Family Caregivers’ Experiences and Coping Strategies in Managing Stroke Patients during the COVID-19 Pandemic: A Qualitative Exploration Study

Background: Stroke is a chronic disease that requires stroke survivors to be supported long-term by their families. This is especially because of the inaccessibility to post-stroke rehabilitation outside hospitals. The Corona Virus Disease 2019 (COVID-19) crisis and the pandemic restrictions in Malaysia are expected to exponentially increase the demand from family caregivers in supporting stroke survivors. Thus, this study aims to explore the burden, experience, and coping mechanism of the family caregivers supporting stroke survivors during the COVID-19 pandemic. Methodology: A phenomenological qualitative study was conducted from November 2020 to June 2021 in Malaysia. A total of 13 respondents were recruited from two public rehabilitation centers in Kota Bharu, Kelantan. In-depth interviews were conducted with the participants. Comprehensive representation of perspectives from the respondents was achieved through purposive sampling. The interviews were conducted in the Kelantanese dialect, recorded, transcribed, and analyzed using thematic analysis. Results: Three themes on burdens and experiences were identified. They were worsening pre-existing issues, emerging new issues, and fewer burdens and challenges. Two themes on coping strategies were also identified. They were problem-focused engagement and emotion-focused engagement. Conclusions: The COVID-19 pandemic has changed the entire system of stroke management. While family caregivers mostly faced the extra burden through different experiences, they also encountered some positive impacts from the pandemic. The integrated healthcare system, especially in the era of digitalization, is an important element to establish the collaborative commitment of multiple stakeholders to compensate burden and sustain the healthcare of stroke survivors during the pandemic.

Sopeutumisvalmennuskursseille osallistuvien lasten vanhempien arvioita hyvinvoinnista, toimintakyvystä ja kurssiodotuksista

Sopeutumisvalmennus on psykososiaalista kuntoutusta, joka tarjoaa tietoa ja tukea sairaudesta tai vammasta, sen hoidosta ja selviytymiskeinoista. Lapset ja nuoret, joilla on pitkäaikaissairaus tai kehityksen häiriöitä, osallistuvat sopeutumisvalmennukseen useimmiten perheenjäsentensä kanssa. Tämän tutkimuksen tavoitteena oli 1) selvittää vanhempien käsityksiä lasten hyvinvoinnista ja toimintakyvystä, 2) arvioida vanhempien omaa hyvinvointia ja perheiden valtaistumista ja 3) selvittää kurssiodotuksia ja niihin yhteydessä olevia tekijöitä. Tutkimus kohdistui Kelan kuntoutuksena vuosina 2014–15 toteutettuihin diabeteskursseihin, oppimisen tai psyykkisen kehityksen häiriöiden kursseihin sekä moni- ja liikuntavammaisten lasten kursseihin. Lasten vanhemmat vastasivat kurssin alussa lomakekyselyyn (n = 357, vastausprosentti 59 %). Kaikissa kurssiryhmissä useimmat vanhemmat arvioivat lapsen terveydentilan hyväksi tai melko hyväksi. Vanhempien arviot niin omasta kuin lapsenkin hyvinvoinnista erosivat kurssiryhmittäin, mutta myös kurssiryhmien sisällä ilmeni vaihtelua. Vanhemmat, joiden lapsella oli diabetes, arvioivat hyvinvointia myönteisemmin kuin vanhemmat, joiden lapsella oli kehityksellinen häiriö. Vanhempien arviot omasta hyvinvoinnistaan korreloivat melko vahvasti lasta koskeviin hyvinvointiarvioihin. Sopeutumisvalmennukseen liittyvät odotukset ja tuen tarpeet koskivat erityisesti vertaistukea ja virkistäytymistä sekä tiedon saantia sairaudesta ja sen hoidosta ja kuntoutuksesta. Kurssiryhmä, lapsen toimintakyvyn rajoitteet, vanhempien hyvinvointi ja perheiden valtaistuminen olivat yhteydessä perheiden odotuksiin ja tuen tarpeisiin. Tutkimuksen keskeinen tulos koski perheen valtaistumisen ja kurssiodotusten välistä yhteyttä. Tarve ammatilliseen asiantuntijuuteen pohjautuvaan tietoon ja psykososiaaliseen tukeen oli vahvempaa niillä perheillä, joilla valtaistumisen tunne oli heikompaa. Sen sijaan ne perheet, joilla valtaistuminen oli voimakkaampaa, odottivat kursseilta vähemmän asiantuntijan tukea ja enemmän vertaistukea ja virkistäytymistä. Abstract Parents´ evaluations of their children´s wellbeing and functioning and identified expectations for psychosocial rehabilitation Finnish adaptation training represents psychosocial rehabilitation, which aims to offer information and guidance for living with an illness or disability as well as promoting coping skills. Children and adolescents with chronic illnesses or developmental disorders participate adaptation training mostly with their family members. The aim of this study was to 1) examine the parents´ perceptions of their child´s wellbeing and functioning, 2) depict their assessments on their own wellbeing and family empowerment, and 3) investigate their needs and expectations for the adaptation training as well as factors connected with different expectations. The study focused on three courses arranged for children either with diabetes, learning or psychological development disorders or multiple or mobility disabilities. The courses were organized in three rehabilitation centers. The parents answered the questionnaire at the beginning of the course (n=357, response rate 59 %). In all course groups most parents perceived their child’s health fairly good or good. The parents of children with diabetes evaluated their child’s wellbeing more positively than the parents of children with developmental disorders. The parents’ wellbeing correlated positively with the children´s wellbeing. Strongest rehabilitation needs and expectations were related to the domains of peer support and recreation, and information about illness or disability and its treatment. The course group, disability of the child, wellbeing of parents and children, and family empowerment were associated with the expectations and needs factors. The main finding of this study addressed the relationship ofthe family empowerment to the expectation domains. Families with weaker empowerment expressed more expectations and needs for professional information and support. More strongly empowered families expressed less needs for professional support and information but more expectations for peer support and recreation.

