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BACKGROUND: Cancer patients undergoing inpatient rehabilitation often have high risk of complications leading to unplanned transfer to acute care. Prior studies have identified factors associated with these transfers but have been limited to examining factors that pertain to initial admission to rehabilitation and were not conducted in a freestanding inpatient rehabilitation facility. OBJECTIVE: The study aimed to include these prerehabilitation factors in addition to factors upon initial assessment in rehabilitation. It was hypothesized that specific factors from each of these periods would be associated with unplanned transfer to acute care. DESIGN: Retrospective cohort study. SETTING: Freestanding academic inpatient rehabilitation facility affiliated with an academic tertiary care facility with a comprehensive cancer center. PATIENTS: Retrospective review of 330 specific encounters unique to 250 patients from March 2017 to September 2018. MAIN OUTCOME MEASURES: The outcome measure was unplanned transfer to acute care. A binary logistic regression model was used to examine the relationship between factors from oncologic history, acute care course, and factors upon admission to rehabilitation to unplanned transfer to acute care. RESULTS: From 330 encounters, there were 111 unplanned transfers (34%). Unplanned transfer to acute care was independently associated with gastrointestinal malignancy (odds ratio [OR] 4.4, p = .01), 6-minute walk test less than 90 m (OR 4.6, p = .003), and prior unplanned transfer (OR 3.5, p = .007). CONCLUSIONS: The study suggests that oncologic and functional prerehabilitation markers are associated with an increased likelihood of unplanned transfer during inpatient cancer rehabilitation. These findings will provide a framework for creating predictive tools for unplanned transfers in cancer rehabilitation patients.

Rehabilitation arrangements for narcotics abuse users in Indonesia have been regulated in Law Number 35 Year 2009 concerning Narcotics. The relevant law describes the function of rehabilitation, but does not specify the categories that are eligible to receive rehabilitation facilities. The elaboration regarding the requirements for receiving the rehabilitation facility is only spelled out in the Supreme Court Circular Letter Number 04 Year 2010. This in turn can lead to wrong actions against narcotics abusers. The implementation of medical and social rehabilitation for narcotics abusers in Indonesia has begun to be improved. This can be seen from the improvement in the quality standards of the rehabilitation facilities, as well as the efforts to strengthen rehabilitation institutions. Referring to the ideal concept of implementing rehabilitation for narcotics abuse users in the perspective of restorative justice, rehabilitation of narcotics abusers must be provided. In this case there are two rehabilitation processes that must be provided, namely medical rehabilitation and social rehabilitation. Medical rehabilitation to restore abusers from dependence, while social rehabilitation so that narcotics abusers can be accepted back into society.

To compare sex differences in alexithymia (poor emotional processing) in males and females with traumatic brain injury (TBI) and uninjured controls.Cross-sectional study.TBI rehabilitation facility in the United States and a university in Canada.Sixty adults with moderate to severe TBI (62% men) and 60 uninjured controls (63% men) (N=120).Not applicable.Toronto Alexithymia Scale-20 (TAS-20).Uninjured men had significantly higher (worse) alexithymia scores than uninjured female participants on the TAS-20 (P=.007), whereas, no sex differences were found in the TBI group (P=.698). Men and women with TBI had significantly higher alexithymia compared with uninjured same-sex controls (both P.001). The prevalence of participants with scores exceeding alexithymia sex-based norms for men and women with TBI was 37.8% and 47.8%, respectively, compared with 7.9% and 0% for men and women without TBI.Contrary to most findings in the general population, men with TBI were not more alexithymic than their female counterparts with TBI. Both men and women with TBI have more severe alexithymia than their uninjured same-sex peers. Moreover, both are equally at risk for elevated alexithymia compared with the norms. Alexithymia should be evaluated and treated after TBI regardless of patient sex.

Care Management for Polytrauma Patients in a Level-1 Trauma Centre Abstract. In our level-1 trauma institution, polytrauma patients with an Injury Severity Score of 16 or higher are facing waiting times for transfer to a rehabilitation facility, causing a negative financial outcome for our institution. The purpose of this study is to stimulate rapid transfer to a rehabilitation facility. In a single-centre case study, care management for (poly)trauma patients was started to ensure time-directed treatment for trauma patients related to Diagnosis-Related Groups (DRG). In the period of 2013-2018 there was an increase in trauma admissions up to 14 % (n = 16 157) with a mean length of hospital stay of 6.4 days, together with a reduction in the number of trauma bed capacity from 50 to 42. In relation to the DRGs, regular trauma patients who were not in need of a stationary rehabilitation facility stayed in line with the expected time of hospital stay. But (poly)trauma patients (n = 1831) with the need of a stationary stay in a rehabilitation centre were faced with waiting times before they could be transferred. The average excess waiting time in relation to DRG for polytrauma patients was 5.1 days. Trauma patients for a rehabilitation centre have a higher Case Mix Index (CMI) compared to those who do not require inpatient rehabilitation (4.22 versus 1.04, p

The focus of this article is about a poetry healing group the author founded at a post-acute rehabilitation facility for senior citizens. The program was established a year and a half ago based on ...

Fibropapillomatosis (FP) is an infectious, neoplastic disease of major concern in sea turtle rehabilitation facilities. Rehabilitating sea turtles that undergo tumor removal surgery often have tumor regrowth and may experience mortality. We evaluated tumor score, removal, and regrowth in rehabilitating green sea turtles with FP in 4 rehabilitation facilities in the southeastern USA during 2009-2017. Of 756 cases, 312 (41%) underwent tumor removal surgery, 155 (50%) of those had tumor regrowth within an average of 46 ± 45 d, and 85 (27%) had multiple (>1) regrowth events. Of 756 turtles with FP, 563 (75%) did not survive after admission into a rehabilitation facility, including 283 (37%) that were euthanized and 280 that died without euthanasia (37%), and 193 survived, including 186 (25%) released and 7 (1%) placed in permanent captive care. Tumor removal surgery increased the odds of tumor regrowth but also enhanced survivorship, whereas tumor regrowth was not a significant predictor of case outcome. Three FP tumor scoring systems were used to assign tumor scores to 449 cases, and differing results emphasize that tumor scoring systems should be applied to the situations and/or location(s) for which they were intended. FP tumor score was not a significant predictor for the event or extent of FP tumor regrowth after surgical excision. Under current rehabilitation regimes, outcomes of rehabilitation for tumored turtles have a low probability of success. The results of this study may be used to help guide clinical decision-making and determine prognoses for rehabilitating sea turtles with FP.

