Rheumatic disease, with its associated costs, is the leading cause of disability in adults (Martin et al, 1988; Yelin and Callahan, 1995) and, with the predicted demographic changes, it is likely to become more prevalent over time. There is evidence that education and self-management programmes can improve symptoms and compliance with prescribed therapies, as well as reduce patient contact with the NHS. In routine clinical practice, patients with arthritis do not always receive the information they want and need. Local experience suggests that the provision of information may be particularly poor for non-Caucasians.
Interprofessional education (IPE) has been advocated in a number of policy documents for nearly 30 years as the main route to enhancing collaboration. Consequently, there has been a steady growth in IPE activity in this country and abroad. Despite this expansion, literature reveals that the planning and delivery of IPE remains a localized and rather haphazard affair with little understanding of the factors that influence its development or implementation. This article examines some of the key factors (conceptual, operational, educational and evaluative) that underpin the design and delivery of successful IPE and also presents a series of ideas to assist practitioners' work in this area.
This study surveyed physiotherapy undergraduates' perceptions of the control ethos of physiotherapeutic specialisms, and investigated whether they preferred a client-centred or a professional-powered model of working.
A sample of individuals aged 5–68 years (n = 39) were examined to determine the relationship between age, the timing of the gait cycle and movement of the joints and eyes when walking in a straight line and turning. Timing of the gait cycle was measured by the use of electrically conductive rubber placed in the shoes, while accelerometers measured movement of the joints. Four electrodes around the eyes assessed eye movement. Stance time, swing time, stance to swing ratio and velocity of movement were unaffected by age from those aged 10–60 years walking in a straight line. Above the age of 60 years, velocity of walking was reduced. There was little difference between individuals aged 10–60 years in terms of timing and velocity of movement in turning. Movement slowed during turns in those aged over 50 years. Accelerometry and ocular data showed that individuals over the age of 40 years had a fivefold increase in movement at the knees and hips and on the head compared to the younger groups. These results seem to show that accelerometry analysis of turns is a better method of evaluating gait and looking for gait abnormalities associated with ageing than analysis of walking in a straight line.
The author was asked to share her experience of the Lomax Active wheelchair range, in relation to working within the specific field of spinal cord injury. From clinical experience, it is the author's opinion that, on returning home from initial rehabilitation, the majority of this client group benefits from a relatively high specification wheelchair that allows them to maintain as independent a lifestyle as possible. Such provision allows clients to optimize their potential and promotes reintegration into the community, while allowing the clients to identify their long-term wheelchair specification requirements.
The objective of this article was to determine the correlation between two measures of hemiplegic shoulder pain, the Ritchie Articular Index (RAI) and the vertical Visual Analogue Scale (VAS), and to explore the effect of participant characteristics on the distribution of the vertical VAS scores in a rehabilitation unit setting. Participants (n = 34) with first time stroke and upper limb hemiplegia were studied. A positive relationship between the RAI and vertical VAS scores (Spearman's rho = 0.57, P <0.01) was found. The distribution of the mean and median scores of the vertical VAS across the RAI scores was as anticipated, except for the RAI score of 3. A longer length of hospital stay and an ischaemic stroke were predictive of unmatched responses on the two pain scales. Either the RAI or the vertical VAS can be used to measure hemiplegic shoulder pain but further studies are required to identify possible explanations for unmatched responses on the two scales. The ability of participants with stroke to use the VAS requires further investigation.
A standard bed may not always be suitable for some children with learning disabilities and behavioural problems, who might be hyperactive, self-harming and unpredictable. In these circumstances, following a thorough assessment, interventions may be implemented to minimize falls and encourage better sleep patterns for the child. A specialist bed may be a consideration. This article provides an independent assessment of the KayserBed KB CM KR4 from Theraposture: a specialist cot bed with a high-sided bed frame and an electrically operated variable height sleeping platform. It is a robustly made bed, which may be particularly suitable to meet the needs of severely disabled children who exhibit challenging behaviour.
A health needs assessment of people with multiple sclerosis (MS) in Leeds identified the need for information as a priority. An information pack was developed using focus groups and individual interviews undertaken with people with MS, carers and health-care professionals. A second group of people with MS participated in a 6-month evaluation, recording symptoms, quality of life and health status at baseline and follow-up. Usage of the information pack and its suitability was recorded. Fatigue and muscle stiffness were the most commonly reported symptoms (79%). Although quality of life was relatively good at baseline, the progressive group became worse (P <0.05) at follow-up. Participants experiencing problems were more likely to use the information, but the pack was thought to be useful by all participants. Consensus as to when it should be given to the newly diagnosed could not be reached.
