A NEURO-ONCOLOGY REHABILITATION TEAM: 2018–2019 UPDATE

INTRODUCTIONA multi-disciplinary Neuro-Oncology Rehabilitation Team (NORT) was established at our institution in 2014. We reviewed NORT inputs, processes and outputs in 2018 to 2019 compared to our previously presented data from 2015, soon after service inception.METHODSRetrospective analysis of patients who received NORT input June 2018 - May 2019 compared to 2015 data. Descriptive analysis of changes to NORT operational processes and structure. Complexity of rehabilitation needs was measured using the Rehabilitation Complexity Scale-Extended V13 (RCS).RESULTS54 children received NORT input in 2018–2019 (10 children in 2015) with total of 129 outputs. NORT input was highest in children with high grade glioma (median reviews: 3; median RCS: 5) and ependymoma (median reviews: 3; median RCS: 5). Pilocytic astrocytoma formed the largest tumour group (n = 11; median reviews: 2; median RCS: 7). 11% patients were referred to neurologist (9% already known); 17% referred to community services (44% already known); 31% referred to neuropsychology. In 2015, outputs were predominantly referral to occupational therapy and physiotherapy. 6 patients (11% of 54) were discharged in 2018–2019 (40% of 10 patients in 2015). 4 patients died. Between 2015 and 2019, developments included: clarifying referral and discharge pathways, use of screening measures, neuropsychology integration, therapy-led drop-in clinics, use of RCS-E. DISCUSSION: There has been a clear increase in utilisation and scope of work of NORT over last 4 years. The strength of this team is multidisciplinary working and expertise. Further developments planned: multidisciplinary rehabilitation interventions and NORT outcome tools.

Effectiveness of Long-Term Rehabilitation Treatment After Stroke

Objectives: Stroke is the leading cause of long-term disability. Therefore, we studied the effects of comprehensive long-term rehabilitation after stroke in improving the quality of life. Methods: Participants were compared in an experimental intervention model, with 120 control subjects, which received conventional short-stay inpatient hospitalization rehab, with 105 study subjects who received comprehensive rehabilitation program using the Guidelines for Adult Stroke Rehabilitation and Recovery from the American Heart Association/American Stroke Association starting in the hospital and extending for 6 months. The effects of rehabilitation were assessed Modified Rankin Scale (mRS), Functional Independence Measure (FIM), Barthel Index (BI) methods at admission, discharge, and 3 and 6 months after discharge. Results: There was no significant difference in the NIHSS, mRS, BI, and FIM scores between study and control patients at admission (p &gt; 0.05). For the mRS, BI, and FIM scores, there was a significant interaction between treatment and time, indicating that the scores improved more rapidly for patients in the study group than the control group over the six-month study period (p &lt; 0.001). A significant improvement in the scores with time was observed in the study and control groups at each time interval (p &lt; 0.001). However, by 3 months after discharge the mRS, BI, and FIM scores of the study group were significantly better than the control group and the gap widened at 6 months, indicating further improvement. Conclusions: We found that providing prolonged by a multidisciplinary rehabilitation team results in higher functional independence and improvements in daily living activities.

