Self-care Function Research Articles

Measuring developmental and functional status in children with disabilities

This study compared performance on the Functional Independence Measure for Children (WeeFIM), the Battelle Developmental Inventory Screening Test (BDIST), and the Vineland Adaptive Behavior Scales (VABS) in children with developmental disabilities. The three instruments were administered to 205 children with identified disabilities. All 205 children were tested using the WeeFIM instrument. The BDIST was administered to 101 children and the VABS to the remaining 104 children. Administration was counterbalanced and randomized across all three instruments. A proportional sampling plan was used to select the 205 children, who ranged in age from 11 to 87 months. A variety of medical diagnoses and levels of severity of motor, cognitive, and communication impairments were systematically included in the sample. Correlations (r) among subscales for all three instruments ranged from 0.42 to 0.92. Correlations for total scores ranged from 0.72 to 0.94. Analyses of potential moderator variables found no significant relation between age and severity of disability (r=0.05) or between socioeconomic status (SES) and severity of disability (r=0.21). Correlations with age were strongest for those subscale scores involving gross and fine motor skills. Correlations with SES and subscale scores ranged from 0.03 to 0.18. The three instruments provide important information regarding childhood performance in motor, self-care, communicative, cognitive, and social skills. The WeeFIM instrument requires less administration time and provides information directly relevant to evaluating functional outcomes for children with disabilities and their families.

Neuro-Occupation: Linking Sensory Deprivation and Self-Care in the ICU Patient

Neuro-occupation is an emerging concept in occupational therapy. The concept of neuro-occupation provides a basis to understand how the nervous system is intertwined with all aspects of occupational performance. This paper uses the framework of neuro-occupation to link a neurological system, the reticular activating system (RAS), to the performance of self-care by patients in an intensive care setting. This correlation is made because the RAS is responsible for organizing sensory information. Inappropriate amounts of stimulation effect the RAS and result in sensory deprivation or sensory overload, which negatively impacts occupational performance. Implications for occupational therapy practice are also addressed.

Upper Extremity Performance and Self-Care Skill Changes in Children with Spastic Cerebral Palsy following Selective Posterior Rhizotomy

Changes in upper extremity and self-care performance following selective posterior rhizotomy (SPR) are reported frequently, but rarely quantified. In this study, 36 children with spastic cerebral palsy were assessed preoperatively and 1 year following SPR using the Quality of Upper Extremity Skills Test (QUEST). Twenty-six children were assessed at similar intervals using the Functional Independence Measure for Children (WeeFIM) as a measure of self-care performance. Wilcoxon matched-pair signed-rank tests were used to compare the QUEST total scores and the WeeFIM motor, cognitive, and total scores before and after SPR. One year after SPR, the total QUEST scores were significantly better (median improvement = 3.2%, p < 0.0001), as were the WeeFIM motor (median improvement = 9.5, p < 0.0001), cognitive (median improvement = 1.0, p < 0.008), and total (median improvement = 11.0, p < 0.0001) scores. The results indicate quantifiable improvements in upper extremity function, and motor and cognitive self-care skills in children 1 year after SPR.

Body mechanics during daily tasks to reduce back pain in women who are pregnant

Although pregnancy is a temporary condition, the prevalence of back pain has been estimated to be approximately 49-50% and pain may continue post partum. Often women have to limit or curtail daily living activities because of the pain. The purpose of this paper is to describe physical changes that occur during pregnancy and discuss positioning and body mechanics to prevent or reduce back pain during performance of self-care, homemaking and vocational activities. Suggested guidelines for continuation of various physical job demands and safety based on the American College of Obstreticians and Gynecologists are described.

An Analyses of Research Trend and Proposition Related to Self-care

【This study was performed to analyse the tendency of the self-care studies, to investigate the variables related to self-care, which could be applied for the data establishing the theory of self-care. To accomplish the objectives of this study, the researchers analyzed 83 studies available that contained the area of self-care, which was published in local and foreign areas between 1981 and Feb. 1997. The findings of this study are as follows : 1) Studies published in Korea were about twice more than foreign studies. According to the statistics, the number of studies in this study tended to increase year by year. Between 1991 and 1995 were most. Analysis on the subject of those studies showed, that they were most dealt with chronic diseases an adaults. 2) The theoretical definition of self-care were most referred to Orem's self-care. For the main concept of studies, self care performance was the most. 3) The correlational study was most often used design and experimental study is tended to increase. The questionnares were the most often used data collection method. There was lots of different variable measuring technique to evaluate main concepts. 4) In the results of analysis on the propositions related to the self-care performance, a client's education, social support, self-efficacy, and level of knowledge as a causal variable were found. Also, the physiological index improved and quality of life were found to be significant effective variables.】

Achievement of appropriate self-care. Does care delivery system make a difference?

