Orofacial myofunctional disorder characteristics in cerebral palsy and their treatment methods

Relevance. The variety of clinical manifestations of orofacial myofunctional disorders in cerebral palsy determines the need to improve diagnosis and treatment approaches. According to the authors, the planning of rehabilitation measures for children with cerebral palsy and orofacial pathology should be individual.Materials and methods. 120 children (mean age 8.7 years) with cerebral palsy and orofacial myofunctional disorders participated in the study with subsequent assessment of dental and neurological statuses during treatment, prevention and rehabilitation.Results. The study established correlations between general motor pathology, malocclusion and changes in the speech organs depending on the clinical form of cerebral palsy. Spastic dysarthria and anarthria were detected in 82 cases, age-appropriate speech and language development - in 38. Occlusion assessment revealed malocclusion in 88 subjects, neutral occlusion – in 32.Conclusions. Modern approaches to the treatment of malocclusion and orofacial myofunctional disorders in children with cerebral palsy allow increasing the effectiveness and quality of rehabilitation, organizing the sequence and continuity of specialist actions in a multidisciplinary rehabilitation team.

Person-centred care transitions for people with stroke: study protocol for a feasibility evaluation of codesigned care transition support

BackgroundCare transitions following stroke should be bridged with collaboration between hospital staff and home rehabilitation teams since well-coordinated transitions can reduce death and disability following a stroke. However, health services are delivered within organisational structures, rather than being based on patients’ needs. The aim of this study protocol is to assess the feasibility, operationalised here as fidelity and acceptability, of a codesigned care transition support for people with stroke.MethodsThis study protocol describes the evaluation of a feasibility study using a non-randomised controlled design. The codesigned care transition support includes patient information using videos, leaflets and teach back; what-matters-to me dialogue; a coordinated rehabilitation plan; bridged e-meeting; and a message system for cross-organisational collaboration. Patients with stroke, first time or recurrent, who are to be discharged home from hospital and referred to a rehabilitation team in primary healthcare for continued rehabilitation in the home will be included. One week after stroke, data will be collected on the primary outcome, namely satisfaction with the care transition support, and on the secondary outcome, namely health literacy and medication adherence. Data on use of healthcare will be obtained from a register of healthcare contacts. The outcomes of patients and significant others will be compared with matched controls from other geriatric stroke and acute stroke units, and with matched historic controls from a previous dataset at the intervention and control units. Data on acceptability and fidelity will be assessed through interviews and observations at the intervention units.Ethics and disseminationEthical approvals have been obtained from the Swedish Ethical Review Authority. The results will be published open-access in peer-reviewed journals. Dissemination also includes presentation at national and international conferences.DiscussionThe care transition support addresses a poorly functioning part of care trajectories in current healthcare. The development of this codesigned care transition support has involved people with stroke, significant other, and healthcare professionals. Such involvement has the potential to better identify and reconceptualise problems, and incorporate user experiences.Trial registration numberhttp://www.clinicaltrials.gov id: NCT02925871. Date of registration 6 October 2016.Protocol version1.

Comprehensive Rehabilitation Outcome Measurement Scale (CROMS); Development and Preliminary Validation of An Interdisciplinary Measure for Rehabilitation Outcomes

Introduction: Comprehensive and interdisciplinary measurement of rehabilitation outcome is an essential part in the assessment and prognosis of a patient. This requires input from various disciplines working with the patient and the rehabilitation team. Moreover, the evaluation measures should consider the cultural compatibility, cost, and comprehensiveness of the contextual factors of the region and as of the country.Methods: The new tool was developed through consensus and followed Delphi process incorporating various rehabilitation professionals. The validity, reliability of the tool was tested on 30 patients and their rehabilitation professionals. The tool was also validated in two native languages and back translated considering the semantics. The construct validity was analyzed using interclass correlation co-efficient (ICC), internal consistency was analyzed using Cronbach’s alpha. Results: The final Comprehensive Rehabilitation Outcome Measurement Scale (CROMS) carries 30 items which can be completed by the person with disability and the professional team. The final tool holds an overall ICC of 0.93 with a Cronbach's Alpha of 0.92 for both patient and therapist reported measures. Conclusion: The 30 item CROMS is a reliable and valid tool that can potentially be used to evaluate functional independence of various patient populations.

