Rehabilitation Experts Research Articles

Coassessment framework to identify person-centred unmet needs in stroke rehabilitation: a case report in Norway

ObjectiveTo describe unmet needs and values in stroke rehabilitation using the Health Value Framework and the associated coassessment tool Health Value Spider, a framework designed to identify and prioritise unmet...

Expert consensus and perspectives on recovery following road traffic crashes: a Delphi study

Purpose To reach expert consensus on a definition for recovery following minor and moderate road traffic crash-related injuries and key factors that influence recovery, and to explore expert perspectives on risk identification methods. Materials and methods A three-round Delphi study was conducted in which 47 experts (insurance representatives, health care professionals and researchers) were consulted. Results Strong expert agreement (86%) was reached for the definition: “Recovery is multifaceted and includes return to activities of daily living (ADLs), work and social/leisure activities at pre-injury level or at a level deemed acceptable by the individual, with minimal ongoing pain and symptoms, considering physical and mental health and wellbeing”. Agreed key factors that influenced recovery included: resilience; coping skills; recovery expectations; pre-existing physical and mental health; workplace support; and, collaboration between the injured individual, treating providers and claim handlers. Expert perspectives on risk identification methods were mixed. Conclusions An accepted definition for recovery following minor and moderate road traffic crash-related injury was established, which could facilitate communication and engagement between different rehabilitation stakeholders. Strong consensus was achieved on nine key factors that influenced recovery. Further research is needed to evaluate whether injured persons agree with this definition and on the utility of risk identification methods. Implications for rehabilitation Expert consensus was established for a definition of recovery following minor and moderate road traffic crash-related injuries and nine key influencing factors. An established definition could facilitate communication and engagement between all rehabilitation stakeholders, which could improve the recovery process of the injured person. Rehabilitation professionals need to be familiar with the role of psychosocial factors, such as recovery expectations, resilience and coping skills, in the recovery process. The use of physical and psychological outcome measures at regular intervals could help to identify risk of poor recovery following minor and moderate road traffic crash-related injuries.

Work-Related Problems and Requested Support in Inflammatory Bowel Disease - Results of a Multi-Perspective Survey

Patients with inflammatory bowel diseases (IBD) are often impaired in their occupational participation and ability to work due to IBD-symptoms and complex psychosocial problems. The aim was to explore work-related problems and requested support of IBD-patients and to develop adequate occupational-oriented offers in rehabilitation with a multi-perspective approach. Guided interviews with employed IBD-patients in medical rehabilitation at 2 measurement points (N=12), guided interviews with employed IBD-patients in specialist gastroenterological care (N=7), 4 focus group interviews with rehabilitation staff (N=27) and expert interviews (N=8) were conducted. The qualitative data have been examined in MAXQDA using content-structuring qualitative content analysis. The 4 different interview groups report a similar spectrum of work-related problems and describe various somatic and psychosocial impairments in the working life of IBD-patients. Physical as well as cognitive impairments, fatigue, pain and psychosocial barriers, which are often associated with reduced productivity at work, are described. Additional restrictions result from unhealthy behaviour at work. The results show an increased need for rehabilitative occupational-oriented offers. IBD patients want a more work-related orientation of rehabilitative offers. They ask for competence-promoting offers to develop specific working skills and coping strategies to maintain their ability to work. The results highlight the range of work-related problems of IBD-patients and show occupational-oriented support opportunities and potentials in rehabilitation sector. Medical rehabilitation must be more tailored to the needs of working IBD-patients and should be more focused on health-related challenges at work. A stronger occupational focus, standardised screening for work-related problems and a competence-promoting orientation of IBD-rehabilitation could enhance the spectrum of rehabilitation offers and maintain the ability to work.

Evaluation of self abilities among people with advanced cancer

Living with cancer can have adverse effects on the self. Various factors affect the person self in daily life. It is well documented that encouragement can provide hope and engagement for a person with cancer to engage in his activities of daily living. The support of family and friends helps the persons to lead his life along with the illness. Cancer rehabilitation is a rapidly evolving field all over the world, in large part because of increases in the number of cancer survivors. Everybody wishes to restore the function as resume their lives as usual. Few argue with the rehabilitation experts that treatment options differ from country to country, and does it affect the survival rate? Little research is done to explore how the self of the person suffering in advanced stages of cancer, and we aim to evaluate how people with cancer experience their sense of self. Thirty interviews were conducted with ten patients with advanced cancer, and grounded theory approach was used for statistical evaluation of data. Accepting self and reassessing self was the result of engaging the person in a specific occupation, which is considered to have a core in rehabilitating the person with advanced cancer. Engagement towards occupation influence the self of a person with advanced cancer.

Physical rehabilitation in Iran after international sanctions: explored findings from a qualitative study

BackgroundAlthough the main aims of sanctions are the political and economic pressures on governments, literature has demonstrated the harsh effects of sanctions on the general public, especially on the patients, poor and disabled people. Since the international sanctions regime negatively affected almost all dimensions of Iran’s health sector, this qualitative study was conducted to investigate the situation of the physical rehabilitation sector after these sanctions.MethodsThis qualitative study was conducted from January 2019 to June 2019 in Iran using Skype, telephone, and face-to-face in-depth semi-structured interviews. Purposive and snowball sampling approaches were used to identify the participants. Also, framework analysis approach was applied to analyze the collected data.ResultsIn total, 38 individuals including health policy-maker, faculty member, rehabilitation expert, Physiotherapist, Occupational therapist, and Orthotist/Prosthetist, were involved in the study. Based on our findings, a number of challenges facing the Iranian physical rehabilitation sector during the international sanctions period included: 1) socioeconomic challenges (inadequate funding, rising inflation rate, high unemployment rate, catastrophic expenditures, and inappropriate employment status of practitioners); 2) education challenges (decreased international collaboration and shortage of training devices and materials); 3) international challenges (rising issues in accessing services for patients from neighborhood countries); and 4) service delivery challenges (shortage of raw materials for producing the orthoses and prostheses, hardening of the importing the needed equipment, inappropriate infrastructures, and impossibility to use external assistance).ConclusionAfter international sanctions, the Iranian physical rehabilitation sector has faced considerable multifaceted challenges. Therefore, the international community must be aware of the situation and be concerned about the irreparable consequences.

Consensus-Based Core Set of Outcome Measures for Clinical Motor Rehabilitation After Stroke-A Delphi Study.

Introduction: Outcome measures are key to tailor rehabilitation goals to the stroke patient's individual needs and to monitor poststroke recovery. The large number of available outcome measures leads to high variability in clinical use. Currently, an internationally agreed core set of motor outcome measures for clinical application is lacking. Therefore, the goal was to develop such a set to serve as a quality standard in clinical motor rehabilitation poststroke.Methods: Outcome measures for the upper and lower extremities, and activities of daily living (ADL)/stroke-specific outcomes were identified and presented to stroke rehabilitation experts in an electronic Delphi study. In round 1, clinical feasibility and relevance of the outcome measures were rated on a 7-point Likert scale. In round 2, those rated at least as “relevant” and “feasible” were ranked within the body functions, activities, and participation domains of the International Classification of Functioning, Disability, and Health (ICF). Furthermore, measurement time points poststroke were indicated. In round 3, answers were reviewed in reference to overall results to reach final consensus.Results: In total, 119 outcome measures were presented to 33 experts from 18 countries. The recommended core set includes the Fugl–Meyer Motor Assessment and Action Research Arm Test for the upper extremity section; the Fugl–Meyer Motor Assessment, 10-m Walk Test, Timed-Up-and-Go, and Berg Balance Scale for the lower extremity section; and the National Institutes of Health Stroke Scale, and Barthel Index or Functional Independence Measure for the ADL/stroke-specific section. The Stroke Impact Scale was recommended spanning all ICF domains. Recommended measurement time points are days 2 ± 1 and 7; weeks 2, 4, and 12; 6 months poststroke and every following 6th month.Discussion and Conclusion: Agreement was found upon a set of nine outcome measures for application in clinical motor rehabilitation poststroke, with seven measurement time points following the stages of poststroke recovery. This core set was specifically developed for clinical practice and distinguishes itself from initiatives for stroke rehabilitation research. The next challenge is to implement this clinical core set across the full stroke care continuum with the aim to improve the transparency, comparability, and quality of stroke rehabilitation at a regional, national, and international level.