The purpose of this article is to review the evidence linking variations in care delivery system with achievement of appropriate self-care. This synthetic review of the research literature used the Outcomes Model for Health Care Research. The concept of self-care was reviewed from several theoretical perspectives, as was the quality of instruments used to measure aspects of self-care. Finally, studies examining the linkage between care delivery system and self-care were critically analyzed. Reliable and valid instruments exist to measure self-care agency and self-care performance, and these data elements are collected routinely in many care settings. Only a few studies, however, have examined the relation between achievement of self-care and variations in delivery systems. Achievement of appropriate self-care may be an outcome measure better suited to nonacute care settings or across the continuum of care. Additionally, work is needed in applying risk-adjustment strategies to the measurement of achievement of appropriate self-care.

The relationships among sensorimotor components, fine motor skill, and functional performance in preschool children.

This correlational study investigated the relationships among sensorimotor components, standardized measures of fine motor skill, and functional performance in self-care, mobility, and social interaction. It also examined which sensorimotor components and fine motor skills were predictors of functional performance. Thirty preschool children with motor delays were evaluated with tests of in-hand manipulation, tactile defensiveness, stereognosis, grasping strength, and fine motor skill. Parents of the subjects were interviewed with the Pediatric Evaluation of Disabilities Inventory. Correlational and regression analyses were computed. Significant correlations were found among sensorimotor components and discrete fine motor skills as measured on standardized observational tests. Few correlations emerged between foundational components of fine motor skill and functional performance in self-care, mobility, and social function. Lack of significant relationships among the variables, all of which were aspects of functional performance might be due to the difference between judgment-based and observational evaluation, the influence of the environmental context on the child's performance, and the influence of cultural values on the opportunities afforded to the child.

Rehabilitation of the Geriatric Orthopaedic Patient

Older patients who are referred for rehabilitation after undergoing orthopaedic procedures have numerous age-related conditions that may interfere with physical performance and safety. The general rehabilitation goals are to return each patient to the premorbid functional level of mobility and self-care, teach the exercises that are to be performed after hospital discharge, reduce the risk of falls, and ensure that the patient is discharged to a safe environment. Before elective surgery, the elderly orthopaedic patient should be instructed to perform breathing exercises to prevent pulmonary complications and active lower limb exercises to maintain good circulation and joint mobility, and be instructed in functional activities for mobilization in and out of bed. Postoperatively, the interdisciplinary rehabilitation team must facilitate early resumption of active exercises and self-care tasks and discourage prolonged bed rest and dependency on nursing staff and family members. Physical and occupational therapy should be provided to restore mobility and self-care functions. If discharge to home is planned, the home environment should be assessed and modifications recommended to reduce the risk of falls and ensure independent functioning to the extent possible. When the rehabilitation goals have been obtained, the patient should be discharged from the hospital, but additional therapy may be required, either at home or at an outpatient facility.

Late outcomes of limb loss after failed infrainguinal bypass

Most reports regarding infrainguinal bypass surgical procedures demonstrate benefits well but pay less attention to adverse outcomes and consequences of failure for the patient. For a wider scope of infrainguinal bypass surgical procedures, we evaluated patient-oriented outcomes of limb loss occurring after failed infrainguinal bypass operations. Eighty-one patients with vascular amputations were identified in a retrospective study. Follow-up was complete with a mean of 3.6 years. Life-table and multivariate analyses were used to assess factors influencing the desired outcome goals of rehabilitation. Mortality rates, social function, risk of contralateral amputation, and the ability to walk were used to measure the late outcome. The long-term survival rate was poor (72% at 1 year; 53% at 3 years) and was not related to traditional risk factors for atherosclerosis. Moreover the risk for contralateral amputation was 10% per year. One year after amputation 81% (47 of 58) of the surviving amputees were walking independently, and 73% (42 of 58) were living at home, 32 with their spouse. At 3 years these results were 73% (27 of 37) and 78% (29 of 37), respectively. In addition, the level of self-care changed significantly (p < 0.001) after amputation. Advanced age (older than 65 years), self-care performance, and living with someone were important predictors of late outcome. It is possible for a high percentage of patients with vascular amputations to return home successfully, either walking or in a wheelchair. Moreover this result can be predicted based on preoperative clinical variables. These data may be helpful to guide fitting of prosthetic devices, planning of discharge home, and use of health care resources.

