Adult Needs and Strengths Assessment-Abbreviated Referral Version to specify psychiatric care needed for incoming patients: exploratory analysis

The present study examined the Adult Needs and Strengths Assessment-Abbreviated Referral Version ratings for a group of 272 incoming psychiatric patients over a 2-yr. period to assess whether the rating scale was useful in predicting clinical placement for psychiatric treatment. Participants were patients (125 women) admitted to Regional Mental Health Care, St. Thomas, Canada between April 2004 and June 2006. Most participants were Euro-Canadian and ranged in age from 16 to 87 years. Clinical cutoff scores were established using observed mean differences in the patients' total scores and are expected to help guide psychiatric triage and longer term rehabilitation placement decisions. A canonical discriminant function analysis showed 85.9% of original level of care placements were correctly classified. The rating scale is a valid and reliable tool to specify level of psychiatric care needed for adults with mental disorders.     

Personality Type Differentiation of Employed Versus Unemployed Clients

The 16 Personality Factors (16 PF) Test was used to determine if personality variables were significantly different for employed and unemployed clients. The results of the study indicate that demographic data failed to demonstrate any significant difference but that four factors on the 16 PF were found to be significant. Results should be of great interest to all professionals concerned with evaluation, adjustment, and/or placement of rehabilitation clients.     

Vocational Appraisal of Social Security Disability Claimants

Rehabilitation centers offering vocational appraisal services to Social Security disability claimants should be aware that the factors of plant physical examinations, age, race, social class, sex, and religion may be barriers to employment which operate independently of work performance ability. When, after vocational appraisal, a claimant is recommended as employable, the rehabilitation center should back up its recommendation by a job-getting technique training program or direct placement help.     

MMPI identification of nonrehabilitants among disabled veterans.

Utilized the Minnesota Multiphasic Personality Inventory (MMPI) with IQ scores and selected biographic data to identify drop-outs in a Veterans Administration vocational rehabilitation program. Subjects were 61 male disabled veterans. Data were collected at VA Hospital Richmond, Virginia, between September 1973 and September 1974. Follow-up six months after entrance into training utilized persistence in training or employment as success criteria. Multivariate analysis identified 32 of 33 successful and 25 of 28 unsuccessful subjects with p less than .001. Factor analysis of the best predictors identified MMPI Psychopathic deviate (Pd) Hypomania (Ma), and Lie (L) scales which was interpreted to be a social adjustment factor. Four other factors were identified. Results indicated the MMPI was a useful instrument in the identification of disabled veterans who were likely to experience difficulty in post-hospital vocational rehabilitation.     

从两种咨询模式看我国心理咨询师的培养

本文分析厂我国大陆目前开展的两种类型的心理咨询,即心理健康咨询和医学心理咨询,心理健康咨询遵循发展和教育模式。主要服务对象是有生活适应问题的来访者,其根本目的是促进他们健康成长和增强适应应对能力。医学心理咨询遵循生物-心理-社会医学模式,其主要服务对象是患有各种非精神病性精神障碍的病人,其主要目的是将病人治愈。作者从两种咨询模式出发,就目前我国心理咨询师和心理治疗师的培养和资格认证提出了一些问题和粗浅的看法。     

A COMPARISON BETWEEN TWO PLACEMENT PROGRAMS FOR HARD-CORE UNEMPLOYED PERSONS

An exploratory placement class was conducted to teach vocational rehabilitation clients techniques of securing jobs. The results of this attempt were compared to a similar program conducted through another agency. The differences between the two programs suggest techniques that could increase the employment potential of vocational rehabilitation clients.     

