Ongoing Rehabilitation Research Articles

Assessment and remediation of perceived handicap in subjects with acquired hearing impairment

In a treatment-comparison group design, a group-rehabilitation program developed for hearing-impaired individuals and their close relatives was evaluated. The majority of subjects had hearing loss from noise exposure. The aim of the program was to give adequate information, psychosocial support, and training for effective coping strategies. Sixty-six consecutive patients at the hearing clinic were included in a pilot study. Standardized questionnaires, intended to measure ‘‘perceived handicap,’’ ‘‘social support,’’ ‘‘perceived negative attitudes,’’ ‘‘acceptance of hearing loss,’’ and ‘‘communication strategies’’ (maladaptive behavior, verbal strategies, and nonverbal strategies), were used at the end of the last group session (short-term evaluation) and with postal questionnaires four months later (long-term evaluation). The evaluation showed that the use of maladaptive behavior (e.g., guessing, pretending to hear, and avoiding interactions) was significantly decreased in the treatment group in a short-term as well as in a long-term perspective (p=0.000 and p=0.032, respectively). The use of verbal strategies was significantly increased in the treatment group after the rehabilitation (p=0.020), but this increase did not reach a significant level four months later. Self-reported handicap was decreased in some conditions. Presently, data from ongoing rehabilitation groups are assessed and statistical data analysis will follow.

The psychosocial consequences of motor vehicle accidents

Motor vehicle accidents are extremely common in Australia and generate large social costs. The survivors of these accidents frequently sustain significant permanent disabilities that require ongoing treatment, rehabilitation, and community care. However, the psychosocial consequences of motor vehicle accidents are usually overlooked. For many survivors of motor vehicle accidents, the trauma and psychological or emotional difficulties they experience can be devastating. Socially and vocationally, the losses associated with motor vehicle accidents can be extensive, particularly if a permanent disability has been sustained. Despite the size and potential cost of the problems associated with motor vehicle accidents, this area has been adequately studied as a source of loss and grief. Given that psychosocial problems can hinder the rehabilitation process, workers must be aware of the adjustment problems that are likely to arise from this type of loss. Accordingly, the aim of the current article is to review the available literature concerning the psychosocial consequences of motor vehicle accidents. It is suggested that motor vehicle accidents warrant specific research attention to determine which factors might assist this population to adjust to their losses and to ensure that efficacious and cost-efficient rehabilitation interventions can be developed.

Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke

Objective: To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke, supervised once a week by therapists. Design: A randomized controlled trial of 100 patients discharged from hospital after a stroke, requiring ongoing therapy. The control group received outpatient or day hospital therapy; the experimental group were visited once a week by an occupational and/or physiotherapist who prescribed a programme of exercises and activities for the following week. Subjects were studied for the first three months after discharge from hospital. Setting: A district general hospital, or the homes of subjects randomized to the experimental group, in New Zealand. Main outcome measures: (1) Characteristics of the groups, (2) gait speed, limb function, activities of daily living, (3) time with therapists, (4) mood of both subjects and caregivers, (5) anticipation of outcome at entry, compared with perceived outcome at exit. Results: No statistical differences between the control and experimental groups in characteristics, or in any outcomes measured, except that the contact time period, but not the number of visits, was longer in the experimental group (p = 0.003). Conclusions: A supervised home-based programme is as effective as outpatient or day hospital therapy.

Planning for the recovery of Lake Toolibin, Western Australia

Lake Toolibin, an intermittently flooded freshwater wetland in the southwest of Western Australia, is threatened by salinization due to extensive clearing within its catchment. The lake is a Wetland of International Importance under the Ramsar Convention because of the extensive stands of trees on the lake bed and its significance as a waterbird breeding site. Past research and monitoring have identified the causes of wetland vegetation and water quality decline and this information has been used to design a Recovery Plan for the lake. The plan is currently in the early stages of implementation and includes both short-term engineering measures to reduce salinity within the lake and long-term rehabilitation measures within the catchment. Community involvement in the recovery process is an integral part of the plan and ensures that recovery of the lake remains as the focus for ongoing catchment rehabilitation.

The challenge of sobriety: natural recovery without treatment and self-help groups.

Natural recovery is a phenomenon that is not understood and largely challenged by self-help group members and professionals working in the field of substance abuse. So strong is the supposition of the process of recovering as a life-long condition that requires treatment and/or a self-help group for on-going support and rehabilitation that recovery on one's own is given little credence. Yet there is growing empirical evidence that natural recovery not only exists, but may be more prominent than is currently recognized. This article presents a study of natural recoverers from alcoholism and problem drinking, reporting their subjective motivating factors and strategies of recovery, while examining an issue of which there is still limited data--the perceived changes since abstaining, i.e., how their lives have been altered by pursuing abstinence on their own. It concentrates on rich narrative data to explore the meaning of the change experience that can be applied to various addictions, for the purpose of illuminating novel approaches that have the potential for expanding practice techniques and forums, thereby enhancing its effectiveness.

