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Woubeshet Ayenew, Emily C. Gathright, Ellen M. Coffey, Amber Courtney, Jodi Rogness and Andrew M. Busch

established psychiatric treatment settings may mitigate some of the access-related barriers to behavior change in SMI populations. Indeed, a behavioral intervention that connected to patients through outpatient psychiatric rehabilitation programs demonstrated promising effects on weight loss 9 and

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Monna Arvinen-Barrow, Damien Clement, Jennifer J. Hamson-Utley, Rebecca A. Zakrajsek, Sae-Mi Lee, Cindra Kamphoff, Taru Lintunen, Brian Hemmings and Scott B. Martin

Context:

Existing theoretical frameworks and empirical research support the applicability and usefulness of integrating mental skills throughout sport injury rehabilitation.

Objective:

To determine what, if any, mental skills athletes use during injury rehabilitation, and by who these skills were taught. Cross-cultural differences were also examined.

Design:

Cross-sectional design.

Setting:

College athletes from 5 universities in the United States and a mixture of collegiate, professional, and recreational club athletes from the United Kingdom and Finland were recruited for this study.

Participants:

A total of 1283 athletes from the United States, United Kingdom, and Finland, who participated in diverse sports at varying competitive levels took part in this study.

Main Outcome Measures:

As part of a larger study on athletes’ expectations of injury rehabilitation, participants were asked a series of open-ended and closed-ended questions concerning their use of mental skills during injury rehabilitation.

Results:

Over half (64.0%) of the sample reported previous experience with athletic training, while 27.0% indicated that they used mental skills during injury rehabilitation. The top 3 mental skills reported were goal setting, positive self-talk/positive thoughts, and imagery. Of those athletes that used mental skills, 71.6% indicated that they felt mental skills helped them to rehabilitate faster. A greater proportion of athletes from the United States (33.4%) reported that they used mental skills during rehabilitation compared with athletes from the United Kingdom (23.4%) and Finland (20.3%). A small portion (27.6%) of the participants indicated that their sports medicine professional had taught them how to use mental skills; only 3% were taught mental skills by a sport psychologist.

Conclusions:

The low number of athletes who reported using mental skills during rehabilitation is discouraging, but not surprising given research findings that mental skills are underutilized by injured athletes in the 3 countries examined. More effort should be focused on educating and training athletes, coaches, and sports medicine professionals on the effectiveness of mental training in the injury rehabilitation context.

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Lance B. Green

The purpose of this treatise is to provide an educational text that (a) cites existing literature supporting a mind-body paradigm for rehabilitation from psychophysiological and psychomotor perspectives, (b) demonstrates the application of imagery techniques within the chronology of an athletic injury, and (c) describes the performance-related criteria to which an athlete can compare his or her progress during rehabilitation. The chronology includes the period of time preceding the injury, the attention given to the athlete immediately following the injury, and the subsequent rehabilitation program leading to the athlete’s return to practice and competition. Examples of imagery experientials are used to illustrate its application throughout the chronology.

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Chih-Hung Chen, Ming-Chang Jeng, Chin-Ping Fung, Ji-Liang Doong and Tien-Yow Chuang

Context:

Whether virtual rehabilitation is beneficial has not been determined.

Objective:

To investigate the psychological benefits of virtual reality in rehabilitation.

Design:

An experimental group underwent therapy with a virtual-reality-based exercise bike, and a control group underwent the therapy without virtual-reality equipment.

Setting:

Hospital laboratory.

Patients:

30 patients suffering from spinal-cord injury.

Intervention:

A designed rehabilitation therapy.

Main Outcome Measures:

Endurance, Borg's rating-of-perceived-exertion scale, the Activation–Deactivation Adjective Check List (AD-ACL), and the Simulator Sickness Questionnaire.

Results:

The differences between the experimental and control groups were significant for AD-ACL calmness and tension.

Conclusion:

A virtual-reality-based rehabilitation program can ease patients' tension and induce calm.

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Andrea Bailey, Nicola Goodstone, Sharon Roberts, Jane Hughes, Simon Roberts, Louw van Niekerk, James Richardson and Dai Rees

Objective:

To develop a postoperative rehabilitation protocol for patients receiving autologous-chondrocyte implantation (ACI) to repair articular-cartilage defects of the knee.

Data Sources:

careful review of both basic science and clinical literature, personal communication with colleagues dealing with similar cases, and the authors’ experience and expertise in rehabilitating numerous patients with knee pathologies, injuries, and trauma.

Data Synthesis:

Postoperative rehabilitation of the ACI patient plays a critical role in the outcome of the procedure. The goals are to improve function and reduce discomfort by focusing on 3 key elements: weight bearing, range of motion, and strengthening.

Conclusions:

The authors present 2 flexible postoperative protocols to rehabilitate patients after an ACI procedure to the knee.

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Fiona McVeigh and Stephen M. Pack

Background:

Research involving long-term follow-up of patients after successful anterior cruciate ligament reconstruction (ACLR) has shown that return-to-sport rates are not as good as would be expected despite many patients’ having normal knee-function scores. The psychological component, specifically fear of reinjury, plays a critical role in determining patients’ return to play and is frequently underestimated. Little is known about the recognition and intervention from the therapist’s perspective.

Aim:

To gain a greater understanding of the views of sports rehabilitators and athletic rehabilitation therapists on recognition of fear of reinjury in clients after ACLR.

