Psychosocial reintegration post-traumatic spinal cord injury in Rwanda: An exploratory study

Background

Traumatic spinal cord injury (TSCI) survivors are confronted by both physical and psychosocial barriers when returning to their communities. Therefore, reintegration is an important aspect of their journey back into social life.

Objectives

To assess psychosocial reintegration after TSCI in Rwanda.

Method

All community-dwelling adults who were registered in the previous epidemiological study were recruited and injury characteristics questionnaire and the Sydney Psychosocial Reintegration Scale version 2 (SPRS-2) were used to collect data through a telephone interview.

Results

The study traced 58 participants, 77.6% (n = 45) were male and 56.9% (n = 33) were categorised with paraplegia. Overall, the results show poor community reintegration. The SPRS-2 and domain mean (SD) scores were: overall SPRS-2 of 20.95 (11.56), occupational activity (OA) of 3.68 (4.31), interpersonal relationship (IR) of 7.11(4.31) and living skills (LS) of 7.43 (5.32). Gender significantly influenced overall SPRS-2 (p = 0.011) and two domains: OA (p = 0.005) and LS (p = 0.012). Level of injury was significantly associated with an OA domain score of SPRS-2 (p = 0.002). Gender explained 29% of the variance in the LS domain of SPRS-2, with males reporting better psychosocial reintegration.

Conclusion

Gender strongly predicted psychosocial reintegration following a TSCI, which is an indication of the role of social support.

Clinical Implications

Traumatic SCI rehabilitation should be holistic to help prepare the person to return to the community. There should be an assessment of an individual's readiness to return to the community before discharge from the hospital.

Does aphasia impact on return to driving after stroke? A scoping review

PURPOSE

Stroke can affect driving, an important activity of daily living. Little is known about whether aphasia (language impairment) impacts driving post-stroke. This scoping review explores impacts and perceived impacts of aphasia on driving performance, and the process of returning to driving post-stroke.

MATERIALS AND METHODS

Scoping review using Arksey and O'Malley's framework, reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Bibliographic databases were searched and international clinical practice guidelines were sourced online. Full-text articles were independently assessed by two reviewers. Results were tabulated and summarised using narrative synthesis.

RESULTS

Forty-three literature sources and 17 clinical practice guidelines were identified. Six studies investigated return to driving with aphasia post-stroke; 37 sources from the broader literature contributed to objectives. It remains unclear whether aphasia impacts fitness-to-drive; however, people with aphasia face barriers in returning to driving due to: (1) uncertainty regarding the role of language in driving; (2) poor awareness and knowledge of aphasia, and (3) communication demands in the patient-journey and assessment.

CONCLUSIONS

The current evidence base is limited, inconsistent, and lacking in quality and recency and there is a lack of guidelines to support clinical practice. People with aphasia face barriers in returning to driving; however, it is unclear if aphasia affects fitness-to-drive post-stroke. Implications for rehabilitationPeople with aphasia, their caregivers and clinicians have identified return to driving as a top 10 research priority.We do not know if aphasia affects fitness-to-drive post-stroke, but communication difficulties can make the process of returning to driving more difficult.Speech pathologists have an important role in ensuring that driving is discussed with people with aphasia post-stroke.Speech pathologists should support the multidisciplinary team to understand and meet the communication needs of people with aphasia throughout the driving evaluation process.

Explaining Male Sex Offender Recidivism: Accounting for Differences in Correctional Supervision

PURPOSE

Contrary to public opinion, empirical studies have consistently shown that persons convicted of a sexual offense (PCSO) are less likely to recidivate with a general offense. While researchers often point toward the surreptitiousness of sexual offending to explain low rates of recidivism, this paper tests a novel explanation: SOs recidivate at lower rates than persons convicted of a non-sexual offense (PCNSO) because they are more often revoked to prison before they are able to commit a new crime, perhaps owing to more restrictive post-release supervision guidelines.

METHODS

Using a sample of 196,468 unique male releases, the difference in general and sexual recidivism between PCSO (n = 29,420) and PCNSO was assessed through survival analyses (Cox regression models).

RESULTS

Results demonstrated that PCSO were significantly less likely to be reconvicted for a general crime, but more likely for a sex offense. They were also more likely to be reincarcerated due to a revocation without a new sentence. Accounting for revocations, the difference in reconviction risk lessens between the groups but does not disappear.

CONCLUSIONS

This analysis provides evidence that differences in community supervision are contributing to the difference in recidivism rates between PCSO and PCNSO. Implications and future research are discussed.

Rehabilitation professionals' views on individual peer support interventions for assisting stroke survivors with reintegration into the community: a qualitative study

PURPOSE

We aimed to explore stroke rehabilitation professionals' understanding and representations of peer support; the benefits they anticipated for patients; and the levers and barriers they perceived to implement the intervention in their practice.

MATERIALS AND METHODS

This qualitative study comprised four focus groups with 21 rehabilitation professionals and four semi-structured interviews. It was held in a French hospital. Interpretation was guided by the Consolidated Framework for Implementation Research.

RESULTS

Although professionals had poor knowledge on peer support, they identified many unmet needs of stroke survivors that peer support could meet such as social, emotional and informational support. Main barriers were the lack of human and financial resources, and of linkage between hospital and community professionals, and the fear that peer support would give false hope to survivors if not delivered properly. They showed ambivalence towards patient engagement, acknowledging its importance, but demonstrating top-down attitudes. They also identified potential avenues for the implementation of peer support for stroke survivors.

CONCLUSIONS

Our study supports the necessity to involve professionals in the construction of peer-support interventions and to sensitise them to provide patient-centred care. It delivers insights on effective implementation strategies to develop peer support interventions for stroke survivors reintegrating the community.

Interventions for Driving Disruption in Community Rehabilitation: A Chart Audit

PURPOSE

After injury or illness, a person's ability to drive may be impacted and they may experience a period of "driving disruption," a period during which they cannot drive although they have not permanently ceased driving. They may require additional information and supports from treating rehabilitation services; however, this process is less understood than others related to driving.

MATERIALS AND METHODS

This study aimed to document the prevalence of driving-related issues and the current practices of a community rehabilitation service, regarding driving interventions. An audit of 80 medical records was conducted in a multidisciplinary community rehabilitation service in Brisbane, Australia.

RESULTS

In total, 61% of clients were "driving-disrupted" on admission and 35% remained driving-disrupted on discharge. Majority of driving-disrupted clients had an acquired brain injury (ABI). Driving-related interventions were not routinely provided, with 29% receiving no information or supports. Clients with ABI more frequently received information; provision of psychosocial support and community access training was infrequent.

CONCLUSIONS

This study highlights that return to driving is a common issue and goal for people undergoing community rehabilitation, with the period of driving disruption extending beyond rehabilitation discharge. It also highlights gaps in community rehabilitation practice, and opportunities to better support these clients.IMPLICATIONS FOR REHABILITATIONMany clients of community rehabilitation services experience driving disruption, often beyond discharge.Driving disruption should be recognised and documented by community rehabilitation services.Current practices may not adequately address the practical and psychological needs of clients experiencing driving disruption.

International Classification of Functioning, Disability, and Health-based rehabilitation program promotes activity and participation of post-stroke patients

Background

The International Classification of Functioning, Disability, and Health (ICF) model has been applied in post-stroke rehabilitation, yet limited studies explored its clinical application on enhancing patients' Activity and Participation (ICF-A&P) level.

Purpose

This study gathered evidence of the effects of an ICF-based post-stroke rehabilitation program (ICF-PSRP) in enhancing community reintegration in terms of ICF-A&P of post-stroke patients.

Methods

Fifty-two post-stroke patients completed an 8 to 12 weeks multidisciplinary ICF-PSRP after setting personal treatment goals in an outpatient community rehabilitation center. Intake and pre-discharge assessments were administered for primary outcomes of Body function (ICF-BF; e.g., muscle strength) and ICF-A&P (e.g., mobility), and secondary outcomes of perceived improvements in ability (e.g., goal attainment and quality of life).

Results

There were significantly higher levels in the ICF-BF and ICF-A&P domains, except cognitive function under the ICF-BF. Improvements in the primary outcomes predicted corresponding secondary outcomes. Firstly, expressive and receptive functions (ICP-BF) were mediated by the everyday language (ICF-A&P) which predicted patients' satisfaction with the language-related quality of life. Secondly, upper extremity function (ICP-BF) was mediated by the lower extremity mobility (ICF-A&P) predicting work and productivity-related quality of life. Content analyses showed that combined ICF-BF and ICF-A&P contents throughout the ICF-PSRP contributed to the positive treatment effects.

