Rehabilitation Process In Order Research Articles

A 3UPS/S Spherical Parallel Manipulator Designed for Robot-Assisted Hand Rehabilitation after Stroke

Hand dysfunction is a common symptom in stroke patients. This paper presents a robotic device which assists the rehabilitation process in order to reduce the need of physical therapy, i.e., a 3UPS/S parallel robotic device is employed for repetitive robot-assisted rehabilitation. Euler angle representation was used to solve the robot’s inverse kinematics. The robot’s joint space and rotational workspace were determined for two scenarios. In the first scenario, the workspace was obtained considering the actuator’s stroke limitations, while in the second scenario, the workspace was determined by adding a second condition, i.e., the range of motion of the spherical joints. Singularity analysis was performed using the geometric algebra approach. The robot was manufactured using additive manufacturing technology. The solution of the inverse kinematic problem was employed to control the robot. The robot can perform a full range of motion during wrist ulnar deviation and radial deviation motions, with the exception of limited wrist flexion and extension motions. The robot has singular configurations within its workspace. Although the spherical joints have roles in reducing the workspace, the primary causes are actuator selection, radii of the base and moving platforms, and the length of the central leg. These factors can be considered to improve the workspace. Singularity can be avoided by carefully selecting the rotation of the moving platform about the Z-axis and avoiding same leg lengths.

Proses Rehabilitasi Terhadap Pecandu Narkotika Belum Sepenuhnya Dapat Memulihkan Dari Ketergantungan

Narcotics addicts according to the narcotics law are required to carry out a rehabilitation process in order to save their lives from drug addiction. The rehabilitation is divided into two, namely medical rehabilitation and social rehabilitation. However, even though they have carried out rehabilitation activities, many addicts have not managed to recover. This is due to many factors, such as the substances contained in narcotics, financial factors, human resource factors, family factors, factors within the addict himself and so on. Moreover, narcotics addicts can no longer return to normal as before, that is, when they have not used narcotics. Thus, it is important to provide this information to generation Z so they don't use narcotics. As generation Z is the younger generation who must be protected from the dangers of narcotics. Therefore, the authors carry out community service activities for generation Z in order to provide an understanding of narcotics so that awareness will grow within them to stay away from narcotics. This service uses the seminar method, namely delivery of material, discussion and evaluation. This service was carried out at SMK Negeri 3 Lubuk Linggau. The participants were students and female students. The results of the dedication concluded that the students of SMK Negeri 3 Lubuk Linggau understood that narcotics addicts could carry out rehabilitation to recover from narcotics dependence, but could not recover 100% because the nerves had been damaged. In addition, from the results of the evaluation carried out by the presenters, all participants answered well.

Rescue, Rehabilitation and Reintegration of female survivors of human trafficking in Northern Tanzania

The victims of human trafficking experience a very traumatic experience from the time they are recruited up to the time of rescue. It is without doubt that they require rehabilitation process in order for them to recover to their normal being before being given other opportunities or reintegrated back into their communities. However, many countries have limited services to the victims of human trafficking and as a result, the victims return to the trafficking cycle. In many it is not clearly stipulated who is responsible for rescue, rehabilitation and reintegration of the victims. It is from this concern the current study sought the importance of establishing and documenting information on the rescue, rehabilitation and reintegration of victims of human trafficking in Northern Tanzania. The study applied a mixed approach technique where qualitative and quantitative methods were used to get data from the study area. Seven district councils of Arusha region were involved in the study. Data collection tools included a questionnaire, focus group discussion and interview. A total of 400 girls and young women were sampled for the study. The findings revealed that only 30.2%of the respondents reported to have received some sort of assistance and service from different stakeholders. Further it was found that study few respondents (34.5%) were willing to go back to their communities while a good number (65.5%) disagreed with the idea of going back to their communities due to different reasons. Much as these services seem to be crucial for the recovery of the victims, in the current study it was reported that they victims could not receive the said services due to lack of funds for implementing this services.