辅助上肢康复训练与自助Bobath握手训练对卒中患者的对比观察

观察由护士辅助上肢运动能力康复训练与患者自助Bobath握手上举训练对脑卒中偏瘫患者上肢功能恢复的影响。将60名患者随机分为对照组和试验组,对照组患者自助做Bobath握手上举训练,试验组由护士给予上肢运动能力分期康复训练。1个月后,两组患者上肢功能差异及日常生活活动（activities of daily living,ADL）能力差异有统计学意义（P〈0．05）。1个月后,两侧肩峰差差异也有非常显著的统计学意义（P〈O．01）。因此,由护士给予上肢运动能力分期康复训练有利于脑卒中偏瘫患者提高上肢功能和日常生活活动能力,以及保持正常的人体姿势利于患者康复。     

A STUDY OF VARIABLES RELATED TO SELECTED JOB PLACEMENT CRITERIA

A random sample of 70 training program graduates from the Georgia Rehabilitation Center was used in the present study. Three placement criteria were as follows: 1) salary; 2) number of weeks between graduation and employment; and 3) number of contacts by a field rehabilitation counselor between graduation and closure. Data were collected on 55 test and rating variables during the students' evaluation and training periods, and intercorrelations were examined to determine significant relationships between these variables and the selected criteria. The results were discussed in terms of program implications.     

Experimental evaluation of rehabilitation in chronic obstructive pulmonary disease: short-term effects on exercise endurance and health status

Randomly assigned 119 adults with chronic obstructive pulmonary disease to an 8-week comprehensive rehabilitation program or to an 8-week education control program. Comprehensive pulmonary rehabilitation included education, physical and respiratory therapy instruction, psychosocial support, and supervised exercise training; education control included biweekly classroom instruction and discussions on respiratory therapy, medical aspects of lung disease, clinical pharmacology, and diet, but no exercise training. Both groups received extensive physiological and psychosocial evaluation before and after the intervention. Six months after enrollment, patients randomly assigned to the rehabilitation program showed significant increases in exercise endurance, whereas patients randomly assigned to control program showed nonsignificant increases. Improvement in self-efficacy was correlated with improvements in exercise endurance.     

Cross-association analysis of EEG and EMG signals according to movement intention state

Rehabilitation within three months plays a significant role in the recovery of damaged motor functions following the onset of a stroke. To increase the effectiveness of rehabilitation, it is important to perform rehabilitative exercises with movement intention. This study analyzed the association between electroencephalogram (EEG) and electromyogram (EMG) signals in healthy individuals in an attempt to verify the differences between the two signals in corticomuscular connectivity as well as the time delay in the flow of information in accordance with the presence of movement intention. To examine the relationship between the brain and muscles, coherence and mutual information analyses were performed on the EEG signals in the motor cortex and EMG signals in the flexor digitorum superficialis muscle during grasping training. Coherence and mutual information between EEG and EMG signals were significantly higher and the time delay of information flow was shorter when subjects performed active exercise with movement intention than when they performed passive exercise without movement intention. These findings could be applied to the rehabilitation of stroke patients to develop a rehabilitative training system with heightened effectiveness through verification of the presence of movement intention in the patients.     

JOB SEEKING SKILL GROUPS

Deinstitutionalization of psychiatric patients to community living arrangements has increased the demand for psychiatric rehabilitation services. Although job seeking skill groups have reported success with varied rehabilitation populations, to date little research has attempted to adapt these methods to a group of chronic psychiatric patients. Forty-four patient entered a ten week job seeking skills group designed to increase their effectiveness in job interviews. At follow-up, over one-third were productively employed and over half of the subjects reported satisfaction with their community adjustment. The results suggest that although employment is a viable goal, it is not the only factor which determines successful community adjustment.     

Cognitive Rehabilitation Therapies for Alzheimer’s Disease: A Review of Methods to Improve Treatment Engagement and Self-Efficacy

Cognitive rehabilitation therapies for Alzheimer’s disease (AD) are becoming more readily available to the geriatric population in an attempt to curb the insidious decline in cognitive and functional performance. However, people with AD may have difficulty adhering to these cognitive treatments due to denial of memory deficits, compromised brain systems, cognitive incapacity for self-awareness, general difficulty following through on daily tasks, lack of motivation, hopelessness, and apathy, all of which may be either due to the illness or be secondary to depression. Cognitive rehabilitation training exercises are also labor intensive and, unfortunately, serve as a repeated reminder about the memory impairments and attendant functional consequences. In order for cognitive rehabilitation methods to be effective, patients must be adequately engaged and motivated to not only begin a rehabilitation program but also to remain involved in the intervention until a therapeutic dosage can be attained. We review approaches to cognitive rehabilitation in AD, neuropsychological as well as psychological obstacles to effective treatment in this population, and methods that target adherence to treatment and may therefore be applicable to cognitive rehabilitation therapies for AD. The goal is to stimulate discussion among researchers and clinicians alike on how treatment effects may be mediated by engagement in treatment, and what can be done to enhance patient adherence for cognitive rehabilitation therapies in order to obtain greater cognitive and functional benefits from the treatment itself.     

