Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
2.
J Allied Health ; 48(2): 81-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167008

RESUMO

PURPOSE: This study examined the impact of video-based and live standardized patient scenarios on attitudes toward and readiness for interprofessional education (IPE) in occupational therapy (OT) and physical therapy (PT) students. In academic health programs, IPE is used to teach the knowledge and skills to develop interprofessional teamwork abilities; however, research is limited on the impact of standardized patient scenario experiences (SPSE) on the effectiveness of IPE in OT and PT students. PARTICIPANTS: The study involved 49 participants: 23 OT and 26 PT students. METHODS: A descriptive quantitative pilot study measured attitudes and readiness for IPE using a repeated-measures design and the Readiness for Inter-Professional Learning Scale (RIPLS), a 19-item Likert scale. Students completed the RIPLS prior to an interprofessional team assignment, following an interprofessional team meeting to plan the standardized patient evaluation, and after a live SPSE. A 3 x 2 repeated-measures MANOVA analyses was used to determine differences between groups and change over time. RESULTS: Statistically significant changes occurred in Teamwork and Professional Identify subscales of the RIPLS for both groups after the live SPSE. IMPACT: Findings support the use of team-based, live SPSE to improve OT and PT students' readiness for and attitudes toward IPE.


Assuntos
Atitude do Pessoal de Saúde , Terapia Ocupacional/educação , Simulação de Paciente , Fisioterapia/educação , Estudantes de Ciências da Saúde/psicologia , Competência Clínica , Processos Grupais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Relações Interprofissionais , Equipe de Assistência ao Paciente/organização & administração , Projetos Piloto
3.
Fam Med ; 51(3): 227-233, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30676638

RESUMO

BACKGROUND AND OBJECTIVES: There are several trends compelling physicians to acquire team-based skills for interprofessional care. One underdeveloped area of team-based skills for physicians is integrated behavioral health (IBH) in primary care. We used a Delphi method to explore what skills were needed for residents to practice integrated behavioral health. METHODS: We conducted a literature review of IBH competencies and found 41 competencies across seven domains unique to physicians. Using a modified Delphi technique, we recruited family medicine educators to rate each competency as "essential," "compatible," or "irrelevant." We also shared findings from the Delphi study with a focus group for additional feedback. RESULTS: Twenty-one participants (12 physicians, nine behavioral health providers) completed all three rounds of the Delphi survey resulting in a list of 21 competencies. The focus group gave additional feedback. CONCLUSIONS: Participants chose skills that required physicians to share responsibilities across the entire care team, were not redundant with standard primary care, and necessitated strong communication ability. Many items were revised to reflect team-based care and a prescribed physician role as a team facilitator. Next steps include determining how these competencies fit with a variety of medical providers and creating effective training programs that develop competency in IBH.


Assuntos
Medicina do Comportamento , Prestação Integrada de Cuidados de Saúde/métodos , Técnica Delfos , Medicina de Família e Comunidade/educação , Internato e Residência , Grupos Focais , Humanos , Equipe de Assistência ao Paciente , Médicos
4.
J Neurol Phys Ther ; 42(2): 84-93, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29547483

RESUMO

BACKGROUND AND PURPOSE: Multisensory reweighting (MSR) deficits in older adults contribute to fall risk. Sensory-challenge balance exercises may have value for addressing the MSR deficits in fall-prone older adults. The purpose of this study was to examine the effect of sensory-challenge balance exercises on MSR and clinical balance measures in fall-prone older adults. METHODS: We used a quasi-experimental, repeated-measures, within-subjects design. Older adults with a history of falls underwent an 8-week baseline (control) period. This was followed by an 8-week intervention period that included 16 sensory-challenge balance exercise sessions performed with computerized balance training equipment. Measurements, taken twice before and once after intervention, included laboratory measures of MSR (center of mass gain and phase, position, and velocity variability) and clinical tests (Activities-specific Balance Confidence Scale, Berg Balance Scale, Sensory Organization Test, Limits of Stability test, and lower extremity strength and range of motion). RESULTS: Twenty adults 70 years of age and older with a history of falls completed all 16 sessions. Significant improvements were observed in laboratory-based MSR measures of touch gain (P = 0.006) and phase (P = 0.05), Berg Balance Scale (P = 0.002), Sensory Organization Test (P = 0.002), Limits of Stability Test (P = 0.001), and lower extremity strength scores (P = 0.005). Mean values of vision gain increased more than those for touch gain, but did not reach significance. DISCUSSION AND CONCLUSIONS: A balance exercise program specifically targeting multisensory integration mechanisms improved MSR, balance, and lower extremity strength in this mechanistic study. These valuable findings provide the scientific rationale for sensory-challenge balance exercise to improve perception of body position and motion in space and potential reduction in fall risk.


