As doenças cerebrovasculares, incluindo o acidente vascular encefálico (AVE), são a segunda causa de morte no mundo, e o principal causador das incapacidades na população adulta. Devido à reorganização cortical, quanto mais precoce a reabilitação é realizada, melhores são os resultados. Desta forma, novos tratamentos e soluções tecnológicas foram desenvolvidos para enfrentar os desafios da reabilitação pós AVE, por exemplo, aumento da intensidade e duração da terapia incluindo manipulação externa, treinamento do movimento bilateral, e reabilitação robótica. Os dispositivos robóticos possibilitam a realização de tarefas específicas repetidas vezes, de forma controlada e confiável, fator determinante para a facilitação da reorganização cortical, com aumento da habilidade motora e melhora do desempenho das atividades funcionais. O objetivo principal deste trabalho foi verificar a adequação e usabilidade da Plataforma Robótica de Reabilitação de Tornozelo - PRRT em indivíduos que precisam de reabilitação de tornozelo decorrente de sequela de AVE, a fim de realizar eventuais ajustes antes que o equipamento seja incorporado na prática clínica. A metodologia consistiu em verificar a adequação ergonômica e técnica do equipamento, e avaliar a satisfação do usuário após o seu uso por meio de questionário. O aparelho foi avaliado tanto em pacientes com déficit motor de hemiparesia, como em indivíduos sem deficiências. Os resultados experimentais mostram que o equipamento é adequado como um recurso auxiliar na avaliação da amplitude de movimento articular do tornozelo e da força muscular, beneficiando os terapeutas na avaliação dos ganhos reais obtidos com as terapias. A partir das respostas ao questionário, verifica-se que os indivíduos sentiram-se satisfeitos com o recurso. Portanto, conclui-se que a PRRT é um recurso auxiliar promissor no tratamento do tornozelo de indivíduos que sofreram lesão neurológica, podendo trazer benefícios em relação à amplitude de movimento e ganho de força, além de proporcionar uma terapia prazerosa e estimulante aos pacientes. / Cerebrovascular diseases, including stroke, are the second leading cause of death worldwide and the leading cause of disability in the adult population. Due to cortical reorganization, the earlier rehabilitation is performed, the better the results. In this way, new treatments and technological solutions were developed to meet the challenges of rehabilitation after stroke, for example, increase of intensity and duration of therapy including external manipulation, bilateral movement training, and rehabilitation robotics. Robotic devices allow performing specific tasks repeatedly in a controlled and reliable way, a key factor for cortical reorganization, with increase of motor skills and improvement of functional activities performance. The main objective of this work was to verify the adequacy and usability of the Robotic Platform for Ankle Rehabilitation in post-stroke patients who need ankle rehabilitation, in order to make any necessary adjustments before the equipment be incorporated into clinical practice. The methodology consisted in verifying ergonomic and technical adequacy, and evaluates user satisfaction after use through a questionnaire. The device was evaluated in patients with motor deficit of hemiparesis, as well as in individuals without disabilities. Experimental results show the proposed equipment is suitable as an auxiliary resource in evaluating the range of motion and muscle strength of the ankle, assisting therapists in the evaluation of real gains obtained with the therapies. From the questionnaire responses, the individuals said they were satisfied with the resource. Therefore, it is concluded that the PRRT is a promising auxiliary resource in the treatment of individuals who have suffered neurological damage, bringing benefits with relation to range of motion and muscle strength, as well as providing pleasurable and stimulating therapy to patients.

Advancements in medicine, policy, and societal attitudes have improved life expectancy, socialization, and participation for individuals with intellectual and developmental disabilities (IDD). However, inconsistent or a lack of services may drive healthcare utilization toward expensive emergency care services. This can negatively impact health outcomes and disrupt physical therapy treatment plans, limiting their effectiveness and further placing individuals with IDD at risk for crisis episodes. Because of its subjective nature, quantifying crisis is challenging using current definitions. Rehabilitation professionals are often active members of the care team for individuals with IDD, however no evidence currently exists regarding how the profession can positively impact crisis intervention. Because these clinicians often develop long-term relationships with patients and work with them on a consistent basis, they are well-positioned to recognize early signs of crisis and make timely referrals to the appropriate health and social service providers but currently lack resources to guide in this decision-making. A better understanding of characteristics of this population related to crisis is needed in order to develop accessible and useful screening tools and to improve clinical reasoning. The purpose of this dissertation was to identify pertinent risk factors related to crisis for individuals with IDD using a novel, objective crisis definition. Using a mixed methods approach, a revised definition of crisis was developed through surveying of expert clinicians and healthcare administrators at a specialty care clinic for individuals with IDD. The addition of four crisis-related events were included in the definition: (1) unplanned hospital utilization; (2) involvement with the criminal justice system; (3) abuse/victimization; (4) unplanned change in living environment. Using retrospective chart review, these four crisis-related events were further analyzed and validated by comparing their occurrence in patients who did (N=41) and did not (N=144) receive formal crisis intervention services at the clinic between January 1, 2014 and March 1, 2019. The risk for unplanned hospital utilization was 3.4 times higher for crisis patients. The risk for involvement with the police or criminal justice system was 13.86 times higher for crisis patients. The risk for abuse and/or victimization was 6.21 times higher for crisis patients. The risk for unplanned change(s) in living environment was 12.7 times higher for crisis patients. Overall, 90% of crisis patients experienced at least one of the four crisis-related events during the study period, compared to 54.2% of non-crisis patients. Five additional risk factors were identified that increased crisis risk: hypothyroidism, bipolar disorder, intermittent explosive disorder, personality disorder, and have multiple psychiatric disorders. No statistically significant differences were found between crisis and non-crisis patients for intellectual disability severity level, mobility status, communication status, neurodevelopmental diagnosis, age, race/ethnicity, or living environment. To the best of our knowledge, the identification of hypothyroidism as a potential crisis risk factor was a novel discovery not previously reported in the literature. The findings of this dissertation have multiple implications for clinical practice and add to the body of knowledge regarding crisis experiences for individuals with IDD. First and foremost, over a fifth of our study sample (22%) utilized formal crisis management services during the study period. This suggests that crisis episodes are common in the IDD population. As the majority of individuals with IDD are community-dwelling and life expectancy continues to increase, the likelihood of physical therapists encountering adults with IDD in clinical practice will subsequently increase. However, physical therapists and physical therapy students routinely report feeling unconfident and uncomfortable treating individuals with disabilities, including individuals with IDD. There is a need, then, to improve clinician confidence and skills to ensure that individuals with IDD receive optimal care, especially into adulthood. The findings of these studies provide foundational knowledge and point toward trends in crisis experiences that can help guide physical therapists and other rehabilitation clinicians.

Obesity is a significant public health concern, with implications for the health and well being of millions of people in the United States and world. The purpose of this thesis is to explore the relationship between obesity, segment biomechanics in the form of joint stress and restricted range of motion, and cardiorespiratory fitness. In three studies, anatomical modeling using three dimensional infrared motion capture system was used to calculate joint stresses and range of motion limitations. The results are applied to better understand the impact that obesity has on biomechanics, taking into consideration factors of fitness and fatigue, during walking and common rehabilitation exercises. The first study compared the biomechanical differences between ten obese and ten normal weight adults while performing squat and lunge exercises and found significant increases in lower limb moments in obese females. Increased moments suggest that obese individuals experience higher biomechanical stress than normal weight individuals and may have less flexibility in selecting movement strategies while performing basic rehabilitation exercises. The second study examined how walking, a commonly prescribed exercise to combat obesity, may impact an obese individual's joint biomechanics. While the results of this study, comparing joint stress in ten obese and ten normal weight females, did not observe significant differences between the obese and normal weight groups, stronger relationships were present between moments and VO2 max, rather than BMI, suggesting the importance of fitness in context of developing walking programs. The final study explicitly addressed the relationship between obesity, fitness and biomechanics. Walking and jogging biomechanics was reported in 30 boys and girls, aged 8-11, before and after a fatigue protocol. Hip and knee moments were moderately associated with cardiorespiratory fitness and showed significant increase after cardiorespiratory fatigue. Including measures of adiposity and strength improved the associations between fitness and moments. This thesis concludes that the relationship between biomechanics and obesity, observed in adults and children, should be understood in the larger framework of the reverse causation hypothesis. The reverse causation hypothesis describes obesity as a positive feedback loop, in which certain factors are related to obesity in a bi-directional manner: both causing, but also amplified by, the presence of excess adipose tissue. While further study is required to clarify these relationships, these associations may have implications for participation in physical activities and long-term effects on the musculoskeletal system, thus illustrating the positive feedback loop of the reverse causation hypothesis.

Die Studienphase ist eine kritische Phase im Leben von Heranwachsenden, in der sie neben fachlichen auch emotionale und soziale Kompetenzen weiterentwickeln müssen. Allgemein machen zahlreiche Heranwachsende traumatische Erfahrungen, die jedoch nicht erkannt oder behandelt werden. Studienanfänger sind dabei mit einigen spezifischen Problemsituationen wie Schikanen durch ältere Studierende, Mobbing, Abwertung und Orientierungslosigkeit konfrontiert. Weil sich solche traumatischen Erfahrungen negativ auf ihr persönliches und akademisches Leben auswirken können, ist eine Identifikation dieser traumatisierten Studierenden von höchster Wichtigkeit, um sie durch effektive Rehabilitationsmaßnahmen zu einem gelingenden sozialen Leben und akademischen Leistungen befähigen zu können. Die hier vorgestellte Studie widmet sich der Untersuchung der Rolle der Emotionalen Intelligenz für Copingstrategien von Heranwachsenden mit traumatischen Erfahrungen. Die kulturvergleichend angelegte Studie untersucht dazu jeweils 100 Universitätsstudierende niedriger Semester aus Deutschland und Sri Lanka. / University education is an important stage of students’ academic life. Therefore, all students need to develop their competencies to attain the goal of passing examinations and also to developing their wisdom related to scientific knowledge they gathered through their academic life. Life in universities is a critical period for individuals as it is a foot step to acquiring the emotional and social qualities in their social life. There are many adolescents who have been affected by traumatic events during their life span but have not been identified or treated. More specifically, there are numerous burning issues within first year university students, namely, ragging done by seniors to juniors, bullying, invalidation and issues related to attitudes changes and orientation. Those factors can be traumatic for both their academic and day to day life style. Identifying the students who are with emotional damages and their resiliency afterwards the traumas and effective rehabilitation from the traumatic events is immensely needed in order to facilitate university students for their academic achievements and social life within the University education. This study tries to figure out the role of Emotional Intelligence for developing coping strategies among adolescents who face traumatic events. Late adolescence students recently enrolled at University (Bachelor students/ first year students) will be selected as sample. The study is to be conducted in a cross cultural manner comparing 100 students each from Germany and Sri Lanka.

This qualitative study investigated the experiences of executive women and their choices in balancing work with marriage and children. Research on women in the workplace tends to conflate categories of hourly workers, part-time employees, and middle- and upper-management careers. Yet, the literature on balancing career and family life does not adequately portray the experiences of executive women. The purpose of the study was to discover executive women's perceptions about their career, how they chose their path, and how their career choices affected their decisions about marriage and children. The research questions for this study examined: (a) The effect of executive women's career choices on their balance of marriage and children, (b) reflection on career choices as an opportunity (enhancement) or loss (conflict) regarding marriage and children, and (c) the sacrifices made or regrets felt, if any, by executive women in pursuing a career. The research questions reflect the study's grounding in role theory, role conflict theory, and spillover theory. Data were collected via personal interviews with 10 participants, which were recorded, transcribed, and coded for themes. Results showed that although participants were conscious of making some sacrifices, such as feeling guilt missing their children's events and not making time for self or women friends and feeling some guilt about those sacrifices, they expressed no regrets for the decisions they made. The study has the potential to effect social change by providing insight about how an important subset of the professional work force attempts to balance career and family life. The study may also help women pursuing business careers make more informed choices about their personal and professional goals.

The purpose of this study is to determine the levels of burnout and role stresses among direct service providers at centers for independent living in Region V, and investigate the relationship between burnout and role stressors among the population. Results showed that the respondents have average level of emotional exhaustion, high level of depersonalization, and low level of personal accomplishment in categorization of MBI scores. When comparing with the MBI-HSS normative samples, it indicated that these providers experience higher burnout than overall samples and the sample in social services. The obtained results supported the previous view that CIL management problems including low salaries, high staff turnover, insufficient resources, excessive caseload, unsatisfactory reward, or general lack of control over job tasks and responsibilities that may effect to high burnout.

No description available.

This study investigated the effects of a short-term in-service training program for rehabilitation practitioners. Specifically, cognitive, attitudinal, and behavioral changes were measured. Also examined with respect to the observed changes were the effects of age, sex, education and other variables. Significant information gain was made by the participants of the training program in comparison with the control group. When the program participants reported their attitudes, no significant difference was found between them and the control group. Judging from the supervisors' ratings, the participants of the program seemed to benefit significantly in terms of information gained, attitudes changed, and placement behaviors exhibited. There was a significant positive correlation between the age of an individual and his or her positive attitude change. The higher the level of education of an individual, the more positive the attitude change that occurred, and the less the amount of dogmatism that was measured. Persons who had been trained in the nonhelping professions showed more positive attitude change than those who had been trained in the helping professions. The questionnaire, answered anonymously by the trainees, indicated that virtually all of them found the training program very worthwhile. When the trainees rated their own perceived change after the training program (on a scale of "none," "slight," "moderate," "much," or "great") the group averaged "moderate" or more change in information, attitude, and behavior, and "much" change in motivation. It was concluded that the training program was effective in advancing the academic achievement of the participants. Judging from the supervisors' ratings, participants benefited significantly in terms of professional growth. The participants were supportive to the training program and expressed the belief that it was of value.

The problem of this study was to investigate the comparative effects of two in-service training programs on the attitudes of rehabilitation practitioners. There were two experimental groups, the consecutive three-day program and the two-week program, and one control group in the study. The two-week program was staggered, having training for five days, a three-week interval, and the remaining five days of training. The two programs were compared to determine which was more effective in altering rehabilitation practitioner attitudes. Conclusions were drawn from the experimental study and related literature review. They were that in-service training programs of two days and less will probably not produce significant attitude changes; in-service programs of three days to five days have a higher probability of producing significant attitude changes; in-service programs of two weeks to six weeks will probably produce less of a positive change than a program of less than two weeks but longer than two days; an in-service program of ten weeks to one year will probably produce less significant changes in attitudes than a shorter program; the shorter the in-service program (i.e., less than ten weeks and more than two days) the greater the probability of gaining significant attitude changes; the critical hour of significant attitude change appears to be around the twenty-fourth hour; and, in attitude change research, instead of measuring training by days across weeks or months, the variable to examine is the total number of hours of training.

No description available.