Goal setting is an important professional method and one of the key concepts that structure a practical field such as physical rehabilitation. However, the actual use of goals in rehabilitation practice is much less straightforward than the general acceptance of the method suggests as goals are frequently unattained, modified or contested. In this paper, I will argue that the difficulties of goal setting in day-to-day medical practice can be understood by unravelling the normative assumptions of goal setting, (...) in this case three different tensions that come along with it. First, goals are developed for a future state that may require activities that clash with necessities of the present situation. Second, professionals in clinical rehabilitation centres elaborate goals for an environment that differs in terms of spatial and social characteristics from the environment in the centre, where people train for the accomplishment of goals. Finally, goal setting requires active patient participation and individual control that sometimes appears impossible, unrealistic, and undesirable. I will describe how professionals deal with these tensions in a creative and dynamic way. With my articulation of the assumptions of goal setting, I hope to contribute to the self-reflection of rehabilitation practitioners as well as to theoretical discussions of goal setting in contexts other than rehabilitation. (shrink)

The purpose of this commentary is to consider circumstances under which it may be ethical to permit patients to use licit substances in rehabilitation contexts. While the content of this commentary may be transferable to other healthcare spaces, our focus on rehabilitation is based on some important distinctions that exist between rehabilitation and acute care spaces.

By now, the laboratory tradition, crafting transportable knowledge that allows for comparison, has been amply studied. However, other knowledge traditions, notably that of the clinic, deserve further articulation. The authors contribute to this by unraveling some specificities of rehabilitation practice. How do laboratory and clinical traditions in rehabilitation relate to independence? The first seeks to quantify people's independence; the latter attends to qualitatively different ways of being independent. While measuring independence is a matter of aggregating scores on a (...) priori established dimensions, clinical rehabilitation concerns coordinating different ways of being independent. While independence scales map a linear development in time, rehabilitation participants juggle with time, including uncertain futures in their present. In clinical practice, then, independence is neither a single, coherent, fact nor a clear-cut, stable goal. Instead, professionals as well as patients work by creatively doctoring with the large variety of elements that are relevant to daily life with long-term disabilities. (shrink)

Dynamic stability of the knee and weakness of the extensor muscles are considered to be the most important functional limitations after anterior cruciate ligament injury, probably due to changes at the central level of motor control rather than at the peripheral level. Despite general technological advances, fewer contraindicative surgical procedures, and extensive postoperative rehabilitation, up to 65% of patients fail to return to their preinjury level of sports, and only half were able to return to competitive sport. Later, it (...) becomes clear that current rehabilitation after knee surgery is not sufficient to address the functional limitations after ACL reconstruction even years after surgery. Therefore, new therapeutic tools targeting the central neural system, i.e., the higher centers of motor control, should be investigated and integrated into current rehabilitation practice. To improve motor performance when overt movement cannot be fully performed, several techniques have been developed to increase physical and mental activation without the need to perform overt movements. Among the most popular cognitive techniques used to increase physical performance are motor imagery and action observation practices. This review, which examines the available evidence, presents the underlying mechanisms of the efficacy of cognitive interventions and provides guidelines for their use at home. (shrink)

Using a longitudinal case study design, we have tracked the recovery of motor function following severe traumatic brain injury (TBI) through a multimodal neuroimaging approach. In 2006, Canadian Soldier Captain (retired) Trevor Greene (TG) was attacked with an axe to the head while on tour in Afghanistan. TG continues intensive daily rehabilitation, which recently included the integration of physical therapy (PT) with neuromodulation using translingual neurostimulation (TLNS) to facilitate neuroplasticity. Recent findings with PT+TLNS demonstrated that recovery of motor (...) function occurred beyond conventional time limits, currently extending past 14-years post-injury. To investigate whether PT+TLNS similarly resulted in associated cognitive function improvements, we examined event-related potentials (ERPs) with the brain vital signs framework. In parallel with motor function improvements, brain vital signs detected significant increases in basic attention (as measured by P300 response amplitude) and cognitive processing (as measured by contextual N400 response amplitude). These objective cognitive improvements corresponded with TG’s self-reported improvements, including a noteworthy and consistent reduction in ongoing symptoms of post-traumatic stress disorder (PTSD). The findings provide valuable insight into the potential importance of non-invasive neuromodulation in cognitive rehabilitation, in addition to initial indications for physical rehabilitation. (shrink)

@FP= Although rehabilitation is often considered a type of punishment for criminal offenders, its objectives are therapeutic rather than punitive. While some theories of punishment claim that criminals deserve to suffer for their crimes, the rehabilitative ideal views criminal behavior more like a disease that should be treated with scientific methods available to cure the offender. Many convicts suffer from mental and physical illness, drug addiction, and limited opportunities for economic success and these problems increase the likelihood that (...) they will engage in criminal activity. If we simply incarcerate the convict while she “pays her debt to society,” she will likely reenter it with all of the obstacles that drove her to crime still in place. She will also need to contend with additional difficulties: a criminal record will impact her employment opportunities, she will be older and still without marketable skills or education, her social relationships may have deteriorated while she was in jail, and she may have become further acclimated to criminal culture. Thus incarcerating offenders could actually make them more likely to commit offenses after they are released, and recidivism rates attest to this. A rehabilitative approach would attempt to treat the underlying cause of her transgressions so that she can return to society to become a full and productive citizen. In other words, instead of exacting revenge against criminals and making their lives worse, rehabilitation tries to help them. (shrink)

