Rehabilitation Services Research Articles

Stroke virtual rehabilitation in rural communities: exploring the perceptions of stroke survivors, caregivers, clinicians, and health administrators

Purpose Rural-dwelling stroke survivors have unmet rehabilitation needs after returning to community-living. Virtual rehabilitation, defined as the use of technology to provide rehabilitation services from a distance, could be a viable and timely solution to address this need, especially within the COVID-19 pandemic context. There is still a minimal understanding of virtual rehabilitation delivery within rural contexts. This study sought to explore the perceptions of rural stakeholders about virtual stroke rehabilitation. Methods Following an interpretive description approach, 17 qualitative interviews were conducted with stroke survivors (n = 5), caregivers (n = 2), clinicians (n = 7), and health administrators (n = 3), and analyzed to understand their experiences and perceptions of virtual stroke rehabilitation. Results We identified three overarching themes from the participant responses (1) The Root of the (Rural) Problem considered how systemic inequities impact stroke survivors’ and caregivers’ access to stroke recovery services; (2) Common Benefits, Different Challenges identified the unique benefits and challenges of delivering virtual rehabilitation within rural contexts; and (3) Ingredients for Success described important considerations for implementing virtual rehabilitation. Conclusion Virtual rehabilitation is generally accepted by all stakeholders as a supplement to in-person services. Addressing the unique barriers faced by rural clinicians and stroke survivors is necessary to provide successful virtual rehabilitation.

State-level characteristics and trends in pre-employment transition service delivery to students with disabilities

BACKGROUND: The Workforce Innovation and Opportunity Act of 2014 (WIOA) substantially changed the way state vocational rehabilitation (VR) agencies prepare transition-age students with disabilities for competitive integrated employment through the provision of pre-employment transition services (Pre-ETS). However, little is known about how state VR agencies are delivering Pre-ETS to students with disabilities in practice. OBJECTIVE: The purpose of this study was to examine state-level provision of Pre-ETS across the United States. METHOD: Descriptive analyses of Rehabilitation Services Administration’s Case Service Report (RSA-911) data of Pre-ETS recipients between 2017 and 2020 were conducted across states. RESULTS: Substantial state-level differences were noted in the type of Pre-ETS provided, how many Pre-ETS were provided to each recipient, the disability characteristics of students, and state use of Pre-ETS provider types (VR staff or vendor). CONCLUSION: State differences in Pre-ETS implementation require further research to investigate best practices within and across states. More differentiated training and technical assistance models aligned with these state-level differences are needed.

Building a foundation for competitive integrated employment: What does the future hold for pre-employment transition services

One of the more creative aspects of the Workforce Innovation Opportunities Act (WIOA, 2014) is the pre-employment transition services program (Pre-ETS). In WIOA, for the first time a federal rehabilitation law has been reauthorized to include a requirement that 15% of the state case management service funding must be devoted to Pre-ETS activities. However, a significant number of state vocational rehabilitation (VR) agencies have been unable to spend this required 15% and therefore millions and millions of dollars nationally have been returned to the Rehabilitation Services Administration. In this paper, we describe how Pre-ETS can be used to get youth with disabilities into competitive and integrated employment, while also outlining many of the systems challenges related to these efforts— specifically for VR and schools. We also provide recommendations for the future to improve outcomes by making Pre-ETS work more effectively.

Unraveling the factors influencing engagement in vocational rehabilitation services among transition-age Hispanic youth: An exploratory study

BACKGROUND: Prior research has investigated the engagement process of vocational rehabilitation (VR) consumers yet limited understanding about transition-age Hispanic youth VR consumers remains. OBJECTIVE: This exploratory cross-sectional study evaluated the factors predicting VR engagement among transition-age Hispanic youth with disabilities who have received pre-employment transition services (pre-ETS). METHOD: Descriptive, bivariate correlation, and stepwise logistic regression analyses were conducted in this study. A total of four categories of independent variables (sociodemographic, contextual, theoretical, and pre-ETS related) were selected to investigate their relationship with VR engagement. RESULTS: Findings revealed that education level, living with family, perceived social support from friends, perceived stigma from others, VR counselors’ ability to speak Spanish, competence, vocational outcome expectancy, and number of pre-ETS received were among the significant predictors of VR engagement, with the final model explaining a total of 87.6% of the variance. CONCLUSION: Findings of this study can help inform practices and policies to bridge the gap surrounding the service delivery and utilization of VR services among transition-age Hispanic youth with disabilities.

