Rehabilitation Program For People Research Articles

Experiences of improvement of everyday life following a rehabilitation programme for people with long-term cognitive effects of COVID-19: Qualitative study.

To explore challenges in everyday life for people with long-term cognitive effects of COVID-19 and whether a rehabilitation programme contributed to the remedy thereof. Healthcare systems around the world need knowledge about acute COVID-19 treatment, long-term effects exerting an impact on peoples' everyday lives, and how to remedy these. This is a qualitative study with a phenomenological approach. Twelve people with long-term cognitive effects of COVID-19 participated in a multidisciplinary rehabilitation programme. Individual semi-structured interviews were made. Data were analysed thematically. Three themes and eight sub-themes emerged with respect to everyday life challenges and experiences of the rehabilitation programme. The themes were (1) Personal insight and knowledge, (2) Changed daily routines at home and (3) Coping with working life. Participants experienced long-term effects of COVID-19 as cognitive challenges, fatigue and headaches, which affected their everyday lives, that is inability to overcome daily tasks at home and at work, maintaining family roles and relations with relatives. The rehabilitation programme contributed to a vocabulary and insights related to the long-term effects of COVID-19 and the experience of being a different person. The programme contributed to changes in daily routines, organising breaks in everyday life and explaining challenges to family/relatives and the way in which they affected daily routines and their role in the family. In addition, the programme supported several of the participants in finding the right workload and working hours. We recommend multidisciplinary rehabilitation programmes inspired by cognitive remediation of long-term COVID-19 cognitive effects. Municipalities and organisations could collaborate in the development and completion of such programmes, possibly comprising both virtual and physical elements. This could facilitate access and reduce costs. Patients contributed to the conduct of the study by participating in the data collection via interviews. Data collection and processing of data are approved by the Region of Southern Denmark (journal number: 20/46585).

A simple intervention for disorders of consciousness- is there a light at the end of the tunnel?

Sleep is a physiological state necessary for memory processing, learning and brain plasticity. Patients with disorders of consciousness (DOC) show none or minimal sign of awareness of themselves or their environment but appear to have sleep-wake cycles. The aim of our study was to assess baseline circadian rhythms and sleep in patients with DOC; to optimize circadian rhythm using an intervention combining blue light, melatonin and caffeine, and to identify the impact of this intervention on brain function using event related potentials. We evaluated baseline circadian rhythms and sleep in 17 patients with DOC with 24-h polysomnography (PSG) and 4-hourly saliva melatonin measurements for 48 h. Ten of the 17 patients (5 female, age 30–71) were then treated for 5 weeks with melatonin each night and blue light and caffeine treatment in the mornings. Behavioral assessment of arousal and awareness [Coma recovery scale-revised (CRS-R)], 24-h polysomnography and 4-hourly saliva melatonin measurements, oddball mismatch negativity (MMN) and subject's own name (SON) experiments were performed twice at baseline and following intervention. Baseline sleep was abnormal in all patients. Cosinor analysis of saliva melatonin results revealed that averaged baseline % rhythmicity was low (M: 31%, Range: 13–66.4%, SD: 18.4). However, increase in % Melatonin Rhythm following intervention was statistically significant (p = 0.012). 7 patients showed improvement of CRS-R scores with intervention and this was statistically significant (p = 0.034). All the patients who had improvement of clinical scores also had statistically significant improvement of neurophysiological responses on MMN and SON experiments at group level (p = 0.001). Our study shows that sleep and circadian rhythms are severely deranged in DOC but optimization is possible with melatonin, caffeine and blue light treatment. Clinical and physiological parameters improved with this simple and inexpensive intervention. Optimization of sleep and circadian rhythms should be integrated into rehabilitation programs for people with DOC.

