Interdisciplinary process: Implications for rehabilitation psychology.

Suggests that the rehabilitation process can be enhanced by working toward development of an interdisciplinary, as distinguished from multidisciplinary, mode of operation. That approach fosters a symbiotic and interactive process among professions and professionals that goes beyond a consultative relationship. Rehabilitation psychologists, by fostering and encouraging an interdisciplinary team and, within that context, by the studied use of behavioral methods, can considerably enhance their impact on patients and professionals alike. Examples of modifications of the treatment environment are presented. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical and statistical standards of therapeutic and diagnostic process in patients with ophthalmic diseases]

Rehabilitation professionals contributing to the plan of care for a patient with a wound must be aware of and follow the rules promulgated by regulators, surveyors, and payers. Certain regulations are of particular importance. When establishing functional outcomes, the rehabilitation professional should ask whether the outcomes are meaningful, practical, and sustainable. By becoming part of the multidisciplinary team, rehabilitation professionals can help to improve cost-effectiveness of wound care and patient outcomes.     

The treatment of refractory ischemic ventricular tachycardia by endoventricular patch plasty reconstruction of the left ventricle

BACKGROUND: Engagement in therapeutic activity among stroke inpatients is advocated by many rehabilitation professionals. However, there is a lack of published evidence to indicate whether this is currently being achieved. OBJECTIVE: To investigate the extent and types of 'rehabilitation' activities on a new neurological rehabilitation ward, and examine change in patients' behaviour related to the new environment and new initiatives. DESIGN: Five one-week observation periods were conducted over two years, with a total of 67 patients being observed. A comparison was made with results of an earlier study of stroke patients' activities conducted at the same hospital. RESULTS: Patients spent an average 43 min per day with therapists (9% of the working day) and this was only marginally supplemented by self-exercise (2% of the working day--approximately 10 min). However, the provision of a new rehabilitation environment was associated with a marked decrease in the time patients spent at their bedsides, and a decrease in time spent passively gazing or watching others. CONCLUSIONS: Overall there was some positive change in patients' behaviour. We suggest that structured guidance is required from the whole multidisciplinary team to stimulate more self-directed therapy practice and recreation.     

Vagal paraganglioma: a review of 46 patients treated during a 20-year period

BACKGROUND: Vagal paragangliomas (VPs) arise from paraganglia associated with the vagus nerve. Approximately 200 cases have been reported in the medical literature. Because of their rarity, most information regarding these tumors has arisen from case reports and small clinical series. OBJECTIVE: To detail the clinicopathologic features of 46 patients with VP with an emphasis on the role of a multidisciplinary skull base team in both the successful extirpation and rehabilitation. DESIGN: Retrospective review of 46 patients with VP managed by a single skull base team. SETTING: An academic tertiary medical center. RESULTS: Forty-six patients were treated over a 20-year period (1978-1998). Ten (22%) demonstrated intracranial extension. There was a history of familial paragangliomas in 9 (20%) of the patients. The incidence of multicentric paragangliomas was 78% in patients with familial paragangliomas vs 23% in patients with nonfamilial paragangliomas. Management of this group of 46 patients consisted of surgery (n = 40), radiation therapy (n = 4), and observation (n = 2). The operative approach consisted of a transcervical excision often combined with a transtemporal or lateral skull base approach as dictated by the tumor extent. Postoperative cranial nerve deficits were common, and, as such, aggressive rehabilitation was a vital component in the management of these tumors. CONCLUSIONS: The management of VP and its associated cranial nerve deficits remains a difficult clinical problem. Options for treatment include surgical resection, radiation therapy, and, in selected cases, observation. Surgical extirpation requires a multidisciplinary skull base team to achieve complete tumor resection. Radiation therapy is reserved for elderly patients and patients at risk for bilateral cranial nerve deficits. Rehabilitation of cranial nerve deficits is an integral part of the management of VP.     

Review of Head injury rehabilitation: Children and adolescents.

