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The National Drug Sector Information Service is committed to supporting those who work to prevent or reduce the harm to individuals, families, communities and the nation caused by alcohol and [...]

Background. Falls are common among hospital inpatients, particularly in rehabilitation wards. Standing balance impairment is widely held to be a contributing factor to fails, is a component of several falls risk screening tools, and has motivated the development of balance retraining programs for the reduction of in-hospital falls. Little rigorous investigation of the link between standing balance impairment and in-hospital falls has been undertaken. Methods. We identified optimal cut-off points of four commonly used balance measures (functional reach, Timed Up and Go, step test, and timed static stance) in a prospective multicenter cohort study. Admission data (n = 1373) were clustered and matched by center then randomly allocated to development and validation data sets. Results. Optimal cut-off points for each test were identified from the development data set. The predictive accuracy of all four balance tests was poor when the optimal cut-off was applied to the validation data set (Youden Index scores ranged between 0.02 and 0.15). Conclusions. These findings do not support an association between admission standing balance and falls in a geriatric rehabilitation setting. This result has implications for content of falls risk screening tools and interventions to prevent falls in a geriatric rehabilitation population. Key Words: Falls--Predicting falls--Predictive value of tests--Rehabilitation.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2007.02.006 Byline: Peter D. Friedmann (a)(b), Lan Jiang (a), Kimber P. Richter (c) Keywords: Tobacco use cessation; Smoking cessation; Substance abuse treatment centers Abstract: The objective of this study was to estimate the prevalence and determinants of cigarette smoking cessation treatment in U.S. outpatient substance abuse treatment (OSAT) units. Author Affiliation: (a) Program to Integrate Psychosocial and Health Services, Research Service, Providence Veterans Affairs Medical Center, Providence, RI, USA (b) Division of General Internal Medicine, Departments of Medicine and Community Health, Brown Medical School and Rhode Island Hospital, Providence, RI, USA (c) Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS, USA Article History: Received 13 October 2006; Revised 17 January 2007; Accepted 16 February 2007 Article Note: (footnote) The views expressed in this article are those of the authors and do not necessarily reflect those of the National Institute on Drug Abuse, the Department of Veterans Affairs, or the Robert Wood Johnson Foundation.

The day activity programs in 53 rehabilitation centers in the Flemish region of Belgium that was conducted on 646 clients are discussed. It was seen that boredom occurred among the clients of these centers due to routinized activities that lacked intrinsic meaning and lack of emphasis on completion of task.

keywords * patients: empowerment * community care * patient centred care These keywords are based on the subject headings from the British Nursing Index This article has been subject to [...]

This study examines health service use and satisfaction with consumer-directed and agency directed personal assistance services for persons enrolled in the Kansas Medicaid Physical Disability Waiver. Findings suggest that health care costs for people using consumer-directed care are slightly lower than for people using agency-directed care. At the same time, people using consumer-directed care appear to be more satisfied with their personal assistance services. The study points to the positive benefits of consumer choice among persons with disabilities enrolled in Medicaid home and community waiver programs. Recognizing the value of both self and agency directed approaches to receiving personal assistance services can help rehabilitation counselors determine which approach may be most beneficial to meeting individual consumers' needs., For many in the disability community, rehabilitation counseling is increasingly tied to reimbursement systems through which persons with disabilities are able to optimize their value to society in collaborative and [...]

Blood pressure management is an important issue for the primary prevention, acute management, and secondary prevention of a stroke. Rehabilitation professionals need to consider the timing in lowering blood pressures [...]

A new National Institute for Disability Rehabilitation and Research (NIDRR) funded grant, a collaboration of six SCI centers, has begun to examine all aspects of the rehabilitation process in an [...]

Effective rehabilitation counseling includes follow-up of former rehabilitation clients for periods of up to three years to assess individual client success and increase client input for program content. The Woodrow Wilson Rehabilitation Center is a comprehensive rehabilitation center that has developed formal follow-up programs for former clients of vocational and medical rehabilitation services. The follow-up includes out-patient visits, phone calls, and satisfaction surveys using the nationally standardized Functional Independence Measure (FIM). The Uniform Data Services is also used to provide automated reports on the follow-up FIM., The purpose of rehabilitation is to increase the independence of the person receiving services when he or she returns to the community, either through increased employment or improved daily living [...]

Rehabilitation professionals are facing new challenges in meeting the social needs of adults with developmental disabilities. Adults with mental retardation live longer than other physically handicapped, and most of them reside in community settings. The concept of mental retardation is evolving from a 'deficiency-model' to a 'support-based model.' Psychiatric co-morbidity in mental retardation also affects the rehabilitative-support services offered to adults with developmental disabilities., This Special Issue reflects a number of trends for those adults with developmental disabilities that have surfaced within the last decade or so in the United States. For professionals in [...]

The comparison of rehabilitated and non-rehabilitated children in the Gabu region of Guinea Bissau based upon mortality and nutritional level showed a 25% reduced mortality and a higher nutritional level in the rehabilitated group. The difference in mortality of the two groups was greater during the first 3 months. Rehabilitated children had higher weight gain in the first 3 months with weight gain differences lasting up to 18 months.

