Dissertations / Theses: 'Multidisciplinary rehabilitation'

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Davenport, M. J., and Faith W. Akin. "A Multidisciplinary Approach to Vestibular Rehabilitation Therapy." Digital Commons @ East Tennessee State University, 2002. https://dc.etsu.edu/etsu-works/2468.

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Sjöström, Rita. "Multidisciplinary rehabilitation in musculoskeletal disorders : Quantitative and qualitative follow-up studies." Doctoral thesis, Mittuniversitetet, Institutionen för hälsovetenskap, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-10636.

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The primary aim of this investigation was to evaluate a seven-week multidisciplinary rehabilitation programme, with emphasis on musculoskeletal disorders, for working-age people, by assessments at the start and end of the rehabilitation programme, and at follow-up examinations 6, 12 and 24 months after completion of the programme. A further aim was to explore the experiences of people not returning to work during a period of six years after participation in an extensive multidisciplinary rehabilitation programme. Sixty participants, 40 women and 20 men (mean age 46.8 ± SD 7.9), with musculoskeletal disorders, mainly neck and back pain, participated in a 7- week rehabilitation programme which was based on a combination of theoretical and practical education, physical activities, relaxation and individual guidance. Before and after the programme and at the follow-up occasions all participants were evaluated with the Global Self-Efficacy Index (GSI), Hospital Anxiety and Depression Scale (HAD), and Stress test (Study I). A group of participants who were still full-time sick-listed (Group I) at the end of the study period were compared with participants who were part-time or not sick-listed (Group II) at the end of the study period (II, III, IV). They were evaluated with the Disability Rating Index (DRI), with the Pain Intensity Rating Index on a visual analogue scale (VAS) (II, III)), mobility tests (III), GSI (III), HAD, and a stress test (IV). Seven women (median age 48 years) and three men (53 years) (Group I) were interviewed and the interviews were analysed by manifest content analysis (V). At the 2-year follow-up full-time sick leave, anxiety, depression and selfexperienced stress had decreased in both sexes. They also showed increased quality of life (QoL) (I). In participants with full-time sick leave (Group I), self-experienced physical disability and pain ratings were high and showed no decrease up until the 2-year follow-up. In participants with part-time or no sick leave (Group II), physical disability and pain ratings decreased gradually throughout the 2-year follow-up period (II). Cervical and thoracolumbar spine range of motion (ROM) was lower in Group I than in Group II from the start of rehabilitation to a 2-year follow-up. Only Group II showed a temporal improvement in ROM. No changes in DRI, VAS or GSI were found in parallel with corresponding temporal changes in any of the ROM (III). Group I experienced no change in anxiety or depression during the study period, in contrast to Group II, in which this decreased. Decreased stress was found in both groups (IV). Group I described perceived barriers to and possibilities of returning to work, and also gave information on what strategies they used, to cope with everyday life (V). The majority of the participants improved and they continued to be physically active, their QoL improved, and most participants returned to work. Ten of the participants, however, were on full-time sick leave throughout the whole study period, with high self-experienced physical disability, high pain rating and no improvement in anxiety and depression. They experienced barriers to re-entering the labour market as consequences of physical symptoms and fatigue. But they also believed in possibilities of returning to work if they could get a modified job adapted to their own capacity. Thus, persons with severe disability and pain did not improve by rehabilitation in this project. New methods of treatment have to be developed for improvement of symptoms resulting in reduction of functional impairment and a consequent need for sick leave.
Huvudsyftet med undersökningen var att utvärdera ett 7-veckors multidisciplinärt rehabiliteringsprogram inriktat på muskuloskeletala besvär, för arbetsföra kvinnor och män, vid start och efter rehabiliteringsprogrammets slut samt vid 6, 12 och 24 månader. Vidare var syftet att undersöka deltagares upplevelse av att inte återgå i någon form av arbete sex år efter deltagande i rehabiliteringsprogrammet. Sextio deltagare, 40 kvinnor och 20 män (medelålder 46.8 ±7.9), med muskuloskeletala besvär, framför allt nack- och ryggbesvär, deltog i ett 7- veckors rehabiliteringsprogram som innehöll en kombination av teoretisk och praktisk undervisning, fysisk aktivitet, avslappning och individuell vägledning. Deltagarna testades före och efter rehabiliteringsprogrammet samt vid uppföljningstillfällena med Globalt Självskattnings Index (GSI), Hospital Anxitey and Depression Scale (HAD) och stress test (Studie I). En grupp deltagare som fortfarande var helt sjukskriven (Grupp I) i slutet av studieperioden, jämfördes med deltagare som var delvis eller inte alls sjukskriven (Grupp II) vid studieperiodens slut (II, III, IV). De utvärderades med Disability Rating Index (DRI), smärtskattning med visuell analog skala (VAS) (II,III), rörlighetsmätning (III), GSI (III), HAD, och stress test (IV). Sju kvinnor (median ålder 48 år) och tre män (53 år) (Grupp I) intervjuades och intervjuerna analyserades med manifest innehållsanalys (V). Vid två års uppföljning hade heltidssjukskrivning, ångest/oro, depression och självupplevd stress minskat hos båda könen. De visade också ökad livskvalitet (I). Deltagarna som var helt sjukskrivna (Grupp I) hade hög självskattad funktionsnedsättning samt smärtskattning och visade ingen förändring vid två års uppföljning. Deltagarna som var delvis eller inte alls sjukskrivna (Grupp II) visade en gradvis förbättring av fysisk funktion och smärtskattning under studieperioden (II). Cervical och thoracolumbar rörlighet var mindre i Grupp I jämfört med i Grupp II från start till två års uppföljning. Endast Grupp II visade en temporär förbättring av den aktiva rörligheten. DRI, VAS och GSI förändrades inte parallellt med förändringarna i den aktiva rörligheten (III). Grupp I upplevde ingen förändring i ångest/oro eller depression under studie perioden jämfört med Grupp II, som minskade ångest/oro och depression. Båda grupperna skattade mindre stress (IV). I studie V beskrevs deltagarnas upplevelser av hinder och möjligheter för att återgå i arbete. De beskrev vidare vilka strategier som användes för att hantera vardagslivet. Majoriteten av deltagarna förbättrades och de fortsatte att vara fysiskt aktiva, livskvaliteten förbättrades och de flesta deltagarna återgick i arbete. Tio av deltagarna var helt sjukskrivna under hela studieperioden, med hög självskattad fysisk funktionsnedsättning, hög smärtskattning och ingen förbättring i ångest/oro eller depression. De upplevde hinder för återgång i arbete, en konsekvens av de fysiska symtomen och trötthet. De trodde också på möjlighet till återgång i arbete om de kunde få ett arbete anpassat till deras egen arbetsförmåga. Alltså, personer med stor funktionsnedsättning och hög smärta förbättrades inte av rehabilitering i det här projektet. Nya metoder av behandling behöver utvecklas för att förbättra symtomen och därmed minska funktionell försämring och behovet av sjukskrivning.

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Sjöström, Rita. "Multidisciplinary rehabilitation in musculoskeletal disorders quantitative and qualitative follow-up studies /." Östersund : Department of Health Sciences, Mittuniversitetet, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-10636.

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Cruickshank, Travis Miles. "The clinical utility of multidisciplinary rehabilitation in individuals with Huntington’s Disease." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2015. https://ro.ecu.edu.au/theses/1586.

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Background Huntington’s disease (HD) is a chronic neurodegenerative disorder characterised by a progressive loss of cognitive function, motor control and psychiatric features. Individuals also display a variety of systemic features. Progressive neuronal dysfunction and neuronal cell death are thought to underlie the onset and progression of many clinical features of HD. Despite scientific progress, there is still no cure or disease modifying therapy for HD, and available pharmaceutical agents only provide partial relief of motor and psychiatric features. An emerging body of evidence indicates that lifestyle enrichment may delay the onset and progression of clinical features, and exert favourable effects on neuropathological aspects of HD. Few studies have evaluated the effects of lifestyle enrichment strategies like multidisciplinary rehabilitation on the clinical features of HD. Moreover, no study has evaluated the effects of multidisciplinary rehabilitation on neuropathological aspects of HD. Aims The initial aim of this thesis was to determine factors that contribute to features of the disease that negatively impact on activities of daily living such as mobility and balance (Chapter 2), and to identify, using a literature review, a rehabilitation strategy that could positively impact on these features of HD (Chapter 3). These studies informed our ultimate aim which was to investigate the clinical utility of multidisciplinary rehabilitation on clinical and neuropathological features of HD (Chapters 4, 5 and 6) Methods In study 1 (Chapter 2), 22 participants were assessed using a battery of balance, mobility, cognitive tests, assessments of muscle strength and body composition measures. Data was . then statistically examined using stepwise linear regression to identify factors that contribute to balance and mobility impairments in individuals with manifest HD. In study 2 (Chapter 3), a systematic search of journal databases was made from inception to July 2014 for studies reporting on resistance exercise in patients with neurodegenerative disorders. Selected studies were abstracted and critically appraised using a quality control checklist. For the intervention studies, (3 and 4 Chapters 4 and 5), 20 participants with manifest HD were randomly assigned to either a control or training group. Individuals randomised to the intervention group were provided with a nine month multidisciplinary intervention comprising once weekly supervised clinical exercise, thrice weekly home based exercise and fortnightly occupational therapy, while those randomised to the control group were asked to continue with their standard care and daily activities. Participants were assessed using motor, cognitive, psychological, body composition and quality of life measures at baseline and at the completion of the intervention. In study 5 (Chapter 6), 15 participants with manifest HD were assessed using magnetic resonance imaging and a battery of cognitive assessments after nine months of multidisciplinary rehabilitation to see whether such a therapy is capable of inducing favourable changes in brain structure and cognitive function. Results The main factors that contribute to mobility and balance impairments in patients with manifest HD were found to be lower limb muscle weakness and a loss of cognitive function (Study 1). Systematic evaluation of the effects of resistance exercise for neurodegenerative disorders showed that it is beneficial for multiple sclerosis and Parkinson’s disease. In particular, improvements in muscle strength, mobility, balance, clinical disease progression, fatigue, functional capacity, quality of life, disease biology, electromyography activity, mood, skeletal muscle volume and architecture were reported in individuals with multiple sclerosis or Parkinson’s disease (PD) after resistance exercise. The most robust effects of resistance exercise were found for muscle strength outcomes, and were more pronounced in individuals with PD (Study 2). The multidisciplinary rehabilitation intervention studies conducted as part of this thesis significantly improved isometric and isokinetic muscle strength, self-perceived balance, body mass, lean tissue mass and fat mass in patients with HD (Studies 3 and 4). Moreover, multidisciplinary rehabilitation also increased grey matter (GM) volume in the caudate nucleus and dorsolateral prefrontal cortex of patients. The significant increases in GM volume were accompanied by, and correlated to, a significant improvement in performance in verbal learning and memory. Conclusions The work presented here shows that lower extremity muscle weakness and a loss of cognitive function significantly contribute to impairments in mobility and balance. This work also shows that strength training has favourable effects on motor function, including strength, mobility and balance, as well as other clinical features in similar neurodegenerative disorders, and thus should be integrated into multidisciplinary rehabilitation interventions for HD. In addition, this study provides evidence that multidisciplinary rehabilitation can significantly improve aspects of motor control, cognitive function and body composition. Finally we show, for the first time, that multidisciplinary rehabilitation can increase GM volume in structures known to degenerate in HD, and that such increases are functionally related to changes in verbal learning and memory. Future work is urgently required to confirm and expand on these exciting findings, particularly with respect to the neurorestorative properties of multidisciplinary rehabilitation.

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Lillefjell, Monica. "Function and Work Ability Following Multidisciplinary Rehabilitation for Individuals with Chronic Musculoskeletal Pain." Doctoral thesis, Norwegian University of Science and Technology, Department of Social Work and Health Science, 2008. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-2187.

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Liebenberg-Weyers, Danica. "A multidisciplinary approach for the assessment of rehabilitation at asbestos mines in South Africa / Danica Liebenberg-Weyers." Thesis, North-West University, 2010. http://hdl.handle.net/10394/4224.

