Transitional rehabilitation goals for people with spinal cord injury: looking beyond the hospital walls

Abstract

Purpose: This study aimed to identify, describe and classify the transitional rehabilitation goals of people with spinal cord injury (SCI) and map these goals to the International Classification of Functioning, Disability and Health (ICF). Method: The five most important rehabilitation goals as rated by clients were extracted from records for 220 clients of a transitional rehabilitation service for people with SCI in Australia over a 5-year period. These goals were thematically classified into domains and then mapped to the ICF framework. Goals were compared across age, gender, length of hospital stay, compensation status, level and completeness of injury. Results: A total of 1100 goals were classified into 18 different goal domains, representing most aspects of the ICF framework. Age was negatively related to vocational goals. Length of hospital stay was positively related to personal care goals but negatively related to community access and vocational goals. Goals did not differ across gender or compensation status but did differ across level and completeness of injury. Conclusions: People with SCI have a range of transitional rehabilitation goals that represent most aspects of the ICF framework. Client-centred community rehabilitation during this transition period offers continuity of care to support the realisation of these rehabilitation goals.

• Implications for Rehabilitation

• Transitional rehabilitation is a relatively new community service model in the rehabilitation literature, especially for people with spinal cord injury.

• Client-centred goal setting is integral to these types of community rehabilitation models.

• Rehabilitation goals in transitional rehabilitation are varied and map well to the International Classification of Functioning, Disability and Health (ICF) with a focus on environmental goals.

• A typology of rehabilitation goals in this setting will assist in service planning and evaluation of hospital and community rehabilitation services.

     

Applications of the International Classification of Functioning,Disability and Health in goal-setting practices in healthcare

Abstract

Purpose: While evidence exists to support the adoption of collaborative goal-setting in healthcare, some clinicians feel that it is not feasible. This article proposes that the development of a standardized collaborative goal-setting approach using the framework and classification system of the International Classification of Functioning, Disability and Health (ICF) could address these feasibility issues. It is the objective of this article to understand the extent to which the ICF has been integrated into current goal-setting literature in order to assess its potential use in a standardized collaborative goal-setting approach. Methods: A scoping review of the literature published in English since 2001 was conducted in EMBASE, Medline and CINAHL. Articles were included in this review if they integrated the ICF into goal-setting practices in any healthcare discipline. Results: Nineteen articles were included in this review. Analysis of these articles revealed that the ICF has been integrated into goal-setting practices. The benefits associated with this integration suggest that integrating the ICF into goal-setting practices can standardize collaborative goal-setting. Conclusion: Evidence from this scoping review supports the use of the ICF in healthcare goal-setting practices because it provides clinicians and patients with specific steps to follow when attempting to set goals collaboratively.

• Implications for Rehabilitation

• Collaborative goal-setting.

• Collaborative goal-setting involves patients working with their clinicians to develop health outcome goals together and is a fundamental component of patient-centered care.

• Some rehabilitation disciplines have yet to fully embrace collaborative goal-setting due to feasibility issues.

• This article proposes that the integration of the International Classification of Functioning, Disability and Health (ICF) into goal-setting practices could standardize collaborative goal-setting in a way that would address these feasibility issues.

     

What components of rehabilitation are helpful from the perspective of individuals with multiple sclerosis?

Abstract

Purpose: To investigate the helpful components of rehabilitation from the point of view of people with multiple sclerosis (MS). Methods: Sixteen focus groups were conducted for 68 adults with MS, who were 6 months through their 2-year multi-professional group-based out-patient rehabilitation programs in three regions of Finland. Data were analyzed using qualitative inductive content analysis combined with counts of the coded data. Results: Participants described 20 helpful components of rehabilitation that were clustered to themes of the rehabilitee himself/herself, structures of everyday life, information, activity, environmental interventions, social relationships and support. The most frequently described components of the seven main themes were peers, advice, physical exercise, assistive technology and home adaptations, and personal responsibility. Conclusions: The helpful components of both in-patient and out-patient rehabilitation that are of particular importance to people with MS are diverse and show the relevance of ICF in rehabilitation and the need for a comprehensive view in rehabilitation. The importance of peers and peer support should be taken into account in rehabilitation planning and related recommendations. The findings show that helpful rehabilitation for people with MS is not a set of mechanistic interventions but requires good social relationships and support.

