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PubMed2005

Reintegration after severe brain injury: a retrospective study.

PRIMARY OBJECTIVE: The evaluation of school and work reintegration of patients following severe brain injury and of the relationship between the most common (early and late) prognostic indicators and reintegration itself. RESEARCH DESIGN: A retrospective study on a population of 353 patients consecutively admitted to an intensive rehabilitation unit (S. Cuore Hospital, Negrar, Italy) from 1991-1999. METHODS AND PROCEDURES: Evaluation of school and work outcome in this population up to December 2001 (follow-up from 2-10 years post-trauma). Data collection was made using the EBIS (European Brain Injury Society) protocol. RESULTS: In December 2001, 53% of those previously working had returned to competitive work; 76.5% of students were continuing with their studies or had progressed into work. There was a significant difference between employed and non-employed groups in terms of GCS, post-traumatic amnesia (PTA), in-patient rehabilitation length of stay (LOS) and GOS at 6 and at 12 months post-injury. CONCLUSIONS: The data confirm the predictive value of the indices used regarding work reintegration in TBI patients. Nevertheless, prolonged and intensive rehabilitation programmes can lead to high re-employment rates in patients whose initial prognosis seemed very poor.

Adolescent↗

PubMed1978

Recovery of some functional properties of the detergent-extracted cholinergic receptor protein from Torpedo marmorata after reintegration into a membrane environment.

The change of affinity of the acetylcholine receptor for agonists and the influence of local anaesthetics has been studied in detail in receptor-rich membranes. These properties are changed after solubilisation by ionic detergents. A method for reproducibly reintegrating the receptor protein into a lipid environment is described. Reintegration of the receptor results in partial recovery of the binding and fluorescence properties of the membrane-bound receptor protein. In particular, the slow affinity change caused by agonists can be recovered but not the effect of local anaesthetics on this change. The fluorescence response to cholinergic ligands of the reintegrated receptor protein labelled with quinacrine does not appear identical to that found with the native receptor-rich membranes. It is suggested that the failure to recover the sensitivity to local anaesthetics is at the origin of the difficulties to regain functional reconstitution.

Animals↗

PubMed1985

Excision and reintegration of the Escherichia coli K-12 chromosomal element e14.

The genetic element e14 is a natural component of the Escherichia coli K-12 chromosome. On induction of the SOS pathways, e14 excises as a 14.4-kilobase circle. We report here on the reintegration of e14 into the chromosome of cured (e14 degrees) E. coli K-12 derivatives. Using a Tn10 insertion mutant of e14, we found that reintegration occurred specifically at the locus originally occupied by e14 and with the same orientation. The reintegration event required neither the RecA nor the RecB functions. The attachment site of the free form was located within a 950-base-pair HindIII-AvaI fragment and shared sufficient homology with the host attachment site to form detectable DNA-DNA hybrids. Even though E. coli C and B/5 did not contain e14, they did possess a HindIII restriction fragment that hybridized to the free e14 attachment fragment. E. coli C could be transformed with e14-1272::Tn10, resulting in integration at this site of homology. The Tn10 mutants were also used in mapping the point of e14 attachment. We found the following sequence: fabD purB atte14 umuC. Furthermore, analysis of a recombinant plasmid that contained both the e14 attachment site and the purB locus showed that these two loci occur within 11 kilobases of each other.

Chromosome Mapping↗

PubMedDate not supplied

Preparing students with special needs for reintegration: curriculum-based measurement's impact on transenvironmental programming.

The original intent of special education pull-out services was to remove students from general education temporarily for intensive, individualized instruction in deficit areas. In many school districts, however, it seems that once students participate in pull-out services, there is little effort to return them to general education. One explanation for this is that not much is known about how best to prepare students for movement up the cascade of services, including reintegration into the mainstream. A promising reintegration approach is transenvironmental programming (TP). Research suggests that supplementing TP with continuous progress monitoring, specifically via curriculum-based measurement (CBM), better prepares students for reintegration than either TP or CBM alone. Findings from the present study provide a possible explanation: Results suggest that special educators using TP who receive CBM information about their students' academic progress are more likely to plan and implement academic interventions in preparation for students' transition than are those special educators who do not receive this information. This supports the hypothesis that the relatively greater success of TP + CBM is due to increased attention to academic preparation. Implications for practice and future research are discussed.

Adult↗

PubMed2005

Reintegrating seriously violent and personality-disordered offenders from a supermaximum security institution into the general offender population.

