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Aim. To explore and compare the content of rehabilitation practices in, respectively, a Danish and a Norwegian region, focusing on how the citizens’ rehabilitation needs are met during rehabilitation in the municipalities. Method. Six Danish and five Norwegian cases were followed 12 months after the onset of stroke. Field work and focus group interviews with multidisciplinary teams in the municipalities were conducted. The conceptual frame of the International Classification of Functioning was used to outline general patterns and local variation in the rehabilitation services. Findings. Each of the settings faces different challenges and opportunities in the provision of everyday life-supportive rehabilitation services. Rehabilitation after stroke in both settings basically follows the same guidelines, but the organization of rehabilitation programmes is more specialized in Denmark than in Norway. Team organization, multidisciplinarity, and collaboration to assess and target the patients’ needs characterized the Danish rehabilitation services. Decentralized coordination and monodisciplinary contributions with scarce or unsystematic collaboration were common in the Norwegian cases. Seamless holistic rehabilitation was challenged in both countries, but more notably in Norway. The municipal services emphasized physical functioning, which could conflict with the patients’ needs. Cognitive disturbances to and aspects of activity or participation were systematically addressed by the interdisciplinary teams in Denmark, while practitioners in Norway found that these disturbances were scarcely addressed. Discussion. The study showed major differences in municipal stroke rehabilitation services in the Northern Norway and Central Denmark Regions—in their ability to conduct everyday life—supportive rehabilitation services. Despite the fact that biopsychosocial conceptions of disease and illness, as recommended in the ICF, have been generally accepted, they seemed scarcely implemented in the political and health managerial arenas, especially in Norway. These national diversities can partly be explained by the size of the municipalities and the available health profiles in delivering patient and family-centred rehabilitation services. [ABSTRACT FROM AUTHOR]

Background: The literature on participation in rehabilitation by those with the most severe acquired brain injury is very sparse. Objectives: The aim of this study was to explore how physiotherapists promote the participation of patients with severe brain injury in therapeutic and daily-life situations in early rehabilitation. Methods: In a qualitative study employing phenomenological philosophy, several video-recorded sessions of patients with a Rancho Los Amigos Scale score of 3-4 were analysed. Empirical themes were identified by four different investigators through individual and consensus-based analyses. The results were theoretically stated and supported. Results: In an effort to achieve patient participation, the following four themes seemed to be significant: 1) consciously encountering the patient in the moment, 2) the employment of concepts surrounding the interaction between body and environment, 3) timing and flow of the activities and 4) comprehensive bodily support, guidance and facilitation of the activity and participation in daily-life skills. Conclusions: The dynamic use of these four themes seemed to enrich early rehabilitation interventions for patients with severe brain injury and low level of consciousness in terms of their participation and functioning in everyday life. [ABSTRACT FROM AUTHOR]

Aim:The purpose of the study was to shed light on the participatory aspect of early rehabilitation, when contact, communication and interaction between the patients and the professionals is minimal, because of the patients’ severe brain injury and complex conditions. Methodology:A qualitative study was chosen. The field study involved five patients (aged 39–64) and included: participant observation and video recordings of 41 rehabilitation situations, five individual interviews and one focus group interview with multidisciplinary rehabilitation experts; together with document review of hospital charts and memos. The data were analyzed using a four-step phenomenological analysis and NVivo 10. Major findings:Participation comes into play in various practices around the patient. Three main themes seem to be important: (1) The dynamic interplay of the multidisciplinary team as an element that influences participation, (2) significant relational encounters and meetings as aspects that impact on the promotion of participation, and (3) significant frameworks that affect involvement, engagement and participation. Principal conclusion:Patients’ participation and recovery are facilitated by a combination of the clinicians’ professional skills, their ability to create a rehabilitation environment in which patients can perform activities, the right framework for the meeting, and a suitable approach, to facilitate fruitful interaction with the patients. [ABSTRACT FROM PUBLISHER]

Early neurorehabilitation is an interdisciplinary field. Thus, in order to eliminate unnecessary barriers for individuals with severe acquired brain injury in early rehabilitation, we need rehabilitation science that supports both quantitative and qualitative research methods. Participation can be studied directly and indirectly. This commentary proposes that active participation and the “lived body” are essential terms in early rehabilitation of severe ABI patients, and a description of how these terms are interpreted and handled in the practice is needed. [ABSTRACT FROM PUBLISHER]

An estimated 125–137 Danish children with acquired brain injury (ABI) require rehabilitation annually, 30–40 of these at a highly specialized level. Constraint-induced movement therapy (CIMT) has shown significant effects in increasing function in children with cerebral palsy. More knowledge of how CIMT can be adapted for the rehabilitation of children with ABI is needed. The primary purpose of the study was to generate new knowledge about the pedagogical initiatives and frameworks involved in children’s participation in and activities during CIMT. Four children with ABI participated in the 60 h intervention. Data generation consisted of qualitative research through participant observations and healthcare professional evaluations. A didactical approach with individualization and a solid structural framework enhanced the possibility of securing the children’s motivation for and participation in the intervention. Adaptation, compensation and individualization were crucial factors in the achievement of changes in functional skills. Spontaneous functional use and natural bimanual involvement increased, indicating that CIMT intervention encourages the retrieval of natural involvement of the impaired upper limb after ABI. Individualization, attention, firm structure and goal-specific tasks are key didactical factors to maintain children’s motivation to participate during CIMT to increase functional skills and spontaneous and natural bimanual involvement of the impaired upper limb during activities. [ABSTRACT FROM PUBLISHER]