• Implications for Rehabilitation

• Helpful components of rehabilitation for people with MS are diverse and show the need for a comprehensive and individual view in rehabilitation.

• Professionally guided peer support should be offered as a part of rehabilitation.

• Interventions related to assistive technology and home adaptations should be an obvious part of rehabilitation.

• It is important to support people with MS to preserve identity as an active person and to take personal responsibility in their own rehabilitation.

     

A multi-site study of the feasibility and clinical utility of Goal Attainment Scaling in geriatric day hospitals

Background: Goal Attainment Scaling (GAS) is an individualized goal-setting and measurement approach that is useful for patients with multiple, individualized health problems, such as those served by geriatric day hospitals (GDHs) and other specialized geriatric programmes. Purpose: To assess the feasibility and utility of GAS in a multi-site study of six GDH affiliated with the Regional Geriatric Programmes of Ontario. Method: Individualized GAS guides were developed for 15 consecutively admitted patients at each site [total n = 90; mean age: 76.2 SD 8.3; 58.9% female; mean attendances: 24.0 SD 10.3]. Staff members (n = 39) were surveyed on their experience with GAS. Results: Mean goals/patient ranged across sites from 2.1 to 4.3. Mean GAS discharge score was 52.3 SD 8.7, close to the theoretically expected values of 50 SD 10. Common goals included mobility, community reintegration, basic and instrumental activities of daily living, medical issues, cognition/communication, and home safety. Estimated mean time to develop a GAS guide ranged across sites from 15.3 to 43.8 min. Conclusion: Clients were often involved in goal setting; family involvement was less frequent. The staff survey identified challenges and benefits regarding the use of GAS. Study results are being used to inform a more consistent approach to the clinical and research use of GAS in GDH.

Implications for Rehabilitation

• The geriatric day hospital (GDH) has had a long history as one element of a comprehensive system of specialized geriatric services with potential advantages including ongoing treatment and rehabilitation from an interdisciplinary team. Despite this history, the evidence for the effectiveness of GDHs in rehabilitation of older persons has been equivocal.

• We found that Goal Attainment Scaling (GAS) was able to detect clinically relevant change in this setting which can aid in demonstrating evidence for the utility and impact of GDHs.

• GAS was feasible in this setting and clinicians felt that GAS may have an effect on speeding up discharge, as a result of having a clearer focus on outcomes that are desired for each patient.

• Clinicians felt the involvement of clients and families in goals settings resulted in more meaningful outcomes for clients and GAS aided in identifying highly individual outcomes such as quality of life and community integration that are routinely difficult to measure with standardized tools.

     

Reflective action assessment with a prospective clinical problem solving tool in the context of rehabilitation medicine: an illustrative case study

Purpose: This study describes a case formulation approach applying a prospective ICF derived clinical tool to assess rehabilitation needs for a community dwelling stroke survivor with care from an outpatient rehabilitation medicine clinic. Method: Case history data on the person were assessed for rehabilitation management planning using a prospective tool to interlink current with projected future functional status in everyday settings. Implicit assessment with reflective action informed decision points at each stage of the rehabilitation process. Results: As a result of reflective action using the prospective tool, rehabilitation management led to significant changes in client participation after limitations to mobility and self care were mapped to the living conditions of the stroke survivor. The context sensitive rehabilitative plan resulted in higher subjective health-related quality of life in the stroke survivor and significant other and enhanced their capacity for participation. Conclusions: Reflective action informed assessment applying ICF concepts to clinical problem solving resulted in positive gains in health-related quality of life in a stroke survivor.

Implications for Rehabilitation

• Reflective inquiry about the use of The International Classification of Disability, Functioning and Health (ICF) enables extension of its applicability in clinical practice settings.

• An ICF-based tool is proposed to interlink the ICF and ICD in rehabilitation case management.

• A case study is used to highlight the use of an ICF-based tool in the context of rehabilitation medicine.