Lessons learned from health system rehabilitation preparedness and response for disasters in LMICs: a scoping review.

Disasters such as earthquakes, conflict, or landslides result in traumatic injuries creating surges in rehabilitation and assistive technology needs, exacerbating pre-existing unmet needs. Disasters frequently occur in countries where existing rehabilitation services are underdeveloped, hindering response to rehabilitation demand surge events. The primary aim of this scoping review is therefore to synthesize the evidence on rehabilitation and assistive technology preparedness and response of health systems in LMICs to the demand associated with disasters and conflict situations. A secondary aim was to summarize related recommendations identified in the gathered literature. A scoping review was conducted using the Arksey and O'Malley framework to guide the methodological development. The results are reported in accordance with PRISMA-ScR. Four bibliographic databases were used: CINHAL, Cochrane, Pubmed, Scopus and. Key international organisations were also contacted. The search period was from 2010-2022. Eligible publications were categorized for analysis under the six World Health Organization health systems buildings blocks. The findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMICs. Of the 27 studies included in the scoping review, 14 focused on service delivery, 6 on health workforce, 4 on health information systems and 3 on the leadership and governance building block. No study focused on financing nor assistive technology. This review found the most frequently referenced recommendations for actions that should be taken to develop rehabilitation services in disasters to be: the provision early and multi-professional rehabilitation, including the provision of assistive technology and psychological support, integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters; and the integration of rehabilitation into disaster preparedness and responseplans. Findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMIC's, largely due to low awareness of rehabilitation, undeveloped rehabilitation health systems and a lack of rehabilitation professionals, and disaster specific training for them. The paucity of availableevidence hinders advocacy efforts for rehabilitation in disaster settings and limits the sharing of experiences and lessons learnt to improve rehabilitation preparedness and response. Advocacy efforts need to be expanded.

Health-related quality of life, needs, and concerns among cancer survivors referred to rehabilitation in primary healthcare setting.

There is a growing need for rehabilitation services beyond hospitals. This study aims to describe challenges faced by cancer survivors (CSs) referred for rehabilitation in primary healthcare, employing standardized scales measuring health-related quality of life (HRQOL) and open-ended questions. Furthermore, the study explores the applicability of patient-reported outcomes (PROs) in comprehensively understanding challenges encountered by CSs. This cross-sectional study involves CSs referred for cancer rehabilitation in a primary healthcare setting, including those participating in PROs as a part of routine practice. HRQOL was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G). The International Classification of Functioning, Disability and Health (ICF) framed the analysis of responses to open-ended questions 'what concerns you the most?' and 'what matters to you?' Results: FACT-G showed the lowest scores for functional well-being (14.4) and emotional well-being (16.6), with higher scores for physical well-being (18.9) and social/family well-being (21.1). Responses to open-ended questions unveiled worries about everyday life and how cancer will impact family well-being presently and in the future. Furthermore, CSs reported a need to maintain normality and proactively address the challenges posed by the disease. CSs referred for rehabilitation in primary healthcare experience comprehensive challenges necessitating a holistic rehabilitation approach. This includes interventions supporting CSs in dealing with uncertainty, regaining a sense of control, and addressing family well-being concerns. When using PROs for need assessment, the combination of validated HRQOL scales and open-ended questions is crucial for an in-depth understanding of CSs' challenges.

