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Medical Care Jun 1997In the past, quality of health care was measured principally with reference to provider-established norms. More recently, increased attention has been paid to patients'... (Review)
Review
In the past, quality of health care was measured principally with reference to provider-established norms. More recently, increased attention has been paid to patients' views on care delivery and outcomes. However, in rehabilitation medicine, this trend has not been established: provider-assessed outcomes during short stays in specific settings are the focus of care. This article offers a theoretic framework for the assessment of rehabilitative care from the patient's perspective. Four domains of the patient's experience and the specific dimensions of each domain are discussed, and their influence on the measurement of quality from the patient's viewpoint is reviewed. A similar comparison is made between patient and provider perspectives on care outcomes. Examples are provided of patient-based outcome measures. Emphasis is placed on the importance of distinguishing between provider and patient perspectives and on giving the patient's views a primary role in evaluating care and outcomes.
Topics: Aged; Decision Making; Disabled Persons; Health Services for the Aged; Humans; Models, Psychological; Outcome Assessment, Health Care; Patient Satisfaction; Patient-Centered Care; Rehabilitation
PubMed: 9191714
DOI: 10.1097/00005650-199706001-00009 -
Clinics in Geriatric Medicine May 2006Stroke is an increasing public health concern throughout the world as the leading cause of long-term disability. It is well known that there exist differences related to... (Review)
Review
Stroke is an increasing public health concern throughout the world as the leading cause of long-term disability. It is well known that there exist differences related to epidemiology, pathophysiology, comorbidity, and functional outcome of stroke patients with advanced age compared with the young. Factors that have been suggested to influence this disparity include age-related complications, availability of resources, lack of aggressive management, and possible diminished capacity for neuroplasticity. This article reviews the current medical and rehabilitative aspects of stroke and the possible disparities related to advanced age.
Topics: Activities of Daily Living; Adaptation, Physiological; Aged; Aged, 80 and over; Disabled Persons; Female; Geriatric Assessment; Humans; Male; Occupational Therapy; Physical Therapy Modalities; Quality of Life; Recovery of Function; Severity of Illness Index; Stroke; Stroke Rehabilitation; Treatment Outcome
PubMed: 16627089
DOI: 10.1016/j.cger.2005.12.012 -
AACN Clinical Issues Feb 2003Cardiac rehabilitation, the structured programming of exercise and risk reduction teaching and counseling to promote healthy living with heart disease, is grounded in a... (Review)
Review
Cardiac rehabilitation, the structured programming of exercise and risk reduction teaching and counseling to promote healthy living with heart disease, is grounded in a strong nurse-patient relationship. This relationship provides a foundation for meeting current healthcare challenges. Three challenges are presented and addressed through specific examples. The challenge of the changing cardiac rehabilitation population is addressed through the example of the heart failure patient. The challenge to create innovative programming is addressed through the example of the Therapeutic Rehabilitative Intensive Program, developed to meet the needs of people who live in communities without cardiac rehabilitation services. The challenge to measure outcomes is addressed through the example of choosing a blood pressure measurement method. In addressing each challenge, the role of the advanced practice nurse is described.
Topics: Blood Pressure; Heart Diseases; Heart Failure; Humans; Outcome Assessment, Health Care; Practice Guidelines as Topic; Rehabilitation; United States
PubMed: 12574699
DOI: 10.1097/00044067-200302000-00003 -
HNO Oct 2008The conservative therapy of long-lasting vestibular disorders has been changed over the last few years by the introduction of neuro(bio-)feedback procedures. A technical... (Review)
Review
The conservative therapy of long-lasting vestibular disorders has been changed over the last few years by the introduction of neuro(bio-)feedback procedures. A technical neurofeedback system applies an additional (acoustic, galvanic, vibrotactile) stimulus to the patient while performing vestibular exercises. This stimulus is dependent on the extent of postural deviation of the patient from a normal (ideal) position in space. The neurofeedback system is body worn and continuously registers any postural deviation from the normal position so that it can apply suitable stimuli to the patient. This new way of rehabilitating patients with vertigo seems to be a promising addition in the therapy of long-lasting, complex vestibular disorders as recent studies have demonstrated.
