Understanding Of Rehabilitation Research Articles

A Criterion Based Rehabilitation Protocol for ACL Repair with Internal Brace Augmentation.

The anterior cruciate ligament (ACL) is one of the main stabilizing structures of the knee and its rupture is a common injury in young active adults. ACL reconstruction has been the preferred operative management of an ACL rupture for several decades; however, success rates are variable. Recently, interest in arthroscopic primary repair of the ligament has increased. The repair is augmented with an Internal Brace (IB), which is an ultra-high strength suture tape that bridges the ligament. This technique protects the ligament during the healing and the ligament is encouraged to heal naturally, whilst not requiring any external braces. It acts as a stabiliser to permit early mobilization and optimise rehabilitation.As understanding of rehabilitation has progressed, there has been an increased focus on early weight-bearing and achieving full range of movement. While detailed criterion-based rehabilitation protocols exist for ACL reconstruction, this is not the case for ACL repair. The purpose of this commentary is to present a novel criterion-based rehabilitation protocol following ACL repair surgery augmented with an IB.Level of EvidenceV

Rehabilitation for people with dementia: a multi-method study examining knowledge and attitudes

BackgroundPeople with dementia are not routinely offered rehabilitation services despite experiencing disability associated with the condition and accumulating evidence for therapies such as exercise, occupational therapy, and cognitive or physical rehabilitation. It is important to understand the needs and preferences of people with dementia regarding rehabilitation services. The aim of this study was to explore thoughts and beliefs about rehabilitation amongst people with dementia and their families.MethodsInterviews with people with dementia and family members regarding their experience of care following diagnosis and their attitudes and beliefs about rehabilitation for dementia. Surveys with older people with cognitive impairment and/or a diagnosis of dementia to determine preferences for services and understanding of rehabilitation programs.ResultsInterviews with 13 participants (n = 6 people living with dementia with mean age 60 and n = 7 care partners) revealed gaps in care post diagnosis. People reported having to seek out services and frequently sought out services which were rehabilitative in nature. Survey data (n = 91 participants, average age 82) showed that most people had heard of rehabilitation (92%) or had experience of rehabilitation (49%) at some point. There was a wide range of services identified as being beneficial. Rehabilitative interventions including case management, exercise and memory strategies were considered desirable.ConclusionsPeople with dementia report having a wide variety of needs. There are gaps following diagnosis where people with dementia report having to seek out their own services. Some interview participants (who tended to be younger) clearly articulated the need for tailored interventions which maximised independence and quality of life. Survey participants, who were on average older, reported that they would participate in individually applicable rehabilitative therapies if they were available.

The 2019 neuro-rehabilitation implementation framework in Ireland: Challenges for implementation and the implications for people with brain injuries

In 2019, eight years after the publication of Ireland’s first neuro-rehabilitation strategy, an implementation framework was published. This paper describes and assesses the Irish health policy journey to the publication of the 2019 Implementation Framework with a particular focus on tracking the rehabilitation needs of people with acquired brain injury (ABI).Internationally, rehabilitation services are a low priority for governments, with policy makers having limited knowledge and understanding of rehabilitation. This low political priority and policy understanding contributes to under-developed and poorly co-ordinated services for people who need neuro-rehabilitation services, including people with Acquired Brain Injury (ABI).Despite the publication of the 2019 neuro-rehabilitation implementation framework, key challenges remain for people with ABI in Ireland, including the absence of services across the ‘pathway’, the under-resourcing of specialist rehabilitation services, the impact on the lives of people with brain injury of poor or no access to services, and the lack of good data on this population. The paper concludes with recommendations on how increased political priority of the rehabilitation needs of people with ABI could enhance implementation of the neuro-rehabilitation implementation framework.

The Randomized Controlled Trials Rehabilitation Checklist: Methodology of Development of a Reporting Guideline Specific to Rehabilitation.

