Early Mobilization Rehabilitation Program for Children With Cerebral Palsy Undergoing Single-Event Multilevel Surgery.

PURPOSE: This study investigates functional and technical outcomes to support an early mobilization approach to rehabilitation after single-event multilevel surgery (SEMLS) for children with cerebral palsy (CP), and disseminates innovative guidelines emphasizing early walking. METHODS: Twenty-three participants with spastic diplegic CP ages 7 through 17 years, Gross Motor Function Classification System levels I to III, who underwent an early mobilization program after SEMLS were reviewed. Outcomes were examined from motion analysis data and clinical documentation. RESULTS: All participants were able to return to school walking at discharge. At 1-year postoperatively, participants had returned to their prior walking level or better. Change in Gait Deviation Index and Pediatric Outcomes Data Collection Instrument indicated improvements in functional mobility and gait consistent with or greater than the literature. CONCLUSION: This intensive early mobilization program restores participation in daily activities, walking, and school within the first month postoperatively.

Synergy Between Licensed Rehabilitation Professionals and Clinical Exercise Physiologists: Optimizing Patient Care for Cancer Rehabilitation.

OBJECTIVES: To differentiate between rehabilitation and exercise training and propose how rehabilitation professionals and exercise physiologists can collaborate to optimize cancer survivor care. DATA SOURCE: Professional organizations and peer-reviewed manuscripts. CONCLUSION: Both professions offer complementary skillsets that, when integrated, optimize the ability of the cancer care team to implement more effective survivorship care plans. Future models of care must incorporate efficient communications between the cancer rehabilitation program and oncology team, include various reimbursement/payment/funding options, and continuously assess program efficacy. IMPLICATIONS FOR NURSING PRACTICE: Nurses must be cognizant of physical needs (ie, functional and conditioning status) and cancer-related comorbidities when referring cancer survivors for exercise reconditioning.

The Who, What, Why, When, Where, and How of Team-Based Interdisciplinary Cancer Rehabilitation.

OBJECTIVE: To review the key components necessary for successful application of rehabilitation principles to oncology survivors. DATA SOURCES: Validated databases, including PubMed, MEDLINE, and Scopus. CONCLUSION: Rehabilitation is an essential component of cancer care that addresses functional needs for oncology survivors and is best accomplished via an interdisciplinary team. Interdisciplinary care, provided by nursing, physiatry, rehabilitation therapy, and exercise physiology, are critical components for comprehensive intervention. Challenges exist in implementing services, but opportunity also exists within the post-acute care sector. IMPLICATIONS FOR NURSING PRACTICE: Nurses play an important role in the screening, assessment, and treatment of cancer-related functional impairments.

Optimizing Cancer Rehabilitation through Activity-focused Approaches.

OBJECTIVES: This article discusses the effects of cancer on broader domains of health; the evidence and application of activity-focused rehabilitation approaches in rehabilitation populations; and the role of nurses in the promotion of activity-focused rehabilitation. DATA SOURCES: Narrative review of rehabilitation literature. CONCLUSION: Cancer impacts activity engagement, community participation, and quality of life. Optimal cancer rehabilitation may lie in adoption and implementation of activity-focused rehabilitation approaches. Recent research suggests that this approach may improve impairments and activity engagement outcomes. IMPLICATIONS FOR NURSING PRACTICE: Nurses are critical for screening for activity limitations and participation restrictions and early referral to rehabilitation treatment. Nurses can also educate survivors on the importance of meta-cognitive and self-management strategies to promote engagement in meaningful activities to reduce long-term disability.

Cancer Rehabilitation in the Pediatric and Adolescent/Young Adult Population.

OBJECTIVES: To identify body impairments, activity limitations, and participation restrictions in children, adolescents, and young adults with cancer amenable to rehabilitation, and provide the recommended screening, assessment and rehabilitation referral information for the health care community. DATA SOURCES: A review of the rehabilitation and pediatric oncology literature regarding functional impairments in combination with clinical expertise from practicing pediatric oncology rehabilitation therapists. CONCLUSION: Rehabilitation intervention has great potential to mitigate the impact of cancer and its treatment and may even have a role in reducing morbidity and mortality. All health care providers have a role in optimizing the function and quality of life in the pediatric cancer population. IMPLICATIONS FOR NURSING PRACTICE: It is imperative for nurses to utilize subjective and clinical screening to identify persons appropriate for rehabilitation referral, collaborate with the rehabilitation team, and support the patients and families in adhering to rehabilitation recommendations.