With the advent of intermediate care as a mainstream element of service delivery, it is necessary to review not only the way in which we classify need but also the nature of the workforce that provides care. Currently, services have been developed around clinical diagnosis with access provided through diagnostically-related clinical teams. For the future, the time is ripe to explore new structures that make more effective use of professional skills while focusing on needs-driven care.
This study looked at the value of an information pack for users of a community rehabilitation team that provides services to people with a physical disability. The packs were generally useful to people living in their own homes, but results were less encouraging for those living in nursing homes.
Rehabilitation is all about partnerships; those between clients and therapists (in nursing, medicine and allied health), therapists and therapists, and family and therapists. Without partnerships, rehabilitation becomes one-sided and the strongest person takes the lead – and with clients recovering from illness or trauma, the strongest person isn't likely to be them.
Through-floor lifts are recommended by occupational therapists as an appropriate solution to clients' access problems. This qualitative study aimed to investigate the experiences of a sample of people, under one local authority, who acquired and lived with such a lift.
The focus of this article is support for students with neurological dysfunction in higher education. The University of Southampton's disability service and the students it supports are used as an example to demonstrate some of the possibilities. An indication of the number of people with neurological impairment at the University is provided, as well as some suggestions for ways in which applicants may best be supported. There is also a brief description of the Disabled Students' Allowances, detailing their purpose and application, and information on the systems that may be used to support academic activities, which include equipment, information technology hardware and software and human support systems. The purpose of this article is to inform colleagues who work in neuropsychology and rehabilitation fields of the practical and financial support that may now be available to those people who either return to or commence study in higher education while managing the consequences of a neurological impairment.
Selecting a wheelchair to meet the needs of individual users involves a number of considerations, such as the diagnosis or disability of the person, his or her projected long-term needs and his or her functional ability, size and sitting ability. Many of the current NHS wheelchairs are heavy and cumbersome and in some instances limit the user’s ability to remain independent. Many clients are provided with or purchase a lightweight wheelchair. However, at the budget end of the market, the wheelchairs available offer limited adjustability to meet the changing needs of the user. The Quickie Classic range of lightweight wheelchairs offers a wide range of adjustment, allowing users to purchase a highly adjustable chair at a modest price.
Most people will agree that physical exercise is beneficial to one's health, but how many really take this knowledge seriously? Promotion of health and wellbeing for older people through physical activity is set in the National Service Framework for Older People (Department of Health, 2001.
The control of the spread of infection is a concern not only in health-care associations but in all public and domestic areas. This article describes the effectiveness of BioCote, a unique antimicrobial solution that has been incorporated into the full range of components of ESL Healthcare’s showering equipment. Test results show that BioCote is extremely effective against Aspergillus niger and other commonly found microorganisms by using a chemical agent to inhibit bacterial growth.
A major feature of foundation degrees, which were introduced as a new development in February 2000, is the high proportion of work-based learning and the concept of ‘earn and learn’. Concurrent with this development was the increasing acknowledgement of the need to provide more flexible education for the NHS workforce. A key feature of the development of foundation degrees was employer involvement in the design and delivery of the programmes, which provided an ideal opportunity to develop a health-care programme that met service needs. Bradford University was successful in obtaining funding to develop a foundation degree in health and social care as part of the pilot phase. One particular pathway of this programme was aimed at meeting the needs of rehabilitation assistants. This article describes how the course meets the demands of the modernization agenda and outlines the challenges faced and future developments. Developments are focussed on short course provision for rehabilitation assistants and a certificate in rehabilitation within the foundation degree framework. Additional support for the transition to learning in the University setting will be offered as part of this provision, to promote access to higher education for this valuable sector of the workforce.
This article will describe how occupational therapists in Toronto, Canada, use the Safety Assessment of Function and the Environment for Rehabilitation (SAFER) tool and the SAFER tool manual to conduct home safety assessments and interventions. Interview, observation and task performance are used by therapists to complete the 97-item SAFER tool, which includes intervention strategies such as client and caregiver education. Further developments of the SAFER tool will be briefly described. Key words: occupational therapy, community, environmental safety, assessment, treatment, intervention
This article describes the input of a stroke family support organizer (FSO) service and investigates whether patient needs are directly related to the number and nature of FSO contacts. Patients seen by the FSO for more visits were significantly younger, less disabled before the stroke, more disabled at recruitment and with lower mood than those with fewer contacts. Significant relationships were found between the amount of contact that involved discussion of benefits and knowledge of benefits, and between discussion of physical health and knowledge of prevention of future stroke. The FSO provided useful information about benefits and physical recovery following stroke.
This article aimed to assess the effect that course attendance had made to both personal and service developments by surveying 30 occupational therapists, physiotherapists and engineers who had attended a university-validated level 3 training course on wheelchair prescription and provision for professional practice.