Surgery for limb threatening ischaemia: A reappraisal of the costs and benefits

To study the quality of life of patients following surgery for critical limb is ischaemia. Part retrospective, part prospective open study. Vascular unit of a University Hospital. Seventy-nine consecutive patients, medium age 75 years (range 44 to 94), who presented with leg threatening ischaemia and who underwent successful revascularisation or a major amputation were studied. Six separate quality of life measures were recorded at 6 months: pain, mobility, anxiety, depression, activities of daily living (Barthel) and lifestyle (Frenchay). The mortality of this group of patients after six months was 24%. Forty-seven patients were available for quality of life assessment six months after initial intervention. Overall, amputation was more costly than successful revascularisation and limb salvage. Limb salvage resulted in greater mobility (p < 0.001) and better performance in self-care (p < 0.001) and lifestyle (p = 0.006), but produced more anxiety and depression (p = 0.04) than major amputation. A subgroup of patients who had major amputation after a failed limb salvage operation consumed a disproportionate amount of resources and, although their mobility was typical of amputees, their self-care and lifestyle scores were similar to those who had successful limb salvage. OBSTRUCTIONS: Limb salvage is attempted in up to 22% of patients for whom primary amputation may provide more expeditious rehabilitation with minimal impairment of their lifestyle performance.

Psychosocial correlates of glycemic control: the Pittsburgh Epidemiology of Diabetes Complications (EDC) study

The psychosocial correlates of glycemic control were examined in an incident cohort of childhood onset insulin-dependent diabetic subjects aged 18 years or older ( n = 592). Glycosylated hemoglobin was measured at subjects' clinical examination, and questionnaires on diabetes self-care activity, barriers to regimen adherence and social support were completed. Demographic information was also collected. Glycosylated hemoglobin (GHb) was correlated with age, income and educational attainment (correlations coefficients between −0.1 and −0.2; P < 0.01), suggesting that older, more educated and wealthier patients have better glycemic control. GHb was also inversely associated with the degree of self-care activity ( r = −0.11; P < 0.01), in particular administering injections at the recommended times and the frequency of performing blood/urine tests. Factors related to self-care behavior were identified, and included degree of social support ( r = 0.14; P < 0.001) and patients' reports of difficulties adhering to their self-care regimen ( r = −0.3; P < 0.0001). Gender was also related to self-care activities, with women reporting more self-care behavior than men (mean self-care scores 17.9 ± 3.7 vs. 16.9 ± 4.0; P < 0.01). Thus psychosocial factors (e.g. low income and education) may have an important effect on glycemic control in adults, and also (e.g. social support and adherence difficulties) seem particularly important in influencing the performance of self-care. As good metabolic control may help avoid the progression of diabetic complications, efforts need to be directed towards patients with these characteristics who are more likely to experience difficulties with self-care.

Predictors of Children’s Self-Care Performance: Testing the Theory of Self-Care Deficit

Orem’s theory of self-care deficit proposes relationships between self-care performance and (a) basic conditioning factors, (b) self-care agency, and (c) dependent-care agent performance. The purpose of this study was to examine these proposed relationships in children. The study sample was composed of 414 students in grades 4 through 12, ages 9 through 18 years. Using regression analyses, study findings were that the variables chosen to represent the basic conditioning factors together accounted for 19% of the variance in children’s self-care performance. Separately, both age and health state were significant predictors. Additionally, when self-care agency was added to the regression model, the combination accounted for 36% of the variance. A correlational analysis showed a moderate relationship between a child’s self-care performance and her or his mothers’ dependent-care agent performance. Future research should continue to investigate Orem’s theories and the operationalization of the concepts.

Response to “Predictors of Children’s Self-Care Performance: Testing the Theory of Self-Care Deficit”

Response to “Predictors of Children’s Self-Care Performance: Testing the Theory of Self-Care Deficit”

Negotiating self-care in rehabilitation nursing.

The authors conducted a study to examine nurse and patient perceptions of self-care and the performance of self-care in rehabilitation settings. The grounded-theory method was used to conduct and analyze in-depth interviews of 12 nurses and 12 rehabilitation patients. Every nurse and every patient had expectations regarding who would control each aspect of the patient's self-care. When these expectations were noncongruent, negotiation usually occurred. Successful negotiation resulted in a balance of self-care, the optimal balance between nurse and patient control.

Cardiac rehabilitation program participation and outcomes after myocardial infarction.

Rehabilitation programs for myocardial infarction (MI) survivors are designed to alter survivors' self-care patterns and to improve long-term physical and psychological outcomes. The purpose of this study was to examine the relationship between participation in cardiac rehabilitation and health state; days of reduced activity; anxiety; depression; self-esteem; quality of life; and performance of exercise, diet, medication, stress-modification, and smoking-reduction self-care behaviors after MI. Interviews were conducted with 197 women and men 1 to 2 years after their initial MI to measure health state, mood, self-esteem, quality of life, and relevant self-care behaviors. Rehabilitation center records were reviewed to determine participation in rehabilitation programs. Rehabilitation participation was significantly associated with health state; days of reduced activity; self-esteem; quality of life; and performance of exercise, diet, and medication self-care. These findings suggest that participation in cardiac rehabilitation is a worthwhile intervention that facilitates recovery from myocardial infarction.

