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There is a dearth of research into what low secure forensic psychiatric rehabilitation means in Australia and internationally. The aim of this study was to understand clinician perspectives of forensic psychiatric rehabilitation in a low secure setting in Australia and offer insight into a model of care. A qualitative methodology was chosen with separate semi-structured interviews being conducted with staff members involved in decision-making for forensic psychiatric patients in a rehabilitation unit. Analysis of the interviews identified three domains that the questions related to: ‘defining and describing security’, ‘defining and describing low secure forensic psychiatric rehabilitation’ and ‘describing the role of staff and services in a low secure forensic psychiatric rehabilitation setting’. Where relevant, themes were abstracted from the questions that related to these domains. This study revealed that clinicians had a varied understanding of definitions for security but a similar understanding of what low secure forensic psychiatric rehabilitation means, what patients are suitable and the general goals of rehabilitation in this setting. Further research is needed on low secure rehabilitation and specific models of care. There is also a need to develop clear definitions for both security and rehabilitation in low secure forensic psychiatric settings. [ABSTRACT FROM AUTHOR]

Objectives: To observe the distribution of patients who presented with low back pain (LBP) and to determine the between therapists' interrater reliability of assessments in a private outpatient setting using treatment-based classification (TBC) subgroups. Methods: An observational and methodological study was conducted. Four hundred and twenty-nine patients (231 male; 198 female) presenting LBP symptoms and referred to conservative treatment were assessed by 13 physical therapists who conducted a 60-min examination process utilizing TBC subgroups. Interrater reliability analyses from six raters were assessed using Fleiss' kappa and previously recorded data (n = 30). Results: In this study, 65.74% of patients were classified in only one subgroup, the most prevalent being stabilization (21.91%), followed by extension (15.38%), traction (11.89%), flexion (10.96%), manipulation (5.13%), and lateral shift (0.47%). Approximately 20.98% of patients were classified in two subgroups, where the most frequent overlaps were flexion + stabilization (7.46%), extension + stabilization (6.06%), flexion + traction (4.20%), extension + manipulation (1.86%), and 13.29% of patients were not classified in any TBC subgroup. Analysis of interrater reliability showed a kappa value of 0.62 and an overall agreement of 66% between raters. Discussion: LBP is a heterogeneous clinical condition and several classification methods are proposed in the attempt to observe better outcomes for patients. Eighty-five percent of patients assessed were able to be classified when using the TBC assessment and reliability analysis showed a substantial agreement between raters. [ABSTRACT FROM AUTHOR]

The Gorkha earthquake on April 25, 2015 had significantly affected the livelihood of people and the overall economy in Nepal. The earthquake had caused damage to about half a million private and public buildings, apart from damage to other infrastructures including schools, hospitals, roads, hydropower, irrigation canals, etc. The earthquake had affected the lives of 8 million people. With significant numbers of actors and stakeholders involved in the reconstruction process, no significant relief has reached the ground or is observable even after 3 years of the disaster. The government has formed National Reconstruction Authority (NRA) as the focal authority for the reconstruction process which is leading the reconstruction process with line agencies and other stakeholders. The longitudinal study was carried out through semi-structured interviews with the engineers working under NRA, local people and social mobilizer, group discussions, and field observation from June 2015 to August 2016 focusing on challenges for timely and quality reconstruction. The research also reviews the experiences from past events in similar social and political condition. This study concludes that the situation was the result of larger institutional gaps as the absence of local government, lack of coordination, bureaucratic hurdles and political transition, weak governance and cross-cutting issues as accessibility, manpower shortage, knowledge gap and other socio-cultural aspects. Authors supplement that the good governance and strategic incorporation of social and cultural aspects of reconstructions along with the technical cross-cutting issues like skilled labour, resources availability and construction knowledge could help to expedite the reconstruction process. [ABSTRACT FROM AUTHOR]

Prison industries represent an important component of service delivery for correctional administrations around the world and yet there have been few attempts to articulate the specific role that they play in prisoner reintegration. This article describes the operation of an Australian prison industry programme. It identifies key programme characteristics that are thought to be associated with success before applying a desistance framework to understand the mechanisms by which change occurs and identify possible areas for improving efficacy. It is concluded that significant opportunities exist to enhance reintegration outcomes in this type of programme. [ABSTRACT FROM PUBLISHER]

Objectives:Arthritis resulting from recurrent intra-articular bleeding in individuals with hemophilia can be severely debilitating due to joint pain and stiffness with subsequent loss of mobility and function. Very limited studies have investigated the potential benefits of joint mobilization for this condition. This case series is a preliminary investigation of safety, as well as immediate and short-term clinical benefits, associated with gentle knee and ankle joint mobilization in people with hemophilic arthropathy. Methods:A single intervention of joint mobilization was applied to the affected knees and/or ankles of 16 individuals with severe or moderate hemophilia within a public hospital setting. Adverse events, as well as immediate (pain-free passive joint range, Timed Up and Go Test with maximum pain numerical rating scale) and short-term (Lower Extremity Functional Scale) effects of the intervention were evaluated with a repeated measures ANOVA. Results:There were no adverse events. An immediate significant increase was observed in pain-free passive ankle joint range of motion (p < 0.05) following the joint mobilization intervention. Discussion:The findings of this case series suggest that gentle joint mobilization techniques may be safely considered as part of a multimodal management approach for hemophilic arthropathy. [ABSTRACT FROM PUBLISHER]

Objective:Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers. Design:Community-level, cross-sectional analysis with multidimensional clinical work ability assessments. Setting:Paltamo, Finland. Participants:Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n = 230, 81%). Main outcome measures:Based on data from theme interviews, patient records, supervisors’ observations of work performance and clinical examinations, a physician concluded the individual’s work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated. Results:Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability. Conclusions:Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed.KEY POINTSAlthough the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce.Work disabilities are common among the unemployed.Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to work.Context sensitivity may add to the accuracy of the doctor’s conclusions on work ability. [ABSTRACT FROM PUBLISHER]