The implications for the substantivalist–relationalist controversy of Barbour and Bertotti's successful implementation of a Machian approach to dynamics are investigated. It is argued that in the context of Newtonian mechanics, the Machian framework provides a genuinely relational interpretation of dynamics and that it is more explanatory than the conventional, substantival interpretation. In a companion paper (Pooley [2002a]), the viability of the Machian framework as an interpretation of relativistic physics is explored. 1 Introduction 2 Newton versus Leibniz 3 Absolute space versus (...) an affine connection 4 Anti-relationalist arguments 5 Rehabilitating relationalism 6 Dynamics on the relative configuration space 7 Intrinsic particle dynamics 8 Conclusion. (shrink)

RESUMEN El artículo constituye una propuesta encaminada a dar respuesta a la necesidad social de la superación del profesor de Educación Física del Centro de Experiencia del Adulto Mayor. Se propone como objetivo fundamentar la estrategia para la superación del profesor de Educación Física dirigida a la rehabilitación acuática de los adultos mayores con limitaciones articulares, desde una visión de ciencia, tecnología y sociedad. Se reconoce la oportunidad que representa el empleo de las nuevas tecnologías como elemento que contribuye a (...) la mejora de la calidad de vida de las personas mayores. La magnitud del reto exige la puesta en acción de todos los resortes con los que la sociedad cuenta, para la atención al envejecimiento, mediante diversos programas, cuya significación contribuye a fortalecer la identidad nacional, y a elevar la cultura general integral de los profesores hacia los adultos mayores lo cual repercutirá en la formación de una conciencia social, política y cultural. ABSTRACT The article constitutes a proposal directed to give answer to the social need for the self-improvement of the teacher of Physical Education of the Center of Experience of the Elder Adult. It proposes as objective: to base the strategy for the self-improvement of the teacher of Physical Education directed to the aquatic rehabilitation of the elderly with articular limitations, from a vision of science, technology and society. It is recognized the opportunity that represents the employment of the new technologies as element that contributes to the progress of the quality of life of the elderly. The magnitude of the challenge demands the putting in action of all the springs with which the society is provided, for the attention to the aging, by means of diverse programs, which significance helps to strengthen the national identity, and to raise the integral general culture of the teachers towards the elderly which will reverberate in the formation of a social, political and cultural conscience. (shrink)

In his Kritik der reinen Vernunft, Kant asserts that laws of nature “carry with them an expression of necessity”. There is, however, widespread interpretive disagreement regarding the nature and source of the necessity of empirical laws of natural sciences in Kant's system. It is especially unclear how chemistry—a science without a clear, straightforward connection to the a priori principles of the understanding—could contain such genuine, empirical laws. Existing accounts of the necessity of causal laws unfortunately fail to illuminate the possibility (...) of non-physical laws. In this paper, I develop an alternative, ‘ideational’ account of natural laws, according to which ideas of reason necessitate the laws of some non-physical sciences. Chemical laws, for instance, are grounded on ideas of the elements, and the chemist aims to reduce her phenomena to these elements via experimentation. Although such ideas are beyond the possibility of experience, their postulation is necessary for the achievement of reason's theoretical ends: the unification and explanation of the cognitions of science. (shrink)

I argue that the conviction, widespread among philosophers, that substantivalism enjoys a clear superiority over relationalism in both Newtonian and relativistic physics is ill-founded. There are viable relationalist approaches to understanding these theories, and the substantival-relational debate should be of interest to philosophers and physicists alike, because of its connection with questions about the correct space of states for various physical theories.

Background: Autonomy is a central concept in both bioethics and rehabilitation. Bioethics has emphasized autonomy as self-governance and its application in treatment decision-making. In addition to discussing decisional autonomy, rehabilitation also focuses on autonomy as functional independence. In practice, responding to patients with diminished autonomy is an important component of rehabilitation care, but also gives rise to tensions and challenges. Our objective was to better understand the complex and distinctive ways that autonomy is understood and upheld in (...) the context of rehabilitation care by reviewing how autonomy is discussed in the rehabilitation literature. Methods: We conducted a scoping review addressing issues of autonomy in the context of mental and physical rehabilitation. Our process followed three sequential steps. We extracted and analyzed bibliometric information. We then examined how autonomy was defined and conceptualized. Finally, we examined how the articles discussed the roles of rehabilitation health professionals in responding to patient autonomy. Findings: The articles include 16 empirical reports, 17 case studies and 30 theoretical papers. The most common conceptual accounts of autonomy drew upon principlism, rights-based and legal analyses, and relational/social approaches. We identified four broad approaches for responding to patient autonomy: supporting, promoting, respecting and advocating. Conclusion: This review helps clarify some of the ambiguities and conceptual distinctions underlying discussions and practices related to autonomy in rehabilitation. It also draws attention to a wide range of activities that health professionals can undertake with the goal of supporting, promoting, respecting and advocating for patient autonomy in rehabilitation care. (shrink)

In a companion paper (Pooley & Brown 2001) it is argued that Julian Barbour's Machian approach to dynamics provides a genuinely relational interpretation of Newtonian dynamics and that it is more explanatory than the conventional, substantival interpretation. In this paper the extension of the approach to relativistic physics is considered. General relativity, it turns out, can be reinterpreted as a perfectly Machian theory. However, there are difficulties with viewing the Machian interpretation as more fundamental than the conventional, spacetime interpretation. Moreover, (...) this state of affairs provides little solace for the relationist for, even when interpreted along Machian lines, general relativity is a substantival theory although the basic entity is space, not spacetime. (shrink)

