Background: A therapeutic model for supporting families of children with a chronic illness or disability is described. The model presupposes that the chronic illness and/or disability of a child constitutes a trauma for the entire family. Method: This paper describes a therapeutic model currently in practice and links it back to psychological dynamics addressed through the clinical interventions and the principles that underlie the model of service. Results: Service delivery comprises the interventions; counselling, psychological first aid, projects, peer groups, parent mentoring, social events and community education. The model is family centred, non-illness specific, preventative, non-linear and flexible. Conclusions: The interventions offered in the model aim to address the psychological dynamics of hope, empowerment, reconnection, coping/resilience and reframing.
Much of the information on which treatment decisions are based in elderly patients is derived from studies involving younger adults. The benefit to risk ratio of any given intervention may be quite different in frail older patients with significant comorbidities, and the applicability of such study findings to routine geriatric medical practice is therefore limited. The recruitment of significant numbers of elderly patients into trials is necessary to enable clinicians to make informed and rational therapeutic decisions in this expanding population.
IntroductionThe optimal model for stroke rehabilitation is unclear. In our service patients are transferred from an acute stroke unit to a dedicated 30 bed stroke rehabilitation unit (SRU) or to 1 of 10 stroke beds in a 28 bed geriatric rehabilitation unit (GRU) according to their address. Patient details and outcomes are recorded prospectively Methodology In a case controlled study 91 consecutive GRU admissions were matched with 91 SRU patients for age, sex, stroke classification and Barthel score on admission to rehabilitation. We compared survival, discharge destination, discharge function (Barthel score) and length of stay. Statisical analysis was with Wilcoxon Rank Sum and Mann-Whitney U tests.Results 91 (12 male) GRU patients aged 78 (62-95) years and 91 (15 male) SRU patients aged 79 (60-95) years were transferred at median day 7 post stroke. Admission Barthel scores were similar: GRU median 58 (range 2-99) and SRU 53 (0-100) 68% and 65% respectively had severe impairment (Barthel <70) There was no difference in outcomes of death/ several with impairment (GRU 23% : SRU 19%) discharge destination (home 72%:72%) median discharge
ConclusionStroke rehabilitation in the geriatric rehabilitation unit was as effective as that in the dedicated stroke rehabilitation unit and was associated with a reduction in length of stay
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