Salzburg Visual Field Trainer (SVFT): A virtual reality device for (the evaluation of) neuropsychological rehabilitation.

OBJECTIVE: "Visual Restitution Therapies" (VRT) claim to ameliorate visual field defects of neurological patients by repeated visual light stimulation, leading to training-related neuroplasticity and resulting in reconnection of lesioned neurons in early cortical areas. Because existing systems are stationary, uncomfortable, and unreliable, we developed a training instrument based on virtual reality goggles. The goal of the "Salzburg Visual Field Trainer" (SVFT) is twofold: (1) The device facilitates the clinical evaluation of established neuropsychological rehabilitation approaches, such as VRT. (2) The device enables patients to independently perform VRT based (or other) neuropsychological training methodologies flexibly and comfortably. METHODS AND ANALYSIS: The SVFT was developed on the principles of VRT. Individual configuration of the SVFT is based on perimetric data of the respective patient's visual field. To validate the utmost important aspect of neuropsychological rehabilitation methodologies-that is displaying stimuli precisely in desired locations in the user's visual field-two steps were conducted in this proof-of-concept study: First, we assessed the individual "blind spots" location and extent of 40 healthy, normal sighted participants. This was done with the help of our recently developed perimetric methodology "Eye Tracking Based Visual Field Analysis" (EFA). Second, depending on the individual characteristics of every participant's blind spots, we displayed-by means of the SVFT-15 stimuli in the respective locations of every participants' blind spots and 85 stimuli in the surrounding, intact visual area. The ratio between visible and non-visible stimuli, which is reflected in the behavioral responses (clicks on a remote control) of the 40 participants, provides insight into the accuracy of the SVFT to display training stimuli in areas desired by the investigator. As the blind spot is a naturally occurring, absolute scotoma, we utilized this blind area as an objective criterion and a "simulated" visual field defect to evaluate the theoretical applicability of the SVFT. RESULTS: Outcomes indicate that the SVFT is highly accurate in displaying training stimuli in the desired areas of the user's visual field with an accuracy of 99.0%. Data analysis further showed a sensitivity of .98, specificity of .99, a positive predictive value of .96, a negative predictive value of .996, a hit rate of .99, a random hit rate of .74 and a RATZ-Index of .98. This translates to 14.7% correct non-reactions, 0.7% false non-reactions, 0.3% false reactions and 84.3% correct reactions to displayed test stimuli during the evaluation study. Reports from participants further indicate that the SVFT is comfortable to wear and intuitive to use. CONCLUSIONS: The SVFT can help to investigate the true effects of VRT based methodologies (or other neuropsychological approaches) and the underlying mechanisms of training-related neuroplasticity in the visual cortex in neurological patients suffering from visual field defects.

Caring Models in Geriatric Rehabilitation: An Integrative Review.

To promote excellence in care, person centered care based on humanistic values are essential. This integrative literature review summarizes the current research on the use of a caring model or approach in rehabilitation wards for elderly and explores the issues or benefits on patient's care or on patient-nurse interactions.

O cuidado do agressor familiar frequente: revisão integrativa da literatura / El cuidado del agresor familiar recurrente: revisión integradora de literatura / Care of perpetrators of repeat family violence: an integrative literature review

Resumo Objetivo Identificar as principais literaturas científicas sobre o cuidado prestado ao agressor familiar frequente e apresentar as experiências exitosas mais relevantes. Métodos Revisão integrativa da literatura, com busca de artigos publicados entre os anos de 2008 a 2017, nas bases de dados MEDLINE, CINAHL e SciELO. Resultados Dos 1.496 artigos identificados, 15 atenderam aos critérios de inclusão. A análise desses estudos revelou duas categorias: Fatores intervenientes à agressividade intrafamiliar e Medidas exitosas para cuidado ou reabilitação de agressores familiares. Conclusão Há escassez de produção sobre a temática em países emergentes. Aspectos como padrões intergeracionais e vivência de situações violentas na infância podem ser intervenientes para o comportamento agressivo contra a família. São apontadas como medidas exitosas para o cuidado do agressor familiar a meditação de atenção plena, o aconselhamento pessoal, a melhoria do padrão do sono, participação em programas de prevenção e em formas de psicoterapia.

