Dissertationen zum Thema „Rehabilitation“

In order to maintain a high quality of life for the residents of growing rural communities a more efficient, sustainable, and pragmatic architectural solution must be devised. The current mentality concerning rural development and lifestyle must be reshaped in order to adapt to an increasingly environmentally conscience world. Within the built environment is the opportunity to provide direction for this positive change. Through extensive research and study, I intend to create an architectural solution that begins to shape its inhabitant's mentality, behavior and lifestyle by utilizing, teaching, and promoting the importance of nature and its cycles. Thus minimizing environmental impacts and conserving energy while improving the health, happiness, and quality of life of the building's occupants. Considering most of a persons life is spent immersed in architecture, the built environment determines a large portion of its inhabitants impact on the environment. This can be significantly minimized if the buildings, required as a necessity in peoples lives, have less impact on the environment. The future project's location should minimize its residents and visitors need for private vehicular transportation by providing an appealing environment for daily economic, recreational and social activities to take place simultaneously. It is my goal to continuously unite nature and man within the building and its surroundings forming awareness and appreciation for the natural world and its cycles by providing gardens through which residents can each begin to personally establish a relationship with nature. Most importantly, the project should be immersed as close to a natural recreational and wildlife area as possible. Through the resident's interaction with gardening environments, the surrounding natural landscape, and the building's use of natural energies and systems, an intimate relationship and sense of dependency on nature will become ingrained in the people living in and experiencing the building. Community and public spaces will be integrated within the development in order to encourage social and economical relationships while further immersing the architecture into the existing community. Ultimately this solution would encourage and promote positive interaction and relationships between the residents, the Bozeman community, and nature. The final result would be an architectural solution that provides a more energy and spatially efficient alternative to lateral development while embracing, improving, and interacting with the local environment, the central core of the city, and the existing community.

Herbert Morris argues in his influential retributivist paper, "Persons and Punishment," that criminals deserve punishment because their actions represent an unfair distribution of benefits and burdens in society. The proper distribution of benefits and burdens is important, in part, to restore law abiding citizens’ confidence that others will follow the law. In this paper I show that Morris's argument for why criminals deserve punishment morally requires us to set up an institution of rehabilitation in addition to the institution of punishment. Such an institution is morally required because neither pure punishment systems nor punishment systems that incorporate quasi-rehabilitative aspects have ever worked to uphold the necessary confidence that Morris tells us law abiding citizens must have in order to protect the social order. Moreover, we cannot abandon Morris's appeal to the duty to maintain social order without also abandoning a plausibly Morrisian framework.

This project investigates the many influences throughout the life span that interact to cause obesity. Heredity factors, overfeeding in infancy and childhood, repeated dieting, inactivity, lifestyle and psychosocial conditions all contribute to the incidence of obesity.

The growing numbers of older people in the UK has resulted in increased demand on existing and prospective health and social care services (Gray, A and Birrell, D 2013, p. 6). Intermediate care for older people has been an important aspect of a wide range of policy developments in the UK, developing from an awareness that hospital admission or a prolonged hospital stay is not necessarily an appropriate or effective intervention for older people (Glasby and Littlechild, 2000, p.110, Parker, 2005, p.9). Contemporary intermediate care policy and practice has developed within the context of research into the issues which impact on the outcomes for older people, including the concepts of caring (Fine, 2012), gender and caring (Clarke and Bennett, 2013) dependency (Fine and Glendinning, 2005), resilience (Netuveli, Wiggins, Montgomery, Hildon, Blane, 2008) and motivation (Shafizadeh, 2007). However, there is a paucity of evidence about the effectiveness or impact of intermediate care units in the UK (Roe and Beech, 2005, p. 62); most research focuses on the impact of NHS services and on disease specific services. This research provides an original contribution to knowledge by exploring the impact of the Lodge, a small intermediate care unit, managed by social services in a unitary authority on the south coast of England. Previous research on intermediate care has focused overwhelmingly on NHS provisions or disease specific rehabilitation. This research is original in exploring both the outcomes of rehabilitation and the voices of older people admitted to the Lodge. The effectiveness of the Lodge was measured by comparing the Barthel scores of residents both pre and post the rehabilitation intervention; as well as whether a resident is discharged to the community as opposed to residential or hospital care. Eleven participants were interviewed using a narrative approach to explore older people’s perspectives of rehabilitation and motivation. From the results, the Lodge was effective in improving the Barthel scores of older people and in facilitating their discharge to the community. Older people were generally positive about the intervention but they were not always clear about the process of admission; nor did the older people appear to have a sense of their goals within the Lodge. Instead, their motivation to return home appeared to be based on the quality and interdependence of the relationships with their family as well as their formal and informal carers.

Bibliography: leaves 86-92.
Quarry operations are only a temporary use of the land, while the environmental impacts associated with them are more long term. For this reason, it is unacceptable to merely abandon a quarry once operations have ceased. This study considers the role of rehabilitation in providing solutions for the disturbances caused by quarrying. The value of adopting a pre-planning approach towards rehabilitation is considered, and the components of a rehabilitation programme are identified. Using this information a rehabilitation checklist is drawn up. A survey of thirty rehabilitation reports, submitted to the Cape Town regional offices of the Department of Mineral and Energy Affairs, was undertaken using the checklist. Results of this survey indicate that rehabilitation reports are submitted merely to meet the minimum legal requirements contained in the Minerals Act of 1991 (Act No 50 of 1991). This study recommends that successful rehabilitation will only be achieved when rehabilitation reports function as effective working documents.

Perceptions of the course and outcome from serious mental illness have changed over the last century and, more recently, the concept of recovery has gained prominence in this field. This paper reviews recent literature on recovery from serious mental illness and discusses both the meaning of the concept and the key contributing factors. Research suggests that empowerment is one of the most salient factors contributing to recovery and the relationship between recovery and empowerment is examined. Most research in the area of empowerment has, to date, focused on community settings and this paper considers the relevance of these ideas in other mental health settings. The relationship between empowerment, recovery and mental health services is discussed. Finally, conclusions are drawn and recommendations for further research are outlined.