33 NeoCHIRP: A Collaborative Care Model for Intestinal Rehabilitation in the NICU

Abstract Background Many children with intestinal failure (IF) start their course in the NICU with medical or surgical conditions limiting enteral feeding. Multidisciplinary intestinal rehabilitation teams have improved outcomes in pediatric IF patients, but this is not well described in neonates. Objectives NeoCHIRP represents a unique IR Team; this study describes its roles in collaborating neonatal and IR care. Design/Methods Retrospective descriptive chart review of neonates at risk for IF in one NICU, of patients admitted between April 1, 2013 and March 31, 2019. All neonates at risk for IF were evaluated weekly by a multidisciplinary Neonatal Children’s IR program in the NICU (NeoCHIRP) that is composed of surgeons, dieticians, neonatologists, IR paediatrician, nurses and patient families, to evaluate nutritional status, and provide recommendations. Data collected included weight, patient characteristics, number of NeoCHIRP visits, type of recommendations, cholestasis interventions, successful oral tolerance, and survival. Results There were 163 patients, 105 males, 58 females with 1-27 weekly visits (mean= 9.1) and gestational age between 23-43 4/7 weeks (median= 35). There were 153 survivors discharged from the NICU and 10 deaths (3 from IF related complications.) Enteral autonomy was achieved by 139/163 patients (85.3%.) Common recommendations made were enteral feeds (96.3%), parenteral nutrition (95%) or sodium management (93.9%.) Recommendations for oral stimulation were made in 79.1%, of which 40.5% (66/163) were exclusively orally fed and 20.2% partially orally fed by discharge. Cholestasis interventions were made in 66.9% and conjugated bilirubin (CB) &amp;lt;15 at discharge in 93 patients (range 0-123, mean 12.9 median 2) with only 23/163 patients with CB &amp;gt;30 at final visit. Evaluation of patient weights showed increased z-scores in only 23/153 (15%) from birth to discharge versus increased z-scores in 51/141 (36.2%) from NeoCHIRP consult to discharge. Conclusion A Multidisciplinary Neonatal Intestinal Failure Team is a useful collaborative model to support NICU medical management, by minimizing poor weight gain, cholestasis and oral aversion. Recommendations made for all NeoCHIRP patients in enteral, parenteral and sodium management resulted in improved weight gain of patients.

Medical rehabilitation at a new coronavirus infection (COVID-19)

The emergence of SARS-CoV-2 and its worldwide spread has become a challenge for healthcare professionals related to rapid diagnosis of infection caused by the new coronaviruses, provision of specialized medical care, rehabilitation and secondary prevention. Currently, there is limited information on primary, secondary prevention and medical rehabilitation of this disease. The most common clinical manifestation of the new variant of coronavirus infection is bilateral pneumonia, with 34% of patients developing acute respiratory distress syndrome (ARDS). Given the unusual pandemic situation and the peculiar COVID-19 pathogenesis, the stereotyped application of generally accepted methods may be unsafe or ineffective. The Union of Rehabilitologists of Russia has prepared Temporary guidelines that are based on the advice on medical rehabilitation of patients with COVID-19 at various stages of special medical care published by WHO specialists, analysis of reports from clinics currently involved in rehabilitation of COVID-19 patients, as well as on the results of clinical studies conducted earlier on the rehabilitation of patients with Post-intensive care syndrome and adult respiratory distress syndrome (ARDS) of non-coronavirus etiology, regulatory documents of the Russian Ministry of Health and Federal Service on Surveillance for Consumer rights protection and human well-being. A syndrome-based approach to the use of means and methods of physical and rehabilitation medicine is also considered. The guidelines are intended for heads of medical organizations and their structural divisions, general practitioners, physicians, infectious disease doctors, pediatricians, emergency physicians of intensive care units in infectious hospitals, physiotherapy and sports medicine doctors, physiotherapists, medical psychologists, physical therapy instructors, nurses and other specialists of multidisciplinary rehabilitation teams working in the field of medical care for patients with COVID-19 at various stages.

A Proposal for Multidisciplinary Tele-Rehabilitation in the Assessment and Rehabilitation of COVID-19 Survivors.