Resumen Objetivo Identificar las principales literaturas científicas sobre el cuidado ofrecido al agresor familiar recurrente y presentar las experiencias exitosas más relevantes. Métodos Revisión integradora de literatura, con búsqueda de artículos publicados entre 2008 y 2017 en las bases de datos MEDLINE, CINAHL y SciELO. Resultados De los 1496 artículos identificados, 15 cumplieron los criterios de inclusión. El análisis de estos estudios reveló dos categorías: factores intervinientes en la agresividad intrafamiliar y medidas exitosas para cuidado o rehabilitación de agresores familiares. Conclusión Hay escasez de producción sobre este tema en países emergentes. Aspectos como patrones intergeneracionales y vivencia de situaciones violentas durante la infancia pueden ser intervinientes en el comportamiento agresivo contra la familia. Se señalaron las siguientes medidas exitosas para el cuidado del agresor familiar: meditación de atención plena, consejos personales, mejora del patrón del sueño, participación en programas de prevención y tipos de psicoterapia.

Abstract Objectives Identifying the main articles in scientific literature on care of perpetrators of repeat family violence and presenting the most relevant successful experiences. Methods Integrative literature review consisting of a survey for articles published from 2008 to 2017 indexed in MEDLINE, CINAHL, and SciELO. Results Out of the 1,496 identified articles, 15 met all inclusion criteria. After analysis of all studies included, two categories were elaborated: intervening factors for intra-familial violence and successful measures for the treatment or rehabilitation of perpetrators of family violence. Conclusion Literature on the topic is scarce in emerging countries. Aspects such as intergenerational patterns and experience of violence in childhood may be intervening factors for aggressive family behavior. Mindfulness meditation, individual counseling, improvement in sleep pattern, participation in prevention programs, and forms of psychotherapy were shown to be successful measures for the care of perpetrators.

Feasibility and Patient Experience of a Home-Based Rehabilitation Program Driven by a Tablet App and Mobility Monitoring for Patients After a Total Hip Arthroplasty.

BACKGROUND: Recent developments in technology are promising for providing home-based exercise programs. OBJECTIVE: The objective of this study was to evaluate the feasibility and patient experience of a home-based rehabilitation program after total hip arthroplasty (THA) delivered using videos on a tablet personal computer (PC) and a necklace-worn motion sensor to continuously monitor mobility-related activities. METHODS: We enrolled 30 independently living patients aged 18-75 years who had undergone THA as a treatment for primary or secondary osteoarthritis (OA) between December 2015 and February 2017. Patients followed a 12-week exercise program with video instructions on a tablet PC and daily physical activity registration through a motion sensor. Patients were asked to do strengthening and walking exercises at least 5 days a week. There was weekly phone contact with a physiotherapist. Adherence and technical problems were recorded during the intervention. User evaluation was done in week 4 (T1) and at the end of the program (T2). RESULTS: Overall, 26 patients completed the program. Average adherence for exercising 5 times a week was 92%. Reasons mentioned most often for nonadherence were vacation or a day or weekend off 25% (33/134) and work 15% (20/134). The total number of technical issues was 8. The average score on the user evaluation questionnaire (range 0-5) was 4.6 at T1 and 4.5 at T2. The highest score was for the subscale "coaching" and the lowest for the subscale "sensor." CONCLUSIONS: A home-based rehabilitation program driven by a tablet app and mobility monitoring seems feasible for THA patients. Adherence was good and patient experience was positive. The novel technology was well accepted. When the home-based rehabilitation program proves to be effective, it could be used as an alternative to formal physiotherapy. However, further research on its effectiveness is needed.

Proposal of an Extended Taxonomy of Serious Games for Health Rehabilitation.