Conclusion

The ICF-PSRP was effective in promoting body function, and activity and participation levels of post-stroke patients. Positive treatment effects are characterized by goal-setting process, cross-domain content design, and community-setting delivery.Clinical trial registration: https://clinicaltrials.gov/study/NCT05941078?id=NCT05941078&rank=1, identifier NCT05941078.

A Network Analysis of the PART-O at 1 and 2 Years After TBI: A Veterans Affairs Model Systems Study

OBJECTIVE

The construct of participation after traumatic brain injury (TBI) can be difficult to operationalize. Psychometric network analysis offers an empirical approach to visualizing and quantifying the associations between activities that comprise participation, elucidating the relations among the construct's components without assuming the presence of a latent common cause and generating a model to inform future measurement methods. The current research applied psychometric network analysis to the Participation Assessment with Recombined Tools-Objective (PART-O) within a sample of service members and veterans (SM/Vs) with a history of TBI at 1 and 2 years ( T1 and T2 ) postinjury.

PARTICIPANTS

Participants ( N = 663) were SM/Vs with a history of TBI who completed comprehensive inpatient rehabilitation services at a Department of Veterans Affairs (VA) Polytrauma Rehabilitation Center (PRC).

SETTING

Five VA PRCs.

DESIGN

Cross-sectional, retrospective analysis of data from the VA TBI Model Systems study.

MAIN MEASURES

PART-O.

RESULTS

Network analysis demonstrated that the PART-O structure was generally consistent over time, but some differences emerged. The greatest difference observed was the association between "spending time with friends" and "giving emotional support" to others. This association was more than twice as strong at T2 as at T1 . The "out of the house" item was most central, as demonstrated by dense connections within its own subscale (Out and About) and items in other subscales (ie, Social Relations and Productivity). When examining items connecting the 3 subscales, the items related to giving emotional support, internet use, and getting out of the house emerged as the strongest connectors at T1 , and the internet was the strongest connector at T2 .

CONCLUSION

Providing emotional support to others is associated with greater participation across multiple domains and is an important indicator of recovery. Being out and about, internet use, and engagement in productive activities such as school and work shared strong associations with Social Relations. Network analysis permits visual conceptualization of the dynamic constructs that comprise participation and has the potential to inform approaches to measurement and treatment.

Goal-setting and personalization under the International Classification of Functioning, Disability, and Health framework: Community reintegration program for post-stroke patients

Background

Body functions and structures, activities, and participation are the core components in the International Classification of Functioning, Disability, and Health (ICF) to identify post-stroke patients' health conditions. The specification of health conditions enhances the outcomes of post-stroke rehabilitation.

Purpose

This study aimed to explore the extent and the processes in an ICF-based post-stroke rehabilitation program (ICF-PSRP) that could enhance patients' community reintegration level.

Methods

Post-stroke patients who completed the ICF-PSRP participated in intake and pre-discharge individual face-to-face semi-structured interviews. In addition, case therapists were invited to a face-to-face semi-structured group interview. Clinician experts were invited to complete an interview with the same interview contents as case therapists but in an online format. All interview recordings were analyzed with the Framework analysis. Patients' treatment goals were mapped with the ICF Core Set for Stroke.

Results

Out of 37 invited post-stroke patients, thirty-three of them completed the interview. Three case therapists and five clinicians completed the interviews. The goals set by the patients and their caregivers showed a broadening of their scope over the course of the program. The changes in scope ranged from the activities to the participation and environmental components. Increases in patient-therapist interactions played an essential role in the goal-setting process, which were integral to personalizing the treatment content. These characteristics were perceived by all parties who contributed to the program outcomes.

Conclusion

The application of ICF's principles and core components offers a useful framework for enhancing post-stroke patients' community reintegration level. Future studies should explore the way in which patient-therapist interaction, exposure to environmental factors, and personalized interventions maximize the benefits of applying this framework to the community integration of post-stroke patients.

The Ripple Effects of Post-Conviction Traumatic Stress in People Required to Register as Sex Offenders and their Families

Post-Conviction Traumatic Stress (PCTS) describes the cognitive, psychological, and physiological symptoms of trauma that result from a range of experiences with the criminal justice system. This pilot study aimed to empirically validate the construct of PCTS utilizing the Post-Traumatic Checklist (PCL-5), an existing measure of Post-Traumatic Stress Disorder (PTSD) according to DSM-5 diagnostic criteria. Using mixed methods, the survey asked about the traumagenic impact of arrests, court proceedings, incarceration, probation/parole supervision, and sex offender registration requirements in a sample of people required to register as sexual offenders (RSOs; n = 290) and their family members (n = 126). The PCL-5 was used to estimate the prevalence of PTSD and to explore the unique presentation of symptoms. Findings indicated that 69% of registrants and 62% of family members reported clinically significant indicators of PTSD. Examples of specific symptom presentations are illustrated through qualitative responses. Implications for clinical treatment, policy, and future research related to PCTS are discussed.

Exploring community reintegration among Nigerian stroke survivors

Background

Community reintegration is one of the ultimate goals of stroke rehabilitation. The increasing burden of stroke morbidity by other non-communicable diseases in Nigeria indicated the need for our study.

Objectives

The authors explored the factors contributing to successful community reintegration among Nigerian stroke survivors.

Method

We conducted an explorative qualitative study design to achieve this aim using in-depth semi-structured interviews with 12-purposively sampled stroke survivors.

Results

Three overarching themes emerged: restriction of participation experienced by stroke survivors, activity limitation as pointers to the quality-of-life experience of stroke survivors and enablers or barriers to community reintegration for stroke survivors. Among the core, sub-themes included incapability of returning to work, difficulty performing domestic activities, social isolation or separation, recreation and leisure time. Enablers of community reintegration included creating a positive mindset, encouragement and social support, while barriers included mobility and speech or language challenges.

Conclusion

Stroke survivors have challenges in returning to work and experience varying levels of activity limitation, which affects their quality of life with identifiable enablers or barriers to community reintegration.

Clinical implications

Stroke survivors with severe functional deficits should be monitored closely and given further rehabilitative assistance to aid functional recovery, thereby facilitating community reintegration.

"All I was Thinking About was Shattered": Women's Experiences Transitioning Out of Anti-Trafficking Shelters During the COVID-19 Lockdown in Uganda

Human trafficking is an egregious violation of fundamental human rights and a global challenge. The long-term harms to survivors' physical, psychological and social wellbeing are profound and well documented, and yet there are few studies exploring how to best promote resilience and holistic healing. This is especially true within shelter programs (where the majority of anti-trafficking services are provided) and during the transition out of residential shelter care, which is often a sensitive and challenging process. The current study begins to address this gap by centering the lived experiences of six women residing in a trafficking-specific shelter in Uganda as they unexpectedly transitioned back to their home communities due to the COVID-19 lockdown. We explore this pivotal moment in participants' post-trafficking journey, focusing on how these women described and interpreted their rapidly changing life circumstances-including leaving the shelter, adjusting back to the community setting, and simultaneously navigating the uncertainties of a global pandemic. Four core themes emerged from the analysis: economic insecurities as a cross-cutting hardship; intensification of emotional and physical symptoms; social disruptions; and sources of hope and resilience. By centering their personal stories of struggle and strength, we hope to elevate survivors' own accounts and draw on their insights to identify actionable considerations for future programming.

Enhancing Veteran Community Reintegration Research (ENCORE): Protocol for a Mixed Methods and Stakeholder Engagement Project

BACKGROUND

Veteran community reintegration (CR) has been defined as participation in community life, including employment or other productive activities, independent living, and social relationships. Veteran CR is a Veterans Health Administration priority, as a substantial proportion of veterans report difficulties with veteran CR following discharge from military service.

OBJECTIVE

Enhancing Veteran Community Reintegration Research (ENCORE) is a project funded by Veterans Health Administration's Health Service Research and Development Service. The goal of ENCORE is to maximize veteran and family reintegration by promoting innovative research and knowledge translation (KT) that informs and improves equitable Department of Veterans Affairs (VA) policies, programs, and services. Overall, 2 strategic objectives guide ENCORE activities: mobilize veteran CR research and promote innovation, relevance, and acceleration of veteran CR research and KT.

