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Yuen HK, Spicher HS, Semon MR, Winwood LM, Dudgeon BJ. Perceptions of Occupational Therapists on the Patient Protection and Affordable Care Act: Five Years After Its Enactment. Occup Ther Health Care 2017; 31:84-97. [PMID: 28094586 DOI: 10.1080/07380577.2016.1270480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study explored the perceptions of occupational therapists regarding the impact and implications of the Patient Protection and Affordable Care Act (PPACA or ACA) on occupational therapy practice. Fifteen occupational therapists participated in an interview to answer open-ended questions related to their thoughts and perceptions regarding the impact and implications of the ACA on their practice. The participants were practicing in eight different states and worked in five different settings with clinical experience ranging from 3 to 38 years; their positions ranged from staff therapist to owner of a free-standing outpatient clinic. Qualitative content analysis was used to synthesize the interview transcripts. Results showed that therapists did not have sufficient knowledge on the various mandates and provisions of the ACA, or were uncertain about what implications the ACA would have on practice, with the ACA affecting some settings more than others. Data revealed the perceived impacts of the ACA on occupational therapy practice include greater attention on documenting outcome-focused care, external accountability pressures on productivity, conscientiousness about clients' insurance coverage, uncertainty about collaborative care delivery, and survival of small businesses. Findings suggest training regarding knowledge about and implications of different elements of the ACA is needed as well as practices needing to promote the services that occupational therapists can provide to improve cost-effectiveness and outcomes in collaborative care environments.
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Affiliation(s)
- Hon K Yuen
- a Department of Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Hillary S Spicher
- a Department of Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Madelyn R Semon
- a Department of Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Leah M Winwood
- a Department of Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Brian J Dudgeon
- a Department of Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
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Smith K, Neville-Jan A, Freeman KA, Adams E, Mizokawa S, Dudgeon BJ, Merkens MJ, Walker WO. The effectiveness of bowel and bladder interventions in children with spina bifida. Dev Med Child Neurol 2016; 58:979-88. [PMID: 26992042 DOI: 10.1111/dmcn.13095] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/27/2022]
Abstract
AIM Using the World Health Organization International Classification of Functioning, Disability and Health (ICF), the aim of this study was to identify effective strategies for managing urinary and bowel complications resulting from spina bifida. METHOD Charts of 210 children between 4- and 13-years-old with spina bifida were reviewed to quantify medical interventions and continence status. Standardized quality of life (QOL) questionnaires were administered to a subset of participants; child and parent interviews were carried out to examine the experience of living with bowel and bladder incontinence. Practitioners were also interviewed to understand their perspectives of intervention effectiveness. RESULTS Chart review indicated less than half of children were continent for bowel and bladder. More variability existed in bowel continence programs, and practitioners considered bowel continence more difficult to achieve than bladder continence. No significant associations were found between continence status and QOL measures. Interviews, however, reflected how managing continence at home and school more broadly affects QOL. Among practitioners, some focused primarily on optimizing physical health while others focused on activity and participation. INTERPRETATION While continence is a goal, programs used to achieve this are individualized and outcomes may be affected by differential treatment effects, environmental factors, and/or stigma experienced by children.
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Affiliation(s)
- Kathryn Smith
- Clinical Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
| | - Ann Neville-Jan
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Kurt A Freeman
- Department of Pediatrics and Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth Adams
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | | | - Brian J Dudgeon
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark J Merkens
- Division of Developmental Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - William O Walker
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Dudgeon BJ. Understanding Habits in Context: A Perspective from a Person with a Disability. OTJR: Occupation, Participation and Health 2016. [DOI: 10.1177/15394492020220s123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Burns M, Baylor C, Dudgeon BJ, Starks H, Yorkston K. Asking the Stakeholders: Perspectives of Individuals With Aphasia, Their Family Members, and Physicians Regarding Communication in Medical Interactions. Am J Speech Lang Pathol 2015; 24:341-57. [PMID: 25760479 DOI: 10.1044/2015_ajslp-14-0051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 02/17/2015] [Indexed: 05/15/2023]
Abstract
PURPOSE The purpose of this study was to explore the experiences of patients with aphasia, their family members, and physicians related to communication during medical interactions. METHOD Face-to-face, semistructured interviews were conducted with 18 participants—6 patients with aphasia, 6 family members involved in patient care, and 6 practicing physicians. A qualitative description approach was used to collect and summarize narratives from participants' perspectives and experiences. Participants were asked about experiences with communication during medical interactions in which the family member accompanied the patient. Interviews were audio- and/or video-recorded, transcribed, and then coded to identify main themes. RESULTS Patients and family members generally described their communication experiences as positive, yet all participants discussed challenges and frustrations. Three themes emerged: (a) patients and family members work as a team, (b) patients and family members want physicians to "just try" to communicate with the patient, and (c) physicians want to interact with patients but may not know how. CONCLUSIONS Participants discussed the need for successful accommodation, or changing how one communicates, to help facilitate the patients' increased understanding and ability to express themselves. Over- and underaccommodation with communication were commonly reported as problems. Speech-language pathologists have a role to play in helping to improve communication during medical interactions. Implications for current speech-language pathologist practice and future directions of research are discussed.