Purpose: To explore the acceptability of using ReaDySpeech, an online speech therapy programme for people with dysarthria after stroke, within usual clinical practice. This early clinical testing underpins future research evaluation of ReaDySpeech. Methods: A prospective, observational design involving interviews with speech and language therapists with experience of using ReaDySpeech. This included the usability of ReaDySpeech, therapists' training/support needs, ease of recruitment of therapist and patient participants, ReaDySpeech technical issues and therapy content. Therapists also provided feedback from the patient participants. Results: Six therapists working in hospital and community-based settings used ReaDySpeech with five patients (12-28 weeks post-stroke, four female, mean age 71 years). Therapists found it was easy to use, training/support was sufficient and they reported positive feedback from participants. Areas to address involved patients' access to Wi-Fi, ease of navigation, content improvements and difficulties recruiting people more than 12 weeks post-stroke as most patients had already been discharged. Conclusions: ReaDySpeech was acceptable and generally feasible to use in clinical practice. This early phase research testing has been essential to improve navigation within the therapy software and content. ReaDySpeech can now be further evaluated with a phase two feasibility trial with earlier recruitment following stroke. [ABSTRACT FROM AUTHOR]

We sought to establish the effects on cognitive performance and autonomic arousal of a multi-electrode transcutaneous electrical sensory stimulator compared with single-electrode stimulation. Progressing from a feasibility study (n = 10) to a repeated-measures, within-subject study (n = 67), healthy, righthanded participants (34 male, mean age 28 ± 11.5 yrs.) received four separate predictable ("lines" or "ring") or unpredictable ("fly" or "random") complex electrical stimulation patterns to the non-dominant forearm via 24 individually programmable electrodes, or single-electrode stimulation. During stimulation, participants in the main study performed a series of cognitively demanding tests or a two-point discrimination task and had their autonomic arousal (skin conductance response) monitored. Single-electrode "first felt" current intensity decreased from distal to proximal forearm, was positively correlated with forearm circumference and was lower in females. Single-electrode stimulation was associated with a significant decline in two-point discrimination performance. There were no significant autonomic arousal or cognitive performance differences between complex patterns, but all patterns were associated with greater autonomic arousal than single-electrode stimulation. In conclusion, gender and forearm location and circumference significantly influence perception-levels for electrical current. Future research should examine whether the induction of increased autonomic arousal, via multi-electrode complex patterns, has improved therapeutic application, compared with single-electrode stimulation. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 72-year-old female with chronic low back pain (LBP) and a surgical history in the lumbar spine was referred to physical therapy for radiating leg pain and presented with a right lumbar lateral shift (LLS).

Best practice mine closure planning and environmental impact assessment (EIA) principles share many common features. This research examined how mine closure planning relates to, and can be integrated with EIA by comparing practice in eight African and Australian jurisdictions. Emphasis was placed on key challenges and opportunities associated with: institutional arrangements for mine closure planning; financial mechanisms for mine site closure and rehabilitation including abandoned/legacy mine sites; transparency of mine closure planning and financing provisions; and regulation of artisanal and small-scale mining activity. Data were gathered through document analysis, interviews and interactions with practitioners from Western Australia, Ghana, Kenya, Nigeria, Mozambique, South Africa, Tanzania and Zambia. Issues associated with mine closure planning and rehabilitation under existing arrangements and opportunities for improvement through existing EIA processes already in place in each jurisdiction are explored. All eight jurisdictions have appropriate regulatory provisions in place already, but implementation capacity remains a challenge. Opportunities for effective practice lie in using mine closure planning and EIA measures in an integrated fashion, avoiding duplication and enabling synergies in management to be realised. [ABSTRACT FROM PUBLISHER]

The article provides information on a medical study analyzing impact of home exercise programs (HEP) on patients with non-specific and specific neck pain. Topics discussed include involvement of degenerative pathology, diagnosis of neck to forecast radiculopathy and cervicogenic headache, and Active Range Of Motion (AROM).

Setting and objective The growing elderly population and the rising number of people with chronic diseases indicate an increasing need for rehabilitation. Norwegian municipalities are required by law to offer rehabilitation. The aim of this study was to investigate how rehabilitation work is perceived and carried out by first-line service providers compared with the guidelines issued by Norway's health authorities. Design and subjects In this action research project, qualitative data were collected through 24 individual interviews and seven group interviews with employees - service providers and managers - in the home-based service of two boroughs in Oslo, Norway. The data were analysed using a systematic text-condensation method. Results The results show that rehabilitation receives little attention in the boroughs and that patients are seldom rehabilitated at home. There is disagreement among professional staff as to what rehabilitation is and should be. The purchaser-provider organization, high speed of service delivery, and scarcity of resources are reported to hamper rehabilitation work. Conclusion and implications A discrepancy exists between the high level of ambitious goals of Norwegian health authorities and the possibilities that practitioners have to achieve them. This situation results in healthcare staff being squeezed by the increasing expectations and demands of the population and the promises and statutory rights coming from politicians and administrators. For the employees in the municipalities to place rehabilitation on the agenda, it is a requirement that authorities understand the clinical aspect of rehabilitation and provide the municipalities with adequate framework conditions for successful rehabilitation work. [ABSTRACT FROM AUTHOR]

In natural forests of Central Africa, several studies indicate a dramatic decrease in commercial trees, including species of concern for conservation. Enrichment planting with these species will favor both the long-term recovery of their populations and biodiversity conservation in logged forests. In this study, we analyzed the survival and growth of 23 species in plantations. Fourteen 0.2–1.1 ha mixed species plantations consisting of single-species 15 × 15 m blocks were studied for 5 years in a logging concession of southeastern Cameroon. The plantation design considered both species light requirements and sensitivity to damage by pests. To identify the best species for enrichment planting, we assessed both species performance and plantation costs. We also tested for relationships between species traits and species performance. Mean annual diameter growth increments ranged from 1.67 to 42.9 mm. No significant relationship was found between growth and survival. Herbivory by wild Bovidae was the main cause of mortality and should be carefully considered in rehabilitation efforts. We found a significant negative relationship between wood density and maximum growth rate. The other traits tested were not good predictors of species performance in plantations. The two best-performing species,Triplochiton scleroxylonandTerminalia superba, could reach the minimum cutting diameter during a 30-year cutting cycle. Costs were high and mechanized site preparation is suggested to reduce them. Widespread adoption of such plantations will only occur if financial incentives or national regulations for assuring regeneration are implemented. EDITED BY Nicholas Brokaw [ABSTRACT FROM PUBLISHER]

The article presents a case study of a 35-year-old nulliparous female consultant who has been admitted to hospital after being treated for right low back and sacral pain. The study was conducted by using the multimodal, multi-disciplinary technique for analyzing the functioning of the sacroiliac joint of the patient. Other topics discussed includes physical therapy examination of the patient, treatment of the patient for two months and diagnostic details of the study.

