Public Rehabilitation Research Articles

Job functions of Swedish public and private sector vocational rehabilitation workers

Purpose. This study has had two main aims, the first to investigate and gather knowledge of the major job functions of Swedish rehabilitation workers, the second to study the frequency of use of these functions in the VR process.Method. Structured questionnaires were sent to Swedish rehabilitation workers from public and private sectors. To identify the major dimensions of Swedish rehabilitation workers' job in the vocational rehabilitation (VR) process, a principal component factor analysis was performed.Results. Results revealed that there are four main factors (dimensions) that comprised the VR process in Sweden. The four factors (dimensions) are job development and career counselling; assessment and counselling interventions; workplace adjustment and employer consultation and client support, personnel development and public relations.Conclusions. The VR process in Sweden is limited in both its scope and depth. This when one compares with the results of studies carried out in the USA, who found seven and six dimensions, respectively. It is argued that it cannot be excluded that the negative trend of extensive sick leave and early pensions are attributable to the limitations in the VR process that have been found. Suggested is the urgent need to put resources in place that would support the further advancement of the knowledge and competencies of the VR services in Sweden.

Complementary and alternative health care use in young children with physical disabilities waiting for rehabilitation services in Canada

Purpose. We wished to determine the frequency of complementary and alternative health care (CAHC) use in preschool aged children with physical disabilities (PD) waiting for public rehabilitation services in the province of Quebec (Canada), to evaluate its effectiveness from the parents’ perspective and to explore factors associated with its utilisation.Method. Children with PD referred to rehabilitation centres from two Montreal hospitals were recruited. We evaluated the use of CAHC and its effectiveness from the parents’ perspective in a cross-sectional manner, using descriptive statistics. We explored factors associated with utilisation, using logistic regression models.Results. In this group of children widi PD(n = 206, mean age: 2.6 years), 31 (15%) used CAHC and 15 (48.4%) of those tried more than one type. CAHC was considered at least moderately beneficial by parents in 53% of the cases. The use of CAHC was higher among children with low health-related quality of life (HRQOL) and children whose mothers were more educated and considered themselves as Canadian (p < 0.05).Conclusions. Although the use of CAHC by young children with PD was low, use of CAHC was higher among children with lower HRQOL and whose mothers were highly educated and Canadian. CAHC use should be evaluated by health providers to better educate parents of children with PD, which may help them to make the best decisions regarding their child’s treatment while waiting for rehabilitation services.

Rehabilitation Counseling in the State or Federal Program: Is There a Future?

Rehabilitation counseling has played a significant role in the public rehabilitation program since its inception. Rehabilitation educators have also been critical in this partnership. This article reviews current trends in the relationships between public rehabilitation agencies, university programs, accreditation bodies, and others to dicuss future potential paths. Also reviewed are current expectations for skills and opportunities for rehabilitation counselors in the state/federal vocational rehabilitation programs. Opposing alternatives for how these relationships may affect the future of rehabilitation counseling practice are suggested.

Collaborative Relationships Between Vocational Rehabilitation and Other One-Stop Partners

The Workforce Investment Act (WIA) brought together federal job training and employment programs to create one comprehensive service system. Among WIA’s core tenets are streamlined services to be developed, designed, and implemented by a variety of mandated and nonmandated partners. The public Vocational Rehabilitation (VR) agency is a mandated partner, and the only one that focuses on disability. Although the intention of WIA was mutual benefit and interaction, the exact nature of the VR partnership with the One-Stop varies. Using a longitudinal research design and case study method, collaborative relationships between other partners in the One-Stop and VR in six U.S. locations was explored. The findings uncovered four models of collaboration: full-time colocation of a few VR staff members, colocation in the same building complex, itinerant staffing, and limited itinerant staffing. There were a number of barriers to collaboration and strategies used in and among the various models to facilitate involvement of VR.