Investigation of the Effect of Inclusive Play and Special Movement Education to Social Communication in Disadvantaged and Peer Children in Preschool (Erzurum Sample)

The aim of this research is to investigate the effect of inclusive play and special movement education applied to disadvantaged and peer preschool children in Erzurum city center on their basic skills.22 students (10 disadvantaged children + 12 peer group children) consisting of disadvantaged children and peer children who were educated in special education and rehabilitation centers in the city center of Erzurum and participated voluntarily. Before the study, two seminars were given to the parents of the students, which determined the purpose and objective of the research. Students participated in a specially prepared game and movement training program for 45-60 minutes, 2 days a week during the summer period. Before starting the research, an interview and observation form consisting of 10 questions was prepared for the parents of the children and the results were recorded. At the end of the 2-month (8-week) period, interviews and observations were made with the parents of the children, and the last situation was recorded and compared with the previous situation.In the first parent interviews, the results of the research; it was observed that the children hesitated to participate in the study, they do not want to get close to other children, refrain from sharing game materials and avoid playing together and do not help. While they stated that they did not comply with the game discipline, they stated that at the end of the study program, their initial negative behavior developed completely in a positive way. In expert observations; it was observed that at the beginning, the children did not want to participate in the studies, did not listen to the volunteers, acted randomly, fought over the play materials used, and avoided playing together. While they observed that they behaved randomly, it was stated that the observations developed completely positively at the end of the research process.As a result, it was concluded that inclusive play and special movement training applied to disadvantaged preschool children and peers contributed positively to the social development of children.

"Why I Stay in Community Psychiatric Rehabilitation" -A Semi-Structured Survey in Schizophrenic Patients

