Activity, Participation, and Goal Awareness After Acquired Brain Injury: A Prospective Observational Study of Inpatient Rehabilitation

Objective To examine the frequency and timing of inpatient engagement in meaningful activities within rehabilitation (within and outside of structured therapy times) and determine the associations between activity type, goal awareness, and patient affect.Methods This prospective observational study performed behavioral mapping in a 42-bed inpatient brain injury rehabilitation unit by recording patient activity every 15 minutes (total 42 hours). The participants were randomly selected rehabilitation inpatients with acquired brain injury; all completed the study. The main outcome measures included patient demographics, observation of activity, participation, goal awareness, and affect.Results The inpatients spent 61% of the therapeutic day (8:30 to 16:30) in their single room and were alone 49% of the time. They were physically socially inactive for 76% and 74% of their awake time, respectively, with neutral affect observed for about half of this time. Goal-related activities were recorded for only 25% of the inpatients’ awake time. The odds of physical activity were 10.3-fold higher among in patients receiving support to address their goals within their rehabilitation program (odds ratio=10.3; 95% confidence interval, 5.02–21.16).Conclusion Inpatients in a mixed brain injury rehabilitation unit spent a large amount of their awake hours inactive and only participated in goal-related activities for a quarter of their awake time. Rehabilitation models that increase opportunities for physical, cognitive, and social activities outside of allied health sessions are recommended to increase overall activity levels during inpatient rehabilitation.

Effect of rehabilitation exercises in improving the motor range of people with partial rupture of the anterior cruciate ligament of the knee joint by ages (30-35) men

The study aimed to prepare rehabilitation exercises using some rubber ropes for people with partial rupture of the anterior cruciate ligament, to recognize their effect on the recovery of motor tides and to reduce the pain of those with partial rupture of the anterior cruciate ligament of the knee joint, and adopted the experimental method by designing the experimental and controlled groups on a sample of those with partial rupture of the anterior cruciate ligament of men (30-35) One year of those who attend the Physiotherapy Center/Rafidain University College of 12 injured were deliberately selected from their community of origin by (100%), and after determining the measuring tools and preparation of exercises applied with rubber ropes per week at a rate of (4) units per week, the total time period for the application of rehabilitation exercises with rubber ropes (12) A consecutive qualifying week, bringing the total number of sessions (48) rehabilitation units, and (4) rubber rope rehabilitation exercises were applied in one rehabilitation unit and the researchers verified the results of their study using the social statistical bag system (SPSS) to be conclusions and application The application of rehabilitation exercises using rubber ropes helps people with partial rupture of the anterior cruciate ligament of the knee joint to improve the motor range of this joint in the cases of tide and bending, and to reduce the degree of pain V.A.S)) in the cases of joint extension and bending, and outperforming their peers who received Exercises in the rehabilitation center, and the need for physiotherapy centers to focus on developing the experiences of their therapists on how to apply rehabilitation exercises using rubber ropes in light of the findings of this study, and to suit the degrees of rubber ropes to suit the level of pain in the injured when used in rehabilitation exercises.

Psychoeducation Strategy: Acceptance and Commitment Therapy (ACT) To Improve Self-Efficacy of Stroke Patients

Background: Stroke is the most common cerebrovascular event. Stroke patients often have biological, spiritual, and psychosocial changes. Psychosocial problems experienced in stroke patients include problems with self-efficacy. Acceptance and Commitment Therapy (ACT) is commonly used to solve psychosocial problems. Objective: This study aims to determine the effect of ACT on the self-efficacy of stroke patients. Methods: This study utilized quantitative and quasi-experimental designs without a control group. The study was conducted in a selected hospital rehabilitation unit in Yogyakarta. The respondents were selected via the purposive sampling technique. The self-efficacy was assessed using The Strategies Used by Patients to Promote Health (SUPPH) questionnaires and statistically tested with the Wilcoxon test. The total number of respondents of this study was 33 stroke patients. The characteristic of respondents was mostly 45 – 64 years old (72.73% ), male (57.6%) and, had a history of stroke for 1 – 6 months (39 %). Result: Wilcoxon test results showed a computed p-value of 0.000 on the effect of ACT on stroke patients’ self-efficacy; thus, the null hypothesis was rejected. In other words, ACT proves its effectiveness in improving stroke patients’ self-efficacy. Conclusion: Based on the data, this research can be concluded that ACT effectively improved the self-efficacy of stroke patients. The researchers recommend utilizing ACT as a nursing intervention for stroke patients in the hospital rehabilitation unit.

