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Kammerlind, Ann-Sofi. "Vestibular rehabilitation therapy in dizziness and disequilibrium /." Linköping : Univ, 2005. http://www.bibl.liu.se/liupubl/disp/disp2005/med914s.pdf.
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Davenport, M. J., and Faith W. Akin. "A Multidisciplinary Approach to Vestibular Rehabilitation Therapy." Digital Commons @ East Tennessee State University, 2002. https://dc.etsu.edu/etsu-works/2468.
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Skubik-Peplaski, Camille L. "ENVIRONMENTAL INFLUENCES ON OCCUPATIONAL THERAPY PRACTICE." UKnowledge, 2012. http://uknowledge.uky.edu/rehabsci_etds/23.
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Rehabilitation hospitals serve to foster a client’s independence in preparation to return home after an injury or insult. Having space in rehabilitation environments that is home-like and supportive for each client can facilitate participation in occupations and assist in learning and practicing the skills needed to transition to home. Yet, typically occupational therapists provide interventions to clients in therapy gyms with exercise and impairment based equipment. Currently the stroke population is changing and identifying the optimal rehabilitation environment is imperative to guide occupational therapy practice. This dissertation contains three studies relating to the rehabilitation environment and occupational therapy interventions. The first study focused on the perceptions of occupational therapists regarding their optimal rehabilitation environment, identifying that they would prefer to offer their clients a variety of rehabilitation environments and that there is a relationship between the environment and the type of intervention provided. A second study examined the effects of occupation-based interventions provided in a home-like environment to an individual recovering from chronic stroke with the results indicating enhanced occupational performance, resumed competence in desired roles, improvement in affected upper extremity function, and notable neuroplastic change. The final study investigated how the rehabilitation environment influenced the interventions used by the occupational therapists. The findings supported the relationship between the therapy environment and a specific intervention; working in the therapy gym with preparatory methods and being in a home-like space using occupation-based interventions. The environment influenced occupational therapy interventions and it is recommended that the occupational therapist match the client’s goals to the ideal environment for optimal intervention.
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Hall, Courtney D., Dara Meldrum, Gary P. Jacobson, and Neil T. T. Shephard. "The Aging Vestibular System: Implications for Rehabilitation." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/476.
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Book Summary: Balance Function Assessment and Management, now in its second edition, continues to comprehensively address the assessment and treatment of balance system impairments through contributions from top experts in the areas of dizziness and vertigo. Designed for use in graduate audiology programs and by practicing audiologists, this is also a valuable text for those in the fields of physical therapy, otolaryngology, and neurology. Assessment chapters focus on ocular motility testing, positional/positioning testing, caloric testing, rotational testing, computerized dynamic posturography, and vestibular evoked potentials. Treatment chapters examine nonmedical, medical, and surgical treatments of dizziness and vertigo, vestibular rehabilitation, and assessment of and intervention for risk of falls. Additionally, this text provides background information on the vestibular and ocular motor systems with corresponding sample cases. New topics addressed in this edition include: Development of the vestibular system Central compensation following peripheral vestibular system impairment Video head impulse test (vHIT) Biomechanics and physiology of balance Electrocochleography (ECochG) Pediatric vestibular system and balance assessment Effects of age on the vestibular and balance systems
An added bonus to the second edition is the companion website that offers additional reference materials, such as video clips, associated with the text.
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Useman, Tammy. "Patient Compliance and Recovery Outcomes in Rehabilitation Therapy." Honors in the Major Thesis, University of Central Florida, 2006. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1007.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
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Hall, Courtney D. "The Role of Emerging Technologies in Rehabilitation." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/583.
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Gallagher, Joanne M. "Compliance of Pressure Garments in Burn Rehabilitation." FIU Digital Commons, 1990. http://digitalcommons.fiu.edu/etd/3620.
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This study examined the pressure volumetric characteristics (compliance) of Jobst, Barton-Carey, and Tubigrip pressure garments for arms following repeated saturation with lubricating substances and repeated washing/drying cycles. The three treatment groups were each composed of one sleeve from each of the manufacturers. Each treatment group was subjected to 20 washing/drying cycles. In addition the sleeves in treatment groups 2 and 3 were saturated with cocoa butter and Lubiderm moisturizer respectively prior to each cycle. Circumferential measurements were taken on the proximal forearm of the sleeve at varying degrees of pressure (mmHg) using a Grafco Standard Sphygomanometer and a Gulick anthropometric tape measure. Measurements were taken initially and following every fifth washing/drying cycle. An analysis of variance (ANOVA) revealed significant results for the main effects and some interactions at the ,01 level. Results showed that the Jobst garments stretched with moisturisers but overall were smaller than the Barton-Carey garments which showed no change with moisturizers. The Tubigrip garments stretched more than the other garments with moisturizers but showed an overall inconsistent pattern,
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Hall, Courtney D., Dara Meldrum, and Susan L. Whitney. "The Role of Emerging Technologies in Vestibular Rehabilitation." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/480.
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Book Summary: Recognized as two of the world's leading authorities on the subject, Susan Herdman and Richard Clendaniel, joined by a team of expert contributors, deliver the 4th Edition of the field's definitive text on the management of vestibular diseases and disorders. From assessment through therapy, they present the scientific and clinical knowledge you need to distinguish between vestibular and non-vestibular dizziness and to plan and implement the appropriate treatments.
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Bays, Laren. "Opinions about sex offenders' progress in therapy." PDXScholar, 1992. https://pdxscholar.library.pdx.edu/open_access_etds/4290.
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Sex offenders are often required by the court to enter therapy and receive help so they can stop deviant sexual behaviors. Mental health professionals must have some means of evaluating a mandated client's progress in therapy, however, there are currently no valid criteria available. A survey form was developed containing 73 items which professionals identified as having possible utility in evaluating progress.
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Danzl, Megan M. "Developing the Rehabilitation Education for Caregivers and Patients (RECAP) Model: Application to Physical Therapy in Stroke Rehabilitation." UKnowledge, 2013. http://uknowledge.uky.edu/rehabsci_etds/12.
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Patient and caregiver education is recognized as a critical component of stroke rehabilitation and physical therapy practice yet the informational needs of stroke survivors and caregivers are largely unmet and optimal educational interventions need to be established. The objective of this dissertation was to develop a theory and model of “Rehabilitation Education for Caregivers and Patients” (RECAP) in the context of physical therapy and stroke rehabilitation, grounded in the experiences and perceptions of stroke survivors, their caregivers, and physical therapists.
Qualitative research methods with a novel grounded theory approach were used. Potential constructs of RECAP were identified from existing research. Next, semi-structured interviews were conducted with 13 stroke survivors and 12 caregivers from rural Appalachian Kentucky, a region with high incidence of stroke and lower levels of educational attainment. Lastly, 13 physical therapists, representing inpatient rehabilitation, outpatient, and home health, were recruited and participated in pre-interview reflection activities and interviews. Data analysis involved predetermined and emerging coding and a constant comparative method was employed. Verification strategies included self-reflective memos, analytic memos, peer debriefing, and triangulation.
The theory generated from this dissertation is: physical therapists continually assess the educational needs of stroke survivors and caregivers, to participate in dynamic educational interactions that involve the provision of comprehensive content, at a point in time, delivered through diverse teaching methods and skilled communication. This phenomenon is influenced by characteristics of the physical therapist and receiver (stroke survivor/caregiver) and occurs within the context of the physical therapist’s professional responsibility, the multidisciplinary team, a complex healthcare system, and the environmental/socio-cultural context. The RECAP theoretical model depicts the relationships between the core and encompassing constructs of the theory.