A global pandemic of a new highly contagious disease called COVID-19 resulting from coronavirus (severe acute respiratory syndrome (SARS)-Cov-2) infection was declared in February 2020. Though primarily transmitted through the respiratory system, other organ systems in the body can be affected. Twenty percent of those affected require hospitalization with mechanical ventilation in severe cases. About half of the disease survivors have residual functional deficits that require multidisciplinary specialist rehabilitation. The workforce to deliver the required rehabilitation input is beyond the capacity of existing community services. Strict medical follow-up guidelines to monitor these patients mandate scheduled reviews within 12 weeks post discharge. Due to the restricted timeframe for these events to occur, existing care pathway are unlikely to be able to meet the demand. An innovative integrated post-discharge care pathway to facilitate follow up by acute medical teams (respiratory and intensive care) and a specialist multidisciplinary rehabilitation team is hereby proposed. Such a pathway will enable the monitoring and provision of comprehensive medical assessments and multidisciplinary rehabilitation. This paper proposes that a model of tele-rehabilitation is integrated within the pathway by using digital communication technology to offer quick remote assessment and efficient therapy delivery to these patients. Tele-rehabilitation offers a quick and effective option to respond to the specialist rehabilitation needs of COVID-19 survivors following hospital discharge.

New Insights Into the Indications for Intestinal Transplantation: Consensus in the Year 2019.

In 2001, a Statement was published that described indications for intestinal transplantation in patients with intestinal failure expected to require parenteral nutrition indefinitely. Since 2001, advances in the management of intestinal failure including transplantation and patient survival, both on extended parenteral nutrition and after transplantation, have improved, leading to a reduction in the number of intestinal transplants worldwide from a peak of 270 per year in 2008 to 149 per year in 2017. These changes suggest that the original 2001 Statement requires reassessment. All patients with permanent intestinal failure should be managed by dedicated multidisciplinary intestinal rehabilitation teams. Under care of these teams, patients should be considered for intestinal transplantation in the event of progressive intestinal failure-associated liver disease, progressive loss of central vein access, and repeated life-threatening central venous catheter-associated infections requiring critical care. Additional indications for transplantation include large desmoid tumors and other intra-abdominal tumors with reasonable expectation of posttransplant cure, extensive mesenteric vein thrombosis and intestinal infarction, total intestinal aganglionosis, and nonrecoverable congenital secretory diarrhea. Quality of life typically improves after successful intestinal transplantation and may support the decision to proceed with transplantation when other indications are present. However, the requirement for life-long immunosuppression and its associated side effects preclude intestinal transplantation if motivated only by an expectation of improved quality of life. Increasing experience with intestinal transplantation and critical appraisal of transplant outcomes including graft survival and patient quality of life together with potential advances in immunosuppression can be expected to influence transplant practices in the future.

Early Rehabilitation for Critically Ill Patients With COVID-19: More Benefits Than Risks.

Early Rehabilitation for Critically Ill Patients With COVID-19: More Benefits Than Risks.

Автоматизация деятельности мультидисциплинарной реабилитацион- ной бригады посредством программного пакета ICF WIZARD

Автоматизация деятельности мультидисциплинарной реабилитацион- ной бригады посредством программного пакета ICF WIZARD

Development of an integrated rehabilitation pathway for individuals recovering from COVID-19 in the community.

COVID-19 is a multisystem illness that has considerable long-term physical, psychological, cognitive, social and vocational sequelae in survivors. Given the scale of this burden and lockdown measures in most countries, there is a need for an integrated rehabilitation pathway using a tele-medicine approach to screen and manage these sequelae in a systematic and efficient way. A multidisciplinary team of professionals in the UK developed a comprehensive pragmatic telephone screening tool, the COVID-19 Yorkshire Rehabilitation Screen (C19-YRS), and an integrated rehabilitation pathway, which spans the acute hospital trust, community trust and primary care service within the National Health Service (NHS) service model. The C19-YRS telephone screening tool, developed previously, was used to screen symptoms and grade their severity. Referral criteria thresholds were applied to the output of C19-YRS to inform the decision-making process in the rehabilitation pathway. A dedicated multidisciplinary COVID-19 rehabilitation team is the core troubleshooting forum for managing complex cases with needs spanning multiple domains of the health condition. The authors recommend that health services dealing with the COVID-19 pandemic adopt a comprehensive telephone screening system and an integrated rehabilitation pathway to manage the large number of survivors in a timely and effective manner and to enable the provision of targeted interventions.

