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Health system challenges affecting rehabilitation services in South Africa.
This article presents challenges and solutions to ensure that South Africa can meet WHO 2030 Rehabilitation Goals for equitable provision of effective public rehabilitation services using the WHO's health system building block framework. IMPLICATIONS FOR REHABILITATION To meet the challenge of providing rehabilitation for those in need requires country-specific, strategic, evidence-informed, and planned decisions in terms of best investment for highest return. Whilst there is sound international evidence for best-practice rehabilitation care, country-specific strategies are required to identify and address local barriers t...
Source: Disability and Rehabilitation - August 2, 2019 Category: Rehabilitation Authors: Morris LD, Grimmer KA, Twizeyemariya A, Coetzee M, Leibbrandt DC, Louw QA Tags: Disabil Rehabil Source Type: research

Effectiveness of the Bobath concept in the treatment of stroke: a systematic review.
CONCLUSIONS: The Bobath concept is not superior to other approaches for regaining mobility, motor control of the lower limb and gait, balance and activities of daily living of patients after stroke. There is moderate evidence regarding the superior results of other approaches in terms of the motor control and dexterity of the upper limb. Due to the limitations concerning the methodological quality of the studies, further well-designed studies are needed. Implications for rehabilitation The Bobath concept is not superior to other approaches for patients after stroke. The treatments that incorporate overuse of the affected u...
Source: Disability and Rehabilitation - April 23, 2019 Category: Rehabilitation Authors: Díaz-Arribas MJ, Martín-Casas P, Cano-de-la-Cuerda R, Plaza-Manzano G Tags: Disabil Rehabil Source Type: research

What are the perceptions and experiences of falls amongst people with stroke who live in the community?
CONCLUSIONS: This study highlights the perceived negative consequences of falls amongst people with stroke, and the potential contribution of falls to the reduced levels of physical activity often seen following a stroke. Our findings emphasise the need to address falls and balance related self-efficacy alongside strategies to promote safe mobility. A paradigm shift may be needed to highlight potentially modifiable intrinsic risk factors and emphasise the relevance and value of proactive fall prevention to people with stroke. Implications for rehabilitation People with stroke may not report falls or may minimise their sign...
Source: Disability and Rehabilitation - December 4, 2018 Category: Rehabilitation Authors: Munford D, Gunn H Tags: Disabil Rehabil Source Type: research

The relationship between Home-time, quality of life and costs after ischemic stroke: the impact of the need for mobility aids, home and car modifications on Home-time.
CONCLUSIONS: Home-time is a stroke outcome associated with disease severity, healthcare costs and patient wellbeing. Streamlining the discharge process for those requiring extra material support may lead to cost savings and higher quality-of-life. Implications for rehabilitation Delays in discharge from the acute hospital or rehabilitation facility are incurred when patients need extra material support in order to return home. Staff from the discharging facility should assist families by giving timely information on the availability and the cost of wheel chairs and walkers; and explaining and planning the need of a stair l...
Source: Disability and Rehabilitation - October 2, 2018 Category: Rehabilitation Authors: Dewilde S, Annemans L, Lloyd A, Peeters A, Hemelsoet D, Vandermeeren Y, Desfontaines P, Brouns R, Vanhooren G, Cras P, Michielsens B, Redondo P, Thijs V Tags: Disabil Rehabil Source Type: research

Auditory rehabilitation after stroke: treatment of auditory processing disorders in stroke patients with personal frequency-modulated (FM) systems.
CONCLUSIONS: Personal FM systems may substantially improve speech-in-noise deficits in stroke patients who are not eligible for conventional hearing aids. FMs are feasible in stroke patients and show promise to address impaired AP after stroke. Implications for Rehabilitation This is the first study to investigate the benefits of personal frequency-modulated (FM) systems in stroke patients with disordered AP. All cases significantly improved speech perception in noise with the FM systems, when noise was spatially separated from the speech signal by 90° compared with unaided listening. Personal FM systems are feasible in s...
Source: Disability and Rehabilitation - March 22, 2016 Category: Rehabilitation Authors: Koohi N, Vickers D, Chandrashekar H, Tsang B, Werring D, Bamiou DE Tags: Disabil Rehabil Source Type: research

A stair-climbing test for measuring mechanical efficiency of ambulation in adults with chronic stroke.
Conclusion: With a minimal detectable change of 0.6% (0.053 of average MEnet score of 10.4%), MEnet values from the stair-climbing test seem sufficiently meaningful to estimate ambulatory ability and its changes with interventions or walking aids in adults with hemiparesis. Implications for Rehabilitation Ambulatory ability can be estimated from mechanical efficiency, obtained from a 5-min stair-climbing test utilizing a 4-step stair, to measure external work, and the change in heart rate above rest to estimate the metabolic cost of the task. A change of > 0.6% in mechanical efficiency by this stair-climbing test indi...
Source: Disability and Rehabilitation - August 12, 2014 Category: Rehabilitation Authors: Harries N, Loeppky JA, Shaheen S, Al-Jarrah M, Molteni F, Hutzler Y, Bar-Haim S, On behalf of the MESF Project Tags: Disabil Rehabil Source Type: research

Knee posture during gait and global functioning post-stroke: a theoretical ICF framework using current measures in stroke rehabilitation.
Conclusions: AKP restricts functioning and participation. Implications for Rehabilitation Identification of abnormal knee posture in gait can indicate potential assessment and treatment priorities, e.g. knee flexor strength is a major determinant of functioning in patients with abnormal knee posture and should be assessed. The identification of an abnormal knee posture post-stroke seems relevant for planning patient's long-term needs (e.g. amount of caregiver support). The interpretation of functional measures based on the ICF framework can enhance clinical-reasoning in rehabilitation post-stroke. PMID: 25095902 [PubM...
Source: Disability and Rehabilitation - August 6, 2014 Category: Rehabilitation Authors: Rosa MC, Marques A, Demain S, Metcalf CD Tags: Disabil Rehabil Source Type: research

The impact of STRENGTH on the expected and actual transition to home experience.
Conclusions: People with stroke described the therapy they received in both the hospital and home as beneficial. The results support the addition of the home-based inpatient program, STRENGTH, to the current rehabilitation system, as it appeared to realign the expectations of people with stroke and better prepare them for their discharge home. Implications for Rehabilitation STRENGTH aids clinicians to identify difficulties in the home environment for people with stroke. STRENGTH improves the confidence of people with stroke while they transition home. Further research is warranted for psychological interventions that prep...
Source: Disability and Rehabilitation - March 27, 2014 Category: Rehabilitation Authors: Gustafsson LA, Hodson TJ, Fleming JM, Hoyle MF Tags: Disabil Rehabil Source Type: research