Rehabilitation Support Research Articles

Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review.

The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries. This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries. A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers. The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies. Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level.

Virtual reality tolerability, sense of presence and usability in Huntington disease: a pilot study.

Several studies demonstrated the utility of immersive virtual reality (VR) as a complementary approach to conventional therapy for improving motor, psychological and cognitive impairment in some pathological conditions. Our pilot study aims to evaluate for the first time: 1) sense of presence, tolerability and usability of VR immersive experience in patients with early stages of Huntington disease (eHDp) compared to healthy controls (HC); 2) correlation between the use of technology/cybersickness and the variables of presence/usability; 3) correlation between clinical characteristics (genetic, motor, functional and cognitive) and VR's variables. We recruited 10 eHDp and 10 age, gender and education matched HC. Participants completed questionnaires about sense of presence, usability, tolerability and technology use profile. Subjects were exposed to different VR scenarios from a first-person perspective through a standalone VR headset. Our results showed no significant statistical difference between eHDp and HC for the sense of presence (p=0.910), usability (p=0.744) and tolerability (p=0.730) during the VR experience. Familiarity with the use of technology was also comparable between groups (p=0.676). Regarding correlations in eHDp group, our results showed no correlations between use of technology/tolerability and the sense of presence/usability. Moreover, clinical characteristics of eHDp (genetic, motor, functional and cognitive scores) did not influence the sense of presence, tolerability and usability. Our research presents preliminary evidence for the applicability of VR in eHDp. These results open up the possibility to explore future applications of this methodology in rehabilitation (i.e., cognitive training, physiotherapy), diagnosis and psychological support in Huntington disease patients.

Prognostic Equations and Accuracy of a Total Score of Functional Independence Measure at Discharge for Different Diseases in a Convalescent Rehabilitation Ward.

Prognosisand goal setting from admission in the convalescent rehabilitation ward, supported by a multidisciplinary team, enhance rehabilitation and discharge support. Predicting functional independence measure (FIM) outcomes can further optimize these processes. This study aimed to develop prognostic equations for the motor FIMat discharge for stroke, hip fracture (HF), vertebral compression fractures (VCFs), and total knee arthroplasty (TKA), which are common diseases in patients admitted to convalescent rehabilitation wards, using multiple regression analysis, and to clarify the difference in the accuracy of the predicted motor FIM according to the disease. This study included 965 patients admitted to our hospital. The objective variable consists of the motor FIM at discharge, and the explanatory variables were age, sex, days from onset to admission, total admission motor FIM, and total admission cognitive FIM. A stepwise multiple regression analysis was performed. The analysis of the difference in the accuracy of predicted motor FIM by disease used the absolute value of the residuals. The total motor FIM and cognitive FIM at admission were extracted for all four diseases included in this study. The absolute value of the residuals appeared to be more accurate for TKA, HF, stroke, and VCF in that order. Although differences in the accuracy of the prediction equation were observed by disease, this prediction equation can be used as an approach to review the details of rehabilitation and discharge and can be tailored to each case.

The investigation of frailty level and factors affecting frailty in older adults with osteoarthritis; a cross-sectional study on Turkish population

Aims: This study aims to evaluate the fragility level, fall risks and factors affecting both conditions of individuals with OA aged 60 and over living in an underdeveloped province. Methods: The research sample consists of 260 individuals over the age of 60 who were diagnosed with osteoarthritis. The frailty of the participants was measured. Their functional mobility and risk of falling were measured. Results: The prevalence of frailty and pre-frailty was found to be 82%. It was revealed that frailty is not always affected by the severity of osteoarthritis and the progression of age. In addition, it was found that factors such as stage IV osteoarthritis and being frail or pre-frail increase the risk of falling. The stage of osteoartritis, education level, lifestyle, and risk of falling explained 24% of the variance in the frailty variable. Having an unhealthy lifestyle increases frailty 20 times; lowincome level increases frailty eight times; and each increase in education level affects frailty at most four times negatively. Conclusion: Psychological rehabilitation and social support may negatively affect the development of frailty in individuals aged 60 years and older. Frail older women with severe OA are more vulnerable to falls.

An Intelligent Hand-Assisted Diagnosis System Based on Information Fusion.