Mental Health Conditions in Partners and Adult Children of Stroke Survivors

Family caregiving after critical illness has been associated with several adverse health outcomes, including various aspects of mental health, but research focusing specifically on family members of stroke survivors is limited. To examine the associations of stroke in a partner or parent with the risk of depression, substance use disorders, anxiety disorders, and self-harm or suicide. This nationwide, population-based cohort study used data from Danish nationwide administrative and clinical registries (2004-2021). Participants included partners and adult children of survivors of stroke. Data analysis was performed from March to December 2023. Having a partner or parent who survived stroke. The Aalen-Johansen estimator was used to compute propensity score-weighted 3-year absolute risks, risk differences, and risk ratios for depression, substance use disorders, anxiety disorders, and self-harm or suicide among partners or children of survivors of stroke compared with partners or children of survivors of myocardial infarction (MI) and matched individuals from the general population. The study included a total of 1 923 732 individuals: 70 917 partners of stroke survivors (median [IQR] age, 68 [59-76] years; 46 369 women [65%]), 70 664 partners of MI survivors (median [IQR] age, 65 [55-73] years; 51 849 women [73%]), 354 570 partners of individuals from the general population (median [IQR] age, 68 [59-76] years; 231 833 women [65%]), 207 386 adult children of stroke survivors (median [IQR] age, 45 [36-52] years; 99 382 women [48%]), 183 309 adult children of MI survivors (median [IQR] age, 42 [33-49] years; 88 078 women [48%]), and 1 036 886 adult children of individuals from the general population (median [IQR] age, 45 [36-52] years; 496 875 women [48%]). Baseline characteristics were well balanced across cohorts after propensity score weighting. Among partners of stroke survivors, the 3-year absolute risk was 1.0% for depression, 0.7% for substance use disorders, 0.3% for anxiety disorders, and 0.04% for self-harm or suicide. Risk ratio point estimates for the assessed outcomes ranged from 1.14 to 1.42 compared with the general population and from 1.04 to 1.09 compared with partners of MI survivors. The elevated risk of depression in partners of stroke survivors was more pronounced after severe or moderate stroke than after mild stroke. Among adult children of stroke survivors, the 3-year absolute risk was 0.6% for depression, 0.6% for substance use disorders, 0.2% for anxiety disorders, and 0.05% for self-harm or suicide. Both absolute risks and risk ratios for adult children of stroke survivors were smaller than those reported in the partner analyses. In this cohort study of partners and adult children of stroke survivors, risks of several mental health conditions and self-harm or suicide were moderately higher compared with the general population and, to a lesser extent, partners and adult children of MI survivors. These findings highlight the potential consequences of stroke among family members, particularly partners, and its findings may possibly serve as a quantitative foundation for the development of future stroke rehabilitation services.

Perception and Experiences of Rehabilitation Service Providers of Teamwork Barriers in Tehran Province, Iran

Background and Objectives: The team plays a role as one of the crucial indicators in increasing the performance of the organization. Understanding the perspective of teamwork providers in rehabilitation regarding the existing obstacles can help a lot to improve the situation. This study aims to percept and experience rehabilitation service providers about teamwork barriers in Tehran Province, Iran. Methods: This qualitative study was conducted by conventional content analysis. The participants included 15 service providers with different genders and locations of activities from within Tehran Province in a snowball pattern. The data were collected by in-depth and quasi-structured interviews and analyzed by conventional content analysis method and using constant comparison. Results: After analyzing the meaningful statements of the interviewees, 3 sub-themes “regulations”, “procedural” and “executive” emerged and from the integration of these sub-themes, the theme of “obstacles” emerged. Conclusion: Some of the results of this research, such as defects in rehabilitation management, imposing double treatment costs on clients, and weakness of teamwork training in the university, have common results. Also, some phrases, such as not paying attention to the role of the municipality in rehabilitation and the number of rehabilitation trustees have not been mentioned in the interviews. Based on the results, it was found that obstacles based on regulations, processes, and implementation play a role in the development of teamwork in rehabilitation.