West Nile Virus (WNV) is the most common mosquito borne cause of viral encephalitis in the United States. Physical and neuro-cognitive recovery from WNND may be prolonged or incomplete leading to chronic cognitive inefficiencies and functional decline. There continues to be no effective treatment of WNV and current management is primarily supportive. The objective of this review is to evaluate the functional outcomes and role of rehabilitation services in subjects with WNND. The charts of five subjects admitted to an acute inpatient brain injury rehabilitation facility from June to December 2012 were retrospectively reviewed. (Mean, Range)-Age (64.8, 43–78 years), Admission Functional Independence Measure (FIM) (45.2, 14–63), Discharge FIM (82.2, 61–100), FIM score gain (37, 24–60), Cognitive FIM gain (7, 1–18), Mobility FIM gain (17.4, 13–20), ADL FIM gain (12.6, 4–23); acute brain injury inpatient rehabilitation facility length of stay (LOS) (17.8, 14–21 days); acute hospital LOS (15, 10–22 days). Of the five subjects, three were discharged home, one was discharged to a skilled nursing facility, and one was discharged to an assisted living facility. Subjects with WNND have significant functional decline across all FIM subcategories and may benefit from a course of brain injury-specific acute inpatient rehabilitation.

OBJECTIVES: This study aims to evaluate the effects of blood pressure (BP) on functional recovery and length of stay (LOS) in post-stroke patients in an acute rehabilitation facility (ARF). PATIENTS AND METHODS: A total of 116 ischemic stroke patients (60 males, 56 females; mean age 70.0±12.8 years; range, 37 to 93 years) who were admitted to the ARF between January 2012 and September 2012 were included. Daily BP measurements with mean systolic and diastolic BP values and Functional Independent Measure (FIM) scores at the time of admission and discharge were measured. The LOS and systolic and diastolic BP ranges were also recorded. RESULTS: There was no significant correlation between the BP and FIM scores. The mean diastolic BP was positively correlated with admission (rs=0.316, p=0.01) and discharge (rs=0.287, p=0.002), FIM scores, and FIM effectiveness (rs=0.185, p=0.047) and negatively correlated with age (r=-0.449, p

Aim: To use Value-Focused Thinking to investigate what is important in the design of inpatient stroke rehabilitation facility buildings. Background: Many stroke patients require inpatient rehabilitation in a dedicated facility. Rehabilitation facilities are healthcare spaces, but they are also learning spaces where patients practice targeted tasks to acquire new skills and to reacquire skills and abilities that were compromised as a result of their stroke. There is currently no consensus regarding how the design of inpatient rehabilitation facilities could be optimized for patients’ learning. Method: We used Value-Focused Thinking to develop a framework of what interdisciplinary experts consider important for inpatient stroke rehabilitation facility design. Two workshops were conducted. The following experts were invited to participate: past patients with experience of stroke rehabilitation; stroke rehabilitation clinicians; stroke rehabilitation academics; healthcare environments academics; learning environments academics; architects, designers, and wayfinders with experience designing healthcare or learning environments; and healthcare design policy makers. Results: Thirty experts participated. The experts’ final framework included 16 criteria that were considered fundamentally important for inpatient stroke rehabilitation facility design, and 14 criteria that were considered instrumentally important. Inpatient stroke rehabilitation facility design should maximize efficiency, maximize effectiveness (i.e., patients’ clinical and functional outcomes), foster emotional well-being, and maximize safety. Opportunities to practice physical, cognitive, and social activity were considered important for patients’ outcomes. Conclusions: Value-Focused Thinking was an effective and equitable means of engaging experts from multiple disciplines. Designers, planners, and developers of inpatient stroke rehabilitation facilities should consider the rehabilitation-specific framework developed in this study alongside evidence from other healthcare settings.

BACKGROUND Retained botulinum toxin solution may be visible in vials and syringe tips after mixing and presumed complete injections, leaving patients without the full prescribed dose. OBJECTIVE To quantify the mean amount of retained toxin within vials, syringes, and needles following spasticity injections (phase 1) and to design/test a targeted intervention for reduced retained toxin (phase 2). DESIGN Prospective cohort quality assurance study. SETTING Outpatient spasticity program in a rehabilitation facility. PARTICIPANTS Nine physicians specializing in physical medicine and rehabilitation, performing successive mixing and injections for spasticity with onabotulinumtoxinA or incobotulinumtoxinA. METHODS After initial review (phase 1), recommendations were made (phase 2) including not inverting the vial to withdraw medication unless needed, favoring 2-mL dilutions when possible, and decapping of vials for more complete medication withdrawal. MAIN OUTCOME MEASUREMENTS Retained volume of toxin solution that was not injected and estimated retained units of toxin. RESULTS A total of 157 vials of botulinum toxin A were tested. Of the 82 initial, phase 1, preintervention vials (8200 units), 5.5% (∼452 units) of toxin solution was retained following mixing and injections. One and 3-mL syringe tips contained a mean of 3.32 and 1.44 units of toxin respectively. Within vials, saline dilutions with 2 mL contained less mean retained toxin (1.89 vs 3.31 units) relative to 1-mL dilution. Awareness of monitoring significantly decreased retained solution in vials (0.035 mL vs 0.069 mL for naive group, P = .002). Phase 2, postintervention testing of 75 vials demonstrated that withdrawing toxin from the inferior edge from a non-inverted vial reduced the retained toxin by 32.8% (P < .001). Decapping the vial further reduced the mean retained toxin to 0.42 units per vial (81.9% reduction, P < .001). CONCLUSIONS A potentially clinically significant amount of botulinum toxin solution is retained following mixing and injections. Implementation of guidelines significantly decreased wasted botulinum toxin. LEVEL OF EVIDENCE III.

Understanding marine animal stranding patterns can aid rehabilitation efforts and evaluations of ecosystem health. The goal of this retrospective study was to identify factors associated with outcome of marine animals presented to a rehabilitation facility in Brigantine, New Jersey, USA. Records of 4819 phocids, cetaceans, and sea turtles were reviewed. Taxa, age, sex, season, and outcome (natural death, euthanasia, transfer to another facility, and successful release) were recorded for each case. Binary logistic regression was employed to identify predictors associated with release, and a multivariate logistic regression model was developed to evaluate whether the association between taxa and chance of release persisted after adjustment for the other variables. Phocids were most likely to strand during winter. Phocids and sea turtles that stranded alive were more likely to be released than to die under care or be euthanized. Taxa, age, and season were all significantly associated with the probability of release. These results provide a reference for phocid, cetacean, and sea turtle stranding and rehabilitation in part of the mid-Atlantic region. Critical evaluation of wildlife rehabilitation is indicated to audit the success of efforts and to assess threats to free-ranging populations.

Objective To determine the clinical utility of the Patient Health Questionnaire-Adolescent (PHQ-A) in screening for depressive disorders in adolescents following traumatic brain injury (TBI). Design Retrospective analysis of data collected as a part of routine clinical care over a period of 4 years. Setting Regional rehabilitation facility. Participants Adolescents (n = 101) with mild to moderate-severe TBI who were referred for an outpatient neuropsychological evaluation within 1 to 12 months postinjury. Main outcome measures PHQ-A, PHQ-A_2 (2-item version), and Processing Speed Index (PSI) from the Wechsler scales of intelligence. Results Both premorbid depressive disorder and PHQ-A scores predicted a postinjury diagnosis of depressive disorder, with a combined sensitivity of 0.91 and specificity of 0.59. PHQ-A_2 did not reach acceptable levels of sensitivity in predicting suicidal thoughts. PHQ-A scores did not add significantly to the prediction of PSI results after accounting for TBI severity. Conclusions PHQ-A has clinical utility as a screening instrument for depressive disorders in outpatient adolescents with TBI when the cutoff for clinically significant concern is set at more than 4 and premorbid psychiatric history is also taken into account.

Objectives: To identify the factors that affect disability after inpatient rehabilitation (IPR) in persons with traumatic brain injury (TBI). Methods: This retrospective study identified 140 patients aged ≥16 years who were admitted to the TBI rehabilitation unit at King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia between 2015 and 2017. The collected data included demographic variables, TBI cause, coma duration, time from injury to IPR, LOS, and Functional Independence Measure (FIM) scores at IPR admission and discharge. Results: Majority of the patients were young males. The TBI was caused by motor vehicle accidents (MVA) in 95% of patients. The mean coma duration, time from injury to IPR admission, and LOS were 47±38, 264±357, and 75±52 days, respectively. The factors that were found to have an association with FIM change were time from injury to IPR admission (p=0.003, r=-0.250), admission FIM score (p=0.003, r=-0.253), and discharge FIM score (p

We studied cognitive performance following discharge from a novel rehabilitation facility, treating individuals with psychosis that developed during trips abroad following mandatory military service. Montreal Cognitive Assessment (MoCA), phonetic and semantic fluency, State-Trait Anxiety, and self-Efficiency were administered before discharge, and 3 and 6 months after discharge. Of the 43 participants (30.2% females), 23(54.8%) had cognitive impairment (MoCA27), and 15(35.7%) had poor phonetic fluency. Anxiety trait and state were high and inversely correlated with self-efficacy (R=-0.48, p = 0.001) and phonetic fluency (R=-0.43, p = 0.004) and was higher among those who experienced physical exposure, females, and those who served in non-combat army units. Six months after discharge, of 32 participants, 28 were working/studying with a 58.1% reduction in smoking and alcohol consumption, and 16 participants stopped substance use. Phonetic fluency improved among the high anxiety state group with no change among the others. High anxiety levels lowered among those who were still using drugs after six months. The anxiety level lowered and 87.1% of the participants were conducting a productive lifestyle at 6 months after discharge, but half still abused cannabis. Bigger sample and longer follow up would be needed to learn more about the impact of rehabilitation.

The aim of this study was to identify the effect of early nutritional assessment and nutritional intervention on outcomes of older adult patients after discharge from an acute care hospital following fall related fracture.This was a feasibility pilot study with post intervention data. One group pretest-posttest study design was implemented. All participants were admitted to a rehabilitation facility in the Southwestern US after a fall related fracture.Discharge destination, Functional Independence Measure (FIM), and length of stay (LOS).A total of 69% of the participants were discharged home. Total FIM scores improved (p0.01). No significant association was identified between prealbumin change and total FIM change. Patients who had improved prealbumin experienced improved FIM and shorter LOS; however, no significant correlations were determined between LOS and prealbumin change.Nutritional interventions are important for recovery during rehabilitation of a fall-related fracture.This project supports early nutritional evaluation and intervention for older adult patients after major orthopedic procedure. Participants who received early intervention had improved outcomes. (194 characters).

Concerns exist that minorities who utilize more resources in an episode-of-care following total hip (THA) and knee arthroplasty (TKA) may face difficulties with access to quality arthroplasty care in bundled payment programs. The purpose of this study is to determine if African American patients undergoing TKA or THA have higher episode-of-care costs compared to Caucasian patients.We queried Medicare claims data for a consecutive series of 7310 primary TKA and THA patients at our institution from 2015 to 2018. We compared patient demographics, comorbidities, readmissions, and 90-day episode-of-care costs between African American and Caucasian patients. A multivariate regression analysis was performed to identify the independent effect of race on episode-of-care costs.Compared to Caucasians, African Americans were younger, but had higher rates of pulmonary disease and diabetes. African American patients had increased rates of discharge to a rehabilitation facility (20% vs 13%, P.001), with higher subacute rehabilitation ($1909 vs $1284, P.001), home health ($819 vs $698, P = .022), post-acute care ($5656 vs $4961, P = .008), and overall 90-day episode-of-care costs ($19,457 vs $18,694, P = .001). When controlling for confounding comorbidities, African American race was associated with higher episode-of-care costs of $440 (P.001).African American patients have increased episode-of-care costs following THA and TKA when compared to Caucasian patients, mainly due to increased rates of home health and rehabilitation utilization. Further study is needed to identify social variables that can help reduce post-acute care resources and prevent reduction in access to arthroplasty care in bundled payment models.