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The asbestos mining industry has left a legacy of pollution that continues to poison former mining areas and surrounding land – posing a significant health risk to local communities. The rehabilitation of sites disturbed by mining activities, aims to negate the adverse effects associated with these post-mining landscapes and to achieve the return of a disturbed site to a degree of its former state or to a sustainable usable condition. In order to assist the effective rehabilitation of derelict and ownerless asbestos mines it was critical to develop a scientific database to indicate the status of rehabilitation at specific sites. The Rehabilitation Prioritisation Index (RPI) was developed in 2007 to indicate the sequence for rehabilitation of asbestos pollution by quantifying the risk associated with a specific pollution site. The use of the RPI has been implemented by the South African Department of Minerals and Energy as part of an integrated approach towards the rehabilitation of the asbestos legacies of the past. In this study, a multidisciplinary approach was applied to sites in three provinces as identified in the RPI, to facilitate the development of the Rehabilitation Monitoring Index (RMI). It is envisioned that this index, as part of a larger monitoring database, would assist in the successful monitoring and long-term rehabilitation of asbestos mines. During the monitoring process, the most prominent aspects governing the rehabilitation process were identified from comprehensive assessments of quantitative and qualitative data. Quantitative parameters included cover depth, physical and chemical soil properties, soil microbial activity, vegetation properties and small mammal surveys. Qualitative data included the footprint area, land use, erosion or flood damage, secondary pollution and water control structure damage. From the quantitative data, those parameters which had the greatest influence on the rehabilitation process were identified. In order of most to least important these groups were analysed by multivariate statistical ordination and classified into four groups: success parameters > essentials to be addressed > reasons for failure > non-distinguishable entities. The qualitative data indicated that the Limpopo Province was in the highest state of degradation after rehabilitation and that site history plays an important role in rehabilitation planning. Quantitative and qualitative parameters were assessed for all sites and applied in the RMI as weighted factors from which the rehabilitation status of a specific site can be calculated. Qualitative data was given a weight of 25% and quantitative data a weight of 75%. RMI values were calculated for each parameter and sites were distributed across a range which classifies the sites according to their rehabilitation status. Once again the Limpopo Province was identified as the province with the least successful rehabilitation. The results from this investigation show that a multidisciplinary approach is a step in the right direction for the successful monitoring of rehabilitated post-mining sites such as asbestos mines. It is however necessary that the RMI must be validated and the weights allocated to qualitative parameters must be reconsidered for the future development of this tool. While the RPI and RMI cannot be compared directly, it might be of great revelation to reassess the RPI values of all the sites after rehabilitation and compare this data to the RMI values.
Thesis (M.Sc. (Environmental Science))--North-West University, Potchefstroom Campus, 2010.

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Keedy, Nicole Hochhausen. "Health locus of control, self-efficacy, and multidisciplinary intervention for chronic back pain." Diss., University of Iowa, 2009. https://ir.uiowa.edu/etd/386.

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Chronic back pain is costly and potentially disabling, with low response to medical procedures. Poor physical and mental health demonstrate correlation with chronic back pain. The current study investigated the value of using health-related locus of control and pain-related self-efficacy to predict physical and mental health outcomes following multidisciplinary intervention for chronic back pain. Form C of the Multidimensional Health Locus of Control scales and the Chronic Pain Self Efficacy scale were administered to 28 males and 33 females ages 28 to 72 completing chronic back pain rehabilitation. Locus of control, self-efficacy, and physical and mental health demonstrated treatment-related changes, with notable improvements in physical and mental health. Regression analyses examined the value of pre-treatment health locus of control and pain-related self-efficacy as predictors of physical and mental health one month following treatment. Higher internal and lower doctor health locus of control, and higher self-efficacy at baseline predicted higher lift scores one month after treatment. Higher baseline self-efficacy also predicted better physical functioning and lower disability at one month. Pain-related self-efficacy and health locus of control may be valuable predictors of treatment benefit for chronic back pain patients. Limitations included low sample size.

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Bartlett, Danielle Megan. "The utility of multidisciplinary rehabilitation as a treatment strategy for circadian rhythm and sleep disturbances in premanifest Huntington’s Disease." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2018. https://ro.ecu.edu.au/theses/2143.

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Background: Huntington’s disease (HD) is a rare, neurodegenerative disease caused by an expanded cytosine-adenine-guanine (CAG) sequence in the Huntingtin gene, resulting in the production of an aberrant protein, mutant huntingtin (mHTT). The mHTT protein exhibits a toxic loss and gain in function, leading to degeneration of neurons in the brain. Consequently, the classic triad of motor, cognitive and mood features of the disease develop. Among the earliest features of HD are circadian rhythm and sleep disturbances. These anomalies present many years prior to formal clinical diagnosis of HD and, while it has been postulated that these disturbances arise as a result of hypothalamic pathology, the neurobiological mechanisms underpinning these sleep disturbances have not yet been robustly investigated. The hypothalamus of the brain contains several key nuclei that are essential in maintaining circadian rhythm and sleep/wake cycles. Hypothalamic pathology and dysregulation of neuroendocrine factors that mediate the sleep/wake cycle have been reported in HD, as early as the premanifest stage. It is not known however if hypothalamic pathology precedes neuroendocrine dysregulation. Identification of mechanisms underpinning sleep and circadian rhythm disturbances will enable the development of therapeutic strategies aimed at mitigating sleep and circadian rhythm anomalies. To date, no therapies exist to combat pathological changes in sleep architecture and circadian rhythm. Evidence from mouse models of HD shows that the circadian rhythm and sleep-wake cycle are amenable to environmental interventions, including exercise, bright light therapy and temporally scheduled feeding. Furthermore, previous studies in HD of multidisciplinary rehabilitation- a construct of exercise and cognitive training, along with social interaction have been shown to increase grey matter volume in the caudate tail and dorsolateral prefrontal cortex in manifest HD, with accompanying improvements in verbal learning and memory. It is postulated that this intervention paradigm could also improve sleep outcomes in HD. Studies in Parkinson’s disease have shown that multidisciplinary rehabilitation improves sleep quality, however, the effects of multidisciplinary rehabilitation on circadian rhythm and sleep outcomes have not yet been investigated in HD and particularly not in premanifest HD when the effects of intervention would be most beneficial. Aims: The initial aim of this thesis was to determine, through a review of the literature, the potential neurobiological mechanisms associated with circadian rhythm and sleep disturbances in individuals with premanifest HD. This was used to inform the next study, which was to determine whether hypothalamic pathology was associated with circadian rhythm and habitual sleep disturbances in individuals with premanifest HD. The next aim was to then determine if nine-months of multidisciplinary rehabilitation could impact on circadian rhythm and habitual sleep outcomes and associated hypothalamic volume in individuals with premanifest HD. The aim of the final study was to explore the effects of a nine-month multidisciplinary rehabilitation program on sleep architecture in individuals with premanifest HD. Methods: For the study presented in Chapter 3 (aim 2), 32 individuals with premanifest HD and 29 healthy age- and gender-matched controls underwent magnetic resonance imaging scans to evaluate hypothalamic volume. Circadian rhythm and habitual sleep were assessed via measurement of morning and evening cortisol and melatonin levels, wrist-worn actigraphy, the Consensus Sleep Diary and sleep questionnaires. Information on mood, physical activity levels and body composition were also collected. In the study presented in Chapter 4 (aim 3) 18 individuals with HD (ten premanifest and eight prodromal) undertook a nine-month multidisciplinary rehabilitation intervention (intervention group) and were compared to a community sample of 11 individuals with premanifest HD receiving standard care (control group). Hypothalamic volume, blood-based BDNF, salivary cortisol and melatonin concentrations, subjective sleep quality, daytime somnolence, habitual sleep-wake patterns and stress, anxiety and depression symptomatology were all evaluated prior to and following the intervention. Sixteen of these individuals also underwent polysomnography and sleep-dependent memory consolidation prior to and following the ninemonth intervention to assess sleep architecture and sleep-dependent memory consolidation (Chapters 4 and 5). Results: Here in Chapter 2, a review of the literature revealed the hypothalamus as a potential modulator of circadian rhythm and sleep disturbances in HD. Chapter 3 shows that hypothalamic grey matter volume in premanifest HD individuals is reduced compared to ageand gender-matched healthy controls. We also observed reduced sleep quality and an increased number of awakenings in premanifest HD individuals compared to healthy controls. Contrary to expectation, there were no strong associations between sleep outcomes and hypothalamic volume. There were, however, differences in the associations between hypothalamic volume and neuroendocrine factors in premanifest HD individuals compared to healthy controls. Following nine months of multidisciplinary rehabilitation, a reduced rate of loss of grey matter volume in the hypothalamus was observed in the premanifest HD intervention group compared to the premanifest HD standard care group (Chapter 4). This was accompanied by a maintenance of brain-derived neurotrophic factor (BDNF) levels in the intervention compared to the control group. No robust changes were observed in the release of circadian-regulated hormones or in habitual sleep outcomes; however, exploratory data revealed changes in sleep architecture, particularly in REM percentage and latency, following the nine-month intervention (Chapter 5). Conclusion: Data presented in this thesis suggests that, although hypothalamic volume is reduced in individuals with premanifest HD, circadian rhythm is maintained, perhaps via neural compensation. Moreover, we provide, for the first time, preliminary data suggesting that multidisciplinary rehabilitation is useful in reducing the loss of volume of the hypothalamus and, while no robust effects on circadian rhythm were observed, improvements in sleep architecture were observed in individuals with premanifest HD. Further randomised controlled studies in a larger cohort of individuals with premanifest and manifest HD are required to confirm and extend on these preliminary findings

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Andersén, Åsa. "Self-efficacy, Vocational Rehabilitation and Transition to Work." Doctoral thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-328796.

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The overall aim of this thesis was to examine the relationship between self-efficacy, individually tailored vocational rehabilitation and transition to work or studies. Study I was a cross-sectional study based on questionnaire- and registry data, investigating whether factors related to sick leave predict self-efficacy in women on long-term sick leave (n= 337) due to pain and/or mental illness. General self-efficacy was low. Anxiety and depression were the strongest predictors for low self-efficacy. Study II used longitudinal data from a randomised controlled trial, comprising partly the same women (n=401) as in Study I. Participants were allocated to either 1) assessment of multidisciplinary team and multimodal intervention (TEAM), 2) acceptance and commitment therapy (ACT), or 3) control group. Self-efficacy increased in the TEAM group in comparison with the control group. Study III had a descriptive qualitative design with individual interviews, studying participants’ (n=14) experiences with an individually tailored vocational rehabilitation project, and encounters with professionals working in it. The participants, who were on long-term sick leave due to mental illness or pain reported overall positive experiences with the project. The project was based on collaboration between authorities and motivational interviewing. The positive experiences were based on four categories: Opportunities for receiving various dimensions of support, Good overall treatment by the professionals, Satisfaction with the working methods of the project, and Opportunities for personal development. Study IV was a prospective cohort study investigating perceived self-efficacy in unemployed young adults (n= 249) aged 19-29 year with disabilities, and the association between self-efficacy and transition to work or studies. The study used questionnaire- and registry data from a vocational rehabilitation project. Higher levels of self-efficacy were associated with increased odds for ‘transition to work’. General self-efficacy was low, and young adults with lower self-efficacy reported worse self-rated health compared with those with higher self-efficacy. This thesis showed that multidisciplinary assessment with a multimodal intervention had positive effects on self-efficacy. Individually tailored vocational rehabilitation, based on cooperation and motivational interviewing, may be beneficial for individuals on long-term sick leave and the interactions between participants and the professionals may affect participants’ self-efficacy positively. Mental health needs to be considered when targeting self-efficacy in vocational rehabilitation. Furthermore, research is needed to a) clarify which components in the multidisciplinary team intervention can increase self-efficacy, b) study the effects of vocational rehabilitation based on an individual design, cooperation and motivational interviewing on self-efficacy, health and transition to work, and c) develop interventions that can increase self-efficacy and support transition to work/ studies in young adults with disabilities.

