Resource allocation for community-based therapy

PURPOSE: Adequate and equitable resourcing of services for children with disabilities and their families is a challenge that is faced by agencies as the growth in client numbers outstrips any increase in available funding. While funding models have been developed within the acute health care and education sectors, there have been few attempts to develop funding models for therapy (occupational therapy, physiotherapy, psychology, and speech pathology) provided within community-based, paediatric disability services. This paper outlines a model for allocating staff resources to provide therapy services for children with physical disabilities based on a project conducted by Novita Children's Services (formerly the Crippled Children's Association of South Australia, Inc.). METHOD: Services were mapped using a framework based on the International Classification of Function developed by the World Health Organization and adopted by the Australian Institute of Health and Welfare. An action research methodology was employed that included focus groups held with staff to identify potential resource drivers; collection of travel time data, client caseload numbers; and developing profiles of services and client groups. A model for allocating staff time was developed to reflect the differing service demands, travel time, leave allowances and time for activities to develop the social environment for individuals with disabilities. RESULTS AND CONCLUSIONS: Analysis indicated that the drivers of staff resources were the type of service delivery (early intervention versus school aged services), model specific (e.g., time required to provide community-based services and work within multi-disciplinary teams), and specific client (need for complex technology or equipment; school/preschool transition times; high health care needs due to dysphagia, deteriorating conditions with changing needs, or post surgery/medication rehabilitation) and family well-being issues. While further data collection and refinement of the model is needed, it provides the organization with more objective and equitable resource allocation and enables improved advocacy for client needs.     

Participation-based therapy for children with physical disabilities

Purpose: Optimizing home and community participation of children with physical disabilities is an important outcome of rehabilitation. Method: A review of literature identified research and theory on participation of children with physical disabilities. The authors’ incorporated current knowledge to conceptualize the experience of optimal participation, formulate principles of participation-based physical and occupational therapy, and develop a five-step process for intervention. A case report was completed to illustrate application to practice. Results: Optimal participation involves the dynamic interaction of determinants (attributes of the child, family, and environment) and dimensions (physical, social, and self engagement) of participation. Real-life experiences enable children to learn new activities and develop skills that optimize their participation and self-determination. Interventions are: goal-oriented, family-centered, collaborative, strengths-based, ecological, and self-determined. A distinguishing feature of intervention is that the therapist’s primary role is to support the child and family to identify challenges to participation and solutions to challenges. The therapist is a consultant, collaborating with the child, family, and community providers to share information, educate, and instruct in ways that build child, family, and community capacity. Conclusion: The model may have utility for collaboration with families and community providers, determining goals for participation, and providing evidence-informed interventions.

Implications for Rehabiliation

• Home and community participation of children with physical disabilities is an important outcome of rehabilitation.

• Optimal participation is conceptualized as the dynamic interaction of determinants (attributes of the child, family, and environment) and dimensions (physical, social, and self engagement) of participation.

• Participation-based physical and occupational therapy is based on the assumption that real-life experiences enable children to learn new activities and develop skills and that the empowerment of families enables them to advocate for the full inclusion and integration of their children in society.

• In participation-based therapy, the therapist is a consultant, collaborating with the child, family, and community providers to share information, educate, and instruct in ways that build child, family, and community capacity.

     

Intellectual disability in Africa: implications for research and service development

Abstract

Although intellectual disability (ID) is probably the largest impairment grouping on the African continent, few indigenous research and evaluation studies have been undertaken. This article is an initial attempt to relate service delivery issues to an African research agenda. We critically analysed the available literature, drawing on academic publications and those of non-governmental agencies. In this process we identified several key issues for further investigation, namely: understanding ID in African contexts, access to education and health care, the provision of appropriate assistance and support, and income generation. We relate our analysis to the recommendations made in the World Report on Disability but with a specific focus on ID in Africa. The need for mainstreaming and prioritising ID in non-disability related and across impairment programmes is highlighted. We note the importance of families and emphasise the need to draw on informal and traditional forms of care and participation. The need for reliable research evidence to support practice is highlighted. We conclude with a call to action by and on behalf of individuals with ID to be included in the development priorities of the continent.