Rehabilitation medicine, aka Physical medicine and Rehabilitation , is the medical specialty which focuses on optimizing function, ability, participation and life satisfaction in the light of noncurable disability and/or chronic disease. It is primarily geared towards the “so what” than towards “what” . PM & R is holistic and patient-centred, thus comprising a well-suited arena for dialogue and patient participation. Many patients experience a severe crisis reaction in the aftermath of major trauma or disease. This “existential rupture” (...) calls for a fundamental revaluation of many aspects of daily life. Crisis management will not merely be a matter of mourning and then back to “business as usual,” as this often is either not possible or not the optimal choice given altered life circumstances. We propose that philosophical practice may be an important addition to the rehabilitation process, by facilitating “lifeworld analyses” and thereby making it possible for the patient to find sources of meaning in life despite disability. This “therapy for the sane” comprises PP rather than psychiatric or psychotherapeutic interventions, and may come to be seen as a key aspect in the training of future physiatrists and other rehabilitation specialists. (shrink)

Using Harvey Sacks’s concept of membership categorization devices, this article examines the help-search sequences in which Japanese rehabilitation team members use a set of categories to locate the availability of stroke family caregivers. Specifically, based on an analysis of audiovisual data from rehabilitation team conferences in Japan, the article illustrates the ways in which participants at the meetings: evaluate the expectable behaviors of various category incumbents; classify which category of person is proper to turn to for help; and (...) arrive at the conclusion that no one is available, and so the patient must be institutionalized. Analysis shows that participants routinely choose co-resident family members to fulfill the caregiver position. However, the position is not guaranteed unless the selected incumbent can satisfy additional criteria, especially physical strength and time availability. By exploring the ways in which participants use categories to negotiate discharge destinations, the article adds to Sacks’s analysis by illustrating methodical activities for deciding whether someone is unavailable to help. Moreover, it considers the applicability of Sacks’s notion of MCDs to Japanese data. (shrink)

Background: The new human coronavirus that leads to COVID-19 has spread rapidly around the world and has a high degree of lethality. In more severe cases, patients remain hospitalized for several days under treatment of the health team. Thus, it is important to develop and use technologies with the aim to strengthen conventional therapy by encouraging movement, physical activity, and improving cardiorespiratory fitness for patients. In this sense, therapies for exposure to virtual reality are promising and have been shown (...) to be an adequate and equivalent alternative to conventional exercise programs.Aim: This is a study protocol with the aim of comparing the conventional physical therapy intervention with the use of a non-immersive VR software during COVID-19 hospitalization.Methods: Fifty patients hospitalized with confirmed diagnosis of COVID-19 will be divided in two groups under physiotherapy treatment using conventional or VR intervention: Group A: participants with COVID-19 will start the first day of the protocol with VR tasks in the morning and then in the second period, in the afternoon, will perform the conventional exercises and Group B: participants with COVID-19 will start the first day with conventional exercises in the morning and in the second period, in the afternoon, will perform activity with VR. All participants will be evaluated with different motor and physiologic scales before and after the treatment to measure improvements.Conclusion: Considering the importance of benefits from physical activity during hospitalization, VR software shows promise as a potential mechanism for improving physical activity. The results of this study may provide new insights into hospital rehabilitation.Trial Registration:ClinicalTrials.gov, identifier: NCT04537858. Registered on 01 September 2020. (shrink)

With the world's population aging, hospitals are facing pressure to adequately meet the needs of a growing number of frail older patients. For this population, comorbidities combined with a limited ability to face stressful situations contribute to frailty whereby a small injury or illness can lead to significant loss of function. It is widely recognized that hospitalized older patients are more vulnerable to physical or cognitive functional decline and require increased assistance in activities of daily living (Creditor 1993; Sager (...) et al. 1996; Mahoney, Sager, and Jalaluddin 1998; Kortebein et al. 2008; English and PaddonJones 2010; Covinsky, Pierluissi, and Johnston 2011; Zisberg et al. 2011;... (shrink)

During the last fifty years, a large part of aristotelian commentarism has been consecrated to Aristotle’s methodology as well in Metaphysics as in Physics. However the last step of Aristotelian research, that is to discover and say the solution of the problem, has been very neglected. This paper wishes to show the philosophical importance of the use of Aristotelian λύσις and her link with dialectic in some cases, but also with science in the most part of the cases.

Patients with strokes to the Anterior Communicating Artery pose an important challenge to rehabilitation teams due to a particular mix of cognitive and behavioral impairments. These deficits often compromise engagement with rehabilitation, learning and generalization. The goal of this article is to describe the long-term presentation of a patient with an ACoA stroke as well as her rehabilitation needs and the many challenges experienced by the rehabilitation team when attempting to facilitate functional, vocational and psychosocial recovery. (...) Based on this case, and the existing literature, a neuropsychological rehabilitation framework to understand and address the specific problems and needs of this population is proposed. This framework demands rehabilitation teams to consider: the slow pattern of recovery of this population, the interaction between cognitive and behavioral impairments, the relevance of physical and social environments, the value of personal projects and the need to include psychological and relational interventions. (shrink)

