[RehaFuturReal®: Evaluation of Implementation in Organizational Structure and in Counseling Process - An Overview of Results]

BACKGROUND

Due to prevailing future challenges in vocational rehabilitation, development process RehaFutur (BMAS) was initiated. In this context, recommendations were made to secure a future-oriented, innovative vocational rehabilitation in Germany. Deutsche Rentenversicherung (DRV) Westfalen transferred these recommendations into a new and applicable counseling concept RehaFutuReal(®). Rehabilitation managers (RM) are central protagonists in counseling process. Therefore, RehaFuturReal(®) focused on optimization of counseling performance. To achieve this aim, rehabilitation managers were taught to work with a case management (CM) based approach. RWTH Aachen supported RehaFuturReal(®) from an academic point of view and conducted a formative and summative evaluation. Primary aim of RWTH Aachen was to support DRV Westfalen during implementation of RehaFuturReal(®) into their organizational structure. Additionally, RWTH Aachen controlled whether transfer of RehaFutuReal(®) in counseling process was successful.

METHOD

From 04-01-13 until 12-31-14, RehaFuturReal(®) was tested by DRV Westfalen in the intervention district Dortmund with 10 RM. There were 3 selection criteria for the overall sample of N=320 insurants: participants were required to have an active employment status, suffered from integration issues and were in need of support to achieve vocational integration. Evaluation of RehaFuturReal(®) was realized summative (pre-post-comparison) and formative (process-orientated). Evaluative judgment regarding implementation in organizational structure and counseling process was performed by using three-stage-concept of Donabedian (quality of structure, process and results). Thereby, feedback of RM, insurants and employers was taken into account.

RESULTS

Analysis of evaluation results revealed a positive overall impression. Implementation into organizational structure was successful on all 3 quality stages: concept of project and CM-training were an adequate basis and appropriately put into practice by fulfilling prescribed objectives, topics and schedule (quality of structure). Rehabilitation managers identified themselves with the implementation process into DRV Westfalen (grading of CM training: M=1,67; SD=0,65; quality of process). Analogous, consultants reported a high level of satisfaction during implementation of new counseling process (possible span: 1-4; M=3,11; SD=0,33; quality of results). Regarding implementation of counseling process, sample fitted into 3 selection criteria wherefore the correct insurants were picked in RehaFuturReal(®) (quality of structure). CM-orientated counseling approach was properly implemented into everyday work of RM by using CM-instruments for documentation (quality of process). RM were highly satisfied (possible span: 1-4) with counseling performance (M=3,43; SD=0,77). Employers also rated counseling performance positively (M=3,38; SD=0,85). By contrast, surveying insurants revealed a heterogeneous impression of satisfaction (M=2,97; SD=1,03) (quality of results).

[Adaptive Performance in Vocational Rehabilitation - A Standardized Self-assessment Questionnaire (ReHadapt) for Application in RehaAssessment® and RehaConsulting]

OBJECTIVES AND METHODS

A rehabilitation training requires the ability to adapt to a changed living and working environment. Qualitative content analysis and quantitative studies were conducted to (1(st)) provide a definition of adaptive performance (AP) in vocational rehabilitation. (2(nd)) A self-assessment questionnaire (ReHadapt) to measure AP was developed and (3(rd)) its validity was proved by the use of exploratory (N1=344) and confirmatory factor analysis (N2=301; N3=254) for categorical variables.

RESULTS

AP is a multidimensional construct which can be assessed by the ReHadapt questionnaire. The ReHadapt questionnaire consists of 30 items which are categorized to the 6 dimensions training-related AP, subject-related AP, health-related AP, social AP towards other participants, social AP towards trainers and identification with future occupation. As expected, reliability (0,81≤Cronbach's Alpha≤0,95) and validity are confirmed. Adaptive Performance predicts return to work mediated by the health-related quality of life.

IMPLICATIONS

Because of its economy and applicability in everyday work-life the ReHadapt can be used for diagnostic and training in RehaAssessment(®) and RehaConsulting.

[Relevance of Personality Factors for Successful Vocational Rehabilitation]

BACKGROUND

The Main purpose of vocational rehabilitation is occupational reintegration of clients into the job market who have lost their job or whose job is threatened because of a handicap or chronicl illness. With regard to existing evidence for the relevance of personality factors for work performance and job achievement, the present study investigated the influence of participants' personality factors on a successful reintegration after a retraining program in a vocational training center over 2 years. A central research objective was to identify prognostic personality factors for successful vocational integration.

METHOD

In this longitudinal study 15 vocational training centers participated at 3 time points of measurement (T1, T2 and T3). Data gathering was based on rehabilitants' self-reports (standardized questionnaires: SVF, BSW, SPR, CSES) about personality aspects. First data collection started at the beginning (T1) and a second survey was conducted at the end of the training 2 years later (T2). Based on the data at measurement points T1 and T2, 4 prognostic models were computed (binary logistic regression analysis) and evaluated, examining the differenzial influence of several scales and items on direct reintegration after completing the vocational retraining and reintegration status 6 months later (T3).

RESULTS

As expected, different variables turned out to be relevant for occupational integration at the end of the training program and 6 months later. Correspondingly other variables appeared to be relevant for occupational reintegration at T1 and at T2. At the end of the vocational training program, approximately 24% of the participants had a job. With respect to direct reintegration, regression analysis revealed that vocational self-efficacy (R(2)=0,175) and self-evaluation were relevant (R(2)=0,383). Approximately 70% of the participants had gotten a job 6 months later. Several stress coping strategies (R(2)=0,170), estimation of the own reintegration prognosis and aspects like vocational center contextual factors (R(2)=0,280) appeared to be relevant for reintegration 6 months later.

[Education, advanced and further training in the field "psychology in rehabilitation"]

The commission for vocational training, training and further education of the German Society of Rehabilitation Science tends to discuss and to give recommendations for various professions in rehabilitation. The working group, which is led by J. Bengel/Freiburg and M. Morfeld/Magdeburg-Stendal created an inventory of Rehabilitation Psychology. The training programs for Rehabilitation Psychology at universities and universities of applied science in Germany are based on a job profile of psychologists in medical and vocational rehabilitation. The different universities have diverse priorities focusing on Rehabilitation Psychology. The offer changes because of the adaption of requirements and implementation of Bologna Reform. The training and further education offers are specific and available for large indication areas. Finally outstanding issues and problems are pointed out.

[Shaping the future of vocational rehabilitation of adults: eight fields of action as starting points for a cross-actor innovation process]

Established by the Federal Ministry of Labour and Social Affairs (BMAS) in October 2007, the Scientific Expert Group RehaFutur had been commissioned to elaborate cornerstones for the medium- and long-term development of vocational rehabilitation of adults with disabilities (re-integration). Initial questions inter alia were as follows: Which function should vocational rehabilitation have in a service- and knowledge-oriented working world that will increasingly be affected by demographic change? How can disabled persons' right to occupational participation by way of vocational rehabilitation, a right stipulated both under the German constitution and in German law, be realized as needed also in the future? Various fields of action have been derived on the basis, for one, of an investigation of the factors, social law, social and education policy as well as European, influencing vocational rehabilitation and, for the other, of an evaluation of current labour market and demographic developments. Dealt with in the fields of action outlined are the aspects: equitable opportunities of access, developmental and needs orientation, closeness to the real occupational and working world, as well as the role of self-determination and self-responsibility. The fields of action are to be understood as framework concept for shaping a cross-actor innovation process. Sustainable vocational rehabilitation is characterized in particular by the fact that it is specifically targeted at promoting disabled persons' self-determination and self-responsibility actively using these in the process and that it strengthens an independent lifestyle, ensures social participation by inclusive structures; also, it facilitates continued participation in working life by ongoing education involving holistic development of professional and personal competencies oriented towards the individual's resources and potentials, safeguarding it by systematic networking with companies. The concept presented for vocational rehabilitation of adults with disabilities encompasses a change of paradigms which service carriers and providers will have to face jointly and including the service users, the rehabilitants.