Atlas of Human Malaria (Atlante della Malaria Umana)

Peter A. Leggat MD, PhD, DrPH, FAFPHM, FACTM, FFTM ACTM, FFTM RCPS (Glasg),Professor and Head , School of Public Health Tropical Medicine and Rehabilitation Sciences James Cook University, Townsville Queensland , Australia. 1st Ed, (viii) + 203 pp, hardcover, €60.00, ISBN 978–88–902892–0–0, Az Color SRL, Sirmione, Italy, 2007. Malaria is one of the most serious of the tropical diseases with more than 500 million cases and 1 million deaths annually.1 About 40% of the world’s population, mainly in some of the poorest countries, are at risk of malaria, and it is a problem for tourists, military personnel, expatriate workers, and those visiting friends and family, traveling to countries where the disease is endemic. For the many who must regularly deal with parasitic diseases, then, an atlas is an invaluable aid, particularly an atlas dedicated to human malaria. At last, a definitive work is dedicated to the microscopic diagnosis of malaria and the related parasitic disease, Babesiosis. This first edition of the Atlas of Human Malaria has a Preface (unusually not written by the authors), a Foreword by Professors Lawrence R. Ash from the University of California Los Angeles and Thomas C. Orihel from Tulane University, Acknowledgments, a Table of Contents, an Introduction, some theoretical background concerning malaria and its life cycle, some technical information on laboratory diagnosis of malaria, over 450 photomicrographs, detailed notes on the appearance of various stages of the malarial parasite …

Three model curricula for teaching clinicians to use the ICF

Purpose. Three systematic programmes to train health professionals to use the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) are described, along with efforts to evaluate their effectiveness.Methods. The first programme was a randomized study comparing the effects of a 2-hour instructor-led programme and a self-directed learning module on ICF-related knowledge, attitudes, and coding skills among occupational therapy graduate students. The second programme was a series of intensive 3.5-day workshops for public sector rehabilitation professionals in South Africa. The third programme involved a series of internet-based teaching modules regarding the ICF for graduate students in rehabilitation counselling.Results. The first project found that both instructor-led and self-guided training formats were effective in improving basic ICF-related knowledge, but only instructor-led training led to a significant improvement in coding skill. It also had more positive effects on ICF-related attitudes. This approach to learning assessment was generalizable to multidisciplinary health professionals in South Africa, who achieved a relatively high degree of coding accuracy after the 3.5-day workshop. Participant evaluations supported the structure, content, and length of the training. Students in the third programme also reported a very positive learning experience and positive views of the ICF.Conclusions. An empirical basis is important for identifying the best and most efficient training methods for particular audiences and specific purposes. The length and format of training can be differentially related to specific training goals (i.e., knowledge, attitudes, and coding skills). Interactive distance learning methods may help to overcome the weaknesses of self-directed training in comparison to face-to-face training.

A Microeconomic Model of the Personnel Shortage in Public Rehabilitation Agencies

A Microeconomic Model of the Personnel Shortage in Public Rehabilitation Agencies

Outcome Discrepancies Among Racially/Ethnically Diverse Consumers of Vocational Rehabilitation Services: Summary and Critique of the Literature

This article summarizes 27 studies that sought to investigate the experiences of various racial/ethnic minority groups in the public vocational rehabilitation agency. Spanning the years since the 1992 Amendments to the Rehabilitation Act, this body of research has identified and defined a significant question: are the experiences and outcomes of consumers who identify as racial/ethnic minority members different from consumers of the majority culture? Did the amendments to the Rehabilitation Act affect a change in outcome discrepancies? A critique of the various methodologies is presented, including: the use of archival data; the use of univariate, non parametric statistics; and the lack of precision in defining/operationalizing the independent variable of race/ethnicity. The use of hierarchical linear modeling is advocated since many variables of interest can be studied simultaneously. A brief summary of the researchers' recommendation of ways in which to provide higher quality outcomes is presented.

