Subject(s)
Attitude to Health , Lumbar Vertebrae/surgery , Orthopedic Procedures , Patient Compliance , Patient Participation , Spinal Diseases/psychology , Humans , Orthopedic Procedures/rehabilitation , Recovery of Function , Spinal Diseases/rehabilitation , Spinal Diseases/surgery , Treatment OutcomeABSTRACT
Pain management is a serious problem for individuals with spinal cord injury (SCI). Recent developments in pain assessment indicate that multiaxial approaches, assessing medical, psychosocial, and behavioral/functional dimensions, are necessary to measure adequately the impact of chronic pain. The application of this multiaxial system to persons with SCI and chronic pain is presented. A review of the literature indicates that the psychometric properties and test utility for most pain measures have not been established for persons with SCI. The assessment task is further confounded by the functional limitations and psychosocial impairments that may accompany SCI. Recommendations are made for adapting established pain measures for use with SCI individuals. The choice of assessment tools for these patients is guided by the multidimensional nature of the pain experience, functional limitations, and the goals of treatment.
Subject(s)
Pain Measurement/methods , Spinal Cord Injuries/complications , HumansABSTRACT
Recent findings suggest that biologic, psychologic, and social variables interact to determine an individual's response to rheumatic disease. Data indicate that specific coping responses and quality of social support modulate the psychosocial impact of the disease. Additional current developments are 1) an increased emphasis on patients' input regarding health care delivery; 2) the development of alternative methods of information dissemination; 3) identification of nonadherence to treatment regimens as an obstacle to clinical trials and to improving outcome; and 4) a trend toward the use of psychosocial assessment tools with established psychometric properties for rheumatic disease populations. A major challenge is the identification of mechanisms by which psychosocial variables interact with biologic processes.
Subject(s)
Rheumatic Diseases/psychology , Social Support , Adaptation, Psychological , Humans , Models, PsychologicalABSTRACT
The ageing process is accompanied by changes in biological functions and the context of behavior. Biological changes are often thought to be the source of poor adaptation to the demands of ageing and disease; however, the data indicate environmental, psychological and social factors must be considered. Problems related to sensory-cognitive ageing, dependency, adherence, sleep disturbance, sexual functioning, psychological distress, family issues and ethics are discussed in terms of their impact on rheumatic disease management. Diagnostic measures developed for the elderly are reviewed and interventions from a behavioral approach are outlined. The chronic nature of rheumatic disease interacts with the changes associated with ageing leading to a complex situation requiring attention to biological, behavioral, environmental and psychosocial factors.
Subject(s)
Aging/psychology , Behavior , Cognition , Rheumatic Diseases/therapy , Aged , Aging/physiology , Dependency, Psychological , Ethics, Medical , Family Health , Humans , Patient Compliance , Rheumatic Diseases/complications , Sensation/physiology , Sexual Dysfunction, Physiological/etiology , Sleep Wake Disorders/therapyABSTRACT
The implementation of prospective payment systems has severely limited the traditional practice of providing rehabilitation services to arthritis patients on rheumatic disease units; however, the admission of these patients to a designated rehabilitation unit may be appropriate. This paper presents data on the provision of inpatient rehabilitation services to patients with arthritis. Two surveys were developed for this study. The first survey sample consisted of 502 hospitals; 163 (52%) of the 313 respondents were identified as facilities providing inpatient arthritis rehabilitation. A second survey regarding patient and program characteristics was completed by 146 of the 313 facilities. The data from rehabilitation units serving arthritis patients are presented with regard to utilization, discharge disposition, sources of payment, patient demographic and diagnostic information, and specialization of the rehabilitation program. The data indicate that persons with arthritis are underrepresented in the rehabilitation population, although the diagnosis is approved for admission under rehabilitation guidelines. This underutilization is attributed to problems of reimbursement, inappropriate admission criteria, inadequately trained staff, and lack of referrals.
Subject(s)
Arthritis/rehabilitation , Rehabilitation Centers , Health Surveys , Humans , Inpatients , United StatesABSTRACT
Rats with chronic hippocampal electrode implants had afterdischarges induced with electrical stimulus intensities of 115, 200, and 800% of a previously determined threshold. Afterdischarge duration, postictal EEG depression duration, and the duration of postictal electrical hypoexcitability were assessed. After discharge duration varied inversely with stimulus intensity as did the duration of postictal hypoexcitability. However, the duration of postictal EEG depression increased with stimulus intensity. This dissociation between postictal neuroexcitability and EEG depression is discussed in terms of possible underlying cholinergic mechanisms.