     

Optimising leisure participation: a pilot intervention study for adolescents with physical impairments

Purpose: To assess the feasibility of an intervention to improve participation in leisure activities of adolescents with physical impairments by changing aspects of the activity or environment. Methods: A pre-test/post-test pilot study of a multi-strategy intervention was used to explore the effectiveness of the strategies and to determine whether the intervention was practical to apply in a community setting. The intervention involved establishing adolescent and family focused goals, measuring and addressing environmental barriers and building activity performance skills. The Goal Attainment Scale (GAS) and the Canadian Occupational Performance Measure measured outcomes. Results: Eight participants (aged 12–19 years; five males) with physical disabilities set participation goals using a structured approach. Analysis of personal and environmental barriers and facilitators for participation guided the choice of intervention strategies to support goal attainment. The natural environment, government policies and availability of transport were identified as the most frequent barriers to participation in leisure. Support to secure appropriate devices to enable participation was commonly required. As a group, attainment of 12 of 17 GAS goals, and progress on four more goals, was demonstrated. Conclusions: The intervention model was applicable and practical to use in a community therapy setting and the majority of the participation goals set were achieved.

• Implications for Rehabilitation

• This ICF-based intervention model was applicable and practical to use in a community therapy setting.

• The majority of the adolescent’s leisure participation goals were achieved following engagement in the multi-strategy intervention.

• Adolescents with sufficient communication skills (CFCS Levels I–III) benefited from a group-based intervention in addition to individualised support.

     

Mapping two measures to the International Classification Of Functioning,Disability and Health and the brief ICF core set for spinal cord injury in the post-acute context

Objective: To evaluate the extent to which the rehabilitation outcome levels (ROL) and the spinal cord independence measure (SCIM) III could be mapped to the International Classification of Functioning, Disability and Health (ICF) and the brief core set for spinal cord injury (SCI) in the post-acute context. Methods: Two professionals used the published protocol to map the concepts derived from both measures to the ICF categories. Further, the endorsed categories at the second level of the ICF were used to determine the coverage of the Brief ICF Core Set for SCI. Results: Three items of the ROL could not be conceptualised within the ICF, while the rest were mapped to 42?second-level categories, mainly to the activity and participation domain. All the items of the SCIM III were mapped, yielding 52 ICF categories, mostly at the third level (32). For the mapping to the Core Set for SCI, the ROL covered five and the SCIM III all nine categories of ‘activities and participation’ included as the candidate categories of the brief version. Conclusion: In terms of content, the ROL appears to be a more global measure of functioning, compared with the SCIM III that covers specific ‘activity’ aspects as proposed in the Brief Core Set for SCI. It is thus recommended that standardised measures, such as the SCIM III, be used due to its conceptual underpinnings and coverage of important aspects.

• Implications for Rehabilitation

• Rehabilitation professionals should select appropriately validated outcome measures specific to the health condition in order to evaluate the effectiveness of rehabilitation.

• Rehabilitation professional working with outcome measures should be aware of the limitations of measures, in terms of content, and supplement the evaluation with appropriate standardised measures or the use of the Core Sets.

• To enhance evidence-based practise in routine clinical practise, standardised outcome measures should be used.

     

Validation of the ICF Core Set for Vocational Rehabilitation from the perspective of patients with spinal cord injury using focus groups

Introduction: The International Classification of Functioning, Disability and Health (ICF) Core Set for Vocational Rehabilitation is an application of the ICF of the World Health Organization with the purpose of identifying problems and resources relevant for people in a vocational rehabilitation given a health condition. Objective: The objective of the study was to validate the Comprehensive ICF Core Set for Vocational Rehabilitation from the perspective of patients with spinal cord injury (SCI). The specific aims were to explore the aspects of functioning and health important to patients with SCI regarding return to work and to examine to what extent these aspects are represented by the current version of the Comprehensive ICF Core Set for Vocational Rehabilitation. Methods: Focus group interviews were conducted. The sampling of patients followed the maximum variation strategy. Sample size satisfied saturation criterion. The focus groups were digitally recorded and transcribed verbatim. The meaning condensation procedure was used for the data analysis. After qualitative data analysis, the resulting concepts were linked to ICF categories according to established linking rules. Results: Twenty-four SCI patients participated in seven focus groups. Sixty-three ICF categories out of 90 ICF categories contained in the Comprehensive ICF Core Set for Vocational Rehabilitation were reported by the patients. Forty-two additional categories that are not covered in the Comprehensive ICF Core Set for Vocational Rehabilitation were found but adding the health condition-specific ICF Core Set for SCI in long-term context, only 11 categories were not covered. Conclusions: The existing version of the Comprehensive ICF Core Set for Vocational Rehabilitation was confirmed almost entirely by the focus groups to explore the vocational situation of patients with SCI.