The aim of this study was to identity the types of physical activity narratives drawn upon by active spinal injured people. More than 50 h of semi-structured life-story interview data, collected as part of larger interdisciplinary program of disability lifestyle research, was analysed for 30 physically active male and female spinal cord injury (SCI) participants. A structural narrative analysis of data identified three narrative types which people with SCI draw on: (1) exercise is restitution, (2) exercise is medicine, and (3) exercise is progressive redemption. These insights contribute new knowledge by adding a unique narrative perspective to existing cognitive understanding of physical activity behaviour in the spinal cord injured population. The implications of this narrative typology for developing effective positive behavioural change interventions are critically discussed. It is concluded that the identified narratives types may be constitutive, as well as reflective, of physical activity experiences and therefore may be a useful tool on which to base physical activity promotion initiatives. [ABSTRACT FROM AUTHOR]

Roofers continue to suffer frequent fall-related injuries and fatalities. The objectives of this research were (a) identifying the factors affecting roofer fall accidents; (b) investigating the frequency distributions of these factors; (c) examining the relationships between the factors; and (d) developing a statistical model for fatal and nonfatal fall outcomes. Occupational Safety & Health Administration (OSHA) accident data was analyzed using categorical variables. After establishing data demographics, cross-tabulation analysis was performed to determine factor relationships, and logistic regression modeling was done to predict accident outcomes using degree of injury as a dependent variable and the significant factors from cross-tabulation as independent variables. It was found that roofers most frequently experienced falls while working in smaller alteration/rehabilitation projects and at heights below 20 feet. Unguarded/improperly secured platforms, walkways, openings, edges and ladders, misjudgment of hazardous situation, and improper choice of equipment/process came out to be significant contributing factors. It was observed that the odds of fatality decreased when roofers were provided OSHA-compliant fall protection systems; used these systems; and received fall protection training per OSHA requirements. The model developed and validated in this study successfully predicted the fall accident outcomes in terms of fatality and nonfatal injury. [ABSTRACT FROM AUTHOR]

Background.Multidisciplinary rehabilitation programmes can improve physical functioning and help patients with long-term pain back to work. Little is known, however, of the extent to which such rehabilitation also affects life satisfaction, pain severity, and disability. We wanted to evaluate if a 5-week rehabilitation programme for patients with long-term pain improves life satisfaction and decreases pain severity and disability. Methods. The subjects were 164 patients aged 18-65 years from a pain rehabilitation clinic. Most of them were referred from primary care units. One group of repeated tests was used. Participants were asked to fill out the LiSat-11 checklist and parts of the Multidimensional Pain Inventory (MPI), including pain severity, at admission, at discharge, and 1 year after the rehabilitation programme. Results. Satisfaction with life as a whole, and six of ten LiSat-11 domains improved during the follow-up, though none reached the levels for the general population. MPI subscales pain severity, pain interference, life control, and affective distress improved, whereas no change was observed for general activity. Patients older than 38 years decreased more in MPI affective distress than younger patients. Gender, pain severity, and work status before the programme did not significantly influence the outcome. Conclusions. The results indicate that multidisciplinary rehabilitation improves life satisfaction, reduces pain severity, and reduces negative psychological, social, and behavioural effects of pain. These outcome variables relate to domains known to be of interest for patients and should therefore be considered for evaluation of rehabilitation programmes for long-term pain. [ABSTRACT FROM AUTHOR]

Tablet and smartphone use is rapidly increasing in developed countries. With this upsurge in popularity, the devices themselves are becoming more user-friendly for all consumers, including the visually impaired. Traditionally, visually impaired patients have received optical rehabilitation in the forms of microscopes, stand magnifiers, handheld magnifiers, telemicroscopes, and electronic magnification such as closed circuit televisions (CCTVs). In addition to the optical and financial limitations of traditional devices, patients do not always view them as being socially acceptable. For this reason, devices are often underutilised by patients due to lack of use in public forums or when among peers. By incorporating smartphones and tablets into a patient's low vision rehabilitation, in addition to traditional devices, one provides versatile and mainstream options, which may also be less expensive. This article explains exactly what the accessibility features of tablets and smartphones are for the blind and visually impaired, how to access them, and provides an introduction on usage of the features. [ABSTRACT FROM AUTHOR]

