Rehabilitation Research Papers - Academia.edu (original) (raw)

Purpose: There is an ongoing concern in lower limb prosthetic rehabilitation with underuse and nonuse of prosthetic technology. The aim of this study was to gather expert opinion on the most important outcomes, predictors and facilitators... more

Purpose: There is an ongoing concern in lower limb prosthetic rehabilitation with underuse and nonuse of prosthetic technology. The aim of this study was to gather expert opinion on the most important outcomes, predictors and facilitators of lower limb prosthetic prescription and use, with a long-term goal of improving satisfaction with prosthetic technology. Method: An electronic Delphi study was conducted using an expert panel of 21 service providers and users and was undertaken over three iterations. Results: The process resulted in the identification of 13 outcomes, 19 predictor and 34 facilitator factors. Conclusions: Psychosocial factors related to service provision and prosthetic use have not been widely recognized or incorporated into clinical practice. We highlight the need for creating standardized measures that incorporate psychosocial factors and that can contribute to a broadly applicable evidence base for optimal prosthetic prescription.

With 68% of prisoners recidivating within a three year period, designing and implementing innovative programming within the corrections setting is a necessity. The transient nature of the jail population begets difficulties for its... more

With 68% of prisoners recidivating within a three year period, designing and implementing innovative programming within the corrections setting is a necessity. The transient nature of the jail population begets difficulties for its successful implementation and maintenance. Since incarcerated females represent a smaller portion of the population, women, who face different challenges than their male counterparts, often receive less opportunity for programming, especially within the jail setting. Parenting, Prison & Pups (PPP), a program which weaves together an evidence-based parenting curriculum, integrated with the use of Animal Assisted Therapy (AAT), serves as a model for how to implement innovative programming within the jail setting at both the federal and county level for female prisoners. This paper outlines strategies to employ and discusses challenges that arise during program creation, implementation, and evaluation, which all require consideration prior to starting a new jail-based program. Despite a multitude of challenges, well-developed strategies can advance program goals and outcomes.

Objective Despite all advancements in hearing amplification, screening, and interventions, concerns still exist about the language outcomes in children with mild to severe hearing loss. The present study aimed to investigate the... more

Objective Despite all advancements in hearing amplification, screening, and interventions, concerns still exist about the language outcomes in children with mild to severe hearing loss. The present study aimed to investigate the production of inflectional morphemes, phrase, and clause structures of children with Moderately Severe Hearing Loss (MSHL) and compare with those of the children with Normal Hearing (NH). Materials & Methods The study participants were 88 NH children, aged 2-5 years, and 10 MSHL children, aged 5-6 years. They were recruited by a convenient sampling method. Speech therapists collected language samples in a free play context of the study children, and then the language samples were transcribed and segmented according to P-LARSP (language assessment, remedy, and screening procedure). Of 100 analyzable units, the speech therapists identified, allocated, and counted 14 inflectional morphemes and all clause and phrase structures in each language sample. Results Ch...

In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing... more

In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself. Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents. Modern rehabilitation protocols emphasize teamwork and proper rehabilitation planning, and the rehabilitation team has to be lead by a trained sports physiotherapist, with an understanding of the protocols and interventions required at various stages. Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding. Inputs from surgeons are mandatory if surgical interventions have been performed. What is often missing in the underdeveloped world is psychological support and a clear understanding by the athlete of his/her rehabilitation protocols. World over, the primary aims are safe return to sports and minimizing reinjury on return to sport; this involves rehabilitation in stages, and current methodology clearly demarcates acute and chronic phases of injury. Close coordination with trainers and coaches is mandatory, and all need to understand that the reconditioning phase is crucial; skill assessment before progression has now become a specialized domain and needs to be introduced at all levels of the sport. A key factor in all sports injury rehabilitation protocols is injury prevention; this involves data maintenance by teams or trainers, which is still not fully developed in the Indian context. The injury and subsequent problems need to be comprehended both by athletes and their coaches. The current review is an attempt to clarify some of the issues that are important and routinely used world over, with the aim to improving rehabilitation after sports even in the underdeveloped world.

as a special issue and supplement of the Journal of Rehabilitation Medicine. Gutenbrunner, Ward, and Chamberlain's (2007) supplement was written with the intent of stating the position of physical and rehabilitation medicine (PRM) in... more

as a special issue and supplement of the Journal of Rehabilitation Medicine. Gutenbrunner, Ward, and Chamberlain's (2007) supplement was written with the intent of stating the position of physical and rehabilitation medicine (PRM) in Europe. It defines the specialty, its work, the competencies of its practitioners and its relationships to other medical disciplines and allied health professionals. It also aims to ensure that PRM is seen as a European specialty, where high quality practitioners working within excellent standards of care can practice in accord with evidence-based medicine, as well as within the context of their different national practices. In doing so, the supplement describes training and skills of PRM specialists. It also provides the underlying principles of specialized rehabilitation, which will allow policymakers, health planners, medical and paramedical colleagues to identify how PRM works and how it can assist the process of allowing people with disabilities to participate fully in society.