This research proposes an innovative, intelligent hand-assisted diagnostic system aiming to achieve a comprehensive assessment of hand function through information fusion technology. Based on the single-vision algorithm we designed, the system can perceive and analyze the morphology and motion posture of the patient's hands in real time. This visual perception can provide an objective data foundation and capture the continuous changes in the patient's hand movement, thereby providing more detailed information for the assessment and providing a scientific basis for subsequent treatment plans. By introducing medical knowledge graph technology, the system integrates and analyzes medical knowledge information and combines it with a voice question-answering system, allowing patients to communicate and obtain information effectively even with limited hand function. Voice question-answering, as a subjective and convenient interaction method, greatly improves the interactivity and communication efficiency between patients and the system. In conclusion, this system holds immense potential as a highly efficient and accurate hand-assisted assessment tool, delivering enhanced diagnostic services and rehabilitation support for patients.

Coming home in the context of very early supported discharge after stroke – An interview study of patients’ experiences

ObjectivesTo explore patients’ experiences of coming home and managing everyday life within the context of very early supported discharge after stroke (VESD). Study designAn explorative qualitative study using semi structured interviews. MethodThis study was nested within a randomised controlled trial,; Gothenburg Very Early Supported Discharge (GOTVED), comparing a home rehabilitation intervention given by a coordinated team (VESD) with conventional care. Eleven participants with a median age 70.0 years (range 63-95) of which nine scoring 0-4 on the NIHSS indicating no symptoms or minor stroke were interviewed on average 12 days after discharge. Data was analysed using thematic analysis. ResultsThe diversity of patients’ experiences was reflected in the overarching main theme Very Early Supported Discharge after stroke - a multifaceted experience, built upon five themes: “Conditions surrounding the discharge”, “Concerns about the condition”, “Confronting a new everyday life”, “Experiences of the intervention” and the “Role of next of kin”. ConclusionsThe respondents were largely satisfied with the very early supported discharge which might be expected, given that it was well planned regarding timing, individualisation and content. The patients need to be aware of the purpose of the VESD intervention. Due to the unpredictability of the stroke and its consequences, interventions need to be flexible. Goal setting is important but must be comprehensible. The role and burden of next of kin should be addressed and negotiated, and the ending of the intervention must be planned, with seamless transition to further rehabilitation and social support including the issue of participation in everyday life.

Efficacy of a Novel Recording Method in Facilitating Rapid Documentation of Disaster Rehabilitation Support Activities

Efficacy of a Novel Recording Method in Facilitating Rapid Documentation of Disaster Rehabilitation Support Activities

Life is better but not without challenges: experiences following discharge from community-based residential mental health rehabilitation-a qualitative content analysis.

Community-based residential mental health rehabilitation units for people experiencing severe and persistent mental illness are increasingly available in Australia. Research completed 20 years ago suggested that people leaving these services often experienced impoverished social lives and other challenges in the community. It is unclear whether contemporary consumers experience similar difficulties. This qualitative study explored contemporary consumers' experiences after leaving community-based residential services. An inductive qualitative content analysis of individual interviews was completed with consumers 12-18 months following discharge from three community care units (CCUs) in Queensland, Australia. The interview schedule explored three questions: (1) What does life look like after leaving the CCU, (2) Has the CCU impacted their life, and (3) How could the CCU experience be improved? A convenience sample was used, with sampling continuing until thematic saturation was achieved. A member of the research team who had relevant lived experience actively supported the analysis and interpretation. Seventeen interviews were completed. Three themes were identified: 'life is better but not without challenges', 'the CCU helps you get ready to go out into the world', and 'strict rules are important but rigid expectations can be hard; things could be better'. Consumers reflected positively on their lives post-discharge from a community-based residential rehabilitation unit and viewed the service as having supported improvements in their lives. The findings suggest the appropriateness of optimism about the possibility of sustained improvements in quality of life after leaving community-based transitional residential rehabilitation support.

The effects of a defendant's childhood physical abuse on lay support for sentencing: The moderating role of essentialism.