Chronic facial pain has many of the clinical characteristics found in other persistent musculoskeletal conditions, such as low back and cervical pain syndromes. Unique to this condition, however, is that painful facial movements may result in rigidity or altered ability to demonstrate mimicry, defined as the natural tendency to adopt the behavioral expressions of other persons involved in the interaction. Loss of ability to communicate through emotional expression can lead to impaired processing of emotions and ultimately social isolation. Diminished quality and quantity of facial expression is associated with chronic face pain, tempromandibular dysfunction, facial asymmetries, and neurological disorders. This report provides a framework for assessment of impaired emotional processing and associated somatosensory alterations. Principles for management for chronic facial pain should include graded motor imagery, in addition to standard treatments of manual therapy, exercise, and patient education. A case study is provided which illustrates these principles. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although post-traumatic stress disorder (PTSD) is a common co-morbidity in chronic pain, little is known about the association between PTSD and pain in the context of chronic pain rehabilitation. OBJECTIVE: The aim of the present study was two-fold: (1) to investigate the association of a possible PTSD diagnosis with symptoms of pain, physical and mental functioning, as well as the use of opioids, and (2) to compare the outcome of multidisciplinary chronic pain rehabilitation for patients with a possible PTSD diagnosis at admission with patients without PTSD at admission. METHOD: A consecutively referred cohort of 194 patients completed a baseline questionnaire at admission covering post-traumatic stress, pain symptoms, physical and mental functioning, as well as self-reported sleep quality and cognitive difficulties. Medication use was calculated from their medical records. A total of 95 were admitted to further multidisciplinary treatment and included in the outcome study. RESULTS: A high prevalence of possible PTSD was found (26.3%). Patients with possible co-morbid PTSD experienced significantly poorer general and mental health, poorer sleep quality, and more cognitive problems as well as inferior social functioning compared to patients without PTSD. Possible co-morbid PTSD did not result in higher use of opioids or sedatives. Surprisingly, possible co-morbid PTSD at admission was not associated with lower levels of symptom reduction from pre- to post-treatment. CONCLUSIONS: Possible co-morbid PTSD in chronic pain is a major problem associated with significantly poorer functioning on several domains. Nevertheless, our results indicate that pain-related symptoms could be treated with success despite possible co-morbid PTSD. However, since PTSD was only measured at admission it is not known whether rehabilitation actually reduced PTSD. [ABSTRACT FROM AUTHOR]

The strengthening of international criminal law through an increased focus on the right to reparation and rehabilitation for victims of crimes against humanity represents an important challenge to health professionals, particularly to those in the field of trauma research and treatment. A brief outline of some developments in the field of international law and justice for victims of gross human rights violations is presented, with a focus on the right to reparation including the means for rehabilitation. The fulfillment of this right is a complex endeavor which raises many questions. The road to justice and reparation for those whose rights have been brutally violated is long and burdensome. The active presence of trauma-informed health professionals in this process is a priority. Some of the issues raised within the context of states' obligations to provide and ensure redress1 and rehabilitation to those subjected to torture and gross human rights violations are discussed, and in particular how rehabilitation can be understood and responded to by health professionals. [ABSTRACT FROM AUTHOR]

Objective. To study the effects on sick leave from an early multidisciplinary assessment at a primary health care centre. Design. Randomized controlled trial. Setting. Patients who saw GPs at a primary health care centre in mid-Sweden and asked for a sickness certificate for psychiatric or musculoskeletal diagnoses were invited to participate. Patients included were sick-listed for less than four weeks; 33 patients were randomized either to an assessment within a week by a physiotherapist, a psychotherapist, and an occupational therapist or to 'standard care'. The therapists used methods and tools they normally use in their clinical work. Main outcome measure. Proportion of patients still sick-listed three months after randomization, total and net days on sick leave, and proportion who were on part-time sick leave. Results. At follow-up after three months, in contrast to the pre-trial hypothesis, there was a trend toward a higher proportion of patients still sick-listed in the intervention group (7/18) as compared with the control group (3/15). The intervention group also had significantly longer sick-listing periods (mean 58 days) than the control group (mean 36 days) (p = 0.038). The proportion of patients who were part time sick-listed was significantly higher in the intervention group (10/18) than in the control group (2/15) (p = 0.027). Conclusions. In this study an early multidisciplinary assessment was associated with longer periods on sick leave and more individuals on part-time sick leave. [ABSTRACT FROM AUTHOR]

The term 'regional interdependence' or RI has recently been introduced into the vernacular of physical therapy and rehabilitation literature as a clinical model of musculoskeletal assessment and intervention. The underlying premise of this model is that seemingly unrelated impairments in remote anatomical regions of the body may contribute to and be associated with a patient's primary report of symptoms. The clinical implication of this premise is that interventions directed at one region of the body will often have effects at remote and seeming unrelated areas. The formalized concept of RI is relatively new and was originally derived in an inductive manner from a variety of earlier publications and clinical observations. However, recent literature has provided additional support to the concept. The primary purpose of this article will be to further refine the operational definition for the concept of RI, examine supporting literature, discuss possible clinically relevant mechanisms, and conclude with a discussion of the implications of these findings on clinical practice and research. [ABSTRACT FROM AUTHOR]

The strengthening of international criminal law through an increased focus on the right to reparation and rehabilitation for victims of crimes against humanity represents an important challenge to health professionals, particularly to those in the field of trauma research and treatment. A brief outline of some developments in the field of international law and justice for victims of gross human rights violations is presented, with a focus on the right to reparation including the means for rehabilitation. The fulfillment of this right is a complex endeavor which raises many questions. The road to justice and reparation for those whose rights have been brutally violated is long and burdensome. The active presence of trauma-informed health professionals in this process is a priority. Some of the issues raised within the context of states' obligations to provide and ensure redress and rehabilitation to those subjected to torture and gross human rights violations are discussed, and in particular how rehabilitation can be understood and responded to by health professionals. [ABSTRACT FROM AUTHOR]

This article describes a part of the interview process that is never usually reported. Listening to what people say is the key to increasing our knowledge of human existences. Procuring knowledge about human experience is much more challenging. Although good sources on how to prepare and conduct an interview exist, the process of the interviewer's perception of the interviewee's message and meaning is less examined. Beyond the role of eliciting the data, the researcher endeavours to reproduce the interviewee's narration and not the voice of the researcher. By illustrating the process during the interview, further transparency and thereby validity may be achieved. To exemplify this, the perception of the interviewer is explored, and here Heidegger's work on self-transposition has proved to be helpful. [ABSTRACT FROM AUTHOR]

