Writing patient-centered functional goals. (9/1047)

Motor learning research, health care policies, reimbursement practices, and the standards of accrediting bodies all support writing patient-centered functional goals of physical therapy. This article defines patient-centered functional goals within the context of the Guide to Physical Therapist Practice and provides a rationale for incorporating functional goals into physical therapy for patients in all areas of practice. The article also describes how physical therapists can collaborate with patients to identify functional goals that are meaningful to them and describes a 5-step process for writing functional goals that are measurable.  (+info)

Program planning, evaluation, and the problem of alcoholism. (10/1047)

Rational program planning and evaluation has been suggested as a necessary skill. First, a conceptual framework for planning and evaluation was presented and discussed, using the example of preventing alcoholism and providing services and rehabilitation for alcoholics. Second, a case study was presented, which is similar to that used by many professionals in their efforts to plan programs. Finally, some of the marked limitations of the case study were pointed out, when it was projected upon the conceptual framework.  (+info)

Effects of task goal and personal preference on seated reaching kinematics after stroke. (11/1047)

BACKGROUND AND PURPOSE: Current theories of motor control in rehabilitation focus on how the nervous system responds to many types of external and internal constraints to execute motor behavior to accomplish a task. However, the dynamic interplay between these 2 constraints remains unclear. This study examined the impact of some aspects of internal and external constraints on motor performance in persons with stroke. METHODS: Twenty-seven persons with stroke used the uninvolved arms to perform an upper-extremity reaching task under 4 experimental conditions, formed by the crossing of functional goals and personal preferences. For the higher level of a functional goal, subjects took a drink from a can of beverage. For the lower level of a functional goal, subjects brought the can to the mouth without drinking. The level of personal preferences was determined, by interview, by the degree of predilection for particular beverages. RESULTS: Significant and large effects of functional goals and personal preference were found in the variables of movement time and reaction time. However, the data trend of the 4 testing conditions varied according to presence of visuospatial neglect and side of lesion. CONCLUSIONS: Offering choices for the treatment activities and incorporating functional goals to therapeutic tasks might enhance response rate or movement efficiency, depending on the side of the lesion and presence of visuospatial neglect. The findings suggest that the consideration of the neglect phenomenon is a necessity when rehabilitative treatment planning incorporates constraint factors.  (+info)

Increases in manic symptoms after life events involving goal attainment. (12/1047)

Bipolar disorder has been conceptualized as an outcome of dysregulation in the behavioral activation system (BAS), a brain system that regulates goal-directed activity. On the basis of the BAS model, the authors hypothesized that life events involving goal attainment would promote manic symptoms in bipolar individuals. The authors followed 43 bipolar I individuals monthly with standardized symptom severity assessments (the Modified Hamilton Rating Scale for Depression and the Bech-Rafaelsen Mania Rating Scale). Life events were assessed using the Goal Attainment and Positivity scales of the Life Events and Difficulties Schedule. As hypothesized, manic symptoms increased in the 2 months following goal-attainment events, but depressed symptoms were not changed following goal-attainment events. These results are congruent with a series of recent polarity-specific findings.  (+info)

Addressing oral disease--the case for tobacco cessation services. (13/1047)

There is strong scientific evidence from clinical and epidemiological studies that tobacco use, particularly cigarette smoking, is linked to periodontal disease as well as other serious but less common oral health diseases. Given the strength of this evidence, dentists must include tobacco cessation services (TCS) as part of their routine care. This paper describes barriers to the adoption of TCS as identified by Alberta dentists participating in a randomized intervention trial and discusses strategies for overcoming these barriers. As well, suggestions are made to professional associations and educational institutes on ways to increase the incorporation of tobacco cessation into professional practice standards.  (+info)

Patient participation in physical therapy goal setting. (14/1047)

BACKGROUND AND PURPOSE: An important part of treatment planning in physical therapy is effective goal setting. The Guide to Physical Therapist Practice recommends that therapists should identify the patient's goals and objectives during the initial examination in order to maximize outcomes. The purpose of this study was to examine whether therapists seek to involve patients in goal setting and, if so, what methods they use. Therapists' attitudes toward participation and patient satisfaction with the examination were also examined. SUBJECTS AND METHODS: Twenty-two physical therapists audiotaped the initial examination of 73 elderly patients (mean of 76.4 years of age, SD = 7.1, range = 65-94). The audiotaped examinations were then scored using the Participation Method Assessment Instrument (PMAI) to determine the frequency of attempts made by therapists to involve patients in goal setting. Therapists and patients completed surveys following the examinations. RESULTS: Therapists' use of participation methods during examinations ranged from a minimum of 1 to a maximum of 19 out of 21 possible items on the PMAI. The therapists stated that they believed that it is important to include patients in goal-setting activities and that outcomes will be improved if patients participate. Patients also indicated that participation is important to them. DISCUSSION AND CONCLUSION: In most cases, the therapists did not fully take advantage of the potential for patient participation in goal setting. Patient and therapist education is needed regarding methods for patient participation during initial goal-setting activities.  (+info)

Frontal lobes and human memory: insights from functional neuroimaging. (15/1047)

The new functional neuroimaging techniques, PET and functional MRI (fMRI), offer sufficient experimental flexibility and spatial resolution to explore the functional neuroanatomical bases of different memory stages and processes. They have had a particular impact on our understanding of the role of the frontal cortex in memory processing. We review the insights that have been gained, and attempt a synthesis of the findings from functional imaging studies of working memory, encoding in episodic memory and retrieval from episodic memory. Though these different aspects of memory have usually been studied in isolation, we suggest that there is sufficient convergence with respect to frontal activations to make such a synthesis worthwhile. We concentrate in particular on three regions of the lateral frontal cortex--ventrolateral, dorsolateral and anterior--that are consistently activated in these studies, and attribute these activations to the updating/maintenance of information, the selection/manipulation/monitoring of that information, and the selection of processes/subgoals, respectively. We also acknowledge a number of empirical inconsistencies associated with this synthesis, and suggest possible reasons for these. More generally, we predict that the resolution of questions concerning the functional neuroanatomical subdivisions of the frontal cortex will ultimately depend on a fuller cognitive psychological fractionation of memory control processes, an enterprise that will be guided and tested by experimentation. We expect that the neuroimaging techniques will provide an important part of this enterprise.  (+info)

Impaired recognition of the goal location during spatial navigation in rats with hippocampal lesions. (16/1047)

Converging evidence suggests that the hippocampus is essential for goal-directed spatial navigation. Successful navigation requires not only the ability to compute an appropriate path toward the target but is also guided by recognition of places along the trajectory between start and goal. To determine whether the hippocampus contributes to place recognition, we trained rats with hippocampal lesions in an annular water maze with a remotely controlled escape platform at a constant location in the corridor. The platform remained submerged and unavailable until the rat had swum at least one full lap. Probe trials with the platform unavailable for 60 sec were inserted at regular intervals. In these trials, the rat would swim over the platform several times, regardless of its navigational abilities. After a few training sessions, all sham-operated control animals reduced their swim velocity when they approached the platform, indicating that they recognized the target location. Rats with hippocampal lesions, in contrast, swam at the same velocity as elsewhere in the corridor. Preoperative training or prolonged postoperative training did not alleviate the deficit. Rats with hippocampal lesions were able to learn a cued version of the task, which implies that the failure to slow down was not attributable to motor inflexibility. Thus, hippocampal lesions caused a severe but selective deficit in the identification of a location, suggesting that the hippocampus may be essential for image recognition during spatial navigation.  (+info)