Frontiers in rehabilitation sciences最新文献

Background: Drowning is a leading cause of death for children. Some populations of children with disabilities, such as children with autism, experience a health disparity in drowning when compared to peers without disabilities.

Objective: This study presents a secondary data analysis of the response to intervention for a 5-day adapted swim instruction program (iCan Swim) for children with disabilities (n = 164 participants) ages 3-18 years.

Methods: This secondary data analysis assessed the effectiveness of the swim intervention on changes in swim skill level from Day 1 to Day 5. Associations between response to intervention (i.e., change score) and participant characteristics were examined using Kendall's tau-b for age and Chi-square for sex and diagnosis. Models were fit using a Poisson regression to examine potential predictors of progress across participants.

Results: Swim skills significantly improved from Day 1 (Md = 1.00, n = 164) to Day 5 (Md = 2.00, n = 164), z = -10.06, p < .001, r = .58). Most participants (61.6%) improved by at least one swim skill level. Age was weakly, yet significantly positively correlated with swim skill level change scores (τ _b = .154, p = .020) and was a significant predictor of swim skill level change for participants with Down Syndrome [b = .091, S.E. = .0434, p = .036, 95%CI (.006,.176)].

Conclusions: While this 5-day adapted swim instruction program was effective for most participants in improving swim skills, certain factors may have contributed to slower progression including participant fearfulness or needing more time. Further study of these factors is warranted.

Introduction: Heritage sites often pose significant accessibility challenges for individuals with visual disabilities due to their preserved architectural features and strict regulations against modifications. In shared streets, designed to encourage pedestrian use and reduce vehicle dominance, these challenges are exacerbated by the lack of tactile and directional cues for visually impaired users. This study, set in the context of Canadian heritage sites, explores how shared streets can be adapted to be more inclusive while respecting the integrity of historical environments.

Objective: The objective of this study is to explore and propose practical solutions to enhance the accessibility of shared streets for individuals with visual disabilities within heritage sites, with a particular focus on preservation requirements.

Methodology: The study adopts a three-phase methodology. First, co-design sessions were conducted with three groups of stakeholders: people with disabilities, caregivers, and experts in accessibility and heritage preservation. Second, a narrative literature review was undertaken to identify practices from existing research and urban planning cases. Finally, solutions were developed in collaboration with a design firm to create practical, adaptable prototypes that address the specific needs identified in earlier phases.

Findings: The co-design sessions revealed several key challenges, including the lack of tactile references, difficulties with snow removal, and the need for clearer delineation between pedestrian and vehicular zones. Solutions such as tactile paving, modular bollards, and the use of contrasting materials were developed to address these issues. The narrative review reinforced the importance of universal design in heritage contexts and provided insights into successful implementations in other urban settings.

Conclusion: The study concludes that shared streets can be made more accessible for individuals with visual disabilities by adopting a modular design approach that integrates tactile cues and adaptable urban furniture. These solutions ensure that accessibility and safety can coexist with heritage preservation, promoting inclusivity in public spaces. The research highlights the importance of stakeholder engagement in the design process and offers a replicable framework for improving accessibility in heritage sites globally. However, further field testing is needed to assess the feasibility and acceptance of these solutions within the regulatory constraints of heritage environments.

Purpose: Patient participation is a complex issue and difficult to establish, but essential to successful spinal cord injury rehabilitation. The purpose of this study was to explore the challenges experienced by nursing staff when they wanted to include the patient's perspective in their rehabilitation.

Methods: Action research methodology was applied to increase knowledge, develop competences, and ultimately change practice. Over a period of two years, four nurses and four certified healthcare workers participated in identifying, testing and evaluating ways to improve patient participation. The data consist of evaluations of patient participation and recorded and transcribed dialogues from meetings and workshops. Transformed into text, data were analysed using the interpretive theory of Ricoeur to identify central themes.

Findings: Three central themes highlight the challenges experienced by the nursing staff while focusing more on patient participation in nursing practice: (1) Struggling to really listen to the patient's perspective, (2) Searching for time to listen to the patient's perspective, (3) Legitimising the patient's perspective in rehabilitation.

Conclusion: Even though nursing staff found patient participation to be vital for individualised rehabilitation, it was difficult to include the patient's perspective. The inclusion was challenged on a personal level, within the nursing group, and in the organisation due to prioritizing physical nursing tasks over the patient's perspective. Thus, the nursing staff struggled to change their nursing practice and to convince their colleagues and leaders that the rehabilitation should be re-organised to perform their nursing role to the full. This indicated a need to work on the attitude and approach of the entire organisation to promoting patient participation and nursing rehabilitation.

South Africa faces the detrimental effects of problematic substance use. The Community Oriented Substance Use Program (COSUP) is a research-based, community-situated harm-reduction program. The International Classification of Functioning, Disability and Health (ICF) was used as the framework to develop a unique tool to determine the functioning of COSUP clients. The study was a quantitative descriptive, cross-sectional design, with data collected from COSUP sites during January 2023 using the COSUP Client Functioning Tool. Twenty-three Likert-scale structured closed questions about clients' perceptions of their functioning and context were analyzed using descriptive statistics. Open-ended questions about COSUP services were thematically analyzed. Most COSUP clients are working-age African males, and many are unemployed. Clients seem to be coping well physically but need more mental health support. Pressing concerns for COSUP clients are feeling stressed and anxious, an inability to handle stress, poor use of free time, not getting support from others, and not having enough money to meet daily needs. Lack of energy and boredom are significant concerns, along with feelings of rejection and loneliness. Facilitating opportunities for sustaining livelihoods requires focus. Even so, there are those who have a sense of hope due to the positive impact of the program. Basing the COSUP Client Functioning Tool on the ICF framework provided a useful picture of the functioning of people who use/d drugs in their contexts. The COSUP Tool is helpful to guide interventions that are responsive to clients' needs.

Postoperative cognitive dysfunction (POCD) is a prevalent complication of the central nervous system in elderly patients following cardiac surgery. This review aims to provide an overview of the etiology, risk factors, diagnostic assessment, and rehabilitation strategies for cognitive dysfunction occurring after cardiac surgery. The pathogenesis of POCD after cardiac surgery includes cerebral microembolism, neuroinflammation, and cryptogenic strokes. Risk factors are associated with advanced age, diminished preoperative cognitive status, and anesthesia. Cognitive function screening tools used for pre- and postoperative assessments can detect changes in patients' cognitive levels in a timely manner. The timely provision of appropriate rehabilitation methods, including cognitive function training, exercise training, transcranial direct current stimulation, and perioperative acupuncture, is crucial, with emerging technologies such as virtual reality playing an increasingly significant role. In conclusion, POCD is a common postoperative complication in elderly cardiac surgery patients, with age and reduced preoperative cognitive function being the primary risk factors. A comprehensive rehabilitation strategy can more effectively address postoperative cognitive dysfunction in patients.

Background: Low-frequency acupuncture is used to maintain skeletal muscle flexibility and improve joint range of motion; however, its definite effects are unclear. This study aimed to determine the effects of low-frequency acupuncture on muscle and fascial stiffness and ankle dorsiflexion range of motion.

Methods: The participants included 12 randomly selected healthy adults. The medial head of the gastrocnemius muscle was selected as the target muscle, and changes in hardness and dorsiflexion range of motion of the ankle joint in the deep fascia, muscle, and deep intermuscular fascia of the same region were measured before and after low-frequency acupuncture intervention. Acupuncture needles were inserted until they passed through the deep intermuscular fascia and electrically stimulated at a frequency of 2 Hz for 15 min. The 12 right legs were the intervention legs, and the 12 left legs were the non-intervention legs.

Results: In the intervention leg, hardness increased in the deep fascia immediately after low-frequency acupuncture, but decreased in all regions (deep fascia, muscle, and deep intermuscular fascia) after 15 min. The rate of change in hardness was the greatest in the muscles and deep intermuscular fascia. Additionally, the ankle's dorsiflexion range of motion increased after 15 min. In contrast, the non-intervention leg showed no significant changes in stiffness or ankle dorsiflexion angle.

Conclusions: Low-frequency acupuncture may decrease muscle stiffness and improve fascial gliding. The change in hardness tended to be greater in the deeper areas.

Design: Prospective, cross-sectional study.

Objectives: To determine the functional outcome and home and social integration of people who had spinal cord injury and completed their inpatient rehabilitation.

Setting: Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh.

Methods: Spinal Cord Independence Measure (SCIM) and Community Integration Questionnaire (CIQ) were used to analyse the relationship between the functional outcome and home and social integration at the end of rehabilitation. Descriptive and inferential statistics were performed to analyse the data.

