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Cioe, Nicholas Joseph. "Factors influencing post-acute brain injury rehabilitation treatment outcome." OpenSIUC, 2012. https://opensiuc.lib.siu.edu/dissertations/454.
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Brain injury has a tremendous effect on the United States. The medical system has a continuum of care available but many of these services are extremely expensive. Despite the effectiveness of residential post-acute brain injury rehabilitation (PABIR) resistance to provide adequate funding remains because of a dearth of randomized controlled trial (RCT) studies demonstrating effectiveness. Some research suggests observational trials are typically more representative of community samples and yield conclusions similar to RCT studies. This study uses a large multi-state naturalistic community-based sample of individuals who received residential PABIR. The purposes of this study were to (1) use logistic regression to identify a model that considered the relationships among the predictor variables to explain treatment outcome for individuals receiving residential PABIR and (2) better understand how self-awareness influences treatment outcome. The final model contained five independent variables (substance use at time of admit, functioning level at time of admit, change in awareness between discharge and admit, admit before or after 6 months post-injury (TPI), and length of stay (LOS) in the program less than or greater than 2 months). The model was statistically significant, ÷2 (5, N=434) = 194.751, p < .001, accounting for 36.2% (Cox & Snell R square) to 61.3% (Nagelkerke R square) of the variance in success rate, and correctly classified 89.4% of cases. Four of the five predictor variables (current substance use, change in awareness, LOS 2 months and TPI 6 months) made statistically significant contributions to the model. The strongest predictor of successful treatment outcome was change in awareness recording an odds ratio of 29.9 indicating that individuals who improved in self-awareness by at least one level were nearly 30 times more likely to be in the successful outcome group, controlling for other factors in the model. Participants were also more likely to be in the successful outcome group if they admitted within 6-months post-injury (5.5x) and stayed longer than 2-months (4.4x). Findings also suggest that active substance use at time of admission did not prevent people from being successful. Importance and implications of these findings are discussed.
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Cioe, Nicholas J. "Differing perceptions and functioning following discharge from post-acute brain injury rehabilitation /." Available to subscribers only, 2009. http://proquest.umi.com/pqdweb?did=1885689771&sid=16&Fmt=2&clientId=1509&RQT=309&VName=PQD.
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Cioe, Nicholas Joseph. "Differing Perceptions and Functioning Following Discharge from Post-Acute Brain Injury Rehabilitation." OpenSIUC, 2009. https://opensiuc.lib.siu.edu/theses/13.
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Brain injury affects nearly 1.5 million people in the United States every year and estimated that 124,000 of those affected will have some form of long-term disability. Impaired Self Awareness (ISA) has been identified as one of the largest obstacles to successful brain injury rehabilitation and adaption to living with a brain injury. Research on the relationship between the awareness of individuals with acquired brain injury (IwABI) and their significant others has been inconsistent. This study examined the role IwABI and their significant others perception concordance&mdashagreement concerning functioning&mdashhas on maintenance of rehabilitation gains at a follow-up date after completion of adolescent brain injury rehabilitation services. Contrary to the hypotheses, the data showed a strong correlation (.872, p&le.01) and significant relationship (t=35, p&le.001) between IwABI and their significant others Functional Area Outcomes Menu (FAOM) scores at follow-up. There was no relationship between functioning at discharge and perception concordance at follow-up or time post-discharge and perception concordance at follow-up. Several explanations for the findings are provided along with suggestions for future investigation of the research subject.
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Wood, Victorine Alexandra. "A critical appraisal of post-acute stroke management in NHS hospitals." Thesis, University of Bristol, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299734.
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Sawchyn, James Matthew. "Awareness of neurobehavioral deficits and emotional adjustment in acute- and post-acute rehabilitation following traumatic brain injury." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/NQ62528.pdf.
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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 <ul> <li> had suffered a traumatic brain injury;</li> <li> had undergone acute rehabilitation at Life Eugene Marais Hospital for the last four years;</li> <li> had completed rehabilitation, in other words had to be post discharge;</li> <li> lived in the province of Gauteng; and</li> <li> was able to speak and understand English or Afrikaans, irrespective of gender, race, religion, culture or age.</li> </ul> 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.<br>Dissertation (MSW)--University of Pretoria, 2012.<br>Social Work and Criminology<br>unrestricted
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Pearce, Emily Anna. "The Stress-Buffering Model of Social Support in Post-Acute Brain Injury Rehabilitation." Antioch University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1493120784985772.