Haptic devices are becoming a common and significant tool in the perspective of robotic neurorehabilitation for motor learning, particularly in post-stroke patients. As a standard approach, this kind of devices are used in a local environment, where the patient interacts with a virtual environment recreated in the computer's screen. In this sense, a general framework for virtual reality based rehabilitation was developed. All the features of the framework, such as the control loop and the external communication, as well as the haptic and graphic rendering, were implemented inside Matlab/Simulink using Handshake proSENSE toolbox, guaranteeing a real-time system. As an example, a five-bar linkage haptic device with two active degrees-of-freedom (DOF) was designed and integrated within the proposed framework, as well as a device for grasping operations. An extension of this standard approach is verified when the therapist is allowed to feel and interact remotely and in real time with the patient. We applied the proposed concept to a single degree-of-freedom master/slave system. One hand orthosis was used as a master device at the therapist's side, while the other was applied to the patient's hand, and used as a slave device. In order to achieve this issue, we proposed two bilateral control systems in order to guarantee an stable interaction between the master and the slave, even in case of variable network conditions (i.e. Internet). By using the master device, the therapist can remotely move the patient's hand and, at the same time, perceive the patient's resistance to the motion, allowing the assessment of important parameters, such as the residual level of spasticity. In this way, it can be remotely assessed the conditions of the patient and consequently can be proposed a proper rehabilitation program.

Haptic devices are becoming a common and significant tool in the perspective of robotic neurorehabilitation for motor learning, particularly in post-stroke patients. As a standard approach, this kind of devices are used in a local environment, where the patient interacts with a virtual environment recreated in the computer's screen. In this sense, a general framework for virtual reality based rehabilitation was developed. All the features of the framework, such as the control loop and the external communication, as well as the haptic and graphic rendering, were implemented inside Matlab/Simulink using Handshake proSENSE toolbox, guaranteeing a real-time system. As an example, a five-bar linkage haptic device with two active degrees-of-freedom (DOF) was designed and integrated within the proposed framework, as well as a device for grasping operations. An extension of this standard approach is verified when the therapist is allowed to feel and interact remotely and in real time with the patient. We applied the proposed concept to a single degree-of-freedom master/slave system. One hand orthosis was used as a master device at the therapist's side, while the other was applied to the patient's hand, and used as a slave device. In order to achieve this issue, we proposed two bilateral control systems in order to guarantee an stable interaction between the master and the slave, even in case of variable network conditions (i.e. Internet). By using the master device, the therapist can remotely move the patient's hand and, at the same time, perceive the patient's resistance to the motion, allowing the assessment of important parameters, such as the residual level of spasticity. In this way, it can be remotely assessed the conditions of the patient and consequently can be proposed a proper rehabilitation program.

This building serves as a rehabilitative center for patients in recovery from mild traumatic brain injuries (mTBI). It is located on the Columbia Medical School and New York Presbyterian Hospital campus in the Washington Heights neighborhood of New York City. The building is designed with three goals in mind: to provide a safe and healing environment tailored specifically to the needs of the patients; to provide a positive working environment for the doctors, nurses, and staff who care for the patients; to provide a space for the public to find healing of their own. Patient rooms are broken up into three stages - dark, intermediate, and light - that encourage a slow and gentle reintroduction into the world. Staff areas are designed to allow in natural light, easy access to the outside, and privacy away from patients that allow the caregivers a space to recover and find moments of revitalization. The roof, open to the public, lifts upward toward the Hudson River and allows an unobstructed view of the Hudson River Greenway, the Hudson River, and Fort Lee, New Jersey. In a neighborhood of overworked doctors and staff, family members visiting sick loved ones, and residents of an urban environment this roof overlook provides a rehabilitating view of a rare natural environment. The following words, sketches, and drawings attempt to convey the process, structure, and poetry of the building.
Master of Architecture

This thesis presents the various methods of assessment and repair of damage to concrete bridges. The current repair and replacement techniques are identified and evaluated. Plausible repair-in-place techniques being used presently are reviewed along with the relevant details. Guidance is also provided for inspection and assessment of damage from accidents, fire, design and construction defects, and other causes.
Suggested guidelines for damage assessment and for selection of repair methods are presented along with some examples from the existing practice. The repair methods have been evaluated on the basis of load requirements, speed of repairs, durability, relative costs, aesthetics, materials, methods, and engineering solutions.
The thesis also deals summarily with the subject of bridge management systems, highlighting the need for effective maintenance and repair management strategies. Examples of two software packages being used currently for management purposes are presented. The case histories presented highlight the various current practices of rehabilitation and replacement.

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Bachelors
Health and Public Affairs
Nursing

Post-stroke sexual difficulties are common but sexuality is an area frequently neglected within stroke rehabilitation. This study aimed to explore the process by which healthcare professionals approach and work with the topic of sexuality within stroke rehabilitation. This was hoped to improve understanding of why current guidelines around addressing post-stroke sexual issues are not followed, and what would support professionals to meet patients’ needs. Ten healthcare professionals working within stroke rehabilitation were interviewed, covering a range of disciplines and settings. The data was analysed using grounded theory methodology. Fourteen major categories were co-constructed from participants’ data and a theoretical model was developed. Although the majority of participants rarely engaged with sexual issues, they adopted both direct and indirect strategies for engaging with the sexual concerns of their patients. Concerns were usually addressed through the provision of information and supportive conversation with a professional. Professionals’ own personal level of comfort with the topic of sexuality interacted with a series of barriers to limit opportunities for engaging with sexual concerns. These barriers included environmental factors relating to the context of stroke rehabilitation, professionals’ perception of lacking abilities and unhelpful attitudes towards patients and sexuality. Positive and inclusive attitudes towards sexuality and professional roles and building a strong therapeutic relationship facilitated professionals taking action. The findings are considered in relation to existing guidelines and research, and the clinical implications for rehabilitation and staff training are discussed.