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Donoso Brown EV, Dudgeon BJ, Gutman K, Moritz CT, McCoy SW. Understanding upper extremity home programs and the use of gaming technology for persons after stroke. Disabil Health J 2015; 8:507-13. [PMID: 25953349 DOI: 10.1016/j.dhjo.2015.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 02/01/2015] [Accepted: 03/13/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Many persons post-stroke continue to have difficulty using their more involved upper extremity and home programs may be poorly adhered to limiting the amount of practice an individual receives. More information on the experience of traditional home program and the acceptability of a novel home intervention was sought. OBJECTIVE To qualitatively describe 1) upper extremity use at home, 2) previous home exercise or activity programs, and 3) the acceptability of a novel upper extremity home program, NeuroGame Therapy (NGT), that combines surface electromyography (sEMG) biofeedback and a commercial computer game. METHODS A purposeful sample of ten persons with moderate to severe upper extremity motor impairment used the NGT intervention in their home for four weeks and completed nested (pre and post) one-on-one interviews. Written transcripts from the interviews were coded and themes were identified to address stated objectives. RESULTS Participants reported that while use of their upper extremity in daily activities was recommended it occurred infrequently. Most participants described previous home programs as being non-specific, were often not carried out as recommended or were self-modified. Participants found NGT to be engaging and motivating, but reported minimal changes in the functional uses of their upper extremity. CONCLUSION These findings suggest that after stroke upper extremity use may be infrequent and home program approaches could be re-examined. NGT was reported to be an acceptable home intervention, but it will require further development and study to understand its value and role in post-stroke rehabilitation.
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Affiliation(s)
- Elena V Donoso Brown
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA; Duquesne University, Department of Occupational Therapy, Rangos School of Health Sciences, 600 Forbes Ave, Pittsburgh, PA 15282, USA.
| | - Brian J Dudgeon
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA; University of Alabama at Birmingham, Department of Occupational Therapy, School of Health Professions, SHPB 353, 1720 2nd Ave South, Birmingham, AL 35294-1212, USA
| | - Karli Gutman
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA
| | - Chet T Moritz
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA; University of Washington, School of Medicine, Department of Physiology & Biophysics, 1959 N.E. Pacific St., Seattle, WA 98195, USA
| | - Sarah Westcott McCoy
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA
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Abstract
BACKGROUND Stroke survivors experience sensory impairments that significantly limit upper-limb functional use. Lack of clear research-based guidelines about their management exacerbates the uncertainty in occupational therapists' decision making to support these clients. PURPOSE This study explores occupational therapists' clinical decision making regarding upper-limb, post-stroke sensory impairments that can ultimately inform approaches to support therapists working with such clients. METHOD Twelve therapists participated in a qualitative descriptive study. Transcripts of semi-structured interviews were analyzed using content analysis. FINDINGS Three overarching categories were identified: deciding on the focus of interventions (describing intervention choices), it all depends (outlining factors considered when choosing interventions), and managing uncertainty in decision making (describing uncertainty and actions taken to resolve it). IMPLICATIONS Providing training about post-stroke sensory impairment and decision making may improve therapists' decision making and ultimately improve client outcomes. Further research is needed to understand the impact of uncertainty on occupational therapy decision making and resulting care practices.
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Kaminsky TA, Mitchell PH, Thompson EA, Dudgeon BJ, Powell JM. Supports and barriers as experienced by individuals with vision loss from diabetes. Disabil Rehabil 2013; 36:487-96. [DOI: 10.3109/09638288.2013.800592] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cook KF, Dunn W, Griffith JW, Morrison MT, Tanquary J, Sabata D, Victorson D, Carey LM, Macdermid JC, Dudgeon BJ, Gershon RC. Pain assessment using the NIH Toolbox. Neurology 2013; 80:S49-53. [PMID: 23479545 DOI: 10.1212/wnl.0b013e3182872e80] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Pain is an important component of health and function, and chronic pain can be a problem in its own right. The purpose of this report is to review the considerations surrounding pain measurement in the NIH Toolbox, as well as to describe the measurement tools that were adopted for inclusion in the NIH Toolbox assessment battery. METHODS Instruments to measure pain in the NIH Toolbox were selected on the basis of scholarly input from a diverse group of experts, as well as review of existing instruments, which include verbal rating scales, numerical rating scales, and graphical scales. RESULTS Brief self-report measures of pain intensity and pain interference were selected for inclusion in the core NIH Toolbox for use with adults. A 0 to 10 numerical rating scale was recommended for measuring pain intensity, and a 6-item Patient Reported Outcome Measurement Information System (PROMIS) short form for measuring pain interference. The 8-item PROMIS Pediatric Pain Interference measure was recommended as a supplemental measure. No specific measure was recommended for measuring pain intensity in children. CONCLUSIONS Core and supplemental measures were recommended for the NIH Toolbox. Additional measures were reviewed for investigators who seek tools for measuring pain intensity in pediatric samples.