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Higgins, Johanne. "Correlates of recovery of upper extremity function in the acute phase post stroke." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0027/MQ50786.pdf.
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Scheuringer, Monika. "The applicability of the FIM in patients with neurological conditions undergoing early post-acute rehabilitation." Diss., lmu, 2007. http://nbn-resolving.de/urn:nbn:de:bvb:19-77952.
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Basobas, Brittani A. "Psychometric Properties of the National Institutes of Health Stroke Scale in Post Acute, Minimally Impaired Stroke Survivors." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1460457853.
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Menon, Anita. "Assessment of unilateral spatial neglect post stroke in acute care hospitals : are we neglecting neglect?" Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=80332.
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Timely and accurate assessment of unilateral spatial neglect (USN) post stroke is a critical component of best practice, given that a recent Clinical Practice Guidelines for stroke has recommended the standardized assessment of USN within 48 hours of regaining consciousness following a stroke. This multi-centered, retrospective study using data from medical charts of a representative sample of individuals admitted to 10 Ontario acute care hospitals from July 15th to December 15th 2002, examined the prevalence, timing and frequency of use of standardized assessments to evaluate USN post stroke. Out of the 248 subjects who should have received a USN assessment, 37.5% received an assessment; only 13.31% with a standardized visual perception tool and of these, only 0.81% (n = 2) with a standardized tool specific to USN assessment. All clients receiving a standardized assessment were evaluated for USN in the near extrapersonal space, the hemispace within reaching distance of the patient: no patient received a standardized assessment for USN in the personal space or far extrapersonal space. Three standardized visual perception tools that include a USN component were used: the Clock Drawing Test (n = 22), the Ontario Society of Occupational Therapists (OSOT) Perceptual Evaluation (n = 8) and the Motor-Free Visual Perception Test (n = 1). Only 8 (3.23%) of the 248 clients were screened with a standardized tool within the 2-day critical period as recommended by Stroke Guidelines. Reassessment was rare, even in those with detected USN, such that only 1 subject was ever reassessed with a standardized tool.
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Westby, Marie D. "First steps in developing clinical practice guidelines for post-acute rehabilitation afater primary total hip and knee arthroplasty." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/23734.
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Total hip (THA) and total knee arthroplasty (TKA) are cost-effective interventions for advanced osteoarthritis (OA) of the knee and hip. With the rapidly growing number of these procedures performed annually in Canada and the United States, greater attention needs to be directed to identify rehabilitation practices that optimize outcomes and minimize cost. Currently, there is no consensus on rehabilitation best practice and no evidence-based clinical practice guidelines to inform clinical decision-making on post-acute rehabilitation following THA and TKA.
A multi-phase, mixed-method project integrated stakeholder perspectives, research evidence and expert opinion to develop best practice recommendations for THA and TKA rehabilitation. Chapter 2 involved 11 focus groups and eight interviews to identify key themes related from North American patients and health care professionals on rehabilitation practices and outcomes. Chapters 3-4 are Cochrane systematic reviews examining the strength of the evidence for post-acute physiotherapy after THA and TKA. Chapter 5-6 involved two parallel Delphi surveys with consumers, clinicians and researchers to develop consensus on a range of rehabilitation topics to inform best practice for THA and TKA rehabilitation.
Chapter 2: Six key themes emerged relating to communication, patient expectations, patient attitude, forms of support, barriers to recovery, and diversity of outcomes. Chapters 3-4: Systematic reviews of THA (n=8) and TKA (n=7) trials revealed limited, low to high quality evidence with mixed findings for various forms of post-acute physiotherapy on pain, function and health-related quality of life. Trial heterogeneity prevented meta-analysis. Chapters 5-6: Consensus (80% agreement) was reached on the need for post-acute rehabilitation, types of interventions, rehabilitation providers, treatment settings, outcomes and outcome measurement. Consensus was not reached regarding timing and dosage of rehabilitation. Sub-group analysis revealed few differences comparing responses by profession, primary role and country.
This thesis has taken important first steps in identifying appropriate rehabilitation interventions and health care resources to optimize individuals’ activity, participation and health-related quality of life after THA and TKA. Further, it highlights the need for more high quality research to address the knowledge gaps and inform policy on this important and understudied aspect of arthroplasty surgery.
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Westby, Marie D. "First steps in developing clinical practice guidelines for post-acute rehabilitation after primary total hip and knee arthroplasty." Thesis, University of British Columbia, 2010. http://hdl.handle.net/2429/23734.