MULTIDISCIPLINARY REHABILITATION TEAM IN EMERGENCY ABDOMINAL SURGERY: THE ROLE OF A HOSPITAL NURSE

Objective: to determine the role of the nurse of the surgical hospital as a member of a multidisciplinary rehabilitation team in different models of rehabilitation care for the patients who have undergone emergency surgery on the abdominal cavity.Materials and methods. The study used the following methods: bibliosemantic, content analysis of legal documents of the organization of rehabilitation care and medical and technological documents for standardization of medical care, structural and logical analysis and descriptive modeling.Results. Nowadays, regarding the regulation of medical and rehabilitation care, the Ministry of Health of Ukraine stands on the position of widespread use of international guidelines for treatment and diagnosis of diseases in the health care system , without requiring strict adherence to unified clinical protocols approved by relevant orders. According to the existing medical and technological documents, all the patients, who have undergone emergency surgery on the abdominal organs, need rehabilitation care during their stay in the surgical hospital in the early postoperative period. There are currently no clear requirements for full-fledged staffing of rehabilitation care on the basis of a multidisciplinary approach. Therefore, there is a need to develop adaptive models for organizing the work of multidisciplinary rehabilitation teams and the formation of the role and functions of individual participants. Within all possible components of the multidisciplinary team in the adaptive model there are only two left as its regular members – namely those that are determined by the requirements of the conditions of procurement of medical services. Another compulsory structural components are to be involved as external consultants. The role and functions of such a team member as a hospital nurse change significantly. She is additionally entrusted with certain functions of a physical therapist's assistant (if necessary, an occupational therapist's assistant) as well as the role of a case manager of the patient's case with the function of communication with external consultants.Conclusions. The optimal organizational model of a multidisciplinary rehabilitation team in a surgical hospitals can not be implemented today in all surgical clinics to ensure the implementation of rehabilitation programs for patients who have undergone surgery on the abdominal organs. The adaptive organizational model of the multidisciplinary rehabilitation team in a surgical hospital involves a significant change in the role and function of the hospital nurse.

Neuropsychological diagnostics and rehabilitation of patients with memory impairments in amnestic syndrome as a result of brain damage of various etiologies

Background. Neuropsychological diagnostics and rehabilitation are among the fundamental practical tasks facing a clinical psychologist. Today, rehabilitation goes beyond the usual framework in which it was 40–50 years ago. The course of the disease, stressful influences radically change the physical, psychological and social functioning of a person. It is the functioning of a person (and not the state of his functions) in new, often limiting living conditions that becomes an object in the modern rehabilitation system, which is a joint activity of the patient, his relatives and specialists of the multidisciplinary rehabilitation team. Objective: analysis and generalization of the diagnostic and rehabilitation experience accumulated in neuropsychological rehabilitation;identification of quality criteria for neuropsychological diagnostics and rehabilitation of patients with memory impairments in case of brain damage, which should be followed by a practicing psychologist in the process of rehabilitation work. Results. Based on the analysis of applied research and practical guidelines, the recommended diagnostic tools for detecting memory impairments are presentedand the main directions and effective methods of rehabilitation work in amnestic syndrome are highlighted. It is shown that different degrees of severity of a amnestic defect requires the choice of an appropriate direction of work in the process of neuropsychological rehabilitation: the formation of new mnestic means; the organization of “suggestive and reminiscent” environments and new strategies for behavior in this environment; general (non-specific) principles of restorative learning. Conclusions. The presented material can serve as a “support” in the practical work of a clinical psychologist with patients with memory impairments and brain lesions.The text outlines the main directions of diagnostic and rehabilitation work which a practicing psychologist must be aware of.