• Implications for Rehabilitation

• Validation of the ICF Core Set for Vocational Rehabilitation as a useful tool to facilitate social reintegration and rehabilitation of patients with SCI.

• Return to work is a key outcome in vocational rehabilitation of patients with SCI including those who are young with long-term employment prospects.

• The results of this study could provide a foundation in utilizing the ICF Core Set for Vocational Rehabilitation to guide rehabilitation goals, service planning and evaluation, and fostering an engaging relationship with employers in the context of SCI rehabilitation.

• SCI patients have specific needs, not entirely covered by the both ICF Core Set for SCI long-term context and for Vocational Rehabilitation. Our results underline some of the second level categories, probably related to specific SCI impairment, which can be useful to plan specific rehabilitation programs to improve the return to work after SCI.

     

Implementation of ICF in goal setting in rehabilitation of children with chronic disabilities at Beitostolen Healthsports Centre

Purpose: Develop an International Classification of Functioning, Disability and Health (ICF) Code Set, useful in goal oriented rehabilitation of a study population of children with chronic disabilities. Method: A triangulation of methods, using an interview to identify the main needs and goals of the study population, and a questionnaire to identify the main problems, with a registration of the frequency within each category. After qualitative and quantitative analyses this resulted in two sets of ICF categories. These two sets were then compared and merged into a proposed ICF Code Set for goal setting. Results: Thirty categories were identified from the interviews and the following linking process. Problems were reported in all suggested categories within the ICF questionnaire, resulting in 49 categories. The comparison of the two sets of categories resulted in a proposed ICF Code Set of 40 categories. Conclusions: Through a triangulation of methods, we developed a tailored code set for the goal setting process in rehabilitation for children with a disability, taking into account both individual preferences and the health professionals’ perspective. Although the external validity is limited, our methodological procedures may have relevance for the implementation of ICF in other clinical settings and populations.

Implications for Rehabilitation

• ICF is increasingly used as the framework for goal setting in rehabilitation.

• Development of ICF Code Sets could provide a basis for individualized treatments through a structured goal planning process.

• A triangulation of methods in the development of such code sets, combining qualitative and quantitative methodology could be of value, seeing the health professionals’ perspective being enriched and deepened by the patients’ preferences.

     

Simplified bipartite concepts of functioning and disability recommended for interdisciplinary use of the ICF

Abstract

Purpose: To argue for and propose bipartite concepts of functioning and disability, to tally with the structure of the ICF classification list, concepts of social models and clinical needs. Method: The ICF concepts are discussed in relation to the history of ideas regarding disability concepts and the needs for such concepts in interdisciplinary rehabilitation. Results: Bipartite concepts are presented; they refer to actual functioning, simply body functions/structures and participation, including functioning in standardized environments. Participation refers to actually performed “activities”, with “activities” simply denoting things that people may do. Bipartite concepts are congruent with the ICF classification and the structure of social models of disability, suitable for clinical and interdisciplinary use and easy to understand. The issue of standardized environments represents a methodological issue rather than the conceptual issue of defining functioning and disability. An individual perspective on activity and activity limitations, i.e. the middle part of the tripartite ICF concept, is somewhat similar to concepts of traditional language that were regarded as too generalizing already in 1912, when the interactional concept of “disability in a social sense” was introduced in rehabilitation practices. Conclusion: Bipartite concepts of functioning and disability are recommended for interdisciplinary use of the ICF.

• Implications for Rehabilitation

• The ICF classification is useful, but the ICF concept of activities in an individual perspective is confusing.

• We suggest a use of the term “activities” simply to denote things that people may do and “participation” to denote actually performed activities.

• Estimations of ability should be explicit about how they are related to environmental factors.