Developments in the Swedish Early Retirement Scheme: The Drive Against High Welfare Expenditure and Ill-health

ABSTRACTThe social insurance system has been an important element in the Swedish welfare model. However, in Sweden as in other Western countries there is an ongoing discussion about the rationality of the post-1940 welfare state. A social right or benefit constantly debated is the right to an early retirement pension. The value of such an early retirement pension has been questioned from economical as well as social or human points of view. The purpose of this article is to shed light on different processes behind the increasing number of early retirement pensioners and on the ongoing rehabilitation programmes in Sweden. A question that will arise: Is there a possible margin of gains from the interventions of the rehabilitation programme?

Dynamic Testing Procedures for Highway Bridges Using Traffic Loads

Dynamic bridge testing techniques used at the University of Sherbrooke on a series of highway bridges in the province of Quebec, Canada, are presented. These procedures were developed to obtain a reliable evaluation of the dynamic amplification factor for existing bridges, as part of an ongoing rehabilitation program of the province's road network. Vertical acceleration responses are obtained under normal or controlled traffic using different test vehicles and loading patterns. The vibration frequencies and mode shapes are calculated from a frequency analysis of the measured data, and used to calibrate finite-element models for each structure. The experimental methods and data-processing techniques are described. The need to establish standard testing procedures is discussed and some recommendations are presented. Examples of test results and comparisons with finite-element eigenvalue analyses are given for three different bridges.

Pharmacological treatment of arousal and cognitive deficits

With the increasing survival of patients with traumatic brain injury (TBI), there is a growing recognition of the severity and heterogeneity of associated cognitive problems. Cognitive impairments ranging from arousal and attentional decrements to memory problems and various disorders of speech and language provide significant obstacles to the ongoing rehabilitation effort. One approach to ameliorating cognitive deficits is to intervene pharmacologically in an effort to effect symptomatic change via neurochemical alteration. In this review we discuss the therapeutic rationale and use of various classes of drugs including stimulants, dopaminergic agents, cholinergic agents, and antidepressants for the cognitive deficits that are apparent within a wide range of patients with acquired brain injury. A thorough review of literature pertaining to TBI is emphasized while necessarily including some studies from other populations. Recommendations based on findings within the literature are suggested as well as an overview on clinical use and monitoring of individual agents.

Interinstitutional agreement of individual functional independence measure (FIM) items measured at two sites on one sample of SCI patients.

Individual items of the Functional Independence Measure (FIM) were analyzed for interinstitutional agreement using a sample of 57 spinal cord injured (SCI) patients at discharge from an acute care rehabilitation setting (ACRS) and at admission to an ongoing rehabilitation setting (ORS). The two FIM ratings were performed within 6 days of each other. The reliability coefficient for total FIM scores was good: 0.83. Individual items were classified into four groups: (1) above average reliability coefficient, above average proportion agreement, which included the feeding items and items from the mobility category; (2) above average reliability coefficient, below average agreement, which included the majority of items in the selfcare category; (3) below average reliability coefficient, above average agreement, which included items in the sphincter control and communication categories; and (4) below average reliability coefficient, below average agreement, which included items in the social cognition category. Patients received significantly higher ratings on most selfcare items in the ACRS, and significantly higher ratings on social cognition items in the ORS. Implications of these results are discussed in terms of using individual FIM items for research purposes. Reliability coefficients were acceptably high for subgroups of complete and incomplete paraplegics and for complete quadriplegics, ranging from 0.74 to 0.87, but low for incomplete quadriplegics, r = 0.49. However, these sample sizes were small, ranging from 9 to 17 patients. Data collection will continue in order to increase sample size and permit further analysis of these subgroups.

Evaluation of coma and vegetative states.

The Coma/Near-Coma (CNC) scale was designed to measure small clinical changes in patients with severe traumatic and nontraumatic brain injuries who were functioning at very low levels characteristic of near-vegetative and vegetative states. In 20 patients followed for 16 weeks the scale identified 25% who ultimately showed modest improvement. Interrater reliability was high (r = .95); validity was supported by significant correlations between CNC- and brain-multimodality evoked potential abnormality scores as well as between scores on the CNC and the Disability Rating Scale. The CNC scale was easily learned and it could be completed quickly and cost effectively. Staff found it useful in recognizing among relatively homogeneous low-level patients those most likely to respond to further rehabilitation care. The CNC appears to be useful for justifying ongoing intensive rehabilitation and for preventing premature transfer to lower levels of care.