METHODS

ENCORE uses a mixed methods and stakeholder-engaged approach to achieve objectives and to ensure that the KT products generated are inclusive, innovative, and meaningful to stakeholders. Project activities will occur over 5 years (2019-2024) in 5 phases: plan, engage, mobilize, promote, and evaluate. All activities will be conducted remotely owing to the ongoing COVID-19 pandemic. Methods used will include reviewing research funding and literature examining the gaps in veteran CR research, conducting expert informant interviews with VA program office representatives, and assembling and working with a Multistakeholder Partnership (MSP). MSP meetings will use external facilitation services, group facilitation techniques adapted for virtual settings, and a 6-step group facilitation process to ensure successful execution of meetings and accomplishment of goals.

RESULTS

As of December 2022, data collection for ENCORE is ongoing, with the team completing interviews with 20 stakeholders from 16 VA program offices providing veteran CR-related services. ENCORE developed and assembled the MSP, reviewed the VA funding portfolio and veteran CR research literature, and conducted a scientific gap analysis. The MSP developed a veteran CR research agenda in 2021 and continues to work with the ENCORE team to prepare materials for dissemination.

CONCLUSIONS

The goal of this program is to improve the impact of veteran CR research on policies and programs. Using a stakeholder-engaged process, insights from key stakeholder groups are being incorporated to set a research agenda that is more likely to result in a relevant and responsive veteran CR research program. Future products will include the development of an effective and relevant dissemination plan and the generation of innovative and relevant dissemination products designed for rapid KT.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/42029.

Psychiatric disorders and comorbidity in a Spanish sample of prisoners at the end of their sentence: Prevalence rates and associations with criminal history

Introduction

This study examined, for the first time, the prevalence of mental disorders and comorbidities among inmates who were about to be released, and their association with criminal history.

Methods

A Spanish sample of 140 prisoners at the end of their sentence was recruited from an occupational program. Psychiatric disorders were determined according to the Diagnostic and Statistical Manual of Mental Disorders criteria. Bivariate analyses followed by multivariate regression models were conducted to identify significant variables for repeat incarceration and violent offending.

Results

The lifetime prevalence of Axis I disorders was 81.4%, with substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD) being the most common diagnoses (51.4 and 31.4%, respectively). The current prevalence of Axis I disorders was 59.0%, including learning disorders (38.6%), ADHD (16.4%), and SUD (5.71%) among the most frequent syndromes. Thirty-six (26.5%) participants met criteria for a current Axis II disorder, which commonly was an antisocial personality disorder (12.5%). The majority of the sample (60.8%) suffered from two or more comorbid disorders during their lifetime, although the current prevalence fell to 23.3%. Childhood ADHD increased the number of imprisonments, while inmates convicted of a violent crime were more likely to present a learning disorder. Having a lifetime diagnosis of SUD or multiple psychiatric disorders appeared to be associated with both repeat incarceration and violent offending.

Conclusion

Given the high rate of mental disorders still present among subjects completing prison sentences and the challenges they may encounter to benefit from vocational programs, our results suggest that appropriate psychiatric care should be provided during imprisonment and after release to facilitate their community reintegration.

Exploring the Multidimensional Participation of Adults Living in the Community in the Chronic Phase following Acquired Brain Injury

This exploratory study aimed to examine multiple aspects of the participation of adults in the chronic phase following acquired brain injury (ABI), considering different disability levels. Our study included 25 adults ≥6 months after ABI (predominantly stroke), living at home, without severe cognitive decline. Primary measures included the Canadian Occupational Performance Measure (subjective participation) and the Mayo-Portland Adaptability Inventory-4 Participation Index (objective participation). The results indicated subjective participation problems in all of the International Classification of Functioning, Disability and Health participation domains. In addition, objective participation was reported as most limited in the areas of leisure and recreational activities, residence, and employment. Both subjective and objective participation profiles varied according to the disability level except for the social and leisure areas, which were found to be similar across all subgroups. However, only partial compatibility was found between the subjective and objective participation aspects. To conclude, our findings indicated that chronic ABI survivors report a variety of subjective and objective participation concerns that varied according to their disability levels. Moreover, the incongruity between the participation aspects suggests that the level of limitation may not necessarily correspond to the importance of a particular participation area. This highlights the need for comprehensive assessments to determine unique individual participation profiles in order to facilitate client-centered interventions supporting the rehabilitation of community-dwelling ABI survivors.

Community reintegration of people with traumatic brain injury in South Africa

BACKGROUND

Traumatic brain injury (TBI) affects cognitive, behavioral and physical function, influencing community reintegration.

OBJECTIVES

To describe the level of community reintegration and the associated influencing factors post-TBI in South Africa.

METHODS

A cross-sectional analysis of patients living with TBI was done, using the Community Integration Questionnaire (CIQ), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and the Quality of Life after Brain Injury Overall Score (QOLIBRI-OS).

RESULTS

Of the 80 participants 54.0% presented with mild TBI. The median (IQR) score of the CIQ, WHODAS 2.0 and QOLIBRI-OS was 22 (7.5)/29, 31(18)/100 and 73 (45.5)/100. There was a moderate inverse relationship between the WHODAS 2.0 and CIQ scores (r = -0.68; p < 0.001) and a moderate positive correlation between the QOLIBRI-OS and CIQ scores (r = 0.54; p < 0.001). The WHODAS 2.0 scores also showed a strong inverse correlation with the QOLIBRI-OS scores (r = -0.76; p < 0.001).

CONCLUSION

The participants had high levels of functioning and low levels of disability, both of which were found to be in tandem with high CIQ scores and generally good quality of life. Post-TBI patients are capable of achieving good community integration provided they attain high levels of functioning.

Community Reintegration of Previously Incarcerated Older Adults: Exploratory Insights from a Canadian Community Residential Facility Program

This paper addresses an immediate gap in knowledge about community reintegration of previously incarcerated older adults. It presents an exploratory case study of a community residential facility program in Ontario, Canada, focusing on the experiences and perspectives of older residents, staff members, and community stakeholders on the community reintegration of previously incarcerated older men. Findings provide insights into the aging-related reintegration issues such as the older men's ability to access health and medical services upon community reentry, the challenges and opportunities of the continuum of support (or lack thereof) to help ease the reintegration process, and stigma and other barriers the older men face as they attempt to access long-term care upon release from correctional institutions. Emergent questions for research, policy, and practice are highlighted and discussed to set an agenda for expanding the thread of inquiry into the community reintegration of previously incarcerated older adults. Future research calls for further investigation into the diversity of experiences (e.g., gender, race/ethnicity, geographical locale) to advance the field of study as it relates to aging and social policy.

Apathy and residual neurological impairment are associated with community reintegration after mild stroke

This study investigated the influence of apathy and positive social support on community reintegration after stroke. A prospective, correlational, cross-sectional design was used. 85 community dwelling participants with and without aphasia were included (≥ 18 years of age, first stroke, ≥ 6 months post-stroke). The Reintegration to Normal Living Index (RNL) measured poststroke participation. The Apathy Evaluation Scale (AES) and Positive Social Interaction domain of the Medical Outcomes Study Social Support Survey assessed apathy and social support respectively. NIH Stroke Scale measured residual neurological impairment. Apathy, social support, and stroke impairment together were strongly associated with the RNL and accounted for 51% of total variance in the RNL. The AES and NIHSS were independent predictors of the RNL, though positive social interaction failed to reach significance. Persons with and without apathy differed significantly on the RNL. Therefore, stroke rehabilitation should address apathy as a potential target for intervention. Future research should determine factors that mediate the relationship between poststroke apathy and community reintegration.

Optimizing a Halfway House to Meet Mental Health Care Users' Occupational Needs : Optimisation d'une maison de transition pour répondre aux besoins occupationnels des usagers des soins de santé mentale

Background. Halfway houses (HwH) may support community reintegration of mental health care users and can be effective in meeting occupational needs of residents. However, they are not optimally used in South Africa. Purpose. This study aimed to improve the functioning of a HwH so that it better meets occupational needs of the resident mental health care users. It draws on Doble & Santha; (2008) seven occupational needs. Method. A four-phase Participatory Action Research methodology was used. We conducted thematic analysis to describe met and unmet needs within PAR phases. Findings. Occupational needs of accomplishment, renewal, pleasure and companionship were being met. However, coherence, agency and affirmation needs were not being met. An additional occupational need for interdependence, based on the African ethic of Ubuntu, was identified. Implications. HwH functioning affected residents' experiences of health and wellbeing. Engagement in collective occupations can contribute to meeting the occupational need of interdependence.