Assuntos
Acidentes por Quedas/prevenção & controle , Terapia por Exercício/métodos , Marcha/fisiologia , Equilíbrio Postural/fisiologia , Idoso , Idoso de 80 Anos ou mais , Exercício/fisiologia , Feminino , Humanos , Masculino , Amplitude de Movimento Articular
5.
J Geriatr Phys Ther ; 40(1): 1-36, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27537070

RESUMO

BACKGROUND: Falls and their consequences are significant concerns for older adults, caregivers, and health care providers. Identification of fall risk is crucial for appropriate referral to preventive interventions. Falls are multifactorial; no single measure is an accurate diagnostic tool. There is limited information on which history question, self-report measure, or performance-based measure, or combination of measures, best predicts future falls. PURPOSE: First, to evaluate the predictive ability of history questions, self-report measures, and performance-based measures for assessing fall risk of community-dwelling older adults by calculating and comparing posttest probability (PoTP) values for individual test/measures. Second, to evaluate usefulness of cumulative PoTP for measures in combination. DATA SOURCES: To be included, a study must have used fall status as an outcome or classification variable, have a sample size of at least 30 ambulatory community-living older adults (≥65 years), and track falls occurrence for a minimum of 6 months. Studies in acute or long-term care settings, as well as those including participants with significant cognitive or neuromuscular conditions related to increased fall risk, were excluded. Searches of Medline/PubMED and Cumulative Index of Nursing and Allied Health (CINAHL) from January 1990 through September 2013 identified 2294 abstracts concerned with fall risk assessment in community-dwelling older adults. STUDY SELECTION: Because the number of prospective studies of fall risk assessment was limited, retrospective studies that classified participants (faller/nonfallers) were also included. Ninety-five full-text articles met inclusion criteria; 59 contained necessary data for calculation of PoTP. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) was used to assess each study's methodological quality. DATA EXTRACTION: Study design and QUADAS score determined the level of evidence. Data for calculation of sensitivity (Sn), specificity (Sp), likelihood ratios (LR), and PoTP values were available for 21 of 46 measures used as search terms. An additional 73 history questions, self-report measures, and performance-based measures were used in included articles; PoTP values could be calculated for 35. DATA SYNTHESIS: Evidence tables including PoTP values were constructed for 15 history questions, 15 self-report measures, and 26 performance-based measures. Recommendations for clinical practice were based on consensus. LIMITATIONS: Variations in study quality, procedures, and statistical analyses challenged data extraction, interpretation, and synthesis. There was insufficient data for calculation of PoTP values for 63 of 119 tests. CONCLUSIONS: No single test/measure demonstrated strong PoTP values. Five history questions, 2 self-report measures, and 5 performance-based measures may have clinical usefulness in assessing risk of falling on the basis of cumulative PoTP. Berg Balance Scale score (≤50 points), Timed Up and Go times (≥12 seconds), and 5 times sit-to-stand times (≥12) seconds are currently the most evidence-supported functional measures to determine individual risk of future falls. Shortfalls identified during review will direct researchers to address knowledge gaps.


