Posts Tagged decision making

[WEB SITE] Researchers Are Developing a Mobile App to Assist Post-TBI Patients – Rehab Managment

A decision support mobile app to help facilitate safety and independent living among TBI patients after returning home from a treatment facility is being developed in collaboration between researchers from Alabama-based Shepherd Center and ChartAssist LLC.

To assist with decision-making, the mobile app will be engineered to help improve the assessment of functional mobility, household activities, sleep, and safety risk.

Such decisions include making differential diagnostic assessments, selecting the most appropriate home- and community-based services and supports, measuring progress, and updating healthcare and supervision needs, according to the researchers, in a media release from Shepherd Center.

The app will also feature the ability to provide multidisciplinary treatment recommendations for TBI patients, as well as to set goals and track outcomes.

“I am thankful to have the opportunity to work with Shepherd Center and Dr Ron Seel, director of brain injury research, to help people with TBI and their families,” says Daniel Joye, president of ChartAssist, in the release. “The need for a decision support app is clear, and our company’s work on multidisciplinary rehabilitation in the mental health community is a great fit for helping people with brain injuries, their families and rehabilitation professionals.”

“I was quickly impressed by the innovative software development work that ChartAssist has done in the mental health community, “ states Ron Seel, PhD, the O. Wayne Rollins Director of Brain Injury Research at Shepherd Center, per the release.

“The software that ChartAssist has developed to facilitate person-centered, multidisciplinary rehabilitation assessment and treatment has broad applicability to helping people with brain injuries, who share many of the same chronic cognitive, behavioral, physical and health conditions experienced by people with mental health disabilities. Leveraging this work to develop secure, user-friendly, evidence-based decision support applications is a natural fit and could greatly improve people’s lives.”

Grants from the National Institute on Disability, Independent Living and Rehabilitation Research, as well as the Shepherd Center Foundation, provided the seed money to develop the app.

[Source: Shepherd Center]

Source: Researchers Are Developing a Mobile App to Assist Post-TBI Patients – Rehab Managment

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[THESIS] Returning to driving post-stroke: Identifying key factors for best practice decision making over the recovery trajectory -Full text PDF

Summary

The purpose of this thesis is to examine the process of returning to driving post-stroke in order to contribute to best practice decision making. A decision tree is suggested to build patient-centred procedures for returning to driving along the post-stroke recovery trajectory.

Part one reviews literature on the return to driving process post-stroke and identifies gaps in knowledge. The stroke recovery trajectory’s three main phases of recovery (acute, rehabilitation and community care) are outlined and act as a framework for the thesis structure. Part two of the thesis describes five separate but related studies carried out to address the research gaps identified.

The first study is a qualitative study that examines attitudes and perceptions of stroke survivors from one to 16 weeks post-stroke. Independence was found to be the primary motivator in stroke survivors’ decisions about fitness to drive. However, during the acute phase stroke survivors were focused on their physical recovery, not returning to driving. Study participants had little knowledge of return to driving procedures or legislation, despite information being available. Gender differences were apparent in factors affecting the return to driving decision making.

The second study examines the psychometric property of practice effect on the Useful Field of View (UFOV, Ball & Owsley, 1993) a pre-driving screening assessment. UFOV scores have been found to be associated with on-road driving assessment scores (George & Crotty, 2010) and used in medical recommendations. Study participants were all stroke survivors with a control group performing the UFOV at three months and assessment group at one, two and three months post-stroke. Findings suggest there was no practice effect in relation to a single three month post-stroke time point. Timing of reassessment was also examined.

The third study examined self-perceived driving confidence measured by the Adelaide Driving Self Efficacy Scale (ADSES, George et al., 2007; George & Crotty, 2010) and driving habits. Results indicated there was a significant statistical association between low self-perceived driving confidence and lower kilometres driven per week, reduce driving scope, driving closer to home and avoiding challenging driving situations.

The fourth study explored self-perceived driving confidence of post-stroke drivers and their non-stroke, aged-matched driving peers measured by the ADSES. No difference was found, suggesting once stroke survivors have returned to driving they have the same levels of selfperceived driving confidence and potential driving scope as their non-stroke driving peers.

The final study focused on decisions to relinquish a driver’s licence among the older Australian general population and used a novel Discrete Choice Experiment (DCE) methodological approach. A general population was used to establish a norm with which future research on specific chronic conditions such as stroke could make comparison. Recommendation of General Practitioners’ (GPs), participants’ local doctors was found to be the primary influencing factor in the decision of older Australians to relinquish their driver’s licence. Advice from family and friends, age and crash risk in the next year were also influencing factors. The costs and availability of public transport options were not influencing factors.

