This chapter reviews specific conditions that may create disability in persons infected with HIV. HIV is caused by one of two retroviruses, HIV-1 or HIV-2, the former being more common worldwide and leading to a hastier decline in immune function. The hallmark of HIV disease is a profound immunodeficiency that results from a progressive quantitative and qualitative deficiency in the subset of T lymphocytes known as T-helper, or cluster of differentiation 4+ (CD4+), cells. Peripheral nerve damage is the most common neurological complication for individuals with HIV/ AIDS. The most common form of peripheral neuropathy in this patient population is distal symmetric peripheral neuropathy (DSPN). Didanosine and stavudine, drugs previously used to treat HIV, are no longer recommended because of their potent neurotoxic effects. Symptoms may include allodynia, which is a painful response to a stimulus that is not typically painful.
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This chapter highlights the selected nursing care topics based on themes that span various disabilities and are essential to the patient’s rehabilitation process. The scope of rehabilitation nursing care is broad; hence, the topics selected are core elements related to basic human needs with an overarching perspective of psychosocial health, which is vital to the patients’ recovery. The rehabilitation nurse’s practice is guided by both standards of practice and standards of professional performance to which the nurse is held accountable. The standards of practice refer to a “competent level of nursing care as demonstrated by critical thinking model known as the nursing process”. These practices include assessing, diagnosing, planning, and implementing aspects of patient care, educating patients and their families, identifying patient outcomes, and coordinating care. The rehabilitation nurse works with the emotional, as well as the physical, aspects of the patient’s condition.
Speech-language pathologists are professionals who specialize in understanding the science behind the process of human communication. As a member of the interdisciplinary team in a medical setting, speech-language pathologists diagnose and treat disorders of speech sound production, resonance, voice, fluency, language, cognition, feeding, and swallowing. At times, the therapists encourage development of untapped potential and skill. In working with those with chronic disabilities, the speech-language pathologist may focus on the appreciation and development of the patients’ preserved abilities. Older adults exhibit retrieval difficulties in spelling, suggestive of challenges with word phonology and orthography. In the acute hospital arena, the speech-language pathologist serves to identify cognitive communication or swallowing deficits, educates patients and families regarding areas of concern, and suggests appropriate discharge treatment options aimed to enhance self-sufficiency. The goal of intervention is not geared to “cure” a disability, but rather, to foster an optimal level of independence and function.
This chapter overviews social work services from public health and boundary spanning perspectives. Social workers work to prevent negative long-term outcomes for persons with disabilities and to optimize the habilitation of the person with residual disabilities. The chapter is based on biopsychosocial framework for understanding the broad range of needs of people with disabilities and will present the epidemiology of disability in American adults. It discusses the policies that underlie disabilities support and services. Using an ecological approach, a multilevel, problem-solving approach to social work services will be defined, with special attention to services that are delivered within a family-centered perspective, which optimize use of policies, benefits, and financial resources to promote optimal rehabilitation and inclusion of the disabled person, and that integrate physical and behavioral health issues in viewing the whole person in a person-centered care approach.
This chapter discusses telerehabilitation and focuses on the challenge of sustainability. It also reviews programs and concepts from a clinical framework: patient-to-clinician telerehabilitation, clinician-to-clinician telerehabilitation, programmed therapy, and apps. Telerehabilitation (TR) is within telehealth-care along with telehomecare, telenursing, and telecoaching. Telerehabilitation seeks to access and enhance patient function by connecting members of the interdisciplinary team to patients for assessment and therapy using adjunctive equipment in the home or community as needed. Telemedicine brings clinical care to the patient in their own environment. This is a potent tool for the interdisciplinary team to sustain the rehabilitation process in the home and community. For patients with brain injury, cognitive rehabilitation that occurs within the patient’s home and community accomplishes greater patient initiation and insight into deficits through self-comparison to past function. Rehabilitation models help to clarify the focus and impact of interventions in planning.
Assistive technology (AT) provides powerful tools used to diminish disability, enable activities of daily living (ADLs), and promotes recreational and vocational pursuits. This chapter serves as an introduction to AT tools, patient assessment, person-centered application of AT and resources for patients, and clinicians alike. AT can increase independence, improve quality of life, and aid persons with disabilities in accomplishing educational and vocational pursuits. Although there are an increasing number of commercial technology and fee-based “add-on” programs available to meet the needs of persons with disabilities, this chapter emphasizes emerging technologies and basic complementary computer-based commercial applications, which are commonly found as part of standard operating systems. Computer technology, including Internet applications, serves as an indispensable tool to enhance vocational reentry and personal satisfaction. The chapter has a major emphasis on profiling specific AT solutions that enhance prognostic efficacy of vocational rehabilitation programs.
Health care has been transforming since its inception when public health issues were not understood, through epidemics and a plethora of infectious diseases, to today’s sophisticated medicine with its myriad levels of subspecialization. As the impact of illnesses transformed over time, so did the medical professions, the health care facilities, and the concept of insurance to assist in covering the rising cost of care. As a subset of telehealth, telerehabilitation has become a viable option for providers and payers to effectively manage rehabilitation care in the postacute environment. Although physicians are primarily focused on their clinical duty to their patient, payment methods clearly have an effect on care delivery. Examples of this, relative to bundled payments, could include the utilization of diagnostic imaging, frequency of physician office visits, inpatient length of stay, and the number of follow-up visits between hospitals and physicians.
This chapter overviews each state workers’ compensation law with an explanation of issues, concerns, or critical areas in service delivery that may arise from it. It aims to contribute to the ability of rehabilitation professionals to assist employers and individuals with disabilities in navigating this maze. Assisting the individual through rehabilitation process to return to productive functioning in the community and in the workplace is the core of the rehabilitation professional’s job. When employment outcomes are part of the rehabilitation goal, knowledge of regulatory requirements that surround the workplace and have an effect on employer and employee behavior is vital for the rehabilitation professional to function effectively. The chapter highlights some of possible areas of conflict or concern that may influence both worker and employer behaviors and has provided a basic introduction for practitioners to pursue further information, given the nature of their services and interventions for persons with disabilities.
For the rehabilitation industry, it is suggested that a rehabilitation-focused accreditation quality model is the best fit as a quality framework for advancing the performance of organizations that provide medical rehabilitation services. In an era where health care expenditures are so significant, value-based rehabilitation in a pay-for-performance environment may be the only way to competitively lower care costs, improve care quality, and drive better patient outcomes. The accreditation model provides the blueprint to cost containment through outcomes. To understand and appreciate the value of accreditation for medical rehabilitation as a quality framework, it is important that accreditation be considered within its evolutionary context in relation to the dynamics of the broader health care industry. Accreditation as a quality framework was constructed by the rehabilitation industry in response to environmental pressures to demonstrate a commitment to quality.
Quality in health care refers to a systems approach to evaluating and improving the health of the individuals served and is closely linked to quality improvement (QI) as an ongoing process of problem identification, intervention, evaluation, and further refinements in service delivery. QI strives for measureable improvements in services and health status of targeted patient groups. Significant variations in health care services have been well documented in various areas including stroke rehabilitation, brain injury outcomes, and the management of acute myocardial infarctions, hip fractures, colon cancer, diabetes, and depression, along with surgical procedures such as coronary artery bypass graft, hysterectomies, and spinal procedures. Risk-adjusted rehabilitation functional outcomes vary by insurance type, geographic region, and race/ethnicity. The variations in patient outcomes, high rates of medical errors, and heath care costs imply that changes in service delivery could lessen these disparities and improve the overall quality of care.