The RECAP theory and model presents a significant advancement in the study of patient and caregiver education in physical therapy in stroke rehabilitation. This research provides a springboard to inform future research, guide RECAP in stroke physical therapy practice, design optimal educational interventions, develop training tools for entry-level curriculum and practicing clinicians, and to potentially translate to the practice of patient and caregiver education for other rehabilitation professionals and patient populations.
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Siegel, Lori L. "Hamstring rehabilitation a systematic review /." Morgantown, W. Va. : [West Virginia University Libraries], 2007. https://eidr.wvu.edu/etd/documentdata.eTD?documentid=5158.
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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.
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Leslie, Rosalind. "Assessing efficacy of cardiac rehabilitation exercise therapy in heart failure patients." Thesis, University of Chester, 2015. http://hdl.handle.net/10034/613538.
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Background: Exercise-based cardiac rehabilitation (CR) is considered routine practice for patients following an acute cardiac event or surgical intervention. Although there is a seemingly strong evidence base supporting it for patients with chronic heart failure (CHF), provision in the UK remains poor for this patient group. In addition, data for CHF patients reported in key CR reviews and meta-analyses are not a true representation of the UKs CHF population. The transferability of current evidence into actual practice settings in the UK therefore remains incongruous. Rationale and aims: Study outcomes have typically included an increase in VO2 peak/ VO2 max, a decrease in natriuretic peptides, improved left ventricular function and improved health related quality of life (QoL). Access to facilities and equipment, such as cardiopulmonary exercise testing equipment is limited in the UK for the majority of CR services thus an alternative means of assessment and exercise prescription is required. The recommended alternative for testing CHF patients is the six-minute walk test (6MWT); this requires a given space and a full practice test, the latter which adds to valuable clinical and staff time available. Methods: The first set of studies of this thesis therefore investigated two adapted assessment procedures for use with CHF patients: i. the use of a shorter practice walk test of two minutes vs six minutes prior to a 6MWT and ii. the use of the space saving Chester step test with an adapted lower step height protocol to accommodate the anticipated lower fitness in CHF (4-inch vs 6-inch). Having determined a more practical and efficient means of assessing exercise capacity in CHF patients, this thesis then used the 6MWT to evaluate the efficacy of a typically recommended 12-week programme (for the UK) of exercise-based rehabilitation. It was the aim of this PhD to also combine the use of the Chester step test with cardiopulmonary measures as a corresponding physiological outcome in a sub-sample of participants; however due to resource problems, only validation of the low-step protocol was possible. In the main intervention study, the efficacy of a 12-week course of supervised moderate intensity exercise in CHF patients (ejection fraction <44%, NYHA class II to III) was then evaluated. For purposes of evaluating safety and recovery of any acute myocardial stress induced by exercise in CHF, a sub-group study was performed to evaluate the influence of an acute exercise session on two-day post-exercise levels of circulating NT-proBNP. Results: In this current suite of studies, participants were more representative of the UK CHF population than typically reported in the current evidence. Their profile involved a median age of 76 ± 16 years (mean: 67 years and range: 30 to 84 years). 98% of whom were prescribed beta-blockers, 66% were diagnosed with atrial fibrillation and 98% had two or more co-morbidities. Study 1 (Chapter 3a) verified the efficacy of a two-minute practice walk in comparison to the recommended six-minute practice walk prior to performing a baseline 6MWT in patients with CHF. Study 2 (Chapter 3b) demonstrated that a 4-inch Chester step test is a reliable assessment when space is an issue, but the criterion validity of the actual oxygen costs at each stage compared with those estimated in healthy populations were significantly lower than recommended estimations from healthy populations. Study 3 (Chapter 4) revealed individual variability in the acute response of NT-proBNP release to exercise that is worthy of further study. However the NT-proBNP data overall did not suggest a need for ‘rest days’ between exercise training sessions. The main intervention study (Study 4, Chapter 5) demonstrated a significant improvement in 6MWT performance responses, compared with control, where an increased walking distance of 25 m (p < .0001) was coupled with a reduction in heart-rate-walking speed index (T1 16.3 ± 7.3 vs T2 15.3 ± 8.7 beats per 10 walked; p < .0001). Perceptually, patients were walking faster for the same rating of perceived exertion (RPE 12 to 13). This improved aerobic functioning coincided with an improved NYHA class (T1 2.3 ± .5 vs T2 1.8 ± .6; p < .0001); however there was no change in resting NT-proBNP levels after 12 weeks. Patients in the “control group” who then went on to be offered the same 12-week intervention achieved similar outcomes, but delaying their commencement of an exercise programme by 12 weeks negatively impacted on participation uptake. Key findings and conclusions: These results have demonstrated that exercise training in CHF can lead to an improvement in both physical and perceived functioning (NYHA class). In light of some previous studies showing decreases in BNP following an exercise programme and others like this one showing no change, further questions are raised about the effect of different types and doses of activity being offered to CHF patients and the responsiveness to training of different types of patients (disease severity and demographics). The nature of the cross-over design of this study revealed that delayed commencement of exercise negatively affects participation uptake by patients, which supports current UK standards in aiming for early referral to CR.
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Henn, M. J., Gubela Mji, and Surona Visagie. "Evaluation of the rehabilitation program for persons with complete paraplegia at Netcare rehabilitation hospital." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/5772.
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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.
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Hastings, Jennifer M. "Bilateral arm training with rhythmic auditory cueing : rehabilitation metts music therapy." Scholarly Commons, 2011. https://scholarlycommons.pacific.edu/uop_etds/781.
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The purpose of this study was to examine the effect of rhythmic auditory cueing on Bilateral Arm Training on movement accuracy and speed for survivors of stroke. Three participants underwent a six-week home training of drum playing in repetitive reaching movements, practicing for three hours a week. They were randomly assigned to the treatment group (Bilateral Arm Training with Rhythmic Auditory Cueing; n = 2) and control group (Bilateral Arm Training only; n= 1). Assessments of the Wolf Motor Function Test (WMFT), tempo velocity, and spatial accuracy were performed at pre-, mid-, and post-training. All participants showed decreases in task performance times on the WMFT and improvements on the Functional Ability Scale, along with increased spatial accuracy. The treatment group maintained tempo velocity throughout the training but the non-cued participant moved slower at post- than at pre- and mid-assessment. Qualitative observations showed that the auditory-cued participants improved in movement quality through increased spatial alignment of the trunk and extension of the paretic arm, whereas the non-cued participant did not. Recommendations for future study as well as for designing home-training programs are given.
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Wressle, Ewa. "Client participation in the rehabilitation process." Doctoral thesis, Linköping : Univ, 2002. http://www.bibl.liu.se/liupubl/disp/disp2002/med722s.pdf.
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Tham, Kerstin. "Unilateral neglect : aspects of rehabilitation from an occupational therapy perspective /." Stockholm, 1998. http://diss.kib.ki.se/1998/91-628-3236-0/.
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Powell, Lois. "Spaced Retrieval in the clinical setting: Memory intervention for individuals with TBI." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1313426760.
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Hall, Courtney D., Stephanie B. Rouse, S. M. Flynn, and W. N. Hoffman. "Development of Rock Steady 1.0 – a Mobile, Gamified Vestibular Rehabilitation Therapy App." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5375.
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Hall, Courtney D. "Assessment of Subjective Complaints." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5379.
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Hall, Courtney D. "Vestibular Rehabilitation and Dizziness in Older Community-Dwelling Adults." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/569.