Clinical symptoms and social functioning in schizophrenia

IntroductionThe aim of the present study was to assess the relationship between social functioning and clinical symptoms in people with schizophrenia, analyzing the influence of both global social functioning and the specific aspects of social functioning, assertiveness and communication skills in the explanation of type of symptoms. Material and methodsA cross-sectional descriptive study composed of 125 people diagnosed with schizophrenia was performed. Patients were assessed with the Communication Skills Questionnaire (CSQ), the Gambrill and Richey Assertiveness Inventory (GR), the Global Assessment of Functioning Scale (GAF) and the Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale and the Clinical Global Impression scale for Schizophrenia (CGI-S). ResultsSOFAS, LSP and GR are related to each of the subscales and total scores of symptoms (p<0.05–0.001). The multiple regressions show that SOFAS and GR explained 59% of the total symptoms. SOFAS and GR, accounting for 65% of the variance, explain positive symptoms. GR and SOFAS explained 34% of the variance of negative symptoms. SOFAS, CSQ and LSP, accounting for 20% of the variance, explain depressive symptoms. SOFAS explained 46% of the variance of cognitive symptoms. ConclusionsOur findings suggest the usefulness of social functioning assessment in the explanation of clinical symptoms in people with schizophrenia. Moreover, our results point out that not only negative and cognitive symptoms, but also positive and depressive symptoms, should be taken into account in the rehabilitation process in order to improve patient adaptation in the community.

A five-bar mechanism to assist finger flexion-extension movement: system implementation

AbstractThe lack of specialized personnel and assistive technology to assist in rehabilitation therapies is one of the challenges facing the health sector today, and it is projected to increase. For researchers and engineers, it represents an opportunity to innovate and develop devices that improve and optimize rehabilitation services for the benefit of society. Among the different types of injuries, hand injuries occur most frequently. These injuries require a rehabilitation process in order for the hand to regain its functionality. This article presents the fabrication and instrumentation of an end-effector prototype, based on a five-bar configuration, for finger rehabilitation that executes a natural flexion-extension movement. The dimensions were obtained through the gradient method optimization and evaluated through Matlab. Experimental tests were carried out to demonstrate the prototype’s functionality and the effectiveness of a five-bar mechanism acting in a vertical plane, where gravity influences the mechanism’s performance. Position control using fifth-order polynomials with via points was implemented in the joint space. The design of the end-effector was also evaluated by performing a theoretical comparison, calculated as a function of a real flexion-extension trajectory of the fingers and the angle of rotation obtained through an IMU. As a result, controlling the two degrees of freedom of the mechanism at several points of the trajectory assures the end-effector trajectory and therefore the fingers’ range of motion, which helps for full patient recovery.

Gait Abnormalities in a Patient with the Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Case Studied with Gait Analysis

Introduction: Hyponatremia, defined as serum sodium concentration &lt;136 mEq/l, represents one of the most challenging clinical disorder in geriatric rehabilitative settings . It is associated with significant morbidity and mortality. Hyponatremia can be often followed by neurological symptoms caused by cerebral oedema and in severe hyponatremia, patients frequently experience balance disorder and a high risk of falls.Materials and Method: We report the case of a female patient, followed after an accurate diagnostic work-up for a syndrome of inappropriate antidiuresis (SIADH). Hyponatremia was initially treated with hypertonic saline infusion and then with fluid restriction. In consideration of the poor response to fluid restriction, treatment with tolvaptan was started. The patient experienced walking problems and was evaluated with an EMG computed Gait Analysis before and after that sodium level was normalized.Results: Gait analysis carried out highlighted neuromuscular instability with alteration of the time parameter and spatial postural deficit. Once corrected the hyposodiemia the patient showed a marked improvement in neuromuscular control with normalization of the temporal and spatial parameter of the step.Conclusions: The clinical manifestations of the patient with SIADH are related to the severity of hyponatremia and the speed with which the sodium deficit is established. The criteria for the diagnosis of SIADH in a patient with hypotonic hyponatremia remain those established by Bartter and Schwartz in 1967. Our suggestions is so to monitor balance and gait disorders and perform serial measurements of urine and serum osmolarity during rehabilitation process in order to prevent unbalance and falling.

