Rehabilitation Disciplines Research Articles

The psychometric properties of the cervical nonorganic signs in patients with neck pain: an assessment of pain expression

Purpose: Neck pain is a common cause of disability. This study investigated the psychometric properties of the cervical nonorganic signs (CNOS), a tool for assessing abnormal illness behaviors in patients with neck pain.Methods: The CNOS was administered on patients with neck pain. Reliability and validity analyses were used to evaluate the psychometric properties. Exploratory factor analysis was used to investigate the dimensionality. Correlations with the Short Form-36 were used to investigate the convergent validity.Results: The results supported the reliability (inter-rater reliability intra-class correlation: 0.920), validity (correlated with body pain (|ρ|=0.31) and vitality (|ρ| =0.30), and two-factor dimensionality (χ2= 5.904, p= 0.66; χ2/df = 0.738; RMSEA< 0.001; CFI = 1.000; TLI = 1.024; SRMR = 0.047) of the scale. The two factors were pain (severe pain) and vitality (poor vitality) expressed by the patients.Conclusion: The CNOS is a reliable and valid instrument for assessing pain and vitality problems. It helps patients to express severe pain and lack of vitality. The rehabilitation discipline could use the scale to understand pain expression and to design proper rehabilitation programs.Implications for RehabilitationThe cervical nonorganic signs has two domains (pain and vitality).The scale is reliable and valid for patients with neck pain.Patients with high scores on the pain domain have severe body pain that may interfere with normal social activities.Clinicians should understand their suffering and try to help them to alleviate the pain.

Toward an International Classification of Functioning, Disability and Health clinical data collection tool: the Italian experience of developing simple, intuitive descriptions of the Rehabilitation Set categories.

As part of international efforts to develop and implement national models including the specification of ICF-based clinical data collection tools, the Italian rehabilitation community initiated a project to develop simple, intuitive descriptions of the ICF Rehabilitation Set, highlighting the core concept of each category in user-friendly language. This paper outlines the Italian experience in developing simple, intuitive descriptions of the ICF Rehabilitation Set as an ICF-based clinical data collection tool for Italy. Consensus process. Expert conference. Multidisciplinary group of rehabilitation professionals. The first of a two-stage consensus process involved developing an initial proposal for simple, intuitive descriptions of each ICF Rehabilitation Set category based on descriptions generated in a similar process in China. Stage two involved a consensus conference. Divided into three working groups, participants discussed and voted (vote A) whether the initially proposed descriptions of each ICF Rehabilitation Set category was simple and intuitive enough for use in daily practice. Afterwards the categories with descriptions considered ambiguous i.e. not simple and intuitive enough, were divided among the working groups, who were asked to propose a new description for the allocated categories. These proposals were then voted (vote B) on in a plenary session. The last step of the consensus conference required each working group to develop a new proposal for each and the same categories with descriptions still considered ambiguous. Participants then voted (final vote) for which of the three proposed descriptions they preferred. Nineteen clinicians from diverse rehabilitation disciplines from various regions of Italy participated in the consensus process. Three ICF categories already achieved consensus in vote A, while 20 ICF categories were accepted in vote B. The remaining 7 categories were decided in the final vote. The findings were discussed in light of current efforts toward developing strategies for ICF implementation, specifically for the application of an ICF-based clinical data collection tool, not only for Italy but also for the rest of Europe. Promising as minimal standards for monitoring the impact of interventions and for standardized reporting of functioning as a relevant outcome in rehabilitation.

Editorial: Neural bases of binocular vision and coordination and their implications in visual training programs.

To see or not to see? That is the question of this research topic. How do human beings see not with their eyes but with their brain, which lies in a moving body, itself evolving in a continuously changing environment? What and how do humans see in the context of a particular task at a given moment? How do humans cease to see after some damage in the brain or neurofunctional disorder? And howmay the basic science of eyemovements and vision help to develop efficient visual training programs? The present research topic, entitled Neural bases of binocular vision and coordination and their implications in visual training programs, aims at putting forward our knowledge of the neural underpinnings of vision in its motor, sensory, cognitive, emotional, and vegetative expressions. It does not target an exhaustive collection of what we know in the field of visual neurosciences. For that purpose, the reader may refer to the volume sets by Chalupa and Werner (2003). Rather, this research topic focuses on the latest findings on the neural aspects of eye movements and visual perception that directly help to understand and improve visual training programs in pathological conditions. Such disorders follow damages of the cerebral visual pathways (e.g., hemianopia) or refer to syndromes hitherto believed to be peripheral but in which neurophysiology and brain imaging are uncovering neural correlates or causes (e.g., amblyopia). The research topic is divided into three parts respectively dedicated to eye movements, visual perception, and visual training programs, each having six chapters, and starts with an overview. In the introductory chapter, Coubard, Urbanski, Bourlon and Gaumet (Coubard et al., 2014) remind the reader of the importance of action in visual processing before describing the cascade of physiological mechanisms underlying eye movements, followed by a description of the five main neurovisual systems. After an overview of pathological conditions causing not eye but brain blindness—also called neurovisual disorders—the authors end by describing the disciplines of visual rehabilitation.

Interdisciplinary Rehabilitation Referrals in a Concussion Clinic Cohort: An Exploratory Analysis

ObjectiveTo assess the frequency and spectrum of referrals to rehabilitation disciplines in a concussion clinic population and factors associated with need for referral. DesignRetrospective study. SettingConcussion clinic within the Physical Medicine and Rehabilitation Department of an academic medical center. ParticipantsPatients receiving physiatric management for concussion care. Main Outcome MeasuresReferral to physical therapy (PT), occupational therapy, speech therapy (ST), neuropsychology, or any referral (Any), and reasons for referral. InterventionsDemographic and clinical variables were analyzed for possible association with referral to rehabilitation disciplines. These independent variables included mechanism of injury, referral source, age, gender, provider, days since injury, presenting Sports Concussion Assessment Tool 2 (SCAT2) symptom score, insurance type, clinical risk factors, whether the injury was work related and whether the patient had been hospitalized. ResultsAmong 262 patients meeting inclusion criteria, the most commonly prescribed individual therapy was physical therapy (74 patients; 28%), followed by speech therapy (60 patients, 23%), neuropsychology (27 patients, 10.3%), and occupational therapy (19 patients, 7.2%). In all, 121 (46%) of patients were referred to one or more disciplines. The most common reasons for referral were cognitive strategies (54 patients, 21%), balance/vestibular therapy (50 patients,19%), and neck pain (32 patients, 12%). Per multivariate logistic regression analysis, covariates associated with PT: age, SCAT2 symptom score, gender, provider, and (inversely) cognitive/learning disorder; ST: time elapsed since injury, gender, and referral source of internal clinic; Any: SCAT2 symptom score. Referrals did not significantly vary by mechanism of injury (sports, fall, vehicular, etc), whether work-related, or whether the patient had been hospitalized. Insurance factors were significant for PT and Any on the univariate analysis but not logistic regression. ConclusionsRelatively little has been described about the typical rehabilitation requirements of individuals recovering from concussion. Although rest and guided return to usual activities have been emphasized as mainstays of management, a large number of patients in this concussion cohort were determined to require additional rehabilitation services to assist in recovery.

Service utilisation in a public post-acute rehabilitation unit following traumatic brain injury

Traumatic brain injury (TBI) causes disability in a proportion of survivors across the spectrum of injury severity. Previous research suggests physical changes are the primary focus of rehabilitation, although cognitive, emotional and behavioural difficulties cause greater concern in the long-term. There is little information about services accessed by those with mild injuries, who often have no physical disabilities. This study investigated factors determining service utilisation in a population-based sample which included 52% mild injuries (PTA ≤ 24 hours). Chi-squares and t-tests were used to examine the impact of demographic, clinical, psychological and physical variables on referral of 175 TBI patients to clinical disciplines in a public, community-based rehabilitation facility in Hobart, Tasmania. Increased service intensity (total disciplines referred to), was associated with greater injury severity (p = .006) and previous TBI (p = .041). Less traditional rehabilitation services (nursing, psychology) received more referrals than traditional disciplines (physiotherapy, occupational therapy, social work). Referral to physiotherapy and occupational therapy was associated with greater injury severity, functional dependence, hospitalisation and older age. Referral to nursing, psychology and social work was associated with more post-concussion symptoms, younger age, anxiety, depression and assault-related injury. The large number of referrals to psychology strengthens the case for including it as a core rehabilitation discipline.

