ABSTRACT: Objectives:To examine the institutional contexts that contribute to the low priority given to the development of self-care independence in a rehabilitation ward.Design:Research was guided by ethnographic principles of Martyn Hammersley and Paul Atkinson (2007). Individual in-depth interviews were completed. Participant observation was done daily during the rehabilitation stay of the patients.Patients:Six men and three women with neurological impairments and their caregivers.Results:Patients' daily routines on a rehabilitation ward in Taiwan are described. Four prominent themes emerged from the data: (1) the attitudes of patients, caregivers, and staff facilitated extended rehabilitation stays within the first year after disability, (2) attending therapy sessions was the most important activity, (3) pragmatic considerations, such as 'faster and easier', outweighed the value of developing self-care independence, and (4) strategic organization of daily routines to keep therapy the priority was critical for daily activity.Conclusion:Multiple institutional factors jeopardize the development of self-care independence in a rehabilitation ward. The factors include the primacy of biomedical-oriented rehabilitation ideology, insurance reimbursement policies, and cultural values associated with family caregiving. They legitimize the low priority given to developing self-care independence. Therapists need to include a critical review of daily routines (what and how activities are carried out inside and outside of therapy clinics) as part of therapy regime to identify opportunities and institutional constraints to the development of self-care independence.
Clinical Rehabilitation 11/2012; · 2.12 Impact Factor
ABSTRACT: To determine whether cognition moderates the association between facility-level characteristics and individual-level impairments and activity of daily living (ADL) dependency.
Longitudinal cohort study.
Nursing homes (NHs) in Minnesota.
Four thousand nine hundred forty-two NH residents admitted to 377 Minnesota NHs during 2004 were followed for 4 to 8 months.
According to the Minimum Data Set (MDS) Cognition Scale 3,132 residents had high cognitive function, and 1,810 had low cognitive function. Total ADL score and scores on three ADL tasks at follow-up were used as outcome variables. MDS-derived impairment measures at admission of pain, depression, incontinence, balance dysfunction, and fall history were used to predict ADL changes. Fifteen resident-level and eight facility-level control variables were included in all four ADL models.
Effects of NHs and impairments on ADLs tended to be weaker for residents with low cognitive function. Bladder incontinence significantly predicted more dependence in total ADLs, toileting, and personal hygiene in both cognitive groups. Balance dysfunction significantly predicted worse total ADLs, toileting, and personal hygiene in the high-cognition group but only worse toileting function in the low-cognition group. In neither subgroup did any impairment predict worse eating function. Cognition did not modify the relationships between pain, depression, and recent falls and ADLs.
Current NH environments and care processes may be inadequate to facilitate ADL changes for residents with severe cognitive impairment. More innovative structural designs, higher staffing levels, and better care processes may be indicated.
Journal of the American Geriatrics Society 11/2010; 58(12):2275-83. · 3.74 Impact Factor
ABSTRACT: This article uses a qualitative design and examines how patients and their caregivers integrate pluralistic health practices into rehabilitation from their perspectives.
Ethnography was used as the framework for research design. Data were collected via participant observation, taped in-depth interviews and regular chart review, and all interviews were transcribed verbatim.
An inpatient rehabilitation unit in Taiwan.
Twenty-one patients, their caregivers and their rehabilitation professionals.
The patients and their caregivers used pluralistic illness explanations and treatments to make sense of their suffering, to control healing and to find the hope that rehabilitation professionals often deliberately avoided giving. Spiritual healing and therapies related to Traditional Chinese Medicine, such as functional food and herbal medicines, were popular alternative therapeutics. Although the patients and their caregivers perceived opposition from the medical staff on the unit, they used a variety of covert strategies to integrate their pluralistic illness explanations and treatments into their daily routines without openly challenging the rehabilitation primacy.
Aware of the rehabilitation staff's opposition, the patients and caregivers resorted to a variety of underground strategies to conceal their use of complementary medical treatments.
Clinical Rehabilitation 06/2009; 23(8):730-40. · 2.12 Impact Factor
ABSTRACT: This study problematizes a unique therapeutic relationship in rehabilitation and how the interaction reflects the integration of rehabilitation ideology with local cultures. The data drew from a larger ethnographic study of a rehabilitation unit in Taiwan. Participants included 21 patient-caregiver pairs and their rehabilitation professionals. They participated in in-depth interviews and participant observation. A tough-love pedagogy emerged as a unique therapeutic relationship in the unit. Patients were asked to interpret the stress with therapy as an inevitable, beneficial experience toward recovery. A prevalent supposition that equated poor physical performance with weak morale legitimized the approach. Cultural metaphors used to describe and define rehabilitation transformed the stress that patients experienced with strenuous exercises into a beneficial substance that aids recovery. The transformation of the therapeutic relationship into a pedagogical one helped connect rehabilitation to shared educational experiences. In the unit, the complicit practice of therapists, caregivers, and patients established and perpetuated the practice of a tough-love pedagogy. The congruence between this tough-love approach and traditional Chinese pedagogical principles made the approach legitimate and desired.
International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 04/2009; 32(3):219-27. · 0.36 Impact Factor
ABSTRACT: Existing studies on the relationships between impairments and activities of daily living (ADLs) in nursing home residents have serious limitations. This study examines the relationships among admission impairments, including pain, depression, incontinence, balance, and falls, and follow-up ADLs, as well as the effect of the nursing home on follow-up ADLs of extended-stay nursing home residents.
This longitudinal cohort study consisted of 4,942 extended-stay residents who were admitted into 377 Minnesota nursing homes during 2004. General linear mixed models were used for all analyses, with 14 resident-level and 8 facility-level control variables.
Incontinence and balance function at admission were significantly associated with increases in ADL dependence at follow-up. Individual nursing homes had independent effects on all three ADL models. Similar findings were found after facility-level control variables were added.
Incontinence predicts subsequent ADL functional levels. The relationship between balance dysfunction and subsequent ADL dependence could be causal. Future studies of the causal relationships between impairments and ADL should examine the effectiveness of impairment interventions on ADL as well as these relationships in different subgroups of nursing home residents.
The Journals of Gerontology Series A Biological Sciences and Medical Sciences 03/2009; 64(4):473-80. · 4.60 Impact Factor
ABSTRACT: The goal of the automated deburring can be achieved by maintaining
a constant force on the grinding tool in the direction normal to the
constraint surface while following the positional trajectory in the
direction tangential to the surface. In this paper, the dynamics of both
the deburring process and the flexible manipulator are investigated in
detail, and a singular perturbation technique is then utilized to
separate the system into a slow subsystem and a fast subsystem, whereby
an adaptive hybrid position/force controller is derived for the slow
subsystem whereas a dynamic feedback controller is developed for the
fast subsystem. It is shown that the motional tracking error and the
force regulation error converge to a small residual set. Finally,
computer simulations and experiments of a 2-link flexible manipulator
confirm the effectiveness of the proposed controller
Robotics and Automation, 1997. Proceedings., 1997 IEEE International Conference on; 05/1997