The importance of body composition assessment in the rehabilitation process

The importance of body composition assessment in the rehabilitation process

Clinical symptoms and social functioning in schizophrenia.

The aim of the present study was to assess the relationship between social functioning and clinical symptoms in people with schizophrenia, analyzing the influence of both global social functioning and the specific aspects of social functioning, assertiveness and communication skills in the explanation of type of symptoms. A cross-sectional descriptive study composed of 125 people diagnosed with schizophrenia was performed. Patients were assessed with the Communication Skills Questionnaire (CSQ), the Gambrill and Richey Assertiveness Inventory (GR), the Global Assessment of Functioning Scale (GAF) and the Global Assessment of Social Functioning Scale (SOFAS), Social Functioning Scale (SFS), Life Skills Profile (LSP) scale and the Clinical Global Impression scale for Schizophrenia (CGI-S). SOFAS, LSP and GR are related to each of the subscales and total scores of symptoms (p<0.05-0.001). The multiple regressions show that SOFAS and GR explained 59% of the total symptoms. SOFAS and GR, accounting for 65% of the variance, explain positive symptoms. GR and SOFAS explained 34% of the variance of negative symptoms. SOFAS, CSQ and LSP, accounting for 20% of the variance, explain depressive symptoms. SOFAS explained 46% of the variance of cognitive symptoms. Our findings suggest the usefulness of social functioning assessment in the explanation of clinical symptoms in people with schizophrenia. Moreover, our results point out that not only negative and cognitive symptoms, but also positive and depressive symptoms, should be taken into account in the rehabilitation process in order to improve patient adaptation in the community.

Determining priorities in functional rehabilitation related to quality of life one-year following a traumatic spinal cord injury

Context/Objective: To determine the relationship between the different functional aspects (as determined by the Spinal Cord Independence Measure) and quality of life (QOL) following a traumatic spinal cord injury (TSCI), considering clinical confounding factors.Design: Retrospective review of a prospective cohortSetting: A single Level-1 trauma center specialized in SCI careParticipants: One hundred and forty-two individuals sustaining an acute traumatic SCIInterventions: Not applicableOutcome measures: The four QOL domains as assessed by the WHOQoL-bref questionnaire 6–12 months following a TSCI.Results: Mobility subscore was the only functional aspect significantly associated with all QOL domains (physical, psychological, social and environmental). Females present better chronic social and environmental QOL when compared to males. The level of injury may also influence environmental QOL.Conclusion: Mobility training (mobility in bed, mobility with or without technical aids, transfers and stair management) should be an important part of the rehabilitation process in order to optimize chronic QOL following a TSCI.

Physical therapists’ perceptions about patients with incomplete post-traumatic paraplegia adherence to recommended home exercises: a qualitative study

BackgroundThe overall purpose of physical therapy for patients with spinal cord injury is to improve health-related quality of life. However, poor adherence is a problem in physical therapy and may have negative impact on outcomes. ObjectivesTo explore the physical therapists’ perspectives about patients with incomplete post-traumatic paraplegia adherence to recommended home exercises. MethodsA qualitative content analysis was conducted. Data were collected in a convenience sample using semi-structured interviews. Thirteen registered physical therapists in Athens area participated in the study. ResultsFive categories emerged from the data: (1) reasons to recommend home exercise by the physical therapist; (2) obstacles to recommend home exercise by the physical therapist; (3) methods addressing these obstacles; (4) the family's role in the adherence to recommended home exercise; and (5) the impact of financial crisis in adherence to recommended home exercise. All participants found the recommended home exercises essential to rehabilitation and health maintenance, and they value their benefits. They also expressed the obstacles that need to be faced during rehabilitation process in order to promote adherence. ConclusionPhysical therapists should take into account the different obstacles that may prevent patients with incomplete post-traumatic paraplegia adherence to recommended home exercises. These involve the patients and their families, while, financial crisis has also an impact in adherence. In order to overcome these obstacles and increase adherence, communication with patient and family while taking into account the individual's needs, capacities, and resources are essential.