To design a medical decision support system (MDSS) that would accurately predict the rehabilitation protocols prescribed by the physicians for patients with knee osteoarthritis (OA) using only their demographic and clinical... more

To design a medical decision support system (MDSS) that would accurately predict the rehabilitation protocols prescribed by the physicians for patients with knee osteoarthritis (OA) using only their demographic and clinical characteristics. The demographic and clinical variables for 170 patients receiving one of three treatment protocols for knee OA were entered into the MDSS. Demographic variables in the model were age and sex. Clinical variables entered into the model were height, weight, BMI, affected side, severity of knee OA, and severity of pain. All patients in the study received one of three treatment protocols for patients with knee OA: (a) hot packs, followed by electrotherapy and exercise, (b) ice packs, followed by ultrasound and exercise and (c) exercise alone. The resilient back propagation artificial neural network algorithm was used, with a ten-fold cross-validation. It was estimated that the MDSS is able to accurately predict the treatment prescribed by the physician for 87% of the patients. We developed an artificial neural network-based decision support system that can viably aid physicians in determining which treatment protocol would best match the anthropometric and clinical characteristics of patients with knee OA. Ziel der vorliegenden Studie war die Konzipierung eines Systems zur Unterstü tzung von medizinischen Entscheidungen (MDSS), das Ä rzten die akkurate Prognose der bei Patienten mit Gonarthrose verordneten Rehabilitation nur anhand ihrer demographischen und klinischen Eigenschaften erlaubt. Die demographischen und klinischen Variablen von 170 Patienten, die eine von drei Behandlungen fü r die Gonarthrose erhielten, wurden in das MDSS ü bertragen. Die demographischen Variablen in dem Modell waren Alter und Geschlecht. Die in das Modell ü bertragenen klinischen Variablen waren Kö rpergrö ße, Kö rpergewicht, BMI, betroffene Seite, Schweregrad der Gonarthrose und Schweregrad der Schmerzen. Alle Studienteilnehmer erhielten eine von drei Behandlungen fü r Patienten mit Gonarthrose: (a) Wä rmebehandlung, gefolgt von Elektrotherapie und Krankengymnastik, (b) Kä lte-Sofortkompressen, gefolgt von Ultraschall und Krankengymnastik, und (c) Krankengymnastik als Monotherapie. Angewandt wurde ein kü nstliches neuronales Netz auf der Basis des belastbaren Backpropagation-Algorithmus mit einer zehnfachen Kreuzvalidierung. Schä tzungen zufolge kann das MDSS die ä rztlich verordnete Therapie bei 87% der

Objective: To translate the theoretical constructs from a model of resilience into a structural equation model and evaluate relationships among the model's theoretical constructs associated with resilience and the occurrence of depressive... more

Objective: To translate the theoretical constructs from a model of resilience into a structural equation model and evaluate relationships among the model's theoretical constructs associated with resilience and the occurrence of depressive symptoms. Design: Quantitative descriptive research design using structural equation modeling (SEM). Participants: Two-hundred and fifty-five individuals with SCI recruited from the Canadian Paraplegic Association (CPA). Outcome Measures: Outcome was measured by the Center for Epidemiologic Studies-Depression Scale. Results: The resilience model fit the data relatively well: 2 (200, N ϭ 255) ϭ 451.57, p Ͻ .001; 2 /df ϭ 2.26; CFI ϭ .92, RMSEA ϭ 0.070 (90% CI: 0.062-0.079), explaining 77% of the variance in depressive symptomatology. Severity of SCI-related stressors significantly influenced perceived stress (␤ ϭ .60) and perceived stress, in turn, affected depressive symptoms (␤ ϭ .66), characteristics of resilience (␤ ϭ Ϫ.43), and social support (␤ ϭ Ϫ.26). The resilience characteristics had an inverse relationship with depressive symptoms (␤ ϭ Ϫ.29). No direct relationship was found between severity of SCI-related stressors and depressive symptoms. Conclusions: Findings provide support for the resilience model and suggests characteristics of resilience "buffer" the perceptions of stress on depressive symptoms. The resilience model may be useful to guide clinical interventions designed to improve the mental health of individuals with SCI.

Skeletal muscle atrophy occurs as a consequence of injury, illness, surgery, and muscle disuse, impacting appreciably on health care costs and patient quality of life, particularly in the absence of appropriate rehabilitation. The... more

Skeletal muscle atrophy occurs as a consequence of injury, illness, surgery, and muscle disuse, impacting appreciably on health care costs and patient quality of life, particularly in the absence of appropriate rehabilitation. The molecular mechanisms that regulate muscle mass during atrophy and rehabilitation in humans have not been elucidated, despite several robust candidate pathways being identified. Here, we induced skeletal muscle atrophy in healthy volunteers using two weeks of limb immobilization, and then stimulated the restoration of muscle mass with six weeks of supervised exercise rehabilitation. We determined muscle mass and function and performed targeted gene expression analysis at prescribed time points during immobilization and rehabilitation. For the first time, we have identified novel changes in gene expression following immobilization-induced atrophy and during a program of rehabilitative exercise that restored muscle mass and function. Furthermore, we have shown that exercise performed immediately following immobilization induces profound changes in the expression of a number of genes in favor of the restoration of muscle mass, within 24 h. This information will be of considerable importance to our understanding of how immobilization and contraction stimulate muscle atrophy and hypertrophy, respectively, and to the development of novel therapeutic strategies aimed at maintaining or restoring muscle mass.

