Patients’ thoughts on their falls in a rehabilitation hospital: a qualitative study of patients with stroke

Background Patients with stroke in rehabilitation wards are at an increased risk of falling. Although patients’ participation in establishing medical safety is considered crucial, there is limited evidence on their perspectives of falls. This study aims to comprehensively elucidate the subjective falling experience of patients with stroke who have been admitted to rehabilitation wards. Methods Twenty-three consecutive patients with stroke (44 to 90 years) who experienced a fall during hospitalisation were interviewed within 1 week after the fall, and thematic analysis was used to analyse the data. Results Five themes surrounding fall events were extracted from the narratives: ‘Psychological background before the action’, ‘Support for the action’, ‘Direct causes of the fall’, ‘Patients’ awareness after the fall’, and ‘Changes in attitudes and behaviours after the fall’. ‘Psychological background before the action’ comprised hastiness or hesitation to call for help. Participants often took an action based on ‘Support for the action’ derived from their past experiences of moving safely, their confidence, and/or motivation to challenge themselves to move. ‘Direct causes of the fall’ consisted of unfamiliar actions, training fatigue, the surrounding environment, reduced physical function due to paralysis, lack of attention, overconfidence in their ability, and insufficient prediction of falls. ‘Patients’ awareness after the fall’ consisted of re-affirming difficult movements, the need for rehabilitation, a reduced ability to move, an increased risk of falling, the need for attention while moving, a fear of falling, and a lack of lessons learned from falling. Finally, patients demonstrated ‘Changes in attitudes and behaviours after the fall’ such as embodying a positive attitude to cope with the risk of falling or behavioural changes to reduce the risk of falling. Conclusions Comprehensive information on patients’ perspectives before and after the fall was elucidated, uncovering many aspects including the psychological background for why patients engaged in risky behaviours resulting in falls, presence of positive thinking, and behaviour after the fall. By incorporating the patients’ views on fall incidences and their assessment, we can develop appropriate prevention strategies against falls.

Opportunities for rehabilitation of facades of historic buildings in Moldova with limestone elements

Most buildings of historical and architectural value located in the Republic of Moldova are built of limestone or brick. The facades are decorated with columns, semi-columns and pilasters, balusters, bas-relief, and consoles. The degradation of historic buildings over time leads to the need for rehabilitation and restoration. Often privately owned buildings are repaired with the application of modern materials without taking into account the original materials, without researching the original elements and materials. Authentic decorative elements are replaced by polyurethane foam elements, which due to their easy installation and relatively low cost, can significantly reduce the financial costs of finishing and decorating facades. The interior walls of the brick are covered with plasterboard. The exterior walls of limestone are plastered with cement-based mortar instead of lime-based mortar. In some cases, the walls were covered with polystyrene. All these replacements reduce the architectural and historical value of the buildings lead to the loss of their authenticity. In order to preserve the value of historic buildings, it is necessary to use local materials. This research examines the possibilities of using limestone both for the rehabilitation of masonry and for the restoration of the decorative elements of buildings built in the XVIII-XX centuries.

The Queen Square Brain Injury Clinic

There is recognition of the need for rehabilitation after TBI, but less for expert diagnosis at the level of pathology and impairment during rehabilitation. To minimise disability and cost and to maximise function, rigorous diagnosis of pathology and its consequences is required. A multidisciplinary Brain Injury clinic can provide a one-stop assessment, triage and subsequent follow-along for patients in the community after moderate-severe traumatic brain injury and enables prescription of the right treatment at the right time.

Neurological and psychological aspects of COVID-19 infection (literature review)

The SARS-CoV-2 virus is the causative agent of the COVID-19 pandemic. The spectrum of clinical manifestations ranges from asymptomatic to critical, life threatening. COVID-19 is known to be a multi-organ disease, not just the respiratory system. It also becomes obvious that neurological and psychological disorders that occur during the acute phase of infection can persist in the postmorbid period, which dictates the need for rehabilitation measures. This literature review is devoted to the analysis of data on the pathogenesis, clinic, rehabilitation of neurological, psychological manifestations of COVID-19 (neuro-COVID), prospects for further research.

Experience of Application of the International Classification of Functioning (ICF) in Assessment of the Need for Rehabilitation of Patients with Operated Breast Cancer

The article presents the results of a study of the biopsychosocial principle in the rehabilitation of patients with breast cancer. Aim. to assess the need for patients with operable breast cancer in rehabilitation measures at various stages of treatment. Results. when assessing the need for rehabilitation of patients with operable breast cancer, it was found that the need for rehabilitation measures in all patients increases in the postoperative period and persists for 12 months after the end of treatment. Special attention should be paid to the indicators of physical and social functioning in subgroups of patients who received neoadjuvant chemotherapy: increased fatigue, weight gain, unstable emotional background impose significant restrictions on the socio-role functioning of patients, reducing the quality of life and increasing the risks associated with the progression of the underlying disease, exacerbation of chronic diseases. Thus, patients who participated in the program of rehabilitation measures in the framework of the biopsychosocial approach showed the best performance after the end of treatment during the observation period: in the subgroup of patients receiving chemotherapy and rehabilitation in the framework of the biopsychosocial model, the dynamics of the recovery needs of the operation sought to average indicators by domain “b4552 Fatigue” – 21%, “b4551 Aerobic capacity “ – 18%, “d240 Handling stress and other psychological demands » – 39%, “b710 Mobility of joint functions “ – 29%, self-service (“d510 Washing”; “ d540 Dressing») – 21%, “b455 Exercise tolerance functions “ – 22%. In the subgroup of patients who received on-demand rehabilitation, there was an increase in the need for rehabilitation by domain: “d240 Handling stress and other psychological demands “ – 45%, “b4552 Fatigue” – 28%, self-service (“d510 Washing”; “ d540 Dressing») – 32%, b455 Exercise tolerance functions – 30%. Conclusion: The results of the study suggest a positive effect of rehabilitation measures on the functioning of patients with operable breast cancer.