Rehabilitation Milieu Research Articles

Abstract WP59: Latino Ethnicity Is Associated With Reduced Cognitive Functioning After Stroke Inpatient Rehabilitation

Brief Introduction: Stroke is one of the leading causes of disability and mortality in the United States, with higher prevalence and functional burden among Latino communities compared to Whites (García & Warren, 2019). The inpatient rehabilitation milieu provides a unique opportunity to examine ethnic differences in stroke functionality. Yet, little is known regarding the functional outcomes of the inpatient stroke rehabilitation experience of Latinos (Cruz-Flores et al., 2011). Therefore, the current study examined the associations between Latino ethnicity and poststroke outcomes in the context of stroke inpatient rehabilitation. Methods: This is a cross-sectional and retrospective analysis of data extracted from an administrative database for years 2005-2016 of 172,937 stroke patients. Data were pooled from inpatient rehabilitation facilities that participated in the secure platform eRehabData. Participants included were 1) age 18 or above, 2) had a stroke admitting diagnosis (ICD 9/10 codes 430-438/I60-I69), and 3) self-reported ethnicity as Latino or White. The analytic strategy included two hierarchical regression analyses and one Independent Samples t-test. Ethnicity was dummy coded to examine differences in outcomes between Latino and White stroke patients. Sociodemographic and clinical covariates were entered into block 1 of each separate hierarchical regression model, consistent with previous studies. Block 2 of each model comprised the outcome measures: admission cognitive functioning scores and discharge cognitive functioning scores. Results: Latinos had greater BMI and lower age compared to Whites. No ethnic differences in LOS were found. Hierarchical regression analyses controlling for covariates showed that Latino participants (relative to Whites) had lower admission cognitive functioning scores and discharge cognitive functioning scores. Conclusions: Ethnic differences were found for Latinos in cognitive functioning at different points throughout stroke inpatient rehabilitation, even after accounting for clinical and sociodemographic covariates. Results are discussed within a framework of social determinants of stroke health for Latinos.

Evidence-Based Clicker Use

An Audience Response System (ARS) commonly used in schools and universities was studied for its benefit in rehabilitation. Audience response systems or "clickers" are technological tools for promoting interactive learning. Clickers were studied for their applicability to clinical settings as well. Current literature shows evidence-based research and best practices for clicker use within schools. This study expanded ARS into the rehabilitation milieu and then analyzed learner opinions and outcomes. Qualitative data was obtained from both professional and patient groups. Clickers were used while presenting research findings at conferences, when conducting staff seminars, and during client support groups and subsequent educational sessions. Response graphs and decision trees illustrate the flexibility of ARS for helping educators match presentation content to audience feedback. Clickers narrowed the gap between those with expertise and those with minimal experience, since immediate clarification was given according to clicker results. ARS helped to engage listeners, which is consistent with clicker research conducted in academic environments. With clickers, the knowledge and viewpoints of participants can be instantly graphed and displayed, and pertinent information can be provided in real-time. Examples from rehabilitation scenarios depict benefits of Audience Response Systems beyond academia.

Nurses Create a Rehabilitative Milieu

Despite the recognition of milieu therapy as a nursing intervention, nursing's contribution to the creation of inpatient environments that facilitate patient rehabilitation has been underresearched. A large study conducted in five inpatient rehabilitation units in Australia that sought to develop a grounded theory of nursing's contribution to inpatient rehabilitation has begun to address this gap in the literature. Analysis of data collected from 53 nurses during interviews and observations of their everyday practice revealed that nurses act purposefully to create a milieu conducive to rehabilitation. In doing so, they target all patients using a range of strategies that include allowing time, keeping patients'spirits up, protecting patients from embarrassment, and making hospitals more homelike than is typically experienced in acute-care environments. As a consequence, rehabilitative milieu therapy is proposed as a subset of milieu therapy.

Pathways to sex workers\' social rehabilitation and assessment of rehabilitation approaches in Nigeria: evidence from a qualitative study

This article asks three questions: What are the characteristics of the pathways to the sex workers social rehabilitation programmes? How are the sex workers managed in these rehabilitation centres? Which of the social rehabilitation approaches is most effective? Answers to these broad questions helped to unveil the treatment of the victims of sex trafficking their ‘rescue' from traffickers. Using qualitative techniques, data were collected from victims of sex trafficking and officials of rehabilitation centres in Edo and Lagos states of Nigeria. The pathways to social rehabilitation were found to be characterized with activities that negate the human rights of the victims. A comparative analysis of the relative effectiveness of the various rehabilitation options showed that faith-based rehabilitation milieu and approach was the most effective place of rehabilitation. However, the study argues for a fusion of the faith-based and social welfare approaches for the most effective outcome. Keywords: Sex workers, Pathways, Social rehabilitation, NigeriaGender & Behaviour Vol. 6 (2) 2008: pp. 1925-1959

Recreation in stroke rehabilitation part two: exploring patients' views

Part one of this article highlighted a lack of research that investigated patients' perceptions of the need for recreational activity while undergoing rehabilitation following stroke. This article investigates whether patients perceive a need for recreation while undergoing stroke rehabilitation in an acute hospital setting. Data were collected using individual interviews and analysed using constant comparison. Participants explained how they had come to be in their current condition and described the ‘purgatory’ of having a stroke. They talked about the ‘lifelines’ that may help them recover sufficiently, one of which was recreation. Many of the findings from this study were congruent with those from other studies. However, this article highlighted a desperation that participants felt to undertake more activity and a desire to incorporate recreation into the rehabilitative milieu.

Creating a Rehabilitative Milieu

Although rehabilitation is a complex process, only some of the factors that contribute to this process and its outcome have been identified and developed in the literature. This article briefly discusses the nature of and proposes a working definition of rehabilitation, then explores the variety of factors that may contribute to the total setting in which people attempt to rehabilitate themselves. The creation of a rehabilitative milieu—an environment that can enhance the process and the outcome of rehabilitation—is proposed as a new focus for the healthcare team. In addition, the pivotal nature of nursing's contribution to the creation of a rehabilitative milieu is highlighted.

Long-Term Care Reconsidered: The Role of the Psychologist in the Geriatric Rehabilitation Milieu

Traditional notions of rehabilitation must be expanded to incorporate a long-term care model sensitive to the unique needs of a heterogeneous geriatric population with multiple chronic impairments. This alternate treatment model posits a reconceptualization of health management within the context of developing a specific milieu to optimize resident psychological status. This milieu is conceived of as serving a geriatric mental health mandate. The relationship between this therapeutic milieu and resident quality of life is explored. The psychologist plays a vital role in articulating mental health objectives germane to the milieu's therapeutic success. The psychologist's specific programmatic interventions at multiple levels of the milieu and their underlying rationale are discussed.

Where can therapeutic community ideals be realized? An examination of three treatment environments.

Staff views about the actual and ideal treatment environment of three therapeutic milieus with psychoanalytic, biological, and rehabilitative orientations were assessed using the Community-Oriented Programs Environment Scale (COPES), real and ideal forms. COPES scores indicated that the staff of the three units shared many beliefs about the ideal milieu but that only staff of the rehabilitation unit felt the milieu had realized its ideals. Disparities between real and ideal COPES scores on the other two units were believed to reflect staffs' inability to resolve the conflicting demands of milieu therapy and other treatment approaches. The authors identify specific sources of conflict on the psychoanalytic and biological milieus and reasons for the greater compatibility of ideology and practice in the rehabilitation milieu.