Research suggests that a defendant's history of experiencing childhood abuse, and its effects on their life and later decision-making, may impact public support for a defendant's sentencing, particularly mitigation. However, no existing research has examined how and why sentencing support may vary based on the time period when the abuse occurs during a defendant's childhood. This experiment, using a sample of the U.S. public (N=400), examines how the age at which a defendant's childhood physical abuse occurs affects lay support for the goals of their sentencing. We hypothesized that participants with higher levels of social and biological trait essentialism would moderate their increased support for more punitive sentencing goals-particularly when a defendant was abused earlier, rather than later, in childhood. Results suggest that social essentialism is associated with increased support for restoration and rehabilitation toward defendants with histories of childhood physical abuse, potentially indicating that the public views the effects of child abuse as more of a social, versus biological, process which may affect support for utilitarian punishment goals.

Early vocational rehabilitation and psychological support for trauma patients to improve return to work (the ROWTATE trial): study protocol for an individually randomised controlled multicentre pragmatic trial

BackgroundModerately severe or major trauma (injury severity score (ISS) > 8) is common, often resulting in physical and psychological problems and leading to difficulties in returning to work. Vocational rehabilitation (VR) can improve return to work/education in some injuries (e.g. traumatic brain and spinal cord injury), but evidence is lacking for other moderately severe or major trauma.MethodsROWTATE is an individually randomised controlled multicentre pragmatic trial of early VR and psychological support in trauma patients. It includes an internal pilot, economic evaluation, a process evaluation and an implementation study. Participants will be screened for eligibility and recruited within 12 weeks of admission to eight major trauma centres in England. A total of 722 participants with ISS > 8 will be randomised 1:1 to VR and psychological support (where needed, following psychological screening) plus usual care or to usual care alone. The ROWTATE VR intervention will be provided within 2 weeks of study recruitment by occupational therapists and where needed, by clinical psychologists. It will be individually tailored and provided for ≤ 12 months, dependent on participant need. Baseline assessment will collect data on demographics, injury details, work/education status, cognitive impairment, anxiety, depression, post-traumatic distress, disability, recovery expectations, financial stress and health-related quality of life. Participants will be followed up by postal/telephone/online questionnaires at 3, 6 and 12 months post-randomisation. The primary objective is to establish whether the ROWTATE VR intervention plus usual care is more effective than usual care alone for improving participants’ self-reported return to work/education for at least 80% of pre-injury hours at 12 months post-randomisation. Secondary outcomes include other work outcomes (e.g. hours of work/education, time to return to work/education, sickness absence), depression, anxiety, post-traumatic distress, work self-efficacy, financial stress, purpose in life, health-related quality of life and healthcare/personal resource use. The process evaluation and implementation study will be described elsewhere.DiscussionThis trial will provide robust evidence regarding a VR intervention for a major trauma population. Evidence of a clinically and cost-effective VR intervention will be important for commissioners and providers to enable adoption of VR services for this large and important group of patients within the NHS.Trial registrationISRCTN: 43115471. Registered 27/07/2021.

The Experience of Social Alienation in Elderly Lung Cancer Patients: A Qualitative Study

PurposeThe aim of this study was to understand the experience of social alienation in elderly lung cancer patients, to explore its causes, and to propose targeted intervention strategies. MethodsFrom July to August 2023, 16 elderly lung cancer patients attending the respiratory department of a tertiary hospital in Changsha City, Hunan Province, were selected for semi-structured interviews using a purposive sampling method. The Colaizzi 7-step method was used to analyze the data. ResultsA total of four themes were distilled: the experience of social alienation in elderly lung cancer patients (pessimistic feelings, inferiority complex, and heavy psychological burden), subjective causes (disease-included shame, avoidant social behavior, and stigmatized labels), objective causes (isolated social states, and reduced amount of socialization), and rehabilitation support. ConclusionThe causes of social alienation in elderly lung cancer patients include multiple aspects of personal, family, and social support, and symptom management and psychological guidance should be strengthened for this population to construct a hospital–society–family triple-linkage care program to help patients recover.