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Total hip (THA) and total knee arthroplasty (TKA) are cost-effective interventions for advanced osteoarthritis (OA) of the knee and hip. With the rapidly growing number of these procedures performed annually in Canada and the United States, greater attention needs to be directed to identify rehabilitation practices that optimize outcomes and minimize cost. Currently, there is no consensus on rehabilitation best practice and no evidence-based clinical practice guidelines to inform clinical decision-making on post-acute rehabilitation following THA and TKA.
A multi-phase, mixed-method project integrated stakeholder perspectives, research evidence and expert opinion to develop best practice recommendations for THA and TKA rehabilitation. Chapter 2 involved 11 focus groups and eight interviews to identify key themes related from North American patients and health care professionals on rehabilitation practices and outcomes. Chapters 3-4 are Cochrane systematic reviews examining the strength of the evidence for post-acute physiotherapy after THA and TKA. Chapter 5-6 involved two parallel Delphi surveys with consumers, clinicians and researchers to develop consensus on a range of rehabilitation topics to inform best practice for THA and TKA rehabilitation.
Chapter 2: Six key themes emerged relating to communication, patient expectations, patient attitude, forms of support, barriers to recovery, and diversity of outcomes. Chapters 3-4: Systematic reviews of THA (n=8) and TKA (n=7) trials revealed limited, low to high quality evidence with mixed findings for various forms of post-acute physiotherapy on pain, function and health-related quality of life. Trial heterogeneity prevented meta-analysis. Chapters 5-6: Consensus (80% agreement) was reached on the need for post-acute rehabilitation, types of interventions, rehabilitation providers, treatment settings, outcomes and outcome measurement. Consensus was not reached regarding timing and dosage of rehabilitation. Sub-group analysis revealed few differences comparing responses by profession, primary role and country.
This thesis has taken important first steps in identifying appropriate rehabilitation interventions and health care resources to optimize individuals’ activity, participation and health-related quality of life after THA and TKA. Further, it highlights the need for more high quality research to address the knowledge gaps and inform policy on this important and understudied aspect of arthroplasty surgery.<br>Medicine, Faculty of<br>Graduate
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Brink, Petrus Badenhorst Naude. "Neuro Consilio: Stimulating visual, haptic, olfactory and auditory senses to promote passive recovery in acute brain injury and post operative neurological patients." Diss., University of Pretoria, 2020. http://hdl.handle.net/2263/78590.
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The following dissertation analyses how users experience space with their different senses. And how we as designers can utilise this to improve rehabilitative designs’ responsiveness to cater to acute brain injury and post-operative neurological surgery patients.
The medical field has shown a rapid increase in neurological development that changes the way doctors have been treating patients thus far. With the rapid growth in development, the associated disciplines need to react to the change in knowledge to provide a facility that accommodates new treatment methods that will always provide the patient with the best care.
When dealing with specialised fields, the architectural design process is limited by the designers’ experience and knowledge, and when it comes to the medical field, it is almost always limited. The regulations and medical planning guidelines cater to the minimum requirements and systematic applications and not set to adapt to patient needs. Thus a multidisciplinary collaborative effort is needed to address the patient’s wellbeing properly.
For the architectural profession to design responsive environments that help promote the patients’ passive recovery principles, we need to be able to identify the effect our spaces have on the brain.
The research aims to broaden the philosophical approach to design to include rehabilitation principles to create more productive environments for patients.
By studying the effect of the spaces on the brain, we know from the brain’s neuroplasticity that the constructive stimulation of the areas affected will increase its recovery rate. Once the principles have been identified, architectural drivers can be deduced from the data sets.
If correctly implemented, the responsive design principles can help produce better rehabilitative methods that don’t have to rely solely on active rehabilitation applications. The end goal is to have this facility serve as a precedent for future projects with a multidisciplinary healthcare program that aims to incorporate responsible passive neurological treatments.<br>Mini Dissertation (MArch (Prof))--University of Pretoria, 2020.<br>Architecture<br>MArch (Prof)<br>Unrestricted
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Joisten, Susanne. "Mobility of geriatric patients at admission to early post-acute rehabilitation facilities predicts change in living situation after discharge." Diss., lmu, 2006. http://nbn-resolving.de/urn:nbn:de:bvb:19-65748.
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Akinladejo, Felix O. "Computer-Supported Rehabilitation Management A Case Study of Using Virtual Reality Technology in Ambulatory Training for Post-Acute Stroke Patients." NSUWorks, 2005. http://nsuworks.nova.edu/gscis_etd/383.