Depth perception in virtual reality: distance estimations in peri- and extrapersonal space

The present study investigated depth perception in virtual environments. Twenty-three participants verbally estimated ten distances between 40 cm and 500 cm in three different virtual environments in two conditions: (1) only one target was presented or (2) ten targets were presented at the same time. Additionally, the presence of a metric aid was varied. A questionnaire assessed subjective ratings about physical complaints (e.g., headache), the experience in the virtual world (e.g., presence), and the experiment itself (self-evaluation of the estimations). Results show that participants underestimate the virtual distances but are able to perceive the distances in the right metric order even when only very simple virtual environments are presented. Furthermore, interindividual differences and intraindividual stabilities can be found among participants, and neither the three different virtual environments nor the metric aid improved depth estimations. Estimation performance is better in peripersonal than in extrapersonal space. In contrast, subjective ratings provide a preferred space: a closed room with visible floor, ceiling, and walls.

The effect of low arousal on visuo-spatial attention

Clinical and experimental evidence suggests a special role of the right hemisphere for alerting and orienting. However, it is not clear whether these attentional aspects should be taken to be independent or interacting. At least on the functional neuroanatomical level there seems to be an overlap in right parietal and frontal cortical structures. In this sleep deprivation study we examined the effect of different levels of arousal on covert orienting of attention repeatedly over a period of 28 h in 11 healthy subjects. The main finding is a disproportionate and significant slowing of responses to stimuli presented to the left visual hemifield that could only be observed in a state of maximally reduced arousal at 5:00 a.m. Furthermore, a facilitation of attentional shifts to the right could be observed in invalid trials when attention had to be reoriented. These results suggest an interaction of arousal and orienting, at least in situations of maximally reduced activation when attentional asymmetries could be provoked even in healthy subjects. The findings are compatible with a right hemisphere dominance for alerting and orienting, and they are discussed in the light of theoretical accounts of visual orienting.

Static and phasic cross-talk effects in discrete bimanual reversal movements

The authors examined the hypothesis that the phasic and the static cross-talk effects found in bimanual movements with different target amplitudes originate at different functional levels of motor control, which implies that the effects can be dissociated experimentally. When the difference between the short and the long amplitudes assigned to the 2 hands of 12 participants was decreased, the static effect disappeared, In contrast, the phasic effect, which can be observed only at short preparation intervals, did not disappear; although it became smaller in absolute terms, in relative terms it did not. In addition, the authors compared the time course of amplitude variability and examined the correlation between left hand and right hand amplitudes. The disappearance of the phasic amplitude assimilation at increasing preparation intervals turned out to be delayed relative to the decline of the correlation between amplitudes. That finding suggests that the assimilation of mean amplitudes and the correlation between left hand and right hand amplitudes are not fully equivalent indicators of intermanual interactions, but may indicate different kinds of inter-limb coupling.

[Psychosocial consequences of screening for microalbuminuria and for some other risk factors]

OBJECTIVE

Obtaining insight into the psychosocial consequences of a screening programme for the progression of heart, vessel and kidney damage.

DESIGN

Questionnaire investigation.

METHOD

This study addressed participants in the 'Prevention of renal and vascular end-stage disease' (PREVEND) study, which included about 40,000 inhabitants of Groningen, the Netherlands, aged 28-75 years, who were asked to send in a vial with morning urine in order to detect microalbuminuria. People with microalbuminuria were invited to a general practitioners' laboratory to determine the risk factors: urinary protein concentration, blood pressure and blood cholesterol level. A questionnaire was sent to 335 participants of the screening who had received the screening results two weeks before.

RESULTS

The response rate was 75%. A minority of the respondents diagnosed with risk factors, expressed some concern. No influence on the wellbeing of this group of participants was established. Almost one-third of the respondents stated that they now 'lived according to healthier principles' because of the screening. On the other hand, there was a certain 'certificate of health effect': about half the smokers and the physically inactive saw the favourable screening result as a legitimation for their life style. An unfavourable screening result had led to additional medical consumption in almost half the respondents. The respondents appreciated the screening and especially the lower-educated had a very positive attitude towards early diagnosis in general.

CONCLUSION

The screening positives showed no diminished wellbeing; their health behaviour improved due to the screening and they had a higher medical consumption. About half the screening negatives regarded the results as a legitimation of their unhealthy life style.

Specification of movement amplitudes for the left and right hands: evidence for transient parametric coupling from overlapping-task performance

Bimanual coordination tasks suggest transient cross-talk between concurrent specification processes for movements of the left and right hand that vanishes as the time for specification increases. In 2 experiments with overlapping and successive unimanual tasks, the hypothesis of transient coupling was examined for a psychological-refractory-period paradigm. Time for specification was manipulated by varying the delay between first and second signal (Experiment 1) and by precuing the first response (Experiment 2). Participants performed rapid reversal movements of same or different amplitudes with the left and right hands. With different amplitudes, reaction times (RTs) of the second responses were longer than with same amplitudes at short delays, and this disappeared at longer delays in Experiment 1. In Experiment 2, precuing also reduced the difference between RTs of second responses in same-amplitude and different-amplitude trials. These findings are consistent with the hypothesis of transient coupling during amplitude specification obtained with bimanual tasks.

Specification of movement amplitudes for the left and right hands: evidence for transient parametric coupling from overlapping-task performance

Bimanual coordination tasks suggest transient cross-talk between concurrent specification processes for movements of the left and right hand that vanishes as the time for specification increases. In 2 experiments with overlapping and successive unimanual tasks, the hypothesis of transient coupling was examined for a psychological-refractory-period paradigm. Time for specification was manipulated by varying the delay between first and second signal (Experiment 1) and by precuing the first response (Experiment 2). Participants performed rapid reversal movements of same or different amplitudes with the left and right hands. With different amplitudes, reaction times (RTs) of the second responses were longer than with same amplitudes at short delays, and this disappeared at longer delays in Experiment 1. In Experiment 2, precuing also reduced the difference between RTs of second responses in same-amplitude and different-amplitude trials. These findings are consistent with the hypothesis of transient coupling during amplitude specification obtained with bimanual tasks.

[Parametric coupling in sequences of bimanual reversal movements with identical and different amplitudes]

In sequences of bimanual movements, the voluntary modulation of the amplitude of the one hand (inducing hand) induces an involuntary modulation of the amplitude of the other hand (dependent hand), the strength of which increases with increasing tempo. By means of a task in which subjects perform sequences of two short and two long reversal movements in alternation with the inducing hand, but constant short or long reversal movements with the dependent hand, we addressed two questions. The first question was concerned with differences in the effects of tempo on the involuntary amplitude modulation of short and long movements; the second question was whether the involuntary amplitude change fades away or is propagated when bimanual movements with certain target amplitudes are repeated. At low tempo the contralateral effect of voluntary amplitude changes on short-amplitude movements was stronger than the effect on long-amplitude movements, but at high tempo this difference was reversed. This result is not consistent with the assumption that contralateral amplitude modulation results from an overflow of efferent commands, which increases with the force of the movement; however, it is consistent with other findings on a transient coupling during amplitude specification (parametric coupling). The involuntary amplitude change was essentially propagated to the next movement in the sequence and did not fade away. This finding suggests that the assimilation of amplitudes that can be observed in bimanual sequences of movements with different, but for each hand constant, amplitudes could result from an effect of transient parametric coupling during the initial specification of amplitudes and need not necessarily be attributed to cross-talk at the level of motor commands or efferent innervation.

Bimanual coupling during the specification of isometric forces

The present study investigated the generalizability of the hypothesis of transient coupling during the preparation of bimanual movements (Spijkers and Heuer 1995) to the specification of isometric forces. In the first experiment we used the timed response paradigm (TRP) to examine the time course of the specification process. Subjects had to generate bimanual isometric force pulses while preparation time was controlled by the TRP. Target forces were weak (20% of maximal voluntary force, MVF) or strong (40% MVF) and assigned randomly to each hand. The first experiment revealed the predicted pattern of correlations between the peak forces but, because the subjects tended to delay responding when time for preparation was very brief, the time course of the specification process did not fully match expectations. In the second experiment we improved force-trajectory feedback and presented two initial cues that were expected to induce better preparation of the default force (30% MVF). Both changes were successful and the results further corroborate the transient-coupling hypothesis.

