Rehabilitation Framework Research Articles

Using the good lives model (GLM) in clinical practice: Lessons learned from international implementation projects

Efforts to implement the Good Lives Model (GLM) in offending treatment programs highlight common challenges across diverse settings. Long described as an overarching framework for rehabilitation, the GLM has recently been reconstructed as a practice framework . In this paper, the authors explore how the reconstruction of the GLM as a practice framework can help address challenges to GLM implementation observed internationally. Challenges to effective implementation of the GLM in a variety of settings and across cultures are described, based upon the authors' experiences helping programs and practitioners use the GLM to their fullest potential. Drawing on the theoretical resources of practice frameworks, it offers ideas for how programs and practitioners can respond to these challenges as implementation efforts unfold. Specifically, the paper focuses on how core values and principles of the GLM (Level 1 of practice frameworks) can inform intervention guidelines (Level 3 of practice frameworks). Research has been clear that proper implementation of any treatment approach can take considerable time to conduct properly; it is the authors' hope to equip programs and practitioners with ideas for moving forward thoughtfully with the GLM.

Rehabilitation of the Postpartum Runner: A 4-Phase Approach

Running after childbirth, specifically how or when to return, is a hot topic in the field of physical therapy and on social media; however, there are significant gaps in the literature supporting when and how to safely initiate running postpartum. During pregnancy and following childbirth (both vaginal and cesarean), the body undergoes changes that may impact strength, neuromuscular control, endurance, and the ability to withstand the high-impact forces and repetitive nature of running. Many mothers experience new or worsened symptoms of musculoskeletal or pelvic floor dysfunction following pregnancy and childbirth and require physical therapy to normalize function. After most major injuries, it is common to participate in formalized rehabilitation; however, this is not the norm for athletes returning to running postchildbirth. Because of lack of evidence, many runners and clinicians struggle to develop appropriate rehabilitation progressions for return to running after childbirth. Pelvic and sports physical therapists must understand biomechanical features of running gait and safely progress strength, endurance, and neuromuscular control of the kinetic chain when guiding a runner back to running. This clinical commentary builds on existing guidelines, research, and expert opinion to propose a 4-phase rehabilitation framework to help runners initiate and progress running after childbirth. The result is an in-depth exercise prescription (intensity, frequency, type), examples of exercises (hip, abdominal, pelvic floor, and foot), running progression, and progression goals to prepare runners for symptom-free running after childbirth (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JWHPT/A58, where authors provide more insight on this return to running framework).

Precision Rehabilitation: Optimizing Function, Adding Value to Health Care

Precision medicine efforts are underway in many medical disciplines; however, the power of precision rehabilitation has not yet been explored. Precision medicine aims to deliver the right intervention, at the right time, in the right setting, for the right person, ultimately bolstering the value of the care that we provide. To date, precision medicine efforts have rarely focused on function at the level of a person, but precision rehabilitation is poised to change this and bring the focus on function to the broader precision medicine enterprise. To do this, subgroups of individuals must be identified based on their level of function via precise measurement of their abilities in the physical, cognitive, and psychosocial domains. Adoption of electronic health records, advances in data storage and analytics, and improved measurement technology make this shift possible. Here we detail critical components of the precision rehabilitation framework, including (1) the synergistic use of various study designs, (2) the need for standardized functional measurements, (3) the importance of precise and longitudinal measures of function, (4) the utility of comprehensive databases, (5) the importance of predictive analyses, and (6) the need for system and team science. Precision rehabilitation has the potential to revolutionize clinical care, optimize function for all individuals, and magnify the value of rehabilitation in health care; however, to reap the benefits of precision rehabilitation, the rehabilitation community must actively pursue this shift.

