Daily rehabilitation nursing increases the nursing time spent on residents

Nurses are primary managers of rehabilitation nursing activities. When improving rehabilitation nursing, it is important to understand the content of care provided and time spent on residents. This study discusses the allocation of nursing staff time within a context of rehabilitation nursing. The variables of rehabilitation nursing and residents' characteristics were derived from the Resident Assessment Instrument. The wage-adjusted direct nursing time was obtained from a time measurement study carried out in November 2002 in long-term care facilities in southern Finland. The average direct wage-adjusted nursing time spent on resident was 93.8 min per day. Residents receiving daily rehabilitation nursing were allocated ∼8 min more wage-adjusted direct nursing time than their peers. More 'hands in care' staff is required for adopting rehabilitation nursing in long-term care units. Maximizing residents' independency should be the goal for rehabilitation care and therefore the focus for allocating both nursing and rehabilitation staff to units and facilities.     

Evaluating the efficacy of acupuncture in defined aspects of stroke recovery

OBJECTIVE: To investigate the efficacy of acupuncture on stroke recovery compared to an inert placebo. DESIGN : Placebo-controlled, randomised, clinical trial. SETTING: Post-stroke rehabilitation wards in five NHS hospitals in the UK. SUBJECTS: Patients between 4 and 10 days after their first stroke. INTERVENTIONS AND OUTCOME MEASURES: The patients received 12 acupuncture or placebo treatments over four weeks. Acupuncture with electrical stimulation was compared with mock TENS, and assessments continued for 12 months after entry. Primary outcome was the Barthel Index (BI). Secondary outcomes were muscle power, Motricity Index (MI), mood, Nottingham Health Profile (NHP) and treatment credibility. RESULTS: 92 patients completed data sets. Data were analysed using both t tests and a structural equation based on longitudinal analysis of both BI and MI, using generalised estimating equations with an exchangeable correlation structure. While both acupuncture and placebo (mock TENS) appeared to have had an equal effect on stroke recovery, there is no significant difference between the two interventions at 12 (p = 0.737, 95 % CI -2.00 to 2.81) and 52 weeks (p = 0.371, 95 % CI -3.48 to 1.32). An apparently accelerated improvement in the MI scores in the acupuncture group at 3 weeks (p = 0.009, 95 % CI 1.55 to 10.77) is interesting. CONCLUSIONS: Acupuncture did not demonstrate specific efficacy over placebo and both groups did as well as normally expected with this condition.     

Factors Associated with Early Attrition from Psychosocial Rehabilitation Programs

This study aimed to identify characteristics associated with early dropout from a vocationally oriented psychosocial rehabilitation (PSR) program for clients with severe mental illness. The sample consisted of 194 individuals who participated in a study comparing a supported employment program to a stepwise vocational program. Study participants who dropped out of the PSR program within 6 months of study entry were compared to those who continued for at least 6 months. Dropouts had poorer competitive employment outcomes than those who continued. Participants with at least a high school diploma, never married, with a schizophrenia-spectrum diagnosis, and those assigned to a stepwise model of vocational rehabilitation were more likely to dropout. The implications of these findings are discussed.     

Epilepsy: role of neuropsychological evaluation

Cognitive deficits are frequent in epileptic patients and can be considered epileptic behavioural markers. They are assessed by neuropsychological exploration, which requires the use of standardized psychometric tests. The neuropsychological data obtained complement the information provided by other perisurgical investigations. In addition to the indications concerning lateralization and the extent of the cerebral dysfunction, neuropsychological findings can assist in anticipating the possible cognitive risks resulting from surgical treatment. Finally, these results are indispensable to implementing neuropsychological rehabilitation, which should be proposed before and/or after surgery, when necessary, to patients involved in a surgical program for epilepsy.     

Editorial: Putting a new face on paediatric rehabilitation

We report about 38 patients aged between 1 and 19 years (36·8% female, 63·2% male; mean age 7·8 years) admitted as inpatients for further neurorehabilitation mostly 4 weeks after severe acquired brain injury (ABI) of different aetiology. Of the patients, 73·7% were in a state of minimal responsiveness (vigilance score >7 WVS) on admission. We evaluate the course of rehabilitaiton and the outcome 6 months after the end of the inpatient-period. The average stay of 15·5 weeks is strikingly low. The average intensity of therapy comes to about 16 units per week including strategies of rehabilitative education. The incidence of good rehabilitation was 21%, whereas almost 45% of patients displayed severe impairment. Although further improvements were found in almost 40% of patients 6 months later, these only slightly changed the overall picture of the GOS values. More than 3/4 returned to their families after rehabilitation, often despite great functional impairment. A return to the former environment outside the family (kindergarten, school) was, however, possible in 2/3 of the subjects. The proportion of minimally responsive patients fell from 73·7% to 18·4% during the stationary rehabilitation phase. After a further 6 months (follow up), 36·4% of the originally minimally responsive patients achieved a GOS value of >5.     

Validation of the relation between the type and amount of seating support provided and Level of Sitting Scale (LSS) scores for children with neuromotor disorders

Objectives: To assess the construct validity of the Level of Sitting Scale (LSS) by examining the relationship between LSS scores and the type and amount of seating supports.

Methods: Secondary analysis of the data for 114 children ≤18 years, with neuromotor disorders who participated in a responsiveness study of the Seated Postural Control Measure.

Results: A significant inverse relationship (Spearman rho?=??0.42, p?<?0.05) was found between LSS scores and amount of seating support provided. Statistically significant differences were also revealed between LSS levels of sitting ability (p?<?0.004) and pelvic, thigh, trunk and head seating components and type of seating system, using Kruskal-Wallis test.

Conclusion: This study provides evidence of construct validity for the LSS in use as a discriminative measure of sitting ability in children with neuromotor disorders. Further validation is justified. Clinically intuitive associations between sitting ability and seating interventions were confirmed.     

Rehabilitation and orthotic management of congenital and acquired meromelia in the lower limbs of children

Children with limb deficiencies or amputations of the lower extremities should be enabled to stand or walk according to their state of development, because standing and walking are among the most important preconditions for the best possible integration. Supplying them with a prosthesis, orthosis and orthoprosthesis is therefore indispensable for rehabilitation. While a prosthesis replaces parts of the extremities, an orthosis stabilizes the existing extremity. Orthoprostheses compensate longitudinal malformations, have a supporting effect, allow growth to be controlled and compensate for shortening. Just as important as the remedy is early medical treatment. The medical team taking care of the patient works out a treatment plan where responsible cooperation with the parents is of utmost importance. The focus of all efforts is, of course, the handicapped child. Examples are used to demonstrate the course of successful rehabilitation of children and adolescents with damaged limbs. Equally the psychological situation of the parents and child is taken into consideration.     

Effectiveness of an electronic cognitive aid in patients with acquired brain injury: A multicentre randomised parallel-group study

The objective of the study was to examine the effectiveness of a customised personal digital assistant (PDA) as a cognitive aid for people with acquired brain injury, using a randomised parallel-group study. The participants were 34 patients with acquired brain injury in a cognitive rehabilitation setting. The experimental group used a customised PDA, while the control group received care-as-usual (paper-and-pencil aids). Measurements were conducted at baseline (T0), after 8 hours of training (T1), after 16 hours of training (T2), and at 5-month follow-up (T3). The main outcome was the attainment of individualised goals. Both groups showed a significant increase in goal attainment (GAS) (p?<?.001). There were no significant differences between the groups at T1 or T2 on any of the other outcome measures. It was concluded that the customised PDA was as effective as paper-and-pencil aids, and may therefore serve as a useful alternative when choosing the optimal rehabilitation strategy for a patient.     

Research Digest

A single-blind within-subjects trial was used to test the efficacy of sending SMS text messages to patients with a traumatic brain injury as a means of improving their recall of rehabilitation goals. Eleven participants were recruited from two community-based rehabilitation centres and were sent text messages relating to three randomly selected goals from a selection of six current goals three times per day for 14 days. Participants’ recall of their rehabilitation goals was assessed at baseline, seven days, and 14 days via free recall and cued recall procedures. Results showed that goals in the “text” condition were recalled better than goals in the “no text” condition. Practical applications and extensions are discussed.