OA44 Increasing access to rehabilitation for knee and hip osteoarthritis - ESCAPE-pain in leisure/community centres

Abstract Background/Aims Enabling Self-management and Coping with Arthritic Pain using Exercise, ESCAPE-pain, is a rehabilitation programme for people with knee and/or hip osteoarthritis (OA) that reduces pain, improves function and reduces healthcare utilisation. The programme is usually delivered in physiotherapy departments. However, financial and logistical constraints in the NHS limit the number of people who can access the programme. Delivering ESCAPE-pain in community centres would increase accessibility, “reach” and provide better on-going support. We trained exercise professionals to deliver ESCAPE-pain in leisure/community centres, monitored whether it continued to be effective and gathered the experiences of participants, facilitators and organisations delivering the programme. Methods 369 exercise professionals were trained to deliver ESCAPE-pain in 41 leisure and community centres across the UK. Pain, function and quality of life (using Knee or Hip Osteoarthritis Outcome Score, K/HOOS), and self-reported activity levels (minutes/week) were measured before and after the programme. Programme participant's and facilitator/organisation’s experiences were evaluated using semi-structured interviews. Results 1386 participants (998 female) were recruited, mean age 70 years. Before the programme only 24% of participants were “fairly/moderately active” (doing >30 mins activity/week), after the programme 78% were “fairly/moderately active (doing >150mins activity/week). These increased activity levels were maintained for 12 months after completing the programme. Participants enjoyed the programme and reported improvements in their pain (10 K/HOOS points; p < 0.0001), function (9pts; p < 0.0001), QoL (10pts; p < 0.0001), understanding, exercise self-efficacy (their confidence in using exercise to control pain and its impact), mental wellbeing and reduced reliance on healthcare professions, medication and surgery. They were able to walk better, farther, without an aid and returned to former activities, felt better in themselves and “the world was a brighter place”. Most people were planning to continue exercising after completing the programme and had joined classes and taken up activities they enjoyed such as swimming, golf, walking, yoga. The exercise professionals enjoyed getting involved in healthcare interventions and offering people an effective intervention. The 17 partner organisations found the programme increased their portfolio of interventions, forming links with the healthcare sector that they saw as important in the future. Many organisations planned to expand the number of centres running the programme permanently. To create revenue streams that enabled them to sustain delivery of ESCAPE-pain organisations formed collaborations with clinical departments, contracted by CCGs, charged a nominal amount for the programme or membership for the organisation and are expanding the programme to other centres within their organisation. Conclusion ESCAPE-pain can be safely delivered by exercise professionals in leisure/community centres, maintains its clinical effectiveness and nurtures habitual exercise. The community-based programme is capable of helping the large and rapidly increasing number of people with OA. ESCAPE-pain is now being delivered in leisure centres across the UK. Disclosure M.V. Hurley: None. A. Carter: None. H. Sheldon: None. M. Connolly: None.

Patient experiences of an 8-week physiotherapy-led rehabilitation programme for people at high risk of back pain-related disability

Patient experiences of an 8-week physiotherapy-led rehabilitation programme for people at high risk of back pain-related disability

Electromyography Activity of Vastus Medialis Obliquus and Vastus Lateralis Muscles During Lower Limb Proprioceptive Neuromuscular Facilitation Patterns in Individuals with and without Patellofemoral Pain Syndrome.

Exercise therapy to strengthen quadriceps muscle is recommended in rehabilitation program for people with patellofemoral pain syndrome (PFPS). This study aimed to investigate the electromyography (EMG) activity of vastus medialis obliquus (VMO), vastus lateralis (VL) and VMO/VL ratio during PNF in individuals with and without PFPS. 26 persons with PFPS and 26 healthy subjects participated to study. All subjects performed PNF patterns (Flexion-Adduction-External Rotation (D1FL), Extension-Adduction-External Rotation (D2EX), D1FL+ load, D2EX+ load) and straight leg raise (SLR). The normalized EMG activity of VMO, VL and VMO/VL ratio were measured and analyzed using repeated measure ANOVA. There were significant main effects of group and exercises for the both VMO and VL (p<0.05). It was found that except SLR and D2EX, in the other motions PFPS group had lower VMO activity compared to healthy group (p<0.05). For VL except SLR, in the other motions PFPS group had lower VL activity too (p<0.05). The PNF patterns activated VMO more than SLR, however it was not significant (p>0.05). Also; there weren't any significant difference between the two groups in VMO/VL activation ratios. Also, performing the PNF patterns with load increased VMO and VL muscles activity significantly (p<0.05). It also found that in PFPS group the VMO/VL ratio values in PNF patterns were significantly more than SLR and the highest VMO/VL ratio value (0.96) was found during D2EX. The PNF patterns due to provide optimal VMO/VL ratio value than SLR and proper balance between these two muscles can be recommended in rehabilitation of individuals with PFPS.