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This study investigated the use of virtual reality (VR) technology in ambulatory training for post-acute stroke patients, and sought to determine whether skills gained in virtual environments transfer to real-world conditions. Patients with stroke typically suffer dysfunctions that impair the complex set of motions involved in walking. The limited amount of therapy and resources offered by the current health care system does not provide the frequency and intensity of training needed for functional recovery of the walking skills in patients following stroke assaults. This study, therefore, developed and investigated an alternative intervention technique capable of providing the frequency and intensity needed for improving the walking skills in post-acute stroke patients. The study also helped clarify the controversies surrounding the issue of whether skills gained in the virtual environment transfer to the real world.
The research study employed the single case design method to report the results observed from four post-acute stroke patients who trained on a computer-based therapy program for about half an hour per day, five days a week, for a period of four consecutive weeks. The patients performed a VR exercise using a head-mounted display, and their gait variables were analyzed to determine the usefulness of virtual reality technology in ambulatory training for post-acute stroke patients.
A follow up examination conducted one week after the intervention sought to determine whether the patients could perform the skills learned on the VR-based intervention program in the real world. The results of the research showed that all the patients improved on their gait parameters and could walk better after the computer-based intervention program. An observational gait analysis carried out showed that the skills gained in the virtual environment transferred to real-world conditions.
The study contributes to the current effort to provide wider access to therapeutic intervention techniques using computer technology, and helps to further resolve the disputed issue of whether skills gained in the virtual environment transfer to real-world conditions. Researchers and professionals in the fields of rehabilitation engineering, physical therapy, physiology, and other fields concerned with the study of human movement, could find the outcome of this work useful in improving their professional practice. Other clinicians could also use the results of this work in formulating realistic treatment goals in problem areas involving physical therapy.
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Ras, Tasleem. "An audit of geriatric stroke rehabilitation services at a post-acute hospital (Booth Memorial) in urban Cape Town, South Africa." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/12604.
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Includes summary.<br>Booth Memorial Hospital (BMH), situated at the foot of Table Mountain in urban Cape Town, South Africa, is an NGO-run hospital in a Public- Private Partnership with the Western Cape Department of Health. The essential service being offered is sub-acute health care, with state hospitals referring patients needing terminal, rehabilitation or convalescent care for a variety of illnesses. Post-acute stroke rehabilitation forms an integral part of the general service being offered by BMH. This dovetails with the state-run rehabilitation hospital in the sense that younger patients able to undergo intense rehabilitation are sent to the state-run hospital, while BMH generally cares for those patients who may not be able to withstand the rigours of an intense rehabilitation program. In our setting, this means that most of the patients seen at BMH for post-stroke rehabilitation are elderly. The elderly patient who has suffered a stroke is vulnerable in many respects. The most obvious vulnerability refers to the physical, emotional and psychological derangements that follow strokes in this age group. In addition, due to rampant poverty prevalent in the community we serve, social and economic factors place this group of patients at an even greater disadvantage. It is an imperative for social survival and an acceptable quality of life that this group of patients retain as much of their independence and empowerment after the stroke as is possible. The current situation of overflowing old-age homes, increasing prevalence of elder abuse and neglect, and the deficiency of community structures to care for the elderly compel health care providers to ensure that a post-stroke rehabilitation service operates with maximal efficiency, given the paucity of resources endemic in our health system. The above factors provided an impetus for this study. A need arose to assess the quality of the stroke rehabilitation services at BMH, as the starting point to what is hoped will be a continuous Quality Improvement Cycle. An additional factor compelling the examination of the quality of service being offered is that the Geriatric population is underserved in the present health system, competing for scarce resources with other vulnerable groups such as children, Cancer patients, and people living with HIV/AIDS. By focussing on a service that is almost exclusively aimed at the elderly, we hope to be able to advocate for greater resource allocation to this age group, given that receiving good health care is essential to the quality of life of the ageing population. This assessment of the current services looked at the Structure, Process of care and Clinical Outcomes of stroke rehabilitation services being given to patients over the age of 65 years. The findings were evaluated against internationally accepted norms of post-acute stroke care, and are presented in this study.
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Murray, Jordan Claire. "Community integration after TBI post-acute rehabilitation : a review." Thesis, 2011. http://hdl.handle.net/2152/ETD-UT-2011-05-2887.