Results: A total of two hundred participants (181 men and 19 women) were recruited for the study. Among the participants, 92.5% of them reported a history of trauma or accident, including road traffic accidents, falls and other injuries. Approximately 60% of participants presented with paraplegia and 62.5% of participants were categorized on the ASIA Impairment Scale (AIS) as Grade A, complete spinal cord injury. Participants with paraplegia and participants with a Grade B, incomplete injury, on the AIS were functionally more independent (p = 0.011)) compared with participants with tetraplegia and other AIS grades. Participants with paraplegia reported having a more active lifestyle (p = 0.040) in their home and social activities compared to those with tetraplegia. There was no significant association found between functional independence at pre-discharged and community integration one-month post-discharge of the people with SCI.

Conclusion: A month after discharge, there is no statistically significant relationship between community reintegration and functional independence. A measure of functional independence may not be a suitable indicator of community integration. It is proposed that to monitor a person's community integration the CIQ could be used with a measure of quality of life as this would indicate a person's contentment with their level of community integration.

Introduction: Hearing loss and Deafness/deafness affects as much as 5% of the world's population and has a considerable health and economic burden. We explored the relationship with hearing and hearing aids as well as other assistive technology for health in general with a cohort of UK adults who have conductive hearing loss. We anticipated that insights could lead to greater understanding for the delivery of assistive technology (AT) for conductive hearing loss and the participant's lived experience related to technology and society.

Methods: This study presents the qualitative findings from a mixed methods study exploring the story of each participant's hearing, the impact on their lives and their experience and use of AT. A purposive sample of 33 adults with conductive hearing loss took part in semi-structured interviews. Participants were aged ≥18 years and had previously attended outpatient ENT or audiology clinic at University Hospitals Sussex NHS Foundation Trust. Transcripts underwent thematic analysis.

Results: The overarching theme was "A changing relationship over time with deafness, themselves and society". The three principle sub-themes of the interviews were "a technological world" describing the necessity of interaction with people & technology' both as children and adults, then the concept of "Normalised Marginalisation"-the struggle of childhood and school in the face of social norms' and typicality. Finally, there were issues raised about visibility and "the visible display of D/deafness", tied to aesthetics, vanity and traditional ideas about masculinity. Many participants described their adoption of new technology or devices as "transforming their life" and their quality of life without assistive technology as significantly impaired.

Conclusion: Insights from this study described the experiences of adults with conductive hearing loss and the ways in which they have a difficult relationship with their deafness, including how they felt and viewed themselves and how they interacted with society, particularly as children and young adults. The potential for benefit of assistive technology for hearing health was deemed by many participants to be a necessary bridge integrating them in relationships with other people in society. Early notions of disability, typicality and social norms frequently persisted into adulthood and these insights should be considered by all those professional seeking to provided hearing health assistance to individuals with conductive hearing loss.

Background: Surgical resection is the preferred treatment for localised non-small cell lung cancer (NSCLC). Rehabilitation is central in the management of the associated impaired quality of life, high symptom burden, deconditioning, and social-existential vulnerability. Yet, optimal content and delivery of rehabilitation are not yet defined. Therefore, we aimed to investigate the current rehabilitation offers, attendance rate, and perceived relevance related to content or delivery. Moreover, we investigated the current symptom burden in the patients.

Methods: We conducted an observational cohort study in patients who had undergone surgical resection for NSCLC 4-6 months earlier at Odense University Hospital, Denmark. We retrieved demographic data from patient registries, and interviewed patients via telephone concerning availability, uptake, and attendance rate of any rehabilitation offer in their local primary care setting; content and delivery; benefits of attending, experienced relevance and "symptom burden generally" (specially developed questions); and "symptom burden here and now" [Edmonton Symptom Assessment Scale (ESAS)].

Results: We approached 128 patients, reached 115, and interviewed the 100 (87%) patients who consented. In total, 88% (88/100) had received a rehabilitation offer, and 75% (66/88) had participated in programmes that either targeted NSCLC (23%) or were general cancer rehabilitation (33%), pulmonary rehabilitation (12%), online (1%), or other (33%). Disease-specific rehabilitation was significantly related to the highest attendance rate and perception of relevance. High attendance (≥75%) was, moreover, significantly related to the offer being delivered by a physiotherapist and having a focus on physical exercise. General symptoms were physically oriented [dyspnoea (65%), pain (47%), fatigue (78%)] and "mild" in ESAS scoring. No differences were observed in any baseline characteristics.

Conclusions: Rehabilitation after surgical resection for localised NSCLC is delivered heterogeneously in Denmark. Disease-specific rehabilitation was positively related to attendance rate and to the perceived relevance of the offer.