Community reintegration needs following paediatric brain injury: perspectives of caregivers and service providers

PURPOSE

To explore the processes of community reintegration of children and families at least one year following a paediatric brain injury from the perspective of caregivers and outpatient/community service providers.

MATERIALS AND METHODS

A qualitative analysis of semi-structured interviews from outpatient or community service providers (N = 14; occupational, physical, and speech and language therapists, neuropsychologists, school counsellors, recreational providers) and caregivers of six children (N = 8) at least one year after their injury. Interviews were transcribed and thematically coded using deductive (employing Bronfenbrenner's ecological systems theory) and inductive approaches.

RESULTS

Themes from both providers and caregivers indicated additional supports needed at all levels of Bronfenbrenner's ecological systems theory (i.e., individual, microsystem, mesosystem/exosystem, macrosystem, chronosystem). Participants felt that several characteristics would be needed in an ideal service system following paediatric brain injury including: community solutions ("it takes a village"), long-term approaches to care, and new financial approaches.

CONCLUSIONS

The results suggest that children and families have substantial community reintegration needs following paediatric brain injury. Multi-system interventions are needed to support long-term community reintegration, especially those that increase communication and support transitions. There is also a strong need for alternative funding to support these efforts.Implications for RehabilitationFamilies with a child with a moderate to severe brain injury face challenges with community reintegration a year or more after their child's injury.Effort should be put into helping families navigate the complex medical, insurance, and school systems with a navigator service and step-down care to ensure a continuum of care and to support community reintegration.Special support should be provided during transitions, such as transitions from hospital care to outpatient care, and across school transitions.

The CORE (Consensus on Relevant Elements) Approach to Determining Initial Core Components of an Innovation

Identifying an intervention's core components is indispensable to gauging whether an intervention is implemented with fidelity and/or is modified; it is often a multi-stage process, starting with the first stage of identifying an initial set of core components that are gradually refined. This first stage of identifying initial core components has not been thoroughly examined. Without a clear set of steps to follow, interventions may vary in the rigor and thought applied to identifying their initial core components. We devised the CORE (Consensus on Relevant Elements) approach to synthesize opinions of intervention developers/implementers to identify an intervention's initial core components, particularly applicable to innovative interventions. We applied CORE to a peer-based intervention that aids military veterans with post-incarceration community reintegration. Our CORE application involved four intervention developers/implementers and two moderators to facilitate the seven CORE steps. Our CORE application had two iterations, moving through Steps 1 (individual core component suggestions) through 7 (group discussion for consensus), then repeating Steps 4 (consolidation of component definitions) through 7. This resulted in 18 consensus-reached initial core components of the peer-based intervention, down from the 60 that the developers/implementers individually suggested at Step 1. Removed components were deemed to not threaten the intervention's effectiveness even if absent. CORE contributes to filling a critical gap regarding identifying an intervention's initial core components (so that the identified components can be subsequently refined), by providing concrete steps for synthesizing the knowledge of an intervention's developers/implementers. Future research should examine CORE's utility across various interventions and implementation settings.

Community reintegration post-stroke in New Zealand: understanding the experiences of stroke survivors in the lower South Island

PURPOSE

Optimal community reintegration is a key rehabilitation outcome post-stroke. This concept has been investigated in many countries but not qualitatively in New Zealand. We explored perceptions about community reintegration of stroke survivors living in southern New Zealand.

METHOD

Qualitative interviews were used to collect data. Recruitment was via local stroke clubs, inviting adult stroke survivors (stroke duration > six months, any severity or type) living in the lower South Island. Data were analysed using the General Inductive Approach.

RESULTS

Eight stroke survivors (two female, six males; age range 50-80 years, mean 66 years (SD = 12); mean time since stroke 6.5 (SD = 4) years) participated. Participants' perceptions of what is integral to reintegration into their community were shaped by four themes, namely: (1) personal relationships, (2) re-establishing normality (old and new), (3) purpose in life, and (4) independence.

CONCLUSIONS

Stroke survivors in New Zealand hold many similar perceptions about optimal community reintegration with those living elsewhere. Key to successful community reintegration, irrespective of geography, culture and ethnicity, appears to be involvement in meaningful activities, and reduced reliance on others whilst maintaining or developing good social relationships. These fundamental components are then contextually nuanced by what is meaningful and important to the individual.IMPLICATIONS FOR REHABILITATIONOptimal community reintegration post-stroke is arguably the key goal of rehabilitation, and thus should be enabled and measured.To optimise community reintegration post-stroke, rehabilitation should focus on enabling stroke survivors' social relationships, independent community mobility, and engagement in meaningful activities.Optimal community reintegration post-stroke is however contextual. Rehabilitation professionals must understand what each patient considers successful community reintegration to be for them and tailor their rehabilitation accordingly.

Community reintegration following holistic milieu-oriented neurorehabilitation up to 30 years post-discharge

BACKGROUND

The primary goal of neurorehabilitation for individuals with acquired brain injury (ABI) is successful community reintegration, which commonly focuses on home independence, productivity, and social engagement. Previous research has demonstrated that holistic treatment approaches have better long-term outcomes than other treatment approaches. Holistic approaches go beyond the fundamental components of neurorehabilitation and address metacognition and self-awareness, as well as interpersonal and functional skills.

OBJECTIVES

The present study aimed to examine community reintegration of individuals with ABI who completed holistic milieu-oriented neurorehabilitation at the Center for Transitional Neuro-Rehabilitation (CTN), Barrow Neurological Institute (BNI) at up to 30-years post-discharge. We evaluated (a) functional independence, (b) productivity and driving status, and (c) psychosocial profiles of the brain injury survivors.

METHOD

Participants included 107 individuals with ABI with heterogeneous etiologies who attended holistic milieu-oriented neurorehabilitation between 1986 and 2016. These participants completed the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a long-term outcome questionnaire (LOQ) specifically developed for this study.

RESULTS

The results demonstrate that 89% of participants were productive at up to 30 years post-discharge (73% engaged in competitive work and/or school) after excluding the retired participants. Almost all of the participants who were engaged in work and/or school reported using compensatory strategies on a long-term basis. Furthermore, only 14% out of 102 study participants were driving at the time of program admission; whereas 58% out of 96 were driving at the time of discharge; and impressively, 70% out of 107 participants were driving at the time of follow-up. Regression analyses revealed that older age at the time of injury, shorter duration between injury and treatment, and better functionality indicated by lower MPAI-4 Ability Index scores significantly predicted a return to driving status at the time of study participation. Psychosocial data from the LOQ revealed positive findings with respect to patients' marital status, living situation, income, and quality of social life.

CONCLUSION

The findings from this study suggest that functional gains made during holistic neurorehabilitation have enduring effects and that patients can benefit highly from holistic milieu therapy beyond the early post-acute phases of their recovery. Additionally, they provide evidence that there is potential to return to driving, years after treatment completion.Our holistic milieu treatment approach addressing metacognition, self-awareness, social and coping skills training, and actively transitioning to community settings, is thought to have contributed to the exceptional and long-lasting outcomes in this study.

Implementing music therapy through telehealth: considerations for military populations

PURPOSE

Telehealth provides psychotherapeutic interventions and psychoeducation for remote populations with limited access to in-person behavioural health and/or rehabilitation treatment. The United States Department of Défense and the Veterans Health Administration use telehealth to deliver primary care, medication management, and services including physical, occupational, and speech-language therapies for service members, veterans, and eligible dependents. While creative arts therapies are included in telehealth programming, the existing evidence base focuses on art therapy and dance/movement therapy, with a paucity of information on music therapy.

METHODS

Discussion of didactic and applied music experiences, clinical, ethical, and technological considerations, and research pertaining to music therapy telehealth addresses this gap through presentation of three case examples. These programmes highlight music therapy telehealth with military-connected populations on a continuum of clinical and community engagement: 1) collaboration between Berklee College of Music in Boston, MA and the Acoke Rural Development Initiative in Lira, Uganda; 2) the Semper Sound Cyber Health programme in San Diego, CA; and 3) the integration of music therapy telehealth into Creative Forces®, an initiative of the National Endowment for the Arts.