Implementing intensive comprehensive aphasia programs in Brazil: Challenges and solutions

ABSTRACT Aphasia, a communication disability prevalent among stroke survivors, significantly impacts psychosocial well-being and quality of life. Intensive Comprehensive Aphasia Programs (ICAPs) provide intensive and comprehensive treatment, incorporating individual and group therapy, patient and family education, and technology utilization. Despite positive outcomes, global implementation of ICAPs remains limited. In Brazil, preliminary evidence supports the development of intensive and comprehensive aphasia programs, such as the Brazilian Aphasia House—a program inspired by the successful Aphasia House model in the United States. The Brazilian Aphasia House offers personalized and intensive therapy in a simulated domestic environment, encompassing individual and group therapy sessions, and patient and family education, with the goal of enhancing functional communication skills and overall quality of life. Operating as a teaching clinic within a public university, it also serves as a training ground for future therapists to expand ICAP availability in Brazil. Challenges in implementing ICAPs in Brazil include socioeconomic barriers, limited public aphasia awareness, a shortage of specialized professionals, transportation, and session costs. Sustainable implementation requires committed leadership and financial resourcing, with involvement from public institutions and universities. By increasing awareness and nationwide implementation of ICAPs, access to aphasia rehabilitation services can be improved, potentially leading to better outcomes for individuals with aphasia and their caregivers. The Brazilian Aphasia House serves as an exemplar of an ICAP, offering intensive and personalized therapy to enhance communication abilities and promote social participation for people with aphasia.

Community-based rehabilitation services implemented by multidisciplinary teams among adults with stroke: a scoping review with a focus on Chinese experience

BackgroundDespite the growing interest in hospital rehabilitation services for communities, studies on existing community-based rehabilitation (CBR) services remain scarce owing to limitations in the development of community health services and regional cultural diversity. As a guaranteed measure for ensuring the quality of rehabilitation services and achieving the desired service outcomes, clear roles and responsibilities in multidisciplinary teams and effective service delivery are particularly important.ObjectiveThis scoping review aimed to determine the scope of community stroke rehabilitation programs involving existing multidisciplinary teams and to analyze the implementation content and implementers’ functional roles to provide guidance for future CBR programs.MethodsThe scoping review design followed the methodology of the Joanna Briggs Institute and was based on the normative scoping review framework proposed by Arksey and O’Malley. The comprehensive CBR framework was proposed by World Health Organization-guided data charting and analysis.ResultsOf the 22,849 identified citations, 74 studies were included, consisting of 6,809 patients with stroke and 49 primary caregivers, most of whom were from China. The most common working mode in CBR programs was a dual approach involving both healthcare professionals in medical institutions and community healthcare professionals. The number of programs in each discipline was in the following descending order: nursing, medical care, rehabilitation, psychology, nutrition, and public health. Among these, multidisciplinary teams comprising medical, nursing, and rehabilitation disciplines were the most common, with a total of 29 programs. Disciplinary members were mainly responsible for implementing their respective disciplinary content, with physicians providing guidance for the programs. More than 82.4% of the studies reported 2–4 intervention strategies. The intervention forms of rehabilitation content were the most diverse, whereas preventive interventions were more homogeneous than others. Physical function and socio-psychological measurements were the most commonly reported outcomes.ConclusionCBR services implemented by multidisciplinary teams can effectively achieve functional and emotional improvement in patients with stroke, and nurses are the most involved in implementation, especially in community settings. The results further emphasize the importance of strengthening the exploration of nurses’ maximum potential to implement CBR plans in future practice.Trial registrationThe registration information for this scoping review can be found at osf.io/pv7tg.

Catheter salvage from central line-related bloodstream infections in pediatric intestinal failure.

