The work of rehabilitation

Purpose.?To describe three years of activity of a rehabilitation unit and to make comparisons between clients who receive different levels of active rehabilitation.

Method.?A retrospective study set in an inpatient rehabilitation facility located in Dunedin, New Zealand, examining 874 inpatient admissions over three financial years (2000?–?2002). Outcome measures include Functional Independence Scores (FIM) at admission and discharge, length of stay, weekly gains in FIM scores, and changes in FIM sub-scores.

Results.?Assessment and rehabilitation patients made significant FIM gains in comparison to assessment only and social relief (respite care) patients. Assessment and rehabilitation patients showed greater gains in the Physical dimensions of the FIM in comparison to the Cognitive although this is probably a function of different scaling. Floor and ceiling effects were not present in the FIM.

Conclusions.?The interdisciplinary rehabilitation program brings about real functional and cognitive gains in a range of patients as measured with the FIM. This adds to the considerable body of research which documents FIM gains and further provides evidence that physical and cognitive gains differ.     

早期康复对脑卒中患者功能活动能力的影响

采用FIM量表对68例急性脑卒中患者功能活动能力进行临床对照研究。两组患者在病后3月时的功能活动能力均有不同程度的改善，但康复组优于对照组（P＜0．001），在恢复独立功能活动者中，康复组16例（47．06％），对照组4例（11．76％）。研究结果表明，早期康复干预有助于脑卒中患者独立功能活动能力的恢复；患者在病后1月内，FIM评定为72．25±20．96分考，经早期康复治疗有可能达到功能活动独立。     

Predicting length of stay in specialist neurological rehabilitation

Aims: A retrospective case series was performed to determine which measures of complexity, dependency and function most accurately predict inpatient neurorehabilitation length of stay for individuals with post-acute neurological disorders.

Methods: Sociodemographic, medical and functional variables were extracted from data submitted to the UK Rehabilitation Outcomes Collaborative. Length of stay was calculated as the total number of inpatient days, functional status was measured using Barthel Index, rehabilitation complexity was measured using Extended Rehabilitation Complexity Scale, and nursing dependency was measured using the Northwick Park Dependency Scale.

Results: The mean rehabilitation length of stay was 70.9 days, with length of stay being 35.1 days higher in inpatients with acquired brain injury than inpatients with spinal cord injury. Diagnostic category, Barthel Index scores, Extended Rehabilitation Complexity Scale scores and Northwick Park Dependency Scale scores at admission independently predicted length of stay. Multiple regressions including diagnostic group, Barthel Index, Extended Rehabilitation Complexity Scale and Northwick Park Dependency Scale statistically significantly predicted 37.9% of the variability in length of stay (p?Conclusions: In conclusion, inpatient length of stay is predicted by diagnostic category, Extended Rehabilitation Complexity Scale, Northwick Park Dependency Scale and Barthel Index. The most influential predictor of rehabilitation length of stay was Northwick Park Dependency Scale score at admission. These results may help facilitate rehabilitation resource planning and implementation of effective commissioning plans.

• Implications for Rehabilitation

• The most accurate predicting variable for length of stay in inpatient neurological rehabilitation was nursing need as measured by the Northwick Park Dependency Scale score on admission.

• Service users and commissioners can be provided with more realistic predictions of length of stay derived from admission variables that can be used in planning inpatient rehabilitation.

• Age and gender do not seem to have an effect on the total length of stay in rehabilitation.

     

FIM score, FIM efficiency, and discharge disposition following inpatient stroke rehabilitation.

The Functional Independence Measure (FIM) is a widely accepted scale used to measure the functional abilities of patients undergoing rehabilitation. Scores at the extremes of this scale correlate with discharge disposition, while midrange scores are less well understood. This study evaluated the rate of FIM change with time ("efficiency"), admission and discharge FIM scores, and discharge disposition of 748 patients who underwent stroke inpatient rehabilitation. Patients with low scores at admission or discharge were likely to be discharged to a facility (63% and 78%, respectively), and those with high scores at admission or discharge almost always returned home (88% and 81%, respectively). Those with midrange scores at admission were more likely to return home (62%) than those with similar scores at discharge (33%). Greater FIM efficiency scores were associated with home discharge. Findings provide insight into discharge planning for stroke patients and indicate the need for more detailed evaluation of the midrange group.     