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Traumatic brain injury (TBI), also referred to as an acquired brain injury, is caused by damage to the brain as a result of trauma to the head. The following report serves as a resource for patients and families wanting to gain information regarding community integration outcomes after participation in post-acute rehabilitation programs. The goal of the post-acute level of medical care is to increase functionality and serve as a transition for the patient from the rehabilitation facility to life within the community. A thorough examination of community integration after participation in a post-acute rehabilitative program with the use of the Community Integration Questionnaire (CIQ) is provided. After investigation of the available literature, four articles were found to meet inclusion criteria and were included within the review. All studies included met the following criteria. Participants were ages 17 to 65 years old, had a diagnosis of moderate to severe TBI, were enrolled in post-acute rehabilitation, and were assessed with the Community Integration Questionnaire (CIQ). Overall, the available literature suggests that completion of a program within a post-acute facility does create positive outcomes for the individual with TBI; however, the outcomes are dependent on various factors regarding TBI severity, the administration of intervention, the type of intervention, time post-onset and age of participants at the time of onset. Future research is necessary to provide a more comprehensive view of post-acute rehabilitation and the outcomes that these patients may expect as they begin their road to recovery.<br>text
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Sawchyn, James Matthew. "Awareness of neurobehavioral deceits and emotional adjustment in acute- and post-acute rehabilitation following traumatic brain injury." Thesis, 2001. https://dspace.library.uvic.ca//handle/1828/10084.
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This dissertation examined injury-based and emotional adjustment factors that may influence an individual's self-awareness of neurobehavioral deficits following traumatic brain injury (TBI). Two studies were completed to examine these issues in acute and post-acute rehabilitation settings using the reports of TBI patients and their significant-others. In Study 1, the Patient Competency Rating Scale (PCRS) and Self-Awareness of Deficits Interview were used to assess the patients' awareness of deficit, while the Profile of Mood States and the Grief Experiences Inventory were used to assess emotional adjustment. Six patients and significant-others were followed weekly during the course of inpatient rehabilitation, and were seen approximately one month after their discharge from hospital. While individual variability was observed, most patients reported minor changes in their level of competence and limited emotional distress. The individual perceptions of patients and of significant-others were generally consistent over the course of inpatient care, and variations in patients' emotional adjustment appeared to be reasonable reactions to circumstantial factors. The emotional adjustment of significant-others varied considerably among the individuals assessed, and this variability likely influenced their ratings of the patient. Staff ratings of the patients were also collected, and identified improvements in functional abilities over time. These results suggest that patient awareness is not a prerequisite for rehabilitation success. A lack of applied or practical experiences may also influence patients' ability to accurately rate their self-competence during the acute phase following TBI.
Study 2 examined 166 individuals referred for post-acute rehabilitation, using the PCRS and the Katz Adjustment Scale (KAS-R) to assess awareness and emotional adjustment. Patients with a history of moderate and severe TBI showed good awareness of their abilities, based on PCRS Discrepancy Scores, while patients with mild TBI were likely to report greater impairments than observed by significant-others. TBI patients showed significant emotional adjustment difficulties on the KAS-R, regardless of the severity of their injury, and there was a strong positive association between patients' acknowledgement of neurobehavioral problems and ratings of their emotional adjustment. General intellectual ability was also strongly related to patients' report of difficulties, such that low IQ and poor emotional adjustment were associated with low ratings of self-competence. On the other hand, the general location of cerebral trauma was not strongly associated with deficits in awareness. Thus, the nature and severity of TBI appeared to be less important than IQ and emotional adjustment in the post-acute rehabilitation patients, although mildly injured patients are more likely to report neurobehavioral deficits than moderate or severely injured patients. Strengths and weakness of the self-other discrepancy approach to measuring self-awareness were considered, and a robust approach to awareness assessment, based on multiple measures, is recommended. Available options include structured interviews, self-report, clinical observation, or objective testing. Furthermore, the emotional adjustment of the patient appeared to become increasingly salient in the assessment of awareness during the post-acute phase, compared to the acute phase of recovery from TBI, where significant-other adjustment may be quite relevant.<br>Graduate
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Kahn, Rebecca. "Stepping up to prevent falls: a fall prevention program for post-acute rehabilitation." Thesis, 2020. https://hdl.handle.net/2144/41408.
