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Stroke, Multiple Sclerosis (MS), traumatic brain injuries (TBI) and neuropathies are the most important diseases in neurological rehabilitation financed by the German Pension Insurance. The primary goal is vocational (re)integration. Driven by multiple findings of neuroscience research the traditional holistic approach with mainly empirically derived strategies was developed further and improved by new evidence-based interventions. This process had been, and continues to be, necessary to meet the health-economic pressures for ever shorter and more efficient rehab measures. Evidence-based interventions refer to symptom-oriented measures, to team-management concepts, as well as to education and psychosocial interventions. Drug therapy and/or neurophysiological measures can be added to increase neuroregeneration and neuroplasticity. Evidence-based aftercare concepts support sustainability and steadiness of rehab results.Mirror therapy, robot-assisted training, mental training, task-specific training, and above all constraint-induced movement therapy (CIMT) can restore motor arm and hand functions. Treadmill training and robot-assisted training improve stance and gait. Botulinum toxine injections in combination with physical and redressing methods are superior in managing spasticity. Guideline-oriented management of associated pain syndromes (myofascial, neuropathic, complex-regional=dystrophic) improve primary outcome and quality of life. Drug therapy with so-called co-analgetics and physical therapy play an important role in pain management. Swallowing disorders lead to higher mortality and morbidity in the acute phase; stepwise diagnostics (screening, endoscopy, radiology) and specific swallowing therapy can reduce these risks and frequently can restore normal eating und drinking.In our modern industrial societies communicative and cognitive disturbances are more impairing than the above mentioned disorders. Speech and language therapy (SLT) is dominant in communicative disorders; the therapists use communicative and/or linguistics-oriented strategies. SLT must begin early after disease onset and with high frequency to elicit good results. PC-assisted (self-)training, possibly telemedically applied, can increase training frequency and time and, hence, improve outcome in aphasia. High-frequency and task-specific training, often PC-assisted, were found to be relevant for improving cognitive functions in all dimensions. Several strategies seem to be efficient in neglect. Visual field deficits can be treated restitutively and compensatingly by PC-assisted training. Attention, memory and executive dysfunctions each require multimodal specific treatment strategies, performed in single and group therapy and in PC-assisted training. Also, education of patients to cope with their impairments and disabilities is another important part. Combined medically and vocationally oriented rehabilitation settings are necessary for raising the rate of return-to-work, especially in patients with motor hand impairments or cognitive disorders. Education of patients and relatives to cope with the chronic neurological diseases and disablements highly improve the sustainability of rehab results and can, in the long run, also reduce mortality and admission to nursing homes. Appropriate physical activity and sports are relevant in the phase of aftercare, by stabilizing both motor coordination and cognitive factors; in MS patients fatigue can be diminished effectively.The main mental comorbidities are anxiety and depression. Pharmacological and psychological treatments have been found to be equally important in this context. Frequently, these mental disorders appear in the phase of aftercare and long-term course only, then worsening outcome sustainability. Efficient concepts to deal with this aspect are still missing. The ambulatory health care system can not cope with it until now.The multitude of evidence-based interventions have over the last 20 years after the Rehab Commission of the Federation of the German Pension Insurance Institutes contributed decisively to even improving primary outcomes and quality of life of neurological patients in spite of shortened length of stay and other restrictions. Neurorehabilitative research, especially the clinically oriented part, had a major influence on the process of professionalization of all members in the neurorehabilitative team. This fact enables new and more efficient organizational structures and working processes within the team; the discussion on this topic has however only just started.  相似文献   

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L B Ellis 《Primary care》1985,12(3):547-555
The increased exposure of health professionals to computers and the decreased cost of this technology make computer-based instruction an increasingly attractive alternative for patient education. This article presents an overview of the present status of computer-based patient education and suggests guidelines for the development and use of such educational materials. It emphasizes general techniques applicable to a wide range of patients and conditions and includes a list of resources available to the interested health professional.  相似文献   

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Rethinking patient education   总被引:1,自引:0,他引:1  
The aim of this paper is to critically examine and challenge some of the assumptions which underpin the research and non-research based literature on patient education. Doubts are expressed concerning the transferability of theories of adult learning to patient education; and concern is expressed over the imbalance in the literature where emphasis is placed on the psychological benefits of teaching, rather than physical outcomes. In the light of the available evidence which suggests that nurses are not 'good patient teachers' the case is made to support the suggestion that patient education should become the responsibility of specialist nurses. In addition, computer-assisted learning (CAL) is proffered as the solution to a number of the problems facing patient educators. CAL is seen as a means of empowering the patient, rather than the nurse to take control, and this is viewed as a positive move in the direction of self-care. The paper concludes by suggesting that CAL might be used with good effect by patients with particular learning difficulties; for example the blind or partially sighted, and people who are illiterate or have a low reading ability.  相似文献   

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This article discusses the use of a computer network to provide instruction for health care providers and patients and provides examples of screens from the educational modules developed for the project. The continuing nursing education and patient education modules were developed as a portion of the components for KARENET (Kellogg Affiliated Remote Environments Network), linking rural Morton, Texas, and the Health Sciences Center at Lubbock, Texas. Both health care providers and patient participants are benefiting from knowledge provided by the methodology of CAI/CMI provided by the network.  相似文献   

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There are many pamphlets, brochures and educational videos available for use in patient teaching. This article is a listing of some of the many items available and where to obtain them.  相似文献   

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Nurses in practice have an increasing need to become aware of the computer-based resources available and the evidence regarding their use in the process of patient education. This synthesis of the literature examines research related to computer-based patient education. A particular focus is placed on the nurse clinician's perspective and the role of the nurse as a patient educator in the digital age. Two primary healthcare database resources, MEDLINE and CINAHL, were selected for review of the current literature. A listing of articles related to the use of computer technology in patient education was obtained from both of these databases. The search strategy included exploding the subject heading terms "computer" and "patient education," and included articles from 1971 to 2001. Computer-based patient education is an effective strategy for improving healthcare knowledge and clinical outcomes. Computer-based learning can be tailored to the individual's age and specific learning needs. Furthermore, although access to computer-based resources continues to be a barrier for some, socioeconomic disparities have no reported impact on patients' abilities to use computer-based technologies effectively.  相似文献   

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《Patient care》1979,13(1):167-8, 175, 177
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Written patient education materials are a commonly used method of presenting information that the patient can be given as a total teaching package or as an adjunct to individual or group classes. This article offers some guidelines for development of written patient education materials.  相似文献   

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Patient education has been widely used by medical schools and schools of nursing as a method for evaluating clinical performance. Training of patients provides a viable method for teaching and evaluating nurse practitioner students as they progress through their educational programs toward clinical competency. Evaluation of patient education experience provided objective and valid information regarding the students' delivery of didactic information and ability to apply knowledge in the clinical setting. The purpose of this article is to describe the preparation of materials for preoperative patient education and to evaluate patient education carried out by second-year students of the University Of Ege School Of Nursing. In this study, students, patients and lecturers evaluated patient education carried out by the nursing students. Criteria including relationships between people (listening, talking and communication ability), and behavior before education (prepare topic content, develop appropriate material for the topic, communicate which topic will be explained, etc.) and during education (attract listeners' attention to the topic, give information about the target, present the content and material of the subject well, etc.) were appraised. According to the results of evaluation, the education carried out by the students achieved the highest score from patients; the students gave the second-highest score. The lecturers gave scores that were lower than those of students and patients. At the end of this study, it has been found that patients were pleased with the education prepared according to their individual requirements and the students were pleased with giving education with the material they have prepared employing their own creativity.  相似文献   

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