Rehabilitation Readiness Research Articles

Towards a Satisfactory Future—Multiprofessional Rehabilitation for Young Persons with ADHD or ASD

There is a lack of knowledge about what kind of support should be offered in adulthood for persons with attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) to promote inclusive participation in meaningful life domains. The core components of multiprofessional rehabilitation intervention for young adults are explored from the perspective of multiprofessional teams. This qualitative study adopts a pragmatic perspective on the core components of rehabilitation. Twenty-six professionals participated in vignette-based focus group interviews (n = 5), and thematic reflexive analysis was used to abductively analyze the data. A total of ten core components were identified. Nine of them were aggregated into three categories: (1) rehabilitation readiness (two core components), (2) adaptive progress in personal goals (four core components), and (3) rehabilitation continuum (three core components). The overarching tenth core component is focusing on the personal goals of daily life, work, studies, and social interaction. A collaborative relationship between the client and professional is essential to ensure adaptive progress and to foster clients’ self-determination. The focus should be on strengths and solutions instead of deficits and challenges. To establish rehabilitation continuum, it is essential to collaborate within the clients’ networks and to promote awareness and inclusive opportunities for working and studying for people with ADHD and ASD.

Does Wait Time During Acute Care for Transfer to Rehabilitation Admission Impact the Outcomes After a Traumatic Spinal Cord Injury?: A Retrospective Cohort Study.

The objective of this study was to determine the impact of wait time in acute care for inpatient functional rehabilitation admission on the inpatient functional rehabilitation length of stay and functional outcome after a traumatic spinal cord injury. A retrospective cohort including 277 patients admitted to a single level 1 spinal cord injury acute care center was completed. Partial correlations were used between wait time (in days) for transfer to inpatient functional rehabilitation, the inpatient functional rehabilitation length of stay, and the Spinal Cord Independence Measure total score in the chronic period, adjusting for confounding variables. Stratified analyses were carried out based on the age group and severity of the injury. Patients had to wait a mean of 7.3 ± 6.4 days (median = 6 days, interquartile range = 2-10 days, max = 29 days) for inpatient functional rehabilitation admission after rehabilitation readiness, which was not associated with the outcomes when adjusted ( P > 0.05). However, individuals 65 yrs or older with a motor-complete injury showed a lower functional status when exposed to wait time for transfer ( r = -0.87, P = 0.02). Wait time up to 29 days may have no impact on the inpatient functional rehabilitation length of stay nor functional outcome after traumatic spinal cord injury. However, additional resources and/or prioritization should be considered for vulnerable subgroups.

Executive Function Moderates Functional Outcomes of Engagement Strategies During Rehabilitation in Older Adults.

This study examined cognitive, affective, and medical impairments and their impact on rehabilitation approaches for improving functional outcome after hospitalization in older adults. A secondary analysis of a randomized clinical trial in 229 adults 65 yrs or older admitted to two skilled nursing facilities undergoing rehabilitation services was conducted. Patients were randomized to receive physical and occupational therapy by therapists trained in systematic approaches to engage patients, called Enhanced Medical Rehabilitation, or standard of care. The outcome of interest was functional improvement, defined as Barthel Index at discharge (controlling for Barthel Index upon admission). This study analyzed the relationship of measures of cognition, depression, and medical comorbidities as predictors of functional outcome and as moderators interacting with treatment group. Clock drawing score moderated treatment effect size; the functional improvement of Enhanced Medical Rehabilitation over standard of care therapy reduced with increasing executive impairment. In contrast, general cognitive abilities, depression, medical comorbidities, and readiness for rehabilitation were neither predictors nor moderators of functional improvement. For older adults undergoing rehabilitation, greater functional improvement with the motivational techniques of Enhanced Medical Rehabilitation was contingent on patients having intact executive function. Given that executive function impairments are common in rehabilitation populations, new strategies are needed to improve treatment outcomes in physical/occupational therapy. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. Upon completion of this article, the reader should be able to (1) Discuss the role of baseline affective, cognitive, and medical impairments in impacting functional outcomes of older adults undergoing rehabilitation; (2) Describe the behavioral change and motivational approaches that are core features of the novel intervention known as Enhanced Medical Rehabilitation (E-MR); and (3) Determine the role of baseline executive function in moderating the effect of rehabilitation intervention on functional outcomes in older adults. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Comprehensive Stroke Care and Outcomes: Time for a Paradigm Shift.