This paper explores the perception of "relatives" during the rehabilitation of young adults with severe acquired brain injury (SABI). This longitudinal qualitative study followed eight young adults with a SABI from hospital discharge to a year and a half after discharge. The design encompassed professional records, interviews, and surveys, including a name generator list completed by the young adults and focus group interviews with both their families and professionals. We apply a sociological theoretical framework concerning friendship, and we employ social network analysis (SNA) methodology to capture, visualise, and analyse the young adults' significant social relations. Social relations engaged as relatives during rehabilitation are to a large extent determined by the perceptions of professionals and the parents of the young adult. These perceptions contain a limited number of social relations, with priority given to biological and juridical ties. This might reflect the reduced social support available for the young adult, who initially had a much larger social network. The authors suggest a professional rethinking of who "relatives" are as well as considering these social ties as dynamic. Rehabilitation professionals must be aware of and pay attention to differing perceptions that exist as to who qualifies as significant social relations in order to reconsider the practical implementation of relative involvement. The perception of who relatives are during the rehabilitation process should be reconsidered and extended to include who the young adult perceive as significant social relations. Relatives are not a fixed entity and should be considered dynamically throughout the rehabilitation process. Social relations of the young adult must to a larger extent be considered during rehabilitation to prevent social isolation in the long run. [ABSTRACT FROM AUTHOR]

Inequalities in illness, service provision, and outcomes are well documented in the Nordic universal welfare state. The ways in which inequalities are produced during illness recovery trajectories remain largely unknown. Long-term brain injury rehabilitation in this context provides a window into veiled aspects of inequality and the underlying mechanisms. We examine inequality empirically by combing framing field structures with the classed abilities of families to mobilise capital after a severe acquired brain injury (severe ABI). Using a Bourdieuan theoretical framework, informed by the concepts of field, doxa, cultural health capital (CHC), and rehabilitation capital (RC), we designed a longitudinal case study encompassing professional records, observations, and interviews that tracked and analysed subjects' trajectories. We found that families' consistent accumulation and conversion of capital was crucial after a severe ABI because of the multifaceted rehabilitation process involving many different field specific agendas and doxas. This study supplements previous concepts (CHC and RC) developed in a health care context by including other rehabilitation contexts. These disparities in forms of capital amongst social classes result in winners and losers and were reflected in the rehabilitation trajectories of the young adults, characterised by continuity on one extreme and broken trajectories on the other. [ABSTRACT FROM AUTHOR]

Purpose: This study describes and compare the ability of professionals working in municipality stroke rehabilitation services to facilitate learning and change in the daily living of stroke survivors in two regions: one in northern Norway, the other central Denmark. Materials and Methods: Semi-structured individual interviews were conducted with survivors 3 and 9 months after discharge from in-patient care. By contrast, field observations and focus group interviews were completed with professionals on multidisciplinary teams in the two regions. A sociocultural perspective on learning was applied during data analysis. Results: Altogether, the ability of municipal health services to facilitate learning and change for stroke survivors during the first year generally depended upon developing comprehensive integrated rehabilitation plans and ensuring access to coordinated, qualified multidisciplinary teams with professional knowledge and skills to support the survivors and their families during processes of adjustment, learning and change. However, Danish stroke survivors seemed positioned to be more active, proactive and empowered, and their processes of learning and change seemed more closely co-constructed with professional support. Conclusion: Findings reveal considerable differences in municipal stroke rehabilitation services in northern Norway and central Denmark and their ability to support stroke survivors in performing self-management. [ABSTRACT FROM AUTHOR]

Background Novel virtual reality rehabilitation systems provide the potential to increase intensity and offer challenging and motivating tasks. The efficacy of virtual reality systems to improve arm motor function early after stroke has not been demonstrated yet in sufficiently powered studies. The objective of the study is to investigate whether VR training as an adjunct to conventional therapy is more effective in improving arm motor function in the subacute phase after stroke than dose-matched conventional training, to assess patient and therapist satisfaction when working with novel virtual reality training and to calculate costeffectiveness in terms of resources required to regain some degree of dexterity. Methods/Design Randomized controlled observer-blind trial. One hundred and twenty patients up to 12 weeks after stroke will be randomized to either a group receiving VR training or dose-matched and therapist attention-matched conventional arm training in addition to standard rehabilitation. During a period of four weeks the patients will be offered additional 4-5 training sessions a week of 45-60 minutes duration by a physiotherapist or an occupational therapist. Study outcomes: Arm motor function, dexterity and independence in daily life activities will be evaluated at baseline, post treatment and three months follow-up assessments with the Action Research Arm Test, Box and Blocks Test and the Functional Independence Measure, respectively. Patient and therapist satisfaction with the implementation of a VR rehabilitation system will also be assessed with questionnaires and interviews. Discussion Virtual reality systems are promising tools for rehabilitation of arm motor function after stroke. Their introduction in combination with traditional physical and occupational therapy may enhance recovery after stroke, and at the same time demand little personnel resources to increase training intensity. The VIRTUES trial will provide further evidence of VR-based treatment strategies to clinicians, patients and health economists. Trial registration ClinicalTrials.gov NCT02079103 [ABSTRACT FROM AUTHOR]