     

Impact of environmental factors in home rehabilitation – a qualitative study from the perspective of older persons using the International Classification of Functioning,Disability and Health to describe facilitators and barriers

Purpose: The aim of this study was to explore older people’s experience of environmental factors that impact on their activity and participation in home rehabilitation. Method: Older people aged between 68 and 93 years and receiving home rehabilitation were interviewed. A qualitative content analysis was performed on the interview text using the predetermined structure of the International Classification of Functioning, Disability and Health (ICF) environmental domain. The text was linked to the closest ICF category. Results: The results identified environmental facilitators and barriers that influenced activity and participation among older people receiving home rehabilitation. Approaches that provided a facilitative environment were access to assistive products and technologies, alterations to the physical environment, social support and relationships, and adjusted health and social care services. Conclusions: A qualitative study using ICF-listed environmental factors contributed a holistic view of facilitators and barriers in home rehabilitation for older people. Awareness of the importance of the impact of the social environment on activities and participation could improve home rehabilitation services for older people. The study represents an important step towards a holistic approach using the ICF, which aims to enable all health care professionals to describe, plan and evaluate rehabilitation services together with older people across the health and social care sectors.

Implications for Rehabilitation

• Environmental factors can be considered as obstacles or facilitators depending on each unique individual’s need.

• In a relatively small sample, this study shows the importance of the impact of the social environment on activities and participation among older people receiving home rehabilitation.

• Using ICF “linking rules” to link environmental factors as facilitators or barriers reported by older people can identify potentially important areas in home rehabilitation service described in the ICF categories. This can facilitate to improve rehabilitation service for older people.

• Reveals health care professionals as one central environmental factor for older people’s rehabilitation.

     

Problems in functioning after a mild traumatic brain injury within the ICF framework: the patient perspective using focus groups

Purpose: To describe problems in body functions, activities, and participation and the influence of environmental factors as experienced after mild traumatic brain injury (TBI), using the ICF framework. To compare our findings with the Brief and Comprehensive ICF Core Sets for TBI. Methods: Six focus-group interviews were performed with 17 participants (nine women, eight men, age ranged from 22 to 55 years) within the context of an outpatient rehabilitation programme for patients with mild TBI. The interviews were transcribed verbatim and analysed using the ICF. Results: One-hundred and eight second-level categories derived from the interview text, showing a large diversity of TBI-related problems in functioning. Problems in cognitive and emotional functions, energy and drive, and in carrying out daily routine and work, were frequently reported. All ICF categories reported with high-to-moderate frequencies were present in the Brief ICF Core Set and 84% in the Comprehensive ICF Core Set. The reported environmental factors mainly concerned aspects of health and social security systems, social network and attitudes towards the injured person. Conclusions: This study confirms the diversity of problems and the environmental factors that have an impact on post-injury functioning of patients with mild TBI.

Implications for Rehabilitation

• Disabilities related to cognitive and emotional functions, energy and drive, and carrying out daily routine and work should be addressed in rehabilitation of people with mild traumatic brain injury (TBI).

• Attention should be given to environmental facilitators and barriers for activities and participation.

• Participation in everyday life after a mild TBI, including social- and work-participation, constitutes a challenge where multidisciplinary rehabilitation efforts should be considered.

• The Brief Core Set does not attain all frequently observed categories of functioning among people with mild TBI.

     

Initial constructs for patient-centered outcome measures to evaluate brain–computer interfaces

Purpose: The authors describe preliminary work toward the creation of patient-centered outcome (PCO) measures to evaluate brain–computer interface (BCI) as an assistive technology (AT) for individuals with severe speech and physical impairments (SSPI). Method: In Phase 1, 591 items from 15 existing measures were mapped to the International Classification of Functioning, Disability and Health (ICF). In Phase 2, qualitative interviews were conducted with eight people with SSPI and seven caregivers. Resulting text data were coded in an iterative analysis. Results: Most items (79%) were mapped to the ICF environmental domain; over half (53%) were mapped to more than one domain. The ICF framework was well suited for mapping items related to body functions and structures, but less so for items in other areas, including personal factors. Two constructs emerged from qualitative data: quality of life (QOL) and AT. Component domains and themes were identified for each. Conclusions: Preliminary constructs, domains and themes were generated for future PCO measures relevant to BCI. Existing instruments are sufficient for initial items but do not adequately match the values of people with SSPI and their caregivers. Field methods for interviewing people with SSPI were successful, and support the inclusion of these individuals in PCO research.

• Implications for Rehabilitation

• Adapted interview methods allow people with severe speech and physical impairments to participate in patient-centered outcomes research.

• Patient-centered outcome measures are needed to evaluate the clinical implementation of brain–computer interface as an assistive technology.

