ABSTRACT
Teniendo en cuenta el insuficiente nivel de actualización del rehabilitador en salud en terapia ocupacional, lo cual atenta contra la atención a pacientes con discapacidades, se elaboró un sistema de procedimientos metodológicos que facilitarán la adquisición, ampliación y perfeccionamiento continuo de los conocimientos y habilidades necesarios para un mejor desempeño en la rehabilitación integral, a partir del carácter científico-tecnológico-asistencial en este proceso.
Keeping in mind the scarce updating level of the health rehabilitator in Occupational Therapy, which is against the care to patients with disabilities, a system of methodological procedures was elaborated that will facilitate the acquisition, amplification and continuous improvement of knowledge and necessary skills for a better acting in the comprehensive rehabilitation, starting from the scientific-technological-assistance character in this process.
Subject(s)
Occupational Therapy , Professional TrainingABSTRACT
Se presenta el caso clínico de una paciente de 9 años de edad que concurre al Servicio de Abordaje Interdisciplinario para la Rehabilitación de Pacientes con Hábitos Orales Disfuncionales y Tratamientos Tempranos, facultad de Odontología, UNC. Es acompañada por su madre quien nos manifiesta su intensapreocupación por la conducta de su hija, quien no se relaciona con sus pares, sólo juega con uno de sushermanos. No se comunica ni responde a nuestras preguntas. La valoración clínica constata un perfil cóncavo, depresión del tercio medio facial en sentido anteroposterior, praxias orofaciales disfuncionales, trastornos foniátricos, y alteraciones posturales- hiperlordosis cervical y cifoescoliosis dorsolumbar. Existen antecedentes hereditarios de Clase III por líneapaterna. En el diagnóstico se comprueba el síndrome de Clase III esqueletal. Se realiza en primera instancia un tratamiento Ortopédico con Mascarilla de Tracción pósteroanterior, intraoralmente utilizamos Plan Six Helix modificadocon ganchos para la tracción. Estaasociación de aparatología permitió estimular biomecánicamente el crecimiento pósteroanterior delmaxilar superior a nivel sutural y protruyó el sector anterosuperior dentario. Posteriormente se aplicóaparatología miofuncional. Estuvo acompañada con apoyo psicológico para aceptar el tratamiento interdisciplinario y estimular su integración social. Además, se rehabilitaron las disfunciones orofaciales y la postura mediante reeducación postural y uso deplantillas ortopédicas. La rehabilitación integral logró redireccionar su crecimiento desde su base de sustentación, armonizando todas sus unidades funcionales y recuperar su autoestima y lograr su socialización.
We presented the clinical case of a 9-year-old patientwho concur to the Service of Early OrthodonticTreatment and Oral Dysfunctional Habits of theDepartment of Child and Adolescent Integral B,Orthodontia area. UNC. She is accompanied by hermother who shows us her intense concern for theconduct of his daughter, who isn´t related to herpeers, only plays with one of the brothers. It alsodoesn´t communicate or respond to ours questions.The girl has socio-emotional disorder.In the clinical evaluation we find a concave profilewith depressed midface, phoniatrics disorders, dysfunctionalorofacial praxis and postural changes incervical lordosis, kyphoscoliosis dorso-lumbar.Class III skeletal features. There are heredity ClassIII from the father family.An orthopedic treatment is in the first instance witha posterior-anterior mask, central rod model Pettit.Intraorally used a Six Helix Plan, modified with hooks for rubber for the mask. This association ofappliance allowed us biomechanically, stimulate anteriorposterior growth of the upper jaw in the suturalarea and protrude forward the upperanteriortooth sector. Later was applied myofunctional equipment, elastic open activator Klammt class Imodified, changed without vestibular arc to let incisorsexpress and lingual bowls. During treatment, she was accompanied with psychological support to accept it and encourage theirsocial integration. Also with phonoaudiological treatment, respiratory disorders, deglutition and foniatricswere treated.The physiatric therapy consisted in postural reeducationand using orthopedics insoles.