Evaluating the impact of land use and land cover change on unprotected wetland ecosystems in the arid-tropical areas of South Africa using the Landsat dataset and support vector machine

The study explored the impact of Land Use and Land Cover (LULC) change dynamics in relation to the condition and status of an unprotected wetland located in the arid-tropical parts of the Limpopo Province, South Africa. The long-term Landsat archival data series was used to map and quantify the impacts of LULC change on the wetland over a period of 36 years (1983–2019). A multi-source satellite image analysis was performed, using the support vector machine (SVM) algorithm and advanced spatially- explicit geographic information system tools. Landsat data series covering the entire study area was used to assess, map and monitor LULC change that occurred over-time. Post-classification maps for the Maungani wetland area were analysed to provide a quantitative assessment and a detailed overview of the rate of change. The generated wetland detection maps for four temporal phases (i.e., 1983–1992, 1992–2001, 2002–2010) were analysed. This study found that the spatial extent of the wetland area declined severely during the period under study with 728 300 ha. The findings of this work provide critical insights and baseline information about the state of unprotected wetlands in the rural parts. This information is useful for the development of tailor-made wetland management strategies and a possible rehabilitation framework for unprotected wetland ecosystems.

The Individual Rehabilitation Project as the core of person-centered rehabilitation: the Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists Framework for Rehabilitation in Europe.

To facilitate the interaction between the health professional and the patient, a framework to guide the rehabilitation process is needed. This framework would encompass three interwoven aspects: the rehabilitation management plan, Individual Rehabilitation Project (IRP), and rehabilitation cycle(s). All three framework aspects focus on the patient and on the aim of rehabilitation, i.e. to optimize a person's functioning across the continuum of care. An IRP is a multi-element, person-centered rehabilitation management scheme, in which rehabilitation is generally provided by a multiprofessional team under the leadership of a physical and rehabilitation medicine (PRM) physician, working in an interdisciplinary manner and together with the patient (or proxy). A reference system for operationalizing functioning and standardizing the process is the International Classification of Functioning, Disability and Health (ICF) - for assessing functioning needs, defining rehabilitation goals and outcomes. The objective of this paper is to present the IRP as a framework for rehabilitation in Europe (EUR-IRP). The specific aims are: 1) to introduce the IRP; and 2) to describe the framework components, elements and variables of the IRP. Demonstration projects (case studies) using the EUR-IRP will be conducted. The present paper presents the efforts to date for developing the EUR-IRP, a key part of the action plan of the PRM Section and Board of the European Union of Medical Specialists to implement the ICF systemwide across the care continuum. This paper serves as another step to bring together practice, science and governance in calling for contribution from rehabilitation clinicians and researchers and professional societies in PRM and beyond.

Design and Validation of Virtual Reality Task for Neuro-Rehabilitation of Distal Upper Extremities.

Stroke, affecting approximately 15 million people worldwide, has long been a global cause of death and disability. Virtual Reality (VR) has shown its potential as an assistive tool for post-stroke rehabilitation. The objective of this pilot study was to define the task-specific performance metrics of VR tasks to assess the performance level of healthy subjects and patients quantitatively and to obtain their feedback for improving the developed framework. A pilot prospective study was designed. We tested the designed VR tasks on forty healthy right-handed subjects to evaluate its potential. Qualitative trajectory plots and three quantitative performance metrics—time taken to complete the task, percentage relative error, and trajectory smoothness—were computed from the recorded data of forty healthy subjects. Two patients with stroke were also enrolled to compare their performance with healthy subjects. Each participant received one VR session of 90 min. No adverse effects were noticed throughout the study. Performance metrics obtained from healthy subjects were used as a reference for patients. Relatively higher values of task completion time and trajectory smoothness and lower values of relative % error was observed for the affected hands w.r.t the unaffected hands of both the patients. For the unaffected hands of both the patients, the performance levels were found objectively closer to that of healthy subjects. A library of VR tasks for wrist and fingers were designed, and task-specific performance metrics were defined in this study. The evaluation of the VR exercises using these performance metrics will help the clinicians to assess the patient’s progress quantitatively and to design the rehabilitation framework for a future clinical study.

Use of “natural therapy” technology in the framework of social and psychological rehabilitation of the elderly

<abstract> <p>The article is devoted to the peculiarities of using “natural therapy” technology in the process of social and psychological rehabilitation of the elderly. The article analyzes the relevance of the problem of social isolation, maladaptation and loneliness of elderly people in different countries of the world, and in Ukraine in particular, leading to sustainable social and psychological dysfunctions and substantiates the need to overcome them. The author's methodology for evaluating the effectiveness of socio-psychological rehabilitation sessions with the elderly using the rehabilitation implements of natural therapy is proposed. The mechanisms and technologies of social and psychological rehabilitation of the elderly using the rehabilitation concept of natural therapy are proposed and have been tested. As part of the research, an experiment was conducted among 100 people, half of whom were engaged in an individual rehabilitation course using the technology of the ecological rehabilitation concept of natural therapy. The article describes the results of the proposed classes for the participants of the experimental group and presents proposals in the field of improving rehabilitation measures based on natural therapy in the framework of the social and psychological rehabilitation of the elderly.</p> </abstract>