Literature review: Dementia can be extremely disruptive and debilitating to everyday life leading to psychological distress. Cognitive rehabilitation is a relatively new intervention in dementia that could potentially alleviate this. The aim of the review was to critically cognitive rehabilitation in dementia. The review revealed a scarcity of research in this area with a number of methodologically limited studies. Despite their limitations the evidence for this intervention was encouraging. Further research employing more robust study designs needs to be conducted focusing on the functional, psychological and social impact of cognitive rehabilitation. Research report: To evaluate the effectiveness of a memory group providing cognitive rehabilitation a two group controlled design was used. Two matched memory clinics supplied the sample. Outcomes were activities of daily living (ADL), mood and carer strain. Memory deficit was also measured. Data was gathered at baseline and three months through a home visit by a researcher independent of the intervention. 26 intervention and 21 control participants were recruited. No statistically significant differences were found between groups at baseline. At three months deterioration in memory and ADL was observed in both groups. This was statistically significant for ADL. In the intervention group mood in participants and carers and carer strain remained stable with no statistically significant differences. In the control group statistically significant increases in participant depression, carer anxiety and depression and carer strain were observed. Effect sizes indicated a medium effect. The memory group did not have a positive effect on ADL but appeared to stabilise mood and carer strain. A possible protective effect of the group against psychological distress is a hypothesis that requires further investigation. Critical appraisal: Reflections on research process including the development for the intervention, the development of the evaluation and conducting the project are discussed.

This document presents the development of a first proposal prototype of a rehabilitation exoskeleton hand. The idea was to create a lighter, less complex and cheaper exoskeleton than the existing models in the market but efficient enough to carry out rehabilitation therapies.The methodology implemented consists of an initial literature review followed by data collection resulting in a pre-design in two dimensions using two different software packages, MUMSA and WinmecC. First, MUMSA provides the parameters data of the movement of the hand to be done accurately. With these parameters, the mechanisms of each finger are designed using WinmecC. Once the errors were solved and the mechanism was achieved, the 3D model was designed.The final result is presented in two printed 3D models with different materials. The models perform a great accurate level on the motion replica of the fingers by using rotary servos. The properties of the model can change depending on the used material. ABS material gives a flexible prototype, and PLA material does not achieve it. The use of distinct methods to print has a high importance on the difficulties of development throughout the entire process of production. Despite found difficulties in the production, the model was printed successfully, obtaining a compact, strong, lightweight and eco-friendly with the environment prototype.

The western world faces an explosion in the number of patients who will fracture their proximal humerus (PH) as a result of the rapidly changing demographics and the increase in osteoporosis. In 1998 there were 110 000 PH fractures in the United Kingdom (UK) and epidemiological studies indicate that the PH fracture incidence is increasing. Scant evidence exists to the optimum management and rehabilitation of these fractures and the aims of the study were to investigate the effect of an accelerated rehabilitation programme on patients' recovery. A Randomised Controlled Trial (RCT) comparing two rehabilitation programmes (n=86) with patients who sustained two-part fractures of the proximal humerus was performed. Patients were randomised to receive immediate physiotherapy within one week (Group A) or delayed physiotherapy (Group B) after 3 weeks immobilisation. Assessment was at 8, 16 and 52 weeks with the Constant Shoulder Score (CSS), Short form generic health survey (SF-36) and Croft Shoulder Disability Questionnaire (CSDQ). Additional reassessment was undertaken at two years. Regression analysis modelling was conducted to identify the risk factors for developed long-term shoulder disability. At the primary outcome point (16 weeks) Group A experienced less pain (p < 0.01) and had greater shoulder function (p < 0.001) compared to Group B. At 52 weeks the differences between the Groups had reduced. Overall, Group A experienced less pain as measured with the SF-36 (mean difference 486 Cl 83 to 889, p < 0.01) and improvedshoulder function (mean difference in AUC 6.4 [95% Cl: 2.5 to 10.5], p < 0.002). At one year, shoulder disability (CSDQ) was 42.8% in Group A and 72.5% in Group B (p < 0.01). By two years, shoulder disability in Group A remained unchanged (43.2%), but had reduced in Group B (59.5%). Immediate physiotherapy following a proximal humerus fracture results in faster recovery with maximal functional benefit being achieved at one year and requires fewer treatment sessions (9 versus 14 treatments, Group-A and B respectively). Delayed rehabilitation by three weeks shoulder immobilisation produces a slower recovery. The belief that patients make an excellent recovery after one year is questionable as 25 patients (33.5%) still reported considerable shoulder disability after two years of their injury. Gender (female), age and high levels of social deprivation were identified as risk factors for continued shoulder problems at two years after the fracture. This work suggests that patients who fracture their PH should not be immobilised before referral for physiotherapy as immediate referral to physiotherapy (within 1 week) results in faster recovery and less reported pain. Physiotherapy should be targeted towards those patients who are identified as having a greater risk of developing long-standing problems. Currently, a wide variation in PH fracture management exists in UK hospitals and implementing clinical care pathways will help target finite resources.

At present, the issue of child rehabilitation is very important. Rehabilitation is achieved by focusing on the impact of a condition of health, developmental difficulties or disability on a person's life, and not on their diagnosis.

Rehabilitation has long been lacking in a unified conceptual framework. Rehabilitation is always voluntary and some people may need help in deciding on the choice of rehabilitation. In all cases, rehabilitation should help strengthen the person with disabilities and his family.