     

What psychological and physical changes predict patients’ attainment of personally meaningful goals six months following a CBT based pain management intervention?

Purpose: To examine the influence of demographic measures, and changes in physical ability, pain, self-efficacy and emotional distress on Goal Attainment Scaling (GAS) scores, after a 15-day CBT based pain management programme.

Method: Chronic pain patients (N?=?257) were referred; 225 (88%) completed the programme and were invited for follow up six months later. One hundred and sixty-two (63%), (mean age 47.7, 71% female) completed the reassessment procedures. GAS scores (which were also repeated at the end the programme), an 11-point Pain Numerical Rating Scale, Pain Self-Efficacy Questionnaire, Hospital Anxiety and Depression Scale, distance walked in 5?mins, number of sit/stand repetitions in 1?min and number of stairs climbed in 1?min were measured on the first day and six months following the programme.

Results: At six months post discharge, changes in goal attainment, physical measures, pain intensity, depression and self-efficacy were observed. Hierarchical regression showed change in GAS was predicted by improvement in walking tolerance and self-efficacy.

Conclusions: The achievement of personally important goals was most significantly associated with change in walking ability and self-efficacy, while controlling for the influence of change in pain.

• Implications for Rehabilitation

• Chronic pain can reduce psychological and physical functioning, leading to a reduction in meaningful activities.

• Achievement of personally important activities as measured by Goal Attainment Scaling can be a more sensitive measure of programme outcome than that captured by many other standard measures.

• Self-efficacy is an important predictor of attainment of patient preferred goals following a CBT based pain management programme, and could be emphasized during treatment along with improved walking ability, to enhance patients’ goal achievement.

     

Integrating medical,assistive, and universally designed products and technologies: assistive technology device classification (ATDC)

Introduction: ISO26000:2010 International Guidance Standard on Organizational Social Responsibility requires that effective organizational performance recognize social responsibility, including the rights of persons with disabilities (PWD), engage stakeholders and contribute to sustainable development. Millennium Development Goals 2010 notes that the most vulnerable people require special attention, while the World Report on Disability 2011 identifies improved data collection and removal of barriers to rehabilitation as the means to empower PWD. Background: The Assistive Technology Device Classification (ATDC), Assistive Technology Service Method (ATSM) and Matching Person and Technology models provide an evidence-based, standardized, internationally comparable framework to improve data collection and rehabilitation interventions. The ATDC and ATSM encompass and support universal design (UD) principles, and use the language and concepts of the International Classification of Functioning, Disability and Health (ICF). Purpose: Use ATDC and ICF concepts to differentiate medical, assistive and UD products and technology; relate technology “types” to markets and costs; and support provision of UD products and technologies as sustainable and socially responsible behavior. Conclusion: Supply-side and demand-side incentives are suggested to foster private sector development and commercialization of UD products and technologies. Health and health-related professionals should be knowledgeable of UD principles and interventions.

Implications for Rehabilitation

• An ICF-based classification that differentiates medical, assistive and universally designed technology has important applications to rehabilitation practice and public policy.

• Connecting individual needs associated with diminished functioning to appropriate technology supports efficient and effective rehabilitation practice, with improved individual and societal outcomes.

• Connecting aggregate needs (markets) to appropriate technology provides a data collection framework to support evidence-based and socially responsible public policy.

     

“I refer to them as my colleagues”: the experience of mutual recognition of self,identity and empowerment in multiple sclerosis

Abstract

Purpose: To explore how persons with multiple sclerosis (MS) experience participating in inpatient rehabilitation, and how it might provide psychosocial benefits. Method: Ten participants with MS who had completed inpatient rehabilitation in Norway and on Tenerife participated in two focus groups. A semi-structured interview protocol was used. Data were analyzed using qualitative content analysis informed by a phenomenological perspective. Results: During inpatient rehabilitation participants shared experiences with symptoms of the disease, of social stigma and coping strategies. They communicated experiences of living with MS and they created a sense of community, they became “colleagues”. This experience gave rise to mutual recognition of ability, impairment, self and identity, and thus facilitated personal empowerment to counteract social stigma through adequate coping strategies. Conclusion: Participating in inpatient rehabilitation gave people with MS the possibility to exchange information and communicate strategies for coping with the disease-related conditions and societal demands. They established social relations recognizing each other’s resources. Participants felt equipped to make decisions and to mobilize individual and collective resources. Recognition of the individual with both ability and impairment can be a key to empowerment.