Treatment of Multiple Behavioural Problems in a Retarded Township Child a Case Study

In this article the successful behavioural treatment of a seven-year-old retarded black township girl is described. The girl presented with (a) pica (indiscriminate eating of non-food substances such as soap, earth, paraffin, candles, rubbish etc.), (b) hazardous unsupervised playing with matches, (c) aggressive behaviour and prolonged crying, and (d) poor development of self-care and participation in household tasks. Contact with the therapist involved 10 one-hour sessions. The pica was treated by discrimination training and a home token economy. The playing with matches was treated by satiation and by reward for playing with matches only when supervised. The aggression was treated by social interventions aimed at eliminating provocation, and integrating her into family and peer activities. In addition, the mother was trained to model and reward self-care behaviours and performance of household tasks. All four targets were successfully treated initially: the pica, unsupervised playing with matches and aggressive outbursts were eliminated, and a marked increase in independent behaviour was achieved. In addition, the mother reported an increase in the girl's self-confidence and assertiveness. Results of follow-up interviews at eight, 12 and 24 months are reported.

Spinal Cord Injuries

Ninety-eight patients with traumatic spinal cord injury, at a median age of 33.5 years (range, 16-72 years), with nonremarkable distributions of neurologic characteristics were investigated at a median of 2.3 years (range, 0.1-23 years) after injury. Functioning, mood disturbances, and overall quality of life were recorded with established self-assessment instruments. Physical dysfunction levels were moderate, being proportionate to neurologic impairment. Psychosocial functions, mood states, and quality-of-life perceptions did not differ from those of a control population sample. Psychosocial function and mood disturbances varied greatly during the first 4 years after injury, but patients' later recordings expressed predominantly a balanced emotional state and a rewarding social life. Progress in this direction consisted of clearly lessened physical dysfunction 1 year after injury and better psychosocial function and well-being after 2 years, whereas patterns of social activities and contacts became gradually less inhibited during a 4-year period after injury. Analysis of complications in patients' histories that affected function and mood showed severe pain to be the only complication that related to lower quality-of-life scores. Urinary incontinence and infection and autonomous dysreflexia related to inhibited self-care performance; spasticity related to impaired ambulation and feeding skills. Gainful employment was the only demographic factor linked to high quality-of-life scores.

Eating problems and nutritional status during hospital stay of patients with severe stroke

Eating problems and nutritional status were studied in a consecutive series of patients who had had strokes. From this cohort, 32 subjects (mean age 73 years) with a hospital stay of 21 days or more are described. Eating problems were identified by direct participant observations of the patients' eating behavior, interviews on admission, inspections of the mouth, and discussions with the patients. Nutritional status was assessed by weight, triceps skinfold thickness (TSF), arm muscular circumference (AMC), plasma albumin, serum transferrin, and plasma prealbumin on admission and then weekly. Eating problems were identified in 27 patients. In a general linear hypothesis program, poor nutritional status 3 weeks after admission was found to be associated with (in decreasing order) low self-care performance, poor nutritional status on admission, male sex, intravenous energy-containing fluids, advanced age, paresis of the right arm, and eating problems. Factors other than eating problems seem to be important for undernutrition in patients with strokes during hospital stay.

Changes in occupational role performance after a severe burn: a retrospective study.

Ten men with severe burn injuries were interviewed to examine their perceptions of the residual impact of severe burn on performance in self-care, home management, work, and leisure occupations within the year after rehabilitation. Three patterns of occupational role performance after a burn were identified: (a) a resumption of participation in all four occupational categories; (b) a return to independence in self-care with substantive impairment in home management, work, and/or leisure roles; and (c) substantive disruption in all occupational roles. Role loss or disruption was commonly associated with reduced endurance, intolerance for standing and walking, and impaired grip strength and upper extremity skill. Suggestions for rehabilitation programming and research are made.

Wrist muscle tone and self-care skill in persons with hemiparesis.

The purpose of this research was to investigate the interaction between muscle tone at the wrist and self-care function in persons with hemiparesis. Dynamic and static muscle tone measurements were taken at the wrist. Self-care ability was measured with a chart review and the Klein-Bell Scale. The results of the study did not support the assumption that there is a significant relationship between muscle tone and activities of daily living for persons with hemiparesis. Perhaps other variables such as the general state of health, cognition, and perception should also be considered during the treatment of self-care.