Quality in residential care from the perspective of people living with dementia: The importance of personhood.

BACKGROUND: Providing quality care for people with dementia to meet the growing demand for services is a significant challenge to Australia and globally. When it comes to planning for current and future care needs, limited information is available on what people living with dementia and their family members consider the meaning of "quality" in residential care services. OBJECTIVE: To describe the meaning of quality residential care from the perspective of people with cognitive impairment and their family members. DESIGN: Qualitative data collection via in-depth interviews and focus groups was undertaken with people with dementia or cognitive impairment living in residential care or the community (n=15), and family members of people with dementia (n=26). Thematic analysis was undertaken to identify key themes. RESULTS: The theme of supporting personhood was identified as the overarching concept of importance to both people with dementia and their family members and as the foundation for quality care. There were subtle differences in how this concept was expressed by people with dementia themselves and their family members. However, for both groups, access to meaningful activities and opportunities to feel useful and valued were identified as important ways to support personhood in residential care. Separate to this theme of personhood, family members also talked about the importance of a supportive physical environment in the care home, while for the people with dementia themselves maintaining a connection with family was an important contributor to their experience of good quality residential care. CONCLUSIONS: Supporting personhood was identified as a critical key concept underpinning quality residential aged care, from the perspective of both people with cognitive impairment and their family members. This highlights the important contribution that the psychological and social characteristics of care make to providing a good quality residential care experience from the perspective of consumers with dementia.

Quality-of-life for individuals with a vestibular impairment following an acquired brain injury (ABI); the clients' perspective.

PRIMARY OBJECTIVE: To investigate how a vestibular deficit following an acquired brain injury (ABI) affects an individuals' quality-of-life. RESEARCH DESIGN: A qualitative exploratory design. PARTICIPANTS: Nine community dwelling individuals who experienced significant symptoms and limitations as a result of their vestibular deficits. METHODS: The individuals participated in face-to-face interviews with open ended questions. Data was analysed initially using a case study research approach, exploring the experience for each individual and then cross-case analysis to determine common themes for the group with the assistance of nVivo 10 qualitative analysis software. RESULTS: Thematic analysis determined four main themes arising from the interviews; (1) validation, (2) definitive diagnosis is more difficult amongst an array of ABI symptoms, (3) vestibular adaptation is more difficult in the presence of an ABI and (4) emotional and social. CONCLUSION: Individuals who suffer a brain injury and experience vestibular symptoms as part of their overall presentation are not diagnosed in a timely manner, with individuals, their families, associates and even health professionals feeling uncertain of the legitimacy of their reported symptoms. It is important that all patients who experience an acquired brain injury are screened for vestibular impairment and, if necessary, receive vestibular rehabilitation including explanation and education.

Isokinetic strength training of lower limb muscles following acquired brain injury.

PRIMARY OBJECTIVE: To investigate the effectiveness of isokinetic strength training of ankle and knee muscles in adults with chronic acquired brain injury (ABI). RESEARCH DESIGN: Series of single case studies. METHODS: Twelve people with ABI participated in a 2.5-week baseline, 12-week intervention and a 4-week follow-up phase. INTERVENTION: Concentric isokinetic exercise, twice a week, for plantarflexors (PFs), dorsiflexors (DFs), knee flexors (KFs) and knee extensors (KEs). OUTCOMES: Peak torque and power at 60 and 90° s⁻¹, PFs and KFs tone at 60° s⁻¹, gait speed and timed chair rises. RESULTS: For single case analyses strength improvements were noted in 11/12 participants' PFs, 5/12 participants' DFs and 7/12 participants' KEs and KFs. Gait speed improved in 8/12 participants and chair rise time improved in 7/12 participants. PFs tone increased in three participants, KFs tone increased in six participants and three participants reported knee pain. For group analyses, peak torque of PFs and KEs, fast gait speed and timed chair rises demonstrated improvement (p < 0.05). CONCLUSIONS: Isokinetic strength training may be effective to improve lower limb muscle strength; however, care needs to be taken in selecting suitable candidates as some individuals reported knee pain with this intensive programme.

An isokinetic muscle strengthening program for adults with an acquired brain injury leads to meaningful improvements in physical function.

PRIMARY OBJECTIVE: To investigate if an isokinetic strength training programme for leg muscles lead to personally meaningful changes in adults with an acquired brain injury (ABI). RESEARCH DESIGN: A qualitative exploratory design. METHODS: Twelve people with ABI participated in pre- and post-intervention face-to-face interviews with open ended questions. Data were initially analysed using a case study research approach exploring individuals experiences and then cross case analysis to determine common themes for the group. INTERVENTION: Twelve-week isokinetic strength training programme for ankle and knee muscles. OUTCOMES: Participants perceived changes. RESULTS: Thematic analysis determined four main themes arising from the interviews; occupation, vitality, sense of self and personal interactions. Participants reported reductions in impairments as a response to the exercise programme and these changes led to increased function and participation in activities they valued. Also marked improvements in vitality were reported as well as increases in self-esteem and general well-being for many participants. CONCLUSIONS: An isokinetic strength training programme resulted in improvements in motor skills and functional abilities that were meaningful for the participants.