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Morris MA, Dudgeon BJ, Yorkston K. A qualitative study of adult AAC users’ experiences communicating with medical providers. Disabil Rehabil Assist Technol 2013; 8:472-81. [DOI: 10.3109/17483107.2012.746398] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE To assess the content, format, and comprehension of the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric physical function related to mobility items for children who use wheelchairs (WCs). METHODS During a cognitive interview, 14 children, aged 8 to 12 years, who use WCs, verbalized their thoughts when answering PROMIS items. The questionnaire appraisal system was used to code summarized text from the interviews. RESULTS The children requested items be more specific and include options for reporting adaptive ways of performing and participating. How they would answer the item depended on the situation and specific environmental supports and constraints they may have experienced. CONCLUSIONS As rehabilitation professionals develop and use self-reported outcome measures, they should explore what is important to children who use WCs regarding their views on physical functioning, the influences of the environment, and variability in the use of devices to assist with functional mobility.
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Affiliation(s)
- Cheryl I Kerfeld
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle 98195, USA.
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Bamer AM, Connell FA, Dudgeon BJ, Johnson KL. Frequency of purchase and associated costs of assistive technology for Washington State Medicaid program enrollees with spina bifida by age. Disabil Health J 2010; 3:155-61. [DOI: 10.1016/j.dhjo.2009.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 10/26/2009] [Accepted: 10/27/2009] [Indexed: 11/29/2022]
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Yorkston KM, Baylor CR, Dietz J, Dudgeon BJ, Eadie T, Miller RM, Amtmann D. Developing a scale of communicative participation: A cognitive interviewing study. Disabil Rehabil 2009; 30:425-33. [DOI: 10.1080/09638280701625328] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chan L, Ciol MA, Shumway-Cook A, Yorkston KM, Dudgeon BJ, Asch SM, Hoffman JM. A longitudinal evaluation of persons with disabilities: does a longitudinal definition help define who receives necessary care? Arch Phys Med Rehabil 2008; 89:1023-30. [PMID: 18503795 DOI: 10.1016/j.apmr.2007.10.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 10/19/2007] [Accepted: 10/30/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess, using a longitudinal definition, the impact of disability on a broad range of objective health care quality indicators. DESIGN Longitudinal cohort study following up with patients over several years. The first 2 interviews, 1 year apart, were used to determine each patient's disability status in activities of daily living (ADLs). Assessment of the health care indicators commenced after the second interview and continued throughout the survey period (an additional 1-3y). SETTING National survey. PARTICIPANTS Participants (N=29,074) of the Medicare Current Beneficiary Survey (1992-2001) with no, increasing, decreasing, and stable ADL disability. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The incidence of 5 avoidable outcomes, receipt of 3 preventive care measures, and adherence to 32 diagnostically based indicators assessing the quality of treatment for acute myocardial infarction [AMI], angina, breast cancer, cerebrovascular accident, transient ischemic attack, cholelithiasis, chronic obstructive pulmonary disease [COPD], congestive heart failure, depression, gastrointestinal bleeding, diabetes, and hypertension. RESULTS For most indicators, less than 75% of eligible patients received necessary care, regardless of disability status. For 5 indicators, less than 50% of patients received appropriate treatment. In a logistic regression analysis that controlled for patient age, sex, race, and income, disability status was a significant factor in 7 quality measures (AMI, breast cancer, COPD, diabetes, angina, pneumonia, annual visits). CONCLUSIONS Using a longitudinal definition of disability and objective health quality indicators, we found that disability status can be an important factor in determining receipt of quality health care in a broad range of diagnostic categories. However, the impact of disability status varies depending on the indicator measured. In this cohort of patients, the changing nature of a person's disability seems to have less impact than whether they ever have had any functional deficits.
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Affiliation(s)
- Leighton Chan
- Rehabilitation Medicine Department, Clinical Research Center, National Institutes of Health, Bethesda, MD 20892-1604, USA.
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Abstract
OBJECTIVES To examine racial and ethnic disparities in mobility limitation, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) in older adults enrolled in Medicare. DESIGN Longitudinal national survey. PARTICIPANTS Community-dwelling respondents in the Medicare Current Beneficiaries Survey from 1992 to 2004 (10,180-16,788 respondents per year). MEASUREMENTS Disability-related outcomes included mobility limitation, difficulty in six ADLs and six IADLs. Explanatory variables included age, sex, racial or ethnic group, living situation, and income level. RESULTS From 1992 to 2004, proportions of Medicare beneficiaries with mobility limitations were stable across racial and ethnic groups, improving slightly for ADLs and IADLs. Blacks reported more limitations in all three disability-related measures. In a longitudinal analysis, the probability of developing mobility limitation was consistently higher for blacks, followed by white Hispanics, white non-Hispanics, and Asians, after adjusting for age, sex, socioeconomic status, and living situation. For ADL and IADL difficulties, the number of reported difficulties increased with age for all ethnic and racial groups. At approximately age 75, Asians and white Hispanics reported difficulties with much higher numbers of ADLs and IADLs than the other groups. CONCLUSION Across all ethnic and racial groups, self-reported disability has declined in the past decade, but even after adjusting for age, sex, socioeconomic status, and living situation, racial and ethnic disparities in disability outcomes persist. Race and ethnicity may influence the reporting of disability, potentially affecting measures of prevalence. Further research is needed to understand whether these differences are a result of perceptions related to disablement or true differences in disability between racial and ethnic groups.