The Bioeconomics of Resource Rehabilitation: A Commercial-Sport Analysis for a Great Lakes Fishery

We construct a fishery model which simulates: (a) stochastic population fluctuations and (b) harvest shifts between commercial and sport user groups. This model then assesses, for both commercial and sport harvesters, the bioeconomic impact of an ongoing rehabilitation plan for the yellow perch fishery of Green Bay, Lake Michigan. Overall economic gains from this plan are positive, with sport anglers reaping sizeable benefits, while commercial harvesters lose moderately. Using probing exercises which approximate economic optimization, the efficient allocation of harvest between sport and commercial user groups is also explored. Uncertainties about sport effort levels greatly influence this optimal allocation.

Pressure Therapy for the Control of Hypertrophic Scar Formation after Burn Injury

Devastating functional problems can result from the formation of hypertrophic scar tissue after burn injury. Although a patient with burns may have several medical problems to contend with because of the injury, most ongoing rehabilitation difficulties are a consequence of the continual wound contraction that occurs in immature burn scars. Treatment of hypertrophic burn scar consists of several surgical options and of pressure therapy, which traditionally involves wearing garments made from elasticized fabric. This article reviews the treatment of hypertrophic scar tissue, with emphasis on its history and on nonsurgical methods of managing the burn scar.

Goal attainment scaling and outcome measurement in postacute brain injury rehabilitation.

Relationships among two-month and final goal attainment scaling (GAS) scores, preadmission and final Portland Adaptability Inventory (PAI) scores, and work outcome for 16 graduates of a comprehensive, postacute brain injury rehabilitation program were examined. Final GAS scores were higher for program graduates who obtained the most desirable work outcomes, and preadmission and final PAI scores were lower for the successful program graduates. Final GAS scores were significantly correlated with other outcome measures. Preadmission PAI scores predicted work outcome, and two-month GAS scores predicted final GAS scores. Initial PAI scores distinguished between program successes and failures, but not between program successes and dropouts. A brief look at one case illustrates the modified application of GAS in postacute brain injury rehabilitation. Results of this study and case analyses support GAS as a quantifiable, individualized measure that is useful for (1) monitoring patient progress, (2) structuring team conferences, (3) ongoing rehabilitation planning and decision-making, (4) concise, relevant communication to family, referral sources, and funding sources, and (5) overall program evaluation when used in the context of other objective outcome measures. Although our results support the clinical utility of GAS, further study is recommended to assess the psychometric characteristics of GAS in this application.

The Identification and Treatment of Alcohol Abuse and Dependency

AbstractRecent epidemiologic and clinical studies have shown that alcohol abuse and dependence are highly prevalent. Careful assessment of drinking habits and related problems is warranted in all patients presenting with either medical or psychiatric complaints. Once a diagnosis of abuse or dependence is made, treatment can be individualized to address the specific needs of the patient, including the potential for alcohol withdrawal and factors relevant to ongoing rehabilitation. The treatment of alcohol withdrawal requires attention to concomitant medical disorders, that if neglected can exacerbate the withdrawal reaction. Good supportive care is generally adequate for the treatment of mild-to-moderate withdrawal reactions. Medications that are cross-tolerant with alcohol (e.g. benzodiazepines) are indicated for moderate-to-severe withdrawal. Alcoholism rehabilitation, while in general shown to be beneficial, consists of a wide variety of treatment settings and therapeutic approaches. There is little evi...

Relatives and Patients as Partners in the Management of Schizophrenia

Considerable advances have been made in the family management of schizophrenia but there remains a major challenge for the psychiatric services to integrate these innovations into clinical practice. A number of important issues need to be considered in developing routine clinical services: the problem of engaging families in a therapeutic programme; the utility of the concept of 'expressed emotion'; and procedures for clinical practice. The latter include the needs of low-EE families; maintaining quality of intervention in a clinical context; responding to the multiplicity of needs of the patient and family; and integrating family interventions with ongoing rehabilitation practice. A model of service provision is described.

The diagnosis of seventy municipal water supply boreholes in Lima, Peru

Borehole diagnoses were carried out in the wake of declining yields and falling water table in the Lima aquifer. The objective was to evaluate, from a representative sample, the rehabilitation that would be required to restore yields and supply increasing demands. Rehabilitation methods are well described in literature. However, the selection and evaluation of techniques, appropriate in a given hydrogeological context, are not well known. This paper describes the current status of the Lima aquifer and the investigations performed in selecting appropriate rehabilitation. It is a case history of comprehensive diagnosis in 70 boreholes. Seven items of field tests were carried out on each borehole, including pumping tests, downhole closed-circuit TV (CCTV) survey, detailed hydrochemical analyses and pump inspection. Rehabilitation needs were evaluated from standardized analyses of hydrogeological and electrical-mechanical data. An effective plan for ongoing rehabilitation, formulated to sustain future supplies was based on the diagnosis. Rehabilitation, aimed at reducing well losses, increasing the length of water column in the borehole and improving the operating efficiency of pumps are the main recommendations of diagnosis. Yield improvement by 56% and increase of the useful life of boreholes by 10 years has been projected from the diagnosis. The programme of rehabilitation is to be implemented.