Aims: Although community psychiatric rehabilitation plays an important role in returning schizophrenic patients to the society, Many patients in China stay in rehabilitation centers for longer periods of time and subsequently fail to integrate. This study aimed is to explore the underlying causes of this trend and identify possible solutions.Methods: A total of 28 schizophrenic patients were enrolled in this study. We used semi-structured telephone interviews to obtain patients’ perceptions on the effectiveness and attraction of community mental rehabilitation, as well as the difficulties of social inclusion, then applied the grounded theory to analyze the responses. Investigation of interviews include effect of community rehabilitation, attractiveness, and difficulties in social communication.Results: Most patients believe that they have gained knowledge, improved skills, friendship and social circles through community mental rehabilitation, with the sense of belonging and enriched life strongly attracting them to the rehabilitation centers. They felt that the difficulty of further integration into society is mainly because of social prejudice and rejection. In addition, the activities of community mental rehabilitation meet the needs of social communication, which also hinder patients from further entering the society.Conclusions: Schizophrenic patients with long-term stay in community mental rehabilitation centers meet their friendship, sense of belonging and social needs by participating in rehabilitation activities. Providing special social opportunity for these patients can get them out of the rehabilitation center. Overall, it is possible for patients to gradually return to society in a collective form.

Sairauskäsitykset, elämänhallinta ja sopeutumisvalmennusta koskevat odotukset

Sopeutumisvalmennus on kuntoutusmuoto, jonka avulla pyritään tukemaan kuntoutujaa vamman tai pitkäaikaisen sairauden hallinnassa. Tutkimuksen tavoitteena oli selvittää sopeutumisvalmennukseen saapuvien aikuisten kuntoutujien elämäntilannetta, sairauskäsityksiä, hallinnan tunnetta, terveyteen liittyvää valtaistumista ja sopeutumisvalmennukseen kohdistuvia odotuksia. Kurssimuotoja oli kolme: syöpää, fibromyalgiaa ja diabetesta sairastavien kurssit. Neljän kuntoutuslaitoksen toteuttamille kursseille osallistui vuosina 2014–15 toteutetun tiedonkeruun aikana 581 kuntoutujaa, joista 377 (65 %) antoi kirjallisen suostumuksen osallistua tutkimukseen ja vastasi alkukyselylomakkeeseen. Kurssiryhmät erosivat sairauskäsitystensä suhteen toisistaan. Kuntoutujien elämäntilanne, sosiaalinen ja institutionaalinen luottamus sekä sairauden rajoitukset olivat yhteydessä hallinnan tunteeseen. Sopeutumisvalmennukseen kohdistuvat odotukset muodostivat neljä ulottuvuutta: palvelutietoja, sairautta ja sen hoitoa koskevia tietoja, psykososiaalista asiantuntijatukea sekä vertaistukea koskevat odotukset. Odotukset vaihtelivat kurssiryhmittäin. Sairauskäsityksiin liittyvät sairauden oireet, huolestuneisuus, tunnereaktiot ja käsitys hoidon vaikutuksista ja omista vaikutusmahdollisuuksista selittivät odotusten vaihtelua. Tietoihin ja psykososiaaliseen asiantuntija-apuun kohdistuvien odotusten todennäköisyyttä lisäsi terveyteen liittyvän valtaistumisen osalta tiedollisen hallinnan vähäisyys, kun taas vertaistukeen liittyvien odotusten todennäköisyyttä lisäsi vahva tiedollinen ja psykososiaalinen hallinta. Abstract Illness perceptions, empowerment and rehabilitation expectations of persons attending psychosocial rehabilitation Adaptation training is a form of psychosocial rehabilitation that aims to empower the client in coping with his or her illness or disability. The aim of the study was to examine the life situation, sense of mastery, illness perceptions, health-related empowerment and rehabilitation needs and expectations of clients attending adaptation training courses for adults with cancer, fibromyalgia or diabetes. In 2014–15, 581 clients attended these courses in four rehabilitation centers; 377 of them gave their informed consent to participate the study and answered the questionnaire at the beginning of the course. The three groups differed according to their illness perceptions and rehabilitation expectations, but there was also much variance between group members. Life situation, perceived disability, and social and institutional trust were associated with sense of mastery. Rehabilitation expectations were grouped into four main dimensions, i.e., information about services and support, information about the illness and treatment and rehabilitation options, psychosocial professional support, and peer support. Illness perceptions, i.e. perceived symptoms, worry, emotional reactions, experienced outcomes of treatment, and perceptions of one’s own possibilities to influence the illness were associated with different dimensions. Health-related empowerment was also connected with expectations. Expectations for information and professional help were stronger in those with weak informational mastery, whereas expectations for peer support were stronger with those whose informational and psychosocial mastery was better than average.