This thesis aimed to investigate strategies for mobility rehabilitation and measurement. Research methods used include: a randomised controlled trial (n=162) with a cost effectiveness analysis of a balance-focused exercise class; a validation study (n=166) of devices to measure step counts during inpatient rehabilitation and; a systematic review with meta-analysis of trials of exercise to enhance mobility in people with frailty (12 trials). An RCT was conducted to evaluate the impact of two weeks of additional standing balance circuit classes in an inpatient rehabilitation population. The intervention group improved their composite balance measure by 3.26 sec (95% CI 0.84 to 5.70, P = 0.009) at two weeks and 3.40 secs (95% CI -0.56 to 7.38, P = 0.092) at three months compared to the control group. The intervention group improved significantly on mobility with a difference in the SPPB of 1.19 (95% CI 0.52 to 1.87, P = 0.001) at two weeks and 1.00 at three months (95% CI 0.00 to 2.00, P = 0.049) compared to the control group. The median cost savings for those who received the intervention was $4,741 (95% CI $137 to $9,372); 94% of bootstraps showed that the intervention was both effective and cost saving. To determine the accuracy of activity monitors for measuring steps in people with mobility limitations, participants wore 16 activity monitors simultaneously during a 6-minute walk test. Overall, the ankle-worn StepWatch Activity Monitor showed the highest agreement with the observed step count (ICC2,1) (0.982, 95% CI 0.975 to 0.986), followed by the Fitbit One worn on the ankle (0.919, 95% CI 0.772 to 0.961) and the thigh-worn ActivPAL (0.781, 95% CI 0.231 to 0.911). All other devices showed poor agreement. To evaluate the evidence for mobility training on mobility and function for frail older people in the community a meta-analysis of RCTs was performed (12 trials, 1,317 participants). Overall mobility training resulted in an improvement in mobility with a 0.47 SMD (95% CI 0.24 to 0.71). At 6 months post intervention there was an improvement of 0.32 SMD (95% CI 0.1 to 0.54). Overall, mobility training resulted in an improvement in function of 0.60 SMD (95% CI 0.21 to 1.00). At 6 months post intervention there was little to no difference with an improvement of 1.29 SMD (95% CI -0.38 to 2.96).

Pulmonary rehabilitation is a highly evidenced intervention used in the management of patients with chronic obstructive pulmonary disease. Both patients and healthcare professionals have anecdotally acknowledged motivation as a key element in a programme. It has been suggested by some authors that motivation should be a prerequisite to entry, yet there is no evidence to support this suggestion. The purpose of this study therefore, was to provide some theory about the role of motivation in pulmonary rehabilitation and to produce a measurement instrument to enable further quantitative study. Methods A qualitative, exploratory investigation using focus groups and face-to-face interviews with patients undergoing a pulmonary rehabilitation programme was undertaken to generate data around factors influencing motivation. Results were used to develop a 43 item self-report questionnaire. The questionnaire was administered to 77 patients before and after a pulmonary rehabilitation programme along with other health status measures. The questionnaire was tested for reliability and validity. Item reduction was performed using factor analysis. Results Motivation within the context of a PR programme was shown to consist of a number of psychological, social and circumstantial variables that fell into 3 broad dimensions: Essential motivation, external motivation and functional outcome. A key finding was that attending pulmonary rehabilitation had an enormous positive influence on the patients’ essential motivation. The questionnaire was reduced to 21 items and principal components analysis demonstrated 9 factors within the questionnaire. These were function, self-efficacy, effort, optimism, tenacity, self worth, isolation, ability and achievement. The questionnaire was named the Malvern pulmonary rehabilitation motivation questionnaire (MPMQ) for identification. The MPMQ was shown to be reliable with internal consistency, reproducibility on test-retest and sensitivity to change. Correlations were found between the MPMQ and health related quality of life, anxiety and depression, breathlessness, exercise capacity and hospital admissions during the previous 12 months. Motivation score was significantly lower in patients who dropped out of the programme and was significantly higher at the end than the start of a programme. Conclusion The MPMQ has been shown to be a reliable tool with sound evidence of validity that can be used to objectively assess patients’ motivation within the context of a pulmonary rehabilitation programme. These findings need to be supported with further evidence for the validity and reliability of the questionnaire. Further investigation of the association of MPMQ score and adherence in pulmonary rehabilitation is needed along with further exploration of the determinants of motivation. This would enable specialist staff to identify patients who are likely to have adherence problems and channel efforts into effective cognitive-behavioural interventions in the ongoing effort to establish the optimum pulmonary rehabilitation programme.