A Primer on Medicaid Telepractice Reimbursement

A Primer on Medicaid Telepractice Reimbursement

Action, Reflection, and Evolution: A Pilot Implementation of Interprofessional Education across Three Rehabilitation Disciplines

Background: Interprofessional collaboration (IPC) is accepted as standard practice in healthcare. Because of this expectation, there is an increased need for growth in interprofessional education (IPE). Despite this need, the scholarship of IPE is limited. To better understand the challenges of IPE and improve on future endeavours, this article describes an IPE collaboration that was less successful, and the conclusions drawn from team reflection regarding IPE. We report on the challenges and the lessons learned.Methods and Findings: After one year of an IPE pilot project, the research team conducted a reflection exercise involving three iterations: 1) initial group meeting to discuss reflection questions, 2) individual review of meeting notes, 3) subsequent group meeting to confirm accuracy of the data. The confirmed data were then analyzed using thematic analysis.Conclusions: The key themes that emerged regarding the limited success of the pilot were focused on communication—between members of the research team, with the students, and with other faculty impacted by the pilot. Recommendations regarding improvements to facilitate future IPE initiatives are discussed. The summary conclusion of our exercise acknowledged that as IP educators we must remain vigilant to demonstrate IPC in the same manner as we teach it.

Rehabilitation Professionals Still Do Not Communicate Effectively About Cognition

ObjectiveTo examine current use of descriptive labels for levels of cognitive impairment and types of memory to explore whether rehabilitation disciplines are now communicating more effectively. DesignSurvey of rehabilitation professionals. SettingHospital rehabilitation programs. ParticipantsRespondents (N=130) representing 8 facilities in 5 states completed surveys. InterventionsNot applicable. Main Outcome MeasuresResponses to survey questions about severity and types of memory impairment were examined with the Kruskal-Wallis test to determine the impact of profession on ratings. Post hoc Mann-Whitney U test comparisons of the 2 professions with the most cognitive assessment experience, psychologists/neuropsychologists and speech-language pathologists, were conducted. ResultsRatings of various deficit levels differed significantly by profession (mild: H=39.780, P<.000; moderate: H=43.309, P<.000; severe: H=38.354, P<.000), but not by program location. In comparing psychologists/neuropsychologists and speech-language pathologists specifically, we found a significant discrepancy in ratings for percentile ranges associated with the terms mild (U=103.000, P<.001), moderate (U=78.000, P<.000), and severe (U=109.000, P<.001). Disagreement on the meaning of descriptive memory terms was noted among rehabilitation professionals in general, with large percentages of respondents not agreeing on the meanings of terms. ConclusionsA significant lack of consensus persists regarding the understanding of common cognitive terminology. This miscommunication affects cognitive impairment descriptors (eg, mild, moderate, severe) and categorization of types of memory. Only half of rehabilitation professionals appear aware of this discrepancy, suggesting that education is necessary to bring greater awareness of the potential for miscommunication.

Translating knowledge in rehabilitation: systematic review.

Clinicians are faced with using the current best evidence to make treatment decisions, yet synthesis of knowledge translation (KT) strategies that influence professional practice behaviors in rehabilitation disciplines remains largely unknown. The purposes of this study were: (1) to examine the state of science for KT strategies used in the rehabilitation professions (physical therapy, occupational therapy, speech-language pathology), (2) to identify the methodological approaches utilized in studies exploring KT strategies, and (3) to report the extent that KT interventions are described. Eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, and CENTRAL) were searched from January 1985 to May 2013 using language (English) restriction. Eligibility criteria specified articles evaluating interventions or strategies with a primary purpose of translating research or enhancing research uptake into clinical practice. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. The published descriptions of the KT interventions were compared with the Workgroup for Intervention Development and Evaluation Research's (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions. Of a total of 2,793 articles located and titles and abstracts screened, 26 studies were included in the systematic review. Eighteen articles reported interventions that used a multicomponent KT strategy. Education-related components were the predominant KT intervention regardless of whether it was a single or multicomponent intervention. Few studies used reminders or audit and feedback intervention (n=3). Only one study's primary outcome measure was an economic evaluation. No clear delineation of the effect on KT strategies was seen. Diverse studies were included; however, the heterogeneity of the studies was not conducive to pooling the data. The modest-to-low methodological quality assessed in the studies underscores the gaps in KT strategies used in rehabilitation and highlights the need for rigorously designed studies that are well reported.