Resumen na manera de rehabilitar el patrimonio cultural de los centros históricos que se encuentran en grave estado de deterioro y predominantemente dedicados a la función comercial, es por medio del fomento a la función habitacional, que... more

Resumen na manera de rehabilitar el patrimonio cultural de los centros históricos que se encuentran en grave estado de deterioro y predominantemente dedicados a la función comercial, es por medio del fomento a la función habitacional, que aporta una connotación social al usual trabajo de la restauración de inmuebles. Este es el caso del Centro Histórico de San Salvador, en el cual se plantea la oportunidad de rescatar el patrimonio cultura singular de lámina troquelada y madera, por medio del impulso de las cooperativas de viviendas por ayuda mutua, para el mejoramiento de la calidad de vida de las pocas familias que aún viven en el centro.

Patients with severe aphasia are rarely treated using speech therapy. We used music therapy to continue to treat a 79-year-old patient with chronic severe aphasia. Interventions 1, 2, and 3 were to practice singing a song that the patient... more

Patients with severe aphasia are rarely treated using speech therapy. We used music therapy to continue to treat a 79-year-old patient with chronic severe aphasia. Interventions 1, 2, and 3 were to practice singing a song that the patient knew, to practice singing a song with a therapist, and to practice saying a greeting using a song with lyrics, respectively. In addition, practice of uttering names of body parts was initiated using touch and rhythm. After intervention 1, the patient could sing spontaneously and repeat lyrics. After intervention 2, she could sing with the therapist, and sing spontaneously and repeat lyrics. After intervention 3, she could memorize words with meaning, say the words in context, and use them. The patient could utter the names of two body parts after therapy with touch and rhythm. These suggest that rehabilitation therapy can still be used in patients with severe cognitive impairment.

Rehabilitation medicine seeks to maximize the functional and psychosocial abilities of patients with disability and improve their quality of life. It is concerned with the three dimensions of disability-impairment, activity limitation,... more

Rehabilitation medicine seeks to maximize the functional and psychosocial abilities of patients with disability and improve their quality of life. It is concerned with the three dimensions of disability-impairment, activity limitation, and restriction in participation-and aims to reduce impairment and prevent or minimize the resulting activity limitation. For this purpose, it requires appropriately staffed and equipped inpatient facilities. To reduce activity limitation that may remain on completion of inpatient care, rehabilitation medicine needs services in the community for the maintenance of achieved improvement and prevention of complications. Minimization of restricted participation needs assistive technology, home adaptation, and psychosocial support for reintegration in society. Teamwork in rehabilitation Disability may relate to several body systems and affect many aspects of life. Therefore, rehabilitation should ad-Need for Rehabilitation Teamwork Training in Europe Teamwork is the cornerstone of rehabilitation medicine. Rehabilitation workers in European countries are well educated in their own disciplines and attain appropriate professional knowledge; however, they lack educational opportunities for acquiring skills and attitudes necessary for effective teamwork, mainly communication, cooperation, and leadership. Consequently, teamwork is compromised and rehabilitation effectiveness reduced. Therefore, training in these components of professional competence needs scaling up in order to increase their impact on rehabilitation care.

— This work deals with the design of an interactive monitoring tool for home-based physical rehabilitation. The software platform includes a video processing stage and the exercise performance evaluation. Image features are extracted by a... more

— This work deals with the design of an interactive monitoring tool for home-based physical rehabilitation. The software platform includes a video processing stage and the exercise performance evaluation. Image features are extracted by a Kinect v2 sensor and elaborated to return the exercises score. Furthermore the tool provides to physiotherapists a quantitative exercise evaluation of subject's performances. The proposed tool for home rehabilitation has been tested on 5 subjects and 5 different exercises and results are presented. In particular both exercises and relative evaluation indexes were selected by specialists in neurorehabilitation.

In this paper, the details of processing algorithms used in a training program with language learning-impaired children (LLI's) are described. The training program utilized computer games, speech/language training exercises, books-ontape... more

In this paper, the details of processing algorithms used in a training program with language learning-impaired children (LLI's) are described. The training program utilized computer games, speech/language training exercises, books-ontape and educational CD-ROM's. Speech tracks in these materials were processed using these algorithms. During a four week training period, recognition of both processed and normal speech in these children continually increased to near age-appropriate levels. We conclude that this form of processed speech is subject to profound perceptual learning effects and exhibits widespread generalization to normal speech. This form of learning and generalization contributes to the rehabilitation of temporal processing deficits and language comprehension in this subject population.

Performance assessment Variability Uncertainty Regression analysis Experimental design a b s t r a c t Inflow and Infiltration (I/I ) into sewer systems is generally unwanted, because, among other things, it decreases the performance of... more

Performance assessment Variability Uncertainty Regression analysis Experimental design a b s t r a c t Inflow and Infiltration (I/I ) into sewer systems is generally unwanted, because, among other things, it decreases the performance of wastewater treatment plants and increases combined sewage overflows. As sewer rehabilitation to reduce I/I is very expensive, water managers not only need methods to accurately measure I/I, but also they need sound approaches to assess the actual performance of implemented rehabilitation measures.

UK PubMed Central (UKPMC) is an archive of life sciences journal literature.

