Post-acute polytrauma rehabilitation and integrated care of returning veterans: Toward a holistic approach.

Throughout the history of war, exposure to combat has been associated with clusters of physical and psychological symptoms labeled in various ways, from “hysteria” to “shell shock” in World War I to “polytrauma” in Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF). Objective: To describe the historical conceptualizations of combat injury and the ways they are relevant to developing current rehabilitation strategies, discuss the symptom complex presented by OEF/OIF veterans, and describe key elements and principles of holistic, integrated care for post-acute OEF/OIF veterans. Conclusions: A conceptualization of rehabilitation recognizing a final common pathway of functional disability and suffering is proposed, and both systematic and treatment-specific aspects at the core of a veteran-centered holistic approach are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cerebral edema after hemodialysis: the "reverse urea effect" lives

A total of 2157 strains of the enteropathogen Campylobacter jejuni were examined for resistance to metronidazole (5 mg l-1). High rates of metronidazole resistance, between 82 and 100%, were observed amongst strains of avian origin, including commercially reared broiler chickens (90.1%, n = 314) and turkeys (92%, n = 100), as well as wild birds sampled from farms and coastal environments, such as starlings (82%, n = 50), and gulls (100%, n = 20). In comparison, isolates from bovine and ovine ruminants were mostly susceptible to metronidazole, including beef cattle (17.3%, n = 653), dairy cows (19.5%, n = 251), grazing sheep (9.0%, n = 55) and lambs at slaughter (5.5%, n = 615). A moderate number of clinical isolates were resistant (62.8%, n = 99). Avian isolates had a higher average minimum inhibitory concentration (MIC) value (15 mg l-1) than cattle, lambs and clinical isolates (3 mg l-1). A June peak was observed in the percentage of metronidazole resistant strains isolated from beef cattle at slaughter. The induction of growth under aerobic and anaerobic conditions did not affect ability to grow in the presence of metronidazole among four test strains. The observations noted in this study indicate a host-phenotype relationship for which resistance to metronidazole may be a useful epidemiological marker.     

Home rehabilitation after stroke. Review of the literature

To find an answer to the question whether domiciliary rehabilitation after stroke is better or cheaper than alternative forms of rehabilitation, a systematic literature review of controlled trials was performed. Three large and two smaller, more preliminary studies of all together a thousand patients were found and regarded methodologically acceptable. Efficacy as regards functional, emotional and qualitative outcome of patients was equivalent for various modes of care. So was the degree of stress, social function and quality of life for the main carers. Home treatment costed less than regular day care but more than routine care including a mixture of outpatient and day care, as considered required. Domiciliary rehabilitation seems to be a good and cost effective alternative for stroke patients who need and cannot manage frequent out-patients visits without ambulance or other exhausting and expensive transports.     

Effectiveness of attention rehabilitation after an acquired brain injury: A meta-analysis.

The efficacy of attention rehabilitation after an acquired brain injury was examined meta-analytically. Thirty studies with a total of 359 participants met the authors' selection criteria. Studies were categorized according to whether training efficacy was evaluated by comparing pre- and posttraining scores only or included a control condition as well. Performance improved significantly (using the d+ statistic) after training in pre-post only studies but not in pre-post with control studies. Further analyses showed that specific-skills training significantly improved performance of tasks requiring attention but that the cognitive-retraining methods included in the meta-analysis did not significantly affect outcomes. These findings demonstrate that acquired deficits of attention are treatable using specific-skills training. Implications of these results for rehabilitation theory and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological factors, rehabilitation adherence, and rehabilitation outcome after anterior cruciate ligament reconstruction.

Objective: To examine prospectively the relationships among psychological factors, rehabilitation adherence, and short-term rehabilitation outcome after knee surgery. Study Design and Participants: Individuals with acute anterior cruciate ligament (ACL) tears (N?=?95) completed measures of self-motivation, social support, athletic identity, and psychological distress before reconstructive surgery. After surgery, 93 participants reported on their completion of home rehabilitation exercises and cryotherapy, and their rehabilitation practitioners indicated the patients' attendance at, and adherence during, rehabilitation sessions. Rehabilitation outcome measures were taken from 69 participants approximately 6 months postsurgery. Main Outcome Measures: Knee laxity, functional ability, and subjective symptoms were the primary outcomes assessed. Results: Self-motivation was significant predictor of home exercise completion; athletic identity and psychological distress were significant predictors of knee laxity; and attendance at rehabilitation sessions and home cryotherapy completion were significant predictors of functional ability. Rehabilitation adherence did not mediate the relationship between psychological factors and rehabilitation outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors affecting return to living alone after medical rehabilitation: A cross-validation study.

Objective: To cross validate and extend the authors' finding that cognition is one of the best predictors of return to living alone after medical rehabilitation. Design: A prospective sample of live-alone older medical rehabilitation patients followed from admission to discharge. Logistic regression identified significant predictors of return to living alone, and measures of predictive power were calculated. Setting: Stroke and geriatric units of a free-standing urban medical rehabilitation hospital. Participants: One hundred ninety-four older consecutively admitted medical rehabilitation patients 60 years old or older. Main Outcome Measure: Return to living alone versus discharge to living with others. Results: Consistent with the authors' original findings, both cognition and self-care motor skills were significant predictors of return to living alone. Cognition acted as a suppressor variable, leading to age and education effects only when entered into the regression equation. New variables did not add significantly to prediction. Conclusion: The value of rehabilitation psychologists' role in making cognition-based recommendations about discharge disposition in live-alone older adults is supported by findings from this study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conservation of resources theory, perceived stress, and chronic fatigue syndrome: Outcomes of a consumer-driven rehabilitation program.