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Affiliation(s)
- Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Yorkston KM, Baylor CR, Klasner ER, Deitz J, Dudgeon BJ, Eadie T, Miller RM, Amtmann D. Satisfaction with communicative participation as defined by adults with multiple sclerosis: a qualitative study. J Commun Disord 2007; 40:433-51. [PMID: 17125785 DOI: 10.1016/j.jcomdis.2006.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Revised: 10/23/2006] [Accepted: 10/25/2006] [Indexed: 05/12/2023]
Abstract
PURPOSE This study examined satisfaction with communicative participation as reported by adults with multiple sclerosis (MS). METHOD Eight community-dwelling adults with MS participated in semi-structured interviews. They were asked to discuss their satisfaction with their communication in a variety of situations. Interviews were analyzed using a constant comparative method of qualitative description. RESULTS Themes derived included: Comfort, consisting of Ease and Confidence; Success of the Outcome, including Function is Achieved and A Connection is Made; and Personal Meaning of Participation, including Personal Preferences, Comparison with the Past, and Thinking about One's Own Communication. CONCLUSIONS Participants described multiple facets of satisfaction with communicative participation. Some of the dimensions were similar to those in existing assessment instruments such as levels of ease or difficulty with performance. Participants did not talk about frequency of activities as a key part of their satisfaction. Implications for identifying intervention targets and treatment outcome measurements are provided. LEARNING OUTCOMES The reader should be able to: 1) define communicative participation and identify key elements of this construct; 2) identify the issues that were most relevant to satisfaction with communicative participation with participants with MS; and 3) identify reasons for greater emphasis on the subjective viewpoint of people with communication disorders in measurement of treatment outcomes.
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Affiliation(s)
- Kathryn M Yorkston
- Department of Rehabilitation Medicine, University of Washington, Box 356490, Seattle, WA 98195-6490, USA.
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Hoffman JM, Shumway-Cook A, Yorkston KM, Ciol MA, Dudgeon BJ, Chan L. Association of mobility limitations with health care satisfaction and use of preventive care: a survey of Medicare beneficiaries. Arch Phys Med Rehabil 2007; 88:583-8. [PMID: 17466726 DOI: 10.1016/j.apmr.2007.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the association between satisfaction with health care, the use of preventive health care, and mobility limitation. DESIGN Cross-sectional analysis of survey data. SETTING Community. PARTICIPANTS A total of 12,769 people, age greater than 65, who participated in the 2001 Medicare Current Beneficiary Survey. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-report of mobility limitation, satisfaction, and use of preventive health care (immunizations, cancer screening). Sampling weights were used in all analyses, including logistic regression for survey data, to calculate estimates for a Medicare population of 31 million. RESULTS After controlling for sociodemographic characteristics, Medicare beneficiaries with mobility limitations were significantly more dissatisfied with their health care compared with beneficiaries without mobility limitations. Receipt of preventive care did not differ for those with and without mobility limitation on some preventive services. CONCLUSIONS Mobility limitation is highly associated with dissatisfaction with health care among older adult beneficiaries. Although Medicare beneficiaries may receive similar rates of preventive care, those with mobility limitation may have more difficulty accessing services and be more dissatisfied with their health care in general.
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Affiliation(s)
- Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195-6490, USA.
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Abstract
Lymphedema is a chronic medical condition caused by lymphatic insufficiency that can lead to extreme swelling and susceptibility to infection. Physical and psychosocial effects of the condition can have a significant impact on an individual's life and level of participation. Research about experiences of individuals living with lymphedema has focused primarily on women with breast cancer, yet individuals with non-cancer-related lymphedema are a distinct group. In this study, the authors used qualitative description to explore the experience of 7 individuals living with advanced and complicated cases of lymphedema who had been treated in an inpatient setting. Findings reveal the extensive impact lymphedema has on those who live with it. Participants spoke of difficulty finding a correct diagnosis and effective treatment, the importance of their inpatient experiences, and the challenges of daily self-management. The authors make recommendations to increase lymphedema awareness, promote inpatient treatment programs, and create effective self-management techniques.
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Affiliation(s)
- Lisa K Bogan
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
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Kaminsky TA, Dudgeon BJ, Billingsley FF, Mitchell PH, Weghorst SJ. Virtual cues and functional mobility of people with Parkinsons disease: A single-subject pilot study. ACTA ACUST UNITED AC 2007; 44:437-48. [DOI: 10.1682/jrrd.2006.09.0109] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Eadie TL, Yorkston KM, Klasner ER, Dudgeon BJ, Deitz JC, Baylor CR, Miller RM, Amtmann D. Measuring communicative participation: a review of self-report instruments in speech-language pathology. Am J Speech Lang Pathol 2006; 15:307-20. [PMID: 17102143 PMCID: PMC2649949 DOI: 10.1044/1058-0360(2006/030)] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To assess the adequacy of self-report instruments in speech-language pathology for measuring a construct called communicative participation. METHOD Six instruments were evaluated relative to (a) the construct measured, (b) the relevance of individual items to communicative participation, and (c) their psychometric properties. RESULTS No instrument exclusively measured communicative participation. Twenty-six percent (n = 34) of all items (N = 132) across the reviewed instruments were consistent with communicative participation. The majority (76%) of the 34 items were associated with general communication, while the remaining 24% of the items were associated with communication at work, during leisure, or for establishing relationships. Instruments varied relative to psychometric properties. CONCLUSIONS No existing self-report instruments in speech-language pathology were found to be solely dedicated to measuring communicative participation. Developing an instrument for measuring communicative participation is essential for meeting the requirements of our scope of practice.