Psychiatric Assistance at Cataract Juvenile

Background: Psychiatric assistance is required in the integrated handling of physical health disorders in the field of other disciplines known as CLP. A collaborative approach to the field of psychiatry with other scientific disciplines in accordance with WHO health criteria that includes physical and mental health for improving health and quality of life. Case presentation: A boy, 8 years, was consulted from the Ophthalmology Department with Right eye cataract juvenile, and left eye ptisis bulbi to give pre-operative psychological assistance for eye assessment and diagnostics. Patient also complained the blurred vision since last year and cannot see anything since 10 months ago. The current condition represents the patient cannot speak, often screams, likes to injure his head and scratch his face. Patients treated in the pediatric’s ward with global developmental delay. Patients were also consulted to the child psychiatry section with childhood autism, audiology, nutrition and metabolic diseases of children, pediatric neurology, and finally collaboration with the Surabaya City Health Office for a follow-up management plan. Conclusions: Child psychiatrist as a liaison, interacting with multidisciplinary medical or rehabilitation teams, families, schools, community and local city government are beneficial in the management of child disorders and improving family wellbeing. &#x0D; &#x0D; Keywords: cataract juvenile; autism; psychiatric assistance; consultation liaison psychiatry (CLP)

88 Profiling Clinical Frailty in Older Adults in an Irish Post-Acute Care Ortho-Geriatric Unit

Abstract Background Clinical frailty upon admission to acute care has been shown to independently predict adverse discharge destination in geriatric patients (1). However, the prevalence of clinical frailty in post-acute care and its impact on length of stay and discharge destination has not been explored to date (2). The aims of this study were to measure clinical frailty upon admission and discharge to a post-acute Ortho-geriatric Unit (OGU) and identify its impact on length of stay (LOS) and discharge destination. Methods A retrospective data analysis was completed of all patients admitted and discharged within a 6-month period. All received routine Multidisciplinary team (MDT) rehabilitation care. Clinical Frailty was assessed within first week of admission and the week prior to discharge using the Clinical Frailty Scale (CFS). Data was analysed using Microsoft Excel. Results Fifty-four patients were admitted over the 6-month period. All were female, mean age 81 years and over half (55%) had a primary diagnosis of hip fracture (n=30). All were deemed frail on admission (CFS score &gt;5). The Mild to Moderate (CFS 5 and CFS 6) Group (n=36) had a mean age 81.1 years, mean LOS 38.75 days, 96.6% independently mobile on discharge and 97.2% discharged home. The Severe (CFS 7 and CFS 8) Group (n=18) had a mean age 85.2 years, mean LOS 85.2 days, 59.4% independently mobile on discharge and 83.3%% discharged home. 75% (n=3) of patients that transitioned to long-term care were in the Severe Group. At discharge 54% of the total participants were deemed frail(CFS&gt;5), 46% less compared to admission scores. Conclusion All admissions to OGU were frail. MDT rehabilitation reduced frailty levels for the majority of subjects’ in this study. Higher admission CFS scores resulted in increased LOS and a trend towards long-term care transition. Further research is warranted to evaluate the efficacy of CFS in post-acute geriatric population.

Clinicians’ views and practices in quality of life in aphasia rehabilitation: a preliminary study

ABSTRACTBackground: Quality of life (QOL) is important to people with aphasia and their family members and is influenced by a range of factors within the scope of practice for speech and language therapy. Interestingly though, clinicians largely assess patients’/clients’ QOL informally through discussion, and rarely measure QOL as an outcome from aphasia rehabilitation. Research is needed to understand why there is relatively little consideration of QOL in clinical practice and little use of formal assessments.Aims: This study explores aphasia clinicians’ views and reported practices regarding QOL as a concept and its assessment.Methods & Procedures: Nineteen practising speech and language therapists working in rehabilitation with adult clients with neurogenic communication disorders volunteered and completed the study. They completed an online survey of 48 questions with a range of response options, including free text. Descriptive and inferential statistics were used for count and categorical data, and content analysis for text responses.Outcomes & Results: These clinicians felt initially unprepared for practice, and had limited awareness, knowledge and confidence in using QOL assessments, but nonetheless thought QOL was important in clinical management. They considered QOL as being individualized, pertaining to life satisfaction and enjoyment, and additionally considered it as communication, participation in activities, education, and emotional support. The majority used informal methods, although some formal assessment use was reported. Many perceived barriers related to lack of resources (physical, staff, and time). Clinicians also reported scope of practice issues with the broader multidisciplinary rehabilitation team and specifically clinical psychology.Conclusions: Training and access to existing available QOL assessments are clear implications from this study. Further research is needed to assess the extent to which these findings are representative of the broader aphasia clinician community in England.