Ten-Year Outcomes of a Systems-Based Approach to Longitudinal Amputation Care in the US Department of Veteran Affairs.

The goal of the US Department of Veterans Affairs (VA) Amputation System of Care (ASoC) is to enhance the quality and consistency of amputation rehabilitation care for veterans with limb loss. The ASoC provides specialized expertise in amputation rehabilitation incorporating the latest practices in medical management, rehabilitation, and artificial limbs in order to minimize disability and to enable the highest level of social, vocational, and recreational success for veterans with amputation. The ASoC serves veterans with limb amputation from any etiology. Between 2009 and 2019, the VA experienced a 34% increase in the number of veterans with amputation who received care. During the same 10-year period, the percentage of veterans with major limb amputation seen in an outpatient amputation specialty clinic each year increased from 4.8 to 26%. This article highlights how the mission of the ASoC has been accomplished over the past decade through prioritization and implementation of key strategic initiatives in learning organization creation, trust in VA care, modernization, and development of a high-performance network with enhanced access and customer service. This synopsis of the VA amputation care program serves as a model of amputation care that can be utilized outside the federal sector and has the potential to serve as a systems-based example for providing longitudinal care to other populations within the VA.

Telemedicine During COVID-19 and Beyond: A Practical Guide and Best Practices Multidisciplinary Approach for the Orthopedic and Neurologic Pain Physical Examination

Background: The COVID pandemic has impacted almost every aspect of human interaction, causing global changes in financial, health care, and social environments for the foreseeable future. More than 1.3 million of the 4 million cases of COVID-19 confirmed globally as of May 2020 have been identified in the United States, testing the capacity and resilience of our hospitals and health care workers. The impacts of the ongoing pandemic, caused by a novel strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have far-reaching implications for the future of our health care system and how we deliver routine care to patients. The adoption of social distancing during this pandemic has demonstrated efficacy in controlling the spread of this virus and has been the only proven means of infection control thus far. Social distancing has prompted hospital closures and the reduction of all non-COVID clinical visits, causing widespread financial despair to many outpatient centers. However, the need to treat patients for non-COVID problems remains important despite this pandemic, as care must continue to be delivered to patients despite their ability or desire to report to outpatient centers for their general care. Our national health care system has realized this need and has incentivized providers to adopt distance-based care in the form of telemedicine and video medicine visits. Many institutions have since incorporated these into their practices without financial penalty because of Medicare’s 1135 waiver, which currently reimburses telemedicine at the same rate as evaluation and management codes (E/M Codes). Although the financial burden has been alleviated by this policy, the practitioner remains accountable for providing proper assessment with this new modality of health care delivery. This is a challenge for most physicians, so our team of national experts has created a reference guide for musculoskeletal and neurologic examination selection to retrofit into the telemedicine experience. Objectives: To describe and illustrate musculoskeletal and neurologic examination techniques that can be used effectively in telemedicine. Study Design: Consensus-based multispecialty guidelines. Setting: Tertiary care center. Methods: Literature review of the neck, shoulder, elbow, wrist, hand, lumbar, hip, and knee physical examinations were performed. A multidisciplinary team comprised of physical medicine and rehabilitation, orthopedics, rheumatology, neurology, and anesthesia experts evaluated each examination and provided consensus opinion to select the examinations most appropriate for telemedicine evaluation. The team also provided consensus opinion on how to modify some examinations to incorporate into a nonhealth care office setting. Results: Sixty-nine examinations were selected by the consensus team. Household objects were identified that modified standard and validated examinations, which could facilitate the examinations.The consensus review team did not believe that the modified tests altered the validity of the standardized tests.Limitations: Examinations selected are not validated for telemedicine. Qualitative and quantitative analyses were not performed. Conclusions: The physical examination is an essential component for sound clinical judgment and patient care planning. The physical examinations described in this manuscript provide a comprehensive framework for the musculoskeletal and neurologic examination, which has been vetted by a committee of national experts for incorporation into the telemedicine evaluation. Key words: COVID, pain, telemedicine, physical examination, spine, shoulder, elbow, hand, hip, knee