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Kauppila, A. M. (Anna-Maija). "Multidisciplinary rehabilitation after primary total knee arthroplasty:a study of its effects on health- related quality of life, functional capacity and cost-effectiveness." Doctoral thesis, Oulun yliopisto, 2011. http://urn.fi/urn:isbn:9789514294914.

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Abstract Knee osteoarthritis (OA) is one of the main causes of chronic disability in elderly people. In end-stage knee OA, patients experience both short- and long-term benefits from total knee arthroplasty (TKA). All the significant deficiencies in functional capacity and health-related quality of life (HRQOL) are not spontaneously resolved after surgery. Therefore, it is essential that patients receive effective rehabilitation. So far, there are no gold standards in terms of outcome measurements of TKA and rehabilitation in connection with surgery. The present series of studies was designed for the purpose of examining the effectiveness and cost-effectiveness of a multidisciplinary rehabilitation program compared with conventional orthopedic care, the attributes of disability in elderly knee OA patients waiting for primary TKA, and the impact of patient-relevant factors on the outcome of TKA one year after surgery. Special emphasis was placed on self-reported functional capacity, HRQOL, and objectively measured functional capacity. Objective and subjective physical function and HRQOL were investigated with a battery of physical function tests and questionnaires (WOMAC, 15D, and RAND-36) during a one-year follow-up. Pain, body mass index (BMI), and antero-posterior laxity of the affected knee were the main attributes of self-reported disability in the patients waiting for primary TKA. The multidisciplinary rehabilitation program did not yield faster attainment of recovery than did conventional orthopedic care. Equal, significant improvement in HRQOL and functional capacity was found in both groups, but conventional care was clearly cost-saving. A preoperative score below the general population level on the 15D, the presence of pain, higher age, and the presence of pulmonary disease preoperatively decreased the possibility of reaching the HRQOL level of the general population. More severe pain preoperatively was associated with a higher degree of functional recovery. The presence of osteoporosis, male gender, impaired function of the opposite knee, and higher age were associated with a lower degree of improvement in self-reported function. The results highlight the multifactorial nature of health status in TKA. Further intervention studies are needed to identify patients who would benefit most from intensive rehabilitation interventions after TKA and to create standards for outcome tools after joint replacement surgery and rehabilitation interventions
Tiivistelmä Polvinivelrikko on merkittävimpiä niistä sairauksista, jotka rajoittavat ikääntyneiden toimintakykyä. Vaikka tekonivelleikkauksella voidaan sekä välittömästi että pidemmän ajan kuluessa kohentaa merkittävästi polvinivelrikosta kärsivien elämänlaatua ja toimintakykyä, osa potilaista ei leikkauksen jälkeenkään selviydy hyvin arjestaan. Siksi on tärkeää, että potilasta kuntoutetaan tekonivelleikkauksen jälkeen asianmukaisesti ja tehokkaasti. Leikkauksen ja kuntoutuksen tuloksellisuutta arvioivien mittareiden käytöstä ei ole olemassa standardoituja suosituksia. Tämän väitöskirjan päätavoitteena oli selvittää 2–4 kuukautta leikkauksen jälkeen toteutetun, moniammatillisen, polikliinisen kuntoutuksen kustannustehokkuutta sekä sen vaikuttavuutta elämänlaatuun ja toimintakykyyn verrattuna perinteiseen ortopediseen hoitokäytäntöön. Lisäksi selvitettiin tekijöitä, jotka heikentävät potilaan toimintakykyä pitkälle edenneessä polvinivelrikossa, sekä potilaslähtöisiä tekijöitä, jotka vaikuttavat leikkaustulokseen vuosi leikkauksen jälkeen. Itsearvioitua toimintakykyä sekä elämänlaatua arvioitiin kyselykaavakkeiden (WOMAC, 15D ja RAND-36) avulla ja fyysistä toimintakykyä mitattiin testipatteristolla. Tutkimuksen seuranta-aika oli yksi vuosi. Painoindeksi, kipu ja leikattavan polven etu-takasuuntainen väljyys selittivät eniten tekonivelleikkausta odottavien potilaiden toimintakyvyn rajoitteita. Potilaiden elämänlaatu ja toimintakyky kohenivat merkittävästi tekonivelleikkauksen jälkeen. Moniammatillisesti toteutettu kuntoutus ei tehostanut leikkauksesta toipumista verrattaessa sitä perinteiseen ortopediseen hoitokäytäntöön, joka vertailussa myös säästi selkeästi kustannuksia. Väestökeskiarvoa huonommaksi koettu elämänlaatu jo ennen leikkausta, kivuliaisuus, korkea ikä ja keuhkosairaudet heikensivät mahdollisuutta saavuttaa väestökeskiarvon tasoinen koettu elämänlaatu vuosi leikkauksen jälkeen. Leikkausta edeltävä vaikea-asteinen kivuliaisuus assosioitui merkittävään toimintakyvyn parantumiseen. Osteoporoosi, miessukupuoli, vastakkaisen polvinivelen epänormaali toiminta ja korkea ikä taas liittyivät vaatimattomampana koettuun toimintakyvyn parantumiseen. Tekonivelleikattujen potilaiden terveydentilan monitekijäisyys heijastuu tutkimustuloksiin. Jatkossa tarvitaan interventiotutkimuksia, jotta voitaisiin paremmin tunnistaa ne potilaat, jotka hyötyisivät eniten tehostetusta leikkauksen jälkeisestä kuntoutuksesta. Lisäksi olisi tärkeää tutkia, miten kuntoutuksen tuloksellisuutta arvioivia mittareita voitaisiin yhtenäistää

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Thomas, Clare Diana. "Evaluation of a multidisciplinary transitional and community rehabilitation intervention for adults with severe acquired brain injury : a case series exploring community integration." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10050647/.

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INTRODUCTION: Healthcare policy in the United Kingdom supports community placement following acquired brain injury (ABI). Evidence supports the efficacy of multidisciplinary neurorehabilitation for this group but is limited for programmes supporting community integration in adults with severe disability. This study describes the development and initial evaluation of a transitional and community intervention in this area. METHODS: The study comprised five repeated measures single case studies as well as semi structured interviews with four of the participants’ relatives or friends. Outcomes measures used were the Community Integration Measure, UK Functional Independence Measure/ Functional Assessment Measure and Mayo Portland Adaptability Inventory. Clinical validity was measured using Goal Attainment Scaling. RESULTS: All participants returned to living in the community with significantly improved functional independence and good goal attainment. One participant reported improved community integration but four did not. Reasons for this include: the impact of insight and anxiety on self-report of community integration; ongoing challenges with independence; and outcome choice. Key successful elements of the intervention were identified including: consistent rehabilitation routines; use of trained support workers; and appropriate use of risk assessment to support independence. The participants’ relatives expressed satisfaction with the intervention and the professional support provided. Concerns raised related to communication of goals and discharge planning, intensity of therapy and the environment of the Transitional Unit. CONCLUSIONS: This study provides an initial positive evaluation of the intervention but indicates the need to complete further evaluation and with additional outcome measures for community integration. Key learning points from the case studies can be replicated in other services, including the use of goal setting protocols, support worker training and protocols for assessment of capacity and risk.

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Thiart, Karen. "Traumatic brain injury (TBI) patients’ post-acute rehabilitation : the experience of family members." Diss., University of Pretoria, 2012. http://hdl.handle.net/2263/28339.

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A traumatic brain injury (TBI) is what its name suggests: an extremely traumatic event that affects the most supremely powerful but fragile organ that controls all our bodily functions and holds the essence that makes individuals unique. Some patients with a traumatic brain injury will recover without realising what the effect could have been and others will be left with effects that will last throughout their lives. “Many sufferers will remain severely incapacitated and a lamentably large number will become part of the statistics on the mortality after TBI” (Burns, 2008a:76). The impairments that an individual faces after a TBI will be dealt with in an acute rehabilitation setting. Significant emotions are experienced by patients with a traumatic brain injury. The researcher believes that this emotional reaction is also experienced by the family members. The event may be even more devastating to the family members, because of the impaired cognitive functions of the injured person. Ross and Deverell (2004:36) state that when individuals are diagnosed with disabling conditions, they experience strong emotional reactions. “Feelings of grief, anxiety, inadequacy, anger, guilt, vulnerability and confusion are some of the more common emotions that clients and their families experience when they encounter a disability in themselves or a family member” (Ross and Deverell, 2004:41). After a traumatic brain injury the patient is usually admitted to an intensive care unit (ICU). Once medically stable and able to participate in an active rehabilitation programme, provided this is authorised by the patient’s medical aid, the patient is transferred to a rehabilitation unit. While in ICU, the outcome is very uncertain and the the family often receives very limited support. Patients are often in a coma and unable to communicate. In working with TBI patients, the researcher found that family members receive very limited support, education on the condition and feedback on the patient’s medical state from team members, and therefore become very anxious when the patient is eventually transferred to a rehabilitation unit. In this study, the researcher focused on the family’s experience from the time of the patient’s admission into ICU until discharge from rehabilitation. During the rehabilitation process, family members are encouraged to support their family member in the rehabilitation unit. This is often very difficult for them, as it entails being confronted with reality and the often devastating impact of the injury. The focus of this study is on the experiences of family members while the patient with a TBI is in hospital and in the rehabilitation unit and the challenges they face. The researcher strove to understand the experiences of family members of patients with TBI, from ICU through until discharge from acute rehabilitation. The goal was to explore the experiences of adult family members of the traumatic brain-injured person in post-acute rehabilitation. The research question was: What were the experiences of adult family members of the person with a traumatic brain injury (TBI) during post-acute rehabilitation? A qualitative approach was used in this study, with a collective case study research design. The population for this study was all the family members of patients who underwent rehabilitation as a result of traumatic brain injury in the Life Eugene Marais Hospital, Pretoria, Gauteng. In this study purposive sampling was used to choose participants who were family members of TBI patients. The criteria for sampling of family members as participants were as follows. The patient

had suffered a traumatic brain injury;
had undergone acute rehabilitation at Life Eugene Marais Hospital for the last four years;
had completed rehabilitation, in other words had to be post discharge;
lived in the province of Gauteng; and
was able to speak and understand English or Afrikaans, irrespective of gender, race, religion, culture or age.

Eight participants who were family members of eight TBI patients were chosen for this study. Semi–structured individual interviews were conducted with participants. Interviews were voice recorded with the permission of the participants and were transcribed by the researcher. The data were analysed by the researcher and the themes and sub-themes generated from the data. The research findings were presented by providing a profile of the research participants and then presenting the themes and sub-themes, including literature control and verbatim quotes from the transcriptions. The themes included the following: Theme One – Understanding of TBI; Theme Two – Period of hospitalisation; Theme Three – Family members’ emotional experience of TBI; Theme Four – Period of rehabilitation; Theme Five – Period post discharge; Theme Six – Support systems; Theme Seven – Effects of TBI and Theme Eight – Future. The conclusions of this study are that traumatic brain injury (TBI) is experienced as severe trauma by family members, who struggle to cope not only initially but especially once the person is discharged and has to be cared for at home. In the long term this experience leads to changes in the family regarding structure, roles, functioning, relationships, communication, finances and social life. Recommendations in this study can be used by the multidisciplinary team to better understand the needs and experiences of the family members of TBI patients and by social workers to improve their intervention and support to these families.
Dissertation (MSW)--University of Pretoria, 2012.
Social Work and Criminology
unrestricted

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Zakrisson, Ann-Britt. "Management of patients with chronic obstructive pulmonary disease in primary health care : a study of a nurse-led multidisciplinary programme of pulmonary rehabilitation." Doctoral thesis, Örebro universitet, Hälsoakademin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-15732.