Increasing access to rehabilitation for knee and hip osteoarthritis – ESCAPE-pain in leisure/community centres

Purpose: Enabling Self-management and Coping with Arthritic Pain using Exercise, ESCAPE-pain, is a rehabilitation programme for people with knee and/or hip osteoarthritis (OA) that reduces pain, improves function and reduces healthcare utilisation. The programme is usually delivered in physiotherapy departments. However, constraints in the NHS limit the number of people who can access the programme. Delivering ESCAPE-pain in community venues would increase accessibility and provide better on-going support.

The GoodHope Exercise and Rehabilitation (GEAR) Program for People With Ehlers-Danlos Syndromes and Generalized Hypermobility Spectrum Disorders.

Introduction: The Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobility Spectrum Disorders (G-HSD) comprise a heterogeneous group of genetic disorders of abnormal synthesis and/or maturation of collagen and other matricellular proteins. EDS is commonly characterized by manifestations such as multi joint hypermobility that can lead to musculoskeletal pains, subluxations and dislocations, fragile skin, organ dysfunction, and chronic significant diffuse pain with fatigue, deconditioning eventuating to poor quality of life. Evidence suggests exercise and rehabilitation interventions may ameliorate symptoms of unstable joints, recurrent subluxations/dislocations, and chronic widespread musculoskeletal pain. To date, there have only been a few reports describing exercise and rehabilitation care strategies for people with EDS.Methods: In this manuscript, we describe the GoodHope Exercise and Rehabilitation (GEAR) program, its overarching principles, as well as the program development and delivery model. The GEAR program aims to decrease functional impairment, reduce pain, increase confidence in symptom self-management, and provide a community of support for people with EDS/G-HSD. To achieve these goals, we detail the model of care that includes exercise and rehabilitation therapy, education for self-management, and support accessing relevant community resources.Strengths and Limitations of the Study: GEAR represents a novel exercise and rehabilitation care model for people with G-HSD and various clinical EDS subtypes, beyond the commonly included hEDS subtype. Systematic collection of data via validated measurements is ongoing and will guide the refinement of GEAR and support the development of emerging exercise and rehabilitation programs for people with EDS.

Adding muscle power exercises to a strength training program for people with patellofemoral pain: protocol of a randomized controlled trial

BackgroundStrong evidence supports the proximal combined with quadriceps strengthening for patellofemoral pain (PFP) rehabilitation. However, most reported rehabilitation programs do not follow specific exercise prescription recommendations or do not provide adequate details for replication in clinical practice. Furthermore, people with PFP have power deficits in hip and knee muscles and it remains unknown whether the addition of power exercises would result in superior or more consistent outcomes. Therefore, this study is designed to verify whether the benefits of a rehabilitation program addressing proximal and knee muscles comprising power and strength exercises are greater than those of a program consisting of strength exercises only.MethodThis study will be a randomized controlled trial that will be conducted at university facilities. A minimum of 74 people with PFP between the ages of 18 and 45 years will be included. The experimental group will engage in a 12-week resistance training program focusing on proximal and knee muscles using power and strength exercises. The control group will engage in a 12-week resistance training program focusing on proximal and knee muscles using strength exercises only. Primary outcomes will be pain intensity and physical function; and secondary outcomes will be kinesiophobia, self-reported improvement, quality of life, peak hip and knee torque, and hip and knee rate of force development. The primary outcomes will be evaluated at baseline, and after 6 weeks, 12 weeks, 3 months, 6 months, and 1 year. The secondary outcomes will be evaluated at baseline and immediately after the interventions. Therapists and participants will not be blinded to group allocation.DiscussionThis randomized clinical trial will investigate if adding power exercises to a progressive resistance training may lead to more consistent outcomes for PFP rehabilitation. The study will provide additional knowledge to support rehabilitation programs for people with PFP.Trial registrationClinicalTrials.gov NCT 03985254. Registered on 26 August 2019.

