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Andersen J.C.,University of Alberta | Majnemer A.,McGill University | O'Grady K.,Glenrose Rehabilitation Hospital | Gordon A.M.,Columbia University
Seminars in Pediatric Neurology | Year: 2013

For children with hemiplegic cerebral palsy, bimanual abilities are central to independent function. Over the last decade, considerable attention has been given to 2 forms of extended practice therapy for the upper limb, constraint-induced movement therapy and intensive bimanual training. This article reviews the varying nature of these 2 approaches and the existing scientific rationale supporting them. Comparisons between these 2 intensive upper extremity training approaches indicate similar improvements in unimanual capacity and bimanual performance outcomes; however, when considering participant and caregiver goal achievement, evidence favors a bimanual approach. Careful selection of either therapy for this population requires consideration of individual and contextual factors in relation to treatment goals. The key ingredients and dose responses remain unknown. Treatment intensity, intrinsic motivation, and individualization of treatment are hypothesized as requisite in either approach. © 2013 Elsevier Inc.

Padwal R.S.,University of Alberta | Wang X.,University of Alberta | Sharma A.M.,University of Alberta | Dyer D.,Glenrose Rehabilitation Hospital
Journal of Obesity | Year: 2012

Background and Objective. The purpose of this retrospective observational study was to examine the influence of severe obesity on length of stay (LOS), rehabilitation efficiency, and hospital costs post-acute rehabilitation in a population-based, tertiary care, publicly-funded regional rehabilitation center. Participants. 42 severely obese subjects (mean age 53 y; mean BMI 50.9 kg/m2) and 42 nonobese controls (mean age 59 y; mean BMI 23.0 kg/m2) matched by sex and admitting diagnosis. Main Outcome Measures. Total LOS, rehab LOS, waiting for transfer LOS, Fuctional Independence Measure (FIM) efficiency, and hospital costs. Results. Compared to controls, severely obese subjects experienced longer total LOS (98.4 vs. 37.4 days; P=0.03), rehabilitation LOS (55.8 vs. 37.4 days; P=0.04), and waiting for transfer LOS (42.6 vs. 0 days; P=0.006); increased hospital costs ($115,822 vs. $43,969; P=0.03); and similar FIM efficiency (0.58 vs. 0.67; P=0.27). Severe obesity was an independent predictor of total LOS (beta-coefficient 0.51; P=0.03), rehab LOS (0.46; P=0.02) but not FIM efficiency (-0.63; P=0.06). Conclusion. Severe obesity adversely affects rehabilitation LOS and expenditures. Targeted interventions in severely obese individuals to optimize post-acute rehabilitation care delivery are needed. © 2012 Raj S. Padwal et al.

Aston M.,Dalhousie University | Breau L.,Glenrose Rehabilitation Hospital | MacLeod E.,Dalhousie University
Journal of Intellectual Disabilities | Year: 2014

Effective and therapeutic relationships between health care providers and clients are important elements for positive health outcomes. Children with intellectual disabilities (IDs) and their parents face unique challenges in establishing relationships with health care providers due to social and institutional stigma and stereotypes associated with children with IDs. In this article, we discuss the theme of building relationships in a hospital setting that emerged from a qualitative feminist poststructuralist study conducted in Canada with 8 children with IDs, 17 mothers, and 12 nurses who cared for them. Our research provides examples of how nurses and mothers worked in and through the system sometimes with frustration but also sometimes with positive excitement to develop supportive relationships. We can learn from these moments of tension and moments of success about how to work together to ensure positive relationships are provided to children with IDs, their parents, and health care professionals. © The Author(s) 2014.

Clark B.G.,University of Alberta | Magill-Evans J.E.,University of Alberta | Koning C.J.,Glenrose Rehabilitation Hospital
Focus on Autism and Other Developmental Disabilities | Year: 2015

Quality of life (QoL) for persons with Autism Spectrum Disorders (ASD) and factors associated with QoL are not well understood. Prior literature has relied on parent-report though this is changing. It may be important to consider both parent-reported QoL and self-report. This study explored QoL in 22 Canadian adolescents (3 girls, 19 boys) ages 13 to 18 years (M = 15.2 years). Adolescents completed the 10 subscales of the KIDSCREEN-52, a standardized questionnaire, while their parents completed the proxy form of the measure and the Adaptive Behavior Assessment System-II. Both parents and adolescents reported mean QoL scores in the lower average range. Intra-class correlation coefficients between parent and self-report were similar to adolescents without special needs except for four subscales. Correlations between QoL and the General Adaptive Composite score were remarkably low. Adolescents with ASD respond differently from their parents in some areas and both reports should be considered. © Hammill Institute on Disabilities 2014.

Vieira E.R.,Florida International University | Freund-Heritage R.,Glenrose Rehabilitation Hospital | Da Costa B.R.,University of Bern
Clinical Rehabilitation | Year: 2011

Objective: To review the literature to identify and synthesize the evidence on risk factors for patient falls in geriatric rehabilitation hospital settings.Data sources: Eligible studies were systematically searched on 16 databases from inception to December 2010.Review methods: The search strategies used a combination of terms for rehabilitation hospital patients, falls, risk factors and older adults. Cross-sectional, cohort, case-control studies and randomized clinical trials (RCTs) published in English that investigated risks for falls among patients ?65 years of age in rehabilitation hospital settings were included. Studies that investigated fall risk assessment tools, but did not investigate risk factors themselves or did not report a measure of risk (e.g. odds ratio, relative risk) were excluded.Results: A total of 2,824 references were identified; only eight articles concerning six studies met the inclusion criteria. In these, 1,924 geriatric rehabilitation patients were followed. The average age of the patients ranged from 77 to 83 years, the percentage of women ranged from 56% to 81%, and the percentage of fallers ranged from 15% to 54%. Two were case-control studies, two were RCTs and four were prospective cohort studies. Several intrinsic and extrinsic risk factors for falls were identified.Conclusion: Carpet flooring, vertigo, being an amputee, confusion, cognitive impairment, stroke, sleep disturbance, anticonvulsants, tranquilizers and antihypertensive medications, age between 71 and 80, previous falls, and need for transfer assistance are risk factors for geriatric patient falls in rehabilitation hospital settings. © The 2011 Author(s).

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