Development and evaluation of a new model for person-centred goal setting using practice development and appreciative inquiry approaches in a rehabilitation unit

Background: This article explores the use of a mixed-methods participatory approach to bring about transformative change to goal setting in an 18-bed, subacute rehabilitation unit in New South Wales. Aim: To use a blended approach underpinned by practice development and appreciative inquiry approaches, to develop and evaluate a model of person-centred goal setting for rehabilitation clients. Methods: Evaluative methods were co-designed and co-agreed by members of the rehabilitation team, based on what the team hoped to achieve in terms of establishing goals for clients in their care and what this meant to clients and each other. Data sources included team discussions, semi-structured interviews with individual team members and clients, a survey and stories using emotional touchpoints. Interpretation of the data involved content analysis for generation of themes and the use of Statistical Package for Social Science software for analysis of the survey. Results: Nine themes emerged. Clients highlighted: barriers to goal achievement; incorporation of goals into daily care; goal achievement; and a sense of purpose. The rehabilitation team highlighted: becoming person-centred; their role in goal setting; and barriers to establishing goals. The survey responses showed the team used person-centred approaches to achieve person-centred goals. Conclusion: Changes to goal setting allowed staff to feel person-centred in their care delivery and gave them the satisfaction of knowing they were doing something meaningful for those in their care. There was strong agreement that a unified team approach to goal setting was key to client satisfaction and achievement of the goals. Clients felt valued and included in making decisions surrounding their care. Implications for practice: • Using the practice development principle of developing collaborative partnerships among healthcare teams leads to greater involvement of clients in their care • Involving clients in goal setting leads to greater success and improved client satisfaction • Appreciative inquiry and practice development approaches are effective in developing partnerships between team members • Staff who treat clients with dignity and respect improve participation in goal setting by the clients • Creating a space in which the emotional needs of clients can be heard and acted on is crucial for success in goal achievement • Appreciative inquiry generates a greater appreciation and understanding of how to deliver person-centred care

Barriers of Implementing Evidence-Based Practice Perceived by Iranian Speech and Language Pathologists: A Qualitative Study

Background: Identifying and removing the barriers faced by speech and language pathologists (SLPs) for implementing evidence-based practice (EBP) can facilitate its administration among Iranian SLPs. Objectives: The present study was conducted to explore the barriers to implementing EBP among Iranian SLPs. Methods: A total of 14 SLPs were recruited using a purposive sampling technique. Semi-structured interviews were conducted for data collection. The interviews continued until data saturation was reached. Data were recorded and transcribed verbatim, and qualitative content analysis was used for data analysis. Results: Data analysis yielded three themes, including individual factors, organizational (workplace) factors, and extra organizational factors, and 13 subthemes. Conclusions: This study demonstrated that Iranian SLPs are faced with several barriers to using EBP in clinical practice, which may be related to both the SLPs themselves and their surroundings. These barriers should be considered by policymakers, administrators, teachers, and rehabilitation team members to facilitate the implementation of EBP by SLPs.

Setting meaningful goals in rehabilitation: A qualitative study on the experiences of clients and clinicians in working with a practical tool

Objective To evaluate the experience of clients and clinicians in working with a tool to help set goals that are personally meaningful to rehabilitation clients. Design We have applied the tool in the outpatient rehabilitation setting. Clients’ and clinicians’ experiences in working with the tool were evaluated in individual, semi-structured interviews and focus group interviews, respectively. Thematic analysis was used to analyze the data. Setting A university medical center and a rehabilitation center. Subjects Clients with a first-time stroke ( n = 8) or multiple sclerosis ( n = 10), and clinicians ( n = 38). Intervention The tool to help set meaningful goals consisted of a session (i) to explore the client's fundamental beliefs, goals and attitudes and (ii) to identify a meaningful overall rehabilitation goal. The results of that session were used by the multidisciplinary rehabilitation team (iii) to help the client to set specific rehabilitation goals that served to achieve the meaningful overall rehabilitation goal. Results Both clients and clinicians reported that the tool helped to set a meaningful overall rehabilitation goal and specific goals that became meaningful as they served to achieve the overall goal. This contributed to clients’ intrinsic rehabilitation motivation. In some clients, the meaningfulness of the rehabilitation goals facilitated the process of behavior change. Both clients and clinicians made suggestions on how the tool could be further improved. Conclusion In the opinion of both clients and clinicians, the tool does indeed result in goal setting that is personally meaningful. Further development, implementation and evaluation of the tool is warranted.