Reviews the book, Head injury rehabilitation: Children and adolescents by Mark Yivisaker. This book is intended to be a practical guide for professionals seeking concrete guidance in the difficult and frustrating search for effective treatment strategies for head injured patients. While maintaining a commitment to scholarship, the authors of the treatment chapters of this textbook have taken as their primary responsibility the clear presentation of a treatment philosophy as well as specific principles and techniques of remediation" (p. xvii). It is clear that the contributors of this volume, most of whom work together at the Rehabilitation Institute of Pittsburgh, labored long and hard to accomplish this goal and, as a result, they have produced a lucid and thorough volume. This book provides a very helpful and coherent account of pediatric head injury rehabilitation. No important topics are overlooked and, although some crucial areas are given fairly short shrift, the coverage is quite within the stated purpose of the work and the task that the authors set for themselves. I think that this book will prove to be a useful manual for neophytes to the head injury rehabilitation field, and to many parents of head injured children. It certainly should be required reading for all who choose to prepare themselves for professional work with head injured children. One final point: although not explicitly stated, the enormous investment of time and effort required by the head injured child and his or her family reflects a capacity that arises more from the heart than from the mind. This commitment can only come from a well-integrated and devoted team of professionals such as the group who authored this book. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oncology nursing research in the USA

Cancer treatment requires a comprehensive team of multidisciplinary health care professionals, and especially nursing is central to provide the complementary care aspect of the cure objective. Nurses involved in cancer care provide public education about the disease, its prevention, screening and early diagnosis. Also they have an important role for patients with any stage of cancer. Oncology nursing as a specialty in the U.S.A. is relatively recent as an organized profession. There have been an increasing number of researches in this field, since the first national cancer nursing conference was held in 1973 and the first national Oncology Nursing Society Congress in 1975. Psychosocial issue is a major area in oncology nursing research, which is discussed in more details in this article.     

A step in the right direction: A resource for collaboration on health-related issues.

Reviews the book, Health-related disorders in children and adolescents edited by L. Phelps (see record 1998-07780-000). This edited text provides an overview of 96 medical conditions that place children at risk of developing psychological or educational problems. The central feature of this book is that it is intended as a reference tool for professionals who collaborate with medical professionals. Increasingly, there have been many vehicles for school psychologists to collaborate with medical professionals, including comprehensive school health care programs and school-based health clinics, and community-based coordinated services that provide children and youth comprehensive care. In this regard, school psychologists are likely to encounter increasing numbers of children who experience health disorders, along with more traditional areas of practice including mental health and educational issues. Although not a purely medically oriented text, Phelps has taken a perspective that school psychologists work within the context of a multidisciplinary team of professionals who are likely to provide services for these children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Compilation of DNA sequences of Escherichia coli K12: description of the interactive databases ECD and ECDC (update 1996)

Over many years, healthcare professionals have strived to improve the quality of patient care. The idea that collaborative care might achieve further improvements is relatively new but is a natural consequence of the Patient's Charter (1992) and other national standards. This article describes how multidisciplinary care planning was introduced in the stroke rehabilitation unit at Clatterbridge Hospital, Wirral Hospital NHS Trust.     

Postoperative management of partial or reconstructive pharyngo-laryngectomies

The multidisciplinary management of patients following pharyngolaryngeal surgery is an essential condition for its functional and socio-professional success. Early, overall rehabilitation, geared to each type of exeresis and to the personality of each patient, will enable both the voice and swallowing to regain their autonomy. A series of 195 patients after partial or reconstructive laryngectomy or pharyngectomy is analysed. The maintenance of a functional crico-arytenoid unity, the preservation of the mucosal sensitivity, the establishment of a facilitating posture and the dynamisation of the neoglottic sphincter are all equally important elements requiring the mobilisation of the entire health care team.     

A multidisciplinary approach to the treatment of child abuse

A multidisciplinary team of professionals and paraprofessionals provides an innovative therapeutic approach for the treatment of child abuse and neglect among a deprived and disadvantaged population of abusing mothers. The therapeutic approach stresses residential care for mother and child, behavior modification through corrective child care experiences, personality modifications through individual and group therapy, and environmental and social changes through staff assistance and education.     