Subject(s)
Female , Humans , Child , Malocclusion, Angle Class III/therapy , Patient Care Team , Patient Care Planning , Posture/physiology , Argentina , Extraoral Traction Appliances , Exercise Therapy , Scoliosis/therapy , Kyphosis/therapyABSTRACT
Se realizó una investigación en sistemas y servicios de salud para evaluar la calidad de la atención brindada en el Servicio de Rehabilitación Integral de base comunitaria, perteneciente al Policlínico Docente "Armando García Aspurú" del municipio de Santiago de Cuba, durante el 2013. La muestra estuvo constituida por 15 profesionales y 180 pacientes, a los cuales se les aplicaron encuestas que fueron validadas a través del coeficiente alfa de Cronbach. Se analizó la dimensión proceso teniendo en cuenta 15 criterios, indicadores y estándares. Al finalizar la evaluación, 12 de estos criterios se consideraron adecuados (80,0 %); por tanto, se cumplió con el estándar establecido. Se concluyó que la atención ofrecida en el servicio antes citado fue adecuada.
An investigation in health systems and services to evaluate the health care quality given in the Comprehensive Rehabilitation Service with community base, belonging to "Armando García Aspurú" Teaching Polyclinic in Santiago de Cuba, was carried out during 2013. The sample had 15 professionals and 180 patients, in whom surveys that were validated through alpha Cronbach coefficient were applied. The process dimension was analyzed taking into account 15 approaches, indicators and standards. When concluding the evaluation, 12 of these approaches were considered appropriate (80.0%); therefore, established standard was fulfilled. It was concluded that the health care aboved mentioned was optimal.
Subject(s)
Primary Health Care , Rehabilitation ServicesABSTRACT
Introducción: la rehabilitación psiquiátrica es el proceder terapéutico encaminado a crear habilidades sociolaborales cuando estas no existen o son pobres. Resulte imprescindible fomentar la rehabilitación integral que permita a los pacientes realizar un mejor aporte y reinserción a la sociedad. Objetivos: determinar la utilidad de la terapia ocupacional en estos pacientes así como comparar el nivel de rehabilitación y determinar el número de pacientes insertados a las actividades de terapia ocupacional al inicio y final del tratamiento. Materiales y Métodos: se realizó un estudio descriptivo en pacientes del servicio de larga estadía del Hospital Psiquiátrico de Matanzas “Antonio Guiteras Holmes”, en el periodo comprendido de abril 2008 a abril 2014. El universo estuvo compuesto por todos los pacientes que ingresaron en el servicio de larga estadía. Resultados: se apreció, al inicio, que la mayoría de los pacientes se encontraban en un nivel I de rehabilitación, al final del estudio el 23.6 % habían avanzado al nivel II, el 41.6 % al nivel III, el 18 % el nivel IV, mientras al 9.8 al V, se detallan las actividades rehabilitatorias al inicio y al final del estudio, apreciándose una mayor participación al final del mismo predominando las técnicas participativas. Al culminar el tratamiento los pacientes que mejor evolucionaron hacia los niveles III, IV y V fueron los que tenían diagnóstico de Esquizofrenia, déficit mental leve y moderado. Conclusiones: la repercusión de la rehabilitación integral y el apoyo social del paciente psiquiátrico con trastorno mental grave arroja resultados positivos en cuanto a su evaluación clínica social.
Background: the psychiatric rehabilitation is the therapeutic procedure directed to create socio-labor skills when these are absent or are poor. It is essential promoting the integral rehabilitation allowing patients a better contribution and their reinsertion into society. Aim: to determine the utility of the occupational therapy in these patients, and also comparing the rehabilitation level and determining the number of patients incorporated to occupational therapy activities at the beginning and at the end of the treatment. Materials and methods: we carried out a descriptive study in patients from the long staying service of the Psychiatric Hospital “Antonio Guiteras Holmes”, in the period from April 2008 to April 2014. The universe was composed by all the patients who were admitted in the long staying service. Outcomes: we stated, at the beginning, that most of the patients were at the rehabilitation level I; at the end of the study, 23, 6 % reached the level II, 41, 6 % reached the level III, 18 % reached the level IV, while 9,8 % reached the level V. We specify the rehabilitative activities at the beginning and at the end of the study, appreciating more participation at the end, and the predominance of participative techniques. At the end of the treatment, the patients who better evolved to the levels III, IV and V were the ones who had diagnoses of schizophrenia, mild and moderated mental deficit. Conclusions: the repercussion of the integral rehabilitation and the social support of the psychiatric patient with serious mental disorders provide positive results as for his social clinic evaluation.