Patients with intestinal failure require central venous access which puts them at risk for central line-associated bloodstream infections (CLABSI). Maintaining vascular patency is critical for this population to receive nutrition support. When CLABSIs occur line salvage can help maintain vascular access. The aim of this study is to assess factors associated with safe and successful central venous catheter salvage. Retrospective cohort study of patients with intestinal failure at two tertiary care institutions between 2012 and 2020. The study examined the rates of attempted salvage, factors associated with successful salvage, and complications associated with salvage attempts. Over the study period, 76 patients with intestinal failure were include while central venous access was in place. There were a total of 94 CLABSIs. Salvage was more likely to be attempted when patients were under the direct care of an intestinal rehabilitation service (95% vs. 68%, p = 0.04). The overall successful salvage rate was 91.6% (n = 77). Gram-positive, Gram-negative, and polymicrobial infections had successful salvage rates of 97%, 92%, and 94% respectively. The successful salvage rate for fungal infections was 40%. There was no difference in 30-day complication rates for hospital readmission, intensive care unit admission, and death between patients who underwent salvage attempt and those who did not. Central line salvage can be safely attempted for many infections in patients with intestinal failure, leading to vascular access preservation.

Associations between burn care services and impairment at discharge after burn injury: Analysis of the Global Burn Registry

BackgroundThroughout the world, burn injury is a major cause of death and disability. In resource-limited countries, burn injury is one of the leading causes of permanent disability among children who survive traumatic injuries, and burn injury is the fourth leading cause of disability worldwide. This study applied Andersen’s model of health care access to evaluate if patient characteristics (predisposing factors), burn care service availability (enabling factors) and injury characteristics (need) are associated with physical impairment at hospital discharge for patients surviving burn injuries globally. Specifically, access to rehabilitation, nutrition, operating theatre, specialized burn unit services, and critical care were investigated as enabling factors. The secondary aim was to determine whether associations between burn care service availability and impairment differed by country income level. Methods: This is a cross-sectional secondary analysis of prospectively collected data from the World Health Organization, Global Burn Registry. The outcome of interest was physical impairment at discharge. Simple and multivariable logistic regressions were used to test the unadjusted and adjusted associations between the availability of burn care services and impairment at hospital discharge, controlling for patient and injury characteristics. Effect modification was analyzed with service by country income level interaction terms added to the models and, if significant, the models were stratified by income. Results: The sample included 6622 patients from 20 countries, with 11.2% classified with physical impairment at discharge. In the fully adjusted model, patients had 89% lower odds impairment at discharge if the treatment facility provided reliable rehabilitation services compared to providing limited or no rehabilitation services (OR.11, 95%CI.08,.16, p < .01). However, this effect was modified by county income with the strong and significant association only present in high/upper middle-income countries. Sophisticated nutritional services were also significantly associated with less impairment in high/upper middle-income countries (OR=.04, 95% CI 0.203, 0.05, p < .01), but significantly more impairment in lower middle/low-income countries (OR=2.01, 95% CI 1.50, 2.69, p < .01). Patients had 444% greater odds of impairment if treated at a center with specialty burn unit services (OR 5.44, 95%CI 3.71, 7.99, p < .01), possibly due to a selection effect. Discussion: Access to reliable rehabilitation services and sophisticated nutritional services were strongly associated with less physical impairment at discharge, but only in resource-rich countries. Although these findings support the importance of rehabilitation and nutrition after burn injury, they also highlight potential disparities in the quantity or quality of services available to burn survivors in poorer countries.

Postoperative pain trajectories in total hip arthroplasty.