Offenders who have committed serious violent acts while incarcerated are often segregated and housed in supermaximum security facilities. Given the highly restricted regime under which they are detained, it is often difficult to decide if they are safe enough to be discharged. However, there is a need to reintegrate them into the general offender population in a lower security institution for humane, correctional, and financial reasons. We propose a transitional strategy to facilitate their reintegration by way of a maximum-security step-down treatment-oriented facility within which both their security requirements and treatment needs could be adequately met. The present study reports the results of such an approach. More than 80% of the offenders (n = 31) were reintegrated into a lower-security facility without relapsing and being returned to the supermaximum institutions within a follow-up period of 20 months. They also have lower institutional offense rate postreintegration compared to prereintegration.

Adult↗

PubMed1992

Teacher, parent, and child evaluative ratings of a school reintegration intervention for children with newly diagnosed cancer.

The disruption of school participation and accompanying social experiences because of cancer and its treatment has been related to major problems in adaptation to the disease. For the child with cancer, continuation of his/her social and academic activities provides an important opportunity to normalize as much as possible a very difficult experience. The present study reports on the children's, parents', and teachers' subjective evaluations of the benefits of a comprehensive school reintegration intervention. Forty-nine children, newly diagnosed with cancer, received comprehensive school reintegration consisting of supportive counseling, educational presentations, systematic liaison between the hospital and the school, and periodic follow-ups. Children parents, and teachers were asked to rate their perceptions of the utility and value of the intervention approach. Overall subjective evaluations were very positive, providing support for the social validity of the school reintegration approach for children with newly diagnosed cancer.

Child↗

PubMed2000

Influence of extracorporeal irradiation on the reintegration of autologous grafts of bone and joint. Study in a canine model.

We studied the effects of irradiation on the reintegration of autologous osteoarticular grafts over a period of 24 weeks in a canine model. In 16 foxhounds the medial femoral condyle was resected, irradiated and immediately replanted. In the control group resection and replantation were performed without irradiation. Reintegration was assessed by macroscopic analysis, histology, radiography and gait analysis. Reintegration was equal at 12 weeks, but significantly inferior in the irradiated group after 24 weeks with delayed bone remodelling. The articular cartilage showed modest degeneration. Conventional radiography and histology showed corresponding changes. Limb function was adequate but the gait was inferior in the treated group.

Animals↗

PubMed1995

Job site analysis facilitates work reintegration.

The Americans with Disabilities Act (ADA) offers challenges and opportunities in rehabilitative care for returning clients to previous employment after medical illness or injury. The process of work reintegration begins with assessing the client's rehabilitation potential to return to work. When clinical reasoning indicates a good rehabilitation potential, a job site analysis (JSA) is conducted to determine the essential functions of the client's work. Upon completion of the JSA, a variety of strategies can be used for successfully returning the client to work. The three case reports in this article illustrate that a JSA can serve as the basis for formulating a holistic treatment plan that addresses skill performance areas affecting work readiness for clients with neurologic and orthopaedic conditions and can facilitate successful work reintegration for these clients. The JSA links clients' rehabilitative care and work reentry after medical illness or injury and maximizes positive outcomes in reintegrating these clients to the workplace in compliance with ADA provision Title I, Employment.

Adult↗

PubMed1999

[Rehabilitation and the socio-occupational reintegration of workers who have had a myocardial infarct: a pilot study].

OBJECTIVE: To evaluate in a pilot study some psychosocial impacts of a multidisciplinary rehabilitation program on work reintegration of postmyocardial infarction (MI) patients. PATIENTS AND METHODS: Two groups of 19 workers among public and governmental enterprises of the greater Quebec city area admitted to hospital for uncomplicated MI where recruited for the study. One group received multidisciplinary cardiac rehabilitation intervention and a structured return to work program. The second group received the usual care post-MI (no organized rehabilitation program). Over a period of 15 months, the following variables were measured patients' perception of their loss of autonomy, and loss of capacity to manage their emotions, physical work capacity and their capacity to meet work requirements. The impact of the intervention on convalescence time and patients' stability at work were also evaluated. RESULTS: The rehabilitation group showed a better development than the usual care group of capacity to manage emotions (P=0.004) and of capacity to return to work (P=0.006). Furthermore, the patients in the intervention group reintegrated their work environment following a convalescence of 84.32+/-35.39 days compared with 151.39 +/-75.53 days for the usual care patients (P=0.0007). CONCLUSION: A multidisciplinary rehabilitation program and a structured return to work program are beneficial for sociovocational reintegration of post-MI patients.

Adaptation, Psychological↗

PubMed2003

Online support to facilitate the reintegration of students with brain injury: trials and errors.