RESULTS

These examples illustrate that participants were found to positively respond to music therapy and community music engagement through telehealth, and reported decrease in pain, anxiety, and depression; they endorsed that telehealth was not a deterrent to continued music engagement, requested continued music therapy telehealth sessions, and recommended it to their peers.

CONCLUSIONS

Knowledge gaps and evolving models of creative arts therapies telehealth for military-connected populations are elucidated, with emphasis on clinical and ethical considerations.IMPLICATIONS FOR REHABILITATIONMusic therapy intervention can be successfully adapted to accommodate remote facilitation.Music therapy telehealth has yielded positive participant responses including decrease in pain, anxiety, and depression.Telehealth facilitation is not a deterrent to continued music engagement.Distance delivery of music through digital platforms can support participants on a clinic to community continuum.

Self-Perception of Physical Function Contributes to Participation in Cognitively- and Physically-Demanding Activities After Stroke

Background: Persons with and without aphasia experience decreased participation in meaningful activities post-stroke that result in reduced autonomy and poorer quality of life. Physical, cognitive, and/or communication deficits are prevalent post-stroke and many activities given up are purported to require high levels of communicative, cognitive, or physical skill. However, the relationship between deficits after stroke and participation in life activities that appear to require high skill levels in these three areas has not been investigated fully.

Objectives: The objectives of this study are to: (1) determine differences in reported participation in communicatively-, cognitively-, or physically-demanding activities in persons after stroke with and without aphasia living in the community, and to (2) investigate whether performance on commonly used self-perception assessments of these three areas predicts reported participation in activities requiring higher levels of skill in these domains.

Methods: In a cross-sectional design, 82 individuals at least 6 months post-stroke with (N = 34) and without aphasia (N = 48) were administered a battery of neuropsychological and participation-based assessments. Supported communication techniques maximized inclusion of individuals with aphasia. A series of regression analyses investigated the relationship between self-perceived communicative, cognitive, and physical functioning and reported participation in activities post-stroke that required high amounts of skilled function in these areas.

Results: People with and without aphasia did not differ in terms of the percentage retained in communicatively-, cognitively-, or physically-demanding activities. All individuals retained higher levels of participation in communicatively- and cognitively-demanding activities (at least 60% retained), compared to participation inphysically-demanding activities (about 50% retained). The strongest predictor for retaining participation in two of the three domains of activities was self-perception of physical function, though much of the variance remained unexplained. Self-perception of communication was not related to participation retention in any of the three domains.

Significance of Impact: Rehabilitation professionals should be aware of the impact that a variety of communicative, cognitive, and physical factors may have on participation post-stroke. Self-perceptions of impairments in communication and cognition may not directly predict participation in activities requiring high levels of communicative and/or cognitive skill, at least for those with mild impairment, even though activities requiring those skills are given up or done less after stroke.

"This Time It's Different" Preparing for Release Through a Prison-Model of CoSA: A Phenomenological and Repertory Grid Analysis

Circles of support and accountability (CoSA) in the prison-model begin prior to the core members' release from prison and continue with them on release in to the community. The purpose of this study was to explore the expectations of release of those convicted of a sexual offense and how this develops during their participation in the prison sessions of CoSA. The research question was to consider how the prison-model of CoSA relates to the desistance of crime, in particular the phases of desistance developed by Gobbels, Ward, and Willis. Data were collected using both phenomenological interviews and repertory grids at two different time points; prior to starting the circle in prison (n = 9) and just before release (n = 5). The findings suggest the prison sessions provide a sense of support and "no longer being alone" often absent in those who sexually offend. The additional prison sessions enabled the participants to experience this during their approaching release date; a stressful period that was characterized by anxiety. Further research is now required to explore whether circles in the prison-model are able to encourage and reinforce the cognitive change required for desistance, enabling the core members to successfully manage their underlying anxieties surrounding societal stigmatization.

Evaluation of Predictive Factors Influencing Community Reintegration in Adult Patients with Stroke

Objectives

Patients with stroke are faced with gait, balance, and fall difficulties which could impact on their community reintegration. In Nigeria, community reintegration after stroke has been understudied. The objective of this study was to evaluate the predictors of community reintegration in adult patients with stroke.

Materials and Methods

Participants were 91 adult patients with stroke. Gait variables, balance self-efficacy, community balance/mobility, and fall self-efficacy were assessed using Rivermead Mobility Index, Activities-specific Balance Confidence Scale, Community Balance and Mobility Scale, and Falls Efficacy Scale-International respectively. Reintegration to Normal Living Index was used to assess satisfaction with community reintegration. Pearson Product-Moment Correlation Coefficient was used to determine the relationship between community reintegration and gait spatiotemporal variables, balance performance, and risk of fall. Multiple regression analysis was used to determine predictors of community reintegration (P ≤ 0.05).

Results

There was significant positive relationship between community reintegration and cadence (r = 0.250, P = 0.017), functional mobility (r = 0.503, P = 0.001), balance self-efficacy (r = 0.608, P = 0.001), community balance/mobility (r = 0.586, P = 0.001), and duration of stroke (r = 0.220, P = 0.036). Stride time (r = -0.282, P = 0.073) and fall self-efficacy (r = 0.566, P = 0.001) were negatively correlated with community reintegration. Duration of stroke, balance self-efficacy, community balance/mobility, and fall self-efficacy (52.7% of the variance) were the significant predictors of community reintegration.

Conclusion

Community reintegration is influenced by cadence, functional mobility, balance self-efficacy, community balance/mobility, and duration of stroke. Hence, improving balance and mobility during rehabilitation is important in enhancing community reintegration in patients with stroke.

Heterogeneity and Its Impact on Rehabilitation Outcomes and Interventions for Community Reintegration in People With Spinal Cord Injuries: An Integrative Review

Background: Various injury characteristics such as cause, level, severity, and time since injury divide individuals with spinal cord injury (SCI) into many subgroups. The heterogeneity among individuals' injuries and personal characteristics has significant implications for SCI rehabilitation practice, specifically directed toward community reintegration, which is a key goal of rehabilitation interventions for people with disabilities. Purpose: This study aims to summarize the evidence on attributes that make the SCI population heterogeneous, the impact of these attributes on community reintegration, and the implications of heterogeneity for rehabilitation interventions directed toward optimizing community reintegration. Methods: We used an integrative review approach to conduct this study. MEDLINE, PubMed, CINAHL, EMBASE, Google Scholar, and PsycINFO were searched from inception until May 2017. Out of 670 articles retrieved, 49 provided evidence on the impact of various attributes that make SCI heterogeneous on rehabilitation outcomes related to community reintegration. Results: An array of injury-related, personal, social, and environmental factors are associated with various rehabilitation outcomes that affect community reintegration of people with SCI. There is level 1 evidence that social support, self-efficacy, and self-esteem facilitate community reintegration among people with SCI while there is level 5 evidence that presence of psychological or medical complications decreases it. There is lack of clarity on the impact of injury-related factors on community reintegration. Conclusion: This integrative review found that social support and individuals' self-efficacy can improve community reintegration of people with SCI. However, evidence regarding the impact of injury characteristics on community reintegration is still underdeveloped. Approaches directed at community reintegration should involve components of psychosocial, physical, and vocational rehabilitation while considering personal and societal aspects of an individual's life.

'No one prepared me to go home': Cerebrovascular accident survivors' experiences of community reintegration in a peri-urban context

BACKGROUND

The South African health system has policies and strategies to ensure effective rehabilitation and reintegration of individuals who have survived a cerebrovascular accident into their respective communities. However, implementation of such guidelines remains an issue.

AIM

This study sought to explore cerebrovascular accident (CVA) survivors' experiences of community integration.

SETTING

The study was located in a peri-urban community within the KwaZulu-Natal Province, South Africa.

METHODS

An explorative qualitative study with eight purposively selected CVA survivors was conducted via semi-structured individual interviews. Data were audio-recorded and manually transcribed prior to thematic analysis. Trustworthiness of the study was maintained by strategies such as analyst triangulation, an audit trail and use of thick descriptions. Ethical principles of autonomy, informed consent, confidentiality and privacy were also maintained in the study.

RESULTS

Six themes emerged that highlighted (1) loss of autonomy and roles, (2) barriers to community reintegration, (3) social isolation of participants, (4) finding internal strength, (5) enablers of community reintegration including the positive influence of support and the benefits derived from rehabilitation and (6) recommendations for rehabilitation.