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Hall, Courtney D. "Management of Dizzy Patient." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/559.
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Gisladottir, Gunnhildur. "Occupational therapy in Iceland attitude, knowledge and cooperation." FIU Digital Commons, 1998. https://digitalcommons.fiu.edu/etd/3942.
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The purpose of this study was to discover attitudes and knowledge of four healthcare student groups toward occupational therapy in Iceland.
A fact-sheet identifying philosophy, theoretical background, skills roles and occupational therapy working areas was developed. Pre-test and post-test questionnaires were used to measure any attitude and knowledge changes which might have occurred after reading the fact-sheet.
The results demonstrated that the four student groups had obtained knowledge about occupational therapy during their university experiences; either from in class information or from field trips to occupational therapy departments. The questionnaire results indicated that students' attitudes toward cooperation with occupational therapists was positive. The overall outcome indicated that as a result of information gained from the fact-sheet, significant attitude and knowledge changes were demonstrated among the four student groups about occupational therapy in Iceland.
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Canyock, John David. "The effect of three positions of shoulder flexion on grip strength." FIU Digital Commons, 1997. http://digitalcommons.fiu.edu/etd/2032.
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This study investigated the effect of shoulder position on grip strength in 30 female students from Florida International University. A Jamar dynamometer was used to measure the grip strength in three testing positions (0,90 and 135 degrees of shoulder flexion with full elbow extension). The highest mean grip strength measurement was found at 135 degrees of shoulder flexion, followed by 0 degrees and then 90 degrees. An ANOVA indicated that there was a significant difference between at least two of the three positions. A Fisher's LSD post hoc test indicated that mean grip strength at 135 degrees of flexion was significantly higher than at 0 and 90 degrees of flexion.
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Binett, Nivia Liz. "The relationship between Common Language and Length of Treatment in Occupational Therapy." FIU Digital Commons, 1995. http://digitalcommons.fiu.edu/etd/1679.
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The diversity of ethnic and cultural groups and the effects of language in the therapeutic relationship are timely professional issues of concern to occupational therapy practitioners. The tri-ethnic, tri-cultural South Florida area offers a natural environment where one can study how patient-therapist interactions are influenced by language barriers in a diverse society. This study examines the effects of language on the adequacy of occupational therapy services, specifically how language affects the length of the treatment program. The nature of diagnosis therapists' ethnicity, and how they impact treatment outcomes are also addressed. A sample was drawn from the occupational therapy outpatient department of a large county hospital. Data taken from patients' charts examined race, sex, age, diagnosis, and language. Number of treatment sessions and length of treatment were viewed as proxy measures for adequacy. Findings indicate that the effect of language cannot be understood aside from ethnicity. Implications for occupational therapy practice are discussed.
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Cruickshank, Travis Miles. "The clinical utility of multidisciplinary rehabilitation in individuals with Huntington’s Disease." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2015. https://ro.ecu.edu.au/theses/1586.
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Background
Huntington’s disease (HD) is a chronic neurodegenerative disorder characterised by a progressive loss of cognitive function, motor control and psychiatric features. Individuals also display a variety of systemic features. Progressive neuronal dysfunction and neuronal cell death are thought to underlie the onset and progression of many clinical features of HD.
Despite scientific progress, there is still no cure or disease modifying therapy for HD, and available pharmaceutical agents only provide partial relief of motor and psychiatric features. An emerging body of evidence indicates that lifestyle enrichment may delay the onset and progression of clinical features, and exert favourable effects on neuropathological aspects of HD. Few studies have evaluated the effects of lifestyle enrichment strategies like multidisciplinary rehabilitation on the clinical features of HD. Moreover, no study has evaluated the effects of multidisciplinary rehabilitation on neuropathological aspects of HD.
Aims
The initial aim of this thesis was to determine factors that contribute to features of the disease that negatively impact on activities of daily living such as mobility and balance (Chapter 2), and to identify, using a literature review, a rehabilitation strategy that could positively impact on these features of HD (Chapter 3). These studies informed our ultimate aim which was to investigate the clinical utility of multidisciplinary rehabilitation on clinical and neuropathological features of HD (Chapters 4, 5 and 6)
Methods
In study 1 (Chapter 2), 22 participants were assessed using a battery of balance, mobility, cognitive tests, assessments of muscle strength and body composition measures. Data was
. then statistically examined using stepwise linear regression to identify factors that contribute to balance and mobility impairments in individuals with manifest HD. In study 2 (Chapter 3), a systematic search of journal databases was made from inception to July 2014 for studies reporting on resistance exercise in patients with neurodegenerative disorders. Selected studies were abstracted and critically appraised using a quality control checklist.
For the intervention studies, (3 and 4 Chapters 4 and 5), 20 participants with manifest HD were randomly assigned to either a control or training group. Individuals randomised to the intervention group were provided with a nine month multidisciplinary intervention comprising once weekly supervised clinical exercise, thrice weekly home based exercise and fortnightly occupational therapy, while those randomised to the control group were asked to continue with their standard care and daily activities. Participants were assessed using motor, cognitive, psychological, body composition and quality of life measures at baseline and at the completion of the intervention. In study 5 (Chapter 6), 15 participants with manifest HD were assessed using magnetic resonance imaging and a battery of cognitive assessments after nine months of multidisciplinary rehabilitation to see whether such a therapy is capable of inducing favourable changes in brain structure and cognitive function.
Results
The main factors that contribute to mobility and balance impairments in patients with manifest HD were found to be lower limb muscle weakness and a loss of cognitive function (Study 1). Systematic evaluation of the effects of resistance exercise for neurodegenerative disorders showed that it is beneficial for multiple sclerosis and Parkinson’s disease. In particular, improvements in muscle strength, mobility, balance, clinical disease progression, fatigue, functional capacity, quality of life, disease biology, electromyography activity, mood, skeletal muscle volume and architecture were reported in individuals with multiple sclerosis or Parkinson’s disease (PD) after resistance exercise. The most robust effects of resistance exercise were found for muscle strength outcomes, and were more pronounced in individuals with PD (Study 2).
The multidisciplinary rehabilitation intervention studies conducted as part of this thesis significantly improved isometric and isokinetic muscle strength, self-perceived balance, body mass, lean tissue mass and fat mass in patients with HD (Studies 3 and 4). Moreover, multidisciplinary rehabilitation also increased grey matter (GM) volume in the caudate nucleus and dorsolateral prefrontal cortex of patients. The significant increases in GM volume were accompanied by, and correlated to, a significant improvement in performance in verbal learning and memory.
Conclusions
The work presented here shows that lower extremity muscle weakness and a loss of cognitive function significantly contribute to impairments in mobility and balance. This work also shows that strength training has favourable effects on motor function, including strength, mobility and balance, as well as other clinical features in similar neurodegenerative disorders, and thus should be integrated into multidisciplinary rehabilitation interventions for HD. In addition, this study provides evidence that multidisciplinary rehabilitation can significantly improve aspects of motor control, cognitive function and body composition. Finally we show, for the first time, that multidisciplinary rehabilitation can increase GM volume in structures known to degenerate in HD, and that such increases are functionally related to changes in verbal learning and memory. Future work is urgently required to confirm and expand on these exciting findings, particularly with respect to the neurorestorative properties of multidisciplinary rehabilitation.
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Smith, Jane Elizabeth. "Rehabilitation following surgery to the low back." Thesis, University of Central Lancashire, 1997. http://clok.uclan.ac.uk/22524/.
