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Biomedical subjects

K Kowalske

Publications and source records attributed to K Kowalske.

7 recordsLinked to original sources
PubMed2000

Vocational reentry following TBI: an enablement model.

OBJECTIVE: To illustrate the importance of environmental factors for optimizing return to work following traumatic brain injury (TBI) using illustrative case examples. DESIGN AND PARTICIPANTS: Three case studies are presented that were selected from an overall sample of 57 TBI survivors. SETIING: Postacute, outpatient TBI rehabilitation program. MAIN OUTCOME MEASURES: Outcome was essentially descriptive and focused on factors associated with successful return to work. RESULTS AND CONCLUSIONS: These case examples point out the necessity of specialized treatment that not only focuses on the specific strengths and weakness of the individual, but also on extant environmental factors, including degree of structure or distractions that either reinforce or preclude optimal performance.

Adolescent↗
PubMed1999

Daily functioning of patients with an amputated lower extremity.

The National Center for Health statistics estimates more than 300,000 individuals with major lower extremity amputation currently are living in the United States. Current healthcare climate mandates effective rehabilitation be provided in the most effective manner. An interdisciplinary amputee team approach to rehabilitation with active participation of the patient should be implemented early in the preamputation period to facilitate short hospital stays and earlier return to productivity with associated cost savings. This paper discusses preoperative assessment and education, postoperative intervention, and indications for inpatient rehabilitation. Gait training with prosthesis in simple and complex environments, assistive devices needed for effective functioning at home, and prosthetic modification for participation in recreational activities are reviewed along with issues related to vocational rehabilitation.

Activities of Daily Living↗
PubMedDate not supplied

Barriers to employment among working-aged patients with major burn injury.

The purpose of this study was to examine the prevalence of preexisting and burn-related impairments and to describe their association with preburn employment status. Data gathered during the acute hospitalization were analyzed on a consecutive series of burn patients aged 16 to 64 years (N = 770) enrolled in a prospective, longitudinal, multicenter study. Patients who were unemployed before the injury were more likely than those who were employed to report being alcohol-dependent (36 vs 18%), abusing other drugs (22 vs 10%), having received psychiatric treatment in the past year (21 vs 6%), and having preexisting physical disability (23 vs 3%); all were significant at P < .001). Of the unemployed patients who received toxicologic screening at admission, 49% tested positive for alcohol and 39% positive for other drugs, percentages that were significantly higher than 26 and 31%, respectively, for the employed. With adjustment for age, sex, race, and education, variables that were most predictive of preinjury unemployment status were preexisting physical disability (odds ratio, 51.0; 95% confidence interval, 7.7-336.9) and being alcohol-positive at admission (odds ratio, 2.8; 95% confidence interval, 1.2-6.8). Unemployed and employed patients also differed significantly in injury patterns and clinical outcomes, with inhalation injury and psychiatric distress being more prevalent among the unemployed and both hand burns and hand surgery among the employed. The greater prevalence of preexisting impairments among survivors who were unemployed before the injury helps explain why preburn employment status is such a powerful determinant of postburn work outcomes, and suggests the need to include psychosocial services in a program of comprehensive rehabilitation.

Adolescent↗
PubMedDate not supplied

Community integration after burn injuries.

Evaluation of community integration is a meaningful outcome criterion after major burn injury. The Community Integration Questionnaire (CIQ) was administered to 463 individuals with major burn injuries. The CIQ results in Total, Home Integration, Social Integration, and Productivity scores. The purposes of this study were to determine change in CIQ scores over time and what burn injury and demographic factors predict CIQ scores. The CIQ scores did not change significantly from 6 to 12 to 24 months postburn injury. Home integration scores were best predicted by sex and living situation; Social Integration scores by marital status; and Productivity scores by functional outcome, burn severity, age, and preburn work factors. The data demonstrate that individuals with burn injuries have significant difficulties with community integration due to burn and nonburn related factors. CIQ scores did not improve over time but improvement may have occurred before the initial 6-month postburn injury follow-up in this study.

Adult↗
PubMedDate not supplied

Neuropathy after burn injury.

The purpose of this study was to evaluate the incidence of neuropathy in a consecutive cohort of patients with major burn injuries and investigate the clinical correlates for both mononeuropathy and generalized peripheral polyneuropathy. Of 572 patients examined, 64 (11%) patients had clinical evidence of mononeuropathy or peripheral neuropathy or both. Associations of mononeuropathy and peripheral neuropathy with potential risk factors were identified using logistic regression analyses. Electrical cause (odds ratio [OR] = 4.1022, P < .01), history of alcohol abuse (OR = 2.2893, P <.05), and number of days in intensive care (OR = 1.0457, P < .001) were significantly associated with mononeuropathy. The number of days in intensive care (OR = 1.0740, P < .001) and patient age (OR = 1.0543, P < .01) were significantly associated with peripheral neuropathy. This study demonstrates that neuropathy is a common complication of severe burn injury in patients who are older, critically ill, have an electrical cause, or history of alcohol abuse.

Adult↗
PubMedDate not supplied

Predictors of quality of life as measured by the Burn Specific Health Scale in persons with major burn injury.

To determine 1) change over time in Quality of Life (QOL) and 2) functional, community reentry, and psychosocial predictors of QOL, data were prospectively collected from adults with major burn injury 2 months after hospital discharge (n = 110) and 6 (n = 97) and 12 (n = 69) months after injury. The dependent QOL variable was the Burn Specific Health Scale (BSHS) and the predictor variables were Brief Symptom Inventory, Functional Assessment Screening Questionnaire, Functional Independence Measure, Pain Analog Scale, and Community Integration Questionnaire. BSHS global scores were unchanged across the measurement periods. Stepwise multiple-regression analyses resulted in statistically significant multiple Rs of.79 at 2 months,.81 at 6 months, and.76 at 12 months. Variables predicting more favorable BSHS global score were less emotional distress and pain at 2 months, less emotional distress and pain and better community reentry at 6 months, and less emotional distress and better community reentry at 12 months.

Adaptation, Psychological↗