Fonctionnement social et rétablissement à la suite d'un premier épisode psychotique

De nos jours, l’idée selon laquelle bon nombre d’individus atteints de psychose peuvent se rétablir sensiblement au fil du temps est de plus en plus répandue. Alors que le milieu médical associe le rétablissement à la rémission symptomatique, les usagers de services en santé mentale le voient plutôt comme un processus où l’absence de symptômes n’est pas une condition sine qua non. Ne s’opposant à ni l’un ni l’autre de ces points de vue, le traitement actuel des psychoses vise le retour à un fonctionnement social approprié. Chez les jeunes atteints d’un premier épisode psychotique, une diminution marquée des symptômes après un traitement pharmacologique se traduit rarement en une amélioration significative du fonctionnement, ce qui justifie la mise en place d’interventions psychosociales. On connait aujourd’hui quelques variables associées au fonctionnement social chez cette population, mais celui-ci a peu été étudié de façon spécifique. De même, on connait mal la manière dont ces jeunes vivent leur rétablissement en tant que processus. Cette thèse porte donc sur le rétablissement et le fonctionnement social de jeunes en début de psychose. La première partie consiste en une introduction aux concepts de rétablissement et de réadaptation, et en une revue de la littérature des interventions psychosociales pouvant favoriser leurs rétablissement et fonctionnement. Plus spécifiquement, nous illustrons comment ces interventions peuvent s’appliquer aux adolescents, clientèle sur laquelle peu de littérature existe actuellement. La deuxième partie présente les résultats d’une étude sur la valeur prédictive de variables sur trois domaines du fonctionnement social de 88 jeunes adultes en début de psychose. Des équations de régression multiple ont révélé qu’un niveau plus élevé de dépression était associé à une vie sociale moins active, qu’un moins bon apprentissage verbal à court terme était associé à un plus bas fonctionnement vocationnel, que le fait d’être de sexe masculin était négativement associé aux habiletés de vie autonome, et qu’un niveau plus élevé de symptômes négatifs prédisait de moins bonnes performances dans les trois sphères du fonctionnement. Finalement, la troisième partie s’intéresse au processus de rétablissement en début de psychose par l’analyse de récits narratifs selon un modèle en cinq stades. Nous avons découvert que l’ensemble de notre échantillon de 47 participants se situaient dans les deux premiers stades de rétablissement lors du premier temps de mesure, et que le fait de se trouver au deuxième stade était associé à de meilleurs scores d’engagement social et de fonctionnement occupationnel, à un meilleur développement narratif, à moins de symptômes négatifs et positifs, et à plus d’années de scolarité. Par ailleurs, l’examen des stades à deux autres temps de mesure a révélé des profils relativement stables sur une période de neuf mois. En somme, les résultats démontrent la nécessité d’évaluer le fonctionnement social de façon plus spécifique et l’importance d’offrir des interventions psychosociales en début de psychose visant notamment le développement des relations et l’intégration scolaire/professionnelle, ou visant à améliorer le faible développement narratif. Cette thèse est, de plus, un premier pas dans l’étude du processus de rétablissement des jeunes atteints de psychose.

Retombées du cirque social (Cirque du Soleil) en contexte de réadaptation sur la participation sociale de jeunes adultes avec déficiences physiques en transition vers la vie active : étude qualitative

Introduction : Les adolescents avec déficiences physiques en transition vers la vie adulte éprouvent des difficultés à établir une participation sociale optimale. Cette étude explore les retombées d'un programme de cirque social sur la participation sociale de ces jeunes selon leur point de vue et celui de leurs parents. Méthode : Étude qualitative exploratoire d’orientation phénoménologique. Neuf personnes avec déficiences physiques, âgées de 18 et 25 ans, ont participé au programme pendant neuf mois. Données recueillies : perceptions de leur qualité de participation sociale à partir d’entrevues semi-structurées en pré, mi-temps et post-intervention avec les participants et un de leurs parents. Le guide d’entrevue validé est ancré sur le Modèle du développement humain- Processus de production du handicap - 2 (HDM-PPH2). L’enregistrement audio des entretiens a été transcrit en verbatim. Le contenu a été analysé avec le logiciel Nvivo 9 à travers une grille de codage préalablement validée (co-codage, codage-inverse). Résultats : Corpus de 54 entrevues. L’âge moyen des jeunes était de 20,0 ± 1,4 années et de 51 ± 3,6 années pour les parents. Selon tous, la participation sociale des jeunes adultes a été optimisée, surtout sur le plan de la communication, des déplacements, des relations interpersonnelles, des responsabilités et de la vie communautaire. La perception de soi et les habiletés sociales, également améliorées, ont favorisé une plus grande auto-efficacité. Conclusion : Cette étude soutient donc le potentiel du cirque social comme approche novatrice et probante en réadaptation physique pour cette population, et appuie la pertinence d’autres études rigoureuses mesurant les diverses retombées possibles et identifiées.