Cancer Rehabilitation, Diabetes, Haemodialysis: AB No: 160: A Framework for Cognitive Rehabilitation for Cancer Survivor Reporting Cognitive Deficits: A Systematic Review

Cancer Rehabilitation, Diabetes, Haemodialysis: AB No: 160: A Framework for Cognitive Rehabilitation for Cancer Survivor Reporting Cognitive Deficits: A Systematic Review

Suppression of positive emotions during pandemic era: a deep learning framework for rehabilitation

The rapidly growing popularity of computer and Android gaming in the pandemic era has led many researchers to focus on the emotional changes and adverse effects of gaming on a player. Sometimes games are played to give relaxation and help to recover from anxiety and stress, but some recent incidents are alarming since vigorous games playing can lead to anxiety and stress. This paper has attempted to overcome the shortcoming of existing literature by a novel approach to detect emotions acquired from electroencephalographic signals using a deep learning algorithm with high accuracy of emotion recognition. The feature extraction and classification algorithms individually outperformed the existing ones in the related area and the combination of them also has shown better performance than the state-of-the-art literature. Outcomes of the proposed framework have shown its wide range of applicability from parental control to cyber security by emotion detection and in terms can help in providing rehabilitation.

Suppression of positive emotions during pandemic era: a deep learning framework for rehabilitation

Suppression of positive emotions during pandemic era: a deep learning framework for rehabilitation

Impact of a COmprehensive Cardiac REhabilitation Framework Among High Cardiovascular Risk Cancer Survivors: Rationale and Study Design of the CORE Trial

Impact of a COmprehensive Cardiac REhabilitation Framework Among High Cardiovascular Risk Cancer Survivors: Rationale and Study Design of the CORE Trial

Muscle training in patients with pulmonary hypertension. a narrative review

Patients with pulmonary hypertension present limited tolerance to exercise and aerobic capacity; which is reflected in the reduction in peak oxygen consumption and their functional performance. This intolerance to exercise has traditionally been attributed to cardiac and respiratory dysfunction. However, as it happens in other chronic diseases, lower-limb and respiratory muscle alterations are also involved in patients with pulmonary hypertension.Increasing evidence suggests that physical exercise training is an efficient and safe strategy. The recommendation for light and moderate-intensity exercise is made within the framework of pulmonary rehabilitation, and its benefits have been previously described.In diseases such as COPD, lower-limb muscle function, exercise tolerance and quality of life improve following exercise training. And just as with COPD, it is necessary to promote evidence-based interventions with pulmonary hypertension. This narrative review focuses on the evaluation, safety and efficacy of training the respiratory muscles and the muscles of upper and lower extremities in patients with pulmonary hypertension.

Exploring the delivery of community rehabilitation services for older people in an urban Canadian setting: Perspectives of service providers, managers and health system administrators.

As the global population of older people increases, policies aimed at improving health care delivery for older people often include supports for ageing in place. Living in the community not only reduces institutionalisation but also improves quality of life and reduces health care costs. For older people, community rehabilitation offers the opportunity to preserve and maximise function while maintaining the ability to live in the community. However, limited research examines the delivery, coordination and integration of community rehabilitation services in health systems. Our case study explored the perspectives of service providers, managers and health system administrators on the strengths, limitations and gaps in community rehabilitation for older people in one Canadian urban health region. Using interpretive description and thematic analysis, we analysed interview data from: 16 service providers, eight managers and five health system administrators. Three themes were identified: (a) Limited Access to Programs and Services; (b) Need to Emphasise Promoting, Maintaining and Restoring Function; and (c) Lack of Flow Across the System. Participants highlighted that restrictive eligibility criteria limited access to services. Services were organised around health conditions that did not address the needs of older people. Long waitlists meant that services were delayed. Transportation costs limited participation of individuals from lower socioeconomic status (SES). Age restrictions did not reflect differences in the ageing process and the health inequities individuals from lower SES groups experienced. There was a lack of emphasis in community rehabilitation programs on maintaining or restoring function in older people, which is the primary focus of rehabilitation. Furthermore, key stakeholders stressed the need for strengthening the integration of service delivery across the continuum of care. The findings underscore the need to develop a conceptual framework for community rehabilitation to promote greater system integration, access and availability of services and to optimise functional outcomes for older people.