Worldwide, stroke is prevalent, costly, and disabling in >80 million survivors. The burden of stroke is increasing despite incredible progress and advancements in evidence-based acute care therapies and despite the substantial changes being made in acute care stroke systems, processes, and quality metrics. Although there has been increased global emphasis on the importance of postacute stroke care, stroke system changes have not expanded to include postacute care and outcome follow-up. Our objectives are to describe the gaps and challenges in postacute stroke care and suboptimal stroke outcomes; to report on stroke survivors' and caregivers' perceptions of current postacute stroke care and their call for improvements in follow-up services for recovery and secondary prevention; and, ultimately, to make the case that a paradigm shift is needed in the definition of comprehensive stroke care and the designation of Comprehensive Stroke Center. Three recommendations are made for a paradigm shift in comprehensive stroke care: (1) criteria should be established for designation of rehabilitation readiness for Comprehensive Stroke Centers, (2) The American Heart Association/American Stroke Association implement an expanded Get With The Guidelines-Stroke program and criteria for comprehensive stroke centers to be inclusive of rehabilitation readiness and measure outcomes at 90 days, and (3) a public health campaign should be launched to offer hopeful and actionable messaging for secondary prevention and recovery of function and health. Now is the time to honor the patients' and caregivers' strongest ask: better access and improved secondary prevention, stroke rehabilitation, and personalized care.

Transmission-Mode Ultrasound for Monitoring the Instantaneous Elastic Modulus of the Achilles Tendon During Unilateral Submaximal Vertical Hopping.

Submaximal vertical hopping capitalizes on the strain energy storage-recovery mechanism associated with the stretch-shortening cycle and is emerging as an important component of progressive rehabilitation protocols in Achilles tendon injury and a determinant of readiness to return to sport. This study explored the reliability of transmission mode ultrasound in quantifying the instantaneous modulus of elasticity of human Achilles tendon during repetitive submaximal hopping. A custom-built ultrasound transmission device, consisting of a 1 MHz broadband emitter and four regularly spaced receivers, was used to measure the axial velocity of ultrasound in the Achilles tendon of six healthy young adults (mean ± SD; age 26 ± 5 years; height 1.78 ± 0.11 m; weight 79.8 ± 13.6 kg) during steady-state unilateral hopping (2.5 Hz) on a piezoelectric force plate. Vertical ground reaction force and lower limb joint kinematics were simultaneously recorded. The potential sensitivity of the technique was further explored in subset of healthy participants (n = 3) that hopped at a slower rate (1.8 Hz) and a patient who had undergone Achilles tendon rupture-repair (2.5 Hz). Reliability was estimated using the mean-within subject coefficient of variation calculated at each point during the ground-contact phase of hopping, while cross-correlations were used to explore the coordination between lower limb kinematics ground reaction forces and ultrasound velocity in the Achilles tendon. Axial velocity of ultrasound in the Achilles tendon was highly reproducible during hopping, with the mean within-subject coefficient of variation ranging between 0.1 and 2.0% across participants. Ultrasound velocity decreased immediately following touch down (−19 ± 13 ms–1), before increasing by 197 ± 81 ms–1, on average, to peak at 2230 ± 87 ms–1 at 67 ± 3% of ground contact phase in healthy participants. Cross-correlation analysis revealed that ultrasound velocity in the Achilles tendon during hopping was strongly associated with knee (mean r = 0.98, range 0.95–1.00) rather than ankle (mean r = 0.67, range 0.35–0.79) joint motion. Ultrasound velocity was sensitive to changes in hopping frequency in healthy adults and in the surgically repaired Achilles tendon was characterized by a similar peak velocity (2283 ± 13 ms–1) but the change in ultrasound velocity (447 ± 21 ms–1) was approximately two fold that of healthy participants (197 ± 81 ms–1). Although further research is required, the technique can be used to reliably monitor ultrasound velocity in the Achilles tendon during hopping, can detect changes in the instantaneous elastic modulus of tendon with variation in hopping frequency and tendon pathology and ultimately may provide further insights into the stretch-shortening cycle and aid clinical decision concerning tendon rehabilitation protocols and readiness to return to sport.