Dynamic testing of learning potential in adults with cognitive impairments: A systematic review of methodology and predictive value

Dynamic testing includes procedures that examine the effects of brief training on test performance where pre‐ to post‐training change reflects patients’ learning potential. The objective of this systematic review was to provide clinicians and researchers insight into the concept and methodology of dynamic testing and to explore its predictive validity in adult patients with cognitive impairments. The following electronic databases were searched: PubMed, PsychINFO, and Embase/Medline. Of 1141 potentially relevant articles, 24 studies met the inclusion criteria. The mean methodological quality score was 4.6 of 8. Eleven different dynamic tests were used. The majority of studies used dynamic versions of the Wisconsin Card Sorting Test. The training mostly consisted of a combination of performance feedback, reinforcement, expanded instruction, or strategy training. Learning potential was quantified using numerical (post‐test score, difference score, gain score, regression residuals) and categorical (groups) indices. In five of six longitudinal studies, learning potential significantly predicted rehabilitation outcome. Three of four studies supported the added value of dynamic testing over conventional testing in predicting rehabilitation outcome. This review provides preliminary support that dynamic tests can provide a valuable addition to conventional tests to assess patients’ abilities. Although promising, there was a large variability in methods used for dynamic testing and, therefore, it remains unclear which dynamic testing methods are most appropriate for patients with cognitive impairments. More research is warranted to further evaluate and refine dynamic testing methodology and to further elucidate its predictive validity concerning rehabilitation outcomes relative to other cognitive and functional status indices.     

The relationships between objective and subjective ratings of disfigurement severity, and psychological adjustment

Although the role of the objectively and subjectively rated severity of appearance problems is often debated, the impact of severity upon psychological adjustment has yet to be explored fully. In this study, 400 patients with a range of physical differences in appearance were recruited through general plastic surgery outpatient clinics and waiting lists. Patients completed the Derriford Appearance Scale 24 (DAS24), a measure of psychological distress and behavioural dysfunction related to self-consciousness of appearance. Severity in the outpatient group was objectively rated by plastic surgeons, and severity amongst the waiting-list group was subjectively rated by the patients themselves. Multiple regression modelling demonstrated a linear relationship between subjective adjustment and severity, with greater perceived severity associated with poorer adjustment. Similar modelling demonstrated a weak but statistically significant quadratic relationship between objectively rated severity and adjustment for normally visible, but not for normally non-visible differences of appearance. Moderate, rather than mild or severe objective severity was most related to poor adjustment.     

Type of items and the magnitude of gender differences on the Mental Rotations Test.

The present study considered the structure of the drawings used in the Mental Rotations Test (MRT) to examine whether distractors that are either a mirror image or structurally different from the target as well as response alternatives with occluded and nonoccluded parts affect the magnitude of gender differences on this test. One hundred and three women and 100 men undergraduate students were given unlimited time to complete the MRT. A gender by occlusion interaction on correct responses showed that gender differences were larger for occluded than for nonoccluded items. Examination of performance as a function of item placement in the test suggested that it is unlikely that the results could be accounted for by differential practice effects in women and men. Implications of these results for explanations of gender differences on the MRT and for the training of spatial abilities are discussed.     

Employment and Rehabilitation Counselors Characterize one another Using Stereotypes

Thirty employment counselors appraised personal and job-related attributes of rehabilitation counselors using a 67-item semantic differential stereotype scale. Thirty rehabilitation counselors rated themselves and also how they believed employment counselors would rate rehabilitation counselors on the same scale. The rehabilitation counselors' self-ratings revealed a generally positive self-portrait; however, the self-ratings, when compared to how they believed employment counselors perceived rehabilitation counselors, yielded statistically significant negative relationships on 60 scales. Comparison of perceived versus actual ratings of rehabilitation counselors by employment counselors showed statistically different ratings on 49 scales, all in a positive direction. That employment counselors perceived rehabilitation counselors much more positively than the latter expected helps explain why placement functions and team cooperation are limited among these professionals, and should therefore be increased.     

An empowerment model of memory training

The authors outline an empowerment model of memory rehabilitation. Unlike conventional cognitive rehabilitation methods, clients' plan and control the treatment process from the earliest stages of therapy. The client identifies functional goals and the therapy is geared to achieve those goals. The empowerment model also emphasizes domain-specific compensatory training. Memory strategies and prosthetic devices are chosen so as to maximize transfer of training in the workplace, training programme, or in the client's activities of daily living. Group therapy involves clients teaching their newly learned skills to other clients. The authors present research findings to document the efficacy of the empowerment model, describe its limitations, and discuss how the model can be implemented effectively.     

Behavioral Health Adjustment in Reserve Component Soldiers During a Noncombat Deployment to Africa

This study benchmarked rates of mental health problems, adjustment difficulties, and perceptions of unit climate among 505 U.S. soldiers (primarily National Guard) deployed to the Horn of Africa in 2012. In addition, the study examined whether differences across these outcomes exist between combat veterans (n = 239) and noncombat veterans (n = 242). Rates of mental health problems among soldiers on this noncombat deployment were lower than rates typically found among soldiers on combat deployments. Furthermore, soldiers without previous combat experience had lower rates of mental health problems and aggression than combat veterans. Similar differences were evident when adjustment difficulties and unit climate variables were compared. Although combat veterans could be valuable in training new soldiers, the results of this study indicate that combat veterans may need more targeted resources to facilitate their adjustment if they are to be optimally utilized.     

Virtual environments for motor rehabilitation: review.

In this paper, the current "state of the art" for virtual reality (VR) applications in the field of motor rehabilitation is reviewed. The paper begins with a brief overview of available equipment options. Next, a discussion of the scientific rationale for use of VR in motor rehabilitation is provided. Finally, the major portion of the paper describes the various VR systems that have been developed for use with patients, and the results of clinical studies reported to date in the literature. Areas covered include stroke rehabilitation (upper and lower extremity training, spatial and perceptual-motor training), acquired brain injury, Parkinson's disease, orthopedic rehabilitation, balance training, wheelchair mobility and functional activities of daily living training, and the newly developing field of telerehabilitation. Four major findings emerge from these studies: (1) people with disabilities appear capable of motor learning within virtual environments; (2) movements learned by people with disabilities in VR transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks; (3) in the few studies (n = 5) that have compared motor learning in real versus virtual environments, some advantage for VR training has been found in all cases; and (4) no occurrences of cybersickness in impaired populations have been reported to date in experiments where VR has been used to train motor abilities.     

Aerobic cycle exercising in a rehabilitation program with a wider choice of intensity

When patients in rehabilitation programs use cycle ergometers for aerobic fitness training, the exercise intensity is often restricted to a small range of heart rate. In this study, a wider choice of intensities was left to the patients without giving up the potential to reduce cardiac risks factors. 24 patients in 3-wk. rehabilitation programs could choose the exercise intensity up to a workload limit preset by the physical therapist. 20 of them exercised at an intensity covering the full range between the aerobic and anaerobic lactate threshold and 4 a little above. The opportunity to vary the workload was frequently used by 67%. In 75% of the exercise sessions, the patients' average heart rates exceeded moderate heart-rate targets recommended in rehabilitation and health promotion for people with moderate cardiac risks without a graded exercise test. In 72% of these sessions, the anaerobic lactate threshold at 4 mmol/L was not exceeded. But a tendency of 33% of the patients to exercise at higher blood lactate or blood pressure levels underlined the necessity of limiting the exercise intensity.