OBJECTIVE: Serious Games is a field of research that has evolved substantially with valuable contributions to many application domains and areas. Patients often consider traditional rehabilitation approaches to be repetitive and boring, making it difficult for them to maintain their ongoing interest and assure the completion of the treatment program. Since the publication of our first taxonomy of Serious Games for Health Rehabilitation (SGHR), many studies have been published with game prototypes in this area. Based on literature review, our goal is to propose an updated taxonomy taking into account the works, updates, and innovations in game criteria that have been researched since our first publication in 2010. In addition, we aim to present the validation mechanism used for the proposed extended taxonomy. MATERIALS AND METHODS: Based on a literature review in the area and on the analysis of the contributions made by other researchers, we propose an extended taxonomy for SGHR. For validating the taxonomy proposal, a questionnaire was designed to use on a survey among experts in the area. RESULTS: An extended taxonomy for SGHR was proposed. As we have identified that, in general, and besides the mechanisms associated with the adoption of a given taxonomy, there were no reported validation mechanisms for the proposals, we designed a mechanism to validate our proposal. The mechanism uses a questionnaire addressed to a sample of researchers and professionals with experience and expertise in domains of knowledge interrelated with SGHR, such as Computer Graphics, Game Design, Interaction Design, Computer Programming, and Health Rehabilitation. CONCLUSION: The extended taxonomy proposal for health rehabilitation serious games provides the research community with a tool to fully characterize serious games. The mechanism designed for validating the taxonomy proposal is another contribution of this work.

The importance of individual' mental status for the true value of functional self-reported questionnaires used in medical rehabilitation.

The physical and mental health are inseparable and integral components of one's health and as such should always be addressed during the process of medical rehabilitation. It should be an obvious fact that the state of individual' mental health can influence and even more, modify, the outcomes of medical rehabilitation. Furthermore, the state of mental status has an effect in determining the reliability of functional self-reported questionnaires that are frequently used in medical rehabilitation. In conclusion, the evaluation and assessment of the individual's mental health status need to be incorporated as a regular part of the comprehensive and holistic approach to medical rehabilitation.

Participant and service provider perceptions of an outpatient rehabilitation program for people with acquired brain injury.

BACKGROUND: A holistic, intensive and interdisciplinary rehabilitation program for people with acquired brain injury (ABI) was developed at the Pitié-Salpêtrière Hospital, France (5 days/week for 7 weeks). This program, recently demonstrated effective, aimed to optimize the ability of people with ABI to perform activities and improve their participation by using individual and group interventions involving ecologically valid activities inside (e.g., in the gym and kitchen) and outside the hospital. However, the perception of the quality of the program by participants and service providers has not yet been reported. OBJECTIVES: This study had 3 objectives: (1) report the perception of participants (adults with ABI) in terms of service quality of the program, (2) report the strengths, weaknesses, opportunities, and threats (SWOT analysis) of the program as perceived by service providers, and (3) triangulate findings to draw conclusions about the program's quality and provide recommendations for quality improvement. METHODS: We used a mixed-methods design with a validated questionnaire (Perception of Quality of Rehabilitation Services [PQRS-Montreal]) and interviews (structured around a SWOT analysis) involving program participants and service providers. RESULTS: We included 33 program participants (mean age 43.6 years) and 12 service providers (mean years with program 7.6 years). In general, study participants showed a convergence of opinion about the high quality of the program, particularly regarding the team and its participant-focused approach. Specific aspects of the program were viewed more negatively by both participants and service providers (i.e., addressing sexuality, family involvement and return to work/volunteer work/school). CONCLUSION: Participant and service provider perceptions of the rehabilitation program under study were generally positive. A reliable and valid questionnaire and interviews helped identify aspects of the program that worked well and those that could be targeted for future quality improvement.

Musical Stairs: A motivational therapy tool for children with disabilities featuring automated detection of stair-climbing gait events via inertial sensors.

Stair-climbing is a key component of rehabilitation therapies for children with physical disabilities. This paper reports on the design of a system, Musical Stairs, to provide auditory feedback during stair-climbing therapies. Musical Stairs is composed of two foot-mounted inertial sensors, a step detection algorithm, and an auditory feedback response. In Phase 1, we establish its clinical feasibility via a Wizard-of-Oz AB/BA cross-over design with 17 children, aged 4-6 years, having diverse diagnoses and gait abilities. Self-, therapist- and blinded-observer reports indicated increased motivation with auditory feedback. Phase 2 describes the construction of a database comprised of synchronized video and inertial data associated with 1568 steps up and down stairs completed by 26 children aged 4-6 years with diverse diagnoses and gait. Lastly, in Phase 3, data from 18 children in the database were used to train a rule-based step detection algorithm based on local minima in the acceleration profile and the foot's swing angle. A step detection rate of 96% [SD=3%] and false positive rate of 6% [SD=5%] were achieved with an independent test set (n=8). Recommendations for future development and evaluation are discussed.