CONCLUSION

The study revealed both positive and negative influences that impact CVA survivors' ability to effectively reintegrate into their respective communities following a CVA. Recommendations include the need for education and awareness around access to rehabilitation services for CVA survivors, advice on how to improve CVA survivors' ability to mobilise in the community and make environmental adaption to facilitate universal access, provision of home programmes and caregiver training for continuity of care and for inclusion of home-based rehabilitation into current models of care.

Clients with stroke and non-stroke and their guardians' views on community reintegration status after in-patient rehabilitation

Aim

The aim of this study was to compare client community reintegration status following discharge from the Kachere Rehabilitation Centre (KRC), Blantyre, Malawi, in 2 consecutive years with client versus guardian perspectives on reintegration status.

Methods

Using quantitative methods, 35 clients with stroke and non-stroke diagnoses (spinal cord dysfunction and neuropathic conditions) and 32 client guardians (the family caregivers in Malawi) were separately interviewed using the WHO Disability Assessment Schedule (DAS) 2.0 (a measure of disability due to reintegration problems back into the community). The results were analyzed using descriptive statistics and the Wilcoxon Signed-Rank Test or the Mann-Whitney U Test, as appropriate, to test for significant differences between groups. The clients' home environments were categorized using an original checklist, the Home Observation Data Form (HOD).

Results

Moderate to severe perceived levels of disability related to reintegration difficulties were noted by clients in years 1 and 2. For those with non-stroke diagnoses, there was a significant change in year 2 results compared to year 1, but not for those with stroke diagnoses. Guardians agreed with their client's perceptions of difficulty in year 2. Major areas of concern were taking care of household responsibilities, participating in day-to-day work or school routines, joining in community activities, and walking one kilometer per day.

Conclusions

Community reintegration challenges in suburban Blantyre, Malawi continued to plague individuals with stroke and non-stroke diagnoses for 2 consecutive years after discharge from KRC. Based on the important role guardians play during their client's rehabilitation phase and when they return to the community, opportunities may exist to improve client perception of disability related to their reintegration status. Future studies are important to replicate these results, investigate the idea of a more important role for guardians in patient-centered care, and the relationship between motor and cognitive function and reintegration status.

University of Alberta Hospital Acute and Convalescent Polio Care and the Reintegration of Polio Patients into Albertan Communities, 1953-80

Following Canada's largest polio epidemic in 1953, Station 67 at the University of Alberta Hospital (UAH) in Edmonton became home to patients who contracted the virus. As young as nine years old, some of these patients lived at the UAH for more than three decades. Akin to wartime services, the epidemic banded together families, patients, doctors, nurses, community members, and later respiratory, physical, and occupational therapists. The nature of the disease, the government response, and the social and economic climate dramatically affected the lived experiences of patients in Alberta's fight against polio. Drawing on archival research and oral interviews, this article argues that it was the agency and resilience of patients, the contributions of healthcare providers to rapid developments in acute and convalescent care, and the dedication of families that were primarily responsible for the recovery and reintegration of polio patients back into the community.

You Do What? A Qualitative Investigation Into the Motivation to Volunteer With Circles of Support and Accountability

Most community members are not accepting of individuals convicted for sexual offenses living in their communities, let alone having regular contact with them. However, a select number of community members choose to give their time to assist these individuals reintegrate from prison into the community. Circles of Support and Accountability (CoSA) was developed as a way to address the issues that many individuals convicted of sex offenses face, that is, little to no prosocial support in the community. In-depth, semistructured interviews were conducted with 18 CoSA volunteers in New Zealand to gain a more thorough understanding of volunteers' motivation to be involved with CoSA. Thematic analysis was used to analyze the data. Three key themes of motivation were identified: (a) Restorative and Justice-Based Motivation, (b) Altruistic Motivation, and (c) Faith-Based Motivation. Findings are discussed in terms of their implications for future recruitment of volunteers for CoSAs.

Turning a Blind Eye: Public Support of Emergency Housing Policies for Sex Offenders

In this study, we examine the influences of citizen decision making in the context of four policy scenarios that would affect the living conditions of sex offenders (SOs) residing at an "emergency shelter" budget motel. We surveyed 773 citizens in an online survey about their support for four policy scenarios that would improve the living conditions of SOs: (a) at no cost to the respondent, (b) in exchange for a US$100 tax increase, and (c) by relocating SOs within the respondent's neighborhood (i.e., "in my backyard"/IMBY scenario). The fourth scenario involved moving nearby SOs into substandard housing located far away from the respondent (i.e., "not in my backyard"/NIMBY). While prior research finds that the public overwhelmingly supports punitive SO policies, we find that indifference is a mainstay of public opinion about improving SO housing conditions. That is, we find only modest levels of average support for any of the policy scenarios, and policy support decreased when increased taxes would be involved, compared with a "no cost" scenario. While no respondent characteristics significantly predicted policy support consistently across all four scenarios, some scenarios showed stark differences in support when considering specific respondent characteristics. Overall, these results suggest that what does affect support depends on the details of the policy being proposed, as well as who is considering the policy. We end by discussing the policy implications of our study for both policymakers and the public.

Looking inside a circle: volunteer experiences of circles of support and accountability

Circles of Support and Accountability (CoSA) is a promising reintegration framework whereby community volunteers support individuals convicted for sexual offenses to reintegrate safely into the community. CoSA has grown in popularity, yet little is known about volunteers' experiences of CoSA, including how they cope with their core member being recalled or reoffending. The aim of the current study is to explore the experiences of CoSA volunteers in New Zealand. In-depth interviews were used to explore experiences. The findings relating to general experiences explored balancing risk management and social support, questioning the place of religion in CoSA, confronting stereotypes, and volunteering in a risk-averse society. The findings also revealed both the commitment to CoSA, and the stress and guilt felt by the volunteers following a recall or re-offense. Findings are discussed in terms of their implications for current and ongoing volunteers, as well as for community approaches to criminal justice.

"It's Sort of Reaffirmed to Me That I'm Not a Monster, I'm Not a Terrible Person": Sex Offenders' Movements Toward Desistance via Peer-Support Roles in Prison

Individuals incarcerated in prisons across the United Kingdom and abroad are able to volunteer for a variety of peer-support roles, which are characterized by prisoner-to-prisoner helping. Some research has found that such roles can represent turning points in the lives of those who have offended and encourage movements toward desistance. This proposed redemptive influence is argued to result from the prosocial behaviors that such roles appear to elicit in their holders. The present study aims to explore the mechanics of this claimed influence. While a limited amount of research has attempted this on a general offending population, no research has done so with a sample of sexual offenders. Given the intensive treatment programs involved in such contexts, and the requirements for sexual offenders to demonstrate reduced risk, the authors believe those serving time for sexual offenses represent an important sample on which to explore the potentially redemptive properties of peer-support roles. To this end, 13 peer supporters participated in semistructured interviews. Transcripts were analyzed using a phenomenologically oriented thematic analysis. Results suggest that sexual offenders who adopt peer-support roles are able to live up to desired selves by "doing good" in prison, "giving back," and consequently resisting negative labels. These benefits have been theoretically linked with better reintegration outcomes for sexual offenders, who are publicly denigrated in the extreme and find it especially difficult to (re)integrate. Suggestions regarding the future utility of such schemes are offered.

Social Support, Dysfunctional Coping, and Community Reintegration as Predictors of PTSD Among Human Trafficking Survivors

Human trafficking exerts psychological effects on survivors that persist after intervention, and even after community reintegration. Effects include anxiety, depression, alienation, disorientation, aggression, suicidal ideation, attention deficit, and posttraumatic stress disorder (PTSD). Community supports and coping mechanisms may mitigate these effects. The report presented here is part of a long-term program of research to develop and test evidence-informed mental health and human capacity-building intervention programs for women and girls who are victims of trafficking. Structural equation modeling was used to assess a conditional process model (moderated mediation) of the effect of social support, coping, and community reintegration on PTSD among n = 144 girls and women. Participants received psychosocial intervention at a residential care facility for trafficking survivors. Results indicate model fit was excellent. Results indicate community reintegration indirectly influenced PTSD through its effect on perceived social support. Survivors who reported more difficulty reintegrating back into the community perceived less social support than those that reported easier community reintegration, and trafficking survivors who perceived less social support indicated more PTSD. Survivors with more PTSD symptoms tended to report using more dysfunctional coping mechanisms.