REHABILITATION PROGRAMS FOR DRINK DRIVERS: A CRITICAL APPRAISAL

Rehabilitation programs for drink drivers have been implemented throughout Australia in an attempt to reduce alcohol related road traffic accidents. Using a rationale proposed by Tugwell et al., the success of rehabilitation programs as a public health measure was assessed. The evaluative literature was reviewed and a survey of ongoing rehabilitation programs in Australia and New Zealand was undertaken. It was concluded that rehabilitation programs for drink drivers should currently be implemented only with caution, since there is a lack of appropriate data about their operation and effectiveness within Australia. Future research needs are discussed.

Economie Analysis of Fishery Rehabilitation Under Biological Uncertainty: A Conceptual Framework and Application

Using the commercial yellow perch (Perca flavescens) fishery of Green Bay, Lake Michigan, as an example, we outline a conceptual framework for estimating economic gains from fishery rehabilitation in the presence of biological uncertainty. Three steps underlie the framework: (a) identifying the key biological uncertainties which hamper forecasts of stock changes induced by rehabilitation efforts; (b) developing plausible "future biotic states" that encompass these uncertainties and their probabilities of occurrence; and (c) estimating the "expected value" of economic gains for commercial fishers from an ongoing rehabilitation plan across these future biotic states. Using this approach, the expected economic gains for commercial fishers from rehabilitation are found to be roughly zero for most plausible scenarios. Since sport gains under this rehabilitation plan are probably substantial, and other economic impacts (regulatory costs and final consumer effects) appear to be small, the analysis suggests that the overall economic gains from the plan are positive.

Status of Cardiovascular Rehabilitation in Virginia

Hospitals and medical clinics in Virginia were surveyed to determine the status of cardiovascular rehabilitation services. Replies from 87% of the 142 institutions surveyed indicated the existence of 49 programs that consisted of one or more patient phases or clinical units. Nonrespondents were usually psychiatric or small community hospitals. Next, a detailed questionnaire was distributed to these 49 institutions to determine the following: (1) program structure and orientation, (2) level of utilization of existing programs, (3) financial status and third-party insurance coverage, (4) safety practices and procedural considerations, (5) adequacy of equipment and facilities, and (6) level of staffing and staff education. Completed questionnaires were received that described 51 cardiovascular rehabilitation units (CRUs), including five patient education units, at 44 institutions (representing a 90% return rate). The replies suggested the following conclusion: (1) existing programs were diverse in terms of administrative structure and orientation; (2) only a modest fraction of clinically eligible cardiovascular patients in the state receive ongoing rehabilitation services; (3) existing units usually do not produce significant net revenue; (4) third-party insurance coverage is usually only partial, with rigid eligibility requirements; (5) adequate staffing, equipment, safety procedures, and facilities are available in most existing units; and (6) confusion exists with regard to procedures for furthering staff education.

Potential conflict between the coal and arable land resources in australia: A case for corporate responsiveness

Background information on possible surface-coal-mining operations in arable agricultural areas in Australia is provided. The major co-occurrence of the coal and arable land resources was in the Darling Downs region of Queensland and the Liverpool Plains region of New South Wales; however, coal development will probably only occur in the former region over the next decade. Analysis of the situation in the Darling Downs region, which consists of 11 Shires, found five companies conducting prefeasibility projects for surface-coal development and the size of exploration areas concerned far exceeding final mined-land disturbance estimates. Most of the land included in the prefeasibility studies was classified as “arable with moderate crop restrictions requiring intensive management” (classes II–IV). The total area of land that may be disturbed at some time in the future was less than 2% of the arable land in the Shires concerned. Project mutual exclusivity and ongoing rehabilitation of disturbed areas further reduce arable land out of production at any one time. It is suggested that, if self-regulation by the coal industry in Australia on rehabilitation issues is to remain a viable option in these areas, an understanding between the corporate and public sectors on the extent and limitations of its responsibilities must be obtained. The current development of a National Conservation Strategy for Australia should assist this to proceed. Research on various rehabilitation issues may be required prior to project commitment to ensure the responsibilities identified are realizable. Integrative problem-solving, incorporating audit procedures, was suggested as a suitable method to achieve these aims and corporate responsiveness was seen as a necessary first step.