Lower-limb work during low- and high-impact tasks in hip-related pain: Associations with sex and symptoms

Background: Hip-related pain (HRP) is a movement-related condition; however, previous biomechanics research into HRP have concentrated on male-dominated cohorts and focused on people undergoing surgical intervention. As a result, little is known about the biomechanical impairments of women with HRP and those not seeking surgery. Therefore, the aims of this study were threefold: (i) to evaluate the differences in lower-limb joint work between football players with and without HRP, (ii) to explore the relationship between lower-limb work and a person’s burden of HRP, and (iii) to determine whether any potential differences/relationships were sex-dependent. Methods: Football players aged 18-50 years were eligible to participate. For the HRP group, participants were eligible if they presented with a 6-month history of HRP; whereas control players were eligible if they presented with no lower-limb or lower-back pain/injury over the previous six months. A total of 88 players with HRP (23 women) and 30 asymptomatic controls (13 women) participated. Biomechanical data were collected during walking and single-leg drop jumps (SLDJ). HRP burden was quantified using the International Hip Outcome Tool (iHOT33). Between-group differences and relationships between lower-limb work done and a person’s burden of HRP were assessed using linear regressions incorporating sex-based interactions. Results: Walking: No joint work variables were different between footballers with and without HRP independent of sex, nor were any relationships with a person’s burden of HRP evident. SLDJ: A sex-specific interaction was present for the knee’s relative contribution to total lower-limb negative work done, with women with HRP demonstrating a lower contribution compared to their asymptomatic female peers (37.7% vs 42.4%, P=0.04). The iHOT33 was significantly associated with positive (P=0.03 to <0.01) and negative (P=0.02 to <0.01) work done by the hip as well as negative work done by the ankle (P=0.03 to 0.01), independent of sex Discussion: Overall, few differences were observed between players with and without HRP. Only one significant between-group difference was revealed, involving the knee in women only, providing further insight that the relationship between hip pain and biomechanics may be modified by sex. In addition, players with a greater self-reported burden of HRP tended to display lower hip joint work during the SLDJ. Rehabilitation programs for people with HRP should target these impairments and normalize lower-limb work done during high impact tasks. COI statement: Funding was supplied by the NHMRC (GNT:1088683).

Means of occupational therapy in (individual) rehabilitation programs for people with Parkinson’s disease

The aim of the work is to develop a set of rehabilitation measures including occupational therapy classes for Parkinson’s disease and to assess the objective condition of patients on the scales of non-motor symptoms, cognitive and mental disorders. Materials and methods. The study of patients was conducted on the basis of anamnesis, objective examination and scales for assessment of non-motor symptoms, cognitive and mental disorders (scale of non-motor symptoms – NMSS, scale of mental disorders – MMSE, Montreal scale of cognitive disorders – MOCA); to assess non-motor symptoms, a patient questionnaire was additionally used to identify autonomic disorders (according to A. M. Wayne, 1998). The control and experimental groups were offered exercise, physiotherapy, massage and nutrition (diet). Occupational therapy was added for the experimental group. Results. After the physical rehabilitation, the condition of the patients significantly improved. The final score in the experimental group of patients with non-motor manifestations of Parkinson’s disease on the scale of assessment of non-motor symptoms was statistically significantly lower and was 61.04 ± 0.39 (P &lt; 0.01). The final score on the scale of mental disorders was statistically significantly higher – 27.78 ± 0.27 (P &lt; 0.01), on the scale of cognitive changes, it also became statistically significantly higher – 25.13 ± 0.19 (P &lt; 0.01). According to A. M. Wayne’s questionnaire of autonomic disorders, the total score in the control group was 64.0 ± 3.2. In the experimental group of patients, the total score was 51.0 ± 5.4 points (P &lt; 0.01). Thus, under the influence of additional occupational therapy classes, in the experimental group both on the scale of non-motor symptoms and by A. M. Wayne’s, questionnaire there was a statistically significant improvement in the condition of patients. Conclusions. Based on the results of the study, it can be concluded that there is a significant difference (P &lt; 0.01) in the condition of patients on the final scores, with the pronounced improvement in the condition of the experimental group patients in comparison with the control group patients, following the results of all survey scales. A significant difference is observed on the scale of non-motor symptoms. A certain role in improving the condition of patients with appropriate screening using study scales and a patient questionnaire to identify autonomic disorders (according to A. M. Wayne, 1998), apparently played a component of the rehabilitation program, which further included occupational therapy classes.