Rehabilitation of executive functions: Implications and strategies

Executive Functions (EF) concern a range of abilitiesincluding problem-solving, planning, initiation, selfmonitoring,conscious attention, cope with new situationsand the ability to modify plans if necessary. It’s ahigh cognitive function that is crucial for a person to getengaged and maintain daily activities whilst keeping agood quality of life. Problems in the EF were formerlyknown as Dysexecutive Syndrome (DS). There are manymodels concerning DS, although the literature on thesubject still remains unclear. Several works appoint theeffects brought by elderly life, as well as abuse of drugsand some psychopathologies. These factors are knownto increase the distress of the frontal circuits and thatcould be associated to executive deficits. The effects ofDS would compromise individuals in day-to-day routine,academic, social and labor fields. There is a growingbody of studies trying to determine the causes, implications,associations and the best way to take care of theseeffects. This work intends to review DS, focusing on themost important fields related to this area, such as psychopathologyassociations, cognitive reserve, assessmentand cognitive rehabilitation programs.

Effects of pulmonary rehabilitation program in a patient with severe asthma diagnosis

Objective: to present the effectiveness of pulmonary rehabilitation programs in the treatmentof a patient with asthma, this is the case of a young Caucasian girl —17 years old— with severe asthma diagnosis, with symptoms since she was eight years old, 10th grade student. Method: She was referred to the program of Pulmonary Rehabilitation after three hospitalizations during the last year due to asthmatic crises, dyspnoea in activities of daily living, and intolerance to physical exercise. In the initial evaluation, a patient with non-controlled asthma was found; she was receiving short-acting medication admitting that she was not complying with regular use and with a prescribed dose of the pharmacological treatment and that she ignored the importance of this commitment for optimal evolution. The patient expressed concern about the progressive deterioration at her respiratory and functional level during the last year and her fear and anxiety for not being able to breathe during activities befitting her age. Results: One month after receiving bronchodilators and long-acting steroids permanently and complying with recommendations about regular use and adequate inhalatory technique, the patient was included in a three-times a-week program of pulmonary rehabilitation during eight weeks for upper and lower extremity endurance and resistance training. Conclusion: This intervention showed significant changes in the patient at functional level and a greater social participation.

SIDUR: development of an information system, using controlled vocabulary designed to the characterization and sample of population with and without disability, attended by Rehabilitation programs, University of Rosario

Introduction: the statistical record used in the Field Academic Programs (PAC for it’s initials in Spanish) of Rehabilitation denotes generalities in the data conceptualization, which complicates the reliable guidance in making decisions and provides a low support for research in rehabilitation and disability. In response, the Research Group in Rehabilitation and Social Integration of Persons with Disabilities has worked on the creation of a registry to characterize the population seen by Rehabilitation PAC. This registry includes the use of the International Classification of Functioning, Disability and Health (ICF) of the WHO. Methodology: the proposed methodology includes two phases: the first one is a descriptive study and the second one involves performing methodology Methontology, which integrates the identification and development of ontology knowledge. This article contextualizes the progress made in the second phase. Results: the development of the registry in 2008, as an information system, included documentary review and the analysis of possible use scenarios to help guide the design and development of the SIDUR system. The system uses the ICF given that it is a terminology standardization that allows the reduction of ambiguity and that makes easier the transformation of health facts into data translatable to information systems. The record raises three categories and a total of 129 variables Conclusions: SIDUR facilitates accessibility to accurate and updated information, useful for decision making and research.

