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Jessica J. DeGaetano, Andrew T. Wolanin, Donald R. Marks and Shiloh M. Eastin

The purpose of this study was to explore the influence of psychosocial factors and psychological flexibility on rehabilitation protocol adherence in a sample of injured collegiate athletes. Self-report measures were given to injured athletes before the start of a physical rehabilitation protocol. Upon completion of rehabilitation, each athlete was assessed by the chief athletic trainer using a measure of rehabilitation adherence. Correlational analyses and bootstrapped logistic regression analyses were conducted to determine whether broad psychosocial factors and level of psychological flexibility predicted engagement and adherence to a rehabilitation protocol. Psychological flexibility, as measured on the Acceptance and Action Questionnaire (2nd ed.; Bond et al., 2011), contributed significantly to the overall logistic regression model. Study findings suggested that assessment of psychological flexibility could give medical providers a way to evaluate both quickly and quantitatively potentially problematic behavioral responding among injured athletes, allowing for more effective adherence monitoring.

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Peggy A. Houglum

When soft tissue is injured, it must follow a complex healing process. The sports medicine specialist delivering care to an injured athlete should have an appreciation and understanding of the phases and timing of the healing process so that appropriate, efficient, and effective rehabilitation program may be established. This paper presents an overview of the chemical and cellular activity involved in soft tissue healing, with emphasis on those aspects that can be affected by a rehabilitation program. Outside factors commonly used in sports injury care and how they may influence tissue healing are addressed. Guidelines are presented for establishing a sports rehabilitation program based on the physiological effects of the healing process. Various aspects of a rehabilitation program must be carefully coordinated with the timing of tissue healing and designed in a logical sequence to permit successful rehabilitation of the injured athlete in an optimal and efficient manner.

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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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Lynne Evans and Lew Hardy

There is an increasing awareness within the sport-related literature of the importance of psychological factors in the rehabilitation of injured athletes. This awareness and subsequent investigations have led to the proposed application of grief response models to injury. However, to date limited attention has been paid to the clinical psychology literature on grief. The purpose of this paper is to redress this oversight by providing a review of the most relevant literature on the psychological responses of injured athletes in light of the philosophical and empirical research into loss and grief in the clinical literature. As a result of this review, a number of issues are raised for future research into grief models of injury.

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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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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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Barıs Seven, Gamze Cobanoglu, Deran Oskay and Nevin Atalay-Guzel

and researchers information about effectiveness of their rehabilitation protocol or helps diagnosis of various neuromuscular and somatosensorial disorders. 4 , 5 One of the frequently used methods is manual muscle testing because it is easy and fast to use in clinics. However, it is a subjective

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Diane M. Wiese-Bjornstal, Kristin N. Wood, Andrew C. White, Amanda J. Wambach and Victor J. Rubio

response to the sport injury and rehabilitation process posits and research supports that sport injuries are stressful life events triggering the use of a wide variety of coping strategies, including R/S coping ( Wiese-Bjornstal et al., 1998 ). Within this model, personal factors such as religious

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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.