Background: Stroke rehabilitation professionals have historically focused rehabilitation on physical functions and overlooked the concept of community reintegration after discharge from inpatient rehabilitation. The l...Background: Stroke rehabilitation professionals have historically focused rehabilitation on physical functions and overlooked the concept of community reintegration after discharge from inpatient rehabilitation. The lack of focus on psychosocial functions post-stroke may lead to lower levels of satisfaction during community reintegration. Methods: This integrative review synthesized findings from research literature on stroke patients’ reintegration into the community after inpatient rehabilitation to address three research questions: a) What specific physical and psychosocial functions have been identified as predictors of successful reintegration into normal living after stroke?, b) How do physical and psychosocial functions promote successful reintegration into normal living after stroke?, and c) What factors have been identified that hinder stroke patients’ reintegration into normal living after stroke? Results: A systematic search of literature identified sixteen studies that provided significant context for the research questions. What physical and psychosocial functions of stroke patients included, for example, improved mobility, independence in daily activities, reduced disability, psychological well-being, self-efficacy, social support, and personal relationships. How physical and psychosocial functions promote reintegration included, for example, disability management, emotional well-being, self-care independence, sense of purpose, and employment influence. Factors that hinder stroke patients’ reintegration consisted of longer stride time, impaired balance/mobility, activities limitation, severe stroke, presence of comorbidity, depressive symptoms, speech and language challenges, inadequate self-efficacy, fear of falling, older age, low educational level, lack of social support, and social isolation. Conclusion: Successful community reintegration after stroke requires a shift of focus from rehabilitation interventions that target physical functions to include interventions that address psychosocial functions.展开更多
Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury...Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function.Methods/design: The COMPASSgoal(Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community reintegration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management(intervention) and supported discharge(control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up.Discussion: Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.展开更多
文摘Background: Stroke rehabilitation professionals have historically focused rehabilitation on physical functions and overlooked the concept of community reintegration after discharge from inpatient rehabilitation. The lack of focus on psychosocial functions post-stroke may lead to lower levels of satisfaction during community reintegration. Methods: This integrative review synthesized findings from research literature on stroke patients’ reintegration into the community after inpatient rehabilitation to address three research questions: a) What specific physical and psychosocial functions have been identified as predictors of successful reintegration into normal living after stroke?, b) How do physical and psychosocial functions promote successful reintegration into normal living after stroke?, and c) What factors have been identified that hinder stroke patients’ reintegration into normal living after stroke? Results: A systematic search of literature identified sixteen studies that provided significant context for the research questions. What physical and psychosocial functions of stroke patients included, for example, improved mobility, independence in daily activities, reduced disability, psychological well-being, self-efficacy, social support, and personal relationships. How physical and psychosocial functions promote reintegration included, for example, disability management, emotional well-being, self-care independence, sense of purpose, and employment influence. Factors that hinder stroke patients’ reintegration consisted of longer stride time, impaired balance/mobility, activities limitation, severe stroke, presence of comorbidity, depressive symptoms, speech and language challenges, inadequate self-efficacy, fear of falling, older age, low educational level, lack of social support, and social isolation. Conclusion: Successful community reintegration after stroke requires a shift of focus from rehabilitation interventions that target physical functions to include interventions that address psychosocial functions.
基金supported by Merit Review Award#I 01 RX000637-01A3 from the United States Department of Veterans Af airs Rehabilitation Research and Development Service Programsupport for the preparatory phase of the project was provided through the Med Star Health Research Institute,a component of the Georgetown Howard Universities Center for Clinical and Translational Sciencesupported by Grant U54 RR026076-01 from the National Center for Research Resources,a component of the National Institutes of Health
文摘Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function.Methods/design: The COMPASSgoal(Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community reintegration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management(intervention) and supported discharge(control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up.Discussion: Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.