The voucher system, as applied in rehabilitation, has its advantages and disadvantages. Under such system, clients can choose the services they prefer. Rehabilitation agencies will then be compelled to improve the quality of their service. However, agencies may consider clients merely as potential sources of revenue rather than patients needing treatment. It is also difficult to formulate a structure that will ensure efficient use of the voucher system., The purpose of this article is to discuss the advantages and potential problems of implementing a voucher system in rehabilitation. Among the major advantages of implementing such a system would [...]

The effect of post-secondary education on the personal growth of blind and visually-impaired clients of a state vocational rehabiliation agency is examined. Results show clients perceive post-secondary education as beneficial to them, especially when they seek employment and try to integrate in the community. Rehabilitation agencies can serve better if they selectively send their clients to college., The overall purpose of this study was to investigate the impact of college or university attendance on blind and visually impaired clients of a state vocational rehabilitation agency. A 50-item Client Survey Questionnaire was sent to a research sample of 171 blind and visually impaired, former clients who: (a) were served by the Florida Division of Blind Services; (b) received post-secondary educational services;.and (c) were "closed 26 -- rehabilitated" over a five-year period, 1988-1992. Out of the 116 ostensibly delivered and received questionnaires, a total of 41 usable returns were analyzed (constituting a 35.3% response rate). Overall, the clients reported that going to college was very beneficial to them -- especially in terms of their employment, their ability to live independently in the community and their overall quality of life. It was concluded that there are numerous benefits for an agency serving blind and visually impaired individuals to selectively send their clients to college (i.e., those who are prepared, ready and motivated). Also included are recommendations for rehabilitation programming and future research., A pervasive, operationalized, underlying assumption upon which rehabilitation services are provided to individuals with visual disabilities is that education is, and would be, uniquely beneficial to them (Augusto & McGraw, [...]

The problem of cigarette smoking among those who are recovering from alcohol dependence is becoming more apparent as chemical dependency units (CDUs) are beginning to restrict smoking for clients and staff and more actively encourage nicotine abstinence. To date, little is known about effective smoking cessation techniques for people with a history of alcohol problems. To obtain new data, a survey of personal experiences with smoking cessation and professional recommendations about nicotine dependence was administered to 124 recovering treatment professionals in CDUs in rural Nebraska. Among the 99 staff with a history of smoking, 81 (80%) had tried to quit smoking and 38 were former smokers at the time of the survey. Quitting 'cold turkey' was the most popular smoking cessation method. Reliance on AA principles was second. The results suggest that recovering staff can successfully quit smoking by applying their professional practice guidelines for alcohol treatment to their personal problems with tobacco.

Substance use disorder treatment professionals historically have been reluctant to address tobacco dependence in their patients, despite a high prevalence of smoking, unique health effects, and evidence of physical addiction to nicotine. We performed two prospective studies to examine (1) the feasibility of a smoke-free policy and nicotine treatment program in an inpatient drug and alcohol treatment program, and (2) the impact of this intervention on long-term treatment outcomes. In both studies we used self-reported data from two groups of patients; one hospitalized after the implementation of the intervention and a historical control. The first set of data indicated that patients were more interested in quitting smoking and were more likely to abstain from smoking after the policy was implemented than before. They did not feel quitting smoking would threaten abstinence, and the policy did not increase early discharges. The second study failed to show that the change in policy was associated with an adverse effect on drug and alcohol treatment outcomes. A small but significant positive effect was demonstrated for smoking cessation. These studies also showed that many patients regard smoking as different from the primary drug that brought them to treatment. Randomized clinical trials testing a variety of smoking intervention techniques are desperately needed in this population to scientifically determine effective methods to decrease smoking.

Nicotine addiction treatment has been integrated with inpatient chemical dependency treatment in the Drug Dependency Treatment program (DDTP) of the Minneapolis VA Medical Center since June 1988. The process of addressing this 'new' drug (nicotine) is described. It has required significant changes in staff awareness and attitudes and several years to melt denial of nicotine addiction and develop new habits that address nicotine in therapeutic interactions with patients. Nicotine recovery has gradually been incorporated into all educational and therapeutic activities as well as the traditional recovery tools. Six weeks postdischarge 58% of patients who were smokers upon admission were nicotine-free or had greatly reduced use, and 98% of these were abstinent from drugs/alcohol. Nicotine use produces frequent and intense addictive urges/cravings that are a central issue in treatment. We believe that including nicotine in chemical dependency treatment supports fuller freedom from addictive urges and abstinence from drugs/alcohol.

Treatments centers have traditionally concentrated on the treatment of alcohol and various other chemical dependencies, frequently omitting treatment for nicotine dependence. Many have felt it to be too much to take away everything at once. Professionals in the treatment community are realizing more and more that nicotine dependence is another manifestation of the disease of addiction. Our philosophy challenges the old adage 'don't take everything away at once,' by addressing the issue of nicotine dependence. We began implementation of a nicotine-free unit at CPC Parkwood Hospital in November 1989. We are currently in the process of adopting a nicotine-free policy at Ridgeview Institute in Smyrna, Georgia. This article traces the evolution of a nicotine-free unit at CPC Parkwood Hospital.