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Affiliation(s)
- Tanya L Eadie
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA 98105, USA.
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Ciol MA, Hoffman JM, Dudgeon BJ, Shumway-Cook A, Yorkston KM, Chan L. Understanding the Use of Weights in the Analysis of Data From Multistage Surveys. Arch Phys Med Rehabil 2006; 87:299-303. [PMID: 16442990 DOI: 10.1016/j.apmr.2005.09.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Accepted: 09/26/2005] [Indexed: 11/25/2022]
Abstract
Understanding the use of weights in the analysis of data from multistage surveys. Large national surveys are powerful tools with which to examine a variety of important rehabilitation-related issues and are currently the only feasible method to study disability trends over time. Because it is impractical to draw simple random samples from the entire United States, national surveys, such as the Medicare Current Beneficiary Survey (MCBS), select random samples of subgroups of a population. Thus, respondents may have unequal probabilities of being included in the survey, and weighting must be used in the analysis before the results may be generalized to the entire United States. Surveys such as the MCBS are rich sources of data for rehabilitation medicine, and it can be expected that more research will be conducted using these data sources. Statistical analysis of these data should account for the sampling scheme used in data collection. We review the principles involved in the design of multistage samples, the calculation of weights, and their use in the data analysis, focusing on their importance in the estimation of population values. Our objective is to help readers to understand and interpret results of research articles using this methodology. Examples using the MCBS data are provided to clarify the concepts presented in the article.
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Affiliation(s)
- Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington, Seattle, 98195, USA.
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Abstract
Abstract
OBJECTIVE. With physical disabilities, persons often experience secondary pain that adds to restrictions in activity and participation. We investigated pain-management strategies used by those with physical disabilities.
METHOD. Qualitative phenomenological inquiry was used in multiple interviews with (N = 28) adults with physical disabilities (9 with amputation, 7 with cerebral palsy, and 12 with spinal cord injury) and subsequent thematic analysis.
RESULTS. Among those with physical disabilities, a distinction is made between usual and unexpected pains. Usual pain is experienced consistently or as a consequence of not getting adequate rest, exercise, or stress-free time. Managing usual pain involves uses of prevention (e.g., exercise/fitness) and/or pragmatic actions through scheduling and pacing daily activities and taking interim retreats. Unexpected pain is experienced periodically and requires an immediate response and change of activity. To manage, persons describe making efforts to create a mind and body disassociation, activating safety nets to support function and alleviate pain, and making decisions to persevere with activity and participation.
CONCLUSION. Advising those with physical disabilities to do proactive planning for both usual and unexpected pain may help them to use varied pain-management strategies to enhance function and minimize negative impacts on participation.
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Affiliation(s)
- Brian J Dudgeon
- Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle 98195, USA.
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Hoffman JM, Yorkston KM, Shumway-Cook A, Ciol MA, Dudgeon BJ, Chan L. Effect of communication disability on satisfaction with health care: a survey of medicare beneficiaries. Am J Speech Lang Pathol 2005; 14:221-8. [PMID: 16229673 DOI: 10.1044/1058-0360(2005/022)] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 07/18/2005] [Indexed: 05/04/2023]
Abstract
PURPOSE To examine the prevalence and characteristics of community-dwelling Medicare beneficiaries reporting a communication disability and the relationship between that disability and dissatisfaction with medical care. METHOD A total of 12,769 Medicare Current Beneficiary Survey respondents age 65 and older in 2001 were categorized by level of communication disability. Sampling weights were used to make inferences about the entire Medicare population. RESULTS Over 16 million beneficiaries reported a communication disability. Hearing problems were most commonly reported (41.99%). The association between dissatisfaction and communication disability was statistically significant (p <or= .05) for 8 of 10 items. CONCLUSIONS Prevalence of dissatisfaction among those with a communication disability varied, ranging from 3.43% to 19.34%. Respondents with a communication disability reported much more dissatisfaction when compared with those respondents without a communication disability.
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Affiliation(s)
- Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle 98195-6490, USA.
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Chan L, Shumway-Cook A, Yorkston KM, Ciol MA, Dudgeon BJ, Hoffman JM. Design and validation of a methodology using the International Classification of Diseases, 9th Revision, to identify secondary conditions in people with disabilities. Arch Phys Med Rehabil 2005; 86:1065-9. [PMID: 15895361 DOI: 10.1016/j.apmr.2004.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To design and validate a methodology that identifies secondary conditions using International Classification of Disease, 9th Revision (ICD-9) codes. DESIGN Secondary conditions were identified through a literature search and a survey of Washington State physiatrists. These conditions were translated into ICD-9 codes and this list was then validated against a national sample of Medicare survey respondents with differing levels of mobility and activities of daily living (ADL) disability. SETTING National survey. PARTICIPANTS Participants (N=9731) in the 1999 Medicare Current Beneficiary Survey with no, mild, moderate, and severe mobility and ADL disability. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Percentage of survey respondents with a secondary condition. The secondary conditions were grouped into 4 categories: medical, psychosocial, musculoskeletal, and dysphagia related (problems associated with difficulty in swallowing). RESULTS Our literature search and survey of 26 physiatrists identified 64 secondary conditions, including depression, decubitus ulcers, and deconditioning. Overall, 70.4% of all survey respondents were treated for a secondary condition. We found a significant relation between increasing mobility as well as ADL disability and increasing numbers of secondary conditions (chi 2 test for trend, P <.001). This relation existed for all categories of secondary conditions: medical (chi 2 test for trend, P <.001), psychosocial (chi 2 test for trend, P <.001), musculoskeletal (chi 2 test for trend, P <.001), and dysphagia related (chi 2 test for trend, P <.001). CONCLUSIONS We created a valid ICD-9-based methodology that identified secondary conditions in Medicare survey respondents and discriminated between people with different degrees of disability. This methodology will be useful for health services researchers who study the frequency and impact of secondary conditions.