We developed a novel gamified system for post-stroke long-term rehabilitation, using the humanoid robot Pepper (Soft Bank, Aldebaran). Here, we present a participatory-design study with insights from both expert clinicians and from stroke patients who underwent a long-term intervention with the robot. We first present the results of a qualitative study with expert clinicians $(\mathrm{n}=12)$ on the compatibility of this system with the needs of post-stroke patients, and then the preliminary results of a long-term intervention study with post-stroke participants $(\mathrm{n}=4)$ in a rehabilitation facility. Both the clinicians and the patients found the robot and the gamified system engaging, motivating and meeting the needs of upper limb rehabilitation. The clinicians gave specific recommendations that may be applicable to a wide range of technologies for post-stroke rehabilitation. ACM Reference format: Ronit Feingold Polak and Shelly Levy-Tzedek. 2020. A Social Robot for Rehabilitation: Expert Clinicians and Post-Stroke Patients’ Evaluation Following a Long-Term Intervention. In Proceedings of HRI ’20: 2020 ACM/IEEE International Conference on Human-Robot Interaction, March 24–26, 2020, Cambridge, UK. ACM, NewYork, NY, USA, 10 pages. https://doi.org/10.1145/3319502.3374797

In 2001 a directive was issued to establish the National Rehabilitation Centre (NRC) to deal with the growing problem of substance misuse in the United Arab Emirates. The NRC has achieved many goals as a treatment and rehabilitation facility as well as a drug and alcohol demand reduction response centre. It is now working towards being an international centre of excellence.

Regular mobilising is important in inpatient rehabilitation, but objective measurements show low patient mobility. We sought to understand multidisciplinary staff perspectives on barriers and enablers to mobility in a rehabilitation setting. A validated barriers survey (standardised score 0-100, higher representing greater barriers) was distributed to 99 clinical staff on two wards at a single rehabilitation facility. The survey was completed by 83 staff (52 nurses, 25 allied health professionals, 4 therapy assistants and 2 medical officers) and identified barriers in behaviour (mean 39, SD 11), attitudes (mean 34, SD 12) and knowledge (mean 23, SD 18). Prominent perceived barriers were nursing workload, unclear responsibility for mobilising, risk of staff injury, patient motivation and family participation; perceived enablers were good knowledge, positive outcome expectations and team communication. These barriers can inform locally tailored strategies to improve rehabilitation patient mobility.

BACKGROUND Rehabilitation facilities have among the highest prevalence of multidrug-resistant organism (MDRO) colonization of any inpatient population. There is no formal consensus on how patients with MDROs should be managed in the rehabilitation setting. AIM The aim of this study was to assess how rehabilitation hospitals throughout Europe manage patients with MDROs, and the impact of MDRO carriage on outcomes. DESIGN Cross-sectional study. SETTING Online questionnaire distributed to European rehabilitation facilities. POPULATION European rehabilitation facilities. METHODS A Survey Monkey® questionnaire was designed and circulated to rehabilitation hospitals via the European Union of Medical Specialists, Physical and Rehabilitation Medicine Section. RESULTS Fifty-four responses were received of which 45 were suitable for analysis. Six out of 26 (23%) countries included in the study reported at least one rehabilitation facility with an estimated MDRO prevalence rate of 31% or higher. Screening of all patients on admission was always carried out in 33% (15 of 45) of facilities. Twenty-five of the 45 facilities (69%), aim to isolate, or cohort patients who have MDROs. Patients with MDROs wait longer for admission (36%, 16 of 45) and in the case of five hospitals admission is refused. Fifty-one percent (23 of 45) of facilities reported that colonization with an MDRO severely or moderately limits rehabilitation outcome. CONCLUSIONS Our research shows that many of the challenges posed by MDROs are common to facilities throughout Europe. We strongly recommend that all patients are screened for MDROs on admission. We stress that any negative impact of a patients MDRO status on their rehabilitation outcome must be minimized. CLINICAL REHABILITATION IMPACT Specific guidance on the management of rehabilitation patients with MDROs, would allow them to partake in a full rehabilitation program, while limiting the spread of MDROs.

Purpose The aim of the study was to reduce postoperative edema in total knee and hip arthroplasty rehabilitation patients. Design A pre- and posttest design was used for this quality improvement project at a rehabilitation facility. Methods Staff and patient edema education was standardized. Staff pre- and posttests were administered. Patients were interviewed to assess for knowledge of edema management. Chart audits were assessed for edema management and length of stay. Findings Average staff knowledge scores (n = 50) increased pre- to posteducational video (64% vs. 70%). Of patients interviewed posteducation (n = 24), 38% were able to list two characteristics of edema. Two chart audits completed pre- and posteducation demonstrated that the majority of patients (n = 30 per group) had edema upon admission (96% vs. 97%). However, length of stay decreased by 3 days (19.2 vs. 16.3). Conclusion Standardized postoperative edema education can improve staff and patient edema knowledge and management. Clinical relevance Edema education is recommended for orthopedic patients in rehabilitation facilities.

Prospective cohort study of the Thai Spinal Cord Injury Registry. To determine whether being admitted to a spinal cord injury (SCI) specialized rehabilitation facility (SSRF) is associated with better functional outcomes. Four rehabilitation facilities in Thailand; one a SSRF and the others non-SSRFs. Data from the one SSRF and three non-SSRFs were extracted from the Thai Spinal Cord Injury Registry. Multivariate regression analysis was used to exclude the effect of confounding factors and prove the independent association of SSRF admission with respect to Spinal Cord Independence Measurement (SCIM) at discharge. Among the 234 new SCI inpatients enrolled, 167 persons (71%) had been admitted to the SSRF. The SSRF had a greater proportion of persons with AIS A, B, C tetraplegia and people with AIS D, whereas the non-SSRFs had a higher proportion of patients with AIS A, B or C paraplegia. Patients discharged from the SSRF demonstrated a greater SCIM score improvement than those from the non-SSRFs (24.1 vs 17.0; p = 0.003). By using multivariate regression analysis controlling for age, time from injury to rehabilitation, severity of injury and SCIM score on admission, SSRF admission was found to be an independent predictive factor of SCIM score improvement at discharge (p = 0.008). Admission to an SSRF is associated with better rehabilitation outcomes. This finding supports the importance of SSRF access to improve the functional outcome of patients with SCI.