Topics: Biofeedback, Psychology; Electric Stimulation Therapy; Humans; Physical Stimulation; Vestibular Diseases
PubMed: 18806973
DOI: 10.1007/s00106-008-1805-z -
Zeitschrift Fur Arztliche Fortbildung Oct 1996Physical and rehabilitation medicine is an independent medical subspecialty and is not derived from "physics" but from "physis-nature". Beside the elements of specific... (Review)
Review
Physical and rehabilitation medicine is an independent medical subspecialty and is not derived from "physics" but from "physis-nature". Beside the elements of specific movements, it does use physical components such as heat, cold, light, water, and electricity for therapeutic purposes. Physical medicine and rehabilitation has always been a discipline with own methods, issues, and own areas of research and theory. The treatment techniques of this specialty are summarized under the term "physiotherapy". Its methods, which also contain balneology and medical climatology, are using physical and physiological principles of order in the organism. The application of this therapy happens for the training of impaired functions, influence of pathogenetic processes causing pain, and for the activation of the body's regeneration capacities. Physiotherapy is not limited to certain diseases or stages of illness but may prevent, abolish, or weaken malregulation of functional units, especially when used in repetitions. A particular focus of the rehabilitation is to address the still remaining functional reserves of an injured organism in a way that a compensation can be reached as close a possible to the etiological point of the pathogenetic chain of causes. Declared goal of the physiotherapy is the induction and optimization of healing processes. Due to this interdisciplinary approach, physical and rehabilitation medicine is an essential part for almost every medical subspecialty. Because of the increasing importance of this discipline, the specialist for physicial and rehabilitation medicine was introduced in Germany in 1992.
Topics: Humans; Patient Care Team; Physical Therapy Modalities; Physical and Rehabilitation Medicine; Rehabilitation; Specialization
PubMed: 9036687
DOI: No ID Found -
Primary Care Sep 1981The goal of the rehabilitative approach to the patient with myocardial infarction is a rapid return to a relatively productive and/or an independent role in society. The... (Review)
Review
The goal of the rehabilitative approach to the patient with myocardial infarction is a rapid return to a relatively productive and/or an independent role in society. The ideal rehabilitation program is incorporated into the plan of care during the acute hospitalization, involves the patient's family and social environment as a support system, and continues in the office of the physician and/or in community facilities.
Topics: Early Ambulation; Exercise Therapy; Humans; Myocardial Infarction; Patient Care Planning; Patient Education as Topic; Physician's Role; Primary Health Care; Quality of Life
PubMed: 7031732
DOI: No ID Found -
Journal of Pediatric Rehabilitation... 2012Spinal cord injury (SCI) often results in a sudden, devastating loss of function. SCI is particularly challenging for the pediatric and adolescent populations who, under... (Review)
Review
Spinal cord injury (SCI) often results in a sudden, devastating loss of function. SCI is particularly challenging for the pediatric and adolescent populations who, under normal circumstances, are still achieving developmental milestones, but following SCI face additional barriers posed by paralysis and the accompanying secondary complications. Advancing technology in rehabilitation is changing the course of how people with spinal cord injury participate in rehabilitation. Technology plays an ever-increasing role in both restorative and compensatory rehabilitative interventions. While the practical or functional needs of the pediatric patient may differ from those of the adult, technology can and does play a role in restoring function for this population. Applications of technology span broad areas, providing improved options for care in grasp and manipulation, seating and mobility, augmentative and alternative communication, electronic aids to daily living, and computer access and use. This article reviews select applications of technology that have great impact on the functional needs of people with spinal cord injury (SCI): therapeutic and functional stimulation, EMG biofeedback and EMG-triggered stimulation, assistive technology for computer access, and implanted functional electrical stimulation systems. Some of these technologies are already in use in the pediatric population, while some are not - yet have great potential for restoring function in this group. The challenges and potential solutions for implementing these technologies in the pediatric population are discussed.
Topics: Activities of Daily Living; Adolescent; Child; Computer Systems; Electric Stimulation Therapy; Electromyography; Humans; Pediatrics; Prostheses and Implants; Self-Help Devices; Spinal Cord Injuries; Technology
PubMed: 23411770
DOI: 10.3233/PRM-2012-00227 -
Journal of Neuroengineering and... Apr 2021Manual treadmill training is used for rehabilitating locomotor impairments but can be physically demanding for trainers. This has been addressed by enlisting robots, but... (Clinical Trial)
Clinical Trial
BACKGROUND
Manual treadmill training is used for rehabilitating locomotor impairments but can be physically demanding for trainers. This has been addressed by enlisting robots, but in doing so, the ability of trainers to use their experience and judgment to modulate locomotor assistance on the fly has been lost. This paper explores the feasibility of a telerobotics approach for locomotor training that allows patients to receive remote physical assistance from trainers.