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Affiliation(s)
- Leighton Chan
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA.
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Abstract
Abstract
PURPOSE. Advances in genetics indicate a need for occupational therapists to develop literacy and skills in genetics as it relates to lifestyle and occupation. The purpose of this study is to identify genetics content areas taught, instructional methods used, and the importance of teaching genetics at the entry-level in occupational therapy curricula.
METHOD. A questionnaire was sent to all entry-level occupational therapy educational programs (N = 157). Structured mailing and follow-up were used.
RESULTS. The response rate was 63.9%. Most respondents (47%) rate teaching genetics as “moderately important.” Genetics content is predominately taught at the introductory or knowledge level rather than at the integration and application level. Respondents indicate a lack of time and space for genetics content and of faculty interest and expertise.
DISCUSSION. As occupational therapy practice evolves to include new genetics, curriculum change will need to be implemented. Development of teaching materials and methods addressing genetics is recommended.
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Affiliation(s)
- Elizabeth M Kanny
- Division of Occupational Therapy, Department of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, Washington 98195, USA.
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Dudgeon BJ, Ehde DM, Cardenas DD, Engel JM, Hoffman AJ, Jensen MP. Describing pain with physical disability: Narrative interviews and the McGill Pain Questionnaire. Arch Phys Med Rehabil 2005; 86:109-15. [PMID: 15641000 DOI: 10.1016/j.apmr.2004.01.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify common pain descriptors used by people with physical disability-related pain and to suggest words that are likely to prompt responses in clinical interviews and assessments. DESIGN Open-ended interviews were coded and then contrasted with responses to a pain questionnaire, obtained through mail or interview surveys. SETTING Rehabilitation research program. PARTICIPANTS Twenty-eight people with physical disability-related pain in a series (n=54) of in-depth interviews and 1053 participants with disabilities who responded to mailed questionnaires or structured interviews about pain and its impact (459 with acquired lower-limb amputation, 471 with spinal cord injury, 123 with cerebral palsy). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Pain interview descriptions and McGill Pain Questionnaire (MPQ). RESULTS Different pain experiences were reflected in narrative descriptions and self-report questionnaire responses. We report the common terms, but across diagnoses use of terms does not appear to clearly differentiate distinct pain phenomenon. Narrative interviews support the use of several MPQ pain descriptors. However, discrete descriptors are recommended when assessing adults with physical disability. CONCLUSIONS We identified pain descriptors that appear to be most useful in assessing daily life and participation experiences with physical disability-related pain. These may be clinically useful, but caution is advised when doing diagnostic workups based solely on sensory and affective pain descriptions.
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Affiliation(s)
- Brian J Dudgeon
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA.
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Dudgeon BJ, Low JF. Occupational therapy and genetic information: considerations and cautions. Am J Occup Ther 2003; 57:227-8. [PMID: 12674316 DOI: 10.5014/ajot.57.2.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Brian J Dudgeon
- Division of Occupational Therapy, Department of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, Washington 98195, USA.
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Abstract
OBJECTIVES To obtain an insider's view about disability-related pain to help rehabilitation clinicians understand the experience and to show how people with disability manage daily living and encounters with other people. DESIGN Qualitative methods by using open-ended interviews and thematic analysis. SETTING Rehabilitation research program. PARTICIPANTS Nine adults with chronic physical disability and pain were recruited from study groups. The 9 included people with spinal cord injury, acquired amputation, or cerebral palsy. INTERVENTION Interview protocol. MAIN OUTCOME MEASURE Phenomenologic analysis of interviews based on codewords derived from interview topics and themes. RESULTS Study participants described pain as a part of daily living that influenced many lifestyle decisions. They characterized pain as plural, meaning that it has multiple locations, distinctive descriptions, and different implications. They also were concerned about pain being a mystery, having unclear causes and consequences. Typically they described pain as a personal venture, with little or dissatisfying communication about pain with family, friends, or health care providers. CONCLUSIONS Understanding pain associated with physical disability can help guide rehabilitation practitioners in their pain assessments, interventions, and related research. Our findings suggest that some people with disability-related pain may benefit from reassurance and specific planning for expected and unexpected pain episodes.
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Affiliation(s)
- Brian J Dudgeon
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA.