ABSTRACT
Se efectuó un estudio descriptivo, longitudinal y prospectivo de 28 mujeres con mastectomía radical modificada, a fin de evaluar las principales alteraciones del hombro ipsolateral y su respuesta ante la atención fisioterapéutica brindada en el Servicio de Rehabilitación Integral del Policlínico Universitario "Julián Grimau García" de Santiago de Cuba, desde junio hasta noviembre del 2011. En la casuística, 3 pacientes abandonaron el tratamiento. La complicación más frecuente fue la omalgia (67,8 %), acompañada en muchos casos de limitación articular y disminución de la fuerza del miembro superior afectado. Entre los procederes terapéuticos empleados figuraron: tratamiento postural, cinesiterapia y masoterapia. La respuesta al tratamiento fue satisfactoria en 96,2 % de las afectadas, puesto que las técnicas y procederes fisioterápicos utilizados eran sencillos y con escasos recursos materiales.
A descriptive, longitudinal and prospective study was conducted in 28 women with modified radical mastectomy in order to assess the main ipsilateral shoulder disorders and their response to physiotherapy provided in Comprehensive Rehabilitation Service of "Julián Grimau García" University Polyclinic of Santiago de Cuba from June to November 2011. In the case series 3 patients discontinued treatment. The most frequent complication was the shoulder pain (67.8%), accompanied in many cases by joint limitation and decreased strength of the affected upper limb. Among the therapeutic procedures were postural treatment, kinesitherapy and massage therapy. The response to treatment was successful in 96.2% of patients, since the used techniques and therapeutic procedures were simple and with limited material resources.
ABSTRACT
Con la intención de incrementar el arsenal terapéutico de la Sala de Rehabilitación Integral Felicita de Barazarte del municipio Bolívar, estado Barinas, de la República Bolivariana de Venezuela se comenzó a utilizar el método Su-Jok en diversas patologías. La periartritis escápulo humeral fue una de las causas frecuentes de consulta por lo que se realizó un estudio observacional descriptivo longitudinal prospectivo, en el periodo comprendido entre Septiembre del 2005 y Febrero del 2006, con el objetivo de valorar la efectividad del método terapéutico en dicha patología. El universo estuvo constituido por los 72 pacientes. Se les confeccionó una historia clínica que recogió el uso de otros métodos de tratamiento antes y durante la aplicación del Su-Jok, tiempo de evolución de la enfermedad, periodicidad del tratamiento con Su-Jok, así como la evolución semanal. El 63.9 por ciento de los pacientes pertenecía al sexo masculino y el grupo de edad de 50-59 años fue el más afectado (30.6 por ciento). Con el uso del Su-Jok disminuyó el empleo de otros métodos para el alivio del dolor, se obtuvo mejores resultados en los pacientes que acudieron en estadios tempranos de la enfermedad y que recibieron diariamente el tratamiento, considerando el Su- Jok efectivo en el tratamiento de la periartritis escápulo humeral.
With the intention of incrementing the therapeutic arsenal of the integral rehabilitation room Felicita de Barazarte from Bolivar municipality, Barina state from Venezuela Bolivarian Republic it began tu use the SU-JOK method in different pathologies. The scapulo humeral periarthritis was one of the frequent cause of consulting. That´s why an observational descriptive longitudinal prospective study was carried out in the period between september 2005 and february 2006. With the aim of appreciate the efectivity of therapeutic method in this disease. The study group was represented by 72 patients. It was created a clinic story that pick up the use of another treatment method before and during the SU-JOK application, time of sickness evolution, periodicity of the SU-JOK application and weekly evolution. The 63,9 percent of patients were male and the group of 50-59 years was the most affected (30,6 percent) with the use of the SU-JOK decreased the use of other methods for pain reliever, it was obtained better results in patients that arrived in early stages of their sickness.