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It is estimated that between 10 and 45% of patients who undergo surgery to the low back continue to suffer pain. This variability cannot be explained solely on the basis of pre-surgical clinical findings. There has been little clear elucidation of the issues which may affect outcome. The study aimed to identify those patients who were most likely to benefit from surgery and those whose rehabilitation might be prolonged by evaluating the psychological, clinical and demographic factors which may influence outcome. In addition, it attempted to investigate the relationship between cardiovascular and endocrine functioning and psychological factors. Eighty nine patients were assessed on a range of pre and peri-operative measures and then various outcome measures post-operatively on four occasions up to six months following surgery. Those who reported low anxiety pre-operatively and those who believed more in their own control over their back problems improved more in several areas of quality of life. Patients of one of the surgeons improved more in several aspects and those who waited longest for their surgery fared less well. Women and those who were not wage earners appeared to be less well rehabilitated when compared to men or those in heavy or active occupations. Depression, social support and coping had little effect on outcome. There were no relationships between self reported, cardiovascular and endocrine measures of anxiety. It is concluded that psychological, demographic and clinical factors can have a far reaching impact on rehabilitation. These factors may be inherent in the patient or may possibly be associated with attitudes of the hospital staff to the patient. It is concluded that the findings have implications for future intervention studies designed to improve the rehabilitation of these patients.
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Richards, Alexandra F. "Sexuality within stroke rehabilitation." Thesis, Canterbury Christ Church University, 2014. http://create.canterbury.ac.uk/12811/.
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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.
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Ashton, Alyssa. "Contextualizing Aquatic Rehabilitative Practices in Canada." Thesis, Université d'Ottawa / University of Ottawa, 2018. http://hdl.handle.net/10393/37708.
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This thesis explored the current context of aquatic rehabilitative practices in Canada. More specifically, three inter-related topics on Aquatic Therapy (AT) and Aquatic Physical Therapy (APT) in Canada were examined: 1) the development of knowledge, training and expertise on APT and AT, 2) recognition and acceptance of cultural and social authority on AT and APT (Starr, 1982), and 3) the practitioners’ perceptions of barriers to practicing and participation in aquatic therapy. Semi-structured qualitative interviews were conducted with seven (7) stakeholders including Ontario aquatic physical therapists, aquatic therapists, instructors on aquatic therapy and members of the College of Physiotherapy of Ontario (CPO) and the Canadian Physiotherapy Association (CPA). Interviews were complimented with open-ended questionnaires sent to Chairs of Physical Therapy programs in seven Canadian Universities.
Our research identified the most common means of acquiring knowledge on aquatic rehabilitative practices was through University Physiotherapy program curriculum; private training courses; and in-house within facilities where aquatic therapists and aquatic physical therapists are employed. This thesis also examined facilitators/barriers to practicing and receiving aquatic therapy and aquatic physical therapy. Through critical analysis, this thesis reflected on the ways in which social and cultural authority (Starr, 1982) are constructed within the field of aquatic therapy (AT) and aquatic physical therapy (APT). Recommendations and areas for future research included specialized training courses by scope of practice, and increased in-pool practicum training within Physiotherapy programs in Canada.
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Grau, Sánchez Jennifer. "Music-supported Therapy in the rehabilitation of motor deficits after stroke." Doctoral thesis, Universitat de Barcelona, 2019. http://hdl.handle.net/10803/670635.
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Motor deficits of the upper extremity are present in the majority of stroke patients, having a significant impact on their autonomy and quality of life. The recovery of motor deficits after stroke mainly relies on rehabilitation, which is a patient-centred process aimed at improving and maintaining the individual’s functioning using therapeutic interventions to promote adaptive learning. Recently, music-based interventions have emerged as a promising tool since they can incorporate many principles of stroke motor rehabilitation. Among these interventions, Music-supported Therapy has been developed to enhance the motor function of the paretic upper extremity in stroke patients by playing musical instruments. Previous studies have shown that Music-supported Therapy can improve the functionality of the paretic upper extremity, promote functional neuroplastic changes and enhance the mood and quality of life of subacute and chronic stroke patients. Despite these promising findings, Music-supported Therapy has not been appropriately contrasted with conventional therapy, and still, several aspects of its effectiveness remain unknown.
The main aim of this thesis was to study the effectiveness of Music-supported Therapy as a therapeutic intervention in the rehabilitation of upper extremity motor function after stroke. This thesis is composed of four studies that made use of different research designs and measurements at the neural, body functions, activity and participation level.
In Study 1, we tested the effectiveness of Music-supported Therapy in treating the hemiparesis of the upper extremity, inducing neuroplastic changes in the sensorimotor cortex and enhancing the quality of life in subacute stroke patients. By using an interventional experimental design, patients were assessed before and after the treatment in an evaluation that comprised standardised clinical motor tests, an assessment of the excitability of the sensorimotor cortex with Transcranial Magnetic Stimulation and a quality of life questionnaire. In Study 2, a randomised controlled trial was conducted to test the effectiveness of adding Music-supported Therapy to a standard rehabilitation program for subacute stroke patients. Participants were randomised into a Music-supported Therapy group or a conventional therapy group in addition to the standard rehabilitation program. Before and after four weeks of treatment, motor and cognitive functions, mood, and quality of life of patients were evaluated. A follow-up evaluation was performed at three months to test the retention of motor gains. In Study 3, a subsample of Study 2 was evaluated with a structural and functional Magnetic Resonance Imaging protocol before and after the intervention. This study aimed to characterise the lesions and white matter damage of patients, test the relationship between corticospinal tract integrity and motor recovery and explore the mechanisms of brain plasticity induced by Music-supported Therapy compared to conventional therapy. In Study 4, a single-case study was conducted to explore the progression of motor improvements throughout the Music-supported Therapy sessions, examine the effects of a second period of training, study the retention of motor gains over time and investigate the generalisation of motor improvements to activities of daily living. An extensive evaluation of the motor function using clinical motor tests and three-dimensional (3D) movement analysis was performed weekly and in a follow-up evaluation.