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Older adults who experience a fall will often sustain injuries which impact on their mobility and their ability to perform functional activities. Having one fall can lead to an increased risk of having another fall, and may also lead to a fear of the participating in functional activities, especially the activity that caused the fall. Every year, 3 million older adults are treated in the emergency room for falls, and at least 300,000 people are hospitalized due to falls (Centers for Disease Control, 2017). After hospitalization, some individuals require a stay in post-acute rehabilitation. In post-acute rehabilitation, these patients are at risk of having another fall, as they are in a new, unknown environment, and because they regularly practice mobility and functional activities with the goal of becoming independent. Preventing falls in the post-acute rehabilitation setting is critical because research has demonstrated that those who experience a fall in this setting have decreased functional outcomes and are less likely to return to their prior living environment.
Stepping Up to Prevent Falls: A Fall Prevention Program for Post-Acute Rehabilitation is an interprofessional and multi-modal fall prevention program. The program consists of staff education, patient education, and implementation of environmental fall prevention interventions. The staff education component will include an in-service discussing the definition of a fall, the risk factors for falls, a fall risk assessment tool and interventions to prevent falls. Non-clinical staff will be educated on fall prevention strategies through posters in the breakroom. Patients will be educated via handouts and one-to-one discussions on how to prevent falls, the risk factors for falls, the consequences of a fall and what to do if a fall occurs. The goal is to decrease falls in order for patients to have better functional outcomes and be able to return to prior level of functioning.
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Grinberg, Eldad. "Occupational therapy leadership: promoting an autonomy-supportive environment based on self-determination theory, to improve patient outcomes in acute and post-acute stroke rehabilitation." Thesis, 2019. https://hdl.handle.net/2144/38178.
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A major dilemma that is being addressed in the current project is the
discrepancies between healthcare system's expectations for a rapid and successful
rehabilitation process and patients after having a stroke ability to meet these expectations
while striving to adapt to the calamitous event in their life. Emphasizing a more
biomedical approach and under implementation of psychosocial approaches, poor
acknowledging of patients' basic psychological needs lead to poor motivation, therapeutic
disengagement and may lead to a rehabilitation failure.
To cope with this gap in the process of stroke rehabilitation, an educational
program aiming for occupational therapists working with patients after having a stroke in
their acute and post-acute rehabilitation phases was constructed. The program guides
practitioners for effective communication with their patients, building a needs-supportive
environment and addressing their patients' basic psychological needs in light of the selfdetermination
theory, theories of adaptation from occupational therapy perspectives and
considering occupational justice and the ICF model. A clinical reasoning, step-by-step
problem solving is introduced using adaptation of known models and innovated models
for interventions that were created for this purpose.
Program delivery through a series of 4-webinar modules is illustrated with their
learning objectives, assignments and discussions. The program evaluation and
implementation are expected to be the initiator of a change in the health and rehabilitation
climate and in Israel.
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Hsieh, Shiau-Fu, and 謝曉芙. "Association between Number of Daughters and Failure of Home Discharge of Stroke Patients after Post-acute Inpatient Rehabilitation." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/82127435074587514876.
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碩士<br>國立臺灣大學<br>流行病學與預防醫學研究所<br>102<br>Background: Discharge disposition has been important for stroke patients after post-acute inpatient rehabilitation. The rate of failure of home discharge in Taiwan was still unknown. In addition, whether the number of daughters affected patients’ home discharge needs investigation.
Methods: We conducted a retrospective case-control study in a tertiary hospital between July 2011 and Sep 2013, investigating stroke patients consecutively discharged from post-acute rehabilitation. Factors regarding patient demographics, family information, as well as disease and function information were collected. We defined the outcome, failure of home discharge or home discharge, from the discharge chart.
Results: One hundred and eighteen of 297 stroke patients (mean age 63 years, 37% women) failed to discharge to home after post-acute inpatient rehabilitation, including 109 admitting to other rehabilitation hospitals and 9 to long-term care facilities. Patients with more daughters tended to be older, female, married, to have ischemic stroke, to receive fewer years of formal education, to have no job, to have homes without stairs, and to have more sons and children. A trend existed between having more daughters and a lower risk of failure of home discharge: having three or more daughters reduced 77 percent of the risk (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.07-0.72), compared with those without daughters (test for trend, p=0.002). Other protective factors included a higher age (OR 0.97, 95%CI 0.95-0.99) and a better function at discharge (OR 0.97, 95%CI 0.95-0.98).
Conclusion: The rate of failure of home discharge after post-acute inpatient rehabilitation was high in Taiwan and having more daughters lowered the risk.