The amputee patient: complications of its process of rehabilitation

This article is centered in the presentation of the complications that can be given in the stump of an amputated patient, considering the context of the phases and the stages of the rehabilitation process through which it must pass this type of patient. Also, the boarding of this subject is framed specially in one of the main causes of amputation in the world and in a country like Colombia that for years has been submerged in a special situation of violence. It also defines different strategies from intervention for the mentioned complications and makes it relevant the necessity of a team of rehabilitation for the treatment of these patients, concluding with the importance that has the inclusion of the patient to its occupational, social and familiar roll, to really complete the rehabilitation process. It also defines different strategies from intervention for the mentioned complications and makes it relevant the necessity of an interdisciplinary rehabilitation team for the treatment of these patients. To finish with the part of the process in witch the patient returns back to its working, social and familiar roll.

Occupational therapy and its relevance in social projects. relationships, learning and opportunities: collection of experiences of University of Alberta Mscot students in Bogotá, Colombia

Occupational therapists are equipped to promote wellbeing through occupation and to enable participation and meaningful engagement of people in their social and physical environments (WFOT, 2012). As such, the role of the occupational therapists is profoundly linked to the social, cultural and environmental characteristics of the contexts in which occupations take place. The central role that context plays in occupational performance creates an interesting dichotomy for the occupational therapist: on one hand, a profound understanding of cultural and social factors is required from the Occupational Therapy (OT) in order to develop a meaningful and successful collaboration with the person; on the other hand, the ability of the occupational therapists to recognize and explore the contextual factor of an occupation-person dyad transcends cultural and spatial barriers. As a result, occupational therapists are equipped to engage in international collaboration and practice, and as such face unique and enriching challenges. International fieldwork experiences have become a tool through which occupational therapists in training can develop the critical skills for understanding the impact of cultural and social factors on occupation. An OT student in an international fieldwork experience faces numerous challenges in leading a process that is both relevant and respectful to the characteristics of the local context: language, cultural perceptions of occupation and personhood, religious backgrounds, health care access, etc. These challenges stand out as ethical considerations that must be considered when navigating an international fieldwork experience (AOTA, 2009). For more than five years now, the Faculty of Rehabilitation Medicine (FRM) of the University of Alberta (UoFA) and the School of Medicine and Health Sciences at the Universidad del Rosario (UR), Bogota, Colombia, have sustained a productive and meaningful international collaboration. This collaboration includes a visit by Dr. Albert Cook, professor of the FRM and former dean, to the UR as the main guest speaker in the International Congress of Technologies for Disability Support (IBERDISCAP) in 2008. Furthermore, Dr. Cook was a speaker in the research seminar of the Assistive Technology Research Group of the Universidad del Rosario. Following Dr. Cook’s visit, Professors Liliana Álvarez and Adriana Ríos travelled to Edmonton and initiated collaboration with the FRM, resulting in the signing of an agreement between the FRM and the UR in 2009, agreement that has been maintained to this day. The main goal of this agreement is to increase academic and cultural cooperation between the UR and the UofA. Other activities have included the cooperation between Dr. Kim Adams (who has largely maintained interest and effort in supporting the capacity building of the UR rehabilitation programs in coordinating the provision of research placement opportunities for UR students at the UofA), an Assistive Technology course for clinicians and students led by Dr. Adams, and a research project that researched the use of basic cell phones to provide social interaction and health information access for people with disabilities in a low-income community in Colombia (led by Tim Barlott, OT, MSc, under the supervision of Dr. Adams). Since the beginning, the occupational therapy programs of the Universidad del Rosario and the University of Alberta have promoted this collaboration and have strived to engage in interactions that provide further development opportunities for students and staff. As part of this process, the international placement experience of UofA OT students was born under the leadership of: Claudia Rozo, OT program director at UR, placement and academic leadership of Elvis Castro and Angélica Monsalve, professors of the occupational therapy program at UR; and Dr. Lili Liu, OT department director at UofA, Cori Schmitz, Academic coordinator of clinical education at the UofA; and Tim Barlott and Liliana Álvarez leading the international and cross-cultural aspect of this collaboration.This publication summarizes and illustrates the process of international placement in community settings in Colombia, undertaken by occupational therapy students of the University of Alberta. It is our hope that this document can provide and document the ethical considerations of international fieldwork experience, the special characteristics of communities and the ways in which cultural and social competences are developed and help international students navigate the international setting. We also hope that this document will stimulate discussion among professional and academic communities about the importance and richness of international placement experiences and encourage staff and students to articulate their daily efforts with the global occupational therapy agenda.

