Time Use of Stroke Patients With Stroke Admitted for Rehabilitation in Skilled Nursing Facilities.

Time Use of Stroke Patients with Stroke Admitted for Rehabilitation in Skilled Nursing Facilities.

Rehabil Nurs. 2013 May 29;
Vermeulen CJ, Buijck BI, van der Stegen JC, van Eijk MS, Koopmans RT, Hafsteinsdóttir TB

PURPOSE: To describe the time use of patients with stroke in five Skilled Nursing Facilities (SNFs) in the Netherlands, focusing on the time spent on therapeutic activities, nontherapeutic activities, interaction with others, and the location where the activities took place. Evidence suggest that task-oriented interventions are the most effective for patients with stroke and that some of these interventions are relevant and feasible for use by nurses. The question arises to what extent elderly patients who had a stroke and rehabilitate in a SNF receive therapeutic training and engage in therapeutic activities. DESIGN: Descriptive, observational design. Therapeutic and nontherapeutic activities of patients were observed at 10-minute intervals during one weekday (8 a.m.-4:30 p.m.) using behavioral mapping. FINDINGS: Forty-two patients with stroke with a mean age of 76 years participated in the study. The patients spent 56% of the day on therapeutic activities, whereas 44% of the day was spent on nontherapeutic activities. Most therapeutic time was spent on nursing care (9%) and physical therapy (4%). Patients stayed an average 41% of the day in their own room and were alone 49% of the day. Therapeutic time use was significantly related to improved functional status, patients with higher functional status spent more time on therapeutic activities. CONCLUSION: Patients spent more than half of the day on therapeutic activities. CLINICAL RELEVANCE: Nurses are faced with the challenge of activating patients with stroke and to assist them to engage in purposeful task-oriented exercises including daily activities. Thereby better rehabilitation results and recovery of patients may be reached. HubMed – rehab

Transitioning Home: Comprehensive Case Management for America’s Heroes.

Rehabil Nurs. 2013 May 29;
Perla LY, Jackson PD, Hopkins SL, Daggett MC, Van Horn LJ

PURPOSE: The conflicts in Afghanistan and Iraq, also known as Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn, have created unique challenges for rehabilitation teams, including nurse and social work case managers. Active duty service members, National Guard and Reservists have deployed in large numbers and as many as 20% have been exposed to blast injury, which can result in polytrauma and traumatic brain injury, the “signature injury” of the war, as well as psychological trauma, and painful musculoskeletal injuries. In addition, there are also documented emotional injuries associated with the constant stress of war and the frequency of exposure to the graphic scenes of war. FINDINGS/CONCLUSIONS: The Departments of Defense and Veterans Affairs work closely to provide comprehensive care coordination and case management for service members and veterans who have honorably served our country. This article describes the case management collaborative between Veterans Affairs and the Department of Defense that ensures service members and veterans receive their entitled healthcare services. CLINICAL RELEVANCE: The complex care needs of these returning service members require astute case management in addition to clinical care. This collaboration ensures the best life-long outcomes and will be discussed in detail in this article. HubMed – rehab

The Control of Movement Following Traumatic Brain Injury.

Compr Physiol. 2013 Jan 1; 3(1): 121-139
Kozlowski DA, Leasure JL, Schallert T

Traumatic brain injury (TBI) results in a variety of impairments in cognition, mood, sensation, and movement, depending upon the location and severity of injury. Although not as extensively studied as cognitive impairments, motor impairments are common, especially in moderately to severely injured patients. The recovery of these deficits is not usually complete; however, extensive effort is put into the rehabilitation of motor skills to enhance independence and quality of life. Understanding the motor recovery process and how it can be influenced by rehabilitation has been extensively studied in animal models of stroke and focal lesions, albeit to a lesser extent following animal models of TBI. Injury-induced neural plasticity is intricately involved in motor recovery and influenced by behavioral compensation and rehabilitation following stroke and focal lesions. New studies in animal models of TBI indicate that neural plasticity and the processes of motor recovery and rehabilitation following brain injury may not mirror those processes shown to occur following stroke. Further examination of motor recovery, rehabilitation, and plasticity in animal models of TBI as well as in individuals with TBI will be necessary to fully understand the control of movement following brain injury. © 2013 American Physiological Society. Compr Physiol 3:121-139, 2013. HubMed – rehab