Schwannoma of the brain stem: case report

Management of diabetes demands that informed patients cooperate with knowledgeable and concerned health professionals in a planned system of health care. It is imperative that each of the numerous health professionals caring for these patients has an understanding of his/her specific role and responsibilities as it relates to the entire health care team and to the individual patient. Acute, in-depth, and continuing phases of diabetes education are briefly described and the importance of altering patient behavior by contracting is documented.     

A multidiscipline approach in low vision rehabilitation

The first low vision clinic was instituted at the Industrial Home for the Blind in 1953 in response to a growing demand that more effective use be made of the residual vision in blind persons. The technology was there. Eye practitioners certainly knew enough about vision problems to offer many of these people an opportunity to enter a new life. The problem was: how to put that knowledge to work through a sound service delivery system. By its twentieth anniversary in 1973 the clinic had seen almost 5,000 patients for low vision evaluation and had built a service which consistently provided substantial and useful improvement in vision through the use of optical aids to a majority of its patients. The low vision optometric staff works as an integral part of a rehabilitation team. That team consists of a number of professionals, including ophthalmologists, social workers, teachers, and a variety of rehabilitation instructors. All members work simultaneously to create a total program of rehabilitation for thepartially sighted. We feel this teamwork approach is of basic importance to effective rehabilitation.     

On becoming a team: a view from the field

Early intervention services have expanded the concept of team participation for speech-language pathologists. Unlike traditional teams that grew out of the individual, direct service model of treatment, early intervention teams include the child's family along with professionals. Family members are invited to participate in assessing and treating their child, and the child is seen from a slightly different perspective by each team participant. Different viewpoints must be integrated and used to the benefit of the child. In this way, treatment options are expanded. Further, professionals may release their roles to other team members as well as learn new skills from other team members. The process of team development is illustrated through the experiences of one family-centered early intervention team.     

Improvement during baseline: three case studies encouraging collaborative research when evaluating caregiver training

The trend in cognitive rehabilitation toward reduced services, which provide more functionally relevant outcomes and the recognition of limited maintenance and generalization with many existing interventions, challenges current research models. There is a need to develop and evaluate interventions that can be implemented by persons other than rehabilitation professionals and that are well suited to naturalistic settings. The researchers responded to these challenges by designing a series of single subject experiments evaluating the effectiveness of training caregivers to provide appropriate cognitive support to persons with brain injury within their own natural living environments. The goal of the original research project included evaluating a collaborative mode of interaction with the subjects and their support persons (as opposed to traditional directive treatment models) where the caregivers and subjects were instrumental in designing the intervention and collective performance data. This paper presents the data from the initial three subject/caregiver groups all of whom demonstrated improvement in the target behaviours during the baseline period. It appeared that the act of measuring client performance changed the behaviours of the support persons and resulted in positive changes in baseline levels. The research and clinical implications of these findings are discussed.     

Response to "Programming for occupational outcomes following traumatic brain injury".

Responds to an article Programming for occupational outcomes following traumatic brain injury by William J. Haffey and Frank D. Lewis (see record 1990-02644-001). The dramatic upsurge in attention paid in the past 10 years to the rehabilitation of persons with traumatic brain injury (TBI) has resulted in an accelerating proliferation of treatment programs purporting to apply specialized techniques that will "remediate" the cognitive and behavioral deficits of this population, with implicit or explicit promises of functional gain. Specifically, given the epidemiologic realities of the TBI population, returning to work is a major goal of the rehabilitation process. With the movement of TBI rehabilitation programs out of academic medical centers and into the private sector, increasing numbers of zealous professionals are ready to apply a variety of treatment approaches, thousands of families are eager to find the "best" program, and more and more nervous insurers are both mandated and requested to pay for expensive treatments that hold out the promise of return to work. Unfortunately, the field of TBI rehabilitation has been more eager to provide services than critically evaluate the effectiveness of those services. The first major contribution of the Haffey and Lewis article is to call attention both to the paucity of posttreatment vocational outcome studies, and to emphasize the need to evaluate the success of various models of vocational rehabilitation. The second major contribution of the Haffey and Lewis article is their offering of a concrete example of one approach to systematic programming for vocational outcomes. Our experience is that vocational potential—and therefore reasonable goals—only emerge as the product of a process that involves testing the client's capacities not just cognitively and behaviorally, but also his or her capacity to conform to a series of messages and procedures that will determine the viability of any given vocational plan. Readers should take from the concrete programming suggestions in this article the laudable objective of making vocational goals, obstacles, and critical events specific and public, but beware of mechanically applying the approach without appreciating the complex subtleties in enabling a brain-injured person to become a productive worker. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of measurement and evaluation in rehabilitation (second edition).