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering a medical intervention is outweighed. For example, if an individual’s refusal to undergo a medical intervention would lead to the transmission of a dangerous infectious disease to other members of (...) the community, one might claim that it would be morally permissible to administer the intervention even in the absence of consent. Indeed, as we shall discuss below, there are a number of examples of public health authorities implementing compulsory or coercive measures for the purposes of infectious disease control (IDC). The plausibility of the thought that non-consensual medical interventions might be justified when performed for the purpose of IDC raises the question of whether such interventions might permissibly be used to realize other public goods. In this article we focus on one possibility: whether it could be permissible to non-consensually impose certain interventions that alter brain states or processes through chemical or physical means on serious criminal offenders. We shall suggest that some such interventions might be permissible if they safely and effectively serve to facilitate the offender’s rehabilitation and thereby prevent criminal recidivism. (shrink)

ObjectiveTo assess the impact of the closure of group-based cardiac rehabilitation training during the first COVID-19 lockdown in spring 2020 on patients’ physical activity, cardiorespiratory fitness, and cardiovascular risk, and to describe the patient experience of lockdown and home-based exercise training during lockdown.DesignMixed methods study. Prospectively collected post-lockdown measurements were compared to pre-lockdown medical record data. Quantitative measurements were supplemented with qualitative interviews about the patient experience during lockdown.SettingOutpatient CR centre in Salzburg, Austria.ParticipantsTwenty-seven patients [six female, mean age (...) 69 years] who attended weekly CR training sessions until the first COVID-19 lockdown in March 2020.Outcome MeasureQuantitative: exercise capacity, cardiovascular risk. Qualitative: individual semi-structured interviews.ResultsExercise capacity had significantly reduced from pre- to post-lockdown: mean power in maximal ergometry 165 vs. 151, p < 0.001; submaximal ergometer training 99 vs. 97, p = 0.038. There was no significant difference in Framingham risk score and other cardiovascular risk factors. Qualitative data showed that almost all patients had kept physically active during lockdown, but 17 said they had been unable to maintain their exercise levels, and 15 felt their cardiorespiratory fitness had deteriorated. Many patients missed the weekly CR training and the motivation and sense of community from training together with others. Several patients stated that without professional supervision they had felt less confident to carry out home-based exercise training at high intensity.ConclusionThis study highlights the importance of group-based supervised exercise training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service on physical activity levels and exercise capacity. Additionally, learning from the COVID-19 pandemic may inform the development and implementation of remote CR modalities going forward. (shrink)

Pulmonary rehabilitation has demonstrated patients’ physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit. A 12-week community-based PR will be implemented (...) in primary healthcare centres where programmes are not available. Healthcare professionals will be trained. 73 patients with CRD and their caregivers will compose the experimental group. The control group will include dyads age- and disease-matched willing to collaborate in data collection but not in PR. Patients/family-centred outcomes will be dyspnoea, fatigue, cough and sputum, impact of the disease, emotional state, number of exacerbations, healthcare utilisation, health-related quality of life and family adaptability/cohesion. Other clinical outcomes will be peripheral and respiratory muscle strength, muscle thickness and cross sectional area, exercise capacity, balance and physical activity. Data will be collected at baseline, at 12 weeks, at 3- and 6-months post-PR. Changes in the outcome measures will be compared between groups, after multivariate adjustment for possible confounders, and effect sizes will be calculated. A cost-benefit analysis will be conducted. This study will enhance patients access to PR, by training healthcare professionals in the local primary healthcare centres to conduct such programmes and actively involving caregivers. The cost-benefit analysis of this intervention will provide an evidence-based insight into the economic benefit of community-based PR in chronic respiratory diseases. The trial was registered in the ClinicalTrials. gov U.S. National Library of Medicine, on 10th January, 2019. (shrink)

Multiple cortical areas of the human brain motor system interact coherently in the low frequency range (< 0.1 Hz), even in the absence of explicit tasks. Following stroke, cortical interactions are functionally disturbed. How these interactions are affected and how the functional organization is regained from rehabilitative treatments as people begin to recover motor behaviors has not been systematically studied. We recorded the intrinsic functional magnetic resonance imaging (fMRI) signals from 30 participants: 17 young healthy controls and 13 aged stroke (...) survivors. Stroke participants underwent mental practice (MP) or both mental practice and physical therapy (MP + PT) within 14-51 days following stroke. We investigated the network activity of five core areas in the motor-execution network, consisting of the left primary motor area (LM1), the right primary motor area (RM1), the left pre-motor cortex (LPMC), the right pre-motor cortex (RPMC) and the supplementary motor area (SMA). We discovered that (i) the network activity dominated in the frequency range 0.06 Hz – 0.08 Hz for all the regions, and for both able-bodied and stroke participants (ii) the causal information flow between the regions: LM1 and SMA, RPMC and SMA, RPMC and LM1, SMA and RM1, SMA and LPMC, was reduced significantly for stroke survivors (iii) the flow did not increase significantly after MP alone and (iv) the flow among the regions during MP+PT increased significantly. We also found that sensation and motor scores were significantly higher and correlated with directed functional connectivity measures when the stroke-survivors underwent MP+PT but not MP alone. The findings provide evidence that a combination of mental practice and physical therapy can be an effective means of treatment for stroke survivors to recover or regain the strength of motor behaviors, and that the spectra of causal information flow can be used as a reliable biomarker for evaluating rehabilitation in stroke survivors. (shrink)