One of the goals of Cochrane Rehabilitation is to strengthen methodology relevant to evidence-based clinical practice. Toward this goal, several research activities have been performed in rehabilitation literature: a scoping review listed the methodological issues in research, a study showed the low clinical replicability of randomized controlled trials, two systematic reviews showed the relevant items in reporting guidelines, and a series of articles discussed main methodological issues as a result of the first Cochrane Rehabilitation Methodological Meeting (Paris 2018). The need to improve the quality of conduct and reporting of research studies in rehabilitation emerged as a relevant task. The aim of this article is to present the Randomized Controlled Trial Rehabilitation Checklists (RCTRACK) project to produce a specific reporting guideline in rehabilitation. The project followed a combination of the CONsolidated Standards of Reporting Trials and EQUATOR Network methodologies. The project includes five phases. The first is kick-off, first consensus meeting and executive and advisory committee identification. The second is literature search and synthesis, where eight working groups will produce knowledge synthesis products (systematic or scoping reviews) to compile items relevant to reporting of randomized controlled trials in rehabilitation. The topics will be as follows: patient selection; blinding; treatment group; control group and co-interventions; attrition, follow-up, and protocol deviation; outcomes; statistical analysis and appropriate randomization; and research questions. The third is guidelines development, which means drafting of a document with the guidelines through a consensus meeting. The fourth is Delphi process consensus, a Delphi study involving all the rehabilitation research and methodological community. The fifth is final consensus meeting and publication. The RCTRACK will be an important contribution to the rehabilitation field and will impact several groups of rehabilitation stakeholders worldwide. The main goal is to improve the quality of the evidence produced in rehabilitation research. The RCTRACK also wants to improve the recognition and understanding of rehabilitation within Cochrane and the scientific and medical community at large.

Reliability, validity, and agreement of the short-form Activities-specific Balance Confidence Scale in people with lower extremity amputations.

Clinicians use the Activities-specific Balance Confidence Scale to understand balance confidence. A short-form Activities-specific Balance Confidence scale, was developed using the six most difficult tasks from the original Activities-specific Balance Confidence scale; however, short-form the short-form scale psychometrics and agreement with the original scale have yet to be explored in people with lower extremity amputations. To determine the relative and absolute reliability, construct validity, and agreement of the short-form Activities-specific Balance Confidence scale. Test-retest with a 2-week interval. Analysis for relative reliability and internal consistency was intraclass correlation coefficient and Cronbach's α, respectively. Absolute reliability was measured using standard error of measurement and minimal detectable change. Bland-Altman plots measured agreement between scales. Construct validity was evaluated against the L Test using a Pearson-product moment correlation. The short-form Activities-specific Balance Confidence (intraclass correlation coefficient = 0.92) and Activities-specific Balance Confidence (intraclass correlation coefficient = 0.91) scales had excellent relative reliability. Both scales demonstrated good internal consistency. Worse absolute reliability was observed in the short-form Activities-specific Balance Confidence scale. Construct validity against the L Test was confirmed. Bland-Altman plots indicated poor agreement between scales. Both scales exhibit excellent relative reliability and good internal consistency and construct validity. Poor agreement between short-form Activities-specific Balance Confidence and Activities-specific Balance Confidence indicates the scales should not be used interchangeably. Inadequate absolute reliability of the short-form Activities-specific Balance Confidence scale suggests the Activities-specific Balance Confidence should be the balance confidence scale of choice. Balance confidence is an important metric for our understanding of rehabilitation and community re-integration in people with lower extremity amputations. Due to inferior absolute reliability and a lack of appropriate items composing the short-form Activities-specific Balance Confidence scale, the full-scale Activities-specific Balance Confidence is recommended for the assessment of balance confidence in this population.

Discourses in stroke rehabilitation as they present themselves in current physiotherapy and occupational therapy

Aim This study aims to discuss current perceptions of rehabilitation and how present rehabilitation practice is affected by dominating discourses in Danish society by exploring discourses expressed in official publications and the constructed journal notes of occupational and physiotherapists’ practice of stroke rehabilitation. Method The frame of reference is Fairclough’s critical discourse analysis. The analysis comprises seven official documents relevant to stroke rehabilitation provided in Danish health services in 2012–2013. Also, notes written by occupational therapists and physiotherapists in medical records of 10 patients with a stroke diagnosis admitted to hospital in 2012. The documents included were read thoroughly. The texts were analyzed deductively, focusing on discursive practice on articulated understandings of rehabilitation, health practice approaches, and social practice. Results The dominating discourses seem to be Western neoliberalism organizational, medical and ethical discourses. The macro level of discourses consisted of political documents addressing rehabilitation nationally. The meso level mainly concerned medical discourses within stroke rehabilitation whereas the micro level represented local medical and ethical discourses. Conclusion The neoliberal discourse supports the medical discourse with strong emphasis on evidence-based interventions. In contrast to ethical discourses, documentation of rehabilitation practice marked more attention being paid to facilitating the patient’s independence than to enabling the regaining of meaningful activities and participation.Implications for RehabilitationIndividualized rehabilitation must be organized with flexibility as it is a complex processCritical reflectiveness among health professionals is needed to provide individualized rehabilitation of high qualityA broader range of stake holders, including patient organizations, are in demand within health policy makingThe discourses that construct rehabilitation policy and practices are sometimes in conflict, which may impact on, and impede, the rehabilitation for the individual patient