Reviews the book, Handbook of measurement and evaluation in rehabilitation (second edition) by Brian Bolton (1987). This book is an excellent introduction to assessment issues and techniques for rehabilitation professionals. An impressive roster of experts in the fields of psychometrics and rehabilitation contributed to this second edition. There are three main sections to the book: a brief introduction to principles of measurement (scores and norms, reliability and validity), discussions of five major types of instruments used with rehabilitation populations (such as intelligence testing and personality testing), and an extended review of assessment applications, ranging from process areas such as career development to specific populations such as mentally retarded individuals. A main strength of the book is its consideration of measurement issues in broad terms; a number of chapters could be lifted and used almost unchanged in other fields in which intelligence testing or career development is relevant. Also, the volume is well referenced and does not shrink from dealing straightforwardly with complex issues. There are also some significant omissions in the volume. Perhaps the most serious of these is the scant attention given to the rise of the computer in rehabilitation assessment. On balance, the handbook seems an evident front-runner for use in training rehabilitation professionals about the basics of assessment. Bolton's book provides a sturdy foundation for learning about assessment, filled as it is with important concepts and a sense of the field's history. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Cardiovascular rehabilitation: A comprehensive approach.

Reviews the book, Cardiovascular rehabilitation: A comprehensive approach, edited by Lyle H. Peterson (1983). This book is a thorough and concise book for the physician, psychologist, rehabilitation counselor, physical therapist, or nurse involved in a treatment team approach to cardiovascular rehabilitation. The text includes research data, philosophical rationale, current references, and an explanation of the theoretical bases of various treatment approaches. Of interest to psychologists are chapters dealing with specific tests, treatment modalities, and the role of the psychologist in the rehabilitation team. The authors attempt to prove with logic, data, and eloquence how a comprehensive cardiovascular rehabilitation center can benefit patients. They also attempt to show the importance of the management of psychological problems in rehabilitation. This text represents an attempt to incorporate psychology into parity with other disciplines in rehabilitation, and as such could be read with profit by both psychologist and nonpsychologist alike. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The place and promise of theory in rehabilitation psychology research.

Objective: Although rehabilitation psychology is more focused on empirical evidence and clinical application than theory development, the authors argue for the primacy of theory and explain why theories are needed in and useful for rehabilitation psychology. Impediments to theory development are discussed, including the difficulties of applying psychological theories in multidisciplinary enterprises and the difficulties in developing a theory-driven research program. The authors offer suggestions by reviewing research settings, knowledge gained through controlled studies, grantsmanship, and then identify topical areas in which new theories are needed. Researcher-practitioners are reminded that rehabilitation psychology benefits from a judicious mix of scientific rigor and real-world vigor. Conclusions: The authors close by advocating for theory-driven research programs that embrace a methodological pluralism, which will, in turn, advance new theory, produce meaningful research programs that inform practice, and realize the goals of this special issue of Rehabilitation Psychology--advances in research and methodology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacokinetics of SPECT radiopharmaceuticals for imaging hypoxic tissues

Low back pain (LBP), a common illness that may progress to chronic disability, costs many billions for care, lost work, and compensation. Conventional medicine does not effectively restore chronic LBP patients to work; multidisciplinary rehabilitation does, but limited or delayed access risks unnecessary costs, additional morbidity, and permanent disability. The authors examine costs of delayed treatment for 23 disabled LBP patients in a rehabilitation program. Compensation costs average $26,159 per patient, a sum covering treatment for 3 patients. Additional medical and societal costs are estimated. Factors causing delay, such as economic incentives and ignorance about pain, and policies to remediate these problems, are discussed.