Total hip arthroplasty (THA) is a common procedure to address pain and enhance function in hip disorders such as osteoarthritis. Despite its success, postoperative patient recovery exhibits considerable heterogeneity. This study aimed to investigate whether patients follow distinct pain trajectories following THA and identify the patient characteristics linked to suboptimal trajectories. This retrospective cohort study analyzed THA patients at a large academic centre (NYU Langone Orthopedic Hospital, New York, USA) from January 2018 to January 2023, who completed the Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity questionnaires, collected preoperatively at one-, three-, six-, 12-, and 24-month follow-up times. Growth mixture modelling (GMM) was used to model the trajectories. Optimal model fit was determined by Bayesian information criterion (BIC), Vuong-Lo-Mendell-Rubin likelihood ratio test (VLMR-LRT), posterior probabilities, and entropy values. Association between trajectory groups and patient characteristics were measured by multinomial logistic regression using the three-step approach. Among the 1,249 patients, a piecewise GMM model revealed three distinct pain trajectory groups: 56 patients (4.5%) in group 1; 1,144 patients (91.6%) in group 2; and 49 patients (3.9%) in group 3. Patients in group 2 experienced swift recovery post-THA and minimal preoperative pain. In contrast, groups 1 and 3 initiated with pronounced preoperative pain; however, only group 3 exhibited persistent long-term pain. Multinomial regression indicated African Americans were exceedingly likely to follow trajectory groups 1 (odds ratio (OR) 2.73) and 3 (OR 3.18). Additionally, odds of membership to group 3 increased by 12% for each BMI unit rise, by 19% for each added postoperative day, and by over four if discharged to rehabilitation services (OR 4.07). This study identified three distinct pain trajectories following THA, highlighting the role of individual patient factors in postoperative recovery. This emphasizes the importance of preoperatively addressing modifiable risk factors associated with suboptimal pain trajectories, particularly in at-risk patients.

Utilizing the REDCap platform in a cardiac rehabilitation service

Utilizing online health data records helps in disseminating, organizing, and securing vital medical data, yet their availability remains scarce. To address this gap, we implemented an online database, REDCap&amp;reg;, in a cardiac rehabilitation service, in addition to describing the clinical profile of program patients. The electronic health record implementation was carried out across four stages, from organizational setup to record initiation. Four forms were created, with 83 input fields in total, and 75 patients were registered. The majority of patients were male, white, elderly, employed, and diagnosed with ischemic heart disease. The implementation of an online database on the REDCap electronic platform in a cardiovascular rehabilitation service enhances data security and insights into patient demographics. These patient data can promote the dissemination of the importance of this service in preventing and treating cardiovascular diseases.

Challenges Posed During and After the COVID-19 Pandemic: Implications for Special Education Teachers

The COVID-19 pandemic affected the ways in which school districts provide educational services to all students, especially students with disabilities. Eligible students with disabilities have a right to a free appropriate public education (FAPE) under the Individuals with Disabilities Education Act (IDEA) and students with disabilities who are not eligible under the IDEA may also have a right to receive a FAPE under Section 504 of the Rehabilitation Act. School personnel need to attend to both of these important federal laws when providing educational services. Shortly after the pandemic began, the U.S. Department of Education, through the Office of Civil Rights and the Office of Special Education and Rehabilitation Services, issued guidance to school districts making it clear that despite school closures, school district personnel had to continue providing FAPE under the IDEA and Section 504. Following the return to school, the Office of Civil Rights investigated the Los Angeles Unified School District in California and the Fairfax County Schools for discriminating against students with disabilities by failing to provide educational services during the pandemic. In this article, we briefly review the guidance from the U.S. Department of Education and discuss important implications for teachers of students with disabilities.

Bi-objective scheduling of physical therapy treatments with coupled operations for inpatients in rehabilitation departments

In recent years, the field of physical therapy has experienced significant growth, particularly due to the impact of the Covid-19 pandemic. However, the capacity of rehabilitation services remains inadequate. This current study deals with scheduling physical therapies with coupled operations and multiple resources in rehabilitation departments, considering bi-objective optimization by minimizing both makespan and waiting time. Based on detailed analysis of practical operations, a mixed integer linear programming model is formulated. For small-size instances, optimal solutions can be obtained using software such as Gurobi. To handle large instances, a compound NSGA-II algorithm (CNSGA-II) is proposed. CNSGA-II consists of First-NSGA-II and Second-NSGA-II, which are associated with patient sequences and their respective treatments. Furthermore, practical heuristics are used to improve the initial solutions for CNSGA-II. The results of a real-work instance show that makespan is reduced by approximately 8.0%–10.8% and the maximum waiting time is reduced by about 26.4%–30.0%, comparing to the Queue Length Priority Algorithm commonly used in practice. The proposed CNSGA-II is further assessed using randomly generated instances and compared to MOEA/D and NSGA-II based on HV and IGD metrics. The results indicate the superior performance and effectiveness of the proposed CNSGA-II algorithm.