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The aim of this thesis was to modify and evaluate effects, as well as todescribe experiences of a nurse-led multidisciplinary programme of pulmonaryrehabilitation in primary health care for patients with chronicobstructive pulmonary disease (COPD) and their next of kin.Interviews were performed with 12 COPD nurses about their experiencesof patient education (I). Forty-nine patients participated in the interventiongroup and 54 in the control group in a quasi-experimentalstudy which investigated the effects of the programme on functional capacity,quality of life and exacerbation frequency during one year (II).Interviews were performed related to the experiences of 20 patients whohad participated in the six-week programme (III) and the experiences of20 next of kin to the patients that had participated (IV).The results showed that COPD nurses fluctuated between security andinsecurity in patient education and were in need of support, time, structureand collaboration to develop their patient education (I). In Study IIthere were no differences between the groups with regard to functionalcapacity and quality of life, but the number of exacerbations decreased inthe intervention group and increased in the control group (II). The patientsin study III had allowed themselves to live at their own pace followingthe programme but a constant fear was present in spite of the programme(III). Next of kin in Study IV had a life that remained overshadowedby illness but there were positive outcomes of the programme aslong as two years afterwards. The next of kin also had constant fear,however (IV).In conclusion, the six week programme brought about results in changingeveryday life. Nevertheless, all lived in the shadow of fear and uncertaintyin spite of the programme. More research is needed to address therequirements of COPD nurses, patients and next of kin.

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Forssell, Ingrid, and Anette Nyström. "Sjuksköterskans upplevelser och erfarenheter av att vårda patienter som insjuknat i stroke : en litteraturöversikt." Thesis, Sophiahemmet Högskola, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-3942.

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Bakgrund Varje år insjuknar 25 000-30 000 personer i Sverige med stroke. Stroke är ett samlingsbegrepp för hjärninfarkt och hjärnblödning som leder till syrebrist eller direkt skada i hjärnan. Hjärnskadorna kan leda till bestående eller övergående funktionsnedsättningar i varierande grad. Patienterna tas om hand av multidisciplinära team där sjuksköterskan ingår i alla leden i vårdkedjan. Sjuksköterskan utför omvårdnad för att stödja patienterna i deras återhämtning, vilket kan bidra till att förbättra prognosen för dessa patienter. Syfte Syftet med litteraturöversikten var att belysa sjuksköterskans upplevelser och erfarenheter av att vårda patienter som insjuknat i stroke. Metod Studiedesignen var en icke-systematisk litteraturöversikt. Studien baserades på 15 artiklar av både kvalitativ och kvantitativ design. Artikelsökningarna genomfördes i databaserna PubMed och CINAHL. Vidare gjordes en kvalitetsgranskning av de 15 vetenskapliga artiklarnas kvalitet och trovärdighet. Slutligen användes en integrerad översiktsmetod som dataanalysmetod för att färdigställa resultatet. Resultat Litteraturöversikten sammanfattade sjuksköterskans upplevelser och erfarenheter av att vårda patienter som insjuknat i stroke. Betydelsefulla aspekter och förhållningssätt som identifierades var att känna ett yrkesansvar, arbeta i multidisciplinära team, arbeta utifrån personcentrerad vård och sjuksköterskans relation med patientens närstående. Förbättringsområden inom strokevård var enligt sjuksköterskorna mer strokeutbildning, bättre samarbete i det multidisciplinära stroketeamet och med patientens närstående. Återkommande problem var tidsbrist och underbemanning. Slutsats Genom att studera och sammanfatta sjuksköterskors upplevelser och erfarenheter av att vårda patienter som insjuknat i stroke kan betydelsefulla aspekter, förhållningssätt och förbättringsområden inom strokevården förstås.
Background Every year 25,000-30,000 people in Sweden take ill with stroke. Stroke is a collective term for cerebral infarction and cerebral hemorrhage that leads to a lack of oxygen or direct damage in the brain. Brain damage can lead to permanent or transient disabilities of varying degrees. Patients are cared for by multidisciplinary teams where the nurse is part of all stages of the care. The nurse performs nursing care to support patients in their recovery and can help improve prognosis for these patients. Aim The purpose of the literature review was to describe the nurse's experiences in caring for patients taken ill with stroke. Method The design of the study was a non-systematic literature review. The study was based on 15 articles of both qualitative and quantitative design. The article searches were made in the databases PubMed and CINAHL. Furthermore, a quality review was made of the quality and credibility of the 15 articles. Finally, an integrated overview was used as a data analysis method to complete the result. Results The literature review summarized the nurse's experiences of caring for stroke patients. Identified significant aspects and attitudes were as follows, to feel a professional responsibility, to work in multidisciplinary teams, to practice person-centered care, and the nurses' relationship with the patient's relatives. According to the nurses, areas for improvement in stroke care were more stroke training, and better collaboration in multidisciplinary stroke teams and with the patient's relatives. Recurring problems were lack of time and understaffing. Conclusions By studying and summarizing the nurse's experiences in caring for patients taken ill with stroke significant aspects, attitudes and areas for improvement in stroke care can be understood.

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Белозьоров, І., О. Проценко, and О. Шаповал. "Мультидисциплінарні аспекти реабілітації постраждалих з опіковою травмою." Thesis, Сумський державний університет, 2017. http://essuir.sumdu.edu.ua/handle/123456789/63561.

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When treating patients with burn injury, it is necessary to combine correction of general changes in patient’s body with rehabilitation treatment for the purpose of relieving local burn consequences. Rehabilitation of patients with burns starts as early as at hospital stage of medical care provision. Specialists of numerous fields are engaged in development of a rehabilitation program, which is individual for each patient, as well as implementation of rehabilitation actions, such as exercise physiologist, physiotherapist, psychologist, dermatologist, nutritionist, etc.
W trakcie leczenia poszkodowanych z oparzeniami korektę ogólnych zmian, zachodzących w organizmie pacjenta, należy połączyć z rehabilitacją w celu likwidacji lokalnych następstw oparzeń. Rehabilitacja chorych z oparzeniami zaczyna się jeszcze na etapie świadczenia pomocy w szpitalu. Do udziału w opracowaniu programu rehabilitacyjnego, indywidualnego dla każdego pacjenta, i realizacji środków rehabilitacyjnych, są załączani specjaliści wielu kierunków – specjalista do spraw terapeutycznego wychowania fizycznego, fizjoterapeuta, psycholog, dermatolog, dietetyk oraz inni.
Законодавчі особливості забезпечення своєчасної та якісної допомоги постраждалим від опіків передбачено Наказом Міністерства охорони здоров’я України «Про систему комбустіологічної допомоги в Україні» (№ 838 від 30.09.2013). Існують також клінічні протоколи надання медичної допомоги хворим з опіками та їх наслідками, згідно яким пацієнти повинні отримувати спеціалізовану медичну допомогу в повному обсязі, необхідному для одужання та профілактики різноманітних ускладнень опікової хвороби.

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Marhold, Charlotta. "Musculoskeletal Pain and Return to Work : A Cognitive-Behavioral Perspective." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2002. http://publications.uu.se/theses/91-554-5234-5/.

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Monageng, Selina Nonkambule. "Tetraplegia The psychosocial problems encountered by black patients once discharged from the hospital /." Diss., Pretoria : [s.n.], 2007. http://upetd.up.ac.za/thesis/available/etd-11052007-121604.

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Kerätär, R. (Raija). "Kun katsoo kauempaa, näkee enemmän:monialainen työkyvyn ja kuntoutustarpeen arviointi pitkäaikaistyöttömillä." Doctoral thesis, Oulun yliopisto, 2016. http://urn.fi/urn:isbn:9789526210865.

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Abstract Unemployed are known to be in poorer health and to use less health care services compared to those employed. However, evidence on the work ability of the unemployed remains scarce. The methods of assessing work ability are very divergent, not least because a shared understanding on the concept of work ability is lacking. Furthermore, the aspect of marginalization gives rise to further challenges when assessing work ability among the unemployed. This study explored the work ability of long-term unemployed, their needs for medical care and rehabilitation as well as the methods of assessing work ability. The aims were to find out to which amount and how the work ability was restricted among the unemployed and to clarify the needs for medical care and rehabilitation among them. Additionally, differences between the methods for assessing the disease-oriented and multidimensional work ability, as well as the need for rehabilitation were analysed. Both qualitative and quantitative methods were used in this multi-method research in three different studies. The multidimensional work ability assessments were conducted among long term unemployed individuals in three Labour Force Service Centres (Oulu, Raahe region and Kainuu) and in one municipality (Paltamo). Furthermore, an illustrated case study was conducted to compare the materials and background theories of disease-oriented and multidimensional work ability assessment methods. The work ability was significantly decreased for a great proportion of long term unemployed, mostly because of mental disorders. In one municipality, 27% of the long term unemployed were found disabled for open labour market, in addition 20% of them were considered to need medical care and rehabilitation to enable return to work. By using multidimensional work ability assessment method, restrictions in work ability as well as the needs for rehabilitation appeared to get identified more accurately than by using the disease-oriented method. The latter had missed potential rehabilitation avenues and had led to under-rehabilitation, misrehabilitation and over-rehabilitation. The results indicate that the practices of assessing work ability should be based on biopsychosocial and not only on biomedical approach of health and therefore existing information from the multidisciplinary network concerning the clients’ functioning should be routinely collected and used. The health care services as well as the work ability assessment procedures should be tailored to meet the special needs of the long term unemployed to support their work ability and potential of returning to work
Tiivistelmä Työttömien terveydentila on heikompi ja he käyttävät vähemmän terveyspalveluja kuin muu samanikäinen väestö. Sen sijaan työttömien työkyvystä ei ole olemassa kattavaa tutkimustietoa. Toisaalta työkyvyn arvioinnin menetelmät ovat epäyhtenäiset, koska työkyvyn käsitteestäkään ei ole yhtenäistä ymmärrystä. Syrjäytymiseen liittyvät ilmiöt aiheuttavat työttömien työkyvyn arviointiin omat erityishaasteensa. Tämän tutkimuksen kohteena olivat pitkäaikaistyöttömien työkyky, sairauksien hoitoon ja kuntoutukseen liittyvät tarpeet sekä työkyvyn arvioinnin menetelmät. Tavoitteena oli selvittää, kuinka suurella osalla ja millä tavoin pitkäaikaistyöttömien työkyky on heikentynyt sekä minkälaista hoidon ja kuntoutuksen tarvetta heillä on. Lisäksi selvitettiin sairauslähtöisen ja monialaisen työkyvyn ja kuntoutustarpeen arvioinnin eroja. Monimenetelmätutkimuksen kolmessa osatutkimuksessa käytettiin sekä laadullisia että määrällisiä menetelmiä. Aineistoina olivat kolmen työvoiman palvelukeskuksen (Oulu, Raahen seutukunta ja Kainuu) ja yhden kunnan (Paltamo) alueella asuville vaikeasti työllistyville henkilöille monialaisesti toteutetut työkyvyn arvioinnit. Lisäksi aineistona analysoitiin sairauslähtöisessä ja monialaisessa työkyvyn arvioinnissa käytettävät tietoaineistot ja tulokset yhdellä esimerkkiasiakkaalla havainnollistaen. Suurella osalla pitkäaikaistyöttömistä työkyky oli merkittävästi heikentynyt, sairausluokista eniten mielenterveyden häiriöiden takia. Yhden kunnan kaikista pitkäaikaistyöttömistä todettiin avoimille työmarkkinoille työkyvyttömiksi 27 % ja näiden lisäksi 20 %:lla todettiin työkykyä kohentavan hoidon ja kuntoutuksen tarvetta. Monialaisen arviointimallin avulla tunnistettiin työkyvyn heikkeneminen ja kuntoutustarve osuvammin kuin perinteisellä sairauslähtöisellä toimintatavalla, joka hukkaa kuntoutuksen potentiaalia ja johtaa alikuntoutukseen, väärinkuntoutukseen tai ylikuntoutukseen. Tulosten perusteella työkyvyn arvioinnin käytännöt tulisi perustaa biopsykososiaaliseen eikä vain biomedikaaliseen terveyskäsitykseen ja niissä tulisi nykyistä enemmän hyödyntää monialaisessa verkostossa olevaa informaatiota tutkittavan toimintakyvystä. Työkyvyn tukemiseksi työttömien terveyspalvelut sekä työkyvyn ja kuntoutustarpeen arvioinnit tulisi aiempaa enemmän suunnitella ja kohdentaa pitkäaikaistyöttömien erityistarpeet huomioiden

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Riberto, Marcelo. "Estimulação transcraniana com corrente contínua associada ao tratamento multidisciplinar da fibromialgia: um estudo duplo-cego, aleatorizado e controlado." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5144/tde-13022009-134542/.