The results of this thesis show that Music-supported Therapy is an effective intervention in the rehabilitation of upper extremity function after stroke. Music-supported Therapy reduces the motor deficits and improves the functionality of the upper extremity of stroke patients in the same manner as conventional therapy, with gains that are generalised to activities of daily living and maintained over time. Moreover, patients treated with Music-supported Therapy have better language abilities, less fatigue and negative emotions, and greater quality of life than those patients treated only with conventional therapy. The pleasure experienced in musical activities is correlated with motor gains in patients treated with Music-supported Therapy, pointing out the importance of motivation in motor skill learning and stroke rehabilitation. Moreover, Music-supported Therapy promotes similar plastic changes than conventional therapy, inducing cortical motor map reorganisation and excitability changes in the sensorimotor cortex in stroke patients although further research is needed to pinpoint the neural plastic changes promoted by the therapy.Los déficits motores de la extremidad superior están presentes en la mayoría de las personas que han sufrido un ictus, e impactan de manera significativa en su autonomía y calidad de vida. La Terapia con soporte Musical ha sido desarrollada para mejorar la función motora de la extremidad superior parética en el ictus mediante el entrenamiento con instrumentos musicales. Sin embargo, esta intervención no ha sido contrastada adecuadamente con la terapia convencional y todavía se desconocen algunos de los aspectos relacionados con su efectividad. El objetivo principal de la presente tesis doctoral fue estudiar la efectividad de la Terapia con soporte Musical como intervención terapéutica en la rehabilitación de la función motora de la extremidad superior después del ictus. Esta tesis está compuesta por cuatro estudios que utilizaron diferentes diseños y evaluaciones a nivel neuronal, de las funciones del cuerpo, y de la actividad y participación de la persona. A través de diseños experimentales, un ensayo controlado aleatorizado y un caso único se evaluaron los efectos de la Terapia con soporte Musical en mejorar la función motora y calidad de vida de las personas que han sufrido un ictus, así como se estudiaron los mecanismos de plasticidad cerebral inducidos por esta intervención. Considerando los resultados en su conjunto, la Terapia con soporte Musical es una intervención efectiva en la rehabilitación de la función de la extremidad superior después del ictus. La Terapia con soporte Musical reduce los déficits motores y mejora la funcionalidad de la extremidad superior en las personas que han sufrido un ictus de la misma manera que la terapia convencional, con mejoras que se generalizan a las actividades de la vida diaria y se mantienen a lo largo del tiempo. Además, los pacientes tratados con Terapia con soporte Musical tienen mejores habilidades lingüísticas, menos fatiga y emociones negativas, y una mayor calidad de vida que los pacientes tratados solo con terapia convencional. El placer experimentado en las actividades musicales se correlaciona con las mejoras motoras en pacientes tratados con Terapia con soporte Musical, señalando la importancia de la motivación en el aprendizaje motor y en la rehabilitación del ictus. Además, la Terapia con soporte Musical promueve cambios plásticos similares a la terapia convencional, induciendo reorganización del mapa motor cortical y cambios en la excitabilidad de la corteza sensorimotora en personas que han sufrido un ictus.
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Hall, Courtney D., Susan J. Herdman, Susan L. Whitney, and Lisa Heusel-Gillig. "Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: Clinical Practice Guideline and Beyond!" Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/565.
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Description:It is estimated that 35.4% of adults in the United States have vestibular dysfunction requiring medical attention, and the condition results in a substantial increase in fall risk. The Neurology Section and APTA supported the development of a clinical practice guideline (CPG) for vestibular rehabilitation of peripheral vestibular hypofunction. A Cochrane Database systematic review concluded that there is moderate to strong evidence in support of vestibular rehabilitation in the management of patients with unilateral vestibular hypofunction for reducing symptoms and improving function. The purpose of the CPG is to review the peer-reviewed literature and make recommendations based on the quality of the research for the treatment of peripheral vestibular hypofunction. The speakers will present the findings of clinical practice guidelines (CPG) for vestibular rehabilitation, including clinical and research recommendations. The session will use a case-based approach to illustrate implementation of these guidelines in clinical practice. Learning Objectives:1 . Describe and discuss the action statements from the vestibular rehabilitation CPG. 2. Implement the action statements into clinical practice. 3. Identify the gaps in the evidence and future research directions in vestibular rehabilitation.
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Hall, Courtney D., Susan J. Herdman, Susan L. Whitney, Stephen P. Cass, Richard A. Clendaniel, and Terry D. Fife. "Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/543.
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Background: Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, “Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?” Methods: A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirty-five articles were identified as relevant to this clinical practice guideline. Results/Discussion: Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program and how to manage and progress themselves independently. As a general guide, persons without significant comorbidities that affect mobility and with acute or subacute unilateral vestibular hypofunction may need once a week supervised sessions for 2 to 3 weeks; persons with chronic unilateral vestibular hypofunction may need once a week sessions for 4 to 6 weeks; and persons with bilateral vestibular hypofunction may need once a week sessions for 8 to 12 weeks. In addition to supervised sessions, patients are provided a daily home exercise program. Disclaimer: These recommendations are intended as a guide for physical therapists and clinicians to optimize rehabilitation outcomes for persons with peripheral vestibular hypofunction undergoing vestibular rehabilitation.
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Bhatti, Pamela T., Susan J. Herdman, Siddarth Datta Roy, Courtney D. Hall, and Ronald J. Tusa. "A Prototype Head-Motion Monitoring System for In-Home Vestibular Rehabilitation Therapy." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/550.
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This work reports the use of a head-motion monitoring system to record patient head movements while completing in-home exercises for vestibular rehabilitation therapy. Based upon a dual-axis gyroscope (yaw and pitch, ± 500-degrees/sec maximum), angular head rotations were measured and stored via an on-board memory card. The system enabled the clinician to document exercises at home. Several measurements were recorded in one patient with unilateral vestibular hypofunction: The total time of exercise for the week (118 minutes) was documented and compared with expected weekly exercise time (140 minutes). For gaze stabilization exercises, execution time of 60 sec was expected, and observed times ranged from 75-100 sec. An absence of rest periods between each exercise instead of the recommended one minute rest period was observed. Maximum yaw head velocities from approximately 100-350 degrees/sec were detected. A second subject provided feedback concerning the ease of use of the HAMMS device. This pilot study demonstrates, for the first time, the capability to capture the head-motion “signature” of a patient while completing vestibular rehabilitation exercises in the home and to extract exercise regime parameters and monitor patient adherence. This emerging technology has the potential to greatly improve rehabilitation outcomes for individuals completing in-home gaze stabilization exercises 1 .
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Herdman, Susan J., Courtney D. Hall, Brian Maloney, Sara Knight, Marti Ebert, and Jessica Lowe. "Variables Associated with Outcome in Patients with Bilateral Vestibular Hypofunction: Preliminary Study." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/556.
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BACKGROUND: Vestibular rehabilitation (VR) improves symptoms and function in some but not all patients with bilateral vestibular hypofunction (BVH). OBJECTIVE: The purpose of this retrospective study was to examine change following vestibular rehabilitation and to identify factors associated with rehabilitation outcome in patients with BVH. METHODS: Data from 69 patients with BVH were analyzed. Factors studied included patient characteristics, subjective complaints and physical function. Outcome measures included symptom intensity, balance confidence, quality of life, gait speed, fall risk, and dynamic visual acuity. Bivariate correlations were used to examine relationships of patient characteristics and baseline measures with outcome measures. One-way ANOVAs were used to compare outcomes in patients with BVH versus unilateral vestibular hypofunction (UVH). RESULTS: As a group, patients with BVH improved in all outcome measures except disability following a course of vestibular rehabilitation (VR); however, only 38-86% demonstrated a meaningful improvement, depending on the specific outcome measure examined. Several factors measured at baseline - age, DGI score, gait speed and perceived dysequilibrium - were associated with outcomes. For example, greater age was related to higher DVA scores at discharge; lower initial DGI scores were related to higher Disability scores at discharge. Compared to patients with UVH, reported previously [9], a smaller percentage of patients with BVH improve and to a lesser extent. CONCLUSION: Consideration of baseline factors may provide guidance for setting patient goals. Further research is needed determine what factors predict outcome and to develop more effective treatment strategies for those patients who do not improve.
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Cooper, Nicholas A. "Gluteus medius dysfunction in chronic low back pain." Diss., University of Iowa, 2017. https://ir.uiowa.edu/etd/5445.
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Low back pain is a common but severe health problem. Chronic low back pain accounts for the bulk of the burden of low back pain. Exercise interventions are effective in the management of chronic low back pain. Current clinical thinking in physical therapy treats low back pain as a heterogeneous entity seeking to match specific interventions to subpopulations. None of these subgroups assess the role of gluteus medius dysfunction in chronic low back pain. These projects seek to describe the prevalence of gluteus medius weakness in people with chronic low back pain and test the effectiveness of a gluteus medius strengthening exercise intervention in people with chronic low back pain.