Background: Despite the favourable effects of new therapeutic approaches during the acute phase of cardiac diseases and consequent favourable short-term outcomes, post-acute management and long term prognosis still remain unsatisfactory. Cardiac rehabilitation (CR) is a multidisciplinary treatment with established beneficial effects for the vast majority of cardiac patients and universally considered an important aspect of secondary prevention. Although it has been shown to reduce both morbidity and mortality and it is a class I recommendation in the guidelines, its use remains still rather limited in Europe and in the rest of the world. Aim: The aim of this PhD research was to examine some aspects still little known, or unknown at all, in this field. In particular, the research aimed to evaluate safety and efficacy of a structured, exercise-based, CR in specific cohorts of patients: after transcatheter aortic valve implantation (TAVI), after left ventricular assist device (LVAD) implantation, and early after an acute myocardial infarction (AMI) in high risk subjects. Methods: All patients (78 TAVI, mean age 82.1±3.6 years, 42 LVAD, 63.4 ± 7.4 years, and 376 AMI, 64.4±12.3 years) were referred to the Institute Codivilla-Putti (in Cortina d’Ampezzo, BL, Italy) for a two week, in-hospital, CR training and comprehensive risk factors interventions early after the acute event (within two weeks TAVI and AMI, within two months after LVAD implantation). TAVI patients were compared with 80 consecutive peer patients who were admitted for CR in the same period after surgical aortic valve replacement (sAVR) and LVAD patients compared with 47 coeval chronic heart failure (CHF) patients who were admitted for CR in the same period after an acute heart failure event. In LVAD cohort, cardiac autonomic function was evaluated by means of heart rate variability. AMI patients were divided into 2 groups according to a 40% left ventricular ejection fraction (LVEF) cut-off at enrolment, in order to evaluate the influence of a reduced LVEF on the rehabilitative process; furthermore, in 326 patients a glucometabolic characterization was obtained by means of a standard oral glucose tolerance test (OGTT) in patients without known diabetes. In all patients the training protocol consisted of a low-medium intensity exercise protocol developed in three sets of exercises, 6 days per week: 30 min of respiratory workout, followed by an aerobic session on a cyclette (or on an arm ergometer in those patients who were not able to cycle) in the morning and, in the afternoon, 30 min of callisthenic exercises. Each session was supervised by a physician and a physiotherapist and all patients were ECG monitored by a telemetry system. Functional capacity was assessed by a six min walking test (6MWT) on admission, and a second test at discharge; when possible, a cardiopulmonary exercise test (CPET) was also performed. The Barthel Index (BI) was used as an autonomy index in TAVI and LVAD cohorts. In AMI patients rate of death, hospitalizations, smoke cessation, physical activity and adherence to pharmacological treatment were recorded at follow up (up to 5 years, median 2 years). Results: Despite the high risk profile of the population, the drop out rate was quite low (1.3% of TAVI, 1.1% of AMI and 11.9% of LVAD patients had to be transferred due to non fatal complications). All the subjects who completed the program had enhanced independence, mobility and functional capacity (mean BI increment was 9.9±12.6, p<0.01 and 11.9±10.5, p<0.01, in TAVI and LVAD patients respectively; mean 6MWT gain was 60.4±46.4 mt, p<0.01, 83.2±36.0 mt, p<0.05, 70.7±55.7 mt, p<0.01, in TAVI, LVAD and AMI patients, respectively). Analysing the specific cohorts, a smaller proportion of TAVI patients, compared with sAVR, was able to complete at least a 6MWT (82% vs 92%) or a CPET (61% vs 95%) but, in those who did, the distance walked at 6MWT at discharge did not significantly differ between the groups (272.7±108 vs. 294.2±101 mt, p=0.42), neither did the exercise capacity assessed by CPET (peak-VO2 12.5±3.6 vs. 13.9±2.7 ml/kg/min, p=0.16). At the end of the program, physical performance in LVAD patients was still generally poor, but not dissimilar from that found in CHF patients (peak-VO2 reached at CPET was 12.5±3.0 vs. 13.6±2.9 ml/kg/min, p=0.20). Evaluating AMI patients, subjects with LVEF<40% achieved significantly lower peak-VO2 at CPET than the controls (15.2±3.9 vs. 18.2±5.2 ml/kg/min, p<0.01). After OGTT administration, a high prevalence of abnormal glucose metabolism was found (54%). As expected, exercise capacity was poorer in diabetic and pre-diabetic patients when compared with normoglicemic (peak-VO2 at CPET 15.3±4.1 vs 17.9±4.8 vs 19.4±5.5 ml/kg/min, p<0.01). At follow up 73% of the subjects reported to exercise regularly, 77% of the smokers definitively quitted and a high adherence to the therapy was registered. Cardiac and all cause mortality resulted 5.0% and 8.0 % at 1 year and 8.0 % and 13.0 % at 5 years, respectively and resulted higher in older people and in those with lower LVEF. Conclusions: Patients who underwent TAVI and LVAD implantation are characterized by a long-term deconditioning status. In this perspective, benefit is not automatically achieved through high-technology interventions and pharmacological management alone. This study have shown that a short-term, supervised, exercise-based CR is feasible, safe and effective in elderly patients after TAVI, as well as after traditional surgery, and after LVAD implantation. An early CR programme enhances independence, mobility and functional capacity and should be encouraged in these subjects. An early and intensive CR, based on physical activity and counselling, resulted to be safe and effective also in high risk patients after AMI, both in the short and in the long period. Indeed, a significant improvement in functional capacity in the short term - independent from the basal ventricular function or glucometabolic status - and a high adherence to therapy and to lifestyle modifications in the long term were achieved. Despite the high risk profile of these patients, this produced a favourable effect on cardiac and total mortality.
Introduzione: Nonostante gli effetti favorevoli di nuovi approcci terapeutici durante la fase acuta delle malattie cardiache e conseguente prognosi più favorevole nel breve termine, la gestione della fase post-acuta di tali patologie e la prognosi a lungo termine rimane ancora insoddisfacente. La Riabilitazione Cardiologica (RC) è un trattamento multidisciplinare con chiari effetti benefici nella stragrande maggioranza dei pazienti cardiologici ed universalmente considerata un aspetto importante della prevenzione secondaria. Sebbene si sia dimostrata in grado di ridurre morbidità e mortalità e sia ormai un trattamento raccomandato in I classe nelle linee guida, il suo uso rimane ancora piuttosto limitato in Europa e nel resto del mondo. Scopo: Lo scopo del presente programma di ricerca è stato esaminare alcuni aspetti ancora pochi noti, se non del tutto sconosciuti, in questo campo. In particolare, la presente ricerca ha avuto lo scopo di valutare sicurezza ed efficacia di una RC strutturata, basata sull’esercizio fisico, in specifiche coorti di pazienti: dopo impianto di valvola aortica transcatetere (TAVI), dopo impianto di assistenza ventricolare sinistra (LVAD), e subito dopo infarto miocardico acuto (AMI) in soggetti ad alto rischio. Metodi: Tutti i pazienti (78 TAVI, età media 82.1±3.6 anni, 42 LVAD, 63.4 ± 7.4 anni, e 376 AMI, 64.4±12.3 anni) sono stati inviati presso l’Istituto Codivilla-Putti (Cortina d’Ampezzo, BL, Italia) per un periodo di riabilitazione cardiologica degenziale di due settimane, basato sull’allenamento fisico ed interventi sui fattori di rischio cardiovascolare, subito dopo l’evento acuto (entro due settimane dopo TAVI ed AMI, entro due mesi dopo impianto di LVAD). I pazienti TAVI sono stati confrontati con 80 pazienti di pari caratteristiche che nello stesso periodo giungevano in riabilitazione dopo sostituzione valvolare aortica per via tradizionale (sAVR); i pazienti LVAD sono stati confrontati con 47 pazienti di pari età affetti da scompenso cardiaco cronico (CHF) che giungevano nello stesso periodo dopo una riacutizzazione di scompenso. Nella coorte dei LVAD è stata inoltre valutata la funzione autonomica mediante lo studio dell’ heart rate variability. Per valutare gli effetti di una depressione della frazione d’eiezione del ventricolo sinistro (LVEF) sul processo riabilitativo, i pazienti AMI sono stati divisi in 2 gruppi in base alla LVEF (cut-off 40%). Inoltre, in 326 pazienti, è stata ottenuta una caratterizzazione glumetabolica mediante una curva da carico di glucosio standard (OGTT) somministrata ai soggetti senza diabete noto. Tutti i pazienti sono stati sottoposti ad un ciclo di ricondizionamento fisico con esercizi prevalentemente aerobici, distribuiti in 3 sessioni quotidiane per 6 giorni alla settimana (30 minuti di ginnastica respiratoria, seguiti da una sessione sulla cyclette, o su un arm-ergometro in coloro che non erano in grado di pedalare, nel pomeriggio 30 minuti di esercizi callistenici), sotto stretto monitoraggio telemetrico e diretta supervisione medica e fisioterapica. La capacità funzionale è stata valutata mediante six min walking test (6MWT) all’ingresso e alla dimissione e un test cardiopolmonare (CPET). Nelle coorti TAVI e LVAD è stata usata la scala di Barthel (Barthel Index, BI) per valutare il grado di autonomia. Nei pazienti AMI è stato registrato al follow up (fino a 5 anni, mediana 2 anni) l’incidenza di morte, nuove ospedalizzazioni, cessazione del fumo, attività fisica ed aderenza alla terapia. Risultati: Nonostante l’alto profilo di rischio della popolazione, il tasso di abbandono dal programma è risultato piuttosto basso (nell’ 1.3% dei pazienti TAVI, 1.1% degli AMI e 11.9% dei LVAD si è reso necessario il trasferimento all’ospedale per acuti per complicazioni non fatali). Tutti i soggetti che hanno completato il programma hanno migliorato la propria indipendenza, mobilità e capacità funzionale (incremento medio del BI 9.9±12.6, p<0.01 e 11.9±10.5, p<0.01, nei pazienti TAVI e LVAD rispettivamente; guadagno medio al 6MWT 60.4±46.4 mt, p<0.01, 83.2±36.0 mt, p<0.05, 70.7±55.7 mt, p<0.01, nei pazienti TAVI, LVAD and AMI, rispettivamente). Analizzando le specifiche coorti, una percentuale più bassa di pazienti TAVI rispetto a quelli del gruppo sAVR sono stati in grado di completare almeno un 6MWT (82% vs 92%) o un CPET (61% vs 95%) ma, in coloro che vi sono riusciti, non vi erano differenze significative tra i due gruppi in termini di distanza percorsa al 6MWT alla dimissione (272.7±108 vs 294.2±101 mt, p=0.42) e capacità funzionale al CPET (VO2 al picco 12.5±3.6 vs 13.9±2.7 ml/kg/min, p=0.16). Al termine del programma la performance fisica nei pazienti LVAD era generalmente scarsa, ma non dissimile da quella dei pazienti CHF (VO2 al picco al CPET 12.5±3.0 vs 13.6±2.9 ml/kg/min, p=0.20). Tra i pazienti AMI, coloro con LVEF<40% hanno raggiunto al CPET un VO2 al picco dell’esercizio significativamente più basso rispetto ai controlli (15.2±3.9 vs 18.2±5.2 ml/kg/min, p<0.01). Dopo somministrazione dell’OGTT è stata riscontrata un’alta prevalenza di alterazioni del metabolismo glucidico non precedente note (54%). Come atteso la capacità fisica era inferiore nei diabetici e nei prediabetici in confronto ai normoglicemici (al CPET VO2 al picco 15.3±4.1 vs 17.9±4.8 vs 19.4±5.5 ml/kg/min, p<0.01). Al follow up 73% dei soggetti hanno riferito di svolgere un’attività fisica regolare, 77% dei fumatori hanno definitivamente smesso ed è stata registrata un’alta aderenza alla terapia. La mortalità cardiaca e per tutte le cause è risultata 5.0% e 8.0% ad 1 anno, 8.0% e 13.0% a 5 anni, rispettivamente, ed è risultata più elevata nei soggetti più anziani ed in quelli con ridotta LVEF. Conclusioni: I pazienti che sono andati incontro ad intervento di TAVI e LVAD sono caratterizzati da un notevole grado di decondizionamento fisico. In tale prospettiva non si può automaticamente raggiungere un beneficio con il solo intervento ad alta tecnologia o con il trattamento farmacologico. Un breve periodo di RC, con supervisione medica, si è dimostrato fattibile, sicuro ed efficace in pazienti anziani dopo TAVI, così come dopo chirurgia aortica tradizionale, e dopo impianto di LVAD. Un programma precoce di RC aumenta l’indipendenza, la mobilità e la capacità funzionale ed andrebbe sicuramente incoraggiato in questi soggetti. Una RC intensiva e precoce basata sull’attività fisica e sul counselling è risultata sicura ed efficace anche in soggetti ad alto rischio dopo AMI, sia nel breve che nel lungo termine. Infatti è stato raggiunto un significativo miglioramento della capacità funzionale nel breve periodo - indipendentemente dalla funzione ventricolare sinistra residua o dallo stato glucometabolico - ed un’elevata aderenza alla terapia e alle modifiche dello stile di vita proposte. Nonostante l’elevato profilo di rischio di tali pazienti, questo può aver prodotto un effetto favorevole sulla mortalità.