The Role of the Therapist in Therapeutic Change: How Knowledge From Mental Health Can Inform Pediatric Rehabilitation.

The therapist is a neglected and poorly understood variable in pediatric rehabilitation. Much more attention has been paid to the role of intervention on client change than the role of therapist-related variables. This article synthesizes what is known in the adult and child mental health literature about the role of the therapist, and integrates this with work in pediatric rehabilitation. The article reviews the mental health literature on the therapist as a random variable associated with client outcomes (role of the therapist alone) and the role of three other therapist-related constructs: the therapist-client relationship (therapist and client), treatment implementation (therapist and intervention), and therapy process (therapist, client, and intervention considered holistically). Implications for clinical practice in pediatric rehabilitation include recognition of change as a multi-determined phenomenon involving common therapist-related factors, the therapist's role in creating facilitative conditions for change (through supportive relationships, positive expectancies, and mastery and learning experiences), and the importance of training in collaborative partnership skills. A contextual approach to therapeutic change is advocated, in which psychosocial factors and mechanisms are acknowledged, the therapist is seen as crucial, and the intervention process is seen as the context or vehicle through which changes occur.

Calidad de vida a los 6 meses tras un ictus / Quality of life 6 months after a stroke

Objetivo. Describir la calidad de vida (CV) de los pacientes a los 6 meses de evolución del ictus y su relación con variables sociodemográficas, clínicas y funcionales. Material y métodos. Estudio multicéntrico de cohortes longitudinal (n = 157). Los pacientes incluidos ingresaron en la fase subaguda tras un ictus en 2 Servicios de Rehabilitación. Se recogieron los siguientes datos a los 6 meses postictus: género, edad, riesgo social, comorbilidad, disfagia, afasia, estado cognitivo, depresión y grado de discapacidad evaluado mediante el índice de Barthel modificado. Se evaluó la influencia de estas variables en la CV, para lo que se empleó la escala específica de calidad de vida para el ictus ECVI-38. Resultados. La media de edad fue de 70,93 ± 11,85 años; fue significativamente superior en las mujeres. El paciente tipo presentó una elevada comorbilidad, un bajo riesgo social y dependencia moderada. La puntuación media total de la escala ECVI-38 fue de 35,30 ± 16,17 y los dominios más afectados los referentes a las actividades comunes y básicas de la vida diaria. Las variables que más se relacionan con la CV fueron el género, la afasia, la disfagia, la depresión, el déficit cognitivo y el estado funcional. El dolor de elevada intensidad estuvo presente en un 21% de los pacientes. Conclusión. Son muy diversas las variables que influyen en la CV del paciente con ictus que se deben considerar, para su potencial abordaje, en la planificación de las intervenciones rehabilitadoras (AU)

Objective. To describe quality of life (QoL) in patients at 6 months poststroke and its relationship with sociodemographic, clinical and functional characteristics. Material and method. This multicenter longitudinal cohort study (n = 157) included patients from 2 hospital rehabilitation services who were admitted for stroke in the subacute phase. The following data were gathered at 6 months poststroke: gender, age, social risk, comorbidity, dysphagia, aphasia, cognitive status, depression, and disability measured by the modified Barthel Index. The influence of these variables on QoL was evaluated using the stroke-specific quality of life scale, ECVI-38. Results. The mean age was 70.93 ± 11.85 years and was significantly higher in women. Most of the patients had high comorbidity, low social risk and moderate dependence. The mean total score on the ECVI-38 scale was 35.30 ± 16.17 and the most affected domains were those concerning common and basic activities of daily living. The variables associated with QoL were gender, aphasia, dysphagia, depression, cognitive impairment, and functional status. High-intensity pain was present in 21% of patients. Conclusion. Numerous variables influence QoL in patients with stroke and should be considered in the planning of rehabilitation interventions (AU)

Práctica mental en la rehabilitación de pacientes con ictus. Una revisión sistemática / Mental practice in the rehabilitation of stroke patients. A systematic review