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Dudgeon BJ. Life on Wheels: For the Active Wheelchair User. Am J Occup Ther 2001. [DOI: 10.5014/ajot.55.3.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Brian J. Dudgeon
- Brian J. Dudgeon, PhD, OTR, Assistant Professor, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Affiliation(s)
- Brian J. Dudgeon
- Brian J. Dudgeon, MS, OTR Lecturer Division of Occupational Therapy Department of Rehabilitation Medicine University of Washington Seattle, WA
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Abstract
Abstract
Continuing changes in human services confront occupational therapy students with challenges and opportunities not traditionally associated with entry-level practice. Consultation as an approach to occupational therapy practice has become more prominent in many settings. Although consultation is normally associated with skilled or expert practice, new practitioners are expected to provide consultation so that an occupational therapy perspective can be incorporated into interdisciplinary and consumer-based service plans. In this article, we review models of consultation and propose that issues of knowledge, interpersonal skills, and diversity readiness are essential to effectively prepare new practitioners for consultation. Problem-based learning is recommended as a technique to expose students to the complexity and diversity of issues to be addressed in consultation. Examples of instructional units that demonstrate the functions of a consultant are provided.
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Affiliation(s)
- Brian J. Dudgeon
- Brian J. Dudgeon, MS, OTR, is Lecturer, Department of Rehabilitation Medicine, University of Washington, Box 356490, Seattle, Washington 98195
| | - Sharon L. Greenberg
- Sharon L. Greenberg, MOT, OTR, is Senior Lecturer, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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Abstract
OBJECTIVE The purpose of this study was to examine educational participation and accommodations for children with spinal cord injury (SCI) or disease in primary, secondary, and postsecondary educational settings. METHOD Written surveys were developed for students with SCI and their teachers. Fifty-three participants had SCI onset before age 18 years, were at least 4 years old and enrolled in a school program, and had residual motor disability without cognitive-behavioral impairments. RESULTS Nearly all participants were enrolled full time in regular education classrooms. Seventy-five percent of primary-level participants and 32% of secondary-level participants were qualified for special education and related services, receiving teacher aide assistance as well as occupational and physical therapy services. Most participants were graduating from high school and pursing postsecondary education. Classroom performance and grades were reported as average or above average, but curriculum modifications were commonly made, and many participants required human assistance and assistive technology in functional and classroom tasks. Access barriers were often reported by participants using wheelchairs, and those using augmentative writing aids were not fluent with these devices. CONCLUSION Accommodations in schools for students with SCI appear to support completion and advancement to higher levels of education, but these accommodations appear to be geared toward participation rather than levels of performance and productivity that may be realistic for work and other community settings.
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Affiliation(s)
- B J Dudgeon
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
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Abstract
OBJECTIVE To examine educational achievement and vocational success of children with SCI. DESIGN Surveys administered to students and teachers, and content analysis of school records. SETTING Regional pediatric rehabilitation program. PARTICIPANTS Participants were selected from 144 children with SCI treated from 1979 through 1992; 98 met inclusion criteria of onset of SCI before the age of 18 years, older than 3 years, residual paresis, and no cognitive impairment; 29% were lost to follow-up, and 53 of the 70 contacted were enrolled. MAIN OUTCOME MEASURES School completion rates, absenteeism, grades, ratings of participation; education and living situations after high school; history of paid employment. RESULTS The 53 responders were: 33 boys, 20 girls; 25 with paraplegia (47%), 28 with tetraplegia (53%); mean length of disability = 9.4 years; 12 primary students (23%), 19 secondary students (36%), and 22 postsecondary participants (41%). Students and teachers rated student participation and performance as average or above compared to peers; 84% of secondary students planned to attend college after graduation. Only 33% of high school students over age 15 had been employed. Ninety-one percent of postsecondary subjects had graduated from high school. Seven (32%) had graduated from college or a vocational program, 11 (50%) were enrolled in college full- or part-time, and 4 others (18%) were neither in school nor employed. Current employment rates were 71% of college graduates, 36% of those in college, and 0% of those who had never enrolled. Level of SCI was not related to employment. CONCLUSIONS Students with SCI demonstrate adequate participation and performance in educational settings, but may benefit from more vocational counseling and opportunities for paid employment.
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Affiliation(s)
- T L Massagli
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
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Dudgeon BJ, Libby AK, McLaughlin JF, Hays RM, Bjornson KF, Roberts TS. Prospective measurement of functional changes after selective dorsal rhizotomy. Arch Phys Med Rehabil 1994; 75:46-53. [PMID: 8291962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Selective dorsal rhizotomy (SDR) followed by intensive postoperative therapy is commonly performed to reduce spasticity in carefully selected children with cerebral palsy. Reduction in spasticity and improvement in range and quality of movements are frequently reported. Functional gains have also been indicated but have not often been examined in a systematic manner. Twenty-nine children with spastic diplegia or quadriplegia received SDR and postoperative physical and occupational therapy. Upper-limb movement, self-care, and functional mobility were evaluated prospectively through preoperative, 6-month, and 12-month follow-up examinations. Significant improvements in the Pediatric Evaluation of Disability Inventory scores for functional mobility and self-care domains were observed for children with spastic diplegia, but not spastic quadriplegia. Children's scores in upper-limb reach and coordination tasks did not consistently improve. When attributing improvements in self-care and mobility independence to SDR and specialized therapy, continued development, new goals, and positive beliefs about progress should also be considered as factors influencing outcome.
