Emmanuelle Careau

Exoskeletons' design and usefulness evidence according to a systematic review of lower limb exoskeletons used for functional mobility by people with spinal cord injury

Abstract Purpose: Rehabilitation professionals have little information concerning lower limb exoskeletons for people with paraplegia. This study has four objectives: (1) Outline the characteristics of the exoskeletons’ design and their usefulness evidence as assistive mobility devices in the community for the Rewalk™, Mina, Indego®, Ekso™ (previously known as the eLEGS™) and Rex®; (2) document functional mobility outcomes of using these exoskeletons; (3) document secondary skills and benefits achieved with these exoskeletons, safety, user satisfaction and applicability in the community; and (4) establish level of scientific evidence of the selected studies. Method: A systematic review of the literature (January 2004 to April 2014) was done using the databases PubMed, CINAHL and Embase and groups of keywords associated with “exoskeleton”, “lower limb” and “paraplegia”. Results: Seven articles were selected. Exoskeleton use is effective for walking in a laboratory but there are no training protocols to modify identified outcomes over the term usage (ReWalk™: 3 months, Mina: 2 months and Indego®: 1 session). Levels of evidence of selected papers are low. Conclusions: The applicability and effectiveness of lower limb exoskeletons as assistive devices in the community have not been demonstrated. More research is needed on walking performance with these exoskeletons compared to other mobility devices and other training contexts in the community. Implications for rehabilitation Characteristics of the exoskeletons’ design and their usefulness evidence as assistive mobility devices in the community are addressed for the Rewalk™, Mina, Indego®, Ekso™ and Rex® ReWalk™, Indego® and Mina lower limb exoskeletons are effective for walking in a laboratory for individuals with complete lower-level SCI. The ReWalk™ has the best results for walking, with a maximum speed of 0.51 m/s after 45 sessions lasting 60 to 120 min; it is comparable to the average speed per day or per week in a manual wheelchair. The level of scientific evidence is low. Other studies are needed to provide more information about performance over the longer term when walking with an exoskeleton, compared to wheelchair mobility, the user’s usual locomotion, the use of different exoskeletons or the training context in which the exoskeleton is used.

Assessing interprofessional teamwork in a videoconference-based telerehabilitation setting

We studied the workings of a rehabilitation team in a videoconference setting to note the pros and cons of videoconferencing in the development of interprofessional care plans (ICPs). We recorded every videoconference held by the teams of the specialized centre and the regional centre for clients with traumatic brain injuries over an 18-month period. Thirteen recorded videoconferences, lasting for 30–98 min, were analysed through an observation grid. On the whole, efficient teamwork was observed: the mean productivity level was 96%, while the percentage of time dedicated to the resolution of technical issues was 2%. During the videoconferences, the clinical coordinator and the client addressed the group most often. One of the most commonly mentioned advantages was the good visual contact provided by videoconferencing. The most often quoted disadvantage was the poor sound quality. The findings from the study support the adoption of videoconferencing and suggest a few guidelines for the development of ICPs.

Interprofessional collaboration: One or multiple realities?

Searching through the literature in the interprofessional field can be a daunting experience. In doing so, the reader is exposed to multiple terms and definitions. “Multidisciplinary,” “interdisciplinary,” “teamwork,” “interprofessional practice,” “collaborative relationships,” “coordination,” “integration,” etc., such terms differentiate and coincide, are used in all kinds of contexts and are often employed interchangeably (Schofield & Amodeo 1999). Petri (2010) recently conducted a concept analysis in which she noted at least six surrogate concepts and related terms associated with the concept of “interdisciplinary collaboration,” including interprofessional collaboration (IPC). Definitions, when provided by the authors (Petri, 2010; Schofield & Amodeo, 1999), often mix and diverge meanings. In this editorial, we explore various approaches to defining “IPC” and discuss some of the underlying epistemological and ontological challenges.