Functional progression milestones following anterior cruciate ligament reconstruction are more appropriate than time-based criteria: a survey among the ESSKA.

The aim of this study was to report current rehabilitation recommendations after ACL reconstruction in ESSKA community, with a particular focus on the specific criteria utilized to guide activity progression METHODS: A web-based survey was developed to investigate preferences between time-based and functional ACL reconstruction rehabilitation progression milestones of ESSKA community. Eight hundred and twenty completed questionnaires were received. Responders were from 86 different countries worldwide, 63% of them from European countries. Functional criteria were considered more appropriate to decide if a patient can start specific activities/exercises by 67% of the responders. Good core and lower extremity neuromuscular control were the most often used functional criteria for decision-making regarding readiness for sport-specific rehabilitation (66%), sport-specific drills without (65%) and with contact (66%). Strength assessed with an isokinetic dynamometer was considered by about half of the responders a determinant to initiate sport-specific drills without (51%-isokinetic strength, LSI > 80%) and with contact (58%-isokinetic strength, LSI > 85-90%). To determine readiness for sport-specific drills, hop tests were used by 40% of respondents for drills without contact and 48% of respondents for drills with contact. The results of this survey involving mainly orthopaedic surgeons indicate that functional measures are considered more appropriate than milestones based on time from surgery to guide progression through the postoperative rehabilitation process after ACLR. The main clinical relevance of this study is that updated information on collective agreement could be useful for clinicians and physiotherapists to delineate their postoperative treatments after ACLR. These results should be interpreted with caution, as this sample represents only a small portion of ESSKA community involved in knee surgery and treating patients following ACLR. III.

Identifying clients’ readiness for hearing rehabilitation within initial audiology appointments: a pilot intervention study

Objective: The current study sought to explore audiologists’ use of the Ida Institute Motivation Tools to help them identify clients’ readiness for change within initial assessment appointments.Design: The study involved a mixed methods intervention design. Data were collected pre- and post-training audiologists to use the Ida Motivation tools in their appointments. Appointments were video-recorded and analysed using conversation analysis. Clients and audiologists also completed questionnaires within each appointment to measure clients’ readiness-for-change.Study sample: Participants included 5 audiologists and 22 adult clients from two Audiology clinics.Results: Audiologists incorporated the Ida Motivation tools into the post-training appointments without a significant increase in appointment time. The Ida tools solicited responses from clients that displayed their ambivalence regarding hearing rehabilitation/aids within their talk. Post‐training, audiologists’ perceptions of clients’ stage of readiness were not significantly more likely to match clients’ self-reported stage on the URICA.Conclusions: The Ida Motivation tools may be useful to solicit clients’ ambivalent feelings towards hearing rehabilitation/aids, however, it is important for audiologists to actively listen for ambivalence within clients’ interactional responses to the tools in order judge clients’ readiness.