Gluteus medius strength was assessed in 150 people seeking care for chronic low back pain and 75 healthy people without low back pain. Gluteus medius was found to be weaker on affected sides compared to unaffected sides within people with chronic low back pain and weaker than people without low back pain. Gluteus medius weakness was a strong predictor of the presence of low back pain.
A gluteus medius strengthening program was compared with lumbar stabilization exercises in 56 people with chronic low back pain. Although there was a clinically significant improvement in pain in people who performed the gluteus medius strengthening exercise program, this was not significantly different from the stabilization exercise intervention. Adherence to exercise was significantly correlated with reduction in pain and perceived improvement of low back pain.
Although gluteus medius weakness is common in people with low back pain and treating this weakness with a targeted exercise intervention is effective, it is not better than a standard stabilization exercise intervention. Doing exercise is likely more important than what exercise is done.
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Yen, Chu-Ling. "Influence of age, physical activity, and motor cortical excitability on neuromuscular control of the wrist in humans." Diss., University of Iowa, 2016. https://ir.uiowa.edu/etd/2298.
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Injury occurs when people are exposed to an unexpected event. There is a knowledge gap regarding whether people can learn to respond to unexpected events and whether this learning is moderated by age, physical activity level, cognitive function, and motor cortical excitability. The purpose of this research was to examine the influence of: 1) age, 2) physical activity, 3) cognitive function, and 4) motor cortical excitability on motor performance and learning during a novel visual motor task of the wrist.
The major outcomes of this research revealed that the ability to respond to unexpected events is reduced with age; however, with practice, older people retain the capacity to learn to respond to unexpected events. This work also demonstrates that elderly people use both feed-forward and feedback strategies to improve their response to unexpected events. Conversely, young people predominantly use a feed-forward strategy to improve their ability to respond to an unexpected event. Importantly, active older people show greater capacity to respond to unexpected events and to learn to improve responses than less active older people. Older people with higher cognitive function demonstrate a greater capacity to respond to unexpected events than those with lower cognitive function. Furthermore, merely increasing motor cortex excitability does not translate into improved performance after young people have learned a motor task. Taken together, age, physical activity, and cognitive function impact human performance and the capacity to learn to respond to unexpected events. These findings have important implications as to how to rehabilitate and/or prevent injury to unexpected events in older people.
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Riley, Nora Havlik. "Neuromuscular adaptations during perturbations in individuals with and without bilateral vestibular loss." Diss., University of Iowa, 2010. https://ir.uiowa.edu/etd/587.
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Approximately 20% of the general population is affected by a vestibular disorder. Vestibular dysfunction is recognized as an important intrinsic factor leading to falls. Despite research on balance strategies with platform perturbations, limited information exists on neuromuscular performance of the knee with perturbations during functional tasks. Improved understanding of the effects of BVL on neuromuscular control of the knee will aid researchers and clinicians in developing rehabilitation programs that address the adaptations and balance deficits that occur with vestibular loss. Hence, the main purpose was to examine accuracy of performance, knee muscle activation patterns and long latency responses in response to unexpected perturbations during a controlled single leg squat in healthy individuals and those with bilateral vestibular loss (BVL).
The first study provided information about the ability to improve performance accuracy with perturbations based on the feedback available. It also showed concomitant changes in the LLR of quadriceps muscles with learning. In the second study, it was found that competent subjects with BVL show similar performance accuracy as healthy individuals during the SLS, with the exception of endpoint error. Muscle strategies are slightly different and vary on firm and foam surfaces. A significant finding was that the LLR is reduced in this group in response to unexpected perturbations, especially when visual feedback is absent. Rehabilitation and/or time living with bilateral vestibular deficiency can lead to a reorganization of the central nervous system, which may partly explain the alterations in neuromuscular control. More research is needed to determine the relationship between the long latency response and fall risk and if different training dosages with perturbations affect these in both healthy and vestibular-deficient populations.
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Wiley, Steve. "Lived experiences of physical therapists in inpatient rehabilitation facilities : an interpretive phenomenological analysis." NSUWorks, 2013. http://nsuworks.nova.edu/hpd_pt_stuetd/28.
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Eide-Corazon, Neva. "Variables which predict positive functional outcomes of rehabilitation in patients recovering from stroke." FIU Digital Commons, 2002. http://digitalcommons.fiu.edu/etd/3122.
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The purpose of this study was to identify which variables predict positive functional outcomes in rehabilitation of patients after a stroke. This study was a retrospective cohort study utilizing the Uniform Data Set from the social service records, the patient information sheet, and the quality assurance records to provide medical and demographic information. Sixty-nine patient records were included in the study.
Multiple regression analysis predicting total Functional Independence Measure (FIM) at discharge was significant, (p < .001). Significant predictors included total FIM at admission, length of stay, cognitive status and average hours of therapy. Higher total FIM admission scores, longer lengths of stay, higher cognitive status and more hours of therapy resulted in higher total discharge FIM scores. Mobility sub-scale FIM at discharge was significantly predicted by total FIM at admission and average hours of therapy, (p
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Mazza, Josie K. "The Role of Recreation Therapy Protocols in Cancer Treatment and Survivor Quality of Life." University of Toledo / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1449697703.
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Culpepper, W. Leigh. "Factors influencing injured athletes' adherence to rehabilitation." Virtual Press, 1992. http://liblink.bsu.edu/uhtbin/catkey/834133.
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The purpose of this study was to examine the influence of self-motivation and several non-psychological variables on injured athletes' adherence to rehabilitation. Twenty-five (17 male, 8 female) injured intercollegiate athletes from several sports (football, gymnastics, diving, swimming, volleyball, cross country/track, baseball, and tennis) participated. After injured athletes reported to the training room for treatment, they were informed of the study by the head athletic trainers. Athletes agreeing to participate were required to complete an injury information form and the Self-Motivation Inventory. The head athletic trainers recorded injury information, attendance to rehabilitation, and made judgments regarding each athletes' adherence to rehabilitation.Adherence was measured four different ways (i.e., attendance rates, trainer judgments, trainer rankings, and a combination of the previous three to create an overall adherence measure). The results of this study are inconclusive, due to the fact that the different adherence measures did not agree for each independent measure. The results, however, suggest that self-motivation and certain non-psychological variables (i.e., academic class, scholarship status, and injury severity) may serve as predictors of injured athletes' adherence to rehabilitation.Department of Counseling Psychology and Guidance Services
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Ahmed, Sara 1974. "The Stroke Rehabilitation Assessment of Movement (STREAM) : validity and responsiveness." Thesis, McGill University, 1998. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=20946.
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The main objectives of this prospective cohort study were to examine the construct and predictive validity of the STREAM, and estimating its responsiveness. Sixty three acute stroke patients were evaluated on the STREAM and other measures of impairment and disability during the first week post-stroke, four weeks later, and three months post-stroke. The results of the study showed that STREAM scores were associated with measures of impairment and disability, and could discriminate subjects based on Balance Scale and Barthel Index scores. Moreover, the STREAM during the first week post-stroke was found to be an independent predictor of discharge destination after the acute care hospital, and of gait speed and the Barthel Index at three months post stroke. In addition, the total and subscale STREAM scores were able to mirror changes in motor performance between each evaluation. The utility and measurement properties of STREAM warrant its use in clinical practice and research.
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Hackney, Madeleine E., Courtney D. Hall, Katharina V. Echt, and Steven L. Wolf. "Application of Adapted Tango as Therapeutic Intervention for Patients With Chronic Stroke." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/553.