SYSTEM OF ECONOMIC MEANS OF STATE ADMINISTRATION OF THE RIGHTS OF PEOPLE WITH DISABILITIES TO HEALTHCARE

At the current stage of the development of society the problem of social protection and state support for people with disabilities is particularly relevant and requires reform and improvement. Ukraine, as a country aspiring to join the European Union, should take into account the best foreign experience of the leading countries of the world in the field of state policy to support people with disabilities and its implementation. The process of reforming the national healthcare system demonstrated the ineffective policy in this area, the high level of corruption and the inability to transform this system to the level of world standards of medical care, especially for people with disabilities. The problem of disability in Ukraine is becoming particularly acute. The goal of this article is to investigate the system of economic means of state administration of the rights of people with disabilities to healthcare, to identify the areas of budgetary management and the formation of a new mechanism of economic administration. Scientific analysis was carried out by using the method of systematic approach and analysis, which enabled us to study theoretical aspects of economic methods of state administration of the right of people with disabilities to healthcare, formation of the budget management in Ukraine for the economic security of the rights to healthcare, and features of the new mechanism of the economic administration of the right of people with disabilities to health care. It has been researched that along with administrative methods of state management of the right to health protection of people with disabilities the economic group of methods is important. These include programs of economic development of health care, rehabilitation programs for people with disabilities, implementation of pilot projects to change the mechanism of financial support for operative treatment, etc. Methods of regulating influence (indirect management) are becoming increasingly important, and economical methods of management belong to them. Implementation ensures that the financial and material interests of the management objects are satisfied through the activities of its subjects, which create favorable conditions for achieving the goals and objectives of management. For example, local self-government bodies, within the limits of their competence, can finance local programs for the development and support of community healthcare institutions. In 2019, a new mechanism of rehabilitation support for children with disabilities was introduced based on the principle of "money follows the people", which should ensure targeting, transparency and improve the quality of rehabilitation services. Resources are divided vertically among regional bodies, which divide budgetary funds among local bodies in proportion to the number of children who require rehabilitation measures, according to the place of their residence (location). The national legislation also reflects the norms that created the conditions for the implementation of the right to work of people with disabilities, as well as ratified Convention on the Rights of Persons with Disabilities and the ILO Convention on professional rehabilitation. From the point of view of the Ministry of Healthcare of Ukraine, the funds allocated by the state are extremely insufficient for the uninterrupted functioning of the medical system. In its budget memorandum for 2021 the ministry has allocated twice as much – 296 billion UAH, 225 billion UAH of which for the implementation of the medical guarantee program (which is 5% of GDP, as required by the Law of Ukraine "On State Financial Guarantees of Medical Services to Population"). But the proposals of the Ministry of Health both at the time of formation of the state budget and at the time of its approval were not taken into account. The requirement of the Law of Ukraine "On State Financial Guarantees of Medical Services to the Population" for the establishment of financing of the program of medical guarantees at the level of 5% of GDP was lengthened for one more year.

Assessment of Force Production in Parkinson's Disease Subtypes.