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Scheuringer, Monika [Verfasser]. "The applicability of the FIM in patients with neurological conditions undergoing early post-acute rehabilitation / vorgelegt von Monika Scheuringer." 2007. http://d-nb.info/98748379X/34.
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Chen, Ying-Hsun, and 陳盈勳. "A Study on the Performance Indicators and Efficiency of the Assessment Tools of Post-acute Care Rehabilitation among Stroke Patients." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/2dmtf6.
Full textAbstract:
碩士<br>國立陽明大學<br>醫務管理研究所<br>106<br>A Study on the Performance Indicators and Efficiency of the Assessment Tools of Post-acute Care Rehabilitation among Stroke Patients
Introduction. Taiwan’s National Health Insurance started the program “The demonstration on improving the quality of post-acute care for cerebrovascular disease” (PAC-CVD) for new onset stroke patients in 2014. The PAC-CVD offers rehabilitation with high frequency and intensity. The PAC-CVD rehabilitation helps improve patients’ functional outcome and even their return to normal life. However, one of the main problems in PAC-CVD is its complicated evaluation instruments. The patients under PAC-CVD rehabilitation ask to receive functional assessments at admission, every 3 weeks during hospitalization, and at discharge. Each measurement contains 15 functional assessment instruments. The process of evaluation takes a lot of time, which increases the work load of the rehabilitation staff. The purpose of this study was to explore the longitudinal trajectories of the 15 functional assessment instruments to measure the functional outcome of patients receiving PAC-CVD rehabilitation and to simplify the process of functional assessment instruments for these patients.
Materials and methods. A total of 135 patients who joined PAC-CVD at one regional hospital in northern Taiwan from February 2014 to September 2017 met the inclusion criteria of this study. We used generalized estimating equation with time trend model, time trend model with co-variable adjustment, and tracking model to evaluate the performance of the 15 functional assessment instruments performed at every measure point and to see if the score measured at admission can predict the scores at the following measure points.
Results. Barthel index (BI) and Motor activity log-quality of movement scale (MAL-Q) had a significant time trend effect and large variability at every measure point, which suggest that they are highly recommended to be performed at every measure point. Berg balance test (BBT), Fugl-Meyer assessment-motor (FMAM), motor activity log-amount of use scale (MAL-A), and concise Chinese aphasia test (CCAT) also had a time trend effect and were suggested to be performed at every measure point; however, they had less variability between scores. Functional oral intake scale (FOIS), Lawton-Brody instrumental activities of daily living scale (IADL), and usual gait speed (UGS) revealed a less time trend effect, but had longitudinal variability. Modified Rankin scale (MRS), six-minute walk test (SMWT), Fugl-Meyer assessment-modified sensation (FMAS), mini-mental state examination (MMSE), mini-nutrition assessment (MNA), and EuroQol-five dimensions questionnaire (EQ5D) showed uncertain effects.
Conclusion. BI and MAL-Q can better reflex the functional outcome of PAC-CVD rehabilitation. BI and MAL-Q are two necessary assessment instruments of PAC-CVD, which should be performed at every measure point. BBT, FMAS, MAL-A, and CCAT are elective assessment instruments, which should be performed at every measure point. FOIS, IADL, and UGS require less frequent measurements but longitudinal observations (assessment at admission, 3 weeks after admission, and at discharge). MRS, SMWT, FMAS, MMSE, MNA, and EQ5D require further study for evaluation.
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Young, J., J. R. Green, A. Forster, et al. "Postacute Care for Older People in Community Hospitals: A Multicentre Randomised, Controlled Trial." 2007. http://hdl.handle.net/10454/2442.
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No<br>OBJECTIVES: To compare the effects of community hospital care on independence for older people needing rehabilitation with that of general hospital care.
DESIGN: Randomized, controlled trial.
SETTING: Seven community hospitals and five general hospitals in the midlands and north of England.
PARTICIPANTS: Four hundred ninety patients needing rehabilitation after hospital admission with an acute illness.
INTERVENTION: Multidisciplinary team care for older people in community hospitals.
MEASUREMENTS: The primary outcome was the Nottingham extended activities of daily living scale (NEADL); secondary outcomes were the Barthel Index, Nottingham Health Profile, Hospital Anxiety and Depression Scale, mortality, discharge destination, 6-month residence status, and satisfaction with services.
RESULTS: Loss of independence at 6 months was significantly less likely in the community hospital group (mean adjusted NEADL change score group difference 3.27; 95% confidence interval 0.26–6.28; P=.03). The results for the secondary outcome measures were similar for the two groups.