The rehabilitation plan can support clients’ active engagement and facilitate the process of change – experiences from people with late effects of polio participating in a rehabilitation programme

Purpose: To explore how the rehabilitation plan influences the rehabilitation process and its outcome in people with late effects of polio participating in an individualised goal-oriented interdisciplinary rehabilitation programme. Methods: Four women and two men with late effects of polio were interviewed before rehabilitation, at discharge, and at follow-up. Data were analysed according to the constant comparative method of grounded theory. Findings: The participants’ experiences formed one core category: “The same starting point but different rehabilitation processes”. Before rehabilitation, all participants experienced a similar starting point: Naïve understanding of rehabilitation. During rehabilitation, two separate processes followed. Four participants experienced their rehabilitation as being a mutually shared process that led to a process of change. They were actively engaged, using the rehabilitation plan, and working towards goals targeting a broad perspective of daily activities. The remaining two participants experienced their rehabilitation as a staff-directed process, with limited use of the rehabilitation plan, focusing on goals mainly related to body functions and self-care, not leading to any substantial changes. Conclusion: When clients experience that they develop a mutually shared rehabilitation process, based on a rehabilitation plan, they became more engaged in their rehabilitation and gained a better understanding of their participation during the process. Knowledge of the differences in how clients use the rehabilitation plan during the rehabilitation process can support their active engagement during rehabilitation. This, in turn, can promote a more holistic view among clients and professionals during the rehabilitation for people with late effects of polio.Implications for RehabilitationClients who experience a rehabilitation that is mutually shared with professionals, have a better understanding of their engagement during the rehabilitation process.When clients and professionals use the rehabilitation plan as a mutual tool, clients become more actively engaged in their rehabilitation process.A structured rehabilitation plan can serve as a map, and support clients’ process of change during the rehabilitation process, also after the rehabilitation period is completed.

Death and Rehabilitation

While rehabilitation is reemerging as an important penological goal, the Supreme Court is eroding the long-revered divide between capital and non-capital sentences. This raises the question of whether and how rehabilitation applies in the capital context. Courts and scholars have long concluded that it does not — that death is completely irrelevant to rehabilitation. Yet, historically, the death penalty in this country has been imposed in large part to induce the rehabilitation of offenders’ characters. Additionally, there are tales of the worst offenders transforming their characters when they are facing death, and several legal doctrines are based on the idea that death spurs rehabilitation. Courts’ and scholars’ conclusion that death is irrelevant to rehabilitation likely stems from changes in our understanding of rehabilitation. While it was once understood as referring to an offender’s character transformation, references to rehabilitation now often focus on offenders’ direct impacts on society. This has the effect, though, of distracting from the humanness of the worst offenders and consequently not providing them with true opportunities to transform their characters — a denial which challenges the Eighth Amendment’s focus on respecting the human dignity of the condemned.

Brain injury rehabilitation: The lived experience of inpatients and their family caregivers

Inpatient rehabilitation is an integral part of the continuum of care for people with severe acquired brain injury (ABI), and may extend for weeks or months. However, there is a lack of research describing the experience of inpatient brain injury rehabilitation. The purpose of this study was to describe and interpret the inpatient brain injury rehabilitation experience from the perspective of patients and their caregivers. Qualitative content analysis of semi-structured interviews from a purposeful sample of 20 patients and 18 of their family caregivers generated in-depth descriptions of the inpatient experience. Three themes were identified; “rehabilitation context/environment”, “activity/occupation”, and “support and adjustment”. The findings provide a greater understanding of rehabilitation from an insider perspective and can assist rehabilitation teams to better meet the needs of people with ABI. Specifically, the need for a therapeutic environment, meaningful occupations and family-centredness in inpatient settings were highlighted by this study.

Clients becoming teachers: Speech-language pathology students' understanding of rehabilitation following clinical practicum in a rehabilitation setting

There has been limited research investigating the conceptual development of rehabilitation in speech-language pathology (SLP) students. The aim of this study was to describe SLP students' understanding of rehabilitation following completion of a clinical practicum in a rehabilitation setting. This study was conducted using a qualitative approach according to grounded theory methodology. Semi-structured interviews were conducted with 10 SLP students who had completed a practicum in a rehabilitation setting. Interview data analysis revealed the emergence of five axial categories. Clients becoming teachers was identified as the core category, as the notion that clients were fundamental to students' understanding of rehabilitation occurred reliably throughout the data and related to all other categories. A theoretical model was proposed that demonstrated successive levels of support to students in the acquisition of their understanding of rehabilitation on practicum. Students' understanding of rehabilitation was derived from client-related interactions and factors experienced on practicum in rehabilitation settings. Rehabilitation practicum provided students with a rich and complex learning environment that may facilitate the development of the “core skills” identified for rehabilitation practice.