Qualitative research in rehabilitation science: opportunities, challenges, and future directions

Purpose: Qualitative research has had a significant impact within rehabilitation science over time. During the past 20 years the number of qualitative studies published per year in Disability and Rehabilitation has markedly increased (from 1 to 54). In addition, during this period there have been significant changes in how qualitative research is conceptualized, conducted, and utilized to advance the field of rehabilitation. The purpose of this article is to reflect upon the progress of qualitative research within rehabilitation to date, to explicate current opportunities and challenges, and to suggest future directions to continue to strengthen the contribution of qualitative research in this field.Methods: Relevant literature searches were conducted in electronic data bases and reference lists. Pertinent literature was examined to identify current opportunities and challenges for qualitative research use in rehabilitation and to identify future directions.Results: Six key areas of opportunity and challenge were identified: (a) paradigm shifts, (b) advancements in methodology, (c) emerging technology, (d) advances in quality evaluation, (e) increasing popularity of mixed methods approaches, and (f) evolving approaches to knowledge translation. Two important future directions for rehabilitation are posited: (1) advanced training in qualitative methods and (2) engaging qualitative communities of research.Conclusion: Qualitative research is well established in rehabilitation and has an important place in the continued growth of this field. Ongoing development of qualitative researchers and methods are essential.Implications for RehabilitationQualitative research has the potential to improve rehabilitation practice by addressing some of the most pervasive concerns in the field such as practitioner–client interaction, the subjective and lived experience of disability, and clinical reasoning and decision making. This will serve to better inform those providing rehabilitation services thereby benefiting patients that are utilizing these services.Changes over time in how qualitative research is conceptualized, conducted, and utilized to advance rehabilitation science have resulted in a number of unique opportunities and challenges in using qualitative research that must be considered within this field.Advances in methodology and increased expectations for evaluation must be considered to ensure quality and credibility of qualitative rehabilitation research within rehabilitation. Improved quality and credibility may increase likelihood of research dissemination and use by clinicians intervening within the rehabilitation process in order to improve clinical practice.In order to maximize opportunities and mitigate challenges there are two principal future directions for rehabilitation scientists to consider: (1) advancing training in qualitative methods to adequately prepare future rehabilitation scientists and (2) engaging qualitative communities of research.

The Influence of Therapeutic Training on Changes in Selected Biomechanical Variables After an Anterior Cruciate Ligament Reconstruction

Abstract Introduction. The number of arthroscopic reconstructions of the anterior cruciate ligament (ACL) has been increasing not only among competitive athletes, but also among recreational athletes. The monitoring of the rehabilitation process in order to determine a safe time to return to the pre-injury activity is thus of great practical importance. The aim of this paper is to analyse the changes in selected biomechanical variables which occur after the therapeutic training following an anterior cruciate ligament reconstruction. Materials and methods. Twenty nine males (age 27.3 ± 5.7 years) after the anterior cruciate ligament reconstruction participated in the study. A quadruple-stranded semitendinosus/gracilis graft was used for the reconstruction. The biomechanical evaluation of the rehabilitation process was provided by an isokinetic dynamometer Biodex System Pro-3 working at speeds of 60 deg/s and 180 deg/s during testing the knee extensor and flexor muscles. In the case of an injured limb, the absolute peak torque, relative peak torque, average power and hamstring/ quadriceps (H/Q) ratio were determined. In addition, the values of flexor and extensor torques for healthy and injured limbs were compared. The study was carried out in four stages: before the surgery, three, six and twelve months after the surgery. Results and analyses. The results showed significant differences in each value between various stages of the biomechanical rehabilitation process of the knee. The applied therapeutic training influenced significantly the changes in the values of the tested variables. The results have confirmed that the biomechanical measurements can be treated as a supplementation to the clinical evaluation of the patient after ACL reconstruction. They may also be used for the optimisation of the therapeutic training.

Termination of sickness benefits or transition to disability pension after changes in sickness insurance: a Swedish register study

Purpose: To assess whether the changes in Swedish sickness insurance in 2008 were associated with termination of benefits (TOB) or transition to disability pension (DP) for individuals in compensated sick leave of varying duration. Changes were (1) introduction of sick-listing guidelines and (2) stricter criteria for eligibility to disability pension and sickness cash benefit and time limits for the latter. Methods: The study population consisted of 2 556 211 cases of compensated sick leave with onset during 2006–2010 from the Swedish national social insurance registers. TOB and DP were analysed with Cox-proportional hazard regression. Results: After the introduction of sick-listing guidelines, TOB increased for both women [hazard ratio (HR) 1.10] and men (HR 1.07). The additional introduction of stricter rules 4 months later were modestly associated with TOB (HR: women 1.01, men 0.99) and transition to DP among men decreased with stronger associations for spells exceeding 180 days (HR 0.86). For women transition to DP surprisingly increased with stricter criteria (HR 1.09), although this pattern was reversed in sick leave spells exceeding 1 year (HR 0.90). Conclusions: Introducing sick-listing guidelines for different illnesses and diseases could have had a considerable impact on TOB. The additional introduction of stricter eligibility rules and time limits seem to have contributed less to TOB but clearly reduced DP in longer sickness spells.Implications for RehabilitationSick-listing guidelines could be a supportive tool for doctors and sickness insurance administrators in the sick-listing process and reduce unnecessary prolongation of sick leave.Specific time limits in sickness insurance and stricter eligibility rules for disability pensions have an impact on compensated sick leave and the welfare of individuals. This has to be considered in the vocational rehabilitation process in order to enhance sustainable return to work.Changes in sickness insurance could influence the duration and exit from compensated sick leave and such changes needs to be considered in studies of vocational rehabilitation, return to work and disability pension.

Sensory and demographic characteristics of deafblindness rehabilitation clients in Montréal, Canada

Demographic changes are increasing the number of older adults with combined age-related vision and hearing loss, while medical advances increase the survival probability of children with congenital dual (or multiple) impairments due to pre-maturity or rare hereditary diseases. Rehabilitation services for these populations are highly in demand since traditional uni-sensory rehabilitation approaches using the other sense to compensate are not always utilizable. Very little is currently known about the client population characteristics with dual sensory impairment. The present study provides information about demographic and sensory variables of persons in the Montreal region that were receiving rehabilitation for dual impairment in December 2010. This information can inform researchers, clinicians, educators, as well as administrators about potential research and service delivery priorities. A chart review of all client files across the three rehabilitation agencies that offer integrated dual sensory rehabilitation services in Montreal provided data on visual acuity, visual field, hearing detection thresholds, and demographic variables. The 209 males and 355 females ranged in age from 4months to 105years (M=71.9, S.D.=24.6), indicating a prevalence estimate for dual sensory impairment at 15/100000. Only 5.7% were under 18years of age, while 69.1% were over the age of 65years, with 43.1% over the age of 85years. The diagnostic combination that accounted for 31% of the entire sample was age-related macular degeneration with presbycusis. Their visual and auditory measures indicated that older adults were likely to fall into moderate to severe levels of impairment on both measures. Individuals with Usher Syndrome comprised 20.9% (n=118) of the sample. The age distribution in this sample of persons with dual sensory impairment indicates that service delivery planning will need to strongly consider the growing presence of older adults as the baby-boomers approach retirement age. The distribution of their visual and auditory limits indicates that the large majority of this client group has residual vision and hearing that can be maximized in the rehabilitation process in order to restore functional abilities and social participation. Future research in this area should identify the specific priorities in both rehabilitation and research in individuals affected with combined vision and hearing loss.

Coping after trans-femoral amputation due to trauma or tumour—a phenomenological approach

Purpose: To describe, by use of a phenomenological approach, how relatively young trans-femoral amputees experienced their amputation and their coping strategies in the acute phase and over time.Method: Eleven trans-femoral amputees, median age 33.5 years, were interviewed. The amputation was caused by tumour, motorcycle accidents or work-related traumas. Amputation was made in median 7.5 years before the interview. The informants were community dwelling and managed well indoors. One had a half disablement pension and all the others were working or studying full time. The interviews were tape-recorded and transcribed verbatim.Results: Two themes emerged. In the first theme ‘Experiences of the amputation’ denial and avoidance were the coping strategies mainly used. In the second theme ‘Coping strategies to relate to a new norm’ the informants used downward comparison, positive comparison and repression. Only one informant indicated a full acceptance of his situation.Conclusion: Relatively young, trans-femoral amputees within this sample, have not reached the acceptance level, though a long time has passed since the amputation. They might have benefited from professional support and guidance during the rehabilitation process in order to improve coping strategies to relate to a new norm.

Factors related to successful job reintegration of people with a lower limb amputation

Schoppen T, Boonstra A, Groothoff JW, van Sonderen E, Göeken LN, Eisma WH. Factors related to successful job reintegration of people with a lower limb amputation. Arch Phys Med Rehabil 2001;82:1425-31. Objective:To study demographically, amputation-, and employment-related factors that show a relationship to successful job reintegration of patients after lower limb amputation. Design: Cross-sectional study. Setting: University hospital. Patients: Subjects had an acquired unilateral major amputation of the lower limb at least 2 years before, were aged 18 to 60 years (mean, 46yr), and were living in the Netherlands. All 322 patients were working at the time of amputation and were recruited from orthopedic workshops. Intervention: Questionnaires sent to subjects to self-report (1) demographic and amputation information and (2) job characteristics and readjustment postamputation. Questionnaire sent to rehabilitation specialists to assess physical work load. Main Outcome Measures: Demographically related (age, gender); amputation-related (comorbidity; reason and level; problems with stump, pain, prosthesis use and problems, mobility, rehabilitation); and employment-related (education, physical workload) information about the success of job reintegration. Results: Job reintegration was successful in 79% and unsuccessful in 21% of the amputees. Age at the time of amputation, wearing comfort of the prosthesis, and education level were significant indicators of successful job reintegration. Subjects with physically demanding jobs who changed type of job before and after the amputation more often successfully returned to work than subjects who tried to stay at the same type of job. Conclusions: Older patients with a low education level and problems with the wearing comfort of the prosthesis are a population at risk who require special attention during the rehabilitation process in order to return to work. Lowering the physical workload by changing to another type of work enhances the chance of successful reintegration. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Teaching Ophthalmology Residents about Rehabilitation

Ophthalmolody is a medical specialty which deals with large numbers of patients who have irreversible impairments. A survey of all ophthalmology residency programs in the United States found, that most programs require that residents receive training in low vision aids and devices, but they do not require training in seven other topics concerning the rehabilitation of visually impaired and blind patients. Those programs that do offer training in rehabilitation rely heavily on clinical training. Since practicing ophthalmologists themselves have an incomplete knowledge of the rehabilitation system, it is unlikely that the clinical model will provide residents with sufficient information about rehabilitation. Ophthalmologists need formal training about the rehabilitation process in order to ensure that their patients receive adequate referrals.