Barriers and facilitators for increased accessibility to quality rehabilitation services in low- and middle- income countries: a systematic review.

With an increasing number of people experiencing limitations in functioning during their life course, the need for comprehensive rehabilitation services is high. In 2017, the WHO Rehabilitation 2030 initiative noted that the need for the establishment and expansion of rehabilitation services is paramount in order to obtain well-being for the population and to ensure equal access to quality healthcare for all. The organization of rehabilitation services is however facing challenges especially in low-and middle-income countries with a very small proportion of people who require rehabilitation actually getting them. Various surveys conducted in low-and -middle income countries have revealed existing gaps between the need for rehabilitation services and the actual receipt of these services. This systematic review aimed to determine the barriers and facilitators for increasing accessibility to rehabilitation services in low- and middle-income countries. Recommendations for strengthening rehabilitation service organization are presented based on the available retrieved data. In this systematic review, an electronic search through three primary databases, including Medline (PubMed), Scopus and Web of Science (WOS) was conducted to identify original studies reporting on barriers and facilitators for rehabilitation service organization in low-and middle-income countries. Date of search: 25th April 2021 (PubMed), 3rd May 2021 (Scopus and Web of Science). All studies including barriers or/and facilitators for rehabilitation services in low- and middle income countries which were written in English were included in the review. The articles written in other languages and grey literature, were excluded from this review. Total of 42 articles were included from year 1989 to 2021. Numerous barriers were identified that related to education, resources, leadership, policy, technology and advanced treatment, community-based rehabilitation (CBR), social support, cultural influences, political issues, registries and standards of care. National health insurance including rehabilitation and funding from government and NGOs are some of the facilitators to strengthen rehabilitation service organization. Availability of CBR programs, academic rehabilitation training programs for allied health professionals, collaboration between Ministry of Heath (MOH) and Non-governmental Organizations (NGOs) on telerehabilitation services are amongst other facilitators. Recommendations for improving and expanding rehabilitation service organization include funding, training, education, and sharing of resources.

Enhancing the Management of Pediatric Sickle Cell Disease by Integrating Functional Evaluation to Mitigate the Burden of Vaso-Occlusive Crises

Sickle cell disease (SCD) imposes a significant health burden, particularly in low- and middle-income countries where healthcare professionals and resources are scarce. This opinion paper delves into the management strategies employed for vaso-occlusive crises (VOCs) in pediatric patients with SCD, advocating for the adoption of a transformative strategy. We explore the integration of functional assessment approaches into existing procedures, highlighting the potential of technology-assisted rehabilitation, including wearable sensors and digital biomarkers, to enhance the effectiveness of managing and preventing VOCs. Rehabilomics, as a comprehensive framework, merges rehabilitation-related data with biomarkers, providing a basis for personalized therapeutic interventions. Despite the promising advantages of these approaches, persistent obstacles such as the limited availability of rehabilitation programs, especially in resource-limited settings, pose challenges. This paper underscores the importance of a collaborative strategy to effectively address the unique obstacles faced by patients with SCD. This collaborative approach involves improving accessibility to rehabilitation services, incorporating technology-supported therapy, and fostering focused research endeavors. The primary objective of this comprehensive approach is to enhance the overall care of SCD patients, with a specific focus on preventing VOCs, as well as providing tailored (neuro)rehabilitation services in resource-limited settings. By examining the current state of SCD management and proposing transformative strategies, this opinion paper seeks to inspire collective action and collaboration to improve outcomes for pediatric SCD patients globally.