Introduction: Community-based mental health rehabilitation is increasingly viewed as occupying a central position within the spectrum of care available to people with 'severe mental illness' (DH, 1999, pp.5). The definitions of rehabilitation informing this care primarily originate from service providers; service user understandings and experiences of rehabilitation have been inadequately explored, and the relationship between it and the potentially related concept of 'recovery' has not been examined. This study begins to address these issues by exploring the lived-experience in mental heath rehabilitation services, with specific attention to understandings and experience of rehabilitation. In doing so, it seeks to promote a fuller understanding of rehabilitation, benefiting the development and delivery of services, whilst providing a foundation from which the desirability of a unified definition of rehabilitation can be considered. Method: Semi-structured, audio-recorded interviews were undertaken with eight participants (seven men and one woman) recruited from 24-hour nurse-supported community mental health rehabilitation provisions. Interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis (Smith & Osborn, 2003). Results: Analysis yielded the three master themes of (i) 'Positioning of Power'; (ii) 'Moving Forward' and (iii) 'A Conducive Setting'. Within these themes respectively, the six subordinate themes of (i) 'Control' and 'Meeting Standards', (ii) 'Being Involved in a Process' and 'Independence through Skills' and (iii) 'Relationships, Re-engagement and Togetherness' and 'Nurturing Environment' were identified. Discussion: The analysis is discussed in relation to the extant literature base, with particular focus on relationships, power, independence, and moving on through services. Implications are identified and recommendations for clinical practice and research are considered. Critical review: The study is reviewed with specific attention to its limitations, quality and control, and the impact of researcher factors on the research process.