Proactive Rehabilitation for Chemotherapy-Induced Peripheral Neuropathy.

OBJECTIVE: To review assessment and management approaches for chemotherapy-induced peripheral neuropathy-related physical function deficits. DATA SOURCES: Peer-reviewed articles from PubMed, Ovid MEDLINE, CINAHL PsycINFO, SPORTDiscus, Scopus, and key studies' reference lists. CONCLUSION: Brief clinical tests (eg, gait, Timed Up and Go) can screen for neuropathy-related physical function deficits. Exercise and physical therapy may be promising treatments, but the efficacy and optimal dose of such treatments for chemotherapy-induced peripheral neuropathy are unclear. IMPLICATIONS FOR NURSING PRACTICE: Screening and assessment of neuropathy-associated physical function deficits should occur throughout neurotoxic chemotherapy treatment. If such deficits are identified, referral for rehabilitation (ie, physical or occupational therapy) and/or exercise interventions is warranted.

Cognitive Rehabilitation for Cognitive Dysfunction after Cancer and Cancer Treatment: Implications for Nursing Practice.

OBJECTIVE: To provide an overview of cognitive rehabilitation approaches for cognitive dysfunction after cancer and cancer treatment. DATA SOURCES: Review and synthesis of empirical articles. CONCLUSION: Cognitive rehabilitation approaches, including cognitive behavioral therapy and cognitive training, for cognitive dysfunction appear feasible to deliver, satisfactory to participants, and have shown promising results in cancer survivors. Future research is needed to address optimal dose, delivery method, access, cost, and the vulnerable aging cancer survivor population. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses must understand the available evidence and be able to provide information and options to cancer survivors to address cognitive changes after cancer.

Programa de reabilitação do assoalho pélvico: relato de 10 anos de experiência / Programa de rehabilitación del piso pélvico: relato de 10 años de experiencia / Pelvic floor rehabilitation program: report of 10 years of experience

RESUMO Objetivo: relatar a criação, experiência de implantação e atendimento realizado no Programa de Reabilitação do Assoalho Pélvico (PRAP), um projeto da Faculdade de Enfermagem da Universidade Estadual de Campinas (UNICAMP), desenvolvido em um centro de saúde de Campinas, São Paulo, Brasil. Resultados: este Programa surgiu devido à elevada demanda de pacientes com incontinência urinária (IU) e necessidade de formação ou capacitação de profissionais para atender esta clientela e multiplicar as ações em outras unidades de saúde. Atualmente o PRAP encontra-se em seu décimo ano de funcionamento, tendo, até o momento, atendido 102 pacientes com IU e outras disfunções do assoalho pélvico e do trato urinário inferior, formado 480 alunos, capacitado oito profissionais de saúde e estimulado pesquisas. Conclusão: as atividades preventivas e de reabilitação do assoalho pélvico constituem-se áreas de importante atuação do enfermeiro e iniciativas como a relatada contribuem para a formação profissional e prática baseada em evidências.

RESUMEN Objetivo: relatar la creación, experiencia de implantación y atendimiento realizado en el Programa de Rehabilitación del Piso Pélvico (en portugués, PRAP1), un proyecto de la Facultad de Enfermería de la Universidad Estadual de Campinas (UNICAMP), desarrollado en un centro de salud de Campinas, San Pablo, Brasil. Resultados: este Programa surgió debido a la elevada demanda de pacientes que sufren de incontinencia urinaria (IU) y necesidad de formación o capacitación de profesionales para atender a esta clientela y multiplicar las acciones en otras unidades de salud. Actualmente el PRAP está en su décimo año de funcionamiento, y ha atendido, hasta este momento, a 102 pacientes con IU y otras disfunciones del suelo pélvico y del tracto urinario inferior, además de haber formado 480 alumnos, capacitado ocho profesionales de la salud y estimulado investigaciones. Conclusión: las actividades preventivas y de rehabilitación del piso pélvico constituyen áreas de importante actuación del enfermero e iniciativas como la relatada, y contribuyen para la formación profesional y práctica basada en evidencias.

ABSTRACT Objective: to relate the creation, experience of establishment and service performed in the Pelvic Floor Rehabilitation Program [(PRAP)], a project of the School of Nursing of University of Campinas (UNICAMP), developed at a health unity in Campinas, São Paulo, Brazil. Results: this Program appeared due to the high demand of patients with urinary incontinence (UI) and need of formation or qualification of professionals to serve those customers and multiply the actions at other health unities. Nowadays, the PRAP is in its tenth year, and it has served 102 patients with UI and other dysfunctions of the pelvic floor and lower urinary tract, qualified 480 health professionals and stimulated researches. Conclusion: the preventive actions of pelvic floor rehabilitation are important areas of the nurse’s performance and initiatives as the related ones contribute for the professional formation and practice based on evidences.

Standardising fast-track surgical nursing care in Denmark.

Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN) in 2004. The unit was responsible for guideline construction and implementation using the 'workshop practice method': establishing a website, creating a knowledge centre, coordinating implementation agents, and arranging national workshops and conferences. The UPN has promoted implementation of fast-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.

Effectiveness of the "Elevated Position" Nursing Care Program in promoting the reconditioning of patients with acute cerebrovascular disease.

AIM: Over 34,000 Japanese patients suffer from a persistent disturbance of consciousness. The purpose of this study was to investigate the effectiveness of the "Elevated Position" Nursing Care Program (EPNCP) in promoting the reconditioning of patients with acute cerebrovascular disease (ACD). The primary assumption of this study was that they could experience the reconditioning process and would reach a reconditioned state through their involvement in the EPNCP, thus improving their level of consciousness and quality of life. METHOD: A historical controlled trial study, based on an intention-to-treat analysis of hospitalized patients with ACD who became participants the day after starting medical or surgical treatment, was used. Trained nurses implemented the EPNCP from May to September 2005 for an experimental group of 45 participants. The data on two independent control groups of 92 and 40 patients with ACD were gathered from historical medical records. The six measures were: Japan Coma Scale; Level of Cognitive Functioning Assessment Scale; number of days from the intervention to sitting in a wheelchair; number of participants who left the intensive care unit (ICU) by wheelchair; Barthel Index; and modified Rankin Scale. RESULTS: Significant differences were found regarding the number of participants who left the ICU by wheelchair, length of time from the EPNCP's commencement to the wheelchair-sitting position, and the Barthel Index 1 week after leaving the ICU. CONCLUSION: The EPNCP was safe for the reconditioning of patients with ACD and somewhat effective in improving their physical function. A comprehensive nursing care program now exists for elevating patients with cerebrovascular disease during the early phase following the onset of symptoms or immediately after surgery. Further research should be conducted, extending the duration of the intervention program and the length of the measurement period, followed by a careful analysis of the results.

Rehabilitation of surgical cancer patients at University of Texas M. D. Anderson Cancer Center.

With early detection and treatment, survival rates for many types of cancer have improved. Long term survivors have number of issues, which can include functional deficits, pain, fatigue, lymphedema and altered bowel and bladder function. Simple activities such as mobility and the ability to perform self care can be limited. In addition, re-integration into society with activities such as driving, social interaction and return to work are often problematic. The goal of cancer rehabilitation is to improve quality of life by minimizing disability and handicap caused by cancer and associated treatments. Initial rehabilitation interventions usually occur in an inpatient setting as patients often experience a decline in functional status due to cancer progression and or surgical treatment. Rehabilitation interventions reduce the debility and functional deficits and add to the quality of life for cancer patients undergoing surgical treatments. The rehabilitation team can assist not only with acute decline in functional status but also with re-integration back in society. Both general and specific rehabilitation interventions based on diagnoses are reviewed.

Tools for the advancement of quality care.

Position statements promoting quality cancer care are invaluable tools for oncology nurses. This article reviews the various position papers that promote quality cancer care, rehabilitation of people with cancer, the patients' rights to quality cancer care, participation in clinical trials, and those issues involving quality cancer care in the Medicare program.