Taking regular walks when living with Parkinson’s disease has beneficial effects on movement and quality of life. Yet, patients usually show reduced physical activity compared to healthy older adults. Using auditory stimulation such as music can facilitate walking but patients vary significantly in their response. An individualized approach adapting musical tempo to patients’ gait cadence, and capitalizing on these individual differences, is likely to provide a rewarding experience, increasing motivation for walk-in PD. We aim to evaluate the observance, safety, (...) tolerance, usability, and enjoyment of a new smartphone application. It was coupled with wearable sensors and delivered individualized musical stimulation for gait auto-rehabilitation at home. Forty-five patients with PD underwent a 1-month, outdoor, uncontrolled gait rehabilitation program, using the BeatWalk application. The music tempo was being aligned in real-time to patients’ gait cadence in a way that could foster an increase up to +10% of their spontaneous cadence. Open-label evaluation was based on BeatWalk use measures, questionnaires, and a six-minute walk test. Patients used the application 78.8% of the prescribed duration and enjoyed it throughout the program. The application was considered “easy to use” by 75% of the patients. Pain, fatigue, and falls did not increase. Fear of falling decreased and quality of life improved. After the program, patients improved their gait parameters in the six-minute walk test without musical stimulation. BeatWalk is an easy to use, safe, and enjoyable musical application for individualized gait rehabilitation in PD. It increases “walk for exercise” duration thanks to high observance.Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02647242. (shrink)

The physical activity-related health competence model assumes that individuals require movement competence, control competence, and self-regulation competence to lead a healthy, physically active lifestyle. Although previous research has already established some measurement factors of the three dimensions, no attempts have so far been made to statistically aggregate them on the sub-competence level. Therefore, the goal of the present study was to test two additional factors for PAHCO and subsequently model the second-order structure with two samples from the fields of (...) rehabilitation and prevention. We conducted two questionnaire surveys with persons with multiple sclerosis and teaching students undergoing a basic qualification course in physical education. After performing exploratory items analysis, we used second-order confirmatory factor analysis and multidimensional scaling to investigate whether the scales could be bundled in accordance with the PAHCO model. The CFAs with 10 factors demonstrated a good model fit. In contrast, the second-order analysis with a simple loading structure on the three sub-competencies revealed an unacceptable model fit. Instead, a second-order model variant was preferred [comparative fit index = 0.926, root mean square error of approximation = 0.048, standardized root mean square residual = 0.065] in which body awareness and self-efficacy had theory-conform cross-loadings. The results of multidimensional scaling were in line with the extracted second-order structure. The present results suggested that the extension of the measurement instrument to 10 first-order factors was psychometrically justified for the two populations. The results from the second-order analyses provided the basis for the creation of sum scores, representing manifest indicators of movement competence, control competence, and self-regulation competence. Future studies are needed that cross-validate the extended measurement model with other populations and that relate the sub-competencies of PAHCO to indicators of health-enhancing physical activity. (shrink)

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion (...) template consisting of a series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values. (shrink)

In the formation of the multi-disciplinary field that investigates the participation of disabled persons in all forms of physical activity, little ethical and philosophical work has been published. This essay serves to contextualise a range of issues emanating from adapted physical activity (APA) and disability sports. First, we offer some general historical and philosophical remarks about the field which serve to situate those issues at the crossroads between the philosophy of disability and the philosophy of sports. Secondly, we (...) bring brief but critical attention to the contestation of key concepts such as ?ability? and ?normality? and the recent criticisms of polarisation of the medical and social models of disability. Finally, we show how these conceptual issues are implicated in the whole spectrum of contexts of APA and disability sports from the ethics of research with and for the disabled, to coaching, rehabilitation and teaching, and sports administration, that are predicated on key ethical concepts including empathy, entitlement and equity. (shrink)

To assess—from a qualitative perspective—the perceptions and attitudes of Spanish rehabilitation professionals (e.g. rehabilitation doctors, speech therapists, physical therapists) about Brain–Computer Interface (BCI) technology. A qualitative, exploratory and descriptive study was carried out by means of interviews and analysis of textual content with mixed generation of categories and segmentation into frequency of topics. We present the results of three in-depth interviews that were conducted with Spanish speaking individuals who had previously completed a survey as part of a (...) larger, 3-country/language, survey on BCI perceptions. 11 out of 15 of these Spanish respondents (survey) either strongly or somewhat accept the use of BCI in rehabilitation therapy. However, the results of our three in-depth interviews show how, due to a strong inertia of attitudes and perceptions about BCI technology, most professionals feel reluctant to use BCI technology in their daily practice (interview). (shrink)

This paper addresses the relatively overlooked field of rehabilitation and physical medicine, offering an epistemological perspective on clinical reasoning in these disciplines, focusing on three different domains: diagnosis, prognosis, and treatment. Rehabilitation sciences, often overshadowed by medicine and nursing, present unique challenges in terms of clinical reasoning. We explore these challenges, highlighting the distinctive features that set rehabilitation apart from clinical medicine. Notably, rehabilitation focuses on functions, aiming to improve an individual’s quality of life, setting (...) it apart from disease-centered medicine. Drawing also from philosophical insights in nursing literature, we offer a multidisciplinary perspective on the epistemological dimensions of rehabilitation and physical medicine, shedding light on their placement within healthcare disciplines. (shrink)