Improving self-efficacy for hearing aid self-management: the early delivery of a multimedia-based education programme in first-time hearing aid users

Objectives: This study examined the effect of a multimedia educational programme for first-time hearing aid users (C2Hear reusable learning objects, RLOs), delivered at the hearing assessment on (1) self-efficacy for hearing aids (primary outcome), and (2) readiness for hearing rehabilitation and hearing aid knowledge (secondary outcomes).Design: A single-centre, prospective, pre-post, randomised controlled trial with two arms. The intervention group (n = 24) received RLOs, and the waitlist control group (n = 23) received a printed booklet on hearing aids. Outcomes were measured at the hearing assessment and hearing aid fitting appointments.Study sample: Fifty-six adult first-time hearing aid users attending a publicly funded audiology service.Results: The RLO group showed significantly greater improvement in self-efficacy and knowledge of hearing aids than the control group. A borderline effect of readiness for hearing rehabilitation was also found. Potential links between hearing aid self-efficacy and knowledge were identified.Conclusions: Early delivery of the RLOs results in greater hearing aid self-efficacy and knowledge at the hearing aid fitting appointment, with indications that RLOs increase readiness for hearing rehabilitation. As knowledge, self-efficacy and readiness are cornerstones of self-management, the C2Hear RLOs can prime first-time hearing aid users to better self-manage their hearing aids before they receive them.

COMMUNICATIVE FEATURES OF PATIENTS WITH COMBINED ADDICTION ON HEROIN AND ALCOHOL

Introduction: chemical dependence on several narcotic or other psychoactive substances at the same time is called poly-drug addiction or complicated drug addiction, the terms "combined addiction" and "combined use" are also often used. It is believed that the simultaneous or alternating regular intake of various psychoactive substances has a more destructive effect on the body than depending on only one drug. In the narcological literature the various forms of combined use of alcohol and heroin were described. There are some data on the psychological characteristics of patients with such forms of addiction, the specifics of these patients in terms of personal readiness for rehabilitation. The aim of the study was to identify the features of interpersonal relations and individual-personal specificity in the field of such relations in patients with heroin-alcohol polydrug addiction. Materials and methods: the Study has been conducted on a sample of 25 patients aged 28 to 50 years using four psychodiagnostic techniques. Tests were used: "Individual typological questionnaire of L.N. Sobchik " (ITO), "Questionnaire of interpersonal relations of A. Rukavishnikov" (OMO), "Diagnosis of interpersonal relations of T. Leary" (DMO), "Diagnosis of interference in the establishment of emotional contacts of V. Boyko". Results: it has been found that heroin and alcohol addicts in the communicative sphere are aggressive, deceitful, tend to dominate, although they retain the need to be accepted by others. Discussion and Conclusions: the obtained data confirm the literature data about more aggressiveness of polynarcomania in the comparison with mononarcomania. The tendency to aggression in interpersonal relations can be attributed to destructive, pathological and socially dangerous features of heroin and alcohol poly-drug addiction. Drug addicts of the studied form are dangerous for others and create communication problems for people forced to communicate with them. A generalizing conclusion is made that heroin-alcohol poly-drug addiction is a source of social destructiveness, and patients with this type of chemical addiction are carriers of this destructiveness.

Fear avoidance and self-efficacy at 4weeks after ACL reconstruction are associated with early impairment resolution and readiness for advanced rehabilitation.