The reintegration of students after acquired/traumatic brain injury (ABI/TBI) continues to be fraught with difficulties. Presented are (1) case studies exploring the potential of online support for teachers of students with ABI after returning from a paediatric rehabilitation centre; (2) results of Internet-based courses about reintegrating students with ABI; (3) outcomes of videoconferencing-based and Internet email-based support; (4) development of an online support process that uses Questions and Answers as a quick and immediate resource for teachers. The authors recommend that a collaborative process be instituted, in order to generate a relatively small number of high quality online resources about re-integrating students into their school and community. A second recommendation focuses on the development of online support network which may be text or email based or which may use videoconferencing over the Internet. Such networks allow students with ABI to maintain contact with their family and friends in the home community and facilitate their reintegration. An Internet-based support structure also allows professionals to provide consultation, collaboration and continuing input.

Adolescent↗

PubMed1993

[Rehabilitation and reintegration of polytraumatized patients].

In this randomized study we attempt to verify treatment results, rehabilitation and social reintegration of multiple trauma patients. Two to 4 years after the accident a clinical follow-up examination was carried out on 104 multiple trauma patients with an average age of 29.5 years who had 7.7 single injuries. Patients with injuries of the central nervous system still showed neurological disorders in 32%. The initially determined Glasgow Coma Scale did not correlate with the long-term prognosis of neurological disorders. Only 4 of 38 thoracic injuries had functional disorders-these patients had required long-term ventilation therapy (> 3 weeks). Former abdominal injuries showed no objective disorders in the follow-up. Most of the injuries to the extremities (79.7%) healed without functional disorder. Only patients with lower limb injuries still had complaints. At the time of the checkup 6.7% had still not been able to work (for more than 24 months) and 26.9% for more than 12 months. The disability rate was less than 20% in 64.3%, 7.2% more than 50% and 9.6% more than 80%. Most of these patients had severe head injuries. There was a relationship between reintegration at work and the age of the patients: 49.2% of patients younger than 25 years were working in their previous profession, 26.9% had here re-educated, and only 7.9% were unemployed. However, in the age group older than 25 years, only 29.2% worked in their previous profession and 12.2% had been re-educated. This follow-up study shows that in multiple trauma patients reintegration at work and in social life is possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1983

The cloned dopa decarboxylase gene is developmentally regulated when reintegrated into the Drosophila genome.

The Drosophila dopa decarboxylase gene, Ddc, functions normally when reintroduced into flies. DNA containing a cloned Ddc gene inserted into a P element transposon was injected into early embryos. Transformants were identified by suppression of the cuticular phenotype of a Ddc mutant allele. The reintegrated genes are expressed in the proper tissue and at the proper stages during development even though their positions within the genome are different from that of the wild-type Ddc gene. Absolute levels of DDC enzyme activity are within 35% of that found in wild-type Canton S flies, the source of the transforming DNA. The transformants' Ddc RNA is indistinguishable from that of wild type. One reintegrated Ddc gene, inserted on the X chromosome, is affected by the dosage compensation mechanism that leads to sex-specific differences in the expression of many X-chromosome genes.

Animals↗

PubMed2005

Validation of the Reintegration to Normal Living Index in a population of community-dwelling people with mobility limitations.

OBJECTIVE: To validate the Reintegration to Normal Living Index (RNLI) in a population of community-dwelling adults with mobility limitations. DESIGN: Cross-sectional survey. SETTING: Community. PARTICIPANTS: Six hundred four people between the ages of 18 and 80 years who had a mobility limitation, lived in the community, and had been discharged from rehabilitation for at least 1 year. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The RNLI. RESULTS: The RNLI is a reliable measure of community reintegration. A 2-factor structure emerged from a principal components analysis that indicates there are 2 subscales of the RNLI in a population with mobility impairments. CONCLUSIONS: The RNLI is a reliable and valid measure for studies of community integration among people living with long-term consequences of a chronic health condition.

Adolescent↗

PubMed1999

Predicting community reintegration after spinal cord injury from demographic and injury characteristics.

OBJECTIVE: To determine the influence of demographic and injury characteristics on the community reintegration of people with spinal cord injury (SCI). DESIGN: Prospective cross-sectional and longitudinal examination of individuals with SCI. SETTING: Follow-up of individuals at 1, 2, 5, 10, 15, and 20 years after SCI who received their initial rehabilitation in a Regional Model Spinal Cord Injury System. PARTICIPANTS: A total of 3,835 individuals who met the inclusion criteria for the National SCI Database were studied cross-sectionally, and a subset of 347 individuals who were also enrolled in a longitudinal study of aging with SCI. MAIN OUTCOME MEASURES: Subscales of the Craig Handicap Assessment and Reporting Technique (CHART). RESULTS: Neurologic classification, age, years postinjury, gender, ethnicity, and education explain 29% of the variance in physical independence, 29% of the variance in mobility, 28% of the variance in occupation. 9% of the variance in social integration, and 18% of the variance in economic self-sufficiency. CONCLUSIONS: Although these factors are inadequate to explain most of the variation in community reintegration (handicap) after SCI, they might appropriately be used to adjust for case-mix differences when comparing rehabilitation facilities and techniques.

Activities of Daily Living↗

PubMed2002

Spinal cord injury medicine. 4. Optimal participation in life after spinal cord injury: physical, psychosocial, and economic reintegration into the environment.

UNLABELLED: This learner-directed module on spinal cord injury (SCI) presents a variety of perspectives of the process of personal and environmental adaptation for reintegration. Adaptation is unique to each person and does not predictably follow stages. Models used for understanding the process include biopsychosocial, ICIDH-2 (International Classification of Functioning, Disability and Health), and sector divisions of the environment. Home modification requires home (intermediate environment) evaluation and sociospatial behavioral mapping for planning and appropriation of remodeling in proportion to functional need and use. Options for access to the natural environment include specialized wheelchairs, climbing rigging, kayaks, and sail boats. Sports participation with adaptations is expanding and includes a larger variety of organizations and leagues. Economic needs are effectively anticipated with development of a life care plan. Procreative options to overcome infertility after SCI include vibratory stimulation for ejaculation, intravaginal insemination, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection. Approaches to requests for withdrawal of life-sustaining care include depression screening, pain evaluation, and assistance in accomplishment of person centered goals. Overall, community reintegration after SCI is continually improving because of better acceptance, accessibility, and technology for building adaptations. OVERALL ARTICLE OBJECTIVES: (a) To review models and theories of medical intervention and disablement and (b) to demonstrate their application in rehabilitation practice by designing unique treatment plans that meet patient person-centered goals.

Adaptation, Physiological↗

PubMed2003

Reliability of scores between stroke patients and significant others on the Reintegration to Normal Living (RNL) Index.

PURPOSE: This study measured reliability between stroke patients' and significant others' scores on items on the Reintegration to Normal Living (RNL) Index and whether there were any scoring biases. METHOD: The 11-item RNL Index was administered to 57 pairs of patients and significants six months after stroke rehabilitation. The index was scored using a 10-point visual analogue scale. Patient and significant other demographic information and data on patients' clinical, functional and cognitive status were collected. Reliability was measured using the intra-class correlation coefficient (ICC) and percent agreement. RESULTS: Overall poor reliability was found for the RNL Index total score (ICC=.36, 95% CI .07 to .59) and the daily functioning subscale (ICC=.24, 95% Cl -.003 to .46) and moderate reliability was found for the perception of self subscale (ICC= .55, 95% Cl .28 to .73). There was a moderate bias for patients to rate themselves as achieving better reintegration than was indicated by significant others, although no demographic or clinical factors were associated with this bias. Exact match agreement was best for the subjective items and worse for items reflecting mobility around the community and participation in a work activity. CONCLUSIONS: Caution is needed when interpreting patient information reported by significant others on the RNL Index. The use of a shorter scale to rate the RNL Index requires investigation.

Activities of Daily Living↗

PubMedDate not supplied

Community reintegration program.

A specific program in practice for community reintegration of the patient with burns is described. It has been demonstrated that a gradual transition for the patient with burns between the acute care setting and active participation in family, leisure, and vocational roles enhances psychosocial and functional recovery. A systematic process of community reintegration within a rehabilitation setting can facilitate this transition for patient and family through Community Skills Training with a therapist and Community Skills Practice before the patient assumes outpatient status.

Activities of Daily Living↗

PubMedDate not supplied

School reintegration.

School reintegration programs have been developed to enhance a positive sense of self-worth in a child who has been burned. The premise of these programs is that cognitive and affective education about children with burns will diminish the anxiety of the patient with burns, the patient's family, faculty and staff of the school, and the students. Five principles guide school reentry programs: (1) preparation begins as soon as possible; (2) planning includes the patient and family; (3) each program is individualized; (4) each patient is encouraged to return to school quickly after hospital discharge; and (5) burn team professionals remain available for consultation to the school. Reintegration programs can vary in format depending on patient and/or family need and capability of the burn team, thus allowing flexibility in assisting every child with burns make the transition from hospital patient to normal living.

Burns↗