Top Stroke Rehabil
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There are barriers to providing early physical medicine and rehabilitation (PM&R) in the intensive care unit (ICU). We present a specific model for undertaking quality improvement (QI) projects and a case study focused on QI for early PM&R in the ICU. ⋯ A structured QI model can be applied to implementation of early PM&R in the ICU resulting in markedly improved delirium status, delivery of PM&R, functional mobility, and length of stay.
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To study the perspectives and experiences of stroke survivors and partners of stroke survivors regarding sexual issues and perceived rehabilitation needs. ⋯ Poststroke sexual issues are complex and suggest the need for the development of a biopsychosocial model of education and treatment intervention. Rehabilitation programs need to evaluate the level of training and services provided to address poststroke sexual issues. Development of clinically useful poststroke sexual adjustment assessment tools and interventions is warranted.
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Poststroke Complex Regional Pain Syndrome (CRPS) affects a significant number of moderate to severely impaired stroke survivors. Until recently, advances in the assessment and management of CRPS have been limited due to the lack of a consensus on diagnostic criteria; however, with the development of the International Association for the Study of Pain diagnostic criteria, the medical and scientific communities are poised to make significant strides. Biomechanical factors and microtrauma to the hemiparetic shoulder may have a significant role in the genesis of CPRS, although the exact pathophysiology that links these triggers to the observed disease manifestation remains uncertain. ⋯ There is no definitive treatment for CRPS, and most patients are treated empirically. Nevertheless, there is consensus that the treatment approach should be interdisciplinary with the goals of edema and pain control, maintenance of joint and muscle biomechanics, and functional restoration. As more rigorous clinical trials emerge, the treatment approach will become more rational with selection of interventions based on a specific mechanism or a combination of mechanisms responsible for a given individual's disease manifestation.
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Stroke-related deficits can impede both functional performance and walking tolerance. Individuals with hemiparesis rely on the stronger limb during exercise and functional tasks. The single limb exercise (SLE) intervention was a unique training protocol that focused only on the hemiparetic limb. Our objective was to determine the effect of the SLE intervention on cardiorespiratory fitness parameters. ⋯ These data suggest that SLE training was an effective method for improving oxygen uptake and reducing energy expenditure during submaximal effort. Unilateral exercise focused on the hemiparetic leg may be an effective intervention strategy to consider for stroke rehabilitation.
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This article uses the medium of clinicians' comments and stories to explore their perceptions of therapeutic relationships and how these relationships come to a close at discharge from aphasia therapy. These narratives are drawn from a qualitative, grounded theory study carried out in South Australia and Northern Territory involving semi-structured interviews with 30 speech pathologists. ⋯ Exploration of these narratives is timely because of the increasing emphasis on person-centeredness in rehabilitation, shared decision making, and authentic relationships. This work is important to encourage reflective practice and greater insight into both speech pathologists' professional identities and their therapeutic relationships.