OBJECTIVE: According to the World Health Organization, estimates about 1,800,000 people lived with disability in Tehran. Against there is little evidence of physical access to rehabilitation facilities in Tehran. This study is aimed to assess the physical access to physical rehabilitation facilities in Tehran and compare it with the country. METHODS: This is a cross-sectional study conducted since January to April 2017. We used a master facilities list of rehabilitation facility that developed in Iran to collect the information. The samples of this study included all existing physical rehabilitation centers in Tehran province. Data analysis was done using the SPSSr version 21.0 (SPSS Inc., Chicago, IL). RESULTS: The results showed that rehabilitation facilities existed at different levels, including inpatient (10.51), outpatient (224.28), community based (36.72), and long-term care (4.96)/1,000,000 populations. Rehabilitation services are provided by rehabilitation professional including: Physical medicine and rehabilitation specialists (8.7), physiotherapists (132.89), occupational therapists (57.4), speech therapists (42.11), and audiologists (48.84) (in 1,000,000 populations). CONCLUSION: Tehran needs to increase the physical access to rehabilitation facilities and compared with country was disproportionate physical access to facilities in most cases. It is necessary to establish an interdisciplinary referral system between different rehabilitation providers.

I describe an approach to art therapy treatment for survivors of traumatic brain injury developed at a rehabilitation facility for adults that serves inpatient, outpatient, and long-term residential clients. This approach is based on a review of the literature on traumatic brain injury, comprehensive neurorehabilitation, brain plasticity, and art therapy, as well as personal experiences working with clients. There is a paucity of recent art therapy literature on working with this population, and given the continually advancing knowledge of the brain and its plastic qualities, attention to a framework for treatment is needed. The comprehensive neurorehabilitation art therapy treatment approach presented is tailored to accommodate clients' individualized presentations while following the goals and core guidelines of brain injury rehabilitation.

This article investigated the feasibility of a tailor-made neurorehabilitation approach using multiple types of hybrid assistive limb (HAL) robots for acute stroke patients. We investigated the clinical outcomes of patients who underwent rehabilitation using the HAL robots. The Brunnstrom stage, Barthel index (BI), and functional independence measure (FIM) were evaluated at baseline and when patients were transferred to a rehabilitation facility. Scores were compared between the multiple-robot rehabilitation and single-robot rehabilitation groups. Nine hemiplegic acute stroke patients (five men and four women; mean age 59.4 ± 12.5 years; four hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using multiple types of HAL robots for 19.4 ± 12.5 days, and 14 patients (six men and eight women; mean age 63.2 ± 13.9 years; nine hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using a single type of HAL robot for 14.9 ± 8.9 days. The multiple-robot rehabilitation group showed significantly better outcomes in the Brunnstrom stage of the upper extremity, BI, and FIM scores. To the best of the authors' knowledge, this is the first pilot study demonstrating the feasibility of rehabilitation using multiple exoskeleton robots. The tailor-made rehabilitation approach may be useful for the treatment of acute stroke.

Objetivo: Conhecer o processo de inclusão social no mercado de trabalho, do paciente amputado, e identificar alterações socioeconômicas, após o processo de reabilitação, além de contribuir para o levantamento de dados socioeconômicos acerca da pessoa com deficiência. Método: Pesquisa retrospectiva, quantitativa e qualitativa, sob a perspectiva dialética. Os dados foram obtidos por meio do Protocolo de Avaliação Social Institucional e relatórios sociais dos pacientes amputados, que passaram pelo ambulatório, após alta do processo em um Centro de Reabilitação no município de São Paulo, no período de abril a setembro de 2016. Resultados: Os sujeitos da pesquisa (23) foram, em sua maioria do gênero masculino (20), em idade ativa (média simples de 39,5 anos), com nível de escolaridade no ensino médio (9). A maioria (21) absteve das atividades laborais. Após a instalação da deficiência, houve queda na renda familiar. Inicialmente, (17) usufruem de benefícios previdenciários, (1) benefício assistencial, e (4) estão em processo de solicitação de benefício. Durante o tratamento reabilitativo, houve redução dos benefícios previdenciários (de 17 para 15), aumento nos benefícios assistenciais (3), (1) aguarda concessão de benefício, e 3 obtiveram alta do INSS. Conclusão: Os resultados apontam que os pacientes amputados sofrem alterações socioeconômicas, após a instalação da deficiência, decorrentes à abstenção as atividades laborais e rebaixamento na renda, apontando para a importância da proteção previdenciária e assistencial. Fatores como idade, escolaridade e quantidade de internações favoreceram o retorno dos pacientes amputados no mercado de trabalho.

Background: With a shift toward value-based and bundled-payment models, identification of areas of cost and quality improvement will be required. Though abundant literature is present on the predictors of discharge destinations, few studies have studied the impact of discharge to a skilled-care or rehabilitation facility on post-discharge outcomes following elective spine surgery. Methods: The 2015–2016 ACS-NSQIP database was queried using Current Procedural Terminology (CPT) codes 22551 and 22552 to retrieve records of patients undergoing ACDF (≤3 levels). Patients who had concurrent posterior cervical spine procedures and surgery for malignancy and spinal deformity were excluded. Results: A total of 15,624 patients were finally included for analysis, 459 (2.9%) patients were discharged to a skilled care or rehabilitation facility. Age of ≥65 years, Black or African-American race, partially dependent or totally dependent functional health status, a LOS ≥3 days, a total operative time >150 min, ASA grade > II and inpatient surgery were significant predictors for a discharge to skilled care/rehabilitation facility. Following adjustment for pre-discharge clinical characteristics, discharge to skilled care or rehabilitation was an independent significant risk factor for renal complications (OR =8.22; 95% CI, 1.84–36.7; P=0.006) and 30-day readmissions (OR =1.63; 95% CI, 1.09–2.42; P=0.016). Conclusions: Discharge to skilled-care or rehabilitation facilities following elective ACDF is associated with higher odds of renal complications and 30-day readmissions. These results stress the importance of careful patient selection prior to discharge to inpatient care facilities to minimize the risk of complications.

OBJECTIVE Patients suffering from haemato-oncological diseases tend to have a weakened immune system after the end of their therapy. To avoid infections, patients are advised to limit contact with other people. This poses the question whether a stay at a rehabilitation facility can be recommended. METHODS We report about 134 rehabilitation stays of patients. Premature discontinuation of the rehabilitation stay was selected as the criterion for a serious complication during the rehabilitation, and the underlying reasons were analysed. RESULTS Compared to the discontinuation rates of patients suffering from solid tumours (2.4%), the percentage of haemato-oncological patients ending prematurely their rehabilitation stay (8.2%) is significantly increased. This rises to 17.1% for patients who have undergone an allogeneic stem cell transplantation. The analysis of the discontinuation reasons revealed that they were not directly connected to the rehabilitation. Apart from the already known risk factors for premature termination of the rehabilitation stay, we have identified the period (days) between the last therapy and the beginning of the rehabilitation stay as a risk factor. CONCLUSIONS We show for the first time that a rehabilitation stay does not pose additional risks for patients suffering from haemato-oncological diseases.

International Classification of Functioning, Disability and Health for Children and Youth extends the list of categories of classification supplementing it with childhood-specific categories. These categories are targeted for child growth and development. The biggest addition of components is in Activities and Participation domains. Complexity of classification causes a problem in adaptation of classification in practice of clinical settings especially in child rehabilitation settings. For the practical application of the classification is drawn up sets of classification categories to assess the functioning of child with specific needs. The literature describes attempts of the practical application of the classification. Widespread measures of functioning are linking with categories of classification. Team members are training to apply the classification in daily practice. New questionnaires based on the classification are composed. It is recommended to focus on the child activities and participation but not only on body functions or structures. The article shows that the implementation of classification in children rehabilitation facility requires structural and organizational changes.

Reports of iatrogenic cold thermal injuries are rare in the literature. Conductive cooling devices, typically employed for their neuroprotective effects, use conductive hydrogel pads to achieve rapid and precise temperature control approaching the level of water immersion. Despite a number of built-in safeguards, prolonged or improper use of these devices can lead to significant thermal injury. To the best of their knowledge, the authors describe the first report of a significant iatrogenic full-thickness injury caused by the use of a surface cooling system in a patient who had recently suffered a cerebrovascular accident. The patient required transfer to the authors' tertiary burn care facility for excisional debridement and coverage with extensive split-thickness skin grafting to the chest, flank, and thighs. The grafts achieved nearly complete take and the patient was ultimately discharged to a rehabilitation facility with improving neurological condition.

Background: In the recent decades, the relationship between psycho-physical disorders and weather conditions has taken on an increased scientific solidity. Furthermore, it is known to every clinician that healthcare practice has an important role in the management of psycho-physical disorders of patients affected by multiple sclerosis. Given that meteorosensitivity is related to the psycho-physical feebleness, this study is an attempt to clarify if treatments in a non-acute care rehabilitation centre can reduce the meteorosensitivity in patients with multiple sclerosis. Methods: In the spring 2014, 42 patients with MS, at Fondazione Don Gnocchi Santa Maria Nascente Centre (Milan, Italy), were observed by two evaluations (initial and final). The initial evaluation was the administration of METEO-Q, a questionnaire able to quantify the meteorosensitivity degree of the subjects, and Beck Depression Inventory-II, mainly. For each patient, passed one month, the final evaluation was carried out with the same modalities. Results: A statistically significant difference was found between initial and final meteorosensitivity degree (P=0.01), with better scores in final evaluations for most of the subjects. The correlation between Beck Depression Inventory-II and meteorosensitivity degree resulted significant and positive (R=0.377; P=0.001) and it confirms the link between psycho-physical feebleness and meteorosensitivity. Finally, no significant correlation emerged between initial meteorosensitivity degree and body mass index (R=0.187; P=0.236). Conclusions: This study confirms the possibility of improving meteorosensitivity, probably by rehabilitation too. Future studies could clarify the effects of health care practice on meteorosensitivity.

This piece is an adaptation from my book, After a Fall: A Sociomedical Sojourn. It is an autoethnographic account of my first two days in a rehabilitation facility following ankle surgery. It introduces how class, gender, race, ethnicity, and aging intersect each other in the facility.

Society is recognized that stroke is a life- threatening condition.Although the death rate from stroke decreases cerebrovasculardisease remains one of the major causes of death and disabilityreasons in many European Union countries, and the high incidencerate of stroke and serious consequences is one of the most importantmedical problems of today . The aim was to evaluate patients afterstroke functional status change in the rehabilitation process. 112stroke patients in treatment and rehabilitation facility in patientswith an average age of 46 years old. Of these, 53.6 per cent. werewomen. Patients were subject to complex rehabilitation treatment,which patients worked full rehabilitation team. Data analysis wasused to case history data. Patients‘ health status was assessed on twopatients on arrival and departure from the medical establishment. Their cognitive function was assessed using a standardized briefmental state examination (MMSE) and the independence of theirdaily lives was assessed in a standardized Functional IndependenceMeasure (FIM). The data were processed using SPSS softwarepackages and STATSTICA . Statistical analysis of data showed that the patients‘ functional status after stroke other positive changes asrehabilitation and improvement of cognitive , self-care and dailyfunctions. General cognitive status of patients differed significantlyin the course of rehabilitation received strong positive relationship,it shows the ratio p (0.85), which indicate a strong positiverelationship. The analysis of the overall condition of subjectsdepending on the type of stroke, it was found that patients withischemic stroke general cognitive status was better than before therehabilitation of patients with hemorrhagic stroke. Recovering, theyalso achieved better results , their data is statistically significantlydifferent (p< 0.05). Overall the condition of independence in dailylife as well as a statistically significant difference in the course ofrehabilitation , and the correlation coefficient p (0.93) showed a verystrong positive relationship. Our results showed improvements inpatients after stroke and cognitive and self-care functions changeduring the course of inpatient rehabilitation. It was also found thatthe improvement in cognitive function and improving self-carein daily life. This shows the correlation coefficient p (0.54). Theanalysis of patients with stroke rehabilitation efficiency dependingon demographic characteristics , they found that patients‘ functionalstatus significantly improved dynamics depending on the typeof stroke . It was also found that patients felt better living in thecity than in rural areas , although these data are not statisticallysignificant . The analysis of functional status changes depending onthe sex , it was found that the general condition was better for menthan for women. As well as their rehabilitation was more successfulthan women , although these data were not significantly different

Rehabilitation of marine turtles in Queensland has multifaceted objectives. It treats individual animals, serves to educate the public, and contributes to conservation. We examined the outcome from rehabilitation, time in rehabilitation, and subsequent recapture and restranding rates of stranded marine turtles between 1996 and 2013 to determine if the benefits associated with this practice are cost-effective as a conservation tool. Of 13,854 marine turtles reported as stranded during this 18-year period, 5,022 of these turtles were stranded alive with the remainder verified as dead or of unknown condition. A total of 2,970 (59%) of these live strandings were transported to a rehabilitation facility. Overall, 1,173/2,970 (39%) turtles were released over 18 years, 101 of which were recaptured: 77 reported as restrandings (20 dead, 13 alive subsequently died, 11 alive subsequently euthanized, 33 alive) and 24 recaptured during normal marine turtle population monitoring or fishing activities. Of the turtles admitted to rehabilitation exhibiting signs of disease, 88% of them died, either unassisted or by euthanasia and 66% of turtles admitted for unknown causes of stranding died either unassisted or by euthanasia. All turtles recorded as having a buoyancy disorder with no other presenting problem or disorder recorded, were released alive. In Queensland, rehabilitation costs approximately $1,000 per animal per year admitted to a center, $2,583 per animal per year released, and $123,750 per animal per year for marine turtles which are presumably successfully returned to the functional population. This practice may not be economically viable in its present configuration, but may be more cost effective as a mobile response unit. Further there is certainly benefit giving individual turtles a chance at survival and educating the public in the perils facing marine turtles. As well, rehabilitation can provide insight into the diseases and environmental stressors causing stranding, arming researchers with information to mitigate negative impacts.

The World Health Organization Atlas reveals lower bed and mental health professionals ratio per population in India. This may be due to a poor allocation of funding in the mental health sector by the Government. This resulted in a lack of complete and comprehensive care ranging from acute treatment to long-term rehabilitation throughout the country. The spiral of specialist care needs such as deaddiction, child psychiatric needs, and rehabilitation facility are available only to a handful of the population in metropolitan cities in India. The launching or establishment of new Mental Health Establishments (MHEs) and upgrading mental health service may provide strategies to bridge this gap from the private mental health sector. Following the inception of "Mental Healthcare Act 2017" (MHCA 2017), the process of setting up MHEs and their operations comes with new legal and healthcare aspects that remain debatable and unsettled. We put forth the basic measures that can be considered and undertaken to establish an exemplary MHE under the MHCA 2017.

We report a case of 66 years old man with sever osteoarthritis (OA) in both knees with severe varus deformity. Patient was treated with bilateral total knee arthroplasty (TKA) simultaneously with wedge augmentation of medial tibial plateau depression of both knees to restore the weight bearing axis of lower limbs. Although the recent trend and countless studies indicates the effectiveness of unilateral TKA and not to address both knees at the same time, this patient was operated same day keeping in mind the challenging surgery of primary bilateral TKA using revision armamentum, and all the possible complications of a lengthy surgery, but the rational was to provide rehabilitation simultaneously to both knees and to maximize the functional outcome of the surgery. Patient was functionally scored prior and post-surgery using international knee score. We report excellent outcome of the procedure using the full potential of a rehabilitation facility.

The aim of our study was to determine independent predictors of discharge disposition to rehabilitation or skilled care (SC) facilities and investigate whether discharge location is associated with unplanned readmission and/or reoperation rates. All elective spinal surgery patients in a national surgical registry were analyzed using between 2011 and 2012. Multivariable logistic regression analysis was used to assess for predictors of discharge to rehabilitation or SC facilities versus home as well as to determine whether discharge disposition was significantly associated with the 30-day unplanned readmission or reoperation. Of 34,023 elective spinal surgery patients, the distribution of discharge locations was as follows: 30,606 (90.0%) discharged home, 1674 (4.9%) discharged to rehabilitation, and 1743 (5.1%) discharged to SC. Patients discharged home were associated with the lowest complication rate relative to rehabilitation and SC facilities. Following multivariable regression analysis, there was a significant increase in the odds of discharge to rehabilitation associated with age, male gender, current smoking, ASA class three and four, history of diabetes, operative time, total hospital length of stay, preoperative neurologic morbidity and having at least one postoperative morbidity event. Moreover, there were 804 (4.06%) 30-day unplanned readmissions and 822 (2.45%) unplanned reoperations. After risk adjustment, discharge to rehabilitation was independently associated with decreased odds of 30-day unplanned readmission (OR=0.41; p=0.008) but not reoperation.

Anliegen: Die exzessive Nutzung des Internets wird als substanzungebundene Form einer Abhangigkeitserkrankung diskutiert. Laut Pravalenzschatzungen ist 1 % der deutschen Bevolkerung betroffen. Ungeklart ist, inwieweit Internetsucht komorbid unter Patienten der stationaren Suchtrehabilitation auftritt. Methode: In 15 Kliniken wurden alle innerhalb eines halben Jahres aufgenommenen Patienten auf das Vorliegen von Internetsucht gescreent. Ergebnisse: 4,2 % der Patienten erfullten die Kriterien. Diese waren haufiger mannlich mit den Primardiagnosen Cannabisabhangigkeit und pathologisches Glucksspiel. Schlussfolgerungen: Dies verdeutlicht den Bedarf an entsprechenden Routinescreenings innerhalb von Reha-Kliniken.

To investigate the effects of whole-body vibration in addition to an exercise programme on functional mobility and related outcomes for frail older fallers.Single-blind randomized parallel group trial.UK; National Health Service assessment and rehabilitation facility for older people.Frail older fallers: 38 (80 ± 8.6 years) performed the exercise with whole-body vibration (vibration group), and 39 (82 ± 8.1 years) without (exercise group).Sixty minutes supervised exercise class three times weekly for eight weeks ± whole-body vibration (up to 5 × 1 minute, 15-30 Hz and 2-8 mm peak-to-peak).Timed Up and Go, 6-m walk, static balance, fear of falling (FES-I) and self-reported health status (SF-12 version 2) were assessed at baseline, four weeks (mobility measures only), eight weeks and six months.Timed Up and Go and 6-m walk improved in both groups at eight weeks (P0.01), but significantly more in the vibration group (timed up and go: 38 vs. 20%, P0.05); 6-m walk: (36 vs. 18.1%, P0.05, respectively). Balance, fear of falling and physical component of the self-reported health status improved similarly in both groups (P0.05). At follow-up, no significant differences from baseline remained for any measure. The mean total time experienced was 37% of maximal target.The addition of whole-body vibration to strength and balance exercise resulted in greater improvements in functional mobility than exercise alone, despite achieving lower than anticipated exposure. Gains from neither intervention were sustained at six months.

Objective: The High-level Mobility Assessment Tool (HiMAT) was developed to measure high-level mobility limitations following traumatic brain injury. The aim of this study was to investigate if the revised HiMAT is valid for use with adults with neurological conditions other than traumatic brain injury. Design: Cross-sectional study. Subjects: Ninety-five participants with neurological conditions. Methods: HiMAT score sheets were retrieved from the central medical files of people who had attended a major rehabilitation facility for a neurological condition from January 2006 to October 2007. Additional HiMAT score sheets were submitted by therapists who participated in the HiMAT User’s Group. Rasch analysis (RUMM2030 software) was used to determine the overall fit of the model, individual item fit and differential item functioning. Results: Rasch analysis supported the internal validity of the revised eight-item HiMAT for individuals with neurological conditions. It showed good overall fit ( P = 0.74), no misfitting items and excellent internal consistency (Person Separation Index = 0.91). The HiMAT is unidimensional with no evidence of response dependency and no differential item functioning for age or sex. Conclusion: Further development of the revised HiMAT is required to investigate other aspects of validity, reliability and responsiveness in different neurological populations. However, the results support the internal validity of the revised HiMAT when used for people with neurological conditions who are able to walk without gait aids.

To be considered for release, raptors undergoing rehabilitation must have recovered from their initial injury in addition to being clinically healthy. For that purpose, a good understanding of reference hematologic values is important in determining release criteria for raptors in a rehabilitation setting. In this study, retrospective data were tabulated from clinically normal birds within 10 days of release from a rehabilitation facility. Hematologic values were compiled from 71 red-tailed hawks (Buteo jamaicensis), 54 Eastern screech owls (Megascops asio), 31 Cooper's hawks (Accipiter cooperii), 30 great-horned owls (Bubo virginianus), 28 barred owls (Strix varia), 16 bald eagles (Haliaeetus leucocephalus), and 12 broad-winged hawks (Buteo platypterus). Parameters collected included a white blood cell count and differential, hematocrit, and total protein concentration. Comparisons were made among species and among previously published reports of reference hematologic values in free-ranging birds or permanently captive birds. This is the first published report of reference values for Eastern screech owls, barred owls, and broad-winged hawks; and the first prerelease reference values for all species undergoing rehabilitation. These data can be used as a reference when developing release criteria for rehabilitated raptors.

Objectives To describe the iterative process of emergency planning and preparedness: risk assessment, planning, rehearsal, implementation, and refinement. Design A narrative reflection of two complete facility evacuations in advance of major hurricanes in 2005 (hurricane Rita) and 2008 (hurricane Ike) conducted by a postacute rehabilitation facility located on the Texas gulf coast. Participants Facility staff involved in the evacuation and ongoing care post evacuation, and adults with moderate to severe acquired brain injury receiving residential postacute rehabilitation and long-term care services. Results Experiences from two evacuations revealed that planning and preparation beyond what is required by licensing and accrediting agencies is necessary; attending to the needs of staff during and after and the emergency is a critical component of planning and preparedness; and the necessity of incorporating "lessons learned" into refinement of emergency preparedness plans. Conclusions Facilities providing residential services to persons with neurological injury are potentially vulnerable to a number of natural and manmade disasters. Careful planning, preparation, and practice are necessary to ensure safe evacuation of persons served and facility personnel in response to an emergency. Experiences (i.e., "lessons learned") from each evacuation, subsequent changes to emergency preparedness plans, and recommendations for emergency preparedness beyond a natural disaster, such as a hurricane, are presented.

A number of patients in a rehabilitation setting were being transferred to acute-care facilities with a diagnosis of congestive heart failure (CHF). A transfer penalty was charged to the rehabilitation facility based on each patient's length of stay. A multidisciplinary team was assembled with physician support to address the problem. The team's goal was to develop a CHF protocol with guidelines that would allow for more frequent nursing assessments and reporting to physicians. The protocol interventions were initiated consistently and monitored on each shift. These interventions allowed for more timely assessment and treatment of patients with signs and symptoms of CHF. As a result, the number of patients being transferred to acute-care hospitals has decreased, allowing patients to complete their rehabilitation process without interruption. The decreased number of patients being transferred to the acute-care setting has resulted in fewer transfer penalties for the rehabilitation facility.

Each hospital, private clinic (PC), or rehabilitation facility (RF) in France has to produce a computer-based annual report on the organization and actions developed for its antibiotic policy to the French Ministry for Health. This report consists of a list of nationally pre-defined items that the physician responsible for the infection control unit has to fill online. A scoring computer program operates at the end of the process.

A point prevalence survey among 125 patients in two units of a rehabilitation facility showed that the physical restraint rate was 12.8% (n=16). The survey examined the reason(s) for restraint use, whether its use had been explained, consent obtained and documented, whether the restraint had been appropriately applied and patients monitored during the period when restraint was applied, and whether alternatives had been attempted. Interestingly, six patients were found to have had their restraints removed either before or after the survey. A slightly less restrictive form of restraint, boxing gloves, was used for seven patients instead of limbs holders. Three patients remained restrained. The results of this study revealed that there was room for improvement in practice of restraints, and that measures to reduce the use of restraints were not necessarily very costly. Applying physical restraints is counter-productive to rehabilitative care. Nurses and other health disciplines need to be better informed regarding restraint reduction programs.

I was first struck by the power of therapeutic songwriting in 1992 when I commenced working at a rehabilitation facility for young adults who had sustained traumatic brain injury These young people were not only undergoing an intensive and exhausting rehabilitation program, but were also moving through a process of grief as they faced the reality of living with a permanent disability At the time I (naively) believed that improvisation would assist these young people to explore their feelings and that they would, in their own time, draw on these experiences to process and resolve this grief. However I was grossly mistaken.