NeuroRehabilitation - Volume 6, issue 2

Authors: Banja, John D.

Article Type: Introduction

DOI: 10.3233/NRE-1996-6201

Citation: NeuroRehabilitation, vol. 6, no. 2, pp. 95-96, 1996

Authors: Tarvydas, Vilia M. | Shaw, Linda

Article Type: Research Article

Abstract: Traumatic brain injury (TBI) rehabilitation is one of the most challenging and complex aspects of rehabilitation clinically, administratively, and ethically. The prevailing standard of care in this area emphasizes the importance of treatment within an interdisciplinary team model. Empirical literature related to both individual clinician and team aspects of the ethical issues involved in head injury rehabilitation has been lacking. This study utilized a survey approach to describe the perceptions of interdisciplinary team members in TBI rehabilitation at various care-levels in rehabilitation regarding ethical issues in their practice. A sample of 84 interdisciplinary team members responded to a new survey …instrument, the Ethical Urgency Survey (EUS), describing the frequency of issues, their importance, and the perceived level of distress with ethical dilemmas in five domains of TBI practice: legal, rehabilitation treatment, family/social, medical treatment, and research issues. Additionally, it was found that there were significant differences between how members of different disciplinary groups viewed these ethical issues. Show more

Keywords: Traumatic brain injury, Interdisciplinary, Ethical perceptions, Rehabilitation

DOI: 10.3233/NRE-1996-6202

Citation: NeuroRehabilitation, vol. 6, no. 2, pp. 97-111, 1996

Authors: Rosenthal, Mitchell | Lourie, Ira

Article Type: Research Article

Abstract: The evaluation of competency in an individual with acquired brain injury has become an area of increasing concern to health care professionals in recent years. The evolving neurobehavioral status, nature and extent of diminished cognition and the post-discharge environment are factors which must be considered when assessing the competency of a person with brain injury to function independently in the community. In addition, clinicians must be familiar with the distinctions between various definitions and models of competency. In most rehabilitation settings, competency to consent to treatment, care for self and property and manage financial affairs are the issues most commonly …observed. In the case of acquired brain injury, clinicians are well-advised to maximize a patient's autonomy and avoid a paternalistic stance, whenever possible. Treatment of the patient and family should be directed toward developing compensatory behaviours to allow for safe and successful community reintegration with as much dignity and autonomy as possible. Show more

Keywords: Brain injury, Ethics, Competency, Rehabilitation, Patient rights, Beneficence

DOI: 10.3233/NRE-1996-6203

Citation: NeuroRehabilitation, vol. 6, no. 2, pp. 113-121, 1996

Authors: Auerbach, Vivian S. | Banja, John D.

Article Type: Research Article

Abstract: Numerous persons receiving rehabilitation services demonstrate compromised judgmental or cognitive ability which occasionally casts doubt on the validity of their consent to, or refusal of, rehabilitation treatment. A 14-member panel of nationally recognized forensic and neurorehabilitation experts (recruited from physiatry, law and mental health) viewed 21 videotaped competency interviews of cognitively impaired inpatients in an acute care rehabilitation hospital. Each rater offered an opinion on whether the interviewee was competent or not based on background history and the interview format presented here. Their ratings are compared with those of the interviewees' treating professionals, who based their competency assessments on their …day-to-day clinical interactions with the patients. Results showed similar judgments among the three groups of videotape raters but statistically significant differences between the ratings of the panel members and the patients' treatment team. Reasons for these discrepancies are explored with additional comments on the conceptual obstacles presented by competency assessments in general. This article also describes a brief evaluation of competence to consent to treatment developed during the research program with input from the panel of experts. Qualified rehabilitation providers might employ such techniques to assess competence to participate in medical decision making. Show more

Keywords: Competency, Consent to treatment, Ethics, Rehabilitation, Decision making

DOI: 10.3233/NRE-1996-6204

Citation: NeuroRehabilitation, vol. 6, no. 2, pp. 123-132, 1996

Authors: Guenther, Robert T. | Weber, Leonard J.

Article Type: Research Article

Abstract: The ethics committee, initially developed in the acute care setting, can serve to address the particular issues and difficult dilemmas that characterize rehabilitation. The same mechanisms of educational programs, policy development, and case consultation serve to address ethical issues in rehabilitation as well as acute care settings. However, ethical issues in rehabilitation differ greatly from those common in acute care settings. Rehabilitation ethics committees must be prepared to consider issues that include the following: procurement of informed consent for services that are rarely discrete, variable levels of program participation, complex cost-benefit analyses that are subject to less relevant values and …biases, unequal access to services, limits of confidentiality, and family/caregiver issues. These difficult issues, peculiar to rehabilitation and made much more complex when patients exhibit cognitive deficits, provide an opportunity for rigorously testing the utility of ethical theory in a complex medical arena. Show more

Keywords: Ethics committees, Rehabilitation, Informed consent, Participation, Injustice, Confidentiality, Caregiver issues

DOI: 10.3233/NRE-1996-6205

Citation: NeuroRehabilitation, vol. 6, no. 2, pp. 133-143, 1996

Authors: Wilkinson, Wendy | Dresden, Cynthia

Article Type: Research Article

Abstract: It has been 5 years since one of the most important civil rights laws was enacted. The Americans with Disabilities Act (ADA), signed into law on July 26, 1990, was passed to give individuals with disabilities the ‘opportunity to compete on an equal basis and to pursue those opportunities for which our free society is justifiably famous…’ Because the discrimination faced by people with disabilities is unique in many aspects, the Act is comprehensive and detailed. The obligation not to discriminate against individuals with disabilities, as with people from other minority groups, is placed on society. As a result of …these precepts, and the specific measures they entail, the ADA has become the subject of heated debate. The role of government in enacting this type of legislation is questioned as are many aspects of the act itself. The authors of this piece debate the legitimacy of the ADA from an ethical perspective. In addition, they evaluate the values inherent in some of the cases that have come down under the ADA. They conclude that the Act was structured to balance competing interests in order to ensure that the rights of people with disabilities are an important factor in societal decision-making. Show more

Keywords: ADA, Disability, Discrimination, Equality, Ethics, Independant living, Legislative history, Reasonable accommodation

DOI: 10.3233/NRE-1996-6206

Citation: NeuroRehabilitation, vol. 6, no. 2, pp. 145-160, 1996

Article Type: Announcement

DOI: 10.3233/NRE-1996-6207

Citation: NeuroRehabilitation, vol. 6, no. 2, pp. 161-161, 1996