Muscle weakness is a secondary motor symptom of Parkinson’s disease (PD), especially in the subtype characterized by postural instability and gait difficulty (PIGD). Since the PIGD subtype also presents worse bradykinesia, we hypothesized that it also shows a decreased rate of force development, which is linked to an increased risk of falling in PD. Therefore, we investigated the effects of PD and PD subtypes on a force production profile and correlated the force production outcomes with clinical symptoms for each PD subtype. We assessed three groups of participants: 14 healthy older adults (OA), 10 people with PD composing the PIGD group, and 14 people with PD composing the tremor-dominant group. Three knee extension maximum voluntary isometric contractions were performed in a leg extension machine equipped with a load cell to assess the force production. The outcome measures were: peak force and rate of force development (RFD) at 50 ms (RFD50), 100 ms (RFD100), and 200 ms (RFD200). We observed lower peak force, RFD50, RFD100, and RFD200 in people with PD, regardless of subtypes, compared with the OA group (p < 0.05 for all comparisons). Together, our results indicated that PD affects the capacity to produce maximal and rapid force. Therefore, future interventions should consider rehabilitation programs for people with PD based on muscle power and fast-force production, and consequently reduce the likelihood of people with PD falling from balance-related events, such as from an unsuccessful attempt to avoid a tripping hazard or a poor and slower stepping response.

Goal setting for people with mild cognitive impairment or dementia in rehabilitation: A scoping review.

Goal setting is an integral part of the rehabilitation process and assists occupational therapists to target therapy towards achieving meaningful outcomes. People with mild cognitive impairment or dementia may experience barriers participating in goal setting due to preconceptions that the person cannot participate owing to changes in both cognitive and communicative abilities. The aim of this review was to identify goal setting approaches, common goals identified, and enablers and barriers to goal setting for people with mild cognitive impairment or dementia participating in specific rehabilitation programmes. Four electronic databases were searched in April 2020 for English language articles that described goal setting processes during a rehabilitation programme for people with mild cognitive impairment or dementia. Studies of all designs were included. Two authors screened citations and full text articles. Data were extracted, synthesised, and presented narratively. Twenty-seven studies met the eligibility criteria. Both structured and nonstructured goal setting methods were used with common tools including the Canadian Occupational Performance Measure, the Bangor Goal Setting Interview and Goal Attainment Scaling. The nature of goals tended to depend on the scope of the rehabilitation programme in which the person was involved. Goal setting was more difficult for people with more advanced symptoms of dementia and when staff lacked skills and experience working with people with dementia. Use of a structured approach to goal setting, establishment of therapeutic rapport, individualisation of goals, and family involvement were reported to be beneficial. Collaborative goal setting is a foundation of rehabilitation for people with dementia and should not be avoided due to preconceptions that the person cannot participate. Results suggests that occupational therapists can use a number of strategies to maximise participation and engagement and play a pivotal role in upskilling staff to enable effective goal setting for people with mild cognitive impairment or dementia.

Convention on the rights of persons with disabilities: Qualitative exploration of barriers to the implementation of articles 25 (health) and 26 (rehabilitation) in Iran.

Background: The International Convention on the Rights of Persons with Disabilities (CRPD) is the most important International Document for recognizing the rights of persons with disabilities, including the right to health and rehabilitation. Islamic Republic Iran acceded to the Convention in 2008, but still has a long way to go to achieve its desired status and in line with the objectives of the convention. This study aimed to identify the barriers to the implementation of articles 25 and 26 of the CRPD in Iran. Methods: This study was performed using conventional content analysis. Twenty-one individuals were recruited by purposive sampling with maximum variation and were continued until saturation. Data were gathered through in-depth, semi-structured interviews from June 2018 to May 2019. MAXQDA version 10 was used for analyzing data. Results: The resulting data analysis yielded 860 initial or open codes. The concepts were categorized into 27 subcategories and 7 categories. Main categories were included: "Structure inefficiency", "lack of comprehensive rehabilitation program", "inadequate awareness", "neglected economy of people with disabilities", "weak access to services", "cultural challenges" and "disregard for new technologies". Conclusion: The findings showed that the executive structures in the country have a lot of problems with health and rehabilitation programs for people with disabilities. It seems understanding the barriers to implementation of articles 25 and 26 of the international CRPD empowers officials in the field and improve services by providing a better view of the disabled. Nevertheless, it is recommended for policymakers to consider rehabilitation as a main element of the health system.