Neurological rehabilitation nursing: a review of the research

Neurological rehabilitation is increasingly seen as a specialist form of rehabilitation requiring specialist nursing knowledge. However, as in many areas of nursing, nurses in this field recognize that there is a need to increase their knowledge base to ensure that they provide the best and most up-to-date quality care for their patients and their families. To achieve high levels of competence, neurological rehabilitation nurses need to be aware of the existing body of research in this field so that they can make sound decisions regarding their practice and future research endeavours. This review aims to validate the existing knowledge base in this area by identifying and critically analysing research conducted in the area of neurological rehabilitation nursing during the decade 1988-1998 and by identifying any gaps and weaknesses that may be addressed by future research. Studies were included in the review if they examined an aspect of rehabilitation nursing, were concerned predominately with the neurological patient and were conducted in an in-patient setting. Research with a medical focus was not included and only research published in English was reviewed. Relevant research located examined the following areas: (1) the role of the rehabilitation nurse; (2) specific problems concerning the neurological rehabilitation patient; (3) specific nursing interventions; (4) rehabilitation nursing practice; (5) the delivery of rehabilitation programmes and team working; and (6) the family of the rehabilitation patient. The review concludes that research in this speciality remains limited both in quantity and quality. Most of the studies lack rigour and, because they were conducted at a single site, their generalizability to other clinical sites may be limited.     

脑卒中后抑郁及干预治疗对神经功能康复的影响

目的观察脑卒中后抑郁及其干预治疗对神经功能缺损康复的影响。方法将90例首发脑卒中伴抑郁的患者随机分为3组,分别给子黛安神、阿米替林和安慰剂治疗,于治疗前、治疗后2、4周及3、6月用汉密顿抑郁量表(HAMD)、神经功能缺损评分表(CSS)检测。结果黛安神组和阿米替林组的HAMD和CSS评分在治疗后显著低于对照组。结论抗抑郁治疗可显著减轻脑卒中后抑郁及其对神经功能恢复的不利影响,有利于神经功能缺损的康复。     

康复训练对慢性精神分裂症患者社会功能的影响

目的探讨院内分类康复训练对慢性精神分裂症患者社会功能康复的影响。方法将120例慢性精神分裂症患者随机分为训练组与对照组各60例;训练组根据功能独立性评定量表评分分为轻度组（≥80分）30例,重度组（〈80分）30例;两组均维持原用抗精神病药物治疗和一般日常管理,训练组在此基础上根据轻、重度分类进行系统康复训练,观察24周。于训练前及训练第4周、12周、24周末采用功能独立性评定量表、阴性症状量表进行评定分析。结果对照组训练前后功能独立性评定量表、阴性症状量表评分均无显著变化（P〉0．05）;训练组训练后各时段功能独立性评定量表评分均呈持续性升高,而阴性症状量表评分均呈持续性下降。轻度组各时段功能独立性评定量表评分均显著高于重度组及对照组（P〈0．05或0．01）;重度组训练前及训练4周末均显著低于对照组（P〈0．05或0．01）,而训练24周末显著高于对照组（P〈0．01）。轻度组训练前及训练后各时段阴性症状量表评分均显著低重度组及对照组（P〈0．01）;重度组训练前显著高于对照组（P〈0．05）,而训练第12周、24周末显著低于对照组（P〈0．01）。结论在药物治疗基础上,联合院内分类康复训练,能显著缓解患者的阴性症状,改善社会功能,提高功能独立性。     

近红外光谱仪在脑卒中瘫痪康复评定中的应用

目的：评价运动疗法对脑血流的影响,探讨脑卒中后瘫痪康复的机制,客观评估脑卒中后瘫痪的结局。方法：应用近红外光谱仪（near infrared spectroscopy,NIRS)观察23例脑卒中后偏瘫患者及9例无脑部疾病者4项不同的主动及被动运动局部脑血流变化,结果：运动时可见脑血流随时间而上升,。在运动末达到峰值,休息时逐渐下降,主动运动引起的局部脑血流比被动运动增加更明显,肢体近端运动引起的脑血流变化明显高于肢体远端运动。对照组左侧肢体与右侧肢体运动时引起的脑血流血流血氧变化无明显差异,病例组患侧肢体运动时比健侧血流增加更多。结论：脑卒中后患肢的主动运动比被动运动更有利于改善脑血流状况,脑卒中后早期NIRS观察运动相关的脑血流变化可以提示预后,运动疗法可改善患侧大脑的侧支循环和局部微循环,达到神经康复的目的。     

The influence of objective measurement tools on communication and clinical decision making in neurological rehabilitation

Rationale Routine collection of outcome measures is advocated to improve quality of care. However, there has been scant investigation of how measurement tools are used in clinical practice and what impact they may have. This paper compares two neuro‐rehabilitation teams, one which routinely used standardized measurement tools and the other which did not. We explore differences in communication and clinical decision making within multidisciplinary team (MDT) meetings to illuminate the influence measurement tools could have on clinical practice. Method Non‐participant observation of MDT meetings in two neurological rehabilitation units in England. Semi‐structured interviews were also carried out with at least one member of each profession in each team. Grounded theory techniques were used to analyse the data. Results Differences in team members' communication within MDT meetings underscored differences in the process of clinical decision making within the teams. Using measurement tools provided a shared understanding to facilitate communication by focusing discussion on the patient's abilities rather than individual professionals' contributions. This led to differences in the way team members identified the nature and cause of patients' problems, monitored their progress and planned for discharge. They provided a ‘neutral ground’ to reach a shared perspective between professionals, thereby avoiding conflict. Externally, use of the tools enabled objective discussion with patients and their families about their progress and was a vehicle to facilitate giving bad news. Conclusion Using standardized measurement tools can promote a patient‐focused approach to care, thus facilitating treatment planning and clinical decision making.     

