The Impact of an Occupation Based Parkinson Caregiver Program on Caregiver\u27s Quality of Life

The goal of the study was to enhance the PD patient’s caregiver’s ability to provide quality care to meet the ever changing needs of a neurodegenerative medical condition along with enhancing quality of life indicators of the caregiver. The community based program covered 7 topics over 4 consecutive weeks. The project design was an experimental one group pre and posttest design. The outcome measurement tool was the Parkinson Caregiver QOL Index. Data was analyzed utilizing a paired t-test for individual questions and the total score on the Parkinson Caregiver QOL Scale. No statistical significance was found between pretest and posttest scores. However, positive improvements were noted on specific components of the scale. Additionally, caregivers self-reported that the course provided valuable and insightful information that will aid both the caregiver and the person with PD. Caregiver burdens and demands are expected to grow as our population ages and chronic conditions are medically managed for longer periods of time. It is essential, that occupational therapists continue to engage in developing research and methods that serve as a guide on best practices to meet the ever changing burdens and demands placed onto the caregiver

Study and reformulation of the technical aid device HomeHoist

Dissertação de mestrado integrado em Engenharia BiomédicaCerebral palsy manifests itself in the first years of a child's life and may be caused by brain injuries, or abnormal brain development, reflecting in disorders in the child's motor capacity, each case varying in terms of severity and type of motor disorders. The average life expectancy of these children has been increasing, which means that it is relevant to find alternatives to improve the quality of life of those affected by this condition. Thus, the HomeHoist project emerged, which aimed to function as a single device for transferring patients with cerebral palsy without burdening the caregiver. The HomeHoist device consisted of an electric wheelchair, with a built-in hoist, removable seat, and free interior space, which allowed the patient to be transferred between various surfaces, such as beds and toilets. Following an internship at the company Orthos XXI, the interest arose to revive this project, which had been concluded in 2014. The aspects identified for improving the device were to incorporate verticalization; include leg raising, which despite being a goal in the original project, was not achieved; split the seat and backrest to customize the operation of the device; free up the lateral space on the seat to facilitate patient handling; and change the structure and components to meet the company's production, reducing production time and cost. Using project methodologies such as the goal tree, analysis of functions, and the method of weighted goals, it was possible, among several solutions, to understand which ones best fit the intended goals, followed by the determination of dimensional constraints and the selection and placement of mechanical components, to obtain a 3D model of the final device. With the model it was possible to obtain 65º verticalization; 155º reclination; the dimensions of the device were as intended; and the foot elevation was incorporated, although it did not allow to completely stretch the legs. Then, a brief analysis of the electrical components to be incorporated was made, followed by the simulation of two components, and with the simulation of one of them, the arch, it was realised that it would have to be redesigned to withstand the load that was applied to it, by increasing the diameter of the tube and the positioning of the rings. Finally, with the production of the prototype, it was possible to understand what should be improved to facilitate the production of the device, both in terms of production and assembly. The functioning of the device was also tested, to confirm the information obtained with the 3D model.A paralisia cerebral manifesta-se nos primeiros anos de vida de uma criança e pode ser provocada por lesões cerebrais, ou desenvolvimento cerebral anormal, refletindo-se em distúrbios na capacidade motora da mesma, cada caso variando em termos de severidade e de tipo de disfunções motoras. A esperança média de vida destas crianças tem vindo a aumentar, o que significa que é relevante encontrar alternativas para melhorar a qualidade de vida daqueles afetados por esta condição. Assim, surgiu o projeto HomeHoist, que tinha como objetivo funcionar como dispositivo único para a transferência de pacientes com paralisia cerebral, sem sobrecarregar o prestador de cuidados. O dispositivo HomeHoist consistia numa cadeira de rodas elétrica, com uma grua incorporada, assento removível e o espaço interior livre, o que permitia transferir o paciente entre várias superfícies, como a cama e vasos sanitários. No seguimento de um estágio na empresa Orthos XXI, surgiu o interesse em reavivar este projeto, que tinha sido concluído em 2014. Os aspetos identificados para a melhoria do dispositivo foram incorporar a função de verticalização; adicionar a elevação de pernas, que apesar de ser um objetivo no projeto original, não foi alcançado; dividir o assento e o encosto de costas, para personalizar o funcionamento do dispositivo; libertar o espaço lateral no assento, para facilitar o manuseamento do paciente; e alterar a estrutura e componentes para irem de encontro à produção da empresa, reduzindo o tempo e custo de produção. Usando metodologias de projeto, como a árvore de objetivos, análise de funções e o método dos objetivos ponderados, foi possível de entre várias soluções, compreender quais as que melhor se enquadravam nos objetivos pretendidos, seguindo-se então a determinação das restrições dimensionais e de seleção e colocação de componentes mecânicos, para obter um modelo 3D do dispositivo final. Com o modelo foi possível obter verticalização de 65º; reclinação de 155º; as dimensões do dispositivo foram ao encontro do pretendido; e a elevação de pés foi incorporada, apesar de não permitir esticar completamente as pernas. De seguida, foi feita uma breve análise dos componentes elétricos a ser incorporados, seguida da simulação FEM de dois componentes, sendo que, com a simulação de um deles, o arco, percebeu-se que o mesmo teria de ser alterado de modo a aguentar a carga que lhe era aplicada, aumentando-se o diâmetro do tubo e o posicionamento das argolas. Por fim, com a produção do protótipo foi possível perceber o que deveria ser melhorado para facilitar a produção do dispositivo, tanto em termos de produção como de montagem. Foi também testado o funcionamento do dispositivo, para confirmar a informação obtida com o modelo 3D

Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar

Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions

This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers

Patients\u27 and caregivers\u27 inside perspectives: living with a left-ventricular assist device as destination therapy

Left-ventricular assist devices (LVADs) have improved the quality of life for many patients with advanced heart failure. Past research focused on technology issues and survival rates, but patients\u27 and caregivers\u27 perspectives of living with an LVAD as a destination therapy (e.g., permanent alternative to transplant) was not explored. Roy\u27s adaptation model provided a framework to guide an understanding of how participants adjusted and accepted living with destination therapy. A hermeneutic-phenomenology as described by van Manen was used to explore and describe the essence of destination therapy from patients\u27 and caregivers\u27 perspectives in order to understand the meaning of this experience. Data saturation was achieved with 14 participants (7 men as patients, 71-76 years old; 1 man and 6 women as caregivers, 50-74 years old), who lived with destination therapy at home. Data was collected using open-ended interviews, thematic analysis was ongoing, and final themes were consensually validated. Procedures to ensure trustworthiness are described. Themes were consistent with Roy\u27s adaptation model. Participants illustrated a process of adjustment and eventually accepted the LVAD as part of their lives. Patients adjusted to the LVAD as part of their bodies, accepted the device as necessary to live, and exhibited an improved quality of life. Caregivers described persistent worry and stress and accepted caregiving as part of life. Dyadic perspectives reflected gratefulness for more time to live despite uncertainties about death and dying. Findings advance the knowledge of destination therapy management. These findings may direct a holistic approach to palliative and end of life care, and can heighten nurses\u27 awareness about the process of adaptation as a vital component for the promotion and maintenance of health and well-being among this growing population. Key words: left-ventricular assist devices, destination therapy, caregivers, hermeneutic phenomenology, Roy Adaptation Model

A review of the effectiveness of lower limb orthoses used in cerebral palsy

To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO

Effective Assessment of Power Standing Device to Adults with Permanent Lower Limb Paralysis

Introduction: Standing routine is a known beneficial daily activity for both healthy and disabled persons, especially those with permanent lower limb paralysis. However, the prescription of standing device for adults with permanent paralysis was inadequate and non-standard in existing local practice because of lack of good design and evidence based funding support. Objective: In view of the availability of new advances in power standing device, we aim to perform an effective health technology assessment (HTA) from professional and users perspectives to develop the decision pathway in prescription for long term home use. Methodology: A functional test and social cost analysis was performed on one high cost new standing mobile devices in recent market. A practical workshop and surveys were performed to collect feedback from 24 healthcare professionals and 8 expert users on a spectrum of new standing mobile device. Results: From the survey results, there was consensus among all participants that ‘Standing’ as daily routine at home is essential and beneficial. 62.5% of healthcare professionals would provide training to users and their cares to facilitate users to perform standing at home. Eight factors were identified from factor analysis in affecting the choice of standing devices for home use by healthcare professionals and users. Users scored high (mean=9.25/10) in “compliance with the new power standing mobile device”. The cost analysis showed considerable savings in social costs in using even the high-cost power standing mobile device. Discussion: The group welcomed power standing device with or without mobile function to support their standing activity at home. A possible clinical decision for prescribing different standing devices with identified factors was summarized. Conclusion: More recent researches have reported the negative health issues associated with prolonged sitting. With more innovative product designs, the power standing devices with or without mobile function is a new concept welcomed by both healthcare professionals and users in promotion of their health, preventing complications as well as independent living in home environment. A larger scale of HTA with structured cost-effectiveness analysis is essential to inform the healthcare resources planners

Safe Lifting Training for Mexican Parents of Children with a Disability

The purpose of this study was to determine to what extent techniques taught during a two-day educational training on body mechanics for lifting and transferring are learned and can be demonstrated by Mexican parents with their children who have a disability. Three parents of children with a disability who attended a culturally relevant educational training on body mechanics lead by graduate occupational therapy students participated in research on their transfer safety. Their body mechanics were observed and scored while they performed up to four transfers prior to and after attending the educational training. Participants performed significantly better on floor transfers after the educational training with a large effect size (d = 2.83). There was no statistically significant difference between pre- and post-tests for bath transfers, and the remaining transfers did not have enough participants to calculate statistical significance. This pilot study had promising results, that using a culturally relevant program, Mexican parents can learn safe transfer techniques. It is important that occupational therapists continue to educate caregivers in how to safely perform a transfer and use multiple methods including verbal instruction, demonstration and practice of real transfers, as well as take into account different cultures and adapt training to be more culturally relevant. Future research is important and could look at a larger sample of participants to see if the training is effective for the other transfer types

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement