scholarly journals The Meaning of Rehabilitation in the Home Environment After Acute Stroke From the Perspective of a Multiprofessional Team

2007 ◽  
Vol 87 (6) ◽  
pp. 778-788 ◽  
Author(s):  
Annica Wohlin Wottrich ◽  
Lena von Koch ◽  
Kerstin Tham
Keyword(s):  
Acute Stroke ◽  
Home Environment ◽  
Physical Therapists ◽  
Contextual Factors ◽  
Main Theme ◽  
Multiprofessional Team ◽  
Rehabilitation Team ◽  
Problem Solving Skills ◽  
Team Members ◽  
Home Based

Background and Purpose Intervention programs for home-based rehabilitation are not fully described in the literature, and rehabilitation team members' experiences and tacit understanding of working with patients after stroke in the home environment need to be further understood. The aim of this study was to identify the meaning of rehabilitation in the home environment after stroke from the perspective of members of a multiprofessional team. Subjects Thirteen members of a multiprofessional outreach team (physical therapists, occupational therapists, speech and language therapists, and a social worker) working at a geriatric hospital in Stockholm, Sweden, participated in the study. Methods A qualitative method (the Empirical Phenomenological Psychological method) was used, with data being obtained from retrospective interviews of the team members after completing home-based rehabilitation of patients after acute stroke. Results One main theme (“supporting continuity”) and 4 subthemes (“making a journey together from hospital to home,” “enabling experiences of functioning,” “refraining from interventions—encouraging patient problem-solving skills,” and “looking for a new phase—uncertain endings”) were revealed. Discussion and Conclusion The findings suggest that contextual factors, both environmental and personal, were considered to be of great importance by the members of the multiprofessional team and were accounted for when they were working in the home environment in the rehabilitation of patients after stroke. Contextual factors detected in the home environment gave valuable information to the team members, who used the information in their strategies to assist the patients in finding continuity in their daily life and to link the past to the present and the “new body” to the “old body.”

scholarly journals Effectiveness of the Home-based Habilitation Programme for Children with Cerebral Palsy

2014 ◽  
Vol 25 (1) ◽  
pp. 6-12
Author(s):  
Maja Racic ◽  
Srebrenka Kusmuk ◽  
Vesna Krstovic-Spremo
Keyword(s):  
Cerebral Palsy ◽  
Muscle Strength ◽  
Muscle Tone ◽  
Gross Motor ◽  
Motor Functions ◽  
Rehabilitation Team ◽  
Team Members ◽  
Home Based ◽  
Children With Cerebral Palsy ◽  
Banja Luka

Abstract Objective This study was undertaken with the aim to compare the effects of home-based habilitation programmes with the effects of hospital-based habilitation programme for children with cerebral palsy (CP) on motor performance and daily functioning. Patients and methods The study was conducted on a sample of 60 children with cerebral palsy. First group included 30 children, 5 to 12 years old, who had a continued physical home treatment and education in public/special school. The second group consisted of 30 children, from Banja Luka region, who continued inpatient habilitation programme and training. Habilitation outcomes were analysed by measuring muscle tone (using original Tardieu Scale), muscle strength, range of motion (ROM), gross motor functions (gross motor function measure-88) and the Barthel Index of activities of daily living (ADL). Results The proportion of clinically significant change in gross motor functions, ADLs, ROM and muscle strength didn't show major differences between the two groups. Conclusion There were no significant differences in effectiveness between home-based and hospital-based habilitation programmes according to the treatment outcomes. The effectiveness of home-based programme increases when supplemented by frequent consultations with the rehabilitation team members and occasional out-patient physical therapy treatment, education as well as counselling and support for parents.

scholarly journals Cultivating Acute Care Rehabilitation Team Collaboration Using the Kawa Model

2019 ◽  
Author(s):  
Jayme Ober ◽  
Jennifer Lape
Keyword(s):  
Acute Care ◽  
Physical Therapists ◽  
Healthcare Team ◽  
Team Collaboration ◽  
Rehabilitation Team ◽  
Team Members ◽  
High Productivity ◽  
Speech Language Pathologist ◽  
Survey Responses ◽  
The Impact

Purpose: Effective healthcare team collaboration is imperative for quality client-centered care, job satisfaction, and overall morale. Rehabilitation team collaboration can be impacted by high productivity demands, differing backgrounds of individual team members, and the unpredictable healthcare environment. The Kawa (river) model, a culturally-neutral model of occupational therapy practice, has been shown to improve communication and collaboration with its use of metaphors, but its utility in various contexts to enhance collaborative practice is still being explored. The purpose of this study was to implement an evidence-based teambuilding intervention with use of the Kawa model to investigate the impact on acute care rehabilitation team collaboration. Method: A 5-week pretest-posttest study was completed with a group of eight rehabilitation team members, consisting of occupational therapists, physical therapists, and a speech language pathologist, in an acute care setting. Pre and post-surveys were utilized to gather quantitative and qualitative data on perceptions of team collaboration, knowledge of the Kawa model, and the model’s utility for collaboration. Results: Outcomes showed overall mean improvements in agreement that the Kawa model provides a common method of communication, and 100% of the participants agreed or strongly agreed that use of the Kawa model can improve acute care rehabilitation team collaboration. Qualitative post-survey responses indicated an enhanced understanding of the components of effective team collaboration. Conclusions & Recommendations: Team collaboration was cultivated with use of the Kawa model. The model provided a successful method for the acute care team to openly discuss and collaboratively problem-solve how to maximize their team flow. Further study of the Kawa model’s utility to improve collaboration in various contexts with broader participant groups is recommended, as well as study of longitudinal effects of a teambuilding intervention with use of the Kawa model.

scholarly journals Adherence to Use of a Home-Based Exercise DVD in People With Huntington Disease: Participants' Perspectives

2012 ◽  
Vol 92 (1) ◽  
pp. 69-82 ◽  
Author(s):  
Hanan Khalil ◽  
Lori Quinn ◽  
Robert van Deursen ◽  
Richard Martin ◽  
Anne Rosser ◽  
...  
Keyword(s):  
Huntington Disease ◽  
Physical Therapists ◽  
Management Strategies ◽  
Exercise Program ◽  
Main Theme ◽  
Therapy Program ◽  
Home Based ◽  
Semistructured Interviews ◽  
Cognitive Problems ◽  
Therapy Sessions

BackgroundIndividualized exercise instruction on a regular basis may be desirable for people with Huntington disease (HD). Sustained interventions, however, may not be the most feasible for lifelong disease management. It is critical, therefore, for physical therapists to find ways to facilitate engagement in independent exercise programs. The capabilities of DVD technology can make the DVD a useful format to facilitate engagement for people with HD who have motivational and cognitive problems.ObjectiveThe purpose of this study was to explore how people with HD used a home-based exercise DVD and how it was perceived by the participants and their caregivers.DesignAn exploratory, mixed-method design was used in this study.MethodsFifteen participants with HD were provided with an exercise DVD, developed by the authors, to support their engagement in a home-based exercise program. Exercise diaries were used to record adherence rates. Semistructured interviews were conducted to explore what factors affected the usability of the DVD. Conversations were audio recorded and fully transcribed. Content analysis approach was used to analyze the interviews.ResultsMost of the participants (11/15, 73.3%) adhered well to the use of the DVD. Participants felt that the exercises were suitable. Commitment of the caregiver as a key to the success of the program was the main theme that emerged from the data. Participants identified barriers and facilitators that affected adherence to using the exercise DVD and described management strategies that helped promote adherence to the exercise program.ConclusionsThe DVD was perceived to be suitable and supportive. The DVD could be appropriate for use in supporting people with HD to engage in exercise at home, either outside of therapy sessions or upon completion of a therapy program.

scholarly journals Nurse Practitioner’s Clinical Triggers for Referral to Other 3D Team Members

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 745-745
Author(s):  
Shawn Ladda
Keyword(s):  
Older Adults ◽  
Community Health ◽  
Nurse Practitioners ◽  
Physical Therapists ◽  
Exercise Program ◽  
Health Educator ◽  
Problem Solving Therapy ◽  
Team Members ◽  
Resource Information ◽  
Registered Dietician

Abstract This presentation features how 3D Team nurse practitioners (NP) use results of clinical assessments to determine whether older adults and caregivers enrolled in the study are referred to other Team members; these assessment results are called “clinical triggers”. Other team members who receive referrals based on NP-generated clinical triggers include: Licensed Clinical Social Workers, who deliver Problem Solving Therapy to older adults with significant depressive symptoms; Occupational Therapists, who deliver an evidence-based dementia care intervention; Physical Therapists, who deliver an adapted Otago exercise program; Registered Dietician, who provides nutrition and dietary instruction; and Community Health Educator, who provides community resource information to address social determinants of health. All clinical triggers will be detailed in this presentation, along with a description of each intervention delivered by other team members except the Community Health Educator. Case studies will be presented to illustrate how study participants receive multiple interventions from the 3D Team.

Abstract T MP102: Hotline Use for Recruitment Support in Acute Stroke Trials: Lessons learned To Date in Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-II

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kathryn A France ◽  
Mushtaq Qureshi ◽  
Jessy Thomas ◽  
Emily Abbott ◽  
Logan Brau ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Lessons Learned ◽  
Local Network ◽  
Drug Management ◽  
Safe Operation ◽  
Team Members ◽  
Clinical Support ◽  
Direct Support ◽  
Protocol Compliance

Background: Use of hotline services for clinical support and safe operation of a research trial is common and important. The value of such services has not been objectively assessed within the context of a large acute stroke clinical trial. Methods: The use of three different hotline services have been tested, and cell and Email- options have also been explored for their advantages. US and Non-US sites are provided access to central hotline services, but for efficiency a local network for managing calls is established in each region. All sites may access both data management and the trial PI via hotline services when needed and this is supported by other technologies in addition. A means for supporting overall trial communications in light of these interactions has been developed and valuable insights are gained. Results: Data gathered from 211 calls logged at the Clinical Coordinating Center through the course of the ATACH-II trial have been summarized: Total Calls Reviewed: 211; Year 2 of trial: 92 calls, Year 3 of trial: 100 calls. Calls received midnight to 8 AM: 19 (9.0%), 8 AM - 5 PM 130 (61.6 %) 5 PM - 12:00 PM 65 (30.8%). Issues Resolved in < 5 min 143/211 (67.8%) Taking > 30 min to resolution 51/211 (24.2%). Purpose of calls: Eligibility 89 (42.2%). protocol compliance including drug management: 77 (36.5%%), randomization/emergency randomization: 16 (7.6%), protocol deviation:13 (6.2%), technological difficulties: 12 (5.7%), AE/SAE: 9 (4.3%), Subject enrollments directly associated with calls: 57 (20.8% of domestic subjects); excluded candidates directly associated with calls: 46 (% not available). Conclusions: In an international trial requiring rapid enrollment of subjects with intracerebral hemorrhage, the role of direct support via a hotline and other immediate communications means has proven to be instrumental in maintaining good protocol compliance and supporting enrollment by site team members .

Abstract WMP68: Smartphone Support System for Mobile Imaging Display and Management of Acute Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kristina Shkirkova ◽  
Eftitan Y Akam ◽  
Josephine F Huang ◽  
Sunil A Sheth ◽  
May Nour ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Integrated System ◽  
Ease Of Use ◽  
Imaging Data ◽  
Acute Stroke Care ◽  
Team Members ◽  
Information Platform ◽  
Stroke Team

Introduction: Rapid dissemination and coordination of clinical and imaging data among multidisciplinary team members is essential for optimal acute stroke care. Standard desktop EMRs are ill-suited for this purpose, but mobile smartphone and tablet applications are highly promising platforms for accelerated, data-driven patient diagnosis and treatment. This study tested an advanced mobile integrated system for distribution of patient clinical and imaging information. Methods: We tested the iStroke/Synapse ERm system (Figure) for smartphone and tablet display and integration of clinical data, CT, MR, and catheter angiographic imaging, and real-time stroke team communications, in consecutive acute neurovascular patients at a Comprehensive Stroke Center. Results: From 5/2014 to 10/2014, the Synapse ERm application was installed and used by 33 stroke team members, in 84 Code Stroke ED patients. Patient age was 69.1 (±17.5), with 40.5% female. Final diagnosis was: ischemic stroke 66%, TIA 7%, ICH 6%, and CV mimic 21%. Each patient record was viewed on average 13 times by at least 3 team members. The most used feature was CT, MR and cath angio image display, viewed on average 4 times per patient by at least 2 users. In-app tweet team communications were sent by average 2 users per case and viewed by average 6 team members. Use of the system was associated with treatment times that exceeded national guideline targets for thrombolysis and endovascular thrombectomy, including door-to-needle 50 min (IQR 24-60) and door-to-groin 92 min (IQR 65-128). In user surveys, the mobile information platform was judged easy to employ in 91% of uses and of added help in stroke management in a substantial majority of cases. Conclusion: The Synapse ERm system, a smartphone/tablet platform for stroke team communication and distribution and integration of clinical and imaging data, showed high ease of use, substantial added management value, and association with rapid processes of care.