Objetivo. Realizar una revisión sistemática de la literatura para conocer la efectividad de la imaginería motora o práctica mental como tratamiento de pacientes con ictus en la recuperación motora del miembro superior e inferior. Estrategia de búsqueda. Se realizó una búsqueda sistemática de artículos científicos publicados, tanto en inglés como en castellano, desde octubre del 2012 hasta diciembre del 2014. Se evaluó la calidad metodológica mediante la escala de Jadad. Selección de los estudios. Se incluyeron un total de 12 artículos. La calidad metodológica de los estudios fue muy pobre en general. Solo cuatro artículos superaron la puntuación 3/5 en la escala Jadad. Síntesis de resultados. Se observó una gran heterogeneidad en la duración y en el número de participantes. El tiempo de tratamiento osciló entre los 5 y las 54 semanas. El tamaño muestral de los estudios estuvo comprendido de media entre 9 y 42 individuos. Los individuos incluidos en los trabajos presentaban hemiparesia, pudiendo afectar esta tanto a miembro superior como inferior, en una fase subaguda o crónica de la enfermedad. Conclusiones. La mayoría de los trabajos incluidos apenas detallaron los parámetros de las intervenciones. En aquellas publicaciones en las que se especificaron, el tiempo de duración por sesión osciló entre 15-20 minutos; con una frecuencia de tratamiento de tres días a la semana durante una media de cuatro semanas; en relación con el tipo de instrucciones, estas fueron principalmente auditivas y visuales; finalmente, el orden de aplicación de la terapia fue variable en relación con la terapia física convencional. Existieron elementos que no se especificaron como el número de ensayos por sesión, el tipo de imaginería empleada, el contexto o la localización de las sesiones (AU)

Objective. To conduct a systematic review of the literature to determine the effectiveness of motor imagery and mental practice as a treatment of patients with stroke for motor recovery of the upper and lower limb. Search strategy. We conducted a systematic search of scientific articles published in both English and Spanish from October 2012 to December 2014. Methodological quality was evaluated using the Jadad scale. Study selection. A total of 12 items were included. The methodological quality of the studies was generally poor. Only four articles exceeded a score of 3/5 on the Jadad scale. Synthesis of the results. There was wide heterogeneity in treatment duration and the number of participants. The treatment time ranged from 5 to 54 weeks. The average sample size of the studies included was between 9 and 42 individuals. Included individuals had hemiparesis, which could affect both the upper and lower limbs in the subacute and chronic phases. Conclusions. Most of the included studies did not describe the parameters of the interventions. In those that did specify them, the duration of each session was between 15 and 20 minutes, with a treatment frequency of three days per week for an average of four weeks. Instructions were auditory and visual. The order of application of the therapy varied in relation to conventional physical therapy. Numerous elements were not specified, such as the number of trials per session, the kind of imagery, and the context or location of the sessions (AU)

Ariadne's thread: a promising new multidisciplinary tool to foster clients' resilience throughout the rehabilitation process.

INTRODUCTION: Resilience plays an important role in the rehabilitation process as it helps people adapt and grow through difficulties. Ariadne's Thread is one of the few assessment and intervention tools that aim to maximize clients' resilience but its impacts have yet to be studied. PURPOSE: This study explored health professionals' perceptions regarding the impact of Ariadne's Thread on clients, on themselves and on the rehabilitation process. METHOD: An exploratory qualitative clinical research design was used to conduct semi-structured interviews with ten health professionals who used Ariadne's Thread directly or indirectly with clients. RESULTS: Health professionals perceived that Ariadne's Thread had a positive impact on clients' personal factors, especially resilience, self-knowledge, self-esteem and motivation. Moreover, as it fosters a common understanding of clients and use of their strengths and interests in interventions, Ariadne's Thread facilitates the interdisciplinary rehabilitation process. It also enables professionals to confirm their treatment approaches and facilitates therapeutic relationships. CONCLUSIONS: Ariadne's Thread is an innovative intervention and a promising way to enhance clients' resilience. Through a positive, holistic and client-centered vision, Ariadne's Thread can have a positive impact on the rehabilitation process, according to the perceptions of the health professionals in this study. Implications for rehabilitation Ariadne's Thread (AT) is one of the few assessment and intervention tools that aims to maximise clients' resilience and spirituality, and enables professionals to address important themes not usually covered in rehabilitation. Due to its effects on knowledge of the client and clients' resilience, self-esteem, strengths and spirituality, AT can enhance the rehabilitation process. Nevertheless, integrating resilience into practice requires a major paradigm shift, not only focusing on treatment results or helping clients to adapt to their disabilities, but also taking into account clients' and their families' strengths and resources.