Motivational Strategies for Stroke Rehabilitation: A Delphi Study

ObjectivesThe primary objective was to provide a list of effective motivational strategies based on consensus among rehabilitation experts, generated using the Delphi technique. The secondary objective was to identify the types of information that are important when selecting motivational strategies. DesignDelphi study. SettingOn-site survey at academic conferences and web-based survey. ParticipantsRehabilitation experts (N=198) including physicians, physical therapists, occupational therapists, and speech-language-hearing therapists who had worked in stroke rehabilitation for at least 5 years. InterventionNot applicable. Main Outcome MeasuresPanelists were asked to rate the effectiveness of motivational strategies and to rate the importance of different types of information using a 5-point Likert scale. Consensus was defined as having been reached for items with an interquartile range of 1 or less. ResultsA total of 116 experts (58.6%) completed the third round of the Delphi survey. Consensus was reached on all of the 26 presented strategies. Seven strategies, such as control of task difficulty and goal setting, were considered to be very effective in increasing patient motivation. In addition, all 11 of the presented types of information regarding patient health status, environmental factors, and personal factors were deemed very important or important in determining which motivational strategies to use. ConclusionsWe generated a list of effective motivational strategies for stroke rehabilitation based on expert consensus. Our results suggest that experts consider a comprehensive range of patient information when choosing motivational strategies. These findings represent a group of consensus-based recommendations for increasing patient adherence to stroke rehabilitation programs, which may be beneficial to many medical professionals working in stroke rehabilitation.

Interactive serious game for shoulder rehabilitation based on real-time hand tracking.

Virtual reality is becoming popular in the rehabilitation field thanks to the several advantages it can offer to patients and physicians. Indeed, serious games can: motivate and engage the patient; offer different levels of challenge and difficulty based on the patient baseline, and integrate objective measures of the patient's performance during each rehabilitation session. We designed and implemented a serious game for shoulder rehabilitation based on real-time hand tracking. The aim was to maintain the medical benefits of traditional rehabilitation, while reducing human resources and costs and facilitating active patient participation. Our software application provides the user with a shoulder horizontal adduction exercise. This exercise takes place in a 2D interactive game environment, controlled by hand movements on a desk pad. The hardware includes a standard desktop computer and screen, and the Leap Motion Controller: a hand tracking system. Changing the desk pad material allows the physiotherapist to vary the friction between the user hand and the supporting surface. Fourteen healthy volunteers and six rehabilitation experts tested our serious game. The results showed that the application is attractive, ergonomic and clinically useful. Despite promising results, clinical validation is necessary to demonstrate the efficacy of the serious game.

Self-Estimated Functional Inability because of Pain questionnaire for Brazilian workers with musculoskeletal pain: face and content validity

ABSTRACT Our study aimed to perform the face and content validity of Self-Estimated Functional Inability because of Pain (SEFIP) for workers, here called the SEFIP-work questionnaire. This is a questionnaire validity study. Our group previously translated and adapted the original version of the SEFIP, which was developed to investigate musculoskeletal pain and dysfunction to be applied to dancers (SEFIP-dance). However, due to the broad scope of the SEFIP-dance, we made changes and adaptations in the Brazilian Portuguese version of the SEFIP-dance to allow its use in workers. Therefore, face and content validity were performed for the development of the SEFIP-work based on opinions of committee of occupational disease and rehabilitation experts. After face and content validity, this SEFIP-work version was applied to 30 working individuals with musculoskeletal pain. The participants were native Brazilian Portuguese speakers aged 18 years and older. Thus, three changes were made to the questionnaire. All participants understood the SEFIP-work items and alternatives. The average total SEFIP-work score was 6.59 (SD=3.66), with the item “parte inferior das costas” (lower back) being the most marked (n=28; 93.33%), with an average score of 1.18 (SD=0.73). In conclusion, the Brazilian Portuguese version of SEFIP-work presents an acceptable level of understanding by workers in the investigation of musculoskeletal pain or discomfort.

Audio-Visual Thumble (AVT): A low-vision rehabilitation device using multisensory feedbacks.

Since the 70s sensory substitution devices have been used for blind individuals to compensate for the lack of vision and enable them to perceive environment through intact sensory modalities. In this study, we present a rehabilitation device called Audio Visual Thumble (AVT), which is a small ring-like device with LED and buzzer, that can be worn on pharynx. We focus on a unique group of low-vision individuals with a black spot or scotoma in their visual field due to a disease called Macular Degeneration. The visual localization abilities of these individuals are highly impaired due to developing scotoma. We recently showed that also their audio localization skills are impaired [9]. Rehabilitation techniques developed so far for Macular Degeneration focus on visual modality only. Since audition can also be used to improve their spatial skills, we developed the AVT device. It permits to associate the multisensory information (audio and visual feedbacks) coming from the device with the own movement (proprioceptive feedback). We propose that the AVT has the potential to help people with visual dysfunctions to improve in the identification of audio and visual targets outside or at the edge of the residual visual field. AVT could be used for a wide range of applications combined with classical rehabilitation techniques in Macular Degeneration patients.Clinical relevance- This device can be an effective addition for low-vision rehabilitation experts and can be used combined with classical rehabilitation methods.

Item development, internal consistency, and known-groups validity of the Self-Directed Mobility Scale

Purpose The aims of the current study include to: (1) describe the item development; and (2) begin the process of establishing the internal consistency and known-groups validity of the Self-Directed Mobility Scale. The purpose of the scale is to assess paediatric physical and occupational therapists’ views towards self-directed mobility and their perceived ability and intentions to advocate for children’s access to self-directed mobility. Methods Three individuals with expertise in kinesiology, psychology, paediatric rehabilitation, and disability studies served as the expert panel for item development. Four samples were included to determine internal consistency and known-groups validity: 350 physical therapists, 89 occupational therapists, 279 kinesiology undergraduate students, and 528 health and wellness undergraduate students. Results The internal consistency was above the acceptable level of 0.70 (range = 0.72–0.77) for all samples when two items regarding promoting other motor skills prior to powered mobility use and the temporary use of a mobility device were removed. Known-groups validity was established between all samples. Conclusions The Self-Directed Mobility Scale appears to be a valid tool for assessing views of self-directed mobility and mobility advocacy intentions in paediatric physical and occupational therapists, as well as undergraduate students. Future work should examine the internal consistency based on study sample to ensure the (> 0.70) acceptable Cronbach’s alpha level is met. Implications for rehabilitation The Self-Directed Mobility Scale is a viable measurement tool to assess views of self-directed mobility and mobility advocacy intentions of pediatric physical and occupational therapists. In combination with other measures, the Self-Directed Mobility Scale may be used in future rehabilitation research to evaluate factors associated with provision of mobility technology to children with disabilities.

Art on Prescription. Dutch Performing Arts Medicine Association (NVDMG) Symposium, Leeuwarden, The Netherlands, October 29, 2019

The focus of the symposium, organized by the Rehabilitation Expertise Center for Music & Dance of Revalidatie Friesland (NL) under the auspices of the Dutch Performing Arts Medicine Association (NVDMG), was the added value of the application of art in health care and the social domain. The abstracts of the presentations provide information about different aspects related to this topic.

Development of virtual reality rehabilitation games for children with attention-deficit hyperactivity disorder

Balance and coordination exercises improve the attention of children with attention-deficit hyperactivity disorder (ADHD), and exercise-based game treatments are effective in training children’s balance control and coordination and improving their cognition and intelligence. This study used immersive virtual reality exercise games as an intervention in rehabilitation to improve the attention, cognitive ability, abstract reasoning, and complex information processing of children with ADHD. This study is comprised of two stages: In the first stage, we interviewed experts in rehabilitation, made observations of rehabilitation sessions for children with ADHD, and developed three games focusing on training body coordination. In the second stage, we used the HTC VIVE (HTC, Taiwan), a virtual reality game console, in a 3-month training program developed for children with ADHD. We compared children’s attention, cognitive ability, abstract reasoning, and complex information processing before and after this program. The results revealed that children with ADHD improved their performance in attention, hyperactivity/impulsivity, and oppositional defiance. Our results may serve as a reference for the clinical use of technological assistive devices in rehabilitation as well as for families, schools, and rehabilitation institutes in implementing daily training and rehabilitation programs for children with ADHD.

Intellectual capital in rehabilitation organizations

PurposeThis paper aims to clear ambiguities regarding the definition of intellectual capital and its components in the evaluation of rehabilitation organizations.Design/methodology/approachA preliminary definition of intellectual capital and its three domains of human, relational and structural capital and separate lists of proposed components for each domain was developed based on the results of a previous study. Fourteen experts in rehabilitation, health management and management engaged in Delphi rounds to reach agreed-upon definitions. Their ideas on relevance and the measurements of each proposed component in the assessment of intellectual capital in rehabilitation organizations were gathered by a questionnaire.FindingsIntellectual capital was defined as “The capital that emerges from the interaction of human resources’ ‘ability to think’ and to ‘create ideas’ with ‘a favorable internal and external organizational environment’ (including the managerial, social, structural, and physical environment, as well as communication between the inside and outside of the organization).” This capital is expected to gradually increase with further education, skills training and the gaining of experience by staff and managers. Also, the further development of intra-organizational structures and inter-relations with the market will empower the organization to adapt to continually changing circumstances, leading to competitive value and profit. Finally, a list of 101 proposed components was agreed upon in the evaluation of intellectual capital in rehabilitation organizations.Originality/valueThis paper may lead to the development of measurement tools and ultimately to planning effective programs to increase intellectual capital in rehabilitation organizations.

My Story of Recovery from Brain Damage

The author (hereafter referred to as I) is a speech-language-hearing pathologist and former professor of neuropsychology at Kobe University, who had been engaged in neuropsychological rehabilitation and research of conditions, such as aphasia and unilateral spatial neglect, for 37 years. In July 2009, I experienced right hemispheric infarction in Kobe City, and developed left-sided hemiparesis and various symptoms of cognitive dysfunctions, which was previously my field of expertise. As a neuropsychological rehabilitation expert, I focused my efforts on recovery and I have recovered the majority of my cognitive and neurologic functions. This is my story of recovery from stroke, in which functional magnetic resonance imaging (fMRI) studies of my arithmetic ability are described. I had been an excellent abacus user with brilliant achievements since elementary school. Premorbidly, I could use the right hemisphere of my brain to visualize a clear image of an abacus. However, my ability to visualize the abacus disappeared following the stroke. Two experiments were conducted involving calculation and digit memory tasks using fMRI. This may be the most important aspect of my story. My recovery process for other cognitive deficits is also delineated here.

Rehabilitation Is a Global Health Priority

Rehabilitation Is a Global Health Priority

Exercising with Baxter: preliminary support for assistive social-physical human-robot interaction

BackgroundThe worldwide population of older adults will soon exceed the capacity of assisted living facilities. Accordingly, we aim to understand whether appropriately designed robots could help older adults stay active at home.MethodsBuilding on related literature as well as guidance from experts in game design, rehabilitation, and physical and occupational therapy, we developed eight human-robot exercise games for the Baxter Research Robot, six of which involve physical human-robot contact. After extensive iteration, these games were tested in an exploratory user study including 20 younger adult and 20 older adult users.ResultsOnly socially and physically interactive games fell in the highest ranges for pleasantness, enjoyment, engagement, cognitive challenge, and energy level. Our games successfully spanned three different physical, cognitive, and temporal challenge levels. User trust and confidence in Baxter increased significantly between pre- and post-study assessments. Older adults experienced higher exercise, energy, and engagement levels than younger adults, and women rated the robot more highly than men on several survey questions.ConclusionsThe results indicate that social-physical exercise with a robot is more pleasant, enjoyable, engaging, cognitively challenging, and energetic than similar interactions that lack physical touch. In addition to this main finding, researchers working in similar areas can build on our design practices, our open-source resources, and the age-group and gender differences that we found.

The development of safe and effective rehabilitation protocols for horses

SummaryRehabilitation has become an important aspect of equine practice. Unfortunately, there is limited knowledge or awareness of the general principles and methods used to develop safe and effective rehabilitation programmes. By following a few basic principles, appropriate rehabilitation programmes can be developed for individual horses with a wide range of injuries and sources of musculoskeletal pain or dysfunction. This article provides an outline of general guidelines to help practitioners interested in developing rehabilitation programmes or working with sports medicine and rehabilitation experts to provide the best possible treatment for individual horses with injuries at different stages of healing.