Methods.-The study was carried out on 20 male Sprague-Dawley rats subdivided in 2 groups (G1: Healthy control, G2: model of pulmonary fibrosis induced by Bleomycine), using whole-body plethysmography and video recordings. Results.-At... more

Methods.-The study was carried out on 20 male Sprague-Dawley rats subdivided in 2 groups (G1: Healthy control, G2: model of pulmonary fibrosis induced by Bleomycine), using whole-body plethysmography and video recordings. Results.-At rest, in G2, a decrease of expiratory time (TE) and total respiratory time (TTOT) was observed when compared to G1. The mean inspiratory flow (VT/TI) didn't increase significately in G2 when compared to G1 at rest. However during drinking, TE and VT/TI increased significately in Fibrosis group. Swallowing frequency didn't significately change but the % of inspiratory swallowing (I-I) increased significately when compared to G1. Discussion.-Fibrosis can probably increase swallong dysfunction and aspiration.

We compared a unilateral robot-assisted training protocol (URTP) and a bilateral robot-assisted training protocol (BRTP) to study their differential effects. We recruited 21 patients with stroke who received 90–105 min of therapy 5... more

We compared a unilateral robot-assisted training protocol (URTP) and a bilateral robot-assisted training protocol (BRTP) to study their differential effects. We recruited 21 patients with stroke who received 90–105 min of therapy 5 days/wk for 4 wk. Participants in the URTP and BRTP groups practiced forearm pronation and supination and wrist flexion and extension in a simultaneous manner with the Bi-Manu-Track. The control group received standard rehabilitation. Clinical measures included the Fugl-Meyer Assessment, the Medical Research Council instrument, grip strength, and the Modified Ashworth Scale to assess motor impairment, muscle power, muscle strength, and spasticity, respectively. The pilot study indicated that the URTP and BRTP might have differential benefits for movement improvement. URTP might be a more compelling approach to improving upper-limb motor impairment, muscle power, and strength at the distal joints than BRTP, whereas BRTP could be an optimal approach to impr...

The present study was targeted to observe the impact of neuropsychological rehabilitation on activities of daily living (ADL) and community reintegration of patients with traumatic brain injury (TBI). Based on purposive sampling... more

The present study was targeted to observe the impact of neuropsychological rehabilitation on activities of daily living (ADL) and community reintegration of patients with traumatic brain injury (TBI). Based on purposive sampling technique, ten patients with TBI falling in the age range of 20-40 years and fulfilling the inclusion and exclusion criteria were chosen from All India Institute of Speech and Hearing, Mysuru, India. A quasi-experimental design, i.e., nonequivalent control group design was chosen for the study. Patients were assessed on Luria-Nebraska Neuropsychological Battery for Adults, Cognitive Symptoms Checklist, and Community Integration Questionnaire. Patients in experimental group were given neuropsychological rehabilitation for 6 months. Brainwave-R and Talking Pen were used as rehabilitative tools. Patients with TBI have significant neuropsychological deficits observed in memory, visuo-spatial organization, arithmetic, spelling, writing, fine motor coordination, a...

The information provided in this publication is general and may not apply in a specific situation. Legal advice should always be sought before taking any legal action based on the information provided. This information is not intended to... more

The information provided in this publication is general and may not apply in a specific situation. Legal advice should always be sought before taking any legal action based on the information provided. This information is not intended to create, nor does receipt of it constitute, a lawyer-client relationship. The publishers and authors accept no responsibility for any acts or omissions contained herein. The information provided was verified between July and November 2018. Be advised that this is a developing area.

Motivation for lifestyle changes to improve health in people with impaired glucose tolerance Aim: To identify factors that could have motivational significance for lifestyle change to facilitate the reduction of Impaired Glucose Tolerance... more

Motivation for lifestyle changes to improve health in people with impaired glucose tolerance Aim: To identify factors that could have motivational significance for lifestyle change to facilitate the reduction of Impaired Glucose Tolerance (IGT) and, consequently, the risk of having type 2 diabetes. Methods: Eighteen people living in a municipality in central Norway participated in the study. A large-scale public health screening study had defined them as people with IGT. The participants took part in a semi-structured interview that focused on four aspects of everyday lifestyle: (1) structure and rhythm, (2) physical health, (3) physical activity and (4) social relations. Results: The interviews showed that the participants in the study changed their priorities regarding daily living. Results indicated four domains of motivational factors that appeared as significant for lifestyle changes. The partici-pants attributed great significance to their physical health and were strongly motivated to prevent disease development by improvement of everyday structure and rhythm, reduction of sickness risk, activity level and social relation. Research indicates, however, that lasting lifestyle changes take time and that health care support must be adapted to the individual in light of their social setting. Conclusion: Persons with IGT appear to benefit from lifestyle changes along four dimensions of motivational significance: Structure and rhythm, Sickness concerns, Activity levels, Social relations. This means that attention needs to be more carefully tailored the individual along these four dimensions than has been the case in traditional health care.

E-health interventions are of a growing importance for self-management of chronic conditions. This study aimed to describe the process adaptions that are needed in cardiac rehabilitation (CR) to implement a self-management system, called... more

E-health interventions are of a growing importance for self-management of chronic conditions. This study aimed to describe the process adaptions that are needed in cardiac rehabilitation (CR) to implement a self-management system, called MyCARDSS. We created a generic workflow model based on interviews and observations at three CR clinics. Subsequently, a workflow model of the ideal situation after implementation of MyCARDSS was created. We found that the implementation will increase the complexity of existing working procedures because 1) not all patients will use MyCARDSS, 2) there is a transfer of tasks and responsibilities from professionals to patients, and 3) information in MyCARDSS needs to be synchronized with the EPR system for professionals.