[Medico-psychological rehabilitation practices: the reflexive technologies].

We have developed a socio-psychological model of healing that is focused on the integrated health indicators and coordinated with the idea of holism in medicine. The holistic principle implies a system of medical care giving priority to health as an integral indicator of the completeness of physical, social, and psychological well-being. The essence of the proposed socio-psychological model is the use of the technology of "assembly" of the subjects of healing that implies the relationship between the physician and the patient based on the mutual trust, dialogue, cooperation, and responsibility. The model can be fully extrapolated to the practical situations of medicopsychological rehabilitation.

Inpatient paediatric rehabilitation in chronic respiratory disorders.

Inpatient pulmonary rehabilitation programs have evolved from tuberculosis sanatoriums to modern medical centres providing standardized comprehensive care in a multidiciplinatory environment. Goals of rehabilitation programs for children and adolescents include restoration of professional activity, improvement of health condition, compliance and disease management as well as restoration of quality of life. Eligibility for an intervention is assessed by defined social and medical criteria. Comprehensive pulmonary rehabilitation programs provide a wide range of health care recourses, including diagnostic procedures, specific medical care, educational interventions and a multiprofessional team. Paediatric rehabilitation programs for chronic respiratory diseases, such as asthma or cystic fibrosis, have been shown to reduce symptoms, increase aerobic fitness and physical strength, improve pulmonary function and inflammation and enhance compliance, self-management, quality of life and psychological symptoms. Regional climatic effects have demonstrated an additional positive effect on the rehabilitation outcome. In addition, first evidence suggests an overall reduction of health care costs.

Residential volatile substance misuse treatment for indigenous youth in Canada.

The Youth Solvent Addiction Program (YSAP) was established in 1996 in response to the misuse of volatile substances among First Nations and Inuit youth in Canada. This article outlines the role of Indigenous culture and its intersection with Western approaches to recovery in YSAP's operation of nine residential treatment centers for youth. Treatment practices and client outcome data are used to illustrate YSAP's approach. Limitations of the article are noted.

Religiousness affects mental health, pain and quality of life in older people in an outpatient rehabilitation setting.

OBJECTIVES: To evaluate the relationship between religiousness and mental health, hospitalization, pain, disability and quality of life in older adults from an outpatient rehabilitation setting in Sao Paulo, Brazil. DESIGN: Cross-sectional study. SUBJECTS/PATIENTS: A total of 110 patients aged 60 years or older were interviewed during attendance at an outpatient rehabilitation service. METHODS: Researchers administered a standardized questionnaire that assessed socio-demographic data, religiousness, self-reported quality of life, anxiety, physical activity limitation, depression, pain and cognition. Predictors were included in each model analysis, and a backward conditional method was used for variable selection using logistic regression (categorical outcomes) or linear regression (continuous outcomes). RESULTS: Thirty-one patients (28.2%) fulfilled criteria for significant depressive symptoms, 27 (24.5%) for anxiety, and 10 (9.6%) for cognitive impairment. Pain was present in 89 (80.7%) patients. Limited depressive symptoms (as assessed by the Geriatric Depression Scale), and greater self-reported quality of life were related to greater self-reported religiousness, as were scores on the Mini-Mental State Examination (less cognitive impairment), and lower ratings of pain. CONCLUSION: Religiousness is related to significantly less depressive symptoms, better quality of life, less cognitive impairment, and less perceived pain. Clinicians should consider taking a spiritual history and ensuring that spiritual needs are addressed among older patients in rehabilitation settings.

Programa de reabilitação ampliada (PRA): uma abordagem multidimensional do processo de reabilitação profissional / Extended rehabilitation program: a multidimensional approach to the occupational rehabilitation process