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Background and Purpose: Dance has demonstrated beneficial effects on mobility in older individuals with movement disorders; yet, effects of partnered dance remain unexamined in individuals with chronic stroke. The purpose of this study was to describe the effects of adapted tango classes on balance, mobility, gait, endurance, dual-task ability, quality of life (QOL), and enjoyment in an older individual with chronic stroke and visual impairment.
Case Description: D.L. was a 73-year-old African American man, 13 years poststroke with spastic hemiplegia, visual impairment, and multiple comorbidities.
Intervention: D.L. attended 20 1?-hour tango classes adapted for older individuals with sensory and motor impairments over 11 weeks.
Outcomes: Measures of balance, mobility, gait, endurance, dual-task ability, and QOL were evaluated before and after the intervention and at 1-month follow-up. D.L. improved on the Berg Balance Scale, 30-s chair stand, Timed Up and Go (single, manual, and cognitive conditions), 6-Minute Walk Test, and backward gait speed. Not all measures improved: balance confidence decreased, and there was no change in forward and fast gait speed or QOL, as measured by the Short Form-12 and the Visual Function Questionnaire–25. Some gains were maintained at one-month follow-up. D.L. reported enjoying the classes, noted improvement in physical well-being, and wanted to continue the program.
Discussion: Thirty hours of adapted tango lessons improved balance, mobility, endurance, and dual-task ability in a participant with chronic stroke. The participant enjoyed the classes, was adherent, and wished to continue. This is the first reported use of adapted tango dance as rehabilitation for an individual with chronic stroke and low vision.
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Custer, Melba G. "DEVELOPING A MODEL OF CLIENT SATISFACTION WITH A REHABILITATION CONTINUUM OF CARE." UKnowledge, 2012. http://uknowledge.uky.edu/rehabsci_etds/7.
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Client satisfaction is an important outcome indicator because it measures multiple domains of the quality of healthcare and rehabilitation service delivery. It is especially important in occupational therapy because it is also client-centered. There are multiple domains of satisfaction and findings described in previous research; however, there is no single standard of measuring client satisfaction or any single working model describing the relationship among variables influencing satisfaction. This research was designed to apply a measure of satisfaction in rehabilitation and to develop a working model of satisfaction.
This study was an exploratory and predictive study using a large existing dataset to test a working logic model of client satisfaction, determine the best predictors of satisfaction, and then to revise the model for future research. After developing the Satisfaction with a Continuum of Care (SCC) in a pilot study, the SCC was completed by 1104 clients from a large Midwest rehabilitation hospital. The SCC results were paired with administrative data with client demographics, functional status, and measures of the` rehabilitation process. Six research questions on the predictors of satisfaction with client-centeredness and clinical quality were answered using logistic regression.
Significant predictors of satisfaction were having a neurological disorder, total rehabilitation hours, and admission to rehabilitation within 15 days of onset. The most robust and consistent predictors of satisfaction in this study were aspects of functional status as measured by the Functional Independence Measure especially improvement in overall and self-care functioning.
The results in the study were consistent with some previous research and inconsistent with others. The finding that improvements in functional status were highly predictive of satisfaction supports the worth that clients place on rehabilitation results including the self-care improvements focused on by occupational therapy.
This study was a partnership involving occupational therapy and a rehabilitation hospital. The finding that changes in self-care function were predictive of satisfaction was intended to isolate the effects of OT. There is a need to demonstrate outcomes and link these to occupational therapy and other rehabilitation disciplines to continue to identify best practices and contribute to the rehabilitation literature.
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Bakken, Annika, and Morine Kalulanga. "Delaktighet vid rehabilitering i hemmet för personer med stroke : - en litteraturstudie." Thesis, Örebro University, School of Health and Medical Sciences, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-10787.
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Syfte: Att belysa hur faktorer inom områdena person, miljö och sysselsättning kan påverka delaktigheten hos personer med stroke vid rehabilitering i hemmet.
Metod: Genom en litteraturstudie har tio vetenskapliga artiklar av kvalitativa och kvantitativ art analyserats utifrån Internationell klassifikation av funktionstillstånd, funktionshinder och hälsa (ICF) och Person Environment Occupation Model (PEO).
Resultat: Resultatet visade att vårdtagare som rehabiliterats i sin hemmiljö upplever mer delaktig i rehabiliteringen i jämförelse med vårdtagare som har genomgått sin rehabilitering på sjukhus. Betydelsefulla faktorer till den ökade delaktigheten är bland annat att vårdgivare får anpassa sig till vårdtagaren, som därmed får ett ökat medbestämmande. Vårdtagare upplever en trygghet när rehabiliteringen äger rum i hemmet, eftersom det är där de har sina gamla aktivitetsmönster. Vårdgivare får även större möjligheter att identifiera vilka aktiviteter som tidigare varit meningsfulla för vårdtagaren. Minskad delaktighet kopplas i flera studier till informationsbrist hos vårdtagarna angående deras nya livssituation och rehabiliteringsinsatser. The Canadian Occupational Performance Measure (COPM) är en klientcentrerad modell som visat stor användbarhet i att få vårdtagare delaktiga i rehabiliteringsprocessen, och då inte minst när det gäller information till vårdtagaren. Litteraturen visade även att det finns brister i samhällsresurser för att personer som drabbats av stroke ska uppleva delaktighet.
Slutsats: För att kunna göra en person delaktig vid rehabilitering i hemmet krävs det att åtgärderna utformas och genomförs i samråd med vårdtagaren. Vårdtagaren ska också få individuellt anpassad information om rehabiliteringsinsatser och förvärvat hälsotillstånd. Ett sätt att främja för vårdtagares optimala delaktighet är att ta hjälp av bedömningsinstrumentet COPM i rehabiliteringsprocessen. Ett bra stöd från samhället är en förutsättning för att bidra till delaktighet hos personer som drabbats av stroke.
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Lederman, Eyal. "The effect of manual therapy techniques on the neuromuscular system." Thesis, King's College London (University of London), 1999. https://kclpure.kcl.ac.uk/portal/en/theses/the-effect-of-manual-therapy-techniques-on-the-neuromuscular-system(3764f2dc-c18b-4f37-a1aa-0bcc0abe64ec).html.
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Stenlund, Therese. "Rehabilitation for patients with burnout." Doctoral thesis, Umeå : Umeå University, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-18434.
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Herdman, Susan J., Courtney D. Hall, and Lisa Heusel Gillig. "Factors Associated with Rehabilitation Outcomes in Patients with Unilateral Vestibular Hypofunction: A Prospective Cohort Study." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/7778.
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Objective:The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR).
Methods:In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge.
Results:There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed and falls after the onset of the UVH predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-based Balance Confidence (ABC) scale and Dynamic Gait Index (DGI) scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of DGI scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk.
Conclusions:Therapists may use these findings for patient education or the need for adjunct therapy such as counseling.
Impact:Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR, which will help therapists create better predictive models.
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Auais, Mohammad. "Hip fracture rehabilitation: where are we now and where are we going?" Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=114481.