This thesis examines how the pressure sensors can be used in rehabilitation for patients with weakened hand strength. The rehabilitation process usually contains everyday tasks to evaluate the patient’s capability and the tools for this part of the rehabilitation process are few. The challenges will be to find a suitable sensor for the application and how to implement the sensor in a versatile prototype with direct feedback for the user. To solve this problem, research will be conducted on different pressure sensor types to determine the most suitable one for this implementation. The resulting prototype is utilizing a force sensing resistor (FSR) mounted on a glove together with a module that presents direct feedback to the patient and caretaker. The glove has pressure sensors in each fingertip to detect the applied force for each individual finger when the patient grips an object. To present the feedback, a visual interface is created in the form of a hand with a LED for each finger, which provides direct visual feedback and a display to present numerical data.
Denna avhandling undersöker hur trycksensorer kan användas vid rehabilitering av patienter med försvagad handstyrka. Rehabiliteringsprocessen innehåller vanligtvis vardagliga uppgifter för att utvärdera patientens förmåga och nuvarande hjälpmedel är få. Utmaningarna är att hitta en lämplig sensor för applikationen och hur man kan implementera sensorn i en mångsidig prototyp med en direkt återkoppling för användaren. För att lösa detta problem kommer forskning att genomföras på olika typer av trycksensorer. Detta görs för att kunna bestämma den mest lämpade sensortypen för denna implementering. Den resulterande prototypen består av en handske med kraft känsliga resistorer (FSR) och en separat modul som ger direkt återkoppling till patienten och vårdtagaren. Handsken har en sensor i varje fingertopp för att detektera applicerad kraft för varje enskilt finger när patienten greppar ett föremål. För att presentera data från sensorerna skapas ett visuellt gränssnitt. Gränssnittet är i form av en hand med lysdioder i varje finger för direkt återkoppling och en bildskärm för att presentera numeriska data.

The purpose of this study was to investigate how well rehabilitation counselor trainees in CORE accredited rehabilitation counseling programs are prepared to advocate clients. In order to seek an answer to this research question, this study (a) measured the rehabilitation counselor trainees' self-reported preparedness to advocate for their clients, (b) assessed the rehabilitation counselor educators' perceptions of their students' preparedness to advocate for their clients, (c) explored the relationship between rehabilitation counselor trainees' self-reported preparedness to advocate for their clients and their educational experiences as well as their demographic information, (d) investigated whether there was a significant difference between rehabilitation counselor educators' perception of their students' preparedness to advocate for their clients and the rehabilitation counselor trainees' self-reported preparedness. The results indicated that rehabilitation counseling students developed advocacy competencies in some areas. However, it was also found that rehabilitation counseling students have lower advocacy competencies in the community and public level domains than in the individual level. Rehabilitation counseling students reported that rehabilitation counseling course work and their prior experiences with persons with disabilities were most substantial factors in the process of developing advocacy competencies.

Thesis (Ph. D.) -- University of Maryland, College Park, 2003.
Thesis research directed by: Counseling and Personnel Services. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.

The development of serious games, requires the participation and collaboration of several disciplines; as in the following thesis, showing the collaboration between physiotherapists and developers. Obviously good collaboration and understanding requires a tool that allows passage of information from one discipline to another. One example of such a tool is the concept of patterns. The concept has been adopted in many communities, one of which is game design where they have been called game design patterns, to offer the same advantages with additional benefits. In the following thesis we use game design patterns in order to translate the requirements of physiotherapists into a serious game. Or more precisely, the aim is to satisfy the requirements of physiotherapists as movements, motivation, and other features and map them into patterns and translate them in a serious game. The validation of the mapping was carried out in three different ways: with the physiotherapists, patients, and finally with game designers. The work carried out, shows an example of how game design patterns can be used to satisfy the requirements of physiotherapists in a game for rehabilitation.