Toward a Rehabilitation Treatment Taxonomy: Summary of Work in Progress

With funding from a cooperative agreement from the National Institute on Disability and Rehabilitation Research, we have worked for the past 5 years on the development of a rehabilitation treatment taxonomy, a system of classifying all treatments delivered by all rehabilitation disciplines for all diagnostic groups of patients, whatever the setting in which these services are delivered. To date, we have focused on developing a conceptual framework for such a taxonomy, specifying the scope of the taxonomy and the basis for classifying treatments. A recent supplement of the Archives of Physical Medicine and Rehabilitation contained a series of articles setting forth the background for the project, our approach to conceptual issues, and the need to classify treatments based on a theory of how active ingredients bring about change in a clinical target of treatment (some aspect of patient functioning) through a specific mechanism of action.1 It also contains papers on how therapists view classification and lessons learned during a previous effort at classifying learning interventions, as well as commentaries by various scholars who had an opportunity to review these papers. Here we summarize the key points. The field of rehabilitation has made substantial advances in defining and measuring the functional outcomes of the rehabilitation process and the patient characteristics that are associated with those outcomes. However, we lack a rigorous and shared approach to defining, classifying, and measuring the rehabilitation treatments that are hypothesized to moderate the relationships between patient factors and outcomes. At present, rehabilitation treatments may be described as number …

Applications of the International Classification of Functioning, Disability and Health in goal-setting practices in healthcare

Purpose: While evidence exists to support the adoption of collaborative goal-setting in healthcare, some clinicians feel that it is not feasible. This article proposes that the development of a standardized collaborative goal-setting approach using the framework and classification system of the International Classification of Functioning, Disability and Health (ICF) could address these feasibility issues. It is the objective of this article to understand the extent to which the ICF has been integrated into current goal-setting literature in order to assess its potential use in a standardized collaborative goal-setting approach. Methods: A scoping review of the literature published in English since 2001 was conducted in EMBASE, Medline and CINAHL. Articles were included in this review if they integrated the ICF into goal-setting practices in any healthcare discipline. Results: Nineteen articles were included in this review. Analysis of these articles revealed that the ICF has been integrated into goal-setting practices. The benefits associated with this integration suggest that integrating the ICF into goal-setting practices can standardize collaborative goal-setting. Conclusion: Evidence from this scoping review supports the use of the ICF in healthcare goal-setting practices because it provides clinicians and patients with specific steps to follow when attempting to set goals collaboratively.Implications for RehabilitationCollaborative goal-setting.Collaborative goal-setting involves patients working with their clinicians to develop health outcome goals together and is a fundamental component of patient-centered care.Some rehabilitation disciplines have yet to fully embrace collaborative goal-setting due to feasibility issues.This article proposes that the integration of the International Classification of Functioning, Disability and Health (ICF) into goal-setting practices could standardize collaborative goal-setting in a way that would address these feasibility issues.

Pain and Its Impact on Inpatient Rehabilitation for Acute Traumatic Spinal Cord Injury: Analysis of Observational Data Collected in the SCIRehab Study

ObjectiveTo describe pain during inpatient rehabilitation and its impact on delivery of inpatient rehabilitation services for persons with spinal cord injury (SCI). DesignProspective observational study and retrospective chart review. SettingSix inpatient rehabilitation facilities participating in the SCIRehab Study. ParticipantsPatients (N=1357) receiving initial rehabilitation after traumatic SCI, for whom pain data were available. InterventionsNot applicable. Main Outcome MeasuresSelf-reported rating of pain intensity (0–10), pain locations, and treatment time by various rehabilitation disciplines. ResultsThe vast majority of patients (97%) reported pain at least once during the rehabilitation stay, with an average pain intensity ± SD of 4.9±2.4. Average pain intensity over the stay was severe (rated 7–10) for 30% of patients, moderate (4–6) for 42%, and mild (1–3) for 25%. Pain prevalence at admission was greater than at discharge (87% vs 74%), as was pain intensity (6.0 vs 4.6). Most (79%) of the 177 participants who did not have pain at admission reported pain at least once later in the rehabilitation stay, but their average high pain intensity over the stay was lower than that of the full sample (1.9 vs 4.9). Nearly half (47%) of patients reported pain at ≥3 locations during the stay, with the back, neck, and shoulder commonly reported. Patients with severe pain spent fewer days in rehabilitation, received less rehabilitation treatment time (hours per week and total hours), and had more treatment sessions altered in objective or content because of pain than those with lower pain levels. ConclusionsPain is a common problem for persons receiving inpatient rehabilitation for traumatic SCI and adversely impacts delivery of therapy services.

SCIRehab Uses Practice-Based Evidence Methodology to Associate Patient and Treatment Characteristics With Outcomes

ObjectivesTo describe the application of practice-based evidence (PBE) methodology to spinal cord injury (SCI) rehabilitation in the SCIRehab study, and to summarize associations of patient characteristics and treatment interventions to outcomes. DesignProspective observational study. SettingSix SCI rehabilitation centers. ParticipantsPatients with traumatic SCI (N=1376) admitted for first rehabilitation. InterventionsNot applicable. Main Outcome MeasuresFIM and residence at discharge, and FIM, residence, Craig Handicap Assessment and Reporting Technique, work/school status, Patient Health Questionnaire-9, Diener Satisfaction with Life Scale, rehospitalization, and presence of pressure ulcers at 1 year postinjury. ResultsPatient demographic and injury characteristics explained significant variation in rehabilitation outcomes, particularly functional outcomes. Regression modeling also identified a large number of significant associations with outcomes when total time in each discipline was modeled and when models were developed for each discipline, examining time spent in the many specific interventions provided by each discipline. ConclusionsThe application of PBE methodology in the SCIRehab study provided extensive information about the process of inpatient SCI rehabilitation. While patient demographic and injury characteristics explain substantial variation in rehabilitation outcomes, particularly functional outcomes, significant relations also were found between the type and quantity of treatment interventions delivered by each rehabilitation discipline and a broad range of outcomes.

Twentieth Anniversary of Nursing Ethics

Nursing and the related disciplines of midwifery, health visiting and rehabilitation are moving into a new era. The general crisis in health care across the developed world has presented the need for new structures, conceptual frameworks and attitudes. Inchoate solutions to the crisis are appearing in different forms—the market and industrial-style management, self-help and the growth of alternative and complementary therapies, the shift to community care, the professionalization of nursing, the return to home birth, new technologies, a new awareness of rights on the part of patients, a growing critique of the biomedical model—all have different and sometimes conflicting impacts on the caring professions.

Measuring Treatment Fidelity in a Rehabilitation Intervention Study

Attaining and demonstrating treatment fidelity is critical in the development and testing of evidence-based interventions. Treatment fidelity refers to the extent to which an intervention was implemented in clinical testing as it was conceptualized and is clearly differentiable from control or standard-of-care interventions. In clinical research, treatment fidelity is typically attained through intensive training and supervision techniques and demonstrated by measuring therapist adherence and competence to the protocol using external raters. However, in occupational and physical therapy outcomes research, treatment fidelity methods have not been used, which, in our view, is a serious gap that impedes novel treatment development and testing in these rehabilitation fields. In this article, we describe the development of methods to train and supervise therapists to attain adequate treatment fidelity in a treatment development project involving a novel occupational and physical therapy-based intervention. We also present a data-driven model for demonstrating therapist adherence and competence in the new treatment and its differentiation from standard of care. In doing so, we provide an approach that rehabilitation researchers can use to address treatment fidelity in occupational and physical therapy-based interventions. We recommend that all treatment researchers in rehabilitation disciplines use these or similar methods as a vital step in the development and testing of evidence-based rehabilitation interventions.

Evidence-Based Practice for Rehabilitation Professionals: Concepts and Controversies

Dijkers MP, Murphy SL, Krellman J. Evidence-based practice for rehabilitation professionals: concepts and controversies.This article describes evidence-based practice (EBP) in the health professions and sciences in general and in the rehabilitation disciplines specifically. It discusses the following: what counts as evidence and how that has changed over the last 4 decades, trends in the short history of evidence-based medicine and EBP, the fallacious nature of most criticisms of EBP, (perceived) shortcomings of clinical research and the resulting evidence in rehabilitation, resources available to clinicians who want their practice to be evidence-based, and the barriers these clinicians face in keeping up with the evidence and applying it in practice. Lastly, it describes how the development of a new art and science, knowledge translation, may play a role in truly making EBP feasible in rehabilitation services.