• Implications for Rehabilitation

• In multiple sclerosis (MS), the clinical symptoms and the unpredictability of the disease may have consequences for how patients relate to self and to others, and hence how they perform socially.

• Stigmatization is commonly experienced among people with MS.

• The recognition experienced from peers create a sense of community.

• We recommend health care professionals to acknowledge the importance of peer support for self, identity and empowerment in MS.

     

2nd International Symposium on Gait and Balance in Multiple Sclerosis: interventions for gait and balance in MS

Abstract

Purpose: To provide a review of the 2nd International Symposium on Gait and Balance in Multiple Sclerosis (MS), emphasizing interventions in gait and balance for people with MS. Method: Review of current research on interventions used with people having MS and with people having other disorders that may provide novel insights into improving gait and balance and preventing falls in people with MS (pwMS). Results: Nine speakers provided evidence-based recommendations for interventions aimed at improving gait and balance dysfunction. Speaker recommendations covered the following areas: balance rehabilitation, self-management, medications, functional electrical stimulation, robotics, sensory augmentation, gait training with error feedback and fall prevention. Conclusions: The causes of gait and balance dysfunction in pwMS are multifactorial and therefore may benefit from a wide range of interventions. The symposium provides avenues for exchange of evidence and clinical experience that is critical in furthering physical rehabilitation including gait and balance dysfunction in MS.

• Implications for Rehabilitation

• Approaches to improve Gait and Balance dysfunction in Multiple Sclerosis.

• Balance exercises that include training of sensory strategies.

• Self-management and self-management support.

• Pharmacologic intervention, such as Dalfampradine.

• Functional electrical stimulation that may provide the extra stimulation to influence coordinated leg movements needed for walking.

     

Cognitive training on stroke patients via virtual reality-based serious games

Purpose: Use of virtual reality environments in cognitive rehabilitation offers cost benefits and other advantages. In order to test the effectiveness of a virtual reality application for neuropsychological rehabilitation, a cognitive training program using virtual reality was applied to stroke patients. Methods: A virtual reality-based serious games application for cognitive training was developed, with attention and memory tasks consisting of daily life activities. Twenty stroke patients were randomly assigned to two conditions: exposure to the intervention, and waiting list control. Results: The results showed significant improvements in attention and memory functions in the intervention group, but not in the controls. Conclusions: Overall findings provide further support for the use of VR cognitive training applications in neuropsychological rehabilitation.

• Implications for Rehabilitation

• Improvements in memory and attention functions following a virtual reality-based serious games intervention.

• Training of daily-life activities using a virtual reality application.

• Accessibility to training contents.

     

Important wheelchair skills for new manual wheelchair users: health care professional and wheelchair user perspectives

Purpose: The purpose of this project was to identify wheelchair skills currently being taught to new manual wheelchair users, identify areas of importance for manual wheelchair skills' training during initial rehabilitation, identify similarities and differences between the perspectives of health care professionals and manual wheelchair users and use the ICF to organize themes related to rehabilitation and learning how to use a manual wheelchair. Method: Focus groups were conducted with health care professionals and experienced manual wheelchair users. ICF codes were used to identify focus group themes. Results: The Activities and Participation codes were more frequently used than Structure, Function and Environment codes. Wheelchair skills identified as important for new manual wheelchair users included propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain. Health care professionals and manual wheelchair users identified the need to incorporate the environment (home and community) into the wheelchair training program. Conclusions: Identifying essential components for training the proper propulsion mechanics and wheelchair skills in new manual wheelchair users is an important step in preventing future health and participation restrictions.

• Implications for Rehabilitation

• Wheelchair skills are being addressed frequently during rehabilitation at the activity-dependent level.

• Propulsion techniques, transfers in an out of the wheelchair, providing maintenance to the wheelchair and navigating barriers such as curbs, ramps and rough terrain are important skills to address during wheelchair training.

• Environment factors (in the home and community) are important to incorporate into wheelchair training to maximize safe and multiple-environmental-setting uses of manual wheelchairs.

• The ICF has application to understanding manual wheelchair rehabilitation for wheelchair users and therapists for improving the understanding of manual wheelchair use.