Interprofessional collaboration: development of a tool to enhance knowledge translation

Abstract Purpose: Interprofessional collaboration (IPC) is a complex and multidimensional process in which different professionals work together to positively impact health care. In order to enhance the knowledge translation and improve rehabilitation practitioners’ knowledge and skills toward IPC, it is essential to develop a comprehensive tool that illustrates how IPC should be operationalized in clinical settings. Thus, this study aims at developing, validating and assessing the usefulness of a comprehensive framework illustrating how the interactional factors should be operationalized in clinical settings to promote good collaboration. Methods: This article presents a mixed-method approach used to involve rehabilitation stakeholders (n = 20) in the development and validation of an IPC framework according to a systematic seven-phase procedure. Results: The final framework shows five types of practices according to four components: the situation of the client and family, the intention underlying the collaboration, the interaction between practitioners, and the combining of disciplinary knowledge. Conclusion: The framework integrates the current scientific knowledge and clinical experience regarding the conceptualization of IPC. It is considered as a relevant and useful KT tool to enhance IPC knowledge for various stakeholders, especially in the rehabilitation field. This comprehensive and contextualized framework could be used in undergraduate and continuing education initiatives. Implications for Rehabilitation The framework developed integrates the current scientific knowledge and clinical experience regarding the conceptualization of interprofessional collaboration (IPC) that is relevant to the rehabilitation field. It could be used in undergraduate and continuing education initiatives to help learners understand the multidimensional and dynamic nature of IPC. It could be useful to support practitioners and managers from the rehabilitation field in their efforts to optimize collaborative practice within their organization.

Consensus group session of experts to describe interprofessional collaboration processes in team meetings

Interprofessional collaboration (IPC) is a complex and multidimensional construct (e.g. D’Amour, FerradaVidela, San Martin Rodriguez, & Beaulieu, 2005) and existing definitions in the literature do not precisely identify which indicators are important to document when evaluating IPC. Moreover, few measurement tools are available to evaluate IPC and those that do exist have not undergone validation (Thannhauser, Russell-Mayhew, & Scott, 2010). To complement existing instruments, we wanted to develop an observation-based IPC measurement tool. However, prior to starting the item development, it was necessary to define interprofessional processes occurring during team meetings and identify the key observable factors.

Development of interprofessional care plans for spinal cord injury clients through videoconferencing

In rehabilitation, interprofessional collaboration is considered an effective way to provide care (Oandasan et al., 2006). The team defines clients’ needs, sets treatment goals which are reviewed regularly, and agrees on intervention methods. Healthcare professionals, clients and relatives all participate in the development of an interprofessional care plan (ICP) which is a planning, coordinating and communication tool used to meet objectives and develop intervention methods for rehabilitation and community reintegration (Blouin & Bergeron, 1997). The ICP is also used to support continuity of care when a client is transferred from a specialized rehabilitation centre to a regional community-based rehabilitation centre. Organizing a transfer from one institution to another requires cooperation between healthcare workers at both sites. Traditionally, transfers have been planned through telephone discussions between two healthcare workers from the same discipline, and sometimes telephone conferencing has been used to involve more than two healthcare workers. A lack of visual contact, though, limits communication and collaboration, and yet distance and work schedules make organizing face-to-face meetings difficult. In order to promote good interprofessional collaboration, videoconferencing is proposed as a communication method for ICP meetings between two institutions. It can also be used to manage family and client expectations, and to guide the interprofessional team’s observations (Fougeyrollas, Bergeron, & Robin, 2007). Preparing the transfer via videoconferencing allows participants to have a real-time dialogue, visual contact and minimal travel. However, very little scientific data was identified in the area of videoconferencing teamwork dynamics (Kairy, Lehoux, Vincent, & Visintin, 2008) and despite the importance of the ICP in the rehabilitation field, it is the focus of very few studies. This report presents the findings of a descriptive study undertaken to examine the workings of interprofessional team videoconferences in the development of ICPs for clients with spinal cord injury.