This study focuses on a 12-year-old girl diagnosed with a pragmatic disorder caused by Autism Spectrum Disorder (ASD). Following an initial evaluation, a pragmatic rehabilitation program was implemented using a combined approach in 15 therapeutic sessions over a 4-month period. The program consisted of structured formats organized into modules to train the verbal, paralinguistic, and nonverbal aspects of communication. The results of the re-evaluation demonstrated the program’s effectiveness, with improvements in communicative intention, proxemic skills, prosodic variations, physical contact (...) with the interlocutor, and verbal fluency in oral messages. Consequently, the implementation of the intervention program significantly enhanced the patients’ pragmatic communication skills in therapeutic, familial, and social contexts. (shrink)

COVID-19 Lockdown was particularly challenging for most mothers of people with intellectual disabilities, including those with Rett syndrome, leading to feelings of abandonment from healthcare services of their children. Within those days, telerehabilitation has represented a valid alternative to support physical activity and treatment, supporting parents in structuring their children’s daily routine at home. This article aims to describe the well-being level of two groups of mothers of girls and women with RTT who were involved in a home-based remotely (...) supervised motor rehabilitation program, respectively, before and during the COVID-19 Italian lockdown. Forty participants with classic RTT were recruited before the lockdown and randomly assigned to two groups that performed the intervention immediately before and during the lockdown, respectively. The intervention included an individualized daily physical activity program carried out for 12 weeks by participants’ parents and fortnightly supervised throughout Skype contacts to plan, monitor, and accommodate individual activities in the participant’s life at home. The short form Caregivers Well-Being Scale was collected for the mothers in each group 12 weeks before intervention, at intervention initiation, immediately after intervention termination, as well as at 12 weeks after intervention termination. Mothers of participants in the Group 1 showed a stable level of well-being across all four evaluations with a slight improvement during the lockdown, without significant change. Similarly, the well-being level of mothers in the Group 2 showed a statistically significant increase in their well-being between T2 and T3 and its reduction to the pre-intervention level between T3 and T4. The results suggest that the lockdown did not negatively affect the participants’ mothers’ well-being, leading to its improvement. Moreover, the proposed intervention could have supported the mothers in managing the new daily routine at home, positively affecting maternal well-being. (shrink)

Every day, millions of people use mobile phones, play video games and surf the Internet. It is thus important to determine how technologies like these change what people think and how they behave. This is a central issue in the study of persuasive technologies. ‘Persuasive technologies’—henceforth ‘PTs’—are digital technologies, such as mobile apps, video games and virtual reality systems, that are deployed for the explicit purpose of changing attitudes and/or behaviours, without using coercion, deception or extreme forms of psychological manipulation (...) (such as hypnosis or indoctrination), and without exerting a direct (not psychologically mediated) physical effect on the brain. Typically PTs employ strategies such as prompting, information provision and encouragement... (shrink)

BackgroundChronic airway diseases are prevalent and costly conditions. Interdisciplinary rehabilitation programs that include Acceptance and Commitment-based components could be important to tackle the vicious circle linking progression of the disease, inactivity, and psychopathological symptoms.MethodsA retrospective evaluation of routinely collected data of an interdisciplinary rehabilitation program was performed. The program included group sessions including patient education, breathing exercise, occupational therapy and an ACT-based psychological treatment, and individual sessions of physical therapy. Demographic data, clinical characteristics of the patients and (...) the values of outcome variables before treatment, at discharge, at 3 months, and at 6 months were extracted from medical records. Multiple imputation was employed to address missing data. Linear mixed models were employed to assess changes over time. Multivariable logistic regression was performed to assess predictors of a minimum clinically important change of health status from baseline to the 6-months follow-up.ResultsData from 31 patients with chronic obstructive pulmonary disease and 12 patients with bronchiectasis were extracted. Health status improved from baseline to discharge to the 3 months follow-up, but not to the 6 months follow-up. Anxiety and depression improved across all the time points. Quality of life did not improve over time. Having a worse health status at baseline and fewer depressive symptoms were significantly associated with achieving a minimum clinically important change of health status at 6 months. The effects of the interdisciplinary program were not different for patients with COPD or with bronchiectasis.DiscussionInterdisciplinary programs including ACT-based components are promising treatments for the rehabilitation of patients with chronic airway diseases. (shrink)

Throughout the Western world people turn towards the health care system seeking help for a variety of psychosomatic/psychosocial health problems. They become “patients” and find themselves within a system of practises that conceptualizes their bodies as “objective” bodies, treats their ill health in terms of the malfunctioning machine, and compartmentalizes their lived experiences into medically interpreted symptoms and signs of underlying biological dysfunction. The aim of this article is to present an alternative way of describing ill health and rehabilitation (...) using the philosophy of Maurice Merleau-Ponty in order to deepen our understanding of the rehabilitation process. I will explore how the experience of chronic pain ruptures the natural connection between body and world and how the rehabilitation process can be understood as the re-insertion of the body into the flow of experience, where the body “disappears” into its natural silence in order to allow the world to once again unfold. The experience of chronic pain places the painful body in focus, resulting in a diminished articulation of both self and world. Persons with illness suffer not only from the physical aspects of pain and discomfort but also from a loss of identity where one feels alienated and detached from things that used to give meaning to ones life. Rehabilitation must not only address the material (medical) body but also the diminished sense of self as well as the retreat from the world outside of the painful body. (shrink)