중증장애인 직업적응훈련 서비스에 대한 현장 실무자 인식에 관한 연구: 중증장애인직업재활지원사업 수행기관을 중심으로

중증장애인 직업적응훈련 서비스에 대한 현장 실무자 인식에 관한 연구: 중증장애인직업재활지원사업 수행기관을 중심으로

Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Patients' experiences in the intensive care unit (ICU) can enhance or impair their subsequent recovery. Improving patient and family experiences on the ICU is an important part of providing high quality care. There is little evidence to guide how to do this in a South Asian critical care context. This study addresses this gap by exploring the experiences of critically ill patients and their families in ICUs in Bangladesh and India. We elicit suggestions for improvements from patients, families and staff and highlight examples of practices that support person-centred care. This multi-site hospital ethnography was carried out in five ICUs in government hospitals in Bangladesh and India, selected using purposive sampling. Qualitative data were collected using non-participant observation and semi-structured interviews and analysed using reflexive thematic analysis. A total of 108 interviews were conducted with patients, families, and ICU staff. Over 1000 hours of observation were carried out across the five study sites. We identified important mediators of patient and family experience that span many different aspects of care. Factors that promote person-centred care include access to ICU for families, support for family involvement in care delivery, clear communication with patients and families, good symptom management for patients, support for rehabilitation, and measures to address the physical, environmental and financial needs of the family. This study has generated a list of recommendations that can be used by policy makers and practitioners who wish to implement person-centred principles in the ICU.

Exploring the potential for providing rehabilitation support to patients after acute cerebrovascular accidents

Acute cerebrovascular accidents (ACVA) are a group of diseases that arise due to circulatory disorders in the brain. Acute strokes are one of the leading causes of mortality and disability, both in Russia and worldwide. The most obvious consequences of a stroke are physical, but in some cases psychological, social, household, and other difficulties become no less important. Comprehensive rehabilitation of patients after acute cerebrovascular accident (ACVA) should cover the entire range of problems associated with this disease to ensure complex and comprehensive recovery. In order to assess patients’condition and their rehabilitation potential, rating scales are used. The purpose of the study was to evaluate motor and sensory impairments before and after rehabilitation in stroke patients using diagnostic scales. The study on the basis of the State Budgetary Institution of Social Services Gerontological Center «Dolgoletie (Longevity)» in Orenburg included 12 women and 8 men who had suffered strokes. The following results were obtained: the overall dynamics of rehabilitation tests in the control group was 4 % in women and 3 % in men. These findings confirm the need to use these assessment methods to objectify treatment results and determine rehabilitation potential.

Stigmatizing ‘evildoers’: how beliefs about evil and public stigma explain criminal justice policy preferences

ABSTRACT Characterizations of offenders as ‘evil’ appear in popular entertainment, political rhetoric, and scholarship and may be rooted in widely endorsed cultural narratives. Integrating psychological and criminological literatures, we argue that endorsement of good-and-evil myths may be associated with criminal justice policy support via stigmatizing attitudes about those who engage in crime. We partially tested these hypotheses in a preliminary study using an online convenience sample (recruited using Amazon MTurk in 2015), then tested the full theoretical model using more comprehensive measures in a survey of American adults conducted via Qualtrics Panel in 2021 (N = 1,162). We found that both belief in evil (i.e. belief in evil forces) and belief in redemptive violence (i.e. belief in a clash between good and evil) were positively associated with punitive policy support, and stigmatizing attitudes partially mediated the effects of both. While belief in redemptive violence was negatively associated with rehabilitative policy support and stigmatizing attitudes mediated that relationship, belief in evil was not associated with support for rehabilitation. We consider the implications of our findings for mitigating the harms of public stigma and punitive criminal justice policy.

Advancing vascularized composite allotransplantation: essential factors for upper extremity transplant program development.

Vascularized Composite Allotransplantation (VCA) offers a unique option to restore form and function after limb loss or facial trauma that cannot be satisfactorily accomplished through traditional prosthetics or reconstructions. Establishing a successful Upper Extremity Transplantation (UET) program requires strong leadership and a structured surgical team, and extensive interdisciplinary collaboration. We conducted a qualitative study among 12 health care professionals and patients. Informed consent was obtained per protocol, and semi-structured interviews were conducted online and recorded. Participants reported their perceptions of factors that either favored or hindered a successful outcome, including functional status before and after surgery, preparation for transplant, shared decision-making, rehabilitation, and psychosocial support. Thematic analysis revealed that it is essential to establish a team comprising various disciplines well before performing VCA procedures. Defining a common goal and choosing a defined leader is a key factor in procedural success and requires open collaboration beyond what is typical. Primary described categories are interdisciplinary collaboration and skills of the VCA team, building and leading a VCA team, pre-transplant procedures, post-transplant course, and factors to consider when establishing a program. The basic roles of team science play an outsized role in establishing a VCA program. Transplantation medicine involves various overlapping scientific and medical categories requiring health professionals to consciously work together to establish complex vertical and horizontal communication webs between teams to obtain positive outcomes. In addition to medical considerations, patient-specific factors such as transparent communication, therapy plan establishment, plan adherence, and continual follow-up are significant factors to overall success.