• Implications for Rehabilitation

• Service provision for people with intellectual disabilities in Africa is not always well served by insights obtained from western research agendas.

• Appropriate and effective rehabilitation requires an understanding of the context and the environment in which the disabled person operates.

• Indigenous research into the provision of support to families and the inclusion of persons with intellectual disability into mainstream programmes as well as disability specific provision is recommended.

     

PDCA在护理人力资源配置中的应用

目的:探讨PDCA理论在护理人力资源配置中的应用效果。方法:以2018年1月—2019年12月参加院内专科护士培训后取得合格证书的共享护士群体为研究对象,遵循PDCA原理"计划、实施、检查、处理",使用鱼骨图分析本院护理人力资源不足的影响因素,讨论改进措施并落实,观察实施效果。结果:应用PDCA循环管理后,患者满意度、...     

儿童早期预警评分在PICU护理人力资源调配中的应用研究

目的探讨儿童早期预警评分系统在PICU护理人力资源调配中的应用价值。方法应用儿童早期预警系统的分值指导责任组长进行人力资源调整,进行实施前后的护理质量评分、医生对护理工作满意度、护士对护理人力资源方案满意度对比。结果在2015年度使用儿童早期预警评分进行动态调整PICU的护理人力资源后,6项护理质量标准考核得分及医生满意度均较实施前有所提高,其中在护理安全管理质量、基础护理质量、危重患儿护理质量及感染管理质量得分显著提高,差异有统计学意义(P0.05);护士对工作忙碌程度、护理人力资源调整方案、绩效考核、工作氛围满意度问卷调查4个条目得分较实施前有所提高,差异有统计学意义(P0.05)。结论应用儿童早期预警评分系统指导PICU的护理人力资源调配,可提高护理质量及医护人员满意度。     

因素型患者分类系统在眼科护理人力资源配置中的应用

目的 构建因素型眼科患者分类系统，探讨其在眼科护理人力资源配置方面可行性及作用。方法 本文依据RMT-PCS原始量表与哈尔滨医科大学第一临床医学院眼科实际护理诉求相结合，构建因素型眼科患者分类量表，此量表的四部分为中心制定67个护理及相关项目，运用整数时数分割法将眼科患者分为四种类型患者进行分析。结果 一类与二类患者占比数量较大，依次为44.88%、49.77%，一类患者在出院病区占比49.48%，手术病区占比46.75%，二类患者在眼底病病区占比50.87%，术后病区，占比48.63%；三类与四类患者集中在创伤绿色通道病区和眼底病病区。眼科5个病区的一类、二类、三类及四类患者每日平均护理时数依次为（1.76±0.67）h、（2.79±0.53）h、（5.97±1.05）h、（12.14±1.34）h。护士配备系数依次为0.34、0.51、1.16、2.18。 结论 因素型眼科患者分类系统为不同患者归类提供量化指标依据，护理配备系数应用对护理管理操作带来科学化依据，对护理人力资源的分配起到指导作用，值得广泛推广。     

United States Medicaid home and community-based services for people with intellectual and developmental disabilities: A scoping review

Emerging research tests the impact of United States Medicaid home and community-based (HCBS) waiver policy on outcomes for people with intellectual and developmental disabilities; however, this body of work has yet to be synthesized. We conducted a scoping review to establish what is known about the impact of Medicaid HCBS policy on the lives of people with intellectual and developmental disabilities. Seven studies met final inclusion criteria. Their findings contribute to preliminary evidence that Medicaid HCBS waivers provide economic benefit at the state and federal level, reduce unmet healthcare needs, increase the likelihood that parents will be able to continue working, and reduce racial disparities in access to care. Additional work should compare HCBS waiver programmes, and their causal pathways, as well as draw international comparisons to similar programming, to determine essential infrastructure needed for a successful HCBS programme.     

Using assistive technology for schoolwork: the experience of children with physical disabilities

Aim.?This study explored the experience of children with physical disabilities using assistive technology for participation with schoolwork to gain a greater understanding of their perspectives and subjective experiences.