Evaluation and Monitoring System for Exercise Rehabilitation Based on Combined Chinese and Western Medicine Technology

INTRODUCTION: Developing exercise rehabilitation assessment and monitoring systems is essential in rehabilitation medicine. Introduces a sports rehabilitation assessment and monitoring system based on combining Chinese and Western medicine technology, aiming to integrate traditional Chinese and Western medicine theory and modern Western medicine technology to provide more comprehensive and personalized rehabilitation services. Through the systematic integration of technologies, the author is committed to building an efficient and precise rehabilitation system to provide patients with more scientific and practical rehabilitation programs. OBJECTIVE: The research system employs various sensor technologies, including motion capture devices, biosensors, and pulse recognition technology, by combining Chinese and Western medicine. The motion capture device enables real-time monitoring of the patient's movement trajectory, joint mobility, and other physiological indicators; the biosensor collects the patient's physiological data, such as heart rate and blood pressure. Meanwhile, Chinese and Western medicine pulse recognition technology was introduced to obtain pulse information specific to Chinese and Western medicine to provide more comprehensive data support for rehabilitation assessment. Integrating these technologies, a multi-level and multi-dimensional rehabilitation assessment system was established. METHODS: This study aims to improve the accuracy and personalization of the rehabilitation assessment and to tailor a rehabilitation plan more in line with the patient's actual situation. Through the combination of Chinese and Western medicine techniques, it aims to break the single perspective of traditional rehabilitation assessment and make the rehabilitation plan closer to the physiological characteristics and pathological state of the patients as well as the needs of the combination of Chinese and Western medicine in the identification and treatment. RESULTS: The system has achieved remarkable results in practical application. The accurate monitoring of the motion capture device provides a more comprehensive understanding of the patient's motor status and accurately analyzes the rehabilitation progress. At the same time, the data collection of biosensors provides doctors with more detailed physiological information, enabling them to formulate rehabilitation plans more comprehensively. The introduction of combined Chinese and Western medicine pulse recognition technology adds a unique auxiliary diagnostic tool of collaborative Chinese and Western medicine to the rehabilitation assessment and improves the personalized level of the rehabilitation plan. CONCLUSION: The sports rehabilitation assessment and monitoring system combining Chinese and Western medicine technology brings new ideas and methods for developing rehabilitation medicine. By fully utilizing the advantages of modern technology and traditional medical knowledge, a comprehensive and in-depth rehabilitation assessment system was constructed to provide patients with more scientific and caring rehabilitation services. Future research will optimize the system's performance and promote the broad application of integrated Chinese and Western medicine technology in rehabilitation.

Psychiatric rehabilitation in routine Indian mental health practice: A review of social protections for persons with mental health conditions

Background: An estimated 200 million Indians have mental health conditions – a sizeable proportion of them requiring psychiatric rehabilitation services. The numbers of mental health professionals are abysmally low. Early psycho-social rehabilitation interventions can improve functional outcomes, reducing disability. Psycho-social interventions have been made possible with the shift away from medical and charity models of disability to the establishment of social protections for vulnerable groups. Materials and Methods: The authors have undertaken a narrative review of all the social protection measures that can be explained to persons affected by mental health conditions and their family members. A larger tabulation is provided as an appendix to this article that has details of all the social protection measures across the states and union territories of India. This tabulation can be useful as a one-stop reference for every mental health practitioner in India toward informing persons affected by mental health conditions and their family members about how recovery journeys can be advanced. The data have been compiled after extensive searches of official government websites, information brochures, and even relevant legal provisions. Conclusion: For almost all the social protection measures provided by the central or state government, a disability certificate is a prerequisite. Rehabilitation today is a collaborative process aimed at community re-integration. In the absence of specialized services like those of clinical psychologists, vocational trainers, and psychiatric social workers, the psychiatrist becomes the sole point of contact. Motivated community members, recovered services users, and family members can aid mental health professionals by disseminating this knowledge further.