Sports Injuries Support: Towards a Proposed Intervention Program for Soccer Training

The aim of this study was to explore the relationship between university football students' experiences of sports injuries and rehabilitation support, and the effectiveness of rehabilitation support provided to this group. The study adopted a mixed research method combining quantitative and qualitative methods, and data were collected through questionnaires and semi-structured interviews. The study population consisted of 180 football students from Jiaqing College and Guangzhou Sports Institute. It was found that the students demonstrated high levels of knowledge, preparation, and application of sports injuries, as well as positive attitudes towards all aspects of rehabilitation support (including physical rehabilitation, psychological support, functional recovery, rehabilitation goals and social support). Correlation analyses with the correlation between sports injuries and rehabilitation support showed a significant positive correlation, emphasizing the importance of rehabilitation support in dealing with sports injuries.

Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries.

To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs. Multicentre prospective cohort study. Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended-Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.

Internet use and risky online activities in children with developmental disorders: parental perspectives

Objectives This study aimed to identify Internet use and risky online activities in children with developmental disorders from the viewpoint of parents. Methods This descriptive study was carried out with the parents of 407 children, aged between 6 and 17, who were receiving educational and rehabilitation support at the special education and rehabilitation centers. A questionnaire consisting of socio-demographic data and information on risky online activities was used to collect data. Results Mobile phones are the preferred device for 89.1% of children to access the Internet. The average age for starting to use a smartphone is 4.57 ± 2.10 years. Most commonly, children use the Internet for playing games (86.5%), listening to music (73.9%), and watching videos (69%). Risky online activities were noted while using the Internet, including revealing actual names (69.8%), submitting personal photos (90.6%), sharing personal photos with others (93.8%), and divulging the streets of their neighborhood (46.1%). Conclusions Internet practices of children with developmental disorders are precarious. Thus, it is crucial for parents to assume substantial responsibility in safeguarding children with developmental disorders from risky online activities. Educational programs should be developed to raise awareness and encourage responsible use of the Internet in order to promote healthy digital literacy.

“Pre-Discharge Syndrome” in Gerontopsychiatric Practice: Clinical Manifestations and Risk Factors

Background: hospitalization of elderly patients is associated with social and psychological maladaptation, reduced levels of daily functioning, and development of hospitalism. Patients whose status suddenly worsened immediately prior to discharge from psychiatric hospital make up a group that is difficult for diagnostics and treatment and not sufficiently studied. The aim of the study was to analyze changes in patients’ status before planned discharge from hospital to identify clinical patterns of deterioration and factors associated with this adverse event. Patients and methods: study participants were selected from 181 consecutive patients of the Geriatric Psychiatry Department of V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology. The main study methods were history-taking and psychological assessment. Results: predischarge deterioration was observed in 81 patients (44.8%) and was represented by exacerbation of mental disorder in 60 cases (33.2%), development of new symptoms in 12 patients (6.6%), or decompensation of somatic disease in 9 cases (5.0%). The history of patients with predischarge worsening was characterized by longer prior hospitalizations. These patients were more heavily pretreated, and had higher rates of hospitalism and non-compliance. For patients with worsening or development of new symptoms of mental disorder median duration of mental disease was respectively 84 and 204 months. They were more prone to violation of compliance, of the prescribed treatment regime and doses. Somatic decompensation occurred in patients with median duration of mental disorder 36 months and was associated with latent refusal to take medicines. Conclusions: an increased risk of predischarge deterioration in geropsychiatric patients with a history of prolonged hospitalizations needs earlier rehabilitation, psychotherapy, and psychological support when planning hospital discharge.