CONCLUSION: Postacute community hospital rehabilitation care for older people is associated with greater independence.
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Chiu, Bing-Wei, and 邱秉葳. "Exploring the relationship between urban-rural health disparities and post-acute rehabilitation care on ischemic stroke patients and mortality in Taiwan." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/qh65ud.
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碩士<br>國立臺灣大學<br>健康政策與管理研究所<br>104<br>Background. Health disparity is one of the key research issues around the world. Because of the uneven distributions of medical resources in Taiwan, the issue of health disparity is derived. In recent years, stroke is the third leading place in Taiwan and it may leave varying degrees of permanent disability. Therefore, they may require continuity of care after acute inpatient discharge. However, the relationship between Post-Acute Care (PAC) and the death of stroke patients is still not clear.
Objective. The aim of this study was to explore the association between urban-rural health disparities and post-acute rehabilitation care on ischemic stroke patients and 1 year mortality.
Methods. This study used data from the nationwide representative sample through the National Health Insurance Research Database between 2011 and 2012. Patients who underwent first time admission in 2011 with a principal ICD-9-CM diagnosis codes 433, 434 and 436 were identified in this study. Cox proportional hazards model was conducted to examine the association between urban-rural health disparities and post-acute rehabilitation care on ischemic stroke patients and 1 year mortality.
Results. There were 1456 patients included in this study. The study showed that compared with patients living in rural areas, patients living in urban tended to survive longer in a year. Moreover, as the frequency of rehabilitation increased, patients tended to survive longer in a year.
Conclusion. Compared with patients living in rural areas, patients living in urban tended to survive longer in a year. Therefore, the importance of resource distribution and accessibility of medical care should be noticed. Meanwhile, patients should rehabilitate within 3 months after discharging from hospitals, and increased the frequency of rehabilitation.
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Joisten, Susanne [Verfasser]. "Mobility of geriatric patients at admission to early post-acute rehabilitation facilities predicts change in living situation after discharge / vorgelegt von Susanne Joisten." 2006. http://d-nb.info/983661456/34.
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Small, Neil A., J. R. Green, Joanna Spink, A. Forster, and J. Young. "Post-acute rehabilitation care for older people in community hospitals and general hospitals - Philosophies of care and patients' and caregivers' reported experiences: a qualitative study." 2009. http://hdl.handle.net/10454/7052.
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Kao, Nien-Tzu, and 高念慈. "Effects of High Intensity Rehabilitations in Cerebral Vascular Accident Patients Admitted in Post-Acute Care Unit." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/h65f4h.
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碩士<br>國立陽明大學<br>醫務管理研究所<br>105<br>Background: Post-acute care is the bridge between acute and long-term care and refers to a range of medical care services that support the individual’s continued recovery from illness or disability. National Health Insurance Administration holds the pilot project: "Post-acute care-cerebrovascular diseases, PAC-CVD" and likes to understand the feasibility and effectiveness of the implementation of PAC.
Aim: Study investigates the improvement of PAC system in patients with stroke and to evaluate the difference between the high-intensity rehabilitation and general intensity rehabilitation.
Methods: We collected the records of PAC-CVD system in patients with stroke from the Taipei Municipal Gan-Dau Hospital. 15 rehabilitation indicators were suggested from 13 official questionnaires and used the pair-T test, Fisher's exact test and one-way analysis of variance to assess the disability improvement of the patients with stroke pre- and post- PAC rehabilitation. The Pearson correlation coefficient and analysis of covariance were used to test the difference between the high and general intensity rehabilitation.
Results: Study collected the 75 PAC-CVD patients from Mar. 2014 to Jan. 2017 including 32 patients with high-intensity rehabilitation and 43 patients with general intensity rehabilitation. 13 indicators had enough sample size to test the difference. All indicators presented the significant improvements after PAC rehabilitation except the gait speed. 10 indicators found the significant improvements from the group of high-intensity rehabilitation. In addition, the days of rehabilitation and the age more than 80 ages may affect the improvement degree for Stroke patients in rehabilitation.
Conclusions: The PAC rehabilitation may be continued recovery from illness or disability for stroke patients except the gait speed. Study is the first to investigate the difference between the degree of rehabilitation and body improvement, presenting the high-intensity rehabilitation can improve the life quality, balance function, and heart function. We suggest to take the high-intensity rehabilitation on the target options, and further collect the PAC-CVD database widely for represented assessing the effects of PAC-CVD project.