Gateway Rehabilitation Center, the largest addiction treatment center in Western Pennsylvania, struggled with the questions of nicotine dependence for many years. It developed what was thought to be a comprehensive nicotine treatment program and became totally smoke free on October 2, 1989. The following narrative describes Gateway's rationale and plan to become smoke free, the reasons for their 'retreat,' and their continued efforts to address nicotine dependence.

Service quality in rehabilitation agencies can be enhanced and customer satisfaction is guaranteed when clients are treated as customers. Furthermore, rehabilitation agencies should solicit feedback from their clients regarding the quality of their service. A better understanding of service characteristics, service quality determinants and the differences between professional and general services could improve the quality of service in rehabilitation centers., Rehabilitation, both public and private sector, is part of the service industry, which employs seven of ten people and generates nearly 70% of the gross national product in the United [...]

Abstract This article describes a Department of Health-funded study that mapped rehabilitation services--and examples of good practice--for older people with dementia in England. The findings suggest that there are potential [...]

The health value of a proper diet and its impact on disease is well known. But there have been few research studies regarding the value of teaching good nutrition to clients in rehabilitation settings. Twelve rehabilitation clients ranging in age from 23 to 59 years were enrolled in this study. The clients had a variety of disabilities: nine were mentally retarded, four had psychiatric diagnoses, and four had medical conditions including hypertension, epilepsy and alcoholism. Of the seven male participants, two were underweight and the remaining five were more than 20 percent overweight. All the women were overweight by at least 20 percent. All of the participants had been identified as likely to be able to live independently following their rehabilitation, and this pointed to the need for nutrition education. A pretest was administered to document the level of nutrition knowledge before instruction and to guide the teacher's lesson plan. The test included 40 questions presented in a pictorial format. Classes met weekly for 30 minutes for a total of eight weeks. Clients who missed sessions received individual make-up lessons. A statistically significant improvement on the nutrition test was seen following the end of the instruction period. Six weeks after the classes ended, the participants evaluated the nutrition class in an informal interview. The comments made by clients led the researchers to believe that nutritional information had been maintained. All clients agreed that they would be interested in continuing to learn about nutrition. A paper-and-pencil questionnaire administered three months after classes ended tested the participants' ability to select a nutritionally balanced meal. Nine of the participants (82 percent) were able to choose a balanced meal. This follow-up was also used for informal feedback from the clients. The lessons helped clients to become more self-directed in the way that they selected food. It is possible that this experience may contribute to the clients' ability to take on more control and responsibility in their lives. (Consumer Summary produced by Reliance Medical Information, Inc.), A Model for Teaching Healthy Nutrition to Clients of Rehabilitation Services A healthy and proper diet has an impact upon disease, physical health, emotional well-being, and provides numerous other benefits [...]

Rehabilitation counselors write Individualized Written Rehabilitation (IWR) plans for each client. Each IWR should be prepared with changing labor trends in mind. A landmark study commissioned by the Department of Labor, called Workforce 2000, has forecasted how the workforce will change. The purpose of this article is to encourage the Rehabilitation Service Administration (RSA) to study its policy in light of Workforce 2000, and to encourage rehabilitation counselors to consider the statistics as they work with clients. The first major trend identified by Workforce 2000 involves demographic changes in the future workforce: the employee will be more likely than now to be older, female, disadvantaged, and a member of a minority group. RSA currently serves mainly those who are in transition from school to work, but needs to respond by developing a service system to retrain older workers who otherwise may be displaced from employment. Minorities are currently a significant part of the RSA caseload. The women currently served by RSA, 43 percent of the caseload, are now more frequently being placed to competitive labor and less often in homemaking jobs. More flexible jobs and work at home will probably become more widely available, due to the trend of more women in the work place and to technological advances. The second major trend is the increasing number of service industry positions and decreasing amount of manufacturing jobs. Two major national initiatives, Projects with Industry and Supported Employment, are training and placing people into sales, service, and clerical occupations. Since physical strength is less important in these positions, people with disabilities may be able to contribute to increased productivity. The third identified trend is the growing need for employees with higher level skills and education. Only 11 percent of current rehabilitants have gone to college, and 13 percent have gone to vocational or trade school. Existing partnerships between rehabilitation and secondary schools need to be extended to colleges as well. Rehabilitation counselors need to adapt to their changing case loads and need support from RSA policies in order to respond to upcoming changes in the workforce. (Consumer Summary produced by Reliance Medical Information, Inc.), Facing the Future: Readying Rehabilitation for the year 2000 As the rehabilitation counselor sits down with the new client, he or she must write the Individualized Written Rehabilitation plan with [...]

SUMMARY While malnutrition is associated with sub-Saharan Africa, there are nearly double the numbers affected in heavily populated areas of South Asia. The Child in Need Institute has been working [...]