Assuntos
Acidentes por Quedas/prevenção & controle , Avaliação Geriátrica/métodos , Modalidades de Fisioterapia , Idoso , Idoso de 80 Anos ou mais , Humanos , Vida Independente , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade
6.
J Med Ethics ; 40(10): 714-6, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24567422

RESUMO

In the 2011 landmark case of W v M, the English Court of Protection ruled that it was unlawful to withdraw artificial nutrition and hydration from a woman who had been in a minimally conscious state for 8 years. From the perspective of the court, the absence of a written advance directive negated the woman's previous, autonomous interests and, consequently, emphasis was given to her current welfare and well-being. While life itself is a moral good, prolonging life for a person in regular pain with no hope of recovering to a more complete state of awareness simply because that person only verbalized her wishes about her treatment decisions seems to drastically undervalue the principle of autonomy. We refute the notion that it is the role of the court to prolong life insofar as it can and argue that withholding and withdrawing life sustaining technologies from patients in a minimally conscious state can be ethically justified.


Assuntos
Diretivas Antecipadas/legislação & jurisprudência , Sistemas de Manutenção da Vida/ética , Suspensão de Tratamento/legislação & jurisprudência , Adulto , Feminino , Humanos , Competência Mental/legislação & jurisprudência , Estado Vegetativo Persistente/terapia , Autonomia Pessoal , Pessoalidade , Suspensão de Tratamento/ética
7.
J Geriatr Phys Ther ; 36(1): 13-23, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22790588

RESUMO

BACKGROUND AND PURPOSE: Fear of falling (FOF) has been correlated with an increased risk for falls, self-restriction of physical activity, and subsequent decrease in quality of life in older adults. The relationship between perceived FOF, participation restriction, and balance and mobility abilities is unclear, as results from prior studies are inconsistent. Few studies have used the Survey of Activities and Fear of Falling in the Elderly (SAFE) as a standard measure of FOF, although this survey provides both a measure of FOF and participation restriction. Only one study has explored the relationship of individual items from the SAFE with balance and mobility tests that predict fall risk. The primary purpose of this study was to investigate the relationships between FOF and participation restriction as measured by the SAFE and actual balance and mobility abilities in a diverse group of older adults. PARTICIPANTS: Eighty-two community-dwelling older adults (17 men) with a mean age of 74 (SD = 8.8; range = 55-91) participated in this study. The sample comprised 45% African Americans and 54% whites. METHODS: Fear of falling and participation restriction were assessed using the SAFE, a self-assessment survey. The SAFE assesses information about participation in 11 functional activities as well as the extent to which fear is a source of participation restriction. Balance and functional mobility were measured using the Berg Balance Scale (BBS) and Timed Get Up & Go Test (TUG), respectively. Participants were categorized as low (N = 36), mixed (N = 19), or high (N = 24) risk for future falls based on their past fall history and results on the BBS and the TUG. Data analysis included χ(2) and Spearman correlation and 2 regression analyses. RESULTS: Both SAFE FOF and participation restriction scores were significantly correlated with BBS and TUG scores. However, SAFE participation restriction scores, but not SAFE FOF scores, predicted BBS and TUG scores. SAFE FOF scores could discriminate older adults at high risk for falls from those at mixed and low risk but could not discriminate between the mixed- and low-risk groups. DISCUSSION/CONCLUSION: The relationship between self-reported participation restriction and objectively measured balance and mobility abilities is stronger than the relationship between self-reported FOF and objectively measured balance and mobility abilities. These findings lend support to the argument that participation restriction may be the critical mediating factor between FOF, balance and mobility limitations, and fall risk. Evaluation of and intervention for FOF and fall risk without direct and specific attention to participation restriction may not yield optimal results. Older adults whose goals include both reduction in fall risk and increase in participation level may need combined treatment approaches.


Assuntos
Acidentes por Quedas , Avaliação Geriátrica/métodos , Limitação da Mobilidade , Equilíbrio Postural , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Características de Residência , Fatores de Risco , População Rural , Autoavaliação
8.
Am J Occup Ther ; 66(2): 169-76, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22394526