Government Agencies and their Discourses of Flood Disaster Preparedness: Impact on Response, Action and Community Empowerment

One of the severe global threats facing the world today is flooding. Similarly, Malaysia is faced with monsoon and flash floods which are the most severe "climate-related natural disasters" for the country. The Malaysian government is the main stakeholder and provider of aid in every stage of disaster. Consequently, the involvement of flood risk communities is said to be minimal and overlooked. Researchers have also stated that there is still a lack of research on human involvement and response. Thus, addressing these gaps, we take on a social constructionist view to situate flood disaster as a social practice and discourse to investigate how government officials ‘talk’ about their involvement in flood disaster mitigation and management. Our analysis is based on the perspective that their ‘talk’ evokes specific disaster discourses which relate to the different ways of understanding flood disaster, and that these discourses in turn shape and impact their response and action for flood mitigation and management as well as community empowerment. To this end, we adopt Van Leeuwen’s representation of social actors and social action framework to identify the disaster discourses drawn upon by the officials. The findings show that government officials employ various discourses that draw on the ‘ traditional framework of relief and rehabilitation ’ and a ‘ top-down government centric approach ’ that focus less on community empowerment. We see a need for the inclusion of a ‘ discourse of shared responsibility ’ that is part of a ‘ proactive approach ’, and sees all parties as partners, and in particular, flood risk communities.

Features of the organization of medical rehabilitation at the present stage

The development of rehabilitation at the present stage is one of the priorities in the field of health and social development. Not only medical organizations, but also other organizations can take part in carrying out medical rehabilitation activities. A prerequisite for the implementation of rehabilitation activities is the availability of a license for medical activity with an indication of medical rehabilitation work. Of great concern is the issue of staffing of medical organizations, especially primary care, by such specialists as a doctor of physical and rehabilitation medicine, a doctor of medical rehabilitation, a medical speech therapist, an ergorehabilitation specialist, etc. In the absence of these specialists in medical organizations, it is impossible to form interdisciplinary rehabilitation teams, and in their absence, the solution of medical rehabilitation issues is questionable.
 The article contains an analysis of the current legal framework for medical rehabilitation. The stages of medical rehabilitation in medical organizations are reflected in accordance with the scale of rehabilitation routing. Four groups of medical organizations carrying out medical rehabilitation have been identified. The shortcomings of the current legal framework for medical rehabilitation are indicated, since a comprehensive rehabilitation system is currently being formed in the Russian Federation. For its successful development and implementation in the practical activities of medical organizations and social institutions, a regulatory and legal framework is being developed and improved.
 The approved Procedure for the organization of medical rehabilitation will allow to systematize and organize this work at a qualitatively new level.

Reintegration experiences in a sample of Israeli parolees on completion of their term of supervision: A qualitative study

For many released prisoners, the period following release is characterized by extreme challenges. The ability to overcome such challenges depends on the services, level of supervision, and type of support available. One type of support offered by the Israeli Prisoners’ Rehabilitation Authority provides a supervisory and rehabilitative framework for reintegration after release from imprisonment, with an emphasis on employment. The present study examines the subjective experiences of ex-prisoners on their journey from incarceration through reentry and reintegration while participating in supervision, treatment, and employment intervention operated by the Israeli Prisoners’ Rehabilitation Authority. Semi-structured interviews were conducted with a sample of released prisoners who successfully completed Israeli Prisoners’ Rehabilitation Authority supervision between 2014 and 2019. The interviews reveal four main themes that in turn identify pathways to “better lives” through the reintegration process.

