• Title/Summary/Keyword: Functional Supervision

Search Result 25, Processing Time 0.021 seconds

The Effect of Treadmill Gait Training Accompanied by Visual Feedback on the Gait and Balance of Chronic Stroke Patients (만성뇌졸중 환자에 시각적 되먹임 트레드밀 보행 훈련이 보행과 균형 능력에 미치는 효과)

  • Kim, Ji-Seon;Ahn, Jin-Hwan;Lee, Hyeon-Hee;Park, Hyo-Jeong;Ki, Kyong-Il
    • PNF and Movement
    • /
    • v.15 no.2
    • /
    • pp.133-140
    • /
    • 2017
  • Purpose: This study compares the effects of treadmill gait training accompanied by visual feedback and general treadmill gait training on the gait and balance ability of patients with chronic stroke. Methods: A total of 11 patients with chronic stroke were randomly divided into either the treadmill gait training accompanied by visual feedback group (six patients) or the general treadmill gait training group (five patients). The gait and balance ability of the two groups were measured before and after the interventions using the functional reach test, the Timed Up and Go (TUG) test, Berg's balance test, and the Biodex balance test. The treadmill gait training accompanied by visual feedback group performed the exercise under the supervision of a therapist after first being provided with a hat and a goal that was devised for the purpose of providing visual feedback information. The interventions were applied to the respective groups for four weeks. For the statistical analysis, we conducted a Mann-Whitney test to compare the results between the two groups. Additionally, the Wilcoxon test was used to compare the results from before and after the intervention in each group. Results: The treadmill gait training accompanied by visual feedback group showed a significant difference in terms of the functional reach test after the intervention when compared to the general treadmill gait training group (p<0.05). Although there was no significant difference, the treadmill gait training accompanied by visual feedback group showed a larger improvement in the TUG test, Berg's balance test, and the Biodex balance test than the general treadmill gait training group (p>0.05). Conclusion: The results of this study suggest that treadmill gait training accompanied by visual feedback can be used as a beneficial intervention scheme for the recovery of the gait and balance ability of patients with chronic stroke.

Study the impact on job satisfaction in the care facility of the empowerment of the members of the organization (요양시설의 조직구성원의 임파워먼트가 직무만족에 미치는 영향에 관한 연구)

  • Kim, Chang-Tae;Gwak, Gyeong-Ja
    • Management & Information Systems Review
    • /
    • v.31 no.4
    • /
    • pp.57-82
    • /
    • 2012
  • The purpose of the study is to suggest the measure for the improvement of job satisfaction and level of empowerment of sanatoriums' social workers by analyzing factors of empowerments' effect on the job satisfaction, and investigating level of empowerment and job satisfaction of social workers of sanatoriums for the elderly and the handicapped. The result of investigation and analysis on subjects of 420 social workers of sanatoriums for the elderly and the handicapped in Youngnam area for this is as follows: First, job characteristic that is empowerments' influence factor of sanatoriums' social workers is appeared in order of feedback, and function variety, and in organization characteristic is appeared in order of leadership, reward, and employee development. Second, level of empowerment that is recognized by sanatoriums' social workers is appeared a little higher than normal level and significance is appeared highest, and next are capability, self-determination ability, and influence. Third, features that showed significant difference with significance in general characteristic of sanatoriums' social workers were 'sex', 'marital status', and 'religion', and features that showed significant difference with capability were sex, age, marital status, academic background, and employment history. And features that showed significant difference with self-determination ability were sex, age, marital status, and employment history, and features that showed significant difference with influence were sex, age, employment history and types of facilities. Fourth, the whole average of job satisfaction of sanatoriums' social workers was 3.82 out of 5, which is generally high, features that showed significant difference statistically were age, marital status, academic background, employment history, and types of facilities. Thus, job satisfaction was appeared as high as 'more than age of thirty' in age, 'married' in marital status, 'under graduates of colleges' in academic background, and 'less than three years' in employment history. Fifth, as for factors that had influence on job satisfaction, the indirect effect with empowerment was appeared that had significant effect in organization characteristic, and had few effect in organization features. On these results, practical measures to increase job satisfaction of sanatoriums' social workers are as follows: First, political approach is required to standardize duty system(by various types of facilities and clients' characteristic) of social workers of sanatoriums for elderly and the handicapped, and help to do the role as professionals with giving better treatment and building self-respect by enough reward. Second, to suggest chances to perform the responsibility for the duty of the scenes by the regular supervision, establish regular supervision system of social workers of sanatoriums for the elderly and the handicapped, and the extension of duty to increase the functional varieties. Third, it is required to motivate to have self confidence for the work and to use potential ability with transforming leadership, and to have more chances of education for the self-development. To increase job satisfaction of sanatoriums' social workers who give direct services in sanatoriums for the elderly and the handicapped, more active and positive empowerment's level improvement is in need by improvement of empowerment for them.

  • PDF

Surgical Repair of Isolated Secundum Atrial Septal Defect - Clinical features, hemodynamic function, early and late results according to age at operation - (이차공형 심방중격결손증의 외과적 치료;연령에 따른 혈류학적 상관관계에 관한 고찰)

  • Lee, S.;Choi, B.C.;Ahn, W.S.;Hur, Y.;Kim, B.Y.;Lee, J.H.;Yu, H.S.
    • Journal of Chest Surgery
    • /
    • v.25 no.11
    • /
    • pp.1318-1326
    • /
    • 1992
  • Backgroud. To determine the influence of age at operation upon surgical outcome in patients with isolated secundum atrial septal defect, retrospective clinical analysis was done. Material and method. From June, 1976 to December, 1991, 146 patients, 63 male and 83 female patients ranging in age from 13 months to 56 years, were operated on for isolated secundum atrial septal defect. The patients were divided into 3 groups according to their age at operation: Group I [<20 years old], 91 patients[62.3%]; Group II [21 to 40 years old], 44 patients[30.1%]; GroupIII[>41 years old], 11 patients[7.6%]. Significant differences in clinical features, hemodynamic function, early and late results between age groups were speculated. Results. One hundred thirty-one patients[89.6%] were symptomatic at the time of operation, the most common symptoms being dyspnea on exertion, recurrent respiratory infection, palpitation and chest pain. Patients in NYHA class III or IV were 3.3% in group I, 25% in groupIII, and 54.5% in group Ill. Hemodynamic data was available for 138 patients [94.5%]. Significant pulmonary hypertension [MPA systolic pressure $^3$ 40mmHg] was noted in 22 patients [15.9%]. Patients with pulmonary vascular disease [Rp/Rs>1.25] were 2% in group I, 7.3% in group Il, and 9.1% in groupIII. But there were no significant differences between the age groups in the size of the shunt or the ratio of pulmonary to systemic flow. Atrial septal defects were closed with direct suture in 144 patients and patch repair was performed in 2 patients with high defect. Atrial arrhythmia [8.2%] was the most common postoperative complication. The mean [LSD] duration of follow-up in all patients was 16$\pm$22 months [range, 1~96 months]. Functional result was excellent regardless of the age groups. During follow-up period, late cardiovascular events were arrhythmia [7 cases], reoperation for recurrent ASD [2 cases], and premature late death due to bacterial endocarditis [1 case]. Incidence of preoperative and late atrial fibrillation was significantly higher in older age group. Conclusion. Age at operation is one of the most important predictor of early and late surgical outcome with its impact on the following factors : 1] hemodynamic alterations and ventricular dysfunction due to longstanding volume and pressure overload, 2] pulmonary vascular disease, and 3] atrial arrhythmia including atrial fibrillation as a result of atrial dilatation. Therefore, among patients with surgically repaired atrial septal defects, those operated on over the age of 20 require careful supervision on the long-term basis.

  • PDF

A Study on the Special Needs of the Hearing-Impaired Person for Disaster Response (청각장애인 재난대응 욕구에 관한 연구)

  • Kim, Soungwan;Kim, Hey Sung;Roh, Sungmin
    • 재활복지
    • /
    • v.21 no.2
    • /
    • pp.63-88
    • /
    • 2017
  • This study evaluated the actual status of special needs of the hearing-impaired person for disaster response. The analysis revealed a significant level of unmet needs in disaster response for hearing-impaired person. The 5 special needs in disaster response include: 1) communication needs, which involve securing the means to make an emergency rescue request and communicating information during the rescue process; 2) transportation needs, which indicate the effective evacuation capacity and the level of training; 3) medical needs, which address the degree of preparedness for physical and mental emergency measures and the delivery of health information for rescue and first aid process; 4) maintaining functional independence needs, which refer to the level of self-preparedness to minimize damage in disaster situations, and; 5) supervision needs, which correspond to a personalized support system provided to disaster-vulnerable groups.

An Intervention Study on Integration of Family Planning and Maternal/Infant Care Services in Rural Korea (가족계획과 모자보건 통합을 위한 조산원의 투입효과 분석 -서산지역의 개입연구 평가보고-)

  • Bang, Sook;Han, Seung-Hyun;Lee, Chung-Ja;Ahn, Moon-Young;Lee, In-Sook;Kim, Eun-Shil;Kim, Chong-Ho
    • Journal of Preventive Medicine and Public Health
    • /
    • v.20 no.1 s.21
    • /
    • pp.165-203
    • /
    • 1987
  • This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

  • PDF