In this chapter, I argue that Aristotle’s doctrine of hylomorphism, which conceived the natural world as consisting of substances which are metaphysically composed of matter and form, is ripe for rehabilitation in the light of quantum physics. I begin by discussing Aristotle’s conception of matter and form, as it was understood by Aquinas, and how Aristotle’s doctrine of hylomorphism was ‘physicalised’ and eventually abandoned with the rise of microphysicalism. I argue that the phenomenon of quantum entanglement, and the emergence (...) of irreducibly macroscopic phenomena in finite temperature quantum systems, have given us good reasons to doubt the truth of microphysicalism. In support of my argument, I show how to construct a hylomorphic interpretation of the de Broglie-Bohm theory that posits a single Cosmic Substance. I then show how to construct a hylomorphic interpretation of an alternative ‘contextual’ wave function collapse theory (recently proposed by the physicists Barbara Drossel and George Ellis) which posits a plurality of thermal substances. Both of these neo-Aristotelian ontologies reject the microphysicalist dogma that nature consists solely of some set of microscopic constituents. (shrink)

This article focuses on ethical concerns about modifying physical activities within a variety of education, recreation, rehabilitation and competition contexts. An ecological frame of reference common within current educational and rehabilitation theories is utilised for reflecting upon adapted physical activity practices. Ethical principles challenged in the article are (a) the utilitarian consequence to all participants; (b) professional paternalism; and (c) empowerment of individuals with a disability. Concerns arising with respect to these ethical principles in adapted (...) class='Hi'>physical activity practices are discussed across modifications in terms of (i) the tasks involved; (ii) the environmental conditions; (iii) the equipment used; (iv) the game rules; and (v) the instruction methods. (shrink)

"From all things One and from One all things," wrote the ancient Greek philosopher Heraclitus. You might read this as a platitude, or as a pleasant spiritual or philosophical idea. You probably wouldn't read it as a more-or-less accurate scientific statement about the nature of the universe. Particle physicist Heinrich Päs, however, does. In The One, Päs makes the surprising and compelling case for monism-the philosophical idea that one single, all-encompassing thing underlies everything we experience-rehabilitating the idea's reputation and reclaiming (...) it for science. At first glance, the idea that "all is one" seems patently absurd. But Päs reveals that monism follows logically from certain principles of quantum mechanics once they are applied to the entire universe. He shows how monism is not only a feasible theory from a scientific perspective but a potentially powerful solution to the stagnation of thought in contemporary physics, arguing that if physics is ever to progress, physicists must learn to embrace insights from outside the narrow silo of experimental knowledge. Along the way, Päs traces monism's often-buried 3000-year history, passing through the lives of a diverse array of great thinkers, including Plato, Galileo, Spinoza, and Goethe, and the churchmen, philosophers, and physicists who fought against monism as well. The result is an epic and expansive journey through thousands of years of human thought and into the nature of reality itself. Equal parts physics, philosophy, and history of ideas, The One is of the rare sort of book that can both the first-time reader with its marvels and revolutionize the worldview of even the most experienced physics buff. (shrink)

Leibniz once argued that scholastic substantial forms do not exist, but he later emphasized that bodies have substantial forms. This implies that he assumed that bodies have intrinsic powers to act by themselves. In order to understand the change of his metaphysics, we need to identify the resources of his motivation to introduce a new view. On the basis of Leibniz’s early works in the 1670s and 80s, this paper explores how his discovery of the law that the quantity of (...) force, measured by mv2, is conserved, affected his development of metaphysics, and argues that the discovery actually motivated him to assume that there are enduring substantial forms in bodies, introducing an argument to establish the existence of forms on the basis of an early work. In the final section of the paper, I examine Daniel Garber’s interpretation according to which the discovery of the conservation law is largely independent of Leibniz’s rehabilitation of substantial forms. (shrink)

Through both an historical and philosophical analysis of the concept of possibility, we show how including both potentiality and actuality as part of the real is both compatible with experience and contributes to solving key problems of fundamental process and emergence. The book is organized into four main sections that incorporate our routes to potentiality: (1) potentiality in modern science [history and philosophy; quantum physics and complexity]; (2) Relational Realism [ontological interpretation of quantum physics; philosophy and logic]; (3) Process Physics (...) [ontological interpretation of relativity theory; physics and philosophy]; (4) on speculative philosophy and physics [limitations and approximations; process philosophy]. We conclude that certain fundamental problems in modern physics require complementary analyses of certain philosophical and metaphysical issues, and that such scholarship reveals intrinsic features and limits of determinism, potentiality and emergence that enable, among others, important progress on the quantum theory of measurement problem and new understandings of emergence. (shrink)

Galileo's refutation of the speed-distance law of fall in his Two New Sciences is routinely dismissed as a moment of confused argumentation. We urge that Galileo's argument correctly identified why the speed-distance law is untenable, failing only in its very last step. Using an ingenious combination of scaling and self-similarity arguments, Galileo found correctly that bodies, falling from rest according to this law, fall all distances in equal times. What he failed to recognize in the last step is that this (...) time is infinite, the result of an exponential dependence of distance on time. Instead, Galileo conflated it with the other motion that satisfies this ‘equal time’ property, instantaneous motion. (shrink)