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Affiliation(s)
- B J Dudgeon
- Department of Rehabilitation Medicine, University of Washington, Seattle 98195
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Dudgeon BJ, Libby AK, McLaughlin JF, Hays RM, Bjornson KF, Roberts TS. Prospective measurement of functional changes after selective dorsal rhizotomy. Arch Phys Med Rehabil 1994. [DOI: 10.1016/0003-9993(94)90336-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Recruitment of occupational therapy students requires both expansion and broadening of ethnic, cultural, age, sex, and geographic distribution. Information used to guide recruitment activities can be limited, quickly outdated, and regionally nonspecific. Applicants to all entry-level programs in the Northwest were surveyed to assess trends that could influence recruitment practices. One hundred thirty-five (82.8%) of the 163 applicants surveyed responded to a questionnaire that probed for sources of exposure to occupational therapy, career goals, and educational preferences. Applicants indicated having an initial interest in allied health or education fields, yet only 36% began college with occupational therapy education in mind. Volunteer or work experience in specific practice settings was identified by approximately 80% of the applicants as an influence in seeking an education in occupational therapy. Career influences, goals, and educational program preferences did not differ among applicants based on age, residential background, grades, or previous degree. An absence of applicants of ethnic minority allows limited application of findings to these targeted groups.
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Affiliation(s)
- B J Dudgeon
- Department of Rehabilitation Medicine, University of Washington, Seattle 98195
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Libby AK, Sherry DD, Dudgeon BJ. Shoulder limitation in juvenile rheumatoid arthritis. Arch Phys Med Rehabil 1991; 72:382-4. [PMID: 2059104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
One hundred consecutive children with juvenile rheumatoid arthritis (JRA) were evaluated for shoulder dysfunction. Shoulder arthritis was virtually absent in all 45 children with pauciarticular onset JRA. Twenty of 40 children (50%) with polyarticular JRA and 12 of 15 (80%) with systemic onset JRA had shoulder involvement characterized by pain or restricted passive range of motion (PROM). Ninety-five percent of those with shoulder arthritis had bilateral involvement. Children with systemic onset were likely to have shoulder disease within 2.5 years of onset and to have more severely limited PROM. Children with polyarticular onset developed shoulder arthritis any time during the course of their disease. With either type of onset, internal rotation was the most commonly and severely limited motion, followed by abduction. Clinicians treating children with JRA should carefully monitor pain and examine both rotational and planar components of shoulder motion.
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Affiliation(s)
- A K Libby
- Children's Hospital and Medical Center, Seattle, WA 98105
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Michaud LJ, Hays RM, Dudgeon BJ, Kropp RJ. Congenital carpal tunnel syndrome: case report of autosomal dominant inheritance and review of the literature. Arch Phys Med Rehabil 1990; 71:430-2. [PMID: 2185719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Carpal tunnel syndrome (CTS) is unusual in childhood, and familial occurrence has been reported infrequently. A case of CTS in a seven-year-old boy, associated with abnormal thickening of the transverse carpal ligament and aplasia of the median nerve distal to this ligament, is described. Clinical, electrodiagnostic, and surgical findings are presented: all were consistent with absence of the median nerve distal to the transverse carpal ligament. Family history of CTS was positive in a pattern consistent with autosomal dominant transmission in three generations. Thickening of the transverse carpal ligament has been described, although infrequently, in childhood and familial CTS. Aplasia of the median nerve distally has not been reported in association with this anatomic abnormality. Case reports of familial CTS are reviewed, and other congenital anomalies which should be considered in the differential diagnosis of CTS in children and adults are discussed.
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Affiliation(s)
- L J Michaud
- Department of Rehabilitation Medicine, Children's Hospital and Medical Center, Seattle, WA 98105
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Dudgeon BJ, DeLisa JA, Miller RM. Optokinetic nystagmus and upper extremity dressing independence after stroke. Arch Phys Med Rehabil 1985; 66:164-7. [PMID: 3977569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Right hemisphere brain-damaged stroke patients demonstrate a variety of neurologic deficits which seem to impair their ability to regain self-care independence. Visual perceptual and visual search disorders have been implicated with persistent functional deficits. The objective of this study was to measure the extent to which defects of optokinetic nystagmus (OKN), an ocular movement reflex, may be associated with inability to regain independent function. Eighteen right hemisphere brain-damaged stroke patients suffering similar sensory-motor deficits were followed up from admission as they underwent self-care training in a comprehensive stroke rehabilitation center. Ten subjects demonstrated unilateral absence of OKN and eight subjects demonstrated bilaterally intact responses upon admission. Upper extremity (UE) dressing independence was used as an indicator of functional skill level at admission, during treatment, and at discharge. Subjects with unilateral loss of OKN were significantly less independent at admission and at discharge when compared to subjects with intact OKN. Although both groups of patients made statistically significant gains in UE dressing, those with defective OKN had a 40% greater inpatient length of stay and were more likely to be discharged to a nursing home or needed care by a significant other after rehabilitation.
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Abstract
Survival from head and neck cancer is not uncommon. However, treatment is often radical and may compromise the patient's appearance, function, and quality of life. The most common modalities of treatment, employed either singly or in combination, are chemotherapy, radiation, and surgery. Each treatment modality involves unique complications and compromises, many of which are amenable to rehabilitation techniques. A role of the occupational therapist on a cancer rehabilitation team is described and an overview of the therapeutic procedures for the evaluation and treatment of common problems recognized in these patients is presented. The material is derived both from clinical experience of the rehabilitation team and from a literature review employed in developing the rehabilitation program.
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