To examine the association of fear avoidance and self-efficacy psychological factors within 4 weeks after anterior cruciate ligament (ACL) reconstruction with knee impairment resolution and readiness for advanced rehabilitation at 12 weeks post-surgery. Seventy-five patients participated. Data collection included demographics; questionnaires on fear avoidance (Pain Catastrophizing Scale, PCS; shortened Tampa Scale for Kinesiophobia, TSK-11) and self-efficacy (modified Self-Efficacy for Rehabilitation Outcome Scale, SER; Knee Activity Self-Efficacy, KASE) at 1, 4, and 12 weeks post-surgery; and knee impairment measures (pain intensity, range of motion, and quadriceps symmetry index) at 12 weeks post-surgery. Readiness for advanced rehabilitation (READY or NOT READY) was determined by knee impairment resolution criteria; demographics and questionnaire scores were compared between groups. Questionnaire scores at 1 and 4 weeks post-surgery and the change between time points were examined for association with knee impairment measures and group assignment. READY included 32 patients; NOT READY included 43 patients. Questionnaire scores improved in both groups over time. Significant correlations across groups were: PCS scores at 1 and 4 weeks post-surgery with pain intensity at 12 weeks post-surgery (r = 0.24 and 0.29, respectively) and KASE score 4 weeks post-surgery with range of motion deficit at 12 weeks post-surgery (r = - 0.26). Contact injury was more prevalent in READY. After accounting for mechanism of injury, higher TSK-11 and fear of re-injury subscale scores at 4 weeks post-surgery increased the odds of NOT READY assignment at 12 weeks post-surgery (odds ratios 1.10 and 1.31, respectively). Lower pain catastrophizing and higher knee activity self-efficacy levels 4 weeks after ACL reconstruction were associated with better knee impairment resolution at 12 weeks post-surgery, whereas lower kinesiophobia at 4 weeks post-surgery increased the odds of meeting advanced rehabilitation criteria at 12 weeks post-surgery. The clinical implication of these findings is that measuring pain catastrophizing, knee activity self-efficacy and kinesiophobia at 4 weeks post-surgery may improve prediction of patients at risk for delayed rehabilitation progression 12 weeks post-surgery. III.

An essential negative effect of a family history of substance use on readiness for drug dependence rehabilitation treatment in inpatients with addictions

To reveal objective factors predicting the readiness of inpatient drug treatment patients to undergo a rehabilitation program. In a retrospective comparative study, drug-dependent individuals (n=199, 16.6% females, 83.4% men, 91.5% opioid-dependent) were studied. After conducting motivational activities based on cognitive-behavioral psychotherapy, the premorbid, anamnestic, clinical, socio-demographic characteristics of patients were studied as possible predictors of readiness for rehabilitation using binary logistic regression. Family history of substance use reduced the probability of readiness for rehabilitation by >4,5 times (p<0.0001, Exp (B) = 4.577, CI 95% [2.0556, 10.190]). The influence of other factors was weaker and manifested itself only with their combinations (female sex + use of several psychoactive drugs; intravenous drug injection + polydrug addiction; non-remission course of disease + family history of substance use) which increased the likelihood of readiness for rehabilitation. There was no effect of social/demographic variables. Family history of substance use significantly reduces the likelihood of readiness for rehabilitation. The clinical severity of the disease, on the other hand, increases the chances of readiness. Patients with a family history of substance use represent a specific group of patients requiring maximum efforts in the process of motivation for rehabilitation.

Reality of working in a community-based, recovery-oriented mental health rehabilitation unit: A pragmatic grounded theory analysis.

In the present study, we explored the experiences of staff working at a recovery-oriented, community-based residential mental health rehabilitation unit in Brisbane, Australia, called a 'community care unit' (CCU). A pragmatic approach to grounded theory was taken in the analysis of the transcripts of semistructured interviews with eight staff. Convenience sampling was used, and there was representation of junior and senior staff across nursing, allied health, and non-clinical support roles. Four key themes emerged from the analysis: (i) rehabilitation is different to treatment; (ii) the CCU is a positive transitional space; (iii) they (consumers) have to be ready to engage; and (iv) recovery is central to rehabilitation practice. Staff understandings of recovery in rehabilitation work were complex and included consideration of both personal and clinical recovery concepts. Rehabilitation readiness was considered important to the ability to deliver recovery-oriented care; however, the shared role of staff in maintaining engagement was acknowledged. Threats to recovery-oriented rehabilitation practice included staff burnout and external pressure to accept consumers who are not ready. The reality of working at a community-based recovery-oriented rehabilitation unit is complex. Active vigilance is needed to maintain a focus on recovery and rehabilitation. Leadership needs to focus on reducing burnout and in adapting these services to emergent needs.