Motor imagery is often used inducing changes in electroencephalographic (EEG) signals for imagery-based brain-computer interfacing (BCI). A BCI is a device translating brain signals into control signals providing severely motor-impaired persons with an additional, non-muscular channel for communication and control. In the last years, there is increasing interest using BCIs also for healthy people in terms of enhancement or gaming. Most studies focusing on improving signal processing feature extraction and classification methods, but the performance of a BCI can also be (...) improved by optimizing the user’s control strategies, e.g., using more vivid and engaging mental tasks for control. We used multichannel EEG to investigate neural correlates of a sports imagery task (playing tennis) compared to a simple motor imagery task (squeezing a ball). To enhance the vividness of both tasks participants performed a short physical exercise between two imagery sessions. EEG was recorded from 60 closely spaced electrodes placed over frontal, central, and parietal areas of 30 healthy volunteers divided in two groups. Whereas Group 1 (EG) performed a physical exercise between the two imagery sessions, Group 2 (CG) watched a landscape movie without physical activity. Spatiotemporal event-related desynchronization (ERD) and event-related synchronization (ERS) patterns during motor imagery (MI) tasks were evaluated. The results of the EG showed significant stronger ERD patterns in the alpha frequency band (8–13 Hz) during MI of tennis after training. Our results are in evidence with previous findings that MI in combination with motor execution has beneficial effects. We conclude that sports MI combined with an interactive game environment could be a future promising task in motor learning and rehabilitation improving motor functions in late therapy processes or support neuroplasticity. (shrink)

In their seeking of simplicity, scientists fall into the error of Whitehead's "fallacy of misplaced concreteness." They mistake their abstract concepts describing reality for reality itself--the map for the territory. This leads to dogmatic overstatements, paradoxes, and mysteries such as the deep incompatibility of our two most fundamental physical theories--quantum mechanics and general relativity. To avoid such errors, we should evoke Whitehead's conception of the universe as a universe-in-process, where physical relations perpetually beget new physical relations. Today, (...) the most promising interpretations of quantum mechanics exemplify this Whiteheadian idea, formalizing physical systems, and the universe itself, as ongoing histories of actualizations of potential states, where actual states and potential states exist in mutually implicative relation as two separate categories of reality—an idea first proposed by Aristotle and rehabilitated by Heisenberg. In these interpretations, the classical conception of a history as a derivative story about fundamental physical objects is reversed: the classical physical object becomes the derivative story about fundamental histories of quantum states. The consistent histories interpretation of Robert Griffiths and the decoherent histories interpretation of Roland Omnès are cardinal examples of this approach to quantum mechanics. Another example, the relational realist interpretation, begins with the decoherent histories approach and formalizes it explicitly as a Whiteheadian interpretation, taking his “algebraic method” and applying it to quantum mechanics via algebraic topology. This branch of mathematics can be thought of as a “de-concretized” geometry in that it focuses only on the logical relations among objects and regions (and relations of these relations) rather than the fixed magnitudes of lines, planes, and other such rigid intervals. It has all the robust logical structure of geometry yet allows for an elasticity of relations that makes topological mathematical structures inherently immune misplaced concretization. (shrink)

In the history of quantum physics several no-go theorems have been proved, and many of them have played a central role in the development of the theory, such as Bell’s or the Kochen–Specker theorem. A recent paper by F. Laudisa has raised reasonable doubts concerning the strategy followed in proving some of these results, since they rely on the standard framework of quantum mechanics, a theory that presents several ontological problems. The aim of this paper is twofold: on the one (...) hand, I intend to reinforce Laudisa’s methodological point by critically discussing Malament’s theorem in the context of the philosophical foundation of quantum field theory; secondly, I rehabilitate Gisin’s theorem showing that Laudisa’s concerns do not apply to it. (shrink)

Background:Women's health has received renewed attention in the last few years including health rehabilitation options for women affected by breast cancer. Dancing has often been regarded as one attractive option for supporting women's well-being and health, but research with women recovering from breast cancer is still in its infancy. Dancing with Health is multi-site pilot study that aimed to evaluate a dance programme for women in recovery from breast cancer across five European countries.Methods:A standardized 32 h dance protocol introduced (...) a range of Latin American dances presented within a sports and exercise framework with influences from dance movement therapy. Fifty-four women (M age 53.51; SD 7.99) participated in the study who had a breast cancer diagnosis 6 weeks, no indication of metastasis, or scheduled surgery/chemotherapy/radiation treatment for the duration of the intervention. Primary outcome data was collected for anthropometric and fitness measures next to cancer-related quality of life.T-tests and Wilcoxon signed ranked tests were used to establish differences pre and post intervention. Cohen's d was also calculated to determine the effect size of the intervention.Results:Statistically significant changes were found for: (i) weight, right and left forearm circumference and hip; (ii) 6 min walking, right and left handgrip, sit-to-stand and sit-and-reach; (iii) the EORTC-QLQ C30 summary score as well as the subscales of emotional and social functioning and symptoms. In all cases the direction of change was positive, while Cohen's d calculated showed that the effect of the intervention for these parameters ranged from intermediate to large.Conclusion:Changes on the above anthropometric, fitness and quality of life measures suggest that the intervention was of value to the participating women recovering from breast cancer. Results also advocate collaborative efforts across countries to further research. (shrink)

Compared to other health care professions such as medicine, nursing and pharmacy, few studies have been conducted to examine the nature of practice errors in occupational and physical therapy. In an ongoing study to determine root causes, typographies and impact of occupational and physical therapy error on patients, focus group interviews have been conducted across the United States. A substantial number of harmful practice errors and/or other patient safety events (deviations or accidents) have been identified. Often these events (...) have had moral dimensions that troubled the therapist involved. In this article, six of these transcribed cases are analyzed, using predominant bioethical theories, ethical principles and professional codes of ethics. The cases and their analyses are intended to be exemplary, improving the readers’ ability to discern and critically address similar such events. Several patient safety strategies are suggested that might have prevented the events described in these cases. (shrink)