The client-centred approach as experienced by male neurological rehabilitation clients in occupational therapy. A qualitative study based on a grounded theory tradition

Purpose To explore the perspectives of male clients in a neurological rehabilitation setting with regard to the occupational therapy they have received and the client-centred approach. Method This study involved a qualitative research design based on the grounded theory tradition. Individual in-depth interviews were used to collect data. Data were analysed using a constant comparative method. Seven male participants from an inpatient neurological setting were included using a theoretical sampling technique. Results Three themes emerged to describe the approach of the therapists to client-centred practice: (a) a shared biomedical focus as the start of the rehabilitation process, (b) the un-simultaneous shift from a biomedical towards a psycho-social focus and (c) formal versus informal nature of gathering client information. Conclusion A client-centred approach entails a shift from the therapist focussing on recovery from the short-term neurological issues towards the long-term consequences of the disease. According to the client, this shift in reasoning must occur at a specific and highly subjective moment during the rehabilitation process. Identifying this moment could strengthen the client-centred approach.

• Implications for Rehabilitation

• Client-centred practice entails a shift from recovering the short-term neurological issues towards the long-term psycho-social consequences of the disease.

• To be effective in client-centred practice, the clients expect from the professional to be an authority with regard to biomedical issues and to be partner with regard to psycho-social issues.

• Client-centred practice is most likely to be successful when client is susceptible to discuss his psycho-social issues and finding this moment is a challenge for the professional.

• Using formal methods for goal setting do not necessarily cover all the information needed for a client-centred therapy programme. Rather, using informal methods could lead to a more valid image of the client.

     

早期认知康复训练对脑卒中患者神经功能恢复的效果评价

目的:观察早期认知康复训练对缺血性脑卒中患者神经功能恢复的效果。方法:按照入院顺序,将60例缺血性脑卒中患者分为对照组(前30例)和观察组(后30例)。两组均进行神经内科常规护理并进行常规康复训练,观察组在此基础上进行1个月的早期认知康复训练。在训练前、训练第15天和第30天观察两组患者神经功能恢复情况。结果:训练前两组患者的临床神经功能缺损程度评分、简易精神状态量表评分及日常生活活动能力Barthel指数评分结果普遍较低,两组差异无统计学意义(P>0.05)。训练后,观察组患者各项评分优于对照组和训练前(P<0.05),对照组训练30天后各项评分优于训练前(P<0.05)。结论:早期认知康复训练能够提高患者的认知功能,增强日常生活能力,改善神经功能缺损症状,促进神经功能的早日恢复。     

The values underlying team decision-making in work rehabilitation for musculoskeletal disorders

Purpose.?This paper presents the results of a qualitative study on the values underlying the decision-making process of an interdisciplinary team working in a work rehabilitation facility of a Québec teaching hospital.

Methods.?In order to document the values underlying the decision-making process, a single case observational study was conducted. Interdisciplinary team weekly discussions on ongoing cases of 22 workers absent from work due to musculoskeletal disorders were videotaped. All discourses were transcribed and analyzed following an inductive and iterative approach. The values identified were validated by feedback from team members.

Results.?Ten common decision values emerged from the data: (1) team unity and credibility, (2) collaboration with stakeholders, (3) worker's internal motivation, (4) worker's adherence to the program, (5) worker's reactivation, (6) single message, (7) reassurance, (8) graded intervention, (9) pain management and (10) return to work as a therapy. The analysis of these values led to the design of a model describing interrelations between them.

Conclusions.?This study throws light on some mechanisms underlying the decisions made by the team and determining its action. This improves understanding of the actions taken by an interdisciplinary team in work rehabilitation and may facilitate knowledge transfer in the training of other teams.     

Nursing time and work in an acute rehabilitation setting.