A new family of rehabilitation techniques, termed Constraint-Induced Movement Therapy or CI Therapy, has been developed that controlled experiments have shown is effective in producing large improvements in limb use in the real-world... more

A new family of rehabilitation techniques, termed Constraint-Induced Movement Therapy or CI Therapy, has been developed that controlled experiments have shown is effective in producing large improvements in limb use in the real-world environment after cerebrovascular accident (CVA). The signature therapy involves constraining movements of the less-affected arm with a sling for 90% of waking hours for 2 weeks, while intensively training use of the moreaffected arm. The common therapeutic factor in all CI Therapy techniques would appear to be inducing concentrated, repetitive practice of use of the more-affected limb. A number of neuroimaging and transcranial magnetic stimulation studies have shown that the massed practice of CI Therapy produces a massive use-dependent cortical reorganization that increases the area of cortex involved in the innervation of movement of the more-affected limb. The CI Therapy approach has been used successfully to date for the upper limb of patients with chronic and subacute CVA and patients with chronic traumatic brain injury and for the lower limb of patients with CVA, incomplete spinal cord injury, and fractured hip. The approach has recently been extended to focal hand dystonia of musicians and possibly phantom limb pain.

Both clinician-reported outcome measures (CROMs) measures and patient-reported outcome measures (PROMs) are applied to evaluate outcomes in rehabilitation settings. The previous data show only a low to moderate correlation between these... more

Both clinician-reported outcome measures (CROMs) measures and patient-reported outcome measures (PROMs) are applied to evaluate outcomes in rehabilitation settings. The previous data show only a low to moderate correlation between these measures. Relationships between functional performance measures (Clinician-Reported Outcome Measures, CROMs) and Patient-Reported Outcome Measures (PROMs) were analysed in rehabilitation patients with traumatic injuries of the lower limb. A cohort of 315 patients with 3 subgroups (127 hip, 101 knee and 87 ankle region) was analysed before and after 3 weeks of inpatient rehabilitation. All three groups showed significant improvements in PROMs with low to moderate effect sizes. Moderate to high effect sizes were found for CROMs. Correlation coefficients between CROMs and PROMs were low to moderate. The performance consistency between PROMs and CROMs ranged from 56.7% to 64.1%. In this cohort of rehabilitation patients with traumatic injuries, CROMs showed higher effect sizes than PROMs. When used in combination, patient-reported outcome and performance measures contribute to collecting complementary information, enabling the practitioner to make a more accurate clinical evaluation of the patient’s condition.

Today advances in techniques and materials for rotator cuff surgery allow the repair of a large variety of types or extensions of cuff lesions in patients from a wide range of age groups who have different kinds of jobs and participate in... more

Today advances in techniques and materials for rotator cuff surgery allow the repair of a large variety of types or extensions of cuff lesions in patients from a wide range of age groups who have different kinds of jobs and participate in different kinds of sports, and who have widely different expectations in terms of recovery of functions and pain relief. A large number of factors must be taken into account before implementing a rehabilita- tion protocol after rotator cuff surgery. These mainly include the technique (materials and procedure) used by the surgeon. Moreover, tissue quality, retraction, fatty infiltration and time from rupture are important biologi- cal factors while the patient’s work or sport or daily activities after surgery and expectations of recovery must also be assessed. A rehabilitation protocol should also take into account the timing of biological healing of bone to tendon or tendon to tendon interface, depending on the type of rupture and repair. This timing should direct the therapist’s choice of correct passive or assisted exercise and mobilisation manoeuvres and the teaching of correct active mobilisation movements the patient has to do. Following accepted knowledge about the time of biolog- ical tissue healing, surgical technique and focused reha- bilitation exercise, a conceptual protocol in four phases could be applied, tailoring the protocol for each patient. It starts with sling rest with passive small self-assisted arm motion in phase one, to prevent post-op stiffness. In phase two passive mobilisation by the patient dry or in water, integrated with scapular mobilisation and stabilis- er reinforcement, are done. Phase three consists of pro- gressive active arm mobilisation dry or in water integrat- ed with proprioceptive exercise and “core” stabilisation. In phase four full strength recovery integrated with the recovery of work or sports movements will complete the protocol. Because of the multi-factorial aspects of the problem, the best results can be obtained through a full transfer of information from the surgeon to the therapist to optimise timing and sizing of the individual rehabilita- tion protocol for each patient.

The problem of mental retardation / intellectual disability is constantly evolving. The main element pointing to the essence of functioning of people with intellectual disabilities is a person's position in the society (Błeszyński,... more

The problem of mental retardation / intellectual disability is constantly evolving. The main element pointing to the essence of functioning of people with intellectual disabilities is a person's position in the society (Błeszyński, 2013, pp. 11-25; J. L. Aber …, 1997, p. 463). “The number of children with select developmental disabilities (autism, attention deficit hyperactivity disorder, and other developmental delays) has increased, requiring more health and education services. Additional study of the influence of risk-factor shifts, changes in acceptance, and benefits of early services is needed” (C. A.Boyle, …, 2011, p. 1034). As indicated by D. D. Smitrz, the twenty-first century brought a paradigm shift from the traditionally negative conception (as a lack or limitation), to a more positive conception, in the spirit of R. Luckasson. The new approach highlighted the importance of the search for the capacity of each person and the environment in which this person lives, lear...