Qualitative study of the implementation of the Continuity of Care and Rehabilitation Program for people with severe mental disorders in Peru.

ABSTRACTObjective.Describe the implementation of the Continuity of Care and Rehabilitation Program (PCC-R) in community mental health centers (CSMCs, Spanish acronym) in Peru.Methods.Qualitative study of the implementation of the PCC-R in four CSMCs in Lima and La Libertad, Peru. Forty-two individual semi-structured interviews were conducted, as well as a focus group with five participants, for a total of 47 informants, including users, family members, and professionals involved in the design, implementation, and monitoring of the program.Results.The PCC-R is a key program for community mental health services in Peru and it enjoys broad acceptability. Providers and users report satisfaction with its results; however, the program lacks a policy document specifying its objectives, organization, and activities. This would explain the variability in its implementation. The PCC-R has limitations in terms of management of financial and human resources, and it is necessary to improve training and supervision. There is consensus on the need, usefulness, and viability of developing a system to monitor the PCC-R. Good practices and suggestions are presented with a view to addressing these challenges.Conclusions.The PCC-R is a flagship program for the CSMCs and for mental health reform in Peru. It has achieved broad acceptability among providers and users. Its implementation combines successes and difficulties, with pending tasks that include developing a policy document, improving resource management, strengthening training and supervision, and implementing a monitoring system for continuous improvement of the program.

Computer-based cognitive rehabilitation program GRADIOR for mild dementia and mild cognitive impairment: new features

BackgroundThe growing number of older people and, with it, the increase of neurological impairments such as dementia has led to the implementation of the use of computer programs for cognitive rehabilitation in people with dementia. For 20 years, we have been developing the GRADIOR cognitive rehabilitation program and conducted several studies associated with its usability and effectiveness. This paper describes the development of the latest version of the GRADIOR computer-based cognitive rehabilitation program for people with different neurological etiologies, especially mild cognitive impairment and mild dementia.ResultsGRADIOR is a program that allows cognitive evaluation and rehabilitation of people affected by cognitive impairment. The new version of GRADIOR is characterized by a structure that is dynamic and flexible for both user and therapist, consisting of: Clinical Manager, Clinical History Manager, Treatment Manager and Report Manager. As a structure based on specific requirements, GRADIOR includes a series of modalities and sub-modalities, each modality comprising a series of exercises with different difficulty levels.DiscussionPrevious studies associated with earlier versions of GRADIOR have allowed the development of a new version of GRADIOR. Taking into account aspects associated with user experience, usability and effectiveness. Aspects that have made it possible to achieve a program that can meet the needs of older people with dementia.

LeRoy Spaniol, PhD, 1938-2020.

Presents the obituary of LeRoy Spaniol, PhD (1938-2020). LeRoy was a professor at Boston University for 31 years and a cofounder and senior director at the Center for Psychiatric Rehabilitation from 1974 until his retirement. Leroy's dedication to service began early in his life as a seminarian, followed by his work as a therapist helping people heal from divorce and serious mental illness. LeRoy's nationally and internationally cited research and prolific publications focused on the role of the family in psychiatric rehabilitation, effectively serving homeless individuals, competency-based staff training, program evaluation, and coping and recovery from serious mental illnesses. LeRoy's research and authorship of training curricula that emphasized the importance of recovery "as a possibility and even an expectation and key paradigm shift for our field" is a hallmark of his work. To that end, one of LeRoy's proudest accomplishments was founding and teaching in the Recovery Education Center, a rehabilitation program for people with psychiatric disabilities at the Center for Psychiatric Rehabilitation at Boston University. LeRoy participated on many national and regional boards of directors and commissions, and research review committees and was a founding member of the National Alliance on Mental Illness (NAMI) of Massachusetts in 1982. His work with families continued in his retirement, serving as president of NAMI of Cape Cod for 8 years. The awards and distinctions that LeRoy received throughout his career are numerous, and of key importance to him was the LeRoy Spaniol Educator Award established by the Psychiatric Rehabilitation Association (PRA). This award is presented to an individual who has made outstanding contributions toward educating and mentoring a new generation of leaders. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Illness management and recovery: one-year follow-up of a randomized controlled trial in Danish community mental health centers: long-term effects on clinical and personal recovery

Background: Illness Management and Recovery (IMR) is a curriculum-based rehabilitation program for people with severe mental illness with the short-term aim of improving illness self-management and the long-term aim of helping people achieve clinical and personal recovery.MethodParticipants with schizophrenia or bipolar disorders were recruited from three community mental health centers in the Capital Region of Denmark and randomized to receive group-based IMR and treatment as usual or only the usual intervention. All outcomes were assessed at baseline, postintervention, and the one-year follow-up. Long-term outcomes were categorized according to clinical recovery (i.e., symptoms, global functioning, and hospitalization) and personal recovery (i.e., hope and personal agency). Generalized linear mixed model regression analyses were used in the intent-to-treat analysis.ResultsA total of 198 participants were included. No significant differences were found between the IMR and control groups in the Global Assessment of Functioning one year after the intervention, nor were there significant differences in symptoms, number of hospital admissions, emergency room visits, or outpatient treatment.ConclusionThe present IMR trial showed no significant effect on clinical and personal recovery at the one-year follow-up. Together with the results of other IMR studies, the present study indicates that the effect of IMR on symptom severity is unclear, which raises questions regarding the impact of IMR on functioning. Additionally, IMR did not affect personal recovery. Although more research is needed, the results indicate that the development of other interventions should be considered to help people with severe mental illness achieve a better level of functioning and personal recovery.Trial registrationTrial registered at http://www.clinicaltrials.gov (NCT01361698).

Reduced vision-related quality of life in people living with dystonia

Purpose: Dystonia is a neurological movement disorder with negative impact on function and quality of life. It is currently unclear whether vision-related quality of life is affected. The aim of this study was to determine whether vision-related quality of life is reduced by dystonia.Materials and methods: A vision-related quality of life questionnaire was delivered online to probe visual function in people living with dystonia. Scores for each of six domains were compared to normative data of 819 healthy participants using one sample t-tests. Respondents were divided into two groups based on whether they had botulinum toxin injections and compared using independent samples t-tests.Results: There were 42 completed responses. There was a difference from norm for two domains; ocular symptoms (t(41) = 2.31, p = 0.026) and role performance (t(41) = 2.85, p = 0.007). There was variation in responses for all six domains. No difference in scores for the botulinum toxin injection group was found for either domain (both p > 0.74).Conclusions: Some people with dystonia experience reduced vision-related quality of life, which has potential to contribute to their disability. Health professionals should be aware of vision-related issues when managing people with dystonia and consider appropriate rehabilitative interventions to reduce disability and enhance quality of life.Implications for rehabilitationDystonia is a neurological movement disorder resulting in abnormal postures and movements.Vision-related quality of life is reduced by dystonia which may contribute to disability and reduced function.Strategies to improve vision-related quality of life should be included in rehabilitation programmes for people living with dystonia.

Rehabilitation peculiarities of persons with cervical ataxia with usage of manual therapy

Based on the analysis of recent scientific researches, the effect of rehabilitation measures on persons with cervical ataxia has been studied. Objective. Highlighting existing rehabilitation methods of persons with cervical ataxia. Methods. Analysis and generalization of scientific and methodical literature. Results. Cervical ataxia is not an independent disease, but a symptom complex that is common in clinical practice, which is etiologically and pathogenetically associated with disorders in the cervical spine. It affects day-to-day activity and ability to work, and may also be the main cause of disability and social maladaptation. There are many manual techniques for influencing various structures that are mediated or directly related to the development of cervical ataxia. However, in clinical practice, the methods of rehabilitation of this pathological state are directed only to the elimination of its symptoms. Due to the large number of etiological factors of its development and the lack of clear guidelines for rehabilitation during this pathology, there is a need for the study and development of technique for the effective restoration of daily activity with further confirmation of its effectiveness by including in the rehabilitation program for people, who suffer from this disease.