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Biomedical subjects

Wendy Coster

Publications and source records attributed to Wendy Coster.

7 recordsLinked to original sources
PubMed2006

Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort.

OBJECTIVE: To examine whether home and community environmental barriers and facilitators are predictors of social and home participation and community participation at 1 and 6 months after discharge from an acute care or inpatient rehabilitation hospital. DESIGN: Cohort study. SETTING: Postacute care. PARTICIPANTS: Adults (N=342) age 18 years or older with a diagnosis of complex medical, orthopedic, or neurologic condition recruited from acute care and inpatient rehabilitation facilities. The mean age +/- standard deviation of participants was 68+/-14 years; 49% were women and 92% were white. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participation in social, home and community affairs as assessed with the Participation Measure for Post-Acute Care. RESULTS: Adjusting for covariates, 1 month after discharge a greater presence of home mobility barriers (P<.01) was associated with less social and home participation; whereas greater community mobility barriers (P<.01) and more social support (P<.001) were associated with greater participation. At 6 months, social support was the only environmental factor associated with participation after adjusting for covariates. CONCLUSIONS: This study provides new empirical evidence that environmental barriers and facilitators do influence participation in a general rehabilitation cohort, at least in the short term.

Activities of Daily Living↗
PubMed2005

Beyond function: predicting participation in a rehabilitation cohort.

OBJECTIVES: To monitor participation in a rehabilitation cohort and to identify determinants of change during a 12-month period posthospitalization following the onset of one of several major disabling conditions. DESIGN: Cohort study. SETTING: Postacute care rehabilitation settings. PARTICIPANTS: Adults (N=435) aged 18 years and older with complex medical, lower-extremity orthopedic, and major neurologic impairments. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: At 1-, 6-, and 12-month follow-ups, community participation and social and home participation were assessed by personal interviews using the Participation Measure for Post-Acute Care. Information on potential determinants was abstracted from the medical chart and by personal interview using standardized instruments. RESULTS: On average, rehabilitation patients achieved modest improvements in their levels of community participation during the first 6 months after acute hospitalization. In contrast, these same patients displayed a modest loss in social and home participation levels during the follow-up period. Activity limitations were the dominant factors that explained much of the variance in the extent of community participation achieved by patients. Personal and social environmental factors played a major role in predicting levels of social and home participation. CONCLUSIONS: The focus of rehabilitation interventions aimed at achieving posthospital participation requires careful consideration of the specific domain of participation that is being targeted.

Adult↗
PubMed2004

Enhancing participation for children with disabilities: application of the ICF enablement framework to pediatric physical therapist practice.

PURPOSE: This paper describes how pediatric physical therapists can utilize the enablement framework, embraced by the World Health Organization in the current International Classification of Functioning, Disability, and Health (ICF). The ICF can guide clinical reasoning related to enhancing participation in desired activities for children with disabilities. In the ICF framework, participation reflects the person's engagement in important life situations. By emphasizing what the person can do in valued contexts, the enablement framework is a positive complement to a focus on functional limitations and disability of the disablement model. SUMMARY OF KEY POINTS: Current conceptual frameworks and policies advocate attention to children's participation. Legislation (Individuals with Disabilities Education Act, Amendments of 1991 and 1997 and the Americans with Disabilities Act of 1990), the Guide to Physical Therapist Practice, and motor control and action perspectives all support the inclusion of children with disabilities in natural environments. These frameworks and laws can guide therapists' clinical reasoning to focus on children's participation in desired activities during the evaluation, goal-setting, and intervention process. A case study of a child with spastic diplegia illustrates how pediatric physical therapists can apply the enablement framework to develop meaningful goals and interventions focused on enhancing the child's participation in desired activities. CONCLUSIONS: Adoption of an enablement perspective may help pediatric physical therapists to focus their evaluations and interventions on promoting children's participation as well as the specific functional activities that enhance participation.

Journal Article↗
PubMedDate not supplied

Functional performance in children with Down syndrome.

OBJECTIVES: The purpose of this study was to describe home and community functional performance in 5-year-old children with Down syndrome. METHOD: In a cross-sectional study of 5-year-old children with Down syndrome in Norway (N=43), functional performance was measured with the Norwegian translation of the Pediatric Evaluation of Disability Inventory (PEDI). Additional descriptive information related to health, disabilities, and function was also gathered. RESULTS: The children showed a wide range of functional performance. Performance of self-care activities appeared most delayed on activities that required fine motor skills. Children appeared less affected in basic functional mobility skills. Parents' identified their main concerns as language functioning and, for the children not yet toilet trained, the management of bladder and bowel control in relation to starting school. CONCLUSION: The results provide baseline information regarding typical levels of functional performance in children with Down syndrome at 5 years of age. However, the broad range of functional performance across children indicates a need for caution in generalizing the results to an individual child.

Activities of Daily Living↗
PubMedDate not supplied

Qualities of caregiver-child interaction during daily activities of children born very low birth weight with and without white matter disorder.

OBJECTIVE: The purpose of this study was to examine qualities of caregiver-child interactions during daily activities of healthy children born full-term and of children born prematurely and very low birth weight with and without white matter disorder. METHOD: Three groups of 12 caregiver-child dyads, representing three levels of child biological risk, were matched on birth history, maternal education, ethnicity, and child gender. Ten expert clinicians used videotapes to rate behaviors of caregivers and their 30-month-old children engaging in dressing and snack activities. Correlations between ratings of three qualities were examined: caregiver directiveness, caregiver engagement, and child engagement. RESULTS: There were no significant differences between groups for the average caregiver and child ratings. However, correlations between caregiver directiveness and caregiver engagement ranged across the three groups from greatest to least biological risk (i.e., r= .63, .35, -.67, respectively). In the full-term group, correlations between the caregiver qualities of directiveness and engagement and child engagement were r= .62 and -.69, respectively. In contrast, the correlations between the caregiver and child qualities were small in the two very-low-birth-weight groups. CONCLUSION: Results suggest patterns of caregiver interactions during daily activities may vary according to the child's level of biological risk. Caregivers of children with the greatest risk (i.e., white matter disorder) were both engaging and directive of their children during the activities, whereas caregivers of full-term children were less engaging when directive. The findings suggest that caregivers may be adjusting the level of their social and emotional assistance during caregiver-child interactions to the level of their children's abilities.

Activities of Daily Living↗
PubMedDate not supplied

Occupational therapy activities and intervention techniques for clients with stroke in six rehabilitation hospitals.

OBJECTIVE: To prospectively monitor occupational therapy activities and intervention techniques used during inpatient stroke rehabilitation in order to provide a description of current clinical practice. METHODS: Data were collected prospectively from 954 clients with stroke receiving occupational therapy from six U.S. rehabilitation hospitals. Descriptive statistics summarized frequency, intensity, and duration of occupational therapy sessions; proportion of time spent in 16 therapeutic activities; and proportion of those activities that included any of 31 interventions. RESULTS: Clients received on average 11.8 days (SD = 7.2) of occupational therapy, with each session lasting on average 39.4 min (SD = 16.9). Upper-extremity control (22.9% of treatment time) and dressing (14.2% of treatment time) were the most frequently provided activities. Interventions provided most frequently during upper-extremity control activities were strengthening, motor learning, and postural awareness. CONCLUSION: Occupational therapy provided reflected an integration of treatment approaches. Upper-extremity control and basic activities of daily living were the most frequent activities. A small proportion of sessions addressed community integration.

Adolescent↗