NeuroRehabilitation - Volume 5, issue 1

Authors: Frank, Robert G. | Johnstone, Brick

Article Type: Introduction

DOI: 10.3233/NRE-1995-5101

Citation: NeuroRehabilitation, vol. 5, no. 1, pp. 1-1, 1995

Authors: Fisher, William P. | Harvey, Richard F. | Kilgore, Karl M.

Article Type: Research Article

Abstract: Advances in fundamental measurement have led to many exciting new developments in functional assessment. This paper presents fundamental measurement theory and method in summary form, and briefly describes its various applications to functional assessment, program evaluation, and outcomes analysis in physical medicine and rehabilitation. The implications of computerized medical records and longitudinal patient tracking in national or global computer networks for functional status and health status gold standards are briefly addressed.

Keywords: Functional assessment, Health status, Rasch, Conjoint measurement, Computerization, Measurement standards

DOI: 10.3233/NRE-1995-5102

Citation: NeuroRehabilitation, vol. 5, no. 1, pp. 3-25, 1995

Authors: Longo, Daniel R.

Article Type: Research Article

Abstract: In this paper clinical quality improvement, also referred to as total quality management, is described as a theoretical and methodological framework. Use of this approach is proposed and examined as a paradigm for quality of care measurement and management in rehabilitation medicine. While the field of rehabilitation has a long tradition in the area of outcomes measurement, in particular that of functional status assessment, the larger framework of clinical quality improvement offers a very promising and more complete framework for rehabilitation than those employed in the past. While the framework requires further testing and research, it has been useful in …some areas of acute, as well as primary care. This paradigm is consistent with the approaches traditionally taken in measuring the quality of rehabilitation medicine. Recommendations are made for its application in rehabilitation medicine. Show more

Keywords: Quality of care, Quality improvement, Rehabilitation quality

DOI: 10.3233/NRE-1995-5103

Citation: NeuroRehabilitation, vol. 5, no. 1, pp. 27-38, 1995

Authors: Fraser, Robert T. | Wehman, Paul

Article Type: Research Article

Abstract: Since the population with a traumatic brain injury is principally young with many years of potential future earning capacity, understanding the issues affecting the vocational outlook for this group is critical. This article overviews the research to date on vocational outcome, emphasizing newly developed multivariate prediction models and encouraging a focus on actually examining the effects of different vocational interventions. The reasons for the variability in current study findings are reviewed with a framework proposed for more meaningful future research on the vocational rehabilitation process for this disability group. It is only through utilization of more standard intake and outcome …variables and manipulation of interventions within this more standardized context that efficient and effective vocational rehabilitation for these survivors will be understood. Show more

Keywords: Traumatic brain injury, Vocational rehabilitation outcome

DOI: 10.3233/NRE-1995-5104

Citation: NeuroRehabilitation, vol. 5, no. 1, pp. 39-48, 1995

Authors: Farmer, Janet E. | Clippard, Dana

Article Type: Research Article

Abstract: Children with disabilities are at increased risk of poor educational outcomes. Although most participate regularly in educational programs, they are less likely to be functionally independent, socially integrated, psychologically adjusted, and engaged in productive activity following school completion. Improved collaboration between rehabilitation specialists and educators has the potential to prevent these secondary complications of disability. Professionals need to specify important outcome domains to track in both settings, consider using a prevention model to guide interventions, and increase awareness of common underlying beliefs about the need for inclusive environments and interdependence.

Keywords: Educational outcomes, Childhood disabilities

DOI: 10.3233/NRE-1995-5105

Citation: NeuroRehabilitation, vol. 5, no. 1, pp. 49-56, 1995

Authors: Hart, Karen A. | Rintala, Diana H.

Article Type: Research Article

Abstract: Long-term outcome assessment of people with spinal cord injury (SCI) beyond acute rehabilitation is becoming an increasingly important issue as life expectancies for people with SCI approach those of the general population. This article provides information about research on the long-term physical and psychological well-being and the community integration of individuals with SCI. Persons with SCI have been found to have more physical and psychological problems and they are less well integrated into the community than the general population. Long-term measurement issues, criteria for selection of instruments, and recommended instruments are discussed.

Keywords: Spinal cord injury, Long-term outcome, Community integration, Paraplegia, Tetraplegia, Quadriplegia

DOI: 10.3233/NRE-1995-5106

Citation: NeuroRehabilitation, vol. 5, no. 1, pp. 57-73, 1995

Authors: Johnstone, Brick | Frank, Robert G.

Article Type: Research Article

Abstract: Neuropsychological assessment is a standard procedure for rehabilitation patients with cognitive dysfunction. However, the use of neuropsychological evaluations in rehabilitation settings is limited as the most commonly used measures were originally developed for diagnostic purposes with an emphasis on localization/lateralization of lesions and description of brain-behavior relationships. As a result, the functional (versus diagnostic) utility of neuropsychological evaluations is questionable at best. Furthermore, neuropsychological evaluation in rehabilitation settings will continue to be of limited utility as long as INS-APA Division 40 guidelines continue to emphasize training in neurologic and neuroanatomic factors, with minimal attention to rehabilitation issues and resources. Several …factors necessitate the use of neuropsychological evaluations for functional rather than diagnostic purposes, including advances in neuroradiological evaluation, the growth of rehabilitation facilities given increased survival rates for brain injured patients, and an associated greater need for psychological services for these patients. Suggestions are offered for improving the functional utility of neuropsychological evaluations, as well as more effective ways to train neuropsychologists in rehabilitation issues and interventions. Show more

Keywords: Neuropsychological evaluation, Rehabilitation psychology, Construct validity, Ecological validity

DOI: 10.3233/NRE-1995-5107

Citation: NeuroRehabilitation, vol. 5, no. 1, pp. 75-86, 1995

Authors: Cherek, Linda | Taylor, Mark

Article Type: Research Article

Abstract: Case management of claims by or for an insurer, whether it be a large employer that self-insures its benefits plan or an insurance company, evolved in response to employers' desire for help in controlling escalating costs. In tracking savings for the disability and health case management services it provides to claimants, Northwestern National Life has documented significant savings. Our recent study of 9747 incurred long-term disability claims from January 1987 to December 1993 revealed an average savings of $35 in disability reserves for every dollar spent on rehabilitation services. For health claims, estimated savings produced by NWNL's medical case management …program have grown from about $500000 in 1987, the program's first year of operation, to $8.1 million in 1993. From an insurance industry perspective, both health care and disability case management services maintain a strong focus on positive rehabilitation outcomes as well as cost effectiveness. Case managers evaluate rehabilitation plans based on their ability to offer quality care, interdisciplinary cooperation, and promote recovery or returning to a productive work life. The health insurance case manager gets involved in cases where there are alternative service delivery options for the treatment plan. Working closely with the physician, patient, family members and other health care professionals, the case manager looks for highly effective, outcome-based rehabilitation facilities. As treatment goals to improve health and physical functioning are reached, the focus of case management shifts to returning an individual to a productive work life where possible or appropriate. The rehabilitation case manager evaluates return-to-work potential, with a primary goal of getting disabled workers back to the same job. Show more

Keywords: Rehabilitation, Case management, Functional outcome, Insurance industry perspective

DOI: 10.3233/NRE-1995-5108

Citation: NeuroRehabilitation, vol. 5, no. 1, pp. 87-95, 1995