Cloud Server and Internet of Things Assisted System for Stress Monitoring

Currently, the Internet of Things (IoT) has gained attention for its capability for real-time monitoring. The advancement in sensor and wireless communication technology has led to the widespread adoption of IoT technology in distinct applications. The cloud server, in conjunction with the IoT, enables the visualization and analysis of real-time sensor data. The literature concludes that there is a lack of remote stress-monitoring devices available to assist doctors in observing the real-time stress status of patients in the hospital and in rehabilitation centers. To overcome this problem, we have proposed the use of the IoT and cloud-enabled stress devices to detect stress in a real-time environment. The IoT-enabled stress device establishes piconet communication with the master node to allow visualization of the sensory data on the cloud server. The threshold value (volt) for real-time stress detection by the stress device is identified by experimental analysis using MATLAB based on the results obtained from the performance of three different physical-stress generating tasks. In addition, the stress device is interfaced with the cloud server, and the sensor data are recorded on the cloud server. The sensor data logged into the cloud server can be utilized for future analysis.

Lessons Learned by Rehabilitation Counselors and Physicians in Services to COVID-19 Long-Haulers: A Qualitative Study

Coronavirus disease (COVID-19) may cause long-lasting adverse consequences after acute recovery, including functional limitations and reduced work capacity. Individuals with long-lasting complications of COVID-19 are known as long-haulers. There is a knowledge gap on how COVID-19 complications affect return-to-work (RTW) efforts. We aimed to describe the challenges that long-haulers encounter when RTW from the perspectives of rehabilitation professionals. In this study, four certified rehabilitation counselors and four rehabilitation physicians in outpatient rehabilitation centers participated in focus groups. Participants discussed challenges in working with long-haulers, including personal attributes, post-COVID-19 symptoms and complications, uncertain recovery and unpredictable outcomes, limited health care accessibility and support, and unsupportive work environments. Participants provide individualized services to meet long-haulers’ diverse needs as they do for all persons with disabilities, although they expressed uncertainty due to the variable disease course and risk of infection. Modifying workplace policies, especially gradual RTW, were frequently mentioned accommodations. The findings highlight the RTW issues of long-haulers. We provide recommendations on increasing awareness of the challenges and job accommodations of long-haulers.

METHODOLOGICAL BASES OF A.S. MAKARENKO’S PEDAGOGY AND HUMANISTIC GUIDELINES OF MODERN EDUCATION

The article deals with the methodological sources and humanistic guidelines of modern education. The philosophical bases of A.S. Makarenko’s pedagogy and pedagogical ideas of G.V. Mohnenko are presented. New approaches to eliminating bad habits such as smoking, alcoholism and drug addiction are shown in modern conditions. The purpose of the study is to identify and systematize humanistic guidelines and dimensions, their meaning and prospects in modern education. In his colonies A.S. Makarenko organized a humanistic and democratic micro-society. One of his main pedagogical ideas was the education of the individual in the team and through the team. The young teacher tokk interest in philosophical works, literature, psychology, history and other sciences, in particular, the works by Bergson, Schopenhauer, Nietzsche and others. The idea of pedagogical expediency was successfully implemented in the practice of A.S. Makarenko, and is closely intertwined with the concept of "common sense" by Henri Bergson. The article considers the following principles of Makarenko's pedagogy: parallel action, i.e. influence on the personality through the team, reliance on positive in the pupil’s personality, perspective lines in the development of the team, "tomorrow's joy" and others. Nowadays, new societal challenges have emerged that require new approaches to education in the context of the spread of alcoholism, smoking and drug addiction. An important and interesting experience is the approaches of Gennady Viktorovich Mokhnenko, an innovative teacher, the founder and head of the largest children's rehabilitation center "Republic Pilgrim" and a network of rehabilitation centers for adults.

ANALYSIS OF FOREIGN EXPERIENCE OF THE ARCHITECTURAL ORGANIZATION OF REHABILITATION CENTERS FOR MILITARY SERVICES

The article discusses the features of the architectural organization of rehabilitation centers in America. The article is aimed at searching for individual design solutions for rehabilitation centers, revealing regional and climatic features that correspond to modern programs, reflect the latest trends in the design of medical facilities