Is a Forensic Cohabitation Program Recovery-Oriented? A Logic Model Analysis

Background. Recovery orientation is a movement in mental health practice. Although general mental health services have taken the lead in promoting recovery, forensic psychiatric systems have lagged behind because of the need to reconcile recovery principles with the complexities of legal mandates. Advocating recovery and making systemic changes can be challenging because they require seeking a balance between the competing duties to the patient and the public. This paper used a logic model framework to demonstrate a cohabitation program that placed a woman and her newborn infant in a secure forensic rehabilitation unit, and analyzed the key assumptions of recovery upon which it was based. Methods. This was a qualitative program evaluation. Data collection involved individual interviews with the woman, the infant’s father, five primary healthcare providers, and five system administrators, and 11 focus groups with unit staff and other patients. Content analysis was used to guide the data analysis and develop the critical components of the program logic model. Results. A logic model that consists of input (team building, program planning, staff and patient preparation, resource management), output (logistic activities, risk management, mental healthcare, staff/other patient support, discharge preparation), and outcome (individual, provider, system, and society) components was developed. Conclusions. This study demonstrates a recovery-oriented program for a woman cohabitating with her baby in a secure forensic psychiatric rehabilitation unit. The logic model provided a comprehensive understanding of the way the recovery principles, such as shared decision-making, positive risk-taking, informed choices, and relational security, were implemented.

Reflecting on experiences of care: an exploratory qualitative descriptive study of the perspectives of stroke survivors, families and staff

ObjectiveThe aim of this study was to identify barriers and enablers from the perspectives of stroke survivors, carers and staff to understand the experiences of care.DesignThe study used a qualitative descriptive methodology and employed semistructured interview technique.SettingA metropolitan stroke rehabilitation unit in Western Australia providing rehabilitation services for inpatients and outpatients.ParticipantsOverall, 10 participants (four staff, four stroke survivors and two primary carers) were interviewed. Transcripts were analysed using thematic analysis.ResultsExperiences of care focused on lack of time, urgency to regain mobility, postshock recovery, uncertainty about the future and the importance of accepting help once home. There was a degree of mismatch between staff experiences of the reality of what can be provided and the experiences and expectations of stroke survivors and families. However, the benefits of a specialised rehabilitation unit were found to contribute to a positive patient experience overall. The specialised unit demonstrated that services must optimise staff time with patients and carers in the poststroke rehabilitation journey to ensure benefits for the long-term well-being for both.ConclusionSeeking patient, family and staff experiences of care can provide valuable insights into facilitating better patient, family and staff engagement for preparation for home-based rehabilitation for stroke survivors and their caregivers. Further research with a larger sample across diverse hospital settings would provide even greater insight into strategies to best address the reality of rehabilitation care and readiness of patients when returning home to the community.

Skeletal Muscle Mass, Sarcopenia and Rehabilitation Outcomes in Post-Acute COVID-19 Patients

The relationship between skeletal muscle mass at the beginning of the post-acute rehabilitation phase and rehabilitation outcomes has been scarcely investigated. The aim of this study was to investigate the impact of the existence of sarcopenia upon admission to a post-acute COVID-19 patient rehabilitation unit on body composition and functional and respiratory capacity at discharge. Thirty-four post-acute COVID-19 patients were referred to our Rehabilitation Unit from different COVID Hospitals in northern Italy. Body weight loss, body composition, handgrip strength, functional parameters, oxygen saturation and related perception of dyspnea in several positions were measured before and after a 28-day multidisciplinary rehabilitation program. Spirometry was performed only upon admission. The intervention included psychiatric support, cognitive behavioral therapy, nutritional therapy and physiotherapy, including aerobic and resistance training. Training volume was 45 min/session, 6 sessions/week. Upon admission, the prevalence of sarcopenia among our patients was 58%. In all of the 34 patients, we observed a trend of improvement in all of the respiratory, body composition, muscle strength and functional parameters considered. Monitoring muscle mass and strength in post-acute COVID-19 patients appears to be a key predictor of rehabilitation outcomes. Early diagnosis of sarcopenia therefore appears to be of paramount importance in the management of post-acute COVID-19 patients.

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