Incongruence between nurses’ and patients’ understandings and expectations of rehabilitation

To explore nurses' understandings and expectations of rehabilitation and nurses' perceptions of patients' understandings and expectations of rehabilitation. Within the context of a broadening appreciation of the benefits of rehabilitation, interest in the nature of rehabilitation is growing. Some believe that rehabilitation services do not adequately meet the needs of patients. Others are interested in the readiness of patients to participate in rehabilitation. Qualitative. Grounded theory using data collected during interviews with nurses in five inpatient rehabilitation units and during observation of the nurses' everyday practice. According to nurses working in inpatient rehabilitation units, there is a marked incongruence between nurses' understandings and expectations of rehabilitation and what they perceive patients to understand and expect. Given these different understandings, an important nursing role is the education of patients about the nature of rehabilitation and how to optimise their rehabilitation. Before patients are transferred to rehabilitation, the purpose and nature of rehabilitation, in particular the roles of patients and nurses, needs to be explained to them. The understandings of rehabilitation that nurses in this study possessed provide a framework for the design of education materials and orientation programmes that inform patients (and their families) about rehabilitation. In addition, reinforcement of the differences between acute care and rehabilitation will assist patients new to rehabilitation to understand the central role that they themselves can play in their recovery.

The Teletón Centers of Child Rehabilitation Mexico: ‘El amor y la ciencia al servicio del hombre’

This paper describes the foundation and distribution of the Teleton and Oritel networks of rehabilitation. An essential component of the Pan-American network, as reported by Dr. Jorge Hernandez Franco, Teleton follows a humanistic perspective in offering a comprehensive biopsychosocial model of therapy and care. Public engagement is central to the success of Teleton and highlights the importance of increasing public understanding of rehabilitation needs and service delivery.

The future of rehabilitation: What role for the probation service?

In this article, the authors draw on arguments developed in their recent book Rehabilitation, Crime and Justice (Raynor and Robinson, 2005) to discuss the aftermath of the ‘What Works’ initiative and the future of rehabilitation. They argue that our understanding of rehabilitation needs to extend beyond narrow correctionalism to a more socially inclusive and relational model, and outline some of the strategies which might enable the probation service, at a time of uncertainty about its future, to contribute to this kind of development.

Multidisciplinary perceptions of the role of nurses and healthcare assistants in rehabilitation of older adults in acute health care

This paper describes the perceptions of nurses, healthcare assistants, doctors and therapists of rehabilitation and the role of nurses and healthcare assistants on an acute older adults ward in a London teaching hospital. The role perception, education and training and attitudes towards the older adults have been identified as barriers that have an impact upon the nurses' role within rehabilitation. However, little is known about the role of nurses and healthcare assistants in rehabilitation of older adults in acute health care. Action research study. Twenty-four semi-structured interviews were conducted and audio recorded about healthcare professionals' understanding of rehabilitation, the type of skills needed and their perceptions of the role of nurses and healthcare assistants in rehabilitation. The interview transcripts were analysed using the thematic content analysis. The findings suggest that the therapists relied on nurses and healthcare assistants for therapy carry-over. Healthcare assistants were perceived as the professional group who could deliver therapy carry-over. There was an evidence of role hierarchy as healthcare assistants perceived that they were not actively involved in decision-making or discharge planning. This paper suggests that healthcare assistants and nurses are viewed as the professional group best placed to deliver therapy carry-over. However, whilst there is an acknowledgement of their role, there remains a reluctance to acknowledge healthcare assistants as a professional group and to involve them within decision-making and discharge planning. Employers must be seen to advocate, support and implement education and training programs for healthcare assistants. However, whilst nurses and healthcare assistants have an integral role in rehabilitation, there needs to be more research into the how they are supported by therapy professionals.

The National Demonstration Centres in Rehabilitation

In the early 1970s, over 20 National Demonstration Centres in Rehabilitation were established by the then Secretary of State, Sir Keith Joseph. They were meant to be a focal point for the development of rehabilitation services, to set standards and to teach the principles and practice of rehabilitation. There was no British Society for Rehabilitation Medicine that could be a focus for doctors interested in the subject at the time, so the centre's newsletters and regular meetings were a real force in promoting interest in and understanding of rehabilitation.