The last chapter of this thesis is the Discussion section which identifies the common themes emerging along with limitations and recommendations for future research directions.

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[WEB SITE] Researchers Are Developing a Mobile App to Assist Post-TBI Patients

A decision support mobile app to help facilitate safety and independent living among TBI patients after returning home from a treatment facility is being developed in collaboration between researchers from Alabama-based Shepherd Center and ChartAssist LLC.

To assist with decision-making, the mobile app will be engineered to help improve the assessment of functional mobility, household activities, sleep, and safety risk.

Such decisions include making differential diagnostic assessments, selecting the most appropriate home- and community-based services and supports, measuring progress, and updating healthcare and supervision needs, according to the researchers, in a media release from Shepherd Center.

The app will also feature the ability to provide multidisciplinary treatment recommendations for TBI patients, as well as to set goals and track outcomes.

“I am thankful to have the opportunity to work with Shepherd Center and Dr Ron Seel, director of brain injury research, to help people with TBI and their families,” says Daniel Joye, president of ChartAssist, in the release. “The need for a decision support app is clear, and our company’s work on multidisciplinary rehabilitation in the mental health community is a great fit for helping people with brain injuries, their families and rehabilitation professionals.”

“I was quickly impressed by the innovative software development work that ChartAssist has done in the mental health community, “ states Ron Seel, PhD, the O. Wayne Rollins Director of Brain Injury Research at Shepherd Center, per the release.

“The software that ChartAssist has developed to facilitate person-centered, multidisciplinary rehabilitation assessment and treatment has broad applicability to helping people with brain injuries, who share many of the same chronic cognitive, behavioral, physical and health conditions experienced by people with mental health disabilities. Leveraging this work to develop secure, user-friendly, evidence-based decision support applications is a natural fit and could greatly improve people’s lives.”

Grants from the National Institute on Disability, Independent Living and Rehabilitation Research, as well as the Shepherd Center Foundation, provided the seed money to develop the app.

[Source: Shepherd Center]

Source: Researchers Are Developing a Mobile App to Assist Post-TBI Patients – Rehab Managment

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[Abstract] Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study.

Abstract

Purpose: The goal of this study was to examine which motor learning options are applied by experienced physiotherapists in neurological rehabilitation, and how they choose between the different options.
Methods: A descriptive qualitative approach was used. A purposive sample of five expert physiotherapists from the neurological ward of a rehabilitation center participated. Data were collected using nine videotaped therapy situations. During retrospective think-aloud interviews, the physiotherapists were instructed to constantly “think aloud” while they were watching their own videos.
Results: Five “operators” were identified: “act”, “know”, “observe”, “assess” and “argue”. The “act” operator consisted of 34 motor learning options, which were clustered into “instruction”, “feedback” and “organization”. The “know”, “observe”, “assess” and “argue” operators explained how therapists chose one of these options. The four operators seem to be interrelated and together lead to a decision to apply a particular motor learning option.
Conclusions: Results show that the participating physiotherapists used a great variety of motor learning options in their treatment sessions. Further, the decision-making process with regard to these motor learning options was identified. Results may support future intervention studies that match the content and process of therapy in daily practice. The study should be repeated with other physiotherapists.

  • Implications for Rehabilitation

  • The study provided insight into the way experienced therapist handle the great variety of possible motor learning options, including concrete ideas on how to operationalize these options in specific situations.

  • Despite differences in patients’ abilities, it seems that therapists use the same underlying clinical reasoning process when choosing a particular motor learning option.

  • Participating physiotherapists used more than the in guidelines suggested motor learning options and considered more than the suggested factors, hence adding practice based options of motor learning to the recommended ones in the guidelines.

  • A think-aloud approach can be considered for peer-to-peer and student coaching to enhance discussion on the motor learning options applied and the underlying choices and to encourage research by practicing clinicians.

 

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Source: Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study – Disability and Rehabilitation –

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[ARTICLE] What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services

Abstract

Introduction: Multi-disciplinary team members predict each patient’s rehabilitation potential to maximise best use of resources. A lack of underpinning theory about rehabilitation potential makes it difficult to apply this concept in clinical practice. This study theorises about rehabilitation potential drawing on everyday decision-making by Health Care Professionals (HCPs) working in stroke rehabilitation services.