Application of the transtheoretical model of behaviour change for identifying older clients’ readiness for hearing rehabilitation during history-taking in audiology appointments

Objectives: The transtheoretical model (TTM) of behaviour change focuses on clients’ readiness for adopting new health behaviours. This study explores how clients’ readiness for change can be identified through their interactions with audiologists during history-taking in initial appointments; and whether clients’ readiness has consequences for the rehabilitation decisions they make within the initial appointment. Design: Conversation analysis (CA) was used to examine video-recorded initial audiology appointments with older adults with hearing impairment. Study sample: The data corpus involved 62 recorded appointments with 26 audiologists and their older adult clients (aged 55+ years). Companions were present in 17 appointments. Results: Clients’ readiness for change could be observed through their interaction with the audiologist. Analysis demonstrated that the way clients described their hearing in the history-taking phase had systematic consequences for how they responded to rehabilitation recommendations (in particular, hearing aids) in the management phase of the appointment. In particular, clients identified as being in a pre-contemplation stage-of-change were more likely to display resistance to a recommendation of hearing aids (80% declined). Conclusions: The transtheoretical model of behaviour change can be useful for helping audiologists individualize management planning to be congruent with individual clients’ needs, attitudes, desires, and psychological readiness for action in order to optimize clients’ hearing outcomes.

Readiness for cancer rehabilitation in Denmark: protocol for a cross-sectional mixed methods study

IntroductionRehabilitation is a key element in most cancer care policies in recognition of the often unmet physical, psychological and social needs among the rising numbers of patients with cancer. A...

Return to work after 9/11

This case study is a report of a rehabilitative employment program that used trauma focused group treatment with individuals who suffered from Posttraumatic Stress Disorder (PTSD) post 9/11. The program was developed in order to assist them to return to the work force. These Individuals lost their jobs because of the 9/11 terrorist attack and experienced financial difficulty, yet because of their PTSD symptoms, had difficulty seeking employment. Individuals were selected for group treatment based on the presence of PTSD symptoms as measured by The Posttraumatic Stress Diagnostic Scale, an external locus of control determined by the Internal and External Locus of Control Scale, low self-esteem as per the Self-Efficacy Scale, and hopelessness, as assessed through the Hopelessness Scale. Additional assessments (Role Checklist, Psychiatric Rehabilitation Determination, Vocational Sentence Completion, Activity Record of the Occupational Questionnaire, and an interview that included a work history) were administered by an occupational therapist. Results of these assessments were used to inform group co-leaders (one social worker and one occupational therapist per group) of their members' symptoms, coping mechanisms, attitudes towards work, rehabilitation readiness, life roles and values, and use of time in order to plan appropriate group intervention. Groups met for once-a-week 90 minute sessions. Group leaders used restructuring and systematic prolonged exposure to encourage group members to describe their traumatic experiences in order to neutralize negative affect states, mange symptoms, and work through guilt and distorted perceptions. Members attended until they began gainful employment. Descriptive data revealed that during the first year of the program, 9/11/2001-9/11/2002, 262 of the 3,567 clients seen (13.6%) returned to the work force.

A Construct Validity Study of Employment Readiness in Persons with Severe Mental Illness

This archival study examined the construct validity of rehabilitation readiness in the employment domain. Rehabilitation readiness in the employment domain is a measure of one's intent to seek employment rather than one's ability to work. A multitrait-multimethod matrix design for construct validation was used to support an inference of construct validity augmented by predictive validity assessments. Participants were 111 unemployed adults with serious psychiatric illnesses newly enrolled in supported employment programs in New Jersey who agreed to participate in the study. Data were collected on demographics, readiness, and symptoms at baseline, as well as on employment activities on a monthly basis for up to 6 months. Participants were enrolled on an ongoing basis, and not all participants reached the 6-month point before the study ended. Two methods of data collection were used: interviewer ratings and client self-report. The resultant pattern of coefficients within the multitrait-multimethod matrix su...

Rehabilitation readiness: A construct validity study of the University of Rhode Island Change Assessment for Vocational Counseling (URICA-VC) scale for persons with mental illness

Purpose/objectives: The study aims to confirm the factorial structure of the URICA-Vocational Counseling (URICA- VC), a scale that has been specifically designed for use in vocational rehabilitation programs. Furthermore, the study explores the clinical utility of the URICA-VC readiness construct within a sample of individuals with psychiatric disabilities seeking competitive employment. Research method/design: Using a sample of 296 individuals with psychiatric disabilities pooled from three separate programs, the author examined the construct validity of the scale using factorial structural analysis, discriminative validity and predictive validity tests. Results: The results confirm the URICA-VC three-factor solution. These three factors discriminate between individuals with varying levels of interest and involvement in vocational rehabilitation services. However, predictive validity is mixed. Conclusion/implications: The use of the URICA-VC for clinical decision-making and research purposes should be carefully considered given the degree of false negatives and positives generated by stage of change categories.

Assessing the relationship between the WNSSP and therapeutic participation in adolescents in low response states following severe traumatic brain injury

Primary objective: This study examines the relationship between scores on the Western Neuro Sensory Stimulation Profile (WNSSP) and therapeutic participation as it relates to rehabilitation readiness (RR) in adolescents with low response following severe traumatic brain injury (TBI).Research design: This is a serial observational design using multiple measures of clinical status and participation.Methods and procedures: Ten children, mean age 16.7 years, who remained in a low response state (30 days or more) were assessed with the WNSSP and videotaped during physical and occupational therapy sessions. Associations were evaluated between WNSSP scores and participation scores related to arousal, awareness and communication.Main outcomes and results: The WNSSP was only associated with the communication score (p < 0.0001). The arousal and awareness scores had no significant impact on the WNSSP score.Conclusions: These results suggest that scores on the WNSSP may be related to the return of communication skills in adolescents in low response states as one part of assessing their therapeutic participation and ultimate rehabilitation readiness. This ability may assist in making decisions regarding care planning.

The Transtheoretical Model: An Exploratory Look at Its Applicability to Injury Rehabilitation

The transtheoretical model has been widely used in the investigation of how people adapt to new behaviors; however, the literature appears to be lacking documentation of any assessment/s administered to injured athletes to determine their readiness for rehabilitation, which depending on the severity of the injury, could possibly represent a behavior change for that individual. To validate the application of the transtheoretical model to injury rehabilitation and assess the impact of stages of change on athletes' adherence and compliance rates. Descriptive correlational. Large Mid Atlantic Division I institution. Seventy injured athletes. Readiness was assessed using the Transtheoretical Model. Adherence was assessed using the percentage of rehabilitation attendance and compliance was assessed using the Sport Injury Rehabilitation Scale. Participants who were advanced in their stages of change generally reported an increase in self efficacy, utilization of pros versus cons, and the use of behavioral processes instead of experiential processes of change. No significant relationships were found between stages of change and athletes' adherence and compliance. Although no statistical significance was found between stages of change and adherence and compliance the results did validate the application of the transtheoretical model to injury rehabilitation.

Results of an Innovative University-based Recovery Education Program for Adults with Psychiatric Disabilities

This study examined the effectiveness of an educational approach to psychiatric rehabilitation called the Recovery Center. Using a quasi-experimental design we recruited 97 intervention and 81 comparison participants and examined the intervention's impact on health, mental health, subjective, and role functioning outcomes. Results suggested that this intervention was effective in improving subjective outcomes, especially empowerment and recovery attitudes, both of which received primary emphasis in the intervention. The Recovery Center, which integrates a bio-psychosocial framework with psycho-educational interventions shows promise as a complement to traditional mental health services in developing readiness for rehabilitation and promoting recovery among individuals with severe psychiatric disabilities.