Urban river pollution in the densely populated city of Dhaka, Bangladesh: Big picture and rehabilitation experience from other developing countries

Rapid urbanization and economic development caused urban river pollution globally. In the developing countries' megapolis, the situation is especially critical in response to the United Nation's sustainable development goal for 2030. Dhaka, Bangladesh, is one of the most densely populated cities in the world. Around 21 million people are living in this city of 1464 km2. Currently, 98% of untreated domestic sewage as well as significant amounts of industrial wastewater discharge from over 7000 industries are contributing to the presence of black and foul water in the urban rivers. In this study, a driving force-impact-challenge-response (DICR) framework is formed to create a big picture of urban river pollution situation, which incorporates nine factors of social, environmental, and governmental aspects. Using this framework, a comparative study was performed between Dhaka rivers and other rivers in developing countries with successful rehabilitation experiences. Accordingly, a strategy for Dhaka's urban river pollution control was developed, which included improvement of sewerage systems, appropriate planning of industrial enterprises, construction of hydraulic structures to modify and improve the water flow, and an efficient management framework and finance investments for river rehabilitation. The key actions necessary to further improve the river water quality in the far future are also suggested, under the condition that dry-weather black and foul occurrence in the Dhaka rivers could be eliminated. The river assessment framework and associated strategies may also help policymakers, the government, and researchers to develop a plan for the rehabilitation of seriously polluted rivers in other developing countries.

Psychoeducation as Precision Health in Military-Related Mild Traumatic Brain Injury

A significant proportion of Service Members and Veterans (SMVs) experience at least 1 mild traumatic brain injury during military activities (mil-mTBI), which can result in enduring cognitive symptoms. Although multiple cognitive rehabilitation (CR) interventions have been developed for this population, patient psychoeducation focusing on biopsychosocial relationships and health behaviors is often cited as the first line of defense for mil-mTBI sequelae. However, theoretical and conceptual foundations of these psychoeducational techniques are not well articulated. This raises questions about the potency of attempts to boost health literacy in affected SMVs, who represent a highly heterogeneous patient population within a special cultural milieu. To elucidate the significance of this problem and identify opportunities for improvement, we view the psychoeducation of SMVs through the lens of educational principles described in serious mental illness, where “psychoeducation” was first formally defined, as well as contextual and phenomenological aspects of mil-mTBI that may complicate treatment efforts. To advance psychoeducation research and practice in mil-mTBI, we discuss how treatment theory, which seeks to link active treatment ingredients with specific therapeutic targets, and an associated conceptual framework for medical rehabilitation—the Rehabilitation Treatment Specification System—can be leveraged to personalize educational content, integrate it into multicomponent CR interventions, and evaluate its effectiveness.

Translating 2019 ACSM Cancer Exercise Recommendations for a Physiatric Practice: Derived Recommendations from an International Expert Panel.

In 2018, the American College of Sports Medicine (ACSM) reconvened an international, multi-disciplinary group of professionals to review pertinent published literature on exercise for people with cancer. The 2018 roundtable resulted in the publication of three articles in 2019. The three articles serve as an important update to the original ACSM Roundtable on Cancer, which convened in 2010. Although the focus of the three 2019 articles is on exercise, which is only one part of comprehensive cancer rehabilitation, the evidence presented in the 2019 ACSM articles has direct implications for physiatrists and other rehabilitation professionals who care for people with cancer. As such, the narrative review presented here has two primary objectives. First, we summarize the evidence within the three ACSM articles and interpret it within a familiar rehabilitation framework, namely the Dietz model of Cancer Rehabilitation, in order to facilitate implementation broadly within rehabilitation practice. Second, via expert consensus, we have tabulated relevant exercise recommendations for specific cancer populations at different points in the cancer care continuum and translated them into text, tables, and figures for ease of reference. Notably, the authors of this article are members of the Cancer Rehabilitation Physician Consortium (CRPC), a group of physicians who subspecialize in cancer rehabilitation medicine (CRM).

‘Like an earthquake in a submarine’: the social and institutional impact of a theatre laboratory programme at the ‘C. Beccaria’ youth detention centre in Milan

ABSTRACT This article presents two key findings from a case study on the impact of a theatre laboratory programme implemented at ‘C. Beccaria’ youth detention centre in Milan. First, the opening of a permanent theatre inside the prison, with the involvement of the broader community, has helped fulfil detained minors’ rights to culture and rehabilitation, as well as remodel the relationship between prison and society. Second, the institution’s reaction to the theatre laboratory has been ambivalent. The article critically examines this tension, exploring the conditions required to rethink and transform the institutional, rehabilitative, and cultural framework of the youth detention centre.