International disability studies最新文献

The nature, advantages and disadvantages, and cost of a hospital-based self-care unit as part of a rehabilitation service are described. The unit's operational policy is critically examined after analysing the records of 40 patients admitted consecutively over a 2-year period and conducting interviews with 27 patients between 4 and 48 weeks after discharge. It is concluded that, compared with a hospital ward, a self-care unit is inexpensive to run and helps to prevent patients from giving up their homes and being admitted to residential homes prematurely. In addition to an assessment and confidence-building role, the unit provides a more appropriate and acceptable environment for patients waiting housing alteration or rehousing than a hospital ward.

This study analyses the proprioceptive effect of wearing a unilateral and then bilateral ankle orthosis on 34 healthy volunteer subjects by posturography. An elastic orthosis with a ligamentous support band was used, and evaluation was performed by a posturographic statokinesimetric platform. Three tests, one without an orthosis, one with one orthosis, and one with two orthoses, were recorded for each volunteer. The results and statistical analyses demonstrated a significant difference in the antero-posterior measurement between the test without ankle orthosis and the tests with one and with two orthoses. This study provides information about the prophylactic effect of wearing a flexible support; it appears that there are important inter-individual variations in postural equilibrium, and the wearing of prophylactic ankle orthoses should be reserved for subjects after a posturographic examination.

An electromyographic investigation of inspiratory respiratory muscles was carried out in six tetraplegic and two normal subjects using needle electrodes. When the normal subjects were using tidal breathing there was no activity present. In the majority of tetraplegic subjects, activity was present in the scalene muscle during tidal breathing. This activity became more marked during deep inspiration. The muscles were hypertrophied and these muscles filled an important respiratory role.

The provision of rehabilitation for stroke patients discharged from hospital in Nottingham was determined in three ways: a longitudinal study of consecutive stroke patients discharged from hospital, a cross-sectional survey of stroke patients attending physiotherapy (PT) and occupational therapy (OT) outpatient departments (OPDs), and an observational study of patients attending for rehabilitation at day hospitals (DHs) and PT and OT OPDs. In the longitudinal study 17% of patients went to DHs and 20% to OPDs. During the cross-sectional study patients most commonly attended twice weekly. Twenty-four per cent of DH attenders were 18 months post-stroke. In the observational study, the proportion of time spent in therapy was 22% in DHs, 38% in PT OPDs, 48% in OPD OT, and 51% in those attending both PT and OT OPDs. Day hospitals are now a major facility for the rehabilitation of stroke outpatients. OPDs may deliver rehabilitation more efficiently than DHs, and both OPDs and DHs compare favourably when compared to inpatient rehabilitation in this respect.

This paper describes an outcome-based assessment protocol that is used with older individuals who are blind. The assessment process demonstrates how the ICIDH theoretical model can be adapted to address small gains in rehabilitation outcome. The model also illustrates refinements in the ICIDH scaling to create effectiveness measures. A two-dimensional Functional Assessment Scale for measuring personal performance capacities has been found to be quite useful in determining individual needs, in quantifying small gains in rehabilitation intervention, and in evaluating programme effectiveness.

The World Health Organization has promoted the concept of community-based rehabilitation as a means of fulfilling the needs of disabled persons in their home environment, and at the same time decreasing the costs of tertiary rehabilitative care. This paper reports on the 10-year experience of a village rehabilitation hospital in rural Ukraine. The hospital was converted to a rehabilitation facility by provision of rehabilitation space, training of local medical and allied health personnel in the principles of rehabilitation, provision of modalities, exercise, hydrotherapy, apiotherapy, and obtaining the necessary physical medical equipment. The cost of this conversion was quite modest and was more than compensated for by the efficient utilization of the facility in the region together with the significant saving in tertiary care costs, including travelling time for patients.

Only a minority of working-age patients referred to rehabilitation medicine services return to work, but could more be helped? A first step is identifying those potentially able to do so. This paper describes the retrospective application of the Vocational Rehabilitation Index (VRI) to 223 patients of working age and with various diagnoses referred to one rehabilitation medicine service. The VRI discriminates between patients who return to work and those who do not, as well as between groups with apparently differing degrees of need for vocational rehabilitation assistance. It also has good face validity. Results suggest that it is feasible to apply the VRI in rehabilitation medicine settings and that further prospective evaluation and practical applications should be undertaken.

A simple movement-analysis system is described which provides a video display of the moving image and an easily-observable EMG signal in the form of a time-synchronized light-emitting-diode (LED) display. Its salient feature is the economic and meaningful way in which both data are displayed simultaneously. Its applications in the field of clinical education and training, in diagnosis, and in rehabilitation are discussed.

This study examines the relationship between falls, postural sway, stance symmetry, and length of hospital admission after stroke. Side of stroke, age, and sex differences are noted. A consecutive sample of 92 stroke patients underwent two assessments, four months apart, at between two and nine months post-stroke. Measurements of weight distribution and sway were made on the Nottingham Balance Platform. Any falls were recorded. A significant relationship was found between sway values at the first assessment and the number of falls (r = 0.27, p less than 0.01). Sway values improved with recovery (z = 2.9, p less than 0.01). Stance symmetry was significantly related to length of stay (r = 0.27, p less than 0.01) and age (r = 0.28, p less than 0.01), but not to falls. A significant difference was found between the weight distribution of right- and left-sided hemiplegias (t = 8.2, p less than 0.001) and stance symmetry improved with recovery (z = 2.9, p less than 0.01). No sex differences were apparent. This suggests that stance symmetry is another index of stroke severity, but that sway and falls frequency are not. However, an important relationship between sway and falls was revealed.

Five patients with traumatic spinal injury received a course of oral anticoagulant therapy with warfarin, heparin, or phenindione for 90 days following injury. These patients, on discontinuation of anticoagulant therapy, developed pulmonary embolus; two of these were confirmed by ventilation perfusion lung scintigraphy, and two were confirmed at post-mortem. The reasons for this are discussed, in particular the importance of delayed anticoagulation, obesity, operations, and mobilization in wheelchairs. The implications for further treatment are discussed.