This article presents and discusses a long-term repeated-immersion research process that explores meaning allocated to an episode of 50 seconds of music improvisation in early neurosurgical rehabilitation by a teenage boy with severe traumatic brain injury and his music therapist. The process began with the original therapy session in August 1994 and extends to the current time of writing in 2013. A diverse selection of qualitative research methods were used during a repeated immersion and engagement with the selected episodes. The multiple methods used in this enquiry include therapeutic narrative analysis and musicological and video analysis during my doctoral research between 2002 and 2004, arts-based research in 2008 using expressive writing, and arts-based research in 2012 based on the creation of a body cast of my right hand as I used it to play the first note of my music improvising in the original therapy episode, which is accompanied by reflective journaling. The casting of my hand was done to explore and reconsider the role of my own body as an embodied and integral, but originally hidden, part of the therapy process. Put together, these investigations explore the potential meanings of the episode of music improvisation in therapy in an innovative and imaginative way. However, this article does not aim at this stage to present a model or theory for neurorehabilitation but offers an example of how a combination of diverse qualitative methods over an extended period of time can be instrumental in gaining innovative and rich insights into initially hidden perspectives on health, well-being, and human relating. [ABSTRACT FROM AUTHOR]

Objective: The Patient-Specific Functional Scale (PSFS) and the Numeric Pain Rating Scale (NPRS) are two measures which the Accident Compensation Corporation (ACC) of New Zealand have made compulsory for physiotherapists to record at a patients initial visit and discharge. Therefore, it is important to assess clinicians' compliance to this reporting requirement, and whether research results regarding effectiveness of these measures are transferable to the clinic. Method: A retrospective observational study that assessed compliance in recording these measures, and analyzed the changes in scores seen across 11 physiotherapy practices in New Zealand over a 12-month period. Results: Overall compliance rates of 51.8% [95% confidence interval (CI): 50.7-52.9] for PSFS and 51.9% (95% CI: 50.7-53.0) for NPRS were reported. These figures increase to 85.3% (95% CI: 82.0-88.6) PSFS; and 85.1% (95% CI: 81.7-88.4) NPRS, when a full discharge for the patient was made. Mean change in PSFS scores were 5.1 (95% CI: 5.0-5.1) points representing an 85.2% (95% CI: 84.1-86.3) change in total score. Discussion: The study has shown that when patients complete a prescribed course of rehabilitation, clinicians show good compliance in recording PSFS and NPRS. Change in PSFS score is, on average, above the minimal clinically important difference shown in previous studies. [ABSTRACT FROM AUTHOR]

Objectives: A recent clinical prediction rule (CPR) identified characteristics that may predict an immediate reduction in pain following lumbopelvic manipulation in patients with patellofemoral pain syndrome. The purpose of this single-arm cohort study was to replicate the proposed CPR in a different population and investigate changes in self-reported pain, hip range of motion, strength, and function immediately following lumbopelvic manipulation. Methods: Forty-four subjects (63.6% female; mean age 27.4 years) met inclusion criteria. Hip internal rotation range of motion, lower extremity strength using a handheld dynamometer, and single/triple hop tests were assessed prior to and immediately following a spinal manipulation. A global rating of change questionnaire was administered after testing and telephonically at 1 week. Paired f-tests compared pre- and post-manipulation range of motion, strength, and hop test limb symmetry indices (

Les rejets sulfurés de la mine abandonnée de Kettara, située à 30 km au Nord-Nord-Ouest de Marrakech, sont directement entreposés sur un substratum schisto-gréseux fracturé. D'une superficie d'environ 16 ha, ils constituent une réelle source de pollution pour l'écosystème local en particulier à cause du Drainage Minier Acide (DMA) vers les eaux de surface et de la nappe phréatique. Le projet de réhabilitation du site minier de Kettara prévoit dans l'un de ses axes de minimiser l'effet DMA par neutralisation à l'aide de dépôts stériles riches en carbonates issus de l'extraction des phosphates de la mine de Youssoufia voisine. Ces derniers seront utilisés à la fois comme amendement des rejets miniers acides et comme couverture évapo-transpirante (barrière capillaire). Notre étude a permis d'une part, de mieux appréhender la nature et la structure du parc à résidus et de son substratum et d'autre part, de caractériser l'impact de ces résidus sur la qualité des ressources en eau souterraine. Les résultats issus de cette étude vont contribuer à la réussite du projet de réhabilitation du site. Editeur Z.W. Kundzewicz Citation Lghoul, M., Kchikach, A., Hakkou, R., Zouhri, L., Guerin, R., Bendjoudi, H., Teíxido, T., Antonio Penã, J., Enriqué, L., Jaffal, M. et Hanich, L., 2012. Etude géophysique et hydrogéologique du site minier abandonné de Kettara (région de Marrakech, Maroc): contribution au projet de réhabilitation. Hydrological Sciences Journal, 57 (2), 370–381. [ABSTRACT FROM PUBLISHER]

Objective. To describe the rehabilitation status three months after first-time myocardial infarction (MI) to identify focus areas for long-term cardiac rehabilitation (CR) in general practice. Design. Population-based cross-sectional study. Setting and subjects. Patients with first-time MI in 2009 from the Central Denmark Region. Data were obtained from patient questionnaires and from registers. Results. Of the 1288 eligible patients, 908 (70.5%) responded. The mean (SD) age was 67.1 (11.7) years and 626 (68.9%) were men. Overall, 287 (31.6%) of the patients lived alone and 398 (45.4%) had less than 10 years of education. Upwards of half (58.5%) of the patients stated that they had participated in hospital-based rehabilitation shortly after admission. A total of 262 (29.2%) were identified with anxiety or depressive disorder or both, according to the Hospital Anxiety and Depression Scale. Of these, 78 (29.8%) reported that they had participated in psychosocial support, and 55 (21.0%) used antidepressants. One in five patients smoked three months after MI although nearly half of the smokers had stopped after the MI. Regarding cardioprotective drugs, 714 (78.6%) used aspirin, 694 (76.4%) clopidogrel, 756 (83.3%) statins, and 735 (81.0%) beta-blockers. Conclusion. After three months, there is a considerable potential for further rehabilitation of MI patients. In particular, the long-term CR should focus on mental health, smoking cessation, and cardioprotective drugs. [ABSTRACT FROM AUTHOR]

Introduction: Chronic manganese (Mn) exposure is a health hazard associated with the mining and processing of Mn ores. Children living in an area with increased environmental exposure to Mn may have symptoms of chronic toxicity that are different from adults who experience occupational exposure. The aim of the study was to compare health outcomes in a pediatric population living near open Mn mines with a group of children from a reference area and then to develop and implement preventive/rehabilitation measures to protect the children in the mining region. Methods: After environmental assessment, a group of 683 children living in a Mn-rich region of Ukraine were screened by clinical evaluation, detection of sIgA (37 children), micronucleus analysis (56 children), and hair Mn content (166 children). Results: Impaired growth and rickets-like skeletal deformities were observed in 33% of the children. This was a significantly higher percentage than in children in the reference region (15%). The children from the Mn-mining region also had increased salivary levels of immunoglobulin A (104.4±14.2 mcg/ml vs. 49.7±6.1 mcg/ml) among the controls (p<0.05), increased serum alpha 1 proteinase inhibitor levels (4.93±0.21 g/l compared with 2.91±0.22 g/l for controls; p<0.001) and greater numbers of micronuclei in the mucous cells of the oral cavity (0.070±0.008 vs. 0.012±0.009, p<0.001). Conclusions: These findings indicate the deleterious health consequences of living in a Mn-mining area. Medical rehabilitation programs were conducted and produced positive results, but further validation of their effectiveness is required. The study provided background information to formulate evidence-based decisions about public health in a region of high Mn exposure. [ABSTRACT FROM AUTHOR]

This qualitative interview study focuses on the personal experiences of partners to a spinal cord injured person. Using a Ricoeurian phenomenological-hermeneutic approach, we analysed seven partners' narratives 1 and 2 years after their partner's injury. The study revealed how the injury was experienced from the partners' perspective through the aftermath. In the acute phase after the injury, partners also felt harmed, and support was needed in relation to their own daily activities, eating, resting, and managing distress. During the institutionalized rehabilitation, partners felt torn between supporting the injured partner and the demanding tasks of everyday life outside the institution. After discharge, partners struggled for the injured partner to regain a well-functioning everyday life and for reestablishing life as a couple. The partner struggled to manage the overwhelming amount of everyday tasks. Some sought to reestablish their usual functions outside the family, whereas others focused on establishing a new life together. The partners experienced much distress and appreciated the support they got, but felt that they were mainly left to manage the difficult process on their own. [ABSTRACT FROM AUTHOR]

A case describing the successful rehabilitation of a patient with a right homonymous hemianopia field loss is presented. The patient was fitted with binocular 20-dioptre ground-in sectorial prisms, following a 2-month trial with Fresnel paste-on prisms. Successful fitting of binocular sectorial prisms was achieved through adjustment of prism power and location to ensure smooth transition between both hemifields of view and to avoid diplopia in primary gaze. Prism power was obtained through empirical calculation based on distance and near prism power requirements, as determined with trial lens prisms, which also allowed for determination of the best prism location. [ABSTRACT FROM AUTHOR]

The mechanisms through which manual therapy inhibits musculoskeletal pain are likely multifaceted and related to the interaction between the intervention, the patient, the practitioner, and the environment. Placebo is traditionally considered an inert intervention; however, the pain research literature suggests that placebo is an active hypoalgesic agent. Placebo response likely plays a role in all interventions for pain and we suggest that the same is true for the treatment effects associated with manual therapy. The magnitude of a placebo response may be influenced by negative mood, expectation, and conditioning. We suggest that manual therapists conceptualize placebo not only as a comparative intervention, but also as a potential active mechanism to partially account for treatment effects associated with manual therapy. We are not suggesting manual therapists include known sham or ineffective interventions in their clinical practice, but take steps to maximize placebo responses to reduce pain. [ABSTRACT FROM AUTHOR]

Background: Natural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention. Objectives: To examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability. Design: Qualitative literature review and secondary data analysis. Results: Absolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the last 40 years. Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries, spinal cord injuries (SCI), and long bone fractures. Studies show that persons with pre-existing disabilities are more likely to die in a natural disaster. Lack of health-related rehabilitation in natural disaster relief may result in additional burdening of the health system capacity, exacerbating baseline weak rehabilitation and health system infrastructure. Little scientific evidence on the effectiveness of health-related rehabilitation interventions following natural disaster exists, however. Although systematic assessment and measurement of disability after a natural disaster is currently lacking, new approaches have been suggested. Conclusion: Health-related rehabilitation potentially results in decreased morbidity due to disabling injuries sustained during a natural disaster and is, therefore, an essential component of the medical response by the host and international communities. Significant systematic challenges to effective delivery of rehabilitation interventions during disaster include a lack of trained responders as well as a lack of medical recordkeeping, data collection, and established outcome measures. Additional development of health-related rehabilitation following natural disaster is urgently required. [ABSTRACT FROM AUTHOR]

Background: Natural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention. Objectives: To examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability. Design: Qualitative literature review and secondary data analysis. Results: Absolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the last 40 years. Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries, spinal cord injuries (SCI), and long bone fractures. Studies show that persons with pre-existing disabilities are more likely to die in a natural disaster. Lack of health-related rehabilitation in natural disaster relief may result in additional burdening of the health system capacity, exacerbating baseline weak rehabilitation and health system infrastructure. Little scientific evidence on the effectiveness of health-related rehabilitation interventions following natural disaster exists, however. Although systematic assessment and measurement of disability after a natural disaster is currently lacking, new approaches have been suggested. Conclusion: Health-related rehabilitation potentially results in decreased morbidity due to disabling injuries sustained during a natural disaster and is, therefore, an essential component of the medical response by the host and international communities. Significant systematic challenges to effective delivery of rehabilitation interventions during disaster include a lack of trained responders as well as a lack of medical recordkeeping, data collection, and established outcome measures. Additional development of health-related rehabilitation following natural disaster is urgently required. [ABSTRACT FROM AUTHOR]