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Hip fracture is a major public health problem in many developed nations. An estimated 30,000 hip fractures occur each year in Canada. To initiate adequate preventive measures, a thorough understanding of hip fracture patients' characteristics and the healthcare services they receive over the continuum of care is warranted. The global objective of this thesis is to contribute to our knowledge base concerning current and future needs, gaps, and solutions to provide optimal care for people with hip fractures.The first part describes the recovery process of patients with hip fractures and its definition. A post acute cohort was followed up to a one year after fracture and the patients' course of recovery was characterized using two methods to define recovery. This study demonstrated that the degree and time course of functional recovery after hip fracture varied on the basis of definition and the pre-fracture functional status. Despite the initial improvement, the functional status of the patients declined following cessation of rehabilitation services.Studying hip fracture patients' care and recovery at a single site over a limited time led to investigating the characteristics of the broader hip fracture population in the province of Quebec. What do we know about hip fracture trends, changes in health profile, and what might this information mean for the future? This guided the author to use an administrative database (Med-Echo) to answer these questions. The results confirmed the hypothesis that the hip fracture population is becoming frailer, which will increase the resources needed, and that the population's health profile differed on the basis of age and sex.The inside-hospital mortality rate and the proportion of patients who are discharged to rehabilitation after fracture are declining over time; consequently, increases the demand on community services. Finding the gaps and describing the needs is the first step to improve the quality of care, but this is not adequate. Therefore, the last part proposes potential solutions. A systematic review aimed at finding solutions to the previously identified gaps, specifically, the fact that hip fracture patients' functional status deteriorates following cessation of rehabilitation and that the need for community rehabilitation services will increase. Therefore, the reported effect in the literature of an extended exercise rehabilitation program was reviewed and quantified. This meta-analysis is the first to show that a clinically significant functional improvement can be gained later than is usually believed with elderly hip fracture patients. Such an improvement suggests that there is no 'plateau' for recovery. Finally, the methodology to evaluate and create a comprehensive program to serve hip fracture patients over the continuum of care is discussed and a simulated multidisciplinary program is proposed as a model.La fracture de la hanche est un problème de santé publique majeur dans de nombreux pays développés. Environ 30 000 fractures de la hanche surviennent chaque année au Canada. Afin d'initier des mesures préventives adéquates, il est nécessaire d'avoir une compréhension approfondie des caractéristiques des cas de fracture de la hanche et des services que les patients reçoivent dans le continuum des soins. L'objectif global de cette thèse est de contribuer à la base de connaissances des besoins actuels et futurs, des lacunes, et des solutions permettant d'offrir des soins optimaux aux personnes ayant souffert de fracture de la hanche. La première partie définit et décrit le processus de rétablissement des patients ayant subit une fracture de la hanche. Une cohorte post soins aiguës a été suivie pendant un an suivant la fracture et le processus de guérison du patient a été étudié en utilisant deux différentes façons de définir le rétablissement. Cette étude a démontré que le degré et le temps de récupération fonctionnelle après fracture de la hanche varient sur la base de la définition du rétablissement choisie et de l'état fonctionnel avant la fracture. Malgré l'amélioration initiale, l'état fonctionnel des patients a diminué suivant l'arrêt des soins de réadaptation. L'étude des soins et du rétablissement des patients ayant une fracture de la hanche dans un seul site pendant un temps limité a mené à examen des caractéristiques de la population souffrant d'une fracture de la hanche dans la province de Québec. Que savons-nous sur les tendances des fractures de la hanche, sur les changements dans le profil de la santé, et qu'est-ce que cette information pourrait signifier pour l'avenir? Ceci a conduit l'auteur à utiliser une base de données administrative (Med-Echo) pour répondre à ces questions. Les résultats ont confirmé l'hypothèse selon laquelle la population de patients ayant une fracture de la hanche devient de plus en plus fragile, ce qui nécessitera une augmentation des ressources. De plus, le profil de santé de cette population comparée à celle la population générale diffère sur les critères de l'âge et du sexe.Le taux de mortalité pendant l'hospitalisation suivant une fracture de hanche est en déclin ainsi que la proportion des patients envoyés en réadaptation à leur congé. Cela a comme conséquence d'augmenter de la demande de services en communauté. Rechercher les lacunes et décrire les besoins constituent une première étape vers l'amélioration de la qualité des soins, mais elle demeure insuffisante. Le but de la dernière partie est de proposer des solutions potentielles. Un examen systématique de la littérature a été mené dans le but de trouver des solutions aux lacunes identifiées précédemment, en particulier, le fait que l'état fonctionnel des patients ayant subit une fracture de la hanche se détériore après l'arrêt de la réadaptation et la nécessité d'augmenter les services de réadaptation communautaires. L'effet rapporté dans la littérature d'un programme d'exercices de réadaptation prolongée a été examiné et quantifié. Cette méta-analyse est la première à démontrer qu'une amélioration cliniquement significative du fonctionnement peut être acquise plus tard qu'on ne le croyait chez les personnes âgées ayant souffert d'une fracture de la hanche. Une telle amélioration suggère qu'il n'y a pas de «plateau» pour la récupération. Enfin, la méthodologie pour évaluer et créer un programme complet visant à servir les patients suivant une fracture de la hanche au cours du continuum des soins est discutée et un programme de simulation multidisciplinaire est proposé en tant que modèle.
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Hackney, Madeleine E., Courtney D. Hall, Katharina V. Echt, and Steven L. Wolf. "Dancing for Balance: Feasibility and Efficacy in Oldest-Old Adults With Visual Impairment." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/554.
Full textAbstract:
Background: Fall risk increases with age and visual impairment, yet the oldest-old adults (>85 years) are rarely studied. Partnered dance improves mobility, balance, and quality of life in older individuals with movement impairment.
Objective: The aim of the study was to determine the feasibility and participant satisfaction of an adapted tango program amongst these oldest-old adults with visual impairment. Exploratory analyses were conducted to determine efficacy of the program in improving balance and gait.
Methods: In a repeated-measures, one-group experimental design, 13 older adults (7 women; age: M = 86.9 years, SD = 5.9 years, range = 77–95 years) with visual impairment (best eye acuity: M = 0.63, SD = 0.6 logMAR) participated in an adapted tango program of twenty 1.5-hour lessons, within 11 weeks. Feasibility included evaluation of facility access, safety, volunteer assistant retention, and participant retention and satisfaction. Participants were evaluated for balance, lower body strength, and quality of life in two baseline observations, immediately after the program and 1 month later.
Results: Twelve participants completed the program. The facility was adequate, no injuries were sustained, and participants and volunteers were retained throughout. Participants reported enjoyment and improvements in physical well-being. Exploratory measures of dynamic postural control (p < .001), lower body strength (p = .056), and general vision-related quality of life (p = .032) scores showed improvements following training.
Discussion: These older individuals with visual impairment benefitted from 30 hours of tango instruction adapted for their capabilities.
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Hackney, Madeleine E., Courtney D. Hall, Katharina V. Echt, and Steven L. Wolf. "Multimodal Exercise Benefits Mobility in Older Adults with Visual Impairment: A Preliminary Study." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/544.
Full textAbstract:
Evidence-based recommendations for interventions to reduce fall risk in older adults with visual impairment are lacking. Adapted tango dance (Tango) and a balance and mobility program (FallProof) have improved mobility, balance, and quality of life (QOL) in individuals with movement impairment. This study compared the efficacy of Tango and FallProof for 32 individuals with visual impairment (age: M = 79.3, SD =11 [51–95 years]). Participants were assigned to Tango or FallProof to complete twenty, 90-min lessons within 12 weeks. Participants underwent assessment of balance, dual-tasking, endurance, gait, and vision-related QOL. The balance reactions of participants in both groups improved (p < .001). Endurance, cognitive dual-tasking, and vision-related QOL may have improved more for Tango than FallProof. Group differences and gains were maintained across time. Both programs could be effective options for motor rehabilitation for older adults with visual impairment because they may improve mobility and QOL while reducing fall risk.