South African physiotherapists’ perception of rehabilitation

In response to questions in an editorial comment by L Davids in the South African Journal of Physiotherapy in February 1991, a questionnaire was sent out to 450 physiotherapists to determine their perception and understanding of rehabilitation. Respondents were also requested to define rehabilitation. The questionnaire was completed by 131 physiotherapists, giving a response rate of 29%. On analysis of the questionnaire it became evident that the respondents had a limited and superficial understanding of rehabilitation. Despite this, they were of the opinion that a large percentage of their work involved rehabilitation, and they were in fact, the most important members of the rehabilitation team.In view of the findings of the questionnaire the authors agree with Davids that more attention and effort should be devoted to the “rehabilitation scene”.

Spinal injury rehabilitation: do staff and patients agree on what they are talking about?

The psychological effects of spinal cord injury on patients themselves have been discussed in a number of articles, but few studies have been made of patients and staff, perceptions of the effectiveness of the treatment they receive and supply. An earlier investigation by the present authors showed that there were differences between the views of staff and of patients in terms of their understanding of rehabilitation. As a consequence, a number of procedural changes were implemented in the Spinal Unit, in an attempt to improve the information provided for patients and their relatives, and the selection and support of staff. Reanalysis of the staff and patients views of rehabilitation were carried out 12 months later using a standardised questionnaire and any changes in response were noted. The present findings are analysed, and the potential implications for other units are noted.

Role of refugia in recovery from disturbances: Modern fragmented and disconnected river systems

Habitats or environmental factors that convey spatial and temporal resistance and/or resilience to biotic communities that have been impacted by biophysical disturbances may be called refugia. Most refugia in rivers are characterized by extensive coupling of the main channel with adjacent streamside forests, floodplain features, and groundwater. These habitats operate at different spatial scales, from localized particles, to channel units such as pools and riffles, to reaches and longer sections, and at the basin level. A spatial hierarchy of different physical components of a drainage network is proposed to provide a context for different refugia. Examples of refugia operating at different spatial scales, such as pools, large woody debris, floodplains, below dams, and catchment basins are discussed. We hope that the geomorphic context proposed for examining refugia habitats will assist in the conservation of pristine areas and attributes of river systems and also allow a better understanding of rehabilitation needs in rivers that have been extensively altered.

The Use of Activities in the Treatment and Rehabilitation of Psychiatric Patients: An Overview

Activities have always been basic to the professional nature of occupational therapy. However, occupational therapists have, on the one hand, been criticized for over‐valuing the media they use and, on the other hand, for discarding the use of activities and therefore discarding their professional essence. In an attempt to highlight the importance of “doing” in therapy, an overview of activities from a number of perspectives is presented, together with the contribution that activities make in the treatment and rehabilitation of psychiatric patients. The importance of structured and well co‐ordinated programmes is stressed and the need for a better understanding of rehabilitation in psychiatry is suggested.

Cardiovascular responses to exercise concerned in rehabilitation of cardiac patients: Physiologic considerations

This paper is concerned with two key physiologic problems upon which the understanding of rehabilitation in cardiology rests: The recent elaboration of Claude Bernard's classical idea of the “milieu interne” and the current revolution in the explanation of cardiac control in exercise in physiologic and pathologic circumstances. As to the first, the concept of homeostasis has only recently come into its own because of the clarification of the juxtaposition of the homeostatic situation vis-a-vis the diametrically different pattern of disengagement of the autonomic components which are encompassed by both. The disengagement from the homeostatic resting state—originally identified during physiologic analyses of exercise situations—is called heterostasis. As a result of the understanding of the bipolar nature of the relationship between homeo- and heterostasis a new and fruitful approach has evolved in respect to the diagnostic and prognostic assessment of the cardiovascular system's actual and—in view of our growing knowledge of the training process—also of its potential resources. In athletics as well as in clinical medicine new vistas have thus been unfolded and the quantitative determination at rest and during exercise of circulatory functions such as heart rate, blood pressure, stroke and minute volume, oxygen intake and ionic exchanges has thereupon assumed a new importance. Secondly, in order to grasp the full implication of the issue in situations with which the physician is confronted when considering the appropriateness of applying physical training in the restorative treatment of cardiac patients another question must be considered: that of the stability of the underlying pathologic process. The answer to this question determines from case to case whether exercise and training can be applied in the treatment of cardiac patients or, in other words, whether their condition is amenable to active rehabilitative treatment.