Can social interaction skills be taught by a social agent? The role of a robotic mediator in autism therapy

Increasingly socially intelligent agents (software or robotic) are used in education, rehabilitation and therapy. This paper discusses the role of interactive, mobile robots as social mediators in the particular domain of autism therapy. This research is part of the project AURORA that studies how mobile robots can be used to teach children with autism basic interaction skills that are important in social interactions among humans. Results from a particular series of trials involving pairs of two children and a mobile robot are described. The results show that the scenario with pairs of children and a robot creates a very interesting social context which gives rise to a variety of different social and non-social interaction patterns, demonstrating the specific problems but also abilities of children with autism in social interactions. Future work will include a closer analysis of interactional structure in human-human and robot-human interaction. We outline a particular framework that we are investigating.

Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke : an explorative observational study

BACKGROUND: People who have suffered a stroke commonly report unfulfilled need for rehabilitation. Using a model of patient satisfaction, we examined characteristics in individuals that at 3 months after stroke predicted, or at 12 months were associated with unmet need for rehabilitation or dissatisfaction with health care services at 12 months after stroke. METHODS: The participants (n = 175) received care at the stroke units at the Karolinska University Hospital, Sweden. The dependent variables "unfulfilled needs for rehabilitation" and "dissatisfaction with care" were collected using a questionnaire. Stroke severity, domains of the Stroke Impact Scale (SIS), the Sense of Coherence scale (SOC) and socio demographic factors were used as independent variables in four logistic regression analyses. RESULTS: Unfulfilled needs for rehabilitation at 12 months were predicted by strength (SIS) (odds ratio (OR) 7.05) at three months, and associated with hand function (SIS) (OR 4.38) and poor self-rated recovery (SIS) (OR 2.46) at 12 months. Dissatisfaction with care was predicted by SOC (OR 4.18) and participation (SIS) (OR 3.78), and associated with SOC (OR 3.63) and strength (SIS) (OR 3.08). CONCLUSIONS: Thirty-three percent of the participants reported unmet needs for rehabilitation and fourteen percent were dissatisfied with the care received. In order to attend to rehabilitation needs when they arise, rehabilitation services may need to be more flexible in terms of when rehabilitation is provided. Long term services with scheduled re-assessments and with more emphasis on understanding the experiences of both the patients and their social networks might better be able to provide services that attend to patients' needs and aid peoples' reorientation; this would apply particularly to those with poor coping capacity.

Usual clinical practice for early supported discharge after stroke with continued rehabilitation at home : an observational comparative study

Introduction: Based on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke. Material and methods: This study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke. Results: At 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs. Conclusions: ESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.

A Acessibilidade como veículo de inclusão social: proposta de dispositivo computacional para os deficientes visuais da cidade de Natal/RN

This study aims to propose a computing device mechanism which is capable to permit a tactile communication between individuals with visual impairment (blindness or low vision) through the Internet or through a local area network (LAN - Local Network Address). The work was developed under the research projects that currently are realized in the LAI (Laboratory of Integrated Accessibility) of the Federal University of Rio Grande do Norte. This way, the research was done in order to involve a prototype capable to recognize geometries by students considered blind from the Institute of Education and Rehabilitation of Blind of Rio Grande do Norte (IERC-RN), located in Alecrim neighborhood, Natal/RN. Besides this research, another prototype was developed to test the communication via a local network and Internet. To analyze the data, a qualitative and quantitative approach was used through simple statistical techniques, such as percentages and averages, to support subjective interpretations. The results offer an analysis of the extent to which the implementation can contribute to the socialization and learning of the visually impaired. Finally, some recommendations are suggested for the development of future researches in order to facilitate the proposed mechanism.