Background: Clinical examination and management of patients with meningiomas is primarily dependent upon appropriate diagnosis of tumor type and surgical intervention. Physical therapists should be able to identify patients presenting with signs and symptoms suggestive of potential central nervous system (CNS) disorders and refer the patient appropriately. Patient characteristics: In this case report, a 52-year-old female was referred to physical therapy after 18 months of unresolved dizziness. Examination: Oculomotor examination revealed evidence of peripheral vestibular and potential CNS disorders. The physical therapist referred the patient to a physician who ordered magnetic resonance imaging (MRI). Intervention: The patient received five physical therapy sessions while waiting for the MRI which revealed a meningioma. The meningioma was surgically removed and the patient was subsequently relieved of all symptoms. Outcomes: Despite the presence of the meningioma, the patient reported improved stability during workrelated activities and decreased dizziness as a result of physical therapy intervention pre-operatively. Discussion: This case report emphasizes the importance of a physical therapists ability to perform and interpret an oculomotor examination in a patient presenting with signs consistent with peripheral vestibular and CNS disorders. It also demonstrates the role of physical therapy in collaboration with physicians in order to provide appropriate patient care management. [ABSTRACT FROM AUTHOR]

Background: Many clinicians and researchers believe that there are subgroups of people with spinal pain who respond differently to treatment and have different prognoses. There has been considerable interest in this topic recently. However, problems occur when conclusions about subgroups are made that are inappropriate given the randomized controlled trial design used. The research design to choose, when developing a study protocol that investigates the effect of treatment subgroups, depends on the particular research question. Similarly, the inferences that can be drawn from an existing study will vary, depending on the design of the trial. Objectives: This paper discusses the randomized controlled trial designs that are suitable to answer particular questions about treatment subgroups. It focuses on trial designs that are suitable to answer four questions: (1) 'Is the treatment effective in a pre-specified group of patients?'; (2) 'Are outcomes of treatment applied using a subgrouping clinical reasoning process, better than a control treatment?'; (3) 'Are the outcomes for a patient subgroup receiving a particular treatment (compared to a control treatment) better than for patients not in the subgroup who receive the same treatment?'; and (4) 'Are outcomes for a number of treatments better if those treatments are matched to patients in specific subgroups, than if the SAME treatments are randomly given to patients?'. Illustrative examples of these studies are provided. Conclusion: If the clinical usefulness of targeting treatments to subgroups of people is to be determined, an important step is a shared understanding of what different RCT designs can tell us about subgroups. [ABSTRACT FROM AUTHOR]

A traumatic spinal cord injury affects the body to an extent that the patient requires the assistance of others to survive and recover. The rehabilitation phase puts the patient in a vulnerable position and involves a considerable amount of strength on the patient's part. The aim of this paper is to explore the vulnerability of the spinal cord patient and how this vulnerability connects to the necessary strength, as the patient struggles to survive the injury and get through the rehabilitation. The circumstances of 12 traumatic spinal cord-injured patients were observed in the rehabilitation unit and after discharge. A phenomenological-hermeneutic narrative approach applying Ricoeur's theory was used. Data were collected by field observation and interviews during the first 2 years after the spinal cord injury. The patient's strength during the rehabilitation was portrayed by their endurance and from their narratives of how they handled difficult situations. The patient's perception of vulnerability varied, and strength was mobilised as a response to the vulnerability to overcome the imbalance between demands and resources. Vulnerability should therefore refer to a person's experience of the situation rather than the person, as it may hinder the professionals' open, explorative approach towards the person. [ABSTRACT FROM AUTHOR]

The most common ankle injuries are ankle sprain and ankle fracture. This review discusses treatments for ankle sprain (including the management of the acute sprain and chronic instability) and ankle fracture, using evidence from recent systematic reviews and randomized controlled trials. After ankle sprain, there is evidence for the use of functional support and non-steroidal anti-inflammatory drugs. There is weak evidence suggesting that the use of manual therapy may lead to positive short-term effects. Electro- physical agents do not appear to enhance outcomes and are not recommended. Exercise may reduce the occurrence of recurrent ankle sprains and may be effective in managing chronic ankle instability. After surgical fixation for ankle fracture, an early introduction of activity, administered via early weight-bearing or exercise during the immobilization period, may lead to better outcomes. However, the use of a brace or orthosis to enable exercise during the immobilization period may also lead to a higher rate of adverse events, suggesting that this treatment regimen needs to be applied judiciously. After the immobilization period, the focus of treatment for ankle fracture should be on a progressive exercise program. [ABSTRACT FROM AUTHOR]

Objective. The aim was to discern common characteristics in the sick-listing cases that physicians in general practice and occupational health services find problematic. Design. Descriptive categorization within a narrative theoretical framework. Setting. Sickness-insurance course for physicians in general practice and occupational health services. Subjects. A total of 195 case reports written by 195 physicians. Main outcome measures. Categories of features regarding medical, work, and social situation as well as medical interventions. Results. Beside age and sex, the following information was often provided: family situation, stressful life events, occupation, problem at work, considerations concerning diagnoses, medical investigations, treatments, and vocational rehabilitation measures. Two-thirds of the patients had been sickness absent for more than a year. The most common type of case reports concerned women, employed in non-qualified nursing occupations, and sick listed due to mental disorders. The most common measures taken by the physicians were referrals to psychotherapy and/or physiotherapy, and prescribing antidepressants (SSRI). Facts about alcohol habits were rarely provided in the cases. Conclusions. Some of the circumstances, such as prolonged sick-listing, are likely to be more or less inevitable in problematic sick-listing cases. Other circumstances, such as stress-full life events, more closely reflect what the reporting physicians find problematic. The categories identified can be regarded as markers of problematic sick-listing cases in general practice and occupational health service. [ABSTRACT FROM AUTHOR]