Stroke is the leading cause of death worldwide and a major contributor to long-term adult hood disability. Acute stroke care and long-term rehabilitation has improved substantially in the developed countries in the last three decades. 1... more

Stroke is the leading cause of death worldwide and a major contributor to long-term adult hood disability. Acute stroke care and long-term rehabilitation has improved substantially in the developed countries in the last three decades. 1 Although Pakistani healthcare system has evolved over the years, but the management of stroke both in the acute and rehabilitation phase remains sub-optimal. 2 The awareness of general public and even general practitioners regarding signs and symptoms of an impending/ evolving stroke is inadequate. 2,3 This results in loss of precious time in which patient can report to the hospital and get urgent medical attention. Absence of qualified neurologists and dedicated stroke units make it difficult to offer good acute stroke care as per the established protocols at most of acute medical care facilities in our country. 2 There are only two hospitals in our country which offer thrombolytic therapy (tPa) for a patient having acute ischaemic stroke. Most of the stroke patients in Pakistan are managed by internal medicine physicians and are discharged home without a neurological consult or long-term rehabilitation plan. A coordinated multidisciplinary stroke rehabilitation can result in decreased mortality, reduced number of complications, shorter length of stay and better Quality of life. 4,5 In Pakistan only few stroke patients are provided coordinated post stroke rehabilitation, mainly due to lack of qualified rehabilitation medicine physicians (physiatrists). Large number of qualified physiotherapists (Doctors of Physiotherapy-DPT) are available in the country. The primary job of a DPT is to provide good physical therapy and mobility training. These therapists could become a great resource for coordinated care and rehabilitation of stroke patients, if properly guided and supervised by Physiatrists and Neurologists. Short term and long term rehab care protocols are needed to be developed and followed to ensure best practice. In the absence of a regulatory authority, some of the physiotherapists overstep their mandate by writing prescriptions for the stroke patients in form of multivitamin injections, neuro-tonics and cerebral stimulants, which have no proven role in the management and recovery of stroke. 6 Functional improvement and ultimately community reintegration are main objectives of rehabilitation. Long term, daily physiotherapy at home for months without proceeding toward this goal is of no benefit for patient and family. 7,8 The social network and a supportive family environment in Pakistan is sometimes a hindrance in regaining independence by the stroke patients. Serving the elderly especially, when disabled by an illness like stroke is considered a social obligation and religious duty. The stroke patient in Pakistan has sometimes multiple attendants (mostly close family members) who cater for all his/her needs including transfers from bed to chair, feeding and bladder and bowel care. This over caring attitudes in which the patient is offered attendant care promotes dependency rather than independence and the patient with stroke never learns the compensatory techniques or take charge of his/her own life post stroke. Families of stroke patients must be educated and trained to direct their care in making a stroke patient functional and independent. Another issue is of alternative and complementary medicine. Due to the strong influence of alternative and traditional medicine in the country and a lack of accountability, many stroke patients end up visiting spiritual healers, homeopathy practitioners and even quacks in the quest for finding a cure for their disability. This not only drains them financially but also wastes precious time and energies, which could have been utilized in following a scientifically proven and beneficial stroke rehabilitation programme. Many a times these practitioners offer stroke patients un-proven therapies, herbal remedies and drugs with unknown composition. Even if a patient is fortunate enough to receive good acute care and a coordinated post stroke rehabilitation tries to re-integrate back into the society, he/she faces societal and community barriers. The general attitudes of the Pakistani society towards a person with disability are negative. 9 There are no disabled friendly public toilets and most of the

Low back pain is a leading cause of disability, and there is a tremendous need for nonsurgical, nonpharmaceutical interventions to manage it. Versatile spinal exoskeletons have been proposed as a method of supporting or augmenting the... more

Low back pain is a leading cause of disability, and there is a tremendous need for nonsurgical, nonpharmaceutical interventions to manage it. Versatile spinal exoskeletons have been proposed as a method of supporting or augmenting the wearer, but experimental data from human subjects are limited, and the effects of such exoskeletons remain poorly understood. We thus present a prototype of a reconfigurable spinal exoskeleton that features easily adjustable resistance and compression at multiple spinal levels, allowing us to study the effect of different exoskeleton configurations on the body. In a pilot evaluation with a single subject, both thoracic and abdominal compression were found to affect trunk angle, low back moment and the electromyogram of the erector spinae, though different exoskeleton configurations had different effects during different tasks. This supports the premise that intelligent mechanical adjustments of a spinal exoskeleton are necessary for optimal support or augmentation of the wearer, though the results need to be examined in a larger, varied sample of subjects.

Background: The life-time incidence of low back pain is high and diagnoses of spinal stenosis and disc prolapse are increasing. Consequently, there is a steady rise in surgical interventions for these conditions. Current evidence suggests... more

Background: The life-time incidence of low back pain is high and diagnoses of spinal stenosis and disc prolapse are increasing. Consequently, there is a steady rise in surgical interventions for these conditions. Current evidence suggests that while the success of surgery is incomplete, it is superior to conservative interventions. A recent survey indicates that there are large differences in the type and intensity of rehabilitation, if any, provided after spinal surgery as well as in the restrictions and advice given to patients in the post-operative period. This trial will test the hypothesis that functional outcome following two common spinal operations can be improved by a programme of post-operative rehabilitation that combines professional support and advice with graded active exercise and/or an educational booklet based on evidence-based messages and advice.