Life habits performance of individuals with brain injury in different living environments.

Background: Little is known about variations in social participation among individuals with traumatic brain injury (TBI) living in different environments. Objective: To examine the social participation of individuals with moderate-to-severe TBI across various living arrangements. Methods: One hundred and thirty-six individuals with moderate-to-severe TBI, living either in natural settings (e.g. home), intermediate settings (e.g. group homes or foster families) or structured settings (e.g. nursing home or long-term care facilities) and requiring daily assistance, were interviewed using the LIFE-H tool, which measures the level of difficulty and the assistance required to carry out life habits and resulting social participation. Participation in six categories of life habits pertaining to Activities of Daily Living and five categories pertaining to Social Roles were examined. Results: The level of difficulty and the assistance required to carry out the life habits and the overall level of social participation were associated with living arrangements. Participation scores in Activities of Daily Living varied across living arrangements while Social Roles scores did not. Conclusion: Living arrangements (such as intermediate settings) may better support social participation in individuals with TBI. There is a need to further study the issue of living arrangements as they seem to facilitate the performance of life habits, which impacts the social participation of individuals with TBI.

Analysis of the strengths, weaknesses, opportunities and threats of the network form of organization of traumatic brain injury service delivery systems

Networks are an increasingly popular way to deal with the lack of integration of traumatic brain injury (TBI) care. Knowledge of the stakes of the network form of organization is critical in deciding whether or not to implement a TBI network to improve the continuity of TBI care. Goals of the study: To report the strengths, weaknesses, opportunities, and threats of a TBI network and to consider these elements in a discussion about whether networks are a suitable solution to fragmented TBI care. Methods: In-depth interviews with 12 representatives of network organization members. Interviews were qualitatively analyzed using the EGIPSS model of performance. Results: The majority of elements reported were related to the networks adaptation to its environment and more precisely to its capacity to acquire resources. The issue of value maintenance also received considerable attention from participants. Discussion: The network form of organization seems particularly sensitive to environmental issues, such as resource acquisition and legitimacy. The authors suggest that the network form of organization is a suitable way to increase the continuity of TBI care if the following criteria are met: (1) expectations toward network effectiveness to increase continuity of care are moderate and realistic; (2) sufficient resources are devoted to the design, implementation, and maintenance of the network; (3) a networks existence and actions are deemed legitimate by community and organization member partners; and (4) there is a good collaborative climate between the organizations.

Facilitator training program: The Université Laval Interprofessional Initiative

ABSTRACT A facilitator training program (FTP) for interprofessional learning (IPL) facilitators has been developed at Université Laval. This article describes the impacts of this program as perceived by the 22 IPL facilitators involved and outlines recommendations. Two qualitative data collection strategies were used to document the facilitators’ pedagogical needs and views of the program’s impacts. Results suggest that the FTP’s pedagogical approach was effective. The IPL facilitators became more aware of their challenges and identified concrete strategies to use. Training initiatives should equip IPL facilitators to cope with uncertainty, create a climate supporting active learning, and facilitate positive interactions between students.

Improving interprofessional collaboration: The effect of training in nonviolent communication

ABSTRACT This article examines the effects of nonviolent communication (NVC) training on the interprofessional collaboration (IPC) of two health and social services sector care teams. The study was conducted in 2013 with two interprofessional teams (N = 9) using a mixed method research design to measure the effects of the training. Individual IPC competency was measured using the Team Observed Structured Clinical Encounter tool, and group competency using the Observed Interprofessional Collaboration tool. A focus group was held to collect participant perceptions of what they learned in the training. Results revealed improvements in individual competency in client/family-centered collaboration and role clarification. Improvements in group competency were also found with respect to teams’ ability to develop a shared plan of action. Data suggests that participants accepted and adopted training content. After the training, they appeared better able to identify the effects of spontaneous communication, more understanding of the mechanisms of empathy, and in a better position to foster collective leadership.