Amputee's Recognition of Rehabilitation Services for Amputation

OBJECTIVE: To evaluate the actual condition of management of stump and prosthesis, difficulties with or without prosthesis in the activities of daily living and the present status of cognizance of rehabilitation services in amputees. METHOD: This study was designed as a questionnaire survey. The questionnaire included the general demographic characteristics, causes of amputation, amputation level and time, practical status of fitting and management of prosthesis, satisfaction of prosthesis, difficulties in activities of daily living under prosthesis. The change of recognition of rehabilitation medicine and the degree of acceptance of rehabilitation services followed by duration-after amputation was also investigated. RESULTS: The most common cause of amputation was vehicular accidents and the mean age was 35.6 years old. The results showed that the amputees had low satisfaction in the prosthesis itself and the management. The role of rehabilitation medicine in fitting and management of prosthesis was insignificant. The 69% of amputees answered that the rehabilitation services were provided after the amputation, but only 40% of amputees reported they had known the services were provided by rehabilitation medicine. This discrepancy probably implied the poor recognition of the role of rehabilitation medicine, even though the rehabilitation services provided to the amputees has been significantly increased in recent 5 years. CONCLUSION: There is a little progress of recognition and role of rehabilitation medicine although the acceptants of rehabilitation services were increased. Physiatrists should take an active participation to the amputee community for extension of recognition and role of rehabilitation medicine.

Cognitive Rehabilitation in Traumatic Brain Injury

Cognitive rehabilitation is integral part of the neurorehabilitation of traumatic brain injury (TBI). Key features after TBI are cognitive (impaired attention and memory, slowed processing speed, deficit in working memory and executive dysfunction) and behavioral sequelae (somatic and pain concern, depression, anxiety, social withdrawal and maladjustment, impulsivity, and poor judgement). Two basic approaches of cognitive rehabilitation is restoration of impaired function (basic skill training) and compensation to adapt cognitive disabilities. In addition, holistic approaches, systemically integrated interventions for remediation of cognitive deficit, functional skills and interpersonal functions, are also effective and are widely accepted in neurorehabilitation program for patients with TBI. Recent data of many researches and accumulation of clinical experiences on cognitive rehabilitation enable us to provide evidence based approaches in specific population of cognitive dysfunction after TBI.