Biomedical subjects

Nicol Korner-Bitensky

Publications and source records attributed to Nicol Korner-Bitensky.

10 recordsLinked to original sources

PubMed2006

'Optimal' participation: a reflective look.

PURPOSE: There is mounting interest by professionals working in the rehabilitation sciences related to the concept of participation, especially given the increasing numbers of individuals worldwide living with chronic illnesses. It is now internationally agreed that participation level is influenced by both personal and environmental factors. The question arises as to the meaning of 'optimal' participation. The main objective of this article is to provide a reflective look at the concept of participation and the meaning of 'optimality' for individuals with and without disability and to explore both in relation to response shift. METHOD: Similarities in definitions of participation are first examined. Normal participation level is discussed leading to an 'optimal' level based on normality. Cases are used to illustrate normality as well as how 'optimal' participation can be achieved through a transition period despite disabilities caused by a health condition such as a stroke. RESULTS: 'Optimal' participation would rely on a perfect fit between an individual's reality (how activities and roles are actually realised) and expectations of how activities and roles should be accomplished. A transition period, including a response shift, following an acute event or onset of a chronic condition can lead to an optimal participation level despite persisting disabilities. CONCLUSIONS: A better understanding of the meaning of optimal participation and its association to response shift is important to clinical practice. Interventions aimed at optimizing participation through assisting clients who are experiencing a response shift can then be designed to maximize participation and concomitantly, quality of life in those with chronic health conditions.

Activities of Daily Living↗

PubMed2006

Canadian psychiatrists' current attitudes, practices, and knowledge regarding fitness to drive in individuals with mental illness: a cross-Canada survey.

OBJECTIVES: To assess current attitudes, practices, and knowledge of Canadian psychiatrists regarding fitness to drive in individuals with mental illness and to explore variations according to provincial legislation. METHOD: We carried out a national cross-sectional survey, using a random sample of psychiatrists. We used a mail survey to collect data. RESULTS: In total, 248 psychiatrists participated; the response rate was 54.2% on traced subjects. The majority (64.1%) reported that they strongly agreed or agreed that addressing patients' fitness to drive is an important issue. However, only 18.0% of respondents were always aware of whether their patients were active drivers. One-fourth strongly agreed or agreed that they were confident in their ability to evaluate fitness to drive. In discretionary provinces, 29.3% of psychiatrists reported not knowing their provincial legislation, as did 14.6% of psychiatrists in mandatory provinces; of those responding, 54.0% from discretionary provinces and 2.8% from mandatory provinces gave incorrect answers. DISCUSSION: Psychiatrists' responses demonstrate a broad range of attitudes, practices, and knowledge. There appears to be a large gap between what is expected of psychiatrists and their readiness and self-perceived ability to make informed clinical decisions related to driving safety. CONCLUSION: There is a clear need for education and guidelines to assist psychiatrists in decision making about driving fitness.

Attitude of Health Personnel↗

PubMed2006

Assessment of unilateral spatial neglect post stroke in Canadian acute care hospitals: are we neglecting neglect?

OBJECTIVE: To estimate the prevalence, timing and frequency of use of standardized and non-standardized assessments to detect unilateral spatial neglect in acute care patients post stroke. DESIGN AND SETTING: Multicentred, retrospective study on medical charts from 10 randomly selected acute care hospitals in Ontario, Canada. SUBJECTS: Three hundred and twenty-four randomly selected medical charts of adult subjects with a primary diagnosis of stroke admitted in 2002 to the participating acute care hospitals. RESULTS: Out of 248 subjects who should have been assessed, 38% received some form of unilateral spatial neglect assessment. Only 13% were assessed with a standardized assessment and of these, 4% within 48 h post stroke or within 48 h of the patient regaining consciousness as recommended by clinical practice guidelines for stroke. Bivariate analysis found significant associations between severity of cognitive impairment and being ever assessed, as well as between the severity of motor deficits of the upper extremity and being ever assessed. CONCLUSION: Routine standardized assessment of unilateral spatial neglect during the acute care phase post stroke was not incorporated into daily practice in this study sample.

Aged↗

PubMed2005

Eliciting information on differential sensation of heat in those with and without poststroke aphasia using a visual analogue scale.

BACKGROUND AND PURPOSE: Aphasia can result in an inability to communicate the presence, location, or intensity of pain. Although visual analogue scales (VASs) exist, it is unknown whether they are useful in assessing pain in individuals with aphasia. The objective was to determine whether those with poststroke aphasia could respond differentially to thermal stimuli of varying intensities using a standardized VAS. METHODS: Five groups of participants were assessed: those without stroke, those with stroke but without aphasia, and 3 groups with varying degrees of aphasia. A 10-cm vertical VAS was used to measure responses to varying thermal intensities delivered on the participant's forearm. RESULTS: Across all 5 groups, a similar proportion demonstrated ability to discriminate between 2 temperatures (chi2=1.899; P=0.75). When presented with 4 temperatures, all groups performed more poorly, yet with similar success rates across groups (chi2=0.1267; P=0.88). The repeated-measures ANOVA revealed no effect of group but a significant effect of temperature (P<0.0001). CONCLUSIONS: A VAS may be useful in clinical identification of differing intensities of stimuli in a substantial proportion of those with aphasia.

Adult↗

PubMed2005

Urinary incontinence after stroke: does rehabilitation make a difference? A systematic review of the effectiveness of behavioral therapy.

This study uses a comprehensive review of the literature to assess the scientific evidence for the effectiveness of behavioral therapies to treat urinary incontinence (UI) post stroke. Evidence for the different behavioral therapies was critically appraised to achieve a level of evidence based on Foley's classification of levels of evidence. Only four randomized clinical trials (RCTs), one cohort study, and recommendations from three clinical practice guidelines were found. There is limited evidence that bladder retraining with urge suppression in combination with pelvic floor exercises results in reduction of UI in male individuals with stroke. Further research is urgently needed to elucidate clinical recommendations about the efficacy of behavioral approaches.

Behavior Therapy↗

PubMed2005

Physical therapists' use of interventions with high evidence of effectiveness in the management of a hypothetical typical patient with acute low back pain.

BACKGROUND AND PURPOSE: Evidence-based practice aims to improve patient care and service delivery, particularly in the management of individuals with low back pain (LBP), the largest client group seen by outpatient physical therapists. The purpose of this study was to determine the prevalence of use of interventions with evidence of effectiveness in the management of acute nonspecific LBP by physical therapists. SUBJECTS: A multicenter cross-sectional study was conducted on 100 physical therapists working with patients with LBP. METHODS: Using a telephone-administered interview, therapists described their current and desired treatment practices for a typical case of LBP. Each intervention reported was coded according to its evidence of effectiveness (strong, moderate, limited, or none). Information on clinician, workplace, and client characteristics also was obtained. RESULTS: The prevalence of use of interventions with strong or moderate evidence of effectiveness was 68%. However, 90% to 96% of therapists also used interventions for which research evidence was limited or absent. Users of interventions with high evidence of effectiveness, as compared with nonusers, had graduated more recently and had taken a higher number of postgraduate clinical courses. DISCUSSION AND CONCLUSION: Although most therapists use interventions with high evidence of effectiveness, much of their patient time is spent on interventions that are not well reported in the literature. The results indicate the need for improvement in the quality of clinical research as well as its dissemination and implementation in a way that is appealing to therapists, such as through practice-related courses.

Acute Disease↗

PubMed2005

Static wrist splint use in the performance of daily activities by individuals with rheumatoid arthritis.

OBJECTIVE: In individuals with rheumatoid arthritis (RA), to identify the influence of wrist splint wear on pain, work performance, endurance, perceived task difficulty, and perceived splint benefit while performing various upper limb tasks. METHODS: This crossover study included 30 individuals with wrist involvement. Pain, work performance, endurance, and perceived task difficulty were assessed with the splint on and off. Using a work simulator, participants performed 14 tasks, 10 assessing work performance and 4 assessing endurance. A visual analog scale (VAS) was used to rate pain, task difficulty, and perceived splint benefit. RESULTS: With the splint on, pain was significantly lower in 5 tasks, as was perceived difficulty in task performance. Work performance did not differ significantly with the splint on versus off. While mean endurance scores were always better with the splint on, differences reached significance on only one task. The task with greatest overall perceived splint benefit was "chopping with a knife." CONCLUSION: Results revealed that for most tasks, there was generally a positive effect of splint use on hand function; however, perceived splint benefit was marginal. For most tasks splint use improved or did not change pain levels, did not interfere with work performance, increased or maintained endurance, and did not increase perceived task difficulty. The findings suggest that wrist splint prescription is not a simple process; clinicians and clients need to work together to determine the daily wear pattern that maximizes benefit and minimizes inconvenience according to the client's individual needs.

Activities of Daily Living↗

PubMed2004

Evaluating unilateral spatial neglect post stroke: working your way through the maze of assessment choices.

This study identified, using a comprehensive review of the literature, 62 standardized and nonstandardized assessment tools that exist to evaluate unilateral spatial neglect (USN). Each standardized tool was critically appraised according to its purpose (hemispace assessed), psychometric properties, and client appropriateness. The findings on the 28 standardized tools were compiled into a USN Assessment Summary Guide to facilitate clinical decision-making regarding the standardized USN assessments that are appropriate for specific clients at different phases of their recovery post stroke.

Humans↗

PubMed2003

Effectiveness of a visual attention retraining program on the driving performance of clients with stroke.

OBJECTIVE: To compare the effectiveness of a visual attention retraining program using the Useful Field of View (UFOV) with a traditional visuoperception treatment program on the driving performance of clients with stroke. DESIGN: Randomized controlled trial. SETTING: Rehabilitation hospital located in Quebec, Canada. PARTICIPANTS: Ninety-seven individuals referred for driving evaluation after a stroke. INTERVENTIONS: Participants were randomized to receive 20 sessions of either UFOV training of visual processing speed, divided attention, and selective attention or traditional computerized visuoperception retraining. MAIN OUTCOME MEASURES: Subjects were evaluated with an on-road driving evaluation, visuoperception tests, and the Test of Everyday Attention. An occupational therapist unaware of group assignment conducted all evaluations. RESULTS: Eighty-four participants completed the outcome evaluation. There were no significant differences between groups on any of the outcome measures. There was, however, almost a 2-fold increase (52.4% vs 28.6%) in the rate of success on the on-road driving evaluation after UFOV training for subjects with right-sided lesions. CONCLUSIONS: Rehabilitation that targets visual attention skills was not significantly more beneficial than traditional perceptual training in improving the outcome of an on-road driving evaluation. However, results suggest a potential improvement for subjects with right-sided lesions, indicating that training must target specific skills.

Aged↗

PubMedDate not supplied

Driving evaluation practices of clinicians working in the United States and Canada.

OBJECTIVE: To determine off-road and on-road driving evaluation practices of clinicians in the United States and Canada who assess individuals with disabilities for fitness to drive. PARTICIPANTS: Participants were 114 clinician attendees at the 2003 annual Association of Driver Educators for the Disabled with driving assessment experience ranging from 1 month to 25 years. MEASURES: Information was elicited regarding the clinician, clientele, referral practices, and off-road and on-road driving evaluation practices and retraining practices using a self-administered questionnaire. RESULTS: Participants were largely occupational therapists (68%) who worked in 42 different states and provinces. The most prevalent clientele were persons with traumatic brain injury (97%) and stroke (96%). Testing times greater than 60 min were common for both the off-road (61%) and on-road (49%) evaluations. Commonly performed off-road assessments included the Brake Reaction Timer; Trail Making Test, Parts A and B; and the Motor Free Visual Perception Test, used by 73%, 72%, and 66%, respectively; comprehensive computer-based driving evaluation was rare. Sixty-one percent indicated that all clients underwent on-road evaluation regardless of the off-road results. Finally, 78% used a standard driving route, whereas 24% used a scoring system to evaluate on-road driving. CONCLUSION: Driving assessment in Canada and the United States is multidimensional and time-intensive. Although the domains being assessed are similar across clincians, specific off-road and on-road assessment practices vary greatly. The majority use nonstandardized on-road assessments.

Automobile Driver Examination↗