Job Burnout Among Public Rehabilitation Counselors

Job burnout among public rehabilitation counselors was explored using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), which measures three components of burnout: (a) emotional exhaustion, (b) depersonalization, and (c) personal accomplishment. Using multiple regression analyses, perceived administrative support was predictive (p &lt; .001) of both emotional exhaustion and depersonalization. Having clearly defined work procedures was predictive (p &lt; .05) of personal accomplishment. Using a 2 (gender) X 2 (race) X 2 (certification status) X 2 (agency location) X 2 (work setting) X 3 (type of degree) X 2 (partnered status) MANOVA. White counselors were found to have higher levels (p &lt; .05) of emotional exhaustion and depersonalization than African American counselors.

Consumers with a disability of substance abuse: Exploring beliefs impacting placement

Given the increased prevalence of substance abuse among U.S. citizens, this study utilized the Theory of Planned Behavior to explore the beliefs influencing the placement of consumers with a disability of substance abuse. Based on the Theory of Planned Behavior, the Disability of Substance Abuse survey was developed and administered to 163 public rehabilitation placement professionals with active caseloads. Participants identified nine outcomes of placement which included increased consumer self-esteem and opportunity for consumer success; reported three groups of persons influencing placement decisions; and delineated nine impediments to placement which included consumer lack of support systems and consumer misdemeanor and arrest history. The findings suggest public rehabilitation placement professionals perceived the placement of persons with a disability of substance abuse as beneficial; however, their behavior was influenced by (a) rehabilitation placement peers in their agency, (b) employers with whom they work, and (c) impediments to, rather than resources for, placement.

Development of a Music Therapy Service in an Australian Public Rehabilitation Hospital

It is often challenging to find information about the details and development of clinical music therapy programs in other parts of the world. This article addresses a gap in the literature by describing the evolution of a neurological rehabilitation program over the past two years in Melbourne, Australia. After providing some local details on the development of rehabilitation music therapy in this part of the world, a brief rationale is offered for the place of music therapy in clinical rehabilitation services. This is followed by a detailed description of the implementation, operation and evaluation of the music therapy program established at the Royal Talbot Rehabilitation Centre in 2004. Music therapy in adult neurological rehabilitation is still an emerging area of practice in Australia. Although the first music therapy service for adult rehabilitation was piloted and developed here over 13 years ago, few rehabilitation facilities currently employ music therapy as a standard part of rehabilitation service. Although research and practice of music therapy in rehabilitation internationally is relatively new, it has been practiced for around 20 to 30 years in the United Kingdom and the United States of America respectively. The scarcity of music therapy positions in rehabilitation facilities in Australia is possibly a reflection of the lack of understanding of music therapy on the part of funding bodies and the shortage of rigorous music therapy research in this field. The establishment of new music therapy positions in rehabilitation facilities reflects the development of music therapy in neurorehabilitation internationally in terms of research, clinical practice and publications.

Predicting employment outcomes of rehabilitation clients with orthopedic disabilities: A CHAID analysis

Purpose. To examine demographic and service factors affecting employment outcomes of people with orthopedic disabilities in public vocational rehabilitation programs in the United States.Method. The sample included 74,861 persons (55% men and 45% women) with disabilities involving the limbs or spinal column who were closed either as rehabilitated or not rehabilitated by their state-run vocational rehabilitation agencies in the fiscal year 2001. Mean age of participants was 41.4 years (SD = 11.2). The dependent variable is employment outcomes. The predictor variables include a set of personal history variables and rehabilitation service variables.Results. The chi-squared automatic interaction detector (CHAID) analysis indicated that job placement services significantly enhanced competitive employment outcomes but were significantly underutilized (only 25% of the clients received this service). Physical restoration and assistive technology services along with support services such as counseling also contributed to positive employment outcomes. Importantly, clients who received general assistance, supplementary security income, and/or social security disability insurance benefits had a significant lower competitive employment rates (45%) than clients without such work disincentives (60%).Conclusion. The data mining approach (i.e., CHAID analysis) provided detailed information and insight about interactions among demographic variables, service patterns, and competitive employment rates through the segmentation of the sample into mutually exclusive homogeneous subgroups.

Meeting manpower needs and competency in Quebec through partnership

The goal of this long-term project is to fulfill present and future rehabilitation personnel needs in a 7-million population province by implementing a university training program in Orientation and Mobility and Rehabilitation Teaching. A study conducted at the government level of Quebec in 2001 stated that, as the actual workers in the field will retire massively between years 2009 and 2016, newly trained personnel in the field of visual impairment would need to integrate the field by that time. A competency-based graduate level university personnel training program was developed and implemented by the École d'optométrie of the Université de Montréal. Considering a strong expertise in the field developed in the past 25 years and a unique public rehabilitation model throughout the province, the training program established partnership with the field, a partnership that shows promises for the future. The program strives for professional standards set in the field of visual impairment in order to prepare a new wave of leaders able to meet future challenges.

Correlates of Job Placement Practice

The Theory of Planned Behavior (TPB) was used to study the factors that influence the intention of public rehabilitation counselors to place consumers living with AIDS into jobs. Participants completed the Rehabilitation Counselor Intention to Place Survey, which was based on 2,089 elicited salient job placement beliefs of 155 public rehabilitation job placement professionals. Rehabilitation Counselor Intention to Place Survey measures of attitudes, influential referent groups, and impediments to job placement were validated, and significant correlations with intention were identified. Hypotheses were developed within the guidelines of the TPB to examine the influence of attitude, referent groups, and impediments to job placement when placing a consumer living with AIDS into a job. The constructs of attitude and referent groups were significant predictors of the intention of public rehabilitation counselors to place consumers living with AIDS into jobs and suggest direction for further applications of the TPB in vocational rehabilitation research.

Reliance on visual information after stroke. Part II: effectiveness of a balance rehabilitation program with visual cue deprivation after stroke: a randomized controlled trial

Bonan IV, Yelnik AP, Colle FM, Michaud C, Normand E, Panigot B, Roth P, Guichard JP, Vicaut E. Reliance on visual information after stroke. Part II: Effectiveness of a balance rehabilitation program with visual cue deprivation after stroke: a randomized controlled trial. Arch Phys Med Rehabil 2004;85:274–8. Objective To test the hypothesis that balance rehabilitation with visual cue deprivation improves balance more effectively than rehabilitation with free vision. Design Single-blind, randomized controlled trial. Setting Public rehabilitation center in France. Participants Twenty patients with hemiplegia after a single-hemisphere stroke that occurred at least 12 months before the study. Intervention Patients were randomly assigned to 1 of 2 balance rehabilitation programs—with and without visual cue deprivation. In all other respects, the programs were identical. Each lasted for 1 hour and was implemented 5 days a week for 4 weeks. All patients completed the program. Mean outcome measures Balance under 6 sensory conditions was assessed by computerized dynamic posturography (EquiTest), gait velocity, timed stair climbing, and self-assessment of ease of gait before and after program completion. Results After completing the program, balance, gait velocity, and self-assessment of gait improved significantly in all patients. The improvements in gait velocity ( P=.03) and timed stair climbing ( P=.01) correlated significantly with improved balance. Balance improved more in the vision-deprived group than in the free-vision group. Conclusions Balance improved more after rehabilitation with visual deprivation than with free vision. Visual overuse may be a compensatory strategy for coping with initial imbalance exacerbated by traditional rehabilitation.

Reliance on visual information after stroke. Part I: balance on dynamic posturography

Bonan IV, Colle FM, Guichard JP, Vicaut E, Eisenfisz M, Tran Ba Huy P, Yelnik AP. Reliance on visual information after stroke. Part I: Balance on dynamic posturography. Arch Phys Med Rehabil 2004;85:268–73. Objective To test the hypothesis that postural imbalance after stroke may be caused by inability to use pertinent somatosensory, vestibular, or visual information. Design Description of the sensory organization of patients with hemiplegia. Setting Public rehabilitation center in France. Participants Forty patients with hemiplegia after a single hemisphere stroke who were at least 12 months poststroke. Interventions Not applicable. Main outcome measures The patients performed computerized dynamic posturography (EquiTest), which is designed to assess a patient’s ability use sensory inputs separately and to effectively suppress inaccurate inputs in case of sensory conflict. Body stability under each of 6 sensory conditions was assessed by an equilibrium score (ES). Results In conditions of altered somatosensory information, with visual deprivation (ES5) or visuovestibular conflict (ES6), the median scores for patients with hemiplegia (ES5–43; ES6–20) were significantly lower than those for normal subjects (ES5–69; ES6–67). Conclusions Many patients with hemiplegia seem to rely on visual input. The mechanism of this excessive visual reliance is discussed. Rehabilitation programs of postural control for the patients with hemiplegia should take into account the possible impairment of sensory organization and should include exercises to be performed under conditions of sensory input deprivation and sensory conflict.

What could be considered a successful city of tomorrow

The author, an architect, is currently President of the International Union of Architects (UIA) and has played an active part in the variousactivities of the Union as a member of the UIA Council between 1985 and 1990, then Vice President for Region II from 1990 to 1993 and Secretary General from 1993 to 1999. Born in Athens (Greece), Vassilis Sgoutas graduated from the University of Cape Town in 1957 and has his own practice in Athens. Projects carried out both in Greece and the Middle East include public buildings, industrial architecture, commercial buildings, hospitals, rehabilitation centers, restoration work and landscape architecture. He has won numerous awards in competitions including 2 of 30 ex-aequo prizes awarded by the Greek Ministry of Public Works for the best buildings of the period 1973-1983 and the Ministry of Environment ex-aequo award for innovative housing. He was President of the Greek Section of the UIA from 1981 to 1993 and has been a representative Council Member of the Technical Chamber of Greece (TEE) since 1984. He is actively involved in matters related to the environment and the disabled. He was a member of the EEC Helios Committee for the Handicapped (1989-1993); member of the Experts Committee for the "European Manual for an Accessible Built Environment" (1990) and the "European Concept for Access" (1995). He is a Board member of the Athens Forest Association and the Greek Spastics Society and a member of the World Society for Ekistics (WSE). The text that follows is an edited and revised version of an address by the author in his capacity as President of UIA to the annual General Assembly of the WSE following the WSE Symposion "Defining Success of the City in the 21st century," Berlin, 24-28 October, 2001.

Rehabilitation Outcomes, Expenditures, and the Provision of Assistive Technology for Persons with Traumatic Brain Injury

This study examined differences in public vocational rehabilitation outcomes (i.e., closure status and weekly earnings) and expenditures for persons with traumatic brain injury (TBI) based on the provision of assistive technology. The sample consisted of 1,145 consumers with TBI whose cases were closed in a southeastern state. Thirty of these consumers received assistive technology during the vocational rehabilitation process. Significant differences were found in closure status and vocational rehabilitation expenditures for consumers with TBI when comparing those who were provided assistive technology with those who were not. No significant differences in weekly earnings were found when comparing the two groups.

Clinical Supervision in Public Rehabilitation Counseling Settings

The present study examined clinical supervision in posteducational rehabilitation counseling settings. The purpose of the study was twofold: to assess the current practice of clinical supervision in the public sector and to empirically validate a model of supervision within the context of a posteducational setting. Current clinical supervisory models and practices, as well as factors that affected the quality of the supervisory working alliance, are discussed.

PROGRAM

Who Should Attend?Persons with disabilities and their family members Special education teachers, regular classroom teachers, and school administrators University professors and researchers Occupational / Physical Therapists Speech/ Language Pathologist Nurses/Physicians Alternative & Augmentative Communication clinicians Manufacturers, distributors, and developers Community agency personnel Government policy makers/lawmakers Private and public rehabilitation service providers Rehabilitation Engineer Assistive Technology Practitioners and Suppliers Employers and human resource specialists