We conducted two experiments to assess the role of referential speech during sign training in which the spoken words corresponding to signs were receptively known to the participants. An alternating treatments design was used to compare... more

We conducted two experiments to assess the role of referential speech during sign training in which the spoken words corresponding to signs were receptively known to the participants. An alternating treatments design was used to compare sign acquisition across two teaching conditions in which referents were presented either with or without the corresponding verbal label. During the first experiment, signs were taught concurrently; during the second experiment, signs within each of the respective conditions were taught in a serial fashion. In both experiments, signs taught by total communication were acquired faster than those taught by sign-alone training.

this paper presents the panel discussion from the "Meet the editor" symposium held at the 4th World congress of the international Society of physical and Rehabilitation Medicine in Seoul in June 2007. it includes contributions by four... more

this paper presents the panel discussion from the "Meet the editor" symposium held at the 4th World congress of the international Society of physical and Rehabilitation Medicine in Seoul in June 2007. it includes contributions by four editors of international journals in rehabilitation. Some of the topics discussed are of a general nature, but will provide useful guidance for the more junior scientific author. Some specific information about the four journals is also presented. topics discussed include the reasons for publishing in peer review journals, important considerations in submitting a manuscript, the peer review process, the effect of electronic publishing, which leads to shorter publication times and the opportunity to preview papers, and the trend towards more open access to journals. the discussion concludes that the field of physical and rehabilitation medicine will continue to expand, with an audience with a broader range of scientific and clinical interests. The International Classification of Functioning, Disability and Health (icF) may be increasingly used as a framework in reporting. New journals may be started, particularly in regions of the world other than europe and the USa, despite the fact that journals currently published in these regions are distributed worldwide.

Визначено особливості соціально-психологічної реабілітації як активації здатності особистості, що постраждала від воєнної травматизації, до життєтворення; розглянуто етапи процесу реабілітації та технології, які доцільно використовувати... more

Визначено особливості соціально-психологічної реабілітації як активації здатності особистості, що постраждала від воєнної травматизації, до життєтворення; розглянуто етапи процесу реабілітації та технології, які доцільно використовувати на кожному з них. Показано, що реабілітаційні впливи розгортаються у 4-векторній – персонально-інструментально-просторово-часовій площині, в межах якої всі чотири напрями реабілітації мають взаємопідсилювальний вплив. Розглянуто ресурси, що забезпечують підтримку і оновлення психологічного здоров’я. Визначено найважливіші аспекти реабілітації в умовах масивної та пролонгованої травматизації, які досліджуються співторобітниками лабораторії соціальної психології особистості Інституту соціальної та політичної психології.

LaVigna, Christian, and Willis (2005) reported on a project where Institute for Applied Behaviour Analysis (IABA) staff trained a professional team in New Zealand (NZ) to provide behavioural services that met defined criteria. The NZ team... more

LaVigna, Christian, and Willis (2005) reported on a project where Institute for Applied Behaviour Analysis (IABA) staff trained a professional team in New Zealand (NZ) to provide behavioural services that met defined criteria. The NZ team was then trained to train other practitioners to meet the same professional standards. However, no client outcomes were reported in that study. This study replicates the NZ study within disability services in Tasmania, Australia. Further, this study examined the associated client outcomes and the impact of the training on severity ratings of subsequent referrals. Tasmanian trainers trained participants to provide behavioural services that met the same professional standards. Client behavioural outcome data showed significant improvement. Referral data showed decreases in severity ratings. The trainer of trainers process is effective in training staff to meet defined professional standards, including desired client outcomes, and to effectively make ...

To compare the effectiveness of errorless learning versus trial and error learning for teaching activities of daily living to patients with acute stroke with or without explicit memory impairments. Randomized crossover. Rehabilitation... more

To compare the effectiveness of errorless learning versus trial and error learning for teaching activities of daily living to patients with acute stroke with or without explicit memory impairments. Randomized crossover. Rehabilitation hospital. Thirty-three adult subjects following an acute stroke. Subjects were taught to prepare a wheelchair for a transfer and to put on a sock with a sock-donner. Tasks were taught using errorless learning or trial and error learning. Explicit memory was assessed using the Neurobehavioral Cognitive Status Exam. Days until subject was able to demonstrate retention of the task, and success or failure at carry-over to a similar task. No significant differences were found in days to retention for either functional task when taught using errorless learning or trial and error learning in subjects with or without explicit memory impairments. Carry-over was significantly better when trial and error learning was used for learning sock donning. When choosing ...