A Comprehensive Strategy to Pain Management for Cancer Patients in an Inpatient Rehabilitation Facility

Cancer pain has been shown to have a significant negative impact on health-related quality of life (HRQoL) for people experiencing it. This is also true for patients admitted to inpatient rehabilitation facilities (IRFs). An interdisciplinary approach is often needed to fully address a person's pain to help them attain maximum functional independence and to ensure a safe discharge home. Improving a patient's performance status in an IRF may also be a crucial determinant in their ability to continue receiving treatment for their cancer. However, if a person is determined to no longer be a candidate for aggressive, disease modulating treatment, IRFs can also be utilized to help patients and family's transition to comfort directed care with palliative or hospice services. This article will discuss the interventions of the multidisciplinary inpatient rehabilitation team to address a person's pain.

Learning self-care skills after spinal cord injury: a qualitative study

Background People with a recent spinal cord injury (SCI) often follow intensive rehabilitation. Learning appropriate self-care, deal with their impairments and prevent secondary health conditions (SHCs), is highly important during rehabilitation. To date it is not clear how self-care skills are taught to people with SCI. The objective of this study was to understand how people with SCI experienced the learning of appropriate self-care skills during inpatient rehabilitation, including the role of the rehabilitation team. Methods Individual semi-structured interviews were conducted with 15 people with SCI, recently discharged from initial inpatient rehabilitation. Interviews were audio-taped, transcribed and analyzed thematically. Results Two main themes and seven sub-themes were identified. Participants stated that the contribution of the rehabilitation team to learning self-care, including prevention of SHCs, was mostly made by optimizing opportunities to learn through experience. For preventing SHCs, education and lessons learned from the professionals during therapy and the formal educational program, was experienced as especially important. Further, the motivational attitude of the professionals which participants found stimulating and was based on respect, combined with their positive contribution as one team, were seen as essentials elements for learning appropriate self-care. However participants did not recognize the contribution of the nursing staff as part of their rehabilitation, although it was seen as very important. An important aspect of the participants’ own contribution was challenging oneself to learn self-care. This was done in different ways by the participants. Further, their own mental adjustment was considered important in the learning process. The gaining of confidence was by most participants seen as personal characteristic, although they also recognized the importance of the team effort and the experiences they underwent. Conclusions Learning appropriate self-care was mostly done through experience, by challenging themselves, and making use of the opportunities given by the members of the rehabilitation team. The same strategies used by the rehabilitation team to teach people with SCI to perform appropriate self-care, were also helpful for the participants to gain confidence. Explicit attention for self-care training as an important goal in SCI rehabilitation may strengthen the nursing staff’s role and stimulate interdisciplinary working.

Joubert syndrome: a case report

Background Joubert syndrome (JS) is a rare autosomal recessive genetic heterogeneously inherited disorder characterized by neurological features that include hypotonia, ataxia, developmental delay, intellectual disability, abnormal eye movements, and neonatal breathing dysregulation. Case presentation The main purposes of the case report are to highlight the benefit of multidisciplinary rehabilitation team approach and describe the clinical features associated with Joubert syndrome. In this case report, we have discussed a 9-month-old girl who presented with developmental delay, impaired vision, and a history of recurrent respiratory infection with respiratory distress. On examination, she had facial dysmorphism, myopia, and hypotonia. Brain magnetic resonance imaging showed a thick, elongated, and abnormally oriented superior cerebellar peduncle showing molar tooth appearance with elongated bat-wing shaped 4th ventricle and hypoplasia of the vermis suggestive of JS. The patient has been treated at Garden Reach Institute for the Rehabilitation and Research (GRIRR), Kolkata, India, by a multidisciplinary team of physiotherapist, speech therapist, special educator, orthotist, medical officer, and social worker that shown excellent improvement in her condition, and she has achieved good sitting balance, able to sit without support, stand with wall support, and able to walk using bilateral AFO and reverse walker. Conclusion Knowledge of characteristic clinical and radiological findings in JS will help in early diagnosis and successful rehabilitation.