Nursing staffing has long been recognized as a significant variable in a hospital budget even through the era of increased productivity and efficiency. In addition, patient acuity has been rising, and increasing demands on nursing personnel have been documented. These increased demands have affected nurse staffing, patient outcomes, and nurse retention, all of which have an impact on our healthcare system. Therefore, it is imperative that nursing time and work be examined in the acute rehabilitation setting--a setting in which research has been sparse. To estimate patient acuity, the activities of nursing personnel must be examined to establish timeframes for the care needed by patients. Previous studies have examined time and work according to pre-established patient acuity categories. California has passed legislation that requires mandatory nurse-staffing ratios in response to the concerns about the adequacy of patient care and safety. We did this study to assess the time and work related to patients with different diagnoses that are typically found in a rehabilitation unit. The data collected can be used to develop a patient acuity system. This study sought to identify how nurses spend their time so that hidden costs and important interventions can be addressed by an institution's administration.     

Changes in quality of life after rehabilitation for patients with progressive neurological disorders

The aim was to study whether patients with progressive neurological disorders experienced a changed quality of life at the end of a rehabilitation period and 3-4 months after their return home. Forty-one and 37 patients respectively filled in a self-administered questionnaire Quality of Life: Status and Change (QLsc). There was a significant difference between the two occasions for responses regarding the items 'My bodily health has become', 'My well-being has become' and 'I am able to maintain a good pace and lead an active life'. The alternatives 'rather good' to 'much better' were chosen more often at the end of the rehabilitation period than after 3-4 months. There were also differences between respondents who had been to the rehabilitation centre for the first time and those who had recurrent visits, regarding the items: 'My bodily health has become', 'My well-being has become' and 'My whole life is'. The alternative neither/nor was rated fairly evenly on both response occasions. The study probably indicates that the recurrent rehabilitation periods at the centre have an effect. When the respondents respond to items with a global focus, they seem to indicate experiences of a higher QOL.     

Feasibility of integrating robotic exoskeleton gait training in inpatient rehabilitation

Abstract

Objective: Learning to walk is a major goal of inpatient rehabilitation and robotic exoskeletons may provide a new gait training approach. Our purpose was to determine the feasibility of integrating the Ekso Gait Training device into inpatient rehabilitation in a neurologic population.

Design: Longitudinal cohort design and convenience sample including physical therapists trained to use the Ekso Bionics Ekso GT? robotic exoskeleton or inpatients with stroke or SCI. Therapists completed a focus group and survey at baseline and 6 months after initial Ekso training. Patients completed a survey indicating their satisfaction with using the Ekso.

Results: Twenty-five patients used the Ekso an average of 4.5 sessions during their 38.5-day rehabilitation stay. Survey and focus group feedback revealed that therapists encountered measurement difficulties with the Ekso and limited treatment time influencing effectiveness of usage. After 6 months, therapists reported an improvement in feasibility. Patients tolerated Ekso sessions well, without any complications or adverse incidents, and reported improved mobility post session.

Conclusion: Integrating Ekso gait training into clinical practice was not seamless but appears feasible. Barriers were addressed within the rehabilitation team and received administrative support in a process lasting several months. Patients enjoyed walking in Ekso and felt secure within the device.

• Implications for rehabilitation

• Integrating Ekso gait training into clinical practice during inpatient rehabilitation is feasible.

• Overcoming barriers to implementation required administrative support and clinician persistence over several months.

• Patients tolerated Ekso sessions well, without any complications or adverse incidents.

     

探讨中医康复护理对脑外伤术后患者社会支持度及功能恢复的影响

目的：探讨中医康复护理对脑外伤术后患者社会支持度及功能恢复的影响。方法选取本院收治的80例脑外伤手术患者作为研究对象,按照入院先后顺序分为两组（n＝40）,对照组患者实施常规护理,研究组在常规护理基础上增加中医康复护理措施,对比两组患者的社会支持度及神经功能、日常生活能力、肢体运动功能恢复情况。结果两组治疗后的Barthel指数、FMA评分均较术前明显提高,NIHSS评分较术前明显降低,且观察组术后的Barthel指数、FMA评分明显高于对照组,NIHSS评分明显低于对照组,P＜0．05;观察组患者术后的主观支持、客观支持、支持利用度评分及SSRS总评分均显著高于对照组,P＜0．05;观察组患者的治疗有效率为92．50％,显著高于对照组（80．00％）,P＜0．05。结论对脑外伤术后患者实施中医康复护理,能够有效促进患者运动功能、神经功能及日常生活能力的提升,同时改善患者的社会支持度,具有重要的临床价值。     

基于人文关怀理念的护理干预在神经康复患者护理管理中的应用效果

目的 探讨基于人文关怀理念护理干预在神经康复患者护理管理中的应用效果.方法 选取2018年3月至2020年3月在本院接受神经康复干预的80例患者,采用随机数字表法将其分为对照组和观察组,每组40例.对照组在护理管理中行常规性康复护理,观察组在护理管理中行基于人文关怀理念的护理干预.比较两组的干预效果.结果 干预后,两组...