Objective: To evaluate the impact of a consumer-driven rehabilitation program on perceptions of loss and gain of interpersonal relationships, energy, material objects, work benefits and opportunities, well-being, and experiences of mastery in persons with chronic fatigue syndrome. Study Design: Participants were randomly assigned to a program group (n = 23) or a control group (n = 24). Outcomes were assessed (a) at baseline, (b) after program participants completed an illness management group, and (c) after they completed one-on-one peer counseling. Setting: A community-based advocacy organization for individuals with disabilities. Interventions: Four months of illness management groups followed by 7 months of one-on-one peer counseling emphasizing goal setting and goal attainment. Main Outcome Measure: The Conservation of Resources Evaluation scale. Results: Significant gains were observed for program participants across all categories of resource gain--interpersonal, energy, material, work, well-being, and mastery resources. Effect sizes were moderate to large. Conclusions: Programs in which participatory action research methods are used may have a positive impact on resource acquisition for individuals with chronic fatigue syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subacute rehabilitation: New opportunities and challenges for rehabilitation psychologists.

Changes in the health care delivery system have obliged rehabilitation service providers to consider alternatives to the traditional model of comprehensive acute inpatient rehabilitation. An option of growing popularity among third-party payers is subacute rehabilitation. This type of rehabilitation is usually provided within a skilled nursing home, provides fewer hours of therapeutic intervention, and uses less professional staff, but may achieve similar outcomes. As subacute rehabilitation has grown, rehabilitation psychologists have been used in these settings, but uncertainties exist as to appropriate roles and reimbursement opportunities. This article provides a framework for understanding the current status of subacute rehabilitation as a part of the rehabilitation continuum of care and how rehabilitation psychologists can maximize their effectiveness in this environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A decisional component of holistic encoding.

It has been proposed (see, specifically, M. J. Farah, K. D. Wilson, M. Drain, & J. N. Tanaka, 1998) that human faces are used in cognition as undifferentiated wholes. General recognition theory (GRT; F. G. Ashby & J. T. Townsend, 1986) is used to represent hypotheses regarding the possible sources for the behavioral evidence supporting holistic representation. Specifically, it is suggested that holism can be understood in terms of violations of informational independence, informational separability, or decisional separability, as these constructs are defined in GRT. Stimuli were presented upright, inverted, and in an encoding task that emphasized the meaningful nature of the stimuli. Patterns of performance (recognition hit rates) were consistent with prior studies. However, there were only a handful of violations of informational separability. Instead, consistent violations of decisional separability suggested a decisional basis for holistic effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rebirth: The rehabilitation process.

Rehabilitation psychology is an evolving discipline both in theory and in practice. Although the processes of mourning and of reintegrating an intact sense of self have been recognized as central to rehabilitation, developmental theory has not been applied to this complex transition. Because traumatic loss often reactivates early developmental issues, we have linked Mahler, Pine, and Bergman's (1975) theory of psychological birth, focusing on the mother–infant dyad, to the process of "rebirth" in rehabilitation. We conceptualized the team as mother and the patient as infant. Mahler et al.'s phases of symbiosis, practicing, rapprochement, and object constancy offer a framework for illuminating the therapeutic process of the team approach. Parallels between the acute in-patient rehabilitation experience and the separation-individuation process are drawn. This development, may strengthen our psychological understanding and interventions with this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stories of commitment: The psychosocial construction of generative lives.

In this study, the authors analyzed the internalized life stories of 40 highly generative people and 30 less generative adults with similar demographic profiles to discern the extent to which the 2 groups constructed different identities. The highly generative adults were more likely to reconstruct the past and anticipate the future as variations on a prototypical commitment story in which the protagonist (a) enjoys an early family blessing or advantage, (b) is sensitized to others' suffering at an early age, (c) is guided by a clear and compelling personal ideology that remains stable over time, (d) transforms or redeems bad scenes into good outcomes, and (e) sets goals for the future to benefit society. Commitment stories sustain and reinforce the modern adult's efforts to contribute in positive ways to the next generation. The findings connect to a growing interdisciplinary literature on narrative and human lives and suggest a new research agenda that draws on nomothetic conventions to interpret storied psychosocial constructions that people fashion to make sense of their lives in time and in culture. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Work in people's lives: A location for counseling psychologists.

The career development–vocational psychology literature has been marked by 2 persistent problems: a slow response to new developments in basic areas of psychology, such as developmental psychology, and a lack of representation of populations other than White and middle-class groups as research participants or as foci of theoretical explanation. After a brief discussion of 2 factors that may have contributed to these problems, a rationale for a new location for this field is developed. The new location focuses on the study of work in people's lives from the perspective of social constructionism and from the perspective of counseling psychologists as applied psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Freud's seduction theory and its rehabilitation: A saga of one mistake after another.

It is argued that Freud's seduction theory was so manifestly false that it was unlikely that his contemporaries would accept it or that he would retain it for very long. It is further argued that the relatively successful attempt by J. M. Masson and others to rehabilitate the theory was achieved partly by exploiting several myths, such as the supposed irrational and hostile manner in which Freud and his theory were received, but was achieved mainly by presenting a version of the seduction theory that was so shorn of its implausible aspects that it posited little more than that child sexual abuse can be pathogenic; in a crucial way, it acknowledged neither the central etiological role given to unconscious memories nor the therapeutic requirement of making them conscious. Once the seduction theory was rehabilitated, however, these original aspects were reclaimed and they served to strengthen the rationale for giving memory recovery a central role in therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)