The authors constructed and validated an instrument that assesses attitudes toward the Americans With Disabilities Act (ADA), a law that protects the civil rights of individuals with disabilities. The Disability Rights Attitude Scale... more

The authors constructed and validated an instrument that assesses attitudes toward the Americans With Disabilities Act (ADA), a law that protects the civil rights of individuals with disabilities. The Disability Rights Attitude Scale (DRAS) demonstrated acceptable reliability and validity with 2 samples of university students (N-421). Reliability analysis resulted in Cronbach's alphas of .91 (Sample 1) and .90 (Sample 2). Principal-components factor analysis indicated that the DRAS essentially consists of 1 factor that accounted for 27% (Sample 1) and 31% (Sample 2) of the total variance. Construct validity analysis resulted in predicted, significant positive correlations with other relevant measures. A stepwise multiple regression analysis revealed that sex, ethnicity, and prior contact with people with disabilities were significant predictors of attitudes toward the law. The DRAS provides a psychometrically sound means of assessing attitudes toward disability rights that may encourage or impede implementation of the ADA. The Americans With Disabilities Act (ADA; 1991) of 1990 is the most comprehensive civil rights law for individuals with disabilities to date. Modeled after the Civil Rights Act of 1964 and the Rehabilitation Act of 1973, the ADA is intended to have a significant impact on the working and living environments of those with disabilities (Johnson & Baldwin, 1993). This law is composed of five titles designed to remove barriers in the areas of employment (Title I), state and local government services (Title II), private and public accommodations and services (Title HI), and telecommunications (Title IV). Title V of the ADA (miscellaneous provisions) encompasses an array of issues, such as nonprotection for those actively using illegal drugs. Overall, the ADA aims at fully including individuals with disabilities in society. Many individuals are required to comply with the ADA, including employers,

SAŽETAK Cerebrovaskularne bolesti su bolesti koje predstavljaju česta oboljenja mozga, a nastaju kao posljedica poremećaja cerebralne cirkulacije. Jedan je od vodećih uzroka mortaliteta u svijetu i u Hrvatskoj, a predstavlja značajan... more

SAŽETAK
Cerebrovaskularne bolesti su bolesti koje predstavljaju česta oboljenja mozga, a nastaju kao posljedica poremećaja cerebralne cirkulacije. Jedan je od vodećih uzroka mortaliteta u svijetu i u Hrvatskoj, a predstavlja značajan javnozdravstveni i socioekonomski problem zbog visokih troškova liječenja, fizikalne rehabilitacije i invaliditeta bolesnika koji su nakon preboljenog moždanog udara često trajno radno onesposobljeni ili potpuno ovisni o tuđoj pomoći. 1 Najnovija istraživanja dokazuju da se moždani udar može uspješno spriječiti djelovanjem na čimbenike rizika. Rana identifikacija faktora rizika moguća je periodičnim kontrolni pregledima mjerenja krvnog tlaka, vrijednosti šećera i lipida u krvi. Procjenom moždane cirkulacije moguće je utvrditi hemodinamski značajna suženja i aterosklerotske promjene intra i ekstrakranijskih krvnih žila. Cilj prevencije obuhvaća dva pristupa: tzv. " pristup visokom riziku "-otkrivanje i liječenje osoba u visokom riziku i " masovni ili populacijski pristup "-npr.smanjivanje unosa soli u želji da se smanji arterijski tlak u čitavoj populaciji. Dobrobiti prevencije uključuju sprječavanje invalidnosti te sekundarno time odlazak u prijevremenu mirovinu, zatim smanjenje stope bolovanja i najvažnije produženje životnog vijeka. Osim farmakoloških metoda, važno je istaknuti da je zdrav način života najbolja prevencija, a podrazumijeva redovitu tjelesnu aktivnost, zdravu prehranu, niski-normalni indeks tjelesne težine, apstencija od pušenja i konzumiranja alkohola u više nego umjerenim količinama.

Smania N, Bonetti P, Gandolfi M, Cosentino A, Waldner A, Hesse S, Werner C, Bisoffi G, Geroin C, Munari D: Improved gait after repetitive locomotor training in children with cerebral palsy. Am J Phys Med Rehabil 2011;90:137Y149.

The actions of the dorsal interosseous, volar interosseous, and lumbrical muscles were investigated using applied electrical stimulation and recording the moments that were generated across the metacarpophalangeal joint in... more

The actions of the dorsal interosseous, volar interosseous, and lumbrical muscles were investigated using applied electrical stimulation and recording the moments that were generated across the metacarpophalangeal joint in flexion/extension and abduction/adduction, the proximal interphalangeal joint in flexion/extension, and the distal interphalangeal joint in flexion/extension. These measurements were made isometrically at various joint angles and levels of stimulation with both able bodied subjects and persons who had sustained tetraplegia. It was determined that the dorsal interossei, including the first, were strong abductors of the fingers and generated a significant moment in metacarpophalangeal (MP) joint flexion and interphalangeal (IP) joint extension. The volar interossei were the primary adductors of the fingers, as well as providing a significant moment in MP joint flexion and IP joint extension. The lumbrical muscles were found to be MP joint flexors and IP joint extensors, although the moments that were generated were on average 70% lower than the interossei. The role of the lumbricals as finger abductors or adductors could not be determined from the data. This information on the actions and moment generating capabilities of the intrinsic muscles led to the incorporation of the interossei into electrically induced hand grasp provided by an implanted neuroprosthesis. The evaluation of the intrinsic muscles in the neuroprosthesis was accomplished by recording the moment generating capabilities of these muscles across each of the joints of the finger. These muscles were capable of generating moments that were 80-90% of the average attained by the able bodied subjects, and have provided a substantial improvement to the electrically induced hand grasp.