Organization of Post-Stroke Rehabilitation Services: Changes between 2013 and 2018 in Services Provided by Health System in Mongolia

Objectives: Stroke related disabilities significantly decrease patients’ quality of life and post-stroke rehabilitation service is essential. Therefore, we studied post-stroke rehabilitation services and facilities provided in Mongolia between 2013 and 2018. Methods: A longitudinal study was performed in a total of 47 Mongolian hospitals that provide stroke rehabilitation services. A questionnaire regarding the organizational structure of rehabilitation units, equipment used, human resources, and adherence to recommended guidelines was developed and administered to specialists in these hospitals. Results: We recruited 47 (89%) out of 50 and 47 (94%) out of 53 hospitals delivering stroke rehabilitation service in 2013 and 2018 respectively. 25-34% of these hospitals provided post-stroke rehabilitation, with the majority being incapable of providing multidisciplinary team rehabilitation. The number of physiatrists and physical therapists increased significantly from 2013 to 2018 (p&lt;.001) although the number of physical (p&lt;.002) and occupational therapists (p&lt;.001) was significantly lower in the rural areas. Utilization of Functional independence measures, namely, the Barthel index and modified Rankin scales were increased in 2018 compared to 2013. Conclusion: The majority of post-stroke rehabilitation services are not improved since 2013. Consistent national programs and policies are required to provide adherence to post-stroke rehabilitation guideline recommendations and implementation in clinical practice.

Evidence-Based Physiatry: The Center for Disease Control Guideline on Pediatric Mild Traumatic Brain Injury and the Expanded Role of Physiatry.