Method and Design:

A qualitative approach, consisting of semistructured interviews with a purposive sample of 8 participants, sports rehabilitators, or athletic rehabilitation therapists. This population has been largely unexamined in this context in previous research.

Main Findings:

Thematic analysis yielded 2 main themes: communication and education. Participants discussed the importance of communication in the client–therapist relationship and how it is used in addressing misinformation and fear of reinjury. All participants used education in outlining the rehabilitation pathway and dealing with those providing social support around the client. Issues emerged relating to therapists’ recognition of observable signs of fear of reinjury in the clinical setting. Overall, participants thought that fear of reinjury was not a barrier to return to play after ACLR.

Conclusion:

There is a need for more education of therapists on recognizing fear of reinjury and the appropriate use of psychological intervention skills as a method for dealing with this throughout the rehabilitation process.

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Scott Cheatham, Monique Mokha and Matt Lee

Context:

Hip-resurfacing arthroplasty (HRA) has become a popular procedure in the treatment of hip-joint arthritis in individuals under the age of 65 y. Although the body of literature examining operative procedures has grown, there is a lack of consistent reporting of the effectiveness of an HRA postoperative rehabilitation program. To date, no systematic reviews have evaluated the available evidence on postoperative rehabilitation programs.

Objective:

To evaluate the available evidence on postoperative rehabilitation programs after HRA.

Evidence Acquisition:

A systematic review was conducted according to the PRISMA guidelines. A search of PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar was conducted in April 2014 using the following keywords alone and in combination: postoperative, postsurgical, rehabilitation, physical therapy, programs, hip resurfacing, arthroplasty, and metal-on-metal. The grading of studies was conducted using the PEDro and Oxford Centre for Evidence-Based Medicine scales.

Evidence Synthesis:

The authors identified 648 citations, 4 of which met the inclusion criteria. The qualifying studies yielded 1 randomized control trial, 2 case reports, and 1 case series, for a total of 90 patients. Patients were mostly male (n = 86), had a mean age of 48 ± 5.47 y, and had been physically active before HRA. Postoperative rehabilitation programs varied in length (range 8–24 wk) and consisted of at least 3 phases. The methodology to assess program effects varied, but all 4 studies did measure a combination of function, pain, and quality of life using written questionnaires, with follow-up ranging from 9 mo to 1 y. The most common questionnaire was the Harris Hip Score.

Conclusion:

This review found postoperative rehabilitation programs after HRA to be underinvestigated. Limited results indicate that postoperative rehabilitation programs may be effective in improving gait (stride length, velocity, and cadence), hip range of motion, and pain and function, as measured by questionnaires, but not hip strength.

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Neil Maguire, Paul Chesterton and Cormac Ryan

athlete rehabilitation from a biopsychosocial perspective. 3 This treatment advice is also replicated in the general population, with the National Institute for Health and Care Excellence 4 recommending that pain education be included to improve clinical outcomes. Sports therapy and rehabilitation (STR

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Kathryn A. Webster and Phillip A. Gribble

Context:

Functional rehabilitation is often employed for ankle instability, but there is little evidence to support its efficacy, especially in those with chronic ankle instability (CAI).

Objective:

To review studies using both functional rehabilitation interventions and functional measurements to establish the effectiveness of functional rehabilitation for both postural control and self-reported outcomes in those with CAI.

Evidence Acquisition:

The databases of Medline, SPORTDiscus, and PubMed were searched between the years 1988 and 2008. Inclusion criteria required articles to have used a clinical research trial involving at least 1 functional rehabilitation intervention, have at least 1 outcome measure of function and/or functional performance, and to have used at least 1 group of subjects who reported either repeated lateral ankle sprains or episodes of “giving way.” The term functional was operationally defined as dynamic, closed-kinetic-chain activity other than quiet standing.

Evidence Synthesis:

Six articles met the inclusion criteria. The articles reviewed used multiple functional means for assessment and training, with a wobble board or similar device being the most common. Despite effect sizes being inconsistent for measures of dynamic postural control, all interventions resulted in improvements. Significant improvements and strong effect sizes were demonstrated for self-reported outcomes.

Conclusions:

The reviewed studies using functional rehabilitation interventions and functional assessment tools were associated with improved ankle stability for both postural control and self-reported function, but more studies may be needed with more consistent effect sizes and confidence intervals to make a definitive conclusion.

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Anthony D. J. Webborn, Roslyn J. Carbon and Brian P. Miller

The concept that exercise therapy is an important and integral part of rehabilitation following injury seems to be universally accepted. However, there is little information on athletes' perceptions of understanding their instructions as they relate to the rehabilitation program. A questionnaire study, involving athletes attending a number of multidisciplinary sports injury clinics over a 6-month period, was performed to examine their understanding of the rehabilitation program relating to site, frequency, and repetitions of exercises as well as reason for exercise. Although exercise prescription for injury was assumed to be commonplace, over 150 consultations were observed and only 22 athletes were prescribed rehabilitation exercises (a total of 56 exercises). Seventy-eight percent of these athletes misunderstood some aspect of their programs, although they did not perceive a problem with their instructions. Written instructions were used infrequently (14%), but when used they significantly improved the athletes' understanding. Since rehabilitation adherence is a problem, athletes should receive adequate explanation and written instructions to ensure that the program is followed correctly. Factors affecting treatment adherence are also discussed.