Relationships Between Community Reintegration and Clinical and Psychosocial Attributes in Individuals With Spinal Cord Injury in a Nigerian City

Background: The bio-psychosocial model for comprehensive understanding of community reintegration among individuals with spinal cord injury (SCI) varies across communities. Yet, information about community reintegration in Nigeria is not available. Objective: To investigate the association between community reintegration and clinical and psychosocial attributes among Nigerians with SCI. Methods: Fifty individuals (31 females; 19 males) with SCI aged 38.6 ± 11.1 years participated in this longitudinal survey. Pain, functional ability, and severity of injury were assessed at discharge and at 1, 2, and 3 months post-discharge from inpatient care using the Visual Analogue Scale (VAS), FIM^®, and American Spinal Injury Association Impairment Scale (AIS), respectively. Self-esteem (SE), social support (SS), and depression were also assessed using the Self-Esteem Questionnaire, Social Support Questionnaire, and Beck Depression Inventory, respectively. CR was assessed at 1, 2, and 3 months post-discharge using the Reintegration to Normal Living Index (RNLI). Data were analyzed using Spearman's rho correlation and Friedman test. Results: The psychosocial and clinical attributes were significantly different from baseline and across the 3 months post-discharge (p < .0001), except for SS. CR significantly correlated with level of injury, function ability, SE, and depression across the 3 months post-discharge (p < .01). CR was significantly correlated with SS only at 1 month post-discharge (p = .027). Conclusion: Individuals with SCI had significant improvement in clinical and psychosocial attributes from discharge to 3 months post-discharge. Improvements in these variables were associated with better reintegration into the community.

Affective and Cognitive Conditions are Stronger Predictors of Success with Community Reintegration than Gait and Balance Performance in Veterans with Mild Traumatic Brain Injury

Introduction

Optimal community reintegration is an integral part of the clinical management of patients with mild traumatic brain injury.

Background/Objective

We sought the contribution and inter-relation of such variables as balance, executive function, and affective regulation to the community reintegration of veterans with mTBI.

Methods

We examined the statistical relationship among the above variables by conducting a series of objective evaluations to assess the balance, gait, executive function, affective regulation, and scores representing the patients’ issues with community reintegration. The data were statistically analyzed for correlation and regression.

Results

High correlation was found among scores for balance and gait, executive function and affective regulation. The first and second best predictors of success with patient’s community reintegration were data representing affective regulation and cognitive impairments, respectively. However, the data for dynamic balance correlated weakly and insignificantly with scores for the three subsets of community reintegration.

Conclusions

We revealed varying degrees of correlation among balance, executive function and affective regulation, and as they related to the community reintegration success of patients with mTBI. The strongest, intermediate and weakest predictors for these patients’ success with community reintegration represented those for affective regulation, executive function, and dynamic balance and gait performance, respectively.

Efficacy of Trunk Regimes on Balance, Mobility, Physical Function, and Community Reintegration in Chronic Stroke: A Parallel-Group Randomized Trial

OBJECTIVE

The study objective was to examine the efficacy of plinth and Swiss ball-based trunk exercise regimes on balance, mobility, physical function, and community reintegration compared with standard physiotherapy in chronic stroke.

SUBJECTS AND METHODS

This observer-blinded parallel-group randomized trial was conducted in outpatient stroke units. People with chronic stroke aged between 30 and 75 years, first onset of unilateral cortical lesion, poor trunk performance, 10 m independent walking ability with or without walking aids, and absence of pusher syndrome were included. Trunk Impairment Scale 2.0, Brunel Balance Assessment, Tinetti scale, gait speed, Stroke Impact Scale-16, and Reintegration to Normal Living Index were the measures. Experimental interventions involved the practice of selective upper and lower trunk movements using either plinth or Swiss ball. Control group received standard physiotherapy. All the patients practiced 1 hour exercise session, 3 sessions a week over a duration of 6 weeks and followed up after 3 and 12 months.

RESULTS

Of 108 patients allocated into 3 groups, baseline characteristics were similar. Postintervention compared with control group, the plinth, and Swiss ball groups showed significant mean changes in the outcome measures: trunk impairment scale 2.0 (3.6;4.1 points), Brunel Balance Assessment (1-level), Tinetti scale (5;5.2 points), gait speed (.06;.08 m/s), Stroke Impact Scale-16 (8.7;7.2 points), and community reintegration (7.6;8.8 points). These improvements were retained during 3-12 months' follow-up. Statistical significant was set at P < .05.

CONCLUSION

Plinth and Swiss ball-based trunk exercise regimes showed significant improvements in balance, mobility, physical function, and community reintegration in chronic stroke as against standard physiotherapy.

Community mobility after stroke: a systematic review

Background Stroke is the leading cause of severe disability and many survivors report long-term physical or cognitive impairments that may impact their ability to achieve community mobility (CM).

PURPOSE

To determine the extent to which people with chronic stroke achieve CM compared to age-matched norms or non-neurologically impaired controls. Methods The StrokEDGE outcome measures were searched to identify validated tools that included >25% of items addressing CM. MEDLINE, CINAHL, Google Scholar, PubMed, PEDro and the Cochrane databases were searched from 2001 to 2015 with the identified outcome measures cross-referenced against search terms related to stroke and CM.

INCLUSION CRITERIA

utilized a validated CM outcome measure, chronic (>3 months post) stroke survivors, and randomized controlled trial, observational or cohort study design. One reviewer screened the studies and performed data extraction and three performed quality appraisal. Fourteen studies met all inclusion criteria. Results Stroke survivors have impaired CM as demonstrated by 30-83% of normative or non-stroke subject CM scores. As time post-stroke increased, CM improved only slightly. Factors found to correlate with the CM were age, education, general well-being, emotional state, motor function and coordination, independence in activities of daily living, balance, endurance and driving status. Limitations of this review include a relatively high functioning cohort, no meta-analysis and reliance on outcome measures not specifically designed to measure CM. Conclusion Survivors of stroke may experience a significant decrease in CM compared to people without neurological injury. Rehabilitation addressing motor function, coordination, independence in activities of daily living, balance and endurance may be important for achieving higher levels of CM. Outcome measures directly addressing CM are needed.

Feasibility of a Novel Intervention to Improve Participation after Stroke

Introduction

Stroke is a leading cause of serious, long-term disability in the US. With shorter inpatient hospital stays, more time in rehabilitation is devoted to medical stabilization and less on skills to regain independence in daily activities. The transition home may be an opportunity for intervention focused on regaining independence. We propose an enhanced rehabilitation transition program called: Community Participation Transition after Stroke (COMPASS).

Method

A prospective, randomized, single-blinded, parallel-group pilot study was completed to demonstrate feasibility with N=15 participants.

Findings

Fidelity to the protocol was achieved: the COMPASS group received 81% of the planned minutes and 83% of the intervention visits. There was no difference between groups for healthcare utilization or falls. Adherence was 85% at 3-months and 71% at 9-months for the home modification intervention. At 6-months, the COMPASS group's reintegration to normal living scores improved by 17.39 points for the COMPASS group, and 1.30 for the control group. Environmental barriers decreased in both groups.

Conclusion

This pilot study demonstrated that it is feasible to implement a community participation intervention during the period of transitioning home from inpatient rehabilitation for stroke survivors. Additional studies are necessary to determine the efficacy of the intervention.

Military Families' Perceptions of Neighborhood Characteristics Affecting Reintegration: Development of an Aggregate Measure

This pilot study evaluated the validity and reliability of an Experience of Neighborhood (EON) measure developed to assess neighborhood characteristics that shape reintegration opportunities for returning service members and their families. A total of 91 post-9/11 veterans and spouses completed a survey administered at the Minnesota State Fair. Participants self-reported on their reintegration status (veterans), social functioning (spouses), social support, and mental health. EON factor structure, internal consistency reliability, and validity (discriminant, content, criterion) were analyzed. The EON measure showed adequate reliability, discriminant validity, and content validity. More work is needed to assess criterion validity because EON scores were not correlated with scores on a Census-based index used to measure quality of military neighborhoods. The EON may be useful in assessing broad local factors influencing health among returning veterans and spouses. More research is needed to understand geographic variation in neighborhood conditions and how those affect reintegration and mental health for military families.

