Traumatic brain injury (TBI), also referred to as an acquired brain injury, is caused by damage to the brain as a result of trauma to the head. The following report serves as a resource for patients and families wanting to gain information regarding community integration outcomes after participation in post-acute rehabilitation programs. The goal of the post-acute level of medical care is to increase functionality and serve as a transition for the patient from the rehabilitation facility to life within the community. A thorough examination of community integration after participation in a post-acute rehabilitative program with the use of the Community Integration Questionnaire (CIQ) is provided. After investigation of the available literature, four articles were found to meet inclusion criteria and were included within the review. All studies included met the following criteria. Participants were ages 17 to 65 years old, had a diagnosis of moderate to severe TBI, were enrolled in post-acute rehabilitation, and were assessed with the Community Integration Questionnaire (CIQ). Overall, the available literature suggests that completion of a program within a post-acute facility does create positive outcomes for the individual with TBI; however, the outcomes are dependent on various factors regarding TBI severity, the administration of intervention, the type of intervention, time post-onset and age of participants at the time of onset. Future research is necessary to provide a more comprehensive view of post-acute rehabilitation and the outcomes that these patients may expect as they begin their road to recovery. / text

Purpose: This study aimed to determine entry-level characteristics of new Doctor of Physical Therapy (DPT) graduates from the perspective of physical therapist employers (PTE), academic faculty (PTF), and final affiliation clinical instructors (CI); determine consensus of those characteristics; and determine if new DPT graduates met entry-level expectations in the adult, acute rehabilitation practice setting or where they have fallen short of expectations. Subjects: Participants included 35 CIs, 40 PTEs, and 43 PTFs, recruited from CARF accredited adult, acute rehab facilities (PTEs and CIs) and PT education programs with DPT graduates (PTFs). Method: A 4-round classic Delphi study was conducted with 3 participant panels through SurveyMonkey TM . Participants rated suggested characteristics and definitions for agreement and ranked them for importance on 5-point Likert scales ranging from “strongly disagree ” to “strongly agree ” and “very unimportant ” to “very important ”, respectively. Controlled feedback to participants included median and interquartile range with a summary of rating rationale responses by round. Results: Percent response of Likert scale agreement ratings and importance rankings determined consensus for “strongly agree ” and “very important ”. Overall Delphi study participation was 60.2%. Agreement and importance opinions of 53 participant generated entry-level characteristics and definitions showed a lack of consensus amongst participants. Five characteristics met 80% consensus for importance: safe, ethical, integrity, communication, and recognition of red flags for PT; only safe achieved consensus for agreement. Seventy-nine percent of participants agreed that new DPT graduates are meeting expectations, 15% agreed with concerns and 6% disagreed. Conclusions: Results appear to indicate consensus of select entry-level characteristics and majority agreement that new DPT graduates are meeting expectations albeit with some concerns in the adult, acute rehab practice setting. Agreement ratings and importance rankings appear to indicate divergence in opinions of new graduate characteristics. Recommendations: Further investigation is needed to understand differences in participant group opinions of entry-level expectations and determine consensus in other practice settings.

<p><em>Background & Rationale</em>: Early mobilization (EM) can minimize intensive care unit aquired weakness (ICUAW) among survivors of critical illness. Clinician awareness of ICUAW, perceived barriers to EM, and acute rehabilitation in Canadian ICUs have not been well described.</p> <p><em>Objective:</em> To assess (1) awareness of ICUAW and EM, (2) perceived institutional, clinician, patient level barriers to EM, (3) stated practice of acute rehabilitation in Canadian ICUs.</p> <p><em>Design</em><strong>:</strong> A cross-sectional, self administered postal survey</p> <p><em>Setting:</em> Academic Intensive Care Units (ICUs) in Canada</p> <p>Subjects: 134 physiotherapists and 302 critical care physicians</p> <p><em>Interventions & Measurements:</em> Item generation followed a review of relevant literature and discussion with 26 content experts. We reduced the survey to 10 domains and 29 specific questions. The survey intrument was piloted and evaluated for clinical sensibility and intra-rater reliability. Up to 3 surveys were mailed to potential respondents. Descriptive statistics were reported as proportions, means (+/- SD) or mode, as appropriate. We used the chi-squared test to compare proportions and multi-variate logisitc regressions to test for association between independent and dependent variables. <em></em></p> <p><em>Main Results:</em> The survey instrument had excellent clinical sensibility and good intra-rater reliability (Cohen’s kappa > 0.4). The overall response rate was 71.3% (311/436) including 87.3% (117/134) of physiotherapists and 64.2% (194/302) of physicians. The incidence of ICUAW in the general medical-surgical population was under-recognized by 68.8% of clinicians and 59.8% of clinicians stated they were either insufficiently trained or informed to mobilize mechanically ventilated patients. Excessive sedation and medical instability were perceived as the most important patient barriers. Limited staffing, safety concerns (by nurses) and delayed clinician recognition to initiate EM were key provider barriers to EM. Important institutional barriers to EM included insufficient guidelines and equipment. Only 19.9% of clinicians stated that patients with suspected ICUAW were referred to an out-patient clinic after ICU discharge for long term rehabilitation.</p> <p><em>Conclusions</em>: Over 60% of respondents to this national survey underestimated the incidence of ICUAW and do not feel adequately trained to mobilize mechanically ventilated patients. Multiple patient, provider and institutional barriers may also contribute. Clinical leaders and administrators should consider these modifiable factors when designing EM programs in the ICU.</p> / Master of Science (MSc)

The primary goal of this study was to develop a preliminary tool to determine caregivers’ needs regarding the management of a person with a traumatic brain injury (TBI), during the acute rehabilitation period. The potential impact of TBI on family dynamics, interpersonal relationships and functional independence is well documented.To facilitate achievement of the main goal this study was divided into two phases. In the first phase, caregivers’ needs were determined by means of both qualitative and quantitative measurements in the form of structured and unstructured observations, the implementation of a “Needs Questionnaire”, a focus group and semi-structured interviews. The results obtained during this phase indicated that caregivers have needs for support from professionals and the community, as well as needs regarding the general management of the person with a TBI and the management of the potential communication difficulties associated with TBI. Based on these needs, a preliminary tool, namely the “Needs questionnaire for caregivers of a person with a traumatic brain injury”, was developed. During the second phase of the study, this tool was administered to caregivers of individuals with TBI before and after the presentation of a workshop to determine whether there is a change in caregivers’ needs once they have received information. A pretest-posttest, experimental design was thus implemented during the second phase of this study. Although further research is required for the qualitative and quantitative validation of this tool, the use of this tool has implications for providing a better understanding of caregivers’ needs during the acute rehabilitation period after TBI. The results of this study further emphasize that improved service delivery in the South African context is reliant on the early identification, by the professional team, of the needs that caregivers of individuals with TBI have. / Dissertation (M (Communication Pathology))--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / unrestricted