Method.?A qualitative study involving thematic analysis of in-depth interviews of the child with a parent or significant adult. Purposeful sampling from a larger study recruited five children aged between 10 and 14 years, with differing physical disabilities who attended mainstream schools. All children used computer-based assistive technology.

Results.?All of the children recognised that assistive technology enabled them to participate and reduced the impact of their physical disability, allowing independent participation, and facilitated higher learning outcomes. Issues related to ease of use, social implications and assistive technology systems are discussed.     

胸部物理治疗在小儿肺炎和肺不张中的临床应用

[目的]探讨胸部物理治疗（CPT）在小儿肺炎、肺不张中的应用效果。[方法]选择60例肺炎、91例肺不张（51例阻塞性肺不张，40例压迫性肺不张）患儿，将肺炎组和肺不张组分别设物理治疗组（CPT组）和对照组，对照组进行常规治疗，CPT组在常规治疗基础上加用CPT治疗，观察两组胸部X线片改善、肺部听诊改善等指标。[结果]肺炎患儿的CPT组胸片痊愈、肺部听诊改善和住院天数较对照组短（P〈0．01）；阻塞性肺不张的CPT组胸片痊愈、肺部听诊改善较对照组短（P〈0．01），而压迫性肺不张CPT组胸片改善与对照组无差异（P〉0．05），肺部听诊改善时间低于对照组（P〈0．05）。[结论]CPT用于小儿肺炎、肺不张治疗中，可促使胸部X线片和听诊结果改善，从而减少呼吸道并发症，缩短住院时间。     

胸部物理治疗在小儿肺炎和肺不张中的临床应用

[目的]探讨胸部物理治疗(CPT)在小儿肺炎、肺不张中的应用效果。[方法]选择60例肺炎、91例肺不张(51例阻塞性肺不张,40例压迫性肺不张)患儿,将肺炎组和肺不张组分别设物理治疗组(CPT组)和对照组,对照组进行常规治疗,CPT组在常规治疗基础上加用CPT治疗,观察两组胸部X线片改善、肺部听诊改善等指标。[结果]肺炎患儿的CPT组胸片痊愈、肺部听诊改善和住院天数较对照组短(P<0.01);阻塞性肺不张的CPT组胸片痊愈、肺部听诊改善较对照组短(P<0.01),而压迫性肺不张CPT组胸片改善与对照组无差异(P>0.05),肺部听诊改善时间低于对照组(P<0.05)。[结论]CPT用于小儿肺炎、肺不张治疗中,可促使胸部X线片和听诊结果改善,从而减少呼吸道并发症,缩短住院时间。     

浙江省护理人力资源配置公平性研究

目的调查2010年浙江护理人力资源配置情况并进行公平性评价,为浙江省护理人力资源合理配置提供实证依据。方法采用卫生经济学中的洛伦兹曲线和基尼系数对浙江省2010年人口普查资料和2010年浙江省卫生统计汇编资料相关数据进行分析。结果浙江省各地的护理人力资源按人口、面积、床位、地理分布的洛伦兹曲线均分布在绝对公平线附近,人口分布的基尼系数为0.12,面积分布的基尼系数为0.055,床位分布的基尼系数为0.032。结论浙江省护理人力资源高于全国水平,各地区护理人力资源按人口分布,面积和床位分布的公平性处于相对公平状态。     

Comparison of the inertial properties and forces required to initiate movement for three gait trainers

The purpose of this study was to evaluate the inertial properties and forces required to initiate movement on two different surfaces in a sample of three commonly prescribed gait trainers. Tests were conducted in a laboratory setting to compare the Prime Engineering KidWalk, Rifton Pacer, and Snug Seat Mustang with and without a weighted anthropometric test dummy configured to the weight and proportions of a 4-year-old child. The Pacer was the lightest and the KidWalk the heaviest while footprints of the three gait trainers were similar. Weight was borne fairly evenly on the four casters of the Pacer and Mustang while 85% of the weight was borne on the large wheels of the mid-wheel drive KidWalk. These differences in frame style, wheel, and caster style and overall mass impact inertial properties and forces required to initiate movement. Test results suggest that initiation forces on tile were equivalent for the Pacer and KidWalk while the Mustang had the highest initiation force. Initiation forces on carpet were lowest for the KidWalk and highest for the Mustang. This initial study of inertia and movement initiation forces may provide added information for clinicians to consider when selecting a gait trainer for their clients.     