Period duration of physical and imaginary movement sequences affects contralateral amplitude modulation

The hypothesis was tested that the strength of cross-manual effects of voluntary amplitude modulations in bimanual tasks increases when less preparation time is available during the execution of a sequence of movements. By means of the continuation procedure, various period durations (600, 800, 1200, and 1800 msec) of movement sequences were imposed. Subjects performed bimanual periodic arm movements on two digitizers: constant-amplitude movements (short or long) with the one hand, and movements of constant short or constant long amplitudes and movements of alternating short and long amplitudes with the other hand. Period-duration-dependent modulations of the amplitude were observed in movements of instructed constant amplitudes when the other hand performed alternating-amplitude movements, but not when the other hand performed constant-amplitude movements. Not only physical performance, but also the imaginary production of alternating-amplitude movements resulted in period-duration-dependent cross-manual effects, though reduced in size. The pattern of results is in agreement with a recently proposed two-level model of cross-manual effects according to which cross-talk can occur at the programming level as well as at the execution level.

Effects of sleep loss, time of day, and extended mental work on implicit and explicit learning of sequences

Tacit knowledge is part of many professional skills and can be studied experimentally with implicit-learning paradigms. The authors explored the effects of 2 different stressors, loss of sleep and mental fatigue, on implicit learning in a serial-response time (RT) task. In the 1st experiment, 1 night of sleep deprivation was shown to impair implicit but not explicit sequence learning. In the 2nd experiment, no impairment of both types of sequence learning was found after 1.5 hr of mental work. Serial-RT performance, in contrast, suffered from both stressors. These findings suggest that sleep deprivation induces specific risks for automatic, skill-based behavior that are not present in consciously controlled performance.

The time course of cross-talk during the simultaneous specification of bimanual movement amplitudes

We investigated the time course of the amplitude specification of rapid bimanual reversal movements (lateral displacements on two digitizers). To this end we used the timed-response paradigm in which the response has to be initiated synchronously with an auditory signal. Information about the required amplitudes was presented at various times before the synchronization signal. Consistent with previous results, the progression of amplitude specification was reflected in the dependence of the amplitudes of the reversal movements on the time interval between amplitude information and synchronization signal. Same or different amplitudes for the hands were used to examine cross-talk at the programming level of the two-level model of intermanual interference. The results indicate the existence of cross-talk in particular at short intervals between information about amplitude and movement initiation. This is consistent with the notion that cross-talk between concurrent processes of amplitude specification is transient and vanishes as the time available for motor programming increases.

On-line visual control of aiming movements?

Two experiments are reported which addressed the flexibility of visuo-motor processing by manipulating the availability of visual information while executing a discrete aiming movement. The flexibility of visuo-motor processing was tested by unexpectedly changing the proportion of the movement trajectory that visual feedback was present. Visual feedback was manipulated for a short (0.30), medium (0.60) or long (0.90) proportion of the trajectory within a block of trials. Each of these three proportions of vision occlusion (Experiment 1) or visual disclusion (Experiment 2) during the initial trajectory was examined. Within a visual condition, one of the three visual feedback proportions occurred with a high probability (p = 0.72), whereas the remaining two proportions each occurred with a low probability (p = 0.14). The results clearly indicated that spatial accuracy was determined by the actual vision period, independent of its probability of occurrence. The data are consistent with a model of continuous on-line control of movement execution.

Temporal coordination of alternative and simultaneous aiming movements of constrained timing structure

Two experiments are reported addressing the preparation and initiation of movements with equal or unequal timing properties for both hands. Temporal coordination was examined in two movement tasks: one in which both hands performed the movements simultaneously (simultaneous aiming task) and one in which only one alternative of two possible movements was executed (choice aiming task). For each task a different group of subjects was used. Besides the timing relationships between both movements, the effects of preparation interval (1, 3, and 5 s), the average velocity (7, 14, 17.5, and 70 cm/s), the presence of advance information about the required velocity of the movement(s), and practice were investigated. Based on the common- and the specific-timing notions, distinct hypotheses were tested as to the effects of the variables on the temporal coordination as revealed by reaction time. A main result was that the effects of timing differences between the hands was task specific. For the choice task the data are in agreement with the common-timing notion of coordination, i.e., only one timing demand at a time can be prepared, whereas in the simultaneous task evidence was obtained for the specific-timing notion, i.e., independent preparation and initiation of different timing properties for the hands. However, it is argued that the results of the choice task probably do not reflect a general inability to prepare movements of different timing requirements for both hands, but is related to a task-specific strategy of selective preparation.