Medical Rehabilitation After Natural Disasters: Why, When, and How?

Rathore FA, Gosney JE, Reinhardt JD, Haig AJ, Li J, DeLisa JA. Medical rehabilitation after natural disasters: why, when, and how?Natural disasters can cause significant numbers of severe, disabling injuries, resulting in a public health emergency and requiring foreign assistance. However, since medical rehabilitation services are often poorly developed in disaster-affected regions and not highly prioritized by responding teams, physical and rehabilitation medicine (PRM) has historically been underemphasized in global disaster planning and response. Recent development of the specialties of “disaster medicine” and “disaster rehabilitation” has raised awareness of the critical importance of rehabilitation intervention during the immediate postdisaster emergency response. The World Health Organization Liaison Sub-Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine has authored this report to assess the role of emergency rehabilitation intervention after natural disasters based on current scientific evidence and subject matter expert accounts. Major disabling injury types are identified, and spinal cord injury, limb amputation, and traumatic brain injury are used as case studies to exemplify the challenges to effective management of disabling injuries after disasters. Evidence on the effectiveness of disaster rehabilitation interventions is presented. The authors then summarize the current state of disaster-related research, as well as lessons learned from PRM emergency rehabilitation response in recent disasters. Resulting recommendations for greater integration of PRM services into the immediate emergency disaster response are provided. This report aims to stimulate development of research and practice in the emerging discipline of disaster rehabilitation within organizations that provide medical rehabilitation services during the postdisaster emergency response.

Towards the joint use of ICD and ICF: A call for contribution

To optimize patient functioning, rehabilitation professionals often rely on measurements of functioning as well as on classifications. Although the International Classification of Diseases (ICD) and the International Classification of Functioning, Disability and Health (ICF) are used, their joint use has yet to become an established practice. To encourage their joint use in daily practice, the World Health Organization (WHO) has invited all rehabilitation practitioners worldwide to support the ICD-11 revision process by identifying the ICF categories that correspond to specific rehabilitation-relevant health conditions. The first step in completing this task, generating the list of these health conditions, was taken at a February 2012 workshop in São Paulo, Brazil. The objectives of this paper are to present the results of the São Paulo workshop, and to invite practitioners to participate in the ICD-ICF joint use initiative. Alternating plenary and small working group sessions were held and 103 rehabilitation-relevant health conditions were identified. With this list available, WHO together with the International Society of Physical and Rehabilitation Medicine (ISPRM), is reaching out to clinicians of all rehabilitation disciplines to take on the challenge of identifying the ICF categories for at least one of the health conditions listed.

Telehealth as a Means of Health Care Delivery for Physical Therapist Practice

Telehealth is defined as the delivery of health-related services and information via telecommunications technologies. According to the American Telemedicine Association (ATA), “telehealth” is a broad term used to describe the use of electronic communications to deliver clinical services as well as other types of health information.1 In rehabilitation, telehealth is defined by the American Physical Therapy Association (APTA) as the use of electronic communications to provide and deliver a host of health-related information and health care services, including, but not limited to, physical therapy–related information and services, over large and small distances.2 Telehealth may be used to provide health education and advice, communicate patient reminders, monitor clinical status, or deliver interventions. Other rehabilitation disciplines, such as occupational therapy and speech therapy, utilize the terms “telerehabilitation”3 and “telepractice”4 as terms to define telehealth in their respective disciplines. The Patient Protection and Affordable Care Act (Public Law 111–148) (PPACA),5 signed into law on March 23, 2010, addresses the use of telehealth as a means of delivering efficient and effective health care in the United States. The national health care reform6 presents a unique opportunity for physical therapists to become identified as clinicians eligible to provide telehealth physical therapy services. However, there are several barriers to overcome if telehealth as a means of health care delivery for physical therapist practice is to become a reality. The objectives of this health policy perspective article are: (1) to describe the development of the telehealth field from a rehabilitation perspective, thereby highlighting some of the potential applications by physical therapists; (2) to discuss current barriers to adoption of telehealth technology by physical therapists; and (3) to identify an overall strategy to achieve long-term adoption of telehealth practices for physical therapists. The earliest applications of telehealth used technology to monitor cardiac …

Incorporating a Client-Centered Approach to Audiologic Rehabilitation

Incorporating a Client-Centered Approach to Audiologic Rehabilitation