Characterization of the motor performance in infants with a diagnosis of Cerebral Palsy in process of rehabilitation: the importance of the proactivity of caregivers

Introduction: The progress in technology, associated to the high survival rate in premature newborn infants in neonatal intensive care units, causes an increase in morbidity. Individuals with CP present complex motor alterations, with primary deficits of abnormal muscle tone affecting posture and voluntary movement, alteration of balance and coordination, decrease of force, and loss of selective motor control with secondary problems of contractures and bone deformities.Objective: The aim of this work is to describe the spontaneous movement and strategies that lead infants with cerebral palsy to move.Methods: Seven infants used to receive assistance at the Essential Stimulation Center of CIAM (Israeli Center for Multidisciplinary Support - Philanthropic Institution), with ages ranging between six and 18 months with diagnosis of Cerebral Palsy (CP) were assessed.Results: The results show the difficulty presented by the infants with respect to the spontaneous motor functions and the necessity of help from the caregiver in order to perform the functional activity (mobility). Prematurity prevails as the major risk factor among the complications.Conclusion: The child development can be understood as a product of the dynamic interactions involving the infant, the family, and the context. Thus, the social interactions and family environment in which the infant live may encourage or limit both the acquisition of skills and the functional independence.

Between freedom and reclusion: Social support as a quality-of-life component in the family caregiver-dependent person binomial

This is a qualitative study which uses Grounded Theory as its methodological framework and Symbolic Interactionism as a theoretical base to understand the experience of family caregivers for Cerebrovascular Accident (CVA) patients with regard to social support during their rehabilitation process at home. The components (themes and categories) of the phenomenon assuming home care and specifically the themes assuming care with support and assuming care without support were inter-related for the purpose of comparison and analysis, in order to apprehend how the interaction between them occurred, It was observed that, in addition to the recovery of the patient's autonomy, social support is one of the intervenient components in the quality of life for the family caregiver-disabled person binomial, particularly with respect to the caregiver's freedom to resume his/her life plan.

Empresa social e economia solidária: perspectivas no campo da inserção laboral de portadores de transtorno mental

O processo da reforma psiquiátrica requer a implementação de políticas públicas que garantam a inserção laboral de portadores de transtorno mental. Para tal, é necessário que o trabalho seja compreendido como promotor de autonomia, de emancipação e de cidadania. O objetivo deste estudo é refletir acerca de concepções teóricas relacionadas à inserção social pelo trabalho, a fim de explorar o campo da inclusão de portadores de transtorno mental no mundo do trabalho. Foram escolhidos os conceitos de empresa social e de economia solidária como fundamentais para o estudo. Na empresa social, o sujeito é entendido como ser social, enfocando-se seu processo de formação no sentido da emancipação. Na economia solidária, objetiva-se o desenvolvimento de uma forma de economia mais justa que tem como característica a igualdade e a solidariedade. Sugerimos que a discussão desses conceitos possa contribuir para embasar a implantação de projetos de inclusão social pelo trabalho.

Rehabilitation with ear prosthesis linked to osseointegrated implants

Background: The absence of an ear, which can be the result of a congenital malformation, surgical tumour resection or traumatic injury, is a significant aesthetic problem. Attachment of ear prostheses with adhesives can cause local irritation for the wearer and affect the colour of the prostheses. Use of implants in craniofacial reconstruction can improve the retention and stability of prostheses giving to patient greater comfort and security relative to adhesive attachment.Objective: The aim of this report was to present a clinical case of a mutilated patient who was rehabilitated by means of installing an ear prosthesis fixed through osseointegrated implants.Materials and methods: The patient had two implants installed in the mastoid region that were linked by a bar, and a clip-type system was used. The ear prosthesis was constructed from medical-use silicone, pigmented to match the patient's skin colour and linked to the retention system.Conclusion: The patient's rehabilitation was satisfactory from both a functional and an aesthetic point of view, making it possible for the patient to return to a normal social life and regain lost self-esteem.