Circles of Support and Accountability for Sex Offenders: A Systematic Review of Outcomes

We conducted a systematic review of studies reporting on the effectiveness of Circles of Support and Accountability (Circles). Circles use volunteers to provide support for sex offenders living in the community. We searched 10 databases up to the end of 2013 and identified 3 relevant outcome studies. An additional 12 papers or reports were identified by searching reference lists, Google, and contacting key authors and Circles providers to obtain unpublished data. These 15 studies comprised one randomized controlled trial, three retrospective cohorts with matched controls, and 11 case series. The majority reported measures of recidivism, particularly reconviction. The 4 studies with controls generally reported that participation in Circles was associated with lower recidivism although there were few statistically significant differences. Few studies examined changes in risk or psychosocial outcomes. A number of methodological issues are discussed. Longer term, prospective follow-up studies with control groups are required to address these issues.

SCiPad: Effective Implementation of Telemedicine Using iPads with Individuals with Spinal Cord Injuries, a Case Series

Background

Individuals with spinal cord injury (SCI) must often travel long distances to see a rehabilitation specialist. While telemedicine (TM) for pressure ulcer management has been used in this population, real-time video telecommunication using iPad has never been described.

Objective

The objective of this study was to provide specialized care for persons with SCI through TM consultation expediently in order to address medical needs, manage secondary complications, and to improve quality of life (QoL) of individuals with SCI.

Methods

Ten individuals with SCI participated in the TM program using iPads for 6 months as a feasibility study at a single-center, county hospital. The participants contacted the project staff for SCI-related conditions and were then connected to an SCI-trained health-care provider within 24 hours via FaceTime. Main outcome measures included health-care utilization; QoL and psychosocial measures collected at baseline and at 6 months: Reintegration to Normal Living Index (RNLI), Life Satisfaction Index A (LSI-A), and Patient Health Questionnaire 9 (PHQ-9); and a Program Satisfaction Survey.

Results

Ten patients (seven with tetraplegia, three with paraplegia; eight males and two females) with an average age of 34.4 (18–54) years were enrolled. The average baseline and 6-month follow-up scores were RNLI—70.1 ± 19.7 and 74.7 ± 21.8, respectively; LSI-A—25.4 ± 7.4 and 26.4 ± 8.2, respectively; and PHQ-9 were 6.8 ± 7.2 and 8.6 ± 6.1, respectively. TM encounters included topics such as pain, bladder and skin management, medication changes, and lab results. The Program Satisfaction Survey yielded positive results with 100% of program completers stating they would recommend the program and would like to continue having TM.

Conclusion

This is the first known successful project using iPad to provide TM in the SCI population. This study discusses the implementation of such a TM program in a health system including limitations. It describes the clinical viability of TM using iPads in the SCI population for care beyond that of just pressure ulcer management. This project provides evidence for using a tablet device like an iPad as an effective and efficient patient management tool.

Enhancing health and independent living for veterans with disabilities by leveraging community-based resources

The number of US veterans with disabilities has increased in recent years as service members have returned home with extensive injuries and veterans from previous wars acquire functional limitations as a consequence of aging with chronic diseases. Veterans with severe disabilities need assistance and support to maintain independence at home and to avoid institutionalization. The US Department of Veterans Affairs (VA) strives to network with community organizations to achieve the best possible outcomes for veterans. Key community resources in the US for individuals with disabilities are Centers for Independent Living (CILs) that provide a wide range of services, promoting independent living and well-being for people across disabilities. The widespread availability and services of CILs nationwide suggest their potential as a community-based resource for veterans, particularly for those with limited access to VA care. In this article, we discuss long-term needs of veterans with disabilities, efforts to address veterans' rehabilitation needs at the VA and opportunities for leveraging the strengths of community-based organizations for veterans. More research is warranted to investigate CIL services and potential for CIL-VA partnerships.

The Role of Dual Tasking in the Assessment of Gait, Cognition and Community Reintegration of Veterans with Mild Traumatic Brain Injury

Background:

This study focussed on the effect of dual versus single tasking on balance, gait and cognition in veterans with mild traumatic brain injury (mTBI). We examined the correlation between these parameters, with responses to questions on community reintegration activities.

Method:

22 male and female veterans (aged 19-65) walked along a narrow and 6.1-meter long path, both at their self-selected and fastest but safe pace under single and dual tasking conditions. For dual tasking, participants were required to recall and vocalize a 5-digit number at the end of the path. The outcome measures were the accuracy, velocity, cadence, stride length, and number of steps off the path. We calculated the reliability and correlation coefficient values for the walking time compared with the stride length, velocity, and percentage of swing and stance.

Results:

Under dual task, the participants demonstrated slower gait, recalled shorter digit span and stepped off the path 12.6% more often than under single task. The stride length decreased by about 20% and the stride velocity increased by over 2% in dual compared with single tasking.

Conclusions:

Dual tasking slows down the gait and reduces the attention span in patients with mTBI, which can negatively impact their community reintegration, at least early after their hospital discharge, hence the need for exercising caution with their community reintegration activities. Dual tasking may have the potential to improve balance, gait and attention span of the patients in the long-term, thus leading to safer community integration, if incorporated in the rehabilitation plans.

"Coming Out" of Prison: An Exploratory Study of LGBT Elders in the Criminal Justice System

This two-phase qualitative study explores the experiences of 10 formerly incarcerated LGBT elders' experiences prior to, during, and after release from prison. A core theme of self and the social mirror emerged from the data that represented LGBT elders ongoing coming-out process of unearthing their "true selves" despite managing multiple stigmatized identities or social locations, such as being LGBT, elderly, HIV positive, formerly incarcerated, and a racial/ethnic minority. These findings further our awareness of an overlooked population of LGBT who are older and involved in the criminal justice system. Recommendations that incorporate suggestions from formerly incarcerated LGBT elders for services and policy reform are presented.

Identifying contextual influences of community reintegration among injured servicemembers

Research suggests that community reintegration (CR) after injury and rehabilitation is difficult for many injured servicemembers. However, little is known about the influence of the contextual factors, both personal and environmental, that influence CR. Framed within the International Classification of Functioning, Disability and Health and Social Cognitive Theory, the quantitative portion of a larger mixed-methods study of 51 injured, community-dwelling servicemembers compared the relative contribution of contextual factors between groups of servicemembers with different levels of CR. Cluster analysis indicated three groups of servicemembers showing low, moderate, and high levels of CR. Statistical analyses identified contextual factors (e.g., personal and environmental factors) that significantly discriminated between CR clusters. Multivariate analysis of variance and discriminant analysis indicated significant contributions of general self-efficacy, services and assistance barriers, physical and structural barriers, attitudes and support barriers, perceived level of disability and/or handicap, work and school barriers, and policy barriers on CR scores. Overall, analyses indicated that injured servicemembers with lower CR scores had lower general self-efficacy scores, reported more difficulty with environmental barriers, and reported their injuries as more disabling.

Caring for patients with limb amputation

This article provides an overview of the care of patients undergoing limb amputation. Absence of a limb can be congenital or the result of trauma or complications of chronic diseases. While the economic burden of limb amputation is significant, nurses have an important role in limiting other losses attributable to limb loss, such as long-term disability leading to loss of employment and delayed return to work or school. Comprehensive nursing assessments and appropriate interventions, pre and post-operatively, as well as early discharge planning and community reintegration can help avoid some of these losses. Nurses should be aware of the resources available in communities and work in multidisciplinary teams to ensure optimal outcomes for patients following limb amputation and their families.

Understanding contextual influences of community reintegration among injured servicemembers

As part of a larger mixed-methods research project investigating the influence of contextual factors on community reintegration (CR), this qualitative study sought to understand the subjective experiences of injured servicemembers and their perception of how contextual factors influenced their CR. More specifically, this article addresses how the influences of contextual factors differ between injured servicemembers with different levels of CR. Using a phenomenological framework, semistructured interviews were conducted with nine injured, community-dwelling servicemembers with low, moderate, and high levels of CR (three per category). Participants provided in-depth descriptions of the contextual barriers and facilitators of CR. Thematic analysis indicated the importance of social support and personal factors (e.g., self-efficacy, personal motivation) as the primary means for being reintegrated into their homes and communities. Other themes indicated factors that had an indirect but important influence on CR, including adapted sports, recreation, and other social programs; rehabilitation programs and therapists; school, work, and volunteering; and organizations and policies in developing social supports and personal factors. Comparisons between servicemembers indicated participants with low CR described many more contextual barriers and far fewer contextual facilitators to reintegration than those with high CR. Those with moderate CR were unique in that they described many facilitators and barriers to reintegration.