Subject(s)
Humans , Male , Female , Scapula , Humerus , Periarthritis/therapy , Rehabilitation Services , Complementary Therapies , Epidemiology, Descriptive , Longitudinal Studies , Prospective Studies , Observational Studies as TopicABSTRACT
Los procesos de rehabilitación de la Enfermedad Cerebro Vascular (ECV) son modelos para los procesos integrales de rehabilitación neurológica en general. Este artículo pretende ofrecer un marco conceptual sobre la ECV y un programa de rehabilitación para dicha enfermedad. Se parte de las definiciones y la epidemiología para centrarse en la evaluación del paciente y en la manejo de la rehabilitación de éste en sus diferentes fases: aguda, subaguda, tardía y ambulatoria. Un proceso de rehabilitación integral en el paciente con EVC, incluye médicos rehabilitadores, enfermeros, fisioterapeutas, terapeutas ocupacionales, fonoaudiólogos, psicólogo, neuropsicólogo, trabajador social, nutricionista, ortesista, educador físico, sociólogo, etc.
In general, rehabilitation processes of cerebrovascular disease (CVD), are model for integral processes of neurological rehabilitation. This article pretends to offer a conceptual frame on CVD and a rehabilitation program for such disease. IT stars with definitions and epidemiology to concentrate on the patient´s assessment and rehabilitation´s management in different stages: acute, sub acute, late and ambulatory. An integral rehabilitation process of the patient with CVD, includes medical rehabilitators, nurses, physiotherapist, occupational therapist, phonoaudiologist, psychologist, social worker, nutritionist, orthesist, physical educator, sociologist, etc.
Subject(s)
Adult , Cerebrovascular Disorders , Comprehensive Health CareABSTRACT
resumen está disponible en el texto completo
Summary In this manuscript we describe results obtained for Group III of the Integral Rehabilitation Program for Outpatient Schizophrenic Patients (IRPS III) at the National Institute of Psychiatry Ramón de la Fuente. This program was created for Mexican schizo-phrenic patients as a refined alternative for the treatment, rehabilitation and integration to a productive life within society. It is interdisciplinary and integral in nature; both patients and their relatives are involved in the treatment and rehabilitation. It includes admission, stabilization of clinical symptoms, and application of strategies for rehabilitation for one year (pharmacological treatment, group psychotherapy, labor -vocation induction therapy, music therapy, psychosocial psychotherapy, occupational therapy, artistic painting, drawing, and Hata-Yoga workshops, psycho-educational workshops for relatives, group dynamics therapy with responsible relatives, and unifamilial psychotherapy); there were assessments at the beginning and at end of the study. Objective To evaluate the efficacy of an interdisciplinary and integral program in these patients, with respect to a control group that received the usual medical-psychiatric treatment. Evaluation was carried out according to: a) Severity of psychiatric symptoms, b) Treatment compliance, c) Everyday performance, d) Psychosocial functioning, e) Global activity, f) Home occupational activities, g) Expressed emotion and attribution of the illness, and h) Patterns of communication and relationship within the family. The goals of this program were to reduce the disabilities and to profit from the conserved functions, as well as to develop other skills in order to increase the quality of life of patients. Methods This was a quasi-experimental pretest-postest prospective study where an experimental group and a control group were compared. The control group (n=39) received the usual psychiatric management, while the experimental group (n=39), participated in addition to this management, in a one-year integral rehabilitation program at the outpatient service of the institute. The sample was obtained in a non-probabilistic and sequential way, according to the established inclusion and exclusion criteria. Variables:Efficacy was evaluated through: a) Severity of psychiatric symptoms; b) Treatment compliance; c) Everyday functioning; d) Psychosocial functioning; e) Occupational activities at home; f) Expressed emotion; g) Patterns of communication and relationship within the family. Instruments: Composite International Diagnostic Interview (CIDI), Positive and Negative Syndrome Scale (PANNS), Clinical Interview and File, Everyday Unemployment Scale, Psychosocial Functioning Scale, Global Assessment Scale, Assessment and Follow-up Questionnaire, Patient Labor Performance Scale, Social Behavior Assessment Schedule (SBAS), Five Minute Speech Sample (FMSS), Verification of the Performance in Occupational Activities for Schizophrenic Patients, Extrapyramidal Symptom Scale. Procedures: a) Incorporation of patients and relatives to the study; b) Stabilization of clinical symptoms; c) Initial assessment; d) Program application; e) Final assessment. Results Demographic data: There were 47 subjects in the final sample, 25 in the experimental group, and 22 controls. There were more males than females in both groups (76% in the experimental group and 63.6% in controls). Being single was the most frequent marital status among patients (88% in the experimental group and 91% in controls). Education was slightly higher in the experimental group, were 40% had a bachelor´s degree as opposed to 27.2% in controls. Treatment compliance: The program had a final efficiency of 64% for the experimental group and 56% for controls. Some of the experimental subject's characteristics at the beginning of the program were related with treatment compliance: age, years of illness history, and number of different diagnoses. It was determined that 62% of the patients who completed the program were less than 30 years old, and in 80% of the cases the onset of the illness was less than 10 years ago. Regarding the number of diagnoses per patient, 60% of those who completed the study had one diagnosis, 40% had two or more. On the contrary, 30% of the patients who abandoned the study had one diagnosis and 70% had two or more. In other words, almost three fourths of the sub-sample that abandoned the Program had more than one diagnosis: 31% had two, 31% had three, and 10% had four or more. Clinical area: In the clinical area, there were no significant differences between groups. However, patients in the experimen-tal group had a higher level of clinical adaptation and treatment compliance. Everyday performance: The everyday performance was improved in patients from the experimental group, with statistically significant changes in 71.5% of the pretest-postest evaluated areas, with emphasis on self-care, family and interpersonal relationships, and remunerated work. In the control group, there was an improvement only in 28.5% of the areas. Psychosocial functioning: Global and by-area psychosocial functioning showed statistically significant differences in the experimental group in all functioning areas; there was an improvement from three to two, the latter number meaning feeling satisfied. This was not the case in the control group. Behavior at home: In the experimental group, the perception in families was that occupational behavior at home was improved, according to the final score. Family assessment: Relatives in the experimental group attributed the problems they had with the patient to personality characteristics. These problems were diminished at the end of the study, but not in the control group. When relatives attributed problems to the way of being and attitudes of patients, there was a decrease of problems from 31.6% to 26.3%. Emotional Expression in relatives from the experimental group was observed in 79.2% at the beginning of the treatment program, which decreased to 33.3% at the end of the study, with a significant difference of p <0.006, as opposed to relatives in the control group, who did not show statistically significant differences. Clinical assessment of families: At the beginning of the program, this group established reiterative communication patterns. The patient showed rejection to communication. Relatives blamed schizophrenia for the lack of communication. At the end of the program, patterns of communication had importantly improved. Conclusions Demographic data in our sample are similar to those described in previous reports for male:female ratio, marital status, and education. Some characteristics of the patients, in particular age, years from onset of illness, and psychiatric comorbidity assessed at recruitment were associated with completing or not the program. At the end of the study it was clear the program reached its goals of reducing the patients' disabilities and profiting of conserved functions: 64% of the patients in the experimental group were more stable in clinical terms, and treatment compliance was better. Also, everyday performance was notably improved. In the experimental group there were pretest-postest statistically significant differences in 71.5% of the studied area, especially in self-care and interpersonal relationships. In the control group there were significant changes only in 28.5% of the areas. One level of improvement was observed in global and by-area psychosocial functioning in the experimental group, but not in controls. Patients at the end of the study had switched from a score of three (neutral, unconcerned) to level two (satisfied with their own functioning). In the control group there were no statistically significant differences. Emotional expression in relatives in the experimental group significantly decreased at the end of the study (p< .006), but not in the control group, given that the latter did not show statistically significant differences. Occupational activities at home were also improved in the experimental group, with better scores at the end of the study. Regarding the assessment of occupational therapy, there were significant differences in four areas. Other areas with positive changes were: disease attribution to the patient, and patterns of communication in the family. The areas with better results were self-care, socialization, and family dynamics, which are frequently altered in schizophrenic patients. These results showed the efficacy of the program in its integral version (pluridimensional). Once the proposed objectives are reached, we propose to continue this program with important modifications of the method, which will be described in future publications.