O PRA foi desenvolvido a partir de uma demanda do Ministério Públicodo Trabalho (MPT) 12ª Região mediante denúncia de uma altaprevalência (10%)de doenças ocupacionais; em especial LER/DORTe transtornos mentais, em uma empresa do ramo de produção e abatede aves e suínos do meio oeste de Santa Catarina. A partir do estabelecimento de parcerias entre o INSS, Centro de Referência Estadualem Saúde do Trabalhador (CEREST/SC), Universidade Federal deSanta Catarina (UFSC) e MPT 12ª Região, o PRA foi desenvolvidocomo uma proposta de Termo de Ajuste de Conduta (TAC), sendo umprojeto único no Brasil e constituído de três pilares: 1. assistencial; 2.vigilância; e 3. requalificação. Fizeram parte da equipe multidisciplinar18 profissionais que ofereciam serviços de fisioterapia, terapia ocupacional (T.O.), psicologia, acupuntura, reeducação postural global(RPG), tai chi chuan, massoterapia, danças circulares, grupo informativo,condicionamento físico, hidroginástica, terapias complementarese assistência social. Este programa foi iniciado em novembro/2007finalizando suas atividades em setembro/2008, atendendo duranteeste período 425 pessoas. Os objetivos principais deste artigo são: 1.descrever a estrutura do PRA e seus procedimentos no pilar assistenciale requalificação; 2. apresentar os principais resultados encontrados.Trata-se de um estudo quantitativo de corte transversal, com coleta dedados em dois momentos (inicio e término do tratamento). Os dadosforam analisados utilizando estatísticas descritivas e inferenciais (média,DP), teste T e Chi-quadrado. Um grande número de trabalhadoresapresentou melhoras significativas nos indicadores qualidade de vida,saúde global, capacidade funcional, depressão, aumento da amplitudede movimento.

The Extended Rehabilitation Program (PRA ? Programa de ReabilitaçãoAmpliado) was developed in response to a demand from thePublic Labor Ministry (MPT) of the 12th District following reports ofa high rate (10%) of occupational diseases?especially RSI/WRULDand mental disorders in a meat-packing company in mid-western SantaCatarina. Since the establishment of a partnership between the INSS,Centro de Referência Estadual em Saúde do Trabalhador (CEREST/SC) --- the State Reference Center for Occupational Health (CEREST/SC), Universidade Federal de Santa Catarina (UFSC) --- the FederalUniversity of Santa Catarina (UFSC), and the 12th District MPT,the PRA was developed as a proposal of Conduct Adjustment Terms(TAC - Termo de Ajuste de Conduta). This is the only such projectin Brazil and has three aspects: 1) assistance; 2) monitoring; and 3)requalification. Eighteen professionals were part of a multidisciplinaryteam who offer such services as: physiotherapy, occupationaltherapy (OT), psychology, acupuncture, postural re-education, tai chichuan, massage therapy, circle dances, information groups, physicalconditioning, water exercises, supplementary therapies, and socialassistance. This program, starting in November of 2007 and endingin September of 2008, attended 425 persons. The main goals of thispaper are: 1) to delineate the structure of the ERP and its proceduresregarding the assistance and requalification aspects; and 2) to presentthe results. This is a cross-sectional, quantitative study collecting dataat two points ? the outset and the termination. Data was analyzed usingdescriptive and inferential statistics (mean and standard deviation),T-test, and chi-square. A large number of workers showed significantimprovement in quality of life, general health, functional capacity,depression, and increase in range of movement.

A strategy for computer-assisted mental practice in stroke rehabilitation.

OBJECTIVE: To investigate the technical and clinical viability of using computer-facilitated mental practice in the rehabilitation of upper-limb hemiparesis following stroke. DESIGN: A single-case study. SETTING: Academic-affiliated rehabilitation center. PARTICIPANT: A 46-year-old man with stable motor deficit of the upper right limb following subcortical ischemic stroke. INTERVENTION: Three computer-enhanced mental practice sessions per week at the rehabilitation center, in addition to usual physical therapy. A custom-made virtual reality system equipped with arm-tracking sensors was used to guide mental practice. The system was designed to superimpose over the (unseen) paretic arm a virtual reconstruction of the movement registered from the nonparetic arm. The laboratory intervention was followed by a 1-month home-rehabilitation program, making use of a portable display device. MAIN OUTCOME MEASURES: Pretreatment and posttreatment clinical assessment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment and the Action Research Arm Test. Performance of the affected arm was evaluated using the healthy arm as the control condition. RESULTS: The patient's paretic limb improved after the first phase of intervention, with modest increases after home rehabilitation, as indicated by functional assessment scores and sensors data. CONCLUSION: Results suggest that technology-supported mental training is a feasible and potentially effective approach for improving motor skills after stroke.