From a case study, complexities and ambiguities characterising the rehabilitation process following a spinal cord injury were revealed. The process of rehabilitation from spinal cord injury is characterized by many different and often conflicting emotions such as despair and hope, depression and optimism, and disappointment. Supporting the patient calls for a detailed understanding of this process. In this study of the first year after a spinal cord injury, one case was especially illustrative. Through a narrative approach the complexity of the rehabilitation process and its core elements were conveyed. Data analysis was based on Ricoeur's theory. The findings were that fight was a core component of the rehabilitation process. Revealing four kinds of fights we discovered a constructive fight with one self and a fight together with other people in contrast to a devastating fight against other people and a fight against oneself stemming from a conflict. The conclusion was that rehabilitation could be seen as a fight where the staff played an important role stimulating and supporting. If they engaged in the patient's, fight the patient's well-being processes towards life. Otherwise, the staff were another burden. [ABSTRACT FROM AUTHOR]

Objective. This study explores former cancer patients' psychosocial rehabilitation needs after hospital discharge. Method. Three focus-group interviews with 15 patients. Results. Five main areas were identified: (1) Need for continuous support and information about rehabilitation opportunities; (2) Support to the family; (3) Psychological help also addressing fear of relapse of cancer; (4) Needs for social support; (5) Needs pertaining to how friends and acquaintances relate to the patients. Conclusion. Each of these aspects should be carefully considered for each patient, preferably by one assigned healthcare provider. Fear of cancer relapse prevails among the patients, the family and the social network and it is important in relation to psychosocial rehabilitation. [ABSTRACT FROM AUTHOR]

Challenging rehabilitation regimes following flexor tendon surgery require patients to complete an hourly exercise regime and wear a thermoplastic splint constantly for four to six weeks. Building on earlier research by the first author the data from his interviews of five peoples' experiences and meanings of their rehabilitation was re-analysed using a phenomenological lifeworld approach. The individuals were found to cope in different ways and degrees with the frustration of disability. Three themes—“struggling-adapting”, “retreating-battling” and “denying-accepting”—capture something of the ambivalence of their experience. The findings also provide insight into how flexor tendon injury, and subsequent surgery and rehabilitation, impact on individuals' lifeworlds. Damage wreaked on daily life comes as a surprise. In different ways, they are all challenged to come to terms with the shock of pain, disability and the double trauma of surgery and rehabilitation. The challenge also involves an emotional and social struggle as personal relationships are disrupted. Three types of phenomenological analyses—narrative, lifeworld and thematic—are presented as iterative, deepening elaborations. Together they offer a more holistic, if still tentative, picture highlighting the relevance of attending to peoples' personal, social and practical responses beyond simply focusing in reductionist ways on physical function. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate how child sexual abuse is terminated. This study attempts to gain insight into how people exposed to incest narrate the termination of the incest relationship. Seven women and one man were recruited from the Incest Support Centre and from snowballing for a 1-2-hour-long in-depth interview using a narrative approach. The subjects' narratives varied according to how they perceived their own role in the termination process, their relationship with the offender, and how well they remembered the stage of termination. A common feature of the narratives was that the feeling of being a victim lasted after the abuse stopped. In this respect, the lack of support from family, friends, and healthcare personnel and the psychological power exercised by the offender were important issues in the narratives. It is suggested that the termination process is affected by the victims' ability to regulate influence and mentalization. Furthermore, a transfer of cultural meanings from the social environment to the individual must have taken place. Future research should focus on the significance of the termination process in terms of psychological functioning and the construction of self and identity. [ABSTRACT FROM AUTHOR]

This overview of the psychiatric hospital system in the Republic of Moldova is conducted by an international team of researchers from Moldova and the United States. The study is based on the interviews and observations made at the three main psychiatric hospitals and a large group home. The discussion is contextualized by a brief analysis of the Soviet system of care for the chronically mentally ill and its strong emphasis on psychiatric rehabilitation. The system of psychiatric care in Moldova at the present time is found to exist on deteriorating vestiges of the Soviet infrastructure and a waning rehabilitation philosophy. Moldovan academia is identified as the most promising source of new ideas and approaches to treatment of the chronically mentally ill. However, the lack of resources in this impoverished country continues to present a formidable obstacle to the meaningful reform. [ABSTRACT FROM AUTHOR]

Stroke patients with aphasia commonly suffer from distress related to their language deficit. They are often unable to express what they experience during their rehabilitation. Hence, the aim of this study was to reveal the meaning of rehabilitation to an aphasic person. With an approach based on the philosophy of Husserl and Merleau-Ponty, two open-ended interviews were analysed through the Empirical Phenomenological Psychological (EPP) method. The essential structure of the meaning of rehabilitation to the informant was that he lived as being responsible in a dichotomised situation. The informant had to adapt his behaviour, thereby destroying his chances of normal interactions; he was supposed to train in a goal-oriented way and believe in recuperation, but at the same time, he had to prepare himself and his next of kin for a failure. The defined impairment of aphasia misled both the informant and health care professionals to focus only language therapy, hence leaving the informant unsupported in other important aspects of the rehabilitation. [ABSTRACT FROM AUTHOR]

The article discusses the dynamics of clinico-psychopathological and sociopsychological indices in the process of complex therapy in patients with different nosological forms of mental diseases. Complex program of treatment and rehabilitation implemented by the V. M. Bekhterev Psychoneurological Research Institute; Clinical material and the methods of investigation; Description of the modified technique of psychodynamic therapy.

The article discusses the dynamics of the quality of life indices in neurological patients in the process of their rehabilitation. Reflections on the notions on neurological patients since 1970; Number of scales and questionnaires used in the investigation of quality of life (QOL); Findings on the analysis of the dynamics of QOL indices with residual organic brain diseases.

The Botswana Association for Psychosocial Rehabilitation (BAPR) will lead in the provision of effective efficient and comprehensive psychosocial rehabilitative services to mental health consumers, which compares with global practices and inspires confidence. The BAPR exists to provide psychosocial services to every individual, family, and community affected by disabling mental illness and HIV/AIDS in order to enhance their well-being. They are committed to lead in the provision of mental health care in the community including research, advocacy, and substance abuse prevention.