Use of the functional independence measure in Japanese rehabilitation team interaction

2019 ◽  
Vol 21 (6) ◽  
pp. 660-689
Author(s):  
Hiroaki Izumi
Keyword(s):  
Clinical Decision Making ◽  
Collaborative Work ◽  
Functional Independence Measure ◽  
Clinical Decision ◽  
Functional Independence ◽  
Disabled Persons ◽  
Rehabilitation Team ◽  
Team Members ◽  
Team Interaction ◽  
Team Meetings

The functional independence measure (FIM) is a clinical scale which is used to evaluate the amount of assistance disabled persons need to conduct their daily living activities. Drawing on 65 video-recorded rehabilitation team meetings and medical records collected from a Japanese hospital, this article utilizes ethnomethodology and conversation analysis to uncover how Japanese rehabilitation team members use the FIM to track changes in the functional status of patients and decide the length of stay in ongoing interactional sequences. Analysis shows that a series of the FIM scores assembled and arranged in situ provide a sequential framework for members to understand the progress of rehabilitation and predict the plateau phase. Moreover, a particular expert is asked about patients’ capacity for further improvements and his or her opinions are treated as a basis for clinical decisions. In this way, diagnostic and clinical decision-making is produced through the ongoing collaborative work of various specialists.

scholarly journals Unmasking Parkinson’s Disease: The Relationship of Grit, Exercise, and Quality of Life

2020 ◽  
Vol 7 (6) ◽  
pp. 1732-1739
Author(s):  
Susan G Klappa ◽  
Julie A I Thompson ◽  
Stuart Blatt
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Support Groups ◽  
Physical Therapists ◽  
The United States ◽  
Community Based ◽  
Coping Responses ◽  
Home Based

The purpose of this study was to investigate grit, exercise, and quality of life (QOL) among individuals diagnosed with Parkinson’s disease (PD). A sample of convenience was used. A survey which included the grit scale, QOL scale, and open-ended questions was distributed to participants (n = 101, 51 male and 50 female) who are members of online PD support groups across the United States. Data were analyzed by SPSS 25. Grit values averaged 3.65 ± 0.51 for participants (n = 101). When divided into groups, mean grit score for community-based exercisers was 3.78 ± 0.42 and 3.10 ± 0.48 for home-based exercisers. Grit was positively correlated to higher QOL on the Parkinson’s disease quality of life (PDQL; r = +0.293, P = .004). Grit was positively correlated to the emotional component of the PDQL ( r = +0.462, P < .001). Participants with higher grit levels had higher emotional coping responses after being diagnosed with PD, exercised more, and were more willing to self-advocate. With limited rehabilitation visits allowed, physical therapists should be aware of community-based programs to redefine participation roles after diagnosis.

scholarly journals Reflections on the ethical dilemmas involved in promoting self-management

2013 ◽  
Vol 21 (4) ◽  
pp. 402-413 ◽  
Author(s):  
Anne Lise Holm ◽  
Elisabeth Severinsson
Keyword(s):  
Older Persons ◽  
Ethical Dilemmas ◽  
Standard Of Care ◽  
Management Plan ◽  
Self Management ◽  
Healthcare Team ◽  
Main Theme ◽  
Team Members ◽  
Staff Members ◽  
Ethical Stance

Due to their understanding of self-management, healthcare team members responsible for depressed older persons can experience an ethical dilemma. Each team member contributes important knowledge and experience pertaining to the management of depression, which should be reflected in the management plan. The aim of this study was to explore healthcare team members’ reflections on the ethical dilemmas involved in promoting self-management among depressed older persons. A qualitative design was used and data were collected by means of focus group interviews. The results revealed one main theme: ‘Lack of trust in the community health care system’s commitment to bringing about effectiveness and change, based on three themes; ‘Struggling to ensure the reliable transfer of information about depressed older persons to professionals and family members’, ‘Balancing autonomy, care and dignity’ and ‘Differences in the understanding of responsibility’. Lack of engagement on the part of and trust between the various professional categories who work in the community are extremely counterproductive and have serious implications for patient dignity as well as safety. In conclusion, ethical dilemmas occur when staff members are unable to act in accordance with their professional ethical stance and deliver an appropriate standard of care.

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