Thesis (MSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: Spinal cord injury is a devastating sudden cause of disability which renders a person paralyzed and dependent on care immediately after the incident. A person who has suffered a spinal cord injury requires an intensive rehabilitation program to achieve physical independence as well as reintegration into the community. The aim of this study was to evaluate the rehabilitation program for patients with complete paraplegia at the Netcare Rehabilitation Hospital, a 120 bed private rehabilitation facility in Johannesburg, where rehabilitation for patients with physical disabilities is offered by an interdisciplinary team. The rehabilitation program was evaluated in terms of effectiveness including the degree of physical independence the patients achieved and how well the program prepared patients for successful integration into the community. The Functional Independence Measure (FIM), a standardized outcome measure that measures certain physical and cognitive functions and the Needs Assessment Checklist (NAC), an instrument designed to assess if the rehabilitation program is geared towards the patients’ individual needs were used as outcome measure. FIM scores were determined on admission and discharge and NAC scores were determined at discharge. A convenient, consecutive sample of sixteen patients with complete paraplegia (ASIA A), with a neurological level between T1 and T12, formed the study population. Consistently high FIM and NAC scores in the area of physical functioning suggested that the rehabilitation program at Netcare Rehabilitation Hospital was effective in terms of providing patients with physical independence. However, NAC results showed that the patients were not completely ready to reintegrate back to their communities. Areas that were identified as particularly problematic were knowledge on follow up health care services in the community, readiness for work and accessibility of the home and work environments. Therefore it is recommended that the rehabilitation team re-evaluate the program and incorporate strategies with the aim to improve it’s effectiveness in terms of preparing patients for community reintegration. It is also recommended that further research is conducted to assess the current success rate with regards to community reintegration and determine challenges to re-integration in order to assist with program panning.
AFRIKAANSE OPSOMMING: ‘n Spinaalkoordbesering is ‘n skielike oorsaak van gestremdheid wat die persoon verlam en afhanklik van sorg laat direk na die voorval. ‘n Persoon wat ‘n spinalkoordbesering opdoen benodig ‘n intensiewe rehabilitasie program om weer fisies onafhanklik te wees en ook om hom/haar voor te berei om weer by die gemeenskap in te skakel. Die doel van hierdie studie was om die rehabilitasie program by die Netcare Rehabilitasie Hospitaal, ‘n 120 bed private rehabilitasie fasiliteit in Johannesburg, waar rehabilitasie vir fisies gestremde persone deur ‘n interdissiplinere span aangebied word, te evalueer. Die program is geevalueer in terme van twee uitkomste naamlik, die graad van fisiese onafhanklikheid wat die pasiënte behaal en tot watter mate die program pasiente voorberei vir herintegrasie in die gemeenskap Die “Functional Independence Measure” (FIM), ‘n gestandaardiseerde uitkoms skaal wat sekere fisiese en kognitiewe funksies meet en die “Needs Assessment Checklist” (NAC), `n instrument wat ontwikkel is om te evalueer of rehabilitasie programme pasiente se spesifieke behoeftes aanspreek. Is gebruik om the rehabilitasie program te evalueer. Die FIM is met toelating en ontslag voltooi en die NAC is met ontslag voltooi. ‘n Steekproef van sestien pasiente met volledige spinaalkoordletsels (ASIA A) tussen T1 en T12 het die studie populasie gevorm. Deurgans hoë FIM en NAC tellings vir fisiese funksionering het daarop gedui dat die rehabilitasie program by die Netcare Rehabilitation Hospital effektief is in terme van fisiese onafhanklikheid van pasiente. Aan die ander kant het die NAC tellings daarop gedui dat die program minder suksesvol is wat betref die voorbereiding van pasiente vir gemeeskapsintegrasie. Spesifieke probleem areas sluit in kennis van waar om opvolg gesondheidssorg in die gemeenskap te bekom, gereedheid vir werk en toeganklikheid van die huis en werksomgewing. Daar word aanbeveel dat die rehabilitasie span by Netcare Rehabilitasie Hospitaal die program herevalueer om die effektiwiteit van die program in terme van die voorbereiding vir gemeenskaps herintegrasie te verbeter. Dit word ook aanbeveel dat ‘n opvolg studie gedoen word om die huidige sukses ten opsigte van gemeenskaps herintegrasie te evalueer en sruikelblokke te identifiseer ten einde die span the help met program beplanning.

AbstraktGenom att använda digitala verktyg går det att stödja barn som är i behov av rehabilitering och på så sätt underlätta deras vardagliga liv. Digitala verktyg som inkluderar ett salutogent perspektiv blir ett allt mer förekommande tillvägagångsätt för att behandla och främja hälsa över en längre tid. Denna form av verktyg kan tillhandahålla aspekter som social interaktion, lärande, kamratstöd, motivation och underhållning. Genom att kombinera och sammanföra dessa aspekter med spelutveckling hoppas vi kunna svara på frågan: Hur kan spelmekaniker integreras och designas in i digitala verktyg för att användas som stöd för barn i rehabiliteringsprocesser? Studien har genom ett holistiskt perspektiv överblickat problemområdet och tagit hjälp av metoder från designforskningen för att praktiskt utforska frågeställningen. I studien har barn som inte lider av någon sjukdom inkluderats i en deltagande designprocess för att få feedback under hela utvecklingen. Detta gjordes för att bättre lämpa de framtagna prototyperna för en riktig slutanvändare i dess verkliga miljö. Även en sjuksköterska har intervjuats för att bredda vårt perspektiv inom vården. Vår slutsats är att en kombinerad metod som omfattar både riktlinjer från Serious Games och traditionell speldesign stärker spelets syfte som en helhet och bidrar med andra viktiga egenskaper som kan användas inom ramen för digitala rehabiliteringsverktyg. Vårt resultat avbildas i de prototyper som utvecklats samt de riktlinjer i hur mätning kan genomföras och designas i detta sammanhang. Dessa erfarenheter och kunskaper kan användas för att bidra till utvecklingen av liknande digitala spel och verktyg för barn. Nyckelord: Mätning inom spel, Kamratstöd, Salutogent perspektiv, Serious Games, Spelutveckling, Spelutveckling, barn och rehabilitering.

Thesis (M.S.)--West Virginia University, 2007.
Title from document title page. Document formatted into pages; contains vi, 98 p. : ill. (some col.). Includes abstract. Includes bibliographical references.

As cardiac rehabilitation (CR) results in reduced mortality and morbidity (e.g. Dusseldorp et al, 1999), it is essential that as many people as possible are given the opportunity to benefit from it. Yet despite proven benefits, uptake of services can be low. This study sought to explore and possibly influence factors which predict attendance, with the ultimate goal of increasing attendance at a CR programme. Whilst sociodemographic and health care systemic factors predict CR attendance, recent research has focused on investigating the role of factors more amenable to change such as psychological factors (e.g. Johnston et al, 1999). Recommendations based on the reviewed research literature are presented as ways of increasing attendance at CR. It was evident from the review that psychological factors predicted attendance. In order to increase our understanding of these factors, interviews were carried out with attenders and non-attenders of CR (n=21). Several differentiating themes were identified: use of medical versus psychological model, illness perception, causal attribution, and attitude to CR. The results were interpreted using the Self Regulatory Model and the Theory of Planned Behaviour. Finally, a simple cost effective psychological intervention was developed and implemented to influence patients' beliefs about recovery and CR, in order to increase their attendance rates at a CR programme (n=87). Using a randomised control trial design, MI patients who received an intervention in the form of two letters, were shown to be significantly more likely to attend CR than those who received normal care (p <0.0025). In conclusion, there are a number of different ways that CR attendance can be increased. Firstly by being aware of how sociodemographic and health care systemic factors influence attendance and providing services accordingly. And secondly by understanding the role of psychological factors on attendance and implementing psychological interventions accordingly.