A mild traumatic brain injury (mTBI) or concussion is the most commonly occurring type of traumatic brain injury in adults and children. Between 2005 and 2009, the United States Center for Disease Control estimated 2–3 million pediatric mTBI-related emergency department and primary care visits occurred. Although there are subtle variation in definitions of mTBI, a consensus has formed around defining this injury as an acute neurological disturbance manifesting with confusion and/or disorientation after a mechanical force to the head and meeting the following parameters: (1) length of loss of consciousness of less than 30 mins; (2) posttraumatic amnesia less than 24 hrs; and (3) a Glasgow Coma Scale of 13–15, 30 mins after injury or at time of presentation to medical care. Guidelines have emerged to direct treatment of specific groups that commonly sustain mTBI, such as the Consensus Statement on Concussion in Sport directed at student athletes, the Ontario Neurotrauma Foundation guidelines for those with mTBI and persistent symptoms, and Veteran’s Affairs/Department of Defense guidelines for mTBI in military service members and veterans. However, evidence based guidelines for pediatric mTBI in the United States were lacking until the most recently published Center for Disease Control Guideline on the Diagnosis and Management of mTBI among Children (https://www.cdc.gov/media/releases/2018/p0904-tbi-guidelines.html).1 GUIDELINE DEVELOPMENT AND METHODOLOGY The new Center for Disease Control guideline is a set of 19 recommendations based on a systematic review of the literature and expert consensus. Clinical questions were developed by the Pediatric Mild Traumatic Brain Injury Work Group, a panel of experts that included rehabilitation specialists and physiatrists. Guidelines were developed in three clinical areas diagnosis, prognosis, and management/treatment. A systematic review of pediatric mTBI and related topics from 1990 to 2015 was conducted using the American Academy of Neurology Guidelines. Each recommendation was based on evidence obtained in the systematic review as well as other relevant scientific information and expert opinion deemed significant by the work group. This work considered strength of evidence as well as additional factors, such as the risks and benefits of the recommendation, importance of the recommendation, feasibility, patient preference, and financial cost. WHAT ARE THE HIGHLIGHTS IN THE NEW GUIDELINES? These guidelines outline a series of practical and feasible recommendations for emergency department, primary care, and specialty providers focusing on readily available mTBI assessment tools, early identification of poor prognostic factors, and education and active rehabilitation as mainstays of treatment. A complete list of recommendations is located in the guideline supplement and patient and family resources are available online (https://www.cdc.gov/traumaticbraininjury/PediatricmTBIGuideline.html).1 In summary, the guideline recommends against the routine use of neuroimaging or serum based biomarkers for diagnosis of mTBI, except when intracranial injury is suspected. Age-appropriate symptom inventories and computer-based cognitive testing should not be used alone but in conjunction with clinical assessment. In the area of prognosis, the guidelines strongly support education of patients and families about the general course of recovery in pediatric mTBI (1–3 mos) and risk factors that are associated with prolonged recovery (premorbid conditions, injury, and noninjury-related factors). Close monitoring of individuals with multiple risk factors for prolonged symptoms and referral to specialty care within 4–6 weeks of injury if symptoms persist. The guidelines strongly support education of patients and families regarding warning signs in the acute period, the emergence of postconcussive symptoms, prevention of a second, overlapping head injury, and guidance for return to school and activity. Although rest was once the mainstay of concussion treatment, the guideline emphasizes a brief period (2–3 days) of reduced activity in the acute period followed by a gradual return to school and noncontact physical activity that does not exacerbate symptoms. The guideline supports the use of individualized return to school plans based on symptom severity and highlights the importance of a collaborative effort in return to school recommendations. Referral specialists and formal neuropsychological testing is recommended in students struggling with return to school or with persistent cognitive symptoms, respectively. Treatment recommendations focus on multidisciplinary care and dedicated symptom-based treatments for acute and chronic headache, sleep dysfunction, and vestibular and oculomotor symptoms are provided. WHY IS THIS RELEVANT TO PHYSIATRISTS? Physiatrists are uniquely positioned to care for children with mTBI because of their role in leading multidisciplinary rehabilitation teams and their specific clinical expertise in pediatric rehabilitation, sports medicine, and traumatic brain injury. The guideline recommends referral to specialty and rehabilitation care in the early subacute period meaning that the number of children with mTBI referred to specialists, such as physiatry, will likely increase. The guideline supports a paradigm shift in the treatment of mTBI from a rest and recover model to an active rehabilitation, symptom-based approach including physical activity, cognitive activity, and specialized rehabilitation (i.e., vestibular). Such an approach is an ideal forum to leverage physiatric skills.

Международная классификация функционирования, ограничений жизнедеятельности и здоровья (МКФ) и культурно-деятельностный подход Л.С. Выготского–А.Н. Леонтьева–А.Р. Лурии

The actual problem of implementation and use of the International Classification of Functioning, Disability and Health (ICFDH) in the work of clinical psychologists taking into account Russian psychological tradition discussed. There is a necessity of operationalizing the ICFDH domains for specialists of the multidisciplinary rehabilitation team, which will facilitate the use of the ICFDH in rehabilitation work for diagnosis, planning and implementing the rehabilitation program and evaluating its effectiveness. The operationalization of the ICFDH domains based on clinical and psychological content is considered. The cultural-activity approach as a methodological basis of clinical and psychological rehabilitation is proposed and the relationship of the major components of the ICFDH with the psychological activity structure (according to A.N. Leontiev) discussed. The different levels of human functioning considered in the ICFDH (in particular, functions, activity, participation) are compared with the levels of activity (psychophysiological functions, operations, actions and activities) according to A.N. Leontiev. It is argued that the process of clinical and psychological rehabilitation can only take place at the level of concrete actions, and not at the level of activity or operations.