Methods: A clinical scenario, checked for face validity, was used in two focus groups to explore meaning and practice around rehabilitation potential. Participants were 12 HCPs working across the stroke pathway. Groups were co-facilitated, audio-recorded and fully transcribed. Analysis paid attention to data grounded in first-hand experience, convergence within and across groups and constructed a conceptual overview of HCPs’ judgements about rehabilitation potential.

Results: Rehabilitation potential is predicted by observations of “carry-over” and functional gain and managed differently across recovery trajectories. HCPs’ responses to rehabilitation potential judgements include prioritising workload, working around the system and balancing optimism and realism. Impacts for patients are streaming of rehabilitation intensity, rationing access to rehabilitation and a shifting emphasis between management and active rehabilitation. For staff, the emotional burden of judging rehabilitation potential is significant. Current service organisation restricts opportunities for feedback on the accuracy of previous judgements.

Conclusion: Patients should have the opportunity to demonstrate rehabilitation potential by participation in therapy. As therapy resources are limited and responses to therapy may be context-dependent, early decisions about a lack of potential should not limit longer-term opportunities for rehabilitation. Services should develop strategies to enhance the quality of judgements through feedback to HCPs of longer-term patient outcomes.

Implications for Rehabilitation

  • Rehabilitation potential is judged at the level of individual patients (rather than population-based predictive models of rehabilitation outcome), draws on different sources of often experiential knowledge, and may be less than reliable.
  • Decisions about rehabilitation potential may have far reaching consequences for individual patients, including the withdrawal of active rehabilitation in hospital or in the community and eventual care placement.
  • A better understanding of what people mean by rehabilitation potential by all team members, and by patients and carers, may improve the quality of joint decision making and communication.

via What is rehabilitation potential? Development of a theoretical model through the accounts of healthcare professionals working in stroke rehabilitation services, Disability and Rehabilitation, Informa Healthcare.

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[WEB SITE] Center on Knowledge Translation for Disability and Rehabilitation Research (KTDRR)

The purpose of the Center on Knowledge Translation for Disability and Rehabilitation Research (KTDRR) is to make it easier to find, understand, and use the results of research that can make a positive impact on the lives of people with disabilities. In collaboration with several national and international partners, the Center on KTDRR carries out integrated training, dissemination, utilization, and technical assistance activities to (a.) increase use of valid and relevant evidence-based research findings that inform decision-making and (b.) increase the understanding and application of knowledge translation principles.

via Center on Knowledge Translation for Disability and Rehabilitation Research (KTDRR).

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[WEB SITE] Cognitive Problems After Traumatic Brain Injury

Group around a table holding up notebooks

What is cognition?

Cognition is the act of knowing or thinking. It includes the ability to choose, understand, remember and use information. Cognition includes:

  • Attention and concentration
  • Processing and understanding information
  • Memory
  • Communication
  • Planning, organizing, and assembling
  • Reasoning, problem-solving, decision-making, and judgment
  • Controlling impulses and desires and being patient

How does TBI affect cognition and what can be done about it?

After a TBI it is common for people to have problems with attention, concentration, speech and language, learning and memory, reasoning, planning and problem-solving.

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Attention and concentration

A person with TBI may be unable to focus, pay attention, or attend to more than one thing at a time. This may result in:

  • Restlessness and being easily distracted.
  • Difficulty finishing a project or working on more than one task at a time.
  • Problems carrying on long conversations or sitting still for long periods of time.

Since attention skills are considered a “building block” of higher level skills (such as memory and reasoning), people with attention or concentration problems often show signs of other cognitive problems as well.

What can be done to improve attention and concentration?

  • Decrease the distractions. For example, work in a quiet room.
  • Focus on one task at a time.
  • Begin practicing attention skills on simple, yet practical activities (such as reading a paragraph or adding numbers) in a quiet room. Gradually make the tasks harder (read a short story or balance a checkbook) or work in a more noisy environment.
  • Take breaks when you get tired.

Continue —>  Cognitive Problems After Traumatic Brain Injury.

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WEB SITE: Cognitive Problems After Traumatic Brain Injury

How does TBI affect cognition and what can be done about it?

After a TBI it is common for people to have problems with attention, concentration, speech and language, learning and memory, reasoning, planning and problem-solving…

μέσω Cognitive Problems After Traumatic Brain Injury.

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