METHODS
In the approach, a trainer holds a small robotic manipulandum that shadows the motion of a large robotic arm magnetically attached to a locomoting patient's leg. When the trainer deflects the manipulandum, the robotic arm applies a proportional force to the patient. An initial evaluation of the telerobotic system's transparency (ability to follow the leg during unassisted locomotion) was performed with two unimpaired participants. Transparency was quantified by the magnitude of unwanted robot interaction forces. In a small six-session feasibility study, six individuals who had prior strokes telerobotically interacted with two trainers (separately), who assisted in altering a targeted gait feature: an increase in the affected leg's swing length.
RESULTS
During unassisted walking, unwanted robot interaction forces averaged 3-4 N (swing-stance) for unimpaired individuals and 2-3 N for the patients who survived strokes. Transients averaging about 10 N were sometimes present at heel-strike/toe-off. For five of six patients, these forces increased with treadmill speed during stance (R = .99; p < 0.001) and increased with patient height during swing (R = .71; p = 0.073). During assisted walking, the trainers applied 3.0 ± 2.8 N (mean ± standard deviation across patients) and 14.1 ± 3.4 N of force anteriorly and upwards, respectively. The patients exhibited a 20 ± 21% increase in unassisted swing length between Days 1-6 (p = 0.058).
CONCLUSIONS
The results support the feasibility of locomotor assistance with a telerobotics approach. Simultaneous measurement of trainer manipulative actions, patient motor responses, and the forces associated with these interactions may prove useful for testing sensorimotor rehabilitation hypotheses. Further research with clinicians as operators and randomized controlled trials are needed before conclusions regarding efficacy can be made.
Topics: Adult; Aged; Exercise Therapy; Feasibility Studies; Female; Gait Disorders, Neurologic; Humans; Locomotion; Male; Middle Aged; Robotics; Stroke Rehabilitation; Telerehabilitation
PubMed: 33882949
DOI: 10.1186/s12984-021-00856-w -
European Journal of Physical and... Jun 2009The aim of the present paper is to systematically review all the new rehabilitation papers published in the first issue of 2009 by the Cochrane Library in order to... (Review)
Review
The aim of the present paper is to systematically review all the new rehabilitation papers published in the first issue of 2009 by the Cochrane Library in order to provide to physicians involved in the field a summary of the best evidence nowadays available. The author systematically searched all the new papers of rehabilitative interest from the 1st issue 2009 of the Cochrane Library. The retrieved papers have been then divided in subgroups on the base of the topic. The number of included papers was five, the dealing with neurological rehabilitation, one about respiratory and one about geriatric rehabilitation. Numerous studies are available on neurological rehabilitation, with new evidence and indications, but more studies are needed. Pulmonary and geriatric topics confirmed to be relevant in the rehabilitation field. The Cochrane Collaboration and its product, the Cochrane Library, are really relevant instruments to improve evidence based medicine in medical practice and thus, also in the rehabilitation field. The present paper can help rehabilitation specialists to easily retrieve the conclusions of the most relevant and updated reviews in order to update their clinical practice in a more rapid and effective way.
Topics: Evidence-Based Medicine; Health Services for the Aged; Humans; Long-Term Care; Multiple Sclerosis; Nervous System Diseases; Pulmonary Disease, Chronic Obstructive; Rehabilitation; Rehabilitation, Vocational; Stroke Rehabilitation
PubMed: 19532107
DOI: No ID Found -
Archives of Physical Medicine and... May 1989This self-directed learning module addresses core concepts in the assessment of any child with disability, including physical growth and development, evolution of... (Review)
Review
This self-directed learning module addresses core concepts in the assessment of any child with disability, including physical growth and development, evolution of reflexes, and cognitive and personality development. It is a section of the chapter on pediatric rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. The rehabilitation perspective is emphasized, especially as it changes to accommodate the developing child, with a focus on specific chronic disorders such as respiratory disease, congenital heart disease, and malignancy. These types of disorders serve as a model for the management of problems that require special medical, rehabilitative, and psychosocial consideration.
Topics: Child; Child Development; Exercise Therapy; Humans; Rehabilitation; Respiration, Artificial
PubMed: 2655554
DOI: 10.1016/0003-9993(89)90022-1