Adaptation for participation!

Abstract

Purpose: To explore children’s experiences with testing, acquiring and using assistive devices.

Methods: Nine children (six boys, three girls, 9–12?years old, with different physical disability and activity experience, participated in semistructured interviews. The interviews were audio-taped, transcribed and analysed using Systematic text condensation.

Results: Assistive devices were reported to contribute to cope activities that the children otherwise would not have participated in. Several subjects listed the need for a shielded environment when adapting to new equipment. The children highlighted “independence in activities” and “having the opportunity to participate in activities with family and friends” as important for frequent use. Need for assistance and lack of localizations to perform the activities were listed as reasons for less frequent use.

Conclusions: This study reveals that it is useful to map each child’s opportunities for independency, appropriate locations for performing the activity and participation with friends, when considering obtaining assistive devices.

• Implications for Rehabilitation

• The use of assistive devices gives many children with physical disabilities the opportunity to participate in physical activity.

• Improving availability to assistive devices for physical activity should be a priority to help facilitate participation.

• Having opportunities to develop perceptions of competence may be essential for a child’s long term participation in physical activity.

     

The experiences and views of parents who care for ventilator-dependent children

Discussion in this paper is drawn from the literature examining the management of children with long-term assisted ventilation, and a study of parents' experiences and views of caring for their ventilator-dependent child at home. Difficulties in undertaking research into this group of children are highlighted. Recommendations are proposed regarding future multidisciplinary, multiagency service development in order to meet the needs of ventilator-dependent children and their families.     

社区护士配置及老年人社区护理服务现状

目的:了解南昌市社区卫生服务机构护士配置及老年人社区护理服务现状。方法:抽取南昌市五大主城区社区卫生服务机构的护士201名进行调查。结果:南昌市社区护士配置基本达标;老年人社区护理服务情况总体较好,排名前五位的项目是定期健康体检、营养饮食指导、合理运动锻炼指导、健康咨询、行为安全指导;50%以上社区护士未提供的项目是免疫接种护理指导、心理咨询、家庭访视、家庭病床服务。结论:目前南昌市社区护士整体素质有待提高。需要对护士配置及老年人社区护理服务内容进行改进,更好地提高老年人社区护理服务的质量。     

The effectiveness of manual physical therapy interventions in pediatric patients with anterior hip pain: a retrospective study

Objectives: The purposes of this study were to: (1) assess the benefit of adding manual therapy (MT) to physical therapy care in pediatric patients with anterior hip pain; (2) assess the relative risk of adverse reactions when MT is used; and (3) report the types of MT used.

Methods: This study was a retrospective chart review of patients treated in a hospital-based sports medicine clinic. The charts of 201 patients (mean age = 14.23?±?2.15 years) met the inclusion criteria and were reviewed. Patients were grouped into those who received MT during their episode of care, and those who did not. Pain efficiency (change in pain/number of visits), number and type of adverse reactions, as well as frequency and type of manual therapy interventions used, were the outcomes of interest.

Results: The mean pain efficiency was significantly less if manual therapy was performed (MT = 0.60 [95% CI 0.47–0.72], no MT = 0.80 [95% CI 0.71–0.90] p = 0.01). There was no significant difference between groups in risk of adverse reactions (MT = 5, no MT = 5). The number of visits was significantly different between groups (MT = 9.43?±?3.9 sessions, and no MT = 7.6?±?5.2 sessions).

Discussion: MT did not increase the risk of an adverse reaction in pediatric patients with anterior hip pain. While it appears to be a safe intervention, it did not improve pain efficiency or patient adherence. Future research should be performed to assess the effectiveness of MT, when performed by skilled therapists, in pediatric patients with hip pain in a controlled manner.

Level of Evidence: 3b.