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A estimulação transcortical com corrente contínua (ETCC) é uma técnica de estimulação não-invasiva do córtex cerebral que tem mostrado efeitos positivos no controle da dor crônica. A hipótese principal deste estudo foi verificar se a associação da ETCC ao tratamento multidisciplinar de pacientes com fibromialgia aumentaria os resultados no controle da dor e melhora da qualidade de vida. O desenho do estudo foi um ensaio clínico controlado, aleatorizado, duplo-cego e de braços paralelos. Vinte e três mulheres com fibromialgia receberam o tratamento habitual de reabilitação com a intervenção multidisciplinar e medicamentos e foram divididas aleatoriamente em um grupo com ETCC anódica sobre o córtex motor esquerdo e catódica na região supra-orbital direita, com corrente contínua de 2mA, por 20 minutos. O outro grupo recebeu estimulação sham, na qual a mesma disposição de eletrodos foi usada sobre o couro cabeludo, porém a corrente foi interrompida após 1 minuto, permanecendo desligada nos 19 minutos restantes. As sessões ocorreram uma vez por semana por 10 semanas consecutivas, sempre antes de terapia multidisciplinar. A dor foi quantificada ao início e ao final do tratamento pela escala pela visual analógica (EVA) e pela dolorimetria de pressão sobre os pontos dolorosos da fibromialgia. A qualidade de vida foi avaliada pelo Questionário de impacto da fibromialgia (FIQ) e SF-36. Como possíveis fatores de confusão, foram avaliados o humor e a capacidade funcional por meio do Índice de depressão de Beck (IDB), Escala de Hamilton (HAM) e questionário HAQ. Não foram descritos efeitos adversos graves. Houve melhora significativa da pontuação do domínio Dor do questionário SF-36, com efeito significante apenas no grupo sob estimulação ativa (de 26,6 ± 12,9 para 45,6 ± 15,1 ao final do tratamento, p=0,006). Nenhum dos demais desfechos apresentou melhora estatisticamente significativa, exceto FIQ que teve evolução marginalmente significativa no grupo ativo (62,1 ± 11,5 para 49,2 ± 21,2; p=0,056) e HAQ que evoluiu de 1,51 ± 0,47 para 1,24 ± 0,4 (p=0,0005), todavia sem diferença entre os grupos. Estes resultados reproduzem parcialmente os achados anteriores de melhora da dor com estímulo nãoinvasivo sobre o córtex motor, mas com dimensões menores, em virtude, talvez, da baixa freqüência de estímulos. A falta de ganhos diferenciados nos grupo ativo em outras dimensões da funcionalidade sugere que a estimulação realizada tem efeito específico sobre a dor. Conclui-se que a associação da ETCC à intervenção multidisciplinar pode trazer ganhos somatórios no controle das queixas clínicas da fibromialgia
Transcranial direct current stimulation (tDCS) is a non-invasive technique of cortical brain stimulation which has shown some positive effects on chronic pain control. The main hypothesis of this study was to verify if the association of tDCS to the multidisciplinary approach in patients with fibromyalgia would increase the results for the control of pain and improve quality of life. The study design was a randomized, double-blinded, shamcontrolled clinical Trial of parallel arms. Twenty tree women with fibromyalgia received the usual treatment with the multidisciplinary approach and drugs, and were randomly allocated in a group with 2mA anodic tDCS for 20 minutes over the left primary motor cortex and the cathode was positioned over the right supra-orbital region. Another group with sham stimulation, with the same electrode positioning, had the electric current interrupted within 1 minute from of stimulation and remained off during the remaining 19 minutes. Stimulations occurred weekly for 10 weeks, always before the multidisciplinary intervention. Pain was rated at the begging of the treatment and after its end by the visual analogue scale (VAS) e pressure dolorimetry on fibromyalgia tender points. Quality of life was evaluated with the Fibromyalgia impact questionnaire (FIQ) and SF-36. As possible confounders, humor and functional capacity were evaluated with Beck depression index (BDI), Hamilton scale (HAM) and HAQ. There were no serious adverse effects. There was a significant improvement in the Pain domain of SF-36, with significant effect only in the group under active tDCS (from 26.6 ± 12.9 to 45.6 ± 15.1 in the end of the treatment, p=0.006). Any of the other outcomes showed statistically significant improvement, except for FIQ, which presented with a marginally significant improvement in the active group (62.1 ± 11.5 to 49.2 ± 21.2; p=0.056) and HAQ (1.51 ± 0.47 to 1.24 ± 0.4; p=0.0005), without any difference in both groups. These results partially reproduce previous findings of pain improvement with non-invasive stimulation of the motor cortex, however with smaller effects, maybe due to the use of a reduced weekly frequency of stimuli. The lack of differential gains in the active group in other dimensions of functioning suggests the used stimulation be specifically effective for pain. The conclusion is that the association of tDCS to the multidisciplinary approach may bring additional improvement in the control of pain in fibromyalgia

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Santos, Sérgio Vilas Boas. "A readaptação funcional aplicada aos policiais federais: reflexões sobre seu alcance, limites e funcionalidade." Universidade Catolica de Salvador, 2015. http://ri.ucsal.br:8080/jspui/handle/123456730/181.

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A readaptação funcional é a volta do trabalhador ao seu posto de trabalho em funções compatíveis com as limitações que eventualmente tenha adquirido em seu labor. No serviço público é a investidura do servidor em cargo de atribuições e responsabilidades compatíveis com a limitação que tenha sofrido em sua capacidade física ou mental, em síntese um direito social. O presente trabalho, aborda o estudo do real alcance da readaptação, assim como, sua funcionalidade e eventuais óbices a sua aplicação, diante da singularidade do ofício policial, incluindo noções de risco, sofrimento e meio ambiente de trabalho e aqui representada pela categoria dos policiais federais. Apesar de um direito estatutário consolidado em lei, a operacionalidade deste instituto (readaptação funcional), quando aplicada a estes servidores, acusam limites e dificuldades que ainda não foram totalmente transpostas. Para confirmar esta afirmação, esta pesquisa analisou as abordagens literárias sobre a readaptação funcional, compreendendo a sua origem e evolução na legislação brasileira, cotejando-a com o entendimento do ofício policial e algumas particularidades que tocam o tema. Para isto realizou um estudo de caso de abordagem qualitativa. Estas análises partiram basicamente de dados coletados em documentos: bibliografias, bases de dados de órgãos públicos, processos administrativos e judiciais e demais pareceres de órgãos de controle interno. Ao final esta pesquisa identificou importantes marcos legais que proporcionam um cenário favorável a readaptação funcional aplicada aos servidores desta carreira, o que, infelizmente também não impediu de constatar a existência de uma dubiedade interpretativa, uma espécie de inabilidade dos gestores responsáveis em apropriar-se da atual noção e importância da readaptação funcional como forma de valorização profissional e de inclusão social no trabalho. A relevância desta pesquisa, portanto, está na peculiaridade do tema proposto, no chamamento e alerta à saúde destes profissionais e na possibilidade de uma nova percepção e abordagem sobre a readaptação funcional como direito estatutário amplo e irrestrito a toda categoria profissional, para tal desiderato, este estudo focou-se nos servidores da segurança pública no âmbito federal.
Functional rehabilitation is the return of the worker to his job in compatible with the constraints which it may have suffered in their work roles. In public service is vested in the office of server roles and responsibilities consistent with the limitation that has suffered in his physical or mental ability, in short a social right. The present work deals with the study of the actual scope of rehabilitation, as well as their functionality and possible obstacles to its implementation on the uniqueness of the police office, here represented by the category of the federal police. Although a consolidated statutory right by law, the operation of this institute (functional adaptation), when applied to these servers, accuse limits and difficulties that have not yet fully transposed. To confirm this assertion, this paper analyzed the literary approaches to functional adaptation, including its origin and evolution of Brazilian legislation, comparing it with the understanding of the police office, and some particulars touching the subject. For this case study conducted a qualitative approach. These analyzes basically left data collected from documents, bibliographies, databases of public institutions, administrative and judicial opinions, and other organs of internal control. At the end of this research identified important legal frameworks that provide a favorable environment to functional adaptation applied to this career servers, which unfortunately did not prevent him from establishing the existence of an interpretive ambiguity, a sort of inability of managers responsible for appropriating current notion and importance of functional adaptation as a form of social inclusion at work. The relevance of this research, therefore, is the peculiarity of the proposed topic, the call and warning to health professionals and those in the possibility of a new perception and approach on functional rehabilitation as broad and unfettered statutory right the entire profession, to this aim, this study focused on public safety servants at the federal level.

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Guêné, Vincent. "La place du travail dans l’activité des ergothérapeutes : des dilemmes de métier : le cas d’un « atelier geste professionnel » dans un programme multidisciplinaire de rééducation." Thesis, Angers, 2018. http://www.theses.fr/2018ANGE0044/document.

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Ce travail de thèse trouve son origine dans une intervention menée auprès du collectif d’ergothérapeutes du centre de rééducation François Gallouedec. Il prend pour objet les dilemmes de métier de ces professionnels lorsqu’ils sont confrontés à la question du travail des patients. L’intervention s’est déployée en suivant une méthodologie développementale propre à la clinique de l’activité. Elle a permis aux ergothérapeutes de prendre pour objet d’analyse leur propre travail lors de programmes de restauration fonctionnelle. La littérature sur ces programmes confirme le choix de s’intéresser aux ergothérapeutes comme principaux destinataires des questions professionnelles des patients. Cependant, les recherches dans le domaine tendent à éluder la question du travail des professionnels de santé et à résumer celui des patients au simple retour à l’emploi.C’est justement pourquoi il nous a semblé intéressant de renverser la question en nous intéressant au travail de ceux qui s’intéressent au travail. Nous avons émis l’hypothèse que ce point difficile confrontait les ergothérapeutes du centre François Gallouedec à des dilemmes de métier notamment lors de la réalisation d’un « atelier geste professionnel ». Les résultats de cette recherche montrent toute l’importance de s’intéresser au travail des professionnels de santé, ce qui est fait mais aussi ce qui n’est pas fait ou ce qu’on aurait voulu faire, pour le développement des modèles de prise en charge des patients. Le réel du travail des rééducateurs peut ainsi devenir une ressource dans la mise en place de programmes de rééducation qui souhaitent s’intéresser à la question du travail du patient
This thesis work originated in an intervention conducted with the collective of occupational therapists of the rehabilitation center François Gallouedec. It focuses on the job dilemmas of these professionals when confronted with the issue of patient’s work.The intervention was deployed following a developmental methodology specific to the clinic of the activity. It allowed occupational therapists to take their own work as an object of analysis during functional restoration programs. The literature on these programs confirms the choice to focus on occupational therapists as the primary addressee for patients' professional issues. However, research in the field tends to evade the question of the work of health professionals and to summarize that of patients simply returning to employment. This is why we felt it necessary to focus on the work of those who are interested in work. We hypothesized that this difficult point confronted the occupational therapists of the François Gallouedec center with job dilemmas, particularly during the realization of a "professional gesture workshop". The results of this research show the importance of taking an interest in the work of health professionals, which is done but also what is not done or what we would have liked to do, for the development of models of patient care. The real work of there educators can thus become a resource in the implementation of rehabilitation programs that wish to be interested in the question of the work of the patient

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Kershaw, Kerri Maxine. "Multidisciplinary rehabilitation in prison : a values, interests and power analysis." Thesis, 2005. https://vuir.vu.edu.au/15617/.

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Over the last twenty years the Victorian justice system has recognized that incarceration of offenders alone does little to rehabilitate prisoners. As a result, it has implemented additional therapeutic programs within prisons. This has resulted in an influx of therapists into prisons and created two distinct work groups with no historical working culture. As research suggests that rehabilitation works best when officers and therapists are united, the present investigation involved interviews with twenty three therapists and twenty one prison officers. All participants have had experience with dedicated rehabilitation programs in Victorian prisons. A qualitative research approach was used, with a particular focus on the role that values, interests and power played in participants' encounters with conflict.