RESUMO

OBJECTIVE: This study examined (1) the relationship of fear of falling to depression, anxiety, activity level, and activity restriction and (2) whether depression or anxiety predicted fear of falling, activity level, activity restriction, or changes in activity level. METHOD: We administered the Survey of Activities and Fear of Falling in the Elderly; the Geriatric Depression Scale-30; and the Hamilton Anxiety Scale, IVR Version, during a one-time visit to 99 community-dwelling adults ≥55 yr old. RESULTS: We found significant relationships between (1) fear of falling and depression, anxiety, and activity level; (2) depression and anxiety; and (3) activity restriction and depression. Activity level was negatively correlated with activity restriction, fear of falling, depression, and anxiety. Anxiety predicted both fear of falling and activity level. Both anxiety and depression predicted activity restriction because of fear of falling and for other reasons. CONCLUSION: Occupational therapy practitioners should consider screening their older adult clientele for fear of falling, anxiety, and depression because these states may lead to fall risk and activity restriction.


Assuntos
Acidentes por Quedas , Ansiedade , Depressão , Medo , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade
9.
J Mot Behav ; 42(4): 197-208, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20501430

RESUMO

Multisensory reweighting (MSR) is an adaptive process that prioritizes the visual, vestibular, and somatosensory inputs to provide the most reliable information for postural stability when environmental conditions change. This process is thought to degrade with increasing age and to be particularly deficient in fall-prone versus healthy older adults. In the present study, the authors investigate the dynamics of sensory reweighting, which is not well-understood at any age. Postural sway of young, healthy, and fall-prone older adults was measured in response to large changes in the visual motion stimulus amplitude within a trial. Absolute levels of gain, and the rate of adaptive gain change were examined when visual stimulus amplitude changed from high to low and from low to high. Compared with young adults, gains in both older adult groups were higher when the stimulus amplitude was high. Gains in the fall-prone elderly were higher than both other groups when the stimulus amplitude was low. Both older groups demonstrated slowed sensory reweighting over prolonged time periods when the stimulus amplitude was high. The combination of higher vision gains and slower down weighting in older adults suggest deficits that may contribute to postural instability.


Assuntos
Acidentes por Quedas , Equilíbrio Postural/fisiologia , Reflexo/fisiologia , Sensação/fisiologia , Adaptação Fisiológica/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Algoritmos , Gráficos por Computador , Feminino , Humanos , Masculino , Dinâmica não Linear , Estimulação Luminosa , Postura/fisiologia , Adulto Jovem
10.
J Med Genet ; 47(5): 332-41, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-19914906

RESUMO

BACKGROUND: Deletion and the reciprocal duplication in 16p11.2 were recently associated with autism and developmental delay. METHOD: We indentified 27 deletions and 18 duplications of 16p11.2 were identified in 0.6% of all samples submitted for clinical array-CGH (comparative genomic hybridisation) analysis. Detailed molecular and phenotypic characterisations were performed on 17 deletion subjects and ten subjects with the duplication. RESULTS: The most common clinical manifestations in 17 deletion and 10 duplication subjects were speech/language delay and cognitive impairment. Other phenotypes in the deletion patients included motor delay (50%), seizures ( approximately 40%), behavioural problems ( approximately 40%), congenital anomalies ( approximately 30%), and autism ( approximately 20%). The phenotypes among duplication patients included motor delay (6/10), behavioural problems (especially attention deficit hyperactivity disorder (ADHD)) (6/10), congenital anomalies (5/10), and seizures (3/10). Patients with the 16p11.2 deletion had statistically significant macrocephaly (p<0.0017) and 6 of the 10 patients with the duplication had microcephaly. One subject with the deletion was asymptomatic and another with the duplication had a normal cognitive and behavioural phenotype. Genomic analyses revealed additional complexity to the 16p11.2 region with mechanistic implications. The chromosomal rearrangement was de novo in all but 2 of the 10 deletion cases in which parental studies were available. Additionally, 2 de novo cases were apparently mosaic for the deletion in the analysed blood sample. Three de novo and 2 inherited cases were observed in the 5 of 10 duplication patients where data were available. CONCLUSIONS: Recurrent reciprocal 16p11.2 deletion and duplication are characterised by a spectrum of primarily neurocognitive phenotypes that are subject to incomplete penetrance and variable expressivity. The autism and macrocephaly observed with deletion and ADHD and microcephaly seen in duplication patients support a diametric model of autism spectrum and psychotic spectrum behavioural phenotypes in genomic sister disorders.