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Lee, Hsiao-Chin, and 李小菁. "Cost effectiveness of a multidisciplinary rehabilitation model in hip fractured elderly patients with internal fixation operation." Thesis, 2004. http://ndltd.ncl.edu.tw/handle/41735956229221943634.

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碩士
長庚大學
護理學研究所
92
The purpose of this study to compare the cost and effectiveness of a multidisciplinary rehabilitation model and conventional model in hip fractured elderly patients with internal fixation operation. The study design was secondary research. The third party payer was the analytic perspective. The data source was from Shyu’s research program, which was conducted a randomized controlled trial of multidisciplinary model at a medical center in northern Taiwan, and funded by the National Health Research Institute, Republic of China in 2001/2003. A total of 40 patients was identified as study samples, 22 were in experimental group (multidisciplinary rehabilitation model) and 18(conventional model) were in control group. The results showed as follows: (1) The cost of treatment up to 3 months after discharge was estimated at NT$ 48,820 per experimental patient and NT$ 44,567 per control patient, and the differences between groups was significant (p=0.048). (2) The performed rates of transferring, bathing, walking and climbing stairs were higher on experimental group than control group, and there was significant differences between two groups in “climbing stairs” (p=0.01). In general activity function, the experimental group had greater functional status than control group (p=0.013). (3)The cost-effectiveness ratio was lower on experimental group than control group under the base line which discounting rate was 5% and the effectiveness was defined as whether the patient returned to independent living or activities of lower limbs was 40 points. The outcomes didn’t change of changing discounting rates and effectiveness criterion during sensitivity analysis. The sensitivity analysis still concluded the multidisciplinary rehabilitation model was more cost-effective than the conventional group. The findings could provide as a reference for health care providers to develop specific interventions for hip fractured elders and related studies.

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KOLEVOVÁ, Tanja. "Využití konceptu koordinované rehabilitace v domově pro seniory." Master's thesis, 2018. http://www.nusl.cz/ntk/nusl-376634.

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This diploma thesis deals with co-ordinated rehabilitation and its use in retirement home specifically in the Center of social services Staroměstská in České Budějovice. It is important to use a co-ordinated rehabilitation concept for achievement of high service quality which means better life quality for pensioners. Co-operation within multidisciplinary team is essential during comprehensive rehabilitation for all persons. The goal of this diploma thesis was to found out how retirement home uses individual components of co-ordinated rehabilitation concept. The principal research question was: How much are employees of retirement home informed about co-ordinated rehabilitation concept? For research was chosen retirement home in the Center of social services Staroměstská in České Budějovice. There were eight employees of this institution participated in the research. It was used method of questioning and half-structured interview technique. Retirement home in the Center of social services Staroměstská uses all aspects of co-ordinated rehabilitation concept. Particularly they utilize medical rehabilitation and social rehabilitation. Most of workers is well-informed about co-ordinated rehabilitation concept. Some of them do not know certain terms. However after explaining of these terms they prove good knowledge of this issue. The employees have satisfactory overview not only about rehabilitation which is directly their scope of working activity but also about other components of co-ordinated rehabilitation. The workers are perfectly informed about medical rehabilitation. They are also mostly satisfied with co-operation in multidisciplinary team. This kind of co-operation takes place at any time of a need or during the meetings or at individual scheduling. The results of this diploma thesis may help to retirement home in the Center of social services Staroměstská in České Budějovice to evaluate the usage of co-ordinated rehabilitation during elderly care. It might also show the measure of co-operation of multidisciplinary team members. This diploma thesis may help to anybody who is interested in specific retirement home or in co-ordinated rehabilitation in general.

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Hoznauerová, Viola. "Multidisciplinární přístup při sanaci rodiny." Master's thesis, 2014. http://www.nusl.cz/ntk/nusl-333040.

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The theoretical part of this diploma thesis aims to summarize the basic information about rehabilitation of a family as a relatively new phenomena in Czech social work with families. Firstly I describe according to a disposable literature functions of a family, its importance to a child as well as the most common problems a family can face. Than I place rehabilitation of a family as an approach into the Czech system of care of vulnerable children and describe disadvantages of the current system. Lastly I decribe the characteristics of rehabilitation of a family as a multidisciplinary approach to family social work. The empirical part of this thesis is based on semi-structured interwievs with profesionals in the field of rehabilitation of a family as well as clients of family rehabilitation services. It aims to find out how can we use educational activities when working with families in danger of social failure. KEY WORDS: family rehabilitation, multidisciplinary approach, families in danger of social failure, case conference Powered by TCPDF (www.tcpdf.org)

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PRÁŠKOVÁ, Anna. "Koordinovaná rehabilitace a její realizace v organizacích pomáhajících osobám po poškození mozku v Českých Budějovicích." Master's thesis, 2018. http://www.nusl.cz/ntk/nusl-376635.

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This thesis concerns with the functioning of coordinated team co-operation in organizations which provide social services to persons after acquired brain injury. Due to the frequency of occurrence and its deadful impact, these injuries become one of the most serious diseases not only in the Czech Republic but in the world. A person who has suffered brain injury is struggling with a number of socio-economic changes. A precondition for achieving full social integration of this individual is to ensure timely care and cooperation of individual experts on the given case. Such cooperation among experts is often missing in interconnected organizations. This can cause slowdown of the process of integration of an individual back to their everyday life. Equally important is the cooperation with family members who have an irreplaceable influence on the rehabilitation. The thesis is divided into two parts - theoretical and research. The theoretical part focuses on the consequences of acquired brain injury as well as on the the possibilities of social security provided by the state. Also, much of the text concerns with the coordinated rehabilitation and multidisciplinary collaboration which has a significant impact on improving the quality of life of people after brain injury. The data collection was carried out with the help of the method of qualitative research strategy, the technique of semi-structured interview with social workers in organizations of the city of Ceske Budejovice who provide social services according to Act 108/2006 Coll., on social services, as amended. The research is aimed at finding out how the coordinated rehabilitation is implemented in social services working with persons after acquired brain injury and then to create a proposal to streamline the implementation of coordinated rehabilitation in these organizations. Following the objectives, two research questions were examined: Which experts are involved in coordinated rehabilitation in social services providing services to people after brain injury? How is the cooperation of the team working with people after brain injury implemented? The data was processed in Atlas.ti 7. The research was carried out within the successfully accepted project at the Faculty of Health and Social Sciences, called Coordinated rehabilitation of patients with brain injury (reg. No. GAJU 138/2016/S), funded by the Grant Agency of the University of South Bohemia. The research results show insufficient cooperation of experts in social services providing care to persons with acquired brain injury. In spite of an acute need of coordinated and multidisciplinary support to such persons, the organizations miss specific professionals or employ workers who carry out works of other professions without the necessary qualification. The time, organizational and financial demands of teamwork make it impossible to provide high-quality multidisciplinary care, which is an important precondition for reintegration of people with brain injury back into work and social life. Team multidisciplinary cooperation brings a lot of positives, on the other hand, it also encounters barriers, which need to be further discussed in order to come to suitable solutions that are not only in the interest of the client and his family, but also great for the whole multidisciplinary team.

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PANSKÁ, Jana. "Možnosti realizace konceptu koordinované rehabilitace u osob s Alzheimerovou chorobou." Master's thesis, 2018. http://www.nusl.cz/ntk/nusl-386661.

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This thesis is focused on concept of coordinated rehabilitation within individuals in care of Alzheimer's disease. Objective of the thesis is to find out the possibilities of coordinated rehabilitation in the current concept of care for people with Alzheimer's disease. The thesis divided to two parts. The first part is focused on Alzheimer's disease, which describes what Alzheimer's disease is, its history, course, epidemiology, its risk factors, symptoms of how Alzheimer's disease is diagnosed and how it is treated. Another part of the theoretical part is dementia, where it is briefly described, what is the disease and other forms and division of dementia. The third and final part of the theoretical part is coordinated rehabilitation. This part describes what is a coordinated rehabilitation, its individual components and the conclusion of a specific activity that is used in a coordinated rehabilitation for people suffering from Alzheimer's disease. The research part of this work is focused on its objective and research questions, the methodology, results, discussion and conclusion are described. The qualitative research method was used in the research part. The technique for obtaining data for this research was a semi-standardized interview that was carried out with residential and outpatient staff providing services to people suffering Alzheimer's disease. The informants were selected by the method of deliberate selection. The data was then processed in Atlas.ti 7. In order to achieve the objective of this work, which is already mentioned above, two research questions have been determined. The first research question was focused on the differences in perception and the possibilities of using components of coordinated rehabilitation in residential and outpatient care for people with Alzheimer's disease. The second research question was focused on how the system of coordinated rehabilitation for people suffering Alzheimer's disease is most limited. The results of my work show that care for people suffering from Alzheimer's disease is insufficiently applied within the coordinated rehabilitation because the vast majority of practitioners who deal with such ill persons every day have no knowledge of this concept.

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Billson, John Henry. "Effect of an aggressive versus conservative, multi-modal rehabilitation programme on chronic lower back pain." Thesis, 2011. http://hdl.handle.net/2263/29008.

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Low back pain has become one of the most influential musculoskeletal diseases of modern society. It is one of most expensive diseases in terms of medical costs and increased worker absenteeism, which can lead to permanent disability and places strain on the economy as a whole. Pain has been recognised as a disease in itself, which has certain consequences when it becomes chronic. Many kinds of treatment options exist with varying degrees of success. The question is thus which treatment option is the most favourable and cost-effective. Conservative treatment is the most recommended form of treatment when no serious underlying diseases are present. Exercise has been shown to be very effective in the treatment of chronic low back pain but there are still questions regarding the use of exercise therapy. The predetermined goal of the study was to ascertain whether an aggressiveprogressive exercise programme, and specifically what kind of exercises, would be more effective in the treatment of chronic low back pain. This was achieved through a number of steps, which included an extensive literature review, the identification of an appropriate test battery with related minimum physical requirements and cut scores, subject recruitment and screening of subjects, the implementation of the intervention and the subsequent re-testing of the subjects. Once the data was completed, the next step was to make use of two case studies to assist in illustrating the effectiveness of individual patients compared to the sample as a whole. These case studies were of patients who completed the entire programme but one took longer to complete the programme. This assists in illustrating the value of maintaining exercise protocol. The results from the present study are extremely positive. The two case studies provided a glimpse of the potential value that could be added through the implementation of more aggressive-progressive exercise interventions in the treatment of chronic low back pain. The final product will greatly assist exercise therapists concerned with the treatment of chronic low back pain along with cognitive-behavioural techniques. Hopefully this study will provide insight into managing chronic low back pain in South Africa from an exercise standpoint. Secondly the study will provide practical techniques to implement in an era in which economic difficulties are rife.AFRIKAANS: Laerugpyn het een van die invloedrykste muskuloskeletale siektes van die moderne samelewing geword. Dit is een van die duurste siektes in terme van mediese koste en verhoogde siekverlof deur werkers, wat kan lei tot permanente ongeskiktheid en ’n verhoogde las plaas op die ekonomie as ’n geheel. Pyn word erken as ’n siekte op sy eie wat sekere gevolge het wanneer dit chronies begin raak. Verskeie soorte behandelingsopsies is beskikbaar met variërende grade van sukses. Die vraag is dus watter behandelingsopsie is die bruikbaarste en koste-doeltreffendste. Konserwatiewe behandeling is die mees aanbevole metode van behandeling wanneer daar geen ernstige onderliggende siektetoestande teenwoordig is nie. Dit is reeds bewys dat oefening baie doeltreffend is in die behandeling van chroniese laerugpyn. Daar bestaan egter steeds vrae rondom die gebruik van oefening as terapie.Die vooropgestelde doelwit van die studie was om te bepaal of ’n aggressiewe-progressiewe inoefeningsprogram doeltreffend sal wees in die behandeling van chroniese laerugpyn, en meer spesifiek watter tipe oefening die doeltreffendste sal wees. Die navorsing het bestaan uit ’n paar stappe wat ingesluit het ’n intensiewe literatuursoektog, die identifisering van ’n gepaste toetsbattery met verwante minimum fisieke vereistes en afsnytellings, die verkryging en evaluering van proefpersone, die implementering van die intervensieprogram en die daaropvolgende hertoetsing van die proefpersone.Nadat die invordering van die data en die gepaardgaande analise van die data voltooi is, was die volgende stap om gebruik te maak van twee gevallestudies ten einde die doeltreffendheid van die intervensieprogram vir individuele proefpersone te ilustreer deur dit te vergelyk met die groep as ’n geheel. Die twee gevallestudies was van proefpersone wat die intervensieprogram volledig voltooi het, alhoewel die een proefpersoon langer geneem het om die intervensieprogram te voltooi. Dit help om die navolgingswaarde van ’n inoefeningsprotokol te illustreer. Die resultate van die huidige studie is uiters positief. Die twee gevallestudies gee ’n mate van insig wat betref die potensiële waarde wat verkry kan word deur die implementering van ’n meer aggressiewe-progressiewe inoefeningsintervensie vir die behandeling van chroniese lae rugpyn. Die finale produk sal die nodige ondersteuning aan oefeningsterapeute bied wat onseker is oor die behandeling van chroniese laerugpyn deur middel van aggressiewe-progressiewe inoefeningsintervensies en kognitiewe gedragstegnieke. Hierdie studie sal dus die begrip en insig van die behandeling van chroniese laerugpyn in Suid-Afrika verhoog vanuit ’n oefeningsuitgangspunt. Tweedens sal die studie die gebruik van praktiese oefentegnieke aanmoedig in ’n era waarin ekonomiese tye moeilik is.
Thesis (DPhil)--University of Pretoria, 2011.
Biokinetics, Sport and Leisure Sciences
unrestricted

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PECHOUŠKOVÁ, Kateřina. "Potřeby pacientů po poškození mozku." Master's thesis, 2017. http://www.nusl.cz/ntk/nusl-364548.

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This diploma thesis is a part of the GAJU project entitled "Coordinated rehabilitation of patients with brain injury (reg. number GAJU 128/2016/S)". At the time when the thesis was elaborated, only the patients who suffered the cerebrovascular accident were engaged in the project, since in the hospital, no suitable patient after brain injury who would need a multidisciplinary team in home care had ever been sought. The selection of the patients was based on the communicative skills criteria e.g. if the skills to participate in the directed conversation based on the Functional Independence Measure Questionnaire (FIM), WHO Disability Assessment Schedule 2.0 and the follow-up questions concerning social issues, physiotherapeutic methods and techniques were preserved. Within the framework of the project, the research has not been finished yet. Given the above mentioned reasons, this thesis is therefore mainly focused on the identification of patients' needs after the cerebrovascular accident (CVA), on the period starting from its first incidence during the first three months period after the discharge from the hospital to home care. The complex results will be presented as a part of the publication activity of the project. The thesis comprises a theoretical and a practical part. The theoretical part presents a comprehensive view on the care for the patients who suffered the cerebrovascular accident. I addressed both the basic characteristics of the cerebrovascular accident and the organisation of the care for the patients in the Czech Republic; furthermore, the coordinated rehabilitation team, the role of a social worker, possibilities of social help provided by the welfare system to patients and their families, and the psychical condition of the patient. In the last chapter, I outline the general concept of human needs according to A. Maslow and describe important needs of the sick people. As far as the research part is concerned, my goal is to identify the needs of patients in home care after the brain injury. In connection with the aim of the thesis, two research questions were defined. The first question is: "What are the needs of the patients after brain injury?". The second question is: "What is the role of a social worker in meeting the needs of a patient with brain injury?" The qualitative research strategy was used; the instructional dialogue technique with patients after brain injury in the South Bohemia Region within the project. When analyzing the data collected from the patients during the first three months after the discharge from the hospital to the home care, seven major patient needs emerged need of help, need of psychical equilibrium, need of self-reliance, need of being without paint, need of recovering to the condition before CVA incidence, and need of establishing a new system of activities. Two of these needs, the need of recovering to the condition before CVA incidence and the need of establishing a new system of activities could be considered as principal, because the other needs are in general heading towards them. Furthermore, the analysis of the results showed the role of a social worker by means of which these needs can be saturated The results of the present thesis are used as a partial part from which the complex results of coordinated rehabilitation of patients after brain injury of the GAJU project are complied. The needs analysis of patients brought the proposals of dealing with/saturation of these needs and therefore had a direct impact on the lives of the respondents. The results of the research will become a part of the publication outputs of the above-mentioned projects.

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Sousa, Jéssica Filipa Ferreira de. "Psicologia & Medicina Física e de Reabilitação: da literatura à prática hospitalar." Master's thesis, 2018. http://hdl.handle.net/10284/7104.

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A Medicina Física e de Reabilitação (MFR) é uma especialidade médica focada na reabilitação como estratégia de saúde, que inclui no seu processo o diagnóstico e o tratamento de patologias (Amorim, 2010). A eficácia da MFR ocorre através da implementação e integração de intervenções a nível biomédico, psicológico, comportamental, educacional, entre outros (União Europeia de Médicos Especialistas [UEMS], 2009). A Psicologia, como ciência que estuda as interações de um indivíduo com o ambiente envolvente, desempenha um papel fulcral na avaliação, prevenção, tratamento e reabilitação de disfunções psicológicas em indivíduos com doenças físicas (Trindade & Teixeira, 1998). Para isso, os psicólogos mantêm um papel ativo nas equipas multidisciplinares, interdisciplinares e transdisciplinares, particularmente nos domínios comportamental, cognitivo, emocional e de gestão de papéis associados com a forma como os indivíduos continuam a sua vida (Peduzzi, 2001). Apesar da escassez de informação sobre a associação destas duas áreas da saúde, existe documentação científica sobre patologias transversais à MFR e à Psicologia, tais como Acidente Vascular Cerebral (AVC), Traumatismo Crânio Encefálico (TCE), e depressão. Motivado pelas evidências sobre a efetividade da intervenção psicológica na redução dos custos com os serviços de saúde, o presente estudo procura contribuir para o aumento do conhecimento nesta área, promovendo o reconhecimento da importância do papel da Psicologia na MFR, direcionado para a avaliação e intervenção junto da população que a MFR atende. A presente dissertação é constituída por dois artigos. O primeiro apresenta uma revisão sistemática da literatura, referente ao período 2000-2017, recorrendo à SciELO, B-ON e PubMed, de modo a determinar em que áreas da saúde a Psicologia e a MFR produzem desfechos benéficos para os indivíduos quando trabalham em conjunto. O segundo artigo, com abordagem quantitativa, apresenta a caracterização sociodemográfica e clínica de 66 adultos que procuraram atendimento nas unidades de Psicologia e de MFR do Hospital-Escola da Universidade Fernando Pessoa, no ano de 2016, através da análise documental, sem acesso aos utentes e garantindo o seu anonimato. Globalmente, não houve total convergência entre os resultados dos dois estudos realizados. A revisão sistemática apontou que as duas unidades de saúde estudadas tornam-se de primordial importância na melhoria da qualidade de vida de utentes com AVC, TCE e incontinência urinária. O estudo empírico revelou as perturbações de humor como a principal patologia transversal, com maior incidência no sexo feminino, entre os 52 e os 61 anos. Os resultados obtidos podem contribuir para definir estudos que explorem a necessidade de avaliação de rotina de variáveis, como a dor, e de avaliações periódicas das intervenções, bem como a pertinência de integrar novos modos de intervenção (p.e., psicoeducação em grupo, fornecimento de materiais escritos ou em áudio).
Physical Medicine & Rehabilitation (PMR) is a medical speciality that is based on rehabilitation as a health strategy, which includes the diagnosis and treatment of pathologies (Amorim, 2010). The effectiveness of PMR occurs through the implementation, application and integration of interventions at the biomedical, psychological, behavioural and educational levels, among others (União Europeia de Médicos Especialistas [UEMS], 2009). Psychology, as the science that studies the interactions between individuals and the environment, plays a core role in the prevention, evaluation, treatment and rehabilitation of psychological dysfunctions in patients with physical illness (Trindade & Teixeira, 1998). To achieve that, psychologists maintain an active role in multidisciplinary, transdisciplinary and interdisciplinary teams, particularly on the behavioural, cognitive, emotional and role management domains associated with the way individuals continue their lives (Peduzzi, 2001). Despite the scarcity of information associated with these two areas of health, it is nowadays possible to find scientific documentation regarding pathologies transversal to PMR and Psychology, such as stroke, traumatic brain injury (TBI) and depressive disorder. Motivated by evidences related to the effectiveness of psychological intervention in reducing costs with health services, the present work seeks to seeks to contribute to the increase of knowledge in this area, promoting the importance of the role of Psychology in the treatment of PMR, directed to the creation of strategies of evaluation and intervention with this population. The present dissertation consists of two articles; the first presents a systematic review of the literature, between the years 2000 and 2017, using scientific databases (SciELO, B-ON, and PubMed) to determine in which areas of healthcare Psychology and PMR produce beneficial outcomes for individuals when working together; the second article presents a sociodemographic and clinical characterization, performed through a documental study with a quantitative approach, of 66 adults who sought care in the Psychology and PMR services in the HE-UFP, in the year 2016. The study does not involve access to participants, since it is based exclusively on the documental analysis, with the extraction of data (coded to ensure anonymity) on variables of interest (sociodemographic, and clinical), and therefore the application of any instruments is not involved. Overall, there was no complete convergence between the results of the studies presented. The systematic revision indicated that the two health units studied are extremely important in the quality of life improvements in patients who suffered from a stroke, TBI, and urinary incontinence. The characterisation study of the users points out the mood disorders as the main transversal pathology, with a higher incidence in the female genre, aged between 52 and 61 years. The obtained results can define the path for studies that evaluate the need for routine evaluation of variables, such as pain, and periodic evaluations of interventions, as well as the pertinence of integrating new modes of intervention (eg. Psychoeducation in group, the supply of written materials, or audio).

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KASTNEROVÁ, Tamara. "Sociálně aktivizační služby a jejich etická reflexe." Master's thesis, 2012. http://www.nusl.cz/ntk/nusl-137551.

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This thesis focuses on the explanation of the concept of social activation services for families with children and touches on the concept of family rehabilitation with which social activation services are associated. It also discusses frequent and less frequent questions and problems, which are deal with by this service and it explains how these problems arise. Using specialized literature and the experience of family support center staff, it characterizes specific work of social activation services, such as the program of the preparation for the return to family and to home, family rehabilitation inside the frame of preliminary measures, social work with families, who have the described problems and basic characteristics of multidisciplinary teams. The goal of this thesis is to critically reflect work of social activation services on the basis of some ethical principles and ethical codes of social workers, with the help of the Center of family support in Aš. Thanks to this reflection it is trying suggest possible ways of solving every day work of social activation services.

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MATĚJKOVÁ, Andrea. "Koordinovaná rehabilitace z pohledu pacienta po poškození mozku a členů multidisciplinárního týmu." Master's thesis, 2018. http://www.nusl.cz/ntk/nusl-386666.

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Abstract This diploma thesis aims to describe coordinated health rehabilitation of people after severe brain injury provided by multidisciplinary team within home environment. It comprises both theoretical and practical part. The theoretical part presents the history and development of coordinated rehabilitation services and the function of multidisciplinary team. Furthermore, it characterizes a brain injury in more details. The practical part was carried out by means of qualitative research strategy semi structured interview. The first part of the research was aimed at the interviews with clients after brain injury and cerebrovascular accident. The interviews started after three months from entering the project and were realized by social workers. Its main propose was to evaluate the care of multidisciplinary team. Clients were questioned about work, time, communication and co-operation of individual experts involved in the process of recovering. The second part of the research used a method called focus group, where 12 members of the team were involved. The goal of the research was to describe how the multidisciplinary team works from both the point of view of a patient after the brain injury and the members of the multidisciplinary team within the project GAJU. The GAJU project is entitled "Coordinated rehabilitation of patients with brain injury (reg. number GAJU 138/2016/S)". The selection of patients was based on the communicative skills criteria e.g. skills to participate in the directed conversation based on the FIM and WHODAS and the follow-up questions concerning social issues, physiotherapeutic and ergo therapeutic methods and techniques. To achieve the aim of the diploma thesis two research questions were defined: "How is the function of multidisciplinary team perceived by clients involved in GAJU project?" and "How is the function perceived by the members of multidisciplinary team involved in GAJU project who put the coordinated rehabilitation into practice?" It was found out that after the discharge from a hospital being with family members was the most important. Besides, multidisciplinary team who regularly commuted to clients helped them. The members of the team were physiotherapists, ergo therapists, social workers and doctors. In view of the fact that physiotherapist attended the client the most frequently, the function of this expert is perceived as crucial during recovery. No less important is ergo therapist who is useful concerning motor activity and presenting various tools and aids leading to improvement. Social worker is apprehended rather as a psychological or informative support. Positively valued is attending clients at home, interconnection of the team members and the progress of the client from all points of view. On the other hand the lack of working experience of some team members is pointed out. Additionally, some clients were not satisfied that the data were collected by means of questionnaires.

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SOUKUPOVÁ, Věra. "Uplatnění Vojtovy metody v rámci uceleného systému rehabilitace v centru ARPIDA v Českých Budějovicích." Master's thesis, 2011. http://www.nusl.cz/ntk/nusl-54529.

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The diploma thesis at hand aims to find out to what extent Vojta method can stimulate child?s ability to receive and actively participate in other means of the comprehensive rehabilitation system. The diploma thesis observes application of Vojta method within the comprehensive system of rehabilitation provided in ARPIDA in České Budějovice. The diploma thesis is divided into two parts. The theoretical part deals with the current state of the issue in question, provides characteristics of individual means of the comprehensive system of rehabilitation, and acquaints the reader with the technique named reflex locomotion, which is referred to as the Vojta method. The practical part comprises of two chapters. The first chapter provides the reader with a description of the selected facility. The second chapter introduces case reports of the clients completed with analyses of interviews held with parents and other members of the multidisciplinary team. Using the mentioned materials, the author produced six case reports of selected clients of ARPIDA centre. Five out of six observed clients were diagnosed with infant cerebral palsy in different forms with combined defects. For the purposes of the diploma thesis, the author used the method of qualitative research. The practical part is based on analyses of medical records and personal documentations of selected clients of ARPIDA centre; author?s own direct observation; analyses of interviews held with parents and other members of the multidisciplinary team; and observations made by the author while performing her duties as a physiotherapist. Finally, it was concluded that application of Vojta method is necessary within the comprehensive system of rehabilitation which strives to reduce the effects of the disability and improve the quality of life in subjects with the said disability. The author?s own research was designed to verify the findings learned from the literature reviewed for the purposes of the theoretical part. The conclusion of the practical part contains a summary of results, assessment of accomplished goals; and research outcomes and recommendations. The thesis may be found useful by both experts and students who have professional interests in the issue; yet, it should also be made available to the members of the multidisciplinary team as a feedback.

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Monteiro, Madalena Henriques. "Abordagem multidisciplinar em cuidados geriátricos." Master's thesis, 2020. http://hdl.handle.net/10316/94257.

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Dissertação de Mestrado em Geriatria apresentada à Faculdade de Medicina
O envelhecimento populacional a que assistimos atualmente, resultado da melhoria das condições sociais e dos avanços técnico-científicos, deve fazer repensar a forma como os cuidados médicos são proporcionados. Como se verifica noutros países ocidentais, o fenómeno da transição epidemiológica traduz-se na carga de doença ser atribuída essencialmente às doenças crónicas não transmissíveis em detrimento das doenças infeciosas, sendo atualmente a principal responsável pela morbimortalidade e aumento dos encargos económicos em saúde. Perante esta realidade inevitável, cabe-nos antecipar e prever as necessidades especiais desta população e adotar medidas para intervir de forma precoce e preventiva e encontrar soluções adequadas às particularidades desta população não só a nível físico, mas também psicológico, funcional e social. Nos últimos anos tem sido demonstrado que prevenir e atuar sobre os fatores de risco tem um impacto na história natural das doenças crónicas. A Geriatria surge como a melhor forma de dar resposta às necessidades de um país que envelhece, com um número crescente de idosos com pluripatologia, polifarmácia e limitação funcional. Tem em consideração igualmente que a abordagem multidimensional e multidisciplinar traz ganhos em saúde para o doente idoso, com o objetivo final de potenciar a sua autonomia e independência, melhorar o seu bem-estar e qualidade de vida. O presente relatório de estágio pretende descrever as atividades realizadas durante o estágio clínico na Unidade de Ortogeriatria do Hospital São Francisco Xavier e no Hospital do Mar, num total de 400 horas realizadas em 2018 e 2019. Tem como objetivo a conclusão do Mestrado em Geriatria da Faculdade de Medicina da Universidade de Coimbra e pretende refletir de forma minuciosa a caracterização de cada serviço, a metodologia de trabalho usada e a caracterização estatística dos doentes observados.
The population aging that we are currently witnessing results from the improvement of social conditions and technical-scientific advances should make us rethink the way medical care is provided. As seen in other western countries the phenomenon of epidemiological transition translates into the burden of disease being attributed essentially to chronic noncommunicable diseases to the detriment of infectious diseases, being currently the main responsible for health morbidity and increased economic burdens in. Faced with this inevitable reality, we must anticipate and foresee the special needs of this population and adopt measures to intervene early and preventively and find solutions appropriate to the particularities of this population not only physically, but also psychological, functional and social. In recent years it has been demonstrated that preventing and acting on risk factors has an impact on the natural history of chronic diseases. Having this into consideration Geriatrics emerge as the best way to respond to the needs of an aging country with an increasing number of elderly people with pluripathology, polypharmacy and functional limitation. Also taking into account that a multidimensional and multidisciplinary approach brings health gains to the elderly patient, with the ultimate goal of enhancing their autonomy and independence, improving their well-being and quality of life. The present internship report describes how activities were carried out during the clinical internship at the Orthogeriatrics Unit of Hospital São Francisco Xavier and Hospital do Mar on a total number of 400 hours held in 2018-2019. The report aims the conclusion of a Master’s degree on Geriatrics at the University of Coimbra and it intends to describe each geriatric medical service, the work methodology used and the statistical characterization of the patients observed.

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Sládková, Petra. "Funkční hodnocení motoriky u pacientů s poškozením mozku před zahájením a po ukončení intenzivní rehabilitace (s cílem dosažení obnovy fyziologických funkcí horní končetiny)." Doctoral thesis, 2013. http://www.nusl.cz/ntk/nusl-328204.

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6 Abstract The rehabilitation of patients with brain damage is an interprofessional, complex, intensive, long-lasting and individually oriented process. One frequent consequence of brain damage is hemiparesis, which also causes a disorder of the upper extremity movement pattern. The movement ability of the upper extremity is essential for an individual's self-sufficiency, the performance of common daily activities, and thus for an independent life in a family setting. Special therapeutic rehabilitation approaches should involve the training of new activities, including the motor learning mechanism that activates brain plasticity. A functional reorganization of the motor cortex occurs along with the activation of reserve neurons and the replacement of damaged synapses. One of the aims of this work was to demonstrate, using objective function methods, the possibility of influencing the movement patterns of a paretic upper extremity by means of intensive interprofessional rehabilitation even several years after the brain damage. The second aim was to demonstrate that the monitoring of motor functions in patients after brain damage leads to improved motivation, thereby improving motor functions. A study was conducted among 55 selected patients after brain damage with central hemiparesis who participated in the...

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RATHOVÁ, Lucie. "Využití koordinované rehabilitace v domově se zvláštním režimem." Master's thesis, 2018. http://www.nusl.cz/ntk/nusl-376643.

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The aim of this diploma thesis is to identify options of how to use the systém of coordinated rehabilitation in a home with a special regime. To obtain information I used qualitative research methodology. Semi-standardized interviews served as the research tool. These interviews were carried out with 10 employees of a home with a special regime run by the City Institute of Social Services in Strakonice. The thesis is divided into a theoretical and a practical part. The theoretical part of the diploma thesis focuses on coordinated rehabilitation as a whole, further, it discusses the individual parts of coordinated rehabilitation. Other chapters describe the most frequent client diagnoses within the Home with a special regime, and finally the standards of social service quality are mentioned. The main research question: What are the options of using coordinated rehabilitation in a home with a special regime? Partial research question: Are employees informed about the options of coordinated rehabilitation? For the purposes of the interview I used questions focused on general identification data, questions focusing on the importance of coordinated rehabilitation, multidisciplinary team. Further, I asked about the individual components of coordinated rehabilitation, and finally, how individual planning is carried out. The result of this diploma thesis is a finding that individual components of coordinated rehabilitation are not fully mutually connected. It would be useful to provide employees with suitable courses to complete their missing knowledge. This diploma thesis might serve as a tool for improving care in the Home with a special regime, it might contribute to the Home with a special regime´s employer awareness of coordnated rehabilitiation, and connect it with practice.

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Kučerová, Anděla. "Činnost střediska výchovné péče z pohledu kurátora pro děti a mládež." Master's thesis, 2012. http://www.nusl.cz/ntk/nusl-306890.

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The thesis focuses on the activity of an educational care centre as an institution which provides services for children who show negative signs in their behaviours and prone to develop behavioural disorders, as well as for their families. The centre also offers help to clients of a children and youth curator, whose role, as part of providing social and legal protection, is mentioned in the first chapter. In addition, attention is given to basic principles of a multidisciplinary cooperation and rehabilitation of a family. Another part describes the activity of the centre, an organisation providing preventive educational care for clients, and specific services of the centre. In the practical part the centre activity is portrayed by children and youth curators. The objective of the thesis is to evaluate the benefits of the educational care centre from the point of view of an OSPOD (a government body for social and legal protection of children) employee and asses what opportunities the centre offers when preventing institutional care and as part of rehabilitation of a family with a child who has behavioural issues.

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Baltov, Petko. "Psychosocial factors associated with outcomes for patients undergoing rehabilitation for chronic whiplash associated disorders." Thèse, 2007. http://hdl.handle.net/1866/17646.

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KARAS, Martin. "Význam dětského centra ovlivňující aktivní zapojení rodiče do procesu sanace." Doctoral thesis, 2017. http://www.nusl.cz/ntk/nusl-364746.

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The present thesis is concerned with the Importance of Children's Centres influencing an active involvement of the family in the remediation process, a theme so far unexplored in this respect. The objective of the thesis is to design suitable starting points of an individual care plan of families at risk which contribute to returning the child to his or her biological family in the remediation process by way of social rehabilitation. This is fulfilled with respect to partial objectives that reveal the influence of social and pathological effects, partial characteristics of remediation of the family and services rendered, and on the basis of these findings, the author identifies the ways, methods and techniques of health and social work that are applied by Children's Centres in relation to an active involvement of parents in a social rehabilitation process. In addition, the present thesis determines aspects of the multidisciplinary help that assist in participation in the support provided, or, as the case may be, aspects that prevent such participation. The thesis is divided into two parts - theoretical and methodological. The theoretical part is engaged in the family as such, its functions, risk factors, the most common types of parental disorders in relation to a family at risk, families at risk, the contemporary status of care of children at risk. The thesis delineates in detail the forms of threats to children and the key risk factors influencing parents with respect to participation in solving the problem per se. The last chapter scrutinizes the problem of family remediation, its characteristics and stages. Further, the last chapter focuses on activities of "Dětské centrum Jihočeského kraje, o.p.s." [Children's Centre of the South Bohemian Region, public service company] in Strakonice and the social rehabilitation service the Centre provides - ways, methods and techniques of health and social work with families at risk. The content of the methodological part gives an explanation of the importance of the Children's Centre influencing an active involvement of parents in the remediation process using social rehabilitation, by applying the method of a semi-conducted interview as a primary technique of data collection. The data acquired are analysed and interpreted in Chapter eight. Chapter nine presents starting points for an individual care plan that serve, in compliance with the rules enumerated, as a functional tool for achieving an active involvement of parents in the social rehabilitation process. The final chapter concludes and further clarifies the problems at issue.

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Dissertations / Theses on the topic 'Multidisciplinary rehabilitation'

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