Assuntos
Anormalidades Múltiplas/genética , Aberrações Cromossômicas , Cromossomos Humanos Par 16/genética , Deficiências do Desenvolvimento/genética , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/genética , Transtorno Autístico/genética , Criança , Pré-Escolar , Deleção Cromossômica , Hibridização Genômica Comparativa , Anormalidades Craniofaciais/genética , Anormalidades Craniofaciais/patologia , Epilepsia/genética , Feminino , Humanos , Lactente , Deficiência Intelectual/genética , Transtornos do Desenvolvimento da Linguagem/genética , Masculino , Microcefalia/genética , Análise de Sequência com Séries de Oligonucleotídeos , Fenótipo , Duplicações Segmentares Genômicas , Adulto Jovem
11.
Exp Brain Res ; 175(2): 342-52, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16858599

RESUMO

Unexplained falls in older adults are thought to arise from subtle deficits in multiple components of the postural control system, including peripheral sensory loss and central sensory processing. One commonly proposed central sensory processing deficit is a decline in the adaptive use of changing or conflicting sensory inputs for estimating body dynamics, i.e., multisensory reweighting. We examined the assumption of impaired multisensory reweighting in healthy and fall-prone older adults using quantitative methods that have previously demonstrated reweighting in young adults. Standing subjects were exposed to simultaneous medio-lateral oscillatory visual and fingertip touch inputs at varying relative amplitudes. No group differences in overall levels of vision and touch gain were found. Both healthy and fall-prone older adults demonstrated the same pattern of adaptive gain change as healthy young adults. Like the young adults, both elderly groups displayed clear evidence of intra- and inter-sensory reweighting to both vision and touch motion stimuli. These data suggest that, for small amplitude vision and touch stimuli, the central sensory reweighting adaptation process remains intact in healthy and fall-prone older adults with sufficiently intact peripheral sensation.


Assuntos
Envelhecimento/fisiologia , Postura/fisiologia , Tato/fisiologia , Visão Ocular/fisiologia , Acidentes por Quedas , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos/métodos , Feminino , Dedos/inervação , Humanos , Masculino , Análise Multivariada , Estimulação Física/métodos
12.
Exp Brain Res ; 174(3): 517-27, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16724180

RESUMO

The properties of sensory reweighting for control of human upright stance have primarily been investigated through experimental techniques such as sinusoidal driving of postural sway. However, other forms of visual inputs that are commonly encountered, such as translation, may produce different adaptive responses. We directly compared sinusoidal and translatory inputs at stimulus parameters that made stimulus velocity comparable with each type of stimulus. Young healthy individuals were compared with healthy elderly and elderly designated as "fall-prone" to investigate whether the hypothesized basis for poor balance control in the "fall-prone" elderly is related to their ability to reweight sensory inputs appropriately. Standing subjects were presented with visual displays which moved in the medial-lateral direction either by (1) oscillating at different amplitudes or (2) simultaneously oscillating and translating at different speeds. All three subject groups showed that increasing the amplitude of the oscillations led to a decrease in gain. Increasing translation speed led to decreases in gain only at speeds above 1 cm/s. This suggests that the nervous system is processing more than just stimulus velocity to determine the postural response. A model implementing "state-dependent noise", in which visual stimulus noise increases with relative speed, was developed to account for the difference between translation and oscillation. The weak group effects question the common view that the fall-prone elderly are deficient in sensory reweighting. One explanation for the apparent discrepancy is that the slow, small-amplitude visual stimuli used in this study probe the asymptotic dynamics of the postural response. If given enough time, even the fall-prone elderly are able to adapt to a new sensory environment appropriately. However, the asymptotic adaptive response may not be functional in terms of preventing falls.


Assuntos
Adaptação Fisiológica , Envelhecimento/fisiologia , Ruído , Equilíbrio Postural/fisiologia , Postura/fisiologia , Percepção Visual/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos/métodos , Feminino , Humanos , Masculino , Percepção de Movimento/fisiologia , Estimulação Luminosa/métodos , Desempenho Psicomotor/fisiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA